Assessment of range planting as a conservation practice

Treesearch

Stuart P. Hardegree; Bruce A. Roundy; Nancy L. Shaw; Corey A. Moffet; Thomas A. Monaco; Thomas A. Jones; Edward F. Redente

2009-01-01

NRCS range-planting Conservation Practice standards are used to develop management recommendations for improving vegetation composition an productivity of grazed plant communities. Individual Conservation Practice recommendations are implemented within a Conservation-Management-System in areas where the existing plant-community attributes are insufficient to meet...

The Effect of Water Management and Land Use Practices on the Restoration of Lee Vining and Rush Creeks

Treesearch

Peter Vorster; G. Mathias Kondolf

1989-01-01

This paper describes water management and land use practices in the Rush and Lee Vining Creek watersheds and evaluates the effect they have had on the stream environment. The management practices will continue to have effects on the flow regime and consequently habitat conditions on lower Lee Vining and Rush Creeks. The implications of existing and potential management...

40 CFR 63.11438 - What are the standards for new and existing sources?

Code of Federal Regulations, 2012 CFR

2012-07-01

... peak temperature below 1540 °C (2800 °F) and comply with one of the management practices in paragraphs... standard requirements in paragraph (c)(1) of this section or the management practice in paragraph (c)(2) of... described in paragraph (c)(1) of this section or the management practice described in paragraph (c)(2) of...

40 CFR 63.11438 - What are the standards for new and existing sources?

Code of Federal Regulations, 2013 CFR

2013-07-01

... peak temperature below 1540 °C (2800 °F) and comply with one of the management practices in paragraphs... standard requirements in paragraph (c)(1) of this section or the management practice in paragraph (c)(2) of... described in paragraph (c)(1) of this section or the management practice described in paragraph (c)(2) of...

40 CFR 63.11438 - What are the standards for new and existing sources?

Code of Federal Regulations, 2011 CFR

2011-07-01

... peak temperature below 1540 °C (2800 °F) and comply with one of the management practices in paragraphs... standard requirements in paragraph (c)(1) of this section or the management practice in paragraph (c)(2) of... described in paragraph (c)(1) of this section or the management practice described in paragraph (c)(2) of...

40 CFR 63.11438 - What are the standards for new and existing sources?

Code of Federal Regulations, 2014 CFR

2014-07-01

... peak temperature below 1540 °C (2800 °F) and comply with one of the management practices in paragraphs... standard requirements in paragraph (c)(1) of this section or the management practice in paragraph (c)(2) of... described in paragraph (c)(1) of this section or the management practice described in paragraph (c)(2) of...

75 FR 3753 - Tishomingo National Wildlife Refuge, Comprehensive Conservation Plan, Johnston County, OK

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-22

... equivalent to existing restoration practices. Recreational opportunities would continue to be limited to... improved or expanded to accommodate more visitors. Current habitat management practices would continue... management practices would contribute to ongoing monitoring and modification of Refuge resources for years to...

Effects of Targeted Professional Development on Teachers' Specific Praise Rates

ERIC Educational Resources Information Center

Simonsen, Brandi; Freeman, Jennifer; Dooley, Kathryn; Maddock, Eleanor; Kern, Laura; Myers, Diane

2017-01-01

Classroom management continues to be a concern for educators, administrators, and policymakers. Although evidence-based classroom management practices exist, teachers often receive insufficient training and support to implement these practices successfully. Schools need reliable and efficient ways to support teachers' classroom management. This…

The Impact of Management Decision-Making on Student Success in Community Colleges: A Case Study

ERIC Educational Resources Information Center

Alt, Albert G.

2012-01-01

This case study examined a multi-college community college district in northern California in a primarily rural area, to understand how their practices compared to management best practices designed to improve student success, barriers that may exist in implementing best practices, and how the institution may improve its own practices. The problem…

Information in medical decision making: how consistent is our management?

PubMed

Lorence, Daniel P; Spink, Amanda; Jameson, Robert

2002-01-01

The use of outcomes data in clinical environments requires a correspondingly greater variety of information used in decision making, the measurement of quality, and clinical performance. As information becomes integral in the decision-making process, trustworthy decision support data are required. Using data from a national census of certified health information managers, variation in automated data quality management practices was examined. Relatively low overall adoption of automated data management exists in health care organizations, with significant geographic and practice setting variation. Nonuniform regional adoption of computerized data management exists, despite national mandates that promote and in some cases require uniform adoption. Overall, a significant number of respondents (42.7%) indicated that they had not adopted policies and procedures to direct the timeliness of data capture, with 57.3% having adopted such practices. The inconsistency of patient data policy suggests that provider organizations do not use uniform information management methods, despite growing federal mandates to do so.

Assessing the effectiveness of green infrastructure stormwater best management practices in New England at the small watershed scale.

EPA Science Inventory

Methods are needed to evaluate the effectiveness of existing Stormwater Best Management Practices (BMPs) and Low Impact Development and to predict the relative effectiveness of proposed stormwater management plans in maintaining the habitat and biotic integrity of streams in New ...

STORMWATER BEST MANAGEMENT PRACTICE MONITORING

EPA Science Inventory

Implementation of an effective BMP monitoring program is not a straight-forward task. BMPs by definition are devices, practices, or methods used to manage stormwater runoff. This umbrella term lumps widely varying techniques into a single category. Also, with the existence of ...

Overview of practice management in child and adolescent psychiatry.

PubMed

Schreter, Robert K

2010-01-01

The manager of a psychiatric practice must create and direct a clinical delivery system, design and oversee the administrative services necessary to support the system, and guide the business operations that contribute to its success. Regardless of the size of the practice, the psychiatrist administrator must handle seven core administrative responsibilities and oversee individual functions and capabilities within each domain. These responsibilities include practice development, clinical services management, medical office operations, clinical management, information management, business management, and risk management. This article provides a roadmap for creating and sustaining successful clinical and administrative endeavors. It can also be used by existing practices as an audit instrument to provide a snapshot of current capabilities so that strengths as well as opportunities for continued growth can be identified.

Practice management for academic dermatology departments.

PubMed

Eaglstein, W H

2000-09-01

Practice management in the academic medical center (AMC) is different than in other environments. Practice is only a part of the practitioner's mission within an AMC. Practice revenue will be subject to a tax or overhead by both the school and the department. Contract and practice guidelines cannot be tailored to the needs of the dermatology practice, because contracts and guidelines are negotiated globally for all of the practices within the AMC. Personnel, on which the practice depends, may report to hospitals and clinics rather than to the practice's management. Even control of the practice's manager may be diluted by a dual or "dotted line" reporting relationship between the department manager and the school practice manager. Although more constraints exist within the AMC, there are some strategic and operational choices that affect a practice's success. Among these are: (1) selection of services offered; (2) creation of satellites; (3) stimulation of faculty effort; (4) enhancement of faculty billing knowledge; and (5) creation of a "tie" between staff and the practice.

An integrated pavement data management and feedback system (PAMS) : a feasibility report.

DOT National Transportation Integrated Search

1981-08-01

This feasibility study report discusses the present practices followed by the Department to manage some 16,000 miles of highways. The practices were defined through existing policy manuals and discussions with individuals and/or sections who have som...

40 CFR 63.11516 - What are my standards and management practices?

Code of Federal Regulations, 2011 CFR

2011-07-01

... feet (2.4 meters) in any one dimension. If you own or operate a new or existing dry abrasive blasting... than 8 feet (2.4 meters) in any one dimension, you may implement management practices to minimize... practices for dry abrasive blasting of objects greater than 8 feet (2.4 meters) in any one dimension are...

40 CFR 63.11516 - What are my standards and management practices?

Code of Federal Regulations, 2012 CFR

2012-07-01

... feet (2.4 meters) in any one dimension. If you own or operate a new or existing dry abrasive blasting... than 8 feet (2.4 meters) in any one dimension, you may implement management practices to minimize... practices for dry abrasive blasting of objects greater than 8 feet (2.4 meters) in any one dimension are...

40 CFR 63.11516 - What are my standards and management practices?

Code of Federal Regulations, 2014 CFR

2014-07-01

... feet (2.4 meters) in any one dimension. If you own or operate a new or existing dry abrasive blasting... than 8 feet (2.4 meters) in any one dimension, you may implement management practices to minimize... practices for dry abrasive blasting of objects greater than 8 feet (2.4 meters) in any one dimension are...

Chemical hazards associated with treatment of waste electrical and electronic equipment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tsydenova, Oyuna; Bengtsson, Magnus, E-mail: bengtsson@iges.or.jp

2011-01-15

This review paper summarizes the existing knowledge on the chemical hazards associated with recycling and other end-of-life treatment options of waste electrical and electronic equipment (e-waste). The hazards arise from the presence of heavy metals (e.g., mercury, cadmium, lead, etc.), flame retardants (e.g., pentabromophenol, polybrominated diphenyl ethers (PBDEs), tetrabromobisphenol-A (TBBPA), etc.) and other potentially harmful substances in e-waste. If improperly managed, the substances may pose significant human and environmental health risks. The review describes the potentially hazardous content of e-waste, examines the existing e-waste management practices and presents scientific data on human exposure to chemicals, workplace and environmental pollution associatedmore » with the three major e-waste management options, i.e., recycling, incineration and landfilling. The existing e-waste management practices and associated hazards are reviewed separately for developed and developing countries. Finally, based on this review, the paper identifies gaps in the existing knowledge and makes some recommendations for future research.« less

Relationships between Electronic Information Media and Records Management Practices: Results of a Survey of United Nations Organizations. A Rand Note.

ERIC Educational Resources Information Center

Bikson, T. K.; Schieber, L.

A Technical Panel on Electronic Records Management (TP/REM), which was established by the Advisory Committee for the Co-ordination of Information Systems (ACCIS), conducted a survey of existing electronic records management practices and standards related to new information and communication technologies and their interrelationships within the…

Wilderness visitor management practices: a benchmark and an assessment of progress

Treesearch

Alan E. Watson

1989-01-01

In the short time that wilderness visitor management practices have been monitored, some obvious trends have developed. The managing agencies, however, have appeared to provide different solutions to similar problems. In the early years, these problems revolved around concern about overuse of the resource and crowded conditions. Some of those concerns exist today, but...

Unstable slope management program.

DOT National Transportation Integrated Search

2009-08-01

This Rapid Response Project gathered information on existing unstable slope management programs, with a : focus on asset management practices in the United States and overseas. On the basis of this study, the research : team summarized and recommende...

Responses of Southeastern amphibians and reptiles to forest management: A review

Treesearch

Kevin R. Russell; T. Bently Wigley; William M. Baughman; Hugh G. Hanlin; W. Mark Ford

2004-01-01

Forest managers in the Southeast increasingly need information about amphibian and reptile responses to silvicultural practices in order to guide sustainable forestry programs. A review of existing literature indicates that effects of silvicultural practices on herpetofauna often are region- and species-specific, with individual taxa responding positively, negatively,...

Efficacy of Coaching Preschool Teachers to Manage Challenging Behavior

ERIC Educational Resources Information Center

Brock, Matthew E.; Beaman-Diglia, Lauren E.

2018-01-01

Many early educators cite behavior management as a top professional development need. Evidence-based practices exist to address severe challenging behavior, but promoting implementation of these practices remains a challenge. In this single-case design study, two preschool teachers received coaching focused on implementing three evidence-based…

Ecological impact of historical and future land-use patterns in Senegal

USGS Publications Warehouse

Parton, W.; Tappan, G. Gray; Ojima, D.; Tschakert, P.

2004-01-01

The CENTURY model was used to simulate changes in total system carbon resulting from land-use history (1850–2000), and impacts of climatic changes and improved land-use management practices in Senegal. Results show that 0.477 Gtons of carbon have been lost from 1850 to 2000. Improved management practices have the potential of increasing carbon levels by 0.116 Gtons from 2000 to 2100. Potential to store carbon exists for improved forest management and agriculture practices in southern Senegal. Potential climatic changes decrease plant production (30 percent), total system carbon (14 percent), and the potential to store carbon from improved management practices (31 percent).

Relevance of Emerging Ecosystem Service Science and Policy to the United States Department of Defense

DTIC Science & Technology

2011-09-01

9 3.3 Natural resource management ...15 4.2 Natural resource management ................................................................................... 16 4.3...5.1.3 Review of existing management practices .............................................................. 24 5.1.4 Demonstration and validation

Attitudes of Vermont dairy farmers regarding adoption of management practices for grassland songbirds

USGS Publications Warehouse

Troy, A.B.; Strong, A.M.; Bosworth, S.C.; Donovan, T.M.; Buckley, N.J.; Wilson, M.L.

2005-01-01

In the northeastern United States, most populations of grassland songbirds occur on private lands. However, little information exists about the attitudes of farmers toward habitat management for this guild. To address this information gap, we surveyed 131 dairy farmers in Vermont's Champlain Valley to assess current hayfield management practices and farmers' willingness to adopt more "bird-friendly" practices. Our results showed a clear trend toward earlier and more frequent hayfield cuts. Farmers indicated they have little flexibility to alter the timing of their cuts on most of their land. However, many farmers (49%) indicated a willingness to adopt alternative management practices on at least a small portion of their land. Combined with the fact that many farmers characterized parts of their land as "wasteland," or economically unproductive land, this result suggests that some leeway exists for increasing songbird habitat quality on at least portions of dairy farms. Although significant differences existed in the amount of land for which farmers were willing to adopt alternative management based on herd size, acreage, and experience, the directionality of these relationships could not be established except tentatively for herd size, in which case it appeared that farmers with smaller herds were more likely to dedicate a greater percentage of their land to alternative management. The results of this study likely have relevance to dairy farms throughout the northern-tier dairy states. Given the increasing trend for agricultural land to be converted into housing, we recommend that extension and education efforts target farmers with large hayfield acreages, encouraging the maintenance of high-quality habitat for grassland songbirds.

Management Training in Business and Industry: A Multimodal Approach to Supervision.

ERIC Educational Resources Information Center

O'Keefe, Edward J.

Historically, a close working relationship has existed between psychology and management. The holistic approach emerging in psychology from Lazarus' multimodal model will have a major impact on management practices, ultimately leading to the development of multidmodal management. The scientific psychology most managers are familiar with was based…

Physicians' perspectives and practices regarding the fertility management of obese patients.

PubMed

Harris, Isiah D; Python, Johanne; Roth, Lauren; Alvero, Ruben; Murray, Shona; Schlaff, William D

2011-10-01

To assess the practice patterns and personal beliefs of fertility physicians who care for obese patients seeking assisted reproduction, we conducted a national survey of fertility program directors from both private and academic practices and discovered that although few practices have firm guidelines regarding the management of obese patients, the overwhelming majority of providers believe that body mass index guidelines or cutoffs should exist. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Managing the star performer.

PubMed

Hills, Laura

2013-01-01

Our culture seems to be endlessly fascinated with its stars in entertainment, athletics, politics, and business, and holds fast to the idea that extraordinary talent accounts for an individual's extraordinary performance. At first glance, managing a star performer in your medical practice may seem like it would be an easy task. However, there's much more to managing a star performer than many practice managers realize. The concern is how to keep the star performer happy and functioning at a high level without detriment to the rest of the medical practice team. This article offers tips for practice managers who manage star performers. It explores ways to keep the star performer motivated, while at the same time helping the star performer to meld into the existing medical practice team. This article suggests strategies for redefining the star performer's role, for holding the star performer accountable for his or her behavior, and for coaching the star performer. Finally, this article offers practical tips for keeping the star performer during trying times, for identifying and cultivating new star performers, and for managing medical practice prima donnas.

A Study of the Relationship between Middle School and High School Teachers Instructional and Behavior Management Practices and Demographic Variables

ERIC Educational Resources Information Center

Santiago, Deborah Albright

2012-01-01

Although teachers implement differentiated instructional techniques to provide students with enriching hands-on activities related to real life experiences, the implementation of instructional techniques has required teachers to rethink and revise their approaches to classroom management (CM). While a gap in research exists on current practices in…

A preliminary report of an educational intervention in practice management

PubMed Central

Crites, Gerald E; Schuster, Richard J

2004-01-01

Background Practice management education continues to evolve, and little information exists regarding its curriculum design and effectiveness for resident education. We report the results of an exploratory study of a practice management curriculum for primary care residents. Methods After performing a needs assessment with a group of primary care residents at Wright State University, we designed a monthly seminar series covering twelve practice management topics. The curriculum consisted of interactive lectures and practice-based application, whenever possible. We descriptively evaluated two cognitive components (practice management knowledge and skills) and the residents' evaluation of the curriculum. Results The mean correct on the knowledge test for this group of residents was 74% (n = 12) and 91% (n = 12) before and after the curriculum, respectively. The mean scores for the practice management skill assessments were 2.62 before (n = 12), and 3.65 after (n = 12) the curriculum (modified Likert, 1 = strongly disagree, 5 = strongly agree). The residents rated the curriculum consistently high. Conclusions This exploratory study suggests that this curriculum may be useful in developing knowledge and skills in practice management for primary care residents. This study suggests further research into evaluation of this curriculum may be informative for practice-based education. PMID:15380023

40 CFR Table 2 to Subpart Jjjjjj... - Work Practice Standards, Emission Reduction Measures, and Management Practices

Code of Federal Regulations, 2014 CFR

2014-07-01

... subcategory . . . You must meet the following . . . 1. Existing or new coal-fired, new biomass-fired, or new... as specified in § 63.11223. 6. Existing biomass-fired boilers that do not meet the definition of... biennially as specified in § 63.11223. 7. New biomass-fired boilers that do not meet the definition of...

40 CFR Table 2 to Subpart Jjjjjj... - Work Practice Standards, Emission Reduction Measures, and Management Practices

Code of Federal Regulations, 2013 CFR

2013-07-01

... subcategory . . . You must meet the following . . . 1. Existing or new coal-fired, new biomass-fired, or new... as specified in § 63.11223. 6. Existing biomass-fired boilers that do not meet the definition of... biennially as specified in § 63.11223. 7. New biomass-fired boilers that do not meet the definition of...

Grants Management in Education: Federal Impact on State Agencies.

ERIC Educational Resources Information Center

Friedman, Burton D.; Dunbar, Laird J.

This monograph examines the impact of grants management on State education from the perspectives of public administration, public finance, governmental accounting and auditing, and intergovernmental relations. Chapter I depicts the context within which OE grants management takes place. Chapter II describes existing grants management practices and…

Concrete slurry, wash and loss water mitigation.

DOT National Transportation Integrated Search

2012-08-01

This report presents an evaluation of wastewaters derived from concrete placement and maintenance and the : preparation of best management practices (BMPs). Investigation and documentation of existing practices was done : to ensure application to rea...

Preliminary study on enhancing waste management best practice model in Malaysia construction industry

NASA Astrophysics Data System (ADS)

Jamaludin, Amril Hadri; Karim, Nurulzatushima Abdul; Noor, Raja Nor Husna Raja Mohd; Othman, Nurulhidayah; Malik, Sulaiman Abdul

2017-08-01

Construction waste management (CWM) is the practice of minimizing and diverting construction waste, demolition debris, and land-clearing debris from disposal and redirecting recyclable resources back into the construction process. Best practice model means best choice from the collection of other practices that was built for purpose of construction waste management. The practice model can help the contractors in minimizing waste before the construction activities will be started. The importance of minimizing wastage will have direct impact on time, cost and quality of a construction project. This paper is focusing on the preliminary study to determine the factors of waste generation in the construction sites and identify the effectiveness of existing construction waste management practice conducted in Malaysia. The paper will also include the preliminary works of planned research location, data collection method, and analysis to be done by using the Analytical Hierarchy Process (AHP) to help in developing suitable waste management best practice model that can be used in the country.

Human resource management in general practice: survey of current practice.

PubMed Central

Newton, J; Hunt, J; Stirling, J

1996-01-01

BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters of practice managers reported having received some type of formal training in staff management. CONCLUSION: This study shows that practice size is a major factor associated with differences in the organization and management of staffing. Any initiatives which increase the scale of primary care functions and services would have to address the issues of communication and coordination that might be associated with such a change. PMID:8855013

Managing risk: clinical decision-making in mental health services.

PubMed

Muir-Cochrane, Eimear; Gerace, Adam; Mosel, Krista; O'Kane, Debra; Barkway, Patricia; Curren, David; Oster, Candice

2011-01-01

Risk assessment and management is a major component of contemporary mental health practice. Risk assessment in health care exists within contemporary perspectives of management and risk aversive practices in health care. This has led to much discussion about the best approach to assessing possible risks posed by people with mental health problems. In addition, researchers and commentators have expressed concern that clinical practice is being dominated by managerial models of risk management at the expense of meeting the patient's health and social care needs. The purpose of the present study is to investigate the risk assessment practices of a multidisciplinary mental health service. Findings indicate that mental health professionals draw on both managerial and therapeutic approaches to risk management, integrating these approaches into their clinical practice. Rather than being dominated by managerial concerns regarding risk, the participants demonstrate professional autonomy and concern for the needs of their clients.

Impact of Crop Conversions on Runoff and Sediment Output in the Lower Mississippi River Basin

NASA Astrophysics Data System (ADS)

Momm, H.; Bingner, R. L.; Elkadiri, R.; Yaraser, L.; Porter, W.

2017-12-01

Farming management practices influence sediment and agrochemical loads exiting fields and entering downstream water bodies. These practices impact multiple physical processes responsible for sediment and nutrient detachment, transport, and deposition. Recent changes in farming practices in the Southern United States coincide with increased grain production, replacing traditional crops such as cotton with corn and soybeans. To grow these crops in the South, adapted crop management practices are needed (irrigation, fertilizer, etc.). In this study, the impact of grain crop adoption on hydrologic processes and non-point source pollutant production is quantified. A watershed located in the Big Sunflower River drainage basin (14,179 km2) - a part of the greater Lower Mississippi River basin - was selected due to its economic relevance, historical agricultural output, and depiction of recent farming management trends. Estimates of runoff and sediment loads were produced using the U.S. Department of Agriculture supported Annualized Agriculture Non-Point Source Pollution (AnnAGNPS) watershed pollution and management model. Existing physical conditions during a 16-year period (2000-2015) were characterized using 3,992 sub-catchments and 1,602 concentrated flow paths. Algorithms were developed to integrate continuous land use/land cover information, variable spatio-temporal irrigation practices, and crop output yield in order to generate a total of 2,922 unique management practices and corresponding soil-disturbing operations. A simulation representing existing conditions was contrasted with simulations depicting alternatives of management, irrigation practices, and temporal variations in crop yield. Quantification of anthropogenic impacts to water quality and water availability at a watershed scale supports the development of targeted pollution mitigation and custom conservation strategies.

A system management methodology for building successful resource management systems

NASA Technical Reports Server (NTRS)

Hornstein, Rhoda Shaller; Willoughby, John K.

1989-01-01

This paper presents a system management methodology for building successful resource management systems that possess lifecycle effectiveness. This methodology is based on an analysis of the traditional practice of Systems Engineering Management as it applies to the development of resource management systems. The analysis produced fifteen significant findings presented as recommended adaptations to the traditional practice of Systems Engineering Management to accommodate system development when the requirements are incomplete, unquantifiable, ambiguous and dynamic. Ten recommended adaptations to achieve operational effectiveness when requirements are incomplete, unquantifiable or ambiguous are presented and discussed. Five recommended adaptations to achieve system extensibility when requirements are dynamic are also presented and discussed. The authors conclude that the recommended adaptations to the traditional practice of Systems Engineering Management should be implemented for future resource management systems and that the technology exists to build these systems extensibly.

What Informs Practice and What Is Valued in Corporate Instructional Design? A Mixed Methods Study

ERIC Educational Resources Information Center

Thompson-Sellers, Ingrid N.

2012-01-01

This study used a two-phased explanatory mixed-methods design to explore in-depth what factors are perceived by Instructional Design and Technology (IDT) professionals as impacting instructional design practice, how these factors are valued in the field, and what differences in perspectives exist between IDT managers and non-managers. For phase 1…

Educating residents for managed care: report on a multidisciplinary conference.

PubMed

Hewson, M G; Fishleder, A J; Halperin, A K; Henry, C A; Isaacson, J H; Kachur, E; Tresolini, C

1998-05-01

A growing number of residency programs are preparing their graduates for the realities of managed care practice. In 1996, The Cleveland Clinic Foundation, a private, nonprofit academic medical center, hosted a two-day conference on managed care education to develop innovative instructional and evaluative approaches that, where appropriate, would build on existing expertise. The conference was attended by invited national experts who had a stake in residents' education: clinical faculty, residents, medical educators, executives of managed care organizations, and representatives of other interested organizations. Participants spent much of their time in four small break out groups, each focusing on one of the following topics that were judged particularly relevant to managed care: preventive and population-based medicine, appropriate utilization of resources, clinician-patient communication, and interdisciplinary team practice. Participants shared existing materials, discussed teaching goals and objectives, and generated ideas for teaching methods, teaching materials, and evaluative methods for their respective topics. The authors summarize the recommendations from the four groups, with an overview of the issues that emerged during the conference concerning curriculum development, integration of managed care topics into existing curricula, staging of the curriculum, experiential teaching methods, negative attitudes and resistance, evaluation of trainees and profiling, program assessment, faculty development, and cooperation between academic medical centers and managed care organizations.

7 CFR 634.1 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-01-01

... best management practices (BMP's) in project areas which have critical water quality problems resulting... approved agricultural portion of a 208 water quality management plan. Participation in RCWP is voluntary. (c) The program is a new USDA program and an extension of existing water-quality management programs...

7 CFR 634.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... best management practices (BMP's) in project areas which have critical water quality problems resulting... approved agricultural portion of a 208 water quality management plan. Participation in RCWP is voluntary. (c) The program is a new USDA program and an extension of existing water-quality management programs...

Guide to good practices for line and training manager activities

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1998-06-01

The purpose of this guide is to provide direction for line and training managers in carrying out their responsibilities for training and qualifying personnel and to verify that existing training activities are effective.

New Jersey interagency emergency management plan.

DOT National Transportation Integrated Search

2005-09-01

This report outlines the research and work performed to lay the foundation for the : development of a New Jersey Interagency Emergency Management Plan. The : research into existing practices within the four state level transportation agencies : revea...

"That's not how we do it": managing the inherited medical practice team.

PubMed

Hills, Laura

2013-01-01

Most medical practice managers who take a new job will inherit an existing team. Those first few days on the job are critical because they can determine whether or not the new manager will succeed. This article provides a game plan for new medical practice managers so they get off on the right foot with their inherited teams. It suggests strategies for learning about the team's culture and for demonstrating visibly that there is a new manager in the job. It offers guidelines about introducing the new manager to the inherited team, discussing past experiences, and establishing new expectations. This article further provides practical tips for serving as a role model, gaining allies, and dealing with troublemakers quickly and effectively. It suggests strategies for speaking about the previous practice manager and for creating excitement with the inherited team. Finally, this article offers a set of 15 questions a new manager can ask members of the inherited team to get to know them, an additional 25-point team assessment instrument, and a step-by-step strategy for raising the bar for mediocre, lackluster, or dysfunctional inherited teams.

78 FR 12347 - Notice of Availability of the Proposed Resource Management Plan and Final Environmental Impact...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-22

... Historic trails. The four alternatives were: Alternative A: Continues existing management practices (no... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLWYR05000 L16100000.DQ0000 LXSS04 K0000] Notice of Availability of the Proposed Resource Management Plan and Final Environmental Impact Statement...

Toward a Critical HRD in Theory and Practice

ERIC Educational Resources Information Center

Fenwick, Tara J.

2004-01-01

Drawing from critical management studies and critical pedagogy, this article proposes principles and practices to support the emerging critical human resource development (HRD) field as one stream among existing theories and practice of HRD. A critical HRD would challenge the subjugation of human knowledge, skills, and relationships to…

Developmentally Appropriate Discipline Practices of Elementary School Principals

ERIC Educational Resources Information Center

Burnett, Donna Silva

2010-01-01

Research has indicated that developmentally appropriate practices (DAP) should be applied to manage behavioral problems in school age children. However, little evidence exists on the extent to which elementary school principals apply these practices appropriately in student discipline. The purpose of this phenomenological study was to explore how…

An Expert EFL Teacher's Class Management

ERIC Educational Resources Information Center

Yazdanmehr, Elham; Akbari, Ramin

2015-01-01

The present research sought to investigate how expert EFL teachers manage their class and keep its discipline. To this aim, the existing prior ELT (English Language Teaching) research on exemplary teachers' practices were reviewed and the typical class management strategies used were extracted. Moreover, 20 ELT specialists including teacher…

15 CFR 930.32 - Consistent to the maximum extent practicable.

Code of Federal Regulations, 2010 CFR

2010-01-01

... COASTAL RESOURCE MANAGEMENT FEDERAL CONSISTENCY WITH APPROVED COASTAL MANAGEMENT PROGRAMS Consistency for... management programs unless full consistency is prohibited by existing law applicable to the Federal agency. (2) Section 307(e) of the Act does not relieve Federal agencies of the consistency requirements under...

Probabilistic framework for product design optimization and risk management

NASA Astrophysics Data System (ADS)

Keski-Rahkonen, J. K.

2018-05-01

Probabilistic methods have gradually gained ground within engineering practices but currently it is still the industry standard to use deterministic safety margin approaches to dimensioning components and qualitative methods to manage product risks. These methods are suitable for baseline design work but quantitative risk management and product reliability optimization require more advanced predictive approaches. Ample research has been published on how to predict failure probabilities for mechanical components and furthermore to optimize reliability through life cycle cost analysis. This paper reviews the literature for existing methods and tries to harness their best features and simplify the process to be applicable in practical engineering work. Recommended process applies Monte Carlo method on top of load-resistance models to estimate failure probabilities. Furthermore, it adds on existing literature by introducing a practical framework to use probabilistic models in quantitative risk management and product life cycle costs optimization. The main focus is on mechanical failure modes due to the well-developed methods used to predict these types of failures. However, the same framework can be applied on any type of failure mode as long as predictive models can be developed.

Synthesis of Knowledge and Practice in Educational Management and Leadership. Volumes 1 and 2. Project No. ED 73-241.

ERIC Educational Resources Information Center

Lavin, Richard J.; Sanders, Jean E.

This is a systematic effort to review the knowledge and practice in management programs. In synthesizing the knowledge base, the study establishes and emphasizes the great need to link the knowledge banks of the producers' world with the users' stations. Several findings support this conclusion: (1) a wealth of knowledge exists; (2) although there…

Enhancing the strategic management of practice learning through the introduction of the role of Learning Environment Manager.

PubMed

Congdon, Graham; Baker, Tracey; Cheesman, Amanda

2013-03-01

This paper describes a process evaluation project designed to enhance the strategic management of practice learning within a large Hospital in the North of England. The aim of the project was to introduce the role of the Learning Environment Manager with dedicated responsibility for practice learning of undergraduate student nurses within the Hospital's 49 practice-settings. Whilst aspects of this role were already evident in several of these settings, the project sought to locate and standardise responsibilities related to the organisation and management of learning and teaching in practice explicitly within the existing staffing structure of each practice-setting. Focus group interviews were used to explore significant aspects of the project with key stakeholder groups comprising Learning Environment Managers, the Hospital Clinical Educator, Hospital Department Managers, Ward Managers, Mentors, University Link Lecturers and undergraduate Student Nurses. Interview data were analysed using thematic content analysis. The findings of the project suggest that the Learning Environment Manager role affords providers of practice learning with a robust approach to establish organisation-wide benchmarks that standardise the strategic management of practice learning in collaboration with partner Universities. The role incorporated many operational activities previously undertaken by the Hospital Clinical Educator, thus enabling the Hospital Clinical Educator to make a more strategic contribution to the on-going quality monitoring and enhancement of practice learning across the Hospital. The Learning Environment Manager role was found to provide mentors with high levels of support which in turn helped to promote consistent, positive and holistic practice learning experiences for undergraduate student nurses across the Hospital. Importantly, the role offers a potent catalyst for nurses in practice to regain responsibility for practice learning and re-establish the value of practice teaching. Copyright © 2012 Elsevier Ltd. All rights reserved.

District of Columbia Motor Carrier Management and Threat Assessment Study

DOT National Transportation Integrated Search

2004-08-01

DDOT asked the Volpe National Transportation Systems Center (Volpe) to conduct an : analysis of existing truck traffic conditions in the District, successful truck management : practices from other areas, stakeholder interests and opinions, and secur...

Developments in weather responsive traffic management strategies.

DOT National Transportation Integrated Search

2011-06-01

This report provides a comprehensive overview of weather-responsive traffic management practices. It focuses on what WRTM strategies exist, where they have been used, the benefits realized, what improvements are needed, and how to implement and evalu...

Putting social impact assessment to the test as a method for implementing responsible tourism practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

McCombes, Lucy, E-mail: l.mccombes@leedsbeckett.ac.uk; Vanclay, Frank, E-mail: frank.vanclay@rug.nl; Evers, Yvette, E-mail: y.evers@tft-earth.org

The discourse on the social impacts of tourism needs to shift from the current descriptive critique of tourism to considering what can be done in actual practice to embed the management of tourism's social impacts into the existing planning, product development and operational processes of tourism businesses. A pragmatic approach for designing research methodologies, social management systems and initial actions, which is shaped by the real world operational constraints and existing systems used in the tourism industry, is needed. Our pilot study with a small Bulgarian travel company put social impact assessment (SIA) to the test to see if itmore » could provide this desired approach and assist in implementing responsible tourism development practice, especially in small tourism businesses. Our findings showed that our adapted SIA method has value as a practical method for embedding a responsible tourism approach. While there were some challenges, SIA proved to be effective in assisting the staff of our test case tourism business to better understand their social impacts on their local communities and to identify actions to take. - Highlights: • Pragmatic approach is needed for the responsible management of social impacts of tourism. • Our adapted Social impact Assessment (SIA) method has value as a practical method. • SIA can be embedded into tourism businesses existing ‘ways of doing things’. • We identified challenges and ways to improve our method to better suit small tourism business context.« less

Hospital management practices and availability of surgery in sub-Saharan Africa: a pilot study of three hospitals.

PubMed

Funk, Luke M; Conley, Dante M; Berry, William R; Gawande, Atul A

2013-11-01

Sub-Saharan Africa has a high surgical burden of disease but performs a disproportionately low volume of surgery. Closing this surgical gap will require increased surgical productivity of existing systems. We examined specific hospital management practices in three sub-Saharan African hospitals that are associated with surgical productivity and quality. We conducted 54 face-to-face, structured interviews with administrators, clinicians, and technicians at a teaching hospital, district hospital, and religious mission hospital across two countries in sub-Saharan Africa. Questions focused on recommended general management practices within five domains: goal setting, operations management, talent management, quality monitoring, and financial oversight. Records from each interview were analyzed in a qualitative fashion. Each hospital's management practices were scored according to the degree of implementation of the management practices (1 = none; 3 = some; 5 = systematic). The mission hospital had the highest number of employees per 100 beds (226), surgeons per operating room (3), and annual number of operations per operating room (1,800). None of the three hospitals had achieved systematic implementation of management practices in all 14 measures. The mission hospital had the highest total management score (44/70 points; average = 3.1 for each of the 14 measures). The teaching and district hospitals had statistically significantly lower management scores (average 1.3 and 1.1, respectively; p < .001). It is possible to meaningfully assess hospital management practices in low resource settings. We observed substantial variation in implementation of basic management practices at the three hospitals. Future research should focus on whether enhancing management practices can improve surgical capacity and outcomes.

78 FR 33774 - Ballast Water Management Reporting and Recordkeeping

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-05

...-AB68 Ballast Water Management Reporting and Recordkeeping AGENCY: Coast Guard, DHS. ACTION: Notice of proposed rulemaking. SUMMARY: The Coast Guard proposes to amend its existing ballast water management (BWM... annual report of their BWM practices. The Coast Guard also proposes to update the current ballast water...

Management of birch for aesthetics and recreation

Treesearch

John H. Noyes

1969-01-01

When paper birch and yellow birch are managed for aesthetic and recreation purposes, timber values become secondary, although in some instances compatibility exists among the several objectives. At times, timber and wood-products production is excluded entirely in the interests of aesthetics and recreation. In keying forest-management practices to the appearance...

Impacts of forest and land management on biodiversity and carbon

Treesearch

Valerie Kapos; Werner A. Kurz; Toby Gardner; Joice Ferreira; Manuel Guariguata; Lian Pin Koh; Stephanie Mansourian; John A. Parrotta; Nokea Sasaki; Christine B. Schmitt; Jos Barlow; Markku Kanninen; Kimiko Okabe; Yude Pan; Ian D. Thompson; Nathalie van Vliet

2012-01-01

Changes in the management of forest and non-forest land can contribute significantly to reducing emissions from deforestation and forest degradation. Such changes can include both forest management actions - such as improving the protection and restoration of existing forests, introducing ecologically responsible logging practices and regenerating forest on degraded...

EMBA Integration: From Rhetoric to Practice

ERIC Educational Resources Information Center

Scott, Charles; Derrick, Frederick; Hoadley, Ellen

2012-01-01

For the modern business world, business education needs to molt from the cocoon of discipline silos to the integrated business education model to train the next generation of managers. Upper management problems are rarely silo specific. Managers do things right, but leaders do the right things; and executive programs exist to build business…

Managerial attitudes and perceived barriers regarding evidence-based practice: An international survey

PubMed Central

Jepsen, Denise M.; Houghton, Edward; ten Have, Steven

2017-01-01

Evidence-based practice (EBP) in management is still in its infancy. Several studies suggest that managers in businesses and other organizations do not consult the scientific evidence when making decisions. To facilitate its uptake, we need to better understand practitioner attitudes and perceived barriers related to EBP. In medicine and nursing, an abundance of research exists on this subject, although such studies are rare in management. To address this gap, we surveyed 2,789 management practitioners in Belgium, the Netherlands, the United States, the United Kingdom and Australia. Our findings indicate that most managers we studied have positive attitudes towards EBP. However, lack of time and a limited understanding of scientific research are perceived as major barriers to the uptake and implementation of EBP in management. Studies in other professions where EBP is far more established also report similar barriers. We discuss the implications of our findings for practice, education and research, providing suggestions to enhance use of EBP in management practice. PMID:28972977

Exploring role confusion in nurse case management.

PubMed

Gray, Frances C; White, Ann; Brooks-Buck, Judith

2013-01-01

This is a report of the results of a pilot project conducted to identify the areas where role confusion/ambiguity exists in the practice of nurse case management. A convenience sample of 25 registered nurses practicing as case managers in a small east coast medical treatment facility's outpatient clinics. Participants responded to 2 Likert-type surveys designed to evaluate role confusion from an individual and a team membership perspective. Analysis indicated that nurse case managers experience role confusion in the specific areas of conflicts between time resources, capabilities, and multiple individual roles. There was no identified role confusion associated with membership on multidisciplinary teams. The application of the Synergy Model as a theoretical framework for nurse case management serves as a benchmark for the implementation of evidence-based practices. This project could serve as the starting point for the development of a skill set for nurse case managers, for the standardization of the practice, and for the recognition of nurse case management as a legitimate nursing subspecialty.

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

PubMed

Stanton, Marietta P; Barnett Lammon, Carol Ann

2008-01-01

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

Active transportation and demand management (ATDM) trajectory-level validation state of the practice review.

DOT National Transportation Integrated Search

2016-04-15

This state of the practice review is a literature and industry review of existing vehicle trajectory datasets, vehicle trajectory collection methods, and traffic simulation model validation techniques. This report has the following four sections and ...

Teacher Self-Assessment of Evidence-Based Classroom Practices: Preliminary Findings across Primary, Intermediate and Secondary Level Teachers

ERIC Educational Resources Information Center

Borgmeier, Chris; Loman, Sheldon L.; Hara, Motoaki

2016-01-01

The limited implementation of evidence-based classroom practices and ways to provide effective professional development to address this challenge remain enduring concerns in education. Despite these concerns, there exists a well-established research literature on evidence-based practices for effective classroom management and instructional…

Impact of managed MediCal on California family practice programs.

PubMed

Zweifler, J A

2001-05-01

An important source of patients for California's family practice program is MediCal. During the past 5 years, MediCal has established a variety of capitated managed care plans. To assess the impact of California's managed MediCal program on the state's 38 family practice training programs. A cross-sectional, retrospective descriptive survey. A 3-page, 11-question survey was developed by family practice residency directors and staff from the California Academy of Family Physicians, San Francisco. The 38 family practice programs in existence in California in September 1997 were stratified by type of managed MediCal in their county and by type of sponsoring institution--university, county, community based, staff-model health maintenance organization, or managed care system. Of the 38 family practice programs, 27 responded; 19 of 27 programs participated in managed MediCal. The total number of family health center patients, and the percentage of MediCal patients (48%-60%) at family practice programs was similar when stratified by programs with and without managed MediCal and by type of sponsorship. Most programs reported that they were able to compete effectively, although most also reported increased administrative, nursing, and front office costs. Managed MediCal patients were directly assigned to residents in only 3 of 19 programs. The introduction of managed MediCal has not adversely affected the number of patients cared for in California's family practice programs. Continued vigilance regarding California family practice programs' involvement in managed MediCal, including collection of accurate data on the number of MediCal patients and the financial and educational implications for California's family practice programs, is warranted.

Strategic directions for developing the Australian general practice nurse role in cardiovascular disease management.

PubMed

Halcomb, Elizabeth J; Davidson, Patricia M; Yallop, Julie; Griffiths, Rhonda; Daly, John

2007-08-01

Practice nursing is an integral component of British and New Zealand primary care, but in Australia it remains an emerging specialty. Despite an increased focus on the Australian practice nurse role, there has been limited strategic role development, particularly relating to national health priority areas. This paper reports the third stage of a Project exploring the Australian practice nurse role in the management of cardiovascular disease (CVD). This stage involved a consensus development conference, undertaken to identify strategic, priority recommendations for practice nurse role development. 1. Practice nurses have an important role in developing systems and processes for CVD management; 2. A change in the culture of general practice is necessary to promote acceptance of nurse-led CVD management; 3. Future research needs to evaluate specific models of care, incorporating outcome measures sensitive to nursing interventions; 4. Considerable challenges exist in conducting research in general practice; and 5. Changes in funding models are necessary for widespread practice nurse role development. The shifting of funding models provides evidence to support interdisciplinary practice in Australian general practice. The time is ripe, therefore, to engage in prospective and strategic planning to inform development of the practice nurse role.

5 CFR 720.203 - Responsibilities of the Office of Personnel Management.

Code of Federal Regulations, 2010 CFR

2010-01-01

... members of minority groups and providing guidance on internal and external recruitment activities directed..., utilizing existing networks for dissemination of job information, and involving the participation of minority group and women's organizations where practicable; (3) Examining existing Federal personnel...

Managing insulin therapy during exercise in type 1 diabetes mellitus.

PubMed

Toni, Sonia; Reali, Maria Francesca; Barni, Federica; Lenzi, Lorenzo; Festini, Filippo

2006-01-01

Exercise is integral to the life of T1DM subjects. Several factors influence the metabolic response to exercise in these patients. Despite physical and psychological benefits of exercise, its hypo- and hyperglycemic effects may cause discouragement from participation in sports and games. To use existing evidence from literature to provide practical indications for the management of insulin therapy in subjects with T1DM who practice sports or physical activities. Bibliographic research was performed on PubMed and the main Systematic Review and Guidelines database were also searched. Existing guidelines are useful but the exact adjustments of insulin dose must be made on an individual basis and these adjustments can be made only by "trial and error" approach. These clinical indications may be a starting point from which health care providers can find practical advices for each patient.

Spatial Dependence and Determinants of Dairy Farmers' Adoption of Best Management Practices for Water Protection in New Zealand

NASA Astrophysics Data System (ADS)

Yang, Wei; Sharp, Basil

2017-04-01

This paper analyses spatial dependence and determinants of the New Zealand dairy farmers' adoption of best management practices to protect water quality. A Bayesian spatial durbin probit model is used to survey data collected from farmers in the Waikato region of New Zealand. The results show that farmers located near each other exhibit similar choice behaviour, indicating the importance of farmer interactions in adoption decisions. The results also address that information acquisition is the most important determinant of farmers' adoption of best management practices. Financial problems are considered a significant barrier to adopting best management practices. Overall, the existence of distance decay effect and spatial dependence in farmers' adoption decisions highlights the importance of accounting for spatial effects in farmers' decision-making, which emerges as crucial to the formulation of sustainable agriculture policy.

Spatial Dependence and Determinants of Dairy Farmers' Adoption of Best Management Practices for Water Protection in New Zealand.

PubMed

Yang, Wei; Sharp, Basil

2017-04-01

This paper analyses spatial dependence and determinants of the New Zealand dairy farmers' adoption of best management practices to protect water quality. A Bayesian spatial durbin probit model is used to survey data collected from farmers in the Waikato region of New Zealand. The results show that farmers located near each other exhibit similar choice behaviour, indicating the importance of farmer interactions in adoption decisions. The results also address that information acquisition is the most important determinant of farmers' adoption of best management practices. Financial problems are considered a significant barrier to adopting best management practices. Overall, the existence of distance decay effect and spatial dependence in farmers' adoption decisions highlights the importance of accounting for spatial effects in farmers' decision-making, which emerges as crucial to the formulation of sustainable agriculture policy.

A social-ecological systems approach for environmental management.

PubMed

Virapongse, Arika; Brooks, Samantha; Metcalf, Elizabeth Covelli; Zedalis, Morgan; Gosz, Jim; Kliskey, Andrew; Alessa, Lilian

2016-08-01

Urgent environmental issues are testing the limits of current management approaches and pushing demand for innovative approaches that integrate across traditional disciplinary boundaries. Practitioners, scholars, and policy-makers alike call for increased integration of natural and social sciences to develop new approaches that address the range of ecological and societal impacts of modern environmental issues. From a theoretical perspective, social-ecological systems (SES) science offers a compelling approach for improved environmental management through the application of transdisciplinary and resilience concepts. A framework for translating SES theory into practice, however, is lacking. In this paper, we define the key components of an SES-based environmental management approach. We offer recommendations for integrating an SES approach into existing environmental management practices. Results presented are useful for management professionals that seek to employ an SES environmental management approach and scholars aiming to advance the theoretical foundations of SES science for practical application. Published by Elsevier Ltd.

[The realization way and lean management about medical consumable material in clinical use].

PubMed

Shang, Changhao; Cheng, Junpei; Xu, Hailin; Wang, Xiaoguang

2015-01-01

The medical consumable material management is an important part of logistic support in the management of hospital, but the hospital has many weak links in the management of supplies. This paper aims to explore the common problems (especially in clinical use) existing in the management of medical consumables and years of management experience in Changhai hospital's practice, then discusses lean management from the perspective of lean management

Organizational management practices for achieving software process improvement

NASA Technical Reports Server (NTRS)

Kandt, Ronald Kirk

2004-01-01

The crisis in developing software has been known for over thirty years. Problems that existed in developing software in the early days of computing still exist today. These problems include the delivery of low-quality products, actual development costs that exceed expected development costs, and actual development time that exceeds expected development time. Several solutions have been offered to overcome out inability to deliver high-quality software, on-time and within budget. One of these solutions involves software process improvement. However, such efforts often fail because of organizational management issues. This paper discusses business practices that organizations should follow to improve their chances of initiating and sustaining successful software process improvement efforts.

Strategic plan modelling by hospital senior administration to integrate diversity management.

PubMed

Newhouse, John J

2010-11-01

Limited research suggests that some hospital senior administrators and chief executive officers (CEOs) have employed a strategic planning function to achieve diversity management practices. As the hospital industry struggles with how to integrate diversity practices to improve patient satisfaction, increase the quality of care and enhance clinical outcomes for minority populations, understanding the planning process involved in this endeavour becomes significant for senior hospital administrators. What is not well understood is what this strategic planning process represents and how it is applied to integrate diversity management. Scant research exists about the type of strategic models that hospital CEOs employ when they wish to reposition their organizations through diversity management. This study examines the strategic planning models used by senior administrators to integrate diversity management for an institutional-wide agenda. A qualitative survey process was used for CEOs in the states of New York, Pennsylvania, New Jersey and Delaware. The key research questions dealt with what type of strategic plan approach senior administrators used for integrating diversity management and what rationale they used to pursue this. Significant differences were reported between three types of strategic plan modelling used by CEOs. Also, when comparing past and current practices over time, such differences existed. The need to integrate diversity management is underscored by this study. How senior hospital administrators apply strategic plan models and what impact these approaches have represent the major implications that this study offers.

Practical and effective rehabilitation of rangelands: lessons learned

USDA-ARS?s Scientific Manuscript database

Disturbed rangelands present significant challenges to land managers and private land owners. Controversy exists on the approach as to how to restore or rehabilitate these degraded rangelands. The proper use of plant materials and aggressive weed control practices can significantly increase the succ...

Integrated Practice Improvement Solutions-Practical Steps to Operating Room Management.

PubMed

Chernov, Mikhail; Pullockaran, Janet; Vick, Angela; Leyvi, Galina; Delphin, Ellise

2016-10-01

Perioperative productivity is a vital concern for surgeons, anesthesiologists, and administrators as the OR is a major source of hospital elective admissions and revenue. Based on elements of existing Practice Improvement Methodologies (PIMs), "Integrated Practice Improvement Solutions" (IPIS) is a practical and simple solution incorporating aspects of multiple management approaches into a single open source framework to increase OR efficiency and productivity by better utilization of existing resources. OR efficiency was measured both before and after IPIS implementation using the total number of cases versus room utilization, OR/anesthesia revenue and staff overtime (OT) costs. Other parameters of efficiency, such as the first case on-time start and the turnover time (TOT) were measured in parallel. IPIS implementation resulted in increased numbers of surgical procedures performed by an average of 10.7%, and OR and anesthesia revenue increases of 18.5% and 6.9%, respectively, with a simultaneous decrease in TOT (15%) and OT for anesthesia staff (26%). The number of perioperative adverse events was stable during the two-year study period which involved a total of 20,378 patients. IPIS, an effective and flexible practice improvement model, was designed to quickly, significantly, and sustainably improve OR efficiency by better utilization of existing resources. Success of its implementation directly correlates with the involvement of and acceptance by the entire OR team and hospital administration.

Long-term effects of grazing management and buffer strips on soil erosion from pastures

USDA-ARS?s Scientific Manuscript database

High grazing pressure can lead to soil erosion in pastures by compacting soil and increasing runoff and sediment delivery to waterways. Limited information exists on the effects of grazing management and best management practices (BMPs), such as buffer strips, on soil erosion from pastures. The obje...

78 FR 579 - Magnuson-Stevens Act Provisions; Fisheries Off West Coast States; Pacific Coast Groundfish...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-03

... by the PCGFMP. II. Major Provisions This final rule contains two types of major provisions. The first... fishing sector because different fishing sectors require different types of management to control catch... existing management measures and do not represent a change from current management practices. These types...

An uneven-aged management strategy: lessons learned

Treesearch

Mark T. Smith; John D. Exline

2002-01-01

Use of an ecosystem approach at a landscape scale to program and guide accomplishments of multi-resource and social objectives has been discussed between researchers and natural resource managers for many years. Presently, great interest exists in the applicability of uneven-aged management practices for such an approach in conifer forests of the Sierra Nevada of...

Counseling women with early pregnancy failure: utilizing evidence, preserving preference.

PubMed

Wallace, Robin R; Goodman, Suzan; Freedman, Lori R; Dalton, Vanessa K; Harris, Lisa H

2010-12-01

To apply principles of shared decision-making to EPF management counseling. To present a patient treatment priority checklist developed from review of available literature on patient priorities for EPF management. Review of evidence for patient preferences; personal, emotional, physical and clinical factors that may influence patient priorities for EPF management; and the clinical factors, resources, and provider bias that may influence current practice. Women have strong and diverse preferences for EPF management and report higher satisfaction when treated according to these preferences. However, estimates of actual treatment patterns suggest that current practice does not reflect the evidence for safety and acceptability of all options, or patient preferences. Multiple practice barriers and biases exist that may be influencing provider counseling about options for EPF management. Choosing management for EPF is a preference-sensitive decision. A patient-centered approach to EPF management should incorporate counseling about all treatment options. Providers can integrate a counseling model into EPF management practice that utilizes principles of shared decision-making and an organized method for eliciting patient preferences, priorities, and concerns about treatment options. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Management of climatic heat stress risk in construction: a review of practices, methodologies, and future research.

PubMed

Rowlinson, Steve; Yunyanjia, Andrea; Li, Baizhan; Chuanjingju, Carrie

2014-05-01

Climatic heat stress leads to accidents on construction sites brought about by a range of human factors emanating from heat induced illness, and fatigue leading to impaired capability, physical and mental. It is an occupational characteristic of construction work in many climates and the authors take the approach of re-engineering the whole safety management system rather than focusing on incremental improvement, which is current management practice in the construction industry. From a scientific viewpoint, climatic heat stress is determined by six key factors: (1) air temperature, (2) humidity, (3) radiant heat, and (4) wind speed indicating the environment, (5) metabolic heat generated by physical activities, and (6) "clothing effect" that moderates the heat exchange between the body and the environment. By making use of existing heat stress indices and heat stress management processes, heat stress risk on construction sites can be managed in three ways: (1) control of environmental heat stress exposure through use of an action-triggering threshold system, (2) control of continuous work time (CWT, referred by maximum allowable exposure duration) with mandatory work-rest regimens, and (3) enabling self-paced working through empowerment of employees. Existing heat stress practices and methodologies are critically reviewed and the authors propose a three-level methodology for an action-triggering, localized, simplified threshold system to facilitate effective decisions by frontline supervisors. The authors point out the need for "regional based" heat stress management practices that reflect unique climatic conditions, working practices and acclimatization propensity by local workers indifferent geographic regions. The authors set out the case for regional, rather than international, standards that account for this uniqueness and which are derived from site-based rather than laboratory-based research. Copyright © 2013 Elsevier Ltd. All rights reserved.

Ideas of and Attitudes towards Projects and Changing Practices: Voices of Four Teachers

ERIC Educational Resources Information Center

Shome, Saurav; Natarajan, Chitra

2013-01-01

The paper reports a study of the project practices of four Indian middle school teachers, elicited through semi-structured interviews of individual teachers. The teachers also responded to a proposal to modify four aspects of existing project practices, viz. subject integration, assessment, group work, and management of resources. The aspects were…

A watershed scale assessment of the impacts of suburban turf management on runoff water quality

NASA Astrophysics Data System (ADS)

Bachman, M.; Inamdar, S. P.; Barton, S.; Duke, J.; Tallamy, D.; Bruck, J.

2014-12-01

Steadily increasing rates of urbanization have raised concerns about the negative impacts of urban runoff on receiving surface water quality. These concerns have been further amplified by landscaping paradigms that encourage high-input, intensively-managed and mono-culture turf and lawn landscapes. We conducted a watershed-scale assessment of turf management practices on water quality vis-à-vis less-intensive management practices that preserve and enhance more diverse and native vegetation. The study treatments with existing/established vegetation and landscaping practices included turf, urban, forest, meadow, and a mixed site with a professional golf course. Stream water sampling was performed during baseflow and storm events. Highest nutrient (nitrate and total nitrogen) concentrations in runoff were observed for the mixed watershed draining the golf course. In contrast, nutrient concentrations in baseflow from the turf watershed were lower than expected and were comparable to those measured in the surrounding meadow and forest sites. Runoff losses from the turf site may have been minimal due to the optimal quality of management implemented. Total nitrogen concentrations from the turf site increased sharply during the first storms following fertilization, suggesting that despite optimal management there exists a risk for nutrient runoff following fertilization. Dissolved organic carbon (DOC) concentrations from the turf site were elevated and aromatic in content while the mixed watershed site yielded more labile DOM. Overall, this study suggests that turf lawns, when managed properly, pose minimal environmental risk to surrounding surface waters. Based on the results of this study, providing homeowners with increased information regarding best management practices for lawn maintenance may serve as a cost-efficient method for reducing suburban runoff pollution.

Modeling effectiveness of management practices for flood mitigation using GIS spatial analysis functions in Upper Cilliwung watershed

NASA Astrophysics Data System (ADS)

Darma Tarigan, Suria

2016-01-01

Flooding is caused by excessive rainfall flowing downstream as cumulative surface runoff. Flooding event is a result of complex interaction of natural system components such as rainfall events, land use, soil, topography and channel characteristics. Modeling flooding event as a result of interaction of those components is a central theme in watershed management. The model is usually used to test performance of various management practices in flood mitigation. There are various types of management practices for flood mitigation including vegetative and structural management practices. Existing hydrological model such as SWAT and HEC-HMS models have limitation to accommodate discrete management practices such as infiltration well, small farm reservoir, silt pits in its analysis due to the lumped structure of these models. Aim of this research is to use raster spatial analysis functions of Geo-Information System (RGIS-HM) to model flooding event in Ciliwung watershed and to simulate impact of discrete management practices on surface runoff reduction. The model was validated using flooding data event of Ciliwung watershed on 29 January 2004. The hourly hydrograph data and rainfall data were available during period of model validation. The model validation provided good result with Nash-Suthcliff efficiency of 0.8. We also compared the RGIS-HM with Netlogo Hydrological Model (NL-HM). The RGIS-HM has similar capability with NL-HM in simulating discrete management practices in watershed scale.

Esophageal cancer screening in achalasia: is there a consensus?

PubMed

Ravi, K; Geno, D M; Katzka, D A

2015-04-01

Achalasia is an important but relatively uncommon disorder. While highly effective therapeutic options exist, esophageal cancer remains a long-term potential complication. The risk of esophageal cancer in achalasia remains unclear, with current guidelines recommending against routine endoscopic screening. However, given limited data and conflicting opinion, it is unknown whether consensus regarding screening practices in achalasia among experts exists. A 10-question survey to assess screening practices in achalasia was created and distributed to 28 experts in the area of achalasia. Experts were identified based on publications and meeting presentations in the field. Survey responses were received from 17 of 28 (61%) experts. Wide geographic distribution was seen among respondents, with eight (47%) from Europe or Australia, seven (41%) from the United States, and two (12%) from Asia. Screening for esophageal cancer was inconsistent, with nine (53%) experts endorsing the practice and eight (47%) not. Screening practices did not differ among geographic regions. No consensus regarding the risk for esophageal cancer in achalasia was seen, with three experts reporting no increased risk compared with the general population, eight experts a lifetime risk of 0.1-0.5%, three experts a 0.5-1% risk, two experts a 1-2% risk, and one expert a 3-5% risk. However, these differences in perception of risk did not influence screening practices. Upper endoscopy was utilized among all experts who endorsed screening. However, practices still varied with screening commencing at or within 1 year of diagnosis in two practices compared with 5 and 10 years in three respective practices each. Surveillance intervals also varied, performed every 2 years in four practices, every 3 years in four practices, and every 5 years in one practice. Practice variation in the management of achalasia itself was also seen, with initial treatment with Heller myotomy endorsed by eight experts, pneumatic dilation by five experts, and two each endorsing peroral endoscopic myotomy or no specific preference. In addition, while 82% (14/17) of experts endorsed long-term follow up of patients, no consensus regarding long-term follow up existed, with annual follow up in eight practices, every 3-6 months in three practices, and every 2 years in three practices. Large practice variation in the long-term management of achalasia exists among experts in the field. Only a slight majority of experts endorse screening for esophageal cancer in achalasia, and no consensus exists regarding how surveillance should be structured even among this group. Interestingly, the lack of consensus on cancer screening parallels a lack of agreement on initial treatment of achalasia. These findings suggest a need for greater homogeneity in the management of longstanding achalasia and cancer screening. Further, this study highlights the need for more data on this topic to foster greater agreement. © 2014 International Society for Diseases of the Esophagus.

The public health nutrition intervention management bi-cycle: a model for training and practice improvement.

PubMed

Hughes, Roger; Margetts, Barrie

2012-11-01

The present paper describes a model for public health nutrition practice designed to facilitate practice improvement and provide a step-wise approach to assist with workforce development. The bi-cycle model for public health nutrition practice has been developed based on existing cyclical models for intervention management but modified to integrate discrete capacity-building practices. Education and practice settings. This model will have applications for educators and practitioners. Modifications to existing models have been informed by the authors' observations and experiences as practitioners and educators, and reflect a conceptual framework with applications in workforce development and practice improvement. From a workforce development and educational perspective, the model is designed to reflect adult learning principles, exposing students to experiential, problem-solving and practical learning experiences that reflect the realities of work as a public health nutritionist. In doing so, it assists the development of competency beyond knowing to knowing how, showing how and doing. This progression of learning from knowledge to performance is critical to effective competency development for effective practice. Public health nutrition practice is dynamic and varied, and models need to be adaptable and applicable to practice context to have utility. The paper serves to stimulate debate in the public health nutrition community, to encourage critical feedback about the validity, applicability and utility of this model in different practice contexts.

Using Appropriate Digital Tools to Overcome Barriers to Collaborative Learning in Classrooms

ERIC Educational Resources Information Center

Wardlow, Liane; Harm, Eian

2015-01-01

Collaborative learning provides students with vital opportunities to create and build knowledge. Existing technologies can facilitate collaborative learning. However, barriers exist to enacting collaborative practices related to the coverage of material for assessments and classroom management concerns, among others. Teachers can overcome these…

A system of safety management practices and worker engagement for reducing and preventing accidents: an empirical and theoretical investigation.

PubMed

Wachter, Jan K; Yorio, Patrick L

2014-07-01

The overall research objective was to theoretically and empirically develop the ideas around a system of safety management practices (ten practices were elaborated), to test their relationship with objective safety statistics (such as accident rates), and to explore how these practices work to achieve positive safety results (accident prevention) through worker engagement. Data were collected using safety manager, supervisor and employee surveys designed to assess and link safety management system practices, employee perceptions resulting from existing practices, and safety performance outcomes. Results indicate the following: there is a significant negative relationship between the presence of ten individual safety management practices, as well as the composite of these practices, with accident rates; there is a significant negative relationship between the level of safety-focused worker emotional and cognitive engagement with accident rates; safety management systems and worker engagement levels can be used individually to predict accident rates; safety management systems can be used to predict worker engagement levels; and worker engagement levels act as mediators between the safety management system and safety performance outcomes (such as accident rates). Even though the presence of safety management system practices is linked with incident reduction and may represent a necessary first-step in accident prevention, safety performance may also depend on mediation by safety-focused cognitive and emotional engagement by workers. Thus, when organizations invest in a safety management system approach to reducing/preventing accidents and improving safety performance, they should also be concerned about winning over the minds and hearts of their workers through human performance-based safety management systems designed to promote and enhance worker engagement. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Maternal-Fetal Medicine Physician and Fellow Perceptions of Business in Medicine.

PubMed

Porter, Blake; Iriye, Brian; Ghamsary, Mark

2018-01-01

 Principles of practice management provide a foundation for clinical success and performance improvement. Scant data exist regarding maternal-fetal medicine (MFM) physicians' knowledge of these topics. We hypothesize that physicians enter practice with inadequate education in practice management.  Surveys were emailed to members of the Society for Maternal-Fetal Medicine rating their knowledge and capabilities in practice management topics, and respondents assessed their current institution's business in the medical curriculum.  A total of 325 (14.4%) physicians responded: 63 fellows in training and 262 MFM physician subspecialists. Practicing physicians reported learning most of their knowledge "in practice after fellowship" (85%) or "never at all" (10%). Only 3% of respondents had adequate business education during fellowship, and only 5% felt prepared to teach business principles. However, 85% of those surveyed agreed that this material should be taught during the fellowship. Among MFM subspecialists and fellows in training at institutions with fellowships, 60% reported no current curriculum for practice management, and those with current curricula reported it had "limited" or "no value" (76%).  There is a significant desire for practice management curricula during MFM fellowship, and current training is insufficient. With many MFM physicians ill-prepared to teach these principles, professional education from other financial fields, and standardized education in practice management from current expert sources is needed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Physiotherapy for cystic fibrosis in Australia and New Zealand: A clinical practice guideline*

PubMed Central

Wilson, Christine; Dentice, Ruth; Cox, Narelle S.; Middleton, Anna; Tannenbaum, Esta; Bishop, Jennifer; Cobb, Robyn; Burton, Kate; Wood, Michelle; Moran, Fiona; Black, Ryan; Bowen, Summar; Day, Rosemary; Depiazzi, Julie; Doiron, Katherine; Doumit, Michael; Dwyer, Tiffany; Elliot, Alison; Fuller, Louise; Hall, Kathleen; Hutchins, Matthew; Kerr, Melinda; Lee, Annemarie L.; Mans, Christina; O'Connor, Lauren; Steward, Ranjana; Potter, Angela; Rasekaba, Tshepo; Scoones, Rebecca; Tarrant, Ben; Ward, Nathan; West, Samantha; White, Dianne; Wilson, Lisa; Wood, Jamie; Holland, Anne E.

2016-01-01

Abstract Physiotherapy management is a key element of care for people with cystic fibrosis (CF) throughout the lifespan. Although considerable evidence exists to support physiotherapy management of CF, there is documented variation in practice. The aim of this guideline is to optimize the physiotherapy management of people with CF in Australia and New Zealand. A systematic review of the literature in key areas of physiotherapy practice for CF was undertaken. Recommendations were formulated based on National Health and Medical Research Council (Australia) guidelines and considered the quality, quantity and level of the evidence; the consistency of the body of evidence; the likely clinical impact; and applicability to physiotherapy practice in Australia and New Zealand. A total of 30 recommendations were made for airway clearance therapy, inhalation therapy, exercise assessment and training, musculoskeletal management, management of urinary incontinence, managing the newly diagnosed patient with CF, delivery of non‐invasive ventilation, and physiotherapy management before and after lung transplantation. These recommendations can be used to underpin the provision of evidence‐based physiotherapy care to people with CF in Australia and New Zealand. PMID:27086904

Managing Employee Assistance Programmes.

ERIC Educational Resources Information Center

Schmidenberg, Olive C.; Cordery, John L.

1990-01-01

Interviews with 20 branch managers and 20 accountants in an Australian bank determined factors influencing the success of an employee assistance program (EAP). It was found that policies requiring supervisors to act against normal managerial practice doom EAPs to failure. Organizational analysis to integrate the EAP within existing organizational…

Determining the barriers and facilitators to adopting best practices in the management of poststroke unilateral spatial neglect: results of a qualitative study.

PubMed

Petzold, Anita; Korner-Bitensky, Nicol; Salbach, Nancy M; Ahmed, Sara; Menon, Anita; Ogourtsova, Tatiana

2014-01-01

A gap exists between best and actual management of poststroke unilateral spatial neglect (USN). Given the negative impact of USN on poststroke recovery, knowledge translation efforts are needed to optimize USN management. To date, no study has investigated the specific barriers and facilitators affecting USN management during the acute care process. To identify the facilitators and barriers that affect evidence-based practice use by occupational therapists (the primary discipline managing USN) when treating individuals with acute poststroke USN. Focus group methodology elicited information from 9 acute care occupational therapists. Key barriers identified included lack of basic evidence-based practice skills specific to USN treatment and personal motivation to change current practices and engrained habits. Key facilitators included the presence of a multidisciplinary stroke team, recent graduation, and an environment with access to learning time and resources. Synthesized Web-based learning was also seen as important to uptake of best practices. It is estimated that upwards of 40% of patients experience poststroke USN in the acute phase, and we have evidence of poor early management. This study identified several modifiable factors that prepare the ground for the creation and testing of a multimodal knowledge translation intervention aimed at improving clinicians' best practice management of poststroke USN.

Biodiversity in Finnish wilderness areas: Historical and cultural constraints to preserve species and habitats

Treesearch

Anna-Liisa Sippola

2002-01-01

The present status of species and habitats in Finnish wilderness areas is largely a consequence of past administrative, use, and management traditions in northern Finland. The existing wilderness legislation sets a framework for management, but historical uses and administrative decisions have influenced many prevailing practices. In addition, management of many uses...

The case for undergraduate medical education in healthcare business and management.

PubMed

Hsu, Benson S; Hosokawa, Michael C; Maria, Bernard

2007-01-01

Current undergraduate medical education does notprepare students to approach the intricacies of healthcare business. This absence within medical education creates significant challenges for physicians throughout their careers. The field of academic medicine has clearly documented the need for medical education to prepare students for practice management, yet there exist only a small number of attempts at exposing students to healthcare business and management. The authors argue that this curriculum must start at the level ofundergraduate medical education. Furthermore, this curriculum must possess the basic components of support, integration, practicality, application, and continuation. Fulfilling these requirements will allow for the successful adaptation of the healthcare business and management curriculum.

To Exist as a Case Manager Is to Constantly Change; to Be Successful, You Must Constantly Adapt.

PubMed

Tahan, Hussein M

Change is inevitable whether in personal or professional lives. Case management practice is always evolving on the basis of the dynamic nature of the U.S. health care environment. Effective case managers are those who possess an adaptive mind-set, recognize the importance to change to maintain success, and remain relevant. They also demonstrate a sense of accountability and responsibility for own learning, professional development, and acquisition of new skills and knowledge. This editorial discusses the nature of change and adaptation and presents key strategies for case managers to remain relevant and effective in dynamic practice environments.

Evidence-based management of otitis media: a 5S model approach.

PubMed

Wasson, J D; Yung, M W

2015-02-01

The 5S model proposes five hierarchical levels (systems, summaries, synopses, syntheses and studies) of pre-appraised evidence to guide evidence-based practice. This review aimed to identify and summarise pre-appraised evidence at the highest available 5S level for the management of different subsets of otitis media: acute otitis media, otitis media with effusion, chronic suppurative otitis media and cholesteatoma in both adults and children. Data sources were pre-appraised evidence resources. Evidence freely available from sources at the highest available level of the 5S model were summarised for this review. System level evidence exists for acute otitis media and otitis media with effusion. Summary level evidence exists for recurrent acute otitis media and medical management of chronic suppurative otitis media. There is an absence of randomised controlled trials to prove the efficacy of surgical management of chronic suppurative otitis media and cholesteatoma. Until randomised controlled trial data are generated, consensus publications on the surgical management of chronic suppurative otitis media and cholesteatoma should be used to guide best practice.

Antimicrobial Drugs

PubMed Central

Becker, Daniel E.

2013-01-01

Antibiotics play a vital role in dental practice for managing orofacial infections. They are used to manage existing infection and they are also used as prophylaxis for certain medical conditions and surgical procedures. This article will review pharmacological and therapeutic considerations for the proper use of these agents for dental infections. PMID:24010989

Evaluation and Development of Pavement Scores, Performance Models and Needs Estimates for the TXDOT Pavement Management Information System : Final Report

DOT National Transportation Integrated Search

2012-10-01

This project conducted a thorough review of the existing Pavement Management Information System (PMIS) database, : performance models, needs estimates, utility curves, and scores calculations, as well as a review of District practices : concerning th...

48 CFR 970.5203-2 - Performance improvement and collaboration.

Code of Federal Regulations, 2011 CFR

2011-10-01

... in the communication of the success of improvements to other management and operating contractors in... management and operation of the contract. This may entail the alteration of existing practices or the... approaches consistent with the statement of work and performance measures of this contract. (b) The...

48 CFR 970.5203-2 - Performance improvement and collaboration.

Code of Federal Regulations, 2010 CFR

2010-10-01

... in the communication of the success of improvements to other management and operating contractors in... management and operation of the contract. This may entail the alteration of existing practices or the... approaches consistent with the statement of work and performance measures of this contract. (b) The...

Comprehensive nursing case management. An advanced practice model.

PubMed

Taylor, P

1999-01-01

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

Spirituality As a Coping Mechanism for Individuals with Parkinson's Disease.

PubMed

Reynolds, Diane

Parkinson's disease (PD) is a chronic neurodegenerative disease that can render individuals totally disabled. Spiritual practices can help mitigate stress and provide a source of strength in PD. This article demonstrates a gap that exists between PD and spiritual coping specific research; discusses existing spiritual coping research in chronic illness; and explores the use of spirituality in managing PD care. Healthcare providers need to provide holistic care and explore mechanisms to assist individuals to manage the demands of living with PD.

Developing the academic nursing practice in the midst of new realities in higher education.

PubMed

Miller, Karen L; Bleich, Michael R; Hathaway, Donna; Warren, Carol

2004-02-01

The academic nursing practice has a role in replenishing the diminished resources that confront higher education and, if well conceived and managed, is a viable option to support existing academic program stability and growth. An alternative model for defining the academic practice--beyond traditional nurse-managed centers--is presented in this article. The cohesive interconnection of the education, research, and practice missions is addressed with examples of how each contributes to a variety of communities of interest and expands professional nursing roles through innovative care model testing and development. With effective business planning and infrastructure support, faculty practice plans can evolve to a second generation, with heightened societal accountability for service, academic, and collaborative research outcomes.

Management of hip fractures in older people in Beijing: a retrospective audit and comparison with evidence-based guidelines and practice in the UK.

PubMed

Tian, M; Gong, X; Rath, S; Wei, J; Yan, L L; Lamb, S E; Lindley, R I; Sherrington, C; Willett, K; Norton, R

2016-02-01

Despite the high burden of hip fracture in China, there is limited information on its management. This study investigated the management of hip fractures in a Beijing tertiary hospital and compared practice with that in 180 hospitals in the UK. The findings show a significant gap exists between the countries. The purpose of this study was to determine if the management of older people with hip fractures in a Beijing tertiary hospital is comparable with the UK best practice guidelines for hip fracture management and the UK National Hip Fracture Database 2012, obtained from 180 hospitals. A retrospective audit was undertaken in a large tertiary care hospital in Beijing. Data were compared with the National Hip Fracture Database 2012 collected in 180 hospitals in the UK on the proportion of patients managed according to the UK Blue Book standards. Sixty-six percent of patients were admitted to an orthopaedic ward within 24 h of fracture, while 100 % of patients in the UK were admitted to an orthopaedic ward within 24 h of arrival to an accident and emergency department. Only 8 % of patients received surgery within 48 h of admission compared with 83 % in the UK; 10 % received no surgery compared with 2.5 % in the UK; and 27 % received orthogeriatrician assessment compared with 70 % in the UK. New pressure ulcers developed in 2 % of patients compared with 3.7 % of those in the UK; whereas, 0.3 % of patients were assessed for osteoporosis treatment and 3.8 % received falls assessment, and comparable figures for the UK were 94 and 92 %, respectively. Significant gaps exist in hip fracture management in the Beijing hospital compared with the best practice achieved in 180 UK hospitals, highlighting the need to implement and evaluate proactive strategies to increase the uptake of best practice hip fracture care in China.

Chronic Subdural Hematoma: A Questionnaire Survey of Management Practice in India and Review of Literature.

PubMed

Avanali, Raghunath; Bhadran, Biju; Krishna Kumar, P; Vijayan, Abhishek; Arun, S; Musthafa, Aneeze M; Panchal, Sunil; Gopal, Vinu V

2016-12-01

To identify the current management modalities practiced by neurosurgeons in India for chronic subdural hematoma. A questionnaire was prepared for the survey and sent via e-mail to neurosurgeons. It covered the following aspects of managing chronic subdural hematoma: 1) demographic and institutional details; 2) choice of surgical procedure; 3) surgical adjutants such as placing a subdural drain; 4) pre- and postoperative care; and 5) recurrences and management. Responses obtained were entered in a SPSS data sheet and analyzed. Response rate of the survey was 9.3%. The majority of neurosurgeons (75%) preferred to do burr whole drainage for primary chronic subdural hematoma and also for recurrences. Only one third of routinely placed a subdural drain. Considerable practice variations exist for medical and perioperative management. Bedside twist drill drainage, which is effective and less costly than operative room procedures, has not gained popularity in practice. The present survey points towards the importance of making management guidelines for this common neurosurgical entity. Copyright © 2016 Elsevier Inc. All rights reserved.

Training vs practice: A tale of opposition in acute cholecystitis.

PubMed

Patel, Purvi P; Daly, Shaun C; Velasco, Jose M

2015-10-18

Acute cholecystitis is one of the most common surgical diagnoses encountered by general surgeons. Despite its high incidence there remains a range of treatment of approaches. Current practices in biliary surgery vary as to timing, intraoperative utilization of biliary imaging, and management of bile duct stones despite growing evidence in the literature defining best practice. Management of patients with acute cholecystitis with early laparoscopic cholecystectomy (LC) results in better patient outcomes when compared with delayed surgical management techniques including antibiotic therapy or percutaneous cholecystostomy. Regardless of this data, many surgeons still prefer to utilize antibiotic therapy and complete an interval LC to manage acute cholecystitis. The use of intraoperative biliary imaging by cholangiogram or laparoscopic ultrasound has been demonstrated to facilitate the safe completion of cholecystectomy, minimizing the risk for inadvertent injury to surrounding structures, and lowering conversion rates, however it is rarely utilized. Choledocholithiasis used to be a diagnosis managed exclusively by surgeons but current practice favors referral to gastroenterologists for performance of preoperative endoscopic removal. Yet, there is evidence that intraoperative laparoscopic stone extraction is safe, feasible and may have added advantages. This review aims to highlight the differences between existing management of acute cholecystitis and evidence supported in the literature regarding best practice with the goal to change surgical practice to adopt these current recommendations.

Training vs practice: A tale of opposition in acute cholecystitis

PubMed Central

Patel, Purvi P; Daly, Shaun C; Velasco, Jose M

2015-01-01

Acute cholecystitis is one of the most common surgical diagnoses encountered by general surgeons. Despite its high incidence there remains a range of treatment of approaches. Current practices in biliary surgery vary as to timing, intraoperative utilization of biliary imaging, and management of bile duct stones despite growing evidence in the literature defining best practice. Management of patients with acute cholecystitis with early laparoscopic cholecystectomy (LC) results in better patient outcomes when compared with delayed surgical management techniques including antibiotic therapy or percutaneous cholecystostomy. Regardless of this data, many surgeons still prefer to utilize antibiotic therapy and complete an interval LC to manage acute cholecystitis. The use of intraoperative biliary imaging by cholangiogram or laparoscopic ultrasound has been demonstrated to facilitate the safe completion of cholecystectomy, minimizing the risk for inadvertent injury to surrounding structures, and lowering conversion rates, however it is rarely utilized. Choledocholithiasis used to be a diagnosis managed exclusively by surgeons but current practice favors referral to gastroenterologists for performance of preoperative endoscopic removal. Yet, there is evidence that intraoperative laparoscopic stone extraction is safe, feasible and may have added advantages. This review aims to highlight the differences between existing management of acute cholecystitis and evidence supported in the literature regarding best practice with the goal to change surgical practice to adopt these current recommendations. PMID:26483868

The Science-Practice Gap among Recreation Managers with HR Responsibilities

ERIC Educational Resources Information Center

Nowicki, Margaret D.; Arnold, Margaret

2007-01-01

Researchers across management fields continue to recognize the importance of conducting research that matters to practitioners (e.g., Nowicki & Rosse, 2001; Ford, Duncan, Bedeian, Ginter, Rousculp, & Adams, 2003) yet continue to point out the schism that exists between needs of practitioners and research interests of academics. This paper…

Thinking About Oak Forests as Responsive Ecosystems

Treesearch

Paul S. Johnson

2004-01-01

Like all forests, oak forests are continually responding to disturbances originating from both within and outside the forest. Oaks (Quercus spp.) owe their very existence to disturbance. In this context, silvicultural and other manage-ment practices can be thought of as planned disturbances designed to direct forest change in specific ways. The...

Bark beetle responses to vegetation management practices

Treesearch

Joel D. McMillin; Christopher J. Fettig

2009-01-01

Native tree-killing bark beetles (Coleoptera: Curculionidae, Scolytinae) are a natural component of forest ecosystems. Eradication is neither possible nor desirable and periodic outbreaks will occur as long as susceptible forests and favorable climatic conditions co-exist. Recent changes in forest structure and tree composition by natural processes and management...

Six Sigma and Introductory Statistics Education

ERIC Educational Resources Information Center

Maleyeff, John; Kaminsky, Frank C.

2002-01-01

A conflict exists between the way statistics is practiced in contemporary business environments and the way statistics is taught in schools of management. While businesses are embracing programs, such as six sigma and TQM, that bring statistical methods to the forefront of management decision making, students do not graduate with the skills to…

Transformational Leadership: Practicing What We Teach in the Management Classroom

ERIC Educational Resources Information Center

Pounder, James S.

2008-01-01

In a Hong Kong study, the author examined the effect on undergraduate business students of university business school instructors' exhibiting a transformational leadership style in the classroom. Transformational leadership is one of the central concepts in management, and research has indicated that a positive association exists between this…

Enhancing the quality of supportive supervisory behavior in long-term care facilities.

PubMed

McGillis Hall, Linda; McGilton, Katherine S; Krejci, Janet; Pringle, Dorothy; Johnston, Erin; Fairley, Laura; Brown, Maryanne

2005-04-01

The practices of managers and registered nurses (RNs) in long-term care facilities are frequently ineffective in assisting the licensed practical nurses (LPNs) and healthcare aides (HCAs) whom they supervise. Little research exists that examines the area of supportive relationships between nursing staff and supervisors in these settings. The purpose of this study was to gather data that could improve management practices in long-term care residential facilities and enhance the quality of the supervisory relationships between supervisors (nurse managers and RNs) and care providers (HCAs and LPNs) in these settings. The study also identified factors that influence the supervisors' ability to establish supportive relationships with care providers. The challenges and barriers to nurse managers and leaders related to enacting supportive behaviors are discussed as well as their implications for long-term care settings.

Experimenting Design and Implementation of an Educational Services Management System Based on ISO/IEC 20000 Standard

NASA Astrophysics Data System (ADS)

Lezcano, Jean-Marc; Adachihara, Hatsuo; Prunier, Marc

European higher education organizations are encouraged to implement quality management practices. Existing quality standards and frameworks do not capitalize an important set of best practices addressing educational services delivery. The ISO/IEC 20000 standard, elaborated from IT service management issues, is widening its field of application and may represent an interesting alternative. A specific approach is needed to apprehend the particular nature of educational services, consider the systemic cooperating roles of educational system and learning system, and define ISO/IEC 20000 vocabulary and concepts adapted to the domain. ISO/IEC 20000 may provide an answer to European Standard Guideline compliance and improve educational services management. The current experimentation is expected to cast light on the complexity, practicality and effectiveness of the use of ISO/IEC 20000 in a first field of "non IT" services.

Testing soil and water conservation methods in 16 countries; do best practices exist?

NASA Astrophysics Data System (ADS)

Jetten, V.; Shrestha, D. P.

2012-04-01

In order to find suitable conservation measures to protect the land from further deterioration leading to desertification, sustainable land management technologies were applied in 16 locations in countries having land degradation problems such as erosion (by wind and water), salinization, vegetation degradation and wild fire. The technologies were selected in consultation with all the stakeholders involved which included farmers, land users, local administrators and scientists. The selected technologies varied from vegetative (planting trees) through agronomic (crop rotation, contour ploughing, minimum tillage) to mechanical (terracing, fencing, prescribed burning) measures. They were applied in the 16 hotspot locations in semi-arid and arid regions to test their suitability for conservation purposes. Improvement on soil conditions was monitored during 2-3 years and the effectiveness of the applied technologies were evaluated. Although data from monitoring is available for only 2-3 years the results show improvements of soil conditions and indicate that good land management practices can help in minimizing land degradation. The results also show that the so called "the best practices" which could be applied everywhere with big success do not exist. Each region is characterized by having its own bio-physical and socio-economic factors which determine whether certain land management practices can be applied successfully which is also socially acceptable in the area.

Factors that influence producer decisions to implement management strategies.

PubMed

Field, Thomas G

2014-12-01

Cow-calf enterprises in the USA are widely divergent in size, locale, resource availability, management skill, and market focus. Furthermore, variation exists in dependence on the cow-calf enterprise as a primary source of income, perception about the utility of a particular management practice or technology, and assessment of cost: benefit resulting from implementation impact decisions. Enterprises with larger cow inventories, greater dependence on income from the cattle enterprise, and that retain ownership further into the supply chain beyond the cow-calf operation are more likely to institute management protocols such as vaccination programs, defined calving seasons, and reproductive technologies. Successful cow-calf managers place the highest priority on herd nutrition, pasture and range management, herd health, financial management marketing, production management, and genetics. Management practices are more likely to be adopted when they align with a manager's perception of the utility, labor availability, favorable cost: benefit outcomes and profit motivation.

Building competencies for nurse administrators in the Republic of Georgia.

PubMed

Nishiyama, M; Wold, J L; Partskhladze, N

2008-06-01

To assess the level of competency among nurse administrators in the Republic of Georgia (Georgia) and to recommend interventions to implement effective nursing management practices in a resource constrained setting. The collapse of the Soviet Union in 1991 resulted in deterioration of the healthcare system in Georgia. Even though the 1995 healthcare reformers recognized that baccalaureate educated nurses were essential resources for quality health care, limited resources delayed further steps. Hence, Georgia has struggled to raise nursing education levels and to establish nursing as a professional occupation. Using an exploratory descriptive research technique, surveys of nurse managers were conducted in 2004 and in 2005. This study assessed the level of practice among Georgian nurse administrators compared with the international competencies of the International Council of Nurses. There were no organized procedures to evaluate competencies of nurses on a regular basis. While minimal clinical nursing practice guidelines exist, nurse managers did not fully utilize them for either mentoring the staff nurses or assuring an adequate quality of nursing care. Many nurse managers viewed financial constraints as an obstacle to delivering better nursing care. Recommendations include: (1) establishing effective protocols to evaluate the competencies of nurses, (2) mandating the use of existing nursing guidelines, (3) establishing effective resource inventory systems, and (4) mandating safety education and ensuring a safe work environment.

Managing water resources infrastructure in the face of different values

NASA Astrophysics Data System (ADS)

Mostert, Erik

Water resources infrastructure (WRI) plays a key role in water management. It can serve or negatively affect some seven to ten different and sometimes conflicting values. WRI management is therefore not a purely technical issue. Economic analyses can help to some extent, but only for values related to current human use. Multi-criteria analysis can cover all values, but in the end WRI management is not an analytical issue, but a governance issue. Different governance paradigms exist: markets, hierarchies and “third alternatives”, such as common pool resources management and network management. This article presents social learning as the most promising paradigm. Positive experiences with social learning have been described and guidance on putting social learning into practice exists. Nonetheless, there are no magic solutions for managing WRI in the face of different values.

Knowledge Management in healthcare libraries: the current picture.

PubMed

Hopkins, Emily

2017-06-01

Knowledge management has seen something of a resurgence in attention amongst health librarians recently. Of course it has never ceased to exist, but now many library staff are becoming more involved in organisational knowledge management, and positioning themselves as key players in the sphere. No single model of knowledge management is proliferating, but approaches that best fit the organisation's size, structure and culture, and a blending of evidence based practice and knowledge sharing. Whatever it is called and whatever models are used, it's clear that for librarians and information professionals, the importance of putting knowledge and evidence into practice, sharing knowledge well and capturing it effectively, are still what we will continue to do. © 2017 Health Libraries Group.

Globalization of pediatric transplantation: The risk of tuberculosis or not tuberculosis.

PubMed

McCulloch, Mignon; Lin, Philana Ling

2017-05-01

The risk of TB among pediatric SOT recipients increases as the globalization of medical care continues to broaden. Unlike adults, children and especially infants are more susceptible to TB as a complication after transplantation. Little data exist regarding the true incidence of TB and the optimal risk-based management of this very vulnerable population. Here, we highlight the theoretical and practical issues that complicate the management of these patients and pose some questions that should be addressed when managing these patients. More data are needed to provide optimal guidance of the best diagnostic and management practices to this unique population. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Knowledge, management and perceived barriers to treatment of molar-incisor hypomineralisation in general dental practitioners and dental nurses in Malaysia.

PubMed

Hussein, A S; Ghanim, A M; Abu-Hassan, M I; Manton, D J

2014-10-01

Molar-incisor hypomineralisation (MIH) is a global dental problem, yet little is known about the knowledge of the general dental practitioners (GDPs) and dental nurses (DNs) regarding this defect in South East Asia. To assess and compare the knowledge of the GDPs and DNs in Malaysia regarding the frequency of occurrence of MIH within their practice, its diagnosis, putative aetiological factors and management. A questionnaire was distributed to GDPs and DNs during a nationwide dental conference in Melaka, Malaysia and who were asked to answer questions about demographic variables, knowledge, attitudes and practices in the management of MIH. Descriptive statistics and bivariate analysis were performed. A 5% level of statistical significance was applied for the analyses. A response rate of 58.2% (131/225) was obtained. Most respondents were aware of MIH and encountered it in their practice (GDPs = 82.5%, DNs = 82.4%). The condition was observed by respondents less in primary molars compared to first permanent molars. Full agreement between GDPs and DNs did not exist concerning the aetiological factors and management of MIH. Glass ionomer cements were the most popular material used in treating MIH. Most respondents (GDPs = 93%, DNs = 76.5%) indicated that they had not received sufficient information about MIH and were willing to have clinical training in the diagnosis and therapeutic modalities of MIH. MIH is identified and encountered by most respondents. Agreement did not exist between GDPs and DNs concerning MIH frequency of occurrence within their practice, its diagnosis, aetiological factors and management.

Multilevel Analysis of the Relationship between Principals' Perceived Practices of Instructional Leadership and Teachers' Self-Efficacy Perceptions

ERIC Educational Resources Information Center

Bellibas, Mehmet Sukru; Liu, Yan

2017-01-01

Purpose: The purpose of this paper is to investigate the extent to which principals' instructional leadership predicts teacher self-efficacy, in order to identify whether a relationship exists between principals' perceived instructional leadership practices and teachers perceived self-efficacy in classroom management, instruction, and student…

How Local Market Pressures Shape Leadership Practices: Evidence from Chile

ERIC Educational Resources Information Center

Carrasco, Alejandro; Fromm, Germán

2016-01-01

Chile is well known worldwide for its extensive use of market-driven mechanisms in education. Using a case study strategy in three schools, this paper shows that "universal" voucher system and mixed provision (co-existence of subsidised private and state-funded schools) policies are reshaping school management practices. The paper draws…

Organizational Training across Cultures: Variations in Practices and Attitudes

ERIC Educational Resources Information Center

Hassi, Abderrahman; Storti, Giovanna

2011-01-01

Purpose: The purpose of this paper is to provide a synthesis based on a review of the existing literature with respect to the variations in training practices and attitudes across national cultures. Design/methodology/approach: A content analysis technique was adopted with a comparative cross-cultural management perspective as a backdrop to…

Human Resource Architectures for New Teachers in Flemish Primary Education

ERIC Educational Resources Information Center

Vekeman, Eva; Devos, Geert; Valcke, Martin

2016-01-01

Since research shows that the quality of a school's teaching force is related to its personnel practices, there is a growing interest in human resource management (HRM) in education. Existing research has generated insights into the differences, constraints and effects of single and isolated HR practices. Yet, little research is available…

Putting into practice error management theory: Unlearning and learning to manage action errors in construction.

PubMed

Love, Peter E D; Smith, Jim; Teo, Pauline

2018-05-01

Error management theory is drawn upon to examine how a project-based organization, which took the form of a program alliance, was able to change its established error prevention mindset to one that enacted a learning mindfulness that provided an avenue to curtail its action errors. The program alliance was required to unlearn its existing routines and beliefs to accommodate the practices required to embrace error management. As a result of establishing an error management culture the program alliance was able to create a collective mindfulness that nurtured learning and supported innovation. The findings provide a much-needed context to demonstrate the relevance of error management theory to effectively address rework and safety problems in construction projects. The robust theoretical underpinning that is grounded in practice and presented in this paper provides a mechanism to engender learning from errors, which can be utilized by construction organizations to improve the productivity and performance of their projects. Copyright © 2018 Elsevier Ltd. All rights reserved.

NIAID-sponsored 2010 guidelines for managing food allergy: applications in the pediatric population.

PubMed

Burks, A Wesley; Jones, Stacie M; Boyce, Joshua A; Sicherer, Scott H; Wood, Robert A; Assa'ad, Amal; Sampson, Hugh A

2011-11-01

Data from many studies have suggested a rise in the prevalence of food allergies during the past 10 to 20 years. Currently, no curative treatments for food allergy exist, and there are no effective means of preventing the disease. Management of food allergy involves strict avoidance of the allergen in the patient's diet and treatment of symptoms as they arise. Because diagnosis and management of the disease can vary between clinical practice settings, the National Institute of Allergy and Infectious Diseases (NIAID) sponsored development of clinical guidelines for the diagnosis and management of food allergy. The guidelines establish consensus and consistency in definitions, diagnostic criteria, and management practices. They also provide concise recommendations on how to diagnose and manage food allergy and treat acute food allergy reactions. The original guidelines encompass practices relevant to patients of all ages, but food allergy presents unique and specific concerns for infants, children, and teenagers. To focus on those concerns, we describe here the guidelines most pertinent to the pediatric population.

Quality assurance and the need to evaluate interventions and audit programme outcomes.

PubMed

Zhao, Min; Vaartjes, Ilonca; Klipstein-Grobusch, Kerstin; Kotseva, Kornelia; Jennings, Catriona; Grobbee, Diederick E; Graham, Ian

2017-06-01

Evidence-based clinical guidelines provide standards for the provision of healthcare. However, these guidelines have been poorly implemented in daily practice. Clinical audit is a quality improvement tool to promote quality of care in daily practice and to improve outcomes through the systematic review of care delivery and implementation of changes. A major priority in the management of subjects with cardiovascular disease (CVD) management is secondary prevention by controlling cardiovascular risk factors and providing appropriate medical treatment. Clinical audits can be applied to monitor modifiable risk factors and evaluate quality improvements of CVD management in daily practice. Existing clinical audits have provided an overview of the burden of risk factors in subjects with CVD and reflect real-world risk factor recording and management. However, consistent and representative data from clinic audits are still insufficient to fully monitor quality improvement of CVD management. Data are lacking in particular from low- and middle-income countries, limiting the evaluation of CVD management quality by clinical audit projects in many settings. To support the development of clinical standards, monitor daily practice performance, and improve quality of care in CVD management at national and international levels, more widespread clinical audits are warranted.

Physiotherapy for cystic fibrosis in Australia and New Zealand: A clinical practice guideline.

PubMed

Button, Brenda M; Wilson, Christine; Dentice, Ruth; Cox, Narelle S; Middleton, Anna; Tannenbaum, Esta; Bishop, Jennifer; Cobb, Robyn; Burton, Kate; Wood, Michelle; Moran, Fiona; Black, Ryan; Bowen, Summar; Day, Rosemary; Depiazzi, Julie; Doiron, Katherine; Doumit, Michael; Dwyer, Tiffany; Elliot, Alison; Fuller, Louise; Hall, Kathleen; Hutchins, Matthew; Kerr, Melinda; Lee, Annemarie L; Mans, Christina; O'Connor, Lauren; Steward, Ranjana; Potter, Angela; Rasekaba, Tshepo; Scoones, Rebecca; Tarrant, Ben; Ward, Nathan; West, Samantha; White, Dianne; Wilson, Lisa; Wood, Jamie; Holland, Anne E

2016-05-01

Physiotherapy management is a key element of care for people with cystic fibrosis (CF) throughout the lifespan. Although considerable evidence exists to support physiotherapy management of CF, there is documented variation in practice. The aim of this guideline is to optimize the physiotherapy management of people with CF in Australia and New Zealand. A systematic review of the literature in key areas of physiotherapy practice for CF was undertaken. Recommendations were formulated based on National Health and Medical Research Council (Australia) guidelines and considered the quality, quantity and level of the evidence; the consistency of the body of evidence; the likely clinical impact; and applicability to physiotherapy practice in Australia and New Zealand. A total of 30 recommendations were made for airway clearance therapy, inhalation therapy, exercise assessment and training, musculoskeletal management, management of urinary incontinence, managing the newly diagnosed patient with CF, delivery of non-invasive ventilation, and physiotherapy management before and after lung transplantation. These recommendations can be used to underpin the provision of evidence-based physiotherapy care to people with CF in Australia and New Zealand. © 2016 The Authors Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

Assessing and changing medical practice culture.

PubMed

Hills, Laura

2011-01-01

Your medical practice has an existing culture that manifests itself daily in literally hundreds of ways. Some aspects of your culture likely support your practice's growth; others may be impeding your progress. This article describes the characteristics of medical practice culture and provides numerous examples of how culture influences behavior. It describes how culture is expressed in a medical practice through objects and artifacts, language, emotions, interactions, practice management systems, and daily work habits. It offers three techniques for assessing an existing medical practice culture and a checklist for conducting culture observations. This article also provides guidelines for identifying a desired medical practice culture and explores why changing culture is so difficult. It describes five reasons employees are likely to resist culture change and provides 12 fundamental changes that will enable a practice to improve its culture. Finally, this article explores how medical practice cultures are formed and perpetuated and provides more than a dozen questions to ask employees in a culture survey.

Hospital waste management in developing countries: A mini review.

PubMed

Ali, Mustafa; Wang, Wenping; Chaudhry, Nawaz; Geng, Yong

2017-06-01

Health care activities can generate different kinds of hazardous wastes. Mismanagement of these wastes can result in environmental and occupational health risks. Developing countries are resource-constrained when it comes to safe management of hospital wastes. This study summarizes the main issues faced in hospital waste management in developing countries. A review of the existing literature suggests that regulations and legislations focusing on hospital waste management are recent accomplishments in many of these countries. Implementation of these rules varies from one hospital to another. Moreover, wide variations exist in waste generation rates within as well as across these countries. This is mainly attributable to a lack of an agreement on the definitions and the methodology among the researchers to measure such wastes. Furthermore, hospitals in these countries suffer from poor waste segregation, collection, storage, transportation and disposal practices, which can lead to occupational and environmental risks. Knowledge and awareness regarding proper waste management remain low in the absence of training for hospital staff. Moreover, hospital sanitary workers, and scavengers, operate without the provision of safety equipment or immunization. Unsegregated waste is illegally recycled, leading to further safety risks. Overall, hospital waste management in developing countries faces several challenges. Sustainable waste management practices can go a long way in reducing the harmful effects of hospital wastes.

Current UK practices in the management of subacromial impingement.

PubMed

Bryceland, James K; Drury, Colin; Tait, Gavin R

2015-07-01

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. BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. 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. 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.

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

Evaluating stakeholder management performance using a stakeholder report card: the next step in theory and practice.

PubMed

Malvey, Donna; Fottler, Myron D; Slovensky, Donna J

2002-01-01

In the highly competitive health care environment, the survival of an organization may depend on how well powerful stakeholders are managed. Yet, the existing strategic stakeholder management process does not include evaluation of stakeholder management performance. To address this critical gap, this paper proposes a systematic method for evaluation using a stakeholder report card. An example of a physician report card based on this methodology is presented.

A patient-focused framework integrating self-management and informatics.

PubMed

Knight, Elizabeth P; Shea, Kimberly

2014-03-01

This article introduces a framework to (a) guide chronic illness self-management interventions through the integration of self-management and nursing informatics, (b) focus self-management research, and (c) promote ethical, patient-empowering technology use by practicing nurses. Existing theory and research focusing on chronic illness, self-management, health-enabling technology, and nursing informatics were reviewed and examined and key concepts were identified. A care paradigm focusing on concordance, rather than compliance, served as the overall guiding principle. This framework identifies key relationships among self-management (patient behaviors), health force (patient characteristics), and patient-defined goals. The role of health-enabling technology supporting these relationships is explored in the context of nursing informatics. The Empowerment Informatics framework can guide intervention design and evaluation and support practicing nurses' ethical use of technology as part of self-management support. Nurses worldwide provide support to patients who are living with chronic illnesses. As pressures related to cost and access to care increase, technology-enabled self-management interventions will become increasingly common. This patient-focused framework can guide nursing practice using technology that prioritizes patient needs. © 2013 Sigma Theta Tau International.

Two management systems in a nursing private practice group.

PubMed

Zahourek, R P

1979-09-01

Entry into private practice can be rewarding for nurses who are willing to risk personal, financial, and professional security. Among the problems faced by the nurse in this new role is the administration of the practice, since few, if any, adequate models exist. This article describes the struggle of nurses in one private nursing practice, Creative Health Services, to meet their needs for individual freedom within an organization that is regulated sufficiently to maintain its viability.

Trust into Mistrust: The Uncertain Marriage between Public and Private Sector Practice for Middle Managers in Education

ERIC Educational Resources Information Center

Thompson, Carol; Wolstencroft, Peter

2018-01-01

The role of the middle manager has proved to be a difficult one to define due to the fluid nature of the tasks performed and the heterogeneity of understanding that exists for the term. This is further complicated by the differences associated with the context in which individual manager's work. This research, which explores the drive towards…

The Development of a Quality Management Framework for Evaluating Medical Device Reprocessing Practice in Healthcare Facilities.

PubMed

Lorv, Bailey; Horodyski, Robin; Welton, Cynthia; Vail, John; Simonetto, Luca; Jokanovic, Danilo; Sharma, Richa; Mahoney, Angela Rea; Savoy-Bird, Shay; Bains, Shalu

2017-01-01

There is increasing awareness of the importance of medical device reprocessing (MDR) for the provision of safe patient care. Although industry service standards are available to guide MDR practices, there remains a lack of published key performance indicators (KPIs) and targets that are necessary to evaluate MDR quality for feedback and improvement. This article outlines the development of an initial framework that builds on established guidelines and includes service standards, KPIs and targets for evaluating MDR operations. This framework can support healthcare facilities in strengthening existing practices and enables a platform for collaboration towards better MDR performance management.

Management of Clostridium difficile Infection in Inflammatory Bowel Disease: Expert Review from the Clinical Practice Updates Committee of the AGA Institute.

PubMed

Khanna, Sahil; Shin, Andrea; Kelly, Ciarán P

2017-02-01

The purpose of this expert review is to synthesize the existing evidence on the management of Clostridium difficile infection in patients with underlying inflammatory bowel disease. The evidence reviewed in this article is a summation of relevant scientific publications, expert opinion statements, and current practice guidelines. This review is a summary of expert opinion in the field without a formal systematic review of evidence. Best Practice Advice 1: Clinicians should test patients who present with a flare of underlying inflammatory bowel disease for Clostridium difficile infection. Best Practice Advice 2: Clinicians should screen for recurrent C difficile infection if diarrhea or other symptoms of colitis persist or return after antibiotic treatment for C difficile infection. Best Practice Advice 3: Clinicians should consider treating C difficile infection in inflammatory bowel disease patients with vancomycin instead of metronidazole. Best Practice Advice 4: Clinicians strongly should consider hospitalization for close monitoring and aggressive management for inflammatory bowel disease patients with C difficile infection who have profuse diarrhea, severe abdominal pain, a markedly increased peripheral blood leukocyte count, or other evidence of sepsis. Best Practice Advice 5: Clinicians may postpone escalation of steroids and other immunosuppression agents during acute C difficile infection until therapy for C difficile infection has been initiated. However, the decision to withhold or continue immunosuppression in inflammatory bowel disease patients with C difficile infection should be individualized because there is insufficient existing robust literature on which to develop firm recommendations. Best Practice Advice 6: Clinicians should offer a referral for fecal microbiota transplantation to inflammatory bowel disease patients with recurrent C difficile infection. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Making Sense of Education Change at Thistle College: The Existence of Witchcraft, Witches and Shamans.

ERIC Educational Resources Information Center

Grant, Kevin

2003-01-01

Discusses a complex and charged change program and its management at a Scottish higher education institution. Discusses the difficulties of the educational change process in higher education, the complexities surrounding notions of organizational cultures and communities of practice, and issues of power and management including the new…

43 CFR 3872.5 - Testimony at hearings to determine character of lands.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) ADVERSE CLAIMS...; whether or not there exists within the tract or tracts claimed any lode or vein of quartz or other rock in... practicable, an adequate quantity or number of representative samples of the alleged mineral-bearing matter or...

Evaluator and Program Manager Perceptions of Evaluation Capacity and Evaluation Practice

ERIC Educational Resources Information Center

Fierro, Leslie A.; Christie, Christina A.

2017-01-01

The evaluation community has demonstrated an increased emphasis and interest in evaluation capacity building in recent years. A need currently exists to better understand how to measure evaluation capacity and its potential outcomes. In this study, we distributed an online questionnaire to managers and evaluation points of contact working in…

Update in perioperative medicine: practice changing evidence published in 2016.

PubMed

Regan, Dennis W; Kashiwagi, Deanne; Dougan, Brian; Sundsted, Karna; Mauck, Karen

2017-10-01

This summary reviews 18 key articles published in 2016 which have significant practice implications for the perioperative medical care of surgical patients. Due to the multi-disciplinary nature of the practice of perioperative medicine, important new evidence is published in journals representing a variety of medical and surgical specialties. Keeping current with the evidence that drives best practice in perioperative medicine is therefore challenging. We set out to identify, critically review, and summarize key evidence which has the most potential for practice change. We integrated the new evidence into the existing body of medical knowledge and identified practical implications for real world patient care. The articles address issues related to anticoagulation, transfusion threshold, immunosuppressive medications, postoperative delirium, myocardial injury after noncardiac surgery, postoperative pain management, perioperative management of antihypertensives, perioperative fasting, and perioperative diabetic control.

Interprofessional education for physiotherapy, medical and dietetics students: a pilot programme.

PubMed

Pullon, Sue; McKinlay, Eileen; Beckingsale, Louise; Perry, Meredith; Darlow, Ben; Gray, Ben; Gallagher, Peter; Hoare, Kath; Morgan, Sonya

2013-03-01

Interprofessional education (IPE) has been shown to enhance interprofessional practice among health professionals. Until recently there has been limited opportunity to undertake such initiatives within existing pre-registration degree courses in New Zealand. This study aimed to test the feasibility of delivering an interprofessional component within existing health professional courses for medicine, physiotherapy and dietetics at the University of Otago, Wellington, New Zealand. An interprofessional case-based course component (on chronic condition management) was developed by academic clinical teachers from schools of medicine, physiotherapy and dietetics at the same location. Evaluation was undertaken using a previously validated pre- and post-survey tool, to ascertain changes in attitude among students towards interprofessional practice, IPE and the effectiveness of health care teams. Focus groups were conducted with students and teachers. Survey results indicated pre-existing positive attitudes to interprofessional practice and education among students. There was a statistically significant increase in positive attitude towards such practice and education, and increased confidence in the effectiveness of heath care teams. Focus group findings were consistent with the survey results for students, and highlighted challenges experienced by the teachers. Students and teachers alike enjoyed the interprofessional interaction and benefited from a collaborative approach to chronic condition management. The timing and nature of learning activities and assessment methods created logistical challenges. Such course components have potential to improve collaborative practice and the quality and safety of health care among graduates. Interprofessional course components need to be equitable across disciplines and embedded in the unidisciplinary courses.

The impact of broiler production system practices on consumer perceptions of animal welfare.

PubMed

de Jonge, Janneke; van Trijp, Hans C M

2013-12-01

This research explores the extent to which different farm management practices influence the perceived animal friendliness of broiler production systems, and how this differs between individuals. Using a conjoint design with paired comparisons, respondents evaluated broiler production systems that were described on the basis of 7 animal welfare-related practices. It was found that practices in the area of outdoor access, stocking density, and day-night rhythm were overall perceived to have a larger impact on perceptions of animal friendliness than other practices, such as transport duration or the type of breed used. However, individuals differed regarding the extent to which they believed the different farm management practices influenced the animal friendliness of the production system. Differences between individuals regarding their knowledge about and familiarity with livestock farming, degree of anthropomorphism, and their moral beliefs regarding animal welfare partly explained the relative importance individuals attached to farm management practices. The obtained insight into which welfare-related farm management practices, in consumers' minds, most strongly contribute to animal welfare, and the existence of differences between consumers, can be helpful in the development of animal welfare-based certification schemes that are appealing to consumers, as well as the positioning of welfare concepts in the market.

Exercise physiologists: essential players in interdisciplinary teams for noncommunicable chronic disease management.

PubMed

Soan, Esme J; Street, Steven J; Brownie, Sharon M; Hills, Andrew P

2014-01-01

Noncommunicable diseases (NCDs), such as obesity and type 2 diabetes mellitus, are a growing public health challenge in Australia, accounting for a significant and increasing cost to the health care system. Management of these chronic conditions is aided by interprofessional practice, but models of care require updating to incorporate the latest evidence-based practice. Increasing research evidence reports the benefits of physical activity and exercise on health status and the risk of inactivity to chronic disease development, yet physical activity advice is often the least comprehensive component of care. An essential but as yet underutilized player in NCD prevention and management is the "accredited exercise physiologist," a specialist in the delivery of clinical exercise prescriptions for the prevention or management of chronic and complex conditions. In this article, the existing role of accredited exercise physiologists in interprofessional practice is examined, and an extension of their role proposed in primary health care settings.

JIT: A Strategic Tool of Inventory Management

NASA Astrophysics Data System (ADS)

Singh, D. K.; Singh, Satyendra

2012-03-01

Investment in inventory absorbs a large portion of the working capital of a company and often it represents a large portion of the total assets of a business. By improving return on investment by increasing the rate of inventory turnover, management often wants to ensure economic efficiency. Effective inventory management enables a firm to provide lower costs, rapid response and flexibility for its customers. Just-in-time (JIT) philosophy is most widely adopted and practices in the recent years worldwide. It aims at reducing total production costs by producing only what is immediately needed and eliminates wastes. It is based on a radically different concept, deviating substantially from the existing manufacturing practices in many respects. It is a very effective tool to reduce the wastage of inventory and manage it effectively. It has the potential to bring substantial changes in the existing setup of a company; can give it a new face, broaden its acceptability and ensure a longer life. It can strategically change the atmosphere needed for longer survival. JIT is radically different from MRP and goes beyond materials management. The new outlook acquired by the company can meet global expectations of the cust

A solid waste management survey in Davao del Sur (school and household waste management survey)

NASA Astrophysics Data System (ADS)

Trondillo, Mark Jude F.; Amaba, Jeneley A.; Paniza, Lyndelle Ann D.; Cubol, John Rhico V.

2018-02-01

Environmental degradation has become a very alarming issue at present. Human activities have been the primary cause of this unfortunate event which has resulted to other complications such as health problems. The resources are limited and people solely depend on it for living. Thus, the necessity to address these concerns arises. Various solid waste management programs have been established however the people's commitment has continued to challenge the local authorities as well as the cooperating agencies. This study was conducted in order to assess the awareness, practice and attitude towards the existing solid waste management programs of the selected students in Davao del Sur. It also aims to measure the effectiveness and current status of these implemented programs. The study used survey method. One hundred sixty eight of 227 students were surveyed using a validated, self-administered instrument. The study revealed that majority of the students is well aware of the existing solid waste management programs, practice them and is willing to learn more about the issue. Others, on the other hand, do the opposite. It is of great importance that all citizens must commit in the implementation of environmental programs so as to be more effective.

Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches

PubMed Central

2013-01-01

Background Self-management support is a key component of effective chronic care management, yet in practice appears to be the least implemented and most challenging. This study explores whether and how self-management support is integrated into chronic care approaches in 13 European countries. In addition, it investigates the level of and barriers to implementation of support strategies in health care practice. Methods We conducted a review among the 13 participating countries, based on a common data template informed by the Chronic Care Model. Key informants presented a sample of representative chronic care approaches and related self-management support strategies. The cross-country review was complemented by a Dutch case study of health professionals’ views on the implementation of self-management support in practice. Results Self-management support for chronically ill patients remains relatively underdeveloped in Europe. Similarities between countries exist mostly in involved providers (nurses) and settings (primary care). Differences prevail in mode and format of support, and materials used. Support activities focus primarily on patients’ medical and behavioral management, and less on emotional management. According to Dutch providers, self-management support is not (yet) an integral part of daily practice; implementation is hampered by barriers related to, among others, funding, IT and medical culture. Conclusions Although collaborative care for chronic conditions is becoming more important in European health systems, adequate self-management support for patients with chronic disease is far from accomplished in most countries. There is a need for better understanding of how we can encourage both patients and health care providers to engage in productive interactions in daily chronic care practice, which can improve health and social outcomes. PMID:23530744

Variation in Pediatric Organ Donor Management Practices Among US Organ Procurement Organizations.

PubMed

Ream, Robert S; Armbrecht, Eric S

2018-03-01

Reports of actual pediatric organ donor management practice among US organ procurement organizations are sparse, and the use of standardized management guidelines is unknown. A recent consensus statement from the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations offers guidelines for the management of the pediatric organ donor. To describe the use of guidelines and routine practices in the management of the pediatric organ donor with respect to hemodynamics, lung and ventilator management, fluid and electrolytes, hormonal replacement therapy, the use of blood products, thermoregulation, and prophylactic antibiotics. Cross-sectional observational study using a survey and follow-up telephone interview with respondents from all 58 US organ procurement organizations. All 58 US Organ Procurement Organizations participated. A majority employed written guidelines for the management of pediatric donor hemodynamics, thermoregulation, fluids, and electrolytes. Management of blood products, the lung, and mechanical ventilation were less commonly committed to written guidelines, but common practices were described. All used various forms of hormonal replacement therapy and the majority administered empiric antibiotic therapy. Wide variation was observed in the management of the lung, mechanical ventilation, and glycemic control. Most OPOs used forms of standardized donor management for the pediatric organ donor although variation in the content of that management exists. Barriers to an evidence-based approach to the pediatric donor need to be determined and addressed.

'Best practice' development and transfer in the NHS: the importance of process as well as product knowledge.

PubMed

Newell, Sue; Edelman, Linda; Scarbrough, Harry; Swan, Jacky; Bresnen, Mike

2003-02-01

A core prescription from the knowledge management movement is that the successful management of organizational knowledge will prevent firms from 'reinventing the wheel', in particular through the transfer of 'best practices'. Our findings challenge this logic. They suggest instead that knowledge is emergent and enacted in practice, and that normally those involved in a given practice have only a partial understanding of the overall practice. Generating knowledge about current practice is therefore a precursor to changing that practice. In this sense, knowledge transfer does not occur independently of or in sequence to knowledge generation, but instead the process of knowledge generation and its transfer are inexorably intertwined. Thus, rather than transferring 'product' knowledge about the new 'best practice' per se, our analysis suggests that it is more useful to transfer 'process' knowledge about effective ways to generate the knowledge of existing practice, which is the essential starting point for attempts to change that practice.

Improving Soil Seed Bank Management.

PubMed

Haring, Steven C; Flessner, Michael L

2018-05-08

Problems associated with simplified weed management motivate efforts for diversification. Integrated weed management uses fundamentals of weed biology and applied ecology to provide a framework for diversified weed management programs; the soil seed bank comprises a necessary part of this framework. By targeting seeds, growers can inhibit the propagule pressure on which annual weeds depend for agricultural invasion. Some current management practices affect weed seed banks, such as crop rotation and tillage, but these tools are often used without specific intention to manage weed seeds. Difficulties quantifying the weed seed bank, understanding seed bank phenology, and linking seed banks to emerged weed communities challenge existing soil seed bank management practices. Improved seed bank quantification methods could include DNA profiling of the soil seed bank, mark and recapture, or 3D LIDAR mapping. Successful and sustainable soil seed bank management must constrain functionally diverse and changing weed communities. Harvest weed seed controls represent a step forward, but over-reliance on this singular technique could make it short-lived. Researchers must explore tools inspired by other pest management disciplines, such as gene drives or habitat modification for predatory organisms. Future weed seed bank management will combine multiple complementary practices that enhance diverse agroecosystems. This article is protected by copyright. All rights reserved.

Projecting the bird community response resulting from the adoption of shelterbelt agroforestry practices in Eastern Nebraska

Treesearch

R. A., II Pierce; D. T. Farrand; W. B. Kurtz

2001-01-01

Evolving agricultural policies have influenced management practices within agroecosystems, impacting available habitats for many species of wildlife. Enhancing wildlife habitat has become an explicit objective of existing agricultural policy. Thus, there is renewed focus on field borders and the use of shelterbelt agroforestry systems to achieve conservation goals in...

A Review of HR Practices in Knowledge-Intensive Firms and MNEs: 2000-2006

ERIC Educational Resources Information Center

Majeed, Zahid

2009-01-01

Purpose: The aim of this paper is to show the association which exists among the wide range of knowledge management, knowledge sharing and HRM practices in the knowledge-intensive firms. Design/methodology/approach: The proposed literature review includes the systematic process of research in the following manner; after identifying the main area…

Physicians with MBA degrees: change agents for healthcare improvement.

PubMed

Lazarus, Arthur

2010-01-01

Increasingly, physicians gravitating toward the fields of quality improvement and healthcare management are seeking MBA degrees to supplement their medical training. Approximately half of all U.S. medical schools offer combined MD-MBA degrees, and numerous executive MBA programs exist for physicians in practice. Physicians who enter management are considered change agents for healthcare improvement, yet they receive little support and encouragement from their medical teachers and practicing colleagues. This situation can be rectified by placing greater value on the role of business-trained physicians and subsidizing their tuition for business school.

Remining - Best Management Practices

EPA Pesticide Factsheets

Benefits of Remining are discussed including; reclamation of abandoned mine lands that the AML program is unlikely to ever restore, decrease or eliminate pollution loads of acidity,iron, manganese and other contaminants from pre-existing discharges.

An interprofessional diabetes experience to improve pharmacy and nursing students' competency in collaborative practice.

PubMed

Pittenger, Amy L; Westberg, Sarah; Rowan, Mary; Schweiss, Sarah

2013-11-12

To improve pharmacy and nursing students' competency in collaborative practice by having them participate in an interprofessional diabetes experience involving social networking. An existing elective course on diabetes management was modified to include interprofessional content based on Interprofessional Education Collaborative (IPEC) competency domains. Web-based collaborative tools (social networking and video chat) were used to allow nursing and pharmacy students located on 2 different campuses to apply diabetes management content as an interprofessional team. Mixed-method analyses demonstrated an increase in students' knowledge of the roles and responsibilities of the other profession and developed an understanding of interprofessional communication strategies and their central role in effective teamwork. Interprofessional content and activities can be effectively integrated into an existing course and offered successfully to students from other professional programs and on remote campuses.

Managing Nonpoint Source Pollution in Western Washington: Landowner Learning Methods and Motivations

NASA Astrophysics Data System (ADS)

Ryan, Clare M.

2009-06-01

States, territories, and tribes identify nonpoint source pollution as responsible for more than half of the Nation’s existing and threatened water quality impairments, making it the principal remaining cause of water quality problems across the United States. Combinations of education, technical and financial assistance, and regulatory measures are used to inform landowners about nonpoint source pollution issues, and to stimulate the use of best management practices. A mail survey of non-commercial riparian landowners investigated how they learn about best management practices, the efficacy of different educational techniques, and what motivates them to implement land management activities. Landowners experience a variety of educational techniques, and rank those that include direct personal contact as more effective than brochures, advertisements, radio, internet, or television. The most important motivations for implementing best management practices were linked with elements of a personal stewardship ethic, accountability, personal commitment, and feasibility. Nonpoint source education and social marketing campaigns should include direct interpersonal contacts, and appeal to landowner motivations of caring, responsibility, and personal commitment.

Towards a Cognitive Organisational Framework for Knowledge Management

DTIC Science & Technology

2001-09-01

of knowledge now exist only at the bottom of the organisation, with management uninformed on specific detail. For many knowledge- based ...the organisation’ s internal context - its internal management practices, learning culture and knowledge base . This has particularly been found to...of the process is based in ’Kaizen’. Within the Western culture we may well have ignored important insights in our own tradition. Traditionally, in

Hydrology of C-3 watershed, Seney National Wildlife Refuge, Michigan

USGS Publications Warehouse

Sweat, Michael J.

2001-01-01

Proposed changes to watershed management practices near C-3 Pool at Seney National Wildlife Refuge will affect surface-water flow patterns, ground-water levels, and possibly local plant communities. Data were collected between fall 1998 and spring 2000 to document existing conditions and to assess potential changes in hydrology that might occur as a consequence of modifications to water management practices in C-3 watershed.Minimum and maximum measured inflows and outflows for the study period are presented in light of proposed management changes to C-3 watershed. Streamflows ranged from 0 to 8.61 cubic meters per second. Low or zero flow was generally measured in late summer and early fall, and highest flows were measured during spring runoff and winter rain events. Ground-water levels varied by about a half meter, with levels closest to or above the land surface during spring runoff into the early summer, and with levels generally below land surface during late fall into early winter.A series of optional management practices that could conserve and restore habitat of the C-3 watershed is described. Modifications to the existing system of a drainage ditch and control structures are examined, as are the possibilities of reconnecting streams to their historical channels and the construction of additional or larger control structures to further manage the distribution of water in the watershed. The options considered could reduce erosion, restore presettlement streamflow conditions, and modify the ground-water gradient.

A biologically-based individual tree model for managing the longleaf pine ecosystem

Treesearch

Rick Smith; Greg Somers

1998-01-01

Duration: 1995-present Objective: Develop a longleaf pine dynamics model and simulation system to define desirable ecosystem management practices in existing and future longleaf pine stands. Methods: Naturally-regenerated longleaf pine trees are being destructively sampled to measure their recent growth and dynamics. Soils and climate data will be combined with the...

A silvicultural Guide for Spruce-Fir in the Northeast

Treesearch

Robert M. Frank; John C. Bjorkbom

1973-01-01

A practical guide to the silvicultural treatment of spruce-fir stands for timber production in New England and New York. Both evenaged and uneven-aged management are considered, covering both the establishment of new stands and the culture of existing stands. Includes a set of prescriptions describing specific treatments for a range of stand conditions and management...

Best Practices in Community Garden Management to Address Participation, Water Access, and Outreach

ERIC Educational Resources Information Center

Drake, Luke; Lawson, Laura

2015-01-01

As community gardens expand across the U.S., Extension professionals can support them not only in horticultural education but also in planning and organization. Knowledge of community garden management is helpful in this regard. Existing research focuses on outcomes and criteria for successful gardens, but is less clear about how community gardens…

An Exploratory Study of the Elements to Develop a Coaching Model

ERIC Educational Resources Information Center

Brown, Gwendolyn

2010-01-01

This exploratory study examined the elements of a coaching model based on the best practices that first focus on providing managers with the ability to develop workers and increase productivity, before using existing models that only support the process of managing workers, when it becomes apparent that the worker is not meeting expected…

Dealing with Organizational Silos with Communities of Practice and Human Resource Management

ERIC Educational Resources Information Center

Forsten-Astikainen, Riitta; Hurmelinna-Laukkanen, Pia; Lämsä, Tuija; Heilmann, Pia; Hyrkäs, Elina

2017-01-01

Purpose: Organizational silos that build on the existing organizational structures are often considered to have negative effects in the form of focus on private narrow objectives and organizational fragmentation. To avoid such harmful outcomes, competence management is called for, and in this, the human resources (HR) function takes a key role.…

Procedures and best management practices for genetically engineered traits in USDA/ARS germplasm and breeding lines

USDA-ARS?s Scientific Manuscript database

Two decades have passed since the commercialization in the U. S. of crops with genetically engineered (GE) traits. Today more than 80% of corn, soybean, canola, sugar beet and cotton acreage in the United States is planted to transgenic cultivars, but concerns exist regarding how best to manage the ...

Profile of an excellent nurse manager: identifying and developing health care team leaders.

PubMed

Kallas, Kathryn D

2014-01-01

The purpose of this research was to identify the profile of an excellent nurse manager who can lead effective health care teams. Leadership attributes and competencies that characterize an excellent nurse manager and tools to identify them are lacking in the literature but are required to efficiently and effectively address the growing shortage of registered nurses (RNs) in health care team leadership roles and the critical linkage of these roles to patient outcomes. A profile of an excellent nurse manager was developed on the basis of the responses of nurse managers across the United States who had been identified as excellent or competent by chief nurse executive assessment or/and the Nurse Manager Ability, Leadership, and Support of Nurses staff survey to the Kouzes and Posner Leadership Practices Inventory: Self Instrument. Statistically significant distinctions exist between nurse managers who are excellent and those who are competent as assessed by the Five Practices of Exemplary Leadership, which together comprise the profile of an excellent nurse manager. The Kouzes and Posner Leadership Practices Inventory: Self Instrument can be used to identify, recruit, and develop RNs in the nurse manager role as excellent leaders of effective health care teams.

Negotiating roadblocks to IDS-physician equity joint ventures.

PubMed

Dubow, S F; Benoff, M

1998-09-01

Integrated delivery systems (IDSs) may find that forming an equity joint venture relationship with a physician group practice is the best way to integrate physicians into their networks. IDSs have a choice between two basic equity structures: affiliated group practice, in which a management services organization (MSO) handles all practice management infrastructure and the physician group is a physician-only organization; and integrated group practice, in which the physician group encompasses both the physician practice and the administrative infrastructure. The choice of equity structure and how it should be implemented hinge on several legal issues, including the existence of a corporate-practice-of-medicine statute in the IDS's state, compliance with the Federal antikickback statute and Stark laws, and various issues regarding the IDS's tax-exempt status. IDSs also should consider pragmatic issues, particularly those associated with aligning the economic incentives of the two partners.

Uncertainty, robustness, and the value of information in managing a population of northern bobwhites

USGS Publications Warehouse

Johnson, Fred A.; Hagan, Greg; Palmer, William E.; Kemmerer, Michael

2014-01-01

The abundance of northern bobwhites (Colinus virginianus) has decreased throughout their range. Managers often respond by considering improvements in harvest and habitat management practices, but this can be challenging if substantial uncertainty exists concerning the cause(s) of the decline. We were interested in how application of decision science could be used to help managers on a large, public management area in southwestern Florida where the bobwhite is a featured species and where abundance has severely declined. We conducted a workshop with managers and scientists to elicit management objectives, alternative hypotheses concerning population limitation in bobwhites, potential management actions, and predicted management outcomes. Using standard and robust approaches to decision making, we determined that improved water management and perhaps some changes in hunting practices would be expected to produce the best management outcomes in the face of uncertainty about what is limiting bobwhite abundance. We used a criterion called the expected value of perfect information to determine that a robust management strategy may perform nearly as well as an optimal management strategy (i.e., a strategy that is expected to perform best, given the relative importance of different management objectives) with all uncertainty resolved. We used the expected value of partial information to determine that management performance could be increased most by eliminating uncertainty over excessive-harvest and human-disturbance hypotheses. Beyond learning about the factors limiting bobwhites, adoption of a dynamic management strategy, which recognizes temporal changes in resource and environmental conditions, might produce the greatest management benefit. Our research demonstrates that robust approaches to decision making, combined with estimates of the value of information, can offer considerable insight into preferred management approaches when great uncertainty exists about system dynamics and the effects of management.

To Be or Not to Be (Stressed): The Critical Role of a Psychologically Healthy Workplace in Effective Stress Management.

PubMed

Grawitch, Matthew J; Ballard, David W; Erb, Kaitlyn R

2015-10-01

This article explains how key practices pertaining to the psychologically healthy workplace can be used to develop a comprehensive approach to stress management in contemporary organizations. Specifically, we demonstrate the ways in which employee involvement, recognition, work-life balance, health and safety, and growth and development practices can be used to assist in the reduction of work stress and the proactive management of strain. Although many organizations strive to establish a positive environment conducive to work and well-being, identifying where to begin can often seem like a daunting task. Currently, many stress management efforts emphasize individual-level interventions that are simply implemented alongside existing organizational practices. We propose that a broader perspective allows for a better understanding of the stress process, resulting in the ability to consider a wider range of changes to organizational processes. Combining knowledge regarding psychologically healthy workplace practices, stress management intervention levels and the personal resource allocation framework, we present a comprehensive framework for approaching workplace stress management, which can be tailored to the unique needs of various organizations, departments and employees. By adopting this broader perspective, we believe organizations can more strategically address employee stress, resulting in more effective stress management and a profound impact on stress-related outcomes. Copyright © 2014 John Wiley & Sons, Ltd.

75 FR 51040 - Issuance of an Experimental Use Permit by the State of Florida

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-18

... determine if the addition of mosquito ovitrap strips (Trap-N-Kill\\TM\\), impregnated with bifenthrin to existing mosquito management practices, will significantly reduce the abundance of the dengue mosquito...

Medication management and practices in prison for people with mental health problems: a qualitative study.

PubMed

Bowen, Robert A; Rogers, Anne; Shaw, Jennifer

2009-10-20

Common mental health problems are prevalent in prison and the quality of prison health care provision for prisoners with mental health problems has been a focus of critical scrutiny. Currently, health policy aims to align and integrate prison health services and practices with those of the National Health Service (NHS). Medication management is a key aspect of treatment for patients with a mental health problem. The medication practices of patients and staff are therefore a key marker of the extent to which the health practices in prison settings equate with those of the NHS. The research reported here considers the influences on medication management during the early stages of custody and the impact it has on prisoners. The study employed a qualitative design incorporating semi-structured interviews with 39 prisoners and 71 staff at 4 prisons. Participant observation was carried out in key internal prison locations relevant to the management of vulnerable prisoners to support and inform the interview process. Thematic analysis of the interview data and interpretation of the observational field-notes were undertaken manually. Emergent themes included the impact that delays, changes to or the removal of medication have on prisoners on entry to prison, and the reasons that such events take place. Inmates accounts suggested that psychotropic medication was found a key and valued form of support for people with mental health problems entering custody. Existing regimes of medication and the autonomy to self-medicate established in the community are disrupted and curtailed by the dominant practices and prison routines for the taking of prescribed medication. The continuity of mental health care is undermined by the removal or alteration of existing medication practice and changes on entry to prison which exacerbate prisoners' anxiety and sense of helplessness. Prisoners with a dual diagnosis are likely to be doubly vulnerable because of inconsistencies in substance withdrawal management. Changes to medication management which accompany entry to prison appear to contribute to poor relationships with prison health staff, disrupts established self-medication practices, discourages patients from taking greater responsibility for their own conditions and detrimentally affects the mental health of many prisoners at a time when they are most vulnerable. Such practices are likely to inhibit the integration and normalisation of mental health management protocols in prison as compared with those operating in the wider community and may hinder progress towards improving the standard of mental health care available to prisoners suffering from mental disorder.

The potential of land management to decrease global warming from climate change

NASA Astrophysics Data System (ADS)

Mayer, A.; Hausfather, Z.; Jones, A. D.; Silver, W. L.

2016-12-01

Recent evidence suggests that negative emissions (i.e. sequestration) is critical to slow climate change (IPCC, 2013; Gasser et al, 2015). Agricultural (crop and grazing) lands have the potential to act as a significant carbon sink. These ecosystems cover a significant proportion of the global land surface, and are largely degraded with regard to soil carbon due to previous management practices (Bai et al, 2008). However, few studies have examined the required scale of land management interventions that would be required to make a significant contribution to a portfolio of efforts aimed at limiting anthropogenic influences on global mean temperature. To address this, we modelled the quantitative effect of a range of soil carbon sequestration rates on global temperature to 2100. Results showed that by assuming a baseline emissions scenario outlined in RCP 2.6, the sequestration of an additional 0.7 Pg C per year through improved agricultural land management practices would produce a reduction of 0.1 degrees C from predicted global temperatures by the year 2100. We also compiled previous estimates of global carbon sequestration potential of agricultural soils to compare with our theoretical prediction to determine whether carbon sequestration through existing land management practices has potential to significantly reduce global temperatures. Assuming long-term soil carbon uptake, the combined potential of agricultural land management-based mitigation approaches exceeded 0.25 degrees C warming reduction by the year 2100. However, results were highly sensitive to potential carbon saturation, defined as the maximum threshold for carbon storage in soil. Our results suggest that current land management technologies and available land area exist and could make a measureable impact on warming reduction. Results also highlighted potential carbon saturation as a key gap in knowledge.

Inter-Generational Differences in Individualism/Collectivism Orientations: Implications for Outlook towards HRD/HRM Practices in India and the United States

ERIC Educational Resources Information Center

Ghosh, Rajashi; Chaudhuri, Sanghamitra

2009-01-01

This article proposes a conceptual model to explore the effects of intergenerational transition in individualism/collectivism orientations on the outlook towards different human resource development (HRD) and management practices. It contributes to the existing cross-cultural research in HRD by defining three prominent generations in India and by…

Leadership and Autonomy: An Examination of the Governance and Management Practices of Four Charter Schools in Charleston, South Carolina

ERIC Educational Resources Information Center

Bohnstengel, Robert E.

2012-01-01

Charter schools are deregulated institutions that are provided considerable autonomy in order to spur innovation, yet little is known about their governance practices. The studies of charter school governance that do exist, however, typically concern cases of charter school failure. The causes of charter school failure are often clear and…

Forum Guide to Supporting Data Access for Researchers: A Local Education Agency Perspective. NFES 2014-801

ERIC Educational Resources Information Center

National Forum on Education Statistics, 2014

2014-01-01

This document recommends a set of core practices, operations, and templates that can be adopted and adapted by local education agencies (LEAs) as they consider how to respond to requests for both new and existing data about the education enterprise. These recommendations reflect core best practices for: (1) managing the flow of requests; (2)…

University versus Practice: A Pilot Study to Identify Skills Shortages That Exist in First-Year Trainee Accountants in South Africa

ERIC Educational Resources Information Center

van Romburgh, Henriëtte; van der Merwe, Nico

2015-01-01

This study aims to determine the skills shortages in first-year trainee accountants entering practice in South Africa and to recommend ways to address and overcome those shortages. Questionnaires were administered to registered audit firms in Gauteng Province to gather the perceptions of senior trainees, managers and partners on the skills…

Utilization management in anatomic pathology.

PubMed

Lewandrowski, Kent; Black-Schaffer, Steven

2014-01-01

There is relatively little published literature concerning utilization management in anatomic pathology. Nonetheless there are many utilization management opportunities that currently exist and are well recognized. Some of these impact only the cost structure within the pathology department itself whereas others reduce charges for third party payers. Utilization management may result in medical legal liabilities for breaching the standard of care. For this reason it will be important for pathology professional societies to develop national utilization guidelines to assist individual practices in implementing a medically sound approach to utilization management. © 2013.

Implementation of sustainable evidence-based practice for the assessment and management of pain in residential aged care facilities.

PubMed

Savvas, Steven; Toye, Christine; Beattie, Elizabeth; Gibson, Stephen J

2014-12-01

Pain is common in residential aged care facilities (RACFs). In 2005, the Australian Pain Society developed 27 recommendations for good practice in the identification, assessment, and management of pain in these settings. This study aimed to address implementation of the standards and evaluate outcomes. Five facilities in Australia participated in a comprehensive evaluation of RACF pain practice and outcomes. Pre-existing pain management practices were compared with the 27 recommendations, before an evidence-based pain management program was introduced that included training and education for staff and revised in-house pain-management procedures. Post-implementation audits evaluated the program's success. Aged care staff teams also were assessed on their reports of self-efficacy in pain management. The results show that before the implementation program, the RACFs demonstrated full compliance on 6 to 12 standards. By the project's completion, RACFs demonstrated full compliance with 10 to 23 standards and major improvements toward compliance in the remaining standards. After implementation, the staff also reported better understanding of the standards (p < .001) or of facility pain management guidelines (p < .001), increased confidence in therapies for pain management (p < .001), and increased confidence in their training to assess pain (p < .001) and recognize pain in residents with dementia who are nonverbal (p = .003). The results show that improved evidence-based practice in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce via this implementation program has shown improvements in staff self-efficacy and practice. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Variations in high reliability practices in the federal fire community: Relative contributions of agency affiliation, years of experience, and position hierarchy and function

Treesearch

Brooke Baldauf McBride; Anne E. Black

2012-01-01

While several studies have examined the relevance of the HRO paradigm for fire management, no known empirical studies exist. In late 2007, in collaboration with researchers at the University of Michigan, we embarked on an exploration of the nature and extent of HRO practices in the US fire community. One of the primary questions was: How do HRO practices vary across...

Current practice in airway management: A descriptive evaluation.

PubMed

Kjonegaard, Rebecca; Fields, Willa; King, Major L

2010-03-01

Ventilator-associated pneumonia, a common complication of mechanical ventilation, could be reduced if health care workers implemented evidence-based practices that decrease the risk for this complication. To determine current practice and differences in practices between registered nurses and respiratory therapists in managing patients receiving mechanical ventilation. A descriptive comparative design was used. A convenience sample of 41 registered nurses and 25 respiratory therapists who manage critical care patients treated with mechanical ventilation at Sharp Grossmont Hospital, La Mesa, California, completed a survey on suctioning techniques and airway management practices. Descriptive and inferential statistics were used to analyze the data. Significant differences existed between nurses and respiratory therapists for hyperoxygenation before suctioning (P =.03). In the 2 groups, nurses used the ventilator for hyper-oxygenation more often, and respiratory therapists used a bag-valve device more often (P =.03). Respiratory therapists instilled saline (P <.001) and rinsed the closed system with saline after suctioning (P =.003) more often than nurses did. Nurses suctioned oral secretions (P <.001) and the nose of orally intubated patients (P =.01), brushed patients' teeth with a toothbrush (P<.001), and used oral swabs to clean the mouth (P <.001) more frequently than respiratory therapists did. Nurses and respiratory therapists differed significantly in the management of patients receiving mechanical ventilation. To reduce the risk of ventilator-associated pneumonia, both nurses and respiratory therapists must be consistent in using best practices when managing patients treated with mechanical ventilation.

Osteoarthritis Management: Time to Change the Deck.

PubMed

Hunter, David J

2017-06-01

This Viewpoint highlights the shortcomings of existing osteoarthritis (OA) clinical practices and emphasizes the opportunity that can come about by virtue of adherence to appropriate management. In an effort to emphasize optimism, there are huge missed opportunities with existing efficacious treatments and tremendous developments that are currently going on that will positively influence future care. How we respond to that opportunity will not only impact the individuals disabled by the disease but also make a massive difference to our society through reducing underemployment and health care waste. J Orthop Sports Phys Ther 2017;47(6):370-372. doi:10.2519/jospt.2017.0605.

Educational Marketing: A Review and Implications for Supporting Practice in Tertiary Education

ERIC Educational Resources Information Center

Stachowski, Christopher Allen

2011-01-01

This article reviews the existing educational marketing literature in the leading tertiary educational management journals. A discussion of the implications for supporting practitioners in non-university settings is presented. (Contains 1 table.)

Evaluating the use of waste-to-energy bottom ash as road construction materials.

DOT National Transportation Integrated Search

2014-02-01

Current management practice, existing regulations, and environmental consequences of municipal solid : waste incineration (MSWI) ash utilization were comprehensively reviewed worldwide and nationwide : in the U.S. Efforts were made to physically and ...

Federal lands highway phase II benchmarking study

DOT National Transportation Integrated Search

2000-11-01

In order to determine the most effective use of existing and future staff, to quantify the appropriate number of engineers and technicians required to deliver the Federal Lands Highway Program and to identify recommended management practices in proje...

Knowledge Translation for Cardiovascular Disease Research and Management in Japan

PubMed Central

Shommu, Nusrat S

2017-01-01

Knowledge translation is an essential and emerging arena in healthcare research. It is the process of aiding the application of research knowledge into clinical practice or policymaking. Individuals at all levels of the health care system, including patients, healthcare professionals, and policymakers, are affected by the gaps that exist between research evidence and practice; the process of knowledge translation plays a role in bridging these gaps and incorporating high-quality clinical research into decision-making. Cardiovascular disease (CVD) management is a crucial area of healthcare where information gaps are known to exist. Although Japan has one of the lowest risks and mortality rates from CVDs, an increasing trend of cardiovascular incidence and changes in the risk factor conditions have been observed in recent years. This article provides an overview of knowledge translation and its importance in the cardiovascular health of the Japanese population, and describes the key steps of a typical knowledge translation strategy. PMID:28757537

Knowledge Translation for Cardiovascular Disease Research and Management in Japan.

PubMed

Shommu, Nusrat S; Turin, Tanvir C

2017-09-01

Knowledge translation is an essential and emerging arena in healthcare research. It is the process of aiding the application of research knowledge into clinical practice or policymaking. Individuals at all levels of the health care system, including patients, healthcare professionals, and policymakers, are affected by the gaps that exist between research evidence and practice; the process of knowledge translation plays a role in bridging these gaps and incorporating high-quality clinical research into decision-making. Cardiovascular disease (CVD) management is a crucial area of healthcare where information gaps are known to exist. Although Japan has one of the lowest risks and mortality rates from CVDs, an increasing trend of cardiovascular incidence and changes in the risk factor conditions have been observed in recent years. This article provides an overview of knowledge translation and its importance in the cardiovascular health of the Japanese population, and describes the key steps of a typical knowledge translation strategy.

Bring Your Own Device and Nurse Managers' Decision Making.

PubMed

Martinez, Karen; Borycki, Elizabeth; Courtney, Karen L

2017-02-01

The Bring Your Own Device phenomenon is important in the healthcare environment because this trend is changing the workplace in healthcare organizations, such as British Columbia. At present, there is little research that exists in Canada to provide a distinct understanding of the complexities and difficulties unique to this phenomenon within the nursing practice. This study focused on the experiences and perceptions of nurse managers regarding how they make decisions on the use of personal handheld devices in the workplace. Telephone interviews (N = 10) and qualitative descriptive analysis were used. Four major themes emerged: (1) management perspective, (2) opportunities, (3) disadvantages, and (4) solutions. Nurse managers and other executives in healthcare organizations and health information technology departments need to be aware of the practice and organizational implications of the Bring Your Own Device movement.

Decay diseases of stemwood: Detection, diagnosis, and management

Treesearch

Walter C. Shortle; Kevin T. Smith; Kenneth R. Dudzik

1996-01-01

Three major needs exist to better relate tree biology research to practical agroforesty (Larsen 1984). The first need is to identify the specific, desired product to be yielded from the forest. Valid and appropriate management techniques to yield one product may not be appropriate to yield a different product, even from the same species of trees. The second need is to...

Comparing Beginning and Experienced Teachers' Perceptions of Classroom Management Beliefs and Practices in Elementary Schools in Turkey

ERIC Educational Resources Information Center

Unal, Zafer; Unal, Aslihan

2009-01-01

The primary objective of this study was to investigate whether a difference in teachers' classroom management styles exists based on years of teaching experience. Data were collected from 282 elementary school teachers employed by 11 elementary schools in Turkey. The Attitudes and Beliefs on Classroom Control Inventory was used to collect the…

Response of School Districts to the New York State Concussion Awareness and Management Act: Review of Policies and Procedures

ERIC Educational Resources Information Center

Kajankova, Maria; Oswald, Jennifer M.; Terranova, Lauren M.; Kaplen, Michael V.; Ambrose, Anne F.; Spielman, Lisa A.; Gordon, Wayne A.

2017-01-01

Background: By 2014, all states implemented concussion laws that schools must translate into daily practice; yet, limited knowledge exists regarding implementation of these laws. We examined the extent to which concussion management policies and procedure (P&P) documents of New York State school districts comply with the State's Concussion…

Impediments to integrated urban stormwater management: the need for institutional reform.

PubMed

Brown, Rebekah R

2005-09-01

It is now well established that the traditional practice of urban stormwater management contributes to the degradation of receiving waterways, and this practice was more recently critiqued for facilitating the wastage of a valuable water resource. However, despite significant advances in alternative "integrated urban stormwater management" techniques and processes over the last 20 years, wide-scale implementation has been limited. This problem is indicative of broader institutional impediments that are beyond current concerns of strengthening technological and planning process expertise. Presented here is an analysis of the institutionalization of urban stormwater management across Sydney with the objective of scoping institutional impediments to more sustainable management approaches. The analysis reveals that the inertia with the public administration of urban stormwater inherently privileges and perpetuates traditional stormwater management practices at implementation. This inertia is characterized by historically entrained forms of technocratic institutional power and expertise, values and leadership, and structure and jurisdiction posing significant impediments to change and the realization of integrated urban stormwater management. These insights strongly point to the need for institutional change specifically directed at fostering horizontal integration of the various functions of the existing administrative regime. This would need to be underpinned with capacity-building interventions targeted at enabling a learning culture that values integration and participatory decision making. These insights also provide guideposts for assessing the institutional and capacity development needs for improving urban water management practices in other contexts.

Understanding the Epidemiology of Heart Failure to Improve Management Practices: An Asia-Pacific Perspective.

PubMed

Rajadurai, Jeyamalar; Tse, Hung-Fat; Wang, Chao-Hung; Yang, Ning-I; Zhou, Jingmin; Sim, David

2017-04-01

Heart failure (HF) is a major global healthcare problem with an estimated prevalence of approximately 26 million. In Asia-Pacific regions, HF is associated with a significant socioeconomic burden and high rates of hospital admission. Epidemiological data that could help to improve management approaches to address this burden in Asia-Pacific regions are limited, but suggest patients with HF in the Asia-Pacific are younger and have more severe signs and symptoms of HF than those of Western countries. However, local guidelines are based largely on the European Society of Cardiology and American College of Cardiology Foundation/American Heart Association guidelines, which draw their evidence from studies where Western patients form the major demographic and patients from the Asia-Pacific region are underrepresented. Furthermore, regional differences in treatment practices likely affect patient outcomes. In the following review, we examine epidemiological data from existing regional registries, which indicate that these patients represent a distinct subpopulation of patients with HF. In addition, we highlight that patients with HF are under-treated in the region despite the existence of local guidelines. Finally, we provide suggestions on how data can be enriched throughout the region, which may positively affect local guidelines and improve management practices. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

(Un)organizing equal collaboration between users and professionals: on management of patient education in Norway.

PubMed

Stokken, Roar

2013-03-01

This is an article about how patient education is managed in Norway, but it also addresses a matter of broader relevance that of how an organization imbued with a request for rational choices is able to take on board a contradictory ideology. In Norway, patient education under the auspice of hospitals is to be conducted as an equal collaboration between users and professionals, posing challenges to the ethos of rationally justified choices within the hospital sector. This calls for an exploration of how the organization copes with the contradictory demands. A theoretical approach on the basis of theories from Scandinavian institutional theory and science and technology studies, informed by documents, interviews and experiences from national, regional and local levels in Norway. The field of patient education is divided into three decoupled domains: one at management level, one at the practical level, and in the middle a domain that acts as an interface between management and practice. This interface mediates the relationship between ideas and practice, without making overt the fact that ideas might not be possible to put into practice and that practice might not reflect ideas. The decoupling of practice and management allows patient education as equal collaboration between users and professionals to thrive as an idea, not subjugated by practical challenges. Thus, it can exist as a guiding star that both management and practitioners can attune to, but this situation might now be threatened by the demand for quality assurance in the field. © 2011 Blackwell Publishing Ltd.

(Un)organizing equal collaboration between users and professionals: on management of patient education in Norway

PubMed Central

Stokken, Roar

2011-01-01

Abstract Background  This is an article about how patient education is managed in Norway, but it also addresses a matter of broader relevance that of how an organization imbued with a request for rational choices is able to take on board a contradictory ideology. In Norway, patient education under the auspice of hospitals is to be conducted as an equal collaboration between users and professionals, posing challenges to the ethos of rationally justified choices within the hospital sector. This calls for an exploration of how the organization copes with the contradictory demands. Methods  A theoretical approach on the basis of theories from Scandinavian institutional theory and science and technology studies, informed by documents, interviews and experiences from national, regional and local levels in Norway. Discussion  The field of patient education is divided into three decoupled domains: one at management level, one at the practical level, and in the middle a domain that acts as an interface between management and practice. This interface mediates the relationship between ideas and practice, without making overt the fact that ideas might not be possible to put into practice and that practice might not reflect ideas. Conclusions  The decoupling of practice and management allows patient education as equal collaboration between users and professionals to thrive as an idea, not subjugated by practical challenges. Thus, it can exist as a guiding star that both management and practitioners can attune to, but this situation might now be threatened by the demand for quality assurance in the field. PMID:21624027

A national survey to define a new core curriculum to prepare physicians for managed care practice.

PubMed

Meyer, G S; Potter, A; Gary, N

1997-08-01

All levels of medical education will require modification to address the challenges in health care practice brought about by managed care. Because preparation for practice in a managed care environment has received insufficient attention, and because the need for change is so great, in 1995 the authors sought information from a variety of sources to serve as a basis for identifying the core curricular components and the staging of these components in the medical education process. This research effort consisted of a survey of 125 U.S. medical school curriculum deans (or equivalent school representatives); four focus groups of managed care practitioners, administrators, educators, and residents; and a survey of a national sample of physicians and medical directors. Findings indicate that almost all the 91 responding school representatives recognized the importance of revising their curricula to meet the managed care challenge and that the majority either had or were developing programs to train students for practice in managed care environments. The focus groups identified a core set of competencies for managed care practice, although numbers differed on whether the classroom or a managed care setting was the best place to teach the components of a new curriculum. Although medical directors and staff physicians differed with respect to the relative levels of importance of these competencies, the findings suggest that before medical school, training should focus on communication and interpersonal skills, information systems, and customer relations; during medical school, on clinical epidemiology, quality assurance, risk management, and decision analysis; during residency, on utilization management, managed care essentials, and multidisciplinary team building; and after residency, on a review of customer relations, communication skills, and utilization management. The authors conclude that a core curriculum and its sequencing can be identified, that the majority of curricular components exist but in s some cases needed to be modified to more clearly relate to managed care practice, and that their findings may provide a useful starting point for making decisions about curricular reform.

Assessment and management of burn pain at the Komfo Anokye Teaching Hospital: a best practice implementation project.

PubMed

Bayuo, Jonathan; Munn, Zachary; Campbell, Jared

2017-09-01

Pain management is a significant issue in health facilities in Ghana. For burn patients, this is even more challenging as burn pain has varied facets. Despite the existence of pharmacological agents for pain management, complaints of pain still persist. The aim of this project was to identify pain management practices in the burns units of Komfo Anokye Teaching Hospital, compare these approaches to best practice, and implement strategies to enhance compliance to standards. Ten evidence-based audit criteria were developed from evidence summaries. Using the Joanna Briggs Institute Practical Application of Clinical Evidence Software (PACES), a baseline audit was undertaken on a convenience sample of ten patients from the day of admission to the seventh day. Thereafter, the Getting Research into Practice (GRiP) component of PACES was used to identify barriers, strategies, resources and outcomes. After implementation of the strategies, a follow-up audit was undertaken using the same sample size and audit criteria. The baseline results showed poor adherence to best practice. However, following implementation of strategies, including ongoing professional education and provision of assessment tools and protocols, compliance rates improved significantly. Atlhough the success of this project was almost disrupted by an industrial action, collaboration with external bodies enabled the successful completion of the project. Pain management practices in the burns unit improved at the end of the project which reflects the importance of an audit process, education, providing feedback, group efforts and effective collaboration.

Assessing diabetes practices in clinical settings: precursor to building community partnerships around disease management.

PubMed

Prochaska, John D; Mier, Nelda; Bolin, Jane N; Hora, Kerrie L; Clark, Heather R; Ory, Marcia G

2009-12-01

Many recommended best practices exist for clinical and community diabetes management and prevention. However, in many cases, these recommendations are not being fully utilized. It is useful to gain a sense of currently utilized and needed practices when beginning a partnership building effort to ameliorate such practice problems. The purpose of this study was to assess current practices in clinical settings within the Brazos Valley in preparation for beginning a community-based participatory research project on improving diabetes prevention and management in this region. Fifty-seven physicians with admission privileges to a regional health system were faxed a survey related to current diabetes patient loads, knowledge and implementation of diabetes-related best practices, and related topics. Both qualitative and quantitative examination of the data was conducted. Fifteen percent of responding providers indicated they implemented diabetes prevention best practices, with significant differences between primary-care physicians and specialists. Respondents indicated a need for educational and counseling resources, as well as an increased health-care workforce in the region. The utilization of a faxed-based survey proved an effective means for assessing baseline data as well as serving as a catalyst for further discussion around coalition development. Results indicated a strong need for both clinical and community-based services regarding diabetes prevention and management, and provided information and insight to begin focused community dialogue around diabetes prevention and management needs across the region. Other sites seeking to begin similar projects may benefit from a similar process.

Doctors as managers of healthcare resources in Nigeria: Evolving roles and current challenges

PubMed Central

Ojo, Temitope Olumuyiwa; Akinwumi, Adebowale Femi

2015-01-01

Over the years, medical practice in Nigeria has evolved in scope and practice, in terms of changing disease patterns, patients' needs, and social expectations. In addition, there is a growing sentiment especially among the general public and some health workers that most doctors are bad managers. Besides drawing examples from some doctors in top management positions that have performed less creditably, critics also harp on the fact that more needs to be done to improve the training of doctors in health management. This article describes the role of doctors in this changing scene of practice and highlights the core areas where doctors' managerial competencies are required to improve the quality of healthcare delivery. Areas such as health care financing, essential drugs and supplies management, and human resource management are emphasized. Resources to be managed and various skills needed to function effectively at the different levels of management are also discussed. To ensure that doctors are well-skilled in managerial competencies, the article concludes by suggesting a curriculum review at undergraduate and postgraduate levels of medical training to include newer but relevant courses on health management in addition to the existing ones, whereas also advocating that doctors be incentivized to go for professional training in health management and not only in the core clinical specialties. PMID:26903692

Current practices of Asia-Pacific cardiologists in the utilization of bioresorbable scaffolds.

PubMed

Chanana, B B; Chandra, Praveen; Cheng, Jack Jun; Dick, Ron; Gwon, Hyeon-Cheol; Hiremath, M S; Huan, Do Quang; Jeamanukoolkit, Anuruck; Jiang, Tiemin; Kwok, On-Hing; Lim, Michael C L; Low, Adrian F; Mathew, Rony; Mathew, Samuel K; McClean, Dougal; Nakamura, Sunao; Nguyen, Michael; Qiao, Shubin; Santoso, Teguh; Saxena, Sudheer; Schultz, Carl; Sengottuvelu, G; Seth, Ashok; Simonton, Charles A; Soo, Chee Siong; Sudhir, Krishnankutty; Tsai, Cheng-Ting; Wasan, Udayachalerm; Whelan, Alan; Wong, Chris; Yap, Yee Guan

2016-11-01

Although Absorb Bioresorbable Vascular Scaffolds (A-BVS) are routinely used in the Asia-Pacific, there is little information on patient selection or deployment technique here. This document investigates the experiences of leading interventional cardiologists from the Asia-Pacific region with a focus on patient characteristics, deployment techniques and management. A detailed questionnaire was distributed to 28 highly-experienced interventional cardiologists ('Authors') from 13 Asia-Pacific countries. The results were discussed at a meeting on patient selection, technical consideration, deployment practices and patient management. Potential patient benefits of Absorb compared to metallic DES, the learning curve for patient selection and preparation, device deployment, and subsequent patient management approaches are presented. Current practices are derived from guidelines optimized for European patients. Differences in approach exist in the Asia-Pacific context, including limited access to imaging and frequency of occurrence of complex lesions. Nevertheless, the use of the Absorb BVS ('Absorb') in certain Asia-Pacific countries has flourished and practices here are continuing to mature. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Nutrition training improves health workers' nutrition knowledge and competence to manage child undernutrition: a systematic review.

PubMed

Sunguya, Bruno F; Poudel, Krishna C; Mlunde, Linda B; Urassa, David P; Yasuoka, Junko; Jimba, Masamine

2013-09-24

Medical and nursing education lack adequate practical nutrition training to fit the clinical reality that health workers face in their practices. Such a deficit creates health workers with poor nutrition knowledge and child undernutrition management practices. In-service nutrition training can help to fill this gap. However, no systematic review has examined its collective effectiveness. We thus conducted this study to examine the effectiveness of in-service nutrition training on health workers' nutrition knowledge, counseling skills, and child undernutrition management practices. We conducted a literature search on nutrition interventions from PubMed/MEDLINE, CINAHL, EMBASE, ISI Web of Knowledge, and World Health Organization regional databases. The outcome variables were nutrition knowledge, nutrition-counseling skills, and undernutrition management practices of health workers. Due to heterogeneity, we conducted only descriptive analyses. Out of 3910 retrieved articles, 25 were selected as eligible for the final analysis. A total of 18 studies evaluated health workers' nutrition knowledge and showed improvement after training. A total of 12 studies with nutrition counseling as the outcome variable also showed improvement among the trained health workers. Sixteen studies evaluated health workers' child undernutrition management practices. In all such studies, child undernutrition management practices and competence of health workers improved after the nutrition training intervention. In-service nutrition training improves quality of health workers by rendering them more knowledge and competence to manage nutrition-related conditions, especially child undernutrition. In-service nutrition training interventions can help to fill the gap created by the lack of adequate nutrition training in the existing medical and nursing education system. In this way, steps can be taken toward improving the overall nutritional status of the child population.

Review of LCA studies of solid waste management systems – Part II: Methodological guidance for a better practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Laurent, Alexis, E-mail: alau@dtu.dk; Clavreul, Julie; Bernstad, Anna

Highlights: • We perform a critical review of 222 LCA studies of solid waste management systems. • We analyse the past LCA practice against the ISO standard and ILCD Handbook guidance. • Malpractices exist in many methodological aspects with large variations among studies. • Many of these aspects are important for the reliability of the results. • We provide detailed recommendations to practitioners of waste management LCAs. - Abstract: Life cycle assessment (LCA) is increasingly used in waste management to identify strategies that prevent or minimise negative impacts on ecosystems, human health or natural resources. However, the quality of themore » provided support to decision- and policy-makers is strongly dependent on a proper conduct of the LCA. How has LCA been applied until now? Are there any inconsistencies in the past practice? To answer these questions, we draw on a critical review of 222 published LCA studies of solid waste management systems. We analyse the past practice against the ISO standard requirements and the ILCD Handbook guidelines for each major step within the goal definition, scope definition, inventory analysis, impact assessment, and interpretation phases of the methodology. Results show that malpractices exist in several aspects of the LCA with large differences across studies. Examples are a frequent neglect of the goal definition, a frequent lack of transparency and precision in the definition of the scope of the study, e.g. an unclear delimitation of the system boundaries, a truncated impact coverage, difficulties in capturing influential local specificities such as representative waste compositions into the inventory, and a frequent lack of essential sensitivity and uncertainty analyses. Many of these aspects are important for the reliability of the results. For each of them, we therefore provide detailed recommendations to practitioners of waste management LCAs.« less

Adaptation of farming practices could buffer effects of climate change on northern prairie wetlands

USGS Publications Warehouse

Voldseth, R.A.; Johnson, W.C.; Guntenspergen, G.R.; Gilmanov, T.; Millett, B.V.

2009-01-01

Wetlands of the Prairie Pothole Region of North America are vulnerable to climate change. Adaptation of farming practices to mitigate adverse impacts of climate change on wetland water levels is a potential watershed management option. We chose a modeling approach (WETSIM 3.2) to examine the effects of changes in climate and watershed cover on the water levels of a semi-permanent wetland in eastern South Dakota. Land-use practices simulated were unmanaged grassland, grassland managed with moderately heavy grazing, and cultivated crops. Climate scenarios were developed by adjusting the historical climate in combinations of 2??C and 4??C air temperature and ??10% precipitation. For these climate change scenarios, simulations of land use that produced water levels equal to or greater than unmanaged grassland under historical climate were judged to have mitigative potential against a drier climate. Water levels in wetlands surrounded by managed grasslands were significantly greater than those surrounded by unmanaged grassland. Management reduced both the proportion of years the wetland went dry and the frequency of dry periods, producing the most dynamic vegetation cycle for this modeled wetland. Both cultivated crops and managed grassland achieved water levels that were equal or greater than unmanaged grassland under historical climate for the 2??C rise in air temperature, and the 2??C rise plus 10% increase in precipitation scenarios. Managed grassland also produced water levels that were equal or greater than unmanaged grassland under historical climate for the 4??C rise plus 10% increase in precipitation scenario. Although these modeling results stand as hypotheses, they indicate that amelioration potential exists for a change in climate up to an increase of 2??C or 4??C with a concomitant 10% increase in precipitation. Few empirical data exist to verify the results of such land-use simulations; however, adaptation of farming practices is one possible mitigation avenue available for prairie wetlands. ?? 2009, The Society of Wetland Scientists.

Implementation of pregnancy weight management and obesity guidelines: a meta-synthesis of healthcare professionals' barriers and facilitators using the Theoretical Domains Framework.

PubMed

Heslehurst, N; Newham, J; Maniatopoulos, G; Fleetwood, C; Robalino, S; Rankin, J

2014-06-01

Obesity in pregnancy is rising and is associated with severe health consequences for both the mother and the child. There is an increasing international focus on guidelines to manage the clinical risks of maternal obesity, and for pregnancy weight management. However, passive dissemination of guidelines is not effective and more active strategies are required for effective guideline implementation into practice. Implementation of guidelines is a form of healthcare professional behaviour change, and therefore implementation strategies should be based on appropriate behaviour change theory. This systematic review aimed to identify the determinants of healthcare professionals' behaviours in relation to maternal obesity and weight management. Twenty-five studies were included. Data synthesis of the existing international qualitative and quantitative evidence base used the Theoretical Domains Framework to identify the barriers and facilitators to healthcare professionals' maternal obesity and weight management practice. The domains most frequently identified included 'knowledge', 'beliefs about consequences' and 'environmental context and resources'. Healthcare professionals' weight management practice had the most barriers compared with any other area of maternal obesity practice. The results of this review will be used to inform the development of an intervention to support healthcare professional behaviour change. © 2014 The Authors. obesity reviews © 2014 International Association for the Study of Obesity.

Participatory approaches to understanding practices of flood management across borders

NASA Astrophysics Data System (ADS)

Bracken, L. J.; Forrester, J.; Oughton, E. A.; Cinderby, S.; Donaldson, A.; Anness, L.; Passmore, D.

2012-04-01

The aim of this paper is to outline and present initial results from a study designed to identify principles of and practices for adaptive co-management strategies for resilience to flooding in borderlands using participatory methods. Borderlands are the complex and sometimes undefined spaces existing at the interface of different territories and draws attention towards messy connections and disconnections (Strathern 2004; Sassen 2006). For this project the borderlands concerned are those between professional and lay knowledge, between responsible agencies, and between one nation and another. Research was focused on the River Tweed catchment, located on the Scottish-English border. This catchment is subject to complex environmental designations and rural development regimes that make integrated management of the whole catchment difficult. A multi-method approach was developed using semi-structured interviews, Q methodology and participatory GIS in order to capture wide ranging practices for managing flooding, the judgements behind these practices and to 'scale up' participation in the study. Professionals and local experts were involved in the research. The methodology generated a useful set of options for flood management, with research outputs easily understood by key management organisations and the wider public alike. There was a wide endorsement of alternative flood management solutions from both managers and local experts. The role of location was particularly important for ensuring communication and data sharing between flood managers from different organisations and more wide ranging stakeholders. There were complex issues around scale; both the mismatch between communities and evidence of flooding and the mismatch between governance and scale of intervention for natural flood management. The multi-method approach was essential in capturing practice and the complexities around governance of flooding. The involvement of key flood management organisations was integral to making the research of relevance to professionals.

Office of Nuclear Energy Knowledge Management Program Situational Analysis Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kimberlyn C. Mousseau

2011-12-01

Knowledge management (KM) has been a high priority for the Department of Energy (DOE) Office of Nuclear Energy (NE) for the past several years. NE Programs are moving toward well-established knowledge management practices and a formal knowledge management program has been established. Knowledge management is being practiced to some level within each of the NE programs. Although it continues to evolve as NE programs evolve, a formal strategic plan that guides the implementation of KM has been developed. Despite the acceptance of KM within DOE NE, more work is necessary before the NE KM program can be considered fully successful.more » Per Dr. David J. Skyrme[1], an organization typically moves through the following evolutionary phases: (1) Ad-hoc - KM is being practiced to some level in some parts of the organization; (2) Formal - KM is established as a formal project or program; (3) Expanding - the use of KM as a discipline grows in practice across different parts of the organization; (4) Cohesive - there is a degree of coordination of KM; (5) Integrated - there are formal standards and approaches that give every individual access to most organizational knowledge through common interfaces; and (6) Embedded - KM is part-and-parcel of everyday tasks; it blends seamlessly into the background. According to the evolutionary phases, the NE KM program is operating at the two lower levels, Ad-hoc and Formal. Although KM is being practiced to some level, it is not being practiced in a consistent manner across the NE programs. To be fully successful, more emphasis must be placed on establishing KM standards and processes for collecting, organizing, sharing and accessing NE knowledge. Existing knowledge needs to be prioritized and gathered on a routine basis, its existence formally recorded in a knowledge inventory. Governance to ensure the quality of the knowledge being used must also be considered. For easy retrieval, knowledge must be organized according to a taxonomy that mimics nuclear energy programs. Technologies need to be established to make accessing the knowledge easier for the user. Finally, knowledge needs to be used as part of a well defined work process.« less

School Operations and Maintenance: Best Practices For Controlling Energy Costs. A Guidebook for K-12 School System Business Officers and Facilities Managers

ERIC Educational Resources Information Center

US Department of Energy, 2004

2004-01-01

Operations and maintenance (O&M) offers not only strategies for maintaining facilities, but also opportunities for reducing energy costs and increasing energy efficiency at existing schools, regardless of age. This Guidebook provides detailed and practical guidance on how K-12 school districts can plan and implement enhancements to their current…

Time-lagged response of carabid species richness and composition to past management practices and landscape context of semi-natural field margins.

PubMed

Alignier, Audrey; Aviron, Stéphanie

2017-12-15

Field margins are key features for the maintenance of biodiversity and associated ecosystem services in agricultural landscapes. Little is known about the effects of management practices of old semi-natural field margins, and their historical dimension regarding past management practices and landscape context is rarely considered. In this paper, the relative influence of recent and past management practices and landscape context (during the last five years) were assessed on the local biodiversity (species richness and composition) of carabid assemblages of field margins in agricultural landscapes of northwestern France. The results showed that recent patterns of carabid species richness and composition were best explained by management practices and landscape context measured four or five years ago. It suggests the existence of a time lag in the response of carabid assemblages to past environmental conditions of field margins. The relative contribution of past management practices and past landscape context varied depending on the spatial scale at which landscape context was taken into account. Carabid species richness was higher in grazed or sprayed field margins probably due to increased heterogeneity in habitat conditions. Field margins surrounded by grasslands and crops harbored species associated with open habitats whilst forest species dominated field margins surrounded by woodland. Landscape effect was higher at fine spatial scale, within 50 m around field margins. The present study highlights the importance of considering time-lagged responses of biodiversity when managing environment. It also suggests that old semi-natural field margins should not be considered as undisturbed habitats but more as management units being part of farming activities in agricultural landscapes, as for arable fields. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cancer related fatigue: implementing guidelines for optimal management.

PubMed

Pearson, Elizabeth J M; Morris, Meg E; McKinstry, Carol E

2017-07-18

Cancer-related fatigue (CRF) is a key concern for people living with cancer and can impair physical functioning and activities of daily living. Evidence-based guidelines for CRF are available, yet inconsistently implemented globally. This study aimed to identify barriers and enablers to applying a cancer fatigue guideline and to derive implementation strategies. A mixed-method study explored the feasibility of implementing the CRF guideline developed by the Canadian Association for Psychosocial Oncology (CAPO). Health professionals, managers and consumers from different practice settings participated in a modified Delphi study with two survey rounds. A reference group informed the design of the study including the surveys. The first round focused on guideline characteristics, compatibility with current practice and experience, and behaviour change. The second survey built upon and triangulated the first round. Forty-five health practitioners and managers, and 68 cancer survivors completed the surveys. More than 75% of participants endorsed the CAPO cancer related fatigue guidelines. Some respondents perceived a lack of resources for accessible and expert fatigue management services. Further barriers to guideline implementation included complexity, limited practical details for some elements, and lack of clinical tools such as assessment tools or patient education materials. Recommendations to enhance guideline applicability centred around four main themes: (1) balancing the level of detail in the CAPO guideline with ease of use, (2) defining roles of different professional disciplines in CRF management, (3) how best to integrate CRF management into policy and practice, (4) how best to ensure a consumer-focused approach to CRF management. Translating current knowledge on optimal management of CRF into clinical practice can be enhanced by the adoption of valid guidelines. This study indicates that it is feasible to adopt the CAPO guidelines. Clinical application may be further enhanced with guideline adaptation, professional education and integration with existing practices.

Rapid resolution of acute subdural hematoma and effects on the size of existent subdural hygroma: a case report.

PubMed

Coşar, Murat; Eser, Olcay; Aslan, Adem; Ela, Yüksel

2007-07-01

The diagnosis and management of acute subdural hematoma is important in neurosurgery practice. Rapid spontaneous resolution of acute subdural hematoma within a few hours is seen rarely on the CT scan. We present a case that enlarged the existent subdural hygroma showing rapid resolution of acute subdural hematoma with resolution in 9 hours after the trauma. Additionally, the follow-up CT scans in the 1st month showed the decrease of enlargement of subdural hygroma. The resolution of acute subdural hematoma and effect of acute subdural hematoma on subdural hygroma must be considered during management. The relation of acute subdural hematoma and subdural hygroma is important for the resolution and management of acute subdural hematoma.

Theory, Concepts and Practical Applications: Integrating Environmental Education and Natural Resource Management.

ERIC Educational Resources Information Center

Parkin, D. R.

1994-01-01

Determines whether the conservation programs offered through the University of Queensland's Gatton College reflect and epitomize the principles of environmental education established by the Tbilisi Declaration for a more environmentally conscious existence. (Author/MDH)

Models for joint ophthalmology-optometry patient management.

PubMed

Kim, John J; Kim, Christine M

2011-07-01

American Academy of Ophthalmology (AAO) and American Society of Cataract and Refractive Surgery (ASCRS) presented a joint position paper in February 2000 declaring that they do not support routine comanagement of patients with the optometrists. American Optometric Association and American Academy of Optometry quickly responded in support of AAO and ASCRS. All four entities did not preclude legitimate and proper comanagement arrangements. Since that time, the pattern of practice has changed, requiring us to rethink our positions. This paper is written to provide a possible model for the ophthalmology-optometry practice management in ophthalmic surgeries including refractive surgery. Since the publication of the Joint Position Paper, the concept of comanagement has faded and a new model of integrated management has evolved. This has occurred as the changes in the employment pattern of the ophthalmic practice have incorporated optometrists into its fold. This evolution allowed ophthalmic and optometric community to co-exist and thrive to provide better patient care.

Assessment of a quality improvement intervention to strengthen pharmaceutical human resources and improve availability and use of HIV medicines in Uganda.

PubMed

Byabagambi, John B; Broughton, Edward; Heltebeitel, Simon; Wuliji, Tana; Karamagi, Esther

2017-01-01

Inadequate medication dispensing and management by healthcare providers can contribute to poor outcomes among HIV-positive patients. Gaps in medication availability, often associated with pharmacy workforce shortages, are an important barrier to retention in HIV care in Uganda. An intervention to address pharmacy staffing constraints through strengthening pharmaceutical management, dispensing practices, and general competencies of facility clinical and pharmacy staff was implemented in 14 facilities in three districts in eastern Uganda. Teams of staff were organised in each facility and supported to apply quality improvement (QI) methods to address deficits in availability and rational use of HIV drugs. To evaluate the intervention, baseline and end line data were collected 24 months apart. Dispensing practices, clinical wellness and adherence to antiretrovirals improved by 45%, 28% and 20% from baseline to end line, respectively. All clients at end line received the medications prescribed, and medications were correctly, completely and legibly labelled more often. Clients better understood when, how much and for how long they were supposed to take their prescribed medicines at end line. Pharmaceutical management practices also improved from baseline in most categories by statistically significant margins. Facilities significantly improved on correctly recording stock information about antiretroviral drugs (53%vs100%, P<0.0001). Coinciding with existing staff taking on pharmaceutical roles, facilities improved management of unwanted and expired drugs, notably by optimising use of existing health workers and making pharmaceutical management processes more efficient. Implementation of this improvement intervention in the 14 facilities appeared to have a positive impact on client outcomes, pharmacy department management and providers' self-reported knowledge of QI methods. These results were achieved at a cost of about US$5.50 per client receiving HIV services at participating facilities.

Practice Nurses' views of their role in the management of Chronic Fatigue Syndrome/Myalagic Encephalitis: a qualitative study

PubMed Central

Chew-Graham, Carolyn; Dixon, Rebecca; Shaw, Jonathan W; Smyth, Nina; Lovell, Karina; Peters, Sarah

2009-01-01

Background NICE guidelines suggest that patients with Chronic Fatigue Syndrome/Myalgic Encephalitis (CFS/ME) should be managed in Primary Care. Practice Nurses are increasingly being involved in the management of long-term conditions, so are likely to also have a growing role in managing CFS/ME. However their attitudes to, and experiences of patients with CFS/ME and its management must be explored to understand what barriers may exist in developing their role for this group of patients. The aim of this study was to explore Practice Nurses' understanding and beliefs about CFS/ME and its management. Methods Semi-structured interviews with 29 Practice Nurses. Interviews were transcribed verbatim and an iterative approach used to develop themes from the dataset. Results Practice nurses had limited understanding about CFS/ME which had been largely gained through contact with patients, friends, personal experiences and the media rather than formal training. They had difficulty seeing CFS/ME as a long term condition. They did identify a potential role they could have in management of CFS/ME but devalued their own skills in psychological intervention, and suggested counselling would be an appropriate therapeutic option. They recognised a need for further training and on going supervision from both medical and psychological colleagues. Some viewed the condition as contentious and held pejorative views about CFS/ME. Such scepticism and negative attitudes will be a significant barrier to the management of patients with CFS/ME in primary care. Conclusion The current role of Practice Nurses in the ongoing management of patients with CFS/ME is limited. Practice Nurses have little understanding of the evidence-base for treatment of CFS/ME, particularly psychological therapies, describing management options in terms of advice giving, self-help or counselling. Practice Nurses largely welcomed the potential development of their role in this area, but identified barriers and training needs which must be addressed to enable them to feel confident managing of patients with this condition. Training must begin by addressing negative attitudes to patients with CFS/ME. PMID:19161604

Impact of the "Guidelines for infection prevention in dentistry" (2006) by the Commission of Hospital Hygiene and Infection Prevention at the Robert Koch-Institute (KRINKO) on hygiene management in dental practices - analysis of a survey from 2009.

PubMed

Hübner, Nils-Olaf; Handrup, Stephan; Meyer, Georg; Kramer, Axel

2012-01-01

To assess trends in hygiene management in dental practices in comparison to an earlier survey in 2002/2003 and to point out key aspects for future efforts. The infection prevention management of all dental practices in Greifswald (n=35) was determined by a questionnaire in a personal interview in 2008/2009. 26% of the dentists did not use sufficient personal protective equipment during the general examination of the patient. In conservative and prosthetic dentistry, 15% still did not use adequate measures and 9% did not even in surgical interventions. Vaccination coverage was clearly too low, as only 35% of dentists were vaccinated against influenza and coverage with other vaccinations was also quite low. 11% of the dentists did not perform a documented anamnesis and in 29% of the dental practices no appointment system for risk patients existed.There were significant deficiencies in the reprocessing of medical devices and in the equipment needed for reprocessing. The opportunity to participate in further training in this field was rejected by 23% of the dentists.In 10 dental practices, the colony count in the dental unit water-conducting system was five times higher than the limit. A contamination with P. aeruginosa was discovered in 4 practices. All units were renovated. Overall, both the hygiene management and hygiene equipment in the practices have improved considerably compared to the previous survey in 2002/2003. This demonstrates the positive effect of the KRINKO guidelines from 2006. However, the survey again showed relevant deficiences in the hygiene management of dental practices, which agrees with a Germany-wide online survey from 2009. While the study revealed persistent deficiencies in hygiene management, especially in reprocessing, it confirms that the KRINKO guidelines for dental practices from 2006 led to significant improvements in hygiene management. Doubts about the impact of the guidelines are not backed by evidence.

A systematic review of collaboration and network research in the public affairs literature: implications for public health practice and research.

PubMed

Varda, Danielle; Shoup, Jo Ann; Miller, Sara

2012-03-01

We explored and analyzed how findings from public affairs research can inform public health research and practice, specifically in the area of interorganizational collaboration, one of the most promising practice-based approaches in the public health field. We conducted a systematic review of the public affairs literature by following a grounded theory approach. We coded 151 articles for demographics and empirical findings (n = 258). Three primary findings stand out in the public affairs literature: network structure affects governance, management strategies exist for administrators, and collaboration can be linked to outcomes. These findings are linked to priorities in public health practice. Overall, we found that public affairs has a long and rich history of research in collaborations that offers unique organizational theory and management tools to public health practitioners.

Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update.

PubMed

Sarin, S K; Kumar, M; Lau, G K; Abbas, Z; Chan, H L Y; Chen, C J; Chen, D S; Chen, H L; Chen, P J; Chien, R N; Dokmeci, A K; Gane, Ed; Hou, J L; Jafri, W; Jia, J; Kim, J H; Lai, C L; Lee, H C; Lim, S G; Liu, C J; Locarnini, S; Al Mahtab, M; Mohamed, R; Omata, M; Park, J; Piratvisuth, T; Sharma, B C; Sollano, J; Wang, F S; Wei, L; Yuen, M F; Zheng, S S; Kao, J H

2016-01-01

Worldwide, some 240 million people have chronic hepatitis B virus (HBV), with the highest rates of infection in Africa and Asia. Our understanding of the natural history of HBV infection and the potential for therapy of the resultant disease is continuously improving. New data have become available since the previous APASL guidelines for management of HBV infection were published in 2012. The objective of this manuscript is to update the recommendations for the optimal management of chronic HBV infection. The 2015 guidelines were developed by a panel of Asian experts chosen by the APASL. The clinical practice guidelines are based on evidence from existing publications or, if evidence was unavailable, on the experts' personal experience and opinion after deliberations. Manuscripts and abstracts of important meetings published through January 2015 have been evaluated. This guideline covers the full spectrum of care of patients infected with hepatitis B, including new terminology, natural history, screening, vaccination, counseling, diagnosis, assessment of the stage of liver disease, the indications, timing, choice and duration of single or combination of antiviral drugs, screening for HCC, management in special situations like childhood, pregnancy, coinfections, renal impairment and pre- and post-liver transplant, and policy guidelines. However, areas of uncertainty still exist, and clinicians, patients, and public health authorities must therefore continue to make choices on the basis of the evolving evidence. The final clinical practice guidelines and recommendations are presented here, along with the relevant background information.

Using project performance to measure effectiveness of quality management system maintenance and practices in construction industry.

PubMed

Leong, Tiong Kung; Zakuan, Norhayati; Mat Saman, Muhamad Zameri; Ariff, Mohd Shoki Md; Tan, Choy Soon

2014-01-01

This paper proposed seven existing and new performance indicators to measure the effectiveness of quality management system (QMS) maintenance and practices in construction industry. This research is carried out with a questionnaire based on QMS variables which are extracted from literature review and project performance indicators which are established from project management's theory. Data collected was analyzed using correlation and regression analysis. The findings indicate that client satisfaction and time variance have positive and significant relationship with QMS while other project performance indicators do not show significant results. Further studies can use the same project performance indicators to study the effectiveness of QMS in different sampling area to improve the generalizability of the findings.

Flexible resource management and its effect on project cost and duration

NASA Astrophysics Data System (ADS)

Pinha, Denis C.; Ahluwalia, Rashpal S.

2018-06-01

In practice, most projects result in cost overruns and schedule slippage due to poor resource management. This paper presents an approach that aims at reducing project duration and costs by empowering project managers to assess different scenarios. The proposed approach addresses combinatorial modes for tasks, multi-skilled resources, and multiple calendars for resources. A case study reported in the literature is presented to demonstrate the capabilities of this method. As for practical implications, this approach enhances the decision-making process which results in improved solutions in terms of total project duration and cost. From an academic viewpoint, this paper adds empirical evidence to enrich the existing literature, as it highlights relevant issues to model properly the complexity of real-life projects.

Using Project Performance to Measure Effectiveness of Quality Management System Maintenance and Practices in Construction Industry

PubMed Central

Leong, Tiong Kung; Ariff, Mohd. Shoki Md.

2014-01-01

This paper proposed seven existing and new performance indicators to measure the effectiveness of quality management system (QMS) maintenance and practices in construction industry. This research is carried out with a questionnaire based on QMS variables which are extracted from literature review and project performance indicators which are established from project management's theory. Data collected was analyzed using correlation and regression analysis. The findings indicate that client satisfaction and time variance have positive and significant relationship with QMS while other project performance indicators do not show significant results. Further studies can use the same project performance indicators to study the effectiveness of QMS in different sampling area to improve the generalizability of the findings. PMID:24701182

Older Adults’ Fears about Diabetes: Using Common Sense Models of Disease to Understand Fear Origins and Implications for Self-Management

PubMed Central

Reynolds, Teresa; Chapman, Christine; Bell, Ronny A.; Grzywacz, Joseph G.; Ip, Edward H.; Kirk, Julienne K.; Arcury, Thomas A.

2013-01-01

This study examines older adults’ fears of diabetes complications and their effects on self-management practices. Existing models of diabetes self-management posit that patients’ actions are grounded in disease beliefs and experience, but there is little supporting evidence. In-depth qualitative interviews were conducted with a community-based sample of 74 African American, American Indian, and white older adults with diabetes. Analysis uses Leventhal’s Common Sense Model of Diabetes to link fears to early experience and current self-management. Sixty-three identified fears focused on complications that could limit carrying out normal activities: amputation, blindness, low blood glucose and coma, and disease progression to insulin use and dialysis. Most focused self-management on actions to prevent specific complications, rather than on managing the disease as a whole. Early experiences focused attention on the inevitability of complications and the limited ability of patients to prevent them. Addressing older adults’ fears about diabetes may improve their diabetes self-management practices. PMID:25364096

Financial statement analysis, internal controls, and audit readiness: Bestpractices for Pakistan army financial management officers

DTIC Science & Technology

2017-06-01

2012). Noland and Metrejean (2013) emphasize the importance of the internal control environment and cite the June 2010 case of a non -existent...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA MBA PROFESSIONAL REPORT FINANCIAL STATEMENT ANALYSIS, INTERNAL CONTROLS , AND...FINANCIAL STATEMENT ANALYSIS, INTERNAL CONTROLS , AND AUDIT READINESS: BEST PRACTICES FOR PAKISTAN ARMY FINANCIAL MANAGEMENT OFFICERS 5. FUNDING NUMBERS 6

Riparian habitat on the Humboldt River, Deeth to Elko, Nevada

NASA Technical Reports Server (NTRS)

Price, K. P.; Ridd, M. K.

1983-01-01

A map inventory of the major habitat types existing along the Humbolt River riparian zone in Nevada is described. Through aerialphotography, 16 riparian habitats are mapped that describe the ecological relationships between soil and vegetation types, flooding and soil erosion, and the various management practices employed to date. The specific land and water management techniques and their impact on the environment are considered.

Costs associated with data collection and reporting for diabetes quality improvement in primary care practices: a report from SNOCAP-USA.

PubMed

West, David R; Radcliff, Tiffany A; Brown, Tiffany; Cote, Murray J; Smith, Peter C; Dickinson, W Perry

2012-01-01

Information about the costs and experiences of collecting and reporting quality measure data are vital for practices deciding whether to adopt new quality improvement initiatives or monitor existing initiatives. Six primary care practices from Colorado's Improving Performance in Practice program participated. We conducted structured key informant interviews with Improving Performance in Practice coaches and practice managers, clinicians, and staff and directly observed practices. Practices had 3 to 7 clinicians and 75 to 300 patients with diabetes, half had electronic health records, and half were members of an independent practice association. The estimated per-practice cost of implementation for the data collection and reporting for the diabetes quality improvement program was approximately $15,552 per practice (about $6.23 per diabetic patient per month). The first-year maintenance cost for this effort was approximately $9,553 per practice ($3.83 per diabetic patient per month). The cost of implementing and maintaining a diabetes quality improvement effort that incorporates formal data collection, data management, and reporting is significant and quantifiable. Policymakers must become aware of the financial and cultural impact on primary care practices when considering value-based purchasing initiatives.

[ISO 9001:2015 Certification in Quality Management].

PubMed

Enders, Christian; Lang, Gabriele E; Lang, Gerhard K; Werner, Jens Ulrich

2017-07-01

Quality management improves the structures, processes and results of organizations of all kinds. Many practices and clinics have their existing quality management system certified according to ISO 9001, (e.g., to check their own quality management system or to obtain a testimonial against third parties). The latest version ISO 9001:2015 contains some changes, both structurally and in terms of content. These changes can be met with reasonable efforts. An ISO 9001:2015 certification represents a value for your organization, but these advantages are often not directly measurable. Georg Thieme Verlag KG Stuttgart · New York.

Factors that influence effective perioperative temperature management by anesthesiologists: a qualitative study using the Theoretical Domains Framework.

PubMed

Boet, Sylvain; Patey, Andrea M; Baron, Justine S; Mohamed, Karim; Pigford, Ashlee-Ann E; Bryson, Gregory L; Brehaut, Jamie C; Grimshaw, Jeremy M

2017-06-01

Inadvertent perioperative hypothermia (IPH) is associated with a range of adverse outcomes. Safe and effective warming techniques exist to prevent IPH; however, IPH remains common. This study aimed to identify factors that anesthesiologists perceive may influence temperature management during the perioperative period. After Research Ethics Board approval, semi-structured interviews were conducted with staff anesthesiologists at a Canadian academic hospital. An interview guide based on the Theoretical Domains Framework (TDF) was used to capture 14 theoretical domains that may influence temperature management. The interview transcripts were coded using direct content analysis to generate specific beliefs and to identify relevant TDF domains perceived to influence temperature management behaviour. Data saturation was achieved after 15 interviews. The following nine theoretical domains were identified as relevant to designing an intervention for practices in perioperative temperature management: knowledge, beliefs about capabilities, beliefs about consequences, reinforcement, memory/attention/decision-making, environmental context and resources, social/professional role/identity, social influences, and behavioural regulation. Potential target areas to improve temperature management practices include interventions that address information needs about individual temperature management behaviour as well as patient outcome (feedback), increasing awareness of possible temperature management strategies and guidelines, and a range of equipment and surgical team dynamics that influence temperature management. This study identified several potential target areas for future interventions from nine of the TDF behavioural domains that anesthesiologists perceive to drive their temperature management practices. Future interventions that aim to close the evidence-practice gap in perioperative temperature management may include these targets.

The Recreational Pilot Practical Test Standard for Powered Parachute

DOT National Transportation Integrated Search

1997-06-01

The I-4 Surveillance and Motorist Information System (SMIS) in the Orlando metropolitan area is Florida's largest existing Freeway Management System (FMS). This system was initially installed in 1991 (Phase I) to help support the TravTek ITS Operatio...

Media filter drain : modified design evaluation and existing design longevity evaluation.

DOT National Transportation Integrated Search

2014-02-01

The media filter drain (MFD), a stormwater water quality treatment best management practice, consists of media made up of : aggregate, perlite, gypsum and dolomite in a trench located along roadway shoulders with gravel and vegetative pre-filtering :...

Key strategies to improve systems for managing patient complaints within health facilities - what can we learn from the existing literature?

PubMed

Mirzoev, Tolib; Kane, Sumit

2018-01-01

Information from patient complaints - a widely accepted measure of patient satisfaction with services - can inform improvements in service quality, and contribute towards overall health systems performance. While analyses of data from patient complaints received much emphasis, there is limited published literature on key interventions to improve complaint management systems. The objectives are two-fold: first, to synthesise existing evidence and provide practical options to inform future policy and practice and, second, to identify key outstanding gaps in the existing literature to inform agenda for future research. We report results of review of the existing literature. Peer-reviewed published literature was searched in OVID Medline, OVID Global Health and PubMed. In addition, relevant citations from the reviewed articles were followed up, and we also report grey literature from the UK and the Netherlands. Effective interventions can improve collection of complaints (e.g. establishing easy-to-use channels and raising patients' awareness of these), analysis of complaint data (e.g. creating structures and spaces for analysis and learning from complaints data), and subsequent action (e.g. timely feedback to complainants and integrating learning from complaints into service quality improvement). No one single measure can be sufficient, and any intervention to improve patient complaint management system must include different components, which need to be feasible, effective, scalable, and sustainable within local context. Effective interventions to strengthen patient complaints systems need to be: comprehensive, integrated within existing systems, context-specific and cognizant of the information asymmetry and the unequal power relations between the key actors. Four gaps in the published literature represent an agenda for future research: limited understanding of contexts of effective interventions, absence of system-wide approaches, lack of evidence from low- and middle-income countries and absence of focused empirical assessments of behaviour of staff who manage patient complaints.

Key strategies to improve systems for managing patient complaints within health facilities – what can we learn from the existing literature?

PubMed Central

2018-01-01

ABSTRACT Background: Information from patient complaints – a widely accepted measure of patient satisfaction with services – can inform improvements in service quality, and contribute towards overall health systems performance. While analyses of data from patient complaints received much emphasis, there is limited published literature on key interventions to improve complaint management systems. Objectives: The objectives are two-fold: first, to synthesise existing evidence and provide practical options to inform future policy and practice and, second, to identify key outstanding gaps in the existing literature to inform agenda for future research. Methods: We report results of review of the existing literature. Peer-reviewed published literature was searched in OVID Medline, OVID Global Health and PubMed. In addition, relevant citations from the reviewed articles were followed up, and we also report grey literature from the UK and the Netherlands. Results: Effective interventions can improve collection of complaints (e.g. establishing easy-to-use channels and raising patients’ awareness of these), analysis of complaint data (e.g. creating structures and spaces for analysis and learning from complaints data), and subsequent action (e.g. timely feedback to complainants and integrating learning from complaints into service quality improvement). No one single measure can be sufficient, and any intervention to improve patient complaint management system must include different components, which need to be feasible, effective, scalable, and sustainable within local context. Conclusions: Effective interventions to strengthen patient complaints systems need to be: comprehensive, integrated within existing systems, context-specific and cognizant of the information asymmetry and the unequal power relations between the key actors. Four gaps in the published literature represent an agenda for future research: limited understanding of contexts of effective interventions, absence of system-wide approaches, lack of evidence from low- and middle-income countries and absence of focused empirical assessments of behaviour of staff who manage patient complaints. PMID:29658393

Examining gender salary disparities: an analysis of the 2003 multistate salary survey.

PubMed

Brown, Lawrence M; Schommer, Jon C; Mott, Dave; Gaither, Caroline A; Doucette, William R; Zgarrick, Dave P; Droege, Marcus

2006-09-01

Pharmacist salary and wage surveys have been conducted at the state and national level for more than 20 years; however, it is not known to what extent, if any, wage disparities due to gender still exist. The overall objective of this study was to determine if wage disparities exist among male and female pharmacists at the multistate and individual state level for each of 6 states studied. A secondary objective was to explore the effect of various demographic variables on the hourly wages of pharmacists. Data were collected from 1,688 pharmacists in 6 states during 2003 using a cross-sectional descriptive survey design. A multiple regression analysis on hourly wage testing the effects of state of practice, practice setting, position, terminal degree, and years in practice was conducted. Subsequent multiple regression analyses were conducted individually for each of the 6 states to test the effects of the above variables on hourly wage for both male and female pharmacists, followed by state-level analyses for male and female pharmacists, respectively. For the pooled data, all variables were found to be significant predictors of hourly wage, except for earning a PharmD degree without a residency or graduate degree. Gender was not a significant predictor of wage disparities in the state-level analyses. Position was the only significant predictor of wage disparities in all states (except Tennessee) such that pharmacists in management positions make significantly higher salaries than those in staff positions. The results of these analyses suggest that wage disparities due to gender do not exist at the state level for the 6 states surveyed, when controlling for practice setting, position, terminal degree, and years in practice. The larger number of men in management positions may explain lower wages for female pharmacists.

Standardization of haematology critical results management in adults: an International Council for Standardization in Haematology, ICSH, survey and recommendations.

PubMed

Keng, T B; De La Salle, B; Bourner, G; Merino, A; Han, J-Y; Kawai, Y; Peng, M T; McCafferty, R

2016-10-01

These recommendations are intended to develop a consensus in the previously published papers as to which parameters and what values should be considered critical. A practical guide on the standardization of critical results management in haematology laboratories would be beneficial as part of good laboratory and clinical practice and for use by laboratory-accrediting agencies. A working group with members from Europe, America, Australasia and Asia was formed by International Council for Standardization in Haematology. A pattern of practice survey of 21 questions was distributed in 2014, and the data were collected electronically by Survey Monkey. The mode, or most commonly occurring value, was selected as the threshold for the upper and lower alert limits for critical results reporting. A total of 666 laboratories submitted data to this study and, of these, 499 submitted complete responses. Full blood count critical results alert thresholds, morphology findings that trigger critical result notification, critical results alert list, notification process and maintenance of critical results management protocol are described. This international survey provided a snapshot of the current practice worldwide and has identified the existence of considerable heterogeneity of critical results management. The recommendations in this study represent a consensus of good laboratory practice. They are intended to encourage the implementation of a standardized critical results management protocol in the laboratory. © 2016 John Wiley & Sons Ltd.

Addressing Prediabetes in Childhood Obesity Treatment Programs: Support from Research and Current Practice

PubMed Central

Grow, H. Mollie; Fernandez, Cristina; Lukasiewicz, Gloria J.; Rhodes, Erinn T.; Shaffer, Laura A.; Sweeney, Brooke; Woolford, Susan J.; Estrada, Elizabeth

2014-01-01

Abstract Background: Type 2 diabetes mellitus (T2DM) and prediabetes have increased in prevalence among overweight and obese children, with significant implications for long-term health. There is little published evidence on the best approaches to care of prediabetes among overweight youth or the current practices used across pediatric weight management programs. Methods: This article reviews the literature and summarizes current practices for screening, diagnosis, and treatment of prediabetes at childhood obesity treatment centers. Findings regarding current practice were based on responses to an online survey from 28 pediatric weight management programs at 25 children's hospitals in 2012. Based on the literature reviewed, and empiric data, consensus support statements on prediabetes care and T2DM prevention were developed among representatives of these 25 children's hospitals' obesity clinics. Results: The evidence reviewed demonstrates that current T2DM and prediabetes diagnostic parameters are derived from adult-based studies with little understanding of clinical outcomes among youth. Very limited evidence exists on preventing progression of prediabetes. Some evidence suggests that a significant proportion of obese youth with prediabetes will revert to normoglycemia without pharmacological management. Evidence supports lifestyle modification for children with prediabetes, but further study of specific lifestyle changes and pharmacological treatments is needed. Conclusion: Evidence to guide management of prediabetes in children is limited. Current practice patterns of pediatric weight management programs show areas of variability in practice, reflecting the limited evidence base. More research is needed to guide clinical care for overweight youth with prediabetes. PMID:25055134

The management of menstrual suppression and uterine bleeding: a survey of current practices in the Pediatric Blood and Marrow Transplant Consortium.

PubMed

Adegite, Enitan A; Goyal, Rakesh K; Murray, Pamela J; Marshal, Mike; Sucato, Gina S

2012-09-01

Current guidelines recommend the use of combined hormonal contraceptive pills for menstrual suppression in pediatric blood and marrow transplant (BMT) recipients but recent research reveals that provider practice varies. This study was designed to describe the current practice for managing menstrual issues, that is, menstrual suppression and uterine bleeding, in pediatric BMT patients and to better understand health care providers' practices in the use of gonadotropin-releasing hormone agonists (GnRHa). A cross sectional survey consisting of 53 questions was distributed via email to principal investigators in the Pediatric Blood and Marrow Transplant Consortium (PBMTC). Responses were collected using www.surveymonkey.com. Menstrual suppression and uterine bleeding in pediatric BMT patients are primarily managed by pediatric oncologists (97%). The most frequently reported hormonal method used for induction of therapeutic amenorrhea was GnRHa (41%). The top three reasons for choosing a method were greater likelihood of amenorrhea, concerns about side effects, and possible gonadal protection. Continuous combined hormonal contraceptive pills were the most commonly used method for the management of clinically significant uterine bleeding regardless of primary method used for menstrual suppression. Despite the 2002 PBMTC guidelines, wide variation in menstrual suppression management practices still exists. Our data show that use of GnRHa is more common than previously reported. Additional research is needed to develop evidence-based practice guidelines in pediatric BMT patients. Copyright © 2012 Wiley Periodicals, Inc.

Designing the role of the embedded care manager.

PubMed

Hines, Patricia; Mercury, Marge

2013-01-01

: The role of the professional case manager is changing rapidly. Health reform has called upon the industry to ensure that care is delivered in an efficient, effective, and high-quality and low cost manner. As a means to achieve this objective, health plans and health systems are moving the care manager out of a centralized location within their organizations to "embedding" them into physician offices. This move enables the care manager to work alongside the primary care physicians and their high-risk patients. This article discusses the framework for designing and implementing an embedded care manager role into a physician practice. Key elements of the program are discussed. IMPLICATIONS FOR CARE MANAGEMENT:: Historically care management has played a foundational role in improving the quality of care for individuals and populations via the efficient and effective use of resources. Now with the goals of health care reform, a successful transition from a volume-based to value-based reimbursement system requires primary care physicians to welcome care managers into their practices to improve patient care, quality, and costs through care coordination across health care settings and populations. : As patient-centered medical homes and integrated delivery systems formulate their plans for population health management, their efforts have included embedding a care manager in the primary practice setting. Having care managers embedded at the physician offices increases their ability to collaborate with the physician and their staff in the implementation and monitoring care plans for their patients. : Implementing an embedded care manager into an existing physician's practice requires the following:Although the embedded care manager is a highly evolving role, physician groups are beginning to realize the benefits from their care management collaborations. Examples cited include improved outreach and coordination, patient adherence to care plans, and improved quality of life.

Traceability of patient records usage: barriers and opportunities for improving user interface design and data management.

PubMed

Cruz-Correia, Ricardo; Lapão, Luís; Rodrigues, Pedro Pereira

2011-01-01

Although IT governance practices (like ITIL, which recommends on the use of audit logs for proper service level management) are being introduced in many Hospitals to cope with increasing levels of information quality and safety requirements, the standard maturity levels of hospital IT departments is still not enough to reach the level of frequent use of audit logs. This paper aims to address the issues related to the existence of AT in patient records, describe the Hospitals scenario and to produce recommendations. Representatives from four hospitals were interviewed regarding the use of AT in their Hospital IS. Very few AT are known to exist in these hospitals (average of 1 per hospital in an estimate of 21 existing IS). CIOs should to be much more concerned with the existence and maintenance of AT. Recommendations include server clock synchronization and using advanced log visualization tools.

Achieving organizational change in pediatric pain management

PubMed Central

Dowden, Stephanie; McCarthy, Maria; Chalkiadis, George

2008-01-01

BACKGROUND: Pain in hospitalized children is often under-treated. Little information exists to guide the process of organizational change with a view to improving pain management practices. OBJECTIVES: To describe the process and results of a hospital-wide review of pain management practices designed to identify deficiencies in service provision and recommend directions for change in a pediatric hospital. DESIGN: Prospective consultation of the clinical staff of a specialist pediatric hospital, using qualitative research methodology involving semistructured individual and group interviews. Recommendations based on the interview findings were made by a hospital-appointed working party. RESULTS: A total of 454 staff (27% of all clinical staff) from a variety of professional backgrounds, representing almost every hospital unit or department, were interviewed. Procedural and persistent (chronic) pain was identified as the area needing the most improvement. Barriers to improving pain management included variability in practice, outmoded beliefs and inadequate knowledge, factors which were seen to contribute to a culture of slow or no change. Recommendations of the working party and changes achieved after the review are described. CONCLUSION: The review process identified deficiencies in the management of pain in children, and barriers to its effective management. With institutional support, the present review has guided improvement. PMID:18719714

Health Care Waste Management Practice in Health Care Institutions of Nepal.

PubMed

Joshi, H D; Acharya, T; Ayer, R; Dhakal, P; Karki, K B; Dhimal, M

2017-01-01

Medical waste is considered as a major public health hazard. In a developing country like Nepal, there is much concern about the management practice of medical waste. This study aimed to assess Health Care Waste Management practice among Health Care Institutions in Nepal. A cross sectional study was carried out between July 2012 to June 2013 in 62 different Health Care Institutions, selected from stratified proportionate random sampling technique from all administrative regions of Nepal. A structured questionnaire and observation checklist were used for data collection. The waste generation rate is found significantly correlated with bed capacity, patient flow rate and annual budget spent in the hospital. It is found significantly higher in Teaching hospital than other Health Care Institutions of Nepal. An average of 3.3 kg/day/patient of medical waste (2.0 kg/day/patient non-hazardous and 1.0 kg/day/patient hazardous waste) was generated during the study period. Further, it was found that most of the Health care wastes were not disinfected before transportation to waste disposal sites. Very limited number of Health Care Institutions had conducted Environmental Assessment. Similarly, some of the Health Care Institutions had not followed Health care waste management guideline 2009 of Nepal Government. We found poor compliance of medical waste management practice as per existing legislation of Government of Nepal. Hence, additional effort is needed for improvement of Health care waste management practice at Health Care Institutions of Nepal.

Co-existence of agricultural production systems.

PubMed

Jank, Bernhard; Rath, Johannes; Gaugitsch, Helmut

2006-05-01

Strategies and best practices for the co-existence of GM and non-GM crops need to be developed and implemented with the participation of farmers and other stakeholders. According to the principle of 'subsidiarity', decisions should be made by the lowest authority possible. When applying this concept to the case of GM crops, the affected society should determine their use and management in a regional decision-making process. Public participation is better accomplished at a lower level, and democratic deficits in decision-making on GMOs are better resolved, enabling farmers to manage or avoid GM crops. Ultimately, voluntary GMO-free zones might be a tool for sustainable co-existence and GM-free production and GMO-free zones might create a specific image for marketing regional products and services, such as tourism.

Understanding the drivers of interprofessional collaborative practice among HIV primary care providers and case managers in HIV care programmes.

PubMed

Mavronicolas, Heather A; Laraque, Fabienne; Shankar, Arti; Campbell, Claudia

2017-05-01

Care coordination programmes are an important aspect of HIV management whose success depends largely on HIV primary care provider (PCP) and case manager collaboration. Factors influencing collaboration among HIV PCPs and case managers remain to be studied. The study objective was to test an existing theoretical model of interprofessional collaborative practice and determine which factors play the most important role in facilitating collaboration. A self-administered, anonymous mail survey was sent to HIV PCPs and case managers in New York City. An adapted survey instrument elicited information on demographic, contextual, and perceived social exchange (trustworthiness, role specification, and relationship initiation) characteristics. The dependent variable, perceived interprofessional practice, was constructed from a validated scale. A sequential block wise regression model specifying variable entry order examined the relative importance of each group of factors and of individual variables. The analysis showed that social exchange factors were the dominant drivers of collaboration. Relationship initiation was the most important predictor of interprofessional collaboration. Additional influential factors included organisational leadership support of collaboration, practice settings, and frequency of interprofessional meetings. Addressing factors influencing collaboration among providers will help public health programmes optimally design their structural, hiring, and training strategies to foster effective social exchanges and promote collaborative working relationships.

Social support and depression of adults with visual impairments.

PubMed

Papadopoulos, Konstantinos; Papakonstantinou, Doxa; Montgomery, Anthony; Solomou, Argyro

2014-07-01

Relatively little research exists with regard to the relationship between social support and depression among adults with visual impairments. Such a gap is noteworthy when one considers that individuals become more dependent on others as they enter middle and late adulthood. The present research will examine the association between social networks, social support and depression among adults with visual impairments. Seventy-seven adults with visual impairments participated in the study. Depression, social network and emotional/practical social support were measured with self-report measures. Additionally, the degree to which emotional/practical social support received were positive or negative and the ability of respondents to self-manage their daily living were assessed. Less than a third of respondents scored above the threshold for depressive symptoms. Depressive symptoms were not related to gender or vision status. Depression was correlated with age, educational level, less positive practical support, more negative practical support and more negative emotional support, with lower perceptions of self-management representing the most robust predictor of depression. Age moderated the relationship between depression and self-management, and between depression and negative emotional support. Lower perceptions of self-management and negative emotional support were significantly associated with depressive symptoms. Copyright © 2014 Elsevier Ltd. All rights reserved.

The impact of risk management practice upon the implementation of recovery-oriented care in community mental health services: a qualitative investigation.

PubMed

Holley, Jessica; Chambers, Mary; Gillard, Steven

2016-08-01

Recovery-oriented care has become guiding principle for mental health policies and practice in the UK and elsewhere. However, a pre-existing culture of risk management practice may impact upon the provision of recovery-oriented mental health services. To explore how risk management practice impacts upon the implementation of recovery-oriented care within community mental health services. Semi-structured interviews using vignettes were conducted with eight mental health worker and service user dyads. Grounded theory techniques were used to develop explanatory themes. Four themes arose: (1) recovery and positive risk taking; (2) competing frameworks of practice; (3) a hybrid of risk and recovery; (4) real-life recovery in the context of risk. In abstract responses to the vignettes, mental health workers described how they would use a positive-risk taking approach in support of recovery. In practice, this was restricted by a risk-averse culture embedded within services. Mental health workers set conditions with which service users complied to gain some responsibility for recovery. A lack of strategic guidance at policy level and lack of support and guidance at practice level may result in resistance to implementing ROC in the context of RMP. Recommendations are made for policy, training and future research.

Climate change, coral reef ecosystems, and management options for marine protected areas.

PubMed

Keller, Brian D; Gleason, Daniel F; McLeod, Elizabeth; Woodley, Christa M; Airamé, Satie; Causey, Billy D; Friedlander, Alan M; Grober-Dunsmore, Rikki; Johnson, Johanna E; Miller, Steven L; Steneck, Robert S

2009-12-01

Marine protected areas (MPAs) provide place-based management of marine ecosystems through various degrees and types of protective actions. Habitats such as coral reefs are especially susceptible to degradation resulting from climate change, as evidenced by mass bleaching events over the past two decades. Marine ecosystems are being altered by direct effects of climate change including ocean warming, ocean acidification, rising sea level, changing circulation patterns, increasing severity of storms, and changing freshwater influxes. As impacts of climate change strengthen they may exacerbate effects of existing stressors and require new or modified management approaches; MPA networks are generally accepted as an improvement over individual MPAs to address multiple threats to the marine environment. While MPA networks are considered a potentially effective management approach for conserving marine biodiversity, they should be established in conjunction with other management strategies, such as fisheries regulations and reductions of nutrients and other forms of land-based pollution. Information about interactions between climate change and more "traditional" stressors is limited. MPA managers are faced with high levels of uncertainty about likely outcomes of management actions because climate change impacts have strong interactions with existing stressors, such as land-based sources of pollution, overfishing and destructive fishing practices, invasive species, and diseases. Management options include ameliorating existing stressors, protecting potentially resilient areas, developing networks of MPAs, and integrating climate change into MPA planning, management, and evaluation.

Systematic review of recent dementia practice guidelines.

PubMed

Ngo, Jennifer; Holroyd-Leduc, Jayna M

2015-01-01

dementia is a highly prevalent acquired cognitive disorder that interferes with activities of daily living, relationships and quality of life. Recognition and effective management strategies are necessary to provide comprehensive care for these patients and their families. High-quality clinical practice guidelines can improve the quality and consistency of care in all aspects of dementia diagnosis and management by clarifying interventions supported by sound evidence and by alerting clinicians to interventions without proven benefit. we aimed to offer a synthesis of existing practice recommendations for the diagnosis and management of dementia, based upon moderate-to-high quality dementia guidelines. we performed a systematic search in EMBASE and MEDLINE as well as the grey literature for guidelines produced between 2008 and 2013. thirty-nine retrieved practice guidelines were included for quality appraisal by the Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool, performed by two independent reviewers. From the 12 moderate-to-high quality guidelines included, specific practice recommendations for the diagnosis and/or management of any aspect of dementia were extracted for comparison based upon the level of evidence and strength of recommendation. there was a general agreement between guidelines for many practice recommendations. However, direct comparisons between guidelines were challenging due to variations in grading schemes. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A state-wide survey of medical emergency management in dental practices: incidence of emergencies and training experience.

PubMed

Müller, M P; Hänsel, M; Stehr, S N; Weber, S; Koch, T

2008-05-01

Only a few data exist about the occurrence of emergencies in dental practice and the training experience of dental practice teams in life support. This study evaluates the incidence of emergencies in dental practices, the attitude of dentists towards emergency management and their training experience. Anonymous questionnaires were sent to all 2998 dentists listed in the Saxony State Dental Council Register in January 2005. 620 questionnaires were returned. 77% of the responders expressed an interest in emergency management and 84% stated that they owned an emergency bag. In the 12-month study period, 57% of the dentists reported up to 3 emergencies and 36% of the dentists reported up to 10 emergencies. Vasovagal syncope was the most frequent emergency (1238 cases). As two cardiac arrests occurred, it is estimated that one sudden cardiac arrest occurs per 638,960 patients in dental practice. 42 severe life-threatening events were reported in all 1,277,920 treated patients. 567 dentists (92%) took part in emergency training following graduation (23% participated once and 68% more than once). Medical emergencies are not rare in dental practice, although most of them are not life-threatening. Improvement of competence in emergency management should include repeated participation in life support courses, standardisation of courses and offering courses designed to meet the needs of dentists.

A review on effectiveness of best management practices in improving hydrology and water quality: Needs and opportunities.

PubMed

Liu, Yaoze; Engel, Bernard A; Flanagan, Dennis C; Gitau, Margaret W; McMillan, Sara K; Chaubey, Indrajeet

2017-12-01

Best management practices (BMPs) have been widely used to address hydrology and water quality issues in both agricultural and urban areas. Increasing numbers of BMPs have been studied in research projects and implemented in watershed management projects, but a gap remains in quantifying their effectiveness through time. In this paper, we review the current knowledge about BMP efficiencies, which indicates that most empirical studies have focused on short-term efficiencies, while few have explored long-term efficiencies. Most simulation efforts that consider BMPs assume constant performance irrespective of ages of the practices, generally based on anticipated maintenance activities or the expected performance over the life of the BMP(s). However, efficiencies of BMPs likely change over time irrespective of maintenance due to factors such as degradation of structures and accumulation of pollutants. Generally, the impacts of BMPs implemented in water quality protection programs at watershed levels have not been as rapid or large as expected, possibly due to overly high expectations for practice long-term efficiency, with BMPs even being sources of pollutants under some conditions and during some time periods. The review of available datasets reveals that current data are limited regarding both short-term and long-term BMP efficiency. Based on this review, this paper provides suggestions regarding needs and opportunities. Existing practice efficiency data need to be compiled. New data on BMP efficiencies that consider important factors, such as maintenance activities, also need to be collected. Then, the existing and new data need to be analyzed. Further research is needed to create a framework, as well as modeling approaches built on the framework, to simulate changes in BMP efficiencies with time. The research community needs to work together in addressing these needs and opportunities, which will assist decision makers in formulating better decisions regarding BMP implementation in watershed management projects. Copyright © 2017 Elsevier B.V. All rights reserved.

Building HR capability in health care organizations.

PubMed

Khatri, Naresh

2006-01-01

The current human resource (HR) management practices in health care are consistent with the industrial model of management. However, health care organizations are not factories. They are highly knowledge-intensive and service-oriented entities and thus require a different set of HR practices and systems to support them. Drawing from the resource-based theory, I argue that HRs are a potent weapon of competitive advantage for health care organizations and propose a five-dimensional conception of HR capability for harnessing HRs in health care organizations. The significant complementarities that exist between HRs and information technologies for delivering safer and better quality of patient care are also discussed.

Rice management interventions to mitigate greenhouse gas emissions: a review.

PubMed

Hussain, Saddam; Peng, Shaobing; Fahad, Shah; Khaliq, Abdul; Huang, Jianliang; Cui, Kehui; Nie, Lixiao

2015-03-01

Global warming is one of the gravest threats to crop production and environmental sustainability. Rice, the staple food of more than half of the world's population, is the most prominent cause of greenhouse gas (GHG) emissions in agriculture and gives way to global warming. The increasing demand for rice in the future has deployed tremendous concerns to reduce GHG emissions for minimizing the negative environmental impacts of rice cultivation. In this review, we presented a contemporary synthesis of existing data on how crop management practices influence emissions of GHGs in rice fields. We realized that modifications in traditional crop management regimes possess a huge potential to overcome GHG emissions. We examined and evaluated the different possible options and found that modifying tillage permutations and irrigation patterns, managing organic and fertilizer inputs, selecting suitable cultivar, and cropping regime can mitigate GHG emissions. Previously, many authors have discussed the feasibility principle and the influence of these practices on a single gas or, in particular, in the whole agricultural sector. Nonetheless, changes in management practices may influence more than one gas at the same time by different mechanisms or sometimes their effects may be antagonistic. Therefore, in the present attempt, we estimated the overall global warming potential of each approach to consider the magnitude of its effects on all gases and provided a comprehensive assessment of suitable crop management practices for reducing GHG emissions in rice culture.

Managing Intermountain rangelands - improvement of range and wildlife habitats: proceedings; 1981 September 15-17; Twin Falls, ID; 1982 June 22-24; Elko, NV

Treesearch

Stephen B. Monsen; Nancy Shaw

1983-01-01

The proceedings summarizes recent research and existing literature pertaining to the restoration and management of game and livestock ranges in the Intermountain Region. Improved plant materials and planting practices are emphasized. The series of 28 papers was presented at the Restoration of Range and Wildlife Habitat Training Sessions held in Twin Falls, Idaho,...

Smart Practices In Building Interorganizational Collaborative Capacity to Strengthen the Florida Comprehensive Disaster Management Enterprise

DTIC Science & Technology

2011-12-01

private company , homeland security and disaster response affects most organizations and networks of people at specific periods of their existence...Preparedness and Assistance Trust Fund, due to controversy over a $2.00 assessment on homeowners’ insurance policies and a $4.00 assessment on commercial...fuel management strategies while taking into consideration rules for traffic safety, insurance and liability factors, right-of-ways and land

EFO-LCI: A New Life Cycle Inventory Database of Forestry Operations in Europe

NASA Astrophysics Data System (ADS)

Cardellini, Giuseppe; Valada, Tatiana; Cornillier, Claire; Vial, Estelle; Dragoi, Marian; Goudiaby, Venceslas; Mues, Volker; Lasserre, Bruno; Gruchala, Arkadiusz; Rørstad, Per Kristian; Neumann, Mathias; Svoboda, Miroslav; Sirgmets, Risto; Näsärö, Olli-Pekka; Mohren, Frits; Achten, Wouter M. J.; Vranken, Liesbet; Muys, Bart

2018-06-01

Life cycle assessment (LCA) has become a common methodology to analyze environmental impacts of forestry systems. Although LCA has been widely applied to forestry since the 90s, the LCAs are still often based on generic Life Cycle Inventory (LCI). With the purpose of improving LCA practices in the forestry sector, we developed a European Life Cycle Inventory of Forestry Operations (EFO-LCI) and analyzed the available information to check if within the European forestry sector national differences really exist. We classified the European forests on the basis of "Forest Units" (combinations of tree species and silvicultural practices). For each Forest Unit, we constructed the LCI of their forest management practices on the basis of a questionnaire filled out by national silvicultural experts. We analyzed the data reported to evaluate how they vary over Europe and how they affect LCA results and made freely available the inventory data collected for future use. The study shows important variability in rotation length, type of regeneration, amount and assortments of wood products harvested, and machinery used due to the differences in management practices. The existing variability on these activities sensibly affect LCA results of forestry practices and raw wood production. Although it is practically unfeasible to collect site-specific data for all the LCAs involving forest-based products, the use of less generic LCI data of forestry practice is desirable to improve the reliability of the studies. With the release of EFO-LCI we made a step toward the construction of regionalized LCI for the European forestry sector.

EFO-LCI: A New Life Cycle Inventory Database of Forestry Operations in Europe.

PubMed

Cardellini, Giuseppe; Valada, Tatiana; Cornillier, Claire; Vial, Estelle; Dragoi, Marian; Goudiaby, Venceslas; Mues, Volker; Lasserre, Bruno; Gruchala, Arkadiusz; Rørstad, Per Kristian; Neumann, Mathias; Svoboda, Miroslav; Sirgmets, Risto; Näsärö, Olli-Pekka; Mohren, Frits; Achten, Wouter M J; Vranken, Liesbet; Muys, Bart

2018-06-01

Life cycle assessment (LCA) has become a common methodology to analyze environmental impacts of forestry systems. Although LCA has been widely applied to forestry since the 90s, the LCAs are still often based on generic Life Cycle Inventory (LCI). With the purpose of improving LCA practices in the forestry sector, we developed a European Life Cycle Inventory of Forestry Operations (EFO-LCI) and analyzed the available information to check if within the European forestry sector national differences really exist. We classified the European forests on the basis of "Forest Units" (combinations of tree species and silvicultural practices). For each Forest Unit, we constructed the LCI of their forest management practices on the basis of a questionnaire filled out by national silvicultural experts. We analyzed the data reported to evaluate how they vary over Europe and how they affect LCA results and made freely available the inventory data collected for future use. The study shows important variability in rotation length, type of regeneration, amount and assortments of wood products harvested, and machinery used due to the differences in management practices. The existing variability on these activities sensibly affect LCA results of forestry practices and raw wood production. Although it is practically unfeasible to collect site-specific data for all the LCAs involving forest-based products, the use of less generic LCI data of forestry practice is desirable to improve the reliability of the studies. With the release of EFO-LCI we made a step toward the construction of regionalized LCI for the European forestry sector.

A Systematic Review of Collaboration and Network Research in the Public Affairs Literature: Implications for Public Health Practice and Research

PubMed Central

Shoup, Jo Ann; Miller, Sara

2012-01-01

Objectives. We explored and analyzed how findings from public affairs research can inform public health research and practice, specifically in the area of interorganizational collaboration, one of the most promising practice-based approaches in the public health field. Methods. We conducted a systematic review of the public affairs literature by following a grounded theory approach. We coded 151 articles for demographics and empirical findings (n = 258). Results. Three primary findings stand out in the public affairs literature: network structure affects governance, management strategies exist for administrators, and collaboration can be linked to outcomes. These findings are linked to priorities in public health practice. Conclusions. Overall, we found that public affairs has a long and rich history of research in collaborations that offers unique organizational theory and management tools to public health practitioners. PMID:22021311

Multimodal evaluation and management of children with concussion: using our heads and available evidence.

PubMed

Gioia, Gerard A

2015-01-01

Significant attention has been focused on concussions in children, but a dearth of research evidence exists supporting clinical evaluation and management. The primary objective of this review paper is to describe a multimodal, developmentally adapted, standardized concussion assessment and active rehabilitation approach for children as young as 5 years old. This study reviews the CDC-funded research programme, including the development of tools for post-concussion symptom assessment involving the child and parent, measurement of specific neurocognitive functions and assessment of dynamic cognitive exertional effects. A clinical approach to active, individualized, moderated concussion rehabilitation management is presented, including a 10-step guide to symptom management, with a specific focus on the school challenges faced by the recovering student. To better inform concussion practice across the developmental age spectrum, a significant need exists for further research evidence to refine clinical assessment methods and develop effective treatment approaches.

Multimodal Evaluation and Management of Children with Concussion: Using our heads and available evidence

PubMed Central

Gioia, Gerard A.

2015-01-01

Significant attention has been focused on concussions in children but a dearth of research evidence exists supporting clinical evaluation and management. The primary objective of this review paper is to describe a multimodal, developmentally adapted, standardized concussion assessment and active rehabilitation approach for children as young as age five. We review our CDC-funded research program including the development of tools for post-concussion symptom assessment involving the child and parent, measurement of specific neurocognitive functions, and assessment of dynamic cognitive exertional effects. A clinical approach to active, individualized, moderated concussion rehabilitation management is presented, including a ten step guide to symptom management, with a specific focus on the school challenges faced by the recovering student. To better inform concussion practice across the developmental age spectrum, a significant need exists for further research evidence to refine our clinical assessment methods and develop effective treatment approaches. PMID:25356518

Loin Pain Haematuria Syndrome - A Narrative Review of Pain Management Strategies

PubMed Central

2016-01-01

Loin pain haematuria syndrome (LPHS) is an uncommon clinical entity that has divided renal physicians, pain practitioners, and even psychiatrists since its initial description. A relative paucity of data exists regarding the condition, with best practice guidelines lacking amid the existing threads of anecdotal experiences and variable follow-up observations. The aim of this article was to review the cumulative published experience of pain relief strategies for LPHS. PMID:27103962

Practice Patterns of Speech-Language Pathologists in Pediatric Vocal Health.

PubMed

Hartley, Naomi A; Braden, Maia; Thibeault, Susan L

2017-05-17

The purpose of this study was to investigate current practices of speech-language pathologists (SLPs) in the management of pediatric vocal health, with specific analysis of the influence of clinical specialty and workplace setting on management approaches. American Speech-Language-Hearing Association-certified clinicians providing services within the United States (1%-100% voice caseload) completed an anonymous online survey detailing clinician demographics; employment location and service delivery models; approaches to continuing professional development; and specifics of case management, including assessment, treatment, and discharge procedures. Current practice patterns were analyzed for 100 SLPs (0-42 years of experience; 77 self-identifying as voice specialists) providing services in 34 U.S. states across a range of metropolitan and nonmetropolitan workplace settings. In general, SLPs favored a multidisciplinary approach to management; included perceptual, instrumental, and quality of life measures during evaluation; and tailored intervention to the individual using a combination of therapy approaches. In contrast with current practice guidelines, only half reported requiring an otolaryngology evaluation prior to initiating treatment. Both clinical specialty and workplace setting were found to affect practice patterns. SLPs in school settings were significantly less likely to consider themselves voice specialists compared with all other work environments. Those SLPs who considered themselves voice specialists were significantly more likely to utilize voice-specific assessment and treatment approaches. SLP practice largely mirrors current professional practice guidelines; however, potential exists to further enhance client care. To ensure that SLPs are best able to support children in successful communication, further research, education, and advocacy are required.

An evidence-based approach to case management model selection for an acute care facility: is there really a preferred model?

PubMed

Terra, Sandra M

2007-01-01

This research seeks to determine whether there is adequate evidence-based justification for selection of one acute care case management model over another. Acute Inpatient Hospital. This article presents a systematic review of published case management literature, resulting in classification specific to terms of level of evidence. This review examines the best available evidence in an effort to select an acute care case management model. Although no single case management model can be identified as preferred, it is clear that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and to form a foundation for the efficacy of hospital case management practice. Although no single case management model can be identified as preferred, this systematic review demonstrates that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and forming a foundation for the efficacy of hospital case management practice. Distinctive aspects of case management frameworks can be used to guide the development of an acute care case management model. The study illustrates: * The effectiveness of case management when there is direct patient contact by the case manager regardless of disease condition: not only does the quality of care increase but also length of stay (LOS) decreases, care is defragmented, and both patient and physician satisfaction can increase. * The preferred case management models result in measurable outcomes that can directly relate to, and demonstrate alignment with, organizational strategy. * Acute care management programs reduce cost and LOS, and improve outcomes. * An integrated case management program that includes social workers, as well as nursing, is the most effective acute care management model. * The successful case management model will recognize physicians, as well as patients, as valued customers with whom partnership can positively affect financial outcomes in terms of reduction in LOS, improvement in quality, and delivery of care.

Optimization of greenhouse gas emissions in second-hand consumer product recovery through reuse platforms.

PubMed

Fortuna, Lorena M; Diyamandoglu, Vasil

2017-08-01

Product reuse in the solid waste management sector is promoted as one of the key strategies for waste prevention. This practice is considered to have favorable impact on the environment, but its benefits have yet to be established. Existing research describes the perspective of "avoided production" only, but has failed to examine the interdependent nature of reuse practices within an entire solid waste management system. This study proposes a new framework that uses optimization to minimize the greenhouse gas emissions of an integrated solid waste management system that includes reuse strategies and practices such as reuse enterprises, online platforms, and materials exchanges along with traditional solid waste management practices such as recycling, landfilling, and incineration. The proposed framework uses material flow analysis in combination with an optimization model to provide the best outcome in terms of GHG emissions by redistributing product flows in the integrated solid waste management system to the least impacting routes and processes. The optimization results provide a basis for understanding the contributions of reuse to the environmental benefits of the integrated solid waste management system and the exploration of the effects of reuse activities on waste prevention. A case study involving second-hand clothing is presented to illustrate the implementation of the proposed framework as applied to the material flow. Results of the case study showed the considerable impact of reuse on GHG emissions even for small replacement rates, and helped illustrate the interdependency of the reuse sector with other waste management practices. One major contribution of this study is the development of a framework centered on product reuse that can be applied to identify the best management strategies to reduce the environmental impact of product disposal and to increase recovery of reusable products. Copyright © 2017 Elsevier Ltd. All rights reserved.

Healthcare waste generation and management practice in government health centers of Addis Ababa, Ethiopia.

PubMed

Tadesse, Menelik Legesse; Kumie, Abera

2014-11-25

Healthcare wastes are hazardous organic and inorganic wastes. The waste disposal management in Addis Ababa city is seen unscientific manner. The waste management practice in the health facilities are poor and need improvement. This study will help different organizations, stakeholders and policy makers to correct and improve the existing situation of healthcare waste legislation and enforcement and training of staff in the healthcare facilities in Addis Ababa. The study aimed to assess the existing generation and management practice of healthcare waste in selected government health centers of Addis Ababa. The cross-sectional study was conducted to quantify waste generation rate and evaluate its management system. The study area was Addis Ababa. The sample size was determined by simple random sampling technique, the sampling procedure involved 10 sub-cities of Addis Ababa. Data were collected using both waste collecting and measuring equipment and check list. The Data was entered by EPI INFO version 6.04d and analyzed by and SPSS for WINDOW version15. The mean (±SD) healthcare waste generation rate was 9.61 ± 3.28 kg/day of which (38%) 3.64 ± 1.45 kg/day was general or non-hazardous waste and (62%) 5.97 ± 2.31 kg/day was hazardous. The mean healthcare waste generation rate between health centers was a significant different with Kurskal-Wallis test (χ2 = 21.83, p-value = 0.009). All health centers used safety boxes for collection of sharp wastes and all health centers used plastic buckets without lid for collection and transportation of healthcare waste. Pre treatment of infectious wastes was not practiced by any of the health centers. All health centers used incinerators and had placenta pit for disposal of pathological waste however only seven out of ten pits had proper covering material. Segregation of wastes at point of generation with appropriate collection materials and pre- treatment of infectious waste before disposal should be practiced. Training should be given to healthcare workers and waste handlers. Incinerators must be constructed in a manner that facilitates complete combustion and the lining of placenta pit should be constructed in water tight material.

The Use of Cannabis for Headache Disorders

PubMed Central

Lochte, Bryson C.; Beletsky, Alexander; Samuel, Nebiyou K.; Grant, Igor

2017-01-01

Abstract Headache disorders are common, debilitating, and, in many cases, inadequately managed by existing treatments. Although clinical trials of cannabis for neuropathic pain have shown promising results, there has been limited research on its use, specifically for headache disorders. This review considers historical prescription practices, summarizes the existing reports on the use of cannabis for headache, and examines the preclinical literature exploring the role of exogenous and endogenous cannabinoids to alter headache pathophysiology. Currently, there is not enough evidence from well-designed clinical trials to support the use of cannabis for headache, but there are sufficient anecdotal and preliminary results, as well as plausible neurobiological mechanisms, to warrant properly designed clinical trials. Such trials are needed to determine short- and long-term efficacy for specific headache types, compatibility with existing treatments, optimal administration practices, as well as potential risks. PMID:28861505

Cyber physical systems based on cloud computing and internet of things for energy efficiency

NASA Astrophysics Data System (ADS)

Suciu, George; Butca, Cristina; Suciu, Victor; Cretu, Alexandru; Fratu, Octavian

2016-12-01

Cyber Physical Systems (CPS) and energy efficiency play a major role in the context of industry expansion. Management practices for improving efficiency in the field of energy consumption became a priority of many major industries who are inefficient in terms of exploitation costs. The effort of adopting energy management means in an organization is quite challenging due to the lack of resources and expertise. One major problem consists in the lack of knowledge for energy management and practices. This paper aims to present authors' concept in creating a Cyber Physical Energy System (CPES) that will change organizations' way of consuming energy, by making them aware of their use. The presented concept will consider the security of the whole system and the easy integration with the existing electric network infrastructure.

SNL Mechanical Computer Aided Design (MCAD) guide 2007.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moore, Brandon; Pollice, Stephanie L.; Martinez, Jack R.

2007-12-01

This document is considered a mechanical design best-practice guide to new and experienced designers alike. The contents consist of topics related to using Computer Aided Design (CAD) software, performing basic analyses, and using configuration management. The details specific to a particular topic have been leveraged against existing Product Realization Standard (PRS) and Technical Business Practice (TBP) requirements while maintaining alignment with sound engineering and design practices. This document is to be considered dynamic in that subsequent updates will be reflected in the main title, and each update will be published on an annual basis.

15 CFR 292.3 - Technical tools, techniques, practices, and analyses projects.

Code of Federal Regulations, 2011 CFR

2011-01-01

... understanding of existing organizations and resources relevant to the proposed project; adequate linkages and... the governing or managing organization to conduct the proposed activities; qualifications of the... objective. The purpose of these projects is to support the initial development, implementation, and analysis...

A synthesis of the "state-of-the-practice for advancing planning and operations integration opportunities within transportation agencies" : [summary].

DOT National Transportation Integrated Search

2014-12-01

Federal law requires that metropolitan transportation plans include operations and : management strategies to improve the performance of existing roads, relieve congestion, : and maximize the safety and mobility of people and cargo. Transportation op...

Curriculum: Managed Visual Reality.

ERIC Educational Resources Information Center

Gueulette, David G.

This paper explores the association between the symbolized and the actualized, beginning with the prehistoric notion of a "reality double," in which no practical difference exists between pictorial representations, visual symbols, and real-life events and situations. Alchemists of the Middle Ages, with their paradoxical vision of the…

The effectiveness of collaborative care for people with memory problems in primary care: results of the CAREDEM case management modelling and feasibility study.

PubMed

Iliffe, Steve; Waugh, Amy; Poole, Marie; Bamford, Claire; Brittain, Katie; Chew-Graham, Carolyn; Fox, Chris; Katona, Cornelius; Livingston, Gill; Manthorpe, Jill; Steen, Nick; Stephens, Barbara; Hogan, Vanessa; Robinson, Louise

2014-08-01

People with dementia and their families need support in different forms, but currently services are often fragmented with variable quality of care. Case management offers a way of co-ordinating services along the care pathway and therefore could provide individualised support; however, evidence of the effectiveness of case management for dementia is inconclusive. To adapt the intervention used in a promising case management project in the USA and test its feasibility and acceptability in English general practice. In work package 1, a design group of varied professionals, with a carer and staff from the voluntary sector, met six times over a year to identify the skills and personal characteristics required for case management; protocols from the US study were adapted for use in the UK. The feasibility of recruiting general practices and patient-carer dyads and of delivering case management were tested in a pilot study (work package 2). An embedded qualitative study explored stakeholder views on study procedures and case management. Four general practices, two in the north-east of England (Newcastle) one in London and one in Norfolk, took part in a feasibility pilot study of case management. Community-dwelling people with dementia and their carers who were not already being case managed by other services. A social worker shared by the two practices in the north-east and practice nurses in the other two practices were trained to deliver case management. We aimed to recruit 11 people with dementia from each practice who were not already being case managed. Numbers of people with dementia and their carers recruited, numbers and content of contacts, needs identified and perceptions of case management among stakeholders. Recruitment of practices and patients was slow and none of the practices achieved its recruitment target. It took more than 6 months to recruit a total of 28 people with dementia. Practice Quality and Outcome Framework registers for dementia contained only 60% of the expected number of people, most living in care homes. All stakeholders were positive about the potential of case management; however, only one of the four practices achieved a level of case management activity that might have influenced patient and carer outcomes. Case managers' activity levels were not related solely to time available for case management. Delivery of case management was hindered by limited clarity about the role, poor integration with existing services and a lack of embeddedness within primary care. There were discrepancies between case manager and researcher judgements about need, and evidence of a high threshold for acting on unmet need. The practice nurses experienced difficulties in ring-fencing case management time. The model of case management developed and evaluated in this feasibility study is unlikely to be sustainable in general practice under current conditions and in our view it would not be appropriate to attempt a definitive trial of this model. This study could inform the development of a case management role with a greater likelihood of impact. Different approaches to recruiting and training case managers, and identifying people with dementia who might benefit from case management, are needed, as is exploration of the scale of need for this type of working. Current Controlled Trials ISRCTN74015152. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 52. See the NIHR Journals Library website for further project information.

The economics of central billing offices.

PubMed

Woodcock, E; Nguyen, L

2000-01-01

The anticipation of economies of scale in physician billing has led many medical practices to consolidate their billing operations. This article analyzes these economies of scale, comparing performance indicators from centralized and decentralized operations. While consolidation provides compliance, control and information, diseconomies of scale can exist in the centralized receivables management process. The authors conclude that physician practices should consider a hybrid approach to billing, thus reaping the benefits of both centralization and decentralization.

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

PubMed

Kislov, Roman; Walshe, Kieran; Harvey, Gill

2012-10-15

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

Application of A Mobile Platform-based System for the Management of Fundus Diease in Outpatient Settings.

PubMed

Dend, Xun; Li, Hong-Yan; Yin, Hong; Liang, Jian-Hong; Chen, Yi; Li, Xiao-Xin; Zhao, Ming-Wei

2016-08-01

Objective To evaluate the application of a mobile platform-based system in the management of fundus disease in outpatient settings. Methods In the outpatient departments of fundus disease,premature babies requiring eye examination under general anesthesia and adults requiring intraocular surgery were enrolled as the subjects. According to the existing clinical practices,we developed a system that met the requirements of clinical practices and optimized the clinical management. Based on the FileMaker database,the tablet computers were used as the mobile platform and the system could also be run in iPad and PC terminals.Results Since 2013,the system recorded 7500 cases of special examinations. Since July 2015,4100 cases of intravitreal drug injection were also recored in the system. Multiple-point and real-time reservation pattern increased the efficiency and opimize the clinical management. All the clinical data were digitalized. Conclusion The mobile platform-based system can increase the efficacy of examination and other clinical processes and standardize data collection;thus,it is feasible for the clinical practices in outpatient departments of ophthalmology.

Persistent barriers and strategic practices: why (asking about) the everyday matters in diabetes care.

PubMed

Rendle, Katharine A S; May, Suepattra G; Uy, Visith; Tietbohl, Caroline K; Mangione, Carol M; Frosch, Dominick L

2013-01-01

The purpose of this study was to explore the everyday barriers to and practices of low-income patients managing their diabetes. The study team conducted semistructured qualitative interviews with 20 patients with type 2 diabetes who were receiving care at safety-net clinics in Southern California. Transcripts were analyzed using grounded theory to identify emergent themes across participants. Participants described managing diabetes with limited financial resources as often a game of balance and negotiation, whereby purchasing healthy foods is abandoned because of a more pressing concern in their life. Although participants described strategic attempts at incorporating healthy dietary practices for diabetes management into their daily decisions, these efforts were significantly impeded by the existence of persistent and seemingly insurmountable barriers. Although the challenges that low-income patients face in managing their diabetes may seem insurmountable at times, there are several ways that health care providers can help reduce the burden of these challenges, including tailoring their recommendations to incorporate the everyday socioeconomic environment of patients and engaging in clear, open communication with patients.

Caught between the global economy and local bureaucracy: the barriers to good waste management practice in South Africa.

PubMed

Godfrey, Linda; Scott, Dianne; Trois, Cristina

2013-03-01

Empirical research shows that good waste management practice in South Africa is not always under the volitional control of those tasked with its implementation. While intention to act may exist, external factors, within the distal and proximal context, create barriers to waste behaviour. In addition, these barriers differ for respondents in municipalities, private industry and private waste companies. The main barriers to implementing good waste management practice experienced by respondents in municipalities included insufficient funding for waste management and resultant lack of resources; insufficient waste knowledge; political interference in decision-making; a slow decision-making process; lack of perceived authority to act by waste staff; and a low priority afforded to waste. Barriers experienced by respondents in private industry included insufficient funding for waste and the resultant lack of resources; insufficient waste knowledge; and government bureaucracy. Whereas, barriers experienced in private waste companies included increasing costs; government bureaucracy; global markets; and availability of waste for recycling. The results suggest that respondents in public and private waste organizations are subject to different structural forces that shape, enable and constrain waste behaviour.

Evaluation of GIS Technology in Assessing and Modeling Land Management Practices

NASA Technical Reports Server (NTRS)

Archer, F.; Coleman, T. L.; Manu, A.; Tadesse, W.; Liu, G.

1997-01-01

There is an increasing concern of land owners to protect and maintain healthy and sustainable agroecosystems through the implementation of best management practices (BMP). The objectives of this study were: (1) To develop and evaluate the use of a Geographic Information System (GIS) technology for enhancing field-scale management practices; (2) evaluate the use of 2-dimensional displays of the landscape and (3) define spatial classes of variables from interpretation of geostatistical parameters. Soil samples were collected to a depth of 2 m at 15 cm increments. Existing data from topographic, land use, and soil survey maps of the Winfred Thomas Agricultural Research Station were converted to digital format. Additional soils data which included texture, pH, and organic matter were also generated. The digitized parameters were used to create a multilayered field-scale GIS. Two dimensional (2-D) displays of the parameters were generated using the ARC/INFO software. The spatial distribution of the parameters evaluated in both fields were similar which could be attributed to the similarity in vegetation and surface elevation. The ratio of the nugget to total semivariance, expressed as a percentage, was used to assess the degree of spatial variability. The results indicated that most of the parameters were moderate spatially dependent Biophysical constraint maps were generated from the database layers, and used in multiple combination to visualize results of the BMP. Understanding the spatial relationships of physical and chemical parameters that exists within a field should enable land managers to more effectively implement BMP to ensure a safe and sustainable environment.

Michigan Oncology Medical Home Demonstration Project: First-Year Results.

PubMed

Kuntz, Gordon; Tozer, Jane; Snegosky, Jeff; Fox, John; Neumann, Kurt

2014-03-01

The Michigan Oncology Medical Home Demonstration Project (MOMHDP) is an innovative multipractice oncology medical home model, supported by payment reform. Sponsored by Priority Health, Physician Resource Management, and ION Solutions, MOMHDP includes four oncology practices and 29 physicians. Oncology practices used existing technologies, with MOMHDP providing evidence-based treatment guideline selection and compliance tracking, automated physician order entry, a patient portal, symptom management/standardized nurse triage, and advance care planning. To support changes in care and administrative models and to focus on quality, MOMHDP modifies provider payments. The program replaces the average sales price payment methodology with a drug acquisition reimbursement plus a care management fee, calculated to increase total drug reimbursement. Additionally, it reimburses for chemotherapy and treatment planning and advance care planning consultation. There is also a shared savings opportunity. MOMHDP will be enhanced in its second year to include a survivorship program, patient distress screening, imaging guidelines, and standardized patient satisfaction surveys. Priority Health patients receiving chemotherapy for a cancer diagnosis were recruited to the program. Results for this group were compared with a control group of patients from a prior period. In addition to the financial results, the project also accomplished the following: (1) adherence to practice-selected guidelines, (2) institution of advance care planning, (3) effective and standardized symptom management; and (4) payment reform. We have identified a number of critical success factors: strong payer/provider collaboration built on trust through transparent use and cost data; timing of clinical standardization must come from the practices, so they can effectively absorb new approaches; having comprehensive, written program documentation and consistently applied training facilitate practice understanding; existing, off-the-shelf technologies help control costs; independent clinical, administrative, and technical coordination improves provider/payer collaboration; everything takes longer than anticipated, including practice commitment, contracting, and technology implementation. Practices are willing to take on clinical standardization with payment reform. Neither practice size nor technology platform variation was a barrier to participation or success in the project. These results represent preliminary reporting from the first multipractice oncology medical home in the United States, to our knowledge, with payer support that includes payment reform. The results are promising, and the concept warrants further study, review, and reporting. [Table: see text].

Status of Neonatal Pain Assessment and Management in Jordan.

PubMed

Abdel Razeq, Nadin M; Akuma, Akuma O; Jordan, Sue

2016-08-01

Current pain assessment and management in neonates need to be fully described before neonatal pain care can be optimized. This study's purpose was to report neonatal nurses' knowledge, existing pain assessment practice, and pharmacological pain management of neonates in Jordan. A cross-sectional descriptive study was conducted. Eighteen neonatal intensive care units in Jordan were included in the study. One hundred eighty-four neonatal nurses participated. Questionnaires were distributed by and returned to the neonatal intensive care units' managers between June and August 2014. Descriptive and inferential statistics were used to present study results. Of 240 questionnaires distributed, 184 useable responses were returned. Nurses' knowledge regarding neonates' neurological development, nociception, and need for neonatal pain management was suboptimal. The analgesics most commonly used to treat neonatal pain were acetaminophen (52%) and lidocaine (45%). Benzodiazepines, phenobarbitone, and muscles relaxants were also used. Most nurses (54%-97%) reported that pain emanating from most painful procedures was never or rarely treated. Circumcision, lumbar punctures, and chest tube insertion were assigned the highest pain scores (≥9), but were rarely accompanied by analgesia. Pain assessment scales were more likely to be used, and procedural pain was more likely to be treated, in private hospitals than public hospitals. Neonates who require special care still suffer unnecessary pain that could be avoided and managed by following best practice recommendations. Disparities between developed and developing countries in quality of neonatal pain care appear to exist. Resources for education and routine care are needed to address these discrepancies. Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Backcasting to identify food waste prevention and mitigation opportunities for infant feeding in maternity services.

PubMed

Ryan-Fogarty, Yvonne; Becker, Genevieve; Moles, Richard; O'Regan, Bernadette

2017-03-01

Food waste in hospitals is of major concern for two reasons: one, healthcare needs to move toward preventative and demand led models for sustainability and two, food system sustainability needs to seek preventative measures such as diet adaptation and waste prevention. The impact of breast-milk substitute use on health services are well established in literature in terms of healthcare implications, cost and resourcing, however as a food demand and waste management issue little has been published to date. This paper presents the use of a desk based backcasting method to analyse food waste prevention, mitigation and management options within the Irish Maternity Service. Best practice in healthcare provision and waste management regulations are used to frame solutions. Strategic problem orientation revealed that 61% of the volume of ready to use breast-milk substitutes purchased by maternity services remains unconsumed and ends up as waste. Thirteen viable strategies to prevent and manage this waste were identified. Significant opportunities exist to prevent waste and also decrease food demand leading to both positive health and environmental outcomes. Backcasting methods display great promise in delivering food waste management strategies in healthcare settings, especially where evidenced best practice policies exist to inform solution forming processes. In terms of food waste prevention and management, difficulties arise in distinguishing between demand reduction, waste prevention and waste reduction measures under the current Waste Management Hierarchy definitions. Ultimately demand reduction at source requires prioritisation, a strategy which is complimentary to health policy on infant feeding. Copyright © 2016 Elsevier Ltd. All rights reserved.

The stakeholder preference for best management practices in the Three Gorges Reservoir Region.

PubMed

Qiu, Jiali; Shen, Zhenyao; Chen, Lei; Xie, Hui; Sun, Chengchun; Huang, Qin

2014-11-01

A qualitative analysis of in-depth interviews with 92 farmers and 42 policy managers in Wuxi County, the Three Gorges Reservoir Region, was conducted to identify stakeholder preferences for alternative best management practices (BMPs) and to determine the factors that affect their acceptance. Policy manager support for most of the practices was relatively stronger than support by farmers, except for the grade stabilization structure (GSS), hillside ditch (HD) and constructed wetland alternative, owing to their perceptions of soil benefits, economic advantages and environmental advantages. Farmers opposed those practices that occupied cultivated lands or changed the conventional planting methods, such as field border, conservation tillage (CT) and contour buffer strips. They tended to accept the BMPs with off-farm pollution reduction, such as GSS, riparian forest buffer and HD, and the BMPs associated with soil benefits, such as nutrient management and Terrace. The result that almost all respondents did not accept CT differed from reports in the existing literature. There is a significant correlation between the acceptance of some BMPs and the townships where the farmers lived (P ≤ 0.05). The environmental conditions and social factors would affect farmer support for BMPs, including local soil conditions, farming methods, economic income, education level and age. The economic advantages of the BMPs were the main motivation for farmers to accept the practices. Furthermore, intensive education efforts, financial incentives or economic subsidies may promote the adoption of the BMPs in our study area.

The Stakeholder Preference for Best Management Practices in the Three Gorges Reservoir Region

NASA Astrophysics Data System (ADS)

Qiu, Jiali; Shen, Zhenyao; Chen, Lei; Xie, Hui; Sun, Chengchun; Huang, Qin

2014-11-01

A qualitative analysis of in-depth interviews with 92 farmers and 42 policy managers in Wuxi County, the Three Gorges Reservoir Region, was conducted to identify stakeholder preferences for alternative best management practices (BMPs) and to determine the factors that affect their acceptance. Policy manager support for most of the practices was relatively stronger than support by farmers, except for the grade stabilization structure (GSS), hillside ditch (HD) and constructed wetland alternative, owing to their perceptions of soil benefits, economic advantages and environmental advantages. Farmers opposed those practices that occupied cultivated lands or changed the conventional planting methods, such as field border, conservation tillage (CT) and contour buffer strips. They tended to accept the BMPs with off-farm pollution reduction, such as GSS, riparian forest buffer and HD, and the BMPs associated with soil benefits, such as nutrient management and Terrace. The result that almost all respondents did not accept CT differed from reports in the existing literature. There is a significant correlation between the acceptance of some BMPs and the townships where the farmers lived ( P ≤ 0.05). The environmental conditions and social factors would affect farmer support for BMPs, including local soil conditions, farming methods, economic income, education level and age. The economic advantages of the BMPs were the main motivation for farmers to accept the practices. Furthermore, intensive education efforts, financial incentives or economic subsidies may promote the adoption of the BMPs in our study area.

[Health insurance dentists' subjective perceptions of quality when implementing quality management in practice - results from a nationwide survey].

PubMed

Kettler, Nele; Chenot, Regine; Jordan, A Rainer

2015-01-01

Statutory health insurance dentists working in private practice have a duty to maintain and improve the quality of dental care. An individual practice's approach to quality management (QM) can be made to reflect the practice's philosophy on quality and standards and can be adapted to the specific requirements of the practice setting they are meant to serve. This study set out to collect data on the subjective perceptions of quality that exist among German dentists, and to canvass their views on the process and benefits of implementing QM systems. In doing so, this study aimed to identify the incentives and obstacles that currently exist in relation to the implementation and further development of practice-based QM systems. As part of a nationally representative cross-sectional study, a random sample of 2,084 dentists was asked to complete a questionnaire on perceptions of quality and QM. The response rate was 40.3 % (n=838). The study's primary end point was defined as the surveyed dentists' interpretative description of quality. The study's secondary end point was defined as the dentists' subjective evaluations of the benefits of QM in the day-to-day management of their own practices. Responses to open-ended questions were analysed using content analysis, while quantitative questions were analysed using descriptive univariate analysis. When analysing respondents' subjective perceptions of quality (primary end point), the following dimensions were revealed as highly significant: patient (mentioned by 31.4 % of the responders), quality of treatment (29.5 %) and staff (14.8 %). As far as the benefits of QM in the day-to-day management of the respondent's own practices (secondary end point) were concerned, these appeared to be linked to the ease of implementation of the organizational tools offered by QM systems: managing emergencies, team meetings and procedural check lists were ranked as "can be implemented to a reasonable degree" and "can be fully implemented" by 82.3 %, 80.2 % and 79.9 % of respondents, respectively. There appeared to be a disconnect between the respondents' subjective perceptions of quality and the benefits of QM as part of day-to-day practice management, with QM systems failing to reflect the respondents' subjective views on quality. The perceptions of QM among German statutory health insurance dentists are generally positive but marked by a disconnect between aspects of quality currently measured by QM systems and the dentists' views on what is required in order to assess quality standards in relation to the dimensions "patient", "quality of treatment" and "staff". A targeted review of the tools offered by QM systems may lead to improved ease of implementation. If QM is to form an integral part of clinical practice, all future developments need to consider the dentists' subjective perceptions of quality and their attitudes towards QM. Copyright © 2015. Published by Elsevier GmbH.

Clinical Practices in Collegiate Concussion Management.

PubMed

Baugh, Christine M; Kroshus, Emily; Stamm, Julie M; Daneshvar, Daniel H; Pepin, Michael J; Meehan, William P

2016-06-01

In recent years, sports leagues and sports medicine experts have developed guidelines for concussion management. The extent to which current clinical practice is consistent with guideline recommendations is unclear. At the collegiate level, there have been few examinations of concussion management practices and the extent to which meaningful differences across divisions of competition exist. The purposes of this study were to (1) examine current practices in concussion diagnosis and management at National Collegiate Athletic Association (NCAA) member colleges, (2) explore the extent to which current practices reflect current recommendations for concussion diagnosis and management, and (3) determine whether there are differences in management patterns across divisions of competition. Descriptive epidemiology study. An electronic questionnaire was sent to sports medicine clinicians at all NCAA member colleges during September and October 2013. Clinicians were asked about baseline assessments, diagnosis and management practices, return-to-play protocols, the perceived prevalence of underdiagnosis, and basic demographic information. Approximately 30% (n = 866) of contacted clinicians, representing nearly 50% (n = 527) of NCAA member colleges, responded to the questionnaire. Preparticipation baseline examinations were administered at the majority of schools (95%), but most (87.5%) administered baseline assessments only to selected high-risk athletes. Computerized neurocognitive testing and balance assessments were most commonly used as preseason baseline and postinjury assessments. Multimodal examination in line with NCAA and other guidance was used only at a minority of institutions. Athletic trainers most commonly administered and interpreted the preseason baseline examination. Most clinicians reported that their institutions' practices were in line with NCAA guidelines during the first 24 hours of an athlete's concussion diagnosis, with exact percentages varying across measures. Differences across divisions of competition included shorter return-to-play time at Division I schools than Division III schools (9.13 vs 10.31 days, respectively) and more frequently referring concussed athletes to a physician within 24 hours of diagnosis at Division I schools. Concussion management at many colleges in the United States incorporates elements recommended by current guidelines; however, there is room to improve. Increasing the use of a multimodal baseline and postinjury examination will elevate the concussion care provided to college athletes and better align with best practice guidance. © 2016 The Author(s).

Restoring longleaf pine (Pinus palustris Mill.) in loblolly pine (Pinus taeda L.) stands: Effects of restoration treatments on natural loblolly pine regeneration

Treesearch

Ben Knapp; Wang Geoff; Huifeng Hu; Joan Walker; Carsyn Tennant

2011-01-01

Historical land use and management practices in the southeastern United States have resulted in the dominance of loblolly pine on many upland sites that historically were occupied by longleaf pine. There is currently much interest in restoring high quality longleaf pine habitats to such areas, but managers may also desire the retention of some existing canopy trees to...

Managing Change in Organizations: A View of Centralization within the Department of Defense.

DTIC Science & Technology

1981-05-01

proposals themselves. Centralization decisions do not involve adding or subtracting tangible elements of existing defense programs. More subtly, a merger or...appropriate action that iust be taken to. reestablish supply support ’ 23 after unexpected disruptions (e.g., normal acquisition practices are useless when...March 1979. 2. Arbose, J. R., "Electrolux’s Quiet Acquisition Rampage", International Management, Vol 35, February 1980, pp 14-16. 3. Atkinson, Scott

30 CFR 585.105 - What are my responsibilities under this part?

Code of Federal Regulations, 2014 CFR

2014-07-01

...? 585.105 Section 585.105 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE RENEWABLE ENERGY AND ALTERNATE USES OF EXISTING FACILITIES ON THE OUTER CONTINENTAL SHELF... practicable; and take measures to prevent unauthorized discharge of pollutants including marine trash and...

30 CFR 585.105 - What are my responsibilities under this part?

Code of Federal Regulations, 2013 CFR

2013-07-01

...? 585.105 Section 585.105 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE RENEWABLE ENERGY AND ALTERNATE USES OF EXISTING FACILITIES ON THE OUTER CONTINENTAL SHELF... practicable; and take measures to prevent unauthorized discharge of pollutants including marine trash and...

30 CFR 585.105 - What are my responsibilities under this part?

Code of Federal Regulations, 2012 CFR

2012-07-01

...? 585.105 Section 585.105 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE RENEWABLE ENERGY AND ALTERNATE USES OF EXISTING FACILITIES ON THE OUTER CONTINENTAL SHELF... practicable; and take measures to prevent unauthorized discharge of pollutants including marine trash and...

Valuation of Online Continuing Medical Education and Telemedicine in Taiwan

ERIC Educational Resources Information Center

Wang, Fuhmei

2008-01-01

Physicians have acknowledged information technology (IT) efficiency and now utilize it in their professional practice and patient management. The benefits of IT within the health care environment has received academic attention, however existing literature currently pertains to limited areas, including the financial effects of telemedicine…

15 CFR 784.5 - Subsidiary arrangements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... subsidiary arrangement—(1) Purpose. If requested by the location or deemed necessary by the U.S. Government... purpose of such an arrangement is to establish procedures for conducting managed access at a specific... extent practicable. The existence of a location-specific subsidiary arrangement does not in any way limit...

15 CFR 784.5 - Subsidiary arrangements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... subsidiary arrangement—(1) Purpose. If requested by the location or deemed necessary by the U.S. Government... purpose of such an arrangement is to establish procedures for conducting managed access at a specific... extent practicable. The existence of a location-specific subsidiary arrangement does not in any way limit...

Ethics in Government: A National Survey of Public Administrators.

ERIC Educational Resources Information Center

Bowman, James S.

1990-01-01

Presents the results of a national survey of 750 practicing government managers regarding ethics in government and society, integrity in public agencies, and moral standards in organizational conduct. The 441 respondents agree that a compelling need exists for guidance in addressing ethical conduct in government. (JOW)

Linking departmental priorities to knowledge management: the experiences of Santa Cruz County's Human Services Department.

PubMed

Lindberg, Arley

2012-01-01

Federal welfare reform, local service collaborations, and the evolution of statewide information systems inspired agency interest in evidence-informed practice and knowledge sharing systems. Four agency leaders, including the Director, Deputy Director, Director of Planning and Evaluation, and Staff Development Program Manager championed the development of a learning organization based on knowledge management throughout the agency. Internal department restructuring helped to strengthen the Planning and Evaluation, Staff Development, and Personnel units, which have become central to supporting knowledge sharing activities. The Four Pillars of Knowledge framework was designed to capture agency directions in relationship to future knowledge management goals. Featuring People, Practice, Technology and Budget, the framework links the agency's services, mission and goals to the process of becoming a learning organization. Built through an iterative process, the framework was created by observing existing activities in each department rather than being designed from the top down. Knowledge management can help the department to fulfill its mission despite reduced resources. Copyright © Taylor & Francis Group, LLC

Healthcare waste management in Asia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Prem Ananth, A.; Prashanthini, V.; Visvanathan, C., E-mail: visu@ait.ac.t

The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper placesmore » recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties - budget support, developing policies and legislation and technology and knowledge management.« less

Medicare managed care. How physicians can make it better.

PubMed

Roggin, G M

1997-12-01

The federal government is attempting to control anticipated, increased Medicare health care costs by providing the senior population with incentives to encourage their movement into managed care programs. For-profit corporate HMOs that currently dominate the managed care arena are coming under increased competitive pressure at a time when their perception of profiteering is undergoing increased public scrutiny. If physicians are to take advantage of this window of opportunity and successfully enter the Medicare managed care marketplace, they must identify the major deficiencies existing in the current model, and fashion a new product that divests itself of the profit orientation of current corporate HMOs. A nonprofit version of a highly integrated, multispecialty provider service organization (PSO) provides an appropriate model to effectively compete with the corporate HMO. The ideal physician-controlled managed care model must: develop a responsive policy board structure; create practice guidelines that decrease variation in physician practice; achieve an appropriate balance between primary and specialty medical care; and adopt a quality-assurance program that effectively addresses both process and outcome data.

Healthcare waste management in Asia.

PubMed

Ananth, A Prem; Prashanthini, V; Visvanathan, C

2010-01-01

The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper places recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties - budget support, developing policies and legislation and technology and knowledge management.

Management of first-episode pelvic inflammatory disease in primary care: results from a large UK primary care database.

PubMed

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

2010-10-01

Prompt and effective treatment of pelvic inflammatory disease (PID) may help prevent long-term complications. Many PID cases are seen in primary care but it is not known how well management follows recommended guidelines. To estimate the incidence of first-episode PID cases seen in UK general practice, describe their management, and assess its adequacy in relation to existing guidelines. Cohort study. UK general practices contributing to the General Practice Research Database (GPRD). Women aged 15 to 40 years, consulting with a first episode of PID occurring between 30 June 2003 and 30 June 2008 were identified, based on the presence of a diagnostic code. The records within 28 days either side of the diagnosis date were analysed to describe management. A total of 3797 women with a first-ever coded diagnosis of PID were identified. Incidence fell during the study period from 19.3 to 8.9/10 000 person-years. Thirty-four per cent of cases had evidence of care elsewhere, while 2064 (56%) appeared to have been managed wholly within the practice. Of these 2064 women, 34% received recommended treatment including metronidazole, and 54% had had a Chlamydia trachomatis test, but only 16% received both. Management was more likely to follow guidelines in women in their 20s, and later in the study period. These analyses suggest that the management of PID in UK primary care, although improving, does not follow recommended guidelines for the majority of women. Further research is needed to understand the delivery of care in general practice and the coding of such complex syndromic conditions.

The Challenges and Recommendations for Gestational Diabetes Mellitus Care in India: A Review

PubMed Central

Morampudi, Suman; Balasubramanian, Gayathri; Gowda, Arun; Zomorodi, Behsad; Patil, Anand Shanthanagowd

2017-01-01

Gestational diabetes mellitus (GDM) is a primary concern in India affecting approximately five million women each year. Existing literature indicate that prediabetes and diabetes affect approximately six million births in India alone, of which 90% are due to GDM. Studies reveal that there is no consensus among physicians and health-care providers in India regarding management of GDM prepartum and postpartum despite available guidelines. Also, there is no consensus among physicians as to when a woman should undergo oral glucose tolerance test after delivery. This clearly shows that management of GDM is challenging and controversial in India due to conflicting guidelines and treatment protocols, despite availability of straightforward protocols for screening and management. Also, a collaborative approach remains a key for GDM management, as patient compliance and proper educational interventions promote better pregnancy outcomes. Management of GDM plays a pivotal role, as women with GDM have an increased chance of developing diabetes mellitus 5–10 years after pregnancy. Also, children born in GDM pregnancies face an increased risk for obesity and type 2 diabetes. The cornerstone for the management of GDM is glycemic control and quality nutritional intake. GDM management is complex in India, and existing challenges are multifactorial. However, there are little published data outlining these challenges. This review gives an account of some of the key challenges from self-management and health-care provider perspective. The recommendations in this review provide insights for building a more structured model for GDM care in India. This research has several practical applications. First, it points out to reaching a consensus on approaches for screening, diagnosis, and treatment of care across clinical practices in the nation that can aid in overcoming certain challenges observed. Second, it highlights the importance to build capacities and capabilities, especially in resource-limited settings. Health education among pregnant women remains a priority to resolve issues related to self-management. More broadly, further research, specifically qualitative is vital to determine forthcoming challenges with respect to patients, caregivers, providers, and policy makers and to provide solutions fitted to practice setting and demographic background. PMID:28392778

Designing healthcare information technology to catalyse change in clinical care.

PubMed

Lester, William T; Zai, Adrian H; Grant, Richard W; Chueh, Henry C

2008-01-01

The gap between best practice and actual patient care continues to be a pervasive problem in our healthcare system. Efforts to improve on this knowledge-performance gap have included computerised disease management programs designed to improve guideline adherence. However, current computerised reminder and decision support interventions directed at changing physician behaviour have had only a limited and variable effect on clinical outcomes. Further, immediate pay-for-performance financial pressures on institutions have created an environment where disease management systems are often created under duress, appended to existing clinical systems and poorly integrated into the existing workflow, potentially limiting their real-world effectiveness. The authors present a review of disease management as well as a conceptual framework to guide the development of more effective health information technology (HIT) tools for translating clinical information into clinical action.

Barriers and enablers to good communication and information-sharing practices in care planning for chronic condition management.

PubMed

Lawn, Sharon; Delany, Toni; Sweet, Linda; Battersby, Malcolm; Skinner, Timothy

2015-01-01

Our aim was to document current communication and information-sharing practices and to identify the barriers and enablers to good practices within the context of care planning for chronic condition management. Further aims were to make recommendations about how changes to policy and practice can improve communication and information sharing in primary health care. A mixed-method approach was applied to seek the perspectives of patients and primary health-care workers across Australia. Data was collected via interviews, focus groups, non-participant observations and a national survey. Data analysis was performed using a mix of thematic, discourse and statistical approaches. Central barriers to effective communication and information sharing included fragmented communication, uncertainty around client and interagency consent, and the unacknowledged existence of overlapping care plans. To be most effective, communication and information sharing should be open, two-way and inclusive of all members of health-care teams. It must also only be undertaken with the appropriate participant consent, otherwise this has the potential to cause patients harm. Improvements in care planning as a communication and information-sharing tool may be achieved through practice initiatives that reflect the rhetoric of collaborative person-centred care, which is already supported through existing policy in Australia. General practitioners and other primary care providers should operationalise care planning, and the expectation of collaborative and effective communication of care that underpins it, within their practice with patients and all members of the care team. To assist in meeting these aims, we make several recommendations.

Research support for effective state and community tobacco control programme response to electronic nicotine delivery systems

PubMed Central

Schmitt, Carol L; Lee, Youn Ok; Curry, Laurel E; Farrelly, Matthew C; Rogers, Todd

2014-01-01

Objective To identify unmet research needs of state and community tobacco control practitioners pertaining to electronic nicotine delivery systems (ENDS or e-cigarettes) that would inform policy and practice efforts at the state and community levels, and to describe ENDS-related research and dissemination activities of the National Cancer Institute-funded State and Community Tobacco Control Research Initiative. Methods To determine specific research gaps relevant to state and community tobacco control practice, we analysed survey data collected from tobacco control programmes (TCPs) in all 50 US states and the District of Columbia (N=51). Survey items covered a range of ENDS issues: direct harm to users, harm of secondhand vapour, cessation, flavours, constituents and youth access. Results There is no ENDS topic on which a majority of state TCP managers feel very informed. They feel least informed about harms of secondhand vapour while also reporting that this information is among the most important for their programme. A majority (N=31) of respondents indicated needs for research on the implications of ENDS products for existing policies. Conclusions TCP managers report that ENDS research is highly important for practice and need research-based information to inform decision making around the inclusion of ENDS in existing tobacco control policies. For optimal relevance to state and community TCPs, research on ENDS should prioritise study of the health effects of ENDS use and secondhand exposure to ENDS vapour in the context of existing tobacco control policies. PMID:24935899

Healthcare waste management practice in the West Black Sea Region, Turkey: A comparative analysis with the developed and developing countries.

PubMed

Ciplak, Nesli; Kaskun, Songul

2015-12-01

The need for proper healthcare waste management has been a crucial issue in many developing countries as it is in Turkey. The regulation regarding healthcare wastes in Turkey was updated in 2005 in accordance with the European Union (EU) waste directives, but it still falls behind meeting the requirements of current waste treatment technologies. Therefore, this study aims to reveal deficiencies, inconsistencies, and improper applications of healthcare waste management in the western part of the Turkish Black Sea Region. In this study, it was revealed that nearly 1 million people live in the region, resulting in 5 million hospital admissions annually. All the healthcare waste produced (1000 tons yr(-1)) is treated in an autoclave plant. However, treating some categories of healthcare wastes in autoclave units mismatches with the EU waste regulations, as alternative treatment technologies are not technically able to treat all types of healthcare wastes. A proper waste management system, therefore, requires an internal segregation scheme to divert these wastes from the main healthcare waste stream. The existing malpractice in the region could cause serious health problems if no measure is taken urgently. It is expected that healthcare waste management in the region and then all across Turkey will be improved with the significant deficiencies and inconsistencies pointed out in this research. In developed countries, specific rules and regulations have already been implemented along with the recommendations for handling of healthcare waste. However, in Turkey, these wastes are treated in autoclave units, which mismatches with the European Union waste regulations, as alternative treatment technologies are not technically capable to treat all types of healthcare wastes. The existing malpractice could cause serious health problems if no measure is taken urgently. The authors demonstrated the existing status of Turkish waste management and revealed deficiencies, inconsistencies, and improper applications in comparison with developed and developing nations to align Turkish practice to European Union requirements.

A Novel Approach to Improving Utilization of Laboratory Testing.

PubMed

Zhou, Yaolin; Procop, Gary W; Riley, Jacquelyn D

2018-02-01

- The incorporation of best practice guidelines into one's institution is a challenging goal of utilization management, and the successful adoption of such guidelines depends on institutional context. Laboratorians who have access to key clinical data are well positioned to understand existing local practices and promote more appropriate laboratory testing. - To apply a novel approach to utilization management by reviewing international clinical guidelines and current institutional practices to create a reliable mechanism to improve detection and reduce unnecessary tests in our patient population. - We targeted a frequently ordered genetic test for HFE-related hereditary hemochromatosis, a disorder of low penetrance. After reviewing international practice guidelines, we evaluated 918 HFE tests and found that all patients with new diagnoses had transferrin saturation levels that were significantly higher than those of patients with nonrisk genotypes (72% versus 42%; P < .001). - Our "one-button" order that restricts HFE genetic tests to patients with transferrin saturation greater than 45% is consistent with published practice guidelines and detected 100% of new patients with HFE-related hereditary hemochromatosis. - Our proposed algorithm differs from previously published approaches in that it incorporates both clinical practice guidelines and local physician practices, yet requires no additional hands-on effort from pathologists or clinicians. This novel approach to utilization management embraces the role of pathologists as leaders in promoting high-quality patient care in local health care systems.

Development of a web-based toolkit to support improvement of care coordination in primary care.

PubMed

Ganz, David A; Barnard, Jenny M; Smith, Nina Z Y; Miake-Lye, Isomi M; Delevan, Deborah M; Simon, Alissa; Rose, Danielle E; Stockdale, Susan E; Chang, Evelyn T; Noël, Polly H; Finley, Erin P; Lee, Martin L; Zulman, Donna M; Cordasco, Kristina M; Rubenstein, Lisa V

2018-05-23

Promising practices for the coordination of chronic care exist, but how to select and share these practices to support quality improvement within a healthcare system is uncertain. This study describes an approach for selecting high-quality tools for an online care coordination toolkit to be used in Veterans Health Administration (VA) primary care practices. We evaluated tools in three steps: (1) an initial screening to identify tools relevant to care coordination in VA primary care, (2) a two-clinician expert review process assessing tool characteristics (e.g. frequency of problem addressed, linkage to patients' experience of care, effect on practice workflow, and sustainability with existing resources) and assigning each tool a summary rating, and (3) semi-structured interviews with VA patients and frontline clinicians and staff. Of 300 potentially relevant tools identified by searching online resources, 65, 38, and 18 remained after steps one, two and three, respectively. The 18 tools cover five topics: managing referrals to specialty care, medication management, patient after-visit summary, patient activation materials, agenda setting, patient pre-visit packet, and provider contact information for patients. The final toolkit provides access to the 18 tools, as well as detailed information about tools' expected benefits, and resources required for tool implementation. Future care coordination efforts can benefit from systematically reviewing available tools to identify those that are high quality and relevant.

Business training and education needs of chiropractors.

PubMed

Henson, Steve W; Pressley, Milton; Korfmann, Scott

2008-01-01

This report is an examination of the perceived need for business skills among chiropractors. An online survey was completed by 64 chiropractors. They assessed the need for business skills and current levels of business skills. Using this information, gaps in business skills are identified. The need for business skills is broad, encompassing all major business functions. Existing business skills are well below needed levels. The chiropractic profession needs significantly greater business and practice management skills. The existing gap between needed business skills and existing skills suggests that current training and education programs are not providing adequate business skills training.

Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial.

PubMed

Crowley, Matthew J; Edelman, David; McAndrew, Ann T; Kistler, Susan; Danus, Susanne; Webb, Jason A; Zanga, Joseph; Sanders, Linda L; Coffman, Cynthia J; Jackson, George L; Bosworth, Hayden B

2016-05-01

Telemedicine-based diabetes management improves outcomes versus clinic care but is seldom implemented by healthcare systems. In order to advance telemedicine-based management as a practical option for veterans with persistent poorly controlled diabetes mellitus (PPDM) despite clinic-based care, we evaluated a comprehensive telemedicine intervention that we specifically designed for delivery using existing Veterans Health Administration (VHA) clinical staffing and equipment. We conducted a 6-month randomized trial among 50 veterans with PPDM; all maintained hemoglobin A1c (HbA1c) levels continuously >9.0% for >1 year despite clinic-based management. Participants received usual care or a telemedicine intervention combining telemonitoring, medication management, self-management support, and depression management; existing VHA clinical staff delivered the intervention. Using linear mixed models, we examined HbA1c, diabetes self-care (measured by the Self-Care Inventory-Revised questionnaire), depression, and blood pressure. At baseline, the model-estimated common HbA1c intercept was 10.5%. By 6 months, estimated HbA1c had improved by 1.3% for intervention participants and 0.3% for usual care (estimated difference, -1.0%, 95% confidence interval [CI], -2.0%, 0.0%; p = 0.050). Intervention participants' diabetes self-care (estimated difference, 7.0; 95% CI, 0.1, 14.0; p = 0.047), systolic blood pressure (-7.7 mm Hg; 95% CI, -14.8, -0.6; p = 0.035), and diastolic blood pressure (-5.6 mm Hg; 95% CI, -9.9, -1.2; p = 0.013) were improved versus usual care by 6 months. Depressive symptoms were similar between groups. A comprehensive telemedicine intervention improved outcomes among veterans with PPDM despite clinic-based care. Because we specifically designed this intervention with scalability in mind, it may represent a practical, real-world strategy to reduce the burden of poor diabetes control among veterans.

Practical guidelines for managing adults with 22q11.2 deletion syndrome

PubMed Central

Fung, Wai Lun Alan; Butcher, Nancy J.; Costain, Gregory; Andrade, Danielle M.; Boot, Erik; Chow, Eva W.C.; Chung, Brian; Cytrynbaum, Cheryl; Faghfoury, Hanna; Fishman, Leona; García-Miñaúr, Sixto; George, Susan; Lang, Anthony E.; Repetto, Gabriela; Shugar, Andrea; Silversides, Candice; Swillen, Ann; van Amelsvoort, Therese; McDonald-McGinn, Donna M.; Bassett, Anne S.

2015-01-01

22q11.2 Deletion syndrome (22q11.2DS) is the most common microdeletion syndrome in humans, estimated to affect up to 1 in 2,000 live births. Major features of this multisystem condition include congenital anomalies, developmental delay, and an array of early- and later-onset medical and psychiatric disorders. Advances in pediatric care ensure a growing population of adults with 22q11.2DS. Informed by an international panel of multidisciplinary experts and a comprehensive review of the existing literature concerning adults, we present the first set of guidelines focused on managing the neuropsychiatric, endocrine, cardiovascular, reproductive, psychosocial, genetic counseling, and other issues that are the focus of attention in adults with 22q11.2DS. We propose practical strategies for the recognition, evaluation, surveillance, and management of the associated morbidities. PMID:25569435

Scale effects of STATSGO and SSURGO databases on flow and water quality predictions

USDA-ARS?s Scientific Manuscript database

Soil information is one of the crucial inputs needed to assess the impacts of existing and alternative agricultural management practices on water quality. Therefore, it is important to understand the effects of spatial scale at which soil databases are developed on water quality evaluations. In the ...

Rainwater collection and management from roofs at the Edison Environmental Center

EPA Science Inventory

In the past, the EPA’s Edison Environmental Center, a 200 acre federal run facility, directed all rainwater from roofed areas to the existing stormwater conveyance system. Over the last several years, modifications have been made to the practice of discharging stormwater to the e...

Longitudinal Variability in Streamwater Chemistry and Carbon and Nitrogen Fluxes in Restored and Degraded Urban Stream Networks

EPA Science Inventory

Stream restoration has increasingly been used as a best management practice for improving water quality in urbanizing watersheds, yet few data exist to assess restoration effectiveness. This study examined the longitudinal patterns in carbon and nitrogen concentrations and mass ...

Practice and Repetition during Exam Preparation in Blended Learning Courses: Correlations with Learning Results

ERIC Educational Resources Information Center

Andergassen, Monika; Mödritscher, Felix; Neumann, Gustaf

2014-01-01

Learner-centric research on factors influencing learning results has focused, among other things, on student characteristics, demographic data, and usage patterns in learning management systems (LMSs). This paper complements the existing research by investigating potential correlations between learning results and LMS usage during exam…

Bringing Context out of the Shadows of Leadership

ERIC Educational Resources Information Center

Hallinger, Philip

2018-01-01

Research on educational leadership and management has resulted in the accumulation of increasingly persuasive findings concerning the impact school leadership can have on school performance. Indeed, there is a growing consensus that there exists a generic set of leadership practices (e.g. goal setting, developing people) which must be adapted to…

Effectiveness and costs of overland skid trail BMPs

Treesearch

Clay Sawyers; W. Michael Aust; M. Chad Bolding; William A. Lakel III

2012-01-01

Forestry Best Management Practices (BMPs) are designed to protect water quality; however, little data exists comparing the efficacy and costs of different BMP options for skid trail closure. Study objectives were to evaluate erosion control effectiveness and implementation costs of five overland skid trail closure techniques. Closure techniques were: waterbar only (...

A new framework for modeling decentralized low impact developments using Soil and Water Assessment Tool

USDA-ARS?s Scientific Manuscript database

Assessing the performance of Low Impact Development (LID) practices at a catchment scale is important in managing urban watersheds. Few modeling tools exist that are capable of explicitly representing the hydrological mechanisms of LIDs while considering the diverse land uses of urban watersheds. ...

The effects of disproportional load contributions on quantifying vegetated filter strip sediment trapping efficiencies

USDA-ARS?s Scientific Manuscript database

Vegetated filter strips (VFSs) are a best management practice (BMP) commonly implemented adjacent to row-cropped fields to trap overland transport of sediment and other constituents present in agricultural runoff. Although they have been widely adopted, insufficient data exist to understand their sh...

40 CFR Table 1 to Subpart Cccccc... - Applicability Criteria and Management Practices for Gasoline Dispensing Facilities With Monthly...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Gallons of Gasoline or More If you own or operate Then you must 1. A new, reconstructed, or existing GDF... fill tube is used, it shall be provided with a submerged drop tube that extends the same distance from...

43 CFR 2653.5 - Cemetery sites and historical places.

Code of Federal Regulations, 2011 CFR

2011-10-01

... create no valid existing right, they operate to segregate the land from all other forms of appropriation... demonstrably enduring symbolic value in the traditions and cultural beliefs and practices of Alaskan Indians... place, the Bureau of Land Management shall segregate from all other appropriation under the public land...

The BGR Contingency Model for Leading Change

ERIC Educational Resources Information Center

Brown, Derek R.; Gordon, Raymond; Rose, Dennis Michael

2012-01-01

The continuing failure rates of change initiatives, combined with an increasingly complex business environment, have created significant challenges for the practice of change management. High failure rates suggest that existing change models are not working, or are being incorrectly used. A different mindset to change is required. The BGR…

Evaluating sustainable water quality management in the U.S.: Urban, Agricultural, and Environmental Protection Practices

NASA Astrophysics Data System (ADS)

van Oel, P. R.; Alfredo, K. A.; Russo, T. A.

2015-12-01

Sustainable water management typically emphasizes water resource quantity, with focus directed at availability and use practices. When attention is placed on sustainable water quality management, the holistic, cross-sector perspective inherent to sustainability is often lost. Proper water quality management is a critical component of sustainable development practices. However, sustainable development definitions and metrics related to water quality resilience and management are often not well defined; water quality is often buried in large indicator sets used for analysis, and the policy regulating management practices create sector specific burdens for ensuring adequate water quality. In this research, we investigated the methods by which water quality is evaluated through internationally applied indicators and incorporated into the larger idea of "sustainability." We also dissect policy's role in the distribution of responsibility with regard to water quality management in the United States through evaluation of three broad sectors: urban, agriculture, and environmental water quality. Our research concludes that despite a growing intention to use a single system approach for urban, agricultural, and environmental water quality management, one does not yet exist and is even hindered by our current policies and regulations. As policy continues to lead in determining water quality and defining contamination limits, new regulation must reconcile the disparity in requirements for the contaminators and those performing end-of-pipe treatment. Just as the sustainable development indicators we researched tried to integrate environmental, economic, and social aspects without skewing focus to one of these three categories, policy cannot continue to regulate a single sector of society without considering impacts to the entire watershed and/or region. Unequal distribution of the water pollution burden creates disjointed economic growth, infrastructure development, and policy enactment across the sectors preventing a holistic approach to water quality management and, thus, rendering our system unsustainable.

Water resources management in the Ganges Basin: a comparison of three strategies for conjunctive use of groundwater and surface water

USGS Publications Warehouse

Khan, Mahfuzur R.; Voss, Clifford I.; Yu, Winston; Michael, Holly A.

2014-01-01

The most difficult water resources management challenge in the Ganges Basin is the imbalance between water demand and seasonal availability. More than 80 % of the annual flow in the Ganges River occurs during the 4-month monsoon, resulting in widespread flooding. During the rest of the year, irrigation, navigation, and ecosystems suffer because of water scarcity. Storage of monsoonal flow for utilization during the dry season is one approach to mitigating these problems. Three conjunctive use management strategies involving subsurface water storage are evaluated in this study: Ganges Water Machine (GWM), Pumping Along Canals (PAC), and Distributed Pumping and Recharge (DPR). Numerical models are used to determine the efficacy of these strategies. Results for the Indian State of Uttar Pradesh (UP) indicate that these strategies create seasonal subsurface storage from 6 to 37 % of the yearly average monsoonal flow in the Ganges exiting UP over the considered range of conditions. This has clear implications for flood reduction, and each strategy has the potential to provide irrigation water and to reduce soil waterlogging. However, GWM and PAC require significant public investment in infrastructure and management, as well as major shifts in existing water use practices; these also involve spatially-concentrated pumping, which may induce land subsidence. DPR also requires investment and management, but the distributed pumping is less costly and can be more easily implemented via adaptation of existing water use practices in the basin.

Post-treatment management options for patients with lung cancer.

PubMed Central

Virgo, K S; McKirgan, L W; Caputo, M C; Mahurin, D M; Chao, L C; Caputo, N A; Naunheim, K S; Flye, M W; Gillespie, K N; Johnson, F E

1995-01-01

OBJECTIVES: The first objective was to identify variations in patient management practice patterns after potentially curative lung cancer surgery. Patient management practice patterns were expected to range from intensive follow-up to no active surveillance. The second objective was to measure whether intensity of follow-up was related to patient outcomes. METHODS: An 18-month retrospective analysis was conducted of 182 patients with low TNM stage (< or = IIIA) lung cancer who were surgically treated with curative intent over the 11-year period from 1982 through 1992 at the St. Louis Department of Veterans Affairs Medical Center. RESULTS: Patients were followed for a mean of 3.3 years, until death or the end of the study. Analyses of diagnostic test and outpatient visit frequency distributions and cluster analyses facilitated the identification of 62 nonintensively followed patients and 120 intensively followed patients. Both groups were comparable at baseline, and there were no significant differences in patient outcomes attributable to intensity of follow-up. Intensively followed patients did, however, live an average of 192 days longer than nonintensively followed patients. CONCLUSIONS: Significant variations in follow-up practice patterns can exist within a single health care facility. In this analysis, variations in test and visit frequency did not result in statistically significant differences in patient outcomes, though the survival difference between groups suggests that some benefit might exist. Only well-designed prospective trials are likely to answer the question of what constitutes optimal follow-up after potentially curative lung cancer treatment. PMID:8526576

Developing a business-practice model for pharmacy services in ambulatory settings.

PubMed

Harris, Ila M; Baker, Ed; Berry, Tricia M; Halloran, Mary Ann; Lindauer, Kathleen; Ragucci, Kelly R; McGivney, Melissa Somma; Taylor, A Thomas; Haines, Stuart T

2008-02-01

A business-practice model is a guide, or toolkit, to assist managers and clinical pharmacy practitioners in the exploration, proposal, development and implementation of new clinical pharmacy services and/or the enhancement of existing services. This document was developed by the American College of Clinical Pharmacy Task Force on Ambulatory Practice to assist clinical pharmacy practitioners and administrators in the development of business-practice models for new and existing clinical pharmacy services in ambulatory settings. This document provides detailed instructions, examples, and resources on conducting a market assessment and a needs assessment, types of clinical services, operations, legal and regulatory issues, marketing and promotion, service development and exit plan, evaluation of service outcomes, and financial considerations in the development of a clinical pharmacy service in the ambulatory environment. Available literature is summarized, and an appendix provides valuable citations and resources. As ambulatory care practices continue to evolve, there will be increased knowledge of how to initiate and expand the services. This document is intended to serve as an essential resource to assist in the growth and development of clinical pharmacy services in the ambulatory environment.

Les programmes revises: Amenagement forestier, interpretation theatrale. Avis a la ministre de l'Enseignement superieur et de la Science (Revised Programs: Forest Management, Theater Arts. Advisory to the Minister of Higher Education and Science).

ERIC Educational Resources Information Center

Conseil des Colleges, Quebec (Quebec).

This two-part report contains an analyses conducted by the Council of Colleges, in Quebec, of proposed revisions to programs in Forestry Management and Theater Arts offered by the province's public colleges. First, the report considers existing and proposed forestry programs in terms of their relationship to the current practices in the forestry…

Neonatal intensive care practices: perceptions of parents, professionals, and managers.

PubMed

Lantz, Björn; Ottosson, Cornelia

2014-06-01

This article explores the differences and similarities in opinions of neonatal intensive care issues between parents, neonatal intensive care unit (NICU) healthcare professionals (nurses and physicians), and managers (neonatal unit managers and pediatric division managers). An exploratory survey (n = 624) was conducted in Sweden during 2012-2013 on the basis of a validated questionnaire composed of 92 neonatal care-related Likert items. A total of 141 parents, 443 professionals, and 40 managers completed the survey. The parents were recruited consecutively from 5 NICUs of the Västra Götaland region in Sweden and the professionals and managers from all 40 NICUs in Sweden. Data were analyzed with analysis of variances, and post hoc analyses were conducted through pairwise t tests with Bonferroni corrections. Professionals and managers differed significantly on 1 item. Parents, however, found 54 items significantly less important than professionals did, but found only 4 to be significantly more important than professionals did. In line with previous research, we found that a gap exists between views of neonatal intensive care practices, with parents on one side and professionals and managers on the other. The nature of this gap, however, differs substantially from previous research, where parents found many items to be more important than professionals did. To develop and improve neonatal intensive care, this gap must be acknowledged and addressed, both in research and in practice. NICU managers need to develop strategies and routines that allow professionals to understand and adjust to the specific priorities of individual parents and families.

Reconciling Biodiversity Conservation and Timber Production in Mixed Uneven-Aged Mountain Forests: Identification of Ecological Intensification Pathways.

PubMed

Lafond, Valentine; Cordonnier, Thomas; Courbaud, Benoît

2015-11-01

Mixed uneven-aged forests are considered favorable to the provision of multiple ecosystem services and to the conciliation of timber production and biodiversity conservation. However, some forest managers now plan to increase the intensity of thinning and harvesting operations in these forests. Retention measures or gap creation are considered to compensate potential negative impacts on biodiversity. Our objectives were to assess the effect of these management practices on timber production and biodiversity conservation and identify potential compensating effects between these practices, using the concept of ecological intensification as a framework. We performed a simulation study coupling Samsara2, a simulation model designed for spruce-fir uneven-aged mountain forests, an uneven-aged silviculture algorithm, and biodiversity models. We analyzed the effect of parameters related to uneven-aged management practices on timber production, biodiversity, and sustainability indicators. Our study confirmed that the indicators responded differently to management practices, leading to trade-offs situations. Increasing management intensity had negative impacts on several biodiversity indicators, which could be partly compensated by the positive effect of retention measures targeting large trees, non-dominant species, and deadwood. The impact of gap creation was more mitigated, with a positive effect on the diversity of tree sizes and deadwood but a negative impact on the spruce-fir mixing balance and on the diversity of the understory layer. Through the analysis of compensating effects, we finally revealed the existence of possible ecological intensification pathways, i.e., the possibility to increase management intensity while maintaining biodiversity through the promotion of nature-based management principles (gap creation and retention measures).

Diagnosis and management of moderate to severe adult atopic dermatitis: a Consensus by the Italian Society of Dermatology and Venereology (SIDeMaST), the Italian Association of Hospital Dermatologists (ADOI), the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC), and the Italian Society of Allergological, Environmental and Occupational Dermatology (SIDAPA).

PubMed

Calzavara Pinton, Piergiacomo; Cristaudo, Antonio; Foti, Caterina; Canonica, Giorgio W; Balato, Nicola; Costanzo, Antonio; DE Pità, Ornella; DE Simone, Clara; Patruno, Cataldo; Pellacani, Giovanni; Peris, Ketty; Girolomoni, Giampiero

2018-04-01

Atopic dermatitis (AD) is a chronic immune-mediated inflammatory skin disease, currently recognized as a systemic disease possibly burdened by various comorbidities, including, but not limited to, other allergic conditions. Management guidelines issued by American and European dermatology and allergy scientific societies are available. However, some discrepancies exist in these guidelines, and some aspects of the management process, including diagnosis and severity assessment, as well as therapy duration and switch criteria, are not fully clarified by existing guidelines. Moreover, biologics such as dupilumab have now entered the therapeutic scenario of moderate-to-severe AD, offering a great opportunity to treat effectively and safely in need AD patients. For all these reasons, four Italian dermatology and allergy scientific societies joined to provide practical guidance for the management of moderate-to-severe adult AD suitable for the Italian clinical practice. Through a modified Delphi procedure, consensus was reached by 63 Italian dermatologists and allergists experienced in the management of adult AD on 14 statements covering five AD areas of interest, i.e. diagnosis, severity definition, current systemic therapies, eligibility criteria to biologic treatments, and comorbidities, with the aim to define treatment goals and improve adult AD management. The potential usefulness of a multidisciplinary approach is also underlined, given the complexity of AD and its comorbidities.

GP views on strategies to cope with increasing workload: a qualitative interview study.

PubMed

Fisher, Rebecca Fr; Croxson, Caroline Hd; Ashdown, Helen F; Hobbs, Fd Richard

2017-02-01

The existence of a crisis in primary care in the UK is in little doubt. GP morale and job satisfaction are low, and workload is increasing. In this challenging context, finding ways for GPs to manage that workload is imperative. To explore what existing or potential strategies are described by GPs for dealing with their workload, and their views on the relative merits of each. Semi-structured, qualitative interviews with GPs working within NHS England. All GPs working within NHS England were eligible. Of those who responded to advertisements, a maximum-variation sample was selected and interviewed until data saturation was reached. Data were analysed thematically. Responses were received from 171 GPs, and, from these, 34 were included in the study. Four main themes emerged for workload management: patient-level, GP-level, practice-level, and systems-level strategies. A need for patients to take greater responsibility for self-management was clear, but many felt that GPs should not be responsible for this education. Increased delegation of tasks was felt to be key to managing workload, with innovative use of allied healthcare professionals and extended roles for non-clinical staff suggested. Telephone triage was a commonly used tool for managing workload, although not all participants found this helpful. This in-depth qualitative study demonstrates an encouraging resilience among GPs. They are proactively trying to manage workload, often using innovative local strategies. GPs do not feel that they can do this alone, however, and called repeatedly for increased recruitment and more investment in primary care. © British Journal of General Practice 2017.

Productivity of sodic soils can be enhanced through the use of salt tolerant rice varieties and proper agronomic practices.

PubMed

Singh, Y P; Mishra, V K; Singh, Sudhanshu; Sharma, D K; Singh, D; Singh, U S; Singh, R K; Haefele, S M; Ismail, A M

2016-04-01

Regaining the agricultural potential of sodic soils in the Indo-Gangetic plains necessitates the development of suitable salt tolerant rice varieties to provide an entry for other affordable agronomic and soil manipulation measures. Thus selection of high yielding rice varieties across a range of sodic soils is central. Evaluation of breeding lines through on-station and on-farm farmers' participatory varietal selection (FPVS) resulted in the identification of a short duration (110-115 days), high yielding and disease resistant salt-tolerant rice genotype 'CSR-89IR-8', which was later released as 'CSR43' in 2011. Several agronomic traits coupled with good grain quality and market value contributed to commercialization and quick adoption of this variety in the sodic areas of the Indo-Gangetic plains of eastern India. Management practices required for rice production in salt affected soils are evidently different from those in normal soils and practices for a short duration salt tolerant variety differ from those for medium to long duration varieties. Experiments were conducted at the Indian Council of Agricultural Research-Central Soil Salinity Research Institute (ICAR-CSSRI), Regional Research Station, Lucknow, Uttar Pradesh, India during 2011 and 2013 wet seasons, to test the hypothesis that combining matching management practices (Mmp) with an improved genotype would enhance productivity and profitability of rice in sodic soils. Mmp were developed on-station by optimizing existing best management practices (Bmp) recommended for the region to match the requirements of CSR43. The results revealed that transplanting 4 seedlings hill -1 at a spacing of 15 × 20 cm produced significantly higher yield over other treatments. The highest additional net gain was US$ 3.3 at 90 kg ha -1  N, and the lowest was US$ 0.4 at 150 kg ha -1  N. Above 150 kg ha -1 , the additional net gain became negative, indicating decreasing returns from additional N. Hence, 150 kg N ha -1 was considered the economic optimum N application rate for CSR43 in these sodic soils. Using 150-60-40-25 kg N-P 2 O 5 -K 2 O-ZnSO 4 ·7H 2 O ha -1 in farmers' fields grown to CSR43 produced an average of 5.5 t ha -1 grain. The results of on-farm evaluation trials of CSR43 showed that matching management practices (Mmp) increased yield by 8% over existing best management practices (Bmp) recommended by ICAR-CSSRI for sodic soils and by 16% over framers' management practices; however, combining Mmp with CSR43 resulted in 35% higher yields over farmers' current varieties and management. This approach of combining cost effective crop and nutrient management options and a salt-tolerant variety can maximize the productivity and profitability of sodic soils in the alluvial Indo-Gangetic plains and in neighboring salt-affected areas of the Ganges mega delta in South Asia.

Understanding effective care management implementation in primary care: a macrocognition perspective analysis.

PubMed

Holtrop, Jodi Summers; Potworowski, Georges; Fitzpatrick, Laurie; Kowalk, Amy; Green, Lee A

2015-08-21

Care management in primary care can be effective in helping patients with chronic disease improve their health status. Primary care practices, however, are often challenged with its implementation. Incorporating care management involves more than a simple physical process redesign to existing clinical care routines. It involves changes to who is working with patients, and consequently such things as who is making decisions, who is sharing patient information, and how. Studying the range of such changes in "knowledge work" during implementation requires a perspective and tools designed to do so. We used the macrocognition perspective, which is designed to understand how individuals think in dynamic, messy real-world environments such as care management implementation. To do so, we used cognitive task analysis to understand implementation in terms of such thinking as decision making, knowledge, and communication. Data collection involved semi-structured interviews and observations at baseline and at approximately 9 months into implementation at five practices in one physician-owned administratively connected group of practices in the state of Michigan, USA. Practices were intervention participants in a larger trial of chronic care model implementation. Data were transcribed, qualitatively coded and analyzed, initially using an editing approach and then a template approach with macrocognition as a guiding framework. Seventy-four interviews and five observations were completed. There were differences in implementation success across the practices, and these differences in implementation success were well explained by macrocognition. Practices that used more macrocognition functions and used them more often were also more successful in care management implementation. Although care management can introduce many new changes into the delivery of primary care clinical practice, implementing it successfully as a new complex intervention is possible. Macrocognition is a useful perspective for illuminating the elements that facilitate new complex interventions with a view to addressing them during implementation planning.

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

PubMed Central

Busetto, Luca; Dicker, Dror; Azran, Carmil; Batterham, Rachel L.; Farpour-Lambert, Nathalie; Fried, Martin; Hjelmesæth, Jøran; Kinzl, Johann; Leitner, Deborah R.; Makaronidis, Janine M.; Schindler, Karin; Toplak, Hermann; Yumuk, Volkan

2018-01-01

Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations. PMID:29207379

Linking the Scales of Scientific inquiry and Watershed Management: A Focus on Green Infrastructure

NASA Astrophysics Data System (ADS)

Golden, H. E.; Hoghooghi, N.

2017-12-01

Urbanization modifies the hydrologic cycle, resulting in potentially deleterious downstream water quality and quantity effects. However, the cumulative interacting effects of water storage, transport, and biogeochemical processes occurring within other land cover and use types of the same watershed can render management explicitly targeted to limit the negative outcomes from urbanization ineffective. For example, evidence indicates that green infrastructure, or low impact development (LID), practices can attenuate the adverse water quality and quantity effects of urbanizing systems. However, the research providing this evidence has been conducted at local scales (e.g., plots, small homogeneous urban catchments) that isolate the measurable effects of such approaches. Hence, a distinct disconnect exists between the scale of scientific inquiry and the scale of management and decision-making practices. Here we explore the oft-discussed yet rarely directly addressed scientific and management conundrum: How do we scale our well-documented scientific knowledge of the water quantity and quality responses to LID practices measured and modeled at local scales to that of "actual" management scales? We begin by focusing on LID practices in mixed land cover watersheds. We present key concepts that have emerged from LID research at the local scale, considerations for scaling this research to watersheds, recent advances and findings in scaling the effects of LID practices on water quality and quantity at watershed scales, and the use of combined novel measurements and models for these scaling efforts. We underscore these concepts with a case study that evaluates the effects of three LID practices using simulation modeling across a mixed land cover watershed. This synthesis and case study highlight that scientists are making progress toward successfully tailoring fundamental research questions with decision-making goals in mind, yet we still have a long road ahead.

Evidence-based safety (EBS) management: A new approach to teaching the practice of safety management (SM).

PubMed

Wang, Bing; Wu, Chao; Shi, Bo; Huang, Lang

2017-12-01

In safety management (SM), it is important to make an effective safety decision based on the reliable and sufficient safety-related information. However, many SM failures in organizations occur for a lack of the necessary safety-related information for safety decision-making. Since facts are the important basis and foundation for decision-making, more efforts to seek the best evidence relevant to a particular SM problem would lead to a more effective SM solution. Therefore, the new paradigm for decision-making named "evidence-based practice (EBP)" can hold important implications for SM, because it uses the current best evidence for effective decision-making. Based on a systematic review of existing SM approaches and an analysis of reasons why we need new SM approaches, we created a new SM approach called evidence-based safety (EBS) management by introducing evidence-based practice into SM. It was necessary to create new SM approaches. A new SM approach called EBS was put forward, and the basic questions of EBS such as its definition and core were analyzed in detail. Moreover, the determinants of EBS included manager's attitudes towards EBS; evidence-based consciousness in SM; evidence sources; technical support; EBS human resources; organizational culture; and individual attributes. EBS is a new and effective approach to teaching the practice of SM. Of course, further research on EBS should be carried out to make EBS a reality. Practical applications: Our work can provide a new and effective idea and method to teach the practice of SM. Specifically, EBS proposed in our study can help safety professionals make an effective safety decision based on a firm foundation of high-grade evidence. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

Guideline funding and conflicts of interest: article 4 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Boyd, Elizabeth A; Akl, Elie A; Baumann, Michael; Curtis, J Randall; Field, Marilyn J; Jaeschke, Roman; Osborne, Molly; Schünemann, Holger J

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use more rigorous processes to ensure that healthcare recommendations are informed by the best available research evidence. This is the fourth of a series of 14 articles prepared to advise guideline developers in respiratory and other disease. It focuses on commercial funding of guidelines and managing conflict of interest effectively in the context of guidelines. In this review, we addressed the following topics and questions. (1) How are clinical practice guidelines funded? (2) What are the risks associated with commercial sponsorship of guidelines? (3) What relationships should guideline committee members be required to disclose? (4) What is the most efficient way to obtain complete and accurate disclosures? (5) How should disclosures be publicly shared? (6) When do relationships require management? (7) How should individual conflicts of interest be managed? (8) How could conflict of interest policies be enforced? The literature review included a search of PubMed and other databases for existing systematic reviews and relevant methodological research. Our conclusions are based on available evidence, consideration of what guideline developers are doing, and workshop discussions. Professional societies often depend on industry funding to support clinical practice guideline development. In addition, members of guideline committees frequently have financial relationships with commercial entities, are invested in their intellectual work, or have conflicts related to clinical revenue streams. No systematic reviews or other rigorous evidence regarding best practices for funding models, disclosure mechanisms, management strategies, or enforcement presently exist, but the panel drew several conclusions that could improve transparency and process.

Use of after action reports (AARs) to promote organizational and systems learning in emergency preparedness.

PubMed

Savoia, Elena; Agboola, Foluso; Biddinger, Paul D

2012-08-01

Many public health and healthcare organizations use formal knowledge management practices to identify and disseminate the experiences gained over time. The "lessons-learned" approach is one such example of knowledge management practice applied to the wider concept of organizational learning. In the field of emergency preparedness, the lessons-learned approach stands on the assumption that learning from experience improves practice and minimizes avoidable deaths and negative economic and social consequences of disasters. In this project, we performed a structured review of AARs to analyze how lessons learned from the response to real-incidents may be used to maximize knowledge management and quality improvement practices such as the design of public health emergency preparedness (PHEP) exercises. We chose as a source of data the "Lessons Learned Information Sharing (LLIS.gov)" system, a joined program of the U.S. Department of Homeland Security DHS and FEMA that serves as the national, online repository of lessons learned, best practices, and innovative ideas. We identified recurring challenges reported by various states and local public health agencies in the response to different types of incidents. We also strove to identify the limitations of systematic learning that can be achieved due to existing weaknesses in the way AARs are developed.

Use of After Action Reports (AARs) to Promote Organizational and Systems Learning in Emergency Preparedness

PubMed Central

Savoia, Elena; Agboola, Foluso; Biddinger, Paul D.

2012-01-01

Many public health and healthcare organizations use formal knowledge management practices to identify and disseminate the experiences gained over time. The “lessons-learned” approach is one such example of knowledge management practice applied to the wider concept of organizational learning. In the field of emergency preparedness, the lessons-learned approach stands on the assumption that learning from experience improves practice and minimizes avoidable deaths and negative economic and social consequences of disasters. In this project, we performed a structured review of AARs to analyze how lessons learned from the response to real-incidents may be used to maximize knowledge management and quality improvement practices such as the design of public health emergency preparedness (PHEP) exercises. We chose as a source of data the “Lessons Learned Information Sharing (LLIS.gov)” system, a joined program of the U.S. Department of Homeland Security DHS and FEMA that serves as the national, online repository of lessons learned, best practices, and innovative ideas. We identified recurring challenges reported by various states and local public health agencies in the response to different types of incidents. We also strived to identify the limitations of systematic learning that can be achieved due to existing weaknesses in the way AARs are developed. PMID:23066408

Sense or nonsense? Traditional methods of animal parasitic disease control.

PubMed

Schillhorn van Veen, T W

1997-07-31

In recent years, there has been a resurgence of interest in traditional health-care practices in the western as well as in the developing world. In animal health, this has led to further interest in ethnoveterinary research and development, a relatively new field of study that covers traditional practices, ethnobotany and application of animal care practices embedded in local tradition. This development has practical applications for animal parasite control, whether related to epidemiology, diagnostics and therapy, or to comprehensive disease control methods leading to integrated pest/disease management. Examples are provided of traditional practices in diagnostics, herd-, grazing- and pasture-management as well as of manipulation and treatment. Many of these applications indicate a basic understanding of disease, especially epidemiology, by farmers and herders, although not always explained, or explainable, in rational western ways. Although abuse and quackery exist, the application of traditional practices seems to make sense in areas without adequate veterinary services. Moreover, acknowledgement of the value of traditional knowledge empowers local herders/farmers to try to solve their herds' disease problems in a cost-effective way. Traditional practices often make sense, albeit with some regulation to ascertain safety and to prevent abuse.

Changes to nurses' practice environment over time.

PubMed

Roche, Michael A; Duffield, Christine; Friedman, Sarah; Twigg, Di; Dimitrelis, Sofia; Rowbotham, Samantha

2016-07-01

To examine changes in the nursing practice environment, retention-related factors, unit stability and patient care tasks delayed or left undone, over two periods between 2004 and 2013. Positive nurse practice environments have been linked to nurse retention and care quality outcomes. The collection of the Practice Environment Scale of the Nursing Work Index, job satisfaction, intent to leave, unit instability and tasks delayed or not done at six acute-care hospitals across three Australian states, in two waves between 2004 and 2013; results from the two waves are compared. On average, practice environment scores declined slightly; nurses reported a greater difficulty in finding another nursing position, lower intent to leave their current job and greater instability in their current position. Rates of delayed tasks increased over the period, whereas rates of tasks left undone have decreased over the period. The decline in nurses' perceptions of the quality of the practice environment is disappointing, particularly given the protracted workforce shortages that have persisted. Significant organisational restructuring and turnover of nurse executives may have contributed to this decline. Managers need to apply existing evidence to improve nurse practice environments and manage instability. © 2016 John Wiley & Sons Ltd.

Evaluation of an Ongoing Diabetes Group Medical Visit in a Family Medicine Practice.

PubMed

Cunningham, Amy T; Delgado, David J; Jackson, Joseph D; Crawford, Albert G; Jabbour, Serge; Lieberthal, Robert D; Diaz, Victor; LaNoue, Marianna

2018-01-01

Group medical visits (GMVs), which combine 1-on-1 clinical consultations and group self-management education, have emerged as a promising vehicle for supporting type 2 diabetes management in primary care. However, few evaluations exist of ongoing diabetes GMVs embedded in medical practices. This study used a quasi-experimental design to evaluate diabetes GMV at a large family medicine practice. We examined program attendance and attrition, used propensity score matching to create a matched comparison group, and compared participants and the matched group on clinical, process of care, and utilization outcomes. GMV participants (n = 230) attended an average of 1 session. Participants did not differ significantly from the matched comparison group (n = 230) on clinical, process of care or utilization outcomes. The diabetes GMV was not associated with improvements in outcomes. Further studies should examine diabetes GMV implementation challenges to enhance their effectiveness in everyday practice. © Copyright 2018 by the American Board of Family Medicine.

Hearing conservation and noise management practices in professional orchestras.

PubMed

O'Brien, Ian; Driscoll, Tim; Ackermann, Bronwen

2012-01-01

Hearing conservation and noise exposure management for professional orchestras is a difficult issue resistant to standard control measures as used in other industries with excessive noise problems. Although there has been a great deal of research into this area in terms of the audiological status of musicians and their exposure to noise, there are relatively few industry-specific strategies that can be adopted by an orchestra looking to address these issues. Australia does not have a uniform approach to hearing conservation management in its orchestras; however, each orchestra actively grapples with the challenges of balancing legal, practical, and artistic concerns. This study systematically investigated hearing conservation practices, noise exposure management, and audiological screening protocols in eight professional orchestras. The research involved personal interviews with staff at each orchestra, including inspection of venues and facilities. While all these orchestras were aware of the risks and were actively taking significant steps to reduce noise exposure, a range of approaches, with varying degrees of effectiveness and understanding of the issue, were found across the sector. There was limited evidence of educational programs for either the musicians at risk of excessive noise exposure or the staff responsible for devising and implementing control measures. In addition, the reported use of adequate personal hearing protection by musicians was poor. As Australia has recently introduced a national approach to workplace health and safety, a similar approach to noise and audiological management across the country's orchestral sector is proposed, drawn from existing research and practice. This will enable both consistent procedures and meaningful dialogue between the orchestras on the topics of hearing conservation, audiological monitoring, and educational practices.

Knowledge Management Implementation and the Tools Utilized in Healthcare for Evidence-Based Decision Making: A Systematic Review.

PubMed

Shahmoradi, Leila; Safadari, Reza; Jimma, Worku

2017-09-01

Healthcare is a knowledge driven process and thus knowledge management and the tools to manage knowledge in healthcare sector are gaining attention. The aim of this systematic review is to investigate knowledge management implementation and knowledge management tools used in healthcare for informed decision making. Three databases, two journals websites and Google Scholar were used as sources for the review. The key terms used to search relevant articles include: "Healthcare and Knowledge Management"; "Knowledge Management Tools in Healthcare" and "Community of Practices in healthcare". It was found that utilization of knowledge management in healthcare is encouraging. There exist numbers of opportunities for knowledge management implementation, though there are some barriers as well. Some of the opportunities that can transform healthcare are advances in health information and communication technology, clinical decision support systems, electronic health record systems, communities of practice and advanced care planning. Providing the right knowledge at the right time, i.e., at the point of decision making by implementing knowledge management in healthcare is paramount. To do so, it is very important to use appropriate tools for knowledge management and user-friendly system because it can significantly improve the quality and safety of care provided for patients both at hospital and home settings.

Collaborative Drug Therapy Management: Case Studies of Three Community-Based Models of Care

PubMed Central

Snyder, Margie E.; Earl, Tara R.; Greenberg, Michael; Heisler, Holly; Revels, Michelle; Matson-Koffman, Dyann

2015-01-01

Collaborative drug therapy management agreements are a strategy for expanding the role of pharmacists in team-based care with other providers. However, these agreements have not been widely implemented. This study describes the features of existing provider–pharmacist collaborative drug therapy management practices and identifies the facilitators and barriers to implementing such services in community settings. We conducted in-depth, qualitative interviews in 2012 in a federally qualified health center, an independent pharmacy, and a retail pharmacy chain. Facilitators included 1) ensuring pharmacists were adequately trained; 2) obtaining stakeholder (eg, physician) buy-in; and 3) leveraging academic partners. Barriers included 1) lack of pharmacist compensation; 2) hesitation among providers to trust pharmacists; 3) lack of time and resources; and 4) existing informal collaborations that resulted in reduced interest in formal agreements. The models described in this study could be used to strengthen clinical–community linkages through team-based care, particularly for chronic disease prevention and management. PMID:25811494

Strategy Guideline: Quality Management in Existing Homes; Cantilever Floor Example

DOE Office of Scientific and Technical Information (OSTI.GOV)

Taggart, J.; Sikora, J.; Wiehagen, J.

2011-12-01

This guideline is designed to highlight the QA process that can be applied to any residential building retrofit activity. The cantilevered floor retrofit detailed in this guideline is included only to provide an actual retrofit example to better illustrate the QA activities being presented. The goal of existing home high performing remodeling quality management systems (HPR-QMS) is to establish practices and processes that can be used throughout any remodeling project. The research presented in this document provides a comparison of a selected retrofit activity as typically done versus that same retrofit activity approached from an integrated high performance remodeling andmore » quality management perspective. It highlights some key quality management tools and approaches that can be adopted incrementally by a high performance remodeler for this or any high performance retrofit. This example is intended as a template and establishes a methodology that can be used to develop a portfolio of high performance remodeling strategies.« less

Multidisciplinary management of chronic heart failure: principles and future trends.

PubMed

Davidson, Patricia M; Newton, Phillip J; Tankumpuan, Thitipong; Paull, G; Dennison-Himmelfarb, Cheryl

2015-10-01

Globally, the management of chronic heart failure (CHF) challenges health systems. The high burden of disease and the costs associated with hospitalization adversely affect individuals, families, and society. Improved quality, access, efficiency, and equity of CHF care can be achieved by using multidisciplinary care approaches if there is adherence and fidelity to the program's elements. The goal of this article was to summarize evidence and make recommendations for advancing practice, education, research, and policy in the multidisciplinary management of patients with CHF. Essential elements of multidisciplinary management of CHF were identified from meta-analyses and clinical practice guidelines. The study factors were discussed from the perspective of the health care system, providers, patients, and their caregivers. Identified gaps in evidence were used to identify areas for future focus in CHF multidisciplinary management. Although there is high-level evidence (including several meta-analyses) for the efficacy of management programs for CHF, less evidence exists to determine the benefit attributable to individual program components or to identify the specific content of effective components and the manner of their delivery. Health care system, provider, and patient factors influence health care models and the effective management of CHF and require focus and attention. Extrapolating trial findings to clinical practice settings is limited by the heterogeneity of study populations and the implementation of models of intervention beyond academic health centers, where practice environments differ considerably. Ensuring that individual programs are both developed and assessed that consider these factors is integral to ensuring adherence and fidelity with the core dimensions of disease management necessary to optimize patient and organizational outcomes. Recognizing the complexity of the multidisciplinary CHF interventions will be important in advancing the design, implementation, and evaluation of the interventions. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.

A practical framework for data management processes and their evaluation in population-based medical registries.

PubMed

Sariyar, M; Borg, A; Heidinger, O; Pommerening, K

2013-03-01

We present a framework for data management processes in population-based medical registries. Existing guidelines lack the concreteness we deem necessary for them to be of practical use, especially concerning the establishment of new registries. Therefore, we propose adjustments and concretisations with regard to data quality, data privacy, data security and registry purposes. First, we separately elaborate on the issues to be included into the framework and present proposals for their improvements. Thereafter, we provide a framework for medical registries based on quasi-standard-operation procedures. The main result is a concise and scientifically based framework that tries to be both broad and concrete. Within that framework, we distinguish between data acquisition, data storage and data presentation as sub-headings. We use the framework to categorise and evaluate the data management processes of a German cancer registry. The standardisation of data management processes in medical registries is important to guarantee high quality of the registered data, to enhance the realisation of purposes, to increase efficiency and to enable comparisons between registries. Our framework is destined to show how one central impediment for such standardisations - lack of practicality - can be addressed on scientific grounds.

A medical home: value and implications of knowledge management.

PubMed

Orzano, A John; McInerney, Claire R; McDaniel, Reuben R; Meese, Abigail; Alajmi, Bibi; Mohr, Stewart M; Tallia, Alfred F

2009-01-01

Central to the "medical home" concept is the premise that the delivery of effective primary care requires a fundamental shift in relationships among practice members and between practice members and patients. Primary care practices can potentially increase their capacity to deliver effective care through knowledge management (KM), a process of sharing and making existing knowledge available or by developing new knowledge among practice members and patients. KM affects performance by influencing work relationships to enhance learning, decision making, and task execution. We extend our previous work to further characterize, describe, and contrast how primary care practices exhibit KM and explain why KM deserves attention in medical home redesign initiatives. Case studies were conducted, drawn from two higher and lower performing practices, which were purposely selected based on disease management, prevention, and productivity measures from an improvement trial. Observations of operations, clinical encounters, meetings, and interviews with office members and patients were transcribed and coded independently using a KM template developed from a previous secondary analysis. Face-to-face discussions resolved coding differences among research team members. Confirmation of findings was sought from practice participants. Practices manifested varying degrees of KM effectiveness through six interdependent processes and multiple overlapping tools. Social tools, such as face-to-face-communication for sharing and developing knowledge, were often more effective than were expensive technical tools such as an electronic medical record. Tool use was tailored for specific outcomes, interacted with each other, and leveraged by other organizational capacities. Practices with effective KM were more open to adopting and sustaining new ways of functioning, ways reflecting attributes of a medical home. Knowledge management differences occur within and between practices and can explain differences in performance. By relying more on social tools rather than costly, high-tech investment, KM leverages primary care's relationship-centered strength, facilitating practice redesign as a medical home.

The benefits of herbicide-resistant crops.

PubMed

Green, Jerry M

2012-10-01

Since 1996, genetically modified herbicide-resistant crops, primarily glyphosate-resistant soybean, corn, cotton and canola, have helped to revolutionize weed management and have become an important tool in crop production practices. Glyphosate-resistant crops have enabled the implementation of weed management practices that have improved yield and profitability while better protecting the environment. Growers have recognized their benefits and have made glyphosate-resistant crops the most rapidly adopted technology in the history of agriculture. Weed management systems with glyphosate-resistant crops have often relied on glyphosate alone, have been easy to use and have been effective, economical and more environmentally friendly than the systems they have replaced. Glyphosate has worked extremely well in controlling weeds in glyphosate-resistant crops for more than a decade, but some key weeds have evolved resistance, and using glyphosate alone has proved unsustainable. Now, growers need to renew their weed management practices and use glyphosate with other cultural, mechanical and herbicide options in integrated systems. New multiple-herbicide-resistant crops with resistance to glyphosate and other herbicides will expand the utility of existing herbicide technologies and will be an important component of future weed management systems that help to sustain the current benefits of high-efficiency and high-production agriculture. Copyright © 2012 Society of Chemical Industry.

Management practices used by white-tailed deer farms in Pennsylvania and herd health problems.

PubMed

Brooks, Jason W; Jayarao, Bhushan M

2008-01-01

To determine current management practices used by white-tailed deer farms in Pennsylvania and identify animal health problems that exist in these herds. Cross-sectional study. Owners and managers of 233 farms in Pennsylvania that raised white-tailed deer. A self-administered questionnaire was mailed to participants. Herds ranged in size from 1 to 350 deer. Land holdings ranged from 0.07 to 607 hectares (0.17 to 1,500 acres). Stocking density ranged from 0.1 to 118.6 deer/hectare (0.04 to 48 deer/acre). Most (84%) respondents raised deer for breeding or hunting stock; 13% raised deer exclusively as pets or for hobby purposes, and purpose varied by herd size. Multiple associations were identified between management or disease factors and herd size. The use of vaccines, use of veterinary and diagnostic services, use of pasture, and use of artificial insemination increased as herd size increased. The most common conditions in herds of all sizes were respiratory tract disease, diarrhea, parasitism, and sudden death. The prevalence of respiratory tract disease increased as herd size increased. Results suggested that many aspects of herd management for white-tailed deer farms in Pennsylvania were associated with herd size, but that regardless of herd size, many preventive medicine practices were improperly used or underused in many herds.

Obesity Management in Europe: Current Status and Objectives for the Future

PubMed Central

Uerlich, Magdalena F.; Yumuk, Volkan; Finer, Nick; Basdevant, Arnaud; Visscher, Tommy L.S.

2016-01-01

Objective This study aims at assessing the status of obesity management in the European region and identifying future goals and objectives of professionals working in the field of obesity. Methods Presidents of all 31 EASO-affiliated (EASO = European Association for the Study of Obesity) national associations for the study of obesity were asked to invite 5 obesity experts from their country to participate in a survey. A total of 74 obesity professionals out of 23 countries participated. Questions addressed the development of guidelines, the status of obesity management, and goals and objectives for the future in obesity management. Further, EASO's three vice-presidents participated in in-depth, semi-structured interviews, in which they were asked to provide their reflection on the survey data. Results Most countries define obesity as a clinical and chronic disease, but various differences in obesity management standards exist across Europe. Existing guidelines mainly focus on the acute treatment of obesity rather than on long-term approaches. Conclusion Multidisciplinary approaches for obesity management and the collaboration between general practitioners and hospitals as well as between professionals at the local level and networks of obesity management centers need to be improved across Europe. Good practices and evidence are available. PMID:27553443

Are Behavioural Interventions Doomed to Fail? Challenges to Self-Management Support in Chronic Diseases.

PubMed

Vallis, Michael

2015-08-01

Self-management and self-management support are concepts very familiar to those of us in diabetes care. These concepts require openness to understanding the behaviours of persons with diabetes broadly, not only behaviours restricted to the biomedical perspective. Understanding the importance of health behaviour change and working within the Expanded Chronic Care Model define the context within which self-management support should occur. The purpose of this perspective is to identify a potential limitation in existing self-management support initiatives. This potential limitation reflects provider issues, not patient issues; that is, true self-management support might require changes by healthcare providers. Specifically, although behavioural interventions within the context of academic research studies are evidence based, behaviour change interventions implemented in general practice settings might prove less effective unless healthcare providers are able to shift from a practice based on the biomedical model to a practice based on the self-management support model. The purpose of this article is to facilitate effective self-management support by encouraging providers to switch from a model of care based on the expert clinician encountering the uninformed help seeker (the biomedical model) to one guided by collaboration grounded in the principles of description, prediction and choice. Key to understanding the value of making this shift are patient-centered communication principles and the tenets of complexity theory. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Concepts, requirements, and design approaches for building successful planning and scheduling systems

NASA Technical Reports Server (NTRS)

Hornstein, Rhoda Shaller; Willoughby, John K.

1991-01-01

Traditional practice of systems engineering management assumes requirements can be precisely determined and unambiguously defined prior to system design and implementation; practice further assumes requirements are held static during implementation. Human-computer decision support systems for service planning and scheduling applications do not conform well to these assumptions. Adaptation to the traditional practice of systems engineering management are required. Basic technology exists to support these adaptations. Additional innovations must be encouraged and nutured. Continued partnership between the programmatic and technical perspective assures proper balance of the impossible with the possible. Past problems have the following origins: not recognizing the unusual and perverse nature of the requirements for planning and scheduling; not recognizing the best starting point assumptions for the design; not understanding the type of system that being built; and not understanding the design consequences of the operations concept selected.

Quality management for the international transport of laboratory animals.

PubMed

Leary, Steven L

2008-01-01

Increased collaboration between investigators at different institutions has increased the number of laboratory animals being transported. The current system of laws and regulations governing animal shipments is inconsistent and government agencies often have areas of overlapping regulatory management. Furthermore, the lack of industry-wide shipping standards and good practices contributes to confusion among those responsible for shipment. One answer to these quality control issues would be the establishment of independent, industry-regulated 'good practices' for animal transport, similar to those used in laboratories for experimental design. These good practices could be based on the existing International Air Transport Association Live Animals Regulations, with contributions from representatives of the specialties involved. Additionally, quality control under the current system of patchwork regulations could be improved if each institution, both academic and commercial, would designate a single point of contact to follow each shipment from start to finish.

An observational analysis of surgical team compliance with perioperative safety practices after crew resource management training.

PubMed

France, Daniel J; Leming-Lee, Susie; Jackson, Tom; Feistritzer, Nancye R; Higgins, Michael S

2008-04-01

Acknowledging the need to improve team communication and coordination among health care providers, health care administrators and improvement officers have been quick to endorse and invest in aviation crew resource management (CRM). Despite the increased interest in CRM there exists limited data on the effectiveness of CRM to change team behavior and performance in clinical settings. Direct observational analyses were performed on 30 surgical teams (15 neurosurgery cases and 15 cardiac cases) to evaluate surgical team compliance with integrated safety and CRM practices after extensive CRM training. Observed surgical teams were compliant with only 60% of the CRM and perioperative safety practices emphasized in the training program. The results highlight many of the challenges the health care industry faces in its efforts to adapt CRM from aviation to medicine. Additional research is needed to develop and test new team training methods and performance feedback mechanisms for clinical teams.

Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults

PubMed Central

2009-01-01

Background: Obstructive sleep apnea (OSA) is a common chronic disorder that often requires lifelong care. Available practice parameters provide evidence-based recommendations for addressing aspects of care. Objective: This guideline is designed to assist primary care providers as well as sleep medicine specialists, surgeons, and dentists who care for patients with OSA by providing a comprehensive strategy for the evaluation, management and long-term care of adult patients with OSA. Methods: The Adult OSA Task Force of the American Academy of Sleep Medicine (AASM) was assembled to produce a clinical guideline from a review of existing practice parameters and available literature. All existing evidence-based AASM practice parameters relevant to the evaluation and management of OSA in adults were incorporated into this guideline. For areas not covered by the practice parameters, the task force performed a literature review and made consensus recommendations using a modified nominal group technique. Recommendations: Questions regarding OSA should be incorporated into routine health evaluations. Suspicion of OSA should trigger a comprehensive sleep evaluation. The diagnostic strategy includes a sleep-oriented history and physical examination, objective testing, and education of the patient. The presence or absence and severity of OSA must be determined before initiating treatment in order to identify those patients at risk of developing the complications of sleep apnea, guide selection of appropriate treatment, and to provide a baseline to establish the effectiveness of subsequent treatment. Once the diagnosis is established, the patient should be included in deciding an appropriate treatment strategy that may include positive airway pressure devices, oral appliances, behavioral treatments, surgery, and/or adjunctive treatments. OSA should be approached as a chronic disease requiring long-term, multidisciplinary management. For each treatment option, appropriate outcome measures and long-term follow-up are described. Citation: Epstein LJ; Kristo D; Strollo PJ; Friedman N; Malhotra A; Patil SP; Ramar K; Rogers R; Schwab RJ; Weaver EM; Weinstein MD. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5(3):263–276. PMID:19960649

What can family medicine practices do to facilitate knowledge management?

PubMed

Orzano, A John; Ohman-Strickland, Pamela A; Patel, Meghal

2008-01-01

Family medicine practices face increasing demands to enhance efficiency and quality of care. Current solutions propose major practice redesign and investment in sophisticated technology. Knowledge management (KM) is a process that increases the capacity of a practice to deliver effective care by finding and sharing information and knowledge among practice members or by developing new knowledge for use by the practice. Our preliminary research in family medicine practices has suggested improved patient outcomes with greater and more effective KM. Research in other organizational settings has suggested that KM can be facilitated by certain organizational characteristics. To identify those organizational characteristics within a family medicine practice that management can effect to enhance KM. We performed a cross-sectional secondary analysis of second-year data from 13 community family medicine practices participating in a practice improvement project. Practice KM, leaderships' promotion of participatory decision making, existence of activities supportive of human resource processes, and effective communication were derived from clinician's, nurses', and staff's responses to a survey eliciting responses on practice organizational characteristics. Hierarchical linear modeling examined relationships between individual practice members' perception of KM and organizational characteristics of the practice, controlling for practice covariates (solo-group, electronic medical record use, and perception of a chaotic practice environment) and staff-level covariates (gender, age, and role). Practices with greater participatory decision making and human resources' processes and effective communication significantly (p < .019, p < .0001, and p < .004) increased odds of reporting satisfactory KM (odds ratio = 2.48, 95% confidence interval = 1.32-4.65; odds ratio = 10.84, 95% confidence interval = 4.04-29.12; and odds ratio = 4.95, 95% confidence interval = 2.02-12.16). The sizes of these effects were not substantially changed even when practice members perceived their practice environment as more chaotic. Steps to facilitate KM should be considered when evaluating more intensive and costly organizational solutions for enhancing family medicine practice performance.

To have and to hold: personnel shortage in a Finnish healthcare organisation.

PubMed

Heilmann, Pia

2010-07-01

Retirements of baby boomers will create a talent shortage in Finnish health care. Concurrently, difficulties exist in recruiting new personnel. This paper provides an overview concerning the bottlenecks in talent management in a Finnish hospital, and finds solutions for recruitment and retention problems of healthcare professionals (nurses and physicians). Because the healthcare staffing shortage is worldwide, the results of this paper are also useful internationally. The research was a qualitative case study and the research method used was group interview. Background data was gathered from the public media and healthcare trade organisations. The bottlenecks of talent management in hospital organisation seem to relate to retaining actions of senior personnel. Concurrently, the organisation should develop new practices for attracting new personnel. Very few efforts on image marketing and recruitment have been done. The Internet has not been fully exploited and recruitment information has not been sent even to the neighbouring nursing college. Job rotation has not been used as a help in recruitment and competence development. Difficulties exist in transmitting tacit knowledge from a retiring nurse to a junior nurse. Leadership skills of the superior seem to be important when retaining and committing senior personnel. Recruitment and retention problems encourage organisations to develop new recruitment and commitment practices as well as management and leadership skills.

A proposed approach may help systematic reviews retain needed expertise while minimizing bias from nonfinancial conflicts of interest.

PubMed

Viswanathan, Meera; Carey, Timothy S; Belinson, Suzanne E; Berliner, Elise; Chang, Stephanie M; Graham, Elaine; Guise, Jeanne-Marie; Ip, Stanley; Maglione, Margaret A; McCrory, Douglas C; McPheeters, Melissa; Newberry, Sydne J; Sista, Priyanka; White, C Michael

2014-11-01

Groups such as the Institute of Medicine emphasize the importance of attention to financial conflicts of interest. Little guidance exists, however, on managing the risk of bias for systematic reviews from nonfinancial conflicts of interest. We sought to create practical guidance on ensuring adequate clinical or content expertise while maintaining independence of judgment on systematic review teams. Workgroup members built on existing guidance from international and domestic institutions on managing conflicts of interest. We then developed practical guidance in the form of an instrument for each potential source of conflict. We modified the Institute of Medicine's definition of conflict of interest to arrive at a definition specific to nonfinancial conflicts. We propose questions for funders and systematic review principal investigators to evaluate the risk of nonfinancial conflicts of interest. Once risks have been identified, options for managing conflicts include disclosure followed by no change in the systematic review team or activities, inclusion on the team along with other members with differing viewpoints to ensure diverse perspectives, exclusion from certain activities, and exclusion from the project entirely. The feasibility and utility of this approach to ensuring needed expertise on systematic reviews and minimizing bias from nonfinancial conflicts of interest must be investigated. Copyright © 2014 Elsevier Inc. All rights reserved.

Quantified carbon input for maintaining existing soil organic carbon stocks in global wheat systems

NASA Astrophysics Data System (ADS)

Wang, G.

2017-12-01

Soil organic carbon (SOC) dynamics in croplands is a crucial component of global carbon (C) cycle. Depending on local environmental conditions and management practices, typical C input is generally required to reduce or reverse C loss in agricultural soils. No studies have quantified the critical C input for maintaining SOC at global scale with high resolution. Such information will provide a baseline map for assessing soil C dynamics under potential changes in management practices and climate, and thus enable development of management strategies to reduce C footprint from farm to regional scales. We used the soil C model RothC to simulate the critical C input rates needed to maintain existing soil C level at 0.1°× 0.1° resolution in global wheat systems. On average, the critical C input was estimated to be 2.0 Mg C ha-1 yr-1, with large spatial variability depending on local soil and climatic conditions. Higher C inputs are required in wheat system of central United States and western Europe, mainly due to the higher current soil C stocks present in these regions. The critical C input could be effectively estimated using a summary model driven by current SOC level, mean annual temperature, precipitation, and soil clay content.

12 CFR Appendix C to Part 30 - OCC Guidelines Establishing Standards for Residential Mortgage Lending Practices

Code of Federal Regulations, 2010 CFR

2010-01-01

.... Preservation of Existing Authority C. Relationship to Other Legal Requirements D. Definitions II. Standards for... injurious to bank customers and that expose the bank to credit, legal, compliance, reputation, and other... and supervisory guidance on fiduciary activities and asset management address the need for national...

Landscape Patterns and Their Influence on Bird Communities Resulting from Agricultural Policies Promoting Shelterbelts in Eastern Nebraska

Treesearch

Robert A., II Pierce; D. Todd Farrand; William B. Kurtz; Jim Brandle; Ron Johnson

2003-01-01

Evolving agricultural policies and technologies have influenced land management practices within agroecosystems, impacting available habitats for many species of wildlife. Increasing available wildlife habitat and enhancing habitat quality have become an explicit objective of existing agricultural policy. Thus, there is renewed focus on utilizing shelterbelt...

40 CFR 63.11516 - What are my standards and management practices?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Testing Air-Cleaning Devices Used in General Ventilation for Removing Particulate Matter, June 4, 1992... requirements of this section and be re-certified every 5 years. (e) [Reserved] (f) Standards for welding. If you own or operate a new or existing welding affected source, you must comply with the requirements in...

Public and private forest ownership in the conterminous United States. Chapter 6.

Treesearch

Greg C. Liknes; Mark D. Nelson; Brett J. Butler

2010-01-01

Forests and the goods and services they provide are influenced by both the biophysical and human environments. To fully understand forest ecosystems, we need to understand the social context in which forests exist because landowners determine land use and management practice. To influence decisions related to the forests, we need to...

Charter School Replication. Policy Guide

ERIC Educational Resources Information Center

Rhim, Lauren Morando

2009-01-01

"Replication" is the practice of a single charter school board or management organization opening several more schools that are each based on the same school model. The most rapid strategy to increase the number of new high-quality charter schools available to children is to encourage the replication of existing quality schools. This policy guide…

Business Candidate Reactions to Community College Recruitment Practices: Effects of Instructional Programs and Job Attributes.

ERIC Educational Resources Information Center

Winter, Paul A.

This paper draws on the literatures of educational administration, management, and marketing to address, empirically, two issues related to community college faculty recruitment: (a) factors influencing faculty application decisions, and (b) the utility of an existing model for recruiting community college faculty. It examines factors influencing…

Wilderness education: an updated review of the literature and new directions for research and practice

Treesearch

Kari Gunderson; Christopher V. Barns; William W. Hendricks; Leo H. McAvoy

2000-01-01

Many scientists, managers and advocates for wilderness consider education key to promoting appreciation and understanding of the cultural, environmental and experiential values of wilderness. Despite the large variety and diversity of wilderness information and education techniques, little research exists on the design and application of wilderness education programs...

Transnational Corporations and Corporate Citizenship: Analyzing New Roles of Organization Development Practitioners

ERIC Educational Resources Information Center

Stolz, Ingo Stephan

2012-01-01

Research shows that too few transnational corporations (TNCs) have the organizational capacity to manage corporate citizenship. Evidence exists that ever more TNCs adopt programs of corporate citizenship development in order to increase this capacity. However, both in academic and practical literature, there is a general lack of a strategic…

Net global warming potential and greenhouse gas intensity influenced by irrigation, tillage, crop rotation, and nitrogen fertilization

USDA-ARS?s Scientific Manuscript database

Little information exists about sources and sinks of greenhouse gases (GHGs) affected by management practices to account for net emissions from agroecosystems. We evaluated the effects of irrigation, tillage, crop rotation, and N fertilization on net global warming potential (GWP) and greenhouse gas...

12 CFR Appendix C to Part 30 - OCC Guidelines Establishing Standards for Residential Mortgage Lending Practices

Code of Federal Regulations, 2014 CFR

2014-01-01

.... Preservation of Existing Authority C. Relationship to Other Legal Requirements D. Definitions II. Standards for... injurious to bank customers and that expose the bank to credit, legal, compliance, reputation, and other... and supervisory guidance on fiduciary activities and asset management address the need for national...

12 CFR Appendix C to Part 30 - OCC Guidelines Establishing Standards for Residential Mortgage Lending Practices

Code of Federal Regulations, 2013 CFR

2013-01-01

.... Preservation of Existing Authority C. Relationship to Other Legal Requirements D. Definitions II. Standards for... injurious to bank customers and that expose the bank to credit, legal, compliance, reputation, and other... and supervisory guidance on fiduciary activities and asset management address the need for national...

A Quantitative Study into the Information Technology Project Portfolio Practice: The Impact on Information Technology Project Deliverables

ERIC Educational Resources Information Center

Yu, Wei

2013-01-01

This dissertation applied the quantitative approach to the data gathered from online survey questionnaires regarding the three objects: Information Technology (IT) Portfolio Management, IT-Business Alignment, and IT Project Deliverables. By studying this data, this dissertation uncovered the underlying relationships that exist between the…

Integrating Geospatial Technologies into Existing Teacher Education Coursework: Theoretical and Practical Notes from the Field

ERIC Educational Resources Information Center

Kerr, Stacey

2016-01-01

Although instruction related to learning management systems and other educational applications in teacher education programs has increased, the potential of geospatial technologies has yet to be widely explored and considered in the teacher education literature, despite its ability to function as an engaging pedagogical tool with teacher…

Waste management practices in the Gulf of Suez - Egypt

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ghzaly, S.M.; Binegar, J.S.

1996-12-31

The Gulf of Suez Petroleum Company (GUPCO) is the largest offshore oil producing company in Egypt. GUPCO currently produces 400,000 BOPD from over 350 wells supported by 87 offshore producing platforms. As a leader of the Egyptian petroleum industry, GUPCO established within its strategies and goals a separate category covering safety, health and Protection of the environment. This step was recognized and emphasized the importance of GUPCO`s role in protecting the Egyptian environment while producing oil and natural gas. This paper discusses the existing waste management practices of the Gulf of Suez Petroleum Company which were put into place tomore » protect the Egyptian environment in the Gulf of Suez-Egypt and GUPCO`s associated operations.« less

Quality Management Framework for Total Diet Study centres in Europe.

PubMed

Pité, Marina; Pinchen, Hannah; Castanheira, Isabel; Oliveira, Luisa; Roe, Mark; Ruprich, Jiri; Rehurkova, Irena; Sirot, Veronique; Papadopoulos, Alexandra; Gunnlaugsdóttir, Helga; Reykdal, Ólafur; Lindtner, Oliver; Ritvanen, Tiina; Finglas, Paul

2018-02-01

A Quality Management Framework to improve quality and harmonization of Total Diet Study practices in Europe was developed within the TDS-Exposure Project. Seventeen processes were identified and hazards, Critical Control Points and associated preventive and corrective measures described. The Total Diet Study process was summarized in a flowchart divided into planning and practical (sample collection, preparation and analysis; risk assessment analysis and publication) phases. Standard Operating Procedures were developed and implemented in pilot studies in five organizations. The flowchart was used to develop a quality framework for Total Diet Studies that could be included in formal quality management systems. Pilot studies operated by four project partners were visited by project assessors who reviewed implementation of the proposed framework and identified areas that could be improved. The quality framework developed can be the starting point for any Total Diet Study centre and can be used within existing formal quality management approaches. Copyright © 2017 Elsevier Ltd. All rights reserved.

Managing waste from confined animal feeding operations in the United States: the need for sanitary reform.

PubMed

Graham, Jay P; Nachman, Keeve E

2010-12-01

Confined food-animal operations in the United States produce more than 40 times the amount of waste than human biosolids generated from US wastewater treatment plants. Unlike biosolids, which must meet regulatory standards for pathogen levels, vector attraction reduction and metal content, no treatment is required of waste from animal agriculture. This omission is of concern based on dramatic changes in livestock production over the past 50 years, which have resulted in large increases in animal waste and a high degree of geographic concentration of waste associated with the regional growth of industrial food-animal production. Regulatory measures have not kept pace with these changes. The purpose of this paper is to: 1) review trends that affect food-animal waste production in the United States, 2) assess risks associated with food-animal wastes, 3) contrast food-animal waste management practices to management practices for biosolids and 4) make recommendations based on existing and potential policy options to improve management of food-animal waste.

Financial management practices and attitudes of dental hygienists: a descriptive study.

PubMed

Russell, Katherine; Stramoski, Sandra

2011-01-01

The purpose of this study was to determine the financial management goals and practices of registered dental hygienists, their satisfaction with their current financial situations and their attitudes about savings, investments and retirement. A 40 question electronic survey was completed by 388 registered dental hygienists. The descriptive instrument assessed financial practices, attitudes, goals and beliefs, retirement mindset, savings habits, debt tendencies and demographic characteristics of respondents. Statistical analyses compared respondents' beliefs about their financial independence and security with their current financial practices. Analyses included: independent samples t-tests, chi-square analysis and ANOVA. Most dental hygienists believed themselves to be financially independent and reported satisfaction with their current financial situation. Significant relationships existed between respondents' satisfaction with their current financial situations and their financial attitudes and practices (saving regularly and having limited debt). Those who indicated they had personally saved for retirement were more likely to view these savings as their largest source of income during retirement, as opposed to Social Security benefits. A majority agreed that financial management education should be included in the dental hygiene curriculum, and that they would attend a continuing education course on the subject if offered. The results of this study suggest that hygienists have confidence in their ability to provide secure financial futures for themselves. Hygienists who practiced sound financial planning, such as adhering to monthly budgets, having wills, lowering debt and saving regularly, reported a higher level of financial security than those who did not. Most respondents expressed interest in receiving education about financial management through the dental hygiene curriculum and continuing education courses.

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

PubMed Central

2012-01-01

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

An exploration of the utility of appraisals for the revalidation of pharmacy professionals in community pharmacy in Great Britain.

PubMed

Jee, Samuel D; Jacobs, Sally; Schafheutle, Ellen I; Elvey, Rebecca; Hassell, Karen; Noyce, Peter R

2013-01-01

With revalidation in pharmacy in the United Kingdom fast approaching, appropriate systems of revalidation in community pharmacy are required. With little known about the potential use of appraisals for evaluating fitness to practice in pharmacy professionals (pharmacists and pharmacy technicians) in this sector, research was undertaken to explore their potential utility in a revalidation process. To examine existing structures and processes in community pharmacy appraisals in Great Britain (ie, England, Scotland, and Wales) and consider the views of pharmacy stakeholders on if, and how, appraisals could contribute to revalidation of pharmacy professionals. Semi-structured telephone interviews were conducted with senior staff (eg, superintendents and professional development managers) from chain community pharmacies as well as pharmacy managers/owners from independent pharmacies. Senior staff from locum agencies and pharmacy technician stakeholders were also interviewed. Appraisals were in place for pharmacists in most chain pharmacies but not in independent pharmacies. Locum pharmacists were not appraised, either by the companies they worked for or by the locum agencies. Pharmacy managers/owners working in independent pharmacies were also not appraised. Pharmacy technicians were appraised in most chain pharmacies but only in some independent pharmacies. Where appraisals were in operation, they were carried out by line managers who may or may not be a pharmacist. Appraisals did not seem to cover areas relevant to fitness to practice but instead focused more on performance related to business targets. This was particularly true for those in more senior positions within the organization such as area managers and superintendent pharmacists. Existing systems of appraisal, on their own, do not seem to be suitable for revalidating a pharmacy professional. Considerable changes to the existing appraisal systems in community pharmacy and employer engagement may be necessary if they are to play a role in revalidation. Copyright © 2013 Elsevier Inc. All rights reserved.

The drainage information and control system of smart city

NASA Astrophysics Data System (ADS)

Mao, Tonglei; Li, Lei; Liu, JiChang; Cheng, Liang; Zhang, Jing; Song, Zengzhong; Liu, Lianhai; Hu, Zichen

2018-03-01

At present, due to the continuous expansion of city and the increase of the municipal drainage facilities, which leads to a serious lack of management and operation personnel, the existing production management pattern already can't adapt to the new requirements. In this paper, according to river drainage management, flood control, water management, auditing, administrative license, etc. different business management requirement, an information management system for water planning and design of smart city based on WebGIS in Linyi was introduced, which can collect the various information of gate dam, water pump, bridge sensor and traffic guide terminal nodes etc. together. The practical application show that the system can not only implement the sharing, resources integration and collaborative application for the regional water information, but also improve the level of the integrated water management.

CULTURAL COMPETENCE IN OUTPATIENT SUBSTANCE ABUSE TREATMENT: MEASUREMENT AND RELATIONSHIP TO WAIT TIME AND RETENTION

PubMed Central

Guerrero, Erick; Andrews, Christina M.

2011-01-01

BACKGROUND Culturally competent practice is broadly acknowledged to be an important strategy to increase the quality of services for racial/ethnic minorities in substance abuse treatment. However, few empirically derived measures of organizational cultural competence exist, and relatively little is known about how these measures affect treatment outcomes. METHOD Using a nationally representative sample of outpatient substance abuse treatment (OSAT) programs, this study used item response theory to create two measures of cultural competence-organizational practices and managers' culturally sensitive beliefs—and examined their relationship to client wait time and retention using Poisson regression modeling RESULTS The most common and precisely measured organizational practices reported by OSAT managers included matching providers and clients based on language/dialect; offering cross-cultural training; and fostering connections with community and faith-based organizations connected to racial and ethnic minority groups. The most culturally sensitive belief among OSAT managers was support for language/dialect matching for racial and ethnic minority clients. Results of regression modeling indicate that organizational practices were not related to either outcome. However, managers' culturally sensitive beliefs were negatively associated with average wait time (p < 0.05), and positively associated with average retention (p < 0.01). CONCLUSIONS Managers' culturally sensitive beliefs—considered to be influential for effective implementation of culturally competent practices—may be particularly relevant in influencing wait time and retention in OSAT organizations that treat Latinos and African American clients. PMID:21680111

Performance management in healthcare: a critical analysis.

PubMed

Hewko, Sarah J; Cummings, Greta G

2016-01-01

Purpose - The purpose of this paper is to explore the underlying theoretical assumptions and implications of current micro-level performance management and evaluation (PME) practices, specifically within health-care organizations. PME encompasses all activities that are designed and conducted to align employee outputs with organizational goals. Design/methodology/approach - PME, in the context of healthcare, is analyzed through the lens of critical theory. Specifically, Habermas' theory of communicative action is used to highlight some of the questions that arise in looking critically at PME. To provide a richer definition of key theoretical concepts, the authors conducted a preliminary, exploratory hermeneutic semantic analysis of the key words "performance" and "management" and of the term "performance management". Findings - Analysis reveals that existing micro-level PME systems in health-care organizations have the potential to create a workforce that is compliant, dependent, technically oriented and passive, and to support health-care systems in which inequalities and power imbalances are perpetually reinforced. Practical implications - At a time when the health-care system is under increasing pressure to provide high-quality, affordable services with fewer resources, it may be wise to investigate new sector-specific ways of evaluating and managing performance. Originality/value - In this paper, written for health-care leaders and health human resource specialists, the theoretical assumptions and implications of current PME practices within health-care organizations are explored. It is hoped that readers will be inspired to support innovative PME practices within their organizations that encourage peak performance among health-care professionals.

United States Department of Agriculture-Agricultural Research Service research programs on microbes for management of plant-parasitic nematodes.

PubMed

Meyer, Susan L F

2003-01-01

Restrictions on the use of conventional nematicides have increased the need for new methods of managing plant-parasitic nematodes. Consequently, nematode-antagonistic microbes, and active compounds produced by such organisms, are being explored as potential additions to management practices. Programs in this area at the USDA Agricultural Research Service investigate applied biocontrol agents, naturally occurring beneficial soil microbes and natural compounds. Specific research topics include use of plant growth-promoting rhizobacteria and cultural practices for management of root-knot and ring nematodes, determination of management strategies that enhance activity of naturally occurring Pasteuria species (bacterial obligate parasites of nematodes), studies on interactions between biocontrol bacteria and bacterial-feeding nematodes, and screening of microbes for compounds active against plant-parasitic nematodes. Some studies involve biocontrol agents that are active against nematodes and soil-borne plant-pathogenic fungi, or combinations of beneficial bacteria and fungi, to manage a spectrum of plant diseases or to increase efficacy over a broader range of environmental conditions. Effective methods or agents identified in the research programs are investigated as additions to existing management systems for plant-parasitic nematodes.

Business Training and Education Needs of Chiropractors

PubMed Central

Henson, Steve W; Pressley, Milton; Korfmann, Scott

2008-01-01

Objective: This report is an examination of the perceived need for business skills among chiropractors. Methods: An online survey was completed by 64 chiropractors. They assessed the need for business skills and current levels of business skills. Using this information, gaps in business skills are identified. Results: The need for business skills is broad, encompassing all major business functions. Existing business skills are well below needed levels. Conclusion: The chiropractic profession needs significantly greater business and practice management skills. The existing gap between needed business skills and existing skills suggests that current training and education programs are not providing adequate business skills training PMID:19043535

A snapshot of pharmacist attitudes and behaviors surrounding the management of pediatric asthma.

PubMed

Elaro, Amanda; Shah, Smita; Armour, Carol L; Bosnic-Anticevich, Sinthia

2015-01-01

The aim of this study is to identify the current status of pediatric asthma management in the Australian community pharmacy setting from the pharmacists' perspective. This research will allow us to identify training needs of community pharmacists. Pharmacists were recruited from the Sydney metropolitan region and asked to complete a self-reported questionnaire that elucidated information on four general domains relating to pediatric asthma management within community pharmacy. All data collected were analysed descriptively. Bivariate Pearson correlations were performed to determine whether interrelationships existed between specific domains. All 77 pharmacists completed the questionnaire. Thirty-two percent had not completed any asthma related CPD in the past year and only 25% of pharmacists reported using the national asthma guidelines in practice. Just over half of the pharmacists (54%) reported that they provide device technique demonstrations for new inhaled medicines, and 35% of pharmacists reported that they check for written asthma self-management plan possession. Although 65% of pharmacists reported confidence in communication skills, most pharmacists were not confident in setting short-/long-term goals with the patient and carer for managing asthma at home. Pharmacists believed that they are just as effective as doctors in providing asthma counseling and education. Lack of time was identified as a significant barrier. We have identified a gap between guideline recommended practices and the self-reported practices of community pharmacists. Pharmacists need more appropriate continuing education programs that can translate into improved pediatric asthma self-management practices and thus improved asthma outcomes in children. This may require an alternative approach.

Health and productivity management: establishing key performance measures, benchmarks, and best practices.

PubMed

Goetzel, R Z; Guindon, A M; Turshen, I J; Ozminkowski, R J

2001-01-01

Major areas considered under the rubric of health and productivity management (HPM) in American business include absenteeism, employee turnover, and the use of medical, disability, and workers' compensation programs. Until recently, few normative data existed for most HPM areas. To meet the need for normative information in HPM, a series of Consortium Benchmarking Studies were conducted. In the most recent application of the study, 1998 HPM costs, incidence, duration, and other program data were collected from 43 employers on almost one million workers. The median HPM costs for these organizations were $9992 per employee, which were distributed among group health (47%), turnover (37%), unscheduled absence (8%), nonoccupational disability (5%), and workers' compensation programs (3%). Achieving "best-practice" levels of performance (operationally defined as the 25th percentile for program expenditures in each HPM area) would realize savings of $2562 per employee (a 26% reduction). The results indicate substantial opportunities for improvement through effective coordination and management of HPM programs. Examples of best-practice activities collated from on-site visits to "benchmark" organizations are also reviewed.

Information technology, the internet, and the future of neurology.

PubMed

Maulden, Sarah A

2003-05-01

This review addresses the impact of information technology and the Internet on the current and future practice of neurology. Information technology is influencing medical practice in ways that could be both beneficial and harmful. Scenarios are presented to depict some of the ways in which the practice of neurology is being influenced by the growth of technology. First, the advantages and disadvantages of e-mail as a means of doctor-patient communication are presented. Some of the ethical and legal issues arising in this context are discussed.Second, the Internet is changing neurologists' relationships to other professionals in the health care industry. Geographical isolation is less problematic than in the past. Telemedicine, including remote consulting via the Web, has special implications for neurologists in several areas, including stroke management, movement disorders, and epilepsy.Third, the growing availability of large databases, powerful search engines, and online full-text journals is discussed. Skill in navigating and managing these resources will become increasingly important. New computer-assisted decision support systems will continue to be implemented. Applications exist or are being developed for use by clinicians for many specific neurologic disorders.Finally, some of the problematic issues concerning medical use of the Internet are discussed, including availability, portability, security, quality, and outcomes. Medical information systems, with their attendant advantages and limitations, will become increasingly significant in the practice of neurology. Despite overall improvement in access to information, major barriers still exist to the proper implementation and utilization of truly integrated information systems.

Research for the development of best management practices for minimizing horse trail impacts on the Hoosier National Forest

USGS Publications Warehouse

Aust, M.W.; Marion, J.L.; Kyle, K.

2005-01-01

This research investigates horse trail impacts to gain an improved understanding of the relationship between various levels of horse use, horse trail management alternatives, and subsequent horse trail degradation. A survey of existing horse trails on the Hoosier National Forest was used to collect data on use-related, environmental and management factors to model horse trail impacts. Results are analyzed to identify which factors are most easily manipulated by managers to effectively avoid and minimize horse trail impacts. A specific focus includes evaluating the relative effect of trail use level, surfacing, grade, and water control on indices of erosion and trafficability such as trail cross sectional area, estimated erosion, muddiness, and incision. Overall, the Hoosier National Forest horse trails could be significantly improved by relocating or closing inherited trails that directly ascend slope or are excessively steep, reducing the distance between water control structures, and by applying gravel to harden trail surfaces and reduce soil erosion. A set of Best Management Practices for trails are included as a product of this work, with recommendations based on this research.

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.

The identification and management of substance use disorders in anesthesiologists.

PubMed

Lefebvre, Lisa G; Kaufmann, I Michael

2017-02-01

The purpose of this article is to review current evidence for the identification and management of substance use disorders in anesthesiologists and to describe an approach to return to practice. Anesthesiologists experience substance use disorders at a rate reported to be 2.7 times that of other physicians. Effective evidence-based treatment is available for physicians with substance use disorders, including anesthesiologists. Significant barriers preventing access to such treatment still exist, some of which are specific to the physician cohort. Standard of care should involve ongoing monitoring of substance use disorders in a chronic disease management paradigm. The outcomes for anesthesiologists treated and monitored for a substance use disorder are similar to those for other physicians and significantly superior to those for the general population. Return to work is possible and is most effectively managed in an occupational health risk management model. The treatment of substance use disorders in anesthesiologists is effective, and a safe return to practice is possible in a majority of cases. National guidelines are needed to ensure equitable access to high-quality treatment and recovery monitoring for all Canadian physicians.

General practitioners' management of mental disorders: a rewarding practice with considerable obstacles.

PubMed

Fleury, Marie-Josée; Imboua, Armelle; Aubé, Denise; Farand, Lambert; Lambert, Yves

2012-03-16

Primary care improvement is the cornerstone of current reforms. Mental disorders (MDs) are a leading cause of morbidity worldwide and widespread in industrialised countries. MDs are treated mainly in primary care by general practitioners (GPs), even though the latter ability to detect, diagnose, and treat patients with MDs is often considered unsatisfactory. This article examines GPs' management of MDs in an effort to acquire more information regarding means by which GPs deal with MD cases, impact of such cases on their practices, factors that enable or hinder MD management, and patient-management strategies. This study employs a mixed-method approach with emphasis on qualitative investigation. Based on a previous survey of 398 GPs in Quebec, Canada, 60 GPs representing a variety of practice settings were selected for further study. A 10-minute-long questionnaire comprising 27 items was administered, and 70-minute-long interviews were conducted. Quantitative (SPSS) and qualitative (NVivo) analyses were performed. At least 20% of GP visits were MD-related. GPs were comfortable managing common MDs, but not serious MDs. GPs' based their treatment of MDs on pharmacotherapy, support therapy, and psycho-education. They used clinical intuition with few clinical tools, and closely followed their patients with MDs. Practice features (salary or hourly fees payment; psycho-social teams on-site; strong informal networks), and GPs' individual characteristics (continuing medical education; exposure and interest in MDs; traits like empathy) favoured MD management. Collaboration with psychologists and psychiatrists was considered key to good MD management. Limited access to specialists, system fragmentation, and underdeveloped group practice and shared-care models were impediments. MD management was seen as burdensome because it required more time, flexibility, and emotional investment. Strategies exist to reduce the burden (one-problem-per-visit rule; longer time slots). GPs found MD practice rewarding as patients were seen as grateful and more complying with medical recommendations compared to other patients, generally leading to positive outcomes. To improve MD management, this study highlights the importance of extending multidisciplinary GP practice settings with salary or hourly fee payment; access to psychotherapeutic and psychiatric expertise; and case-discussion training involving local networks of GPs and MD specialists that encourage both knowledge transfer and shared care.

General practitioners' management of mental disorders: A rewarding practice with considerable obstacles

PubMed Central

2012-01-01

Background Primary care improvement is the cornerstone of current reforms. Mental disorders (MDs) are a leading cause of morbidity worldwide and widespread in industrialised countries. MDs are treated mainly in primary care by general practitioners (GPs), even though the latter ability to detect, diagnose, and treat patients with MDs is often considered unsatisfactory. This article examines GPs' management of MDs in an effort to acquire more information regarding means by which GPs deal with MD cases, impact of such cases on their practices, factors that enable or hinder MD management, and patient-management strategies. Methods This study employs a mixed-method approach with emphasis on qualitative investigation. Based on a previous survey of 398 GPs in Quebec, Canada, 60 GPs representing a variety of practice settings were selected for further study. A 10-minute-long questionnaire comprising 27 items was administered, and 70-minute-long interviews were conducted. Quantitative (SPSS) and qualitative (NVivo) analyses were performed. Results At least 20% of GP visits were MD-related. GPs were comfortable managing common MDs, but not serious MDs. GPs' based their treatment of MDs on pharmacotherapy, support therapy, and psycho-education. They used clinical intuition with few clinical tools, and closely followed their patients with MDs. Practice features (salary or hourly fees payment; psycho-social teams on-site; strong informal networks), and GPs' individual characteristics (continuing medical education; exposure and interest in MDs; traits like empathy) favoured MD management. Collaboration with psychologists and psychiatrists was considered key to good MD management. Limited access to specialists, system fragmentation, and underdeveloped group practice and shared-care models were impediments. MD management was seen as burdensome because it required more time, flexibility, and emotional investment. Strategies exist to reduce the burden (one-problem-per-visit rule; longer time slots). GPs found MD practice rewarding as patients were seen as grateful and more complying with medical recommendations compared to other patients, generally leading to positive outcomes. Conclusions To improve MD management, this study highlights the importance of extending multidisciplinary GP practice settings with salary or hourly fee payment; access to psychotherapeutic and psychiatric expertise; and case-discussion training involving local networks of GPs and MD specialists that encourage both knowledge transfer and shared care. PMID:22423592

Sharing lessons learned and best practices in deactivation and decommissioning techniques among U.S. Department of Energy contractors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lackey, Michael B.; Waisley, Sandra L.; Dusek, Lansing G.

2007-07-01

Approximately $153.2 billion of work currently remains in the United States Department of Energy's (DOE's) Office of Environmental Management (EM) life cycle budget for United States projects. Contractors who manage facilities for the DOE have been challenged to identify transformational changes to reduce the life cycle costs and develop a knowledge management system that identifies, disseminates, and tracks the implementation of lessons learned and best practices. At the request of the DOE's EM Office of Engineering and Technology, the Energy Facility Contractors Group (EFCOG) responded to the challenge with formation of the Deactivation and Decommissioning (D and D) and Facilitymore » Engineering (DD/FE) Working Group. Since October 2006, members have already made significant progress in realizing their goals: adding new D and D best practices to the existing EFCOG Best Practices database; participating in lessons learned forums; and contributing to a DOE initiative on identifying technology needs. The group is also participating in a DOE project management initiative to develop implementation guidelines, as well as a DOE radiation protection initiative to institute a more predictable and standardized approach to approving authorized limits and independently verifying cleanup completion at EM sites. Finally, a D and D hotline to provide real-time solutions to D and D challenges is also being launched. (authors)« less

The pattern of anxiolytic and hypnotic management by Australian general practice trainees.

PubMed

Holliday, Simon M; Morgan, Simon; Tapley, Amanda; Henderson, Kim M; Dunlop, Adrian J; van Driel, Mieke L; Spike, Neil A; McArthur, Lawrence A; Ball, Jean; Oldmeadow, Christopher J; Magin, Parker J

2017-03-01

Guidelines recommend anxiolytics and hypnotics (A/H) as second-line, short-term medications. We aimed to establish prevalence and associations of A/H prescribing by Australian general practice (GP) trainees. A cross-sectional analysis from a cohort study of vocational trainees from four GP Regional Training Providers during 2010-2013. General practice trainees act as independent practitioners (including for prescribing purposes) while having recourse to advice from a GP supervisor. Practice and trainee demographic data were collected as well as patient, clinical and educational data from 60 consecutive consultations of each trainee each training term. Analysis was at the level of individual problem managed, with the outcome factor being prescription of any anxiolytic or hypnotic. Overall, 645 registrars (response rate 94.0%) prescribed 68 582 medications in 69 621 consultations (with 112 890 problems managed). A/Hs were prescribed for 1.3% of problems managed and comprised 2.2% of all prescriptions. They were prescribed particularly for insomnia (28.2%) or anxiety (21.8%), but also for many 'off-label' indications. Significant associations of A/H prescriptions were: patient-level (greater age, Aboriginal and Torres Strait Islander status, English-speaking background, being new to the trainee but not to the practice); trainee-level (male) and consultation-level (longer duration, pre-existing problem, specialist referral not being made). Prescribing was significantly lower in one of the four Regional Training Providers. GP trainees, inconsistent with most guideline recommendations, prescribe A/Hs mainly as maintenance therapy to unfamiliar and older patients. Our results suggest that changes in management approaches are needed which may be facilitated by support for psychotherapeutic training. [Holliday SM, Morgan S, Tapley A, Henderson KM, Dunlop AJ, van Driel ML, Spike NA, McArthur LA, Ball J, Oldmeadow CJ, Magin PJ. The pattern of anxiolytic and hypnotic management by Australian general practice trainees. Drug Alcohol Rev 2017;36:261-269]. © 2016 Australasian Professional Society on Alcohol and other Drugs.

Mind the Gap: How do climate and agricultural management explain the "yield gap" of croplands around the world?

NASA Astrophysics Data System (ADS)

Licker, R.; Foley, J. A.; Johnston, M.

2007-12-01

At present, cultivated lands extend across approximately fifteen million square kilometers of the Earth's surface, making it one of the most dominant land cover types. The management practices used on these lands have become increasingly intensified, requiring large inputs of fertilizers and water, in addition to mechanization and biotechnology. These intensified practices have had implications for ecosystem goods and services ranging from water quality and availability to carbon sequestration. However, the billions of additional people that are projected to inhabit the planet in the twenty-first century will require further outputs from our global agricultural system. Given our food system's already expansive and intensive state, it is important to consider where the additional yields might come from and what additional management inputs this might require. In this study, we compare yields both within crop types and within regions of similar climate to determine where yield gaps exist. We do so using recently created, five-minute datasets of the area harvested and yield of 175 different crop types for the year 2000. We also explore the links of these yield gaps to global patterns of management. For example, we consider the ways in which management practices such as irrigation and fire are influencing yields around the world - analyses that can help critically evaluate the level of management currently employed and help imagine what management might be necessary to achieve higher yields in the future. These data will be needed in the next generation of Earth System models, in order to better represent the practices of agricultural land use in more realistic ways, thereby improving our understanding of land use / land cover change on the global carbon and water cycles, and the climate system.

Pesticide management approach towards protecting the safety and health of farmers in Southeast Asia.

PubMed

Mohammad, Norsyazwani; Abidin, Emilia Zainal; How, Vivien; Praveena, Sarva Mangala; Hashim, Zailina

2018-06-27

It is estimated that pesticide production and use have increased continuously in the countries of Southeast Asia in recent years. Within the context of protecting the safety and health of workers in the agricultural sector, there is an existing gap in the implementation of the pesticide management framework because safety and health effects arising from occupational exposures continue to be reported. This study aims to provide narrative similarities, differences and weaknesses of the existing pesticide management system in Southeast Asian countries (Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam) within the context of occupational safety and health. This is preliminary traditional review study. Pesticide regulation and management at the country level were identified using web-based search engines such as Scopus, ScienceDirect, PubMed and Google. Book, reports, legislation document and other documents retrieved were also gathered from international organizations and specific websites of governmental agency in Southeast Asian countries. The scope of this review is only limited to literature written in English. In total, 44 review articles, reports and documents were gathered for this study. The approach of pesticide management in protecting safety and health in the agricultural setting were benchmarked according to the elements introduced by the United States Environmental Protection Agency, namely, (1) the protection of workers and (2) the practice of safety. All countries have assigned a local authority and government organization to manage and control pesticide use in the agricultural sector. The countries with the highest usage of pesticide are Thailand, Philippines and Malaysia. Most Southeast Asian countries have emphasized safety practice in the management of pesticide usage, but there were less emphasis on the element of protection of workers within the framework in Indonesia, Myanmar, Thailand and Vietnam. The governing bodies in the countries of Southeast Asia have placed significant effort to develop framework related to pesticide management at the country level. The implementation of pesticide management based on the existing framework is evident in most of the countries but needs to be improved. It is suggested that emphasis be given to the implementation of diagnosis, health surveillance and reporting system as well as following or adopting standard guidelines for the protection of workers in terms of safety and health in the agricultural sector.

A review of legal framework applicable for the management of healthcare waste and current management practices in Ethiopia.

PubMed

Haylamicheal, Israel Deneke; Desalegne, Solomon Akalu

2012-06-01

The management of healthcare waste (HCW) requires special attention due to the risk posed by the presence of hazardous waste. The first step towards this is the issuance of national legislation complemented by policy documents, regulations and technical guidelines. In Ethiopia there is no specific legislation for healthcare waste management (HCWM). However, there are various legislations which may provide a legal framework for the management of HCW. This review assesses the various legislations that are relevant to HCWM. It also looks into the institutional arrangements put in place and waste management practices that prevail in the country. It was found that, although the existing legislations have provisions that may provide a legal framework for the management of HCW in Ethiopia, they are not comprehensive and lack specificity in terms of defining hazardous HCW and its categories; in indicating legal obligations of healthcare facilities (HCFs) in handling, transporting, treating and disposing HCW, and record keeping and reporting. There is overlapping of mandates and lackof co-ordination among various government institutions that are responsible for HCWM. The HCWM practices also do not conform to the principles of waste management in general and HCWM in particular. Thus, to better manage HCW in Ethiopia, a specific and comprehensive legislation and policy document on HCWM with clear designation of responsibilities to various stakeholders should be issued immediately. Moreover, training and awareness raising activities on proper HCWM should be undertaken targeting medical staffs, HCF administrators, waste handlers, policy and decision makers and the general public.

Significant differences between vascular and nonvascular surgeons in the perioperative management of antiplatelet therapies in patients with coronary stents.

PubMed

Kilic, Arman; Sultan, Ibrahim S; Arnaoutakis, George J; Black, James H; Reifsnyder, Thomas

2015-04-01

An increasing number of patients undergoing noncardiac surgery have coronary stents. Although guidelines regarding perioperative management of antiplatelet therapies in this patient population exist, practice patterns remain incompletely understood. This study evaluated these practice patterns, with particular attention to differences in management between vascular and nonvascular surgeons. A link to a 16-question survey was displayed in the American College of Surgeons (ACS) electronic newsletter NewsScope, which is posted on the ACS Web site. Questions were focused on perioperative management of antiplatelets (aspirin, clopidogrel) for bare-metal (BMS; placed within 2 months) and drug-eluting stents (DES; placed within the past year) during low- and high-risk bleeding procedures, assuming a patient with no other confounding medical issues. Primary stratification was by surgeon specialty. A total of 244 surgical providers responded to the survey, of which 40 (17%) were vascular surgeons. The majority of respondents were attending surgeons in practice for at least 10 years (79%, n = 190). A significantly higher percentage of vascular versus nonvascular surgeons would not stop aspirin preoperatively in low bleeding risk procedures (BMS: 90% vs. 54%, P = 0.001; DES: 88% vs. 58%, P = 0.009). A higher percentage of vascular surgeons would not stop aspirin preoperatively in high bleeding risk procedures as well (BMS: 70% vs. 28%, P < 0.001; DES: 78% vs. 32%, P < 0.001). Most vascular surgeons would not stop clopidogrel in a low-risk BMS patient (53% vs. 21% of nonvascular surgeons, P = 0.001). Similar findings with clopidogrel were observed in low- (would not stop: 65% vascular versus 30% nonvascular, P < 0.001) and high-risk DES patients (would not stop: 30% vascular versus 8% nonvascular, P = 0.001). The same trends were observed in resuming antiplatelets in the postoperative period. The majority of respondents were not familiar with professional guidelines regarding perioperative antiplatelet management (52%, n = 128), with no differences between vascular and nonvascular surgeons (45% vs. 54%, P = 0.30). This national survey demonstrates significant variation in perioperative antiplatelet management in patients with coronary stents, with marked differences between vascular and nonvascular surgeons. More effective communication of existing guidelines or the development of new specialty-specific professional guidelines appears prudent in reducing this variability in practice. Copyright © 2015 Elsevier Inc. All rights reserved.

Existing capacity to manage pharmaceuticals and related commodities in East Africa: an assessment with specific reference to antiretroviral therapy

PubMed Central

Waako, Paul J; Odoi-adome, Richard; Obua, Celestino; Owino, Erisa; Tumwikirize, Winnie; Ogwal-okeng, Jasper; Anokbonggo, Willy W; Matowe, Lloyd; Aupont, Onesky

2009-01-01

Background East African countries have in the recent past experienced a tremendous increase in the volume of antiretroviral drugs. Capacity to manage these medicines in the region remains limited. Makerere University, with technical assistance from the USAID supported Rational Pharmaceutical Management Plus (RPM Plus) Program of Management Sciences for Health (MSH) established a network of academic institutions to build capacity for pharmaceutical management in the East African region. The initiative includes institutions from Uganda, Tanzania, Kenya and Rwanda and aims to improve access to safe, effective and quality-assured medicines for the treatment of HIV/AIDS, TB and Malaria through spearheading in-country capacity. The initiative conducted a regional assessment to determine the existing capacity for the management of antiretroviral drugs and related commodities. Methods Heads and implementing workers of fifty HIV/AIDS programs and institutions accredited to offer antiretroviral services in Uganda, Kenya, Tanzania and Rwanda were key informants in face-to-face interviews guided by structured questionnaires. The assessment explored categories of health workers involved in the management of ARVs, their knowledge and practices in selection, quantification, distribution and use of ARVs, nature of existing training programs, training preferences and resources for capacity building. Results Inadequate human resource capacity including, inability to select, quantify and distribute ARVs and related commodities, and irrational prescribing and dispensing were some of the problems identified. A competence gap existed in all the four countries with a variety of healthcare professionals involved in the supply and distribution of ARVs. Training opportunities and resources for capacity development were limited particularly for workers in remote facilities. On-the-job training and short courses were the preferred modes of training. Conclusion There is inadequate capacity for managing medicines and related commodities in East Africa. There is an urgent need for training in aspects of pharmaceutical management to different categories of health workers. Skills building activities that do not take healthcare workers from their places of work are preferred. PMID:19272134

Design of material management system of mining group based on Hadoop

NASA Astrophysics Data System (ADS)

Xia, Zhiyuan; Tan, Zhuoying; Qi, Kuan; Li, Wen

2018-01-01

Under the background of persistent slowdown in mining market at present, improving the management level in mining group has become the key link to improve the economic benefit of the mine. According to the practical material management in mining group, three core components of Hadoop are applied: distributed file system HDFS, distributed computing framework Map/Reduce and distributed database HBase. Material management system of mining group based on Hadoop is constructed with the three core components of Hadoop and SSH framework technology. This system was found to strengthen collaboration between mining group and affiliated companies, and then the problems such as inefficient management, server pressure, hardware equipment performance deficiencies that exist in traditional mining material-management system are solved, and then mining group materials management is optimized, the cost of mining management is saved, the enterprise profit is increased.

Integrating Climate Change Adaptation into Public Health Practice: Using Adaptive Management to Increase Adaptive Capacity and Build Resilience

PubMed Central

McDowell, Julia Z.; Luber, George

2011-01-01

Background: Climate change is expected to have a range of health impacts, some of which are already apparent. Public health adaptation is imperative, but there has been little discussion of how to increase adaptive capacity and resilience in public health systems. Objectives: We explored possible explanations for the lack of work on adaptive capacity, outline climate–health challenges that may lie outside public health’s coping range, and consider changes in practice that could increase public health’s adaptive capacity. Methods: We conducted a substantive, interdisciplinary literature review focused on climate change adaptation in public health, social learning, and management of socioeconomic systems exhibiting dynamic complexity. Discussion: There are two competing views of how public health should engage climate change adaptation. Perspectives differ on whether climate change will primarily amplify existing hazards, requiring enhancement of existing public health functions, or present categorically distinct threats requiring innovative management strategies. In some contexts, distinctly climate-sensitive health threats may overwhelm public health’s adaptive capacity. Addressing these threats will require increased emphasis on institutional learning, innovative management strategies, and new and improved tools. Adaptive management, an iterative framework that embraces uncertainty, uses modeling, and integrates learning, may be a useful approach. We illustrate its application to extreme heat in an urban setting. Conclusions: Increasing public health capacity will be necessary for certain climate–health threats. Focusing efforts to increase adaptive capacity in specific areas, promoting institutional learning, embracing adaptive management, and developing tools to facilitate these processes are important priorities and can improve the resilience of local public health systems to climate change. PMID:21997387

An exploration of the roles of nurse managers in evidence-based practice implementation.

PubMed

Wilkinson, Joyce E; Nutley, Sandra M; Davies, Huw T O

2011-12-01

Internationally, nurses face ongoing difficulties in making a reality of evidence-based practice. Existing studies suggest that nurse managers (NMs) should play a key role in leading and facilitating evidence-based practice, but the nature of this role has not yet been fully explored or articulated. This is one of the first studies to investigate the roles of NMs in evidence-based practice implementation. METHODOLOGY AND METHODS: Using a case study approach the study explores five propositions in relation to the NMs' potential evidence-based practice role and the extent to which their attitudes, knowledge, and skills support such a role. In doing so, it draws on interviews (n= 51), documentary analysis and observational data. Data analysis reveals that the role of NMs in facilitating evidence-based practice is under-articulated, largely passive and currently limited by competing demands. Progress in implementing evidence-based practice in the case study sites is largely explained by factors other than the role played by NMs. As such, the findings expose significant discrepancies between NMs' actual roles and those espoused in the literature as being necessary. Contextual factors are important and it is clear that the role of the contemporary NM places considerable emphasis on management and administration to the detriment of clinical practice concerns. The study reveals that NMs are only involved in evidence-based practice implementation in a passive role, not the full engagement described in the literature as being necessary. This study adds previously lacking detail of the roles of NMs. It elucidates why exhortations to NMs to become more involved in evidence-based practice implementation are ineffective without action to address the problems identified. Copyright ©2011 Sigma Theta Tau International.

Open innovation in the European space sector: Existing practices, constraints and opportunities

NASA Astrophysics Data System (ADS)

van Burg, Elco; Giannopapa, Christina; Reymen, Isabelle M. M. J.

2017-12-01

To enhance innovative output and societal spillover of the European space sector, the open innovation approach is becoming popular. Yet, open innovation, referring to innovation practices that cross borders of individual firms, faces constraints. To explore these constraints and identify opportunities, this study performs interviews with government/agency officials and space technology entrepreneurs. The interviews highlight three topic areas with constraints and opportunities: 1) mainly one-directional knowledge flows (from outside the space sector to inside), 2) knowledge and property management, and 3) the role of small- and medium sized companies. These results bear important implications for innovation practices in the space sector.

Development and validation of PRISM: a survey tool to identify diabetes self-management barriers.

PubMed

Cox, Elizabeth D; Fritz, Katie A; Hansen, Kristofer W; Brown, Roger L; Rajamanickam, Victoria; Wiles, Kaelyn E; Fate, Bryan H; Young, Henry N; Moreno, Megan A

2014-04-01

Although most children with type 1 diabetes do not achieve optimal glycemic control, no systematic method exists to identify and address self-management barriers. This study develops and validates PRISM (Problem Recognition in Illness Self-Management), a survey-based tool for efficiently identifying self-management barriers experienced by children/adolescents with diabetes and their parents. Adolescents 13 years and older and parents of children 8 years and older visiting for routine diabetes management (n=425) were surveyed about self-management barriers. HbA1c was abstracted from the electronic health record. To develop PRISM, exploratory and confirmatory factor analyses were used. To assess validity, the association of PRISM scores with HbA1c was examined using linear regression. Factor analyses of adolescent and parent data yielded well-fitting models of self-management barriers, reflecting the following domains: (1) Understanding and Organizing Care, (2) Regimen Pain and Bother, (3) Denial of Disease and Consequences, and (4) Healthcare Team, (5) Family, or (6) Peer Interactions. All models exhibited good fit, with χ(2) ratios<2.21, root mean square errors of approximation<0.09, Confirmatory Fit Indices and Tucker-Lewis Indices both >0.92, and weighted root mean square residuals<1.71. Greater PRISM barrier scores were significantly associated with higher HbA1cs. Our findings suggest at least six different domains exist within self-management barriers, nearly all of which are significantly related to HbA1c. PRISM could be used in clinical practice to identify each child and family's unique self-management barriers, allowing existing self-management resources to be tailored to the family's barriers, ultimately improving effectiveness of such services. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Development and Validation of PRISM: A Survey Tool to Identify Diabetes Self-Management Barriers

PubMed Central

Cox, Elizabeth D.; Fritz, Katie A.; Hansen, Kristofer W.; Brown, Roger L.; Rajamanickam, Victoria; Wiles, Kaelyn E.; Fate, Bryan H.; Young, Henry N.; Moreno, Megan A.

2014-01-01

Aims Although most children with type 1 diabetes don’t achieve optimal glycemic control, no systematic method exists to identify and address self-management barriers. This study develops and validates PRISM (Problem Recognition in Illness Self-Management), a survey-based tool for efficiently identifying self-management barriers experienced by children/adolescents with diabetes and their parents. Methods Adolescents 13 years and older and parents of children 8 years and older visiting for routine diabetes management (n=425) were surveyed about self-management barriers. HbA1c was abstracted from the electronic health record. To develop PRISM, exploratory and confirmatory factor analyses were used. To assess validity, the association of PRISM scores with HbA1c was examined using linear regression. Results Factor analyses of adolescent and parent data yielded well-fitting models of self-management barriers, reflecting the following domains: 1) Understanding and Organizing Care, 2) Regimen Pain and Bother, 3) Denial of Disease and Consequences, and 4) Healthcare Team, 5) Family, or 6) Peer Interactions. All models exhibited good fit, with X2 ratios<2.21, root mean square errors of approximation<0.09, Confirmatory Fit Indices and Tucker-Lewis Indices both >0.92, and weighted root mean square residuals<1.71. Greater PRISM barrier scores were significantly associated with higher HbA1cs. Conclusions Our findings suggest at least six different domains exist within self-management barriers, nearly all of which are significantly related to HbA1c. PRISM could be used in clinical practice to identify each child and family’s unique self-management barriers, allowing existing self-management resources to be tailored to the family’s barriers, ultimately improving effectiveness of such services. PMID:24552680

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cassidy, Helen; Rossiter, David

The Low Level Waste Repository (LLWR) is the primary facility for disposal of Low Level Waste (LLW) in the United Kingdom (UK), serving the UK nuclear industry and a diverse range of other sectors. Management of LLW in the UK historically was dominated by disposal to the LLWR. The value of the LLWR as a national asset was recognised by the 2007 UK Governmental Policy on management of solid LLW. At this time, analysis of the projected future demand for disposal at LLWR against facility capacity was undertaken identifying a credible risk that the capacity of LLWR would be insufficientmore » to meet future demand if existing waste management practices were perpetuated. To mitigate this risk a National Strategy for the management of LLW in the UK was developed by the Nuclear Decommissioning Authority (NDA), partnered with LLW Repository Ltd. (the organisation established in 2008 to manage the LLWR on behalf of NDA). This strategy was published in 2010 and identified three mechanisms for protection of the capacity of LLWR - application of the Waste Hierarchy by waste producers; optimised use of existing assets for LLW management; and opening of new waste treatment and disposal routes to enable diversion of waste away from the LLWR. (authors)« less

Anesthetic management of Costello syndrome: a case report.

PubMed

Williams, Christol

2014-04-01

Costello syndrome is a rare genetic disorder with an estimated 300 medical cases worldwide. Typical features that characterize this syndrome include short stature, macrocephaly, developmental delay, loose skin folds, distinctive coarse facial features, and multiorgan system anomalies. The following case report discusses the anesthetic management for a 3-year-old boy undergoing general anesthesia for a scheduled dental restoration, hydrocelectomy, inguinal hernia repair, and bilateral myringotomy with placement of pressure equalization tubes. A scarcity of literature for the anesthetic management of Costello syndrome (also known as faciocutaneoskeletal syndrome) exists. Utilizing an overview of the pertinent literature, clinical practice recommendations are suggested for the anesthetic implications of managing a pediatric patient with this rare syndrome.

Imagining Moral Bioenhancement Practices: Drawing Inspiration from Moral Education, Public Health Ethics, and Forensic Psychiatry.

PubMed

Specker, Jona; Schermer, Maartje H N

2017-07-01

In this article, we consider contexts or domains in which (future) moral bioenhancement interventions possibly or most likely will be implemented. By looking closely at similar or related existing practices and their relevant ethical frameworks, we hope to identify ethical considerations that are relevant for evaluating potential moral bioenhancement interventions. We examine, first, debates on the proper scope of moral education; second, proposals for identifying early risk factors for antisocial behaviour; and third, the difficult balancing of individual freedom and third party concerns in (forensic) psychiatry. In imagining moral bioenhancement in practice, we observe that unlike other forms of enhancement, moral enhancement fundamentally asks how the interests and preferences of the individual and the interests of others should be weighed (in view of public safety and managing public risk). Highly diverse domains such as education, mental health, and the judicial domain might be involved, and moral bioenhancement might challenge existing institutional settings. Given these highly varied contexts and domains, it appears unlikely that there will be a distinct set of practices that will be referred to as "moral bioenhancement."

Mild cognitive impairment and prospective memory: translating the evidence into neuropsychological practice.

PubMed

Kinsella, Glynda J; Pike, Kerryn E; Cavuoto, Marina G; Lee, Stephen D

2018-04-30

There has been a recent rapid development of research characterizing prospective memory performance in mild cognitive impairment (MCI) in older age. However, this body of literature remains largely separated from routine clinical practice in neuropsychology. Furthermore, there is emerging evidence of effective interventions to improve prospective memory performance. Therefore, our objective in this article was to offer a clinical neuropsychological perspective on the existing research in order to facilitate the translation of the evidence-base into clinical practice. By conducting a critical review of the existing research related to prospective memory and MCI, we highlight how this data can be introduced into clinical practice, either within diagnostic assessment or clinical management. Prospective memory is impaired in older adults with MCI, with a pattern of performance that helps with differential diagnosis from healthy aging. Clinical neuropsychologists are encouraged to add prospective memory assessment to their toolbox for diagnostic evaluation of clients with MCI. Preliminary findings of prospective memory interventions in MCI are promising, but more work is required to determine how different approaches translate to increasing independence in everyday life.

Human resources management for a hospital pharmacy department.

PubMed

Chase, P A

1989-06-01

The concepts of human resources management (HRM) are presented, and the application of HRM concepts to a hospital pharmacy department is described. Low salaries and poor working conditions had precipitated a mass exodus of pharmacists from a 650-bed, tertiary-care medical center. The newly hired director of pharmacy sought to rebuild the department by developing a three-stage HRM model consisting of needs forecasting, performance management, and advanced management systems. In the needs-forecasting stage, the strengths and weaknesses of departmental programs were determined through analysis of existing standards of practice, situational analysis, and financial analyses; the strengths and weaknesses of departmental employees were determined through the use of talent inventories, turnover analysis, analysis of time and leave records, reevaluation of the department's job classifications, performance and productivity evaluations, and productivity evaluations, and development of a philosophy of practice and mission statement. Needs and problems were addressed by examining each existing program and developing new policies and procedures, performance standards, quality assurance mechanisms, and productivity expectations. Personnel needs and problems were addressed by designing a system of differentiated career ladders, contracting with pharmacists for career moves, developing the skills of currently employed pharmacists, and implementing a succession planning model. The model has been in place for approximately three years and is beginning to yield the desired results. Application of HRM concepts to a hospital pharmacy department appears to have been successful in improving employee morale and in helping the department to meet goals of expanded and improved services.

The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units.

PubMed

Vogus, Timothy J; Sutcliffe, Kathleen M

2011-01-01

Prior research has found that safety organizing behaviors of registered nurses (RNs) positively impact patient safety. However, little research exists on the joint benefits of safety organizing and other contextual factors that help foster safety. Although we know that organizational practices often have more powerful effects when combined with other mutually reinforcing practices, little research exists on the joint benefits of safety organizing and other contextual factors believed to foster safety. Specifically, we examined the benefits of bundling safety organizing with leadership (trust in manager) and design (use of care pathways) factors on reported medication errors. A total of 1033 RNs and 78 nurse managers in 78 emergency, internal medicine, intensive care, and surgery nursing units in 10 acute-care hospitals in Indiana, Iowa, Maryland, Michigan, and Ohio who completed questionnaires between December 2003 and June 2004. Cross-sectional analysis of medication errors reported to the hospital incident reporting system for the 6 months after the administration of the survey linked to survey data on safety organizing, trust in manager, use of care pathways, and RN characteristics and staffing. Multilevel Poisson regression analyses indicated that the benefits of safety organizing on reported medication errors were amplified when paired with high levels of trust in manager or the use of care pathways. Safety organizing plays a key role in improving patient safety on hospital nursing units especially when bundled with other organizational components of a safety supportive system.

Policy trends of extended producer responsibility in Malaysia.

PubMed

Agamuthu, P; Victor, Dennis

2011-09-01

This paper seeks to examine the provisions for extended producer responsibility (EPR) within the Malaysian environmental and waste management policies and to determine its existing practice and future prospects in Malaysia. Malaysian waste generation has been increasing drastically where solid waste generation was estimated to increase from about 9.0 million tonnes in 2000 to about 10.9 million tonnes in 2010, to about 12.8 million tonnes in 2015 and finally to about 15.6 million tonnes in 2020. Malaysian e-waste was estimated to be about 652 909 tonnes in 2006 and was estimated to increase to about 706 000 tonnes in 2010 and finally to about 1.2 million tonnes in 2020. The projected increasing generation of both solid waste and scheduled wastes is expected to burden the country's resources and environment in managing these wastes in a sustainable manner. The concept of EPR is provided for in the Malaysia waste management system via the Environmental Quality Act 1974 and the Solid Waste and Public Cleansing Management Act 2007. However, these provisions in the policy are generic in nature without relevant regulations to enable its enforcement and as such the concept of EPR still remains on paper whereas the existing practice of EPR in Malaysia is limited through voluntary participation. In conclusion, policy trends of EPR in Malaysia seem to indicate that Malaysia may be embarking on the path towards EPR through the enactment of an EPR regulation.

78 FR 40553 - Privacy Act of 1974: Republication of Notice of Systems of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-05

...In accordance with 5 U.S.C. 552a(e)(4), the Tennessee Valley Authority (TVA) is republishing in full a notice of the existence and character of each TVA system of records. TVA is correcting minor typographical and stylistic errors in previously existing notices and has updated those notices to reflect current organizational structure. Also, updates are being made to show any changes to system locations; managers and addresses; categories of individuals and records; procedures and practices for storing, retrieving, accessing, retaining, and disposing of records.

Arsenic: a roadblock to potential animal waste management solutions.

PubMed

Nachman, Keeve E; Graham, Jay P; Price, Lance B; Silbergeld, Ellen K

2005-09-01

The localization and intensification of the poultry industry over the past 50 years have incidentally created a largely ignored environmental management crisis. As a result of these changes in poultry production, concentrated animal feeding operations (CAFOs) produce far more waste than can be managed by land disposal within the regions where it is produced. As a result, alternative waste management practices are currently being implemented, including incineration and pelletization of waste. However, organic arsenicals used in poultry feed are converted to inorganic arsenicals in poultry waste, limiting the feasibility of waste management alternatives. The presence of inorganic arsenic in incinerator ash and pelletized waste sold as fertilizer creates opportunities for population exposures that did not previously exist. The removal of arsenic from animal feed is a critical step toward safe poultry waste management.

Diagnosis and management of temperature abnormality in ICUs: a EUROBACT investigators' survey.

PubMed

Niven, Daniel J; Laupland, Kevin B; Tabah, Alexis; Vesin, Aurélien; Rello, Jordi; Koulenti, Despoina; Dimopoulos, George; de Waele, Jan; Timsit, Jean-Francois

2013-12-10

Although fever and hypothermia are common abnormal physical signs observed in patients admitted to intensive care units (ICU), little data exist on their optimal management. The objective of this study was to describe contemporary practices and determinants of management of temperature abnormalities among patients admitted to ICUs. Site leaders of the multi-national EUROBACT study were surveyed regarding diagnosis and management of temperature abnormalities among patients admitted to their ICUs. Of the 162 ICUs originally included in EUROBACT, responses were received from 139 (86%) centers in 23 countries in Europe (117), South America (8), Asia (5), North America (4), Australia (3) and Africa (2). A total of 117 (84%) respondents reported use of a specific temperature threshold in their ICU to define fever. A total of 14 different discrete levels were reported with a median of 38.2°C (inter-quartile range, IQR, 38.0°C to 38.5°C). The use of thermometers was protocolized in 91 (65%) ICUs and a wide range of methods were reportedly used, with axillary, tympanic and urinary bladder sites as the most common as primary modalities. Only 31 (22%) of respondents indicated that there was a formal written protocol for temperature control among febrile patients in their ICUs. In most or all cases practice was to control temperature, to use acetaminophen, and to perform a full septic workup in febrile patients and that this was usually directed by physician order. While reported practice was to treat nearly all patients with neurological impairment and most patients with acute coronary syndromes and infections, severe sepsis and septic shock, this was not the case for most patients with liver failure and fever. A wide range of definitions and management practices were reported regarding temperature abnormalities in the critically ill. Documenting temperature abnormality management practices, including variability in clinical care, is important to inform planning of future studies designed to optimize infection and temperature management strategies in the critically ill.

Research on multi-user encrypted search scheme in cloud environment

NASA Astrophysics Data System (ADS)

Yu, Zonghua; Lin, Sui

2017-05-01

Aiming at the existing problems of multi-user encrypted search scheme in cloud computing environment, a basic multi-user encrypted scheme is proposed firstly, and then the basic scheme is extended to an anonymous hierarchical management authority. Compared with most of the existing schemes, the scheme not only to achieve the protection of keyword information, but also to achieve the protection of user identity privacy; the same time, data owners can directly control the user query permissions, rather than the cloud server. In addition, through the use of a special query key generation rules, to achieve the hierarchical management of the user's query permissions. The safety analysis shows that the scheme is safe and that the performance analysis and experimental data show that the scheme is practicable.

Management of patients with amyotrophic lateral sclerosis.

PubMed

Pautex, Sophie; Janssens, Jean-Paul; Vuagnat, Hubert; Conne, Pierre; Zulian, Gilbert B

2005-10-15

Standard recommendations for the clinical management of patient with ALS have been edited in recent years. These documents emphasise the importance of patient's autonomy. To measure how these different recommendations can be applied in the context of a general hospital without a specific ALS clinic. Review of medical records of 21 patients with an ALS diagnosis treated by the University Hospitals Geneva who died from 1996-2002. Patients suffered from distressing symptoms during their last hospitalisation. Artificial nutrition was given to 5 patients. Six patients had non invasive ventilation (NIV). Written advance directives were only available in 2 cases. Discussions about theses issues were also conducted late in the evolution of the disease. Some discrepancies between our daily practice and the existing recommendations exist, particularly regarding the key issues of artificial nutrition and ventilatory support.

[Opinion of the primary care veterinarians of Andalusia concerning the management of their professional practice].

PubMed

Conti Cuesta, F; Baena Parejo, M I; Pinzón Pulido, S A

1999-01-01

This study describes the opinion of the veterinarians in Andalusia regarding the organization and management of their professional practice and pinpoints solutions to the problems found for the purpose of providing planning and management aspects in view of the reforms undertaken in the Andalusian Health Service Strategy Plan. Descriptive opinion poll employing a questionnaire filled out by each individual among all of the Primary Care (PC) veterinarians in Andalusia (including those who have been currently employed who possess at least one year's experience, except substitutes). A description was provided of their personal traits, their opinion of the management-related factors involved in their professional practice. A description was also provided of the suggestions for improving the problems found to exist. Over 70% said they were aware of the objectives, although only the coordinators found them to be clearly motivating the practice. Their opinion was that the indicators of activity neither include any quality-related criteria nor afford the possibility of evaluating the activity they are carrying out. They believed that the contributions from other members of the multidisciplinary team improve their work and are in favor of continuing their involvement therein. They were satisfied with doing their work (the coordinators to a greater degree). They found the productivity pay to be too low and not useful as regards providing them with any incentive. They were not satisfied with the training with which they are provided and thought that what they are offered is far less than their other colleagues in the health care field. Most were of the opinion that they should remain under the authority of the Andalusian Health Service. This group prefers to continue working for the same organization, but improving the following management aspects: training offer, practice incentives and activity indicators.

College Students and Personal Finance: Exploring the Relationships among Financial Well-Being, Money Management Practices, and Engagement in Personal Finance Education

ERIC Educational Resources Information Center

Davtyan, Arman

2010-01-01

Despite ample evidence of the relative financial illiteracy of students in college, personal finance education remains inconsistent across postsecondary institutions in the United States. Moreover, existing programs and services related to personal finance education have had modest success in attracting student interest and participation. To…

The Computer and Personal Privacy, Part III: The Regulation of Computer Records in the United States.

ERIC Educational Resources Information Center

Rubin, Michael Rogers

1989-01-01

Examines the major federal and state laws that govern the privacy aspects of the use of computer databases in three areas: private institutions, state and local governments, and the federal government. The ability of existing privacy laws to prevent abusive information collection, dissemination, and management practices is evaluated. (four…

New Techniques of Difference: On Data as School Pupils

ERIC Educational Resources Information Center

Thoutenhoofd, Ernst D.

2017-01-01

Pupils--the learners of both educational thought and of educational practice--exist ever more as data, as do the strictures and goals through which these pupils are pedagogically managed. I elaborate this thought by way of a single example: a particular kind of pupils whose number is reportedly on the increase, namely pupils diagnosed with…

25 Point Implementation Plan to Reform Federal information Technology Management

DTIC Science & Technology

2010-12-09

8 6 . Develop a strategy for shared services . . . . . . . . . . . . . . . . . . . . . . 8...or shared services exist . Government officials have been trying to adopt best practices for years – from the Raines Rules of the 1990s through the...Additionally, leveraging shared services of “commodity” applications such as e-mail across functional organizations allows organizations to redirect

Toward an HRD Auditing Protocol: Assessing HRD Risk Management Practices

ERIC Educational Resources Information Center

Clardy, Alan

2004-01-01

Even though HRD-related programs and activities carry risks that should be monitored and assessed, there is little literature on how auditing applies to the HRD function; the existing literature on the topic defines HRD auditing in widely different ways. The nature of risk for organizational process is discussed, followed by a review of the…

Extending the Capabilities of Internet-Based Research: Lessons from the Field.

ERIC Educational Resources Information Center

Tingling, Peter; Parent, Michael; Wade, Michael

2003-01-01

Summarizes the existing practices of Internet research and suggests extensions to them (e.g., consideration of new capabilities, such as adaptive questions and higher levels of flexibility and control) based on a large-scale, national Web survey. Lessons learned include the use of a modular design, management of Web traffic, and the higher level…

The Decline of Competition: A Study of Cooperative Approaches to University Research Management. ASHE Annual Meeting Paper.

ERIC Educational Resources Information Center

Holland, Barbara A.

This paper analyzes the organizational strategies and dynamics of cooperation appropriate to research consortia. The experiences of nine existing research consortia are reviewed in an effort to propose guidelines for practice in the design of research consortia, and to expand understanding of the nature of interinstitutional cooperation. The nine…

University of Missouri-St. Louis: Data-Driven Online Course Design and Effective Practices

ERIC Educational Resources Information Center

Grant, Mary Rose

2012-01-01

Analytics has a significant place in the future of higher education by guiding reform and system change. As this case study has shown, analytics can do more than evaluate what students have done and predict what they will do. Learning analytics can be transformative, altering existing pedagogical processes, research, data management, and…

The effect of mid-rotation fertilization on the wood properties of loblolly pine (Pinus taeda)

Treesearch

Finto Antony; Lewis Jordan; Laurence R. Schimleck; Richard F. Daniels; Alexander Clark III

2009-01-01

Mid-rotation fertilization is a common practice in the management of loblolly pine (Pinus taeda L.) plantations, typically providing large improvements in growth. However, concerns exist about the quality of wood produced following fertilization. The objective of this study was to develop an understanding of wood property changes following fertilization. Wood...

The Need to Practice What We Teach: The Sticky Floor Effect in Colleges of Business in Southern U.S. Universities

ERIC Educational Resources Information Center

Johnson, Cooper; Long, Jamye; Faught, Sam

2014-01-01

The Sticky Floor Effect, a relatively new career advancement barrier concept, theorizes there exist obstacles for women preventing them from advancing to first level management positions. Of significant importance to institutions of higher learning's colleges of business, the Sticky Floor Effect highlights issues of consistency, moral…

Emergency nurses' knowledge of pain management principles.

PubMed

Tanabe, P; Buschmann, M

2000-08-01

The purpose of this study was to determine areas of emergency nurses' knowledge deficit regarding pain management, and to identify barriers to pain management as perceived by emergency nurses. Data were collected anonymously in a mail survey using a 52-item knowledge questionnaire addressing pain management principles and asking emergency nurses (Illinois Emergency Nurses Association members) to rate various barriers as to how often they affect their practice. Questionnaires were mailed to all Illinois ENA members (n = 1000). Three hundred five emergency nurses' questionnaires were returned. A significant deficit existed on 2 domains of knowledge: understanding of the terms "addiction," "tolerance," and "dependence"; and knowledge of various pharmacologic analgesic principles. Nurses with a master's degree or higher, or those who attended a 1-day seminar on pain management, achieved statistically significantly higher scores. The 2 barriers identified by emergency nurses as the most common were the inability to administer medication until a diagnosis is made (53%), and inadequate assessment of pain and pain relief (48%) (the percentage indicates how often the emergency nurses believed the barrier was present in their practice). The data indicate that emergency nurses may not have a good understanding of the management of pain with drugs, or of such issues as risk of addiction.

Marsh management plans in practice: Do they work in coastal Louisiana, USA?

NASA Astrophysics Data System (ADS)

Cowan, James H.; Turner, R. Eugene; Cahoon, Donald R.

1988-01-01

Louisiana's coastal wetlands represent about 41% of the nation's total and are extensively managed for fish, fur, and waterfowl. Marsh management plans (MMPs) are currently used to avoid potential user conflicts and are believed to be a best management practice for specific management goals. In this article, we define MMPs and examine their variety, history, impacts, and future. A MMP is an organized written plan submitted to state and federal permitting agencies for approval and whose purpose is to regulate wetland habitat quantity and quality (control land loss and enhance productivity). MMPs are usually implemented by making structural modifications in the marsh, primarily by using a variety of water control structures in levees to impound or semi-impound managed areas. It appears that MMPs using impoundments are only marginally successful in achieving and often contradict management goals. Although 20% of coastal Louisiana may be in MMPs by the year 2000, conflict resolution of public and private goals is compromised by a surfeit of opinion and dearth of data and experience. Based on interpretation of these results, we believe the next phase of management should include scientific studies of actual impacts, utilization of post-construction monitoring data, inventory of existing MMPs, development of new techniques, and determination of cumulative impacts.

Healthcare waste management status in Lagos State, Nigeria: a case study from selected healthcare facilities in Ikorodu and Lagos metropolis.

PubMed

Longe, Ezechiel O

2012-06-01

A survey of healthcare waste management practices and their implications for health and the environment was carried out. The study assessed waste management practices in 20 healthcare facilities ranging in capacity from 40 to 600 beds in Ikorodu and metropolitan Lagos, Lagos State, Nigeria. The prevailing healthcare waste management status was analysed. Management issues on quantities and proportion of different constituents of waste, segregation, collection, handling, transportation, treatment and disposal methods were assessed. The waste generation averaged 0.631 kg bed(-1) day(-1) over the survey area. The waste stream from the healthcare facilities consisted of general waste (59.0%), infectious waste (29.7%), sharps and pathological (8.9%), chemical (1.45%) and others (0.95%). Sharps/pathological waste includes disposable syringes. In general, the waste materials were collected in a mixed form, transported and disposed of along with municipal solid waste with attendant risks to health and safety. Most facilities lacked appropriate treatment systems for a variety of reasons that included inadequate funding and little or no priority for healthcare waste management as well as a lack of professionally competent waste managers among healthcare providers. Hazards associated with healthcare waste management and shortcomings in the existing system were identified.

Evidence-informed physical therapy management of performance-related musculoskeletal disorders in musicians

PubMed Central

Chan, Cliffton; Ackermann, Bronwen

2014-01-01

Playing a musical instrument at an elite level is a highly complex motor skill. The regular daily training loads resulting from practice, rehearsals and performances place great demands on the neuromusculoskeletal systems of the body. As a consequence, performance-related musculoskeletal disorders (PRMDs) are globally recognized as common phenomena amongst professional orchestral musicians. These disorders create a significant financial burden to individuals and orchestras as well as lead to serious consequences to the musicians’ performance and ultimately their career. Physical therapists are experts in treating musculoskeletal injuries and are ideally placed to apply their skills to manage PRMDs in this hyper-functioning population, but there is little available evidence to guide specific injury management approaches. An Australia-wide survey of professional orchestral musicians revealed that the musicians attributed excessively high or sudden increase in playing-load as major contributors to their PRMDs. Therefore, facilitating musicians to better manage these loads should be a cornerstone of physical therapy management. The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favorable outcomes. After these methodologies were employed, the intervention studies were conducted with a national cohort of professional musicians including: health education, onsite injury management, cross-training exercise regimes, performance postural analysis, and music performance biomechanics feedback. The outcomes of all these interventions will be discussed alongside a focussed review on the existing literature of these management strategies. Finally, a framework for best-practice physical therapy management of PRMDs in musicians will be provided. PMID:25071671

Evaluation of Facility Management by Multivariate Statistics - Factor Analysis

NASA Astrophysics Data System (ADS)

Singovszki, Miloš; Vranayová, Zuzana

2013-06-01

Facility management is evolving, there is no exact than other sciences, although its development is fast forward. The knowledge and practical skills in facility management is not replaced, on the contrary, they complement each other. The existing low utilization of science in the field of facility management is mainly caused by the management of support activities are many variables and prevailing immediate reaction to the extraordinary situation arising from motives of those who have substantial experience and years of proven experience. Facility management is looking for a system that uses organized knowledge and will form the basis, which grows from a wide range of disciplines. Significant influence on its formation as a scientific discipline is the "structure, which follows strategy". The paper deals evaluate technology building as part of an facility management by multivariate statistic - factor analysis.

Clinical terminology support for a national ambulatory practice outcomes research network.

PubMed

Ricciardi, Thomas N; Lieberman, Michael I; Kahn, Michael G; Masarie, F E

2005-01-01

The Medical Quality Improvement Consortium (MQIC) is a nationwide collaboration of 74 healthcare delivery systems, consisting of 3755 clinicians, who contribute de-identified clinical data from the same commercial electronic medical record (EMR) for quality reporting, outcomes research and clinical research in public health and practice benchmarking. Despite the existence of a common, centrally-managed, shared terminology for core concepts (medications, problem lists, observation names), a substantial "back-end" information management process is required to ensure terminology and data harmonization for creating multi-facility clinically-acceptable queries and comparable results. We describe the information architecture created to support terminology harmonization across this data-sharing consortium and discuss the implications for large scale data sharing envisioned by proponents for the national adoption of ambulatory EMR systems.

Clinical Terminology Support for a National Ambulatory Practice Outcomes Research Network

PubMed Central

Ricciardi, Thomas N.; Lieberman, Michael I.; Kahn, Michael G.; Masarie, F.E. “Chip”

2005-01-01

The Medical Quality Improvement Consortium (MQIC) is a nationwide collaboration of 74 healthcare delivery systems, consisting of 3755 clinicians, who contribute de-identified clinical data from the same commercial electronic medical record (EMR) for quality reporting, outcomes research and clinical research in public health and practice benchmarking. Despite the existence of a common, centrally-managed, shared terminology for core concepts (medications, problem lists, observation names), a substantial “back-end” information management process is required to ensure terminology and data harmonization for creating multi-facility clinically-acceptable queries and comparable results. We describe the information architecture created to support terminology harmonization across this data-sharing consortium and discuss the implications for large scale data sharing envisioned by proponents for the national adoption of ambulatory EMR systems. PMID:16779116

Factors influencing how senior nurses and midwives acquire and integrate coaching skills into routine practice: a grounded theory study.

PubMed

Rafferty, Rae; Fairbrother, Greg

2015-06-01

To introduce a theory which describes the process of and explicates the factors moderating, the acquisition and integration of leadership coaching skills into the routine practice of senior nurses and midwives. Organizations invest significant resources in leadership coaching programs to ensure that coaching is embedded as a core function of the manager's role. However, even after training, many managers remain unable to undertake this role successfully. The process by which health professionals translate 'manager as coach' training into successful practice outcomes, has remained largely unexplored. A grounded theory study design. Data, collected between February 2012-May 2013, included in-depth interviews with 20 senior nurses and midwives who had attended a leadership coaching program and analysis of nine reflective practice journals. Multiple researchers coded and analysed the data using constant comparative techniques. The outcomes of coaching training ranged from inappropriate use of the coaching skills through to transformed managerial practice. These outcomes were influenced by the dynamic interaction of three central domains of the emergent theoretical model: pre-existing individual perceptions, program elements and contemporaneous experiences. Interactions occurred within the domains and between them, impacting on activators such as courage, motivation, commitment and confidence. The study offers new insights into how senior nurses and midwives acquire and integrate coaching skills into their routine practice. The process is described as multifactorial and dynamic and has implications for the training design, delivery and organizational support of future leadership coaching programs. © 2015 John Wiley & Sons Ltd.

Pattern of medical waste management: existing scenario in Dhaka City, Bangladesh

PubMed Central

Hassan, M Manzurul; Ahmed, Shafiul Azam; Rahman, K Anisur; Biswas, Tarit Kanti

2008-01-01

Background Medical waste is infectious and hazardous. It poses serious threats to environmental health and requires specific treatment and management prior to its final disposal. The problem is growing with an ever-increasing number of hospitals, clinics, and diagnostic laboratories in Dhaka City, Bangladesh. However, research on this critical issue has been very limited, and there is a serious dearth of information for planning. This paper seeks to document the handling practice of waste (e.g. collection, storage, transportation and disposal) along with the types and amount of wastes generated by Health Care Establishments (HCE). A total of 60 out of the existing 68 HCE in the study areas provided us with relevant information. Methods The methodology for this paper includes empirical field observation and field-level data collection through inventory, questionnaire survey and formal and informal interviews. A structured questionnaire was designed to collect information addressing the generation of different medical wastes according to amount and sources from different HCE. A number of in-depth interviews were arranged to enhance our understanding of previous and existing management practice of medical wastes. A number of specific questions were asked of nurses, hospital managers, doctors, and cleaners to elicit their knowledge. The collected data with the questionnaire survey were analysed, mainly with simple descriptive statistics; while the qualitative mode of analysis is mainly in narrative form. Results The paper shows that the surveyed HCE generate a total of 5,562 kg/day of wastes, of which about 77.4 per cent are non-hazardous and about 22.6 per cent are hazardous. The average waste generation rate for the surveyed HCE is 1.9 kg/bed/day or 0.5 kg/patient/day. The study reveals that there is no proper, systematic management of medical waste except in a few private HCE that segregate their infectious wastes. Some cleaners were found to salvage used sharps, saline bags, blood bags and test tubes for resale or reuse. Conclusion The paper reveals that lack of awareness, appropriate policy and laws, and willingness are responsible for the improper management of medical waste in Dhaka City. The paper also shows that a newly designed medical waste management system currently serves a limited number of HCE. New facilities should be established for the complete management of medical waste in Dhaka City. PMID:18221548

A tale of four practices.

PubMed

Miller-Day, Michelle; Applequist, Janelle; Zabokrtsky, Keri; Dalton, Alexandra; Kellom, Katherine; Gabbay, Robert; Cronholm, Peter F

2017-09-18

Purpose The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. This transformation presents a challenge to many care delivery organizations. The purpose of this paper is to describe attributes shaping successful and unsuccessful practice transformation within four medical practice groups. Design/methodology/approach As part of a larger study of 25 practices transitioning into a PCMH, the current study focused on diabetes care and identified high- and low-improvement medical practices in terms of quantitative patient measures of glycosylated hemoglobin and qualitative assessments of practice performance. A subset of the top two high-improvement and bottom two low-improvement practices were identified as comparison groups. Semi-structured interviews were conducted with diverse personnel at these practices to investigate their experiences with practice transformation and data were analyzed using analytic induction. Findings Results show a variety of key attributes facilitating more successful PCMH transformation, such as empanelment, shared goals and regular meetings, and a clear understanding of PCMH transformation purposes, goals, and benefits, providing care/case management services, and facilitating patient reminders. Several barriers also exist to successful transformation, such as low levels of resources to handle financial expense, lack of understanding PCMH transformation purposes, goals, and benefits, inadequate training and management of technology, and low team cohesion. Originality/value Few studies qualitatively compare and contrast high and low performing practices to illuminate the experience of practice transformation. These findings highlight the experience of organizational members and their challenges in practice transformation while providing quality diabetes care.

Effects of Management on Soil Carbon Pools in California Rangeland Ecosystems

NASA Astrophysics Data System (ADS)

Silver, W. L.; Ryals, R.; Lewis, D. J.; Creque, J.; Wacker, M.; Larson, S.

2008-12-01

Rangeland ecosystems managed for livestock production represent the largest land-use footprint globally, covering more than one-quarter of the world's land surface (Asner et al. 2004). In California, rangelands cover an estimated 17 million hectares or approximately 40% of the land area (FRAP 2003). These ecosystems have considerable potential to sequester carbon (C) in soil and offset greenhouse gas emissions through changes in land management practices. Climate policies and C markets may provide incentives for rangeland managers to pursue strategies that optimize soil C storage, yet we lack a thorough understanding of the effects of management on soil C pools in rangelands over time and space. We sampled soil C pools on rangelands in a 260 km2 region of Marin and Sonoma counties to determine if patterns in soil C storage exist with management. Replicate soil samples were collected from 35 fields that spanned the dominant soil orders, plant communities, and management practices in the region while controlling for slope and bioclimatic zone (n = 1050). Management practices included organic amendments, intensive (dairy) and extensive (other) grazing practices, and subsoiling. Soil C pools ranged from approximately 50 to 140 Mg C ha-1 to 1 m depth, with a mean of 99 ± 22 (sd) Mg C ha-1. Differences among sites were due primarily to C concentrations, which exhibited a much larger coefficient of variation than bulk density at all depths. There were no statistically significant differences among the dominant soil orders. Subsoiling appeared to significantly increase soil C content in the top 50 cm, even though subsoiling had only occurred for the first time the previous Nov. Organic amendments also appeared to greatly increase soil C pools, and was the dominant factor that distinguished soil C pools in intensive and extensive land uses. Our results indicate that management has the potential to significantly increase soil C pools. Future research will determine the location of sequestered C within the soil matrix and its turnover time.

Part II: managing perioperative hyperglycemia in total hip and knee replacement surgeries.

PubMed

Agos, Florence; Shoda, Casey; Bransford, Deborah

2014-09-01

Perioperative hyperglycemia management is an important factor in reducing the risk of surgical site infections (SSIs) in all patients regardless of existing history of diabetes. Reduction of SSIs is one of the quality indicators reported by the National Healthcare Safety Networks of the Centers for Disease Control and Prevention (CDC). In 2009 and 2010, the orthopedic surgical unit had an increased number of SSIs above the CDC benchmark. This article describes the impact of an evidence-based practice standard for perioperative hyperglycemia management in the reduction of SSIs in patients having total hip and knee replacement surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

'That doesn't translate': the role of evidence-based practice in disempowering speech pathologists in acute aphasia management.

PubMed

Foster, Abby; Worrall, Linda; Rose, Miranda; O'Halloran, Robyn

2015-07-01

An evidence-practice gap has been identified in current acute aphasia management practice, with the provision of services to people with aphasia in the acute hospital widely considered in the literature to be inconsistent with best-practice recommendations. The reasons for this evidence-practice gap are unclear; however, speech pathologists practising in this setting have articulated a sense of dissonance regarding their limited service provision to this population. A clearer understanding of why this evidence-practice gap exists is essential in order to support and promote evidence-based approaches to the care of people with aphasia in acute care settings. To provide an understanding of speech pathologists' conceptualization of evidence-based practice for acute post-stroke aphasia, and its implementation. This study adopted a phenomenological approach, underpinned by a social constructivist paradigm. In-depth interviews were conducted with 14 Australian speech pathologists, recruited using a purposive sampling technique. An inductive thematic analysis of the data was undertaken. A single, overarching theme emerged from the data. Speech pathologists demonstrated a sense of disempowerment as a result of their relationship with evidence-based practice for acute aphasia management. Three subthemes contributed to this theme. The first described a restricted conceptualization of evidence-based practice. The second revealed speech pathologists' strained relationships with the research literature. The third elucidated a sense of professional unease over their perceived inability to enact evidence-based clinical recommendations, despite their desire to do so. Speech pathologists identified a current knowledge-practice gap in their management of aphasia in acute hospital settings. Speech pathologists place significant emphasis on the research evidence; however, their engagement with the research is limited, in part because it is perceived to lack clinical utility. A sense of professional dissonance arises from the conflict between a desire to provide best practice and the perceived barriers to implementing evidence-based recommendations clinically, resulting in evidence-based practice becoming a disempowering concept for some. © 2015 Royal College of Speech and Language Therapists.

Best practice guidelines for the operation of a donor human milk bank in an Australian NICU.

PubMed

Hartmann, B T; Pang, W W; Keil, A D; Hartmann, P E; Simmer, K

2007-10-01

Until the establishment of the PREM Bank (Perron Rotary Express Milk Bank) donor human milk banking had not occurred in Australia for the past 20 years. In re-establishing donor human milk banking in Australia, the focus of the PREM Bank has been to develop a formal and consistent approach to safety and quality in processing during the operation of the human milk bank. There is currently no existing legislation in Australia that specifically regulates the operation of donor human milk banks. For this reason the PREM Bank has utilised existing and internationally recognised management practices for managing hazards during food production. These tools (specifically HACCP) have been used to guide the development of Standard Operating Procedures and Good Manufacturing Practice for the screening of donors and processing of donor human milk. Donor screening procedures are consistent with those recommended by other human milk banks operating internationally, and also consistent with the requirements for blood and tissue donation in Australia. Controlled documentation and record keep requirements have also been developed that allow complete traceability from individual donation to individual feed dispensed to recipient and maintain a record of all processing and storage conditions. These operational requirements have been developed to reduce any risk associated with feeding pasteurised donor human milk to hospitalised preterm or ill infants to acceptable levels.

Development of a Comprehensive Programme to Prevent and Reduce the Negative Impact of Railway Fatalities, Injuries and Close Calls on Railway Employees.

PubMed

Bardon, Cécile; Mishara, Brian L

2015-09-01

This article presents a strategy to prevent trauma, support and care for railway personnel who experience critical incidents (CI) on the job, usually fatalities by accident or suicide. We reviewed all publications on CI management, support and care practices in the railway industry, as well as practices in place in Canada (unpublished protocols). Semi structured interviews were conducted with 40 train engineers and conductors involved in CIs and the content was coded and analysed quantitatively. Employees' satisfaction with the help received after the incident varies according to the behaviour of the local manager, company officers and police, the level of compliance with existing company protocols to help them, the presence of unmet expectations for support and care, their perceived competency of clinicians they consulted and the level of trust toward their employers. On the basis of the interview results, the review of existing railway practices and discussions with railway stakeholders, a model protocol was developed for a comprehensive workplace prevention, support and care protocol to reduce the negative impact of railway critical incidents on employees. This protocol includes preventive actions before traumatic events occur, immediate responses at the site of incident, interventions within the first few days after the incident and longer term support and interventions provided by the company and by outsourced experts.

'Animateurs' and animation: what makes a good commissioning manager?

PubMed

Checkland, Kath; Snow, Stephanie; McDermott, Imelda; Harrison, Stephen; Coleman, Anna

2012-01-01

To examine the managerial behaviours adopted by commissioning managers in English primary care trusts (PCTs), and to explore the impact of these behaviours. Qualitative case studies were undertaken in four PCTs, focusing on staff engaged in the commissioning of hospital services. Both formal and informal observation were undertaken (150 hours), and 41 in-depth interviews conducted with managers and general practitioners (GPs). Managers adopted many managerial behaviours familiar from the literature, including sharing information, and networking inside and outside the organization. Multiple organizational layers and unclear decision-making processes hindered this activity. In addition, some managers with responsibility for facilitating practice-based commissioning (PbC) adopted a managerial mode that we have called being an 'animateur'. This approach involved the active management of disparate groups of people over whom the manager had no authority, and appeared to be a factor in determining success. It was facilitated by managerial autonomy and was more prevalent where managers were seen to have legitimacy. Some organizational practices appeared to inhibit its development. From 2012/13 it is planned that GPs will be taking more responsibility for commissioning in the English NHS. This research suggests that managers of the new commissioning organizations will require a deep and contextualized understanding of the NHS and that it is important that organizational processes do not inhibit managerial behaviour. Legitimacy may be an issue in contexts were managers are automatically transferred from their existing appointments.

Building managed primary care practice networks to deliver better clinical care: a qualitative semi-structured interview study.

PubMed

Pawa, Jasmine; Robson, John; Hull, Sally

2017-11-01

Primary care practices are increasingly working in larger groups. In 2009, all 36 primary care practices in the London borough of Tower Hamlets were grouped geographically into eight managed practice networks to improve the quality of care they delivered. Quantitative evaluation has shown improved clinical outcomes. To provide insight into the process of network implementation, including the aims, facilitating factors, and barriers, from both the clinical and managerial perspectives. A qualitative study of network implementation in the London borough of Tower Hamlets, which serves a socially disadvantaged and ethnically diverse population. Nineteen semi-structured interviews were carried out with doctors, nurses, and managers, and were informed by existing literature on integrated care and GP networks. Interviews were recorded and transcribed, and thematic analysis used to analyse emerging themes. Interviewees agreed that networks improved clinical care and reduced variation in practice performance. Network implementation was facilitated by the balance struck between 'a given structure' and network autonomy to adopt local solutions. Improved use of data, including patient recall and peer performance indicators, were viewed as critical key factors. Targeted investment provided the necessary resources to achieve this. Barriers to implementing networks included differences in practice culture, a reluctance to share data, and increased workload. Commissioners and providers were positive about the implementation of GP networks as a way to improve the quality of clinical care in Tower Hamlets. The issues that arose may be of relevance to other areas implementing similar quality improvement programmes at scale. © British Journal of General Practice 2017.

Mild traumatic brain injury in children: management practices in the acute care setting.

PubMed

Kool, Bridget; King, Vivienne; Chelimo, Carol; Dalziel, Stuart; Shepherd, Michael; Neutze, Jocelyn; Chambers, Nikki; Wells, Susan

2014-08-01

Accurate diagnosis, treatment and follow up of children suffering mild traumatic brain injury (MTBI) is important as post-concussive symptoms and long-term disability might occur. This research explored the decisions clinicians make in their assessment and management of children with MTBI in acute care settings, and identified barriers and enablers to the delivery of best-practice care. A purposeful sample of 29 clinicians employed in two metropolitan paediatric EDs and one Urgent Care clinic was surveyed using a vignette-based questionnaire that also included domains of guideline awareness, attitudes to MTBI care, use of clinical decision support systems, and knowledge and skills for practising evidence-based healthcare. Overall, the evaluation and management of children presenting acutely with MTBI generally followed best-practice guidelines, particularly in relation to identifying intracranial injuries that might require surgical intervention, observation for potential deterioration, adequate pain management and the provision of written head injury advice on discharge. Larger variation emerged in regard to follow-up care and referral pathways. Potential barriers to best- practice were lack of guideline awareness, attitudes to MTBI, and lack of time or other priorities. Opportunities exist to improve care for children who present in acute care settings following mild traumatic brain injury. These include having up-to-date guidelines that are consistent across acute care settings; providing clearer pathways for referral and follow up; targeting continuing medical education towards potential complications; and providing computerised decision support so that assessment and management are conducted systematically. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Ares Launch Vehicles Lean Practices Case Study

NASA Technical Reports Server (NTRS)

Doreswamy, Rajiv; Self, Timothy A.

2007-01-01

The Ares launch vehicles team, managed by the Ares Projects Office (APO) at NASA Marshall Space Flight Center, has completed the Ares I Crew Launch Vehicle System Requirements Review and System Definition Review and early design work for the Ares V Cargo Launch Vehicle. This paper provides examples of how Lean Manufacturing, Kaizen events, and Six Sigma practices are helping APO deliver a new space transportation capability on time and within budget, while still meeting stringent technical requirements. For example, Lean philosophies have been applied to numerous process definition efforts and existing process improvement activities, including the Ares I-X test flight Certificate of Flight Readiness (CoFR) process, risk management process, and review board organization and processes. Ares executives learned Lean practices firsthand, making the team "smart buyers" during proposal reviews and instilling the team with a sense of what is meant by "value-added" activities. Since the goal of the APO is to field launch vehicles at a reasonable cost and on an ambitious schedule, adopting Lean philosophies and practices will be crucial to the Ares Project's long-term SUCCESS.

Career Management for Scientists and Engineers

NASA Astrophysics Data System (ADS)

Borchardt, John K.

2000-05-01

This book will be an important resource for both new graduates and mid-career scientists, engineers, and technicians. Through taking stock of existing or desired skills and goals, it provides both general advice and concrete examples to help asses a current job situation or prospect, and to effectively pursue and attain new ones. Many examples of properly adapted resumes and interview techniques, as well as plenty of practical advice about adaptation to new workplace cultural paradigms, such as team-based management, make this book an invaluable reference for the professional scientist in today's volatile job market.

Drug-nutrient interaction in clinical nutrition.

PubMed

Chan, Lingtak-Neander

2002-05-01

Drug-nutrient interactions have been recognized for decades. It is known that improper management of some of these interactions may lead to therapeutic failure or cause serious adverse effects to the patients. While most of the known drug-nutrient interactions involve changes in oral bioavailabilities and absorption of the offending compounds, recent investigations suggest that different mechanisms also exist. A mechanism-derived classification system for drug-nutrient interactions has only recently been developed. This system should facilitate the future research and development of practice guidelines in the identification and management of important interactions.

Biomass fuels update. TVAs biomass fuels program

NASA Astrophysics Data System (ADS)

1982-02-01

Equipment was installed and tests were conducted on the ethanol from hardwood project. Location of hardwoods, to improve forest management, and to reduce the cost of harvesting woody biomass was assessed. Substantial underutilized cropland exists in the Valley, and a questionnaire survey was administered to supplement available cropland data. The potential liquid fuel yields and production management practices for alternative starch, sugar, and vegetable oil crops were determined to obtain benchmark data and to evaluate alcohol production from alternative agricultural feedstocks. Workshops were conducted to provide information on production of alcohol.

Ontology-based approaches for cross-enterprise collaboration: a literature review on semantic business process management

NASA Astrophysics Data System (ADS)

Hoang, Hanh H.; Jung, Jason J.; Tran, Chi P.

2014-11-01

Based on an in-depth analysis of the existing approaches in applying semantic technologies to business process management (BPM) research in the perspective of cross-enterprise collaboration or so-called business-to-business integration, we analyse, discuss and compare methodologies, applications and best practices of the surveyed approaches with the proposed criteria. This article identifies various relevant research directions in semantic BPM (SBPM). Founded on the result of our investigation, we summarise the state of art of SBPM. We also address areas and directions for further research activities.

From troglodytes to information managers: information management and technology needs to achieve the primary care NHS modernization agenda--the views of three GPs.

PubMed

Rooney, I; Hornby, S

2000-09-01

In response to the information management and technology changes proposed by the Government's NHS modernization initiative this article examines the issues that GPs feel to be of major significance to their work. Although information and communications technology is widely used in general practice there is no one agreed standard system. The level of technology and the manner in which it is used is also diverse throughout the profession, as are the attitudes that exist amongst GPs regarding the value of information management and technology, and the benefits efficient information management offers to them and to their patients. The views of three local GPs from practices with varying levels of information technology were obtained through semi-structured interviews and the findings developed in the light of current discussions in the published literature. The GPs chosen reflect the disparity within general practice and, perhaps, other units of the NHS in the use and understanding of information management. The main conclusions were that there is ambivalence and scepticism about what NHSnet currently has to offer; that local electronic records benefit patient care, but when networked more widely problems of confidentiality and security result. Practitioners were also mindful of the financial costs of changes and concerned, given the impact of PCGs and clinical governance, as to who will be responsible for ensuring a common level of electronic records, IT provision, and financial and technological support.

Implementing a Swedish regionalized medical program supported by digital technologies: possibilities and challenges from a management perspective.

PubMed

Pettersson, Fanny L M

2013-01-01

In 2011, Umeå University in Sweden was facing its first attempt to transform the existing medical program into a regionalized medical program (RMP), supported by the use of digital technologies. The Swedish RMP means that students are distributed in geographically separated groups while doing their five clinical clerkship semesters. To provide medical students with ways of undertaking their theoretical studies when geographically distributed, digital technologies are used for educational and administrative purposes. In this article, the Swedish RMP will be described and related to previous international research on educating medical students in rural settings. The aim of this article was, from a management perspective, to understand if and how contradictions arise during the implementation process of the Swedish RMP, supported by digital technologies. Based on this analysis, a further aim was to discuss, from a management perspective, the possibilities and challenges for improvement of this medical educational practice, as well as to provide implications for other similar changes in medical programs internationally. To identify possible contradictions during the implementation process, ethnographically inspired observations were made during management work meetings, before and during the first regionalized semester. In addition, in-depth follow-up interviews were held in May and June 2011 with six management executives of the Swedish RMP, concerning their expectations and experiences of the implementation process. The qualitative and activity theory (AT)-inspired analysis resulted in the emergence of two main themes and seven sub-themes. The analysis suggests that a number of contradictions arose during the implementation process of the Swedish RMP. For instance, a contradiction constituted as a conflict between the university management and some teachers concerning how digital technologies and technology enhanced learning (TEL) could and should be used when educating medical students. In addition, due to the use of digital technologies the implementation process helped to reveal existing problems and tensions in educational practice, not previously visible to management. These included contradictions such as a lack of alignment in how course goals, teaching practices, and examinations should be carried out. Further, obsolete course content and overlap between courses and subjects were identified, leading to an overhaul of all semesters, not only those regionalized. This study showed how contradictions in educational practice arose when the Swedish RMP, supported by digital technologies, was implemented. These contradictions involve both possibilities and challenges for management to improve how and with what quality the Swedish RMP is conducted. A challenge for management is to find the most effective way to enhance up-take and use of the more interactive and innovative TEL-solutions. However, a possibility is that the regionalization process and implemented improvements may also influence non-regionalized semesters, with the potential to eventually increase the quality of the entire program.

Health, migration and border management: analysis and capacity-building at Europe's borders.

PubMed

Hollings, Jennifer; Samuilova, Mariya; Petrova-Benedict, Roumyana

2012-04-01

Three key elements were analysed in Hungary, Poland and Slovakia as a basis for strengthening the capacity of staff and structures related to health, migration and border management: public health concerns linked to migration, health needs and rights of migrants and the occupational health of staff. This IOM project was implemented through an in-depth situation analysis as well as the development of training modules and public health guidelines. Findings indicate a paucity of existing data, gaps in the health care for migrants and few existing tools for border officials and health professionals. Sets of training modules were developed for each of these groups, including common modules on migration and the right to health and intercultural communication, as well as targeted health modules. The guidelines promote good practices in the context of border management and detention. The EU is working towards a common immigration policy and integrated border management; however, a harmonized approach to migration and health is still lacking. Further research and piloting of the developed materials is needed to fully establish an adaptable, common toolkit.

Research support for effective state and community tobacco control programme response to electronic nicotine delivery systems.

PubMed

Schmitt, Carol L; Lee, Youn Ok; Curry, Laurel E; Farrelly, Matthew C; Rogers, Todd

2014-07-01

To identify unmet research needs of state and community tobacco control practitioners pertaining to electronic nicotine delivery systems (ENDS or e-cigarettes) that would inform policy and practice efforts at the state and community levels, and to describe ENDS-related research and dissemination activities of the National Cancer Institute-funded State and Community Tobacco Control Research Initiative. To determine specific research gaps relevant to state and community tobacco control practice, we analysed survey data collected from tobacco control programmes (TCPs) in all 50 U.S. states and the District of Columbia (N=51). Survey items covered a range of ENDS issues: direct harm to users, harm of secondhand vapour, cessation, flavours, constituents and youth access. There is no ENDS topic on which a majority of state TCP managers feel very informed. They feel least informed about harms of secondhand vapour while also reporting that this information is among the most important for their programme. A majority (N=31) of respondents indicated needs for research on the implications of ENDS products for existing policies. TCP managers report that ENDS research is highly important for practice and need research-based information to inform decision making around the inclusion of ENDS in existing tobacco control policies. For optimal relevance to state and community TCPs, research on ENDS should prioritise study of the health effects of ENDS use and secondhand exposure to ENDS vapour in the context of existing tobacco control policies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Implications of global climate change for the assessment and management of human health risks of chemicals in the natural environment.

PubMed

Balbus, John M; Boxall, Alistair B A; Fenske, Richard A; McKone, Thomas E; Zeise, Lauren

2013-01-01

Global climate change (GCC) is likely to alter the degree of human exposure to pollutants and the response of human populations to these exposures, meaning that risks of pollutants could change in the future. The present study, therefore, explores how GCC might affect the different steps in the pathway from a chemical source in the environment through to impacts on human health and evaluates the implications for existing risk-assessment and management practices. In certain parts of the world, GCC is predicted to increase the level of exposure of many environmental pollutants due to direct and indirect effects on the use patterns and transport and fate of chemicals. Changes in human behavior will also affect how humans come into contact with contaminated air, water, and food. Dietary changes, psychosocial stress, and coexposure to stressors such as high temperatures are likely to increase the vulnerability of humans to chemicals. These changes are likely to have significant implications for current practices for chemical assessment. Assumptions used in current exposure-assessment models may no longer apply, and existing monitoring methods may not be robust enough to detect adverse episodic changes in exposures. Organizations responsible for the assessment and management of health risks of chemicals therefore need to be more proactive and consider the implications of GCC for their procedures and processes. Copyright © 2012 SETAC.

Ecosystem Based Management in Transition: From Ocean Policy to Application

NASA Astrophysics Data System (ADS)

Saumweber, W. J.; Goldman, E.

2016-02-01

Ecosystem-based management (EBM) has been proposed as a means to improve resource management and stewardship for more than two decades. Over this history, its exact goals and approaches have evolved in concert with advances in science and policy, including a greater understanding of ecosystem function, valuation, and thresholds for change, along with direct reference to EBM principles in statute, regulation, and other Executive Actions. Most recently, and explicitly, the Administration's National Ocean Policy (NOP) called for the development of a Federal EBM framework that would outline principles and guidelines for implementing EBM under existing authorities. This cross-agency framework has yet to be developed, but, the NOP, and related Administration initiatives, have resulted in the practical application of EBM principles in several issue-specific policy initiatives ranging from fisheries and marine protected area management to coastal adaptation and water resource infrastructure investment. In each case, the application of EBM principles uses apparently unique policy mechanisms (e.g. marine planning, ecosystem services assessment, adaptive management, dynamic ocean management, etc.). Despite differences in terminology and policy context, each of these policy initiatives is linked at its core to concepts of integrated and adaptive management that consider broad ecosystem function and services. This practical history of EBM implementation speaks to both the challenges and opportunities in broad incorporation of EBM across diverse policy initiatives and frameworks. We suggest that the continued growth of EBM as a practical policy concept will require a move away from broad frameworks, and towards the identification of specific resource management issues and accompanying policy levers with which to address those issues. In order to promote this progression, Federal policy should recognize and articulate the diverse set of policy mechanisms encompassed under the rubric of EBM and seek to require similar approaches across the spectra of resource management issues.

Ecosystem Based Management in Transition: From Ocean Policy to Application

NASA Astrophysics Data System (ADS)

Saumweber, W. J.; Goldman, E.

2016-12-01

Ecosystem-based management (EBM) has been proposed as a means to improve resource management and stewardship for more than two decades. Over this history, its exact goals and approaches have evolved in concert with advances in science and policy, including a greater understanding of ecosystem function, valuation, and thresholds for change, along with direct reference to EBM principles in statute, regulation, and other Executive Actions. Most recently, and explicitly, the Administration's National Ocean Policy (NOP) called for the development of a Federal EBM framework that would outline principles and guidelines for implementing EBM under existing authorities. This cross-agency framework has yet to be developed, but, the NOP, and related Administration initiatives, have resulted in the practical application of EBM principles in several issue-specific policy initiatives ranging from fisheries and marine protected area management to coastal adaptation and water resource infrastructure investment. In each case, the application of EBM principles uses apparently unique policy mechanisms (e.g. marine planning, ecosystem services assessment, adaptive management, dynamic ocean management, etc.). Despite differences in terminology and policy context, each of these policy initiatives is linked at its core to concepts of integrated and adaptive management that consider broad ecosystem function and services. This practical history of EBM implementation speaks to both the challenges and opportunities in broad incorporation of EBM across diverse policy initiatives and frameworks. We suggest that the continued growth of EBM as a practical policy concept will require a move away from broad frameworks, and towards the identification of specific resource management issues and accompanying policy levers with which to address those issues. In order to promote this progression, Federal policy should recognize and articulate the diverse set of policy mechanisms encompassed under the rubric of EBM and seek to require similar approaches across the spectra of resource management issues.

Exploring drivers and challenges in implementation of health promotion in community mental health services: a qualitative multi-site case study using Normalization Process Theory.

PubMed

Burau, Viola; Carstensen, Kathrine; Fredens, Mia; Kousgaard, Marius Brostrøm

2018-01-24

There is an increased interest in improving the physical health of people with mental illness. Little is known about implementing health promotion interventions in adult mental health organisations where many users also have physical health problems. The literature suggests that contextual factors are important for implementation in community settings. This study focused on the change process and analysed the implementation of a structural health promotion intervention in community mental health organisations in different contexts in Denmark. The study was based on a qualitative multiple-case design and included two municipal and two regional provider organisations. Data were various written sources and 13 semi-structured interviews with 22 key managers and frontline staff. The analysis was organised around the four main constructs of Normalization Process Theory: Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring. Coherence: Most respondents found the intervention to be meaningful in that the intervention fitted well into existing goals, practices and treatment approaches. Cognitive Participation: Management engagement varied across providers and low engagement impeded implementation. Engaging all staff was a general problem although some of the initial resistance was apparently overcome. Collective Action: Daily enactment depended on staff being attentive and flexible enough to manage the complex needs and varying capacities of users. Reflexive Monitoring: During implementation, staff evaluations of the progress and impact of the intervention were mostly informal and ad hoc and staff used these to make on-going adjustments to activities. Overall, characteristics of context common to all providers (work force and user groups) seemed to be more important for implementation than differences in the external political-administrative context. In terms of research, future studies should adopt a more bottom-up, grounded description of context and pay closer attention to the interplay between different dimensions of implementation. In terms of practice, future interventions need to better facilitate the translation of the initial sense of general meaning into daily practice by active local management support that occurs throughout the implementation process and that systematically connects the intervention to existing practices.

Protocol for audit of current Filipino practice in rehabilitation of stroke inpatients.

PubMed

Gonzalez-Suarez, Consuelo B; Dizon, Janine Margarita R; Grimmer, Karen; Estrada, Myrna S; Liao, Lauren Anne S; Malleta, Anne-Rochelle D; Tan, Ma Elena R; Marfil, Vero; Versales, Cristina S; Suarez, Jimah L; So, Kleon C; Uyehara, Edgardo D

2015-01-01

Stroke is one of the leading medical conditions in the Philippines. Over 500,000 Filipinos suffer from stroke annually. Provision of evidence-based medical and rehabilitation management for stroke patients has been a challenge due to existing environmental, social, and local health system issues. Thus, existing western guidelines on stroke rehabilitation were contextualized to draft recommendations relevant to the local Philippine setting. Prior to fully implementing the guidelines, an audit of current practice needs to be undertaken, thus the purpose of this audit protocol. A clinical audit of current practices in stroke rehabilitation in the Philippines will be undertaken. A consensus list of data items to be captured was identified by the audit team during a 2-day meeting in 2012. These items, including patient demographics, type of stroke, time to referral for rehabilitation management, length of hospital stay, and other relevant descriptors of stroke management were included as part of the audit. Hospitals in the Philippines will be recruited to take part in the audit activity. Recruitment will be via the registry of the Philippine Academy of Rehabilitation Medicine, where 90% of physiatrists (medical doctors specialized in rehabilitation medicine) are active members and are affiliated with various hospitals in the Philippines. Data collectors will be identified and trained in the audit process. A pilot audit will be conducted to test the feasibility of the audit protocol, and refinements to the protocol will be undertaken as necessary. The comprehensive audit process will take place for a period of 3 months. Data will be encoded using MS Excel(®). Data will be reported as means and percentages as appropriate. Subgroup analysis will be undertaken to look into differences and variability of stroke patient descriptors and rehabilitation activities. This audit study is an ambitious project, but given the "need" to conduct the audit to identify "gaps" in current practice, and the value it can bring to serve as a platform for implementation of evidence-based stroke management in the Philippines to achieve best patient and health outcomes, the audit team is more than ready to take up the challenge.

Interactions between pesticides and pathogen susceptibility in honey bees.

PubMed

O'Neal, Scott T; Anderson, Troy D; Wu-Smart, Judy Y

2018-04-01

There exist a variety of factors that negatively impact the health and survival of managed honey bee colonies, including the spread of parasites and pathogens, loss of habitat, reduced availability or quality of food resources, climate change, poor queen quality, changing cultural and commercial beekeeping practices, as well as exposure to agricultural and apicultural pesticides both in the field and in the hive. These factors are often closely intertwined, and it is unlikely that a single stressor is driving colony losses. There is a growing consensus, however, that increasing prevalence of parasites and pathogens are among the most significant threats to managed bee colonies. Unfortunately, improper management of hives by beekeepers may exacerbate parasite populations and disease transmission. Furthermore, research continues to accumulate that describes the complex and largely harmful interactions that exist between pesticide exposure and bee immunity. This brief review summarizes our progress in understanding the impact of pesticide exposure on bees at the individual, colony, and community level. Copyright © 2018 Elsevier Inc. All rights reserved.

MRI-guided stereotactic neurosurgical procedures in a diagnostic MRI suite: Background and safe practice recommendations.

PubMed

Larson, Paul S; Willie, Jon T; Vadivelu, Sudhakar; Azmi-Ghadimi, Hooman; Nichols, Amy; Fauerbach, Loretta Litz; Johnson, Helen Boehm; Graham, Denise

2017-07-01

The development of navigation technology facilitating MRI-guided stereotactic neurosurgery has enabled neurosurgeons to perform a variety of procedures ranging from deep brain stimulation to laser ablation entirely within an intraoperative or diagnostic MRI suite while having real-time visualization of brain anatomy. Prior to this technology, some of these procedures required multisite workflow patterns that presented significant risk to the patient during transport. For those facilities with access to this technology, safe practice guidelines exist only for procedures performed within an intraoperative MRI. There are currently no safe practice guidelines or parameters available for facilities looking to integrate this technology into practice in conventional MRI suites. Performing neurosurgical procedures in a diagnostic MRI suite does require precautionary measures. The relative novelty of technology and workflows for direct MRI-guided procedures requires consideration of safe practice recommendations, including those pertaining to infection control and magnet safety issues. This article proposes a framework of safe practice recommendations designed for assessing readiness and optimization of MRI-guided neurosurgical interventions in the diagnostic MRI suite in an effort to mitigate patient risk. The framework is based on existing clinical evidence, recommendations, and guidelines related to infection control and prevention, health care-associated infections, and magnet safety, as well as the clinical and practical experience of neurosurgeons utilizing this technology. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

Towards hospital standardization in Europe.

PubMed

Shaw, Charles; Bruneau, Charles; Kutryba, Basia; de Jongh, Guido; Suñol, Rosa

2010-08-01

There is no simple tool to assess compliance with common national and European directives, guidance and professional advice on the management of healthcare institutions. Despite evidence of unacceptable variations in the protection of patient and staff safety little attention has been given to harmonizing the way services are organized and managed. Existing systems which define organizational standards, or assess compliance with them, are not in a position to extend this activity into or across national borders in Europe. Certification, accreditation and licensing programmes are too variable to provide a common basis for consistent assessment. Consensual standards would inevitably be minimal if they were to achieve acceptance by all or a majority of member state governments; they would not be standards for excellence or help the majority of organizations to improve performance. This paper proposes the development of a framework and measurement tool, initially for hospitals, which could be used for self-assessment or peer review to demonstrate compliance with European legislation, guidance and public expectations without infringing national responsibilities. A common code of management practice could be developed through a process similar to that adopted for clinical practice guidelines by the European commission-funded project on appraisal of guidelines research and evaluation. In practice, the legal relationships between member states and intergovernmental organizations inhibit the harmonization of management practice across-borders. Faster progress to higher levels of performance would be achieved by voluntary, non-regulatory cooperation of enthusiasts to define, measure and improve the quality of healthcare in European hospitals.

Logging damage using an individual tree selection practice in Appalachian hardwood stands

Treesearch

Neil I. Lamson; H. Clay Smith; Gary W. Miller

1985-01-01

Four West Virginia hardwood stands, managed using individual-tree selection for the past 30 years, were examined after the third and, in one instance, the fourth periodic harvest to determine the severity of logging damage. On existing skid roads, trees were removed with a rubber-tired skidder or a crawler tractor with a rubber-tired arch. Logging damage reduced...

Cause-effect relationships in analytical surveys: An illustration of statistical issues

Treesearch

Gary L. Gadbury; Hans T. Schreuder

2003-01-01

Establishing cause-effect is critical in the field of natural resources where one may want to know the impact of management practices, wildfires, drought, etc. on water quality and quantity, wildlife, growth and survival of desirable trees for timber production, etc. Yet, key obstacles exist when trying to establish cause-effect in such contexts. Issues involved with...

Forested Wetlands: Functions, Benefits and the Use of Best Management Practices

Treesearch

David J. Welsch; David L. Smart; James N. Boyer; Paul Minken; Howard C. Smith; Tamara L. McCandless

1995-01-01

Wetlands are complex and fascinating ecosystems that perform a variety of functions of vital importance to the environment and to the society whose very existence depends on the quality of the environment. Wetlands regulate water flow by detaining storm flows for short periods thus reducing Wetlands protect lake shore and coastal areas by buffering the erosive action...

7 CFR 14.6 - Criteria for determining the pri- mary purpose of payments with respect to potential exclusion...

Code of Federal Regulations, 2010 CFR

2010-01-01

... conservation includes actions that, for a given level of water supply, reduce the demand for or use of water by... reuse of water, thereby making existing supplies available for other current or future uses; or (iv) Improving land management practices for the purpose of reducing water use, loss, waste, increasing the...

Management and Operations of Online Programs: Ensuring Quality and Accountability. Promising Practices in Online Learning

ERIC Educational Resources Information Center

Watson, John; Gemin, Butch

2009-01-01

Online learning is growing rapidly as states and districts are creating new online schools, and existing programs are adding new courses and students. The growth reflects the spreading understanding that online courses and programs can serve a wide variety of students and needs. These include: (1) Creating opportunities for small and rural school…

Influence of forest road buffer zones on sediment transport in the Southern Appalachian Region

Treesearch

Johnny M. Grace; Stanley J. Zarnoch

2013-01-01

A gap exists in the understanding of the effectiveness of forest road best management practices (BMP) in controlling sediment movement and minimizing risks of sediment delivery to forest streams. The objective of this paper is to report the findings of investigations to assess sediment travel distances downslope of forest roads in the Appalachian region, relate...

Defense Cybersecurity: Opportunities Exist for DOD to Share Cybersecurity Resources with Small Businesses

DTIC Science & Technology

2015-09-01

risk self- Communications identified by small businesses . The guidance Commission includes links to addit ional cybersecurity resources...Working Group 4: Final Report. The report’s appendix provides cybersecurity risk management and best practice recommendations for small and medium...including small businesses . Cybersecurity education for risk assessment and planning. These programs provide education and training that small

Instream flow and water regime of selected riparian habitats in west-central Montana

Treesearch

Stephanie K. Mulica; Donald F. Potts; Robert D. Pfister

2002-01-01

Groundwater and surface water extraction and diversion for agricultural and human use has become common practice in the arid and semi-arid western United States. Surface water and groundwater are often not effectively managed during these processes, and few laws exist to protect riparian vegetation in the case of depletion of in-stream flows. "Instream flow"...

Criteria for internal auditing.

PubMed

Holder, W W; Clay, R J

1979-01-01

An effective, inclusive internal auditing endeavor should help assure hospital managements that (1) an adequate system of internal control exists to assure the safeguarding of assets and the reliability of data produced by the financial information system, (2) uneconomic operating practices are detected promptly so they can be remedied, and (3) program results and effectiveness levels are of sufficiently high quality to demonstrate managerial competence.

Using web-based technology to deliver scientific knowledge: the Southern Forest Encyclopedia Network.

Treesearch

John M. Pye; H. Michael Rauscher; Deborah K. Kennard; Patricia A. Flebbe; J. Bryan Jordin; William G. Hubbard; Cynthia Fowler; James Ward

2007-01-01

Forest science, like any science, is a continuous process of discovering new knowledge, reevaluating existing knowledge, and revising our theories and management practices in light of these changes. The forest science community has not yet found the solution to the problem of getting continuously changing science efficiently and effectively into the hands of those who...

Current practices are variable in the evaluation and management of patients with anomalous aortic origin of a coronary artery: Results of a survey.

PubMed

Agrawal, Hitesh; Mery, Carlos M; Day, Patrick E; Sexson Tejtel, S Kristen; McKenzie, E Dean; Fraser, Charles D; Qureshi, Athar M; Molossi, Silvana

2017-09-01

Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in young athletes in the USA. Long-term outcome data for these patients are lacking to date. There is insufficient knowledge on the best approach to these patients and they are managed in a nonuniform manner. An online survey of 15 questions regarding management of AAOCA was sent out to 198 cardiac healthcare providers. The goal was to define gaps in knowledge to justify a dedicated scientific forum for discussion of AAOCA. Descriptive statistics were performed. A total of 91 providers (46%) completed the survey including pediatric cardiology subspecialists (40%), general pediatric cardiologists (24%), cardiovascular (CV) surgeons (22%), adult cardiologists (10%), nurse practitioners (8%), cardiology fellows (3%) and CV anesthesiologist (1%). Forty-eight percent had been practicing for over 15 years and 28% were in their first 5 years of practice. Fifty-two percent of the providers cared for adults and 93% cared for children/adolescents. Eighty-eight percent were affiliated with an academic institution. All but one provider practiced in the USA, 62% practiced in Texas. Half of participants (50%) were very comfortable managing AAOCA patients and 36% were somewhat comfortable. Providers utilized various imaging tests to confirm the anatomy including computed tomography angiography 88%, cardiac magnetic resonance imaging 70%, cardiac catheterization 60%, echocardiogram 12%, IVUS 2% and myocardial perfusion scan 1%. The majority felt comfortable in counseling the families and felt that depending on the type of lesion these patients should get surgical referral (85%) vs clinical follow up (67%) with exercise restriction (65%). There is heterogeneity in the way AAOCA patients are currently evaluated and managed. A knowledge gap exists even with participants from academic institutions. Long-term data with a defined approach to management of these patients may help to improve outcomes and prevent unnecessary exercise restriction or surgery. © 2017 Wiley Periodicals, Inc.

Effects of perceived workplace politics in hospitals on nurses' behavioural intentions in Ghana.

PubMed

Atinga, Roger A; Domfeh, Kwame A; Kayi, Esinam; Abuosi, Aaron; Dzansi, Gladys

2014-03-01

To examine the effects of perceived workplace politics in hospitals on nurses' job satisfaction, commitment, exit intention, job neglect, absenteeism and performance. One of the factors contributing to nurses' poor advancement in clinical practice is the existence of petty politics, which has given rise to competing self-interest. However, little evidence exists to inform policy direction on the implication of politics on nurses' behaviour. A total of 610 nurses comprising associate and nursing professionals completed a structured questionnaire modelled on workplace politics and its outcome variables. Descriptive statistics and mean comparisons were used to analyse data. A multivariate regression model was computed to examine association between perceived politics and nurses' behavioural intentions. Perceived politics potentially leads to decline in job satisfaction, commitment and work performance. However, perceived workplace politics is associated with high intention to leave, negligent behaviour and absenteeism. Measures aimed at improving nursing management and health-care delivery should be directed at minimising the use of politics to promote self-interest. Evidence-based best practices in nursing management centred on the creation of an enabling environment for nurses to participate in decision-making should be given critical attention. © 2013 John Wiley & Sons Ltd.

Head trauma in the cat: 2. assessment and management of traumatic brain injury.

PubMed

Garosi, Laurent; Adamantos, Sophie

2011-11-01

Feline trauma patients are commonly seen in general practice and frequently have sustained some degree of brain injury. Cats with traumatic brain injuries may have a variety of clinical signs, ranging from minor neurological deficits to life-threatening neurological impairment. Appropriate management depends on prompt and accurate patient assessment, and an understanding of the pathophysiology of brain injury. The most important consideration in managing these patients is maintenance of cerebral perfusion and oxygenation. For cats with severe head injury requiring decompressive surgery, early intervention is critical. There is a limited clinical evidence base to support the treatment of traumatic brain injury in cats, despite its relative frequency in general practice. Appropriate therapy is, therefore, controversial in veterinary medicine and mostly based on experimental studies or human head trauma studies. This review, which sets out to describe the specific approach to diagnosis and management of traumatic brain injury in cats, draws on the current evidence, as far as it exists, as well as the authors' clinical experience. Copyright © 2011 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

Neonatal extravasation injury: prevention and management in Australia and New Zealand-a survey of current practice.

PubMed

Restieaux, Matthew; Maw, Andrew; Broadbent, Roland; Jackson, Pam; Barker, David; Wheeler, Ben

2013-03-11

Extravasation injury remains an important cause of iatrogenic injury in neonatal intensive care. This study aims to describe the current approach to extravasation injury (EI) prevention and management in Neonatal Intensive Care Units (NICUs) in Australia and New Zealand. A literature review regarding extravasation injury in the newborn was carried out to inform questionnaire design. An internet-based survey was then conducted with the clinical directors of the 27 tertiary NICUs in Australia and New Zealand. The survey received a 96% response rate. Approximately two thirds of Australian and New Zealand NICUs have written protocols for prevention and management of extravasation injury. Considerable practice variation was seen for both prevention and treatment of EI. 92% of units had experienced cases of significant EI. Australian and New Zealand tertiary neonatal units clearly recognise EI as an important cause of iatrogenic morbidity and mortality. Significant variation still exists among units with regards to guidelines for both prevention and management of EI. We recommend that neonatal staff should remain vigilant, ensuring that guidelines for the prevention and treatment of EI are available, and rigorously followed.

Best Practice for the Administration of Daratumumab in Multiple Myeloma: Australian Myeloma Nurse Expert Opinion

PubMed Central

King, Tracy; Jagger, Jacqueline; Wood, Jodie; Woodrow, Carmel; Snowden, Alicia; Haines, Sally; Crosbie, Christina; Houdyk, Kristen

2018-01-01

Patients with multiple myeloma (MM) are typically of an advanced age and may have significant co-existing medical conditions. They have often had multiple lines of therapy and as such experience disease-related effects alongside associated treatment toxicities. Daratumumab is a monoclonal antibody approved for the treatment of MM in the relapsed/refractory setting. Clinical studies found that daratumumab showed good tolerability as a monotherapy and in combination with current standard therapies. However, the administration of daratumumab does require specific management considerations. It is administered as an intravenous infusion and infusion-related reactions (IRRs) may occur. Daratumumab also interferes with routine blood transfusion tests, giving false positives for the indirect antiglobulin test. This article highlights key nursing care considerations and practical management aspects to improve the treatment experience of patients receiving daratumumab infusions. Pretreatment aspects, patient education, pre- and post-medication, daratumumab administration, and the management of IRRs are discussed. An IRR management sheet that could be used by nurses and a patient information sheet are located at the end of this article.

Animosity, antagonism, and avatars: teaching conflict management in second life.

PubMed

Evans, Dena A; Curtis, Anthony R

2011-11-01

Conflict exists in all health care organizations and may take many forms, including lateral or horizontal violence. The Essentials of Baccalaureate Nursing Education identified the development of conflict resolution strategies as core knowledge required of the bachelor's of science in nursing generalist. However, learning the art of conflict management takes both time and practice. With competition for clinical space increasing, class time in short supply, and traditional clinical opportunities for teaching conflict management lacking, a virtual approach to teaching conflict resolution was explored through the use of Second Life®. The project presented here explored students' perceptions of this unique approach to learning conflict management and sought to examine the effectiveness of this teaching method. Copyright 2011, SLACK Incorporated.

Quality Assurance Practices in Obstetric Care: A Survey of Hospitals in California.

PubMed

Lundsberg, Lisbet S; Lee, Henry C; Dueñas, Grace Villarin; Gregory, Kimberly D; Grossetta Nardini, Holly K; Pettker, Christian M; Illuzzi, Jessica L; Xu, Xiao

2018-02-01

To assess hospital practices in obstetric quality management activities and identify institutional characteristics associated with utilization of evidence-supported practices. Data for this study came from a statewide survey of obstetric hospitals in California regarding their organization and delivery of perinatal care. We analyzed responses from 185 hospitals that completed quality assurance sections of the survey to assess their practices in a broad spectrum of quality enhancement activities. The association between institutional characteristics and adoption of evidence-supported practices (ie, those supported by prior literature or recommended by professional organizations as beneficial for improving birth outcome or patient safety) was examined using bivariate analysis and appropriate statistical tests. Most hospitals regularly audited adherence to written protocols regarding critical areas of care; however, 77.7% and 16.8% reported not having written guidelines on diagnosis of labor arrest and management of abnormal fetal heart rate, respectively. Private nonprofit hospitals were more likely to have a written protocol for management of abnormal fetal heart rate (P=.002). One in 10 hospitals (9.7%) did not regularly review cases with significant morbidity or mortality, and only 69.0% regularly tracked indications for cesarean delivery. Moreover, 26.3%, 14.3%, and 8.7% of the hospitals reported never performing interprofessional simulations for eclampsia, shoulder dystocia, or postpartum hemorrhage, respectively. Teaching status was associated with more frequent simulations in these three areas (P≤.04 for all), while larger volume was associated with more frequent simulations for eclampsia (P=.04). Hospitals in California engage in a wide range of practices to assure or improve quality of obstetric care, but substantial variation in practice exists among hospitals. There is opportunity for improvement in adoption of evidence-supported practices.

Psychoanalysis in modern mental health practice.

PubMed

Yakeley, Jessica

2018-05-01

Like any discipline, psychoanalysis has evolved considerably since its inception by Freud over a century ago, and a multitude of different psychoanalytic traditions and schools of theory and practice now exist. However, some of Freud's original ideas, such as the dynamic unconscious, a developmental approach, defence mechanisms, and transference and countertransference remain essential tenets of psychoanalytic thinking to this day. This Review outlines several areas within modern mental health practice in which contemporary adaptations and applications of these psychoanalytic concepts might offer helpful insights and improvements in patient care and management, and concludes with an overview of evidence-based psychoanalytically informed treatments and the links between psychoanalysis, attachment research, and neuroscience. Copyright © 2018 Elsevier Ltd. All rights reserved.