Analysing Mentoring Dialogues for Developing a Preservice Teacher's Classroom Management Practices

ERIC Educational Resources Information Center

Sempowicz, Tracey; Hudson, Peter

2011-01-01

A key concern for preservice teachers is classroom management, including student behaviour management, which also has been a factor associated with teachers leaving the profession within the first five years. This study investigates the mentoring practices used to guide the mentee's classroom management. Using multiple data sources (e.g., lesson…

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.

Identifying the critical factors of green supply chain management: Environmental benefits in Pakistan.

PubMed

Mumtaz, Ubaidullah; Ali, Yousaf; Petrillo, Antonella; De Felice, Fabio

2018-05-30

Pakistan is a developing country characterized by a growing industrialization, which is the major cause of environmental pollution in the country. To control the significant increase in pollution a green incentive has started, aiming to moderate the adverse effects of environmental pollution. Thus, Green Supply Chain Management (GSCM) plays an important role in influencing the total environment impact of any organizations. This study considers ten Pakistani industries that have implemented GSCM practices. The Decision-Making Trial and Evaluation Laboratory technique (DEMATEL) is used to find influential factors in selecting GSCM criteria. The results show that organizational involvement is the most important dimension useful to implement GSCM practices. In addition, commitment from senior managers, ISO 14000 certification of suppliers and recycle of waste heat are considered significant factors. The paper also signifies the casual relationship among the dimensions and the factors in the form of diagraphs. The main management implication of the paper is to help decision makers to focus on the critical dimensions/factors in order to implement the GSCM practices more effectively in Pakistan. Copyright © 2018 Elsevier B.V. All rights reserved.

Goal setting education and counseling practices of diabetes educators.

PubMed

Malemute, Charlene L; Shultz, Jill Armstrong; Ballejos, Miriam; Butkus, Sue; Early, Kathaleen Briggs

2011-01-01

The purpose of this study was to identify goal setting education practices used by diabetes educators working with type 2 diabetes patients. Data were collected by a mail questionnaire with 179 diabetes educators purposively selected from the 2008 American Association of Diabetes Educators membership listing. Many diabetes educators (52%) reported that more than 75% of their patients set goals for diabetes control. Independent factor patterns for the frequency of information collected from the patient for the first diabetes education session showed that educators either focused on patients' self-management practices (exercise and dietary practices, knowledge, and social impacts of diabetes) or issues with learning about self-management, such as understanding the patient's learning style and motivation for managing diabetes. Factor patterns overall showed diverse approaches to working with patients, including strategies used with patients struggling with dietary goals and the importance of tasks to complete during the first patient session. Although most educators reported practices that were largely patient centered as promoted by the American Diabetes Association (ADA) and models of chronic disease management, patterns of practice suggest that diabetes educators vary considerably in how they apply education practices, especially with dietary self-management education.

Commitment to and preparedness for sustainable supply chain management in the oil and gas industry.

PubMed

Wan Ahmad, Wan Nurul K; Rezaei, Jafar; Tavasszy, Lóránt A; de Brito, Marisa P

2016-09-15

Our current dependency on the oil and gas (O&G) industry for economic development and social activities necessitates research into the sustainability of the industry's supply chains. At present, studies on sustainable supply chain management (SSCM) practices in the industry do not include firm-internal factors that affect the sustainability strategies employed by different functional areas of its supply chains. Our study aims to address this gap by identifying the relevant internal factors and exploring their relationship with SSCM strategies. Specifically, we discuss the commitment to and preparedness for sustainable practices of companies that operate in upstream and downstream O&G supply chain. We study the impact of these factors on their sustainability strategies of four key supply chain functions: supplier management, production management, product stewardship and logistics management. The analyses of data collected through a survey among 81 companies show that management preparedness may enhance sustainable supply chain strategies in the O&G industry more than commitment does. Among the preparedness measures, management of supply chain operational risks is found to be vital to the sustainability of all supply chain functions except for production management practices. The findings also highlight the central importance of supplier and logistics management to the achievement of sustainable O&G supply chains. Companies must also develop an organizational culture that encourages, for example, team collaboration and proactive behaviour to finding innovative sustainability solutions in order to translate commitment to sustainable practices into actions that can produce actual difference to their SSCM practices. Copyright © 2016 Elsevier Ltd. All rights reserved.

A guideline for interpersonal capabilities enhancement to support sustainable facility management practice

NASA Astrophysics Data System (ADS)

Sarpin, Norliana; Kasim, Narimah; Zainal, Rozlin; Noh, Hamidun Mohd

2018-04-01

Facility management is the key phase in the development cycle of an assets and spans over a considerable length of time. Therefore, facility managers are in a commanding position to maximise the potential of sustainability through the development phases from construction, operation, maintenance and upgrade leading to decommission and deconstruction. Sustainability endeavours in facility management practices will contribute to reducing energy consumption, waste and running costs. Furthermore, it can also help in improving organisational productivity, financial return and community standing of the organisation. Facility manager should be empowered with the necessary knowledge and capabilities at the forefront facing sustainability challenge. However, literature studies show a gap between the level of awareness, specific knowledge and the necessary skills required to pursue sustainability in the facility management professional. People capability is considered as the key enabler in managing the sustainability agenda as well as being central to the improvement of competency and innovation in an organisation. This paper aims to develop a guidelines for interpersonal capabilities to support sustainability in facility management practice. Starting with a total of 7 critical interpersonal capabilities factors identified from previous questionnaire survey, the authors conducted an interview with 3 experts in facility management to assess the perceived importance of these factors. The findings reveal a set of guidelines for the enhancement of interpersonal capabilities among facility managers by providing what can be done to acquire these factors and how it can support the application of sustainability in their practice. The findings of this paper are expected to form the basis of a mechanism framework developed to equip facility managers with the right knowledge, to continue education and training and to develop new mind-sets to enhance the implementation of sustainability measures in FM practices.

Challenges in the management of chronic noncommunicable diseases by Indonesian community pharmacists.

PubMed

Puspitasari, Hanni P; Aslani, Parisa; Krass, Ines

2015-01-01

We explored factors influencing Indonesian primary care pharmacists' practice in chronic noncommunicable disease management and proposed a model illustrating relationships among factors. We conducted in-depth, semistructured interviews with pharmacists working in community health centers (Puskesmas, n=5) and community pharmacies (apotek, n=15) in East Java Province. We interviewed participating pharmacists using Bahasa Indonesia to explore facilitators and barriers to their practice in chronic disease management. We audiorecorded all interviews, transcribed ad verbatim, translated into English and analyzed the data using an approach informed by "grounded-theory". We extracted five emergent themes/factors: pharmacists' attitudes, Puskesmas/apotek environment, pharmacy education, pharmacy professional associations, and the government. Respondents believed that primary care pharmacists have limited roles in chronic disease management. An unfavourable working environment and perceptions of pharmacists' inadequate knowledge and skills were reported by many as barriers to pharmacy practice. Limited professional standards, guidelines, leadership and government regulations coupled with low expectations of pharmacists among patients and doctors also contributed to their lack of involvement in chronic disease management. We present the interplay of these factors in our model. Pharmacists' attitudes, knowledge, skills and their working environment appeared to influence pharmacists' contribution in chronic disease management. To develop pharmacists' involvement in chronic disease management, support from pharmacy educators, pharmacy owners, professional associations, the government and other stakeholders is required. Our findings highlight a need for systematic coordination between pharmacists and stakeholders to improve primary care pharmacists' practice in Indonesia to achieve continuity of care.

Dietitians' views of overweight and obese people and reported management practices.

PubMed

Harvey, E L; Summerbell, C D; Kirk, S F L; Hill, A J

2002-10-01

To examine dietitians' views of overweight and obese people, to explore the role of level of severity on these perceptions (overweight vs. obesity), and to explore the relationship between dietitians' views and their reported weight management practices. An independent measures survey, questioning dietitians about either overweight or obese people. One-hundred and eighty-seven members of the British Dietetic Association. A questionnaire exploring beliefs about the causes, attitudes, perceptions of responsibility and reported weight management practices. Physical inactivity was identified as an important causative factor for both overweight and obesity. Mood, eating too much of the wrong foods, repeated dieting and interpersonal factors were also seen as relatively important for both groups. Attitudes were mixed, but were generally neutral to positive. The most negative attitudes were described in terms of perceived reduced self-esteem, sexual attractiveness and health. Dietitians rated obese people more negatively than overweight people. They viewed both overweight and obese people as being responsible for their excess weight. They also reported very similar management practices for overweight and obese people. Beliefs about the causes of overweight explained more of the variance in practice than dietitians' attitudes towards or perceived responsibility of overweight and obese people. However, these associations were not consistent and strong, and other factors not investigated here are likely to have a greater influence on weight management practices.

Stroke unit Nurse Managers' views of individual and organizational factors liable to influence evidence-based practice: A survey.

PubMed

Drury, Peta; McInnes, Elizabeth; Hardy, Jennifer; Dale, Simeon; Middleton, Sandy

2016-04-01

The uptake of evidence into practice may be impeded or facilitated by individual and organizational factors within the local context. This study investigated Nurse Managers of New South Wales, Australia, stroke units (n = 19) in their views on: leadership ability (measured by the Leadership Practices Inventory), organizational learning (measured by the Organizational Learning Survey), attitudes and beliefs towards evidence-based practice (EBP) and readiness for change. Overall Nurse Managers reported high-level leadership skills and a culture of learning. Nurse Managers' attitude towards EBP was positive, although nursing colleague's attitudes were perceived as less positive. Nurse Managers agreed that implementing evidence in practice places additional demands on staff; and almost half (n = 9, 47%) reported that resources were not available for evidence implementation. The findings indicate that key persons responsible for evidence implementation are not allocated sufficient time to coordinate and implement guidelines into practice. The findings suggest that barriers to evidence uptake, including insufficient resources and time constraints, identified by Nurse Managers in this study are not likely to be unique to stroke units. Furthermore, Nurse Managers may be unable to address these organizational barriers (i.e. lack of resources) and thus provide all the components necessary to implement EBP. © 2015 John Wiley & Sons Australia, Ltd.

[Discussion on logistics management of medical consumables].

PubMed

Deng, Sutong; Wang, Miao; Jiang, Xiali

2011-09-01

Management of medical consumables is an important part of modern hospital management. In modern medical behavior, drugs and medical devices act directly on the patient, and are important factors affecting the quality of medical practice. With the increasing use of medical materials, based on practical application, this article proposes the management model of medical consumables, and discusses the essence of medical materials logistics management.

Success under duress: policies and practices managers view as keys to profitability in five California hospitals with challenging payer mix.

PubMed

Rundall, Thomas; Oberlin, Shelley; Thygesen, Brian; Janus, Katharina

2012-01-01

Hospitals with a challenging payer mix (CPM)-high proportions of uninsured and Medicaid patients and a low proportion of commercially insured patients-are an important source of care for low-income, uninsured people. Achieving profitability is difficult for CPM hospitals. From 2005 through 2008, only one-third of 67 CPM hospitals in California reported positive total margins. In-depth group interviews were completed with the management leadership teams of a diverse group of five profitable CPM hospitals to identify the management strategies and practices that the hospitals' leadership teams credited for their financial success. Twelve management policy and practice topics were identified. Four of the policies and practices that managers identified involve organizational actions to increase hospital revenue or operational efficiency. These factors are consistent with those identified in previous research. However, managers also identified eight factors not previously revealed in research on hospital profitability, including management policies and practices that establish the organizational culture, workforce, relationships, monitoring systems, and governance necessary to ensure that hospital employees and affiliated physicians support and successfully implement organizational actions necessary to achieve profitability.

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…

The Influence of Perceptions of Practice Characteristics: An Examination of Agricultural Best Management Practice Adoption in Two Indiana Watersheds

ERIC Educational Resources Information Center

Reimer, Adam P.; Weinkauf, Denise Klotthor; Prokopy, Linda Stalker

2012-01-01

Agricultural best management practices (BMPs), or conservation practices, can help reduce nonpoint source pollution from agricultural lands, as well as provide valuable wildlife habitat. There is a large literature exploring factors that lead to a producer's voluntary adoption of BMPs, but there have been inconsistent findings. Generally, this…

A Digital Curate's Egg: A Risk Management Approach to Enhancing Data Management Practices

ERIC Educational Resources Information Center

Knight, Gareth

2012-01-01

This article provides a case study of work performed at King's College London to survey information management practices, policies, and procedures applied by data creators and managers within three research units and three business units, and to determine the risk factors that may limit access and use of their digital assets over time. The…

Managing Self-Access Language Learning: Principles and Practice

ERIC Educational Resources Information Center

Gardner, David; Miller, Lindsay

2011-01-01

This paper is based on a research project looking at the management of self-access language learning (SALL) from the perspective of the managers of self-access centres. It looks at the factors which influence the practice of seven managers of self-access language learning in tertiary institutions in Hong Kong. The discussion centres around five…

An Examination of Assistant Professors' Project Management Practices

ERIC Educational Resources Information Center

Alpert, Shannon Atkinson; Hartshorne, Richard

2013-01-01

Purpose: The purpose of this research was to identify factors that influence the use of project management in higher education research projects by investigating the project management practices of assistant professors. Design/methodology/approach: Using a grounded theory approach that included in-depth, semi-structured interviews with 22…

Middle Managers' Experiences and Role in Implementing an Interactive Tailored Patient Assessment eHealth Intervention in Clinical Practice.

PubMed

Varsi, Cecilie; Ekstedt, Mirjam; Gammon, Deede; Børøsund, Elin; Ruland, Cornelia M

2015-06-01

The role of nurse and physician managers is considered crucial for implementing eHealth interventions in clinical practice, but few studies have explored this. The aim of the current study was to examine the perceptions of nurse and physician managers regarding facilitators, barriers, management role, responsibility, and action taken in the implementation of an eHealth intervention called Choice into clinical practice. Individual qualitative interviews were conducted with six nurses and three physicians in management positions at five hospital units. The findings revealed that nurse managers reported conscientiously supporting the implementation, but workloads prevented them from participating in the process as closely as they wanted. Physician managers reported less contribution. The implementation process was influenced by facilitating factors such as perceptions of benefits from Choice and use of implementation strategies, along with barriers such as physician resistance, contextual factors and difficulties for front-line providers in learning a new way of communicating with the patients. The findings suggest that role descriptions for both nurse and physician managers should include implementation knowledge and implementation skills. Managers could benefit from an implementation toolkit. Implementation management should be included in management education for healthcare managers to prepare them for the constant need for implementation and improvement in clinical practice.

Integrated weed management systems with herbicide-tolerant crops in the European Union: lessons learnt from home and abroad.

PubMed

Lamichhane, Jay Ram; Devos, Yann; Beckie, Hugh J; Owen, Micheal D K; Tillie, Pascal; Messéan, Antoine; Kudsk, Per

2017-06-01

Conventionally bred (CHT) and genetically modified herbicide-tolerant (GMHT) crops have changed weed management practices and made an important contribution to the global production of some commodity crops. However, a concern is that farm management practices associated with the cultivation of herbicide-tolerant (HT) crops further deplete farmland biodiversity and accelerate the evolution of herbicide-resistant (HR) weeds. Diversification in crop systems and weed management practices can enhance farmland biodiversity, and reduce the risk of weeds evolving herbicide resistance. Therefore, HT crops are most effective and sustainable as a component of an integrated weed management (IWM) system. IWM advocates the use of multiple effective strategies or tactics to manage weed populations in a manner that is economically and environmentally sound. In practice, however, the potential benefits of IWM with HT crops are seldom realized because a wide range of technical and socio-economic factors hamper the transition to IWM. Here, we discuss the major factors that limit the integration of HT crops and their associated farm management practices in IWM systems. Based on the experience gained in countries where CHT or GMHT crops are widely grown and the increased familiarity with their management, we propose five actions to facilitate the integration of HT crops in IWM systems within the European Union.

Factors affecting the innovative practice of nurse managers in health organisations.

PubMed

Williams, Lindy; McMurray, Adela J

This exploratory study reports on two surveys conducted in metropolitan and rural health organisations. Two questionnaires consisting of open and closed questions were distributed to a total of 340 respondents resulting in 176 usable responses, yielding a response rate of 53%. The findings revealed that nurse managers require fairness, trust, recognition, supervisory encouragement, organisational support, and reward for efforts. These are key aspects of organisational climate, which support innovative practice. Experience and innovation were significantly related and other factors such as, management structures and management styles, also had an impact on nurse managers' ability to exhibit innovative behaviour in the 21st Century workplace.

Adherence To Diabetes Mellitus Treatment Guidelines From Theory To Practice: The Missing Link.

PubMed

Hashmi, Noreen Rahat; Khan, Shahzad Ali

2016-01-01

Diabetes mellitus is a complex multisystem disease that requires high quality care. Clinical practice guidelines help physicians and patients make the best possible health care decisions and improve health care management of diabetic patients. These guidelines provide the norms for clinical management as well as monitoring of diabetes care. They are not simple algorithms but are based on structured evidence based diabetic management protocols developed from randomized controlled trials. Despite the widespread availability of this diabetic guideline, their use is suboptimal at best. There are several factors blamed for contributing to this missing link from available theoretical guideline recommendations to practical applications of these guidelines. We present a brief review based on available literature review for an ongoing interventional study being done by authors in two tertiary care hospital in Lahore Pakistan for improving adherence to diabetes guidelines. We will discuss guideline implementation cycle and also present a framework encompassing various factors involved in adherence to guidelines. Until recently the emphasis to improve the guideline adherence targeted the factors relating to individual health care professionals in reference to their knowledge, attitude practice of the guidelines. However, we will discuss that broader range of health care systems, organizational factors, and factors relating to patients which may also significantly impact the adherence to the guidelines. The framework emphasises that it is important to understand the factors that act as barriers and contribute to the missing link between theory and practice of diabetic guidelines. This will help plan appropriate strategies in the pre-implementation stage for effective and improved diabetes guidelines adherence and management.

Differences in cardiovascular disease risk factor management in primary care by sex of physician and patient.

PubMed

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

2010-01-01

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

Managing caries: the need to close the gap between the evidence base and current practice.

PubMed

Schwendicke, F; Doméjean, S; Ricketts, D; Peters, M

2015-11-13

Underpinned by a changing knowledge of the aetiology of caries and its sequelae, and assisted by established and advancing dental materials, there is growing evidence supporting less invasive management of dental caries based on the principles of minimal intervention dentistry. This narrative review assesses both the evidence and the adoption of less invasive caries management strategies and describes ways in which the gap between evidence and practice might be overcome. While there is increasing data supporting less invasive management of carious lesions, these are not standard in most dental practices worldwide. Usually, clinical studies focused on efficacy as outcome, and did not take into consideration the views and priorities of other stakeholders, such as primary care dentists, educators, patients and those financing services. Involving these stakeholders into study design and demonstrating the broader advantages of new management strategies might improve translation of research into practice. In theory, clinical dentists can rely on a growing evidence in cariology regarding less invasive management options. In practice, further factors seem to impede adoption of these strategies. Future research should address these factors by involving major stakeholders and investigating their prioritised outcomes to narrow or close the evidence gap.

Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors

PubMed Central

Russell, Grant M.; Dahrouge, Simone; Hogg, William; Geneau, Robert; Muldoon, Laura; Tuna, Meltem

2009-01-01

PURPOSE New approaches to chronic disease management emphasize the need to improve the delivery of primary care services to meet the needs of chronically ill patients. This study (1) assessed whether chronic disease management differed among 4 models of primary health care delivery and (2) identified which practice organizational factors were independently associated with high-quality care. METHODS We undertook a cross-sectional survey with nested qualitative case studies (2 practices per model) in 137 randomly selected primary care practices from 4 delivery models in Ontario Canada: fee for service, capitation, blended payment, and community health centers (CHCs). Practice and clinician surveys were based on the Primary Care Assessment Tool. A chart audit assessed evidence-based care delivery for patients with diabetes, congestive heart failure, and coronary artery disease. Intermediate outcomes were calculated for patients with diabetes and hypertension. Multiple linear regression identified those organizational factors independently associated with chronic disease management. RESULTS Chronic disease management was superior in CHCs. Clinicians in CHCs found it easier than those in the other models to promote high-quality care through longer consultations and interprofessional collaboration. Across the whole sample and independent of model, high-quality chronic disease management was associated with the presence of a nurse-practitioner. It was also associated with lower patient-family physician ratios and when practices had 4 or fewer full-time-equivalent family physicians. CONCLUSIONS The study adds to the literature supporting the value of nurse-practitioners within primary care teams and validates the contributions of Ontario’s CHCs. Our observation that quality of care decreased in larger, busier practices suggests that moves toward larger practices and greater patient-physician ratios may have unanticipated negative effects on processes of care quality. PMID:19597168

Physician cardiovascular disease risk factor management: practice analysis in Japan versus the USA.

PubMed

Schuster, Richard J; Zhu, Ye; Ogunmoroti, Oluseye; Terwoord, Nancy; Ellison, Sylvia; Fujiyoshi, Akira; Ueshima, Hirotsugu; Muira, Katsuyuki

2013-01-01

There is a 42% lower cardiovascular disease (CVD) death rate in Japan compared with the USA. Do physicians report differences in practice management of CVD risk factors in the two countries that might contribute to this difference? CVD risk factor management reported by Japanese versus US primary care physicians was studied. We undertook a descriptive study. An internet-based survey was conducted with physicians from each country. A convenience sample from the Shiga Prefecture in Japan and the state of Ohio in the USA resulted in 48 Japanese and 53 US physicians completing the survey. The survey group may not be representative of a larger sample. The survey demonstrated that 98% of responding Japanese physicians spend <10 minutes performing a patient visit, while 76% of US physicians spend 10 to 20 minutes (P < 0.0001) managing CVD risk factors. Eighty-seven percent of Japanese physicians (vs. 32% of US physicians) see patients in within three months for follow-up (P < 0.0001). Sixty-one percent of Japanese physicians allocate < 30% of visit time to patient education, whereas 60% of US physicians spend > 30% of visit time on patient education (P < 0.0001). Prescriptions are renewed very frequently by Japanese physicians (83% renewing less than monthly) compared with 75% of US physicians who renew medications every one to six months (P < 0.0001). Only 20% of Japanese physicians use practice guidelines routinely compared with 50% of US physicians (P = 0.0413). US physicians report disparities in care more frequently (P < 0.0001). Forty-three percent of Japanese (vs. 10% of US) physicians believe that they have relative freedom to practise medicine (P < 0.0001). Many factors undoubtedly affect CVD in different countries. The dominant ones include social determinants of health, genetics, public health and overall culture (which in turn determine diet, exercise and other factors). Yet the medical care system is an expensive component of society and its role in managing CVD risk factors deserves study. This descriptive report poses questions that require a more definitive study either with a more representative sample or direct observation of physician practices. US physicians responding to the survey reported greater administrative efforts, frustration and disparities in their practice, yet they followed practice guidelines more carefully. Japanese physicians responding reported focusing on quick, frequent visits that may have been more medication oriented, expecting more patient responsibility in self-care, which may have resulted in better chronic disease management. There may be differences in CVD risk factor management by primary care physicians in Japan versus the USA.

Challenges in the management of chronic noncommunicable diseases by Indonesian community pharmacists

PubMed Central

Puspitasari, Hanni P.; Aslani, Parisa; Krass, Ines

2015-01-01

Objectives: We explored factors influencing Indonesian primary care pharmacists’ practice in chronic noncommunicable disease management and proposed a model illustrating relationships among factors. Methods: We conducted in-depth, semistructured interviews with pharmacists working in community health centers (Puskesmas, n=5) and community pharmacies (apotek, n=15) in East Java Province. We interviewed participating pharmacists using Bahasa Indonesia to explore facilitators and barriers to their practice in chronic disease management. We audiorecorded all interviews, transcribed ad verbatim, translated into English and analyzed the data using an approach informed by “grounded-theory”. Results: We extracted five emergent themes/factors: pharmacists’ attitudes, Puskesmas/apotek environment, pharmacy education, pharmacy professional associations, and the government. Respondents believed that primary care pharmacists have limited roles in chronic disease management. An unfavourable working environment and perceptions of pharmacists’ inadequate knowledge and skills were reported by many as barriers to pharmacy practice. Limited professional standards, guidelines, leadership and government regulations coupled with low expectations of pharmacists among patients and doctors also contributed to their lack of involvement in chronic disease management. We present the interplay of these factors in our model. Conclusion: Pharmacists’ attitudes, knowledge, skills and their working environment appeared to influence pharmacists’ contribution in chronic disease management. To develop pharmacists’ involvement in chronic disease management, support from pharmacy educators, pharmacy owners, professional associations, the government and other stakeholders is required. Our findings highlight a need for systematic coordination between pharmacists and stakeholders to improve primary care pharmacists’ practice in Indonesia to achieve continuity of care. PMID:26445618

Vineyard soil bacterial diversity and composition revealed by 16S rRNA genes: Differentiation by vineyard management

USDA-ARS?s Scientific Manuscript database

Here, we demonstrate how vineyard management practices influence shifts in soil resources, which in turn affects shifts in soil-borne bacterial communities. The objective is to determine the hierarchical effects of management practices, soil attributes and location factors on the structure of soil-b...

High-performance work systems in health care management, part 1: development of an evidence-informed model.

PubMed

Garman, Andrew N; McAlearney, Ann Scheck; Harrison, Michael I; Song, Paula H; McHugh, Megan

2011-01-01

: Although management practices are recognized as important factors in improving health care quality and efficiency, most research thus far has focused on individual practices, ignoring or underspecifying the contexts within which these practices are operating. Research from other industries, which has increasingly focused on systems rather than individual practices, has yielded results that may benefit health services management. : Our goal was to develop a conceptual model on the basis of prior research from health care as well as other industries that could be used to inform important contextual considerations within health care. : Using theoretical frameworks from A. Donabedian (1966), P. M. Wright, T. M. Gardner, and L. M. Moynihan (2003), and B. Schneider, D. B. Smith, and H. W. Goldstein (2000) and review methods adapted from R. Pawson (2006b), we reviewed relevant research from peer-reviewed and other industry-relevant sources to inform our model. The model we developed was then reviewed with a panel of practitioners, including experts in quality and human resource management, to assess the applicability of the model to health care settings. : The resulting conceptual model identified four practice bundles, comprising 14 management practices as well as nine factors influencing adoption and perceived sustainability of these practices. The mechanisms by which these practices influence care outcomes are illustrated using the example of hospital-acquired infections. In addition, limitations of the current evidence base are discussed, and an agenda for future research in health care settings is outlined. : Results may help practitioners better conceptualize management practices as part of a broader system of work practices. This may, in turn, help practitioners to prioritize management improvement efforts more systematically.

Does identity shape leadership and management practice? Experiences of PHC facility managers in Cape Town, South Africa

PubMed Central

Daire, Judith; Gilson, Lucy

2014-01-01

In South Africa, as elsewhere, Primary Health Care (PHC) facilities are managed by professional nurses. Little is known about the dimensions and challenges of their job, or what influences their managerial practice. Drawing on leadership and organizational theory, this study explored what the job of being a PHC manager entails, and what factors influence their managerial practice. We specifically considered whether the appointment of professional nurses as facility managers leads to an identity transition, from nurse to manager. The overall intention was to generate ideas about how to support leadership development among PHC facility managers. Adopting case study methodology, the primary researcher facilitated in-depth discussions (about their personal history and managerial experiences) with eight participating facility managers from one geographical area. Other data were collected through in-depth interviews with key informants, document review and researcher field notes/journaling. Analysis involved data triangulation, respondent and peer review and cross-case analysis. The experiences show that the PHC facility manager’s job is dominated by a range of tasks and procedures focused on clinical service management, but is expected to encompass action to address the population and public health needs of the surrounding community. Managing with and through others, and in a complex system, requiring self-management, are critical aspects of the job. A range of personal, professional and contextual factors influence managerial practice, including professional identity. The current largely facility-focused management practice reflects the strong nursing identity of managers and broader organizational influences. However, three of the eight managers appear to self-identify an emerging leadership identity and demonstrate related managerial practices. Nonetheless, there is currently limited support for an identity transition towards leadership in this context. Better support for leadership development could include talent-spotting and nurturing, induction and peer-mentoring for newly appointed facility managers, ongoing peer-support once in post and continuous reflective practice. PMID:25274644

Critical management practices influencing on-site waste minimization in construction projects.

PubMed

Ajayi, Saheed O; Oyedele, Lukumon O; Bilal, Muhammad; Akinade, Olugbenga O; Alaka, Hafiz A; Owolabi, Hakeem A

2017-01-01

As a result of increasing recognition of effective site management as the strategic approach for achieving the required performance in construction projects, this study seeks to identify the key site management practices that are requisite for construction waste minimization. A mixed methods approach, involving field study and survey research were used as means of data collection. After confirmation of construct validity and reliability of scale, data analysis was carried out through a combination of Kruskal-Wallis test, descriptive statistics and exploratory factor analysis. The study suggests that site management functions could significantly reduce waste generation through strict adherence to project drawings, and by ensuring fewer or no design changes during construction process. Provision of waste skips for specific materials and maximisation of on-site reuse of materials are also found to be among the key factors for engendering waste minimization. The result of factor analysis suggests four factors underlying on-site waste management practices with 96.093% of total variance. These measures include contractual provisions for waste minimization, waste segregation, maximisation of materials reuse and effective logistic management. Strategies through which each of the underlying measures could be achieved are further discussed in the paper. Findings of this study would assist construction site managers and other site operatives in reducing waste generated by construction activities. Copyright © 2016 Elsevier Ltd. All rights reserved.

The fear factor of risk - clinical governance and midwifery talk and practice in the UK.

PubMed

Scamell, Mandie

2016-07-01

Through the critical application of social theory, this paper will scrutinise how the operations of risk management help to constitute midwives׳ understandings of childbirth in a particular way. Drawing from rich ethnographic data, collected in the southeast of England, the paper presents empirical evidence to critically explore how institutional concerns around risk and risk management impact upon the way midwives can legitimately imagine and manage labour and childbirth. Observational field notes, transcribed interviews with various midwives, along with material culture in the form of documentary evidence will be used to explore the unintended consequences of clinical governance and its risk management technologies. Through this analysis the fear factor of risk in midwifery talk and practice will be introduced to provide an insight into how risk management impacts midwifery practice in the UK. Copyright © 2016. Published by Elsevier Ltd.

Practice recommendations for pain assessment by self-report with African American older adults.

PubMed

Booker, Staja Star; Pasero, Chris; Herr, Keela A

2015-01-01

Despite decades of education and clinical practice guidelines underscoring disparities in pain management, pain continues to be inadequately managed in older African American adults as a result of patient, provider, and systems factors. Critical factors influencing pain assessment in older African American adults has not been extensively examined, contributing to a lack of data to inform health care providers' knowledge on culturally-responsive pain assessment in older African Americans. Assessing pain in older African Americans is unique because differences in language, cultural beliefs, and practices moderate how they report and express pain. This paper presents an overview of patient-provider factors that affect pain assessment in older African Americans with a focus on this population's unique cultural beliefs and practices. Recommendations for best practices for performance of a culturally-responsive pain assessment with older African Americans are provided. Copyright © 2015 Elsevier Inc. All rights reserved.

Towards an evaluation framework for information quality management (IQM) practices for health information systems--evaluation criteria for effective IQM practices.

PubMed

Mohammed, Siti Asma; Yusof, Maryati Mohd

2013-04-01

Poor information quality (IQ) must be understood as a business problem rather than systems problem. In health care organization, what is required is an effective quality management that continuously manages and reviews the factors influencing IQ in health information systems (HIS) so as to achieve the desired outcomes. Hence, in order to understand the issues of information quality management (IQM) practices in health care organizations, a more holistic evaluation study should be undertaken to investigate the IQM practices in health care organizations. It is the aim of this paper to identify the significant evaluation criteria that influence the production of good IQ in HIS. Six selected frameworks and best practices both from health informatics and information systems literature have been reviewed to identify the evaluation criteria from the perspective of human, organizational and technological factors. From the review, it was found that human and organization factors are of greater significance in influencing HIS IQ. Our review depicts that there is still shortage in finding a comprehensive IQM evaluation framework. Thus, the criteria from the frameworks reviewed can be used in combination for more comprehensive evaluation criteria. Integrated IQM evaluation criteria for HIS are then proposed in this study. Poor IQ is the result of complex interdependency within sociotechnical factors in health care organization and lack of formal and structured IQM practices. Thus, a feedback mechanism such as evaluation is needed to understand the issues in depth in the future. © 2012 Blackwell Publishing Ltd.

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

The Impacts of Various Environments Factors and Adaptive Management Strategies on Food Crops in the 21st Century Based on a Land Surface Model

NASA Astrophysics Data System (ADS)

Jain, A. K.; Lin, T. S.; Lawrence, P.; Kheshgi, H. S.

2017-12-01

Environmental factors - characterized by increasing levels of CO2, and changes in temperature and precipitation patterns - present potential risks to global food supply. To date, understanding of environmental factors' effects on crop production remains uncertain due to (1) uncertainties in projected trends of these factors and their spatial and temporal variability; (2) uncertainties in the physiological, genetic and molecular basis of crop adaptation to adaptive management practices (e.g. change in planting time, irrigation and N fertilization etc.) and (3) uncertainties in current land surface models to estimate the response of crop production to changes in environmental factors and management strategies. In this study we apply a process-based land surface model, the Integrated Science Assessment model (ISAM), to assess the impact of various environmental factors and management strategies on the production of row crops (corn, soybean and wheat) at regional and global scales. Results are compared to corresponding simulations performed with the crop model in the Community Land Model (CLM4.5). Each model is driven with historical atmospheric forcing data (1901-2005), and projected atmospheric forcing data under RCP 4.5 or RCP 8.5 (2006-2100) from CESM CMIP5 simulations to estimate the effects of different climate change projections on potential productivity of food crops at a global scale. For each set of atmospheric forcing data, production of each crop is simulated with and without inclusion of adaptive management practices (e.g. application of irrigation, N fertilization, change in planting time and crop cultivars etc.) to assess the effect of adaptation on projected crop production over the 21st century. In detail, three questions are addressed: (1) what is the impact of different climate change projections on global crop production; (2) what is the effect of adaptive management practices on projected crop production; and (3) how do differences in model mechanisms in ISAM and CLM4.5 impact projected global crop production and adaptive management practices (irrigation and N fertilizer) over the 21st century. The major outcomes of this study will help to understand the uncertainties in potential productivity of food crops under different environmental conditions and management practices.

Management of asthma in Australian general practice: care is still not in line with clinical practice guidelines.

PubMed

Barton, Christopher; Proudfoot, Judith; Amoroso, Cheryl; Ramsay, Emmae; Holton, Christine; Bubner, Tanya; Harris, Mark; Beilby, Justin

2009-06-01

We investigated the quality of primary care asthma management in a sample of Australian general practices. 247 general practitioners (GPs) from 97 practices completed a structured interview about management of asthma, diabetes and hypertension/heart disease. A further structured interview with the senior practice principal and practice manager was used to collect information about practice capacity for chronic disease management. Just under half of GPs (47%) had access to an asthma register and the majority (76%) had access to spirometry in their practice. In terms of routine management of asthma, 12% of GPs reported using spirometry routinely, 13% routinely reviewed written asthma action plans, 27% routinely provided education about trigger factors, 30% routinely reviewed inhaler technique, 24% routinely assessed asthma severity, and 29% routinely assessed physical activity. Practice characteristics such as practice size (p=1.0) and locality (rural/metropolitan) (p=0.7) did not predict quality of asthma management nor did indicators of practice capacity including Business maturity, IT/IM maturity, Multidisciplinary teamwork, and Clinical linkages. Gaps remain in the provision of evidence-based care for patients with asthma in general practice. Markers of practice capacity measured here were not associated with guideline-based respiratory care within practices.

Depression screening and management among adolescents in primary care: factors associated with best practice.

PubMed

Taliaferro, Lindsay A; Hetler, Joel; Edwall, Glenace; Wright, Catherine; Edwards, Anne R; Borowsky, Iris W

2013-06-01

To compare depression identification and management perceptions and practices between professions and disciplines in primary care and examine factors that increase the likelihood of administering a standardized depression screening instrument, asking about patients' depressive symptoms, and using best practice when managing depressed adolescents. Data came from an online survey of clinicians in Minnesota (20% response rate). Analyses involved bivariate tests and linear regressions. The analytic sample comprised 260 family medicine physicians, 127 pediatricians, 96 family nurse practitioners, and 54 pediatric nurse practitioners. Overall, few differences emerged between physicians and nurse practitioners or family and pediatric clinicians regarding addressing depression among adolescents. Two factors associated with administering a standardized instrument included having clear protocols for follow-up after depression screening and feeling better prepared to address depression among adolescents. Enhancing clinicians' competence to address depression and developing postscreening protocols could help providers implement universal screening in primary care.

Exploring Cultural Influences of Self-Management of Diabetes in Coastal Kenya

PubMed Central

Abdulrehman, Munib Said; Woith, Wendy; Jenkins, Sheryl; Kossman, Susan; Hunter, Gina Louise

2016-01-01

In spite of increasing prevalence of diabetes among Kenyans and evidence suggesting Kenyans with diabetes maintain poor glycemic control, no one has examined the role of cultural attitudes, beliefs, and practices in their self-management of diabetes. The purpose of this ethnographic study was to describe diabetes self-management among the Swahili of coastal Kenya, and explore factors that affect diabetes self-management within the context of Swahili culture. Thirty men and women with type 2 diabetes from Lamu town, Kenya, participated in this study. Diabetes self-management was insufficiently practiced, and participants had limited understanding of diabetes. Economic factors such as poverty and the high cost of biomedical care appear to have more influence in self-management behavior than socio-cultural and educational factors do. Economic and socio-cultural influences on diabetes self-management should not be underestimated, especially in a limited resource environment like coastal Kenya, where biomedical care is not accessible or affordable to all. PMID:28462335

The physician's office: can it influence adult immunization rates?

PubMed

Nowalk, Mary Patricia; Bardella, Inis Jane; Zimmerman, Richard Kent; Shen, Shunhua

2004-01-01

To determine which office and patient factors affect adult influenza and pneumococcal vaccination rates. Patient interviews and self-administered surveys of office managers. In a 2-stage random cluster sample, 22 practices in 4 strata (Veterans' Affairs, rural, urban/suburban, and inner city) and 15 patients per physician in each practice (n = 946) were selected. Office managers completed a questionnaire regarding office practices and logistics affecting immunizations. Data were examined using chi2 and regression analyses without and with patient factors in the models. Practice factors significantly related to influenza vaccination status were stratum (VA OR = 2.04; 95% CI = 1.18, 3.53; P < .05 vs inner-city), time allotted for acute care visits (16-20 min vs 10-15 min OR = 2.49; 95% CI = 1.68, 3.09; P < .001), the practice not having a source of free vaccines (OR = .43; 95% CI = .3, .62; P < .001), and the interaction between being an urban/suburban practice and having a source of free flu vaccines (OR = 4.0; 95% CI = 2.63, 6.09; P < .001). Practice factors related to pneumococcal vaccination status were the number of immunization promotion activities (> or = 3 vs 0-2 OR = 1.97; 95% CI = 1.33, 2.94; P = .002) and the time allotted for acute care visits (16-20 min vs 10-15 min OR = 1.94; 95% CI = 1.18, 3.19; P = .011). When practice and patient factors were combined in the analyses, patient factors were more important. Although patient factors are more important than practice factors, practices that allot more time for acute care visits and use more immunization promotion activities have higher vaccination rates.

Computer Assisted Chronic Disease Management: Does It Work? A Pilot Study Using Mixed Methods

PubMed Central

Jones, Kay M.; Biezen, Ruby; Piterman, Leon

2013-01-01

Background. Key factors for the effective chronic disease management (CDM) include the availability of practical and effective computer tools and continuing professional development/education. This study tested the effectiveness of a computer assisted chronic disease management tool, a broadband-based service known as cdmNet in increasing the development of care plans for patients with chronic disease in general practice. Methodology. Mixed methods are the breakthrough series methodology (workshops and plan-do-study-act cycles) and semistructured interviews. Results. Throughout the intervention period a pattern emerged suggesting GPs use of cdmNet initially increased, then plateaued practice nurses' and practice managers' roles expanded as they became more involved in using cdmNet. Seven main messages emerged from the GP interviews. Discussion. The overall use of cdmNet by participating GPs varied from “no change” to “significant change and developing many the GPMPs (general practice management plans) using cdmNet.” The variation may be due to several factors, not the least, allowing GPs adequate time to familiarise themselves with the software and recognising the benefit of the team approach. Conclusion. The breakthrough series methodology facilitated upskilling GPs' management of patients diagnosed with a chronic disease and learning how to use the broadband-based service cdmNet. PMID:24959576

End-of-life care practices of critical care nurses: A national cross-sectional survey.

PubMed

Ranse, Kristen; Yates, Patsy; Coyer, Fiona

2016-05-01

The critical care context presents important opportunities for nurses to deliver skilled, comprehensive care to patients at the end of life and their families. Limited research has identified the actual end-of-life care practices of critical care nurses. To identify the end-of-life care practices of critical care nurses. A national cross-sectional online survey. The survey was distributed to members of an Australian critical care nursing association and 392 critical care nurses (response rate 25%) completed the survey. Exploratory factor analysis using principal axis factoring with oblique rotation was undertaken on survey responses to identify the domains of end-of-life care practice. Descriptive statistics were calculated for individual survey items. Exploratory factor analysis identified six domains of end-of-life care practice: information sharing, environmental modification, emotional support, patient and family centred decision-making, symptom management and spiritual support. Descriptive statistics identified a high level of engagement in information sharing and environmental modification practices and less frequent engagement in items from the emotional support and symptom management practice areas. The findings of this study identified domains of end-of-life care practice, and critical care nurse engagement in these practices. The findings highlight future training and practice development opportunities, including the need for experiential learning targeting the emotional support practice domain. Further research is needed to enhance knowledge of symptom management practices during the provision of end-of-life care to inform and improve practice in this area. Copyright © 2015 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Factors Influencing Farmers’ Adoption of Best Management Practices: A Review and Synthesis

EPA Science Inventory

Best management practices (BMPs) for reducing agricultural non-point source pollution are widely available. However, agriculture remains a major global contributor to degradation of waters because farmers often do not adopt BMPs. To improve water quality, it is necessary to under...

Information Security Management Practices of K-12 School Districts

ERIC Educational Resources Information Center

Nyachwaya, Samson

2013-01-01

The research problem addressed in this quantitative correlational study was the inadequacy of sound information security management (ISM) practices in K-12 school districts, despite their increasing ownership of information assets. Researchers have linked organizational and sociotechnical factors to the implementation of information security…

Increasing the relevance of research to health care managers: hospital CEO imperatives for improving quality and lowering costs.

PubMed

Alexander, Jeffrey A; Hearld, Larry R; Jiang, H Joanna; Fraser, Irene

2007-01-01

Evidence-based management assumes that available research evidence is consistent with the problems and decision-making conditions faced by those who will utilize this evidence in practice. This article attempts to identify how hospital leaders view key determinants of hospital quality and costs, as well as the fundamental ways these leaders "think" about solutions to quality and cost issues in their organizations. The objective of this analysis is to better inform the research agenda and approaches pursued by health services research so that this research reflects the "realities" of practice in hospitals. We conducted a series of semistructured interviews with a convenience sample of eight hospital and three health system leaders. Questions focused on current and future challenges facing hospitals as they relate to hospital quality, costs, and efficiency, and potential solutions to those challenges. Nine major organizational and managerial factors emerged from the interviews, including staffing, evidence-based practice, information technology, data availability and benchmarking, and leadership. Hospital leaders tend to think about these factors systemically and consider process-related factors as the important drivers of cost and quality. The results suggest a need to expand the methods utilized by health services researchers to make their research more relevant to health care managers. Expanding research methods to reflect the systemic way that managers view the challenges and solutions facing their organizations may enhance the application of research findings into management practice. Finally, better communication is needed between the research and practice communities. Researchers must learn to think more like managers if their research is to be relevant, and managers must learn to more effectively communicate their issues with the research community and frame their problems in researchable terms.

Factors affecting implementation of an evidence-based practice in the Veterans Health Administration: Illness management and recovery.

PubMed

McGuire, Alan B; Salyers, Michelle P; White, Dominique A; Gilbride, Daniel J; White, Laura M; Kean, Jacob; Kukla, Marina

2015-12-01

Illness management and recovery (IMR) is an evidence-based practice that assists consumers in managing their illnesses and pursuing personal recovery goals. Although research has examined factors affecting IMR implementation facilitated by multifaceted, active roll-outs, the current study attempted to elucidate factors affecting IMR implementation outside the context of a research-driven implementation. Semi-structured interviews with 20 local recovery coordinators and 18 local IMR experts were conducted at 23 VA medical centers. Interviews examined perceived and experienced barriers and facilitators to IMR implementation. Data were analyzed via thematic inductive/deductive analysis in the form of crystallization/immersion. Six factors differed between sites implementing IMR from those not providing IMR: awareness of IMR, importer-champions, autonomy-supporting leadership, veteran-centered care, presence of a sensitive period, and presence of a psychosocial rehabilitation and recovery center. Four factors were common in both groups: recovery orientation, evidence-based practices orientation, perceived IMR fit within program structure, and availability of staff time. IMR can be adopted in lieu of active implementation support; however, knowledge dissemination appears to be key. Future research should examine factors affecting the quality of implementation. (c) 2015 APA, all rights reserved).

Sociodemographic Factors and Self-Management Practices Related to Type 2 Diabetes among Hispanics and Non-Hispanic Whites in a Rural Setting

ERIC Educational Resources Information Center

Coronado, Gloria D.; Thompson, Beti; Tejeda, Silvia; Godina, Ruby; Chen, Lu

2007-01-01

Context: Hispanics in the United States have a higher prevalence of non-insulin-dependent diabetes mellitus (type 2 diabetes) and experience more complications for the disease than non-Hispanic whites. Differences in medical management or self-management practices may, in part, explain the relative high risk for diabetes complications among…

Site establishment practices influence loblolly pine mortality throughout the stand rotation

Treesearch

Felipe G. Sanchez; Robert J. Eaton

2010-01-01

During a rotation, land managers need to estimate yields, update inventories, and evaluate stand dynamics. All of these factors in land management are heavily influenced by tree mortality. Tree mortality can, in turn, be influenced by land management practices from the inception of the stand and throughout the rotation. We describe the impact of organic matter removal...

Development and construct validity of the Classroom Strategies Scale-Observer Form.

PubMed

Reddy, Linda A; Fabiano, Gregory; Dudek, Christopher M; Hsu, Louis

2013-12-01

Research on progress monitoring has almost exclusively focused on student behavior and not on teacher practices. This article presents the development and validation of a new teacher observational assessment (Classroom Strategies Scale) of classroom instructional and behavioral management practices. The theoretical underpinnings and empirical basis for the instructional and behavioral management scales are presented. The Classroom Strategies Scale (CSS) evidenced overall good reliability estimates including internal consistency, interrater reliability, test-retest reliability, and freedom from item bias on important teacher demographics (age, educational degree, years of teaching experience). Confirmatory factor analyses (CFAs) of CSS data from 317 classrooms were carried out to assess the level of empirical support for (a) a 4 first-order factor theory concerning teachers' instructional practices, and (b) a 4 first-order factor theory concerning teachers' behavior management practice. Several fit indices indicated acceptable fit of the (a) and (b) CFA models to the data, as well as acceptable fit of less parsimonious alternative CFA models that included 1 or 2 second-order factors. Information-theory-based indices generally suggested that the (a) and (b) CFA models fit better than some more parsimonious alternative CFA models that included constraints on relations of first-order factors. Overall, CFA first-order and higher order factor results support the CSS-Observer Total, Composite, and subscales. Suggestions for future measurement development efforts are outlined. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Does identity shape leadership and management practice? Experiences of PHC facility managers in Cape Town, South Africa.

PubMed

Daire, Judith; Gilson, Lucy

2014-09-01

In South Africa, as elsewhere, Primary Health Care (PHC) facilities are managed by professional nurses. Little is known about the dimensions and challenges of their job, or what influences their managerial practice. Drawing on leadership and organizational theory, this study explored what the job of being a PHC manager entails, and what factors influence their managerial practice. We specifically considered whether the appointment of professional nurses as facility managers leads to an identity transition, from nurse to manager. The overall intention was to generate ideas about how to support leadership development among PHC facility managers. Adopting case study methodology, the primary researcher facilitated in-depth discussions (about their personal history and managerial experiences) with eight participating facility managers from one geographical area. Other data were collected through in-depth interviews with key informants, document review and researcher field notes/journaling. Analysis involved data triangulation, respondent and peer review and cross-case analysis. The experiences show that the PHC facility manager's job is dominated by a range of tasks and procedures focused on clinical service management, but is expected to encompass action to address the population and public health needs of the surrounding community. Managing with and through others, and in a complex system, requiring self-management, are critical aspects of the job. A range of personal, professional and contextual factors influence managerial practice, including professional identity. The current largely facility-focused management practice reflects the strong nursing identity of managers and broader organizational influences. However, three of the eight managers appear to self-identify an emerging leadership identity and demonstrate related managerial practices. Nonetheless, there is currently limited support for an identity transition towards leadership in this context. Better support for leadership development could include talent-spotting and nurturing, induction and peer-mentoring for newly appointed facility managers, ongoing peer-support once in post and continuous reflective practice. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Practice leadership and active support in residential services for people with intellectual disabilities: an exploratory study.

PubMed

Beadle-Brown, J; Mansell, J; Ashman, B; Ockenden, J; Iles, R; Whelton, B

2014-09-01

We hypothesised that a key factor determining the quality of active support was 'practice leadership' - provided by the first-line manager to focus staff attention and develop staff skills in providing direct support to enable people with intellectual disabilities to have a good quality of life. This exploratory study focused on what levels of practice leadership were found and its role in explaining variation in active support. Relevant aspects of management, including practice leadership, were assessed by questionnaires administered to staff in residential settings alongside observational measures of active support and resident engagement in meaningful activity. Relationships between these variables were explored using regression and post hoc group comparisons. There was wide variation, with average levels of practice leadership being low, though improving over the period studied. Practice leadership had a significant impact on active support, but was fully mediated by the effect of quality of management. When the quality of management was higher better practice leadership did produce a significant difference in active support. However, higher quality of management on its own did not produce better active support. A number of limitations are acknowledged and further research is required. Practice leadership appears to be an important factor in enabling staff to provide active support but as part of generally good management. Given the rather low levels found, attention needs to be given to the training, career development and support of practice leaders and also to how to protect their time from their many other responsibilities. © 2013 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Factors Affecting the Perception of Importance and Practice of Patient Safety Management among Hospital Employees in Korea.

PubMed

Kim, In-Sook; Park, MiJeong; Park, Mi-Young; Yoo, Hana; Choi, Jihea

2013-03-01

The study was undertaken to identify factors affecting perception of the importance and practice of patient safety management (PSM) among hospital employees in Korea. This study was conducted using a descriptive design and a self-report questionnaire. Two hundred and eighty employees were recruited from three hospitals using a convenience sampling method. Measures were perception of the importance, practice, and characteristics of PSM. Data were analyzed using descriptive statistics including t test, one-way analysis of variance, Pearson's correlation analysis, and multiple regression. Factors affecting perception of the importance of PSM were whether hospital employees were in contact with patients while on duty, weekly working hours, education on PSM, and perceived adequacy of PSM system construction. Factors affecting the practice of PSM were perceived adequacy of work load, perceived adequacy of PSM system construction and perception of its importance. The findings of this study indicate a need for developing strategies to improve perception of the importance and practice of PSM among all hospital employees, and provide a reference for future experimental studies. Copyright © 2013. Published by Elsevier B.V.

Greenhouse gas emissions and management practices that impact them in US rice systems

USDA-ARS?s Scientific Manuscript database

Previous reviews have quantified factors affecting greenhouse gas (GHG) emissions from Asian rice (Oryza sativa L.) systems, but not from rice systems typical for the United States, which often vary considerably particularly in practices (i.e., water and carbon management) that affect emissions. Usi...

Retinopathy of prematurity: An update on screening and management

PubMed Central

Jefferies, Ann L

2016-01-01

Retinopathy of prematurity is a proliferative disorder of the developing retinal blood vessels in preterm infants. The present practice point reviews new information regarding screening and management for retinopathy of prematurity, including the role of risk factors in screening, optimal scheduling for screening examinations, pain management, digital retinal photography and antivascular endothelial growth factor therapy. PMID:27095887

The effect of physician practice organization on efficient utilization of hospital resources.

PubMed

Burns, L R; Chilingerian, J A; Wholey, D R

1994-12-01

This study examines variations in the efficient use of hospital resources across individual physicians. The study is conducted over a two-year period (1989-1990) in all short-term general hospitals with 50 or more beds in Arizona. We examine hospital discharge data for 43,625 women undergoing cesarean sections and vaginal deliveries without complications. These data include physician identifiers that permit us to link patient information with information on physicians provided by the state medical association. The study first measures the contribution of physician characteristics to the explanatory power of regression models that predict resource use. It then tests hypothesized effects on resource utilization exerted by two sets of physician level factors: physician background and physician practice organization. The latter includes effects of hospital practice volume, concentration of hospital practice, percent managed care patients in one's hospital practice, and diversity of patients treated. Efficiency (inefficiency) is measured as the degree of variation in patient charges and length of stay below (above) the average of treating all patients with the same condition in the same hospital in the same year with the same severity of illness, controlling for discharge status and the presence of complications. After controlling for patient factors, physician characteristics explain a significant amount of the variability in hospital charges and length of stay in the two maternity conditions. Results also support hypotheses that efficiency is influenced by practice organization factors such as patient volume and managed care load. Physicians with larger practices and a higher share of managed care patients appear to be more efficient. The results suggest that health care reform efforts to develop physician-hospital networks and managed competition may promote greater parsimony in physicians' practice behavior.

The effect of physician practice organization on efficient utilization of hospital resources.

PubMed Central

Burns, L R; Chilingerian, J A; Wholey, D R

1994-01-01

OBJECTIVE. This study examines variations in the efficient use of hospital resources across individual physicians. DATA SOURCES AND SETTING. The study is conducted over a two-year period (1989-1990) in all short-term general hospitals with 50 or more beds in Arizona. We examine hospital discharge data for 43,625 women undergoing cesarean sections and vaginal deliveries without complications. These data include physician identifiers that permit us to link patient information with information on physicians provided by the state medical association. STUDY DESIGN. The study first measures the contribution of physician characteristics to the explanatory power of regression models that predict resource use. It then tests hypothesized effects on resource utilization exerted by two sets of physician level factors: physician background and physician practice organization. The latter includes effects of hospital practice volume, concentration of hospital practice, percent managed care patients in one's hospital practice, and diversity of patients treated. Efficiency (inefficiency) is measured as the degree of variation in patient charges and length of stay below (above) the average of treating all patients with the same condition in the same hospital in the same year with the same severity of illness, controlling for discharge status and the presence of complications. PRINCIPAL FINDINGS. After controlling for patient factors, physician characteristics explain a significant amount of the variability in hospital charges and length of stay in the two maternity conditions. Results also support hypotheses that efficiency is influenced by practice organization factors such as patient volume and managed care load. Physicians with larger practices and a higher share of managed care patients appear to be more efficient. CONCLUSIONS. The results suggest that health care reform efforts to develop physician-hospital networks and managed competition may promote greater parsimony in physicians' practice behavior. PMID:8002351

Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults.

PubMed

Shuman, Clayton J; Xie, Xian-Jin; Herr, Keela A; Titler, Marita G

2017-11-01

Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.

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.

Provider- and patient-related determinants of diabetes self-management among recent immigrants: Implications for systemic change.

PubMed

Hyman, Ilene; Shakya, Yogendra; Jembere, Nathaniel; Gucciardi, Enza; Vissandjée, Bilkis

2017-02-01

To examine provider- and patient-related factors associated with diabetes self-management among recent immigrants. Demographic and experiential data were collected using an international survey instrument and adapted to the Canadian context. The final questionnaire was pretested and translated into 4 languages: Mandarin, Tamil, Bengali, and Urdu. Toronto, Ont. A total of 130 recent immigrants with a self-reported diagnosis of type 2 diabetes mellitus who had resided in Canada for 10 years or less. Diabetes self-management practices (based on a composite of 5 diabetes self-management practices, and participants achieved a score for each adopted practice); and the quality of the provider-patient interaction (measured with a 5-point Likert-type scale that consisted of questions addressing participants' perceptions of discrimination and equitable care). A total of 130 participants in this study were recent immigrants to Canada from 4 countries of origin-Sri Lanka, Bangladesh, Pakistan, and China. Two factors were significant in predicting diabetes self-management among recent immigrants: financial barriers, specifically, not having enough money to manage diabetes expenses ( P  = .0233), and the quality of the provider-patient relationship ( P = .0016). Participants who did not have enough money to manage diabetes were 9% less likely to engage in self-management practices; and participants who rated the quality of their interactions with providers as poor were 16% less likely to engage in self-management practices. Financial barriers can undermine effective diabetes self-management among recent immigrants. Ensuring that patients feel comfortable and respected and that they are treated in culturally sensitive ways is also critical to good diabetes self-management. Copyright© the College of Family Physicians of Canada.

Talent management best practices: how exemplary health care organizations create value in a down economy.

PubMed

Groves, Kevin S

2011-01-01

: Difficult economic conditions and powerful workforce trends pose significant challenges to managing talent in health care organizations. Although robust research evidence supports the many benefits of maintaining a strong commitment to talent management practices despite these challenges, many organizations compound the problem by resorting to workforce reductions and limiting or eliminating investments in talent management. : This study examines how nationwide health care systems address these challenges through best practice talent management systems. Addressing important gaps in talent management theory and practice, this study develops a best practice model of talent management that is grounded in the contextual challenges facing health care practitioners. : Utilizing a qualitative case study that examined 15 nationwide health care systems, data were collected through semistructured interviews with 30 executives and document analysis of talent management program materials submitted by each organization. : Exemplary health care organizations employ a multiphased talent management system composed of six sequential phases and associated success factors that drive effective implementation. Based on these findings, a model of talent management best practices in health care organizations is presented. : Health care practitioners may utilize the best practice model to assess and enhance their respective talent management systems by establishing the business case for talent management, defining, identifying, and developing high-potential leaders, carefully communicating high-potential designations, and evaluating talent management outcomes.

Capacity, responsibility, and motivation: a critical qualitative evaluation of patient and practitioner views about barriers to self-management in people with multimorbidity.

PubMed

Coventry, Peter A; Fisher, Louise; Kenning, Cassandra; Bee, Penny; Bower, Peter

2014-10-31

Primary care is increasingly focussed on the care of people with two or more long-term conditions (multimorbidity). The UK Department of Health strategy for long term conditions is to use self-management support for the majority of patients but there is evidence of limited engagement among primary care professionals and patients with multimorbidity. Furthermore, multimorbidity is more common in areas of socioeconomic deprivation but deprivation may act as a barrier to patient engagement in self-management practices. Effective self-management is considered critical to meet the needs of people living with long term conditions but achieving this is a significant challenge in patients with multimorbidity. This study aimed to explore patient and practitioner views on factors influencing engagement in self-management in the context of multimorbidity. A qualitative study using individual semi-structured interviews with 20 patients and 20 practitioners drawn from four general practices in Greater Manchester situated in areas of high and low social deprivation. Three main factors were identified as influencing patient engagement in self-management: capacity (access and availability of socio-economic resources and time; knowledge; and emotional and physical energy), responsibility (the degree to which patients and practitioners agreed about the division of labour about chronic disease management, including self-management) and motivation (willingness to take-up types of self-management practices). Socioeconomic deprivation negatively impacted on all three factors. Motivation was especially reduced in the presence of mental and physical multimorbidity. Full engagement in self-management practices in multimorbidity was only present where patients' articulated a sense of capacity, responsibility, and motivation. Patient 'know-how' or interpretive capacity to self-manage multimorbidity is potentially an important precursor to responsibility and motivation, and might be a critical target for intervention. However, individual and social resources are needed to generate capacity, responsibility, and motivation for self-management, pointing to a balanced role for health services and wider enabling networks.

Attitudes, norms and controls influencing lifestyle risk factor management in general practice.

PubMed

Ampt, Amanda J; Amoroso, Cheryl; Harris, Mark F; McKenzie, Suzanne H; Rose, Vanessa K; Taggart, Jane R

2009-08-26

With increasing rates of chronic disease associated with lifestyle behavioural risk factors, there is urgent need for intervention strategies in primary health care. Currently there is a gap in the knowledge of factors that influence the delivery of preventive strategies by General Practitioners (GPs) around interventions for smoking, nutrition, alcohol consumption and physical activity (SNAP). This qualitative study explores the delivery of lifestyle behavioural risk factor screening and management by GPs within a 45-49 year old health check consultation. The aims of this research are to identify the influences affecting GPs' choosing to screen and choosing to manage SNAP lifestyle risk factors, as well as identify influences on screening and management when multiple SNAP factors exist. A total of 29 audio-taped interviews were conducted with 15 GPs and one practice nurse over two stages. Transcripts from the interviews were thematically analysed, and a model of influencing factors on preventive care behaviour was developed using the Theory of Planned Behaviour as a structural framework. GPs felt that assessing smoking status was straightforward, however some found assessing alcohol intake only possible during a formal health check. Diet and physical activity were often inferred from appearance, only being assessed if the patient was overweight. The frequency and thoroughness of assessment were influenced by the GPs' personal interests and perceived congruence with their role, the level of risk to the patient, the capacity of the practice and availability of time. All GPs considered advising and educating patients part of their professional responsibility. However their attempts to motivate patients were influenced by perceptions of their own effectiveness, with smoking causing the most frustration. Active follow-up and referral of patients appeared to depend on the GPs' orientation to preventive care, the patient's motivation, and cost and accessibility of services to patients. General practitioner attitudes, normative influences from both patients and the profession, and perceived external control factors (time, cost, availability and practice capacity) all influence management of behavioural risk factors. Provider education, community awareness raising, support and capacity building may improve the uptake of lifestyle modification interventions.

The primary-specialty care interface in chronic diseases: patient and practice characteristics associated with co-management.

PubMed

Larochelle, Jean-Louis; Feldman, Debbie Ehrmann; Levesque, Jean-Frederic

2014-11-01

Specialist physicians may act either as consultants or co-managers for patients with chronic diseases along with their primary healthcare (PHC) physician. We assessed factors associated with specialist involvement. We used questionnaire and administrative data to measure co-management and patient and PHC practice characteristics in 702 primary care patients with common chronic diseases. Analysis included multilevel logistic regressions. In all, 27% of the participants were co-managed. Persons with more severe chronic diseases and lower health-related quality of life were more likely to be co-managed. Persons who were older, had a lower socioeconomic status, resided in rural regions and who were followed in a PHC practice with an advanced practice nurse were less likely to be co-managed. Co-management of patients with chronic diseases by a specialist is associated with higher clinical needs but demonstrates social inequalities. PHC practices more adapted to chronic care may help optimize specialist resources utilization. Copyright © 2014 Longwoods Publishing.

The Primary-Specialty Care Interface in Chronic Diseases: Patient and Practice Characteristics Associated with Co-Management

PubMed Central

Larochelle, Jean-Louis; Feldman, Debbie Ehrmann; Levesque, Jean-Frederic

2014-01-01

Objective: Specialist physicians may act either as consultants or co-managers for patients with chronic diseases along with their primary healthcare (PHC) physician. We assessed factors associated with specialist involvement. Methods: We used questionnaire and administrative data to measure co-management and patient and PHC practice characteristics in 702 primary care patients with common chronic diseases. Analysis included multilevel logistic regressions. Results In all, 27% of the participants were co-managed. Persons with more severe chronic diseases and lower health-related quality of life were more likely to be co-managed. Persons who were older, had a lower socioeconomic status, resided in rural regions and who were followed in a PHC practice with an advanced practice nurse were less likely to be co-managed. Discussion: Co-management of patients with chronic diseases by a specialist is associated with higher clinical needs but demonstrates social inequalities. PHC practices more adapted to chronic care may help optimize specialist resources utilization. PMID:25617515

Factors influencing healthcare service quality

PubMed Central

Mosadeghrad, Ali Mohammad

2014-01-01

Background: The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods: Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results: Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion: This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality. PMID:25114946

Participatory innovation process for testing new practices for soil fertility management in Chókwè Irrigation Scheme (Mozambique)

NASA Astrophysics Data System (ADS)

Sánchez Reparaz, Maite; de Vente, Joris; Famba, Sebastiao; Rougier, Jean-Emmanuel; Ángel Sánchez-Monedero, Miguel; Barberá, Gonzalo G.

2015-04-01

Integrated water and nutrient management are key factors to increase productivity and to reduce the yield gap in irrigated systems in Sub-Saharan Africa. These two elements are affected by an ensemble of abiotic, biotic, management and socio-economic factors that need to be taken into account to reduce the yield gap, as well as farmers' perceptions and knowledge. In the framework of the project European Union and African Union cooperative research to increase Food production in irrigated farming systems in Africa (EAU4Food project) we are carrying out a participatory innovation process in Chókwè irrigation scheme (Mozambique) based on stakeholders engagement, to test new practices for soil fertility management that can increase yields reducing costs. Through a method combining interviews with three farmers' associations and other relevant stakeholders and soil sampling from the interviewed farmers' plots with the organization of Communities of Practices, we tried to capture how soil fertility is managed by farmers, the constraints they find as well as their perceptions about soil resources. This information was the basis to design and conduct a participatory innovation process where compost made with rice straw and manure is being tested by a farmers' association. Most important limitations of the method are also evaluated. Our results show that socio-economic characteristics of farmers condition how they manage soil fertility and their perceptions. The difficulties they face to adopt new practices for soil fertility management, mainly related to economic resources limitations, labour availability, knowledge time or farm structure, require a systemic understanding that takes into account abiotic, biotic, management and socio-economic factors and their implication as active stakeholders in all phases of the innovation process.

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.

Service readiness, health facility management practices, and delivery care utilization in five states of Nigeria: a cross-sectional analysis.

PubMed

Gage, Anastasia J; Ilombu, Onyebuchi; Akinyemi, Akanni Ibukun

2016-10-06

Existing studies of delivery care in Nigeria have identified socioeconomic and cultural factors as the primary determinants of health facility delivery. However, no study has investigated the association between supply-side factors and health facility delivery. Our study analyzed the role of supply-side factors, particularly health facility readiness and management practices for provision of quality maternal health services. Using linked data from the 2005 and 2009 health facility and household surveys in the five states in which the Community Participation for Action in the Social Sector (COMPASS) project was implemented, indices of health service readiness and management were developed based on World Health Organization guidelines. Multilevel logistic regression models were run to determine the association between these indices and health facility delivery among 2710 women aged 15-49 years whose last child was born within the five years preceding the surveys and who lived in 51 COMPASS LGAs. The health facility delivery rate increased from 25.4 % in 2005 to 44.1 % in 2009. Basic amenities for antenatal care provision, readiness to deliver basic emergency obstetric and newborn care, and management practices supportive of quality maternal health services were suboptimal in health facilities surveyed and did not change significantly between 2005 and 2009. The LGA mean index of basic amenities for antenatal care provision was more positively associated with the odds of health facility delivery in 2009 than in 2005, and in rural than in urban areas. The LGA mean index of management practices was associated with significantly lower odds of health facility delivery in rural than in urban areas. The LGA mean index of facility readiness to deliver basic emergency obstetric and neonatal care declined slightly from 5.16 in 2005 to 3.98 in 2009 and was unrelated to the odds of health facility delivery. Supply-side factors appeared to play a role in health facility delivery after controlling for socio-demographic factors. Improving uptake of delivery care would require greater attention to rural-urban inequities and health facility management practices, and to increasing the number of health facilities with fundamental elements for delivery of basic emergency obstetric and neonatal care.

Factor Analysis of Therapist-Identified Treatment Targets in Community-Based Children's Mental Health.

PubMed

Love, Allison R; Okado, Izumi; Orimoto, Trina E; Mueller, Charles W

2018-01-01

The present study used exploratory and confirmatory factor analyses to identify underlying latent factors affecting variation in community therapists' endorsement of treatment targets. As part of a statewide practice management program, therapist completed monthly reports of treatment targets (up to 10 per month) for a sample of youth (n = 790) receiving intensive in-home therapy. Nearly 75 % of youth were diagnosed with multiple co-occurring disorders. Five factors emerged: Disinhibition, Societal Rules Evasion, Social Engagement Deficits, Emotional Distress, and Management of Biodevelopmental Outcomes. Using logistic regression, primary diagnosis predicted therapist selection of Disinhibition and Emotional Distress targets. Client age predicted endorsement of Societal Rules Evasion targets. Practice-to-research implications are discussed.

Clinical Practice Patterns and Beliefs in the Management of Hamstrings Strain Injuries.

PubMed

Di Trani Lobacz, Andrea; Glutting, Joseph; Kaminski, Thomas W

2016-02-01

Hamstrings strain injuries (HSIs) are among the most commonly occurring injuries in sport and are top causes of missed playing time. Lingering symptoms, prolonged recovery, and a high reinjury rate (12%-34%) make HSI management a frustrating and challenging process for the athletic trainer (AT). The clinical practice patterns and opinions of ATs regarding HSI treatment and rehabilitation are unknown. To examine the frequency of method use and opinions about current HSI management among ATs. Cross-sectional study. Survey administered to registrants at the 2013 National Athletic Trainers' Association Clinical Symposia and AT Expo. A total of 1356 certified ATs (691 men, 665 women; age = 35.4 ± 10.5 years, time certified = 11.92 ± 9.75 years). A survey was distributed electronically to 7272 registrants and on paper to another 700 attendees. Validity and reliability were established before distribution. Participants reported demographic information and rated their frequency of treatment and rehabilitation method use and agreement with questions assessing confidence, satisfaction, and desire for better clinical practice guidelines. Exploratory factor analysis and principal axis factor analysis were used. We also calculated descriptive statistics and χ(2) tests to assess practice patterns. The response rate was 17% (n = 1356). A 2-factor solution was accepted for factor analysis (r = 0.76, r = 0.70), indicating that ATs follow either a contemporary or traditional management style. Various practice patterns were evident across employment settings and years of clinical experience. Satisfaction with the current HSI management plan was high (73.6%), whereas confidence in returning an athlete to play was lower (62.0%). Rates of use were associated with belief in effectiveness for all methods assessed (P < .001). Higher confidence levels were associated with high use of several methods; we observed increased satisfaction (χ(2)2 = 22.5, P = .002) but not increased confidence levels in more experienced ATs. Our study demonstrated the lack of consensus in HSI treatment and rehabilitation and the ATs' desire for better clinical practice guidelines. Future research in which multimodal strategies, including both traditional and contemporary methods, are studied is warranted for effective management of HSI.

Cattle as ecosystem engineers: New grazing management enhances rangeland biodiversity

USDA-ARS?s Scientific Manuscript database

A confluence of factors has shaped the composition and structure of vegetation on rangelands in the American West. These factors include climate, soils, topography, history of grazing and fire (both wildfire and prescribed fire) as well as legacy effects from prior land management practices. Despite...

Lean practices for quality results: a case illustration.

PubMed

Hwang, Pauline; Hwang, David; Hong, Paul

2014-01-01

Increasingly, healthcare providers are implementing lean practices to achieve quality results. Implementing lean healthcare practices is unique compared to manufacturing and other service industries. The purpose of this paper is to present a model that identifies and defines the lean implementation key success factors in healthcare organisations. The model is based on an extant literature review and a case illustration that explores actual lean implementation in a major USA hospital located in a Midwestern city (approximately 300,000 people). An exploratory/descriptive study using observation and follow-up interviews was conducted to identify lean practices in the hospital. Lean practice key drivers include growing elderly populations, rising medical expenses, decreasing insurance coverage and decreasing management support. Effectively implementing lean practices to increase bottom-line results and improve organisational integrity requires sharing goals and processes among healthcare managers and professionals. An illustration explains the model and the study provides a sound foundation for empirical work. Practical implications are included. Lean practices minimise waste and unnecessary hospital stays while simultaneously enhancing customer values and deploying resources in supply systems. Leadership requires clear project targets based on sound front-end planning because initial implementation steps involve uncertainty and ambiguity (i.e. fuzzy front-end planning). Since top management support is crucial for implementing lean practices successfully, a heavyweight manager, who communicates well both with top managers and project team members, is an important success factor when implementing lean practices. Increasingly, green orientation and sustainability initiatives are phrases that replaced lean practices. Effective results; e.g. waste reduction, employee satisfaction and customer values are applicable to bigger competitive challenges arising both in specific organisations and inter-organisational networks. Healthcare managers are adopting business practices that improve efficiency and productivity while ensuring their healthcare mission and guaranteeing that customer values are achieved. Shared understanding about complex goals (e.g. reducing waste and enhancing customer value) at the front-end is crucial for implementing successful lean practices. In particular, this study shows that nursing practices, which are both labour intensive and technology enabled, are good candidates for lean practice.

Constructing Ability Groups in the Secondary School: Issues in Practice.

ERIC Educational Resources Information Center

Ireson, Judith; Clark, Helen; Hallam, Susan

2002-01-01

Examines grouping practices in 45 secondary schools in England based on information provided by curriculum managers and department heads about allocation procedures, factors affecting the size and number of student groups, movement between groups, pressures and constraints on movement, and behavioral and motivational factors. Finds wide variety of…

Individual differences in temperament and behavioral management practices for nonhuman primates

PubMed Central

Coleman, Kristine

2011-01-01

Effective behavioral management plans are tailored to unique behavioral patterns of each individual species. However, even within a species behavioral needs of individuals can vary. Factors such as age, sex, and temperament can affect behavioral needs of individuals. While some of these factors, such as age and sex, are taken into account, other factors, such as an individual’s temperament, are rarely specifically provided for in behavioral management plans. However, temperament may affect how animals respond to socialization, positive reinforcement training and other forms of enrichment. This review will examine how individual differences in temperament might affect, or be affected by, behavioral management practices for captive primates. Measuring temperament may help us predict outcome of social introductions. It can also predict which animals may be difficult to train using traditional methods. Further, knowledge of temperament may be able to help identify individuals at risk for development of behavioral problems. Taken together, understanding individual differences in temperament of captive primates can help guide behavioral management decisions. PMID:22518067

Factors influencing practice variation in the management of nephrotic syndrome: a qualitative study of pediatric nephrology care providers

PubMed Central

Samuel, Susan M.; Flynn, Rachel; Zappitelli, Michael; Dart, Allison; Parekh, Rulan; Pinsk, Maury; Mammen, Cherry; Wade, Andrew; Scott, Shannon D.

2017-01-01

Background: Treatment protocols for childhood nephrotic syndrome are highly variable between providers and care centres. We conducted a qualitative study to understand the complex multilevel processes that lead to practice variation and influence provider management of nephrotic syndrome. Methods: Focus groups with multidisciplinary pediatric nephrology care providers (n = 67) from 10 Canadian pediatric nephrology centres that had more than 1 pediatric nephrologist were conducted between September 2013 and April 2015. Focus group discussions were guided by the Ottawa Model for Research Use. We used a semistructured interview guide to elicit participants' perspectives regarding 1) the work setting and context of the clinical environment, 2) reasons for variation at the provider level and 3) clinical practice guidelines for nephrotic syndrome. Focus group discussions were transcribed and analyzed concurrently with the use of qualitative content analysis. Results: Emerging themes were grouped into 2 categories: centre-level factors and provider-level factors. At the centre level, the type of care model used, clinic structures and resources, and lack of communication and collaboration within and between Canadian centres influenced care variation. At the provider level, use of experiential knowledge versus empirical knowledge and interpretation of patient characteristics influenced provider management of nephrotic syndrome. Interpretation: Centre- and provider-level factors play an important role in shaping practice differences in the management of childhood nephrotic syndrome. Further research is needed to determine whether variation in care is associated with disparities in outcomes. PMID:28592406

An Investigation of the Applicability of Modern Management Processes by Industrial Managers in Turkey.

ERIC Educational Resources Information Center

Lauter, Geza Peter

This study noted American concepts of modern management which Turkish industrial managers tend to find difficult: identified cultural, economic, and other factors that impede application of modern management processes; and compared the practices of American overseas managers with those of Turkish managers of domestic firms. Managerial performance…

7 CFR 1437.402 - Carrying capacity.

Code of Federal Regulations, 2011 CFR

2011-01-01

... factors, such as soil type, elevation, and topography, result in a significant difference of carrying... management and maintenance practices are improvements over those practices generally associated with the...

7 CFR 1437.402 - Carrying capacity.

Code of Federal Regulations, 2010 CFR

2010-01-01

... factors, such as soil type, elevation, and topography, result in a significant difference of carrying... management and maintenance practices are improvements over those practices generally associated with the...

Non-face-to-face consultations and communications in primary care: the role and perspective of general practice managers in Scotland.

PubMed

Hanna, Lisa; May, Carl; Fairhurst, Karen

2011-01-01

Practice managers play an important role in the organisation and delivery of primary care, including uptake and implementation of technologies. Little is currently known about practice managers' attitudes to the use of information and communication technologies, such as email or text messaging, to communicate or consult with patients. To investigate practice managers' attitudes to non-face-to-face consultation/communication technologies in the routine delivery of primary care and their role in the introduction and normalisation of these technologies. We carried out a mixed-methods study in Scotland, UK. We invited all practice managers in Scotland to take part in a postal questionnaire survey. A maximum variation sample of 20 survey respondents participated subsequently in in-depth qualitative interviews. Practice managers supported the use of new technologies for routine tasks to manage workload and maximise convenience for patients, but a range of contextual factors such as practice list size, practice deprivation area and geographical location affected whether managers would pursue the introduction of these technologies in the immediate future. The most common objections were medico-legal concerns and lack of perceived patient demand. Practice managers are likely to play a central role in the introduction of new consultation/communication technologies within general practice. They hold varying views on the appropriateness of these technologies, influenced by a complex mix of contextual characteristics. Managers from areas in which the ethos of the practice prioritises personalised care in service delivery are less enthusiastic about the adoption of remote consultation/communication technologies.

Understanding practice: the factors that influence management of mild traumatic brain injury in the emergency department--a qualitative study using the Theoretical Domains Framework.

PubMed

Tavender, Emma J; Bosch, Marije; Gruen, Russell L; Green, Sally E; Knott, Jonathan; Francis, Jill J; Michie, Susan; O'Connor, Denise A

2014-01-13

Mild traumatic brain injury is a frequent cause of presentation to emergency departments. Despite the availability of clinical practice guidelines in this area, there is variation in practice. One of the aims of the Neurotrauma Evidence Translation program is to develop and evaluate a targeted, theory- and evidence-informed intervention to improve the management of mild traumatic brain injury in Australian emergency departments. This study is the first step in the intervention development process and uses the Theoretical Domains Framework to explore the factors perceived to influence the uptake of four key evidence-based recommended practices for managing mild traumatic brain injury. Semi-structured interviews were conducted with emergency staff in the Australian state of Victoria. The interview guide was developed using the Theoretical Domains Framework to explore current practice and to identify the factors perceived to influence practice. Two researchers coded the interview transcripts using thematic content analysis. A total of 42 participants (9 Directors, 20 doctors and 13 nurses) were interviewed over a seven-month period. The results suggested that (i) the prospective assessment of post-traumatic amnesia was influenced by: knowledge; beliefs about consequences; environmental context and resources; skills; social/professional role and identity; and beliefs about capabilities; (ii) the use of guideline-developed criteria or decision rules to inform the appropriate use of a CT scan was influenced by: knowledge; beliefs about consequences; environmental context and resources; memory, attention and decision processes; beliefs about capabilities; social influences; skills and behavioral regulation; (iii) providing verbal and written patient information on discharge was influenced by: beliefs about consequences; environmental context and resources; memory, attention and decision processes; social/professional role and identity; and knowledge; (iv) the practice of providing brief, routine follow-up on discharge was influenced by: environmental context and resources; social/professional role and identity; knowledge; beliefs about consequences; and motivation and goals. Using the Theoretical Domains Framework, factors thought to influence the management of mild traumatic brain injury in the emergency department were identified. These factors present theoretically based targets for a future intervention.

Are person-related and socio-structural factors associated with nurses' self-management support behavior? A correlational study.

PubMed

Duprez, Veerle; Beeckman, Dimitri; Verhaeghe, Sofie; Van Hecke, Ann

2018-02-01

To explore nurses' self-perceived behavior of supporting patients' self-management, and its association with person-related and socio-structural factors. Correlational study in a sample of nurses from nine general hospitals, three community healthcare organizations, and six private community practices. Nurses with >50% of their patients living with a chronic condition were eligible to participate. Data were collected at two time-points. Self-management support behavior was measured by the SEPSS-36 instrument. The person-related and socio-structural associated factors were derived from behavioral theories and measured by validated questionnaires. Nurses (N=477) scored overall low on self-management support behavior. Nurses lacked mainly competencies in collaborative goalsetting, shared decision making and organizing follow-up. Factors predicting nurses' behavior in supporting patients' self-management were self-efficacy, priority, perceived supervisor support and training in self-management support. This model explained 51.7% of the variance in nurses' behavior. To date, nurses do not optimally fulfil their role in supporting patients' self-management. Self-management support is practiced from a narrow medical point of view and primarily consists of informing patients, which is the lowest level of patient participation. It is essential to better prepare and support nurses - and by extend all healthcare professionals - for the challenges of supporting patients' self-management. Copyright © 2017 Elsevier B.V. All rights reserved.

Nurse Managers' prerequisite for nursing development: a survey on pressure ulcers and contextual factors in hospital organizations.

PubMed

Gunningberg, Lena; Brudin, Lars; Idvall, Ewa

2010-09-01

To describe and compare pressure ulcer prevalence in two county councils and concurrently explore Nurse Managers' perspective of contextual factors in a hospital organization. Despite good knowledge about risk factors and prevention of pressure ulcers, the prevalence of pressure ulcers remains high. Nurse Managers' have a key role in implementing evidence-based practice. The present study included five hospitals in two Swedish county councils: county council A (non-university setting) and county council B (university setting). A pressure ulcer prevalence study was conducted according to the methodology developed by the European Pressure Ulcer Advisory Panel. The Nurse Managers' answered a (27-item) questionnaire on contextual factors. County council B had significantly less pressure ulcers grade (2-4) (7.7%) than county council A (11.3%). The Nurse Managers' assessed only two out of the 27 general contextual items significantly differently. Some significant differences were observed in ward organization. In county council B, the Nurse Managers' seemed more aware of prevention strategies compared with Nurse Managers' in county council A. The Nurse Managers' should take more responsibility to develop the prerequisite for quality improvement in nursing. Nursing outcomes (e.g. pressure ulcers) should be incorporated into national quality registries for benchmarking and Nurse Managers' competence in evidence-based practice and research methodology increased. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

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.

GPs' considerations in multimorbidity management: a qualitative study.

PubMed

Luijks, Hilde D; Loeffen, Maartje J W; Lagro-Janssen, Antoine L; van Weel, Chris; Lucassen, Peter L; Schermer, Tjard R

2012-07-01

Scientific evidence on how to manage multimorbidity is limited, but GPs have extensive practical experience with multimorbidity management. To explore GPs' considerations and main objectives in the management of multimorbidity and to explore factors influencing their management of multimorbidity. Focus group study of Dutch GPs; with heterogeneity in characteristics such as sex, age and urbanisation. The moderator used an interview guide in conducting the interviews. Two researchers performed the analysis as an iterative process, based on verbatim transcripts and by applying the technique of constant comparative analysis. Data collection proceeded until saturation was reached. Five focus groups were conducted with 25 participating GPs. The main themes concerning multimorbidity management were individualisation, applying an integrated approach, medical considerations placed in perspective, and sharing decision making and responsibility. A personal patient-doctor relationship was considered a major factor positively influencing the management of multimorbidity. Mental-health problems and interacting conditions were regarded as major barriers in this respect and participants experienced several practical problems. The concept of patient-centredness overarches the participants' main objectives. GPs' main objective in multimorbidity management is applying a patient-centred approach. This approach is welcomed since it counteracts some potential pitfalls of multimorbidity. Further research should include a similar design in a different setting and should aim at developing best practice in multimorbidity management.

Practice environment and its association with professional competence and work-related factors: perception of newly graduated nurses.

PubMed

Numminen, Olivia; Ruoppa, Eija; Leino-Kilpi, Helena; Isoaho, Hannu; Hupli, Maija; Meretoja, Riitta

2016-01-01

To explore newly graduated nurses' (NGN) perception of their practice environment and its association with their self-assessed competence, turnover intentions and job satisfaction as work-related factors. The impact of practice environment on nurses' work is important. Positive practice environments are associated with positive organisational, nurse and patient outcomes. How this applies to NGNs needs further exploration. A cross-sectional descriptive correlation design was used. Data were collected with PES-NWI and NCS instruments from 318 Finnish registered nurses, and analysed statistically. Newly graduated nurses' perception of their practice environment was mainly positive. Most positive perceptions related to collegial nurse-physician relations, and the least positive to staffing and resource adequacy. Positive perceptions were also associated with higher professional competence, higher perceptions of quality of care and lower intentions to leave the job or profession. The findings revealed strong and significant associations between practice environment and work-related factors. Practice environment is an important element in supporting NGNs' competence, retention and job satisfaction. Nursing management should pay attention to NGNs' perceptions of their practice environment. Management's ability to create and maintain positive practice environments can foster NGNs' professional development and job satisfaction, and consequently retain them in the workforce. © 2015 John Wiley & Sons Ltd.

Ecological and evolutionary approaches to managing honey bee disease

PubMed Central

Brosi, Berry J.; Delaplane, Keith S.; Boots, Michael; de Roode, Jacobus C.

2017-01-01

Honey bee declines are a serious threat to global agricultural security and productivity. While multiple factors contribute to these declines, parasites are a key driver. Disease problems in honey bees have intensified in recent years, despite increasing attention to addressing them. Here we argue that we must focus on the principles of disease ecology and evolution to understand disease dynamics, assess the severity of disease threats, and manage these threats via honey bee management. We cover the ecological context of honey bee disease, including both host and parasite factors driving current transmission dynamics, and then discuss evolutionary dynamics including how beekeeping management practices may drive selection for more virulent parasites. We then outline how ecological and evolutionary principles can guide disease mitigation in honey bees, including several practical management suggestions for addressing short- and long-term disease dynamics and consequences. PMID:29046562

Hotel housekeeping work influences on hypertension management.

PubMed

Sanon, Marie-Anne

2013-12-01

Characteristics of hotel housekeeping work increase the risk for hypertension development. Little is known about the influences of such work on hypertension management. For this qualitative study, 27 Haitian immigrant hotel housekeepers from Miami-Dade County, FL were interviewed. Interview transcripts were analyzed with the assistance of the Atlas.ti software for code and theme identification. Influences of hotel housekeeping work on hypertension management arose both at the individual and system levels. Factors at the individual level included co-worker dynamics and maintenance of transmigrant life. Factors at the system level included supervisory support, workload, work pace, and work hiring practices. No positive influences were reported for workload and hiring practices. Workplace interventions may be beneficial for effective hypertension management among hotel housekeepers. These work influences must be considered when determining effective methods for hypertension management among hotel housekeepers. © 2013 Wiley Periodicals, Inc.

Exploring parental factors related to weight management in survivors of childhood central nervous system tumors.

PubMed

Santa Maria, Diane; Swartz, Maria C; Markham, Christine; Chandra, Joya; McCurdy, Sheryl; Basen-Engquist, Karen

2014-01-01

Childhood central nervous system tumor survivors (CCNSTS) are at risk for adverse health issues. Little research has been conducted to explore the role of parental factors in weight management to mitigate adverse health outcomes. We conducted 9 group interviews (n=20) with CCNSTS, their parents, and health care providers to ascertain parental factors that may influence weight management practices in CCNSTS. Three main themes were identified: parenting style, parent-child connectedness, and food and physical activity (PA) environment. Although most parents adopted an authoritative parenting style related to diet and PA practices, some adopted a permissive parenting style. Participants expressed high levels of connection that may hinder the development of peer relationships and described the food and PA environments that promote or hinder weight management through parental modeling of healthy eating and PA and access to healthy food and activities. Weight management interventions for CCNSTS may experience greater benefit from using a family-focused approach, promoting positive food and PA environments, parental modeling of healthy eating and exercise, and partnering with youth to adopt weight management behaviors.

Rationale and methods of the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA).

PubMed

Rodríguez-Artalejo, Fernando; Guallar, Eliseo; Borghi, Claudio; Dallongeville, Jean; De Backer, Guy; Halcox, Julian P; Hernández-Vecino, Ramón; Jiménez, Francisco Javier; Massó-González, Elvira L; Perk, Joep; Steg, Philippe Gabriel; Banegas, José R

2010-06-30

The EURIKA study aims to assess the status of primary prevention of cardiovascular disease (CVD) across Europe. Specifically, it will determine the degree of control of cardiovascular risk factors in current clinical practice in relation to the European guidelines on cardiovascular prevention. It will also assess physicians' knowledge and attitudes about CVD prevention as well as the barriers impeding effective risk factor management in clinical practice. Cross-sectional study conducted simultaneously in 12 countries across Europe. The study has two components: firstly at the physician level, assessing eight hundred and nine primary care and specialist physicians with a daily practice in CVD prevention. A physician specific questionnaire captures information regarding physician demographics, practice settings, cardiovascular prevention beliefs and management. Secondly at the patient level, including 7641 patients aged 50 years or older, free of clinical CVD and with at least one classical risk factor, enrolled by the participating physicians. A patient-specific questionnaire captures information from clinical records and patient interview regarding sociodemographic data, CVD risk factors, and current medications. Finally, each patient provides a fasting blood sample, which is sent to a central laboratory for measuring serum lipids, apolipoproteins, hemoglobin-A1c, and inflammatory biomarkers. Primary prevention of CVD is an extremely important clinical issue, with preventable circulatory diseases remaining the leading cause of major disease burden. The EURIKA study will provide key information to assess effectiveness of and attitudes toward primary prevention of CVD in Europe. A transnational study creates opportunities for benchmarking good clinical practice across countries and improving outcomes. (ClinicalTrials.gov number, NCT00882336).

Examination of the relationship between project management critical success factors and project success of oil and gas drilling projects

NASA Astrophysics Data System (ADS)

Alagba, Tonye J.

Oil and gas drilling projects are the primary means by which oil companies recover large volumes of commercially available hydrocarbons from deep reservoirs. These types of projects are complex in nature, involving management of multiple stakeholder interfaces, multidisciplinary personnel, complex contractor relationships, and turbulent environmental and market conditions, necessitating the application of proven project management best practices and critical success factors (CSFs) to achieve success. Although there is some practitioner oriented literature on project management CSFs for drilling projects, none of these is based on empirical evidence, from research. In addition, the literature has reported alarming rates of oil and gas drilling project failure, which is attributable not to technical factors, but to failure of project management. The aim of this quantitative correlational study therefore, was to discover an empirically verified list of project management CSFs, which consistent application leads to successful implementation of oil and gas drilling projects. The study collected survey data online, from a random sample of 127 oil and gas drilling personnel who were members of LinkedIn's online community "Drilling Supervisors, Managers, and Engineers". The results of the study indicated that 10 project management factors are individually related to project success of oil and gas drilling projects. These 10 CSFs are namely; Project mission, Top management support, Project schedule/plan, Client consultation, Personnel, Technical tasks, Client acceptance, Monitoring and feedback, Communication, and Troubleshooting. In addition, the study found that the relationships between the 10 CSFs and drilling project success is unaffected by participant and project demographics---role of project personnel, and project location. The significance of these findings are both practical, and theoretical. Practically, application of an empirically verified CSFs list to oil and gas drilling projects could help oil companies improve the performance of future drilling projects. Theoretically, the study's findings may help to bridge a gap in the project management CSFs literature, and add to the general project management body of knowledge.

On becoming a coach: a pilot intervention study with managers in long-term care.

PubMed

Cummings, Greta; Mallidou, Anastasia A; Masaoud, Elmabrok; Kumbamu, Ashok; Schalm, Corinne; Spence Laschinger, Heather K; Estabrooks, Carole A

2014-01-01

Health care leaders have called for the development of communication and leadership skills to improve manager-employee relationships, employee job satisfaction, quality care, and work environments. The aim of the study reported here was to pilot how a 2-day coaching workshop ("Coaching for Impressive CARE") conducted as a leadership development strategy influenced frontline care managers' coaching practices in residential long-term care (LTC) settings. We had four objectives: (a) to identify managers' perceptions of their role as a coach of employee performance in LTC facilities, (b) to understand managers' intentions to coach employee performance, (c) to examine opportunities and factors that contributed to or challenged implementation of workshop coaching skills in daily leadership/management practice, and (d) to examine managers' reports of using coaching practices and employee responses after the workshop. We used an exploratory/descriptive design involving pre-/post-workshop surveys, e-mail reminders, and focus groups to examine participation of 21 LTC managers in a 2-day coaching workshop and their use of coaching practices in the workplace. Focus group findings provided examples of how participants used their coaching skills in practice (e.g., communicating empathy) and how staff responded. Factors contributing to and challenging implementation of these coaching skills in the workplace were identified. Attitudes and intentions to be a coach increased significantly, and some coaching skills were used more frequently after the workshop, specifically planning for performance change with employees. The coaching workshop was feasible to implement, well received by participants, influenced their willingness to become coaches, and had some noted impact on their use of coaching behaviors in the workplace. Coaching skills by managers to improve staff performance with residents in LTC facilities can be learned.

Relating management practices and nutrient export in agricultural watersheds of the United States

USGS Publications Warehouse

Sprague, Lori A.; Gronberg, Jo Ann M.

2012-01-01

Relations between riverine export (load) of total nitrogen (N) and total phosphorus (P) from 133 large agricultural watersheds in the United States and factors affecting nutrient transport were evaluated using empirical regression models. After controlling for anthropogenic inputs and other landscape factors affecting nutrient transport-such as runoff, precipitation, slope, number of reservoirs, irrigated area, and area with subsurface tile drains-the relations between export and the area in the Conservation Reserve Program (CRP) (N) and conservation tillage (P) were positive. Additional interaction terms indicated that the relations between export and the area in conservation tillage (N) and the CRP (P) progressed from being clearly positive when soil erodibility was low or moderate, to being close to zero when soil erodibility was higher, to possibly being slightly negative only at the 90th to 95th percentile of soil erodibility values. Possible explanations for the increase in nutrient export with increased area in management practices include greater transport of soluble nutrients from areas in conservation tillage; lagged response of stream quality to implementation of management practices because of nitrogen transport in groundwater, time for vegetative cover to mature, and/or prior accumulation of P in soils; or limitations in the management practice and stream monitoring data sets. If lags are occurring, current nutrient export from agricultural watersheds may still be reflecting the influence of agricultural land-use practices that were in place before the implementation of these management practices.

HRD Practices and Talent Management in the Companies with the Employer Brand

ERIC Educational Resources Information Center

Kucherov, Dmitry; Zavyalova, Elena

2012-01-01

Purpose: The employer brand could be a key factor of competitiveness for a company in a contemporary labour market. The purpose of this paper is to identify the features of human resource development (HRD) practices and talent management in companies with employer brand (CEBs). Design/methodology/approach: The authors examined three economic…

Management of Dentin Hypersensitivity by National Dental Practice-Based Research Network practitioners: results from a questionnaire administered prior to initiation of a clinical study on this topic.

PubMed

Kopycka-Kedzierawski, Dorota T; Meyerowitz, Cyril; Litaker, Mark S; Chonowski, Sidney; Heft, Marc W; Gordan, Valeria V; Yardic, Robin L; Madden, Theresa E; Reyes, Stephanie C; Gilbert, Gregg H

2017-01-13

Dentin hypersensitivity (DH) is a common problem encountered in clinical practice. The purpose of this study was to identify the management approaches for DH among United States dentists. One hundred eighty five National Dental Practice-Based Research Network clinicians completed a questionnaire regarding their preferred methods to diagnose and manage DH in the practice setting, and their beliefs about DH predisposing factors. Almost all dentists (99%) reported using more than one method to diagnose DH. Most frequently, they reported using spontaneous patient reports coupled with excluding other causes of oral pain by direct clinical examination (48%); followed by applying an air blast (26%), applying cold water (12%), and obtaining patient reports after dentist's query (6%). In managing DH, the most frequent first choice was desensitizing, over-the-counter (OTC), potassium nitrate toothpaste (48%), followed by fluorides (38%), and glutaraldehyde/HEMA (3%). A total of 86% of respondents reported using a combination of products when treating DH, most frequently using fluoride varnish and desensitizing OTC potassium nitrate toothpaste (70%). The most frequent predisposing factor leading to DH, as reported by the practitioners, was recessed gingiva (66%), followed by abrasion, erosion, abfraction/attrition lesions (59%) and bruxism (32%). The majority of network practitioners use multiple methods to diagnose and manage DH. Desensitizing OTC potassium nitrate toothpaste and fluoride formulations are the most widely used products to manage DH in dental practice setting.

Ecological and evolutionary approaches to managing honeybee disease.

PubMed

Brosi, Berry J; Delaplane, Keith S; Boots, Michael; de Roode, Jacobus C

2017-09-01

Honeybee declines are a serious threat to global agricultural security and productivity. Although multiple factors contribute to these declines, parasites are a key driver. Disease problems in honeybees have intensified in recent years, despite increasing attention to addressing them. Here we argue that we must focus on the principles of disease ecology and evolution to understand disease dynamics, assess the severity of disease threats, and control these threats via honeybee management. We cover the ecological context of honeybee disease, including both host and parasite factors driving current transmission dynamics, and then discuss evolutionary dynamics including how beekeeping management practices may drive selection for more virulent parasites. We then outline how ecological and evolutionary principles can guide disease mitigation in honeybees, including several practical management suggestions for addressing short- and long-term disease dynamics and consequences.

When does adoption of health information technology by physician practices lead to use by physicians within the practice?

PubMed Central

McClellan, Sean R; Casalino, Lawrence P; Shortell, Stephen M; Rittenhouse, Diane R

2013-01-01

Objective We sought to determine the extent to which adoption of health information technology (HIT) by physician practices may differ from the extent of use by individual physicians, and to examine factors associated with adoption and use. Materials and methods Using cross-sectional survey data from the National Study of Small and Medium-Sized Physician Practices (July 2007–March 2009), we examined the extent to which organizational capabilities and external incentives were associated with the adoption of five key HIT functionalities by physician practices and with use of those functionalities by individual physicians. Results The rate of physician practices adopting any of the five HIT functionalities was 34.1%. When practices adopted HIT functionalities, on average, about one in seven physicians did not use those functionalities. One physician in five did not use prompts and reminders following adoption by their practice. After controlling for other factors, both adoption of HIT by practices and use of HIT by individual physicians were higher in primary care practices and larger practices. Practices reporting an emphasis on patient-centered management were not more likely than others to adopt, but their physicians were more likely to use HIT. Discussion Larger practices were most likely to have adopted HIT, but other factors, including specialty mix and self-reported patient-centered management, had a stronger influence on the use of HIT once adopted. Conclusions Adoption of HIT by practices does not mean that physicians will use the HIT. PMID:23396512

Practicing Dentists’ Self-Efficacy and Associated Factors in Managing the Treatment of Adults with Mental and Physical Disabilities: An Exploratory Cross-Sectional Study in Riyadh, Saudi Arabia

PubMed Central

AlQahtani, Sakher; Zakaria Murshid, Ebtissam; Kassim, Saba

2017-01-01

Background: Provision of oral healthcare to adults with mental and physical disabilities (AMPD) remains a challenging area across various healthcare systems. The present study aimed to assess self-reported efficacy and investigate factors associated with self-efficacy in the management of AMPD among practicing dentists in Saudi Arabia. Methods: A pilot-tested, self-administered questionnaire was distributed to a convenience sample of 1000 dentists. Descriptive and inferential analyses were performed on the collected responses. Results: Among the respondents (54%), 43% were males. Only 14% described their self-efficacy in managing AMPD as “High”. Multivariable regression analyses revealed significant associations between “High” self-efficacy and male gender (Odd ratio (OR) = 2.39, 95% CI = 1.16–4.89), experience practicing dentistry for 11 years or more (OR = 2.19, 95% CI = 1.04–4.47), specialization in pediatric dentistry (OR = 3.98, 95% CI = 1.31–12.07), previous experience in managing AMPD (OR = 4.23, 95% CI = 1.59–11.22), and awareness of regulations for managing AMPD (OR = 2.62, 95% CI = 1.42–4.38). The interaction of gender x age was significantly associated (p = 0.028) with “High” self-efficacy. Gender-stratified analyses revealed a significant association between age and “High” self-efficacy among male dentists only. Conclusions: The findings of the present study highlight that a large percentage of dentists reported “Low/Moderate” self-efficacy in managing AMPD, particularly among female dentists. However, further studies are required to verify the factors associated with self-efficacy in the present study, and to identify other factors that may influence self-efficacy in managing AMPD. PMID:29232884

Practicing Dentists' Self-Efficacy and Associated Factors in Managing the Treatment of Adults with Mental and Physical Disabilities: An Exploratory Cross-Sectional Study in Riyadh, Saudi Arabia.

PubMed

AlQahtani, Sakher; Murshid, Ebtissam Zakaria; Fadel, Hani Talal; Kassim, Saba

2017-12-11

Background: Provision of oral healthcare to adults with mental and physical disabilities (AMPD) remains a challenging area across various healthcare systems. The present study aimed to assess self-reported efficacy and investigate factors associated with self-efficacy in the management of AMPD among practicing dentists in Saudi Arabia. Methods: A pilot-tested, self-administered questionnaire was distributed to a convenience sample of 1000 dentists. Descriptive and inferential analyses were performed on the collected responses. Results: Among the respondents (54%), 43% were males. Only 14% described their self-efficacy in managing AMPD as "High". Multivariable regression analyses revealed significant associations between "High" self-efficacy and male gender (Odd ratio (OR) = 2.39, 95% CI = 1.16-4.89), experience practicing dentistry for 11 years or more (OR = 2.19, 95% CI = 1.04-4.47), specialization in pediatric dentistry (OR = 3.98, 95% CI = 1.31-12.07), previous experience in managing AMPD (OR = 4.23, 95% CI = 1.59-11.22), and awareness of regulations for managing AMPD (OR = 2.62, 95% CI = 1.42-4.38). The interaction of gender x age was significantly associated ( p = 0.028) with "High" self-efficacy. Gender-stratified analyses revealed a significant association between age and "High" self-efficacy among male dentists only. Conclusions: The findings of the present study highlight that a large percentage of dentists reported "Low/Moderate" self-efficacy in managing AMPD, particularly among female dentists. However, further studies are required to verify the factors associated with self-efficacy in the present study, and to identify other factors that may influence self-efficacy in managing AMPD.

Searching for management approaches to reduce HAI transmission (SMART): a study protocol.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia J; Walker, Daniel M; Aldrich, Alison M; Sova, Lindsey N; Gaughan, Alice A; Slevin, Caitlin M; Hebert, Courtney; Hade, Erinn; Buck, Jacalyn; Grove, Michele; Huerta, Timothy R

2017-06-28

Healthcare-associated infections (HAIs) impact patients' lives through prolonged hospitalization, morbidity, and death, resulting in significant costs to both health systems and society. Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are two of the most preventable HAIs. As a result, these HAIs have been the focus of significant efforts to identify evidence-based clinical strategies to reduce infection rates. The Comprehensive Unit-based Safety Program (CUSP) provides a formal model for translating CLABSI-reduction evidence into practice. Yet, a national demonstration project found organizations experienced variable levels of success using CUSP to reduce CLABSIs. In addition, in Fiscal year 2019, Medicare will expand use of CLABSI and CAUTI metrics beyond ICUs to the entire hospital for reimbursement purposes. As a result, hospitals need guidance about how to successfully translate HAI-reduction efforts such as CUSP to non-ICU settings (clinical practice), and how to shape context (management practice)-including culture and management strategies-to proactively support clinical teams. Using a mixed-methods approach to evaluate the contribution of management factors to successful HAI-reduction efforts, our study aims to: (1) Develop valid and reliable measures of structural management practices associated with the recommended CLABSI Management Strategies for use as a survey (HAI Management Practice Guideline Survey) to support HAI-reduction efforts in both medical/surgical units and ICUs; (2) Develop, validate, and then deploy the HAI Management Practice Guideline Survey, first across Ohio hospitals, then nationwide, to determine the positive predictive value of the measurement instrument as it relates to CLABSI- and CAUTI-prevention; and (3) Integrate findings into a Management Practices Toolkit for HAI reduction that includes an organization-specific data dashboard for monitoring progress and an implementation program for toolkit use, and disseminate that Toolkit nationwide. Providing hospitals with the tools they need to successfully measure management structures that support clinical care provides a powerful approach that can be leveraged to reduce the incidence of HAIs experienced by patients. This study is critical to providing the information necessary to successfully "make health care safer" by providing guidance on how contextual factors within a healthcare setting can improve patient safety across hospitals.

Factors in Sustainable Development: Current and Innovative Livestock and Range Management Practices as Perceived by Cattle-Producing Ejidatarios and Private Cattle Ranchers of Sonora, Mexico. A Summary Report of Research. Department Information Bulletin 99-4.

ERIC Educational Resources Information Center

Hamlett, Peggy J.

A study was conducted to identify and compare livestock production and range management practices currently in use in the Texas/Mexico border corridor, and to determine the acceptance of selected innovative practices among cattle ranchers in the State of Sonora, Mexico. Information was collected from private livestock producers who were members of…

Factors affecting vaccine handling and storage practices among immunization service providers in Ibadan, Oyo State, Nigeria.

PubMed

Dairo, David M; Osizimete, Oyarebu E

2016-06-01

Improper handling has been identified as one of the major reasons for the decline in vaccine potency at the time of administration. Loss of potency becomes evident when immunised individuals contract the diseases the vaccines were meant to prevent. Assessing the factors associated with vaccine handling and storage practices. This was a cross-sectional study. Three-stage sampling was used to recruit 380 vaccine handlers from 273 health facilities from 11 Local Government areas in Ibadan. Data was analysed using SPSS version 16. Seventy-three percent were aware of vaccine handling and storage guidelines with 68.4% having ever read such guidelines. Only 15.3% read a guideline less than 1 month prior to the study. About 65.0% had received training on vaccine management. Incorrect handling practices reported included storing injections with vaccines (13.7%) and maintaining vaccine temperature using ice blocks (7.6%). About 43.0% had good knowledge of vaccine management, while 66.1% had good vaccine management practices. Respondents who had good knowledge of vaccine handling and storage [OR=10.0, 95%CI (5.28 - 18.94), p < 0.001] and had received formal training on vaccine management [OR=5.3, 95%CI (2.50 - 11.14), p< 0.001] were more likely to have good vaccine handling and storage practices. Regular training is recommended to enhance vaccine handling and storage practices.

The Many Organisational Factors Relevant to Planning Change in Emergency Care Departments: A Qualitative Study to Inform a Cluster Randomised Controlled Trial Aiming to Improve the Management of Patients with Mild Traumatic Brain Injuries.

PubMed

Bosch, Marije; Tavender, Emma J; Brennan, Sue E; Knott, Jonathan; Gruen, Russell L; Green, Sally E

2016-01-01

The Neurotrauma Evidence Translation (NET) Trial aims to design and evaluate the effectiveness of a targeted theory-and evidence-informed intervention to increase the uptake of evidence-based recommended practices for the management of patients who present to an emergency department (ED) with mild head injuries. When designing interventions to bring about change in organisational settings such as the ED, it is important to understand the impact of the context to ensure successful implementation of practice change. Few studies explicitly use organisational theory to study which factors are likely to be most important to address when planning change processes in the ED. Yet, this setting may have a unique set of organisational pressures that need to be taken into account when implementing new clinical practices. This paper aims to provide an in depth analysis of the organisational context in which ED management of mild head injuries and implementation of new practices occurs, drawing upon organisational level theory. Semi-structured interviews were conducted with ED staff in Australia. The interviews explored the organisational context in relation to change and organisational factors influencing the management of patients presenting with mild head injuries. Two researchers coded the interview transcripts using thematic content analysis. The "model of diffusion in service organisations" was used to guide analyses and organisation of the results. Nine directors, 20 doctors and 13 nurses of 13 hospitals were interviewed. With regard to characteristics of the innovation (i.e. the recommended practices) the most important factor was whether they were perceived as being in line with values and needs. Tension for change (the degree to which stakeholders perceive the current situation as intolerable or needing change) was relatively low for managing acute mild head injury symptoms, and mixed for managing longer-term symptoms (higher change commitment, but relatively low change efficacy). Regarding implementation processes, the importance of (visible) senior leadership for all professions involved was identified as a critical factor. An unpredictable and hectic environment brings challenges in creating an environment in which team-based and organisational learning can thrive (system antecedents for innovation). In addition, the position of the ED as the entry-point of the hospital points to the relevance of securing buy-in from other units. We identified several organisational factors relevant to realising change in ED management of patients who present with mild head injuries. These factors will inform the intervention design and process evaluation in a trial evaluating the effectiveness of our implementation intervention.

The Many Organisational Factors Relevant to Planning Change in Emergency Care Departments: A Qualitative Study to Inform a Cluster Randomised Controlled Trial Aiming to Improve the Management of Patients with Mild Traumatic Brain Injuries

PubMed Central

Bosch, Marije; Tavender, Emma J.; Brennan, Sue E.; Knott, Jonathan; Gruen, Russell L.; Green, Sally E.

2016-01-01

Background The Neurotrauma Evidence Translation (NET) Trial aims to design and evaluate the effectiveness of a targeted theory-and evidence-informed intervention to increase the uptake of evidence-based recommended practices for the management of patients who present to an emergency department (ED) with mild head injuries. When designing interventions to bring about change in organisational settings such as the ED, it is important to understand the impact of the context to ensure successful implementation of practice change. Few studies explicitly use organisational theory to study which factors are likely to be most important to address when planning change processes in the ED. Yet, this setting may have a unique set of organisational pressures that need to be taken into account when implementing new clinical practices. This paper aims to provide an in depth analysis of the organisational context in which ED management of mild head injuries and implementation of new practices occurs, drawing upon organisational level theory. Methods Semi-structured interviews were conducted with ED staff in Australia. The interviews explored the organisational context in relation to change and organisational factors influencing the management of patients presenting with mild head injuries. Two researchers coded the interview transcripts using thematic content analysis. The “model of diffusion in service organisations” was used to guide analyses and organisation of the results. Results Nine directors, 20 doctors and 13 nurses of 13 hospitals were interviewed. With regard to characteristics of the innovation (i.e. the recommended practices) the most important factor was whether they were perceived as being in line with values and needs. Tension for change (the degree to which stakeholders perceive the current situation as intolerable or needing change) was relatively low for managing acute mild head injury symptoms, and mixed for managing longer-term symptoms (higher change commitment, but relatively low change efficacy). Regarding implementation processes, the importance of (visible) senior leadership for all professions involved was identified as a critical factor. An unpredictable and hectic environment brings challenges in creating an environment in which team-based and organisational learning can thrive (system antecedents for innovation). In addition, the position of the ED as the entry-point of the hospital points to the relevance of securing buy-in from other units. Conclusions We identified several organisational factors relevant to realising change in ED management of patients who present with mild head injuries. These factors will inform the intervention design and process evaluation in a trial evaluating the effectiveness of our implementation intervention. PMID:26845772

Opportunities for Reducing Nitrate Export from Drainage Systems through In-field Nitrogen Management, Cropping Practices, and Drainage Design and Management

NASA Astrophysics Data System (ADS)

Helmers, M.; Zhou, X.; Qi, Z.; Christianson, R.; Pederson, C.

2011-12-01

Subsurface drainage systems are widely used throughout the upper Midwest corn-belt. While the use of these drainage systems has greatly increased crop production, they have also increased nitrate-nitrogen export to downstream waterbodies. As a result, there is a need to evaluate and implement management practices that have potential to reduce nitrate-nitrogen loss. A twenty year study in Iowa has shown that major factors in nitrate-nitrogen loss are land use and hydrology. Studies from north-central Iowa have also indicated that nitrogen application rate and to a lesser degree timing of nitrogen application important factors for nitrate-nitrogen loss. A four-year (2007-2010) drainage management study in southeast Iowa indicates that shallow and controlled drainage systems have potential to decrease subsurface drainage and thereby reduce nitrate-N loss from drain water but the level of implementation of controlled drainage may be limited by topography. Cropping practices through cover crops or perennial biomass crops have also been documented to have potential to reduce downstream nitrate-nitrogen export but the level of implementation may be limited by management and economic considerations. To achieve reduction goals for protection of local and regional water quality will require a combination of these practices at the landscape scale.

Trust in management, communication and organisational commitment: Factors influencing readiness for change management in organisation

NASA Astrophysics Data System (ADS)

Ahmad, Mohd Hafis; Ismail, Syuhaida; Rani, Wan Nurul Mardiah Wan Mohd; Wahab, Mohammad Hussaini

2017-10-01

Organisational change occurs when an organisation makes a transition from its current state to some desired future state in minimising employee resistance and cost to the organisation while simultaneously maximising the effectiveness of the change effort. This paper, aims at appraising the change management of organisation in Malaysia since limited research has been done to examine readiness for change by the employees in the organisation. This paper is materialising its objectives of (1) investigating the current practice of organisation and employees in the organisation towards change management and (2) assessing the factors influencing readiness of organisation and employees in the organisation towards change management. It is found via literature review that change management is a structured approach for ensuring that changes are thoroughly and smoothly implemented to transitioning individuals, teams, and organisations to a desired future state by focusing on the wider impacts of change, particularly on people, where change does not happen in isolation and it impacts the whole organisation. Furthermore, it is found that current practice of organisation and employees in the organisation towards change management involved in three main factors, namely trust in management, communication and organisational commitment; with the factor for trust in management is the positive vision for the future by management team, meanwhile for communication, it is found that there is good communication between supervisors and employees about the organisation's policy toward the changes. The factor found in organisational commitment is employees enjoying discussing about their organisation with outsiders. The findings of this paper provide a positive impact on change management planning, which ultimately help in ensuring more effective change programme implementation in the organisation in Malaysia.

ICARUSS, the Integrated Care for the Reduction of Secondary Stroke trial: rationale and design of a randomized controlled trial of a multimodal intervention to prevent recurrent stroke in patients with a recent cerebrovascular event, ACTRN = 12611000264987.

PubMed

Joubert, J; Davis, S M; Hankey, G J; Levi, C; Olver, J; Gonzales, G; Donnan, G A

2015-07-01

The majority of strokes, both ischaemic and haemorrhagic, are attributable to a relatively small number of risk factors which are readily manageable in primary care setting. Implementation of best-practice recommendations for risk factor management is calculated to reduce stroke recurrence by around 80%. However, risk factor management in stroke survivors has generally been poor at primary care level. A model of care that supports long-term effective risk factor management is needed. To determine whether the model of Integrated Care for the Reduction of Recurrent Stroke (ICARUSS) will, through promotion of implementation of best-practice recommendations for risk factor management reduce the combined incidence of stroke, myocardial infarction and vascular death in patients with recent stroke or transient ischaemic attack (TIA) of the brain or eye. A prospective, Australian, multicentre, randomized controlled trial. Academic stroke units in Melbourne, Perth and the John Hunter Hospital, New South Wales. 1000 stroke survivors recruited as from March 2007 with a recent (<3 months) stroke (ischaemic or haemorrhagic) or a TIA (brain or eye). Randomization and data collection are performed by means of a central computer generated telephone system (IVRS). Exposure to the ICARUSS model of integrated care or usual care. The composite of stroke, MI or death from any vascular cause, whichever occurs first. Risk factor management in the community, depression, quality of life, disability and dementia. With 1000 patients followed up for a median of one-year, with a recurrence rate of 7-10% per year in patients exposed to usual care, the study will have at least 80% power to detect a significant reduction in primary end-points The ICARUSS study aims to recruit and follow up patients between 2007 and 2013 and demonstrate the effectiveness of exposure to the ICARUSS model in stroke survivors to reduce recurrent stroke or vascular events and promote the implementation of best practice risk factor management at primary care level. © 2015 World Stroke Organization.

Hotel Housekeeping Work Influences on Hypertension Management

PubMed Central

Sanon, Marie-Anne

2013-01-01

Background Characteristics of hotel housekeeping work increase the risk for hypertension development. Little is known about the influences of such work on hypertension management. Methods For this qualitative study, 27 Haitian immigrant hotel housekeepers from Miami-Dade County, FL were interviewed. Interview transcripts were analyzed with the assistance of the Atlas. ti software for code and theme identification. Results Influences of hotel housekeeping work on hypertension management arose both at the individual and system levels. Factors at the individual level included co-worker dynamics and maintenance of transmigrant life. Factors at the system level included supervisory support, workload, work pace, and work hiring practices. No positive influences were reported for workload and hiring practices. Conclusions Workplace interventions may be beneficial for effective hypertension management among hotel housekeepers. These work influences must be considered when determining effective methods for hypertension management among hotel housekeepers. PMID:23775918

Classroom Management through the Eyes of Elementary Teachers in Turkey: A Phenomenological Study

ERIC Educational Resources Information Center

Akin, Sibel; Yildirim, Ali; Goodwin, A. Lin

2016-01-01

This study aims to explore Turkish elementary teachers' (1) perceptions of classroom management, (2) classroom management problems they experience, (3) factors causing these problems, and (4) their classroom management practices. The study employed phenomenological research design in the qualitative tradition. The participants included 15…

Factors influencing the development and implementation of advanced radiographer practice in Australia – a qualitative study using an interpretative phenomenological approach

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

Page, Barbara A, E-mail: barbpage09@gmail.com; Bernoth, Maree; Davidson, Rob

2014-09-15

The purpose of this study was to explore the factors influencing the implementation or the lack of implementation of advanced practitioner role in Australia. This study uses an interpretative phenomenological approach to explore the in-depth real life issues, which surround the advanced practitioner as a solution to radiologist workforce shortages in Australia. Research participants are radiographers, radiation therapists and health managers registered with the Australian Institute of Radiography (AIR) and holding senior professional and AIR Board positions with knowledge of current advanced practice. In total, seven interviews were conducted revealing education, governance, technical, people issues, change management, government, costs andmore » timing as critical factors influencing advanced practice in Australia. Seven participants in this study perceived an advanced practice role might have major benefits and a positive impact on the immediate and long-term management of patients. Another finding is the greater respect and appreciation of each other's roles and expertise within the multidisciplinary healthcare team. Engagement is required of the critical stakeholders that have been identified as ‘blockers’ (radiologists, health departments) as well as identified allies (e.g. emergency clinicians, supportive radiologists, patient advocacy groups). The research supports that the AIR has a role to play for the professional identity of radiographers and shaping the advanced practice role in Australia.« less

Role and Value of Clinical Pharmacy in Heart Failure Management.

PubMed

Stough, W G; Patterson, J H

2017-08-01

Effectively managing heart failure requires a multidisciplinary, holistic approach attuned to many factors: diagnosis of structural and functional cardiac abnormalities; medication, device, or surgical management; concomitant treatment of comorbidities; physical rehabilitation; dietary considerations; and social factors. This practice paper highlights the pharmacist's role in the management of patients with heart failure, the evidence supporting their functions, and steps to ensure the pharmacist resource is available to the broad population of patients with heart failure. © 2017 American Society for Clinical Pharmacology and Therapeutics.

Use of active management of the third stage of labour in seven developing countries.

PubMed

Stanton, Cynthia; Armbruster, Deborah; Knight, Rod; Ariawan, Iwan; Gbangbade, Sourou; Getachew, Ashebir; Portillo, Jose Angel; Jarquin, Douglas; Marin, Flor; Mfinanga, Sayoka; Vallecillo, Jesus; Johnson, Hope; Sintasath, David

2009-03-01

To document the use of active management of the third stage of labour for preventing postpartum haemorrhage and to explore factors associated with such use in seven developing countries. Nationally representative samples of facility-based deliveries were selected and observed to determine the use of active management of the third stage of labour and associated factors. Policies on active management were assessed through document review and interviews with relevant professionals. Use of a uterotonic during the third or fourth stages of labour was nearly universal. Correct use of active management of the third stage of labour was found in only 0.5% to 32% of observed deliveries due to multiple deficiencies in practice. In every country except Indonesia, policies regarding active management were conflicting. Developing countries have not targeted decreasing postpartum haemorrhage as an achievable goal; there is little use of active management of the third stage of labour, and policies regarding such management often conflict. Studies are needed to identify the most effective components of active management so that the most efficient package of practices can be promoted.

Motivational theory applied to hospital pharmacy practice.

PubMed

Grace, M

1980-12-01

In recent years a great deal of attention has been paid to motivation and job satisfaction among hospital pharmacy practitioners. Institutional pharmacy managers should become more aware of ways in which they can motivate members of their staff. Specifically, Frederick Herzberg's Two-Factor Theory is discussed in reference to its origination, major tenets, and practical applications in institutional pharmacy practice settings. Principally, Herzberg's theory explains needs of workers in terms of extrinsic factors called "hygienes" and intrinsic factors called "motivators." The theory suggests that job satisfaction and dissatisfaction are not opposites but two separate dimensions. According to this theory, an employee will be motivated if the task allows for the following: 1)actual achievement, 2) recognition for achievement, 3) increased responsibility, 4) opportunity for growth (professionally), and 5) chance for advancement. It is concluded that some of these suggested applications can be useful to managers who are faced with low morale among the members of their staff.

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.

Obstetric care providers' knowledge, practice and associated factors towards active management of third stage of labor in Sidama Zone, South Ethiopia.

PubMed

Tenaw, Zelalem; Yohannes, Zemenu; Amano, Abdela

2017-09-07

Active management of third stage of labor played a great role to prevent child birth related hemorrhage. However, maternal morbidity and mortality related to hemorrhage is high due to lack of knowledge and skill of obstetric care providers 'on active management of third stage of labor. Our study was aimed to assess knowledge, practice and associated factors of obstetric care providers (Midwives, Nurses and Health officers) on active management of third stage of labor in Sidama Zone, South Ethiopia. An institution based cross sectional study design was conducted from December 1-30 /2015 among midwives, nurses and health officers. Simple random sampling technique was used to get the total of 528 participants. Data entry was done using EPI Info 3.5.1 and exported to SPSS version 20.0 software package for analysis. The presence of association between independent and dependent variables was assessed using odds ratio with 97% confidence interval by applying logistic regression model. Of the 528 obstetric care providers 37.7% and 32.8% were knowledgeable and skilled to manage third stage of labor respectively. After controlling for possible confounding factors, the result showed that pre/in service training, being midwife and graduation year were found to be the major predictors of proper active management of third stage of labor. The knowledge and practice of obstetric care providers towards active management of third stage of labor can be improved with appropriate interventions like in-service trainings. This study also clearly showed that the level of knowledge and practice of obstetric care providers to wards active management of third stage of labor needs immediate attention of Universities and health science colleges better to revise their obstetrics course contents, health institutions and zonal health bureau should arrange trainings for their obstetrics care providers to enhance skill.

Cultivar and Year Rather than Agricultural Practices Affect Primary and Secondary Metabolites in Apple Fruit

PubMed Central

Renard, Catherine M. G. C.; Plenet, Daniel; Gautier, Hélène; Touloumet, Line; Girard, Thierry; Simon, Sylvaine

2015-01-01

Many biotic and abiotic parameters affect the metabolites involved in the organoleptic and health value of fruits. It is therefore important to understand how the growers' decisions for cultivar and orchard management can affect the fruit composition. Practices, cultivars and/or year all might participate to determine fruit composition. To hierarchize these factors, fruit weight, dry matter, soluble solids contents, titratable acidity, individual sugars and organics acids, and phenolics were measured in three apple cultivars (‘Ariane’, ‘Melrose’ and ‘Smoothee’) managed under organic, low-input and conventional management. Apples were harvested at commercial maturity in the orchards of the cropping system experiment BioREco at INRA Gotheron (Drôme, 26) over the course of three years (2011, 2012 and 2013). The main factors affecting primary and secondary metabolites, in both apple skin and flesh, were by far the cultivar and the yearly conditions, while the management system had a very limited effect. When considering the three cultivars and the year 2011 to investigate the effect of the management system per se, only few compounds differed significantly between the three systems and in particular the total phenolic content did not differ significantly between systems. Finally, when considering orchards grown in the same pedoclimatic conditions and of the same age, instead of the usual organic vs. conventional comparison, the effect of the management system on the apple fruit quality (Fruit weight, dry matter, soluble solids content, titratable acidity, individual sugars, organic acids, and phenolics) was very limited to non-significant. The main factors of variation were the cultivar and the year of cropping rather than the cropping system. More generally, as each management system (e.g. conventional, organic…) encompasses a great variability of practices, this highlights the importance of accurately documenting orchard practices and design beside the generic type of management in such studies. PMID:26618711

EVALUATION OF A NURSE-LED HYPERTENSION MANAGEMENT INTERVENTION IN AUSTRALIAN GENERAL PRACTICE: THE IMPRESS INTERVENTION.

PubMed

Stephen, Catherine

2016-08-01

Hypertension is currently the most frequently seen condition in Australian general practice (Britt et al. 2015). Of the 4.6 million Australians living with hypertension, many struggle to keep their blood pressure under control and are at increased risk of renal failure, cardiovascular disease and premature death (Australian Institute of Health and Welfare, 2015; Cadilhac et al. 2012). The General Practice Nurse (GPN) has a significant role to play in supporting self-management and lifestyle risk factor reduction.

Strategic HRD Practices as Key Factors in Organizational Learning

ERIC Educational Resources Information Center

Tseng, Chien-Chi; McLean, Gary N.

2007-01-01

Relationships between strategic HRD practices and organizational learning were explored through a literature review. Organizations that learn and develop their SHRD practices have more opportunities to obtain and integrate the nine SHRD outcomes in the learning process: organizational missions and goals, top management leadership, environmental…

Paving the Way for the 21st Century: The Human Factor in Higher Education Financial Management.

ERIC Educational Resources Information Center

Ginsburg, Sigmund G., Ed.

This book presents human resources issues that will affect the financial management of colleges and universities as they move into the 21st century. It examines how business managers and human resources managers must balance human resources management policies and practices against the financial demands on the institution. It discusses the…

Unresolved pain in children: a relational ethics perspective.

PubMed

Olmstead, Deborah L; Scott, Shannon D; Austin, Wendy J

2010-11-01

It is considered the right of children to have their pain managed effectively. Yet, despite extensive research findings, policy guidelines and practice standard recommendations for the optimal management of paediatric pain, clinical practices remain inadequate. Empirical evidence definitively shows that unrelieved pain in children has only harmful consequences, with no benefits. Contributing factors identified in this undermanaged pain include the significant role of nurses. Nursing attitudes and beliefs about children's pain experiences, the relationships nurses share with children who are suffering, and knowledge deficits in pain management practices are all shown to impact unresolved pain in children. In this article, a relational ethics perspective is used to explore the need for nurses to engage in authentic relationships with children who are experiencing pain, and to use evidence-based practices to manage that pain in order for this indefensible suffering of children to end.

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.

Determinants of HMO success: the case of Complete Health.

PubMed

Widra, L S; Fottler, M D

1992-01-01

The health maintenance organization (HMO) industry has experienced a variety of difficulties and criticisms in recent years. Various hybrid models have been proposed to alleviate these problems. This article presents an in-depth case study of factors associated with the success of one such hybrid: an individual practice association (IPA)-model HMO affiliated with an academic health center. The major success factors identified include the plan design/structure, the strategic orientation/practices, and the stakeholder management orientation practices.

Prevalence, predictors, and patient outcomes associated with physician co-management: findings from the Los Angeles Women's Health Study.

PubMed

Rose, Danielle E; Tisnado, Diana M; Tao, May L; Malin, Jennifer L; Adams, John L; Ganz, Patricia A; Kahn, Katherine L

2012-06-01

Physician co-management, representing joint participation in the planning, decision-making, and delivery of care, is often cited in association with coordination of care. Yet little is known about how physicians manage tasks and how their management style impacts patient outcomes. To describe physician practice style using breast cancer as a model. We characterize correlates and predictors of physician practice style for 10 clinical tasks, and then test for associations between physician practice style and patient ratings of care. We queried 347 breast cancer physicians identified by a population-based cohort of women with incident breast cancer regarding care using a clinical vignette about a hypothetical 65-year-old diabetic woman with incident breast cancer. To test the association between physician practice style and patient outcomes, we linked medical oncologists' responses to patient ratings of care (physician n=111; patient n=411). After adjusting for physician and practice setting characteristics, physician practice style varied by physician specialty, practice setting, financial incentives, and barriers to referrals. Patients with medical oncologists who co-managed tasks had higher patient ratings of care. Physician practice style for breast cancer is influenced by provider and practice setting characteristics, and it is an important predictor of patient ratings. We identify physician and practice setting factors associated with physician practice style and found associations between physician co-management and patient outcomes (e.g., patient ratings of care). © Health Research and Educational Trust.

Survey of primary care providers' knowledge of screening for, diagnosing and managing prediabetes.

PubMed

Tseng, Eva; Greer, Raquel C; O'Rourke, Paul; Yeh, Hsin-Chieh; McGuire, Maura M; Clark, Jeanne M; Maruthur, Nisa M

2017-11-01

Prediabetes affects 86 million US adults, but primary care providers' (PCPs') knowledge, practices, attitudes and beliefs toward prediabetes are unclear. Assess PCPs' (1) knowledge of risk factors that should prompt prediabetes screening, laboratory criteria for diagnosing prediabetes and guidelines for management of prediabetes; (2) management practices around prediabetes; (3) attitudes and beliefs about prediabetes. Self-administered written survey of PCPs. One hundred forty of 155 PCPs (90%) attending an annual provider retreat for academically affiliated multispecialty practices in the mid-Atlantic region. Descriptive analyses of survey questions on knowledge, management, and attitudes and beliefs related to prediabetes. Multivariate logistic regression was used to determine the association between provider characteristics (gender, race/ethnicity, years since training, specialty and provider type) and knowledge, management, and attitudes and beliefs about prediabetes. Six percent of PCPs correctly identified all of the risk factors that should prompt prediabetes screening. Only 17% of PCPs correctly identified the laboratory parameters for diagnosing prediabetes based on both fasting glucose and hemoglobin A1c. Nearly 90% of PCPs reported close follow-up (within 6 months) of patients with prediabetes. Few PCPs (11%) selected referral to a behavioral weight loss program as the recommended initial management approach to prediabetes. PCPs agreed that patient-related factors are important barriers to lifestyle change and metformin use. Provider characteristics were generally not associated with knowledge, management, attitudes and beliefs about prediabetes in multivariate analyses. Addressing gaps in knowledge and the underutilization of behavioral weight loss programs in prediabetes are two essential areas where PCPs could take a lead in curbing the diabetes epidemic.

Expanding the domains of attitudes towards evidence-based practice: the evidence based practice attitude scale-50.

PubMed

Aarons, Gregory A; Cafri, Guy; Lugo, Lindsay; Sawitzky, Angelina

2012-09-01

Mental health and social service provider attitudes toward evidence-based practice have been measured through the development and validation of the Evidence-Based Practice Attitude Scale (EBPAS; Aarons, Ment Health Serv Res 6(2):61-74, 2004). Scores on the EBPAS scales are related to provider demographic characteristics, organizational characteristics, and leadership. However, the EBPAS assesses only four domains of attitudes toward EBP. The current study expands and further identifies additional domains of attitudes towards evidence-based practice. A qualitative and quantitative mixed-methods approach was used to: (1) generate items from multiples sources (researcher, mental health program manager, clinician/therapist), (2) identify potential content domains, and (3) examine the preliminary domains and factor structure through exploratory factor analysis. Participants for item generation included the investigative team, a group of mental health program managers (n = 6), and a group of clinicians/therapists (n = 8). For quantitative analyses a sample of 422 mental health service providers from 65 outpatient programs in San Diego County completed a survey that included the new items. Eight new EBPAS factors comprised of 35 items were identified. Factor loadings were moderate to large and internal consistency reliabilities were fair to excellent. We found that the convergence of these factors with the four previously identified evidence-based practice attitude factors (15 items) was small to moderate suggesting that the newly identified factors represent distinct dimensions of mental health and social service provider attitudes toward adopting EBP. Combining the original 15 items with the 35 new items comprises the EBPAS 50-item version (EBPAS-50) that adds to our understanding of provider attitudes toward adopting EBPs. Directions for future research are discussed.

A review of best management practices and the mitigation of stream-breeding salamanders in the eastern deciduous forest

Treesearch

Thomas A. Maigret; John J. Cox

2014-01-01

Timber harvest has been implicated as a causative factor in the decline of amphibian populations and diversity in many areas of the world. The adoption of best management practices (BMPs) is intended to minimize the impacts of timber harvest on the biotic community, including amphibians and their habitat requirements. Herein, we synthesize the current scientific...

Management and Accounting in English Higher Education Influenced by Environmental and Academia-Specific Factors

ERIC Educational Resources Information Center

von Alberti-Alhtaybat, Larissa; Al-Htaybat, Khaldoon; Hutaibat, Khaled

2012-01-01

This article originates from a longitudinal study of management and accounting practices in the English higher education sector. The processes of strategic management and strategic management accounting in several English higher education institutions were investigated, from planning to assessment, and their meaning to members of staff. The study…

An examination on the influence of small and medium enterprise (SME) stakeholder on green supply chain management practices

NASA Astrophysics Data System (ADS)

Shahlan, M. Z.; Sidek, A. A.; Suffian, S. A.; Hazza, M. H. F. A.; Daud, M. R. C.

2018-01-01

In this paper, climate change and global warming are the biggest current issues in the industrial sectors. The green supply chain managements (GSCM) is one of the crucial input to these issues. Effective GSCM can potentially secure the organization’s competitive advantage and improve the environmental performance of the network activities. In this study, the aim is to investigate and examine how a small and medium enterprises (SMEs) stakeholder pressure and top management influence green supply chain management practices. The study is further advance green supply chain management research in Malaysia focusing on SMEs manufacturing sector using structural equation modelling. Structural equation modelling is a multivariate statistical analysis technique used to examine structural relationship. It is the combination of factor analysis and multi regression analysis and used to analyse structural relationship between measure variable and latent factor. This research found that top management support and stakeholder pressure is the major influence for SMEs to adopt green supply chain management. The research also found that top management is fully mediate with the relationship between stakeholder pressure and monitoring supplier environmental performance.

Implementation of safety management systems in Hong Kong construction industry - A safety practitioner's perspective.

PubMed

Yiu, Nicole S N; Sze, N N; Chan, Daniel W M

2018-02-01

In the 1980s, the safety management system (SMS) was introduced in the construction industry to mitigate against workplaces hazards, reduce the risk of injuries, and minimize property damage. Also, the Factories and Industrial Undertakings (Safety Management) Regulation was introduced on 24 November 1999 in Hong Kong to empower the mandatory implementation of a SMS in certain industries including building construction. Therefore, it is essential to evaluate the effectiveness of the SMS in improving construction safety and identify the factors that influence its implementation in Hong Kong. A review of the current state-of-the-practice helped to establish the critical success factors (CSFs), benefits, and difficulties of implementing the SMS in the construction industry, while structured interviews were used to establish the key factors of the SMS implementation. Results of the state-of-the-practice review and structured interviews indicated that visible senior commitment, in terms of manpower and cost allocation, and competency of safety manager as key drivers for the SMS implementation. More so, reduced accident rates and accident costs, improved organization framework, and increased safety audit ratings were identified as core benefits of implementing the SMS. Meanwhile, factors such as insufficient resources, tight working schedule, and high labor turnover rate were the key challenges to the effective SMS implementation in Hong Kong. The findings of the study were consistent and indicative of the future development of safety management practice and the sustainable safety improvement of Hong Kong construction industry in the long run. Copyright © 2018 National Safety Council and Elsevier Ltd. All rights reserved.

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.

The Hidden Factors Behind Japan's Highly Productive Management Methods.

ERIC Educational Resources Information Center

Dillon, Linda S.

1984-01-01

Discusses Japanese management from the perspective of the complex relationship between Japanese culture and their practice of lifelong employment, shared authority in decision making, and dissolution of many of the privileges of rank. (Author)

Factors influencing emergency medicine physicians' management of sports-related concussions: a community-wide study.

PubMed

Giebel, Stephen; Kothari, Rashmi; Koestner, Amy; Mohney, Gretchen; Baker, Robert

2011-12-01

Numerous guidelines to grade and manage sports-related concussions have been published. However, little is known about how frequently they are implemented in the emergency department. This study evaluates the current practices of emergency physicians (EPs) in managing sports-related concussions. To evaluate the current practice of EP evaluation and management of sports-related concussions. All EPs and emergency medicine residents in Kalamazoo County were surveyed regarding their management of sports-related concussions. The surveys obtained demographic data, participants' use of guidelines, and the importance of clinical and non-clinical factors in deciding when to allow a player to return to play. Of the 73 EP respondents, only 23% used a nationally recognized guideline, with no significant difference between attending and resident EPs. The symptomatic complaints of loss of consciousness, amnesia of the event, and difficulty concentrating were ranked most important by EPs in assessing patients with sports-related concussions. Among non-clinical factors, residents were significantly more likely than attendings to report that medical-legal, parental, and players' concerns were more likely to influence their decision in allowing a patient to return to play. EPs take into consideration important clinical factors in assessing patients with sports-related concussion. However, almost 75% do not use any nationally recognized guideline in their evaluation. Residents are more likely than attendings to be influenced by non-clinical factors. Copyright © 2011 Elsevier Inc. All rights reserved.

Soft skill appraisal for dentistry: a tool for positive practice management.

PubMed

Jawale, Bhushan Arun; Bendgude, Vikas; Husain, Nadeem; Thosar, Nilima; Tandon, Piyush

2011-11-01

Soft skills adoption is a learning experience for every practitioner and every academician. Author has expressed his opinion for success through educational and real values of soft skill. Soft skills behavior of individual and institution help in achieving desirable goals in general and specialty practices. Author also focused on some realistic soft skill methods for improvisation of practices for all doctor. These skills indulge positive energy in human relationship for working in symbiosis and explore infinite capabilities at institutional and doctoral level. Here, some optimistic suggestions are given for improving dental practices and academic fulfillments. These soft skills help to organize, plan and manage, and track changes during the course of the growing dental practices. However, understanding of the soft skills in practice management, its simplicity and complexity and also, its contributing factors, helps practitioners to understand the dynamic, social and complex contexts of practices. It is really helpful to all practitioners to grow their practices using soft skills.

Impact of implementing electronic clinical practice guidelines for the diagnosis, control and treatment of cardiovascular risk factors: A pre-post controlled study.

PubMed

Comin, Eva; Catalan-Ramos, Arantxa; Iglesias-Rodal, Manuel; Grau, Maria; Del Val, Jose Luis; Consola, Alicia; Amado, Ester; Pons, Angels; Mata-Cases, Manel; Franzi, Alicia; Ciurana, Ramon; Frigola, Eva; Cos, Xavier; Davins, Josep; Verdu-Rotellar, Jose M

To evaluate the impact of computerized clinical practice guidelines on the management, diagnosis, treatment, control, and follow-up of the main cardiovascular risk factors: hypertension, hypercholesterolaemia, and type 2 diabetes mellitus. Pre-post controlled study. Catalonia, autonomous community located in north-eastern Spain. Individuals aged 35-74 years assigned to general practitioners of the Catalan Health Institute. The intervention group consisted of individuals whose general practitioners had accessed the computerized clinical practice guidelines at least twice a day, while the control group consisted of individuals whose general practitioner had never accessed the computerized clinical practice guidelines platform. The Chi-squared test was used to detect significant differences in the follow-up, control, and treatment variables for all three disorders (hypertension, hypercholesterolaemia, and type 2 diabetes mellitus) between individuals assigned to users and non-users of the computerized clinical practice guidelines, respectively. A total of 189,067 patients were included in this study, with a mean age of 56 years (standard deviation 12), and 55.5% of whom were women. Significant differences were observed in hypertension management, treatment and control; type 2 diabetes mellitus management, treatment and diagnoses, and the management and control of hypercholesterolaemia in both sexes. Computerized clinical practice guidelines are an effective tool for the control and follow-up of patients diagnosed with hypertension, type 2 diabetes mellitus, and hypercholesterolaemia. The usefulness of computerized clinical practice guidelines to diagnose and adequately treat individuals with these disorders remains unclear. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

e-Learning competency for practice nurses: an evaluation report.

PubMed

Heartfield, Marie; Morello, Andrea; Harris, Melanie; Lawn, Sharon; Pols, Vincenza; Stapleton, Carolyn; Battersby, Malcolm

2013-01-01

Practice nurses in Australia are now funded to facilitate chronic condition management, including self-management support. Chronic disease management requires an established rapport, support and proactivity between general practitioners, patients and the practice nurses. To achieve this, training in shared decision making is needed. e-Learning supports delivery and achievement of such policy outcomes, service improvements and skill development. However, e-learning effectiveness for health care professionals' is determined by several organisational, economic, pedagogical and individual factors, with positive e-learning experience linked closely to various supports. This paper reinforces previous studies showing nurses' expanding role across general practice teams and reports on some of the challenges of e-learning. Merely providing practice nurses with necessary information via web-based learning systems does not ensure successful learning or progress toward improving health outcomes for patients.

Factors Influencing the Evolution of Vocational Teachers' Beliefs and Practices Related to Classroom Management during Teacher Education

ERIC Educational Resources Information Center

Girardet, Céline; Berger, Jean-Louis

2018-01-01

Two studies were conducted to investigate the evolution of 71 Swiss vocational teachers' classroom management as a result of the inputs of a teacher education program, and to identify the factors that encouraged or impeded teacher change. Study 1 consisted of a longitudinal survey, and Study 2 of interviews. Longitudinal analyses were performed…

AUTOMATED GEOSPATIAL WATERSHED ASSESSMENT (AGWA): A GIS-BASED HYDROLOGIC MODELING TOOL FOR LANDSCAPE ASSESSMENT AND WATERSHED MANAGEMENT

EPA Science Inventory

The assessment of land use and land cover is an extremely important activity for contemporary land management. A large body of current literature suggests that human land-use practice is the most important factor influencing natural resource management and environmental condition...

Human Resource Management in Selected Japanese Firms, Their Foreign Subsidiaries and Locally Owned Counterparts.

ERIC Educational Resources Information Center

Jain, Hem C.

1990-01-01

Examines differences between Japanese and North American personnel management philosophies. Considers to what extent practices of Japanese corporations have been transferred to subsidiaries in Canada, India, Malaysia, and Singapore, compared to locally owned firms. Shows how cultural factors affect styles of personnel management. (SK)

Managing Abiotic Factors of Compost to Increase Soilborne Disease Suppression

ERIC Educational Resources Information Center

Griffin, Deirdre E.

2012-01-01

Soilborne pathogens can devastate crops, causing economic losses for farmers due to reduced yields and expensive management practices. Fumigants and fungicides have harmful impacts on the surrounding environment and can be toxic to humans. Therefore, alternative methods of disease management are important. The disease suppressive abilities of…

A quantitative study of the U.S. wood pallet industry based on supply chain management practices

Treesearch

Henry Quesada-Pineda; Scarlett Sanchez-Gomez; Philip A. Araman

2012-01-01

Pallets play an important role in the movement of goods from place to place. They are not only used in warehouses or distribution centers, but also in all those activities that require an efficient and effective method of transportation. To better understand business practices and external factors that impacts supply chain management (SCM), a survey of 1,500 U.S. wood...

The office management of ejaculatory disorders

PubMed Central

2016-01-01

Premature ejaculation (PE), delayed ejaculation (DE), anejaculation (AE) and retrograde ejaculation (RE) are four main ejaculatory disorders (EjDs) observed in clinical practice. Despite their high prevalence, EjDs remain underdiagnosed and undertreated. Primary care physicians should incorporate the discussion of sexual health topics into routine visits to facilitate EjD diagnosis and treatment. Because the causes of EjDs are multifactorial, the management of EjDs is etiology-specific and may require a holistic approach. Dapoxetine, a selective serotonin reuptake inhibitor, is the only drug approved for on-demand treatment of lifelong and acquired PE. In clinical practice, scheduled follow-up visits, risk factor treatment, appropriate dose escalation, adequate sexual attempts, patient education, and partner involvement are critical factors responsible for optimal overall management of PE and dapoxetine treatment outcomes. PMID:27652225

The office management of ejaculatory disorders.

PubMed

Jiann, Bang-Ping

2016-08-01

Premature ejaculation (PE), delayed ejaculation (DE), anejaculation (AE) and retrograde ejaculation (RE) are four main ejaculatory disorders (EjDs) observed in clinical practice. Despite their high prevalence, EjDs remain underdiagnosed and undertreated. Primary care physicians should incorporate the discussion of sexual health topics into routine visits to facilitate EjD diagnosis and treatment. Because the causes of EjDs are multifactorial, the management of EjDs is etiology-specific and may require a holistic approach. Dapoxetine, a selective serotonin reuptake inhibitor, is the only drug approved for on-demand treatment of lifelong and acquired PE. In clinical practice, scheduled follow-up visits, risk factor treatment, appropriate dose escalation, adequate sexual attempts, patient education, and partner involvement are critical factors responsible for optimal overall management of PE and dapoxetine treatment outcomes.

Management of severe asthma: targeting the airways, comorbidities and risk factors.

PubMed

Gibson, Peter G; McDonald, Vanessa M

2017-06-01

Severe asthma is a complex heterogeneous disease that is refractory to standard treatment and is complicated by multiple comorbidities and risk factors. In mild to moderate asthma, the burden of disease can be minimised by inhaled corticosteroids, bronchodilators and self-management education. In severe asthma, however, management is more complex. When patients with asthma continue to experience symptoms and exacerbations despite optimal management, severe refractory asthma (SRA) should be suspected and confirmed, and other aetiologies ruled out. Once a diagnosis of SRA is established, patients should undergo a systematic and multidimensional assessment to identify inflammatory endotypes, risk factors and comorbidities, with targeted and individualised management initiated. We describe a practical approach to assessment and management of patients with SRA. © 2017 Royal Australasian College of Physicians.

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.

Nursing professional practice environments: setting the stage for constructive conflict resolution and work effectiveness.

PubMed

Siu, Heidi; Spence Laschinger, Heather K; Finegan, Joan

2008-05-01

The aim of this study was to examine the impact of nurses' perceived professional practice environment on their quality of nursing conflict management approaches and ultimately their perceptions of unit effectiveness from the perspective of Deutsch's theory of constructive conflict management. Rising reports of hostility and conflict among Canadian nurses are a concern to nurses' health and the viability of effective patient care delivery. However, research on the situational factors that influence nurses' ability to apply effective conflict resolution skills that lead to positive results in practice is limited. A nonexperimental, predictive design was used in a sample of 678 registered nurses working in community hospitals within a large metropolitan area in Ontario. The results supported a modified version of the hypothesized model [chi2(1) = 16.25, Goodness of Fit = 0.99, Comparative Fit Index = 0.98, Root-Mean-Square Error of Approximation = 0.15] linking professional practice environment and core self-evaluation to nurses' conflict management and, ultimately, unit effectiveness. Professional practice environment, conflict management, and core-self evaluation explained approximately 46.6% of the variance in unit effectiveness. Positive professional practice environments and high core self-evaluations predicted nurses' constructive conflict management and, in turn, greater unit effectiveness.

Why different countries manage death differently: a comparative analysis of modern urban societies.

PubMed

Walter, Tony

2012-03-01

The sociology of death, dying and bereavement tends to take as its implicit frame either the nation state or a homogenous modernity. Between-nation differences in the management of death and dying are either ignored or untheorized. This article seeks to identify the factors that can explain both similarities and differences in the management of death between different modern western nations. Structural factors which affect all modern nations include urbanization and the division of labour leading to the dominance of professionals, migration, rationality and bureaucracy, information technology and the risk society. How these sociologically familiar structural features are responded to, however, depends on national histories, institutions and cultures. Historically, key transitional periods to modernity, different in different nations, necessitated particular institutional responses in the management of dying and dead bodies. Culturally, key factors include individualism versus collectivism, religion, secularization, boundary regulation, and expressivism. Global flows of death practices depend significantly on subjugated nations' perceptions of colonialism, neo-colonialism and modernity, which can lead to a dominant power's death practices being either imitated or rejected. © London School of Economics and Political Science 2012.

Do management practices support or constrain safe driving behaviour? A multi-level investigation in a sample of occupational drivers.

PubMed

Newnam, Sharon; Warmerdam, Amanda; Sheppard, Dianne; Griffin, Mark; Stevenson, Mark

2017-05-01

It has been estimated that one-third of all work-related deaths occur while driving for work-related purposes. Despite this, many organisations are unaware of the practices, beyond those that identify and control the impact of unforeseen events (i.e., risk management), that predispose drivers to risk. This study addresses the issue by identifying the management practices operationalised as, High Performance Workplace Systems (HPWS) that influence safe driver behaviour. The study also explores the value given to safety by senior level management as a moderator of the relationship between HPWS practices and driver behaviour. Each factor was tested within a two level hierarchical model consisting of 911 drivers, nested within 161 supervisors and 83 organisations. The findings highight that under conditions of high investment in job and work design, communication and selection practices, drivers reported poorer driving behaviour. An interaction effect also demonstrated that under conditions of high investment in remuneration, drivers reported safer behaviour, but only when they perceived that managers valued and prioritised safety. The findings challenge current thinking in the management of workplace road safety. Copyright © 2017 Elsevier Ltd. All rights reserved.

Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff.

PubMed

Knowles, Serena; Lam, Lawrence T; McInnes, Elizabeth; Elliott, Doug; Hardy, Jennifer; Middleton, Sandy

2015-01-01

Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009). Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is required to explore the influence of opinion leaders and organizational culture on clinicians' behaviour intentions related to bowel management for intensive care patients.

Correlates of domestic waste management and related health outcomes in Sunyani, Ghana: a protocol towards enhancing policy.

PubMed

Addo, Henry O; Dun-Dery, Elvis J; Afoakwa, Eugenia; Elizabeth, Addai; Ellen, Amposah; Rebecca, Mwinfaug

2017-07-03

Domestic waste generation has contributed significantly to hampering national waste management efforts. It poses serious threat to national development and requires proper treatment and management within and outside households. The problem of improper waste management has always been a challenge in Ghana, compelling several national surveys to report on the practice of waste management. However, little is known about how much waste is generated and managed within households and there is a serious dearth of information for national policy and planning. This paper seeks to document the handling and practice of waste management, including collection, storage, transportation and disposal along with the types and amount of waste generated by Households and their related health outcome. The study was a descriptive cross-sectional study and used a multi-stage sampling technique to sample 700 households. The study was planned and implemented from January to May 2015. It involved the use of structured questionnaires in the data collection over the period. Factors such as demographic characteristics, amount of waste generated, types of waste bins used within households, waste recycling, cost of disposing waste, and distance to dumpsite were all assessed. The paper shows that each surveyed household generated 0.002 t of waste per day, of which 29% are both organic and inorganic. Though more than half of the respondents (53.6%) had positive attitude towards waste management, only 29.1% practiced waste management. The study reveals that there is no proper management of domestic waste except in few households that segregate waste. The study identified several elements as determinants of waste management practice. Female respondents were less likely to practice waste management (AOR 0.45; 95% Cl 0.29, 0.79), household size also determined respondents practice (AOR 0.26; Cl 0.09, 0.77). Practice of recycling (AOR 0.03; Cl 0.02, 0.08), distance to dumpsite (AOR 0.45; Cl 0.20, 0.99), were all significant predictors of waste management practice. Cholera which is a hygiene related disease was three times more likely to determine households' waste management practice (AOR 3.22; Cl 1.33, 7.84). Considering the low waste management practice among households, there is the need for improved policy and enhanced education on proper waste management practice among households.

Nurse-led clinics for atrial fibrillation: managing risk factors.

PubMed

Jacob, Liril

2017-12-14

Atrial fibrillation (AF) is the most common and sustained cardiac arrhythmia rated by cardiologists as one of the most difficult conditions to manage. Traditionally, AF management has focused on the three pillars of rate control, rhythm control and anticoagulation. However, more recently, cardiovascular risk-factor management in AF has emerged as a fourth and essential pillar, delivering improved patient outcomes. In the UK, AF is a condition that is often managed poorly, with patients reporting a lack of understanding of their condition and treatment options. Many aspects of assessment and communication in AF management are time consuming. Failure to address those aspects may negatively affect the quality of care. Nurse-led clinics can contribute significantly in the areas of patient education and sustained follow-up care, improving outcomes and addressing current deficiencies in AF risk-factor management due to scarcity of medical resources. This article discusses the major cardiovascular risk factors associated with AF, drawing on evidence from the literature, and considers the effectiveness and implications for practice of introducing community-based nurse-led clinics for risk-factor management in patients with AF.

Homeland Security. Management Challenges Facing Federal Leadership

DTIC Science & Technology

2002-12-01

Security Management Challenges Facing Federal Leadership 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...including attention to management practices and key success factors. HOMELAND SECURITY Management Challenges Facing Federal Leadership www.gao.gov/cgi...significant management and coordination challenges if it is to provide this leadership and be successful in preventing and responding to any future

The development and effectiveness of a health information website designed to improve parents' self-efficacy in managing risk for obesity in preschoolers.

PubMed

Davies, Marilyn A; Terhorst, Lauren; Nakonechny, Amanda J; Skukla, Nimisha; El Saadawi, Gilan

2014-10-01

To evaluate the effects of web-based information on parental self-efficacy in managing obesity risk in preschoolers. The project included a literature review and the development and field testing of an information website that presented information on how to manage nine obesity risk factors for childhood obesity. Parents stated that they had no problems using the website, and 69% reported improved self-efficacy on at least two risk factors. Many parents access the Internet to obtain health information. A website that offers practical information on managing childhood obesity risk factors is a valuable resource for obesity prevention efforts. © 2014, Wiley Periodicals, Inc.

"… Trial and error …": Speech-language pathologists' perspectives of working with Indigenous Australian adults with acquired communication disorders.

PubMed

Cochrane, Frances Clare; Brown, Louise; Siyambalapitiya, Samantha; Plant, Christopher

2016-10-01

This study explored speech-language pathologists' (SLPs) perspectives about factors that influence clinical management of Aboriginal and Torres Strait Islander adults with acquired communication disorders (e.g. aphasia, motor speech disorders). Using a qualitative phenomenological approach, seven SLPs working in North Queensland, Australia with experience working with this population participated in semi-structured in-depth interviews. Qualitative content analysis was used to identify categories and overarching themes within the data. Four categories, in relation to barriers and facilitators, were identified from participants' responses: (1) The Practice Context; (2) Working Together; (3) Client Factors; and (4) Speech-Language Pathologist Factors. Three overarching themes were also found to influence effective speech pathology services: (1) Aboriginal and Torres Strait Islander Cultural Practices; (2) Information and Communication; and (3) Time. This study identified many complex and inter-related factors which influenced SLPs' effective clinical management of this caseload. The findings suggest that SLPs should employ a flexible, holistic and collaborative approach in order to facilitate effective clinical management with Aboriginal and Torres Strait Islander people with acquired communication disorders.

Role of nurse practitioners in reducing cardiovascular risk factors: a retrospective cohort study.

PubMed

Klemenc-Ketis, Zalika; Terbovc, Alenka; Gomiscek, Bostjan; Kersnik, Janko

2015-11-01

To determine the impact of nurse practitioners' counselling on reducing cardiovascular risk factors in patients participating in routine preventive check-ups. A new model of 'renewed' family practice was introduced in Slovenia as a pilot project in 2011, in which nurse practitioners are included in a team carrying out preventive activities and managing patients with stable chronic diseases. A retrospective cohort study. This study was conducted in 16 family medicine practices (eight renewed and eight regular family practices). In each family practice, a systematic sample was selected of registered patients participating in a cardiovascular preventive check-up. Data on sex, age, blood pressure, cholesterol, blood sugar, smoking, level of physical activity and cardiovascular risk were collected. Patients attending renewed family practices received counselling on risk factors from nurse practitioners (test group), and patients attending regular family practices received counselling from family physicians (control group). Data were collected again at least one and no more than five years after the baseline consultation. There were 128 patients in the test group and 129 patients in the control group. At the control visit, the patients counselled by nurse practitioners had significantly lower levels of systolic blood pressure and cholesterol and practiced regular physical activity significantly more often than patients counselled by family physicians. Nurse practitioners can be at least as successful as physicians when counselling patients on cardiovascular risk factors during their preventive check-ups. This study showed that nurse practitioners have an important role in managing patients at the primary care level. © 2015 John Wiley & Sons Ltd.

Assessment and management of risk factors for the prevention of lifestyle-related disease: a cross-sectional survey of current activities, barriers and perceived training needs of primary care physiotherapists in the Republic of Ireland.

PubMed

O'Donoghue, G; Cunningham, C; Murphy, F; Woods, C; Aagaard-Hansen, J

2014-06-01

To provide a snapshot of current activities, barriers and perceived training needs for the assessment and management of behavioural risk factors in physiotherapy practice in primary care settings in the Republic of Ireland. Cross-sectional survey of primary care physiotherapists. Two hundred and twenty primary care physiotherapists were invited to participate. Each received a questionnaire, consisting of 23 questions, within five key sections. Its main focus was the risk factor management practices of physiotherapists. Descriptive statistics and frequencies were used to analyse the data. A response rate of 74% (163/220) was achieved. Level of physical activity was the most common risk factor assessed at initial and follow-up visits (78%, 127/163), followed by dietary status (55%, 90/163). Few respondents included smoking status and alcohol consumption in their assessment; however, the majority considered them as risk factors that should be addressed. The main reasons why smoking status and alcohol consumption were not assessed were lack of time, limited knowledge and expertise, not traditionally viewed as the physiotherapist's role, and patient's lack of interest in changing their unhealthy behaviour. The findings highlight an untapped potential in relation to physiotherapists addressing lifestyle-related risk factors. A number of strategies are required to improve the systematic assessment and management of these risk factors. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Soil Erosion map of Europe based on high resolution input datasets

NASA Astrophysics Data System (ADS)

Panagos, Panos; Borrelli, Pasquale; Meusburger, Katrin; Ballabio, Cristiano; Alewell, Christine

2015-04-01

Modelling soil erosion in European Union is of major importance for agro-environmental policies. Soil erosion estimates are important inputs for the Common Agricultural Policy (CAP) and the implementation of the Soil Thematic Strategy. Using the findings of a recent pan-European data collection through the EIONET network, it was concluded that most Member States are applying the empirical Revised Universal Soil Loss Equation (RUSLE) for the modelling soil erosion at National level. This model was chosen for the pan-European soil erosion risk assessment and it is based on 6 input factors. Compared to past approaches, each of the factors is modelled using the latest pan-European datasets, expertise and data from Member states and high resolution remote sensing data. The soil erodibility (K-factor) is modelled using the recently published LUCAS topsoil database with 20,000 point measurements and incorporating the surface stone cover which can reduce K-factor by 15%. The rainfall erosivity dataset (R-factor) has been implemented using high temporal resolution rainfall data from more than 1,500 precipitation stations well distributed in Europe. The cover-management (C-factor) incorporates crop statistics and management practices such as cover crops, tillage practices and plant residuals. The slope length and steepness (combined LS-factor) is based on the first ever 25m Digital Elevation Model (DEM) of Europe. Finally, the support practices (P-factor) is modelled for first time at this scale taking into account the 270,000 LUCAS earth observations and the Good Agricultural and Environmental Condition (GAEC) that farmers have to follow in Europe. The high resolution input layers produce the final soil erosion risk map at 100m resolution and allow policy makers to run future land use, management and climate change scenarios.

Impact of an educational program on knowledge and practice of health care staff toward pharmaceutical waste management in Gaza, Palestine.

PubMed

Tabash, Mohammed I; Hussein, Rim A; Mahmoud, Aleya H; El-Borgy, Mohamed D; Abu-Hamad, Bassam A

2016-04-01

In health care facilities, pharmaceutical waste is generally discharged down the drain or sent to landfill. Poor knowledge about their potential downstream impacts may be a primary factor for improper disposal behavior. The objective of this study was to determine the impact of an intervention program on knowledge and practice of health care staff regarding pharmaceutical waste management. The study was designed as a pre/posttest intervention study. Total sample size was 530 in the pre-intervention phase, and then a subsample of 69 individuals was selected for the intervention and the post-intervention phases. Paired-sample t test was used to assess the difference between pretest and follow-up test results. A statistically significant improvement in knowledge and practice was achieved (P<0.001). Poor knowledge and poor practice levels (scores<50%) were found to improve to satisfactory levels (scores≥75%). Therefore, educational programs could be considered as an effective tool for changing health care staff practice in pharmaceutical waste management. In health care facilities, pharmaceutical waste is generally discharged down the drain or sent to landfill. A lack of knowledge about the potential impacts of this type of waste may be a leading factor in improper disposal behavior. Following an educational program, statistically significant improvement in knowledge and practice of health care staff as regards to pharmaceutical waste management (PWM) was achieved. It is thus recommended that authorities implement training-of-trainers (TOT) programs to educate health care staff on PWM and organize refreshment workshops regularly.

Water quality, biodiversity, and codes of practice in relation to harvesting forest plantations in streamside management zones

Treesearch

Daniel G. Neary; Philip J. Smethurst; Brenda Baillie; Kevin C. Petrone

2011-01-01

Streamside management zones (SMZs) are special landscape units that include riparian areas and adjacent lands that mitigate the movement of sediment, nutrients and other chemicals from upland forest and agricultural management areas into streams. The size, shape, and management of SMZs are governed by various combinations of economic, ecological, and regulatory factors...

Leadership styles of Finnish nurse managers and factors influencing it.

PubMed

Vesterinen, Soili; Isola, Arja; Paasivaara, Leena

2009-05-01

The purpose of the present study was to explore nurse managers' perceptions of their leadership styles and factors influencing it. It is a challenge for nurse managers to retain nurses in hospitals and to ensure a high quality of care in nursing practice. Leadership style is an important part of leadership. Knowledge concerning nurse managers' resonant and non-resonant leadership styles provides nurse managers with tools to reflect on their own leadership style. Open-ended, tape-recorded interviews were conducted with 13 nurse managers from five Finnish hospitals and two long-term care facilities. The data were analysed using qualitative content analysis. Five categories of leadership style were discerned: visionary, coaching, affiliate, democratic, commanding. Factors that influence leadership style were identified: earlier superiors, values, information, cooperation, employees and education. The results of this study show that Finnish nurse managers use both resonant and non-resonant leadership styles. The findings of this study show that nurse managers use a variety of leadership styles. The study demonstrates the importance of knowledge about leadership styles and factors influencing it among nurse managers providing future leadership and management education.

Nutrient management

USDA-ARS?s Scientific Manuscript database

Nutrient management has been defined as “the science and art directed to link soil, crop, weather and hydrologic factors with cultural, irrigation and soil and water conservation practices to achieve the goals of optimizing nutrient use efficiency, yields, crop quality, and economic returns, while r...

Training and certification of work schedule managers may improve shift scheduling practices

DOT National Transportation Integrated Search

2011-02-01

The Federal Railroad Administration (FRA) Human Factors Research and Development (R&D) Program : sponsored the implementation of a strategic job analysis to investigate the job of work schedule managers : (WSMs) across a diverse range of industries t...

The impact of nursing leadership and management on the control of HIV/AIDS: an ethnographic study.

PubMed

Nawafleh, Hani; Francis, Karen; Chapman, Ysanne

2012-10-01

This paper reports on an aspect of a larger ethnographic study that sought to investigate the impact of HIV/AIDS on the practice of primary care nurses in Jordan. Nursing leadership and the style of management adopted by senior nursing and medical administrators at the Ministry of Heath were identified as factors impacting on the practice of the nurses and their capacity to raise community awareness and contribute to the prevention and control of HIV/AIDS. The study was undertaken in three rural and three urban primary health care centres (PHCC). Data collection included participant observation, key informant interviews, and document analysis. These data informed the development of descriptive ethnographic accounts that allowed for the subsequent identification of common and divergent themes reflective of factors recognized as influencing the practice of the nurse participants.

From Observation to Information: Data-Driven Understanding of on Farm Yield Variation

PubMed Central

Jiménez, Daniel; Dorado, Hugo; Cock, James; Prager, Steven D.; Delerce, Sylvain; Grillon, Alexandre; Andrade Bejarano, Mercedes; Benavides, Hector; Jarvis, Andy

2016-01-01

Agriculture research uses “recommendation domains” to develop and transfer crop management practices adapted to specific contexts. The scale of recommendation domains is large when compared to individual production sites and often encompasses less environmental variation than farmers manage. Farmers constantly observe crop response to management practices at a field scale. These observations are of little use for other farms if the site and the weather are not described. The value of information obtained from farmers’ experiences and controlled experiments is enhanced when the circumstances under which it was generated are characterized within the conceptual framework of a recommendation domain, this latter defined by Non-Controllable Factors (NCFs). Controllable Factors (CFs) refer to those which farmers manage. Using a combination of expert guidance and a multi-stage analytic process, we evaluated the interplay of CFs and NCFs on plantain productivity in farmers’ fields. Data were obtained from multiple sources, including farmers. Experts identified candidate variables likely to influence yields. The influence of the candidate variables on yields was tested through conditional forests analysis. Factor analysis then clustered harvests produced under similar NCFs, into Homologous Events (HEs). The relationship between NCFs, CFs and productivity in intercropped plantain were analyzed with mixed models. Inclusion of HEs increased the explanatory power of models. Low median yields in monocropping coupled with the occasional high yields within most HEs indicated that most of these farmers were not using practices that exploited the yield potential of those HEs. Varieties grown by farmers were associated with particular HEs. This indicates that farmers do adapt their management to the particular conditions of their HEs. Our observations confirm that the definition of HEs as recommendation domains at a small-scale is valid, and that the effectiveness of distinct management practices for specific micro-recommendation domains can be identified with the methodologies developed. PMID:26930552

Greening academia: Developing sustainable waste management at Higher Education Institutions

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

Zhang, N.; Williams, I.D., E-mail: idw@soton.ac.uk; Kemp, S.

Higher Education Institutions (HEIs) are often the size of small municipalities. Worldwide, the higher education (HE) sector has expanded phenomenally; for example, since the 1960s, the United Kingdom (UK) HE system has expanded sixfold to >2.4 million students. As a consequence, the overall production of waste at HEIs throughout the world is very large and presents significant challenges as the associated legislative, economic and environmental pressures can be difficult to control and manage. This paper critically reviews why sustainable waste management has become a key issue for the worldwide HE sector to address and describes some of the benefits, barriers,more » practical and logistical problems. As a practical illustration of some of the issues and problems, the four-phase waste management strategy developed over 15 years by one of the largest universities in Southern England - the University of Southampton (UoS) - is outlined as a case study. The UoS is committed to protecting the environment by developing practices that are safe, sustainable and environmentally friendly and has developed a practical, staged approach to manage waste in an increasingly sustainable fashion. At each stage, the approach taken to the development of infrastructure (I), service provision (S) and behavior change (B) is explained, taking into account the Political, Economic, Social, Technological, Legal and Environmental (PESTLE) factors. Signposts to lessons learned, good practice and useful resources that other institutions - both nationally and internationally - can access are provided. As a result of the strategy developed at the UoS, from 2004 to 2008 waste costs fell by around Pounds 125k and a recycling rate of 72% was achieved. The holistic approach taken - recognizing the PESTLE factors and the importance of a concerted ISB approach - provides a realistic, successful and practical example for other institutions wishing to effectively and sustainably manage their waste.« less

Greening academia: developing sustainable waste management at Higher Education Institutions.

PubMed

Zhang, N; Williams, I D; Kemp, S; Smith, N F

2011-07-01

Higher Education Institutions (HEIs) are often the size of small municipalities. Worldwide, the higher education (HE) sector has expanded phenomenally; for example, since the 1960s, the United Kingdom (UK) HE system has expanded sixfold to >2.4 million students. As a consequence, the overall production of waste at HEIs throughout the world is very large and presents significant challenges as the associated legislative, economic and environmental pressures can be difficult to control and manage. This paper critically reviews why sustainable waste management has become a key issue for the worldwide HE sector to address and describes some of the benefits, barriers, practical and logistical problems. As a practical illustration of some of the issues and problems, the four-phase waste management strategy developed over 15 years by one of the largest universities in Southern England--the University of Southampton (UoS)--is outlined as a case study. The UoS is committed to protecting the environment by developing practices that are safe, sustainable and environmentally friendly and has developed a practical, staged approach to manage waste in an increasingly sustainable fashion. At each stage, the approach taken to the development of infrastructure (I), service provision (S) and behavior change (B) is explained, taking into account the Political, Economic, Social, Technological, Legal and Environmental (PESTLE) factors. Signposts to lessons learned, good practice and useful resources that other institutions--both nationally and internationally--can access are provided. As a result of the strategy developed at the UoS, from 2004 to 2008 waste costs fell by around £125k and a recycling rate of 72% was achieved. The holistic approach taken--recognizing the PESTLE factors and the importance of a concerted ISB approach--provides a realistic, successful and practical example for other institutions wishing to effectively and sustainably manage their waste. Copyright © 2011 Elsevier Ltd. All rights reserved.

Management of long term sickness absence: a systematic realist review.

PubMed

Higgins, Angela; O'Halloran, Peter; Porter, Sam

2012-09-01

The increasing impact and costs of long term sickness absence have been well documented. However, the diversity and complexity of interventions and of the contexts in which these take place makes a traditional review problematic. Therefore, we undertook a systematic realist review to identify the dominant programme theories underlying best practice, to assess the evidence for these theories, and to throw light on important enabling or disabling contextual factors. A search of the scholarly literature from 1950 to 2011 identified 5,576 articles, of which 269 formed the basis of the review. We found that the dominant programme theories in relation to effective management related to: early intervention or referral by employers; having proactive organisational procedures; good communication and cooperation between stakeholders; and workplace-based occupational rehabilitation. Significant contextual factors were identified as the level of support for interventions from top management, the size and structure of the organisation, the level of financial and organisational investment in the management of long-term sickness absence, and the quality of relationships between managers and staff. Consequently, those with responsibility for managing absence should bear in mind the contextual factors that are likely to have an impact on interventions, and do what they can to ensure stakeholders have at least a mutual understanding (if not a common purpose) in relation to their perceptions of interventions, goals, culture and practice in the management of long term sickness absence.

Comparison of provider and plan-based targeting strategies for disease management.

PubMed

Annis, Ann M; Holtrop, Jodi Summers; Tao, Min; Chang, Hsiu-Ching; Luo, Zhehui

2015-05-01

We aimed to describe and contrast the targeting methods and engagement outcomes for health plan-delivered disease management with those of a provider-delivered care management program. Health plan epidemiologists partnered with university health services researchers to conduct a quasi-experimental, mixed-methods study of a 2-year pilot. We used semi-structured interviews to assess the characteristics of program-targeting strategies, and calculated target and engagement rates from clinical encounter data. Five physician organizations (POs) with 51 participating practices implemented care management. Health plan member lists were sent monthly to the practices to accept patients, and then the practices sent back data reports regarding targeting and engagement in care management. Among patients accepted by the POs, we compared those who were targeted and engaged by POs with those who met health plan targeting criteria. The health plan's targeting process combined claims algorithms and employer group preferences to identify candidates for disease management; on the other hand, several different factors influenced PO practices' targeting approaches, including clinical and personal knowledge of the patients, health assessment information, and availability of disease-relevant programs. Practices targeted a higher percentage of patients for care management than the health plan (38% vs 16%), where only 7% of these patients met the targeting criteria of both. Practices engaged a higher percentage of their targeted patients than the health plan (50% vs 13%). The health plan's claims-driven targeting approach and the clinically based strategies of practices both provide advantages; an optimal model may be to combine the strengths of each approach to maximize benefits in care management.

Managing diversity in health services organizations.

PubMed

Muller, H J; Haase, B E

1994-01-01

The changing ethnic, racial, and gender workforce characteristics require innovations in management philosophy and practice. Valuing employees' differences is believed to be a competitive advantage in many modern corporations. This article offers recommendations to health care managers for rethinking and improving the management of their heterogeneous workforces. A conceptual framework and evaluative criteria are developed in an attempt to better understand the factors that influence effective diversity management. The experiences of health services institutions in the Southwest (already a multicultural region) are studied to illustrate various approaches to diversity management. Leader philosophy and support, organizational policies and programs, workforce composition, structural integration, and organizational type constitute the main elements in this study. As the nation debates restructuring the health industry, it should also take the opportunity to integrate a management philosophy that values diversity and its practice.

Clinical factors affecting physicians' management decisions in cases of female partner abuse.

PubMed

Ferris, L E; Norton, P; Dunn, E V; Gort, E H

1999-06-01

This study determined which clinical factors influence Canadian primary care physicians' management decisions in cases of female partner abuse. We used a cross-sectional survey design and randomly sampled (n = 2,014) English-speaking Canadian physicians with a primary interest in family or general practice who were practicing in any of the 12 provinces and territories in Canada and who were active in private practice and registered to prescribe. Respondents completed a questionnaire that required them to score management decision plans in response to case scenarios illustrating typical office-based situations that might involve domestic violence. The response rate was 50.7% (n = 1,022). Using forward stepwise regression analysis, the strongest predictor of whether a physician endorsed a management plan in response to violence was whether the woman acknowledged or revealed the abuse. Male physicians were more likely than females to endorse talking with the suspected abuser if he was known to them, regardless of the quality of this patient-physician relationship with the abuser. Decisions about whether to deal with the abuse or the selection of a management plan are not dependent on the severity of the physical abuse and the emotional consequences. Whether a woman acknowledges or reveals the abuse, as well as whether both the male and female patients are in the physician's practice, are predictive of whether a physician's response to a case scenario involves dealing with spousal abuse and how he/she will address it.

Decisions about weight management: a synthesis of qualitative studies of obesity.

PubMed

Brown, I; Gould, J

2011-04-01

There is a high non-attendance and dropout attrition from weight management interventions for adults with obesity. Patient dissatisfaction with consultations involving decisions about interventions may be a factor. A systematic review was undertaken of qualitative studies reporting perceptions, experiences, contexts and influences for adults facing, or reflecting on, weight management. The aim was to synthesize a generic model of influences on decision-making about weight management for adult patients. Electronic database and hand searches identified 29 qualitative studies involving 1387 participants (mean age 45.3 years; mean BMI 37.1 kg m(-2) ; 79.9% women). Seven overarching themes were inductively derived from extracted data spanning: cultural identity; social structures such as gender; responses to obesity stigma; previous weight loss experiences; personal motivators and barriers; social support; and practical resources. A model is presented in the paper. Improving decisions about weight management requires attention to how diffuse cultural and psycho-social factors, such as obesity stigma, influence patient choices. Reflection on experiences of previous attempts at weight loss is also essential, as are practical resource factors - particularly for less affluent groups. Considering these factors along with more established theories of individual psychological motivations and barriers may help to improve initial participation and retention within interventions. © 2011 The Authors. Clinical Obesity © 2011 International Association for the Study of Obesity.

Workplace in fluency management: factoring the workplace into fluency management.

PubMed

Cassar, M C; Neilson, M D

1997-01-01

This article addresses competency-based standards and guidelines for the involvement of speech-language pathologists in the workplace of clients who stutter. It advocates broadening customary practices in stuttering treatment and suggests that speech-language pathologists should extend their scope of service delivery to the workplace. It presents a sequence for the collaborative involvement of the employer and other workplace members and proposes strategies for evaluating workplace based fluency programs. Issues of fluency management, transfer, maintenance, and efficacy are discussed in the workplace context. Also addressed is workplace communication as well as such factors as stereotypes, discrimination, and resistance to change which may impinge on workplace intervention. It is argued that structured intervention, transfer, and generalization within a collaborative workplace framework facilitates best practice for the fluency clinician and more appropriate outcomes for the diversity of clients who stutter.

Pathways to high and low performance: factors differentiating primary care facilities under performance-based financing in Nigeria

PubMed Central

Mabuchi, Shunsuke; Sesan, Temilade; Bennett, Sara C

2018-01-01

Abstract The determinants of primary health facility performance in developing countries have not been well studied. One of the most under-researched areas is health facility management. This study investigated health facilities under the pilot performance-based financing (PBF) scheme in Nigeria, and aimed to understand which factors differentiated primary health care centres (PHCCs) which had performed well, vs those which had not, with a focus on health facility management practices. We used a multiple case study where we compared two high-performing PHCCs and two low-performing PHCCs for each of the two PBF target states. Two teams of two trained local researchers spent 1 week at each PHCC and collected semi-structured interview, observation and documentary data. Data from interviews were transcribed, translated and coded using a framework approach. The data for each PHCC were synthesized to understand dynamic interactions of different elements in each case. We then compared the characteristics of high and low performers. The areas in which critical differences between high and low-performers emerged were: community engagement and support; and performance and staff management. We also found that (i) contextual and health system factors particularly staffing, access and competition with other providers; (ii) health centre management including community engagement, performance management and staff management; and (iii) community leader support interacted and drove performance improvement among the PHCCs. Among them, we found that good health centre management can overcome some contextual and health system barriers and enhance community leader support. This study findings suggest a strong need to select capable and motivated health centre managers, provide long-term coaching in managerial skills, and motivate them to improve their practices. The study also highlights the need to position engagement with community leaders as a key management practice and a central element of interventions to improve PHCC performance. PMID:29077844

Consensus statement on a framework for the management of comorbidity and extra-articular manifestations in rheumatoid arthritis.

PubMed

Loza, Estíbaliz; Lajas, Cristina; Andreu, Jose Luis; Balsa, Alejandro; González-Álvaro, Isidoro; Illera, Oscar; Jover, Juan Ángel; Mateo, Isabel; Orte, Javier; Rivera, Javier; Rodríguez Heredia, José Manuel; Romero, Fredeswinda; Martínez-López, Juan Antonio; Ortiz, Ana María; Toledano, Esther; Villaverde, Virginia; Carmona, Loreto; Castañeda, Santos

2015-03-01

The objective of the study was to develop evidence-based and practical recommendations for the detection and management of comorbidity in patients with rheumatoid arthritis (RA) in daily practice. We used a modified RAND/UCLA methodology and systematic review (SR). The process map and specific recommendations, based on the SR, were established in discussion groups. A two round Delphi survey permitted (1) to prioritize the recommendations, (2) to refine them, and (3) to evaluate their agreement by a large group of users. The recommendations cover: (1) which comorbidities should be investigated in clinical practice at the first and following visits (including treatments, risk factors and patient's features that might interfere with RA management); (2) how and when should comorbidities and risk factors be investigated; (3) how to manage specific comorbidities, related or non-related to RA, including major adverse events of RA treatment, and to promote health (general and musculoskeletal health); and (4) specific recommendations to assure an integral care approach for RA patients with any comorbidity, such as health care models for chronic inflammatory patients, early arthritis units, relationships with primary care, specialized nursing care, and self-management. These recommendations are intended to guide rheumatologists, patients, and other stakeholders, on the early diagnosis and management of comorbidity in RA, in order to improve disease outcomes.

The assessment and management of chemotherapy-induced nausea and vomiting among cancer patients in a chemotherapy ward: a best practice implementation project.

PubMed

Gu, Lingli; Li, Jing

2016-03-01

Chemotherapy-induced nausea and vomiting (CINV) are considered to be two of the most distressing side-effects of chemotherapy. They have a negative impact on a patient's quality of life and can influence the continuance of treatment. Owing to the lack of effective management of CINV, regular assessment and management of CINV is recommended for patients undergoing chemotherapy. The aim of this project was to integrate the available evidence on the assessment and management of CINV into practice, and implement strategies to improve compliance with evidence-based practice. The project carried out a pre- and post-implementation audit procedure using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs. Five audit criteria were established according to the best available evidence on the assessment and management of CINV. The program was divided into three phases and conducted over four months in the chemotherapy ward, Fudan University Shanghai Cancer Center, Shanghai, China. Sixty patients and 14 oncology nurses were involved in this project. The results of the follow-up cycle showed that the compliance rates regarding patient education, risk factors evaluation and non-pharmacologic managements were 100%, 100% and 80%, respectively. The rate of validated tools being used by patients and nurses improved by 93% and 97%, respectively. This project demonstrated that the use of pre- and post-best practice audits is an effective method for incorporating evidence into practice in a chemotherapy ward. The practice of assessing and managing CINV was significantly improved. The next step is to develop strategies for sustaining the new procedures of CINV assessment and management.

General business theory applied to the physician's practice.

PubMed

Shaw, D V

2002-01-01

In the pursuit of clinical excellence in today's competitive medical market place, practice managers--clinical or non-clinical--can loose sight of standard management and business principles that are key to success. Also, at times individuals are hesitant to identify a physician practice as a 'business,' preferring to see it as a social good. Still, it is a business--perhaps dealing with a product that is a social good, but still, a business. And, as such, benefits can be derived from a review of business management theory. This article provides a brief review of such theory and also illustrates how to apply this theory to the physician's practice. Key factors in building a successful business will be discussed and applied to the clinical practice, such as resource maximization, rate of return and product mix synergy. Some tools to assist the reader in analyzing their practice will also be provided, such as the RVU Analysis and the Ratio of Service Analysis.

Barriers to, and facilitators of post-operative pain management in Iranian nursing: a qualitative research study.

PubMed

Rejeh, N; Ahmadi, F; Mohammadi, E; Anoosheh, M; Kazemnejad, A

2008-12-01

Unrelieved post-operative pain continues to be a major clinical challenge, despite advances in management. Although nurses have embraced a crucial role in pain management, its extent is often limited in Iranian nursing practice. To determine Iranian nurses' perceptions of the barriers and facilitators influencing their management of post-operative pain. This study was qualitative with 26 participant nurses. Data were obtained through semi-structured serial interviews and analysed using the content analysis method. Several themes emerged to describe the factors that hindered or facilitated post-operative pain management. These were grouped into two main themes: (1) barriers to pain management after surgery with subgroups such as powerlessness, policies and rules of organization, physicians leading practice, time constraints, limited communication, interruption of activities relating to pain, and (2) factors that facilitated post-operative pain management that included the nurse-patient relationship, nurses' responsibility, the physician as a colleague, and nurses' knowledge and skills. Postoperative pain management in Iran is contextually complex, and may be controversial. Participants believed that in this context accurate pain management is difficult for nurses due to the barriers mentioned. Therefore, nurses make decisions and act as a patient comforter for pain after surgery because of the barriers to effective pain management.

Factors influencing evidence-based practice in prosthetics and orthotics.

PubMed

Andrysek, Jan; Christensen, James; Dupuis, Annie

2011-03-01

The importance of evidence-based practice is being recognized across a broad range of healthcare disciplines as a means for improving patient outcomes and also efficiently managing healthcare resources. The objective of this work was to obtain information from clinicians about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics. Cross sectional survey. An internet survey was developed and distributed to 300 prosthetists and orthotists currently practicing in Canada. A principal component factor analysis of the survey results revealed ten primary factors affecting evidence-based practice. These include time constraints, workload and system demands, limited relevant evidence from research, and gaps in skills and knowledge required to perform evidence-based practice. Clinicians value research as a means of improving clinical practice, but they are faced with a number of practical barriers in performing evidence-based practice. This study provides empirical data about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics. Such data are essential in order to inform those involved in improving existing clinical practices, including educators, professional organizations, and governing bodies.

Consumer perceptions on sustainable practices implemented in foodservice organizations in Korea

PubMed Central

Ju, Seyoung

2016-01-01

BACKGROUND/OBJECTIVES Sustainable practices in foodservice organizations including commercial and noncommercial ones are critical to ensure the protection of the environment for the future. With the rapid growth of the foodservice industry, wiser usage of input sources such as food, utilities, and single use packaging should be reconsidered for future generations. Therefore, this study aims to investigate the customer's perceptions on sustainable practices and to identify the relationship among sustainable practices, social contribution and purchase intention. SUBJECTS/METHODS The study was conducted using content analyses by reviewing articles on sustainable food service practices published domestically and abroad. Thereafter, data were collected with a face-to-face survey using a questionnaire and analyzed with factor analyses and multiple regressions. RESULTS Sustainable practices classified with factor analysis consisted of 6 dimensions of green food material procurement, sustainable food preparation, green packaging, preservation of energy, waste management, and public relations on green activity, with a total of 25 green activities in foodservice operations. Consumers were not very familiar with the green activities implemented in the foodservice unit, with the lowest awareness of "green food material procurement (2.46 out of 5 points)", and the highest awareness of "green packaging (3.74)" and "waste management (3.28). The factors influencing the perception of social contribution by foodservice organizations among 6 sustainable practice dimensions were found to be public relations on green activity (β = 0.154), waste management (β = 0.204) and sustainable food preparation (β = 0.183). Green packaging (β = 0.107) and the social contribution of the foodservice organization (β = 0.761) had strong relationships with the image of the organization. The purchase intentions of customers was affected only by the foodservice image (β = 0.775). CONCLUSIONS The results of this study suggest that sustainable practices by foodservice organization present a good image to customers and increase the awareness of valuable contributions that benefit the customer as well as the community. PMID:26865923

Consumer perceptions on sustainable practices implemented in foodservice organizations in Korea.

PubMed

Ju, Seyoung; Chang, Hyeja

2016-02-01

Sustainable practices in foodservice organizations including commercial and noncommercial ones are critical to ensure the protection of the environment for the future. With the rapid growth of the foodservice industry, wiser usage of input sources such as food, utilities, and single use packaging should be reconsidered for future generations. Therefore, this study aims to investigate the customer's perceptions on sustainable practices and to identify the relationship among sustainable practices, social contribution and purchase intention. The study was conducted using content analyses by reviewing articles on sustainable food service practices published domestically and abroad. Thereafter, data were collected with a face-to-face survey using a questionnaire and analyzed with factor analyses and multiple regressions. Sustainable practices classified with factor analysis consisted of 6 dimensions of green food material procurement, sustainable food preparation, green packaging, preservation of energy, waste management, and public relations on green activity, with a total of 25 green activities in foodservice operations. Consumers were not very familiar with the green activities implemented in the foodservice unit, with the lowest awareness of "green food material procurement (2.46 out of 5 points)", and the highest awareness of "green packaging (3.74)" and "waste management (3.28). The factors influencing the perception of social contribution by foodservice organizations among 6 sustainable practice dimensions were found to be public relations on green activity (β = 0.154), waste management (β = 0.204) and sustainable food preparation (β = 0.183). Green packaging (β = 0.107) and the social contribution of the foodservice organization (β = 0.761) had strong relationships with the image of the organization. The purchase intentions of customers was affected only by the foodservice image (β = 0.775). The results of this study suggest that sustainable practices by foodservice organization present a good image to customers and increase the awareness of valuable contributions that benefit the customer as well as the community.

Knowledge Creation in Constructivist Learning

ERIC Educational Resources Information Center

Jaleel, Sajna; Verghis, Alie Molly

2015-01-01

In today's competitive global economy characterized by knowledge acquisition, the concept of knowledge management has become increasingly prevalent in academic and business practices. Knowledge creation is an important factor and remains a source of competitive advantage over knowledge management. Constructivism holds that learners learn actively…

THE USE OF LANDSCAPE SCIENCE FOR THE ASSESSMENT OF ENVIROMENTAL SECURITY

EPA Science Inventory

The assessment of land use and land cover is an extremely important activity for contemporary land management. Human land-use practices (including type, magnitude, and distribution) are the most important factors influencing

environmental management at local, regional, nat...

How psychosocial factors affect well-being of practice assistants at work in general medical care?--a questionnaire survey.

PubMed

Goetz, Katja; Berger, Sarah; Gavartina, Amina; Zaroti, Stavria; Szecsenyi, Joachim

2015-11-11

Well-being at work is an important aspect of a workforce strategy. The aim of the study was to explore and evaluate psychosocial factors and health and work-related outcomes of practices assistants depending on their employment status in general medical practices. This observational study was based on a questionnaire survey to evaluate psychosocial aspects at work in general medical practices. A standardized questionnaire was used, the Copenhagen Psychosocial Questionnaire (COPSOQ). Beside descriptive analyses linear regression analyses were performed for each health and work-related outcome scale of the COPSOQ. 586 practice assistants out of 794 respondents (73.8 %) from 234 general medical practices completed the questionnaire. Practice assistants reported the highest scores for the psychosocial factor 'sense of community' (mean = 85.9) and the lower score for 'influence at work' (mean = 41.2). Moreover, practice assistants who worked part-time rated their psychosocial factors at work and health-related outcomes more positively than full-time employees. Furthermore, the two scales of health related outcomes 'burnout' and 'job satisfaction' showed strong associations between different psychosocial factors and socio-demographic variables. Psychosocial factors at work influence well-being at work and could be strong risk factors for poor health and work-related outcomes. Effective management of these issues could have an impact on the retention and recruitment of health care staff.

Risk factors and monitoring for water quality to determine best management practices for splash parks.

PubMed

de Man, H; Leenen, E J T M; van Knapen, F; de Roda Husman, A M

2014-09-01

Splash parks have been associated with infectious disease outbreaks as a result of exposure to poor water quality. To be able to protect public health, risk factors were identified that determine poor water quality. Samples were taken at seven splash parks where operators were willing to participate in the study. Higher concentrations of Escherichia coli were measured in water of splash parks filled with rainwater or surface water as compared with sites filled with tap water, independent of routine inspection intervals and employed disinfection. Management practices to prevent fecal contamination and guarantee maintaining good water quality at splash parks should include selection of source water of acceptable quality.

Predictors of Success for Electronic Health Record Implementation in Small Physician Practices

PubMed Central

Ancker, J.S.; Singh, M.P.; Thomas, R.; Edwards, A.; Snyder, A.; Kashyap, A.; Kaushal, R.

2013-01-01

Background The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs. Objectives Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management. Methods This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success. Results Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 – 26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success. Conclusions A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them. PMID:23650484

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.

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.

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.

Learning, Changing and Managing in Mental Health.

ERIC Educational Resources Information Center

Henderson, Jeanette

2001-01-01

Examined factors affecting the application of learning to practice in British mental health services, considering the role of administrators and emphasizing distance education. Data from administrators and health professionals indicated that workers who studied mental health often felt disempowered and isolated when introducing new practice ideas…

Influence of organizational factors on safety

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

Haber, S.B.; Metlay, D.S.; Crouch, D.A.

There is a need for a better understanding of exactly how organizational management factors at a nuclear power plant (NPP) affect plant safety performance, either directly or indirectly, and how these factors might be observed, measured, and evaluated. The purpose of this research project is to respond to that need by developing a general methodology for characterizing these organizational and management factors, systematically collecting information on their status and integrating that information into various types of evaluative activities. Research to date has included the development of the Nuclear Organization and Management Analysis Concept (NOMAC) of a NPP, the identification ofmore » key organizational and management factors, and the identification of the methods for systematically measuring and analyzing the influence of these factors on performance. Most recently, two field studies, one at a fossil fuel plant and the other at a NPP, were conducted using the developed methodology. Results are presented from both studies highlighting the acceptability, practicality, and usefulness of the methods used to assess the influence of various organizational and management factors including culture, communication, decision-making, standardization, and oversight. 6 refs., 3 figs., 1 tab.« less

Supervisors' perceptions of organizational policies are associated with their likelihood to accommodate back-injured workers.

PubMed

McGuire, Connor; Kristman, Vicki L; Shaw, William S; Loisel, Patrick; Reguly, Paula; Williams-Whitt, Kelly; Soklaridis, Sophie

2017-02-01

Background Low back pain (LBP) is a major concern among North American workplaces and little is known regarding a supervisor's decision to support job accommodation for workers with LBP. The extent to which supervisors are included in a company's effort to institute disability management policies and practices and workplace safety climate are two factors that may influence a supervisor's decision to accommodate workers with LBP. Objective Determine the association between supervisors' perceptions of disability management policies, corporate safety culture and their likelihood of supporting job accommodations for workers with LBP. Methods We conducted a cross-sectional study of supervisors (N=796) recruited from a non-random, convenience sample of 19 Canadian and US employers. The outcome was supervisors' likeliness to support job accommodation and the exposure was global work safety culture and disability management policies and practices. A multivariable generalized linear modelling strategy was used and final models for each exposure were obtained after assessing potential effect modifiers and confounders. Results In the study, 796 eligible supervisors from 19 employers participated. Disability management policies and practices were positively associated with supervisors' likeliness to accommodate (β=0.19; 95% CI: 0.13; 0.24) while no significant association was found between corporate safety culture (β= -0.084; 95% CI: -0.19; 0.027) and supervisors' likeliness to accommodate. Conclusions Employers should ensure that proactive disability management policies and practices are clearly communicated to supervisors in order to improve job modification and return to work efforts. Implications for Rehabilitation Low back pain (LBP) is a major workplace concern and little is known regarding what factors are associated with a supervisor's likelihood to support job accommodation for workers with LBP. The objective of this article was to determine the association between supervisors' perceptions of disability management policies and practices, corporate safety culture and their likelihood of support job accommodations for workers with LBP. Results suggest that disability management policies and practices are positively associated with supervisors' likelihood to accommodate while corporate safety culture is not. These results are important for employers as it suggests that employers should ensure that their disability management policies and practices are clearly communicated to supervisors in order to improve job accommodation and return to work efforts.

Management of gout in a South Auckland general practice.

PubMed

Reaves, Esther; Arroll, Bruce

2014-03-01

In New Zealand, the highest prevalence of gout is in Maori and Pacific people. Counties Manukau District Health Board (CMDHB) has the highest Maori and Pacific population of any New Zealand District Health Board. A CMDHB study found that a high proportion of patients with gout were also at increased risk of cardiovascular disease. The primary objective was to examine whether the control of gout had changed over time at one clinic. The secondary objective was to assess the management of cardiovascular risk factors in patients with gout at that clinic. The mean serum uric acid level of patients with gout in the practice had risen in comparison with a similar audit carried out in March 2009. This indicates that the control of gout for patients at the practice has worsened over time. Many patients had not had an annual serum uric acid test. A repeat uric acid level was scheduled for all patients with gout in the practice, with follow-up appointments to be arranged if the result was abnormal. Gout is often suboptimally managed. Serum uric acid levels may only be tested when a patient presents with an acute attack of gout. Consideration should be given to a minimum of annual serum uric acid levels. Appropriate management of modifiable cardiovascular risk factors in this particular cohort is important and should be a particular focus of care.

A linear regression approach to evaluate the green supply chain management impact on industrial organizational performance.

PubMed

Mumtaz, Ubaidullah; Ali, Yousaf; Petrillo, Antonella

2018-05-15

The increase in the environmental pollution is one of the most important topic in today's world. In this context, the industrial activities can pose a significant threat to the environment. To manage problems associate to industrial activities several methods, techniques and approaches have been developed. Green supply chain management (GSCM) is considered one of the most important "environmental management approach". In developing countries such as Pakistan the implementation of GSCM practices is still in its initial stages. Lack of knowledge about its effects on economic performance is the reason because of industries fear to implement these practices. The aim of this research is to perceive the effects of GSCM practices on organizational performance in Pakistan. In this research the GSCM practices considered are: internal practices, external practices, investment recovery and eco-design. While, the performance parameters considered are: environmental pollution, operational cost and organizational flexibility. A set of hypothesis propose the effect of each GSCM practice on the performance parameters. Factor analysis and linear regression are used to analyze the survey data of Pakistani industries, in order to authenticate these hypotheses. The findings of this research indicate a decrease in environmental pollution and operational cost with the implementation of GSCM practices, whereas organizational flexibility has not improved for Pakistani industries. These results aim to help managers regarding their decision of implementing GSCM practices in the industrial sector of Pakistan. Copyright © 2017 Elsevier B.V. All rights reserved.

Investigating factors influencing construction waste management efforts in developing countries: an experience from Thailand.

PubMed

Manowong, Ektewan

2012-01-01

Rapid economic growth and urbanization in developing countries lead to extensive construction activities that generate a large amount of waste. A challenge is how to manage construction waste in the most sustainable way. In the developing world, research on construction waste management is scarce and such academic knowledge needs to be responsive to actual practices in the industry in order to be implemented. As construction projects involve a number of participants and stakeholders, their participation and commitment can have a major influence on the goals of green and sustainable construction for urban development. This study provides a significant step in conducting a very first research of this kind in Thailand by aiming to investigate the level of construction stakeholders' commitment as well as the achievement of construction waste management in order to improve short-term practices and to establish a long-term strategic construction waste management plan. In this study, a structural equation model was employed to investigate the influence of factors that are related to environmental aspects, social aspects, and economic aspect of construction waste management. Concern about health and safety was found to be the most significant and dominant influence on the achievement of sustainable construction waste management. Other factors affecting the successful management of construction waste in Thai construction projects were also identified. It is perceived that this study has potential to contribute useful guidelines for practitioners both in Thailand and other developing countries with similar contexts.

Role stressors and coping strategies among nurse managers.

PubMed

Udod, Sonia; Cummings, Greta G; Care, W Dean; Jenkins, Megan

2017-02-06

Purpose The purpose of this paper is to share preliminary evidence about nurse managers' (NMs) role stressors and coping strategies in acute health-care facilities in Western Canada. Design/methodology/approach A qualitative exploratory inquiry provides deeper insight into NMs' perceptions of their role stressors, coping strategies and factors and practices in the organizational context that facilitate and hinder their work. A purposeful sample of 17 NMs participated in this study. Data were collected through individual interviews and a focus group interview. Braun and Clarke's (2006) six phase approach to thematic analysis guided data analysis. Findings Evidence demonstrates that individual factors, organizational practices and structures affect NMs stress creating an evolving role with unrealistic expectations, responding to continuous organizational change, a fragmented ability to effectively process decisions because of work overload, shifting organizational priorities and being at risk for stress-related ill health. Practical implications These findings have implications for organizational support, intervention programs that enhance leadership approaches, address individual factors and work processes and redesigning the role in consideration of the role stress and work complexity affecting NMs health. Originality/value It is anticipated that health-care leaders would find these results concerning and inspire them to take action to support NMs to do meaningful work as a way to retain existing managers and attract front line nurses to positions of leadership.

Safety climate practice in Korean manufacturing industry.

PubMed

Baek, Jong-Bae; Bae, Sejong; Ham, Byung-Ho; Singh, Karan P

2008-11-15

Safety climate survey was sent to 642 plants in 2003 to explore safety climate practices in the Korean manufacturing plants, especially in hazardous chemical treating plants. Out of 642 plants contacted 195 (30.4%) participated in the surveys. Data were collected by e-mail using SQL-server and mail. The main objective of this study was to explore safety climate practices (level of safety climate and the underlying problems). In addition, the variables that may influence the level of safety climate among managers and workers were explored. The questionnaires developed by health and safety executive (HSE) in the UK were modified to incorporate differences in Korean culture. Eleven important factors were summarized. Internal reliability of these factors was validated. Number of employees in the company varied from less than 30 employees (9.2%) to over 1000 employees (37.4%). Both managers and workers showed generally high level of safety climate awareness. The major underlying problems identified were inadequate health and safety procedures/rules, pressure for production, and rule breaking. The length of employment was a significant contributing factor to the level of safety climate. In this study, participants showed generally high level of safety climate, and length of employment affected the differences in the level of safety climate. Managers' commitment to comply safety rules, procedures, and effective safety education and training are recommended.

Attributes of nursing work environment as predictors of registered nurses' job satisfaction and intention to leave.

PubMed

Choi, Sandy Pin-Pin; Cheung, Kin; Pang, Samantha Mei-Che

2013-04-01

To examine how front-line registered nurses' perception of their work environment associates with and predicts nurse outcomes in terms of job satisfaction and turnover intention. Mounting evidence has pointed to an inseparable link between attributes of the nursing work environment and nurse outcomes. However, there is a paucity of research examining nurses' perception of their work environment beyond the Western context. This cross-sectional survey involved 1271 registered nurses working in 135 inpatient units in 10 public hospitals in Hong Kong. The instrument comprised items developed from in-depth interviews with front-line nurses that explored nurses' perception of their work environment. Factor analysis identified five dimensions (professionalism, co-worker relationship, management, staffing and resources, and ward practice) of the nursing work environment. Logistic regression analysis further identified professionalism, management and ward practice as significant factors in predicting nurses' turnover intention, and staffing and resources as an additional factor in predicting their job satisfaction. Attributes of the nursing work environment have a significant bearing on nurses' job satisfaction and intention to leave. Managerial effort should focus on improving nurses' work conditions through detailed resource planning, effective management and removal of work constraints that affect nursing practice. © 2012 Blackwell Publishing Ltd.

Embattled and embittered or empowered and evolving: nurse practitioner attitudes toward managed care.

PubMed

Hayes, Eileen F

2007-03-01

To explore the attitudes of nurse practitioners (NPs) toward managed care and to identify the sources of negative attitudes and the factors that may ameliorate them. NPs, members of the Massachusetts Coalition of NPs, participated in in-depth interviews about the impact of managed care on their practice. The sources of NP negativity about managed care for many study participants lay in their not appreciating the importance of the business aspects of practice and the provider's role in controlling healthcare costs, reluctance to work with what they perceived as a rigid "system," and lack of support for them to navigate it. They felt pressured by productivity issues, time constraints, practice restrictions, and documentation demands associated with reimbursement. Those who sustained a more positive attitude were realistic about healthcare economics, were willing and able to negotiate the system, were creative and flexible, and felt empowered by knowledge of the business of practice. Some NPs, however, chose to work in practices where they did not feel as pressured as their counterparts in large, busy primary care practices. IMPLICATIONS FOR NP PRACTICE AND EDUCATION: Understanding experiences that have influenced NP attitudes regarding managed care may assist NP faculty to better prepare NP students for their future roles. NPs must be able to challenge, yet be part of, an evolving system that promotes cost-effective health care for everyone, which was what managed care originally was intended to do.

Employer Factors Related to Workers' Compensation Claims and Disability Management.

ERIC Educational Resources Information Center

Habeck, Rochelle V.; And Others

1991-01-01

Explored empirical relationship between employer disability prevention and management practices and their workers' compensation claims experience. Data from 124 firms revealed high variability among firms within same industry and operating under same state workers' compensation statute. Findings support assumption that significant portion of…

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…

The Framework of Knowledge Creation for Online Learning Environments

ERIC Educational Resources Information Center

Huang, Hsiu­-Mei; Liaw, Shu­-Sheng

2004-01-01

In today's competitive global economy characterized by knowledge acquisition, the concept of knowledge management has become increasingly prevalent in academic and business practices. Knowledge creation is an important factor and remains a source of competitive advantage over knowledge management. Information technology facilitates knowledge…

Predictors of nurse practitioners' autonomy: effects of organizational, ethical, and market characteristics.

PubMed

Ulrich, Connie; Soeken, Karen; Miller, Nancy

2003-07-01

To identify the predictors of autonomy of nurse practitioners (NPs) affiliated directly and/or indirectly with managed-care systems (e.g., HMOs). A mailed survey sent to a stratified random sample of 254 NPs certified and licensed to practice in the state of Maryland. The measures consisted of selected organizational characteristics; market factors of HMO penetration and percentage of client population enrolled in managed care; and factors of ethical concern, such as ethical ideology, ethics education, and autonomy. The County Surveyor Database was used to assess market penetration in the state. Although NPs were ethically concerned about their autonomy in a managed-care environment (70.2%), actual autonomy scores were high. The higher the percentage of HMO penetration, percentage of client population enrolled in managed care, and perceived ethical concern, the lower the perceived autonomy of NPs. Findings may be used for future research to address the complexity of variables that influence the autonomous practice of NPs.

Ethical decision making in pain management: a conceptual framework.

PubMed

Carvalho, Ana Sofia; Martins Pereira, Sandra; Jácomo, António; Magalhães, Susana; Araújo, Joana; Hernández-Marrero, Pablo; Costa Gomes, Carlos; Schatman, Michael E

2018-01-01

The practice and study of pain management pose myriad ethical challenges. There is a consensual opinion that adequate management of pain is a medical obligation rooted in classical Greek practice. However, there is evidence that patients often suffer from uncontrolled and unnecessary pain. This is inconsistent with the leges artis, and its practical implications merit a bioethical analysis. Several factors have been identified as causes of uncontrolled and unnecessary pain, which deprive patients from receiving appropriate treatments that theoretically they have the right to access. Important factors include (with considerable regional, financial, and cultural differences) the following: 1) failure to identify pain as a priority in patient care; 2) failure to establish an adequate physician-patient relationship; 3) insufficient knowledge regarding adequate prescription of analgesics; 4) conflicting notions associated with drug-induced risk of tolerance and fear of addiction; 5) concerns regarding "last-ditch" treatments of severe pain; and 6) failure to be accountable and equitable. The aim of this article was to establish that bioethics can serve as a framework for addressing these challenging issues and, from theoretical to practical approaches, bioethical reflection can contextualize the problem of unrelieved pain. This article is organized into three parts. First, we illustrate that pain management and its undertreatment are indeed ethical issues. The second part describes possible ethical frameworks that can be combined and integrated to better define the ethical issues in pain management. Finally, we discuss possible directions forward to improve ethical decision making in pain management. We argue that 1) the treatment of pain is an ethical obligation, 2) health science schools, especially medical training institutions, have the duty to teach pain management in a comprehensive fashion, and 3) regulatory measures, which prevent patients from access to opioid treatment as indicated in their cases, are unethical and should be reconsidered. Developing an ethical framework for pain management will result in enhanced quality of care, linking the epistemic domains of pain management to their anthropological foundations, thereby making them ethically sound.

Silvicultural research and the evolution of forest practices in the Douglas-fir region.

Treesearch

Robert O. Curtis; Dean S. DeBell; Richard E. Miller; Michael Newton; J. Bradley St. Clair; William I. Stein

2007-01-01

Silvicultural practices in the Douglas-fir region evolved through a combination of formal research, observation, and practical experience of forest managers and silviculturists, and changing economic and social factors. This process began more than a century ago and still continues. It has had a great influence on the economic well-being of the region and on the...

"Stay cool, sell stuff cheap, and smile": Examining how reputational management of dental tourism reinforces structural oppression in Los Algodones, Mexico.

PubMed

Adams, Krystyna; Snyder, Jeremy; Crooks, Valorie A; Berry, Nicole S

2017-10-01

Los Algodones, Mexico is characteristic of other medical border towns whose proximity to the Mexico-United States border enables American and Canadian patients to take advantage of economic asymmetries on either side of the border to access desired health care. Los Algodones is unique, however, in its focus on the provision of dental care and claims by local residents that it has the highest concentration of dentists per capita in the world. In this paper, we present an analysis of interviews with employees working in Los Algodones' dental tourism industry to examine interviewees' participation in practices related to reputational management of the industry site. Drawing on our interview discussions, we argue that many of these reputational management practices reinforce structural injustices and raise concerns for structural exploitation in the industry. This analysis nuances ethical considerations for medical tourism by highlighting structural factors informing unjust practices within the industry, factors which might be relevant to other medical tourism contexts. Copyright © 2017 Elsevier Ltd. All rights reserved.

Epidemiology of Cranial Cruciate Ligament Disease Diagnosis in Dogs Attending Primary-Care Veterinary Practices in England.

PubMed

Taylor-Brown, Frances E; Meeson, Richard L; Brodbelt, Dave C; Church, David B; McGreevy, Paul D; Thomson, Peter C; O'Neill, Dan G

2015-08-01

To estimate the prevalence and risk factors for a diagnosis of cranial cruciate ligament (CCL) disease in dogs and to describe the management of such cases attending primary-care veterinary practices. Historical cohort with a nested case-control study. Nine hundred and fifty-three dogs diagnosed with CCL disease from 171,522 dogs attending 97 primary-care practices in England. Medical records of dogs attending practices participating in the VetCompass project that met selection criteria were assessed. Univariate and multivariate logistic regression methods were used to evaluate association of possible risk factors with diagnosis of CCL disease. The prevalence of CCL disease diagnosis was estimated at 0.56% (95% confidence interval 0.52-0.59). Compared with crossbred dogs, Rottweilers, West Highland White Terriers, Golden Retrievers, Yorkshire Terriers, and Staffordshire Bull Terriers showed increased odds of CCL disease diagnosis while Cocker Spaniels showed reduced odds. Increasing bodyweight within breeds was associated with increased odds of diagnosis. Dogs aged over 3 years had increased odds of diagnosis compared with dogs aged less than 3 years. Neutered females had 2.1 times the odds of diagnosis compared with entire females. Insured dogs had 4 times the odds of diagnosis compared with uninsured dogs. Two-thirds of cases were managed surgically, with insured and heavier dogs more frequently undergoing surgery. Overall, 21% of cases were referred, with referral more frequent in heavier and insured dogs. Referred dogs more frequently had surgery and an osteotomy procedure. Breed predispositions and demographic factors associated with diagnosis and case management of CCL disease in dogs identified in this study can be used to help direct future research and management strategies. © Copyright 2015 by The American College of Veterinary Surgeons.

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

PubMed

Griffiths, Peter; Maben, Jill; Murrells, Trevor

2011-10-01

An association between quality of care and staffing levels, particularly registered nurses, has been established in acute hospitals. Recently an association between nurse staffing and quality of care for several chronic conditions has also been demonstrated for primary care in English general practice. A smaller body of literature identifies organisational factors, in particular issues of human resource management, as being a dominant factor. However the literature has tended to consider staffing and organisational factors separately. We aim to determine whether relationships between the quality of clinical care and nurse staffing in general practice are attenuated or enhanced when organisational factors associated with quality of care are considered. We further aim to determine the relative contribution and interaction between these factors. We used routinely collected data from 8409 English general practices. The data, on organisational factors and the quality of clinical care for a range of long term conditions, is gathered as part of "Quality and Outcomes Framework" pay for performance system. Regression models exploring the relationship of staffing and organisational factors with care quality were fitted using MPLUS statistical modelling software. Higher levels of nurse staffing, clinical recording, education and reflection on the results of patient surveys were significantly associated with improved clinical care for COPD, CHD, Diabetes and Hypothyroidism after controlling for organisational factors. There was some evidence of attenuation of the estimated nurse staffing effect when organisational factors were considered, but this was small. The effect of staffing interacted significantly with the effect of organisational factors. Overall however, the characteristics that emerged as the strongest predictors of quality of clinical care were not staffing levels but the organisational factors of clinical recording, education and training and use of patient experience surveys. Organisational factors contribute significantly to observed variation in the quality of care in English general practices. Levels of nurse staffing have an independent association with quality but also interact with organisational factors. The observed relationships are not necessarily causal but a causal relationship is plausible. The benefits and importance of education, training and personal development of nursing and other practice staff was clearly indicated. Copyright © 2011. Published by Elsevier Ltd.

An Assessment of Air Force Development Portfolio Management Practices

DTIC Science & Technology

2002-01-01

of Product Innovation Management , 12, 235–246. Cooper, R. G., & Kleinschmidt, E. J. (1995). Benchmarking the firm’s criti- cal success factors in new...product development. Journal of Product Innovation Management , 12, 374– 391. Cooper, R. G., Edgett, S. J., & Klein- schmidt, E. J. (1998a). Best...Scott, G. M. (2000). Critical technology management issues of new product development in high-tech companies. Journal of Product Innovation Management , 17

Innovative physical therapy practice: a qualitative verification of factors that support diffusion of innovation in outpatient physical therapy practice

PubMed Central

Sabus, Carla; Spake, Ellen

2016-01-01

Background and purpose New ideas, methods, and technologies spread through cultures through typical patterns described by diffusion of innovation (DOI) theory. Professional cultures, including the physical therapy profession, have distinctive features and traditions that determine the adoption of practice innovation. The Consolidated Framework for Implementation Research (CFIR) proposes a framework of innovation implementation specific to health care services. While the CFIR has been applied to medical and nursing practice, it has not been extended to rehabilitation professions. The purpose of this qualitative study was to verify the CFIR factors in outpatient physical therapy practice. Design Through a nomination process of area rehabilitation managers and area directors of clinical education, 2 exemplar, outpatient, privately owned physical therapy clinics were identified as innovation practices. A total of 18 physical therapists (PTs), including 3 owners and a manager, participated in the study. Methods The 2 clinics served as case studies within a qualitative approach of directed content analysis. Data were collected through observation, spontaneous, unstructured questioning, workflow analysis, structured focus group sessions, and artifact analysis including clinical documents. Focus group data were transcribed. All the data were analyzed and coded among 4 investigators. Results Through data analysis and alignment with literature in DOI theory in health care practice, the factors that determine innovation adoption were verified. The phenomena of implementation in PT practice are largely consistent with models of implementation in health care service. Within the outpatient practices studied, patient-centered care and collaborative learning were foundational elements to diffusion of an innovation. Conclusion Innovation in outpatient physical therapy practice can be understood as a social process situated within the culture of the physical therapy professional that follows predictable patterns that strongly align with DOI theory and the CFIR. PMID:29355199

Innovative physical therapy practice: a qualitative verification of factors that support diffusion of innovation in outpatient physical therapy practice.

PubMed

Sabus, Carla; Spake, Ellen

2016-01-01

New ideas, methods, and technologies spread through cultures through typical patterns described by diffusion of innovation (DOI) theory. Professional cultures, including the physical therapy profession, have distinctive features and traditions that determine the adoption of practice innovation. The Consolidated Framework for Implementation Research (CFIR) proposes a framework of innovation implementation specific to health care services. While the CFIR has been applied to medical and nursing practice, it has not been extended to rehabilitation professions. The purpose of this qualitative study was to verify the CFIR factors in outpatient physical therapy practice. Through a nomination process of area rehabilitation managers and area directors of clinical education, 2 exemplar, outpatient, privately owned physical therapy clinics were identified as innovation practices. A total of 18 physical therapists (PTs), including 3 owners and a manager, participated in the study. The 2 clinics served as case studies within a qualitative approach of directed content analysis. Data were collected through observation, spontaneous, unstructured questioning, workflow analysis, structured focus group sessions, and artifact analysis including clinical documents. Focus group data were transcribed. All the data were analyzed and coded among 4 investigators. Through data analysis and alignment with literature in DOI theory in health care practice, the factors that determine innovation adoption were verified. The phenomena of implementation in PT practice are largely consistent with models of implementation in health care service. Within the outpatient practices studied, patient-centered care and collaborative learning were foundational elements to diffusion of an innovation. Innovation in outpatient physical therapy practice can be understood as a social process situated within the culture of the physical therapy professional that follows predictable patterns that strongly align with DOI theory and the CFIR.

A quantitative analysis of attitudes and behaviours concerning sustainable parasite control practices from Scottish sheep farmers.

PubMed

Jack, Corin; Hotchkiss, Emily; Sargison, Neil D; Toma, Luiza; Milne, Catherine; Bartley, David J

2017-04-01

Nematode control in sheep, by strategic use of anthelmintics, is threatened by the emergence of roundworms populations that are resistant to one or more of the currently available drugs. In response to growing concerns of Anthelmintic Resistance (AR) development in UK sheep flocks, the Sustainable Control of Parasites in Sheep (SCOPS) initiative was set up in 2003 in order to promote practical guidelines for producers and advisors. To facilitate the uptake of 'best practice' approaches to nematode management, a comprehensive understanding of the various factors influencing sheep farmers' adoption of the SCOPS principles is required. A telephone survey of 400 Scottish sheep farmers was conducted to elicit attitudes regarding roundworm control, AR and 'best practice' recommendations. A quantitative statistical analysis approach using structural equation modelling was chosen to test the relationships between both observed and latent variables relating to general roundworm control beliefs. A model framework was developed to test the influence of socio-psychological factors on the uptake of sustainable (SCOPS) and known unsustainable (AR selective) roundworm control practices. The analysis identified eleven factors with significant influences on the adoption of SCOPS recommended practices and AR selective practices. Two models established a good fit with the observed data with each model explaining 54% and 47% of the variance in SCOPS and AR selective behaviours, respectively. The key influences toward the adoption of best practice parasite management, as well as demonstrating negative influences on employing AR selective practices were farmer's base line understanding about roundworm control and confirmation about lack of anthelmintic efficacy in a flock. The findings suggest that improving farmers' acceptance and uptake of diagnostic testing and improving underlying knowledge and awareness about nematode control may influence adoption of best practice behaviour. Copyright © 2017 Elsevier B.V. All rights reserved.

Waste management barriers in developing country hospitals: Case study and AHP analysis.

PubMed

Delmonico, Diego V de Godoy; Santos, Hugo H Dos; Pinheiro, Marco Ap; de Castro, Rosani; de Souza, Regiane M

2018-01-01

Healthcare waste management is an essential field for both researchers and practitioners. Although there have been few studies using statistical methods for its evaluation, it has been the subject of several studies in different contexts. Furthermore, the known precarious practices for waste management in developing countries raise questions about its potential barriers. This study aims to investigate the barriers in healthcare waste management and their relevance. For this purpose, this paper analyses waste management practices in two Brazilian hospitals by using case study and the Analytic Hierarchy Process method. The barriers were organized into three categories - human factors, management, and infrastructure, and the main findings suggest that cost and employee awareness were the most significant barriers. These results highlight the main barriers to more sustainable waste management, and provide an empirical basis for multi-criteria evaluation of the literature.

Perioperative management of haemophilia B: A critical appraisal of the evidence and current practices.

PubMed

Neufeld, E J; Solimeno, L; Quon, D; Walsh, C; Seremetis, S; Cooper, D; Iyer, N N; Hoxer, C S; Giangrande, P

2017-11-01

While there is substantial literature addressing the principles of general management of haemophilia, literature on perioperative management of haemostasis is scarce. The aim of this study was to better understand perioperative management among congenital haemophilia B patients (without inhibitors) and to gain insights into real-world surgical practices. A systematic literature review, with an emphasis on haemophilia B, was conducted using EMBASE ® , Medline ® and the Cochrane Library. Studies from 1974 to June 2015 were accessed, and 132 studies were eligible for the full-study review. An international expert panel with five haematologists and one surgeon reviewed the resulting literature and provided further insights. The literature review revealed that documented experience in the perioperative management of bleeding risk in haemophilia B patients is relatively scarce. Therefore, the review was amended to provide a comprehensive overview of the perioperative management for haemophilia A and B patients; the expert panel applied a particular focus to haemophilia B. Several gaps were identified in the literature including the lack of consensus on defining surgery in terms of bleeding risk, optimal factor levels during surgery and lack of robust evidence on surgical outcomes. The ensuing discussions with the expert panel provided validation of some of the results from the systematic literature review and proposed future directions for perioperative management. Suggestions included collaboration with haemophilia treatment centres (HTCs) to collect real-world data on perioperative management, establishing the need for optimal factor level monitoring practice, and the appropriate adoption of extended half-life products in clinical settings. © 2017 John Wiley & Sons Ltd.

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.

Models meet data: Challenges and opportunities in implementing land management in Earth system models.

PubMed

Pongratz, Julia; Dolman, Han; Don, Axel; Erb, Karl-Heinz; Fuchs, Richard; Herold, Martin; Jones, Chris; Kuemmerle, Tobias; Luyssaert, Sebastiaan; Meyfroidt, Patrick; Naudts, Kim

2018-04-01

As the applications of Earth system models (ESMs) move from general climate projections toward questions of mitigation and adaptation, the inclusion of land management practices in these models becomes crucial. We carried out a survey among modeling groups to show an evolution from models able only to deal with land-cover change to more sophisticated approaches that allow also for the partial integration of land management changes. For the longer term a comprehensive land management representation can be anticipated for all major models. To guide the prioritization of implementation, we evaluate ten land management practices-forestry harvest, tree species selection, grazing and mowing harvest, crop harvest, crop species selection, irrigation, wetland drainage, fertilization, tillage, and fire-for (1) their importance on the Earth system, (2) the possibility of implementing them in state-of-the-art ESMs, and (3) availability of required input data. Matching these criteria, we identify "low-hanging fruits" for the inclusion in ESMs, such as basic implementations of crop and forestry harvest and fertilization. We also identify research requirements for specific communities to address the remaining land management practices. Data availability severely hampers modeling the most extensive land management practice, grazing and mowing harvest, and is a limiting factor for a comprehensive implementation of most other practices. Inadequate process understanding hampers even a basic assessment of crop species selection and tillage effects. The need for multiple advanced model structures will be the challenge for a comprehensive implementation of most practices but considerable synergy can be gained using the same structures for different practices. A continuous and closer collaboration of the modeling, Earth observation, and land system science communities is thus required to achieve the inclusion of land management in ESMs. © 2017 John Wiley & Sons Ltd.

Factors influencing the perception of medical staff and outpatients of dual practice in Shanghai, People's Republic of China.

PubMed

Chen, Haiping; Li, Meina; Dai, Zhixin; Deng, Qiangyu; Zhang, Lulu

2016-01-01

Dual practice is defined as a physician's performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people's perception. A cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis. The study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals' human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients. This study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of publicity activities and more flexible management system of hospitals' human resource would promote physicians' willingness to participate in dual practice. In addition, perception of outpatients of dual practice was affected by demographic characteristics.

Factors influencing the perception of medical staff and outpatients of dual practice in Shanghai, People’s Republic of China

PubMed Central

Chen, Haiping; Li, Meina; Dai, Zhixin; Deng, Qiangyu; Zhang, Lulu

2016-01-01

Objective Dual practice is defined as a physician’s performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people’s perception. Methods A cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis. Results The study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals’ human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients. Conclusion This study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of publicity activities and more flexible management system of hospitals’ human resource would promote physicians’ willingness to participate in dual practice. In addition, perception of outpatients of dual practice was affected by demographic characteristics. PMID:27621600

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.

Using risk assessment in periodontics.

PubMed

Woodman, Alan J

2014-08-01

Risk assessment has become a regular feature in both dental practice and society as a whole, and principles used to assess risk in society are similar to those used in a clinical setting. Although the concept of risk assessment as a prognostic indicator for periodontal disease incidence and activity is well established in the management of periodontitis, the use of risk assessment to manage the practical treatment of periodontitis and its sequelae appears to have less foundation. A simple system of initial risk assessment - building on the use of the Basic Periodontal Examination (BPE), clinical, medical and social factors - is described, linked to protocols for delivering care suited to general dental practice and stressing the role of long-term supportive care. The risks of not treating the patient are considered, together with the possible causes of failure, and the problems of successful treatment are illustrated by the practical management of post-treatment recession.

Factors associated with early childhood education and care service implementation of healthy eating and physical activity policies and practices in Australia: a cross-sectional study.

PubMed

Wolfenden, Luke; Finch, Meghan; Nathan, Nicole; Weaver, Natasha; Wiggers, John; Yoong, Sze Lin; Jones, Jannah; Dodds, Pennie; Wyse, Rebecca; Sutherland, Rachel; Gillham, Karen

2015-09-01

Many early childhood education and care (ECEC) services fail to implement recommended policies and practices supportive of healthy eating and physical activity. The purpose of this study was to assess whether certain theoretically-based factors are associated with implementation of healthy eating and physical activity policies and practices in a sample of ECEC services. A cross-sectional survey was conducted with Service Managers of ECEC services. The survey assessed the operational characteristics, policy, and practice implementation, and 13 factors were suggested by Damschroder's Consolidated Framework for Implementation Research to impede or promote implementation. Logistic regression analyses found a significant association between implementation factor score and full implementation (OR 1.38; 95% CI 1.18-1.61; p = <0.01), indicating that for every one point increase in implementation score, ECEC services were 38 % more likely to be fully implementing the policies and practices. The findings highlight the opportunities for improving implementation of obesity prevention interventions in this setting by developing interventions that address such factors.

A mixed methods evaluation of the maternal-newborn dashboard in Ontario: dashboard attributes, contextual factors, and facilitators and barriers to use: a study protocol.

PubMed

Dunn, Sandra; Sprague, Ann E; Grimshaw, Jeremy M; Graham, Ian D; Taljaard, Monica; Fell, Deshayne; Peterson, Wendy E; Darling, Elizabeth; Harrold, JoAnn; Smith, Graeme N; Reszel, Jessica; Lanes, Andrea; Truskoski, Carolyn; Wilding, Jodi; Weiss, Deborah; Walker, Mark

2016-05-04

There are wide variations in maternal-newborn care practices and outcomes across Ontario. To help institutions and care providers learn about their own performance, the Better Outcomes Registry & Network (BORN) Ontario has implemented an audit and feedback system, the Maternal-Newborn Dashboard (MND), for all hospitals providing maternal-newborn care. The dashboard provides (1) near real-time feedback, with site-specific and peer comparison data about six key performance indicators; (2) a visual display of evidence-practice gaps related to the indicators; and (3) benchmarks to provide direction for practice change. This study aims to evaluate the effects of the dashboard, dashboard attributes, contextual factors, and facilitation/support needs that influence the use of this audit and feedback system to improve performance. The objectives of this study are to (1) evaluate the effect of implementing the dashboard across Ontario; (2) explore factors that potentially explain differences in the use of the MND among hospitals; (3) measure factors potentially associated with differential effectiveness of the MND; and (4) identify factors that predict differences in hospital performance. A mixed methods design includes (1) an interrupted time series analysis to evaluate the effect of the intervention on six indicators, (2) key informant interviews with a purposeful sample of directors/managers from up to 20 maternal-newborn care hospitals to explore factors that influence the use of the dashboard, (3) a provincial survey of obstetrical directors/managers from all maternal-newborn hospitals in the province to measure factors that influence the use of the dashboard, and (4) a multivariable generalized linear mixed effects regression analysis of the indicators at each hospital to quantitatively evaluate the change in practice following implementation of the dashboard and to identify factors most predictive of use. Study results will provide essential data to develop knowledge translation strategies for facilitating practice change, which can be further evaluated through a future cluster randomized trial.

Associations of farm management practices with annual milk sales on smallholder dairy farms in Kenya.

PubMed

Richards, Shauna; VanLeeuwen, John; Shepelo, Getrude; Gitau, George Karuoya; Kamunde, Collins; Uehlinger, Fabienne; Wichtel, Jeff

2015-01-01

Cows on smallholder dairy farms (SDF) in developing countries such as Kenya typically produce volumes of milk that are well below their genetic potential. An epidemiological study was conducted to determine reasons for this low milk production, including limited use of best management practices, such as suboptimal nutritional management. An observational cross-sectional study of 111 SDF was performed in Nyeri County, Kenya in June of 2013 determining the effect of cow factors, farmer demographics and farm management practices on the volume of milk sold per cow per year (kg milk sold/cow). In particular, the effect of feeding high protein fodder trees and other nutritional management practices were examined. Approximatly 38% of farmers fed fodder trees, but such feeding was not associated with volume of milk sold per cow, likely due to the low number of fodder trees per farm. Volume of milk sold per cow was positively associated with feeding dairy meal during the month prior to calving, feeding purchased hay during the past year, deworming cows every 4 or more months (as opposed to more regularly), and having dairy farming as the main source of family income. Volume of milk sold per cow was negatively associated with a household size of >5 people and feeding Napier grass at >2 meters in height during the dry season. An interaction between gender of the principal farmer and feed shortages was noted; volume of milk sold per cow was lower when female farmers experienced feed shortages whereas milk sold per cow was unaffected when male farmers experienced feed shortages. These demographic and management risk factors should be considered by smallholder dairy farmers and their advisors when developing strategies to improve income from milk sales and animal-source food availability for the farming families.

How we use recombinant activated Factor VII in patients with haemophilia A or B complicated by inhibitors. Working group of hematology experts from Australia and New Zealand, Melbourne, April 2011.

PubMed

Brown, S A; Barnes, C; Curtin, J; Dunkley, S; Ockelford, P; Phillips, J; Rowell, J; Smith, M; Tran, H

2012-11-01

The management of bleeds in patients with haemophilia A or B complicated by inhibitors is complex. Recombinant activated Factor VII (rFVIIa; NovoSeven RT) is an established therapy in these patients. To develop a consensus-based guide on the practical usage of rFVIIa in haemophilia complicated by inhibitors, nine expert haemophilia specialists from Australia and New Zealand developed practice points on the usage of rFVIIa, based on their experience and supported by published data. Practice points were developed for 13 key topics: control of acute bleeding; prophylaxis; surgical prophylaxis; control of breakthrough bleeding during surgery or treatment of acute bleeds; paediatric use; use in elderly; intracranial haemorrhage; immune tolerance induction; difficult bleeds; clinical monitoring of therapy; laboratory monitoring of therapy; concomitant antifibrinolytic medication; practical dosing. Access to home therapy with rFVIIa is important in allowing patients to administer treatment early in bleed management. In adults, 90-120 μg/kg is the favoured starting dose in most settings. Initial dosing using 90-180 μg/kg is recommended for children due to the effect of age on the pharmacokinetics of rFVIIa. In the management of acute bleeds, 2-hourly dosing is appropriate until bleeding is controlled, with concomitant antifibrinolytic medication unless contraindicated. The practice points provide guidance on the usage of rFVIIa for all clinicians involved in the management of haemophilia complicated by inhibitors. © 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

The feasibility and acceptability of nurse-led chronic disease management interventions in primary care: An integrative review.

PubMed

Stephen, Catherine; McInnes, Susan; Halcomb, Elizabeth

2018-02-01

To explore the feasibility and acceptability of nurse-led chronic disease management and lifestyle risk factor reduction interventions in primary care (general practice/family practice). Growing international evidence suggests that interventions delivered by primary care nurses can assist in modifying lifestyle risk factors and managing chronic disease. To date, there has been limited exploration of the feasibility and acceptability of such interventions. Integrative review guided by the work of Whittemore and Knafl (). Database search of CINAHL, Medline and Web of Science was conducted to identify relevant literature published between 2000-2015. Papers were assessed for methodological quality and data abstracted before thematic analysis was undertaken. Eleven papers met the inclusion criteria. Analysis uncovered four themes: (1) facilitators of interventions; (2) barriers to interventions; (3) consumer satisfaction; and (4) primary care nurse role. Literature supports the feasibility and acceptability of nurse-led interventions in primary care for lifestyle risk factor modification. The ongoing sustainability of these interventions rests largely on organizational factors such as funding, educational pathways and professional support of the primary care nursing role. Further robust research around primary care nurse interventions is required to strengthen the evidence base. © 2017 John Wiley & Sons Ltd.

Evaluating hybrid bermudagrass using spectral reflectance under different mowing heights and trinexapac-ethyl applications

USDA-ARS?s Scientific Manuscript database

Quantitative spectral reflectance data has the potential to improve the evaluation of turfgrass variety trials when management practices are factors in the testing of turf aesthetics and functionality. However, the practical application of this methodology has not been well-developed. The objectives...

Dimensionality of Upper Elementary Mathematics Instruction: Exploring Factors across Two Observational Instruments

ERIC Educational Resources Information Center

Blazar, David; Braslow, David; Charalambous, Charalambos Y.

2015-01-01

Over the past several years, research teams have developed observational instruments to measure the quality of teachers' instructional practices. Instruments such as Framework for Teaching (FFT) and the Classroom Assessment Scoring System (CLASS) assess general teaching practices, including student-teacher interactions, behavior management, and…

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.

[Discussion on developing a data management plan and its key factors in clinical study based on electronic data capture system].

PubMed

Li, Qing-na; Huang, Xiu-ling; Gao, Rui; Lu, Fang

2012-08-01

Data management has significant impact on the quality control of clinical studies. Every clinical study should have a data management plan to provide overall work instructions and ensure that all of these tasks are completed according to the Good Clinical Data Management Practice (GCDMP). Meanwhile, the data management plan (DMP) is an auditable document requested by regulatory inspectors and must be written in a manner that is realistic and of high quality. The significance of DMP, the minimum standards and the best practices provided by GCDMP, the main contents of DMP based on electronic data capture (EDC) and some key factors of DMP influencing the quality of clinical study were elaborated in this paper. Specifically, DMP generally consists of 15 parts, namely, the approval page, the protocol summary, role and training, timelines, database design, creation, maintenance and security, data entry, data validation, quality control and quality assurance, the management of external data, serious adverse event data reconciliation, coding, database lock, data management reports, the communication plan and the abbreviated terms. Among them, the following three parts are regarded as the key factors: designing a standardized database of the clinical study, entering data in time and cleansing data efficiently. In the last part of this article, the authors also analyzed the problems in clinical research of traditional Chinese medicine using the EDC system and put forward some suggestions for improvement.

Understanding diagnosis and management of dementia and guideline implementation in general practice: a qualitative study using the theoretical domains framework.

PubMed

Murphy, Kerry; O'Connor, Denise A; Browning, Colette J; French, Simon D; Michie, Susan; Francis, Jill J; Russell, Grant M; Workman, Barbara; Flicker, Leon; Eccles, Martin P; Green, Sally E

2014-03-03

Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important role in diagnosing and managing dementia; however, there are gaps between recommended and current practice. The aim of this study was to explore GPs' reported practice in diagnosing and managing dementia and to describe, in theoretical terms, the proposed explanations for practice that was and was not consistent with evidence-based guidelines. Semi-structured interviews were conducted with GPs in Victoria, Australia. The Theoretical Domains Framework (TDF) guided data collection and analysis. Interviews explored the factors hindering and enabling achievement of 13 recommended behaviours. Data were analysed using content and thematic analysis. This paper presents an in-depth description of the factors influencing two behaviours, assessing co-morbid depression using a validated tool, and conducting a formal cognitive assessment using a validated scale. A total of 30 GPs were interviewed. Most GPs reported that they did not assess for co-morbid depression using a validated tool as per recommended guidance. Barriers included the belief that depression can be adequately assessed using general clinical indicators and that validated tools provide little additional information (theoretical domain of 'Beliefs about consequences'); discomfort in using validated tools ('Emotion'), possibly due to limited training and confidence ('Skills'; 'Beliefs about capabilities'); limited awareness of the need for, and forgetting to conduct, a depression assessment ('Knowledge'; 'Memory, attention and decision processes'). Most reported practising in a manner consistent with the recommendation that a formal cognitive assessment using a validated scale be undertaken. Key factors enabling this were having an awareness of the need to conduct a cognitive assessment ('Knowledge'); possessing the necessary skills and confidence ('Skills'; 'Beliefs about capabilities'); and having adequate time and resources ('Environmental context and resources'). This is the first study to our knowledge to use a theoretical approach to investigate the barriers and enablers to guideline-recommended diagnosis and management of dementia in general practice. It has identified key factors likely to explain GPs' uptake of the guidelines. The results have informed the design of an intervention aimed at supporting practice change in line with dementia guidelines, which is currently being evaluated in a cluster randomised trial.

Modifications of coronary risk factors.

PubMed

Albu, Jeanine; Gottlieb, Sheldon H; August, Phyllis; Nesto, Richard W; Orchard, Trevor J

2006-06-19

In addition to the revascularization and glycemic management interventions assigned at random, the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) design includes the uniform control of major coronary artery disease risk factors, including dyslipidemia, hypertension, smoking, central obesity, and sedentary lifestyle. Target levels for risk factors were adjusted throughout the trial to comply with changes in recommended clinical practice guidelines. At present, the goals are low-density lipoprotein cholesterol <2.59 mmol/L (<100 mg/dL) with an optional goal of <1.81 mmol/L (<70 mg/dL); plasma triglyceride level <1.70 mmol/L (<150 mg/dL); blood pressure level <130 mm Hg systolic and <80 mm Hg diastolic; and smoking cessation treatment for all active smokers. Algorithms were developed for the pharmacologic management of dyslipidemia and hypertension. Dietary prescriptions for the management of glycemia, plasma lipid profiles, and blood pressure levels were adapted from existing clinical practice guidelines. Patients with a body mass index >25 were prescribed moderate caloric restriction; after the trial was under way, a lifestyle weight-management program was instituted. All patients were formally prescribed both endurance and resistance/flexibility exercises, individually adapted to their level of disability and fitness. Pedometers were distributed as a biofeedback strategy. Strategies to achieve the goals for risk factors were designed by BARI 2D working groups (lipid, cardiovascular and hypertension, and nonpharmacologic intervention) and the ongoing implementation of the strategies is monitored by lipid, hypertension, and lifestyle intervention management centers.

Modifications of Coronary Risk Factors

PubMed Central

Albu, Jeanine; Gottlieb, Sheldon H.; August, Phyllis; Nesto, Richard W.; Orchard, Trevor J.

2009-01-01

In addition to the revascularization and glycemic management interventions assigned at random, the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) design includes the uniform control of major coronary artery disease risk factors, including dyslipidemia, hypertension, smoking, central obesity, and sedentary lifestyle. Target levels for risk factors were adjusted throughout the trial to comply with changes in recommended clinical practice guidelines. At present, the goals are low-density lipoprotein cholesterol <2.59 mmol/L (<100 mg/dL) with an optional goal of <1.81 mmol/L (<70 mg/dL); plasma triglyceride level <1.70 mmol/L (<150 mg/dL); blood pressure level <130 mm Hg systolic and <80 mm Hg diastolic; and smoking cessation treatment for all active smokers. Algorithms were developed for the pharmacologic management of dyslipidemia and hypertension. Dietary prescriptions for the management of glycemia, plasma lipid profiles, and blood pressure levels were adapted from existing clinical practice guidelines. Patients with a body mass index >25 were prescribed moderate caloric restriction; after the trial was under way, a lifestyle weight-management program was instituted. All patients were formally prescribed both endurance and resistance/flexibility exercises, individually adapted to their level of disability and fitness. Pedometers were distributed as a biofeedback strategy. Strategies to achieve the goals for risk factors were designed by BARI 2D working groups (lipid, cardiovascular and hypertension, and nonpharmacologic intervention) and the ongoing implementation of the strategies is monitored by lipid, hypertension, and lifestyle intervention management centers. PMID:16813737

Influence of socio-demographic, labour and professional factors on nursing perception concerning practice environment in Primary Health Care.

PubMed

Parro Moreno, Ana; Serrano Gallardo, Pilar; Ferrer Arnedo, Carmen; Serrano Molina, Lucía; de la Puerta Calatayud, M Luisa; Barberá Martín, Aurora; Morales Asencio, José Miguel; de Pedro Gómez, Joan

2013-11-01

To analyze the perception of nursing professionals of the Madrid Primary Health Care environment in which they practice, as well as its relationship with socio-demographic, work-related and professional factors. Cross-sectional, analytical, observational study. Questionnaire sent to a total of 475 nurses in Primary Health Care in Madrid (former Health Care Areas 6 and 9), in 2010. Perception of the practice environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, as well as; age; sex; years of professional experience; professional category; Health Care Area; employment status and education level. There was a response rate of 69.7% (331). The raw score for the PES-NWI was: 81.04 [95%CI: 79.18-82.91]. The factor with the highest score was "Support from Managers" (2.9 [95%CI: 2.8-3]) and the lowest "Workforce adequacy" (2.3 [95%CI: 2.2-2.4]). In the regression model (dependent variable: raw score in PES-NWI), adjusted by age, sex, employment status, professional category (coefficient B=6.586), and years worked at the centre (coefficient B=2.139, for a time of 0-2 years; coefficient B=7.482, for 3-10 years; coefficient B=7.867, for over 20 years) remained at p≤0.05. The support provided by nurse managers is the most highly valued factor in this practice environment, while workforce adequacy is perceived as the lowest. Nurses in posts of responsibility and those possessing a higher degree of training perceive their practice environment more favourably. Knowledge of the factors in the practice environment is a key element for health care organizations to optimize provision of care and to improve health care results. Copyright © 2012 Elsevier España, S.L. All rights reserved.

The importance of human resources management in health care: a global context.

PubMed

Kabene, Stefane M; Orchard, Carole; Howard, John M; Soriano, Mark A; Leduc, Raymond

2006-07-27

This paper addresses the health care system from a global perspective and the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care services. We explored the published literature and collected data through secondary sources. Various key success factors emerge that clearly affect health care practices and human resources management. This paper will reveal how human resources management is essential to any health care system and how it can improve health care models. Challenges in the health care systems in Canada, the United States of America and various developing countries are examined, with suggestions for ways to overcome these problems through the proper implementation of human resources management practices. Comparing and contrasting selected countries allowed a deeper understanding of the practical and crucial role of human resources management in health care. Proper management of human resources is critical in providing a high quality of health care. A refocus on human resources management in health care and more research are needed to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes from and access to health care around the world.

The importance of human resources management in health care: a global context

PubMed Central

Kabene, Stefane M; Orchard, Carole; Howard, John M; Soriano, Mark A; Leduc, Raymond

2006-01-01

Background This paper addresses the health care system from a global perspective and the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care services. Methods We explored the published literature and collected data through secondary sources. Results Various key success factors emerge that clearly affect health care practices and human resources management. This paper will reveal how human resources management is essential to any health care system and how it can improve health care models. Challenges in the health care systems in Canada, the United States of America and various developing countries are examined, with suggestions for ways to overcome these problems through the proper implementation of human resources management practices. Comparing and contrasting selected countries allowed a deeper understanding of the practical and crucial role of human resources management in health care. Conclusion Proper management of human resources is critical in providing a high quality of health care. A refocus on human resources management in health care and more research are needed to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes from and access to health care around the world. PMID:16872531

Practical approach to childhood masturbation--a review.

PubMed

Mallants, Charita; Casteels, Kristina

2008-10-01

The aim of this article is to review the literature for information that could guide the clinical practitioner in the assessment and management of childhood masturbation. The boundary between normal and abnormal or deviant masturbation in children remains unclear. Besides the link with sexual abuse, other environmental factors and individual factors, as well as psychiatric disorders, are mentioned in relation to masturbation and sexual behaviour in general in children. However, evidence-based information is missing and, therefore, a safety management approach is advised when a clinician is confronted with childhood masturbation. We conclude that normal psychosexual development, as well as environmental and individual factors, should be considered in the assessment and management of childhood masturbation.

A systematic review of factors influencing knowledge management and the nurse leaders' role.

PubMed

Lunden, Anne; Teräs, Marianne; Kvist, Tarja; Häggman-Laitila, Arja

2017-09-01

To describe factors facilitating or inhibiting the development of registered nurses' competency and nurse leader's role in knowledge management. Nurses' competency directly influences patient safety and the quality and effectiveness of patient care. Challenges of nurse leaders in knowledge management include acquiring, assessing and utilising current knowledge and assessing and enhancing competency. A systematic search was conducted in PubMed, CINAHL, SCOPUS and ERIC databases in April 2015. The search identified 18 relevant research articles published between 2009 and 2015. The quality of the studies was appraised in accordance with study designs. Knowledge management is facilitated by an organisation culture that supports learning, sharing of information and learning together. Leader commitment and competency were factors related to leadership facilitating knowledge management. Nurse leaders need evidence-based interventions to support shared learning and to create infrastructures that facilitate competence development. Future research is especially needed to evaluate connections between knowledge management and patient outcomes. The results of this review can be utilised in enhancing factors to facilitate knowledge management in clinical practice and identifying nurse leaders' role in strengthening nurses' competency. © 2017 John Wiley & Sons Ltd.

Facilitating adaptive management in a government program: A household energy efficiency case study.

PubMed

Curtis, Jim; Graham, Alex; Ghafoori, Eraj; Pyke, Susan; Kaufman, Stefan; Boulet, Mark

2017-02-01

Interim evaluations of government programs can sometimes reveal lower than expected outcomes, leading to the question of how adjustments can be made while the program is still underway. Although adaptive management frameworks can provide a practical roadmap to address this question, a lack of successful learnings and poor implementation have hampered the progress and wider application of adaptive management. Using a case study involving an energy efficiency government program targeting low-income households, this article provides supporting evidence on how adaptive management can be facilitated and applied. Factors such as proactive and responsive leadership, establishing a research-practice interface, and recognizing the skills, expertise, and contributions of multiple stakeholders guided adjustments to the program, and later paved the way for longer-term organizational learning that impacted how other programs are delivered. Implications for knowledge and practice, and a discussion of the challenges faced in the program, advance current thinking in adaptive management. Copyright © 2016 Elsevier Ltd. All rights reserved.

A COMPARISON OF GREEN SUPPLY CHAIN MANAGEMENT PRACTICES AMONG INDUSTRIES SECTORS IN CHINA

NASA Astrophysics Data System (ADS)

Sun, Ying; Miyadera, Tetsuhiko; Fujita, Tsuyoshi

This paper aims to examine the differences of Green supply chain management (GSCM) implementation among chemical, automobile and machinery industries in China based on a questionnaire survey designed by Industrial Ecology at two industrial parks in Shenyang city. Exploratory factor analysis and one way analysis of variance (ANOVA) were used to analyze the data. The main result was that the GSCM practices of the three industries are still at a beginning stage. The level of GSCM practices of automobile industry (promoted by international market competition) was higher than those of chemical and machinery industry (promoted by domestic laws and policies).

Cancer education and effective dissemination: information access is not enough.

PubMed

Ousley, Anita L; Swarz, Jeffrey A; Milliken, Erin L; Ellis, Steven

2010-06-01

Education is the main avenue for disseminating new research findings into clinical practice. Understanding factors that affect translation of research into practice may help cancer educators design programs that facilitate the time it takes for research-indicated practices to become standard care. To understand various factors, the National Cancer Institute (NCI) Office of Education and Special Initiatives (OESI)(1) with individual cooperation from Oncology Nursing Society (ONS), American Society of Clinical Oncology (ASCO), and Association of Oncology Social Work (AOSW) administered a Practitioner Information Needs survey to five different types of practitioners involved in cancer care. While most of the 2,864 practitioners (83%) agreed they had access to current practice information, practitioners in large practice settings were more likely to report having access to research than those small practice settings. However, only 33% indicated that they had adequate time to access the information. Colleagues or experts within the organization were cited as the most frequently relied on information resource (60%), and peer-reviewed journals were cited as second (57%). Overall, 66% strongly or somewhat agreed that their organizations exhibit effective change management practices. A majority (69%) agreed that implementation of new practices is hindered by the lack of available staff time. Financial factors and the characteristics of the information presented were also believed to be factors contributing to research implementation. Group differences were observed among practitioner groups and practice settings for some factors.

Modelling multiple hospital outcomes: the impact of small area and primary care practice variation.

PubMed

Congdon, Peter

2006-11-16

Appropriate management of care--for example, avoiding unnecessary attendances at, or admissions to, hospital emergency units when they could be handled in primary care--is an important part of health strategy. However, some variations in these outcomes could be due to genuine variations in health need. This paper proposes a new method of explaining variations in hospital utilisation across small areas and the general practices (GPs) responsible for patient primary care. By controlling for the influence of true need on such variations, one may identify remaining sources of excess emergency attendances and admissions, both at area and practice level, that may be related to the quality, resourcing or organisation of care. The present paper accordingly develops a methodology that recognises the interplay between population mix factors (health need) and primary care factors (e.g. referral thresholds), that allows for unobserved influences on hospitalisation usage, and that also reflects interdependence between hospital outcomes. A case study considers relativities in attendance and admission rates at a North London hospital involving 149 small areas and 53 GP practices. A fixed effects model shows variations in attendances and admissions are significantly related (positively) to area and practice need, and nursing home patients, and related (negatively) to primary care access and distance of patient homes from the hospital. Modelling the impact of known factors alone is not sufficient to produce a satisfactory fit to the observations, and random effects at area and practice level are needed to improve fit and account for overdispersion. The case study finds variation in attendance and admission rates across areas and practices after controlling for need, and remaining differences between practices may be attributable to referral behaviour unrelated to need, or to staffing, resourcing, and access issues. In managerial terms, the analysis points to the utility of formal statistical analysis of hospitalisation rates as a prelude to non-statistical investigation of primary care resourcing and organisation. For example, there may be implications for the location of staff involved in community management of chronic conditions; health managers may also investigate whether some practices have unusual populations (homeless, asylum seekers, students) that explain different hospital use patterns.

Examining Acceptance of an Integrated Personal Health Record (PHR)

ERIC Educational Resources Information Center

Morton, Alicia A.

2011-01-01

Objective: The purpose of this project was to examine the practice question, "What are the factors influencing acceptance of integrated PHRs for self-care management among the Howard University Hospital (HUH) Diabetes Treatment Clinic (DTC) patients?" These factors include a) demographic characteristics, b) computer…

Factors influencing workers to follow food safety management systems in meat plants in Ontario, Canada.

PubMed

Ball, Brita; Wilcock, Anne; Aung, May

2009-06-01

Small and medium sized food businesses have been slow to adopt food safety management systems (FSMSs) such as good manufacturing practices and Hazard Analysis Critical Control Point (HACCP). This study identifies factors influencing workers in their implementation of food safety practices in small and medium meat processing establishments in Ontario, Canada. A qualitative approach was used to explore in-plant factors that influence the implementation of FSMSs. Thirteen in-depth interviews in five meat plants and two focus group interviews were conducted. These generated 219 pages of verbatim transcripts which were analysed using NVivo 7 software. Main themes identified in the data related to production systems, organisational characteristics and employee characteristics. A socio-psychological model based on the theory of planned behaviour is proposed to describe how these themes and underlying sub-themes relate to FSMS implementation. Addressing the various factors that influence production workers is expected to enhance FSMS implementation and increase food safety.

Clinical presentation and management of drug-induced agranulocytosis.

PubMed

Andrès, Emmanuel; Zimmer, Jacques; Mecili, Mustapha; Weitten, Thierry; Alt, Martine; Maloisel, Frédéric

2011-04-01

In this article, we report and discuss the clinical presentation and management of idiosyncratic drug-induced agranulocytosis (neutrophil count <0.5 × 10(9)/l). Idiosyncratic drug-induced agranulocytosis remains a potentially serious adverse event owing to the frequency of severe sepsis with severe deep tissue infections (e.g., pneumonia), septicemia and septic shock in approximately two-thirds of all hospitalized patients. However, several prognostic factors have recently been identified that may be helpful in practice to identify 'susceptible' patients. Old age (>65 years), septicemia or shock, metabolic disorders such as renal failure and a neutrophil count below 0.1 × 10(9)/l are currently consensually accepted as poor prognostic factors. In this potentially life-threatening disorder, modern management with broad-spectrum antibiotics and hematopoietic growth factors (particularly granulocyte colony-stimulating factor) is likely to improve prognosis. Thus, with appropriate management, the mortality rate from idiosyncratic drug-induced agranulocytosis is currently approximately 5%.

Munchausen Syndrome by Proxy

PubMed Central

Yaacob, B.M.J

1999-01-01

Munchausen syndrome by proxy is a rare disorder in child psychiatric practice. A case of Munchausen syndrome by proxy that was managed in the Child Psychiatric clinic, Universiti Sains Malaysia Hospital is reported. Factors that suggest the diagnosis are discussed. Multidisciplinary approach to the management of such cases is warranted. PMID:22589687

Tillage and planting date effects on weed dormancy, emergence, and early growth in organic corn

USDA-ARS?s Scientific Manuscript database

Weed management is a major constraint to adoption of reduced-tillage practices for organic grain production. Tillage, cover crop management, and crop planting date are all factors that influence the periodicity and growth potential of important weed species in these systems. Therefore, we assessed...

Management practices to reduce lupine-induced Crooked Calf Syndrome in the Northwest

USDA-ARS?s Scientific Manuscript database

Many factors contribute to the incidence of lupine-induced “Crooked Calf Syndrome” (CCS) in the northwestern U.S. A 1-5% incidence of CCS is common on many ranches and higher incidences occur when environmental conditions are conducive to lupine population increases. Multiple management strategies s...

15 CFR 918.3 - Eligibility, qualifications, and responsibility of a Sea Grant College.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) Leadership. The Sea Grant College candidate must have achieved recognition as an intellectual and practical...) Organization. The Sea Grant College candidate must have created the management organization to carry on a... management competence. The extent and quality of an institution's relationships are critical factors in...

Winter habitat selection patterns of Merriam's turkeys in the southern Black Hills, South Dakota

Treesearch

Chad P. Lehman; Mark A. Rumble; Lester D. Flake

2007-01-01

In northern areas of their expanded range, information on Merriam's turkeys (Meleagris gallopavo merriami) is lacking, specifically pertaining to wintering behavior and factors associated with winter habitat selection. Forest managers need detailed quantification of the effects of logging and other management practices on wintering habitats...

Factors influencing sediment plume development from forest roads

Treesearch

Johnny M. Grace

2005-01-01

Southern forests, which rely on intensive management practices, are some of the most productive forests in the United States. Intensive forest management utilizes forest operations, such as site preparation, fertilization, thinning, and harvesting, to increase site productivity and reduce rotation time. These forest operations are essential to meet the ever-...

Sciurids in Pacific Northwest managed and old-growth forests.

Treesearch

A.B. Carey

1995-01-01

An understanding of the factors governing sciurid abundance in the Pacific Northwest is essential for prescribing forest management practices for second-growth forests where recovery of Spotted Owl (Strix occidentalis) populations and enhancement of biodiversity are objectives. We compared results of companion studies of sciurids in western...

Antifungal effect of essential oils on southern yellow pine

Treesearch

Vina W. Yang; Carol A. Clausen

2007-01-01

Moisture management remains the most critical factor for controlling mold growth on wood and wood products during storage, construction, and while in service. When moisture management practices fail to adequately control moisture, plant extracts demonstrating antifungal properties may provide protection for these applications. The objective of this study was to...

TQM--Will It Work in Your Library?

ERIC Educational Resources Information Center

Butcher, Karyle

Scarce resources, changing customer expectation, and the changing role of top management are all factors that have contributed to the implementation of total quality management (TQM) in libraries. Instructional articles, conferences, and videos can alleviate some concerns of cost and time commitment. Many libraries already practice some of the…

Implementation of School-Based Management in Indonesia. Monograph

ERIC Educational Resources Information Center

Vernez, Georges; Karam, Rita; Marshall, Jeffery H.

2012-01-01

This study provides a quantitative and qualitative status report on the implementation of school-based management (SBM) in Indonesia, identifies factors associated with the successful practices of SBM, and assesses SBM effects on student achievement eight years after its inception. The authors' findings are based on face-to-face surveys of…

AN EVALUATION OF HYDROLOGIC RESPONSE TO 25 YEARS OF LANDSCAPE CHANGE IN A SEMI-ARID WATERSHED

EPA Science Inventory

The assessment of land use and land cover is an extremely important activity for contemporary land management. A large body of current literature suggests that human land-use practices are the most important factor influencing natural resource management at multiple scales. D...

Factors that facilitate registered nurses in their first-line nurse manager role.

PubMed

Cziraki, Karen; McKey, Colleen; Peachey, Gladys; Baxter, Pamela; Flaherty, Brenda

2014-11-01

To determine the factors that attract and retain Registered Nurses in the first-line nurse manager role. The first-line nurse manger role is pivotal in health-care organisations. National demographics suggest that Canada will face a first-line nurse manager shortage because of retirement in the next decade. Determination of factors that attract and retain Registered Nurses will assist organisations and policy makers to employ strategies to address this shortage. The study used an exploratory, descriptive qualitative approach, consisting of semi-structured individual interviews with 11 Registered Nurses in first-line nurse manager roles. The findings revealed a discrepancy between the factors that attract and retain Registered Nurses in the first-line nurse manager role, underscored the importance of the mentor role and confirmed the challenges encountered by first-line nurse managers practicing in the current health-care environment. The first-line nurse manager role has been under studied. Further research is warranted to understand which strategies are most effective in supporting first-line nurse managers. Strategies to support nurses in the first-line nurse manager role are discussed for the individual, programme, organisation and health-care system/policy levels. © 2013 John Wiley & Sons Ltd.

The effects of structure, strategy and market conditions on the operating practices of physician-organization arrangements.

PubMed

Alexander, J A; Vaughn, T E; Burns, L R

2000-11-01

Research to date has documented weak or inconsistent associations between market and organizational factors and the adoption of physician-organization arrangements (POAs) (e.g. physician-hospital organizations, management service organizations and independent practice associations) designed to increase physician integration. We argue that POAs may mask considerable variation in how these entities are operated and governed. Further, because the operating policies and practices of POAs are likely to influence more directly the behaviour of physicians than the structural form of the POA, they may be more sensitive to the market and organizational contingencies that encourage integration. This study attempts to test empirically the relative effects of POA type and market, strategic and organization factors on the operating policies and practices of market-based POAs. Results suggest that type of POA, and market, strategic and organizational factors affect risk sharing, physician selection practices, physician monitoring practices and ways in which monitoring information is used to influence physician behaviour in POAs.

Building resilience to social-ecological change through farmers' learning practices in semi-arid Makueni County Kenya

NASA Astrophysics Data System (ADS)

Ifejika Speranza, Chinwe; Kiteme, Boniface; Kimathi Mbae, John; Schmude, Miron

2015-04-01

Social-ecological change is resulting in various risks and opportunities to farmers, which they address through complex multi-strategies to sustain their agricultural-based livelihoods and agricultural landscapes. This paper examines how various stakeholders such as research and government organisations, local and international non-governmental organisations, private companies, farmer groups, individual actors and farmers draw on scientific, external and localised knowledge to address the needs of farmers in sustainable land management and food production. What is the structure of collaboration between the various actors and how does this influence the potential for learning, not only for the farmers but also for other stakeholders? How does the supplied knowledge meet farmers' knowledge needs and demands for sustainable land management and food production? To what extent and how is knowledge co-produced among the various stakeholders? What different types of learning can be identified and what are their influences on farmers' sustainable land management practices? How does farmer learning foster the resilience of agricultural landscapes? Answers to these questions are sought through a case study in the semi-arid areas of Makueni County, Kenya. Particular environmental risks in the study area relate to recurrent droughts and flooding, soil erosion and general land degradation. Opportunities in the study area arise short-term due to more conducive rainfall conditions for crop and vegetation growth, institutional arrangements that foster sustainable land management such as agroforestry programmes and conservation agriculture projects. While farmers observe changes in their environment, they weigh the various risks and opportunities that arise from their social-ecological context and their own capacity to respond leading to the prioritization of certain adaptations relative to others. This can mean that while certain farmers may have knowledge on sustainable land management practices, their capacity to act can be constrained by various factors. Through learning about new land management technologies and adaptation practices, and adapting these to their local contexts, farmers attempt to balance the risks and opportunities arising from social-ecological change. They share and transfer the acquired knowledge to other farmers. While success has been achieved in adoption of sustainable land management practices by many farmers, adoption by other farmers and practice by all farmers remain constrained by various social-ecological factors. The implications of the research findings for interventions and policies aimed at sustainable land management and improved food production are discussed.

Tuberculosis management practices by private practitioners in Andhra Pradesh, India.

PubMed

Achanta, Shanta; Jaju, Jyoti; Kumar, Ajay M V; Nagaraja, Sharath Burugina; Shamrao, Srinivas Rao Motta; Bandi, Sasidhar Kumar; Kumar, Ashok; Satyanarayana, Srinath; Harries, Anthony David; Nair, Sreenivas Achutan; Dewan, Puneet K

2013-01-01

Private medical practitioners in Visakhapatnam district, Andhra Pradesh, India. To evaluate self-reported TB diagnostic and treatment practices amongst private medical practitioners against benchmark practices articulated in the International Standards of Tuberculosis Care (ISTC), and factors associated with compliance with ISTC. Cross- sectional survey using semi-structured interviews. Of 296 randomly selected private practitioners, 201 (68%) were assessed for compliance to ISTC diagnostic and treatment standards in TB management. Only 11 (6%) followed a combination of 6 diagnostic standards together and only 1 followed a combination of all seven treatment standards together. There were 28 (14%) private practitioners who complied with a combination of three core ISTC (cough for tuberculosis suspects, sputum smear examination and use of standardized treatment). Higher ISTC compliance was associated with caring for more than 20 TB patients annually, prior sensitization to TB control guidelines, and practice of alternate systems of medicine. Few private practitioners in Visakhapatnam, India reported TB diagnostic and treatment practices that met ISTC. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance.

An assessment of nitrogen-based manure application rates on 39 U.S. swine operations.

PubMed

Lory, John A; Massey, Raymond E; Zulovich, Joseph M; Hoehne, John A; Schmidt, Amy M; Carlson, Marcia S; Fulhage, Charles D

2004-01-01

Water quality concerns and revised regulations are changing how confined animal feeding operations manage manure. Devising acceptable and feasible changes in manure practices requires a full understanding of the forces shaping current manure management decisions. Previous theoretical models have shown that a wide range of factors influence the lowest cost solution for manure management. We used a mechanistic model to characterize the manure management practices on 39 swine operations (20 unagitated lagoon and 19 slurry operations) in five states (Iowa, Missouri, North Carolina, Oklahoma, and Pennsylvania). Information was collected from each operation about animal numbers, feed and water use, manure handling and storage characteristics, field locations, crop rotation, fertilizer need, and equipment inventory and usage. Collected data were used as input and to validate results from a mechanistic model that determined acres required for manure application, manure application rate, time required for manure application, value of manure, and costs of manure management. The 39 farms had a mean of 984 animal units (AU) per operation, 18.2 AU ha(-1) (7.4 AU acre(-1)), and manure application costs of dollar 10.49 AU(-1) yr(-1). Significant factors affecting manure management included operation size, manure handling system, state, and ownership structure. Larger operations had lower manure management costs (r2 = 0.32). Manure value potentially exceeded manure application costs on 58% of slurry and 15% of lagoon operations. But 38% of slurry operations needed to apply manure off the farm whereas all lagoon operations had sufficient land for N-based manure management. Manure management was a higher percentage of gross income on contract operations compared with independents (P < 0.01). This research emphasized the importance of site-specific factors affecting manure management decisions and the economics of U.S. swine operations.

Clinical endpoints for developing pharmaceuticals to manage patients with sporadic or genetic risk of colorectal cancer

PubMed Central

Rial, Nathaniel S.; Zell, Jason A.; Cohen, Alfred M.; Gerner, Eugene W.

2013-01-01

To reduce the morbidity and mortality from colorectal cancer, current clinical practice focuses on screening for early detection and polypectomy as a form of secondary prevention, complemented with surgical interventions when appropriate. No pharmaceutical agent is currently approved for use in clinical practice for the management of patients with risk of colorectal cancer. This article will review earlier attempts to develop pharmaceuticals for use in managing patients with sporadic or genetic risk of colorectal cancer. It will also discuss therapeutic endpoints under evaluation in current efforts to develop drugs for treating colorectal cancer risk factors. PMID:22928902

Contingency Management of Health Care Organizations: It Depends.

PubMed

Olden, Peter C

Managers in health care organizations (HCOs) must perform many processes and activities, such as planning goals, designing organization structure, leading people, motivating employees, making decisions, and resolving conflict. How they do all this strongly affects the performance and outcomes of their organizations and themselves. Some managers develop a usual way of performing their jobs and achieve some success with a preferred method of leading or a favorite approach to motivating. However, their success will be limited if they always rely on a standard "1-size-fits-all" approach. This is because contingency factors influence the effectiveness of a given approach to managing. The "best" approach depends on contingency factors, including the situation and the people involved. Managers should choose an approach to fit with the changing contingency factors. This article explains why and how managers should develop a contingency approach to managing HCOs. The development of contingency theory is briefly described. Practical application of contingency management is explained for leading, motivating, decision making, and resolving conflict. By using a contingency approach, managers can be more effective when managing their HCOs.

A Systematic Review of the Impact of Educational Programs on Factors That Affect Nurses' Post-Operative Pain Management for Children.

PubMed

AlReshidi, Nahar; Long, Tony; Darvill, Angela

2018-03-01

Despite extensive research in the international arena into pain and its management, there is, as yet, little research on the topic of pain in children in Saudi Arabia and in the Gulf countries generally. A systematic review was conducted to explore the impact of education programs on factors affecting paediatric nurses' postoperative pain management practice. This was done in order to advise the creation of an educational program for nurses in Saudi Arabia. Knowledge about pain, attitudes towards pain, beliefs about children's pain, perceptions of children's reports of pain, self-efficacy with regard to pain management, and perceptions of barriers to optimal practice were all considered to be relevant factors. The review was restricted to randomized controlled trials and quasi-experimental designs, excluding studies focussed on chronic pain or populations other than solely children. Studies published in English between 2000 and 2016 were identified using CINAHL, MEDLINE, Ovid SP, The Cochrane Library, ProQuest, and Google Scholar databases. Of 499 published studies identified by the search, 14 met the inclusion criteria and were included in the review. There was evidence of educational programs exerting a postive impact on enhancing pediatric nurses' knowledge of pain and modifing their attitudes towards it, but only limited evidence was available about the impact on nurses' beliefs and perceptions of children's reports of pain, nurses' self-efficacy, or barriers to optimal practice. None of the studies was conducted in Saudi Arabia. Studies were needed to address additional aspects of preparedness for effective postperative pain management. Details of educational programs used as experimental intervention must be included in reports.

Orthopaedic Resident Practice Management and Health Policy Education: Evaluation of Experience and Expectations.

PubMed

Stautberg Iii, Eugene F; Romero, Jose; Bender, Sean; DeHart, Marc

2018-04-11

Introduction Practice management and health policy have generally not been considered integral to orthopaedic resident education. Our objective was to evaluate residents' current experience and knowledge, formal training, and desire for further education in practice management and health policy. Methods We developed a 29-question survey that was divided into three sections: practice management, initial employment opportunity, and health policy. Within each section, questions were directed at a resident's current experience and knowledge, formal training, and interest in further education. The survey was distributed at the end of the academic year through an Internet-based survey tool (www.surveymonkey.com) to orthopaedic residents representing multiple programs and all postgraduate years. Results The survey was distributed to 121 residents representing eight residency programs. Of those, 87 residents responded, resulting in a 72% response rate. All postgraduate years were represented. Regarding practice management, 66% had "no confidence" or "some confidence" in coding clinical encounters. When asked if practice models, finance management, and coding should be taught in residency, 95%, 93%, and 97% responded "yes," respectively. When evaluating first employment opportunities, the three most important factors were location, operating room block time, and call. Regarding health policy, 28% were "moderately familiar" or "very familiar" with the Physician Payments Sunshine Act, and 72% were "not familiar" or "somewhat familiar" with bundled payments for arthroplasty. Finally, when asked if yearly lectures in political activities would enhance resident education, 90% responded "yes." Discussion and conclusion Regarding practice management, the survey suggests that current orthopaedic residents are not familiar with basic topics, do not receive formal training, and want further education. The survey suggests that residents also receive minimal training in health policy. Residents feel that health policy will be important in their careers, and they would benefit from formal training in residency.

Physical space and its impact on waste management in the neonatal care setting

PubMed Central

Manzi, Sean

2014-01-01

This paper reports an investigation intended to obtain some understanding of how the working environment might influence the practice and knowledge of those involved in the management of healthcare waste. The National Health Service (NHS) has a continuing waste problem, and the way it manages waste harms the environment and consumes resources. It has been estimated that the carbon footprint of the NHS in England is approximately 20 million tons of CO2e. It has been suggested that better waste segregation could lead to more effective recycling, saving up to 42,000 tonnes of CO2. This qualitative study employed non-participant observation and semi-structured interviews. The interviews were carried out with the key informants within the participating neonatal intensive care unit. Findings from this study indicate that space and the physical arrangement of the environment are significant and influential factors in clinical practice. Where the clinical environment is not supportive, poor infection control and waste management practice is likely to occur. However, proximity of staff caused by a lack of physical space might facilitate situated learning and a collective development of knowledge in practice. The implementation of sustainable waste management practices would be more likely to succeed in an environment that facilitates correct waste segregation. PMID:28989373

[Quality assurance in airway management: education and training for difficult airway management].

PubMed

Kaminoh, Yoshiroh

2006-01-01

Respiratory problem is one of the main causes of death or severe brain damage in perioperative period. Three major factors of respiratory problem are esophageal intubation, inadequate ventilation, and difficult airway. The wide spread of pulse oximeter and capnograph reduced the incidences of esophageal intubation and inadequate ventilation, but the difficult airway still occupies the large portion in the causes of adverse events during anesthesia. "Practice guideline for management of the difficult airway" was proposed by American Society of Anesthesiologists (ASA) in 1992 and 2002. Improvement of knowledge, technical skills, and cognitive skills are necessary for the education and training of the difficult airway management. "The practical seminar of difficult airway management (DAM practical seminar)" has been cosponsored by the Japanese Association of Medical Simulation (JAMS) in the 51 st and 52 nd annual meetings of Japanese Society of Anesthesiologists and the 24th annual meeting of Japanese Society for Clinical Anesthesia. The DAM practical seminar is composed of the lecture session for ASA difficult airway algorithm, the hands-on training session for technical skills, and the scenario-based training session for cognitive skills. Ninty six Japanese anesthesiologists have completed the DAM practical seminar in one year. "The DAM instructor course" should be immediately prepared to organize the seminar more frequently.

Managed care penetration and other factors affecting computerized physician order entry in the ambulatory setting.

PubMed

Menachemi, Nir; Ford, Eric W; Chukmaitov, Askar; Brooks, Robert G

2006-12-01

To estimate the current uses level of ambulatory computerized physician order entry (A-CPOE) among physicians and to examine the relationship of managed care penetration as well as other market and practice characteristics to use of A-CPOE by physicians. This study uses both primary and secondary data sources. The primary data source was a large-scale survey of physicians' use of information technologies in Florida. Secondary data on managed care penetration were obtained from the Florida Agency for Health Care Administration, and other market-level data were extracted from the area resource file. A hierarchical logistic regression model was used to examine the correlation of county-level and practice-level characteristics with physicians' self-reported use of A-CPOE systems. Overall, 1360 physicians (32.4%) indicated use of an A-CPOE system. Findings suggest that 1% more managed care penetration was associated with 2.1% lower use of A-CPOE (P = .003). Additionally, practice size, multispecialty affiliation, and primary care practice were significantly and positively correlated with the use of A-CPOE. Physician age was negatively associated with A-CPOE use. Managed care organizations may experience significant financial savings from A-CPOE use by physicians; however, managed care penetration in a community negatively affects A-CPOE use among physicians in their practices. Further study regarding the causal nature of this association is warranted.

EVALUATION OF THE FARM MANAGEMENT PHASE OF THE FARM AND HOME MANAGEMENT PROGRAM IN NEW YORK STATE. EXTENSION STUDY, NUMBER 1.

ERIC Educational Resources Information Center

ALEXANDER, FRANK D.; LONGEST, JAMES W.

THE MAIN PURPOSE OF THIS 1956-60 LONGITUDINAL STUDY WAS TO COMPARE CHANGES IN FARM PRACTICES AND RELATED KNOWLEDGE AND IN INCOME AND RELATED BUSINESS FACTORS AMONG 87 PARTICIPANTS (DAIRYMEN) IN THE FARM MANAGEMENT PHASE OF THE NEW YORK STATE FARM AHD HOME MANAGEMENT PROGRAM, WITH THOSE OF A CONTROL GROUP OF 87 WHO DID NOT PARTICIPATE. IN 1956, THE…

Factors affecting job motivation among health workers: a study from Iran.

PubMed

Daneshkohan, Abbas; Zarei, Ehsan; Mansouri, Tahere; Maajani, Khadije; Ghasemi, Mehri Siyahat; Rezaeian, Mohsen

2014-11-26

Human resources are the most vital resource of any organizations which determine how other resources are used to accomplish organizational goals. This research aimed to identity factors affecting health workers' motivation in Shahid Beheshti University of Medical Sciences (SBUMS). This is a cross-sectional survey conducted with participation of 212 health workers of Tehran health centers in November and December 2011. The data collection tool was a researcher-developed questionnaire that included 17 motivating factors and 6 demotivating factors and 8 questions to assess the current status of some factors. Validity and reliability of the tool were confirmed. Data were analyzed with descriptive and analytical statistical tests. The main motivating factors for health workers were good management, supervisors and managers' support and good working relationship with colleagues. On the other hand, unfair treatment, poor management and lack of appreciation were the main demotivating factors. Furthermore, 47.2% of health workers believed that existing schemes for supervision were unhelpful in improving their performance. Strengthening management capacities in health services can increase job motivation and improve health workers' performance. The findings suggests that special attention should be paid to some aspects such as management competencies, social support in the workplace, treating employees fairly and performance management practices, especially supervision and performance appraisal.

Identifying factors associated with experiences of coronary heart disease patients receiving structured chronic care and counselling in European primary care

PubMed Central

2012-01-01

Background Primary care for chronic illness varies across European healthcare systems. In patients suffering from coronary heart disease (CHD), factors associated with patients’ experiences of receiving structured chronic care and counselling at the patient and practice level were investigated. Methods In an observational study comprising 140 general practices from five European countries (Austria, Germany, the Netherlands, Switzerland and the United Kingdom), 30 patients with Coronary Heart Disease (CHD) per practice were chosen at random to partake in this research. Patients were provided with a questionnaire and the Patient Assessment of Chronic Illness Care (PACIC-5A) - instrument. Practice characteristics were assessed through a practice questionnaire and face to face interviews. Data were aggregated to obtain two practice scores representing quality management and CHD care, respectively. A hierarchical multilevel analysis was performed to examine the impact of patient and practice characteristics on PACIC scores. Results The final sample included 1745 CHD-patients from 131 general practices with a mean age of 67.8 (SD 9.9) years. The overall PACIC score was 2.84 (95%CI: 2.79; 2.89) and the 5A score reflecting structured lifestyle counselling was 2.75 (95% CI: 2.69; 2.79). At the patient level, male gender, more frequent practice contact and fewer related or unrelated conditions were associated with higher PACIC scores. At the practice level, performance scores reflecting quality management (p = 0.013) and CHD care (p = 0.009) were associated with improved assessment of the structured chronic care and counselling received. Conclusions Patients’ perceived quality of care varies. However, good practice management and organisation of care were positively reflected in patients’ assessments of receiving structured chronic illness care. This highlights the importance of integrating patient experiences into quality measurements to provide feedback to health care professionals. PMID:22838403

Rh Factor Blood Test

MedlinePlus

... of Privacy Practices Notice of Nondiscrimination Manage Cookies Advertising Mayo Clinic is a not-for-profit organization and proceeds from Web advertising help support our mission. Mayo Clinic does not ...

Supervisor and organizational factors associated with supervisor support of job accommodations for low back injured workers

PubMed Central

Kristman, Vicki L; Shaw, William S.; Reguly, Paula; Williams-Whitt, Kelly; Soklaridis, Sophie; Loisel, Patrick

2016-01-01

PURPOSE Temporary job accommodations contribute to the prevention of chronic work disability due to low back pain (LBP) through the facilitation of early return to work; yet, workplace dimensions of job accommodation are poorly understood. The objective of this study was to determine supervisor and organizational factors associated with supervisors’ support for temporary job accommodations for LBP injured workers. METHODS Supervisors were recruited from 19 workplaces in the USA and Canada and completed an online survey regarding job accommodation practices and potential associated factors with respect to a case vignette of a worker with LBP. Multivariable linear regression was used to identify the most parsimonious set of factors associated with supervisors’ support for accommodations. RESULTS A total of 804 supervisors participated with 796 eligible for inclusion in the analysis. The final set of factors explained 21% of the variance in supervisors’ support for temporary job accommodations. Considerate leadership style (β = .261; 95 % CI: .212, .310), workplace disability management policies and practices (β = .243; 95 % CI: .188, .298), and supervisor autonomy for designing and providing workplace accommodations (β = .156; 95 % CI: .071, .241) had the largest effect on supervisor support for accommodations. CONCLUSION Factors predicting supervisors’ likelihood to accommodate LBP injured workers include use of considerate leadership style, workplace disability management policies and practices, and supervisor autonomy. Workplace interventions targeting these factors should be developed and evaluated for their ability to improve work disability prevention outcomes. PMID:27032398

Psychological factors associated with weight loss maintenance: theory-driven practice for nurse practitioners.

PubMed

Valek, Rebecca M; Greenwald, Beverly J; Lewis, Carolyn C

2015-04-01

The authors discuss the psychological factors associated with weight loss maintenance and the use of Pender's health promotion model as a guide for the construction of clinical interventions to address these factors. The psychological factors include internal drive for weight maintenance, ongoing self-monitoring, long-term flexibility, positive mood and emotions, appropriate goals, and management of external stimuli. Nurse practitioners can help combat obesity trends through caring for patients in a holistic manner. Periodic psychological needs-assessments for patients who desire to maintain weight loss may further promote long-term success in weight management. © The Author(s) 2015.

Research on Influencing Factors of Salespeople's Empowerment Readiness in Green Energy Enterprise

NASA Astrophysics Data System (ADS)

Dong, Yuan; Liu, Xiaohui

As market competition in green energy enterprises continues to intensify, marketing activities are enlarging and customer demand is increasingly growing and diversifying. More and more green energy enterprises have empowered their own salespeople. And managers in green energy enterprises are more concerned with the issues which employees suit to be empowered and which factors will influence employee empowerment readiness. This paper proposes the definition of salespeople's empowerment readiness, analyzes influencing factors of salespeople's empowerment readiness, discusses the effect mechanism of influencing factors of salespeople's empowerment readiness, finally, and puts forward some suggestions to enhance salespeople's empowerment readiness from the perspective of human resource management practice.

Critical factors influencing physicians' intention to use computerized clinical practice guidelines: an integrative model of activity theory and the technology acceptance model.

PubMed

Hsiao, Ju-Ling; Chen, Rai-Fu

2016-01-16

With the widespread use of information communication technologies, computerized clinical practice guidelines are developed and considered as effective decision supporting tools in assisting the processes of clinical activities. However, the development of computerized clinical practice guidelines in Taiwan is still at the early stage and acceptance level among major users (physicians) of computerized clinical practice guidelines is not satisfactory. This study aims to investigate critical factors influencing physicians' intention to computerized clinical practice guideline use through an integrative model of activity theory and the technology acceptance model. The survey methodology was employed to collect data from physicians of the investigated hospitals that have implemented computerized clinical practice guidelines. A total of 505 questionnaires were sent out, with 238 completed copies returned, indicating a valid response rate of 47.1 %. The collected data was then analyzed by structural equation modeling technique. The results showed that attitudes toward using computerized clinical practice guidelines (γ = 0.451, p < 0.001), organizational support (γ = 0.285, p < 0.001), perceived usefulness of computerized clinical practice guidelines (γ = 0.219, p < 0.05), and social influence (γ = 0.213, p < 0.05) were critical factors influencing physicians' intention to use computerized clinical practice guidelines, and these factors can explain 68.6 % of the variance in intention to use computerized clinical practice guidelines. This study confirmed that some subject (human) factors, environment (organization) factors, tool (technology) factors mentioned in the activity theory should be carefully considered when introducing computerized clinical practice guidelines. Managers should pay much attention on those identified factors and provide adequate resources and incentives to help the promotion and use of computerized clinical practice guidelines. Through the appropriate use of computerized clinical practice guidelines, the clinical benefits, particularly in improving quality of care and facilitating the clinical processes, will be realized.

Examining structural and clinical factors associated with implementation of standing orders for adult immunization.

PubMed

Yonas, Michael A; Nowalk, Mary Patricia; Zimmerman, Richard K; Ahmed, Faruque; Albert, Steven M

2012-01-01

A proven method to increase vaccination rates in primary care is a standing orders program (SOP) for nonphysician staff to assess and vaccinate eligible individuals without a specific written physician order. This study describes a mixed methods approach to examining physicians' beliefs and attitudes about and adoption of SOPs for adult immunizations, specifically, influenza and pneumococcal polysaccharide vaccine. Focus groups and in-depth interviews of physicians, nurses, practice managers, and the medical director of a managed care health plan were conducted. Results were used to enrich a concise survey based on the Awareness-to-Adherence model of physician behavior and previous research, which was mailed to 1,640 general internists and family physicians nationwide. Barriers to SOPs identified through qualitative methods were lack of interest in changing the status quo, a physician-dominated hierarchy, and fear of malpractice. Facilitators included having an electronic medical record and a practice culture that was open to change. The survey (response rate 67%) confirmed the facilitators and further identified patient, physician, and practice factors that served as barriers to establishing and maintaining SOPs. This mixed methods approach provided the opportunity to develop a tailored and practice-oriented survey for examining the contextual factors influencing clinical providers' decisions to implement SOPs for adult immunization. © 2011 National Association for Healthcare Quality.

Best practice in wound assessment.

PubMed

Benbow, Maureen

2016-03-02

Accurate and considered wound assessment is essential to fulfil professional nursing requirements and ensure appropriate patient and wound management. This article describes the main aspects of holistic assessment of the patient and the wound, including identifying patient risk factors and comorbidities, and factors affecting wound healing to ensure optimal outcomes.

[Case management process identified from experience of nurse case managers].

PubMed

Park, Eun-Jun; Kim, Chunmi

2008-12-01

The purpose of this study was to develop a substantive theory of case management (CM) practice by investigating the experience of nurse case managers caring for Medical Aid enrollees in Korea. A total of 12 nurses were interviewed regarding their own experience in CM practice. Data were recorded and analyzed using grounded theory. Empowerment was the core category of CM for Medical Aid enrollees. The case managers engaged in five phases as follows, phase of inquiring in advance, building a relationship with the client, giving the client critical mind, facilitating positive changes in the client's use of healthcare services, and maintaining relationship bonds. These phases moved gradually and were circular if necessary. Also, they were accelerated or slowed depending on factors including clients' characteristics, case managers' competency level, families' support level, and availability of community resources. This study helps understand what CM practice is and how nurses are performing this innovative CM role. It is recommended that nurse leaders and policy makers integrate empowerment as a core category and the five critical CM phases into future CM programs.

Beyond Magnet® Designation: Perspectives From Nurse Managers on Factors of Sustainability and High-Performance Programming.

PubMed

Hayden, Margaret A; Wolf, Gail A; Zedreck-Gonzalez, Judith F

2016-10-01

The aim of this study was to identify patterns of high-performing behaviors and nurse manager perceptions of the factors of Magnet® sustainability at a multidesignated Magnet organization. The Magnet program recognizes exemplary professional nursing practice and is challenging to achieve and sustain. Only 10% (n = 42) of Magnet hospitals sustained designation for 12 years or longer. This study explored the perspectives of Magnet nurse managers regarding high-performing teams and the sustainability of Magnet designation. A qualitative study of nurse managers was conducted at 1 multidesignated Magnet organization (n = 13). Interview responses were analyzed using pattern recognition of Magnet model domains and characteristics of high-performing teams and then related to factors of Magnet sustainability. Transformational leadership is both an essential factor for sustainability and a potential barrier to sustainability of Magnet designation. Transformational nursing leaders lead high-performing teams and should be in place at all levels as an essential factor in sustaining Magnet redesignation.

Factors influencing physicians' prescribing behaviour in the treatment of childhood diarrhoea: knowledge may not be the clue.

PubMed

Paredes, P; de la Peña, M; Flores-Guerra, E; Diaz, J; Trostle, J

1996-04-01

Proper diarrhoea treatment has received greater attention during the last 10 years. However, the unjustified use of medicines to treat simple episodes of acute diarrhoea continues to divert attention and available resources away from appropriate treatment. A study to identify the factors determining prescribing practices for diarrhoea treatment was carried out in a peri-urban part of Lima, Peru in 1991. Physicians were interviewed, and then their practice was assessed by visits of confederates with healthy children described as ill, by interviews with mothers of sick children leaving the clinic, or by both of these methods. Physicians' reported practices in treating diarrhoea cases were compared to their actual practices. Although physicians' knowledge of drug management seemed to influence the low frequency of prescription of antidiarrhoeal drugs, it did not have the same influence on prescription of antimicrobials. Our results suggest that the diagnostic process and consequently the treatment decision do not follow a scientific rationale for this illness. The physicians' prescribing practices seemed to be more related to agreement with social expectations and the caretakers' perception of the physicians' role than they were to the standard biomedical rules of diarrhoea management.

Cultural practices in Appalachian hardwood sapling stands--are they worthwhile?

Treesearch

Gary W. Miller

1986-01-01

Forest managers often question the economic feasibility of cultural practices in hardwood sapling stands. Investment factors, including initial treatment cost, required rate of return, investment period, and stand response to treatment are discussed in terms of how they affect the outcome of early investments in even-aged hardwood stands. Attention is focused on...

[Abdominal gunshot wounds. Ballistic data and practical management].

PubMed

Vicq, P; Jourdan, P; Chapuis, O; Baranger, B

1996-01-01

The mortality from abdominal gunshot wounds remains high, either in civilian or military cases. The severity factors of these wounds include bullet calibre and energy transfer of the missile. This paper studies some of the ballistics features of abdominal gunshot wounds. Practical guidelines are inferred concerning diagnosis and treatment of these wounds.

Children's Mental Health: The Changing Interface between Primary and Specialty Care. Reprint.

ERIC Educational Resources Information Center

Steinberg, A. G.; Gadomski, A.; Wilson, M. D.

The landscape for children's mental health services has changed dramatically due to the confluence of several factors. The emergence of managed care has influenced access to as well as the scope of primary care practice. Evidence-based medicine is steadily emerging and driving practice guideline development. In the rapidly changing and…

Evaluation of changes in equine care and limb-related abnormalities in working horses in Jaipur, India, as part of a two year participatory intervention study.

PubMed

Whay, Helen R; Dikshit, Amit K; Hockenhull, Jo; Parker, Richard M A; Banerjee, Anindo; Hughes, Sue I; Pritchard, Joy C; Reix, Christine E

2015-01-01

Previous studies have found the prevalence of lameness in working horses to be 90-100%. Risk factors for lameness in this important equine population, together with risk-reduction strategies adopted by their owners, are poorly understood. The objective was to uncover risk factors for lameness and limb abnormalities in working horses, by associating clinical lameness examination findings on three occasions over two years with owner reported changes in equine management and work practices over this period. Twenty-one communities of horse owners in Jaipur, India, took part in a participatory intervention (PI) project aiming to reduce risk factors for poor welfare, particularly lameness and limb problems. Associations between quantitative measures of equine lameness/limb abnormalities and reported changes in management and work practices were compared with 21 control (C) communities of owners where no intervention had taken place. Key findings from 'complete cases', where the same horse stayed with the same owner for the whole study period (PI group = 73 owners of 83 horses, C group = 58 owners of 66 horses), were that more positive statements of change in equine management and work practices were made by PI group owners than C group owners. A mixed picture of potential risk factors emerged: some reported management improvements, for example reducing the weight of the load for cart animals, were associated with improved limbs and lameness, and others, such as making improvements in shoeing and increasing the age at which their animals started work, with negative outcomes. This study illustrates the complexity and interacting nature of risk factors for lameness in working horses, and highlights the importance of longitudinal investigations that recognise and address this. PI group owners found the project useful and requested similar inputs in future. Our findings demonstrate the value of exploratory and participatory research methodology in the field of working horse welfare.

Looking Through a Social Lens: Conceptualising Social Aspects of Knowledge Management for Global Health Practitioners

PubMed Central

Limaye, Rupali J.; Sullivan, Tara M.; Dalessandro, Scott; Jenkins, Ann Hendrix

2017-01-01

Knowledge management plays a critical role in global health. Global health practitioners require knowledge in every aspect of their jobs, and in resource-scarce contexts, practitioners must be able to rely on a knowledge management system to access the latest research and practice to ensure the highest quality of care. However, we suggest that there is a gap in the way knowledge management is primarily utilized in global health, namely, the systematic incorporation of human and social factors. In this paper, we briefly outline the evolution of knowledge management and then propose a conceptualization of knowledge management that incorporates human and social factors for use within a global health context. Our conceptualization of social knowledge management recognizes the importance of social capital, social learning, social software and platforms, and social networks, all within the context of a larger social system and driven by social benefit. We then outline the limitations and discuss future directions of our conceptualization, and suggest how this new conceptualization is essential for any global health practitioner in the business of managing knowledge. Significance for public health Managing knowledge is essential for improving population health outcomes. Global health practitioners at all levels of the health system are bombarded with information related to best practices and guideline changes, among other relevant information to provide the best quality of care. Knowledge management, or the act of effectively using knowledge, has yet to capitalize on the power of social connections within the context of global health. While social elements have been incorporated into knowledge management activities, we suggest that systematically integrating key concepts that leverage social connections, such as social systems, social capital, social learning, and social software, will yield greater benefit with regard to health outcomes. As such, we outline a new conceptualization of knowledge management, focusing on the social aspects of the practice, and posit that such an approach can further the impact of global health interventions and is crucial for global health practitioners. PMID:28480173

Promoting evidence-based practice: managing change in the assessment of pressure damage risk.

PubMed

Gerrish, K; Clayton, J; Nolan, M; Parker, K; Morgan, L

1999-11-01

This study set out to facilitate the development of evidence-based practice in the assessment of pressure damage risk to patients within a large acute hospital. The importance of nursing practice being based on the best available evidence is emphasized in recent health policy. Meeting this objective is not easy as both individual and organizational factors create barriers to the implementation of research findings and the achievement of change. The study was based on an action research model. It comprised three stages: a review of the research evidence; a survey of qualified nurses' knowledge of risk assessment of pressure damage and an audit of record keeping, and a multifaceted approach to achieving change in which researchers, managers, practitioners and clinical nurse specialists worked together collaboratively. The findings from the survey and audit indicated a shortfall in nurses' knowledge of risk assessment of pressure damage and in their record keeping. The researchers, with the help of the clinical nurse specialist, built upon these findings by assisting practitioners and managers to take ownership of the need to base practice on the appropriate evidence. Achieving evidence-based practice is a complex undertaking that requires the development of an evaluative culture and a commitment by practitioners and managers to change practice. Researchers can play a valuable role in facilitating this process.

Project management practice and its effects on project success in Malaysian construction industry

NASA Astrophysics Data System (ADS)

Haron, N. A.; Devi, P.; Hassim, S.; Alias, A. H.; Tahir, M. M.; Harun, A. N.

2017-12-01

The rapid economic development has increased the demand for construction of infrastructure and facilities globally. Sustainable development and globalization are the new ‘Zeitgeist’ of the 21st century. In order to implement these projects successfully and to meet the functional aim of the projects within their lifetime, an efficient project management practice is needed. The aim of this study is to identify the critical success factors (CSFs) and the extent of use of project management practice which affects project success, especially during the implementation stage. Data were obtained from self-administered questionnaires with 232 respondents. A mixed method of data collection was adopted using semi-structured interview and questionnaire approach. The result of the analysis of data obtained showed that new and emerging criteria such as customer satisfaction, competency of the project team, and performance of subcontractors/suppliers are becoming measures of success in addition to the classic iron triangle’s view of time, cost and quality. An insight on the extent of use of different project management practice in the industry was also achieved from the study.

A collaborative project to improve identification and management of patients with chronic kidney disease in a primary care setting in Greater Manchester.

PubMed

Humphreys, John; Harvey, Gill; Coleiro, Michelle; Butler, Brook; Barclay, Anna; Gwozdziewicz, Maciek; O'Donoghue, Donal; Hegarty, Janet

2012-08-01

Research has demonstrated a knowledge and practice gap in the identification and management of chronic kidney disease (CKD). In 2009, published data showed that general practices in Greater Manchester had a low detection rate for CKD. A 12-month improvement collaborative, supported by an evidence-informed implementation framework and financial incentives. 19 general practices from four primary care trusts within Greater Manchester. Number of recorded patients with CKD on practice registers; percentage of patients on registers achieving nationally agreed blood pressure targets. The collaborative commenced in September 2009 and involved three joint learning sessions, interspersed with practice level rapid improvement cycles, and supported by an implementation team from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Greater Manchester. At baseline, the 19 collaborative practices had 4185 patients on their CKD registers. At final data collection in September 2010, this figure had increased by 1324 to 5509. Blood pressure improved from 34% to 74% of patients on practice registers having a recorded blood pressure within recommended guidelines. Evidence-based improvement can be implemented in practice for chronic disease management. A collaborative approach has been successful in enabling teams to test and apply changes to identify patients and improve care. The model has proved to be more successful for some practices, suggesting a need to develop more context-sensitive approaches to implementation and actively manage the factors that influence the success of the collaborative.

The Global Nonalcoholic Fatty Liver Disease Epidemic: What a Radiologist Needs to Know

PubMed Central

Pereira, Keith; Salsamendi, Jason; Casillas, Javier

2015-01-01

Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of disorders from a benign steatosis to hepatocellular carcinoma (HCC). Metabolic syndrome, mainly obesity, plays an important role, both as an independent risk factor and in the pathogenesis of NAFLD. With the progressive epidemics of obesity and diabetes mellitus, the prevalence of NAFLD and its associated complications is expected to increase dramatically. Therapeutic strategies for treating NAFLD and metabolic syndrome, particularly obesity, are continuously being refined. Their goal is the prevention of NAFLD by the management of risk factors, prevention of progression of the disease, as well as management of complications, ultimately preventing morbidity and mortality. Optimal management of NAFLD and metabolic syndrome requires a multidisciplinary collaboration between the government as well as the health system including the nutritionist, primary care physician, radiologist, hepatologist, oncologist, and transplant surgeon. An awareness of the clinical presentation, risk factors, pathogenesis, diagnosis, and management is of paramount importance to a radiologist, both from the clinical perspective as well as from the imaging standpoint. With expertise in imaging modalities as well as minimally invasive percutaneous endovascular therapies, radiologists play an essential role in the comprehensive management, which is highlighted in this article, with cases from our practice. We also briefly discuss transarterial embolization of the left gastric artery (LGA), a novel method that promises to have an enormous potential in the minimally invasive management of obesity, with details of a case from our practice. PMID:26167390

Insight into dementia care management using social-behavioral theory and mixed methods.

PubMed

Connor, Karen; McNeese-Smith, Donna; van Servellen, Gwen; Chang, Betty; Lee, Martin; Cheng, Eric; Hajar, Abdulrahman; Vickrey, Barbara G

2009-01-01

For health organizations (private and public) to advance their care-management programs, to use resources effectively and efficiently, and to improve patient outcomes, it is germane to isolate and quantify care-management activities and to identify overarching domains. The aims of this study were to identify and report on an application of mixed methods of qualitative statistical techniques, based on a theoretical framework, and to construct variables for factor analysis and exploratory factor analytic steps for identifying domains of dementia care management. Care-management activity data were extracted from the care plans of 181 pairs of individuals (with dementia and their informal caregivers) who had participated in the intervention arm of a randomized controlled trial of a dementia care-management program. Activities were organized into types, using card-sorting methods, influenced by published theoretical constructs on self-efficacy and general strain theory. These activity types were mapped in the initial data set to construct variables for exploratory factor analysis. Principal components extraction with varimax and promax rotations was used to estimate the number of factors. Cronbach's alpha was calculated for the items in each factor to assess internal consistency reliability. The two-phase card-sorting technique yielded 45 activity types out of 450 unique activities. Exploratory factor analysis produced four care-management domains (factors): behavior management, clinical strategies and caregiver support, community agency, and safety. Internal consistency reliability (Cronbach's alpha) of items for each factor ranged from.63 for the factor "safety" to.89 for the factor "behavior management" (Factor 1). Applying a systematic method to a large set of care-management activities can identify a parsimonious number of higher order categories of variables and factors to guide the understanding of dementia care-management processes. Further application of this methodology in outcome analyses and to other data sets is necessary to test its practicality.

Professional roles in physiotherapy practice: Educating for self-management, relational matching, and coaching for everyday life.

PubMed

Solvang, Per Koren; Fougner, Marit

2016-11-01

The patient's active participation in treatment and rehabilitation represents a cultural change in clinical practice as well as a major change in physiotherapist and patient roles. This article presents findings from a study aimed at gaining a better understanding of how physiotherapists in actual practice understand their interactions with patients during the treatment process. This article reports on the findings from focus-group interviews with physiotherapists working in three different settings. Analyses of the interview data identified three modes of physiotherapy practice. In one, physiotherapists educate their patients to be self-managing in conducting exercise programs based on sound evidence. Educational films available on the Internet are included in these efforts to teach patients. In another, physiotherapists emphasize the importance of a close relationship to the patient. A good personal chemistry is believed to improve the treatment process. And finally, what physiotherapists learn about the living conditions and the biographies of their patients was shown to be very important. Understanding the importance of the life-world and taking this into consideration in the treatment process were factors considered to be central to good practice. The article concludes with a discussion linking these findings to those of other studies identifying those factors contributing to our knowledge of what is involved in biopsychosocial practice in physiotherapy.

Primary care practice organization influences colorectal cancer screening performance.

PubMed

Yano, Elizabeth M; Soban, Lynn M; Parkerton, Patricia H; Etzioni, David A

2007-06-01

To identify primary care practice characteristics associated with colorectal cancer (CRC) screening performance, controlling for patient-level factors. Primary care director survey (1999-2000) of 155 VA primary care clinics linked with 38,818 eligible patients' sociodemographics, utilization, and CRC screening experience using centralized administrative and chart-review data (2001). Practices were characterized by degrees of centralization (e.g., authority over operations, staffing, outside-practice influence); resources (e.g., sufficiency of nonphysician staffing, space, clinical support arrangements); and complexity (e.g., facility size, academic status, managed care penetration), adjusting for patient-level covariates and contextual factors. Chart-based evidence of CRC screening through direct colonoscopy, sigmoidoscopy, or consecutive fecal occult blood tests, eliminating cases with documented histories of CRC, polyps, or inflammatory bowel disease. After adjusting for sociodemographic characteristics and health care utilization, patients were significantly more likely to be screened for CRC if their primary care practices had greater autonomy over the internal structure of care delivery (p<.04), more clinical support arrangements (p<.03), and smaller size (p<.001). Deficits in primary care clinical support arrangements and local autonomy over operational management and referral procedures are associated with significantly lower CRC screening performance. Competition with hospital resource demands may impinge on the degree of internal organization of their affiliated primary care practices.

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.

Physicians' opinions and clinical practice patterns for actinic keratosis management in Italy.

PubMed

Peris, K; Neri, L; Calzavara Pinton, P; Catricalà, C; Pellacani, G; Pimpinelli, N; Peserico, A

2014-04-01

We report dermatologists' opinions and clinical practice patterns about clinical factors driving decision making in the management of actinic keratosis (AK) in Italy. We carried out a cross-sectional survey among 33 Italian dermatologists. Physicians were asked to report their management choices in consecutive patients with AK seen at their practice within 2 weeks since study initiation. We collected patients' clinical and socio-demographic characteristics with a standardized data collection form and assessed physicians' opinions on AK management with a self-reported questionnaire. Six hundred fifty-seven patients with new, single AK lesions without evidence of photo-damaged skin in the surrounding areas, were predominantly treated with lesion-directed therapies (primarily cryotherapy). In contrast, physicians preferentially prescribed field-directed therapies to patients with multiple lesions and evidence of photo-damaged skin in AK surrounding areas. However we observed a wide variation in treatment choices and physicians' opinions on AK management. Dermatologists underlined the importance of fostering patients' adherence and minimize therapy side effects. Overall, our results show that current guidelines regarding management of AK are only partially integrated in dermatology practice. The active dissemination of up-to-date national guidelines might help harmonize clinical decision making in this complex and fast growing therapeutic area.

The evolution of behavior guidance: a history of professional, practice, corporate and societal influences.

PubMed

Strange, David M

2014-01-01

Behavior guidance in pediatric dentistry is a composite of influences including expert opinion, historical precedent, scientific studies, and social factors including the law and the media. The early icons of pediatric dentistry injected their personal views on child management, and those often reflected the child-rearing norms of the times. The business of pediatric dentistry with its efficiency and quality orientations also shaped approaches to behavior management. Scientific studies contributed minimally. A major influence on behavior guidelines in recent years has been external scrutiny of techniques prompted by media and other exposure of both private practice and corporate management of children. Changing parenting and reaction of society to authority have also had significant impact on behavior. This paper describes in more detail the evolution of behavior guidance and the subsequent codification of practices into professionally derived guidelines.

Outcome of career expectancies and early professional burnout among newly qualified dentists.

PubMed

Gorter, R C; Storm, M K; te Brake, J H M; Kersten, H W; Eijkman, M A J

2007-08-01

To measure burnout development, outcome of expectations with regard to dental career and feelings of being unprepared for practice among newly graduated general dental practitioners. In 1997, 50 dentists were approached to fill in the Maslach Burnout Inventory, Dutch version (UBOS) and some additional variables between six months and one year after graduation at the Academic Centre for Dentistry Amsterdam (ACTA) (76% response). Six years later, in 2003, the same 50 dentists, plus another 60 who had graduated in the same period at ACTA, were approached (78% response). Using Repeated Measures analysis, mean scores of dentists for whom two measurements were available on the three UBOS subscales (N=24) showed no statistically significant changes over six years on Emotional Exhaustion, Depersonalisation, or Personal Accomplishment. The same was true for group means of all in 1997 (N=33) compared with all in 2003 (N=82). However, according to manual criteria, varying percentages (7.2% - 24.4%) of dentists showed an unfavourable level on either one of the UBOS dimensions. Factors most frequently mentioned to be responsible for being unprepared for practice were: law and insurance matters (61.2%), practice organisation (56.6%) and staff management (55.2%). Most frequently reported factors that came out (much) worse than expected were: stressfulness of work (45.1%), and staff management (43.4%). Burnout appears no threat for the average newly qualified dentist. However, some individuals report alarmingly high burnout scores at an early professional stage. Practice management is the professional aspect about which young professionals worry most. It is recommended that dental schools pay attention to practice management skills and the stressfulness of work in the curriculum. Also, longitudinal monitoring of dental students and newly qualified dentists on burnout development is strongly advocated.

Management practices as risk factors for the presence of bulk milk antibodies to Salmonella, Neospora caninum and Leptospira interrogans serovar hardjo in Irish dairy herds.

PubMed

O' Doherty, E; Berry, D P; O' Grady, L; Sayers, R

2014-06-01

A survey of management practices in 309 Irish dairy herds was used to identify risk factors for the presence of antibodies to Salmonella, Neospora caninum and Leptospira interrogans serovar hardjo in extensively managed unvaccinated dairy herds. A previous study documented a herd-level seroprevalence in bulk milk of 49%, 19% and 86% for Salmonella, Neospora caninum and leptospira interrogans serovar hardjo, respectively in the unvaccinated proportion of these 309 herds in 2009. Association analyses in the present study were carried out using multiple logistic regression models. Herds where cattle were purchased or introduced had a greater likelihood of being positive to leptospira interrogans serovar hardjo (P<0.01) and Salmonella (P<0.01). Larger herds had a greater likelihood of recording a positive bulk milk antibody result to leptospira interrogans serovar hardjo (P<0.05). Herds that practiced year round calving were more likely to be positive to Neospora caninum (P<0.05) compared to herds with a spring-calving season, with no difference in risk between herds that practiced split calving compared to herds that practiced spring calving. No association was found between presence of dogs on farms and prevalence of Neospora caninum possibly due to limited access of dogs to infected materials including afterbirths. The information from this study will assist in the design of suitable control programmes for the diseases under investigation in pasture-based livestock systems.

Chapter 7. Assessing soil factors in wildland improvement programs

Treesearch

Arthur R. Tiedemann; Carlos F. Lopez

2004-01-01

Soil factors are an important consideration for successful wildland range development or improvement programs. Even though many soil improvement and amelioration practices are not realistic for wildlands, their evaluation is an important step in selection of adapted plant materials for revegetation. This chapter presents information for wildland managers on: the...

Exploration of a Contextual Management Framework for Strategic Learning Alliances

ERIC Educational Resources Information Center

Dealtry, Richard

2008-01-01

Purpose: This article aims to take a further step forward in examining those important business factors that will shape the future of best practice in the quality management of internal and external strategic alliances. Design/methodology/approach: The article presents a speculative scenario on the future of strategic alliances in education,…

ERP and Knowledge Management Integration: The Case of Malaysian Business Firms

ERIC Educational Resources Information Center

Supramaniam, Mahadevan; Kuppusamy, Mudiarasan

2010-01-01

In order to compete in a global environment, Malaysian business firms need to improve their products and services through best practices. This paper aims to investigate the critical success factors to adopt Enterprise Resource Planning (ERP) with knowledge management (KM) strategies among Malaysian business firms. In order to achieve the research…

Health supply chain management.

PubMed

Zimmerman, Rolf; Gallagher, Pat

2010-01-01

This chapter gives an educational overview of: * The actual application of supply chain practice and disciplines required for service delivery improvement within the current health environment. * A rationale for the application of Supply Chain Management (SCM) approaches to the Health sector. * The tools and methods available for supply chain analysis and benchmarking. * Key supply chain success factors.

Impacts and management implications of ice storms on forests in the southern United States

Treesearch

Don C. Bragg; Michael G Shelton; Boris Zeide

2003-01-01

Abstract: This review explores the ecological and silvicultural impacts of ice storms on forests in the southern United States. Different environmental factors like weather conditions, topography, vegetation, stand density, and management practices influence the degree of glaze damage a particular forest may experience. Additionally, the frequent...

Implementing Human Resources Management (HRM) within Dutch VET Institutions: Examining the Fostering and Hindering Factors

ERIC Educational Resources Information Center

Runhaar, Piety; Sanders, Karin

2013-01-01

Vocational Education and Training (VET) Institutions face serious challenges, like the implementation of competence-based education and upcoming teacher shortages, which urge them to implement Human Resources Management policy and practices (HRM). The implementation of HRM, however, often stagnates. This paper describes a qualitative study--in…

Nurses in Australian general practice: implications for chronic disease management.

PubMed

Halcomb, Elizabeth J; Davidson, Patricia M; Salamonson, Yenna; Ollerton, Richard; Griffiths, Rhonda

2008-03-01

The purpose of this study was to describe the demographic and employment characteristics of Australian practice nurses and explore the relationship between these characteristics and the nurses' role. Nursing in general practice is an integral component of primary care and chronic disease management in the United Kingdom and New Zealand, but in Australia it is an emerging specialty and there is limited data on the workforce and role. National postal survey embedded in a sequential mixed method design. 284 practice nurses completed a postal survey during 2003-2004. Descriptive statistics and factor analysis were utilized to analyse the data. Most participants were female (99%), Registered Nurses (86%), employed part-time in a group practice, with a mean age of 45.8 years, and had a hospital nursing certificate as their highest qualification (63%). The tasks currently undertaken by participants and those requiring further education were inversely related (R2 = -0.779). Conversely, tasks perceived to be appropriate for a practice nurse and those currently undertaken by participants were positively related (R2 = 0.8996). There was a mismatch between the number of participants who perceived that a particular task was appropriate and those who undertook the task. This disparity was not completely explained by demographic or employment characteristics. Extrinsic factors such as legal and funding issues, lack of space and general practitioner attitudes were identified as barriers to role expansion. Practice nurses are a clinically experienced workforce whose skills are not optimally harnessed to improve the care of the growing number of people with chronic and complex conditions. Relevance to clinical practice. Study data reveal a need to overcome the funding, regulatory and interprofessional barriers that currently constrain the practice nurse role. Expansion of the practice nurse role is clearly a useful adjunct to specialist management of chronic and complex disease, particularly within the context of contemporary policy initiatives.

Documentation of Sexual Partner Gender Is Low in Electronic Health Records: Observations, Predictors, and Recommendations to Improve Population Health Management in Primary Care

PubMed Central

Yehia, Baligh R.

2015-01-01

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

Factors associated with family violence by persons with psychiatric disorders.

PubMed

Labrum, Travis; Solomon, Phyllis L

2016-10-30

Family violence by persons with psychiatric disorders (PD) is a highly under-researched area. The primary objective of the present analysis was to identify perpetrator, victim, and interaction/relationship factors associated with this phenomenon. The secondary objective was to examine the extent to which the relationship between caregiving and family violence was mediated by limit-setting practices used towards relatives with PD. 573 adults across the U.S. with an adult relative with PD completed an online survey. Multivariate logistic regression was performed examining the association of factors with the occurrence of family violence. Mediation was assessed with Sobel testing. Family violence was significantly associated with the following factors: perpetrator-income, illegal drug use, psychiatric hospitalization, treatment attendance, and use of medications; victim-age, employment status, income, and mental health status; interaction/relationship-parental relationship, co-residence, use of limit-setting practices, representative payeeship, and unofficial money management. Mediation was statistically significant. Increasing access to mental health and/or substance abuse treatment may decrease the risk of family violence. Interventions may benefit from attempting to decrease/modify the use of limit-setting practices. Where family representative payeeship or unofficial money management exists, it is advisable for practitioners to assess and address financial coercion and promote greater collaboration in financial decision-making. Published by Elsevier Ireland Ltd.

A sequential factorial analysis approach to characterize the effects of uncertainties for supporting air quality management

NASA Astrophysics Data System (ADS)

Wang, S.; Huang, G. H.; Veawab, A.

2013-03-01

This study proposes a sequential factorial analysis (SFA) approach for supporting regional air quality management under uncertainty. SFA is capable not only of examining the interactive effects of input parameters, but also of analyzing the effects of constraints. When there are too many factors involved in practical applications, SFA has the advantage of conducting a sequence of factorial analyses for characterizing the effects of factors in a systematic manner. The factor-screening strategy employed in SFA is effective in greatly reducing the computational effort. The proposed SFA approach is applied to a regional air quality management problem for demonstrating its applicability. The results indicate that the effects of factors are evaluated quantitatively, which can help decision makers identify the key factors that have significant influence on system performance and explore the valuable information that may be veiled beneath their interrelationships.

From shared care to disease management: key-influencing factors.

PubMed

Eijkelberg, I M; Spreeuwenberg, C; Mur-Veeman, I M; Wolffenbuttel, B H

2001-01-01

In order to improve the quality of care of chronically ill patients the traditional boundaries between primary and secondary care are questioned. To demolish these boundaries so-called 'shared care' projects have been initiated in which different ways of substitution of care are applied. When these projects end, disease management may offer a solution to expand the achieved co-operation between primary and secondary care. Answering the question: What key factors influence the development and implementation of shared care projects from a management perspective and how are they linked? The theoretical framework is based on the concept of the learning organisation. Reference point is a multiple case study that finally becomes a single case study. Data are collected by means of triangulation. The studied cases concern two interrelated Dutch shared care projects for type 2 diabetic patients, that in the end proceed as one disease management project. In these cases the predominant key-influencing factors appear to be the project management, commitment and local context, respectively. The factor project management directly links the latter two, albeit managing both appear prerequisites to its success. In practice this implies managing the factors' interdependency by the application of change strategies and tactics in a committed and skillful way. Project management, as the most important and active key factor, is advised to cope with the interrelationships of the influencing factors in a gradually more fundamental way by using strategies and tactics that enable learning processes. Then small-scale shared care projects may change into a disease management network at a large scale, which may yield the future blueprint to proceed.

The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists.

PubMed

Lindahl, Jared R; Fisher, Nathan E; Cooper, David J; Rosen, Rochelle K; Britton, Willoughby B

2017-01-01

Buddhist-derived meditation practices are currently being employed as a popular form of health promotion. While meditation programs draw inspiration from Buddhist textual sources for the benefits of meditation, these sources also acknowledge a wide range of other effects beyond health-related outcomes. The Varieties of Contemplative Experience study investigates meditation-related experiences that are typically underreported, particularly experiences that are described as challenging, difficult, distressing, functionally impairing, and/or requiring additional support. A mixed-methods approach featured qualitative interviews with Western Buddhist meditation practitioners and experts in Theravāda, Zen, and Tibetan traditions. Interview questions probed meditation experiences and influencing factors, including interpretations and management strategies. A follow-up survey provided quantitative assessments of causality, impairment and other demographic and practice-related variables. The content-driven thematic analysis of interviews yielded a taxonomy of 59 meditation-related experiences across 7 domains: cognitive, perceptual, affective, somatic, conative, sense of self, and social. Even in cases where the phenomenology was similar across participants, interpretations of and responses to the experiences differed considerably. The associated valence ranged from very positive to very negative, and the associated level of distress and functional impairment ranged from minimal and transient to severe and enduring. In order to determine what factors may influence the valence, impact, and response to any given experience, the study also identified 26 categories of influencing factors across 4 domains: practitioner-level factors, practice-level factors, relationships, and health behaviors. By identifying a broader range of experiences associated with meditation, along with the factors that contribute to the presence and management of experiences reported as challenging, difficult, distressing or functionally impairing, this study aims to increase our understanding of the effects of contemplative practices and to provide resources for mediators, clinicians, meditation researchers, and meditation teachers.

Impact of managed care on healthcare delivery practices: the perception of healthcare administrators and clinical practitioners.

PubMed

Tietze, Mari F

2003-01-01

Managed care has introduced changes, such as cost effectiveness, access to care, and quality of care, to many components of the U.S. healthcare delivery system. These changes have affected how healthcare administrators and clinical practitioners perceive the impact of managed care on healthcare delivery practices. A survey was initiated to explore whether the perceptions of administrators differed from those of practitioners and to discover which organizational variables could explain the difference. A descriptive, cross-sectional survey design was used for the target population of administrators and practitioners in high, moderate, and low managed-care-penetration markets. Two investigator-developed instruments--the Managed Care Perceptions Inventory (MCPI) and the MCPI-Demographic--and an intact centralization of decision-making assessment subscale were used for data collection. Administrators had a statistically significant, more positive perception of the impact of managed care on healthcare delivery than did practitioners. When the distinction between administrator and practitioner was not used as a grouping factor, managed care market penetration, nonprofit status, and years in current employment position were factors that had statistically significant associations with a more positive perception of managed care. Based on these findings, both administrators and practitioners have a role in maintaining awareness regarding their perceptions and should work collaboratively to address issues of concern. Similarly, promoting trust and commitment at the organizational level is important. Recommendations for further research are also provided.

Access to laboratory testing: the impact of managed care in the Pacific Northwest.

PubMed

LaBeau, K M; Simon, M; Steindel, S J

1999-01-01

Patient access to health-care services has become an important issue owing to the growth of managed care organizations and the number of patients enrolled. To better understand the current issues related to access to laboratory testing, with a particular focus on the impact of managed care, we gathered information from a network of clinical laboratories in the Pacific Northwest. Two questionnaires were sent to the 257 Laboratory Medicine Sentinel Monitoring Network participants in November 1995 and March 1996 to investigate trends in the availability and utilization of laboratory testing services and changes in onsite testing menus. Although laboratories reported that managed care was a factor in their decisions about laboratory practices, testing decisions were more likely made for business reasons, based on medical practice changes and marketplace influences not associated with managed care.

Treating pulmonary embolism in Pacific Asia with direct oral anticoagulants.

PubMed

Cohen, Alexander; Jeyaindran, Sinnadurai; Kim, Jae Yeol; Park, Kihyuk; Sompradeekul, Suree; Tambunan, Karmel L; Tran, Huyen; Tsai, I-Chen; Ward, Christopher; Wong, Raymond

2015-08-01

Pulmonary embolism (PE) is the principal preventable cause of in-hospital deaths. Prevalence of PE in Asians is uncertain but undoubtedly underestimated. Asians and Caucasians have similar non-genetic risk factors for PE, and there is mounting evidence that PE affects Asians much more commonly than previously supposed; incidence, especially among high-risk patients, may approach that in Caucasians. Furthermore, PE incidence in Asia is increasing, due to both increased ascertainment, and also population ageing and growing numbers of patients with predisposing risk factors. Despite being warranted, thromboprophylaxis for high-risk patients is not routine in Pacific Asian countries/regions. There also appears to be scope to implement venous thromboembolism (VTE) management guidelines more assiduously. Anticoagulants, primarily heparins and warfarin, have been the mainstays of VTE management for years; however, these agents have limitations that complicate routine use. The complexity of current guidelines has been another barrier to applying evidence-based recommendations in everyday practice. Updated management approaches have considerable potential to improve outcomes. New oral anticoagulants that are easier to administer, require no, or much less, monitoring or dose-adjustment and have a favourable risk/benefit profile compared with conventional modalities, may offer an alternative with the potential to simplify VTE management. However, more information is required on practical management and the occurrence and treatment of bleeding complications. Increasing recognition of the burden of PE and new therapeutic modalities are altering the VTE management landscape in Pacific Asia. Consequently, there is a need to further raise awareness and bridge gaps between the latest evidence and clinical practice. Copyright © 2015. Published by Elsevier Ltd.

Measuring clinical management by physicians and nurses in European hospitals: development and validation of two scales.

PubMed

Plochg, Thomas; Arah, Onyebuchi A; Botje, Daan; Thompson, Caroline A; Klazinga, Niek S; Wagner, Cordula; Mannion, Russell; Lombarts, Kiki

2014-04-01

Clinical management is hypothesized to be critical for hospital management and hospital performance. The aims of this study were to develop and validate professional involvement scales for measuring the level of clinical management by physicians and nurses in European hospitals. Testing of validity and reliability of scales derived from a questionnaire of 21 items was developed on the basis of a previous study and expert opinion and administered in a cross-sectional seven-country research project 'Deepening our Understanding of Quality improvement in Europe' (DUQuE). A sample of 3386 leading physicians and nurses working in 188 hospitals located in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Validity and reliability of professional involvement scales and subscales. Psychometric analysis yielded four subscales for leading physicians: (i) Administration and budgeting, (ii) Managing medical practice, (iii) Strategic management and (iv) Managing nursing practice. Only the first three factors applied well to the nurses. Cronbach's alpha for internal consistency ranged from 0.74 to 0.86 for the physicians, and from 0.61 to 0.81 for the nurses. Except for the 0.74 correlation between 'Administration and budgeting' and 'Managing medical practice' among physicians, all inter-scale correlations were <0.70 (range 0.43-0.61). Under testing for construct validity, the subscales were positively correlated with 'formal management roles' of physicians and nurses. The professional involvement scales appear to yield reliable and valid data in European hospital settings, but the scale 'Managing medical practice' for nurses needs further exploration. The measurement instrument can be used for international research on clinical management.

Bridging the gap between preventive and restorative dentistry: identification of caries risk factors and strategies for minimizing risk.

PubMed

Maragliano-Muniz, Pamela

2013-10-01

Following the introduction of CAMBRA (Caries Management by Risk Assessment) in 2007, a number of recommendations for office protocols were introduced, and many companies have formulated products and procedures for implementing CAMBRA. As a result, the implementation of a caries management program can be confounding and overwhelming to a dental practitioner. Understanding risk factors as they contribute to the caries process can help mitigate confusion and guide the practitioner when selecting materials for their practice. Ultimately, knowing how the risk factors play a role in the progression of dental caries will lead to appropriate risk management and product recommendations. The purpose of this article is to discuss the contribution of risk factors to the caries process and to introduce strategies that restorative dentists can utilize to minimize caries risk.

Ethical decision making in pain management: a conceptual framework

PubMed Central

Carvalho, Ana Sofia; Martins Pereira, Sandra; Jácomo, António; Magalhães, Susana; Araújo, Joana; Hernández-Marrero, Pablo; Costa Gomes, Carlos; Schatman, Michael E

2018-01-01

Introduction The practice and study of pain management pose myriad ethical challenges. There is a consensual opinion that adequate management of pain is a medical obligation rooted in classical Greek practice. However, there is evidence that patients often suffer from uncontrolled and unnecessary pain. This is inconsistent with the leges artis, and its practical implications merit a bioethical analysis. Several factors have been identified as causes of uncontrolled and unnecessary pain, which deprive patients from receiving appropriate treatments that theoretically they have the right to access. Important factors include (with considerable regional, financial, and cultural differences) the following: 1) failure to identify pain as a priority in patient care; 2) failure to establish an adequate physician–patient relationship; 3) insufficient knowledge regarding adequate prescription of analgesics; 4) conflicting notions associated with drug-induced risk of tolerance and fear of addiction; 5) concerns regarding “last-ditch” treatments of severe pain; and 6) failure to be accountable and equitable. Objective The aim of this article was to establish that bioethics can serve as a framework for addressing these challenging issues and, from theoretical to practical approaches, bioethical reflection can contextualize the problem of unrelieved pain. Methods This article is organized into three parts. First, we illustrate that pain management and its undertreatment are indeed ethical issues. The second part describes possible ethical frameworks that can be combined and integrated to better define the ethical issues in pain management. Finally, we discuss possible directions forward to improve ethical decision making in pain management. Discussion We argue that 1) the treatment of pain is an ethical obligation, 2) health science schools, especially medical training institutions, have the duty to teach pain management in a comprehensive fashion, and 3) regulatory measures, which prevent patients from access to opioid treatment as indicated in their cases, are unethical and should be reconsidered. Conclusion Developing an ethical framework for pain management will result in enhanced quality of care, linking the epistemic domains of pain management to their anthropological foundations, thereby making them ethically sound. PMID:29844699

Development of the Champlain primary care cardiovascular disease prevention and management guideline

PubMed Central

Montoya, Lorraine; Liddy, Clare; Hogg, William; Papadakis, Sophia; Dojeiji, Laurie; Russell, Grant; Akbari, Ayub; Pipe, Andrew; Higginson, Lyall

2011-01-01

Abstract Problem addressed A well documented gap remains between evidence and practice for clinical practice guidelines in cardiovascular disease (CVD) care. Objective of program As part of the Champlain CVD Prevention Strategy, practitioners in the Champlain District of Ontario launched a large quality-improvement initiative that focused on increasing the uptake in primary care practice settings of clinical guidelines for heart disease, stroke, diabetes, and CVD risk factors. Program description The Champlain Primary Care CVD Prevention and Management Guideline is a desktop resource for primary care clinicians working in the Champlain District. The guideline was developed by more than 45 local experts to summarize the latest evidence-based strategies for CVD prevention and management, as well as to increase awareness of local community-based programs and services. Conclusion Evidence suggests that tailored strategies are important when implementing specific practice guidelines. This article describes the process of creating an integrated clinical guideline for improvement in the delivery of cardiovascular care. PMID:21673196

Survey of expert practice and perceptions of the supporting clinical evidence for the management of uveitis-related cataract and cystoid macular oedema.

PubMed

Sreekantam, Sreekanth; Denniston, Alastair K O; Murray, Philip I

2011-10-01

To survey the practice of uveitis experts in the management of uveitic cataract and cystoid macular oedema (CMO). A structured questionnaire containing two clinical scenarios was sent to members of the International Uveitis Study Group (IUSG). The questionnaire surveyed both respondents' current practice and their perception of the supporting clinical evidence. For uveitic cataract, 70% required a 3-month inflammation-free period before surgery, and 76% gave a prophylactic preoperative systemic corticosteroid. For uveitic CMO, 87% gave corticosteroids, usually orally. Preferred second-line agents were methotrexate (39%), cyclosporin (24%), azathioprine (17%), and mycophenolate (7%). Respondents suggested the evidence underlying their decisions was either absent or relatively weak (levels III or IV), and in most cases personal experience was a factor. This survey highlights areas of consensus and variation among uveitis experts in managing uveitic cataract and CMO, and emphasizes the need for further clinical trials to establish the best practice.

Retention of allied health professionals in rural New South Wales: a thematic analysis of focus group discussions.

PubMed

Keane, Sheila; Lincoln, Michelle; Smith, Tony

2012-06-22

Uneven distribution of the medical workforce is globally recognised, with widespread rural health workforce shortages. There has been substantial research on factors affecting recruitment and retention of rural doctors, but little has been done to establish the motives and conditions that encourage allied health professionals to practice rurally. This study aims to identify aspects of recruitment and retention of rural allied health professionals using qualitative methodology. Six focus groups were conducted across rural NSW and analysed thematically using a grounded theory approach. The thirty allied health professionals participating in the focus groups were purposively sampled to represent a range of geographic locations, allied health professions, gender, age, and public or private work sectors. Five major themes emerged: personal factors; workload and type of work; continuing professional development (CPD); the impact of management; and career progression. 'Pull factors' favouring rural practice included: attraction to rural lifestyle; married or having family in the area; low cost of living; rural origin; personal engagement in the community; advanced work roles; a broad variety of challenging clinical work; and making a difference. 'Push factors' discouraging rural practice included: lack of employment opportunities for spouses; perceived inadequate quality of secondary schools; age related issues (retirement, desire for younger peer social interaction, and intention to travel); limited opportunity for career advancement; unmanageable workloads; and inadequate access to CPD. Having competent clinical managers mitigated the general frustration with health service management related to inappropriate service models and insufficient or inequitably distributed resources. Failure to fill vacant positions was of particular concern and frustration with the lack of CPD access was strongly represented by informants. While personal factors affecting recruitment and retention of allied health study participants were similar to doctors, differences also existed. Allied health professionals were attracted by advanced work roles in a context of generalist practice. Access to CPD and inequitable resource distribution were strong 'push' factors in this group. Health policy based on the assumption of transferability between professions may be misguided.

Cultural issues and other factors that affect self-management of Type 2 Diabetes Mellitus (T2D) by Chinese immigrants in Australia.

PubMed

Eh, Kexin; McGill, Margaret; Wong, Jencia; Krass, Ines

2016-09-01

To investigate the influence of cultural and other factors on diabetes self-management behaviors among Australian Chinese immigrants with T2D. A cross-sectional survey was conducted between June and October 2015. The questionnaire comprised several validated scales examining aspects of self-management practice including medication adherence, acculturation and demographics. Participants were recruited from the community and Diabetes Center of the Royal Prince Alfred Hospital (RPAH), Sydney, Australia. Of the 139 participants, a majority were female, from mainland China, with high school level education and a mean age of 64 (SD±12) years. Participants were found to have poor self-management practices generally but moderate medication adherence. 13.7% of participants reported incorporating TCM into their diabetes treatment and 24% reported a cultural shame surrounding a diabetes diagnosis. Higher levels of acculturation predicted better medication adherence, whereas stronger beliefs in TCM predicted poorer medication adherence. Gender, education level and duration of diabetes were also predictors of diabetes self-management behaviors. This study provided insight into cultural influences on diabetes self-management and medication taking among Chinese immigrants in Australia. Health care providers should take these into account in delivering culturally sensitive care and advice to achieve better health outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Recommendations for the Prophylactic Management of Skin Reactions Induced by Epidermal Growth Factor Receptor Inhibitors in Patients With Solid Tumors

PubMed Central

Deplanque, Gaël; Komatsu, Yoshito; Kobayashi, Yoshimitsu; Ocvirk, Janja; Racca, Patrizia; Guenther, Silke; Zhang, Jun; Lacouture, Mario E.; Jatoi, Aminah

2016-01-01

Inhibition of the epidermal growth factor receptor (EGFR) is an established treatment that extends patient survival across a variety of tumor types. EGFR inhibitors fall into two main categories: anti-EGFR monoclonal antibodies, such as cetuximab and panitumumab, and first-generation tyrosine kinase inhibitors, such as afatinib, gefitinib, and erlotinib. Skin reactions are the most common EGFR inhibitor-attributable adverse event, resulting in papulopustular (acneiform) eruptions that can be painful and debilitating, and which may potentially have a negative impact on patients’ quality of life and social functioning, as well as a negative impact on treatment duration. Shortened treatment duration can, in turn, compromise antineoplastic efficacy. Similarly, appropriate management of skin reactions is dependent on their accurate grading; however, conventional means for grading skin reactions are inadequate, particularly within the context of clinical trials. Treating a skin reaction only once it occurs (reactive treatment strategies) may not be the most effective management approach; instead, prophylactic approaches may be preferable. Indeed, we support the viewpoint that prophylactic management of skin reactions should be recommended for all patients treated with EGFR inhibitors. Appropriate prophylactic management could effectively reduce the severity of skin reactions in patients treated with EGFR inhibitors and therefore has the potential to directly benefit patients and improve drug adherence. Accordingly, here we review published and still-emerging data, and provide practical and evidence-based recommendations and algorithms regarding the optimal prophylactic management of EGFR inhibitor-attributable skin reactions. Implications for Practice: Epidermal growth factor receptor (EGFR) inhibitors extend patient survival across a variety of tumor types. The most common EGFR inhibitor-attributable adverse events are skin reactions. Prophylactic—rather than reactive—management of skin reactions for all patients receiving EGFR inhibitors should be recommended because appropriate prophylaxis could effectively reduce the severity of skin reactions; thus, the derivation of highly effective prophylactic strategies has the potential to directly benefit patients. Accordingly, a review of the available data leads to practical and evidence-based recommendations and algorithms regarding the optimal prophylactic management of EGFR inhibitor-attributable skin reactions. PMID:27449521

Systematic review of descriptive studies that investigated associated factors with the management of incontinence in older people in care homes.

PubMed

Roe, Brenda; Flanagan, Lisa; Jack, Barbara; Shaw, Christine; Williams, Kate; Chung, Alan; Barrett, James

2013-03-01

Incontinence is prevalent among older populations and residents in care homes. This paper is a review of descriptive studies that investigated associated factors related to managing urinary incontinence in older people in care homes. A systematic literature review was undertaken. MEDLINE and CINHAL were searched from 1996-2010 using the Cochrane Incontinence Review Group search strings for urinary and faecal incontinence including all research designs. Sixteen studies were identified that reported on associated factors related to comorbidities, management preferences, policies, staff views and knowledge or methodological studies. Non-invasive methods involving toileting and use of pads were common management approaches. No studies aimed at maintaining continence were identified. Factors associated with incontinence need to also be considered when planning and managing care for individuals, and developing and designing systems of care within care homes. Further study in care home populations to change or inform practice and provide effective care is warranted. Preventive studies that maintain continence are required. Older people and their families should be involved with decisions regarding their preferred care, goals, management and outcomes for managing incontinence, promoting or maintaining continence. © 2011 Blackwell Publishing Ltd.

Management Practices of Cotton Producers in Lauderdale County, Tennessee.

ERIC Educational Resources Information Center

Peal, Charles T.; Dotson, Robert S.

Eighty-one randomly selected cotton producers in Lauderdale County were interviewed for the purposes of: (1) characterizing those in different cotton yield groups, (2) determining which practices were being used by those in different yield groups, and (3) identifying some of the factors influencing the farmers to use or not to use the 12 practices…

Children's Language Production: How Cognitive Neuroscience and Industrial Engineering Can Inform Public Education Policy and Practice

ERIC Educational Resources Information Center

Leisman, Gerry

2012-01-01

Little of 150 years of research in Cognitive Neurosciences, Human Factors, and the mathematics of Production Management have found their way into educational policy and certainly not into the classroom or in the production of educational materials in any meaningful or practical fashion. Whilst more mundane concepts of timing, sequencing, spatial…

Clinicians' management of children and adolescents with acute pharyngitis.

PubMed

Park, Sarah Y; Gerber, Michael A; Tanz, Robert R; Hickner, John M; Galliher, James M; Chuang, Ilin; Besser, Richard E

2006-06-01

Sore throat is a common complaint in children and adolescents. With increasing antimicrobial resistance because of antimicrobial overuse, accurate diagnosis is imperative. Appropriate management of acute pharyngitis depends on proper use and interpretation of clinical findings, rapid antigen-detection tests, and throat cultures. We surveyed pediatricians and family physicians to evaluate their management strategies for children and adolescents with acute pharyngitis and to assess the availability and use of diagnostic tests in office practice. In 2004, surveys were mailed to a random sample of 1000 pediatrician members of the American Academy of Pediatrics and 1000 family physician members of the American Academy of Family Physicians. We assessed factors associated with physicians using an appropriate management strategy for treating acute pharyngitis. Of 948 eligible responses, 42% of physicians would start antimicrobials before knowing diagnostic test results and continue them despite negative results, with 27% doing this often or always. When presented with clinical scenarios of patients with acute pharyngitis, < or =23% chose an empirical approach, 32% used an inappropriate strategy for a child with pharyngitis suggestive of group A Streptococcus, and 81% used an inappropriate strategy for a child with findings consistent with viral pharyngitis. Plating cultures in the office was associated with an appropriate management strategy, although not statistically significant. Solo/2-person practice and rural location were both independent factors predicting inappropriate strategies. There is much room for improvement in the management of acute pharyngitis in children and adolescents. Most physicians use appropriate management strategies; however, a substantial number uses inappropriate ones, particularly for children with likely viral pharyngitis. Efforts to help physicians improve practices will need to be multifaceted and should include health policy and educational approaches.

Management of dairy heifers and its relationships with the incidence of clinical mastitis.

PubMed

Parker, K I; Compton, C W R; Anniss, F M; Weir, A M; McDougal, S

2007-10-01

To describe aspects of management of dairy heifers before calving and determine risk factors for clinical mastitis postpartum in heifers, at the herd level, under pasture-based management systems in the Waikato and Taranaki regions of New Zealand. Dairy herdowners (n=578) provided information via a prospective survey about their practices for rearing heifers and management of mastitis. A proportion of herdowners (n=250) subsequently provided data on the cases of clinical mastitis in their herds, including the date, cow identification, age and quarter affected from cases occurring in the 4 months after the planned start of calving (PSC) in the subsequent lactation. The relationship between management factors and the proportion of heifers diagnosed with clinical mastitis within a herd was examined using bivariate and multivariate analyses. The herd average percentage of heifers with clinical mastitis was 13.6 (95% confidence interval (CI)=12.3-14.9)%, and multiparous cows with clinical mastitis was 9.0 (95% CI=8.2-9.8)% in the first 4 months of lactation. There were positive relationships between the proportion of heifers with clinical mastitis and average milk production per cow (kg milksolids/ lactation; p<0.001), number of cows milked per labour unit (p=0.003), stocking rate (<> 3.30 cows/ha; p=0.002), and incidence of clinical mastitis in multiparous cows (%/120 days; p<0.04), in the final multivariate model. The proportion of heifers with clinical mastitis per herd was lower in herds that milked their lactating cows in multiple groups (p=0.02). The risk of clinical mastitis in heifers was significantly associated with management practices. It may be possible to reduce the incidence of clinical mastitis in heifers by modification of management practices at the herd level, and further studies are required to investigate this.

Research on the water resources regulation ability model of dams in the Huai He River Basin considering ecological and management factors

NASA Astrophysics Data System (ADS)

Shui, Y.; Liu, H. C.; Li, L. H.; Yu, G. G.; Liu, J.

2016-08-01

Research that assesses the scheduling ability of dams gamers a great deal of attention due to the global water resource crisis. These studies can provide useful and practical suggestions for scheduling the water resources of dams to solve problems, such as addressing ecological water needs and so on. Recent studies have primarily evaluated the schedule ability of dams according to their quantifiable attributes, such as water quantity, flow velocity, etc. However, the ecological and management status can directly determine the possibility and efficiency of a dam's water resource scheduling. This paper presents an evaluation model to assess the scheduling capacity of dams that takes into consideration ecological and management factors. In the experiment stage, this paper takes the Sha Ying river of the Huai He River Basin as an example to evaluate the scheduling ability of its dams. The results indicate that the proposed evaluation model can provide more precise and practical suggestions.

Nurses' reflections on pain management in a nursing home setting.

PubMed

Clark, Lauren; Fink, Regina; Pennington, Karen; Jones, Katherine

2006-06-01

Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.

Farm Management, Environment, and Weather Factors Jointly Affect the Probability of Spinach Contamination by Generic Escherichia coli at the Preharvest Stage

PubMed Central

Navratil, Sarah; Gregory, Ashley; Bauer, Arin; Srinath, Indumathi; Szonyi, Barbara; Nightingale, Kendra; Anciso, Juan; Jun, Mikyoung; Han, Daikwon; Lawhon, Sara; Ivanek, Renata

2014-01-01

The National Resources Information (NRI) databases provide underutilized information on the local farm conditions that may predict microbial contamination of leafy greens at preharvest. Our objective was to identify NRI weather and landscape factors affecting spinach contamination with generic Escherichia coli individually and jointly with farm management and environmental factors. For each of the 955 georeferenced spinach samples (including 63 positive samples) collected between 2010 and 2012 on 12 farms in Colorado and Texas, we extracted variables describing the local weather (ambient temperature, precipitation, and wind speed) and landscape (soil characteristics and proximity to roads and water bodies) from NRI databases. Variables describing farm management and environment were obtained from a survey of the enrolled farms. The variables were evaluated using a mixed-effect logistic regression model with random effects for farm and date. The model identified precipitation as a single NRI predictor of spinach contamination with generic E. coli, indicating that the contamination probability increases with an increasing mean amount of rain (mm) in the past 29 days (odds ratio [OR] = 3.5). The model also identified the farm's hygiene practices as a protective factor (OR = 0.06) and manure application (OR = 52.2) and state (OR = 108.1) as risk factors. In cross-validation, the model showed a solid predictive performance, with an area under the receiver operating characteristic (ROC) curve of 81%. Overall, the findings highlighted the utility of NRI precipitation data in predicting contamination and demonstrated that farm management, environment, and weather factors should be considered jointly in development of good agricultural practices and measures to reduce produce contamination. PMID:24509926

Cropping practices manipulate abundance patterns of root and soil microbiome members paving the way to smart farming.

PubMed

Hartman, Kyle; van der Heijden, Marcel G A; Wittwer, Raphaël A; Banerjee, Samiran; Walser, Jean-Claude; Schlaeppi, Klaus

2018-01-16

Harnessing beneficial microbes presents a promising strategy to optimize plant growth and agricultural sustainability. Little is known to which extent and how specifically soil and plant microbiomes can be manipulated through different cropping practices. Here, we investigated soil and wheat root microbial communities in a cropping system experiment consisting of conventional and organic managements, both with different tillage intensities. While microbial richness was marginally affected, we found pronounced cropping effects on community composition, which were specific for the respective microbiomes. Soil bacterial communities were primarily structured by tillage, whereas soil fungal communities responded mainly to management type with additional effects by tillage. In roots, management type was also the driving factor for bacteria but not for fungi, which were generally determined by changes in tillage intensity. To quantify an "effect size" for microbiota manipulation, we found that about 10% of variation in microbial communities was explained by the tested cropping practices. Cropping sensitive microbes were taxonomically diverse, and they responded in guilds of taxa to the specific practices. These microbes also included frequent community members or members co-occurring with many other microbes in the community, suggesting that cropping practices may allow manipulation of influential community members. Understanding the abundance patterns of cropping sensitive microbes presents the basis towards developing microbiota management strategies for smart farming. For future targeted microbiota management-e.g., to foster certain microbes with specific agricultural practices-a next step will be to identify the functional traits of the cropping sensitive microbes.

Investigating solid waste production and associated management practices in private dental units

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

Kontogianni, S.; Xirogiannopoulou, A.; Karagiannidis, A.

In the municipality of Thessaloniki in 2006 mercury-bearing dental wastes were not managed properly by 80% of dentists and metal-bearing waste was handled in accordance with internationally established best management practices by less than 50% of dentists. Those results were documented through a biennial field-based research study that took place in private dental units within the Thessaloniki Urban Area. For quantifying the waste produced, structured questionnaires were used and interviews with dentists were performed. In the present work, results of this survey are presented; critical parameters and factors affecting the quantity and quality of the dental waste stream are reportedmore » together with the analysis and classification of dominant conditions and needs of the dental sector in the waste management field.« less

Patient safety culture in Norwegian primary care: a study in out-of-hours casualty clinics and GP practices.

PubMed

Bondevik, Gunnar Tschudi; Hofoss, Dag; Hansen, Elisabeth Holm; Deilkås, Ellen Catharina Tveter

2014-09-01

This study aimed to investigate patient safety attitudes amongst health care providers in Norwegian primary care by using the Safety Attitudes Questionnaire, in both out-of-hours (OOH) casualty clinics and GP practices. The questionnaire identifies five major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, and Working conditions. Cross-sectional study. Statistical analysis included multiple linear regression and independent samples t-tests. Seven OOH casualty clinics and 17 GP practices in Norway. In October and November 2012, 510 primary health care providers working in OOH casualty clinics and GP practices (316 doctors and 194 nurses) were invited to participate anonymously. To study whether patterns in patient safety attitudes were related to professional background, gender, age, and clinical setting. The overall response rate was 52%; 72% of the nurses and 39% of the doctors answered the questionnaire. In the OOH clinics, nurses scored significantly higher than doctors on Safety climate and Job satisfaction. Older health care providers scored significantly higher than younger on Safety climate and Working conditions. In GP practices, male health professionals scored significantly higher than female on Teamwork climate, Safety climate, Perceptions of management and Working conditions. Health care providers in GP practices had significant higher mean scores on the factors Safety climate and Working conditions, compared with those working in the OOH clinics. Our study showed that nurses scored higher than doctors, older health professionals scored higher than younger, male GPs scored higher than female GPs, and health professionals in GP practices scored higher than those in OOH clinics - on several patient safety factors.

Developmental dysplasia of the hip: addressing evidence gaps with a multicentre prospective international study.

PubMed

Schaeffer, Emily K; Study Group, Ihdi; Mulpuri, Kishore

2018-05-07

There is a lack of high quality evidence available to guide clinical practice in the treatment and management of developmental dysplasia of the hip (DDH). Evidence has been limited by persistent confusion on diagnostic and classification terminology, variability in surgeon decision making and a reliance on single centre, retrospective studies with small patient numbers. To address gaps in knowledge regarding screening, diagnosis and management of DDH, the International Hip Dysplasia Institute began a multicentre, international prospective study on infants with hips dislocated at rest. This review discusses the current state of screening, diagnostic and management practices in DDH and addresses important unanswered questions that will be critical in identifying best practices and optimising patient outcomes. There is insufficient evidence to support universal ultrasound screening; instead, selective screening should be performed by 6-8 weeks of age on infants with risk factors of breech presentation, family history, or history of clinical hip instability. Follow-up of infants with risk factors and normal initial screening should be considered to at least 6 months of age. Brace treatment is a sensible first-line treatment for management of dislocated hips at rest in infants < 6 months of age. Early operative reduction may be considered as there is insufficient evidence to support a protective role for the ossific nucleus in the development of avascular necrosis.

The relationship between quality management practices and organisational performance: A structural equation modelling approach

NASA Astrophysics Data System (ADS)

Jamaluddin, Z.; Razali, A. M.; Mustafa, Z.

2015-02-01

The purpose of this paper is to examine the relationship between the quality management practices (QMPs) and organisational performance for the manufacturing industry in Malaysia. In this study, a QMPs and organisational performance framework is developed according to a comprehensive literature review which cover aspects of hard and soft quality factors in manufacturing process environment. A total of 11 hypotheses have been put forward to test the relationship amongst the six constructs, which are management commitment, training, process management, quality tools, continuous improvement and organisational performance. The model is analysed using Structural Equation Modeling (SEM) with AMOS software version 18.0 using Maximum Likelihood (ML) estimation. A total of 480 questionnaires were distributed, and 210 questionnaires were valid for analysis. The results of the modeling analysis using ML estimation indicate that the fits statistics of QMPs and organisational performance model for manufacturing industry is admissible. From the results, it found that the management commitment have significant impact on the training and process management. Similarly, the training had significant effect to the quality tools, process management and continuous improvement. Furthermore, the quality tools have significant influence on the process management and continuous improvement. Likewise, the process management also has a significant impact to the continuous improvement. In addition the continuous improvement has significant influence the organisational performance. However, the results of the study also found that there is no significant relationship between management commitment and quality tools, and between the management commitment and continuous improvement. The results of the study can be used by managers to prioritize the implementation of QMPs. For instances, those practices that are found to have positive impact on organisational performance can be recommended to managers so that they can allocate resources to improve these practices to get better performance.

Using a fuzzy DEMATEL method for analyzing the factors influencing subcontractors selection

NASA Astrophysics Data System (ADS)

Kozik, Renata

2016-06-01

Subcontracting is a long-standing practice in the construction industry. This form of project organization, if manage properly, could provide the better quality, reduction in project time and costs. Subcontractors selection is a multi-criterion problem and can be determined by many factors. Identifying the importance of each of them as well as the direction of cause-effect relations between various types of factors can improve the management process. Their values could be evaluated on the basis of the available expert opinions with the application of a fuzzy multi-stage grading scale. In this paper it is recommended to use fuzzy DEMATEL method to analyze the relationship between factors affecting subcontractors selection.

Adaptive management of ecosystem services across different land use regimes.

PubMed

Ruhl, J B

2016-12-01

Using adaptive management to manage desired flows of ecosystem services may seem on the surface to be a good fit, but many social, economic, environmental, legal, and political factors influence how good a fit. One strongly influential factor is the land use regime within which the profile of ecosystem services is being managed. Shaped largely by legal mandates, market forces, and social and cultural practices, different land use regimes present different opportunities for and constraints on goals for ecosystem services and pose different decision making environments. Even where all other conditions appear amenable to using adaptive management, therefore, it is essential to consider the constraining (or liberating) effects of different land use regimes when deciding whether to adopt adaptive management to achieve those goals and, if so, how to implement it. Copyright © 2016 Elsevier Ltd. All rights reserved.

Enhancing nurses' empowerment: the role of supervisors' empowering management practices.

PubMed

Montani, Francesco; Courcy, François; Giorgi, Gabriele; Boilard, Amélie

2015-09-01

This study tests a theoretical model where: (a) nurses' dispositional resistance to change is indirectly negatively related to behavioural empowerment through the mediating role of psychological empowerment; and (b) supervisors' empowering management practices buffer both the negative relationship between dispositional resistance to change and psychological empowerment and the indirect negative relationship between resistance to change and behavioural empowerment via psychological empowerment. Promoting a high level of empowerment among nursing personnel is important to ensure their effectiveness in the context of organizational change. It is thus essential to advance our current understanding of the factors that hamper nurses' psychological and behavioural expressions of empowerment and to clarify supervisor practices that can overcome such barriers. A cross-sectional research design. We collected survey data during 2012 from a sample of 197 nurses from a Canadian hospital undergoing a major organizational change. Results from moderated mediation analyses provided evidence for an indirect negative relationship between dispositional resistance to change and behavioural empowerment through psychological empowerment, and for a moderating (buffering) effect of supervisors' empowering management practices on this mediated relationship. These findings provided support for our hypotheses. Supervisors' empowering management practices represent an important contextual buffer against the negative effects of dispositional resistance to change on nurses' empowerment. Organizations should develop empowering management skills among nurses' supervisors to counteract the detrimental effects of dispositional resistance to change and to sustain an empowered nursing workforce. © 2015 John Wiley & Sons Ltd.

Health workers' views of a program to facilitate physical health care in mental health settings: implications for implementation and training.

PubMed

Baker, Wendy; Harris, Melanie; Battersby, Malcolm

2014-12-01

Physical comorbidities shorten the lifespan of people with severe mental illness therefore mental health clinicians need to support service users in risk factor-related behaviour change. We investigated mental health care workers' views of a physical health self-management support program in order to identify implementation requirements. Qualitative interviews were conducted with workers who had differing levels of experience with a self-management support program. Themes were identified using interpretive descriptive analysis and then matched against domains used in implementation models to draw implications for successful practice change. Three main themes emerged related to: (1) understandings of disease management within job roles; (2) requirements for putting self-management support into practice; and (3) challenges of coordination in disease management. Priority domains from implementation models were inner and outer health service settings. While staff training is required, practice change for care which takes account of both mental and physical health also requires changes in organisational frameworks. © The Royal Australian and New Zealand College of Psychiatrists 2014.

Sociocultural factors and breast cancer in sub-Saharan Africa: implications for diagnosis and management.

PubMed

Tetteh, Dinah A; Faulkner, Sandra L

2016-01-01

The incidence of breast cancer is on the rise in sub-Saharan Africa (SSA) and efforts at early diagnosis have not been very successful because the public has scant knowledge about the disease, a large percentage of breast cancer cases are diagnosed late and mainly rural SSA women's practice of breast self-examination is poor. In this paper, we argue that an examination of the social and cultural contexts of SSA that influence breast cancer diagnosis and management in the region is needed. We discuss the implications of sociocultural factors, such as gender roles and spirituality, on breast cancer diagnosis and management in SSA.

District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study.

PubMed

Ng'ang'a, Njoki; Byrne, Mary Woods; Kruk, Margaret E; Shemdoe, Aloisia; de Pinho, Helen

2016-08-08

In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews. The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs. The incongruence in perspectives offered by members of CHMTs and mid-level providers points to deficient HRH management practices, which contribute to poor practice environments in acute obstetric settings in Tanzania. Our findings indicate that members of CHMTs require additional support to adequately fulfill their HRH management role. Further research conducted in low-income countries is necessary to determine the appropriate package of interventions required to strengthen the capacity of members of CHMTs.

Factors Affecting Job Motivation among Health Workers: A Study From Iran

PubMed Central

Daneshkohan, Abbas; Zarei, Ehsan; Mansouri, Tahere; Maajani, Khadije; Ghasemi, Mehri Siyahat; Rezaeian, Mohsen

2015-01-01

Objective: Human resources are the most vital resource of any organizations which determine how other resources are used to accomplish organizational goals. This research aimed to identity factors affecting health workers’ motivation in Shahid Beheshti University of Medical Sciences (SBUMS). Method: This is a cross-sectional survey conducted with participation of 212 health workers of Tehran health centers in November and December 2011. The data collection tool was a researcher-developed questionnaire that included 17 motivating factors and 6 demotivating factors and 8 questions to assess the current status of some factors. Validity and reliability of the tool were confirmed. Data were analyzed with descriptive and analytical statistical tests. Results: The main motivating factors for health workers were good management, supervisors and managers’ support and good working relationship with colleagues. On the other hand, unfair treatment, poor management and lack of appreciation were the main demotivating factors. Furthermore, 47.2% of health workers believed that existing schemes for supervision were unhelpful in improving their performance. Conclusion: Strengthening management capacities in health services can increase job motivation and improve health workers’ performance. The findings suggests that special attention should be paid to some aspects such as management competencies, social support in the workplace, treating employees fairly and performance management practices, especially supervision and performance appraisal. PMID:25948438

Tuberculosis Management Practices by Private Practitioners in Andhra Pradesh, India

PubMed Central

Achanta, Shanta; Jaju, Jyoti; Kumar, Ajay M. V.; Nagaraja, Sharath Burugina; Shamrao, Srinivas Rao Motta; Bandi, Sasidhar Kumar; Kumar, Ashok; Satyanarayana, Srinath; Harries, Anthony David; Nair, Sreenivas Achutan; Dewan, Puneet K.

2013-01-01

Setting Private medical practitioners in Visakhapatnam district, Andhra Pradesh, India. Objectives To evaluate self-reported TB diagnostic and treatment practices amongst private medical practitioners against benchmark practices articulated in the International Standards of Tuberculosis Care (ISTC), and factors associated with compliance with ISTC. Design Cross- sectional survey using semi-structured interviews. Results Of 296 randomly selected private practitioners, 201 (68%) were assessed for compliance to ISTC diagnostic and treatment standards in TB management. Only 11 (6%) followed a combination of 6 diagnostic standards together and only 1 followed a combination of all seven treatment standards together. There were 28 (14%) private practitioners who complied with a combination of three core ISTC (cough for tuberculosis suspects, sputum smear examination and use of standardized treatment). Higher ISTC compliance was associated with caring for more than 20 TB patients annually, prior sensitization to TB control guidelines, and practice of alternate systems of medicine. Conclusion Few private practitioners in Visakhapatnam, India reported TB diagnostic and treatment practices that met ISTC. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance. PMID:23967158

Dynamics of Soil Erosion as Influenced by Watershed Management Practices: A Case Study of the Agula Watershed in the Semi-Arid Highlands of Northern Ethiopia.

PubMed

Fenta, Ayele Almaw; Yasuda, Hiroshi; Shimizu, Katsuyuki; Haregeweyn, Nigussie; Negussie, Aklilu

2016-11-01

Since the past two decades, watershed management practices such as construction of stone bunds and establishment of exclosures have been widely implemented in the semi-arid highlands of northern Ethiopia to curb land degradation by soil erosion. This study assessed changes in soil erosion for the years 1990, 2000 and 2012 as a result of such watershed management practices in Agula watershed using the Revised Universal Soil Loss Equation. The Revised Universal Soil Loss Equation factors were computed in a geographic information system for 30 × 30 m raster layers using spatial data obtained from different sources. The results revealed significant reduction in soil loss rates by about 55 % from about 28 to 12 t ha -1 per year in 1990-2000 and an overall 64 % reduction from 28 to 10 t ha -1 per year in 1990-2012. This change in soil loss is attributed to improvement in surface cover and stone bund practices, which resulted in the decrease in mean C and P-factors, respectively, by about 19 % and 34 % in 1990-2000 and an overall decrease in C-factor by 29 % in 1990-2012. Considerable reductions in soil loss were observed from bare land (89 %), followed by cultivated land (56 %) and shrub land (49 %). Furthermore, the reduction in soil loss was more pronounced in steeper slopes where very steep slope and steep slope classes experienced over 70 % reduction. Validation of soil erosion estimations using field observed points showed an overall accuracy of 69 %, which is fairly satisfactory. This study demonstrated the potential of watershed management efforts to bring remarkable restoration of degraded semi-arid lands that could serve as a basis for sustainable planning of future developments of areas experiencing severe land degradation due to water erosion.

Learning management by self-employed occupational therapists in private practice.

PubMed

Millsteed, Jeannine; Redmond, Janice; Walker, Elizabeth

2017-04-01

This study explored how occupational therapists in private practice developed the business skills needed to operate a successful private practice. The literature shows that many small-business owner-managers have poorly developed business skills, and some experience high rates of failure. This indicates that to be successful in private practice, occupational therapists need to gain mastery of management competencies in addition to their professional clinical competencies. A qualitative study, using in-depth interviews, collected data from twenty-six self-employed occupational therapists on their experiences of becoming a small-business owner-manager. A narrative analysis built an understanding about how these therapists developed their business competencies. Analysis revealed the factors affecting the development of business competencies were interactions between the initial motivations for start-up, growth aspirations and engagement with external business environments. Business competencies developed through a combination of formal learning prior to starting their businesses, and informal learning once their businesses were in operation. Lower level learning occurred in the routine and operational processes, with higher level learning through discontinuous events resulting in a transformation in the therapists' understanding about themselves as business owner-managers. Findings led to a proposition that occupational therapists make the transition to becoming successful small-business owner-manager through management learning that includes elements of self-reflection, identifying environmental opportunities and risks, developing capabilities, and strategic planning for growth and development. It provides insights on what occupational therapists need to consider to become successful small-business owner-managers. © 2016 Occupational Therapy Australia.

Food store owners' and managers' perspectives on the food environment: an exploratory mixed-methods study.

PubMed

Gravlee, Clarence C; Boston, P Qasimah; Mitchell, M Miaisha; Schultz, Alan F; Betterley, Connie

2014-10-03

Neighborhood characteristics such as poverty and racial composition are associated with inequalities in access to food stores and in the risk of obesity, but the pathways between food environments and health are not well understood. This article extends research on consumer food environments by examining the perspectives of food-store owners and managers. We conducted semistructured, open-ended interviews with managers and owners of 20 food stores in low-income, predominantly African American neighborhoods in Tallahassee, Florida (USA). The interviews were designed to elicit store managers' and owners' views about healthy foods, the local food environment, and the challenges and opportunities they face in creating access to healthy foods. We elicited perceptions of what constitutes "healthy foods" using two free-list questions. The study was designed and implemented in accord with principles of community-based participatory research. Store owners' and managers' conceptions of "healthy foods" overlapped with public health messages, but (a) agreement about which foods are healthy was not widespread and (b) some retailers perceived processed foods such as snack bars and sugar-sweetened juice drinks as healthy. In semistructured interviews, store owners and managers linked the consumer food environment to factors across multiple levels of analysis, including: business practices such as the priority of making sales and the delocalization of decision-making, macroeconomic factors such as poverty and the cost of healthier foods, individual and family-level factors related to parenting and time constraints, and community-level factors such as crime and decline of social cohesion. Our results link food stores to multilevel, ecological models of the food environment. Efforts to reshape the consumer food environment require attention to factors across multiple levels of analysis, including local conceptions of "healthy foods", the business priority of making sales, and policies and practices that favor the delocalization of decision making and constrain access to healthful foods.

Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements.

PubMed

Heneghan, Steven J; Bordley, James; Dietz, Patrick A; Gold, Michael S; Jenkins, Paul L; Zuckerman, Randall J

2005-11-01

The purpose of this study is to determine the differences between rural and urban surgeons with regard to practice patterns, factors in choosing a practice location, and educational needs. A list of surgeons obtained from the American Medical Association was examined using the Office of Management and Budget definition of rural. Seventeen hundred rural surgeons were mailed surveys; 421 responded. One hundred fourteen urban surgeons were contacted by telephone. Questions were designed to measure job and community satisfaction, factors influencing their decision to practice in their current location, spectrum and volume of cases, and their perceived educational needs. Age distribution did not differ markedly between urban and rural surgeons. Motivation to practice in their current location varied considerably between urban and rural surgeons. Both groups equally rated quality of life as the leading factor influencing their current practice location. Urban surgeons rated other factors, such as income, practice growth, hospital facilities, and proximity to family, higher than rural surgeons. Practice patterns and educational needs also varied between the two groups. Rural surgeons performed more procedures per year with more variety in procedure type. Both groups felt that additional training in advanced laparoscopic techniques would be helpful, and rural surgeons felt that additional training in the surgical subspecialty areas was important. Although rural and urban surgeons do not differ in age or the importance of lifestyle in deciding career location, different factors do impact their choice of location. Practice pattern and educational needs varied markedly between rural and urban general surgeons.

Studying the Impacts of Environmental Factors and Agricultural Management on Methane Emissions from Rice Paddies Using a Land Surface Model

NASA Astrophysics Data System (ADS)

Lin, T. S.; Gahlot, S.; Shu, S.; Jain, A. K.; Kheshgi, H. S.

2017-12-01

Continued growth in population is projected to drive increased future demand for rice and the methane emissions associated with its production. However, observational studies of methane emissions from rice have reported seemingly conflicting results and do not all support this projection. In this study we couple an ecophysiological process-based rice paddy module and a methane emission module with a land surface model, Integrated Science Assessment Model (ISAM), to study the impacts of various environmental factors and agricultural management practices on rice production and methane emissions from rice fields. This coupled modeling framework accounts for dynamic rice growth processes with adaptation of photosynthesis, rice-specific phenology, biomass accumulation, leaf area development and structures responses to water, temperature, light and nutrient stresses. The coupled model is calibrated and validated with observations from various rice cultivation fields. We find that the differing results of observational studies can be caused by the interactions of environmental factors, including climate, atmospheric CO2 concentration, and N deposition, and agricultural management practices, such as irrigation and N fertilizer applications, with rice production at spatial and temporal scales.

Supervisor and Organizational Factors Associated with Supervisor Support of Job Accommodations for Low Back Injured Workers.

PubMed

Kristman, Vicki L; Shaw, William S; Reguly, Paula; Williams-Whitt, Kelly; Soklaridis, Sophie; Loisel, Patrick

2017-03-01

Purpose Temporary job accommodations contribute to the prevention of chronic work disability due to low back pain (LBP) through the facilitation of early return to work; yet, workplace dimensions of job accommodation are poorly understood. The objective of this study was to determine supervisor and organizational factors associated with supervisors' support for temporary job accommodations for LBP injured workers. Methods Supervisors were recruited from 19 workplaces in the USA and Canada and completed an online survey regarding job accommodation practices and potential associated factors with respect to a case vignette of a worker with LBP. Multivariable linear regression was used to identify the most parsimonious set of factors associated with supervisors' support for accommodations. Results A total of 804 supervisors participated with 796 eligible for inclusion in the analysis. The final set of factors explained 21 % of the variance in supervisors' support for temporary job accommodations. Considerate leadership style (β = 0.261; 95 % CI 0.212, 0.310), workplace disability management policies and practices (β = 0.243; 95 % CI 0.188, 0.298), and supervisor autonomy for designing and providing workplace accommodations (β = 0.156; 95 % CI 0.071, 0.241) had the largest effect on supervisor support for accommodations. Conclusion Factors predicting supervisors' likelihood to accommodate LBP injured workers include use of considerate leadership style, workplace disability management policies and practices, and supervisor autonomy. Workplace interventions targeting these factors should be developed and evaluated for their ability to improve work disability prevention outcomes.

Southern forest resource conditions and management practices from 1950-2000: Benefits of research

Treesearch

Jacek P. Siry

2004-01-01

Over the past five decades, research progress and implementation have been the leading factors supporting the rapid development of southern forestry. The South has become the leading timber-supplying region in the United States, taking advantage of a large accumulation of growing stock and a substantial investment in intensive, research-based management treatments....

Managing Systemic Curriculum Change: A Critical Analysis of Hong Kong's Target-Oriented Curriculum Initiative.

ERIC Educational Resources Information Center

Carless, David

1997-01-01

Describes Hong Kong's Target-Oriented Curriculum (TOC), a major curriculum renewal initiative designed to improve the quality of learning in local primary schools. Discusses the context in which it was introduced and factors that proved problematic in managing change. Focuses on five elements in the change process: practicality, ownership, teacher…

Perspectives on site productivity of loblolly pine plantations in the southern United States

Treesearch

Eric D. Vance; Felipe G. Sanchez

2006-01-01

Pine plantations in the U.S. South include some of the most intensively managed and productive forests in the world. Studies have been established in recent decades to answer questions about whether the productivity of these plantations is sustainable. While intensive management practices greatly enhance tree growth, their effects on factors controlling growth...

Predicting forest road surface erosion and storm runoff from high-elevation sites

Treesearch

J. M. Grace III

2017-01-01

Forest roads are a concern in management because they represent areas of elevated risks associated with soil erosion and storm runoff connectivity to stream systems. Storm runoff emanating from forest roads and their connectivity to downslope resources can be influenced by a myriad of factors, including storm characteristics, management practices, and the interaction...

Managing the space-time-load continuum in TMDL planning: A case study for understanding groundwater loads through advanced mapping techniques

EPA Science Inventory

The lag time between groundwater recharge and discharge in a watershed and the potential groundwater load to streams is an important factor in forecasting responses to future land use practices. We call this concept managing the “space-time-load continuum”. It’s understood that i...

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…

Influences of health literacy, judgment skills, and empowerment on asthma self-management practices.

PubMed

Londoño, Ana Maria Moreno; Schulz, Peter J

2015-07-01

Asthma self-management has been recognized as an essential factor for the improvement of asthma outcomes and patients' quality of life (WHO, 2013). Likewise, empowerment and health literacy have been noted as important elements for the management of chronic diseases. To study the influence of health literacy and empowerment on asthma self-management. This cross-sectional study used a self-reported questionnaire assessing health literacy, judgment skills, empowerment, and asthma self-management; 236 patients were recruited from medical offices in Switzerland and Italy. Judgment skills (B=2.28, p<0.001) and empowerment (B=0.19, p<0.05) have a significant and positive influence on several asthma self-management practices such as use of medicines, timely medical consultation, and asthma triggers control whereas health literacy (B=-0.15, p<0.175) appeared to have a negative effect on self-management practices. However, this was not significant. These findings suggest that empowered patients with adequate judgment skills carry out key self-management tasks more appropriately, which in turn will potentially result in better asthma control. This study recommends that both empowerment and judgment skills should be addressed in patient education as they serve as essential motivators to engage patients in these behaviors. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Effects of environmental factors and management practices on microclimate, winter physiology, and frost resistance in trees

PubMed Central

Charrier, Guillaume; Ngao, Jérôme; Saudreau, Marc; Améglio, Thierry

2015-01-01

Freezing stress is one of the most important limiting factors determining the ecological distribution and production of tree species. Assessment of frost risk is, therefore, critical for forestry, fruit production, and horticulture. Frost risk is substantial when hazard (i.e., exposure to damaging freezing temperatures) intersects with vulnerability (i.e., frost sensitivity). Based on a large number of studies on frost resistance and frost occurrence, we highlight the complex interactive roles of environmental conditions, carbohydrates, and water status in frost risk development. To supersede the classical empirical relations used to model frost hardiness, we propose an integrated ecophysiologically-based framework of frost risk assessment. This framework details the individual or interactive roles of these factors, and how they are distributed in time and space at the individual-tree level (within-crown and across organs). Based on this general framework, we are able to highlight factors by which different environmental conditions (e.g., temperature, light, flood, and drought), and management practices (pruning, thinning, girdling, sheltering, water aspersion, irrigation, and fertilization) influence frost sensitivity and frost exposure of trees. PMID:25972877

Effects of environmental factors and management practices on microclimate, winter physiology, and frost resistance in trees.

PubMed

Charrier, Guillaume; Ngao, Jérôme; Saudreau, Marc; Améglio, Thierry

2015-01-01

Freezing stress is one of the most important limiting factors determining the ecological distribution and production of tree species. Assessment of frost risk is, therefore, critical for forestry, fruit production, and horticulture. Frost risk is substantial when hazard (i.e., exposure to damaging freezing temperatures) intersects with vulnerability (i.e., frost sensitivity). Based on a large number of studies on frost resistance and frost occurrence, we highlight the complex interactive roles of environmental conditions, carbohydrates, and water status in frost risk development. To supersede the classical empirical relations used to model frost hardiness, we propose an integrated ecophysiologically-based framework of frost risk assessment. This framework details the individual or interactive roles of these factors, and how they are distributed in time and space at the individual-tree level (within-crown and across organs). Based on this general framework, we are able to highlight factors by which different environmental conditions (e.g., temperature, light, flood, and drought), and management practices (pruning, thinning, girdling, sheltering, water aspersion, irrigation, and fertilization) influence frost sensitivity and frost exposure of trees.

An Analysis of the Impact of Total Quality Management on Employee Performance with mediating role of Process Innovation

NASA Astrophysics Data System (ADS)

Nadia Dedy, Aimie; Zakuan, Norhayati; Zaleha Omain, Siti; Rahim, Kamaruzzaman Abdul; Ariff, Mohd Shoki Md; Sulaiman, Zuraidah; Zameri Mat Saman, Muhamad

2016-05-01

TQM practices are important to provide customer satisfaction by improved product performance and sustained towards the organizational goal. The objective of this study was to analyse the relationship between TQM practices, process innovation and employee performance. In this study, six critical success factors of TQM have been identified namely customer focus, leadership, training, teamwork, communication, and top management. Based on thorough literature review, employee performances have been measured by two constructs which are job satisfaction and workplace environment. The study used methodology of quantitative approach. The questionnaires for this study were randomly distributed to 102 employees in the selected car manufacturer companies. The respondents were choosing from management team, supervisor, technician and others worker. Results of the study support the proposed hypotheses that there are significant relationship between TQM practices, process innovation and employee performance.

Effective management of construction company in terms of linguistic communication

NASA Astrophysics Data System (ADS)

Shirina, Elena; Gaybarian, Olga; Myasischev, Georg

2017-10-01

The research presented here has been made over the years in the field of increasing the effectiveness of management in a construction company in terms of applied linguistics. The aim of this work is to share with the scientific community some practical findings of applying the technology of process management of the company, in particular the methods of linguistic efficiency considering the factors of the linguistic personality of the employee. The study deals with the description of applied linguistic and managerial models, views, practical results of their application in the applied field in order to assess production sustainability and minimize losses. The authors applied the developed technology to practical use, and the article presents the results of this application. The authors continue the research in this direction aiming at improving the production effectiveness of the proposed technologies and eliminating some identified drawback.

Antibiotic Types and Handling Practices in Disease Management among Pig Farms in Ashanti Region, Ghana

PubMed Central

Osei Sekyere, John

2014-01-01

Antibiotic resistance in bacteria is affected by the type of antibiotics used and how they are handled. The types of antibiotics used by 110 pig farms in the Ashanti region and the handling practices of the farmers during disease management were assessed. Injectable tetracycline, sulphadimidine, benzylpenicillin, and dihydrostreptomycin containing antibiotics were overly used by the farmers especially in the management of diarrhea, rashes, and coughs. Unsafe storage and disposal practices observed among the farms reflected the abysmal knowledge on appropriate use of antibiotics. Misdiagnosis and inadequate protection during antibiotic handling in the farms increased the risk of antibiotic resistance development and spread. The factors affecting antibiotic resistance development and spread are rife in pig farms in Ashanti region and appropriate education and veterinary interventions are needed to prevent resistant bacteria from becoming endemic in pork and pig farm communities. PMID:26464936

Occupational health hazards in a prosthodontic practice: review of risk factors and management strategies

PubMed Central

Arunachalam, Kuthalingam Subbiah; Solomon, EGR

2012-01-01

The intent of this article was to analyze the potential hazards and risks involved in persons exposed to prosthodontic practice. These risks include exposure to physical and chemical hazards, dental materials, infectious environment, inappropriate working pattern and psychosocial stress. The potential harm of these hazards and its prevention is highlighted. Prosthodontists, students, dental technicians, and others working in the prosthodontic clinics and laboratory should be aware of the specific risk factors and take measures to prevent and overcome these hazards. PMID:23236581

Deconstructing dementia and delirium hospital practice: using cultural historical activity theory to inform education approaches.

PubMed

Teodorczuk, Andrew; Mukaetova-Ladinska, Elizabeta; Corbett, Sally; Welfare, Mark

2015-08-01

Older patients with dementia and delirium receive suboptimal hospital care. Policy calls for more effective education to address this though there is little consensus on what this entails. The purpose of this clarification study is to explore how practice gaps are constructed in relation to managing the confused hospitalised older patient. The intent is to inform educational processes in the work-place beyond traditional approaches such as training. Adopting grounded theory as a research method and working within a social constructionist paradigm we explored the practice gaps of 15 healthcare professionals by interview and conducted five focus groups with patients, carers and Liaison mental health professionals. Data were thematically analysed by constant comparison and theoretical sampling was undertaken until saturation reached. Categories were identified and pragmatic concepts developed grounded within the data. Findings were then further analysed using cultural historical activity theory as a deductive lens. Practice gaps in relation to managing the confused older patient are determined by factors operating at individual (knowledge and skill gaps, personal philosophy, task based practice), team (leadership, time and ward environmental factors) and organisational (power relationships, dominance of medical model, fragmentation of care services) levels. Conceptually, practice appeared to be influenced by socio-cultural ward factors and compounded by a failure to join up existing "patient" knowledge amongst professionals. Applying cultural historical activity theory to further illuminate the findings, the central object is defined as learning about the patient and the mediating artifacts are the care relationships. The overarching medical dominance emerges as an important cultural historical factor at play and staff rules and divisions of labour are exposed. Lastly key contradictions and tensions in the system that work against learning about the patient are identified. Cultural historical activity theory can be used to advance understanding of practice gaps in order to develop a broader transformative approach to dementia and delirium practice and education. Structural changes at an individual, team and systems level resulting from this novel understanding of practice complexity are proposed. Contradictions can be used as foci for expansive learning. Lastly, interprofessional education (formal and informal) is advocated to further knotwork and improve the care of the older confused patient.

Risks and Protective Factors for Stress Self-Management in Parents of Children With Autism Spectrum Disorder: An Integrated Review of the Literature.

PubMed

Bonis, Susan A; Sawin, Kathleen J

Stress in parents of children with autism spectrum disorder (ASD) has been reported to be very high. However, little is known about what risk and protective factors influence parental stress self-management in this population. Accordingly, this manuscript is a synthesis of the risk and protective factors that impact self-management of stress in these parents. The concepts in the individual and family self-management theory context domain were used as a framework to guide data collection and analysis. Searches were conducted using CINAHL, MedLine and PsychInfo. Studies were included if they addressed context factors in parents of children with ASD and were written in English. Ninety-eight studies met review criteria. This review highlighted risk factors to parental stress self-management within the context of condition-specific factors, physical and social environment, and individual and family. The most concerning of these findings is that parents struggle accessing a diagnosis and services for their child and are frustrated with health care providers' knowledge of ASD and lack of communication. The risks parents experience as they care for their child with ASD far outweigh the protective factors for self-management of parental stress. Nurses who are aware of these issues can make important changes to their practice and have a significant impact on parental stress self-management and the care of children with ASD. Copyright © 2016 Elsevier Inc. All rights reserved.

Mastitis prevention and control practices and mastitis treatment strategies associated with the consumption of (critically important) antimicrobials on dairy herds in Flanders, Belgium.

PubMed

Stevens, M; Piepers, S; De Vliegher, S

2016-04-01

The main objectives of this study were to evaluate to what extent variations in herd-level antimicrobial consumption (AMC) can be explained by differences in management practices that are consistently effective in the prevention of (sub)clinical mastitis, on the one hand, and by differences in mastitis treatment strategies, on the other hand. Antimicrobial consumption data were obtained during 2012 and 2013 by "garbage can audits" and expressed as antimicrobial treatment incidences (ATI) for all compounds combined (total ATI) and for the critically important antimicrobials for human health separately. Data on mastitis prevention and control practices were obtained via face-to-face interviews performed during herd visits in March 2013. Some management practices and treatment strategies related to udder health were associated with the total AMC. However, the results demonstrated that implementing effective udder health management practices does not necessarily imply a low AMC and vice versa. Herds participating in a veterinary herd health management program and herds selectively drying off cows used fewer antimicrobials compared with herds not participating in such a program or applying blanket dry-cow therapy. Moreover, herds treating (some) (sub)clinical mastitis cases with intramammary homeopathic substances consumed fewer antimicrobials than herds not applying such homeopathic treatments. Besides these factors, no other direct association was found between effective udder health management practices on the one hand and AMC on the other hand. Also, the use of critically important antimicrobials was only associated with the way in which subclinical mastitis cases were treated. The latter indicates that the AMC of critically important antimicrobials is potentially driven by factors other than those included in this study such as those related to the "mindset" of the veterinarians and their farmers. Future research should therefore aim to unravel the reasoning of vets and their farmers behind the use of those critically important antimicrobials for the treatment of mastitis and other diseases. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Productivity of forests of the United States and its relation to soil and site factors and management practices: a review.

Treesearch

C.C. Grier; K.M. Lee; N.M. [and others] Nadkarni

1989-01-01

Data on net primary biological productivity of United States forests are summarized by geographic region. Site factors influencing productivity are reviewed. This paper is a review of existing literature in the productivity of various forest regions of the United States, the influence of site factors on forest productivity, and the impact of various...

Factors Influencing Attitude, Safety Behavior, and Knowledge regarding Household Waste Management in Guinea: A Cross-Sectional Study

PubMed Central

Mamady, Keita

2016-01-01

Waste indiscriminate disposal is recognized as an important cause of environmental pollution and is associated with health problems. Safe management and disposal of household waste are an important problem to the capital city of Guinea (Conakry). The objective of this study was to identify socioeconomic and demographic factors associated with practice, knowledge, and safety behavior of family members regarding household waste management and to produce a remedial action plan. I found that no education background, income, and female individuals were independently associated with indiscriminate waste disposal. Unplanned residential area was an additional factor associated with indiscriminate waste disposal. I also found that the community residents had poor knowledge and unsafe behavior in relation to waste management. The promotion of environmental information and public education and implementation of community action programs on disease prevention and health promotion will enhance environmental friendliness and safety of the community. PMID:27092183

Factors Influencing Attitude, Safety Behavior, and Knowledge regarding Household Waste Management in Guinea: A Cross-Sectional Study.

PubMed

Mamady, Keita

2016-01-01

Waste indiscriminate disposal is recognized as an important cause of environmental pollution and is associated with health problems. Safe management and disposal of household waste are an important problem to the capital city of Guinea (Conakry). The objective of this study was to identify socioeconomic and demographic factors associated with practice, knowledge, and safety behavior of family members regarding household waste management and to produce a remedial action plan. I found that no education background, income, and female individuals were independently associated with indiscriminate waste disposal. Unplanned residential area was an additional factor associated with indiscriminate waste disposal. I also found that the community residents had poor knowledge and unsafe behavior in relation to waste management. The promotion of environmental information and public education and implementation of community action programs on disease prevention and health promotion will enhance environmental friendliness and safety of the community.

Managing bundled payments.

PubMed

Draper, Andrew

2011-04-01

Results of Medicare's ACE demonstration project and Geisinger Health System's ProvenCare initiative provide insight into the challenges hospitals will face as bundled payment proliferates. An early analysis of these results suggests that hospitals would benefit from bringing full automation using clinical IT tools to bear in their efforts to meet these challenges. Other important factors contributing to success include board and physician leadership, organizational structure, pricing methodology for bidding, evidence-based medical practice guidelines, supply cost management, process efficiency management, proactive and aggressive case management, business development and marketing strategy, and the financial management system.

Factors supporting self-management in Parkinson's disease: implications for nursing practice.

PubMed

Chenoweth, Lynn; Gallagher, Robyn; Sheriff, June N; Donoghue, Judith; Stein-Parbury, Jane

2008-09-01

Aim.  To identify the factors associated with better self-management in people with moderate to high levels of Parkinson's disease following an acute illness event. Design and methods.  A prospective, descriptive study conducted with 75 persons with Parkinson's disease over the age of 55, collected twice: within a week of an acute event and 1 month later, after resuming usual life at home. Participants completed a questionnaire on self-rated health status, self-efficacy, sense of coherence, symptom monitoring and medication and general self-management. Background.  Parkinson's disease is a chronic neurological condition that affects many dimensions of life, including threats to self-identity and confidence in self-management. Self-management has the potential to reduce costs through decreased hospital admissions, disease progression and avoidance of complications. While evidence for the relationships between self-management and self-efficacy and sense of coherence has been demonstrated in some chronic illness groups, this has not previously been demonstrated in Parkinson's disease. Results.  The independent predictors of better self-management were not being hospitalized in the last 6 months, more frequent symptom checking and better self-efficacy for self-management. The influence of other factors on self-management, such as sense of coherence, was mediated through self-efficacy. Support of family and others was associated with better self-efficacy both directly and through an improved sense of coherence. Conclusions and relevance to nursing practice.  The presence of informal support plays an important role in sustaining self-efficacy and sense of coherence and hence self-management in persons with Parkinson's disease. Since these attributes are amenable to change, nurses are in a good position to encourage participation in Parkinson's support groups, teach self-management skills through regular symptom monitoring and to assess and promote self-efficacy and sense of coherence. © 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd.

Using nurse managers' perceptions to guide new graduates toward positive nurse relationships.

PubMed

Moore, Linda Weaver; Sublett, Cynthia; Leahy, Cathy; Bradley, Jennifer M

One of the greatest challenges new graduates confront when transitioning to practice is establishing positive relationships with experienced nurses. Nursing faculty must prepare graduates for this challenge. However, nursing faculty are often removed from everyday practice and must rely on the perceptions of those entrenched in practice in order to ground teaching endeavors in authenticity. Nurse managers are well positioned to provide knowledgeable insights to nursing faculty regarding nurse relationships. The purpose of this qualitative, descriptive study was to explore nurse managers' perceptions regarding new graduates' relationships with more experienced nurses. Researcher-participant audiotaped interviews were conducted with 13 nurse managers. A content analysis revealed that all participants believed nurse relationships were significant, that factors such as perceived inequities and stressful occurrences triggered poor relationships, that new graduates were often targeted for negative relationships, and that reasons for targeting of new graduates included prolonged dependence on experienced nurses and either over or under confidence of the new graduate. Providing a supportive, protective environment and hiring practices that promote team unity were posed as strategies that could help to prevent targeting of new graduates. Findings provide real-life, practice based information that can underpin nurse educators' teaching regarding nurse relationships and relationship building. Copyright © 2017 Elsevier Inc. All rights reserved.

Modelling multiple hospital outcomes: the impact of small area and primary care practice variation

PubMed Central

Congdon, Peter

2006-01-01

Background: Appropriate management of care – for example, avoiding unnecessary attendances at, or admissions to, hospital emergency units when they could be handled in primary care – is an important part of health strategy. However, some variations in these outcomes could be due to genuine variations in health need. This paper proposes a new method of explaining variations in hospital utilisation across small areas and the general practices (GPs) responsible for patient primary care. By controlling for the influence of true need on such variations, one may identify remaining sources of excess emergency attendances and admissions, both at area and practice level, that may be related to the quality, resourcing or organisation of care. The present paper accordingly develops a methodology that recognises the interplay between population mix factors (health need) and primary care factors (e.g. referral thresholds), that allows for unobserved influences on hospitalisation usage, and that also reflects interdependence between hospital outcomes. A case study considers relativities in attendance and admission rates at a North London hospital involving 149 small areas and 53 GP practices. Results: A fixed effects model shows variations in attendances and admissions are significantly related (positively) to area and practice need, and nursing home patients, and related (negatively) to primary care access and distance of patient homes from the hospital. Modelling the impact of known factors alone is not sufficient to produce a satisfactory fit to the observations, and random effects at area and practice level are needed to improve fit and account for overdispersion. Conclusion: The case study finds variation in attendance and admission rates across areas and practices after controlling for need, and remaining differences between practices may be attributable to referral behaviour unrelated to need, or to staffing, resourcing, and access issues. In managerial terms, the analysis points to the utility of formal statistical analysis of hospitalisation rates as a prelude to non-statistical investigation of primary care resourcing and organisation. For example, there may be implications for the location of staff involved in community management of chronic conditions; health managers may also investigate whether some practices have unusual populations (homeless, asylum seekers, students) that explain different hospital use patterns. PMID:17109747

From shared care to disease management: key-influencing factors

PubMed Central

Eijkelberg, Irmgard M.J.G.; Spreeuwenberg, Cor; Mur-Veeman, Ingrid M.; Wolffenbuttel, Bruce H.R.

2001-01-01

Abstract Background In order to improve the quality of care of chronically ill patients the traditional boundaries between primary and secondary care are questioned. To demolish these boundaries so-called ‘shared care’ projects have been initiated in which different ways of substitution of care are applied. When these projects end, disease management may offer a solution to expand the achieved co-operation between primary and secondary care. Objective Answering the question: What key factors influence the development and implementation of shared care projects from a management perspective and how are they linked? Theory The theoretical framework is based on the concept of the learning organisation. Design Reference point is a multiple case study that finally becomes a single case study. Data are collected by means of triangulation. The studied cases concern two interrelated Dutch shared care projects for type 2 diabetic patients, that in the end proceed as one disease management project. Results In these cases the predominant key-influencing factors appear to be the project management, commitment and local context, respectively. The factor project management directly links the latter two, albeit managing both appear prerequisites to its success. In practice this implies managing the factors' interdependency by the application of change strategies and tactics in a committed and skilful way. Conclusion Project management, as the most important and active key factor, is advised to cope with the interrelationships of the influencing factors in a gradually more fundamental way by using strategies and tactics that enable learning processes. Then small-scale shared care projects may change into a disease management network at a large scale, which may yield the future blueprint to proceed. PMID:16896415

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

Implementing Role-Changing Versus Time-Changing Innovations in Health Care: Differences in Helpfulness of Staff Improvement Teams, Management, and Network for Learning.

PubMed

Nembhard, Ingrid M; Morrow, Christopher T; Bradley, Elizabeth H

2015-12-01

Health care organizations often fail in their effort to implement care-improving innovations. This article differentiates role-changing innovations, altering what workers do, from time-changing innovations, altering when tasks are performed or for how long. We examine our hypothesis that the degree to which access to groups that can alter organizational learning--staff, management, and external network--facilitates implementation depends on innovation type. Our longitudinal study using ordinal logistic regression and survey data on 517 hospitals' implementation of evidence-based practices for treating heart attack confirmed our thesis for factors granting access to each group: improvement team's representativeness (of affected staff), senior management engagement, and network membership. Although team representativeness and network membership were positively associated with implementing role-changing practices, senior management engagement was not. In contrast, senior management engagement was positively associated with implementing time-changing practices, whereas team representativeness was not, and network membership was not unless there was limited management engagement. These findings advance implementation science by explaining mixed results across past studies: Nature of change for workers alters potential facilitators' effects on implementation. © The Author(s) 2015.

Ecological Knowledge Among Communities, Managers and Scientists: Bridging Divergent Perspectives to Improve Forest Management Outcomes

NASA Astrophysics Data System (ADS)

Rist, Lucy; Shackleton, Charlie; Gadamus, Lily; Chapin, F. Stuart; Gowda, C. Made; Setty, Siddappa; Kannan, Ramesh; Shaanker, R. Uma

2016-04-01

Multiple actors are typically involved in forest management, namely communities, managers and researchers. In such cases, suboptimal management outcomes may, in addition to other factors, be symptomatic of a divergence in perspectives among these actors driven by fundamental differences in ecological knowledge. We examine the degree of congruence between the understandings of actors surrounding key issues of management concern in three case studies from tropical, subtropical and boreal forests. We identify commonly encountered points of divergence in ecological knowledge relating to key management processes and issues. We use these to formulate seven hypotheses about differences in the bodies of knowledge that frequently underlie communication and learning failures in forest management contexts where multiple actors are involved and outcomes are judged to be suboptimal. Finally, we present a set of propositions to acknowledge and narrow these differences. A more complete recognition of the full triangulation between all actors involved, and of the influence that fundamental differences in ecological knowledge can exert, may help lead to a more fruitful integration between local knowledge and practice, manager knowledge and practice, and contemporary science in forest management.

Crowd-Sourcing Management Activity Data to Drive GHG Emission Inventories in the Land Use Sector

NASA Astrophysics Data System (ADS)

Paustian, K.; Herrick, J.

2015-12-01

Greenhouse gas (GHG) emissions from the land use sector constitute the largest source category for many countries in Africa. Enhancing C sequestration and reducing GHG emissions on managed lands in Africa has to potential to attract C financing to support adoption of more sustainable land management practices that, in addition to GHG mitigation, can provide co-benefits of more productive and climate-resilient agroecosystems. However, robust systems to measure and monitor C sequestration/GHG reductions are currently a significant barrier to attracting more C financing to land use-related mitigation efforts.Anthropogenic GHG emissions are driven by a variety of environmental factors, including climate and soil attributes, as well as human-activities in the form of land use and management practices. GHG emission inventories typically use empirical or process-based models of emission rates that are driven by environmental and management variables. While a lack of field-based flux and C stock measurements are a limiting factor for GHG estimation, we argue that an even greater limitation may be availabiity of data on the management activities that influence flux rates, particularly in developing countries in Africa. In most developed countries there is a well-developed infrastructure of agricultural statistics and practice surveys that can be used to drive model-based GHG emission estimations. However, this infrastructure is largely lacking in developing countries in Africa. While some activity data (e.g. land cover change) can be derived from remote sensing, many key data (e.g., N fertilizer practices, residue management, manuring) require input from the farmers themselves. The explosive growth in cellular technology, even in many of the poorest parts of Africa, suggests the potential for a new crowd-sourcing approach and direct engagement with farmers to 'leap-frog' the land resource information model of developed countries. Among the many benefits of this approach would be high resolution management data to support GHG inventories at multiple scales. We present an overall conceptual model for this approach and examples from on-going projects in Africa employing direct farmer engagement, cellular technology and apps to develop this information resource.

Thai district Leaders' perceptions of managing the direct observation treatment program in Trang Province, Thailand.

PubMed

Choowong, Jiraporn; Tillgren, Per; Söderbäck, Maja

2016-07-28

Thailand is 18th out of the 22 countries with the highest tuberculosis (TB) burden. It will be a challenge for Thailand to achieve the UN Millennium Development target for TB, as well as the new WHO targets for eliminating TB by 2035. More knowledge and a new approach are needed to tackle the complex challenges of managing the DOT program in Thailand. Contextual factors strongly influence the local implementation of evidence in practice. Using the PARIHS model, the aim has been to explore district leaders' perceptions of the management of the DOT program in Trang province, Thailand. A phenomenographic approach was used to explore the perceptions among district DOT program leaders in Trang province. We conducted semi-structured interviews with district leaders responsible for managing the DOT program in five districts. The analysis of the data transcriptions was done by grouping similarities and differences of perceptions, which were constructed in a hierarchical outcome space that shows a set of descriptive categories. The first descriptive category revealed a common perception of the leaders' duty and wish to comply with the NTP guidelines when managing and implementing the DOT program in their districts. More varied perceptions among the leaders concerned how to achieve successful treatment. Other perceptions concerned practical dilemmas, which included fear of infection, mutual distrust, and inadequate knowledge about TB. Further, the leaders perceived a need for improved management practices in implementing the TB guidelines. Using the PARIHS framework to gain a retrospective perspective on the district-level policy implementation of the DOT program and studying the leadership's perceptions about applying the guidelines to practice, has brought new knowledge about management practices. Additional support and resources from the regional level are needed to manage the challenges.

Association between sleep behavior and sleep-related factors among university students in Hong Kong.

PubMed

Suen, Lorna K P; Hon, K L Ellis; Tam, Wilson W S

2008-09-01

Sleep problems among university students are common; however, the association between many sleep-related factors and sleep behaviors is still unclear. The purpose of this study is to examine different sleep behaviors and sleep-related factors influencing such behaviors in university students. A descriptive survey was conducted on 400 university students in Hong Kong. The instruments for data collection consisted of the Pittsburgh Sleep Quality Index (PSQI), a sleep hygiene practice questionnaire, demographic data, and other sleep-related factors. The results reveal that 57.5% of the 400 university students are poor sleepers. Sex, year of study, sleep hygiene practice, and perceived adequate sleep in the past month all demonstrate significant associations with poor sleepers. A high prevalence of sleep-related problems among college students is confirmed and associated factors are identified. Students should be encouraged to follow sleep hygiene practice, adequate time management for academic and social activities, and suitable stress-relieving measures.

[Computer-assisted cardiovascular disease management: better implementation of care but no improvement in clinical outcomes].

PubMed

de Wit, Niek J

2012-01-01

Computer support is considered by many to be a promising strategy for improving healthcare interventions, especially in the management of chronic diseases. So far, however, evidence of the effectiveness of ICT support in healthcare is limited. Recently, computer-supported cardiovascular disease management was compared with usual care during an RCT comprised of 1100 primary care patients. This trial demonstrated that neither the clinical outcome nor the cardiovascular morbidity rate improved, even though management of the risk factors improved over 1 year of follow-up. The pragmatic design of the RCT in daily general practice may have restricted implementing the computer support, and may also have hampered the evaluation of the cardiovascular effects. The results demonstrate that although computer support may help improve the performance of disease management, its impact on disease outcomes is questionable. ICT innovations in healthcare require rigorous investigative evaluation before their implementation in daily practice can be justified.

Smothering in UK free-range flocks. Part 2: investigating correlations between disease, housing and management practices.

PubMed

Rayner, A C; Gill, R; Brass, D; Willings, T H; Bright, A

2016-09-10

Smothering, when birds group together in a way that results in death from suffocation, is a welfare and economic concern for the egg industry. This questionnaire-based study explored correlations between disease, housing, management practices and smothering on free-range farms. A binomial logistic regression approach was used to test whether question responses predicted occurrence of nest box smothers (NBS) and panic and recurring smothers (PSRS) on farms. Breed (P=0.008) and nest box manufacturer (P=0.014) predicted NBS. Breed and nest box design have been previously reported to affect nesting behaviour. The affect of nest box manufacturer found in this study may illustrate the effect of nest box design features or house layouts. Nest box manufacturer (P=0.009), feeding oyster grit or grain on the litter (P<0.001) and range use on a sunny day (P<0.001) also predicted PSRS. Implementing some management practices to encourage desirable behaviours (eg ranging) may contribute to smothering, whereas some management practices such as those aimed at occupying birds may be beneficial, illustrating the delicate balance of factors involved in free-range egg production. It is hoped that these results will stimulate further work exploring the suitability of housing design and management of laying hens in light of smothering. British Veterinary Association.

Factors influencing private health providers' technical quality of care for acute respiratory infections among under-five children in rural West Bengal, India.

PubMed

Chakraborty, Sarbani; Frick, Kevin

2002-11-01

In many developing countries, private health practitioners provide a significant portion of curative care for diseases which are of public health importance. Currently, health sector reform efforts in these countries are fostering increased participation of private providers in the delivery of health services, including those of public health importance. Guaranteeing good technical quality of care is critical to the process. However, little is known about private providers' technical quality of care (disease management practices) and the factors influencing these services. The purpose of this study was to contribute information on this topic. The study was conducted among private providers in rural West Bengal, India and focused on providers' disease management practices for acute respiratory infections (ARI) among under-five children. World Health Organization (WHO) guidelines for ARI case management were used as the expected standard of care. Observations of patient-provider encounters and interviews with the providers and mothers were the main sources of data. The study found that private health providers in rural West Bengal have inadequate technical quality of care. The problem was related both to low levels of performance (limited potential) and inconsistency in performance (within-provider variation). Limited potential for good technical quality for ARI among the providers was related to lack of knowledge (technical incompetence). One of the important factors influencing within-provider variation was patient load. Since rural private providers operate on a fee-for-service payment system, there are incentives related to seeing many patients. The study concluded that to bring about sustainable improvements in private providers' ARI disease management practices, training programs and interventions that improved compliance were necessary.

[Therapeutic options for weight management in schizophrenic patients treated with atypical antipsychotics].

PubMed

Cordes, J; Sinha-Röder, A; Kahl, K G; Malevani, J; Thuenker, J; Lange-Asschenfeldt, C; Hauner, H; Agelink, M W; Klimke, A

2008-12-01

Extensive, selective literature review of 2500 articles from the last years (up to December 2007) predominantly from Medline and Cochrane, using as search terms "antipsychotic or schizophrenia or individual drug names (amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone)" and the terms "BMI, weight gain, metabolic syndrome, diabetes, lipid(s), cholesterol, triglycerides" was conducted. Regardless of the advantages ascribed to atypical antipsychotics and the special effectiveness of clozapine in patients resistant to therapy and at risk for suicide, the probability of weight gain is considerably increased for some of these substances. Patients with schizophrenia have a considerably reduced life expectancy associated with an increased prevalence of cardiovascular risk factors. There is a lack of practical guidelines integrated into clinical psychiatric care for the management of cardiovascular risk factors. The monitoring of patients treated with atypics, which has been recommended in the APA/ADA Consensus Paper in light of these facts, is insufficiently established in clinical practice. A regular monitoring can convey self control and motivation to the patient. In the case of corresponding risk constellations further decisions regarding indication and therapy have to be considered. Especially patients with a high cardiovascular risk profile are highly recommended to participate in a weight-management program for prevention purposes. Such a special program should include elements of dietetic treatment and behaviour and exercise therapy. First controlled studies suggest an effective prevention of weight gain and metabolic changes when applying such a structured program. The practice oriented step by step concept presented here is meant to provide points of reference for the implementation of required medical and psychoeducative measures facilitating the management of weight and further cardiovascular risk factors in the context of psychiatric care in patients with schizophrenia.

The Impact of Practical Relevance on Training Transfer: Evidence from a Service Quality Training Program for German Bank Clerks

ERIC Educational Resources Information Center

Liebermann, Susanne; Hoffmann, Stefan

2008-01-01

The management literature provides a variety of recommendations as to how workers' customer orientation might be improved, including through training. Crucial factors in the process of transferring the contents of service quality training programs to practice, however, have not yet been sufficiently analysed. This study proposes and tests a model…

Encouraging Wildland Fire Preparedness: Lessons Learned from Three Wildfire Education Programs

Treesearch

Victoria Sturtevant; Sarah McCaffrey

2006-01-01

Managers may often wonder why some people do not choose to adopt defensible space practices despite understanding the benefits of doing so. Research has sought to understand why a new practice or innovation is or is not adopted. This paper will briefly discuss factors found to influence adoption rates and describe how three different fire education programs - Firewise...

Diagnostic strategies for urinary tract infections in French general practice.

PubMed

Kinouani, S; de Lary de Latour, H; Joseph, J-P; Letrilliart, L

2017-10-01

We aimed to describe the diagnostic management procedures for detection of urinary tract infections in general practice and their correlated factors. We analyzed data from the ECOGEN study on urinary tract infections, collected in France between November 2011 and April 2012. This national cross-sectional study was carried out in general practices. Data was coded according to the International Classification of Primary Care. A total of 340 consultations or home visits were held for urinary tract infections. The five most frequent diagnostic procedures were (in descending order) clinical examination (67.6%), urine cytobacteriological examination (UCBE) (47.9%), urine dipstick test (15.6%), blood test (8.5%), and imaging (6.5%). No urine dipstick test or UCBE was performed in 43% of cases. Factors correlated with diagnostic procedures were age and gender of patients, annual number of consultations held by family physicians, and duration of consultation. Family physicians did not comply with guidelines on diagnostic management for detection of urinary tract infections. We hypothesized that this non-compliance could be due to the family physicians' environment and characteristics, and to clinical practice guidelines. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Improving self-management of cancer risk factors, underscreening for cancer and depression among general practice patients: study protocol of a randomised controlled trial

PubMed Central

Carey, Mariko; Sanson-Fisher, Rob; Oldmeadow, Christopher; Mansfield, Elise; Walsh, Justin

2016-01-01

Introduction General practitioners have a key role in reducing cancer risk factors, screening for cancer and managing depression. Given the time-limited nature of consultations, a new and more time-efficient approach is needed which addresses multiple health needs simultaneously, and encourages patient self-management to address health risks. The aim of this cluster randomised controlled trial is to test the effectiveness of a patient feedback intervention in improving patient self-management of health needs related to smoking, risky alcohol consumption and underscreening for cancers at 1 month follow-up. Methods and analysis Adult general practice patients will be invited to participate in a baseline survey to assess cancer risk factors, screening needs and depression. A total of 360 participants identified by the baseline survey as having at least one health need (a self-reported cancer risk factor, underscreening for cancer, or an elevated depression score) will be randomised to an intervention or control group. Participants in the intervention group will receive tailored printed feedback summarising their identified health needs and recommended self-management actions to address these. All participants will be invited to complete a telephone interview 1 month following recruitment to assess self-management actions taken in relation to health needs identified in the baseline survey. Control group participants will receive tailored printed feedback on their identified health needs after their follow-up interview. A logistic regression model, with group allocation as the main predictor, will be used to assess the impact of the intervention on self-management actions. Ethical considerations and dissemination Participants identified as being at risk of depression will be advised to speak with their doctor. Results will be disseminated via publication in peer-reviewed journals. The study has been approved by the University of Newcastle Human Research Ethics Committee. Trial registration number ACTRN12616001443482. PMID:27864255

Managing patient demand: a qualitative study of appointment making in general practice.

PubMed

Gallagher, M; Pearson, P; Drinkwater, C; Guy, J

2001-04-01

Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments. To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations. A qualitative study using participant observation. Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice. Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists. Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments. Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria.

Managing patient demand: a qualitative study of appointment making in general practice.

PubMed Central

Gallagher, M; Pearson, P; Drinkwater, C; Guy, J

2001-01-01

BACKGROUND: Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments. AIM: To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations. DESIGN OF STUDY: A qualitative study using participant observation. SETTING: Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice. METHOD: Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists. RESULTS: Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments. CONCLUSION: Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria. PMID:11458480

Selecting information technology for physicians' practices: a cross-sectional study.

PubMed

Eden, Karen Beekman

2002-04-05

Many physicians are transitioning from paper to electronic formats for billing, scheduling, medical charts, communications, etc. The primary objective of this research was to identify the relationship (if any) between the software selection process and the office staff's perceptions of the software's impact on practice activities. A telephone survey was conducted with office representatives of 407 physician practices in Oregon who had purchased information technology. The respondents, usually office managers, answered scripted questions about their selection process and their perceptions of the software after implementation. Multiple logistic regression revealed that software type, selection steps, and certain factors influencing the purchase were related to whether the respondents felt the software improved the scheduling and financial analysis practice activities. Specifically, practices that selected electronic medical record or practice management software, that made software comparisons, or that considered prior user testimony as important were more likely to have perceived improvements in the scheduling process than were other practices. Practices that considered value important, that did not consider compatibility important, that selected managed care software, that spent less than 10,000 dollars, or that provided learning time (most dramatic increase in odds ratio, 8.2) during implementation were more likely to perceive that the software had improved the financial analysis process than were other practices. Perhaps one of the most important predictors of improvement was providing learning time during implementation, particularly when the software involves several practice activities. Despite this importance, less than half of the practices reported performing this step.

Outpatient management of young febrile infants with urinary tract infections.

PubMed

Schnadower, David; Kuppermann, Nathan; Macias, Charles G; Freedman, Stephen B; Agrawal, Dewesh; Mao, Jingnan; Dayan, Peter S

2014-09-01

Controversy exists regarding the disposition of young febrile infants who present to emergency departments (EDs) with urinary tract infections (UTIs). In a large multicenter cohort of such patients, we aimed to determine the variation in patient disposition and clinical factors independently associated with outpatient management. Secondary analysis of a retrospective study of infants 29 to 60 days with fever (≥38.0°C), urinalysis finding, and culture-proven UTIs presenting to 20 North American EDs belonging to the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. We determined independent factors associated with outpatient management. Of 1764 infants with UTIs, 132 (7.5%) were discharged home from the ED. The proportion of infants managed as outpatients varied among sites (0%-20.0%). Of the 132 infants, 29 (22.0%) were subsequently hospitalized after culture results were known, including 5 patients with bacteremia. None of the 107 patients initially discharged from the ED for whom outcomes were known had adverse events (0%; 95% CI, 0%-2.7%). On multivariable regression and generalized estimated equations analyses, only clinical site, presence of upper respiratory tract infection symptoms, absence of vomiting, and having fewer than 10 white blood cells per microliter on cerebrospinal fluid examination were independently associated with discharge from the ED. Clinical site was the factor most highly associated with outpatient management (odds ratio, 8.8; 95% confidence interval, 5.2-15.0). There is substantial practice variation regarding the disposition of febrile infants 29 to 60 days of age with UTIs. Institutional practice is the strongest predictor of outpatient management. Further evidence is needed to guide the management of non-toxic-appearing young febrile infants with UTIs.

Effect of beach management policies on recreational water quality.

PubMed

Kelly, Elizabeth A; Feng, Zhixuan; Gidley, Maribeth L; Sinigalliano, Christopher D; Kumar, Naresh; Donahue, Allison G; Reniers, Adrianus J H M; Solo-Gabriele, Helena M

2018-04-15

When beach water monitoring programs identify poor water quality, the causes are frequently unknown. We hypothesize that management policies play an important role in the frequency of fecal indicator bacteria (FIB) exceedances (enterococci and fecal coliform) at recreational beaches. To test this hypothesis we implemented an innovative approach utilizing large amounts of monitoring data (n > 150,000 measurements per FIB) to determine associations between the frequency of contaminant exceedances and beach management practices. The large FIB database was augmented with results from a survey designed to assess management policies for 316 beaches throughout the state of Florida. The FIB and survey data were analyzed using t-tests, ANOVA, factor analysis, and linear regression. Results show that beach geomorphology (beach type) was highly associated with exceedance of regulatory standards. Low enterococci exceedances were associated with open coast beaches (n = 211) that have sparse human densities, no homeless populations, low densities of dogs and birds, bird management policies, low densities of seaweed, beach renourishment, charge access fees, employ lifeguards, without nearby marinas, and those that manage storm water. Factor analysis and a linear regression confirmed beach type as the predominant factor with secondary influences from grooming activities (including seaweed densities and beach renourishment) and beach access (including charging fees, employing lifeguards, and without nearby marinas). Our results were observable primarily because of the very large public FIB database available for analyses; similar approaches can be adopted at other beaches. The findings of this research have important policy implications because the selected beach management practices that were associated with low levels of FIB can be implemented in other parts of the US and around the world to improve recreational beach water quality. Copyright © 2018 Elsevier Ltd. All rights reserved.

Quality of Project Management Education and Training Programmes

NASA Astrophysics Data System (ADS)

Bodea, Constanta-Nicoleta; Dascalu, Maria; Coman, Melania

The paper refers to the factors which influence the quality of training and education on project management. A survey was made and the main results are presented. 81 % of the responses came from China. The rest were professionals of different EU nationalities. The percentage of Project Managers who answered the questions is rather low - 8%. In the "Others" category, we have software developers, financial managers and professors, who are involved in both training on project management, but also as team members or team managers in projects, thus ensuring a balanced overview of both theory and practical issues.

Factors affecting professional ethics in nursing practice in Iran: a qualitative study.

PubMed

Dehghani, Ali; Mosalanejad, Leili; Dehghan-Nayeri, Nahid

2015-09-09

Professional ethics refers to the use of logical and consistent communication, knowledge, clinical skills, emotions and values in nursing practice. This study aimed to explore and describe factors that affect professional ethics in nursing practice in Iran. This qualitative study was conducted using conventional content analysis approach. Thirty nurses with at least 5 years of experience participated in the study; they were selected using purposive sampling. Data were collected through semi-structured interviews and analyzed using thematic analysis. After encoding and classifying the data, five major categories were identified: individual character and responsibility, communication challenges, organizational preconditions, support systems, educational and cultural development. Awareness of professional ethics and its contributing factors could help nurses and healthcare professionals provide better services for patients. At the same time, such understanding would be valuable for educational administrators for effective planning and management.

Practical aspects of the control of cardiovascular risk in type 2 diabetes mellitus and the metabolic syndrome

PubMed Central

Cerghizan, Anca; Bala, Cornelia; Nita, Cristina; Hancu, Nicolae

2007-01-01

Cardiovascular disease is unanimously recognized as the major burden in type 2 diabetes, in terms of both mortality and morbidity. There is an extensive evidence coming from epidemiological studies that supports this statement. The presence of the metabolic syndrome confers a higher risk of long-term death, and dysglycemia appears to be responsible for the most of the excess risk. The metabolic syndrome also has an essential role in the modern concept of cardiovascular prevention. Global cardiovascular risk represents the action and consequences of all risk factors that simultaneously or sequentially act on the body, leading to atherogenesis/atherosclerosis. In daily practice, a stepwise approach to control cardiovascular risk in people with type 2 diabetes has been proposed. This algorithm comprises three steps: identification of cardiovascular risk factors, interpretation of global cardiovascular risk, and intervention for all identified risk factors and diseases. In the past decades, the whole concept of diabetes and the metabolic syndrome care has undergone a radical change. From here the concept of modern management of those diseases emerged: early, multi-factorial and intensive control. This concept emphasized early and aggressive interventions for all cardiovascular risk factors in the long-term management. The model of multiple cardiovascular risk factor intervention ought to be implemented in daily practice as much as possible. This offers a unique opportunity to reduce the devastating cardiovascular morbidity and mortality in people with type 2 diabetes and the metabolic syndrome. PMID:18650987

Temporal Variation in Honey Production by the Stingless Bee Melipona subnitida (Hymenoptera: Apidae): Long-Term Management Reveals its Potential as a Commercial Species in Northeastern Brazil.

PubMed

Koffler, Sheina; Menezes, Cristiano; Menezes, Paulo Roberto; Kleinert, Astrid de Matos Peixoto; Imperatriz-Fonseca, Vera Lucia; Pope, Nathaniel; Jaffé, Rodolfo

2015-06-01

Even though stingless beekeeping has a great potential as a sustainable development tool, the activity remains essentially informal, technical knowledge is scarce, and management practices lack the sophistication and standardization found in apiculture. Here, we contributed to the further development of stingless beekeeping by investigating the long-term impact of management and climate on honey production and colony survival in the stingless bee Melipona subnitida Ducke (1910). We analyzed a 10-yr record of 155 M. subnitida colonies kept by a commercial honey producer of northeastern Brazil. This constitutes the longest and most accurate record available for a stingless bee. We modeled honey production in relation to time (years), age, management practices (colony division and food supplementation), and climatic factors (temperature and precipitation), and used a model selection approach to identify which factors best explained honey production. We also modeled colony mortality in relation to climatic factors. Although the amount of honey produced by each colony decreased over time, we found that the probability of producing honey increased over the years. Colony divisions decreased honey production, but did not affect honey presence, while supplementary feeding positively affected honey production. In warmer years, the probability of producing honey decreased and the amount of honey produced was lower. In years with lower precipitation, fewer colonies produced honey. In contrast, colony mortality was not affected by climatic factors, and some colonies lived up to nine years, enduring extreme climatic conditions. Our findings provide useful guidelines to improve management and honey production in stingless bees. © The Authors 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Adoption of Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a History of Falls.

PubMed

Phelan, Elizabeth A; Aerts, Sally; Dowler, David; Eckstrom, Elizabeth; Casey, Colleen M

2016-01-01

A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice.

Adoption of Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a History of Falls

PubMed Central

Phelan, Elizabeth A.; Aerts, Sally; Dowler, David; Eckstrom, Elizabeth; Casey, Colleen M.

2016-01-01

A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice. PMID:27660753

Ground beetles in Mediterranean olive agroecosystems: Their significance and functional role as bioindicators (Coleoptera, Carabidae)

PubMed Central

Mazzei, Antonio; Bonacci, Teresa; Scalercio, Stefano; Iannotta, Nino; Brandmayr, Pietro

2018-01-01

The impact of agricultural practices and soil management on the communities of arthropods living in the agricultural landscape is acknowledged as a critical issue by the literature, and it needs to be better investigated to improve the ecological sustainability of agriculture. In the present study, we aimed to study how soil management affect carabid species distribution in one of the most typical agroecosystem of the Mediterranean region, i.e. the olive grove. In South Italy olive plantations feature different types of soil management, from tillage to half- or full-cover cropping. Species distribution has been examined for a total of 10,189 individuals and 62 species collected from 17 sites. Notably from our analysis we have observed that three factors (climax vegetation, soil features and soil management) explained half of the data variability. The composition of species groupings mirrors both bioclimatic conditions (climax vegetation) and soil features, especially watering, while soil management affects the species distribution, with different intensity from site to site. Eleven species have been recognized as the most abundant in the different facets of the studied olive groves and consequently designated as characteristics of the olive agroecosystem. The species traits of the sampled species have been weighted for a compelling evaluation of the effects of agricultural management on biodiversity, showing uniform traits distribution when coping with the ecological factors that characterize the different plantation facets. We have found that carabid beetles can be used as model organisms for studying the effects of agricultural practices. Our study suggests that the interaction of man-induced trasformation with the natural background of the olive agroecosystem may be difficult to disentangle, so that such complexity must be taken into account when carabid beetles are expected to provide an ecosystem service for good agricultural practices. PMID:29558493

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

PubMed

Thomas, Nicola; Gallagher, Hugh; Jain, Neerja

2014-01-01

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

Relationship of self-management to personality types and indices.

PubMed

Williams, R L; Verble, J S; Price, D E; Layne, B H

1995-06-01

This study addressed the relationship between self-management (as measured by the Lifestyle Approaches Inventory, Williams, Moore, Pettibone, & Thomas, 1992) and personality types and indexes (as measured by the Myers-Briggs Type Indicator, Myers & McCaulley, 1985) in a sample of 347 university students. Correlational analyses indicated that the self-management factor most consistently linked to the Myers-Briggs indices was Organization of Physical Space. The Myers-Briggs index most consistently correlated with the self-management factors was Judgment-Perception. Overall, male and female subjects showed similar patterns of relationships between the self-management and personality indices. When the self-management scores were compared for the various Myers-Briggs types, the analysis indicated that types having a J (planful and organized) or S (precise and practical) in the typology tended to score higher than those having a P (spontaneous and flexible) or N (imaginative and insightful).

Managing mechanistic and organic structure in health care organizations.

PubMed

Olden, Peter C

2012-01-01

Managers at all levels in a health care organization must organize work to achieve the organization's mission and goals. This requires managers to decide the organization structure, which involves dividing the work among jobs and departments and then coordinating them all toward the common purpose. Organization structure, which is reflected in an organization chart, may range on a continuum from very mechanistic to very organic. Managers must decide how mechanistic versus how organic to make the entire organization and each of its departments. To do this, managers should carefully consider 5 factors for the organization and for each individual department: external environment, goals, work production, size, and culture. Some factors may push toward more mechanistic structure, whereas others may push in the opposite direction toward more organic structure. Practical advice can help managers at all levels design appropriate structure for their departments and organization.

Scale development of safety management system evaluation for the airline industry.

PubMed

Chen, Ching-Fu; Chen, Shu-Chuan

2012-07-01

The airline industry relies on the implementation of Safety Management System (SMS) to integrate safety policies and augment safety performance at both organizational and individual levels. Although there are various degrees of SMS implementation in practice, a comprehensive scale measuring the essential dimensions of SMS is still lacking. This paper thus aims to develop an SMS measurement scale from the perspective of aviation experts and airline managers to evaluate the performance of company's safety management system, by adopting Schwab's (1980) three-stage scale development procedure. The results reveal a five-factor structure consisting of 23 items. The five factors include documentation and commands, safety promotion and training, executive management commitment, emergency preparedness and response plan and safety management policy. The implications of this SMS evaluation scale for practitioners and future research are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Bees for development: Brazilian survey reveals how to optimize stingless beekeeping.

PubMed

Jaffé, Rodolfo; Pope, Nathaniel; Torres Carvalho, Airton; Madureira Maia, Ulysses; Blochtein, Betina; de Carvalho, Carlos Alfredo Lopes; Carvalho-Zilse, Gislene Almeida; Freitas, Breno Magalhães; Menezes, Cristiano; Ribeiro, Márcia de Fátima; Venturieri, Giorgio Cristino; Imperatriz-Fonseca, Vera Lucia

2015-01-01

Stingless bees are an important asset to assure plant biodiversity in many natural ecosystems, and fulfill the growing agricultural demand for pollination. However, across developing countries stingless beekeeping remains an essentially informal activity, technical knowledge is scarce, and management practices lack standardization. Here we profited from the large diversity of stingless beekeepers found in Brazil to assess the impact of particular management practices on productivity and economic revenues from the commercialization of stingless bee products. Our study represents the first large-scale effort aiming at optimizing stingless beekeeping for honey/colony production based on quantitative data. Survey data from 251 beekeepers scattered across 20 Brazilian States revealed the influence of specific management practices and other confounding factors over productivity and income indicators. Specifically, our results highlight the importance of teaching beekeepers how to inspect and feed their colonies, how to multiply them and keep track of genetic lineages, how to harvest and preserve the honey, how to use vinegar traps to control infestation by parasitic flies, and how to add value by labeling honey containers. Furthermore, beekeeping experience and the network of known beekeepers were found to be key factors influencing productivity and income. Our work provides clear guidelines to optimize stingless beekeeping and help transform the activity into a powerful tool for sustainable development.

Initial investigation of organisational factors associated with the implementation of active support.

PubMed

Fyffe, Chris; McCubbery, Jeffrey; Reid, Katharine J

2008-09-01

Active support (AS) has been shown to increase the amount of time that residents in shared residential settings are involved in purposeful activities. The organisational processes required to implement AS have been less well researched. Staff in community houses answered questions about the occurrence of organisational activities and processes thought to assist AS implementation (e.g., training and teamwork), their understanding of engagement, and their experience of changes in staff practice consistent with AS (including implementation problems). Non-house-based managers were also interviewed about their role in AS implementation. Reported occurrence of organisational activities and processes (e.g., training and teamwork) and understanding of engagement were associated with more reports of changes in staff practice and fewer staff reports of implementation problems. Staff reports on the role of non-house-based managers were not associated with reports of changes in staff practice or with reports of fewer AS implementation problems. Non-house-based managers' reports overestimated their role in AS implementation when compared with reports from house-based staff groups. While there are limitations in the research design (including the reliance on staff reports), the findings support the importance of wider organisational factors (beyond training programs for direct support staff) as integral to the implementation of AS. There is a need for further research on AS implementation.

Bees for Development: Brazilian Survey Reveals How to Optimize Stingless Beekeeping

PubMed Central

Jaffé, Rodolfo; Pope, Nathaniel; Carvalho, Airton Torres; Maia, Ulysses Madureira; Blochtein, Betina; de Carvalho, Carlos Alfredo Lopes; Carvalho-Zilse, Gislene Almeida; Freitas, Breno Magalhães; Menezes, Cristiano; de Fátima Ribeiro, Márcia; Venturieri, Giorgio Cristino; Imperatriz-Fonseca, Vera Lucia

2015-01-01

Stingless bees are an important asset to assure plant biodiversity in many natural ecosystems, and fulfill the growing agricultural demand for pollination. However, across developing countries stingless beekeeping remains an essentially informal activity, technical knowledge is scarce, and management practices lack standardization. Here we profited from the large diversity of stingless beekeepers found in Brazil to assess the impact of particular management practices on productivity and economic revenues from the commercialization of stingless bee products. Our study represents the first large-scale effort aiming at optimizing stingless beekeeping for honey/colony production based on quantitative data. Survey data from 251 beekeepers scattered across 20 Brazilian States revealed the influence of specific management practices and other confounding factors over productivity and income indicators. Specifically, our results highlight the importance of teaching beekeepers how to inspect and feed their colonies, how to multiply them and keep track of genetic lineages, how to harvest and preserve the honey, how to use vinegar traps to control infestation by parasitic flies, and how to add value by labeling honey containers. Furthermore, beekeeping experience and the network of known beekeepers were found to be key factors influencing productivity and income. Our work provides clear guidelines to optimize stingless beekeeping and help transform the activity into a powerful tool for sustainable development. PMID:25826402

Human factors in waste management - potential and reality

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

Thompson, J.S.

There is enormous potential for human factors contributions in the realm of waste management. The reality, however, is very different from the potential. This is particularly true for low-level and low-level mixed-waste management. The hazards are less severe; therefore, health and safety requirements (including human factors) are not as rigorous as for high-level waste. High-level waste management presents its own unique challenges and opportunities. Waste management is strongly driven by regulatory compliance. When regulations are flexible and open to interpretation and the environment is driven so strongly by regulatory compliance, standard practice is to drop {open_quotes}nice to have{close_quotes} features, likemore » a human factors program, to save money for complying with other requirements. The challenge is to convince decision makers that human factors can help make operations efficient and cost-effective, as well as improving safety and complying with regulations. A human factors program should not be viewed as competing with compliance efforts; in fact, it should complement them and provide additional cost-effective means of achieving compliance with other regulations. Achieving this synergy of human factors with ongoing waste management operations requires educating program and facility managers and other technical specialists about human factors and demonstrating its value {open_quotes}through the back door{close_quotes} on existing efforts. This paper describes ongoing projects at Los Alamos National Laboratory (LANL) in support of their waste management groups. It includes lessons learned from hazard and risk analyses, safety analysis reports, job and task analyses, operating procedure development, personnel qualification/certification program development, and facility- and job-specific training program and course development.« less

Opinions of general practitioners about psychotherapy and their relationships with mental health professionals in the management of major depression: A qualitative survey

PubMed Central

Dumesnil, Hélène; Apostolidis, Thémis; Verger, Pierre

2018-01-01

Background French general practitioners (GPs) refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates. Objectives This qualitative study aims to explore general practitioners' (GP) opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression. Methods In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content. Results We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists, Conclusion Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area. PMID:29385155

Safety Concerns of Startup Airlines

DOT National Transportation Integrated Search

1997-01-01

Startup airlines that do not have sufficient capital are forced to acquire older aircraft and contract out maintenance, crew training, and operation management. These factors can contribute to the poorly supervised practices as illustrated in this ca...

Are medical educators following General Medical Council guidelines on obesity education: if not why not?

PubMed Central

2013-01-01

Background Although the United Kingdom’s (UK’s) General Medical Council (GMC) recommends that graduating medical students are competent to discuss obesity and behaviour change with patients, it is difficult to integrate this education into existing curricula, and clinicians report being unprepared to support patients needing obesity management in practice. We therefore aimed to identify factors influencing the integration of obesity management education within medical schools. Methods Twenty-seven UK and Irish medical school educators participated in semi-structured interviews. Grounded theory principles informed data collection and analysis. Themes emerging directly from the dataset illustrated key challenges for educators and informed several suggested solutions. Results Factors influencing obesity management education included: 1) Diverse and opportunistic learning and teaching, 2) Variable support for including obesity education within undergraduate medical programmes, and 3) Student engagement in obesity management education. Findings suggest several practical solutions to identified challenges including clarifying recommended educational agendas; improving access to content-specific guidelines; and implementing student engagement strategies. Conclusions Students’ educational experiences differ due to diverse interpretations of GMC guidelines, educators’ perceptions of available support for, and student interest in obesity management education. Findings inform the development of potential solutions to these challenges which may be tested further empirically. PMID:23578257

[Quality management (TQM) in public health-care (PHC): principles for cost-performance calculations and cost reductions with better quality].

PubMed

Bergholz, W

2008-11-01

In many high-tech industries, quality management (QM) has enabled improvements of quality by a factor of 100 or more, in combination with significant cost reductions. Compared to this, the application of QM methods in health care is in its initial stages. It is anticipated that stringent process management, embedded in an effective QM system will lead to significant improvements in health care in general and in the German public health service in particular. Process management is an ideal platform for controlling in the health care sector, and it will significantly improve the leverage of controlling to bring down costs. Best practice sharing in industry has led to quantum leap improvements. Process management will enable best practice sharing also in the public health service, in spite of the highly diverse portfolio of services that the public health service offers in different German regions. Finally, it is emphasised that "technical" QM, e.g., on the basis of the ISO 9001 standard is not sufficient to reach excellence. It is necessary to integrate soft factors, such as patient or employee satisfaction, and leadership quality into the system. The EFQM model for excellence can serve as proven tool to reach this goal.

Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice.

PubMed

Hajjaj, F M; Salek, M S; Basra, M K A; Finlay, A Y

2010-05-01

This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine.

Effects of urban tree management and species selection on atmospheric carbon dioxide

Treesearch

David J. Nowak; Jack C. Stevens; Susan M. Sisinni; Christopher J. Luley

2002-01-01

Trees sequester and store carbon in their tissue at differing rates and amounts based on such factors as tree size at maturity, life span, and growth rate. Concurrently, tree care practices release carbon back to the atmosphere based on fossil-fuel emissions from maintenance equipment (e.g., chain saws, trucks, chippers). Management choices such as tree locations for...

Prevention of central venous catheter infections: a survey of paediatric ICU nurses' knowledge and practice.

PubMed

Ullman, Amanda J; Long, Debbie A; Rickard, Claire M

2014-02-01

Central venous catheters are important in the management of paediatric intensive care unit patients, but can have serious complications which worsen the patients' health, prolong hospital stays and increase the cost of care. Evidence-based recommendations for preventing catheter-related bloodstream infections are available, but it is unknown how widely these are known or practiced in the paediatric intensive care environment. To assess nursing knowledge of evidence based guidelines to prevent catheter-related bloodstream infections; the extent to which Australia and New Zealand paediatric intensive cares have adopted prevention practices; and to identify the factors that encouraged their adoption and improve nursing knowledge. Cross-sectional surveys using convenience sampling. Tertiary level paediatric intensive care units in Australia and New Zealand. Paediatric intensive care nursing staff and nurse managers. Between 2010 and 2011, the 'Paediatric Intensive Care Nurses' Knowledge of Evidence-Based Catheter-Related Bloodstream Infection Prevention Questionnaire' was distributed to paediatric intensive care nursing staff and the 'Catheter-Related Bloodstream Infection Prevention Practices Survey' was distributed to nurse managers to measure knowledge, practices and culture. The questionnaires were completed by 253 paediatric intensive care nurses (response rate: 34%). The mean total knowledge score was 5.5 (SD=1.4) out of a possible ten, with significant variation of total scores between paediatric intensive care sites (p=0.01). Other demographic characteristics were not significantly associated with variation in total knowledge scores. All nursing managers from Australian and New Zealand paediatric intensive care units participated in the survey (n=8; response rate: 100%). Wide practice variation was reported, with inconsistent adherence to recommendations. Safety culture was not significantly associated with mean knowledge scores per site. This study has identified that there is variation in the infection prevention approach and nurses' knowledge about catheter-related bloodstream infection prevention. The presence of an improved safety culture, years of paediatric intensive care experience and higher qualifications did not influence the nurses' uptake of recommendations, therefore further factors need to be explored in order to improve understanding and implementation of best practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

Adoption and farmer perception of best management practices in Southern Spain

NASA Astrophysics Data System (ADS)

Guzmán, Gema; Portero, Ángela; Vanwallenghem, Tom; Laguna, Ana; Vanderlinden, Karl; Giráldez, Juan Vicente; Bijttebier, Jo; ten Berge, Hein

2015-04-01

Soil resources in many parts of Europe are being degraded due to non-sustainable land and soil management practices. During the past decennia, best management practices (BMPs) have been developed in order to maintain or restore soil health. However, the adoption rate in practice is rather low. Amongst other reasons, these practices might lack on-farm compatibility, or farmers may lack confidence in the proposed measures. In order to assess the adoption of management practices (MPs) and obtain information on farmer perception a study was performed in the Southern region of Spain (Andalusia), within three predefined farm type zones (FTZs) corresponding to arable, permanent crop and mixed farms. In order to identify main drivers and barriers for the adoption of different tillage practices, a sequential mixed method was applied, by combining qualitative and quantitative research techniques at different stages in time. First, a qualitative data-collection though semi-structured interviews were conducted in each FTZ to identify behavioral outcomes, normative referents and control factors for each unique MP in that specific FTZ context. Secondly, the quantitative stage of the mixed method approach encompassed a large scale survey based on the final list of control factors, outcomes and referents of each BMP which resulted from the first stage. As a final qualitative step, focus groups were conducted in each FTZ to elaborate on possible solutions towards the barriers on one or more MPs For this particular region of Spain, we observed that the adoption rates of a certain MP differed among subregions within each FTZ. In general barriers and drivers were found to vary in their nature and across the different subregions, although some of them were common across all subregions. It is noteworthy that the Common Agricultural Policy is the main influential agent for farmers' decisions and their perception of drivers (financial support) and limitations (rigidity of the measures) with respect to the implementation of certain MPs. Furthermore, in all the FTZs, farmers strongly demanded an extension service which responds to their needs and plays the role of an exchange channel between researchers and farmers.

Performance indicators: healthcare professionals' views.

PubMed

Gu, Xiuzhu; Itoh, Kenji

2016-08-08

Purpose - The purpose of this paper is to capture factors behind professional views of indicator usefulness as a common structure for assessing healthcare performance and their important characteristics to design limited key performance indicators (PIs) for holistic hospital management. Design/methodology/approach - Two surveys were conducted using self-administered questionnaires, in which hospital manager/staff respondents were asked to rate the 52 PIs' usefulness. In total, 228 manager and 894 staff responses were collected. Findings - Eight factors were elicited from manager and staff responses as performance measures with 72 percent cumulative variance accounted for. Hospital managers and staff showed similar performance measure perceptions: high-utility acknowledgment on safety, operational efficiency and patient/employee satisfaction but relatively low-employee development concerns. Manager indicator usefulness perceptions were rather homogeneous and significantly higher than staff for almost all performance measures. Practical implications - Homogeneous manager views mean that a single key PI set for hospital management may be established regardless of hospital attributes. The following aspects may be measures that should be managed in a healthcare organization based on their key PIs: patient/employee safety, operational efficiency, financial effectiveness and patient/employee satisfaction. Originality/value - This is a pilot study on hospital management PIs in Japan. The eight-dimensional factor structure and findings about healthcare provider perceptions may be useful for healthcare management.

The contribution of demographic and morbidity factors to self-reported visit frequency of patients: a cross-sectional study of general practice patients in Australia

PubMed Central

Knox, Stephanie A; Britt, Helena

2004-01-01

Background Understanding the factors that affect patients' utilisation of health services is important for health service provision and effective patient management. This study aimed to investigate the specific morbidity and demographic factors related to the frequency with which general practice patients visit a general practitioner/family physician (GP) in Australia. Methods A sub-study was undertaken as part of an ongoing national study of general practice activity in Australia. A cluster sample of 10,755 general practice patients were surveyed through a random sample of 379 general practitioners. The patient reported the number of times he/she had visited a general practitioner in the previous twelve months. The GP recorded all the patient's major health problems, including those managed at the current consultation. Results Patients reported an average of 8.8 visits to a general practitioner per year. After adjusting for other patient demographics and number of health problems, concession health care card holders made on average 2.6 more visits per year to a general practitioner than did non-card holders (p < .001). After adjustment, patients from remote/very remote locations made 2.3 fewer visits per year than patients from locations where services were highly accessible (p < .001). After adjustment for patient demographics, patients with diagnosed anxiety made on average 2.7 more visits per year (p = 0.003), those with diagnosed depression 2.2 more visits than average (p < .0001), and those with back problems 2.4 more visits (p = 0.009) than patients without the respective disorders. Conclusions Anxiety, back pain and depression are associated with greater patient demand for general practice services than other health problems. The effect of sociodemographic factors on patient utilisation of general practice services is complex. Equity of access to general practice services remains an issue for patients from remote areas, while concession health care card holders are attending general practice more frequently than other patients relative to their number of health problems. PMID:15318948

Rainfall erosivity and rainfall return period in the experimental watershed of Aracruz, in the Coastal Plain of Espirito Santo, Brazil

USDA-ARS?s Scientific Manuscript database

The knowledge of the factors influencing water erosion is relevant to land management practices. Rainfall, expressed by rainfall erosivity, is very important among the factors affecting water erosion. Thus, the objective of this study was to determine rainfall erosivity and return period for the Coa...

Sensory Factors in the School Learning Environment. What Research Says to the Teacher Series No. 35.

ERIC Educational Resources Information Center

McVey, G. F.

Through proper management of the sensory factors inherent in the classroom environment, teachers can improve the comfort, development, and academic performance of students. Some principles and practical procedures that may be applied directly by the classroom teacher are suggested in this pamphlet. A number of guidelines, references, and suggested…

Relationship Between Labor and Delivery Unit Management Practices and Maternal Outcomes.

PubMed

Plough, Avery C; Galvin, Grace; Li, Zhonghe; Lipsitz, Stuart R; Alidina, Shehnaz; Henrich, Natalie J; Hirschhorn, Lisa R; Berry, William R; Gawande, Atul A; Peter, Doris; McDonald, Rory; Caldwell, Donna L; Muri, Janet H; Bingham, Debra; Caughey, Aaron B; Declercq, Eugene R; Shah, Neel T

2017-08-01

To define, measure, and characterize key competencies of managing labor and delivery units in the United States and assess the associations between unit management and maternal outcomes. We developed and administered a management measurement instrument using structured telephone interviews with both the primary nurse and physician managers at 53 diverse hospitals across the United States. A trained interviewer scored the managers' interview responses based on management practices that ranged from most reactive (lowest scores) to most proactive (highest scores). We established instrument validity by conducting site visits among a subsample of 11 hospitals and established reliability using interrater comparison. Using a factor analysis, we identified three themes of management competencies: management of unit culture, patient flow, and nursing. We constructed patient-level regressions to assess the independent association between these management themes and maternal outcomes. Proactive management of unit culture and nursing was associated with a significantly higher risk of primary cesarean delivery in low-risk patients (relative risk [RR] 1.30, 95% CI 1.02-1.66 and RR 1.47, 95% CI 1.13-1.92, respectively). Proactive management of unit culture was also associated with a significantly higher risk of prolonged length of stay (RR 4.13, 95% CI 1.98-8.64), postpartum hemorrhage (RR 2.57, 95% CI 1.58-4.18), and blood transfusion (RR 1.87, 95% CI 1.12-3.13). Proactive management of patient flow and nursing was associated with a significantly lower risk of prolonged length of stay (RR 0.23, 95% CI 0.12-0.46 and RR 0.27, 95% CI 0.11-0.62, respectively). Labor and delivery unit management varies dramatically across and within hospitals in the United States. Some proactive management practices may be associated with increased risk of primary cesarean delivery and maternal morbidity. Other proactive management practices may be associated with decreased risk of prolonged length of stay, indicating a potential opportunity to safely improve labor and delivery unit efficiency.

Analysis of factors influencing safety management for metro construction in China.

PubMed

Yu, Q Z; Ding, L Y; Zhou, C; Luo, H B

2014-07-01

With the rapid development of urbanization in China, the number and size of metro construction projects are increasing quickly. At the same time, and increasing number of accidents in metro construction make it a disturbing focus of social attention. In order to improve safety management in metro construction, an investigation of the participants' perspectives on safety factors in China metro construction has been conducted to identify the key safety factors, and their ranking consistency among the main participants, including clients, consultants, designers, contractors and supervisors. The result of factor analysis indicates that there are five key factors which influence the safety of metro construction including safety attitude, construction site safety, government supervision, market restrictions and task unpredictability. In addition, ANOVA and Spearman rank correlation coefficients were performed to test the consistency of the means rating and the ranking of safety factors. The results indicated that the main participants have significant disagreement about the importance of safety factors on more than half of the items. Suggestions and recommendations on practical countermeasures to improve metro construction safety management in China are proposed. Copyright © 2013 Elsevier Ltd. All rights reserved.

Professional commitment to changing chronic illness care: results from disease management programmes.

PubMed

Lemmens, Karin; Strating, Mathilde; Huijsman, Robbert; Nieboer, Anna

2009-08-01

The aim of this exploratory study was to investigate to what extent primary care professionals are able to change their systems for delivering care to chronic obstructive pulmonary disease (COPD) patients and what professional and organizational factors are associated with the degree of process implementation. Quasi-experimental design with 1 year follow-up after intervention. Three regional COPD management programmes in the Netherlands, in which general practices cooperated with regional hospitals. All participating primary care professionals (n = 52). COPD management programme. Professional commitment, organizational context and degree of process implementation. Professionals significantly changed their systems for delivering care to COPD patients, namely self-management support, decision support, delivery system design and clinical information systems. Associations were found between organizational factors, professional commitment and changes in processes of care. Group culture and professional commitment appeared to be, to a moderate degree, predictors of process implementation. COPD management was effective; all processes improved significantly. Moreover, theoretically expected associations between organizational context and professional factors with the implementation of COPD management were indeed confirmed to some extent. Group culture and professional commitment are important facilitators.

An Examination of Cultural Values and Pain Management in Foreign-Born Spanish-Speaking Hispanics Seeking Care at a Federally Qualified Health Center.

PubMed

Torres, Calia A; Thorn, Beverly E; Kapoor, Shweta; DeMonte, Colette

2017-11-01

Most studies done with Hispanics illustrate their preference for self-management practices; therefore, examining the factors driving patients to seek medical care for pain management will help elucidate what patients want and need from their doctors for pain management. The aim of the present study was to obtain patients' perspectives and enhance our understanding of the cultural beliefs influencing pain management decisions of foreign-born Spanish-speaking Hispanics with low acculturation. Twenty-four individuals (17 females and 7 males) with self-reported chronic pain completed the study. Participants attended a focus group and shared about pain management practices and their experiences with medical care for pain management. Descriptive data on pain and mood variables were collected to examine how this population compares with the norms reported in the pain literature for Hispanics. Participants reported a preference for pain self-management and noninvasive medical treatments and expressed negative attitudes toward pain medications, although wanting the option of pain medications as a "last resort." Satisfaction with medical care for pain was highly influenced by the participants' expectations and preference for personal, warm, and friendly interactions. Our findings are consistent with previous reports on Hispanics' preference for self-care practices. Perhaps foreign-born Hispanics may rely on self-care practices and delay medical attention for pain management because of their unfamiliarity with the US health care system. Other potential explanations for a reliance on self-care for pain management involve patients having a limited understanding of or access to effective treatment options for chronic pain and negative experiences with US medical providers. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Inexplicable or Simply Unexplained? The Management of Maize Seed in Mexico

PubMed Central

Dyer, George A.; López-Feldman, Alejandro

2013-01-01

Farmer management of plant germplasm pre-dates crop domestication, but humans’ role in crop evolution and diversity remains largely undocumented and often contested. Seemingly inexplicable practices observed throughout agricultural history, such as exchanging or replacing seed, continue to structure crop populations across the developing world. Seed management practices can be construed as events in the life history of crops and management data used to model crop demography, but this requires suitable quantitative data. As a prerequisite to addressing the causes and implications of maize seed management, we describe its patterns of variation across Mexico by drawing from the literature and new analysis. We find that rates of seed replacement, introduction and diffusion differ significantly across regions and altitudinal zones, but interactions among explanatory factors can obscure patterns of variation. The type, source, geographic origin and ownership of seed help explain observed rates. Yet, controlling for the characteristics of germplasm barely reduces interregional differences vastly exceeding variation across elevations. With few exceptions, monotonic altitudinal trends are absent. Causal relationships between management practices and the physical environment could determine farmers’ wellbeing and crop conservation in the face of climate change. Scarce and inconsistent data on management nevertheless could prevent an understanding of these relationships. Current conceptions on the management and dynamics of maize diversity are founded on a patchwork of observations in surprisingly few and dissimilar environments. Our estimates of management practices should shed light on differences in maize population dynamics across Mexico. Consistency with previous studies spanning over a decade suggests that common sets of forces are present within large areas, but causal associations remain unknown. The next step in explaining crop diversity should address variation in seed management across space and time simultaneously while identifying farmers’ values and motivations as underlying forces. PMID:23840847

Inexplicable or simply unexplained? The management of maize seed in Mexico.

PubMed

Dyer, George A; López-Feldman, Alejandro

2013-01-01

Farmer management of plant germplasm pre-dates crop domestication, but humans' role in crop evolution and diversity remains largely undocumented and often contested. Seemingly inexplicable practices observed throughout agricultural history, such as exchanging or replacing seed, continue to structure crop populations across the developing world. Seed management practices can be construed as events in the life history of crops and management data used to model crop demography, but this requires suitable quantitative data. As a prerequisite to addressing the causes and implications of maize seed management, we describe its patterns of variation across Mexico by drawing from the literature and new analysis. We find that rates of seed replacement, introduction and diffusion differ significantly across regions and altitudinal zones, but interactions among explanatory factors can obscure patterns of variation. The type, source, geographic origin and ownership of seed help explain observed rates. Yet, controlling for the characteristics of germplasm barely reduces interregional differences vastly exceeding variation across elevations. With few exceptions, monotonic altitudinal trends are absent. Causal relationships between management practices and the physical environment could determine farmers' wellbeing and crop conservation in the face of climate change. Scarce and inconsistent data on management nevertheless could prevent an understanding of these relationships. Current conceptions on the management and dynamics of maize diversity are founded on a patchwork of observations in surprisingly few and dissimilar environments. Our estimates of management practices should shed light on differences in maize population dynamics across Mexico. Consistency with previous studies spanning over a decade suggests that common sets of forces are present within large areas, but causal associations remain unknown. The next step in explaining crop diversity should address variation in seed management across space and time simultaneously while identifying farmers' values and motivations as underlying forces.

Factors Contributing to the Decline of Traditional Practices in Communities from the Gwallek-Kedar area, Kailash Sacred Landscape, Nepal.

PubMed

Atreya, Kishor; Pyakurel, Dipesh; Thagunna, Krishna Singh; Bhatta, Laxmi Dutt; Uprety, Yadav; Chaudhary, Ram Prasad; Oli, Bishwa Nath; Rimal, Sagar Kumar

2018-05-01

Traditional knowledge and practices are increasingly recognized in the resource conservation and management practices, however are declining in many parts of the world including Nepal. Studies on the inventory of traditional knowledge are available, albeit limited, and empirical analysis of factors contributing to the decline of traditional knowledge are negligible in Nepal. We thus initiated this study in the Nepal part of the Kailash Sacred Landscape to (i) document traditional knowledge and practices on agriculture, forest-based herbal remedy, and genetic resource conservation; and (ii) identify factors contributing to the decline of traditional practices in the communities. Data was collected during September-December 2015 through key informant interviews, focus group discussions, and households survey. The household survey data was used in binary logistic regression analysis to identify factors contributing to the decline of six key traditional practices. The study documented 56 types of traditional practices. The regressions showed that the age of the respondent, distance to the nearest forest, distance to the nearest motorable road, family members' ill health, and seasonal migration of the household members for jobs significantly influencing to the decline of the particular traditional practices, however, their effects vary within a practice and among the practices. The use of modern medicine, increasing road linkages, decreasing trend of plant resource availability, and agriculture intensification are responsible for the decline of the particular traditional practices. We recommend to recognize their significance in the governing socio-ecological systems and to link the traditional and scientific knowledge systems through policy formulations.

Patients' Priorities and Attitudes Towards Their Temporo-Mandibular Disorders.

PubMed

Kelleher, Martin; Ray-Chaudhuri, Arijit; Khawaja, Noman

2015-08-01

The diagnosis and appropriate management of temporo-mandibular disorders (TMDs) remains controversial. Current scientific evidence highlights the importance of psychosocial factors in sufferers and the reducing emphasis on occlusal or dental/prosthetic factors. This paper describes the findings of a survey of 211 patients reporting pain from their temporo-mandibular joint area and associated structures. This article offers busy primary dental care practitioners a cost effective questionnaire for obtaining relevant information from patients about the history of their condition and highlights what patients hope to achieve through the management of their disorder. It also emphasises the importance of communicating effectively with patients and offers practical tips for the management of TMDs in primary care.

Career stress and female managers' health in Taiwan's hospitals: a multilevel model approach.

PubMed

Chen, Duan-Rung; Lin, Yeh-Yun; Chung, Kuo-Piao

2008-01-01

This study investigates how perception-induced stress (barrier) and social capital (facilitator) affect the health of female managers. On the basis of the responses of 229 valid questionnaires of middle- and high-level female managers in large-scale hospitals, using a multilevel data analysis approach, this study investigates how perception-induced stress and social capital influence self-reported poor health of female managers. Analysis results indicate that all 3 perception-induced stresses (i.e., promotion-related procedural justice, promotion rate, and work-family conflict) and 2 social capital variables (i.e., mentor-assisted promotion and higher ranking mentor in other departments) are significantly associated with the health of female mangers. Factors involving the career success of women also affect their health. Health care organizations expecting to benefit from the long-term contribution of female elites must promote organizational equity and more heavily emphasize flexible work schedules, family-friendly policies, and perception management practices. In addition, adequately designed mentorship practices can greatly benefit female managers.

Human resources management and firm performance: The differential role of managerial affective and continuance commitment.

PubMed

Gong, Yaping; Law, Kenneth S; Chang, Song; Xin, Katherine R

2009-01-01

In this study, the authors developed a dual-concern (i.e., maintenance and performance) model of human resources (HR) management. The authors identified commonly examined HR practices that apply to the middle manager level and classified them into the maintenance- and performance-oriented HR subsystems. The authors found support for the 2-factor model on the basis of responses from 2,148 managers from 463 firms operating in China. Regression results indicate that the performance-oriented HR subsystems had a positive relationship with firm performance and that the relationship was mediated by middle managers' affective commitment to the firm. The maintenance-oriented HR subsystems had a positive relationship with middle managers' continuance commitment but not with their affective commitment and firm performance. This study contributes to the understanding of how HR practices relate to firm performance and offers an improved test of the argument that valuable and firm-specific HR provide a source of competitive advantage. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Critical Essay: Building new management theories on sound data? The case of neuroscience

PubMed Central

Lindebaum, Dirk

2015-01-01

In this critical essay, I contend that accelerating demands for novel theories in management studies imply that new methodologies and data are sometimes accepted prematurely as supply of these novel theories. This point is illustrated with reference to how neuroscience can inform management research. I propose two demand forces that foster the increased focus on neuroscience in management studies, these being (i) the direction of public research funding, and (ii) publication bias as a boost for journal impact factor. Looking at the supply side, I note that (i) the statistical power of studies using functional magnetic resonance imaging (or fMRI, the ‘gold’ standard) is unacceptably low, (ii) the use of imprecise ‘motherhood’ statements, and (iii) the dismissal of ethical concerns in the formulation of management theories and practice informed by neuroscience. I then briefly outline the bad consequences of this for management theory and practice, emphasize why it is important to prevent these consequences, and offer some methodological suggestions for future research. PMID:27041766

Modeling factors explaining physicians’ satisfaction with competence

PubMed Central

Lepnurm, Rein; Dobson, Roy Thomas; Peña-Sánchez, Juan-Nicolás; Nesdole, Robert

2015-01-01

Objective: Attention to physician wellness has increased as medical practice gains in complexity. Physician satisfaction with practice is critical for quality of care and practice growth. The purpose of this study was to model physicians’ self-reported Satisfaction with Competence as a function of their perceptions of the Quality of Health Services, Distress, Coping, Practice Management, Personal Satisfaction and Professional Equity. Methods: Comprehensive questionnaires were sent to a stratified sample of 5300 physicians across Canada. This cross-sectional study focused on physicians who examined and treated individual patients for a final study population of 2639 physicians. Response bias was negligible. The questionnaires contained measures of Satisfaction with Competence, Quality of Health Services, Distress, Coping, Personal Satisfaction, Practice Management and Professional Equity. Exploring relationships was done using Pearson correlations and one-way analysis of variance. Modeling was by hierarchical regressions. Results: The measures were reliable: Satisfaction with Competence (α = .86), Quality (α = .86), Access (α = .82), Distress (α = .82), Coping (α = .76), Personal Satisfaction (α = .78), Practice Management (α = .89) and the dimensions of Professional Equity (Fulfillment, α = .81; Financial, α = .93; and Recognition, α = .75) with comparative validity. Satisfaction with Competence was positively correlated with Quality (r = .32), Efficiency (r = .37) and Access (r = .32); negatively correlated with Distress (r = −.54); and positively correlated with Coping strategies (r = .43), Personal Satisfaction (r = .57), Practice Management (r = .17), Fulfillment (r = .53), Financial (r = .36) and Recognition (r = .54). Physicians’ perceptions on Quality, Efficiency, Access, Distress, Coping, Personal Satisfaction, Practice Management, Fulfillment, Pay and Recognition explained 60.2% of the variation in Satisfaction with Competence, controlling for years in practice, self-reported health and duties of physicians. Conclusion: Satisfaction with Competence could be affected by excessive accumulation of duties, concerns about quality, efficiency, access, excessive distress, inadequate coping abilities, personal satisfaction with life as a physician, challenges in managing practices and persistent inequities among physicians. PMID:27092256

Modeling factors explaining physicians' satisfaction with competence.

PubMed

Lepnurm, Rein; Dobson, Roy Thomas; Peña-Sánchez, Juan-Nicolás; Nesdole, Robert

2015-01-01

Attention to physician wellness has increased as medical practice gains in complexity. Physician satisfaction with practice is critical for quality of care and practice growth. The purpose of this study was to model physicians' self-reported Satisfaction with Competence as a function of their perceptions of the Quality of Health Services, Distress, Coping, Practice Management, Personal Satisfaction and Professional Equity. Comprehensive questionnaires were sent to a stratified sample of 5300 physicians across Canada. This cross-sectional study focused on physicians who examined and treated individual patients for a final study population of 2639 physicians. Response bias was negligible. The questionnaires contained measures of Satisfaction with Competence, Quality of Health Services, Distress, Coping, Personal Satisfaction, Practice Management and Professional Equity. Exploring relationships was done using Pearson correlations and one-way analysis of variance. Modeling was by hierarchical regressions. The measures were reliable: Satisfaction with Competence (α = .86), Quality (α = .86), Access (α = .82), Distress (α = .82), Coping (α = .76), Personal Satisfaction (α = .78), Practice Management (α = .89) and the dimensions of Professional Equity (Fulfillment, α = .81; Financial, α = .93; and Recognition, α = .75) with comparative validity. Satisfaction with Competence was positively correlated with Quality (r = .32), Efficiency (r = .37) and Access (r = .32); negatively correlated with Distress (r = -.54); and positively correlated with Coping strategies (r = .43), Personal Satisfaction (r = .57), Practice Management (r = .17), Fulfillment (r = .53), Financial (r = .36) and Recognition (r = .54). Physicians' perceptions on Quality, Efficiency, Access, Distress, Coping, Personal Satisfaction, Practice Management, Fulfillment, Pay and Recognition explained 60.2% of the variation in Satisfaction with Competence, controlling for years in practice, self-reported health and duties of physicians. Satisfaction with Competence could be affected by excessive accumulation of duties, concerns about quality, efficiency, access, excessive distress, inadequate coping abilities, personal satisfaction with life as a physician, challenges in managing practices and persistent inequities among physicians.

Characterization of broiler cake and broiler litter, the by-products of two management practices.

PubMed

Sistani, K R; Brink, G E; McGowen, S L; Rowe, D E; Oldham, J L

2003-10-01

The application of broiler manure and bedding (litter) on land has been a long-used disposal method that benefits plant and soil. For proper manure management, factors such as nutrient content, house cleaning management, application methods, and many land, crop, and climatic factors must be considered. A study was undertaken to characterize broiler cake and broiler litter as the by-products of two management systems in Mississippi. Broiler cake and litter productions were quantified and analyzed for four flocks during 1999 and 2000. The overall means for broiler cake production were 12.50, 13.90, and 10.30 kg m(-2) for producers 1, 2, and 3, respectively. Significantly greater quantities of litter, 27.50, 29.0, and 28.30 kg m(-2) than cake were determined for the same producers. The cake and litter moisture averaged 455 and 277 g kg(-1), respectively. No significant differences were observed between cake and litter total N, NH4-N, total C, total P, and water-soluble P (WP). However, cake had significantly greater Ca, Mg, K, Cu, Fe, Mn, and Zn than litter. Approximately 16.8% of the broiler cake and 15.2% of the broiler litter total P were in the form of water-soluble P. The NH4-N content of the cake and the litter were 12.5% and 11.5% of the cake and litter total nitrogen, respectively. The results also showed the advantage of the decaking practice with respect to the quantity of the manure generated for land application. Approximately 57% of the litter remains in the poultry house with decaking practice after each growth cycle compared to the 0% for total cleanout practice.

Practice change in community pharmacy: using change-management principles when implementing a pharmacy asthma management service in NSW, Australia.

PubMed

Feletto, Eleonora; Lui, Grace Wan Ying; Armour, Carol; Saini, Bandana

2013-02-01

This study aimed to investigate the application of a research-based change-management tool, the Pharmacy Change Readiness Wheel (PCRW), in practice, and the impact it had on the implementation of an asthma service (Pharmacy Asthma Management Service or PAMS). All pharmacists implementing the PAMS in the state of New South Wales, Australia, were provided training using a custom-designed module explaining change readiness as it applied to the PAMS. This training and a self-administered PCRW checklist were completed before PAMS implementation. Following PAMS service delivery, semi-structured phone interviews were conducted with the pharmacists and any additional staff involved regarding their experiences of change management. Interviews were transcribed verbatim and content analysed. Thirty seven of the forty five pharmacies who delivered PAMS returned the PCRW checklist (82% response rate) and participants from 29 pharmacies were interviewed (29 pharmacists and six additional staff). Perception of readiness for change before service delivery was remarkably high. From the interviews conducted after service delivery it was evident that systematic management of the practice change using theoretical concepts had not really been undertaken and that many challenges were faced in the implementation of practice change (PAMS). The results of the content analysis from the interviews revealed that factors external or internal to the pharmacy or those related to the individual pharmacist could affect implementation of practice change. Change is not as straightforward as it may appear and is a multi-step process over time. Pharmacists were unaware of this. A change-management framework should be applied to specific services with enough flexibility so that pharmacists can individualise them for their pharmacies. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

Pain Assessment and Management After a Knowledge Translation Booster Intervention.

PubMed

Stevens, Bonnie J; Yamada, Janet; Promislow, Sara; Barwick, Melanie; Pinard, Marie

2016-10-01

Inadequate pain treatment leaves hospitalized children vulnerable to immediate and long-term sequelae. A multidimensional knowledge translation intervention (ie, the Evidence-based Practice for Improving Quality [EPIQ]) improved pain assessment, management, and intensity outcomes in 16 units at 8 Canadian pediatric hospitals. The sustained effectiveness of EPIQ over time is unknown, however. The goals of this study were to determine the following: (1) sustainability of the impact of EPIQ on pain assessment, management, and intensity outcomes 12, 24, and 36 months after EPIQ; (2) effectiveness of a pain practice change booster (Booster) intervention to sustain EPIQ outcomes over time; and (3) influence of context on sustainability. A prospective, repeated measures, cluster randomized controlled trial was undertaken in the 16 EPIQ units, 12 months after EPIQ completion, to determine the effectiveness of a practice change booster (Booster) to sustain EPIQ outcomes. Generalized estimating equation models examined outcomes controlling for child and unit contextual factors. Outcomes achieved during EPIQ were sustained in the use of any pain assessment measure (P = .01) and a validated pain assessment measure in the EPIQ units (P = .02) up to 36 months after EPIQ. Statistically significant improvements in pain management practices persisted in EPIQ units; results varied across time. There were no significant differences in outcomes after implementation of the Booster between the Booster and Nonbooster groups. Improved pain assessment and management practices were sustained after EPIQ; however, the Booster did not seem to provide additional impact. Copyright © 2016 by the American Academy of Pediatrics.

Practical implications of incentive systems are utilized by dental franchises.

PubMed

Yavner, S B

1989-01-01

The success of any dental practice depends, among other factors, on the critical role of staff employees. In order to encourage desired staff behaviors, incentive systems can be designed for employee dentists, assistants/hygienists and managers. A survey of dental franchises was conducted in 1987 for the purpose of examining their incentive control systems. The specific incentives employed by these dental franchises for their employees are analyzed. The implications of these incentive systems used by dental franchise organizations for all dental practices are then discussed.

Helping or hindering: the role of nurse managers in the transfer of practice development learning.

PubMed

Currie, Kay; Tolson, Debbie; Booth, Jo

2007-09-01

This paper reports selected findings from a recent PhD study exploring how graduates from a BSc Specialist Nursing programme, with an NMC-approved Specialist Practitioner Qualification, engage in practice development during their subsequent careers. The UKCC (1998) defines specialist practice as requiring higher levels of judgement, discretion and decision-making, with leadership in clinical practice development forming a core dimension of this level of practice. However, there is little evidence in the published literature that describes or evaluates the practice development role of graduate specialist practitioners. This study applied a modified Glaserian approach to grounded theory methods. A preliminary descriptive survey questionnaire was posted to all graduates from the programme, response rate of 45% (n=102). From these respondents, theoretical sampling decisions directed the selection of 20 participants for interview, permitting data saturation. The grounded theory generated by this study discovered a basic social process labelled 'making a difference', whereby graduate specialist practitioners are increasingly able to impact in developing patient care at a strategic level by coming to own the identity of an expert practitioner (Currie, 2006). Contextual factors strongly influence the practitioner journey, with organizational position and other people presenting enabling or blocking conditions. The line manager plays a crucial role in helping or hindering graduate specialist practitioners to transfer their learning to the clinical setting and become active in practice development. Recommendations to enhance managerial support for the practice development role of graduate specialist practitioners are proposed. ADDING TO CURRENT KNOWLEDGE: This work adds to currently limited knowledge of the graduate specialist practitioners' role in the leadership of clinical practice development. In addition, the findings emphasize the potential influence of the workplace environment by analyzing organizational factors in the specific context of the graduate specialist practitioner attempting to develop practice.

Factors influencing the development of evidence-based practice among nurses: a self-report survey

PubMed Central

2012-01-01

Background Health authorities in several countries have decided that the health care services should be evidence-based. Recent research indicates that evidence-based practice may be more successfully implemented if the interventions overcome identified barriers. Aims The present study aimed to examine factors influencing the implementation of evidence-based practice among nurses in a large Norwegian university hospital. Methods Cross-sectional data was collected from 407 nurses during the period November 8 to December 3, 2010, using the Norwegian version of Developing Evidence-based Practice questionnaire (DEBP). The DEBP included data on various sources of information used for support in practice, on potential barriers for evidence-based practice, and on self-reported skills on managing research-based evidence. The DEBP was translated into Norwegian in accordance with standardized guidelines for translation and cultural adaptation. Results Nurses largely used experienced-based knowledge collected from their own observations, colleagues and other collaborators for support in practice. Evidence from research was seldom used. The greatest barriers were lack of time and lack of skills to find and manage research evidence. The nurse’s age, the number of years of nursing practice, and the number of years since obtaining the last health professional degree influenced the use of sources of knowledge and self-reported barriers. Self-reported skills in finding, reviewing and using different sources of evidence were positively associated with the use of research evidence and inversely related to barriers in use of research evidence. Conclusion Skills in evidence-based practice seem to reduce barriers to using research evidence and to increase use of research evidence in clinical practice. PMID:23092366

A Global Meta-Analysis on the Impact of Management Practices on Net Global Warming Potential and Greenhouse Gas Intensity from Cropland Soils.

PubMed

Sainju, Upendra M

2016-01-01

Management practices, such as tillage, crop rotation, and N fertilization, may affect net global warming potential (GWP) and greenhouse gas intensity (GHGI), but their global impact on cropland soils under different soil and climatic conditions need further evaluation. Available global data from 57 experiments and 225 treatments were evaluated for individual and combined effects of tillage, cropping systems, and N fertilization rates on GWP and GHGI which accounted for CO2 equivalents from N2O and CH4 emissions with or without equivalents from soil C sequestration rate (ΔSOC), farm operations, and N fertilization. The GWP and GHGI were 66 to 71% lower with no-till than conventional till and 168 to 215% lower with perennial than annual cropping systems, but 41 to 46% greater with crop rotation than monocroppping. With no-till vs. conventional till, GWP and GHGI were 2.6- to 7.4-fold lower when partial than full accounting of all sources and sinks of greenhouse gases (GHGs) were considered. With 100 kg N ha-1, GWP and GHGI were 3.2 to 11.4 times greater with partial than full accounting. Both GWP and GHGI increased curvilinearly with increased N fertilization rate. Net GWP and GHGI were 70 to 87% lower in the improved combined management that included no-till, crop rotation/perennial crop, and reduced N rate than the traditional combined management that included conventional till, monocopping/annual crop, and recommended N rate. An alternative soil respiration method, which replaces ΔSOC by soil respiration and crop residue returned to soil in the previous year, similarly reduced GWP and GHGI by 133 to 158% in the improved vs. the traditional combined management. Changes in GWP and GHGI due to improved vs. traditional management varied with the duration of the experiment and inclusion of soil and climatic factors in multiple linear regressions improved their relationships. Improved management practices reduced GWP and GHGI compared with traditional management practices and combined management practices were even more effective than individual management practices in reducing net GHG emissions from cropland soils. Partial accounting overestimated GWP and GHGI values as sinks or sources of net GHGs compared with full accounting when evaluating the effect of management practices.

A Global Meta-Analysis on the Impact of Management Practices on Net Global Warming Potential and Greenhouse Gas Intensity from Cropland Soils

PubMed Central

Sainju, Upendra M.

2016-01-01

Management practices, such as tillage, crop rotation, and N fertilization, may affect net global warming potential (GWP) and greenhouse gas intensity (GHGI), but their global impact on cropland soils under different soil and climatic conditions need further evaluation. Available global data from 57 experiments and 225 treatments were evaluated for individual and combined effects of tillage, cropping systems, and N fertilization rates on GWP and GHGI which accounted for CO2 equivalents from N2O and CH4 emissions with or without equivalents from soil C sequestration rate (ΔSOC), farm operations, and N fertilization. The GWP and GHGI were 66 to 71% lower with no-till than conventional till and 168 to 215% lower with perennial than annual cropping systems, but 41 to 46% greater with crop rotation than monocroppping. With no-till vs. conventional till, GWP and GHGI were 2.6- to 7.4-fold lower when partial than full accounting of all sources and sinks of greenhouse gases (GHGs) were considered. With 100 kg N ha-1, GWP and GHGI were 3.2 to 11.4 times greater with partial than full accounting. Both GWP and GHGI increased curvilinearly with increased N fertilization rate. Net GWP and GHGI were 70 to 87% lower in the improved combined management that included no-till, crop rotation/perennial crop, and reduced N rate than the traditional combined management that included conventional till, monocopping/annual crop, and recommended N rate. An alternative soil respiration method, which replaces ΔSOC by soil respiration and crop residue returned to soil in the previous year, similarly reduced GWP and GHGI by 133 to 158% in the improved vs. the traditional combined management. Changes in GWP and GHGI due to improved vs. traditional management varied with the duration of the experiment and inclusion of soil and climatic factors in multiple linear regressions improved their relationships. Improved management practices reduced GWP and GHGI compared with traditional management practices and combined management practices were even more effective than individual management practices in reducing net GHG emissions from cropland soils. Partial accounting overestimated GWP and GHGI values as sinks or sources of net GHGs compared with full accounting when evaluating the effect of management practices. PMID:26901827

Practice status of specialized agencies for occupational health management of small- to medium-size enterprises and the factors improving their performance: a cross-sectional survey study.

PubMed

Lee, Saerom; Myong, Jun-Pyo; Kim, Eun-A; Eom, Huisu; Choi, Bowha; Kang, Young Joong

2017-01-01

We examined the current status of specialized agencies for occupational health management (SAs) and their workforce. Furthermore, we aimed to clarify the current practice status of SA healthcare professionals and factors that influence their performance. To examine the current SA workforce, we analyzed data from the 2014 Survey of Current Status of SA and their Workforce from the Ministry of Employment and Labor (MOEL). Furthermore, we mailed out an original questionnaire to SA professionals to determine their current health management status and factors that affect their performance. Data from the respondents ( N  = 384) were analyzed. In 2014, the workforce performing health management in SAs comprised 232 physicians, 507 nurses, and 312 occupational hygienists, with no significant regional differences in the distribution of physicians and nurses. According to the findings of the questionnaire, the average daily number of worker consultations by physicians and nurses was 22.8, while the average time taken for health management ranged from 74.3 to 104.3 min, depending on the size of the firm. Most of the respondents (41.5%) answered that they were following-up on more than 80% of individuals with illnesses. Among health management tasks, performance scores of "consultations for general diseases" and "consultations for lifestyle habits" were relatively high, whereas health promotion activities at workplaces were relatively low. There was a significant correlation between the utilization of general and special health examination results and task performance. Among health management tasks, follow-up management of individuals with illnesses and consultations for disease/lifestyle habits were relatively well performed, whereas health promotion activities at workplaces were not performed well. Among factors that positively influenced SA performance at workplaces, only the utilization of health examination results had significant effects. Therefore, to accomplish health management goals and perform effective health management at workplaces, there is a need to establish a comprehensive system of occupational health service outsourcing integrating health examinations and health management services. Furthermore, the current task system, which focuses on follow-up management, should be expanded to incorporate preventive and health promotion functions-the fundamental functions of occupational health services (OHS).

The use of multi-criteria decision analysis to tackle waste management problems: a literature review.

PubMed

Achillas, Charisios; Moussiopoulos, Nicolas; Karagiannidis, Avraam; Banias, Georgias; Perkoulidis, George

2013-02-01

Problems in waste management have become more and more complex during recent decades. The increasing volumes of waste produced and social environmental consciousness present prominent drivers for environmental managers towards the achievement of a sustainable waste management scheme. However, in practice, there are many factors and influences - often mutually conflicting - criteria for finding solutions in real-life applications. This paper presents a review of the literature on multi-criteria decision aiding in waste management problems for all reported waste streams. Despite limitations, which are clearly stated, most of the work published in this field is reviewed. The present review aims to provide environmental managers and decision-makers with a thorough list of practical applications of the multi-criteria decision analysis techniques that are used to solve real-life waste management problems, as well as the criteria that are mostly employed in such applications according to the nature of the problem under study. Moreover, the paper explores the advantages and disadvantages of using multi-criteria decision analysis techniques in waste management problems in comparison to other available alternatives.

[Precision nutrition in the era of precision medicine].

PubMed

Chen, P Z; Wang, H

2016-12-06

Precision medicine has been increasingly incorporated into clinical practice and is enabling a new era for disease prevention and treatment. As an important constituent of precision medicine, precision nutrition has also been drawing more attention during physical examinations. The main aim of precision nutrition is to provide safe and efficient intervention methods for disease treatment and management, through fully considering the genetics, lifestyle (dietary, exercise and lifestyle choices), metabolic status, gut microbiota and physiological status (nutrient level and disease status) of individuals. Three major components should be considered in precision nutrition, including individual criteria for sufficient nutritional status, biomarker monitoring or techniques for nutrient detection and the applicable therapeutic or intervention methods. It was suggested that, in clinical practice, many inherited and chronic metabolic diseases might be prevented or managed through precision nutritional intervention. For generally healthy populations, because lifestyles, dietary factors, genetic factors and environmental exposures vary among individuals, precision nutrition is warranted to improve their physical activity and reduce disease risks. In summary, research and practice is leading toward precision nutrition becoming an integral constituent of clinical nutrition and disease prevention in the era of precision medicine.

Physiotherapists' beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies.

PubMed

Gardner, Tania; Refshauge, Kathryn; Smith, Lorraine; McAuley, James; Hübscher, Markus; Goodall, Stephen

2017-07-01

What influence do physiotherapists' beliefs and attitudes about chronic low back pain have on their clinical management of people with chronic low back pain? Systematic review with data from quantitative and qualitative studies. Quantitative and qualitative studies were included if they investigated an association between physiotherapists' attitudes and beliefs about chronic low back pain and their clinical management of people with chronic low back pain. Five quantitative and five qualitative studies were included. Quantitative studies used measures of treatment orientation and fear avoidance to indicate physiotherapists' beliefs and attitudes about chronic low back pain. Quantitative studies showed that a higher biomedical orientation score (indicating a belief that pain and disability result from a specific structural impairment, and treatment is selected to address that impairment) was associated with: advice to delay return to work, advice to delay return to activity, and a belief that return to work or activity is a threat to the patient. Physiotherapists' fear avoidance scores were positively correlated with: increased certification of sick leave, advice to avoid return to work, and advice to avoid return to normal activity. Qualitative studies revealed two main themes attributed to beliefs and attitudes of physiotherapists who have a relationship to their management of chronic low back pain: treatment orientation and patient factors. Both quantitative and qualitative studies showed a relationship between treatment orientation and clinical practice. The inclusion of qualitative studies captured the influence of patient factors in clinical practice in chronic low back pain. There is a need to recognise that both beliefs and attitudes regarding treatment orientation of physiotherapists, and therapist-patient factors need to be considered when introducing new clinical practice models, so that the adoption of new clinical practice is maximised. [Gardner T, Refshauge K, Smith L, McAuley J, Hübscher M, Goodall S (2017) Physiotherapists' beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies. Journal of Physiotherapy 63: 132-143]. Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

TEK, local perceptions of risk, and diversity of management practices of Agave inaequidens in Michoacán, Mexico.

PubMed

Torres, Ignacio; Blancas, José; León, Alejandro; Casas, Alejandro

2015-08-05

Mescal production is the main economic activity associated to agaves in Mexico, which involves 53 species mostly harvested from forests. The increasing mescal demand has influenced risk in both agave populations and mescal production, but other social and ecological factors also intervene. We hypothesized that the greater the risk the greater the complexity of management responses; otherwise, the greater the probability of populations' depletion. We analysed this hypothesis by examining the diversity of risk conditions and management practices of Agave inaequidens in the state of Michoacán, in central-western Mexico. We studied five communities of Michoacán, documenting through 41 semi-structured interviews the use forms, risk perception, number of agaves annually extracted, and the management practices. Using a matrix with social-ecological and technological data analyzed by PCA, we evaluated similarities of management contexts. A data matrix with information on risk of agave populations, and other about management practices were analysed also through CCA and PCA. The scores of the first principal components were considered as indexes of risk and management complexity, respectively. A regression analysis of these indexes evaluated their relation. We recorded 34 different uses of A. inaequidens, the most important being mescal production (mentioned by 76.1 % of people interviewed). Nearly 12.5 % of people practice only gathering, but others mentioned the following practices: Selective let standing of agaves for seed production (20 %); in situ transplanting of saplings; seed propagation in nurseries and saplings transplanting to forest (10 %); suckers transplanting (7.5 %); seed dispersal in forests; banning (5 %); enhancing of agave growth by removing tree canopies (2.5 %); transplanting from the wild to live fences (45 %); intensive plantations (35 %). The highest vulnerability of agave populations was identified in communities where risk is not counteracted by management. In two communities we identified the highest risk (annual extraction from 4,353 to 6,557 agaves), but different actions counteracting such risk. Interchange of knowledge and management experiences developed by handlers is crucial for the regional conservation, recovering, and sustainable management of A. inaequidens populations.

A naturalistic study of changes in pharmacological prescription for borderline personality disorder in clinical practice: from APA to NICE guidelines.

PubMed

Pascual, Juan C; Martín-Blanco, Ana; Soler, Joaquim; Ferrer, Alicia; Tiana, Thais; Alvarez, Enrique; Pérez, Víctor

2010-11-01

Although no psychotropic agents are specifically licensed for the management of borderline personality disorder (BPD), pharmacological treatment appears to be common. This study aimed to examine the drug prescriptions for patients with BPD in clinical practice, analyze the prescription patterns from the appearance of the American Psychiatric Association guidelines in 2001 until the National Institute for Health and Clinical Excellence guidelines in 2009, and identify the factors associated with such prescription of each type of drug. Naturalistic study on 226 consecutive BPD patients admitted to an outpatient BPD program. Socio-demographic, clinical and pharmacological treatment information was collected; factors associated with drug prescription were examined using logistic regression analyses for dichotomous outcomes measures. Changes in prescription patterns over time were also evaluated. Patients received an average of 2.7 drugs; only 6% were drug-free; 56% were taking ≥3 drugs and 30% ≥4 drugs. Over the past 8 years, prescription of antidepressants has remained stable; there has been a significant reduction in prescription of benzodiazepines and an increase in the use of mood stabilizers and atypical antipsychotics. Comorbidity with Axis I disorders was the main factor associated with drug prescription. Drug prescription and polypharmacy are common in the management of BPD in clinical practice.

PORTALS: design of an innovative approach to anticoagulation management through eHealth.

PubMed

Talboom-Kamp, E P W A; Verdijk, N A; Talboom, I J S H; Harmans, L M; Numans, M E; Chavannes, N H

2017-03-16

For the monitoring of International Normalized Ratio (INR) values, venous thromboembolism (VTE) and atrial fibrillation (AF) patients can visit anticoagulation clinics, laboratories, or physicians for venous puncture. Point-of-care testing (POCT) made it possible for patients to monitor INR themselves (self-monitoring) and even self-adjust their medication dosage (self-dosage). Both skills are accepted as forms of self-management. eHealth applications can improve this self-management, resulting in better clinical outcomes. Our study, called PORTALS, aims at identifying the optimal implementation strategy of training to improve self-management and explore factors that enhance good self-management skills. In addition, the relationship between the implementation strategy of training, clinical outcomes, and individual characteristics will be investigated. Of the 247 recruited participants, 110 chose to continue with regular care. 137 patients have been randomly divided in subgroups and compared using a parallel cohort design: one group will be trained and educated by e-learning, and the other group will receive face-to-face group training. More insight in factors that enhance good self-management will help to improve clinical outcomes and patient satisfaction on anticoagulation therapy. Our study will provide practical insights and knowledge of eHealth in daily practice and of the importance of education on the adoption of self-management. We expect the self-management program including training to help patients to better manage their own INR values and medication use, thereby increasing health status and diminishing thromboembolic events and hospitalisation. The Netherlands National Trial Register, number NTR3947 .

Enhancing resilience, empowerment, and conflict management among baccalaureate students: outcomes of a pilot study.

PubMed

Pines, Eula W; Rauschhuber, Maureen L; Cook, Jennifer D; Norgan, Gary H; Canchola, Leticia; Richardson, Cynthia; Jones, Mary Elaine

2014-01-01

To manage interpersonal conflict, nursing students need evidence-based interventions to strengthen stress resiliency, psychological empowerment, and conflict management skills. A pilot 1-group, pre-post-design, 2-semester intervention used simulated experiences to enhance these skills with 60 undergraduate nursing students. Findings suggest that integration of conflict resolution skills throughout the curriculum, with repeated opportunities to practice using a variety of styles of conflict management in relation to situational factors, may be beneficial to prepare students for the challenges of today's healthcare environment.

Research on evaluation methods for water regulation ability of dams in the Huai River Basin

NASA Astrophysics Data System (ADS)

Shan, G. H.; Lv, S. F.; Ma, K.

2016-08-01

Water environment protection is a global and urgent problem that requires correct and precise evaluation. Evaluation methods have been studied for many years; however, there is a lack of research on the methods of assessing the water regulation ability of dams. Currently, evaluating the ability of dams has become a practical and significant research orientation because of the global water crisis, and the lack of effective ways to manage a dam's regulation ability has only compounded this. This paper firstly constructs seven evaluation factors and then develops two evaluation approaches to implement the factors according to the features of the problem. Dams of the Yin Shang ecological control section in the Huai He River basin are selected as an example to demonstrate the method. The results show that the evaluation approaches can produce better and more practical suggestions for dam managers.

Ambulatory surgery centers best practices for the 90s.

PubMed

Hoover, J A

1994-05-01

Outpatient surgery will be the driving force in the continued growth of ambulatory care in the 1990s. Providing efficient, high-quality ambulatory surgical services should therefore be a priority among healthcare providers. Arthur Andersen conducted a survey to discover best practices in ambulatory surgical service. General success characteristics of best performers were business-focused relationships with physicians, the use of clinical protocols, patient convenience, cost management, strong leadership, teamwork, streamlined processes and efficient design. Other important factors included scheduling to maximize OR room use; achieving surgical efficiencies through reduced case pack assembly errors and equipment availability; a focus on cost capture rather than charge capture; sound materiel management practices, such as standardization and vendor teaming; and the appropriate use of automated systems. It is important to evaluate whether the best practices are applicable to your environment and what specific changes to your current processes would be necessary to adopt them.

Factors affecting reproductive performance of dairy cows.

PubMed

Coleman, D A; Thayne, W V; Dailey, R A

1985-07-01

We conducted two studies to determine how herd management practices and traits of individual cows affect performance of the herd and of the cow within a herd. Management practices, reproductive performance of the herd, and relationships between management and reproductive performance were characterized on 83 dairy farms with 7596 cows. Data included 21 management variables (e.g., facilities, herd health program, estrous detection program) and 8 performance variables obtained from Dairy Herd Improvement or unofficial records (e.g., size of herd, production, days open). Although varying among herds, annual average herd incidences of reproductive disorders and reproductive performance were similar to those reported. Managerial practices influenced incidences of retained placenta and uterine infection, days open of cows not bred and of all cows, services per conception, and percentages of herd open more than 100 days and culled for low production. Veterinarian was the most consistent variable influencing herd reproductive performance. Data also were collected from production and lifetime records of 2532 cows in 19 herds. Reproductive performance was affected by season of calving, production, maturity, and reproductive disorders. Several cows with extremely poor reproductive records were maintained.

Management and prevalence of long-term conditions in primary health care for adults with intellectual disabilities compared with the general population: A population-based cohort study.

PubMed

Cooper, Sally-Ann; Hughes-McCormack, Laura; Greenlaw, Nicola; McConnachie, Alex; Allan, Linda; Baltzer, Marion; McArthur, Laura; Henderson, Angela; Melville, Craig; McSkimming, Paula; Morrison, Jill

2018-01-01

In the UK, general practitioners/family physicians receive pay for performance on management of long-term conditions, according to best-practice indicators. Management of long-term conditions was compared between 721 adults with intellectual disabilities and the general population (n = 764,672). Prevalence of long-term conditions was determined, and associated factors were investigated via logistic regression analyses. Adults with intellectual disabilities received significantly poorer management of all long-term conditions on 38/57 (66.7%) indicators. Achievement was high (75.1%-100%) for only 19.6% of adults with intellectual disabilities, compared with 76.8% of the general population. Adults with intellectual disabilities had higher rates of epilepsy, psychosis, hypothyroidism, asthma, diabetes and heart failure. There were no clear associations with neighbourhood deprivation. Adults with intellectual disabilities receive poorer care, despite conditions being more prevalent. The imperative now is to find practical, implementable means of supporting the challenges that general practices face in delivering equitable care. © 2017 John Wiley & Sons Ltd.

The potential of palliative care for patients with respiratory diseases

PubMed Central

Narsavage, Georgia L.; Chen, Yea-Jyh; Korn, Bettina; Elk, Ronit

2017-01-01

Based on the demonstrated effectiveness of palliative care in the alleviation of symptoms and enhancement of life quality, it is important to incorporate palliative care early in the respiratory disease trajectory. Quality palliative care addresses eight domains that are all patient and family centred. Palliative care interventions in respiratory conditions include management of symptoms such as dyspnoea, cough, haemoptysis, sputum production, fatigue and respiratory secretion management, especially as the end-of-life nears. A practical checklist of activities based on the domains of palliative care can assist clinicians to integrate palliative care into their practice. Clinical management of patients receiving palliative care requires consideration of human factors and related organisational characteristics that involve cultural, educational and motivational aspects of the patient/family and clinicians. Educational aims To explain the basic domains of palliative care applicable to chronic respiratory diseases. To review palliative care interventions for patients with chronic respiratory diseases. To outline a checklist for clinicians to use in practice, based on the domains of palliative care. To propose recommendations for clinical management of patients receiving palliative care for chronic respiratory diseases. PMID:29209422

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.

Risk management in obstetric care for family physicians: results of a 10-year project.

PubMed

Nesbitt, Thomas S; Hixon, Allen; Tanji, Jeffrey L; Scherger, Joseph E; Abbott, Dana

2003-01-01

Malpractice issues within the United States remain a critical factor for family physicians providing obstetric care. Although tort reform is being widely discussed, little has been written regarding the malpractice crisis from a risk management perspective. Between 1989 and 1998, a 10-year risk management study at the UC Davis Health System provided a unique collaboration between researchers, a mutual insurance carrier and family physicians practicing obstetrics. Physicians were asked to comply with standardized clinical guidelines, attend continuing medical education (CME) seminars, and submit obstetric medical records for review. Feedback analysis was provided to each physician on their records, and the insurance carrier tracked interim malpractice claims. One hundred and ninety-four physicians participated, attending to 32,831 births. Compliance with project guidelines was 91%. Five closed obstetric cases were reported with only one settlement reported to the National Provider Data Bank. Physicians believed the project was beneficial to their practices. Family physicians practicing obstetrics are willing to participate in a collaborative risk management program and are compliant with standardized clinical guidelines. The monetary award for successful malpractice claims was relatively low. This collaborative risk management model may offer a potential solution to the current malpractice crisis.

Psychometric properties of DAPonDEN: definitions, attitudes and practices in relation to diarrhea during enteral nutrition questionnaire.

PubMed

Majid, Hazreen A; Bin Sidek, Muhamad Adam; Chinna, Karuthan

2013-01-01

To investigate the psychometric properties of the developed 21 item questionnaire to measure definitions, attitudes and management practices in relation to diarrhea during enteral nutrition (DAPonDEN). Data were analyzed using exploratory factor analysis from a cross sectional study of 102 nurses aged 18 and over, conducted from December 2011 to February 2012 in Malaysia. Face and content validity of DAPonDEN were first evaluated by few expert panels and patients. For this study, adult nurses were recruited from the adult wards. In the final model, three items in DAPonDEN were dropped. In the exploratory factor analysis, five factors were extracted that explained a total of 55% of the variation in the remaining 18 items. The Kaiser-Meyer-Olkin (KMO) value was 0.723. For definition, there were two underlying factors: 'Key items in defining diarrhea' and 'non-key items in defining diarrhea'. For attitude there was a single factor. For practice, there were two underlying factors: 'enteral nutrition (EN) related' and 'awareness related'. The items in each of the underlying dimensions seem to measure the respective concepts for definition, attitude and practices adequately. The 18-items DAPonDEN instrument can be a suitable education tool to be used in relation to diarrhea during EN. Copyright © 2013 Elsevier Inc. All rights reserved.

Understanding the work done by NHS commissioning managers: an exploration of the microprocesses underlying day-to-day sensemaking in UK primary care organisations.

PubMed

Checkland, Kath; Harrison, Stephen; Snow, Stephanie; Coleman, Anna; McDermott, Imelda

2013-01-01

The purpose of this paper is to explore the practical daily work undertaken by middle-level managers in Primary Care Trusts (PCTs), focusing upon the micro-processes by which these managers enact sensemaking in their organisations. The research took a case study approach, undertaking detailed case studies in four PCTs in England. Data collection included shadowing managers, meeting observations and interviews. The research elucidated two categories of enactment behaviour exhibited by PCT managers: presence/absence; and the production of artefacts. Being "present" in or "absent" from meetings enacted sensemaking over and above any concrete contribution to the meeting made by the actors involved. This paper explores the factors affecting these processes, and describes the situations in which enactment of sense is most likely to occur. Producing artefacts such as meeting minutes or PowerPoint slides also enacted sense in the study sites in addition to the content of the artefact. The factors affecting this are explored. The study has practical implications for all managers seeking to maximise their influence in their organisations. It also provides specific evidence relevant to managers working in the new Clinical Commissioning Groups currently being formed in England. The study expands the understanding of sensemaking in organisations in two important ways. Firstly, it moves beyond discourse to explore the ways in which behaviours can enact sense. Secondly, it explores the distinction between active and unconscious sensemaking.

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.

The Relationship of Workplace Culture With Nursing-Sensitive Organizational Factors.

PubMed

Hahtela, Nina; McCormack, Brendan; Paavilainen, Eija; Slater, Paul; Helminen, Mika; Suominen, Tarja

2015-01-01

The aim of this study is to explore the relations of workplace culture on nursing-sensitive organizational factors. The need for standardized and valid measures for nursing-sensitive organizational outcomes has already been recognized in the literature. A cross-sectional questionnaire survey of 21 inpatient acute care units in 9 organizations at the municipal primary healthcare level was conducted. Participants included licensed practical nurses, registered nurses, and nurse managers. Workplace culture, especially the overarching factor of stress, correlated with the use of supplemental nursing staff and patients' length of stay. It is essential to find and test workplace-sensitive indicators so that managers will have a wider range of methods to plan and evaluate nursing outcomes.

Psychogenic Non-epileptic Seizures: An Updated Primer.

PubMed

Baslet, Gaston; Seshadri, Ashok; Bermeo-Ovalle, Adriana; Willment, Kim; Myers, Lorna

2016-01-01

Psychogenic non-epileptic seizures are the most common paroxysmal event misdiagnosed as epilepsy. They significantly affect quality of life, functional status, and use of medical resources. The goal of this review is to provide guidance to psychiatrists and other mental health professionals in the understanding and practical management of this condition. An abundance of new reports on the pathogenesis and effective treatments have become available over the last decade, yet specific barriers impede the fluid transition to treatment and remain an important challenge in the management of patients with psychogenic non-epileptic seizures. In the context of these difficulties, we initially present background information on psychogenic non-epileptic seizures covering their historic context, epidemiology, etiologic factors (including psychiatric, neuromedical, and neuropsychological factors), and current neurobiological models. Updated evidence-based treatments are discussed along with data on long-term outcomes. We also provide practical tools to help clinicians navigate differential diagnoses, establish their interdisciplinary roles, communicate the diagnosis, deliver treatment, and sort out commonly encountered challenges in the management of this condition. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

2015 Oman Heart Association guidelines for the management of hypertension : practical recommendations from the Oman Heart Association (OHA).

PubMed

El-Deeb, Mohammed H; Sulaiman, Kadhim J; Al-Riyami, Abdullah A; Mohsin, Nabil; Al-Mukhaini, Mohamed; Al-Lamki, Mohamed; Al-Busaidi, Noor; Al-Salmi, Issa; Al-Lawati, Jawad; Al-Rawahi, Najib; Al-Riyami, Mohamed B; Abdul-Rahman, Said; Al-Hinai, Said; Jaffer, Batool; Al-Wahaebi, Ahmed; Al-Khalili, Hanan; Al-Zadjali, Matllooba

2015-03-01

Hypertension (HTN) is a major independent risk factor for the development of stroke, coronary artery disease (CAD), peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD). HTN is a growing public health problem in Oman, almost certainly the most prevalent modifiable risk factor for cardiovascular disease (CVD). The risk of CVD in patients with HTN can be greatly reduced with lifestyle modifications and effective antihypertensive therapy. Randomized trials have shown that blood pressure (BP) lowering produces rapid reductions in CV risk. Several studies have shown that the majority of the hypertensive patients remain uncontrolled. It is well established that the observed poor control of the disease is not only related to poor adherence to medications, but also to limited awareness and adherence to evidence-based management of hypertension among physicians. Several guidelines for the management of patients with hypertension have been published. However, the aim of this document is to provide the busy physicians in Oman with more concise and direct approach towards implementing these guidelines into clinical practice.

Stop Stroke: development of an innovative intervention to improve risk factor management after stroke.

PubMed

Redfern, Judith; Rudd, Anthony D; Wolfe, Charles D A; McKevitt, Christopher

2008-08-01

Stroke survivors are at high risk of stroke recurrence yet current strategies to reduce recurrence risk are sub-optimal. The UK Medical Research Council (MRC) have proposed a framework for developing and evaluating complex interventions, such as community management of stroke secondary prevention. The Framework outlines a five-phased approach from theory through to implementation of effective interventions. This paper reports Phases I-III of the development of a novel intervention to improve risk factor management after stroke. The pre-clinical/theoretical phase entailed reviewing the literature and undertaking quantitative and qualitative studies to identify current practices and barriers to secondary prevention. In Phase I (modelling), findings were used to design an intervention with the potential to overcome barriers to effective stroke secondary prevention management. The feasibility of delivering the intervention and its acceptability were tested in the Phase II exploratory trial involving 25 stroke survivors and their general practitioners. This led to the development of the definitive risk factor management intervention. This comprises multiple components and involves using an on-going population stroke register to target patients, carers and health care professionals with tailored secondary prevention advice. Clinical, socio-demographic and service use data collected by the stroke register are transformed to provide an individualised secondary prevention package for patients, carers and health care professionals at three time points: within 10 weeks, 3 and 6 months post-stroke. The intervention is currently being evaluated in a randomised controlled trial. Further research is needed to test generalisability to other aspects of stroke management and for other chronic diseases. The MRC Framework for complex interventions provides a structured approach to guide the development of novel interventions in public health. Implications for practice in stroke secondary prevention will emerge when the results of our randomised controlled trial are published.

Thromboembolism prophylaxis in patients with Philadelphia-negative myeloproliferative neoplasms-Clinical practice among Nordic specialists.

PubMed

Bjerrum, Ole Weis; Samuelsson, Jan; Ghanima, Waleed; Kauppila, Marjut; Andersen, Christen Lykkegaard

2018-05-01

Patients with Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) have higher risks of developing thromboembolisms compared to the general population. International guidelines on the management of MPNs therefore include recommendations concerning thromboembolism prophylaxis. In clinical practice, strict adherence to guidelines may be challenging and dependent on factors such as physician experience, outpatient clinic setting, and access to therapy; however, no data exist on physician adherence or patient compliance to thromboembolism prophylaxis in MPNs. The Nordic Myeloproliferative Neoplasm Study Group (NMPN) performed a survey among Nordic hematology specialists with the aim of documenting the implementation of international recommendations in a region of Northern Europe with similar healthcare systems. The study showed that Nordic specialists managed their patients in accordance with international guidelines concerning medical intervention, but to a lesser degree regarding the management of additional cardiovascular risk factors. The survey also drew attention to the common clinical dilemma of combining antiaggregatory agents with vitamin K antagonists (VKA), or novel oral anticoagulants (NOAC), as well as phlebotomy limits in female polycythemia vera patients. The results of this study highlight the importance of considering all risk factors for thrombosis and an optimal collaboration with the primary healthcare sector. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Good practices in health care "management experimentation models": insights from an international public-private partnership on transplantation and advanced specialized therapies.

PubMed

Longo, Maria Cristina

2015-01-01

The research analyzes good practices in health care "management experimentation models," which fall within the broader range of the integrative public-private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the "management experimentation models" are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations. In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC - Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies. The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable. The recognition of ISMETT's good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.

Ecological and socio-cultural factors influencing plant management in Náhuatl communities of the Tehuacán Valley, Mexico.

PubMed

Blancas, José; Casas, Alejandro; Pérez-Salicrup, Diego; Caballero, Javier; Vega, Ernesto

2013-06-02

Management types and their intensity may vary according to indicators such as: (1) practices complexity, (2) degree of techniques specialization, (3) occurrence and types of social regulations, (4) artificial selection intensity, (5) energy invested, (6) tools types, and (7) amounts of resources obtained. Management types of edible plants were characterized and analyzed in Náhuatl communities of the Tehuacán Valley. We expected that both natural and human pressures generate risk on plant resources availability, influencing human responses of management directed to decrease risk. We particularly hypothesized that magnitude of risk would be a direct function of human pressures favored by cultural and economic value and ecological factors such as scarcity (restricted distribution and abundance). Management practices may decrease risk of plant resources, more effectively when they are more intense; however, absence or insufficiency of management practices on endangered plants may favor loss of their populations. Understanding current management motives and their consequences on the purpose of ensuring availability of plant resources might allow us to understand similar processes occurring in the past. This issue is particularly important to be studied in the Tehuacán Valley, where archaeologists documented possible scenarios motivating origins of plant management by agriculture during prehistory. Through ethnobotanical collecting, 55 semi-structured and free listing interviews we inventoried edible plant species used in five villages of Coyomeapan, Mexico. We identified: (1) native plant species whose products are obtained exclusively through simple gathering, (2) native species involving simple gathering and other management types, and (3) non-native species managed by agricultural management. We conducted in depth studies on the 33 native species managed through gathering and other types of practices. We carried out a total of 660 sessions of detailed interviews to 20 households randomly selected. We showed to people voucher specimens and photos of the sample of species chosen and documented their cultural and economic values. Spatial availability of these plant species was evaluated through vegetation sampling. Values for each cultural, economic, and ecological indicator were codified and averaged or summed and weighed according to frequency of interviewees' responses or ecological conditions per plant species. With the standardized values of these indicators we performed a PCA and scores of the first principal component were considered as a risk index, which summarizes information of thirteen indicators of human use, demand and scarcity of each plant species. Similarly, eleven indicators of energy invested, complexity, tools and management strategies were used for performing PCA and scores of the first principal component were considered as management intensity index for each plant species. A linear regression analysis was performed to analyze the relation between risk and management intensity indexes. Amounts of variation of management data explained by ecological, cultural and economic information, as well as their risk level were analyzed through canonical correspondence analyses (CCA). A total of 122 edible plant species were recorded, nearly 30% of them were introduced domesticated plants, 51 were wild species obtained exclusively by simple gathering and 33 were native species obtained by simple gathering and other management practices, these latter were the ones more deeply studied. People recognized variants in 21 of these latter 33 species, the variants receiving differential use, management, artificial selection and incipient domestication. The lowest values of management intensity corresponded to species under simple gathering and tolerance, mostly annual abundant plants, occasionally consumed by few people. The highest management intensity values were recorded in species with economic importance, mostly perennial with recognized variants whose management requires using tools, and which are protected by collective regulations. The regression analysis indicated significant value R² = 0.433 (P < 0.001) between risk and management indexes. CCA explained 65.5% of variation of management intensity, mainly by socio-cultural factors (32.6%), whereas ecological data explained 21.3% and the intersection of all factors 11.6%. Variation of management intensity is 67.6% explained by risk variables. Length-span of life cycle, reproductive system type, distribution, number of parts used, number of management and use forms and type of regulations were statistically significant. People manage plant resources according to the role these play in households' subsistence, the quantity available and the quality of their useful products; particularly important is the balance between resources availability and demand. Management responses to risk are also influenced by the ease to propagate or manipulate individual plants and time requiring the construction of manipulation strategies and techniques.

Ecological and socio-cultural factors influencing plant management in Náhuatl communities of the Tehuacán Valley, Mexico

PubMed Central

2013-01-01

Background Management types and their intensity may vary according to indicators such as: (1) practices complexity, (2) degree of techniques specialization, (3) occurrence and types of social regulations, (4) artificial selection intensity, (5) energy invested, (6) tools types, and (7) amounts of resources obtained. Management types of edible plants were characterized and analyzed in Náhuatl communities of the Tehuacán Valley. We expected that both natural and human pressures generate risk on plant resources availability, influencing human responses of management directed to decrease risk. We particularly hypothesized that magnitude of risk would be a direct function of human pressures favored by cultural and economic value and ecological factors such as scarcity (restricted distribution and abundance). Management practices may decrease risk of plant resources, more effectively when they are more intense; however, absence or insufficiency of management practices on endangered plants may favor loss of their populations. Understanding current management motives and their consequences on the purpose of ensuring availability of plant resources might allow us to understand similar processes occurring in the past. This issue is particularly important to be studied in the Tehuacán Valley, where archaeologists documented possible scenarios motivating origins of plant management by agriculture during prehistory. Methods Through ethnobotanical collecting, 55 semi-structured and free listing interviews we inventoried edible plant species used in five villages of Coyomeapan, Mexico. We identified: (1) native plant species whose products are obtained exclusively through simple gathering, (2) native species involving simple gathering and other management types, and (3) non-native species managed by agricultural management. We conducted in depth studies on the 33 native species managed through gathering and other types of practices. We carried out a total of 660 sessions of detailed interviews to 20 households randomly selected. We showed to people voucher specimens and photos of the sample of species chosen and documented their cultural and economic values. Spatial availability of these plant species was evaluated through vegetation sampling. Values for each cultural, economic, and ecological indicator were codified and averaged or summed and weighed according to frequency of interviewees’ responses or ecological conditions per plant species. With the standardized values of these indicators we performed a PCA and scores of the first principal component were considered as a risk index, which summarizes information of thirteen indicators of human use, demand and scarcity of each plant species. Similarly, eleven indicators of energy invested, complexity, tools and management strategies were used for performing PCA and scores of the first principal component were considered as management intensity index for each plant species. A linear regression analysis was performed to analyze the relation between risk and management intensity indexes. Amounts of variation of management data explained by ecological, cultural and economic information, as well as their risk level were analyzed through canonical correspondence analyses (CCA). Results A total of 122 edible plant species were recorded, nearly 30% of them were introduced domesticated plants, 51 were wild species obtained exclusively by simple gathering and 33 were native species obtained by simple gathering and other management practices, these latter were the ones more deeply studied. People recognized variants in 21 of these latter 33 species, the variants receiving differential use, management, artificial selection and incipient domestication. The lowest values of management intensity corresponded to species under simple gathering and tolerance, mostly annual abundant plants, occasionally consumed by few people. The highest management intensity values were recorded in species with economic importance, mostly perennial with recognized variants whose management requires using tools, and which are protected by collective regulations. The regression analysis indicated significant value R2 = 0.433 (P < 0.001) between risk and management indexes. CCA explained 65.5% of variation of management intensity, mainly by socio-cultural factors (32.6%), whereas ecological data explained 21.3% and the intersection of all factors 11.6%. Variation of management intensity is 67.6% explained by risk variables. Length-span of life cycle, reproductive system type, distribution, number of parts used, number of management and use forms and type of regulations were statistically significant. Conclusion People manage plant resources according to the role these play in households’ subsistence, the quantity available and the quality of their useful products; particularly important is the balance between resources availability and demand. Management responses to risk are also influenced by the ease to propagate or manipulate individual plants and time requiring the construction of manipulation strategies and techniques. PMID:23725379

An evaluation of the nursing practice environment and successful change management using the new generation Magnet Model.

PubMed

Grant, Bettyanne; Colello, Sandra; Riehle, Martha; Dende, Denise

2010-04-01

To discuss the new Magnet Model as it relates to the successful implementation of a practice change. There is growing international interest in the Magnet Recognition Programme. The latest generation of the Magnet Model has been designed not only as a road map for organizations seeking to achieve Magnet recognition but also as a framework for nursing practice and research in the future. The Magnet Model was used to identify success factors related to a practice change and to evaluate the nursing practice environment. Even when proposed changes to practice are evidence based and thoughtfully considered, the nurses' work environment must be supportive and empowering in order to yield successful and sustainable implementation of new practice. Success factors for implementation of a practice change can be illuminated by aligning environmental characteristics to the components of the new Magnet Model. The Magnet Model provides an exceptional framework for building an agile and dynamic work force. Thoughtful consideration of the components and inter-relationships represented in the new model can help to both predict and ensure organizational vitality.

Organizations and social worker wellbeing: the intra-organizational context of practice and its impact on a practitioner's subjective well-being.

PubMed

Shier, Micheal L; Graham, John R

2013-01-01

This study aimed to better understand the varied factors that contribute to social worker subjective well-being (SWB) (the social science concept for happiness). Using qualitative methods of inquiry 19 social workers who reported having low to medium levels of workplace and profession satisfaction were interviewed to assess those factors within their lives that they perceived as impacting their well-being. One thematic category from the analysis was aspects of the intraorganizational context of workplaces that can impact social worker SWB. Respondents identified interpersonal workplace relationships, decision-making processes, management/supervisory dynamics, workload and workplace expectations, access to resources and infrastructure support, and inter-organizational relationships as key intra-organizational factors contributing to their overall wellbeing. In conclusion, these findings have practical application within organizations for structured policies and unstructured practices to improve social worker subjective well-being.

How does the knowledge environment shape procurement practices for orthopaedic medical devices in Mexico?

PubMed

Lingg, Myriam; Wyss, Kaspar; Durán-Arenas, Luis

2016-07-08

In organisational theory there is an assumption that knowledge is used effectively in healthcare systems that perform well. Actors in healthcare systems focus on managing knowledge of clinical processes like, for example, clinical decision-making to improve patient care. We know little about connecting that knowledge to administrative processes like high-risk medical device procurement. We analysed knowledge-related factors that influence procurement and clinical procedures for orthopaedic medical devices in Mexico. We based our qualitative study on 48 semi-structured interviews with various stakeholders in Mexico: orthopaedic specialists, government officials, and social security system managers or administrators. We took a knowledge-management related perspective (i) to analyse factors of managing knowledge of clinical procedures, (ii) to assess the role of this knowledge and in relation to procurement of orthopaedic medical devices, and (iii) to determine how to improve the situation. The results of this study are primarily relevant for Mexico but may also give impulsion to other health systems with highly standardized procurement practices. We found that knowledge of clinical procedures in orthopaedics is generated inconsistently and not always efficiently managed. Its support for procuring orthopaedic medical devices is insufficient. Identified deficiencies: leaders who lack guidance and direction and thus use knowledge poorly; failure to share knowledge; insufficiently defined formal structures and processes for collecting information and making it available to actors of health system; lack of strategies to benefit from synergies created by information and knowledge exchange. Many factors are related directly or indirectly to technological aspects, which are insufficiently developed. The content of this manuscript is novel as it analyses knowledge-related factors that influence procurement of orthopaedic medical devices in Mexico. Based on our results we recommend that the procurement mechanism should integrate knowledge from clinical procedures adequately in their decision-making. Without strong guidance, organisational changes, and support by technological solutions to improve the generation and management of knowledge, procurement processes for orthopaedic high-risk medical devices will remain sub-optimal.

MO-E-18A-01: Imaging: Best Practices In Pediatric Imaging

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

Willis, C; Strauss, K; MacDougall, R

This imaging educational program will focus on solutions to common pediatric imaging challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children's hospitals. Areas of focus will include general radiography, the use of manual and automatic dose management in computed tomography, and enterprise-wide radiation dose management in the pediatric practice. The educational program will begin with a discussion of the complexities of exposure factor control in pediatric projection radiography. Following this introduction will be two lectures addressing the challenges of computed tomography (CT) protocol optimization in the pediatric population. The firstmore » will address manual CT protocol design in order to establish a managed radiation dose for any pediatric exam on any CT scanner. The second CT lecture will focus on the intricacies of automatic dose modulation in pediatric imaging with an emphasis on getting reliable results in algorithmbased technique selection. The fourth and final lecture will address the key elements needed to developing a comprehensive radiation dose management program for the pediatric environment with particular attention paid to new regulations and obligations of practicing medical physicists. Learning Objectives: To understand how general radiographic techniques can be optimized using exposure indices in order to improve pediatric radiography. To learn how to establish diagnostic dose reference levels for pediatric patients as a function of the type of examination, patient size, and individual design characteristics of the CT scanner. To learn how to predict the patient's radiation dose prior to the exam and manually adjust technique factors if necessary to match the patient's dose to the department's established dose reference levels. To learn how to utilize manufacturer-provided automatic dose modulation technology to consistently achieve patient doses within the department's established size-based diagnostic reference range. To understand the key components of an enterprise-wide pediatric dose management program that integrates the expanding responsibilities of medial physicists in the new era of dose monitoring.« less

The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists

PubMed Central

Fisher, Nathan E.; Cooper, David J.; Rosen, Rochelle K.

2017-01-01

Buddhist-derived meditation practices are currently being employed as a popular form of health promotion. While meditation programs draw inspiration from Buddhist textual sources for the benefits of meditation, these sources also acknowledge a wide range of other effects beyond health-related outcomes. The Varieties of Contemplative Experience study investigates meditation-related experiences that are typically underreported, particularly experiences that are described as challenging, difficult, distressing, functionally impairing, and/or requiring additional support. A mixed-methods approach featured qualitative interviews with Western Buddhist meditation practitioners and experts in Theravāda, Zen, and Tibetan traditions. Interview questions probed meditation experiences and influencing factors, including interpretations and management strategies. A follow-up survey provided quantitative assessments of causality, impairment and other demographic and practice-related variables. The content-driven thematic analysis of interviews yielded a taxonomy of 59 meditation-related experiences across 7 domains: cognitive, perceptual, affective, somatic, conative, sense of self, and social. Even in cases where the phenomenology was similar across participants, interpretations of and responses to the experiences differed considerably. The associated valence ranged from very positive to very negative, and the associated level of distress and functional impairment ranged from minimal and transient to severe and enduring. In order to determine what factors may influence the valence, impact, and response to any given experience, the study also identified 26 categories of influencing factors across 4 domains: practitioner-level factors, practice-level factors, relationships, and health behaviors. By identifying a broader range of experiences associated with meditation, along with the factors that contribute to the presence and management of experiences reported as challenging, difficult, distressing or functionally impairing, this study aims to increase our understanding of the effects of contemplative practices and to provide resources for mediators, clinicians, meditation researchers, and meditation teachers. PMID:28542181

Knowledge Management Assessment Trends

DTIC Science & Technology

2011-01-01

Recommendations for strategies and approaches to close the gaps An action plan with practical and operational solutions, along with a pilot and evaluation...access to a continuity book or a formal program to orient them to the organization. The BCKS assessment team has helped organizations close these gaps ...managers, and employees in the organization. The Knowledge Assessment identifies: • Knowledge and performance gaps • The causes or factors

Compensation and exotic livestock disease management: the views of animal keepers and veterinarians in England.

PubMed

Hamilton-Webb, A; Naylor, R; Little, R; Maye, D

2016-11-19

Relatively little is known about the perceived influence of different compensation systems on animal keepers' management of exotic livestock disease. This paper aims to address this research gap by drawing on interviews with 61 animal keepers and 21 veterinarians, as well as a series of nine animal keeper focus groups across five different livestock sectors in England. The perceived influence of current compensation systems on disease control behaviour was explored and alternative compensation systems that respectively reward positive practices and penalise poor practices were presented in the form of scenarios, alongside a third system that considered the option of a cost-sharing levy system between industry and government. The results indicate that animal keepers consider themselves to be influenced by a range of non-financial factors, for example, feelings of responsibility, reputation and animal welfare concerns, in the context of their exotic disease management practices. The majority of animal keepers were unaware of the current compensation systems in place for exotic diseases, and were therefore not consciously influenced by financial recompense. Concerns were raised about linking compensation to disease management behaviour due to auditing difficulties. A cost-sharing levy system would likely raise awareness of exotic disease and compensation among animal keepers, but differentiation of payments based upon individual farm-level risk assessments was called for by participants as a strategy to promote positive disease management practices. British Veterinary Association.

A typology of intellectual property management for public health innovation and access: design considerations for policymakers.

PubMed

Taubman, Antony

2010-01-19

This paper seeks to set the practical discipline of public interest intellectual property (IP) management in public health into its broader policy context. The most immediate and direct impact of IP systems on public welfare results not from international standards nor from national legislation - though these norms are fundamentally important - but rather from the accumulated impact of numerous practical choices whether or not to seek IP protection; where and where not; and how any exclusive rights are deployed, by whom, and to what end. IP management is the essentially practical exercise of limited exclusive rights over protected subject matter, the judicious use of those rights to leverage outcomes that advance an institution's or a firm's objectives. Exclusive rights are used to construct and define knowledge-based relationships, to leverage access to technology and other necessary resources, and to enhance market-based incentives. IP management choices range across a broad spectrum, spanning public domain strategies, open or exclusive licensing, and strong exclusivity. The idea of 'exclusive rights', as a specific legal mechanism, can run counter to expectations of greater openness and accessibility, but actual outcomes will depend very much on how these mechanisms are used in practice. For public interest or public sector institutions concerned with health research and development, particularly the development of new medicines, IP management choices can be just as critical as they are for private firms, although a predominant institutional concentration on advancing direct public interest objectives may lead to significantly different approaches in weighing and exercising practical choices for IP management: even so, a private sector approach should not be conflated with exclusivity as an end in itself, nor need public interest IP management eschew all leverage over IP. This paper offers a tentative framework for a richer typology of those choices, to give a sense of practical options available and the factors that might guide their application, but without advocating any particular approach.

A Typology of Intellectual Property Management for Public Health Innovation and Access: Design Considerations for Policymakers§

PubMed Central

Taubman, Antony

2010-01-01

This paper seeks to set the practical discipline of public interest intellectual property (IP) management in public health into its broader policy context. The most immediate and direct impact of IP systems on public welfare results not from international standards nor from national legislation – though these norms are fundamentally important - but rather from the accumulated impact of numerous practical choices whether or not to seek IP protection; where and where not; and how any exclusive rights are deployed, by whom, and to what end. IP management is the essentially practical exercise of limited exclusive rights over protected subject matter, the judicious use of those rights to leverage outcomes that advance an institution's or a firm's objectives. Exclusive rights are used to construct and define knowledge-based relationships, to leverage access to technology and other necessary resources, and to enhance market-based incentives. IP management choices range across a broad spectrum, spanning public domain strategies, open or exclusive licensing, and strong exclusivity. The idea of ‘exclusive rights’, as a specific legal mechanism, can run counter to expectations of greater openness and accessibility, but actual outcomes will depend very much on how these mechanisms are used in practice. For public interest or public sector institutions concerned with health research and development, particularly the development of new medicines, IP management choices can be just as critical as they are for private firms, although a predominant institutional concentration on advancing direct public interest objectives may lead to significantly different approaches in weighing and exercising practical choices for IP management: even so, a private sector approach should not be conflated with exclusivity as an end in itself, nor need public interest IP management eschew all leverage over IP. This paper offers a tentative framework for a richer typology of those choices, to give a sense of practical options available and the factors that might guide their application, but without advocating any particular approach. PMID:20517487

Organising primary health care for people with asthma: the patient's perspective.

PubMed Central

Paterson, C; Britten, N

2000-01-01

BACKGROUND: The 1993 chronic disease management contract encourages United Kingdom general practices to implement a standardised package of care with an emphasis on regular visits to an asthma clinic. AIM: To explore the views of people with asthma about the organisation of asthma care in general practice. METHOD: Semi-structured interviews with 20 patients registered with one practice with a nurse-run asthma clinic. The sample was selected to provide people with a wide range of ages and disease severity, and included parents of children. RESULTS: The age range of the interviewees was five to 87 years (parents of children were interviewed) and half of the interviewees had attended the asthma clinic at some time. In describing how they managed their asthma, people identified their medical care alongside other important factors, such as avoiding smoking and pollution, and a decision to seek medical help was made in the context of all of life's other priorities. People expressed diverse views about the organisation of care, describing how their needs changed over time and how they balanced up several factors in deciding what was best for them. These factors were encompassed by four themes: the accessibility of care, severity of asthma and dealing with uncertainty, self-knowledge and self-management, and expert knowledge and therapeutic relationships. Interviewees were evenly split between wishing to be seen regularly in the clinic and wishing only to attend when needing help. CONCLUSION: Patients required asthma services that allow individual choice and flexibility, and eight service objectives were identified that would cover most people's needs. PMID:10897514

An efficacy trial of brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial).

PubMed

Laws, Rachel A; Chan, Bibiana C; Williams, Anna M; Davies, Gawaine Powell; Jayasinghe, Upali W; Fanaian, Mahnaz; Harris, Mark F

2010-02-23

Lifestyle risk factors, in particular smoking, nutrition, alcohol consumption and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care (PHC) has been shown to be an effective setting to address lifestyle risk factors at the individual level. However much of the focus of research to date has been in general practice. Relatively little attention has been paid to the role of nurses working in the PHC setting. Community health nurses are well placed to provide lifestyle intervention as they often see clients in their own homes over an extended period of time, providing the opportunity to offer intervention and enhance motivation through repeated contacts. The overall aim of this study is to evaluate the impact of a brief lifestyle intervention delivered by community nurses in routine practice on changes in clients' SNAP risk factors. The trial uses a quasi-experimental design involving four generalist community nursing services in NSW Australia. Services have been randomly allocated to an 'early intervention' group or 'late intervention' (comparison) group. 'Early intervention' sites are provided with training and support for nurses in identifying and offering brief lifestyle intervention for clients during routine consultations. 'Late intervention site' provide usual care and will be offered the study intervention following the final data collection point. A total of 720 generalist community nursing clients will be recruited at the time of referral from participating sites. Data collection consists of 1) telephone surveys with clients at baseline, three months and six months to examine change in SNAP risk factors and readiness to change 2) nurse survey at baseline, six and 12 months to examine changes in nurse confidence, attitudes and practices in the assessment and management of SNAP risk factors 3) semi-structured interviews/focus with nurses, managers and clients in 'early intervention' sites to explore the feasibility, acceptability and sustainability of the intervention. The study will provide evidence about the effectiveness and feasibility of brief lifestyle interventions delivered by generalist community nurses as part of routine practice. This will inform future community nursing practice and PHC policy. ACTRN12609001081202.

Development and Testing of the Nurse Manager EBP Competency Scale.

PubMed

Shuman, Clayton J; Ploutz-Snyder, Robert J; Titler, Marita G

2018-02-01

The purpose of this study was to develop and evaluate the validity and reliability of an instrument to measure nurse manager competencies regarding evidence-based practice (EBP). The Nurse Manager EBP Competency Scale consists of 16 items for respondents to indicate their perceived level of competency on a 0 to 3 Likert-type scale. Content validity was demonstrated through expert panel review and pilot testing. Principal axis factoring and Cronbach's alpha evaluated construct validity and internal consistency reliability, respectively. Eighty-three nurse managers completed the scale. Exploratory factor analysis resulted in a 16-item scale with two subscales, EBP Knowledge ( n = 6 items, α = .90) and EBP Activity ( n = 10 items, α = .94). Cronbach's alpha for the entire scale was .95. The Nurse Manager EBP Competency Scale is a brief measure of nurse manager EBP competency with evidence of validity and reliability. The scale can enhance our understanding in future studies regarding how nurse manager EBP competency affects implementation.

What are the practical implications for treating diabetes in light of recent evidence? Updated recommendations from the Global Partnership for Effective Diabetes Management.

PubMed

Bailey, Clifford J; Blonde, Lawrence; Del Prato, Stefano; Leiter, Lawrence A; Nesto, Richard

2009-10-01

The Global Partnership for Effective Diabetes Management was established in 2004 to provide practical guidance to improving glycaemic control for people with type 2 diabetes. Those recommendations have been updated to take account of recent trials assessing the effects of intensive glucose control. We continue to emphasis the importance of early and sustained glycaemic control, aiming for HbA( 1c) 6.5-7% wherever safe and appropriate. Individualisation of targets and the management process is strongly encouraged to accommodate patient circumstances and to avoid hypoglycaemia. Prompt introduction of combinations of agents is suggested when monotherapy is inadequate.Treatments will preferably address the underlying pathophysiology of type 2 diabetes and integrate within a wider programme of care which also aims to reduce modifiable cardiovascular risk factors and better equip patients in the self-management of their condition.

Relationships of dead wood patterns with biophysical characteristics and ownership according to scale in Coastal Oregon, USA

Treesearch

Rebecca S.H. Kennedy; Thomas A. Spies; Matthew J. Gregory

2008-01-01

Dead wood patterns and dynamics vary with biophysical factors, disturbance history, ownership, and management practices; the relative importance of these factors is poorly understood, especially at landscape to regional scales. This study examined current dead wood amounts in the Coastal Province of Oregon, USA, at multiple spatial scales. Objectives were to: (1)...

Designing School Systems to Encourage Data Use and Instructional Improvement: A Comparison of School Districts and Charter Management Organizations

ERIC Educational Resources Information Center

Farrell, Caitlin C.

2015-01-01

Purpose: As state and federal accountability systems have increased demands for evidence of student achievement, the use of data to inform practice has become more prevalent. More research is needed to understand not only "what" organizational factors shape data-use efforts but also "how" these factors enable or constrain…

Analysis of Workplace Health Education Performed by Occupational Health Managers in Korea.

PubMed

Kim, Yeon-Ha; Jung, Moon-Hee

2016-09-01

To evaluate workplace health education as practiced by occupational health managers based on standardized job tasks and suggest priority tasks and areas to be trained. The study was conducted between November 10, 2013 and April 30, 2014. The tool used in this study was standardized job tasks of workplace health education for occupational health managers which was developed through methodological steps. It was evaluated by 233 worksite occupational health managers. Data were analyzed using SPSS 21.0. Predicting variables of workplace health education performance were the "analysis and planning" factor, type of enterprise, and form of management. Healthcare professionals and occupational health managers who managed the nonmanufacturing industry showed high importance and low performance level in "analysis and planning" factor. "Analysis and planning" skill is priority training area for healthcare professionals and occupational health managers who managed nonmanufacturing industry. It is necessary to develop a training curriculum for occupational health managers that include improving analysis of worksites and plans for a health education program. Copyright © 2016. Published by Elsevier B.V.

Grower networks support adoption of innovations in pollination management: The roles of social learning, technical learning, and personal experience.

PubMed

Garbach, Kelly; Morgan, Geoffrey P

2017-12-15

Management decisions underpinning availability of ecosystem services and the organisms that provide them in agroecosystems, such as pollinators and pollination services, have emerged as a foremost consideration for both conservation and crop production goals. There is growing evidence that innovative management practices can support diverse pollinators and increase crop pollination. However, there is also considerable debate regarding factors that support adoption of these innovative practices. This study investigated pollination management practices and related knowledge systems in a major crop producing region of southwest Michigan in the United States, where 367 growers were surveyed to evaluate adoption of three innovative practices that are at various stages of adoption. The goals of this quantitative, social survey were to investigate grower experience with concerns and benefits associated with each practice, as well as the influence of grower networks, which are comprised of contacts that reflect potential pathways for social and technical learning. The results demonstrated that 17% of growers adopted combinations of bees (e.g. honey bees, Apis mellifera, with other species), representing an innovation in use by early adopters; 49% of growers adopted flowering cover crops, an innovation in use by the early majority 55% of growers retained permanent habitat for pollinators, an innovation in use by the late majority. Not all growers adopted innovative practices. We found that growers' personal experience with potential benefits and concerns related to the management practices had significant positive and negative relationships, respectively, with adoption of all three innovations. The influence of these communication links likely has different levels of importance, depending on the stage of the adoption that a practice is experiencing in the agricultural community. Social learning was positively associated with adopting the use of combinations of bees, highlighting the potentially critical roles of peer-to-peer networks and social learning in supporting early stages of adoption of innovations. Engaging with grower networks and understanding grower experience with benefits and concerns associated with innovative practices is needed to inform outreach, extension, and policy efforts designed to stimulate management innovations in agroecosystems. Copyright © 2017 Elsevier Ltd. All rights reserved.

The determinants of efficiency in the Canadian health care system.

PubMed

Allin, Sara; Grignon, Michel; Wang, Li

2016-01-01

In spite of the vast number of studies measuring economic efficiency in health care, there has been little take-up of this evidence by policy-makers to date. This study provides an illustration of how a system-level study drawing on best practice in empirical measurement of efficiency may be of practical use to health system decision makers and managers. We make use of the rich data available in Canada to undertake a robust two-stage data envelopment analysis to calculate efficiency at the regional (sub-provincial) level. Decisions about what the health system produces (the outcome to measure efficiency against) and what are the resources it has to produce that outcome were based on interviews and consultation with health system decision makers. Overall, we find large inefficiencies in the Canadian health care system, which could improve outcomes (here, measured as a reduction in treatable causes of death) by between 18 and 35% across our analyses. Also, we find that inefficiencies are the result of three main sets of factors that policy makers could pay attention to: management factors, such as hospital re-admissions; public health factors, such as obesity and smoking rates; and environmental factors such as the population's average income.

A qualitative study of work-life balance amongst specialist orthodontists in the United Kingdom.

PubMed

Bateman, Lindsey E; Collins, Joanne M; Cunningham, Susan J

2016-12-01

To identify factors affecting work-life balance amongst male and female orthodontists in the UK. A qualitative interview-based study with a cross-sectional design. Specialist orthodontists working in specialist practice and the hospital service in the UK were selected by purposive sampling. In-depth semi-structured interviews were conducted with 18 orthodontic specialists. Interview transcripts were analyzed using Framework Analysis. Four main themes pertaining to work-life balance in orthodontics were identified: work factors affecting work-life balance, life factors affecting work-life balance, perception and effects of work-life balance and suggestions for managing work-life balance within the profession. There was substantial variation in the work-life balance of the orthodontists interviewed in this study; however the majority reported high levels of career satisfaction despite difficulties maintaining a good work-life balance. Whilst there were some clear distinctions in the factors affecting work-life balance between the hospital environment and specialist practice (including additional professional commitments and teaching/training-related issues), there were also a number of similarities. These included, the lack of flexibility in the working day, managing patient expectations, taking time off work at short notice and the ability to work part-time.

Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes.

PubMed

Stevens, Bonnie J; Yamada, Janet; Estabrooks, Carole A; Stinson, Jennifer; Campbell, Fiona; Scott, Shannon D; Cummings, Greta

2014-01-01

Hospitalized children frequently receive inadequate pain assessment and management despite substantial evidence to support effective pediatric pain practices. The objective of this study was to determine the effect of a multidimensional knowledge translation intervention, Evidence-based Practice for Improving Quality (EPIQ), on procedural pain practices and clinical outcomes for children hospitalized in medical, surgical and critical care units. A prospective cohort study compared 16 interventions using EPIQ and 16 standard care (SC) units in 8 Canadian pediatric hospitals. Chart reviews at baseline (time 1) and intervention completion (time 2) determined the nature and frequency of painful procedures and of pain assessment and pain management practices. Trained pain experts evaluated pain intensity 6 months post-intervention (time 3) during routine, scheduled painful procedures. Generalized estimating equation models compared changes in outcomes between EPIQ and SC units over time. EPIQ units used significantly more validated pain assessment tools (P<0.001) and had a greater proportion of patients who received analgesics (P=0.03) and physical pain management strategies (P=0.02). Mean pain intensity scores were significantly lower in the EPIQ group (P=0.03). Comparisons of moderate (4-6/10) and severe (7-10/10) pain, controlling for child and unit level factors, indicated that the odds of having severe pain were 51% less for children in the EPIQ group (adjusted OR: 0.49, 95% CI: 0.26-0.83; P=0.009). EPIQ was effective in improving practice and clinical outcomes for hospitalized children. Additional exploration of the influence of contextual factors on research use in hospital settings is required to explain the variability in pain processes and clinical outcomes. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.