Science.gov

Sample records for initial work-up management

  1. Heavy menstrual bleeding: work-up and management.

    PubMed

    James, Andra H

    2016-12-02

    Heavy menstrual bleeding (HMB), which is the preferred term for menorrhagia, affects ∼90% of women with an underlying bleeding disorder and ∼70% of women on anticoagulation. HMB can be predicted on the basis of clots of ≥1 inch diameter, low ferritin, and "flooding" (a change of pad or tampon more frequently than hourly). The goal of the work-up is to determine whether there is a uterine/endometrial cause, a disorder of ovulation, or a disorder of coagulation. HMB manifest by flooding and/or prolonged menses, or HMB accompanied by a personal or family history of bleeding is very suggestive of a bleeding disorder and should prompt a referral to a hematologist. The evaluation will include the patient's history, pelvic examination, and/or pelvic imaging, and a laboratory assessment for anemia, ovulatory dysfunction, underlying bleeding disorder, and in the case of the patient on anticoagulation, assessment for over anticoagulation. The goal of treatment is to reduce HMB. Not only will the treatment strategy depend on whether there is ovulatory dysfunction, uterine pathology, or an abnormality of coagulation, the treatment strategy will also depend on the age of the patient and her desire for immediate or long-term fertility. Hemostatic therapy for HMB may serve as an alternative to hormonal or surgical therapy, and may even be life-saving when used to correct an abnormality of coagulation. © 2016 by The American Society of Hematology. All rights reserved.

  2. Classical Hodgkin’s lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up

    PubMed Central

    Brusamolino, Ercole; Bacigalupo, Andrea; Barosi, Giovanni; Biti, Giampaolo; Gobbi, Paolo G.; Levis, Alessandro; Marchetti, Monia; Santoro, Armando; Zinzani, Pier Luigi; Tura, Sante

    2009-01-01

    The Italian Society of Hematology (SIE), the Italian Society of Experimental Haematology (SIES) and the Italian Group for Bone Marrow Transplantation (GITMO) commissioned a project to develop practice guidelines for the initial work-up, therapy and follow-up of classical Hodgkin’s lymphoma. Key questions to the clinical evaluation and treatment of this disease were formulated by an Advisory Committee, discussed and approved by an Expert Panel (EP) composed of senior hematologists and one radiotherapist. After a comprehensive and systematic literature review, the EP recommendations were graded according to their supporting evidence. An explicit approach to consensus methodologies was used for evidence interpretation and for producing recommendations in the absence of a strong evidence. The EP decided that the target domain of the guidelines should include only classical Hodgkin’s lymphoma, as defined by the WHO classification, and exclude lymphocyte predominant histology. Distinct recommendations were produced for initial work-up, first-line therapy of early and advanced stage disease, monitoring procedures and salvage therapy, including hemopoietic stem cell transplant. Separate recommendations were formulated for elderly patients. Pre-treatment volumetric CT scan of the neck, thorax, abdomen, and pelvis is mandatory, while FDG-PET is recommended. As to the therapy of early stage disease, a combined modality approach is still recommended with ABVD followed by involved-field radiotherapy; the number of courses of ABVD will depend on the patient risk category (favorable or unfavorable). Full-term chemotherapy with ABVD is recommended in advanced stage disease; adjuvant radiotherapy in patients without initial bulk who achieved a complete remission is not recommended. In the elderly, chemotherapy regimens more intensive than ABVD are not recommended. Early evaluation of response with FDG-PET scan is suggested. Relapsed or refractory patients should receive high

  3. Diagnostic work-up and therapeutic options in management of pediatric status epilepticus.

    PubMed

    Mastrangelo, Mario; Celato, Andrea

    2012-05-01

    Status epilepticus (SE) is a life-threatening neurologic disorder comprising prolonged and unremitting crisis, and two or more series of seizures without complete intercritical recovery. We reviewed the literature through a Pubmed/Medline research using key words including status epilepticus, antiepileptic drugs and children, in order to revise and compare international/national protocols and to examine pediatric guidelines in SE management. Neurologic impairment and SE etiology seem to be the most independent risks for mortality. A deep semiologic evaluation is essential to addressing diagnostic work-up. Ematochemical parameters, plasma levels of antiepileptic drugs and clinically oriented toxic/metabolic screening should be mandatory for investigating both causes and effects of SE. Electroencephalography is clearly helpful to characterize focal from generalized SE and to distinguish epileptic events from pseudoseizures, and it is deal to find nonconvulsive SE. Neuroimaging techniques could detect epileptogenic lesions (such as cortical malformations, tumors, demyelinating disorders or strokes) but are common in practice to find negative or controversial results. Pharmacologic management can be essentially arranged in three stages: benzodiazepines for early SE (lasting less than 30 minutes), phenytoin/fosphenytoin, phenobarbital, valproate, levetiracetam or lacosamide for established SE (30-90 minutes), and anesthetics for refractory SE (more than 90 minutes). Status epilepticus is the most common neurologic emergency in childhood. A systematic diagnostic work-up and a three steps based therapeutic approach is required at this age.

  4. [Work-up and management of constrictive pericarditis: a critical review].

    PubMed

    Pinamonti, Bruno; Habjan, Sara; De Luca, Antonio; Proclemer, Alberto; Morea, Gaetano; Abate, Elena; Vitrella, Giancarlo; Sinagra, Gianfranco

    2016-03-01

    Constrictive pericarditis is a rare pericardial disorder that causes an impairment of cardiac filling and frequently heart failure. The clinical presentation is non-specific and the differential diagnosis includes myocardial diseases, particularly restrictive cardiomyopathy. Echocardiography has a central role in the initial diagnosis. Some peculiar signs, such as abnormal inspiratory shift of the interventricular septum, increased respiratory variations of transmitral, transtricuspid and hepatic vein flow velocities and the normality of early diastolic relaxation velocity (e') at tissue Doppler, increase the likelihood of the disease. These signs are an expression of increased ventricular interdependence and dissociation between intrathoracic and intracardiac pressures typical of pericardial constriction. For further diagnosis, computed tomography and magnetic resonance are used to identify the presence of pericardial thickening. Invasive cardiac catheterization is indicated in dubious cases and in the assessment of the severity of hemodynamic abnormalities, especially in cases with surgical indication. Pericardiectomy is indicated in symptomatic patients meeting the diagnostic criteria of constrictive pericarditis and is able to improve the prognosis.

  5. Current understanding of coronary in-stent restenosis. Pathophysiology, clinical presentation, diagnostic work-up, and management.

    PubMed

    Schiele, T M

    2005-11-01

    In-stent restenosis is the limiting entity following coronary stent implantation. It is associated with significant morbidity and cost and thus represents a major clinical and economical problem. Worldwide, approximately 250 000 in-stent restenotic lesions per year have to be dealt with. The pathophysiology of instent restenosis is multifactorial and comprises inflammation, smooth muscle cell migration and proliferation and extracellular matrix formation, all mediated by distinct molecular pathways. Instent restenosis has been recognised as very difficult to manage, with a repeat restenosis rate of 50% regardless of the mechanical angioplasty device used. Much more favourable results were reported for the adjunctive irradiation of the in-stent restenotic lesion, with a consistent reduction of the incidence of repeat in-stent restenosis by 50%. Data from the first clinical trials on drug-eluting stents for the treatment of in-stent restenosis have shown very much promise yielding this strategy likely to become the treatment of choice. This review outlines the histological and molecular findings of the pathophysiology, the epidemiology, the predictors and the diagnostic work-up of in-stent restenosis and puts emphasis on the various treatment options for its prevention and therapy.

  6. Limited role of bone marrow aspiration and biopsy in the initial staging work-up of gastric mucosa-associated lymphoid tissue lymphoma in Korea.

    PubMed

    Min, Byung-Hoon; Park, Jun Young; Kim, Eun Ran; Min, Yang Won; Lee, Jun Haeng; Rhee, Poong-Lyul; Rhee, Jong Chul; Kim, Jae J

    2014-11-01

    The aim of this study was to investigate the frequency of disseminated gastric mucosa-associated lymphoid tissue (MALT) lymphoma and the role of bone marrow study in the initial staging work-up. A total of 194 patients with gastric MALT lymphoma was enrolled. The incidence of disseminated disease was evaluated in the initial staging work-up. The demographic data and tumor characteristics were compared according to Helicobacter pylori infection status. Localized disease of Lugano stage I accounted for 97.4% of the enrolled cases. Abdominal computed tomography revealed abdominal lymph node metastasis in five patients (2.6%). Bone marrow (BM) involvement was found in only one patient without H. pylori infection (0.5%). No patient showed positive findings on chest computed tomography or positron emission tomography. H. pylori-negative cases showed a significantly higher frequency of advanced-stage disease than H. pylori-positive cases (10.0% vs 0.6%). In patients achieving complete remission, no extragastric recurrence occurred during follow-up. The incidence of disseminated disease, including BM involvement, was very low in Korean gastric MALT lymphoma patients. It might be beneficial to perform BM aspiration and biopsy as a part of staging work-up only in patients with risk factors for advanced disease such as H. pylori negativity.

  7. Work-up and management of a high-risk patient with primary central nervous system lymphoma

    PubMed Central

    Zeynalova, Pervin A.; Tumyan, Gayane S.; Dolgushin, Mikhail B.; Akhmedov, Mobil I.

    2016-01-01

    Primary central nervous system lymphoma (PCNSL) is a rare disorder that, in 95% of cases, represents diffuse large B-cell lymphoma. As such, making an accurate diagnosis is important. At present, stereotactic-guided biopsy is a recognized method of choice for tissue analysis. However, the diagnostic work-up for high-risk patients is determined by their performance status. Here, we report a case of PCNSL in a high-risk patient, for whom diagnosis was established by cerebrospinal fluid cytology and flow cytometry, which significantly shortened a diagnostic work-up period and allowed for the immediate treatment of the patient. PMID:28154784

  8. Work up of the child with hypertension.

    PubMed

    Sanders, John T; Jones, Deborah P

    2010-01-01

    This paper outlines the work up of children with hypertension. In those with confirmed hypertension, the initial work up should be focused on the evaluation for renal parenchymal and renovascular disease. Secondary evaluation should be focused on history and clinical findings. Consideration of angiography should be made in children with severe hypertension and no evidence of renal parenchymal disease, with hypertension requiring more than a single antihypertensive agent to achieve adequate BP control, or with confirmed BP > 99th percentile for sex/age/height percentile. Screening for endocrinopathies should be directed by compatible history and findings on physical examination and should not be a part of a routine initial work up. In any child diagnosed with hypertension, attempts should be made to evaluate for end-organ disease and co-morbid conditions, particularly left ventricular hypertrophy. Pediatricians should establish a degree of comfort in the evaluation and management of hypertension; however, children with severe and complicated hypertension should be referred to a specialist well versed and practiced in the evaluation and management of this disease.

  9. Clinical Case Seminar: Post-menopausal ovarian androgen excess: challenges in diagnostic work-up and management of ovarian thecosis.

    PubMed

    Mamoojee, Yaasir; Ganguri, Murali; Taylor, Norman; Quinton, Richard

    2017-10-04

    A 72 year old female was referred to the Department of Endocrinology with a 20-year history of hirsutes, mostly affecting her face and torso, the initial onset of which dated shortly after menopause age 52 years. There was no history of subfertility, menstrual irregularity, or hyperandrogenism during reproductive life to suggest prior polycystic ovary syndrome (PCOS), with three live births, two miscarriages and one still-birth. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  10. Histologic work-up of non-palpable breast lesions classified as probably benign at initial mammography and/or ultrasound (BI-RADS category 3).

    PubMed

    Gruber, R; Jaromi, S; Rudas, M; Pfarl, G; Riedl, C C; Flöry, D; Graf, O; Sickles, E A; Helbich, T H

    2013-03-01

    To determine the accuracy of a probably benign assessment of non-palpable breast lesions (BI-RADS category 3) at mammography and/or ultrasound with immediate histological work-up. Stereotactic or ultrasound guided core needle breast biopsy (NBB) was performed to evaluate 288 lesions, which were prospectively assessed as BI-RADS category 3. Imaging findings included 195 masses, 73 calcification cases, 16 focal asymmetries, and four architectural distortion cases. After NBB, patients underwent either open surgical biopsy (OSB) (n=204) or mammographic follow-up (n=84) for at least 24 months. Histological results of NBB were compared with those of OSB. Three of the 288 lesions (1.0%) proved to be malignant at histological work-up, two of them were ductal carcinoma in situ (DCIS) and one of them was an invasive carcinoma. NBB revealed invasive carcinoma in 1/288 (0.35%) and atypical ductal hyperplasia (ADH) in 13/288 (4.5%) lesions. OSB revealed DCIS in 2/204 (1%) and invasive carcinoma in 1/204 (0.5%) lesions. The two DCIS were underestimated as ADH by NBB. The remaining 285 (99%) lesions proved to be benign at OSB or remained stable during follow-up. Confirmed by tissue diagnosis, the low likelihood of malignancy of prospectively assessed probably benign lesions is below the 2% threshold established for BI-RADS category 3. Imaging follow-up is a safe and effective alternative to immediate histological work-up for such lesions. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  11. Incidentalomas: initial management.

    PubMed

    Hitzeman, Nathan; Cotton, Erin

    2014-12-01

    Incidentalomas are increasingly common findings on radiologic studies, causing worry for physicians and patients. Physicians should consider the risk of discovering incidentalomas when contemplating imaging. Patients may assume that incidentalomas are cancer, and may not be aware of the radiation risks associated with repeat imaging. Once incidentalomas are detected, appropriate management is dependent on an informed patient's wishes and the clinical situation. Guidelines are provided for the initial management of eight incidentalomas (pituitary, thyroid, pulmonary, hepatic, pancreatic, adrenal, renal, and ovarian). Patients presenting with pituitary incidentalomas should undergo pituitary-specific magnetic resonance imaging if the lesion is 1 cm or larger, or if it abuts the optic chiasm. Thyroid incidentalomas are ubiquitous, but nodules larger than 1 to 2 cm are of greater concern. Worrisome pulmonary incidentalomas are those larger than 8 mm or those with irregular borders, eccentric calcifications, or low density. However, current guidelines recommend that even pulmonary incidentalomas as small as 4 mm be followed. Solid hepatic incidentalomas 5 mm or larger should be monitored closely, and multiphasic scanning is helpful. Pancreatic cystic neoplasms have malignant potential, and surgery is recommended for pancreatic cysts larger than 3 cm with suspicious features. Adrenal lesions larger than 4 cm are usually biopsied. The Bosniak classification is a well-accepted means of triaging renal incidentalomas. Lesions at category IIF or greater require serial monitoring or surgery. Benign or probably benign ovarian cysts 3 cm or smaller in premenopausal women or 1 cm or smaller in postmenopausal women do not require follow-up. Ovarian cysts with thickened walls or septa, or solid components with blood flow, should be managed closely.

  12. Adrenal incidentalomas: are they being worked up appropriately?

    PubMed Central

    Sahni, Pooja; Trivedi, Apoorva; Omer, Abdulkadir; Trivedi, Nitin

    2016-01-01

    Introduction Adrenal incidentalomas are defined as masses picked up on imaging studies that were done for apparently different reasons. With frequent use of imaging modalities, incidental adrenal masses are commonly encountered in clinical practice. Guidelines are currently available for the diagnosis and management of adrenal incidentalomas, but the appropriateness of initial work-up and subsequent follow-up of incidental adrenal masses in the community hospital setting is unknown. Objective We studied the appropriateness of initial work-up and follow-up of incidental adrenal masses discovered on abdominal computerized tomography (CT). Methods In our retrospective study, we reviewed sequential CT scans of the abdomen performed in the month of January 2010 at a community hospital. Once patients with one or more adrenal masses were identified, outpatient charts for initial biochemical testing and follow-up imaging were obtained either through directly accessing the electronic medical records or through contacting primary care physician's offices. Patient charts were reviewed to assess the data for the next 2 years following the discovery of an adrenal abnormality. Results Twenty adrenal masses were incidentally discovered on 723 abdominal CTs performed within the month of January 2010 resulting in an overall incidence of 2.76%. Of the patients with incidentally discovered adrenal masses, appropriate biochemical and follow-up imaging were only performed in patients referred to an endocrinologist (2 of 20 patients). Thirty percent of patients with incidental masses received a repeat CT scan for non-adrenal reasons, and no change in the mass size was noted. Conclusion Despite published guidelines, the initial work-up and follow-up of patients with an incidentally discovered adrenal mass is unsatisfactory. There is a desperate need for education of providers regarding appropriate work-up of incidental adrenal masses. PMID:27802863

  13. [Dyspepsia: work-up or provisional treatment?].

    PubMed

    Koelz, H R

    1995-05-09

    Dyspepsia is defined as symptoms that are considered by a physician to originate from the upper gastrointestinal tract. The term 'functional dyspepsia' designates dyspepsia after exclusion of organic causes. Dyspepsia is a frequent problem in general practice. Mainly for economical reasons, it is impossible to perform every available diagnostic test in every patient to exclude all possible organic causes. The initial work-up is directed at identifying alarm symptoms and alarm signs from history, physical examination, and simple laboratory tests. The presence of any alarm symptoms or alarm sign requires prompt investigation. If none can be found, empirical drug treatment may be performed according to the leading symptom. Treatment failure or rapid recurrence require additional investigations, in particular by gastroscopy.

  14. Initial management of temporomandibular disorders.

    PubMed

    Syrop, Steven B

    2002-08-01

    The existing dental literature does not support the superiority of any one type of treatment to manage TMD. Few studies meet rigorous scientific standards of the randomized clinical trial. This has led to enormous controversy. The initial management of TMD does not have to be controversial. Noninvasive, reversible modalities can be employed that carry very little risk and a high degree of success (Table 4). The success rate of this approach has been studied and determined to be 75% to 90%. Of course, not every patient will get better with this approach. For those who do not improve more advanced techniques must be used, and referral to specialists in TMD, neurology, and rehabilitation medicine may be required. A few patients will need surgery. Initial treatment of TMD requires relatively simple modalities, such as patient education, adherence to a soft diet, reducing oral habits, self-directed home physical therapy, muscle relaxation, the use of medication, and the proper use of bite plates. The majority of TMD patients will respond successfully to these basic treatments.

  15. Managing Dualities in Planned Change Initiatives

    ERIC Educational Resources Information Center

    Barge, J. Kevin; Lee, Michael; Maddux, Kristy; Nabring, Richard; Townsend, Bryan

    2008-01-01

    Dualities play an important role in creating the conditions for change and managing planned change initiatives. Building on Seo, Putnam, and Bartunek's (2003) work, this study focuses on the dualities associated with managing change processes. A case study of a planned change process called the Circle of Prosperity Initiative, a multi-stakeholder…

  16. Managing Dualities in Planned Change Initiatives

    ERIC Educational Resources Information Center

    Barge, J. Kevin; Lee, Michael; Maddux, Kristy; Nabring, Richard; Townsend, Bryan

    2008-01-01

    Dualities play an important role in creating the conditions for change and managing planned change initiatives. Building on Seo, Putnam, and Bartunek's (2003) work, this study focuses on the dualities associated with managing change processes. A case study of a planned change process called the Circle of Prosperity Initiative, a multi-stakeholder…

  17. Initial Management of Traumatic Wounds.

    PubMed

    Devriendt, Nausikaa; de Rooster, Hilde

    2017-08-04

    When traumatic wounds are quickly and accurately treated, morbidity and costs can be significantly decreased. Several factors, such as time delay between injury and treatment, the degree of contamination, extension and depth of the wound, and the mechanism of injury, influence the treatment and prognosis and stress the importance of a patient-specific approach. Although all traumatic wounds are contaminated, antibiotic therapy is seldom required if correct wound management is installed. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Hanford Tanks Initiative risk management guide

    SciTech Connect

    Schaus, P.S.

    1997-10-29

    This project-specific Risk Management Guide describes the general approach and process being used by the HTI Project to manage risk associated with execution of the HTI mission. It includes the initial identification of risk and the quantification of its likelihood and severity of its consequences. It further addresses the formulation of risk mitigation plans, periodic statusing of the Risk Management List, and risk closure.

  19. Addison disease - diagnosis and initial management.

    PubMed

    O'Connell, Susan; Siafarikas, Aris

    2010-11-01

    Adrenal insufficiency is a rare disease caused by either primary adrenal failure (Addison disease) or by impairment of the hypothalamic-pituitary-adrenal axis. Steroid replacement therapy normalises quality of life, however, adherence can be problematic. This article provides information on adrenal insufficiency focusing on awareness of initial symptoms and on risk scenarios, emergency management and baseline investigations, complete investigations and long term management. Early recognition of adrenal insufficiency is essential to avoid associated morbidity and mortality. Initial diagnosis and decision to treat are based on history and physical examination. Appropriate management includes emergency resuscitation and steroid administration. Initial investigations can include sodium, potassium and blood glucose levels. However, complete investigations can be deferred. Specialist advice should be obtained and long term management includes a Team Care Arrangement. For patients, an emergency plan and emergency identification are essential.

  20. Initial management strategies for follicular lymphoma

    PubMed Central

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

    2013-01-01

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

  1. Work up of Pediatric Urinary Tract Infection

    PubMed Central

    Copp, Hillary L.; Schmidt, Bogdana

    2016-01-01

    Pediatric UTI costs the healthcare system upwards of 180 million dollars annually, and accounts for over 1.5 million clinician visits per year. Accurate and timely diagnosis of these infections is important for determining appropriate treatment and preventing long-term complications such as renal scarring, hypertension, and end-stage renal disease. Outside of the first 12 months, girls are more likely to be diagnosed with a UTI. About half of boys with UTI will be diagnosed within the first 12 months of life. The prevalence and incidence of pediatric UTI varies by age, race/ethnicity, sex and circumcision status. Diagnosis of UTI is made based on history and exam findings and confirmed with appropriately collected urine. If a bag specimen is negative, this can be used to rule out UTI without the need for confirmatory culture; however positive urinalysis tests from bag specimen warrant further investigation with a catheterized specimen or suprapubic aspiration. Urine culture is the gold standard for diagnosing UTI: Greater than 50,000 CFU on a catheterized specimen or suprapubic aspiration indicate presence of a UTI. Greater than 100,000 CFU on a voided specimen is considered a positive culture. There is no consensus on the need and optimal strategy for imaging in the setting of urinary tract infection in the pediatric population. Prompt recognition of UTI and antibiogram-based, empiric treatment or culture-based, targeted treatment should be initiated within 72 of presentation. PMID:26475948

  2. Strategies for initial management of hypertension

    PubMed Central

    Gupta, Rajeev; Guptha, Soneil

    2010-01-01

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

  3. Recent Initiatives in Labor-Management Cooperation.

    ERIC Educational Resources Information Center

    National Center for Productivity and Quality of Working Life, Washington, DC.

    This report draws on a series of conferences held to develop guides for labor-management cooperation at the plant level. These included six recent initiatives conferences held in cooperation with State University Institutes of Industrial Relations and the Federal Mediation and Conciliation Service (FMCS) and a seventh sponsored by the Commission…

  4. Update on Washington initiatives on ecosystem management

    SciTech Connect

    Kostka, D.

    1995-12-01

    A biological {open_quotes}revolution{close_quotes} is in progress. Due to initiatives of the Clinton-Gore administration, biologists across the nation are trying to define and use a new concept called ecosystem management. {open_quotes}Ecosystem management{close_quotes} was born in the frustration of trying to deal with the spotted owl controversy in the Northwest. Biologists could not agree on what should be done. And the biologists and economists rarely got together to try to solve problems. Some astute individuals realized that to achieve a sustainable development, ecosystems would have to be managed on a much larger scale than merely small plots of lands. And people from many different backgrounds and disciplines would need to come together to find solutions. This paper will present the views of a Washington insider who has been a player (although too frequently a minor league player!) in administration initiatives to infuse ecosystem management principles and practices in our national conscience. Today, federal agency staff talk to those in other offices within their own agency. Federal agency staff also work on joint projects across federal agencies. In addition, state government, nonprofits, universities, interested individuals, and tribal governments are becoming involved. This is the biological {open_quotes}revolution{close_quotes} that is in progress. The emphasis is shifting from looking at the life history and problems of single species to a much broader approach of examining many species, including humans. The author will present a report on results of the ecosystem management initiative in the last year and point out some of the hurdles still ahead.

  5. The AGU Data Management Maturity Model Initiative

    NASA Astrophysics Data System (ADS)

    Bates, J. J.

    2015-12-01

    In September 2014, the AGU Board of Directors approved two initiatives to help the Earth and space sciences community address the growing challenges accompanying the increasing size and complexity of data. These initiatives are: 1) Data Science Credentialing: development of a continuing education and professional certification program to help scientists in their careers and to meet growing responsibilities and requirements around data science; and 2) Data Management Maturity (DMM) Model: development and implementation of a data management maturity model to assess process maturity against best practices, and to identify opportunities in organizational data management processes. Each of these has been organized within AGU as an Editorial Board and both Boards have held kick off meetings. The DMM model Editorial Board will recommend strategies for adapting and deploying a DMM model to the Earth and space sciences create guidance documents to assist in its implementation, and provide input on a pilot appraisal process. This presentation will provide an overview of progress to date in the DMM model Editorial Board and plans for work to be done over the upcoming year.

  6. Work-up of the Incidental Adrenal Mass.

    PubMed

    Baltzer, Pascal; Clauser, Paola; Klatte, Tobias; Walz, Jochen

    2016-02-01

    Incidental adrenal masses (or adrenal incidentalomas [AI]) are a common finding during imaging and are present in up to 5% of the computed tomography (CT) scans performed on the general population. The best way to manage these lesions is still under discussion. To evaluate recent literature and available guidelines regarding the work-up of AIs. We used a medical search engine to identify studies published in the past 5 yr regarding AIs. We also evaluated current guidelines and the most relevant papers published before 2010. Unenhanced and contrast-enhanced CT, with laboratory tests to exclude functional lesions, are the most sensitive and specific methods currently available for the characterisation of adrenal masses. Magnetic resonance imaging, positron emission tomography-CT and fine-needle aspiration biopsy can be used as adjunct diagnostic tools in indeterminate lesions but are rarely indicated. In a relatively high number of indeterminate nodules, follow-up or surgery is suggested, although most of these lesions turn out to be benign. Various imaging modalities, with CT being most important, are available to diagnose malignant and functional lesions in AIs. An improved identification of benign lesions is warranted to reduce the number of unnecessary surgeries and follow-up examinations in patients with benign lesions. We performed a review of the literature on and guidelines for the management of incidental adrenal masses. It is possible to detect the presence of lesions that require surgery in the majority of cases. Follow-up is required for lesions that are not treated surgically. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  7. Risk management for the Space Exploration Initiative

    NASA Astrophysics Data System (ADS)

    Buchbinder, Ben

    1993-01-01

    Probabilistic Risk Assessment (PRA) is a quantitative engineering process that provides the analytic structure and decision-making framework for total programmatic risk management. Ideally, it is initiated in the conceptual design phase and used throughout the program life cycle. Although PRA was developed for assessment of safety, reliability, and availability risk, it has far greater application. Throughout the design phase, PRA can guide trade-off studies among system performance, safety, reliability, cost, and schedule. These studies are based on the assessment of the risk of meeting each parameter goal, with full consideration of the uncertainties. Quantitative trade-off studies are essential, but without full identification, propagation, and display of uncertainties, poor decisions may result. PRA also can focus attention on risk drivers in situations where risk is too high. For example, if safety risk is unacceptable, the PRA prioritizes the risk contributors to guide the use of resources for risk mitigation. PRA is used in the Space Exploration Initiative (SEI) Program. To meet the stringent requirements of the SEI mission, within strict budgetary constraints, the PRA structure supports informed and traceable decision-making. This paper briefly describes the SEI PRA process.

  8. Effect of radiologists' diagnostic work-up volume on interpretive performance.

    PubMed

    Buist, Diana S M; Anderson, Melissa L; Smith, Robert A; Carney, Patricia A; Miglioretti, Diana L; Monsees, Barbara S; Sickles, Edward A; Taplin, Stephen H; Geller, Berta M; Yankaskas, Bonnie C; Onega, Tracy L

    2014-11-01

    mammograms. Increases in work-ups for any radiologist yielded significant increases in FPR false-positive rate (P = .011) and CDR cancer detection rate (P = .001) and a nonsignificant increase in sensitivity (P = .15). Radiologists with a lower annual volume of any work-ups had consistently lower FPR false-positive rate , sensitivity, and CDR cancer detection rate at all annual interpretive volumes. These findings support the hypothesis that radiologists may improve their screening performance by performing the diagnostic work-up for their own recalled screening mammograms and directly receiving feedback afforded by means of the outcomes associated with their initial decision to recall. Arranging for radiologists to work up a minimum number of their own recalled cases could improve screening performance but would need systems to facilitate this workflow.

  9. Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

    PubMed Central

    Anderson, Melissa L.; Smith, Robert A.; Carney, Patricia A.; Miglioretti, Diana L.; Monsees, Barbara S.; Sickles, Edward A.; Taplin, Stephen H.; Geller, Berta M.; Yankaskas, Bonnie C.; Onega, Tracy L.

    2014-01-01

    fewer mammograms to 24.6 for more than 50 mammograms. Increases in work-ups for any radiologist yielded significant increases in FPRfalse-positive rate (P = .011) and CDRcancer detection rate (P = .001) and a nonsignificant increase in sensitivity (P = .15). Radiologists with a lower annual volume of any work-ups had consistently lower FPRfalse-positive rate, sensitivity, and CDRcancer detection rate at all annual interpretive volumes. Conclusion These findings support the hypothesis that radiologists may improve their screening performance by performing the diagnostic work-up for their own recalled screening mammograms and directly receiving feedback afforded by means of the outcomes associated with their initial decision to recall. Arranging for radiologists to work up a minimum number of their own recalled cases could improve screening performance but would need systems to facilitate this workflow. © RSNA, 2014 Online supplemental material is available for this article. PMID:24960110

  10. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 3 2011-01-01 2011-01-01 false Initial review by manager. 473.22 Section 473.22 Energy... Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager. (a) Upon expiration of the time for filing information under these regulations, the manager shall— (1...

  11. 28 CFR 549.63 - Initial medical evaluation and management.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Initial medical evaluation and management... MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.63 Initial medical evaluation and management. (a... hunger strike: (1) Measure and record height and weight; (2) Take and record vital signs; (3) Urinalysis...

  12. The economic approach to the stroke work-up.

    PubMed

    Shriver, M E; Prockop, L D

    1993-02-01

    Stroke is the leading cause of morbidity in the United States and the expenditure for stroke aftercare, including lost wages, is astronomical. Reduction of risk factors and use of the most accurate diagnostic technology allows for intervention prior to catastrophic neurologic deficit. The most advantageous combination of diagnostic testing with regard to risk-benefit has been debated, but it is generally agreed that the cost of even the most sophisticated stroke work-up is far less than that of stroke aftercare.

  13. Cracking haematuria in adolescent with negative work up.

    PubMed

    Guo, Perry; Belostotsky, Vladimir

    2013-05-24

    A 16-year-old girl was referred to our nephrology clinic with persistent visible haematuria (2 months), no urinary tract infection, proteinuria ranging from negligible to 1.5 g/l, normal kidney function and otherwise negative work up including immunology screen. After negative ultrasound scans of the kidneys and bladder, normal renal biopsy and normal cystoscopy, a CT angiogram was obtained. It showed no evidence of arteriovenous malformation but revealed compression of left renal vein (nutcracker syndrome).

  14. Continuous Risk Management: A NASA Program Initiative

    NASA Technical Reports Server (NTRS)

    Hammer, Theodore F.; Rosenberg, Linda

    1999-01-01

    NPG 7120.5A, "NASA Program and Project Management Processes and Requirements" enacted in April, 1998, requires that "The program or project manager shall apply risk management principles..." The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to comply with this edict. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This presentation will briefly discuss the six functions for risk management: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions.

  15. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 3 2012-01-01 2012-01-01 false Initial review by manager. 473.22 Section 473.22 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION AUTOMOTIVE PROPULSION RESEARCH AND DEVELOPMENT Review and Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager....

  16. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 3 2013-01-01 2013-01-01 false Initial review by manager. 473.22 Section 473.22 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION AUTOMOTIVE PROPULSION RESEARCH AND DEVELOPMENT Review and Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager....

  17. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Initial review by manager. 473.22 Section 473.22 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION AUTOMOTIVE PROPULSION RESEARCH AND DEVELOPMENT Review and Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager....

  18. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 3 2014-01-01 2014-01-01 false Initial review by manager. 473.22 Section 473.22 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION AUTOMOTIVE PROPULSION RESEARCH AND DEVELOPMENT Review and Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager....

  19. Knowledge Management Initiatives at a Small University

    ERIC Educational Resources Information Center

    Gill, Avninder

    2009-01-01

    Purpose: The purpose of this paper is to address the knowledge management (KM) challenges faced by the administration of a small university which does not have a mature research culture. Design/methodology/approach: The paper follows both technocratic as well as ecological approaches to develop a sustainable KM. Strengths, weaknesses,…

  20. Knowledge Management Initiatives at a Small University

    ERIC Educational Resources Information Center

    Gill, Avninder

    2009-01-01

    Purpose: The purpose of this paper is to address the knowledge management (KM) challenges faced by the administration of a small university which does not have a mature research culture. Design/methodology/approach: The paper follows both technocratic as well as ecological approaches to develop a sustainable KM. Strengths, weaknesses,…

  1. Hanford Tanks Initiative requirements and document management process guide

    SciTech Connect

    Schaus, P.S.

    1998-05-22

    This revision of the guide provides updated references to project management level Program Management and Assessment Configuration Management activities, and provides working level directions for submitting requirements and project documentation related to the Hanford Tanks Initiative (HTI) project. This includes documents and information created by HTI, as well as non-HTI generated materials submitted to the project.

  2. Paradise nearly Gained. Volume 1: Developing the Frontline Management Initiative.

    ERIC Educational Resources Information Center

    Barratt-Pugh, Llandis; Soutar, Geoffrey N.

    The Frontline Management Initiative (FMI) provides a framework for competency-based development of frontline managers in Australian enterprises. The FMI's impact on businesses was examined in a national study that included the following activities: focus groups; a national survey of management development and targeted national survey of FMI users;…

  3. Pediatric trauma resuscitation: initial fluid management.

    PubMed

    Schweer, Lynn

    2008-01-01

    Fluid management is a vital component in the resuscitative care of the injured child. The goal of fluid resuscitation is to restore tissue perfusion without compromising the body's natural compensatory mechanism. Recent literature has questioned the timing, type, and amount of fluid administration during the resuscitative phase. When managing a pediatric resuscitation, it is imperative to use a variety of age-appropriate physiologic parameters because reliance on blood pressure alone will lead to delayed recognition of shock. Establishing vascular access, via peripheral intravenous, central venous, or intraosseous catheter, should be a high nursing priority. Hemorrhage control and fluid resuscitation of an injured child remains a top priority of trauma care. Early intravenous access with appropriate fluid administration continues to be a universal treatment for the hypotensive trauma patient. Fluid resuscitation in the early phase of care, whether in the field, emergency department, or operating room, should be targeted toward perfusing critical organs, such as the brain and heart. Once obvious bleeding is controlled, the overall goal for fluid management centers on maintaining oxygen delivery to perfuse vital structures with enough oxygen and energy substrates to maintain cellular function, thus avoiding tissue ischemia. However, specific issues around timing and type of fluid administration, once thought to be straightforward, have triggered increasing investigation of current beliefs.

  4. Variability in state Medicaid medication management initiatives.

    PubMed

    Neyarapally, George A; Smith, Marie A

    Many U.S. states have expanded Medicaid programs, with over 70 million beneficiaries now enrolled. States' interest in improving care quality and lowering costs has spurred experimentation with several medication management (MM) programs. The implementation of MM programs for beneficiaries has been sporadic, and program elements and implementation methods have been heterogeneous. A survey was conducted to: (1) determine covered MM services in state Medicaid programs, (2) report innovative MM program findings, and (3) identify challenges in creating sustainable MM programs. The survey was sent to state Medicaid pharmacy directors in February 2015. The survey data focused on the type and extent of pharmacist-provided MM services, MM provider qualifications, patient eligibility criteria and enrollment strategies, MM delivery settings and referral patterns, MM program evaluations, program costs and sustainability models, key implementation challenges, and future program enhancements. Many Medicaid programs generally followed Medicare Part D Medication Therapy Management requirements. Highly variable findings were due to different Medicaid eligibility criteria, pharmacist integration with health teams, access to electronic medical records (EMRs), and MM delivery methods/settings to optimize drug therapy regimens. Several implementation challenges were identified. Pharmacist integration on care teams and access to EMRs improves MM implementation. MM program evaluation funding and data support must be secured prior to program implementation. The findings and discussion here can assist states with limited or preliminary Medicaid MM experience to progress toward sustainable programs. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Diagnosis and initial management of dysmenorrhea.

    PubMed

    Osayande, Amimi S; Mehulic, Suarna

    2014-03-01

    Dysmenorrhea is one of the most common causes of pelvic pain. It negatively affects patients' quality of life and sometimes results in activity restriction. A history and physical examination, including a pelvic examination in patients who have had vaginal intercourse, may reveal the cause. Primary dysmenorrhea is menstrual pain in the absence of pelvic pathology. Abnormal uterine bleeding, dyspareunia, noncyclic pain, changes in intensity and duration of pain, and abnormal pelvic examination findings suggest underlying pathology (secondary dysmenorrhea) and require further investigation. Transvaginal ultrasonography should be performed if secondary dysmenorrhea is suspected. Endometriosis is the most common cause of secondary dysmenorrhea. Symptoms and signs of adenomyosis include dysmenorrhea, menorrhagia, and a uniformly enlarged uterus. Management options for primary dysmenorrhea include nonsteroidal anti-inflammatory drugs and hormonal contraceptives. Hormonal contraceptives are the first-line treatment for dysmenorrhea caused by endometriosis. Topical heat, exercise, and nutritional supplementation may be beneficial in patients who have dysmenorrhea; however, there is not enough evidence to support the use of yoga, acupuncture, or massage.

  6. [Constrictive pericarditis: etiology, diagnostic work-up, and therapy].

    PubMed

    Föll, Daniela; Geibel-Zehender, Annette; Bode, Christoph

    2010-03-01

    Constrictive pericarditis is characterized by a fibrous thickened pericardial layer which prevents the cardiac chambers from regular filling. Today, this disease is often caused by previous cardiac surgery or mediastinal radiotherapy, whereas tuberculosis as a cause is less important nowadays. Due to the reduced diastolic filling the cardiac output is diminished and the veins are engorged. The patients present with ascites, liver congestion, and dilated jugular veins. A pericardial effusion, the ECG or an echocardiography may give first hints for the diagnosis. The chest X-ray examination might detect pericardial calcifications (see Figure 2). Doppler echocardiography and cardiac catheterization, especially during breathing maneuvers, are diagnostic, as they demonstrate the diastolic filling disturbance ("dip-plateau sign", see Figure 1), the equal increase of left and right ventricular end-diastolic and mean atrial pressures, and the strong dependency of ventricular filling from respiration. Computed tomography or magnetic resonance imaging might reveal the thickened pericardial layer (see Figures 3 and 4). The most important differential diagnosis is restrictive cardiomyopathy, which has similar clinical and hemodynamic findings. A comprehensive diagnostic work-up is necessary, as the constrictive pericarditis may be cured by a timely performed pericardial resection.

  7. Management Control System Support of Initiatives for Disruptive Students

    ERIC Educational Resources Information Center

    Scott, Colin

    2011-01-01

    Purpose: The purpose of the paper is to investigate the management control system (MCS) support of school initiatives to develop the school climate and to re-engage disruptive students. Design/methodology/approach: The paper adopts an approach of critical action research interviews with management and document reviews informed by Habermasian…

  8. 28 CFR 549.63 - Initial medical evaluation and management.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.63 Initial medical evaluation and management. (a... hunger strike: (1) Measure and record height and weight; (2) Take and record vital signs; (3) Urinalysis... weight and vital signs at least once every 24 hours while the inmate is on a hunger strike....

  9. 28 CFR 549.63 - Initial medical evaluation and management.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.63 Initial medical evaluation and management. (a... hunger strike: (1) Measure and record height and weight; (2) Take and record vital signs; (3) Urinalysis... weight and vital signs at least once every 24 hours while the inmate is on a hunger strike....

  10. Attitudes toward Anger Management Scale: Development and Initial Validation

    ERIC Educational Resources Information Center

    Boudreaux, David J.; Dahlen, Eric R.; Madson, Michael B.; Bullock-Yowell, Emily

    2014-01-01

    This article describes the development and preliminary validation of the Attitudes Toward Anger Management Scale (ATAMS), a self-report measure of attitudes toward anger management services. Undergraduate volunteers ("N" = 415) completed an initial version of the instrument. Principal components analysis yielded a two-factor solution.…

  11. [Initiative management of medical instruments and equipments' operation and maintenance].

    PubMed

    Jia, Guo-Lliang; Ge, Yi; Deng, Hou-Bin

    2005-03-01

    We expatiate on an initiative management mode of medical instruments and equipments' operation and maintenace, which is different from the usual passive management. The application of this mode is helpful for keeping them in good condition and increasing the activity ratio, and thus to increase their economic and social benefits.

  12. Attitudes toward Anger Management Scale: Development and Initial Validation

    ERIC Educational Resources Information Center

    Boudreaux, David J.; Dahlen, Eric R.; Madson, Michael B.; Bullock-Yowell, Emily

    2014-01-01

    This article describes the development and preliminary validation of the Attitudes Toward Anger Management Scale (ATAMS), a self-report measure of attitudes toward anger management services. Undergraduate volunteers ("N" = 415) completed an initial version of the instrument. Principal components analysis yielded a two-factor solution.…

  13. Management Control System Support of Initiatives for Disruptive Students

    ERIC Educational Resources Information Center

    Scott, Colin

    2011-01-01

    Purpose: The purpose of the paper is to investigate the management control system (MCS) support of school initiatives to develop the school climate and to re-engage disruptive students. Design/methodology/approach: The paper adopts an approach of critical action research interviews with management and document reviews informed by Habermasian…

  14. Undescended testis: how extensive should the work up be?

    PubMed

    Shera, Altaf Hussain; Baba, Aejaz Ahsan; Gupta, Shyam Kumar; Gupta, Geetanjali; Sherwani, Afak Yusuf

    2010-01-01

    The aim of this study was to highlight various anomalies associated with undescended testis and to determine how much work up is necessary for this condition. The study was conducted in the department of Pediatric Surgery SKIMS Srinagar, Kashmir. All patients between 0-14 years of age who attended out patient department (OPD) from January 2002 to December 2003 with maldescent of testes were included in the study. Detailed relevant history and physical examination findings were recorded in all the cases. Baseline investigations were performed along with ultrasonography of the abdomen. In relevant cases other investigations like intravenous urography, micturating cystourethrography, CT scan and laparoscopy were performed as and when indicated. A total of 250 cases of undescended testis were registered during this period. Maximum number of cases were in the age group of 5-10 years. In 130 (52%) cases the right testis was undescended while 75 (30%) had left sided undescended testis and 45 (18%) had bilateral undescended testis. Maldescended testis comprised 11% of the admissions. The majority of cases were having gestational age of 37 weeks or more. The associated anomalies picked up on investigations included duplication of upper urinary tract (3.2%), hydronephrosis and polycystic kidney (0.8% each), horseshoe kidney, ectopic kidney, crossed renal ectopia (0.4% each) Posterior urethral valves, Prune belly syndrome (0.4%) and spina bifida (0.4%). On detailed clinical examination of genitalia several abnormalities were picked which included hydrocele, hypospadias, hernia, chordee, micropenis and ambiguous genitalia. We recommend ultrasonography to be done in all cases of undescended testis in addition to a thorough history and physical examination. Intravenous pyelography, micturating cystourethrogram, CT scan and other investigations should be performed selectively based on history, physical examination or ultrasound findings.

  15. [Autoantibody-associated autoimmune encephalitis and cerebellitis : Clinical presentation, diagnostic work-up and treatment].

    PubMed

    Lewerenz, J; Jarius, S; Wildemann, B; Wandinger, K-P; Leypoldt, F

    2016-12-01

    There is no other field of neurology where clinically relevant serological biomarkers have witnessed a surge in importance over the past decade resembling that in autoimmune encephalitis and cerebellitis. A multitude of newly discovered neuronal autoantibodies facilitate early diagnosis, estimation of prognosis, and therapeutic decision-making. However, this has led to growing uncertainty with regard to meaningful patient selection, the appropriate extent of testing, and management of seronegative cases. This review summarizes the essential aspects of the clinical presentation, diagnostic work-up, pathophysiology, and treatment of autoimmune encephalitis and cerebellitis.

  16. [Panorama of self-management initiatives in Spain].

    PubMed

    Nuño-Solinis, Roberto; Rodríguez-Pereira, Carolina; Piñera-Elorriaga, Koldo; Zaballa-González, Irune; Bikandi-Irazabal, Javier

    2013-01-01

    To describe the current situation of self-management initiatives in Spain. We performed a descriptive study of self-management support initiatives in Spain from the perspective of the patient as expert. Three databases were searched in October 2010 (Pubmed, Scientific Electronic Library Online [SCIELO] and Indice Médico Español [IME]), using the following Keywords «paciente experto» (expert patient), «paciente activo» (active patient) and «apoyo al autocuidado» (self-management support). Web sites were also consulted, using the same key words. Of the initiatives found, we selected those with the most advanced development and continuity, using the perspective of the expert patient (in which patients have an active role) and with a systematic format and methodology. A questionnaire was designed and was sent to the heads of the selected initiatives in the last quarter of 2010. To update the information, the questionnaire was sent again between August and September, 2012. Subsequently, the web sites were visited to review their contents and presence in social networks. Seven initiatives were identified in the autonomous regions of Murcia, Andalusia, Galicia, Castile-La Mancha, Basque Country, and Catalonia. These initiatives used distinct methodologies, formats and assessment systems. In Spain, there is increasing interest in the development of self-management support programs, although their scope is limited and their impact is mostly unknown, except for patient satisfaction. There is a need for studies on results assessment to identify the impact of these initiatives in our setting, as well as for studies on their implementation to encourage the introduction of patient activation initiatives in routine clinical practice. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

  17. Land Management Panel: Army’s Net Zero Installation Initiative

    DTIC Science & Technology

    2012-05-24

    Assistant Secretary of the Army (Installations, Energy & Environment) DRAFT DECK 1 Land Management Panel Army’s Net Zero Installation...00-00-2012 4. TITLE AND SUBTITLE Land Management Panel Army’s Net Zero Installation Initiative 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM...water in new / renovated federal buildings from solar power • 30% by FY2015 if life cycle cost-effective Fossil fuel use in new / renovated

  18. Work up of incidental adrenal mass: state of the art.

    PubMed

    Bada, Maida; Castellan, Pietro; Tamburro, Fabiola R; Berardinelli, Francesco; Neri, Fabio; Cindolo, Luca; Schips, Luigi

    2016-11-18

    Due to the increasing use of radiological investigations, the detection of incidental adrenal masses has become even more frequent. Therefore, it is crucial to identify the nature of the adrenal mass in order to decide the type of treatment that should be undertaken. Toward this goal, biochemical tests are useful in order to assess catecholamines levels for the presence of a pheochromocytoma or cortisol excess in case of Cushing's syndrome. Furthermore, the dexamethasone suppression test and late-night salivary cortisol may be useful in measuring plasma cortisol, respectively, in the blood and urine. Hyperaldosteronism could be suspected in the presence of arterial hypertension. With regard to imaging modalities, the contrast washout and Hounsfield units estimation might play a role as indicators on computed tomography. In terms of treatment, a surgical approach is most suitable for a hyperfunctioning adrenal mass irrespective of size, and for nonfunctioning masses >4 cm. For indeterminate smaller lesions, with washout >50%, <10 Hounsfield Unit, nonfunctioning, benign-appearing, undergoing a follow-up in regular intervals is more appropriate in order to estimate mass growth. This paper summarizes recent findings on the management of incidental adrenal masses, with a special focus on the use of imaging, surgical management and follow-up modalities in improving patient outcomes.

  19. Initial resuscitation and management of pediatric septic shock

    PubMed Central

    Martin, Kelly; Weiss, Scott L.

    2015-01-01

    The pediatric sepsis syndrome remains a common cause of morbidity, mortality, and health care utilization costs worldwide. The initial resuscitation and management of pediatric sepsis is focused on 1) rapid recognition of abnormal tissue perfusion and restoration of adequate cardiovascular function, 2) eradication of the inciting invasive infection, including prompt administration of empiric broad-spectrum antimicrobial medications, and 3) supportive care of organ system dysfunction. Efforts to improve early and aggressive initial resuscitation and ongoing management strategies have improved outcomes in pediatric severe sepsis and septic shock, though many questions still remain as to the optimal therapeutic strategies for many patients. In this article, we will briefly review the definitions, epidemiology, clinical manifestations, and pathophysiology of sepsis and provide an extensive overview of both current and novel therapeutic strategies used to resuscitate and manage pediatric patients with severe sepsis and septic shock. PMID:25604591

  20. Initial management of trauma. The first 5 minutes.

    PubMed

    Barton, R G; Cerra, F B

    1990-10-01

    Trauma is the leading cause of death in young Americans and is responsible for the loss of more productive years of life than heart disease and cancer combined. Initial management of trauma consists of the establishment or maintenance of a patent airway, ensurance of adequate breathing, and resuscitation of the circulation. All of these are accomplished simultaneously with a cursory survey to identify immediately life-threatening injuries and to prevent permanent disability.

  1. The significance and work-up of minor gastrointestinal bleeding in hospitalized nursing home patients.

    PubMed Central

    Suatengco, R.; Posner, G. L.; Marsh, F.

    1995-01-01

    Twenty-seven consecutive admissions from nursing homes who underwent a gastrointestinal (GI) consult for coffee ground vomitus or occult GI bleeding to evaluate the outcome were reviewed retrospectively to determine whether a GI work-up was or would have been useful. There were 15 deaths, all associated with severe infection or respiratory failure. Endoscopy, barium studies, and a history of nonsteroidal anti-inflammatory drug use or peptic ulcer disease did not affect the management or outcome. No patient developed major GI bleeding. When nursing home patients present with coffee ground vomitus or newly found occult blood in the stool, efforts should be made to identify and vigorously treat any acute underlying infection or respiratory failure. Endoscopy is not helpful in this clinical situation. Both the primary care physician and the GI consultant should be aware of these associations and should focus on the underlying etiology. PMID:7473849

  2. Wyoming Landscape Conservation Initiative data management and integration

    USGS Publications Warehouse

    Latysh, Natalie; Bristol, R. Sky

    2011-01-01

    Six Federal agencies, two State agencies, and two local entities formally support the Wyoming Landscape Conservation Initiative (WLCI) and work together on a landscape scale to manage fragile habitats and wildlife resources amidst growing energy development in southwest Wyoming. The U.S. Geological Survey (USGS) was tasked with implementing targeted research and providing scientific information about southwest Wyoming to inform the development of WLCI habitat enhancement and restoration projects conducted by land management agencies. Many WLCI researchers and decisionmakers representing the Bureau of Land Management, U.S. Fish and Wildlife Service, the State of Wyoming, and others have overwhelmingly expressed the need for a stable, robust infrastructure to promote sharing of data resources produced by multiple entities, including metadata adequately describing the datasets. Descriptive metadata facilitates use of the datasets by users unfamiliar with the data. Agency representatives advocate development of common data handling and distribution practices among WLCI partners to enhance availability of comprehensive and diverse data resources for use in scientific analyses and resource management. The USGS Core Science Informatics (CSI) team is developing and promoting data integration tools and techniques across USGS and partner entity endeavors, including a data management infrastructure to aid WLCI researchers and decisionmakers.

  3. Advances in the Genetic Screening, Work-up, and Treatment of Pancreatic Cancer.

    PubMed

    Frucht, Harold; Stevens, Peter D.; Fogelman, David R.; Verna, Elizabeth C.; Chen, Johnson; Chabot, John A.; Fine, Robert L.

    2004-10-01

    Familiarity with the updated results in genetic screening and work-up presented here is essential to early diagnosis and possible cure. In the metastatic setting, we most frequently begin with the GTX regimen, consisting of Gemcitabine, Taxotere, and Xeloda. The regimen is based on our laboratory data demonstrating a synergistic increase in cell killing of pancreatic cancer cell lines. The combination takes advantage of the selective cell cycle effects of each of the three drugs. In our initial experience, we have seen a response rate of 40% at metastatic sites and 31% at the primary site after nine cycles of GTX. We are now conducting a formal phase II protocol to confirm these results. The median survival of this group of patients (at least 10.4 months) is as long as, or longer than other currently used regimens. In those patients who do not tolerate GTX or progress despite the regimen, we have found that a regimen of the same three drugs, administered on a different schedule, can produce responses. In the neoadjuvant (unresectable) setting, we treat with GTX initially and then follow with radiation; gemcitabine is used as a radiosensitizer during this treatment. An aggressive surgical approach with a team of surgeons were able to resect for cure 12 of the 16 patients who were initially unresectable; one year survival of these 12 was 100%; 2 year survival was 50%. Future work in this disease should focus on targeted agents such as bevacizumab.

  4. Overview of the federal interagency ecosystem management initiative

    SciTech Connect

    Huke, S.

    1995-12-01

    In early 1994, the White House established a Federal Interagency Ecosystem Management Task Force and Working Group to implement the ecosystem management recommendation in the Vice President`s National Performance Review. The Task Force identified seven ecosystems where mature interagency ecosystem-based activities are mature and ongoing and may provide valuable lessons for broader application. Case studies of each of the seven ecosystems were prepared by interagency teams conducting interviews with representatives of federal, state, and local governments and private interests. The seven ecosystems are: the Southern Appalachian Highlands, Anacostia River Watershed, Prince William Sound, Pacific Northwest Forests, Coastal Louisiana, South Florida, and Great Lakes ecosystems. A final synthesis report, scheduled for completion in the Spring of 1995, will provide an overview of constraints, opportunities, and recommendations in five issue areas: legal, budgetary, science, institutional, policy, and public involvement. A second phase of this initiative will entail the development of ecosystem management strategies for three {open_quotes}new initiatives{close_quotes} laboratories.

  5. Southern Appalachian Mountains initiative: Regional partnership for air quality management

    SciTech Connect

    Brewer, P.F.

    1999-07-01

    The Southern Appalachian Mountains Initiative (SAMI) is a voluntary partnership of state and federal agencies, industry, environmental groups, academia, and interested public. SAMI was established to identify and recommend air emissions management strategies to remedy existing and prevent future adverse air quality impacts to natural resources in Southern Appalachia, with particular focus on Class I national park and wilderness areas. SAMI's integrated assessment is focusing simultaneously on ozone, visibility impairment, and acid deposition. Computer models are linking emissions, atmospheric transport, exposures, and environmental and socioeconomic effects. The assessment is considering the impacts of existing and newly enacted federal air regulatory requirements and alternative emissions management strategies that SAMI might recommend for regional, state, or community-based actions.

  6. Trends in initial management of prostate cancer in New Hampshire.

    PubMed

    Ingimarsson, Johann P; Celaya, Maria O; Laviolette, Michael; Rees, Judy R; Hyams, Elias S

    2015-06-01

    Prostate cancer management strategies are evolving with increased understanding of the disease. Specifically, there is emerging evidence that "low-risk" cancer is best treated with observation, while localized "high-risk" cancer requires aggressive curative therapy. In this study, we evaluated trends in management of prostate cancer in New Hampshire to determine adherence to evidence-based practice. From the New Hampshire State Cancer Registry, cases of clinically localized prostate cancer diagnosed in 2004-2011 were identified and classified according to D'Amico criteria. Initial treatment modality was recorded as surgery, radiation therapy, expectant management, or hormone therapy. Temporal trends were assessed by Chi-square for trend. Of 6,203 clinically localized prostate cancers meeting inclusion criteria, 34, 30, and 28% were low-, intermediate-, and high-risk disease, respectively. For low-risk disease, use of expectant management (17-42%, p < 0.001) and surgery (29-39%, p < 0.001) increased, while use of radiation therapy decreased (49-19 %, p < 0.001). For intermediate-risk disease, use of surgery increased (24-50%, p < 0.001), while radiation decreased (58-34%, p < 0.001). Hormonal therapy alone was rarely used for low- and intermediate-risk disease. For high-risk patients, surgery increased (38-47%, p = 0.003) and radiation decreased (41-38%, p = 0.026), while hormonal therapy and expectant management remained stable. There are encouraging trends in the management of clinically localized prostate cancer in New Hampshire, including less aggressive treatment of low-risk cancer and increasing surgical treatment of high-risk disease.

  7. Breckinridge Project, initial effort. Report VI. Project Management Plan

    SciTech Connect

    1982-01-01

    Report VI presents a comprehensive plan for the management of the Breckinridge Project. For the purpose of this report, the project work is divided into five major project phases: Development, Engineering, Procurement, Construction, and Operations. The results of the Development Phase (Initial Effort) of the project are discussed in Section 1.0. This phase of the project was performed under a Cooperative Agreement with US Department of Energy and has produced 43 volumes of documentation. Fifteen volumes contain information of proprietary nature for patented processes and are therefore classified as Limited Access; however, twenty-eight volumes are not classified and are suitable for public dissemination. This Project Management Plan is a volume of the unclassified documentation. The other twenty-seven volumes contain comprehensive data on technical, financial, and environmental aspects of the project. Each of the four remaining project phases is presented starting with the extensive planning that will be performed and continuing through to the execution and completion of each phase. The major roles of the Operator, Ashland Synthetic Fuels, Inc. (ASFI), and the Managing Contractor are defined. Although a contract has not yet been executed with a Managing Contractor, the procedures, controls, organization and management philosophy of Bechtel Petroleum, Inc., are presented in this report as being representative of those used by contractors in the business of performing the engineering, procurement, and construction of projects of this size and complexity. The organizational structures of the Operator and the Managing Contractor are described, with designation of key project team personnel by job description and organization charts. Provisions for cost, schedule, and material control are described.

  8. Portfolio management for off-line revenue initiatives.

    PubMed

    Edgett, S J

    1996-01-01

    During the past decade, the health services sector has experienced a period of rapid change that has resulted in the creation of a large number of new services. This article advocates the use of a service development matrix as a planning aid for senior managers seeking to attract additional revenue through the development of new services. By strategically selecting and developing new services, rather than simple imitating other health care providers, marketers will be better able to focus limited corporate resources on new service initiatives that generate positive returns.

  9. Initial surgical management of ulcerative colitis in the biologic era.

    PubMed

    Geltzeiler, Cristina B; Lu, Kim C; Diggs, Brian S; Deveney, Karen E; Keyashian, Kian; Herzig, Daniel O; Tsikitis, Vassiliki L

    2014-12-01

    The initial minimum operation for ulcerative colitis is a total abdominal colectomy. Healthy patients may undergo proctectomy at the same time; however, for ill patients, proctectomy is delayed. Since the introduction of biologic medications in 2005, ulcerative colitis medical management has changed dramatically. We examined how operative management for ulcerative colitis has changed from the prebiologic to biologic eras. We conducted a retrospective review of data on patients with ulcerative colitis who were included in the Nationwide Inpatient Sample database. This study was conducted at a single university. A total of 1,547,852 patients with ulcerative colitis who were admitted to a US hospital from 1991 to 2011 were included in the study. We examined patients whose initial operation consisted of total abdominal colectomy without proctectomy versus a total proctocolectomy with or without a pouch. We also examined which operation was done at the time of the construction of an ileoanal pouch. Patients who underwent colectomy and pouch construction in the same hospitalization were compared with those who received pouch formation at a subsequent hospitalization. Ulcerative colitis-related admissions rose by 170% during the years examined, and the number of patients who required total abdominal colectomy increased by 44%. Total abdominal colectomy increased by 15%, as opposed to total proctocolectomy (p < 0.001). Pouch construction at a subsequent operation increased by 16% (p = 0.002). Since 2008, total abdominal colectomy has surpassed total proctocolectomy as the most common initial surgical intervention for ulcerative colitis. The Nationwide Inpatient Sample is a retrospective database, and we were limited to examining the variables within it. Total abdominal colectomy is currently the most common initial operation for patients with ulcerative colitis, and an ileoanal pouch is more frequently constructed at a subsequent hospitalization. These trends coincide with

  10. Clinical Course of Vitreomacular Traction Managed Initially by Observation.

    PubMed

    Tzu, Jonathan H; John, Vishak J; Flynn, Harry W; Smiddy, William E; Jackson, Jared R; Isernhagen, Blake A; Carver, Adam; Leonard, Robert; Tabandeh, Homayoun; Boyer, David S; Berrocal, Maria H; Suzuki, Mihoko; Freund, K Bailey; Gross, Jeffrey G

    2015-05-01

    To investigate the clinical course and outcomes of patients with vitreomacular traction (VMT) managed initially by observation. This noncomparative case series included patients with a diagnosis of VMT based on clinical symptoms and findings on spectral-domain optical coherence tomography (SD-OCT) between 2005 and 2014. VMT was documented using a standardized grading system based on the degree of distortion of the foveal contour. Data were collected at five retina clinics using standardized collection forms. Visual acuity, changes in SD-OCT findings, and timing of the release of VMT as seen on SD-OCT were recorded. The study included 230 eyes of 185 patients. Mean age was 72.5 years, and mean follow-up was 32 months. At baseline, VMT grading was grade 1 in 92 eyes (40%), grade 2 in 118 eyes (51.3%), and grade 3 in 20 eyes (8.7%). By last follow-up, spontaneous release of VMT occurred in 73 eyes (31.7%). Spontaneous release of VMT occurred at a mean of 18 months (median: 10.9 months) after initial visit. Mean logMAR best corrected visual acuity (BCVA) was 0.28 (20/55) (range: 20/20 to 20/400) at baseline and 0.25 (20/51) (range: 20/20 to 20/400) at last follow-up. Pars plana vitrectomy was performed in 10 eyes (4.1%) for macular hole (six eyes) and increased VMT (four eyes); BCVA was at least 20/40 in eight of the 10 eyes at last follow-up. Patients with VMT generally had a favorable clinical course when managed initially by observation. Spontaneous release of VMT occurred in approximately one-third of patients. At last follow-up, pars plana vitrectomy was performed in fewer than 5% of patients. Copyright 2015, SLACK Incorporated.

  11. Public school educator's knowledge of initial management of dental trauma.

    PubMed

    Vergotine, Rodney J; Govoni, Robert

    2010-04-01

    To compare the level of knowledge of physical education teachers/athletic coaches (PETs) and academic teachers (ATs) regarding dental trauma management. Surveys were sent to all high schools (17) and all middle schools (23) in the Milwaukee public school system. All PETs and approximately 20 ATs at each school were invited to participate. The survey evaluated knowledge of dental trauma management via two case scenarios. Survey was completed by 140 ATs and 119 PETs. For the urgency of treatment for tooth fractures 81% of ATs and 53% of PETs responded correctly, a significant difference (P < .0001). With regards to avulsions, 56% of ATs and 46% of PETs responded that immediate professional assistance was needed. Only 7% of PETs would replant an avulsed tooth compared with 12% of ATs, a difference that was significant (P = .0062). Milk was chosen as a transportation medium for an avulsed tooth by 25% of ATs and 23% of PETs. Knowledge regarding the initial management of dental trauma was low for both groups. Educational campaigns regarding dental trauma should be targeted at all teachers.

  12. The European initiative for quality management in lung cancer care.

    PubMed

    Blum, Torsten G; Rich, Anna; Baldwin, David; Beckett, Paul; De Ruysscher, Dirk; Faivre-Finn, Corinne; Gaga, Mina; Gamarra, Fernando; Grigoriu, Bogdan; Hansen, Niels C G; Hubbard, Richard; Huber, Rudolf Maria; Jakobsen, Erik; Jovanovic, Dragana; Konsoulova, Assia; Kollmeier, Jens; Massard, Gilbert; McPhelim, John; Meert, Anne-Pascale; Milroy, Robert; Paesmans, Marianne; Peake, Mick; Putora, Paul-Martin; Scherpereel, Arnaud; Schönfeld, Nicolas; Sitter, Helmut; Skaug, Knut; Spiro, Stephen; Strand, Trond-Eirik; Taright, Samya; Thomas, Michael; van Schil, Paul E; Vansteenkiste, Johan F; Wiewrodt, Rainer; Sculier, Jean-Paul

    2014-05-01

    Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe. The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide variation in content and scope, as well as methodological quality but at the same time there was relevant duplication. The feasibility study demonstrated that it is, in principle, feasible to collect prospective demographic and clinical data on patients with lung cancer. Legal obligations vary among countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe.

  13. Maximizing medication therapy management services through a referral initiative.

    PubMed

    Imberg, Audrey J; Swanoski, Michael T; Renier, Colleen M; Sorensen, Todd D

    2012-07-15

    The implementation and effects of an initiative to refer patients to receive medication therapy management (MTM) services after hospital discharge are described. A check box to order an MTM appointment was added to the discharge medication order form printed for hospitalized patients in an integrated health system. Hospitalists were informed about MTM services and encouraged to refer hospitalized patients to the service who were at risk for adverse drug events or medication nonadherence. A retrospective case series review was conducted to evaluate documented MTM encounters, comparing the number of patients seen at the MTM practice for hospital follow-up during the four months before and after the initiative's implementation. Secondary endpoints included revenue generated by MTM encounters and the percentage of patients with documented drug therapy problems due to medication nonadherence. A total of 313 encounters were included in the analysis (142 preimplementation and 171 postimplementation). The percentage of MTM hospital follow-up encounters significantly increased from the preimplementation period to the post-implementation period, from 30.28% (n = 43) to 63.74% (n = 109) (p < 0.001). After the referral initiative was implemented, MTM hospital follow-up encounters were more likely to reveal medication nonadherence, compared with regular office visits (odds ratio, 2.1; 95% confidence interval, 1.01-4.34; p = 0.039). The implementation of an initiative to refer hospitalized patients to an MTM service in an integrated health system increased the percentage of recently discharged patients seen in an MTM practice; patients seen postimplementation were more likely to be nonadherent to their medication regimen.

  14. Management of patients with Graves' orbitopathy: initial assessment, management outside specialised centres and referral pathways.

    PubMed

    Perros, Petros; Dayan, Colin M; Dickinson, A Jane; Ezra, Daniel; Estcourt, Stephanie; Foley, Peter; Hickey, Janis; Lazarus, John H; MacEwen, Caroline J; McLaren, Julie; Rose, Geoffrey E; Uddin, Jimmy; Vaidya, Bijay

    2015-04-01

    Graves' orbitopathy (GO) is uncommon, but responsible for considerable morbidity. A coordinated approach between healthcare professionals is required in order to meet the needs of patients. Early diagnosis can be achieved by a simple clinical assessment. Low-cost effective interventions can be initiated by generalists, which may improve outcomes. Moderate-to-severe GO should be referred to specialised centres. Recommendations for clinical diagnosis, initial management and referral pathways are highlighted.

  15. 77 FR 11798 - Federal Housing Administration (FHA) Risk Management Initiatives: Revised Seller Concessions...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-28

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 24 CFR Chapter II Federal Housing Administration (FHA) Risk Management Initiatives... title (Federal Housing Administration (FHA) Risk Management Initiatives: Revised Seller Concessions). 1...

  16. Initial robotics research for environmental restoration and waste management

    SciTech Connect

    Hamel, W.R.; Mann, R.C. )

    1990-06-01

    This paper describes the initial research and development activities at the Oak Ridge National Laboratory (ORNL) that will support the technology development component of the overall National Robotics Technology Development Program (NRTDP). The NRTDP is a subelement of the US Department of Energy's (DOE's) Environmental Restoration and Waste Management (ER and WM) 5-Year Applied Research, Development, Demonstration, Testing, and Evaluation Plan and of overall efforts at DOE operational sites around the country. ORNL research will focus on fundamental improvement of remote manipulation through enhancements of the human man/machine interface, integration of automated functions, and the incorporation of machine intelligence to increase productivity. Background and goals for these activities are presented in this paper.

  17. Eye on children: acute work-up for pediatric Horner's syndrome. case presentation and review of the literature.

    PubMed

    Cahill, Joseph A; Ross, Joshua

    2015-01-01

    Ptosis and anisocoria in a child may be subtle indications of occult pathology, and making the observation acutely in the emergency department (ED) is important in guiding patient management and treatment. Emergency physicians must evaluate patients to exclude serious or life-threatening emergencies and ensure correct disposition of patients. Horner syndrome in children may be considered congenital or acquired and may be from benign or malignant causes. When an isolated, acquired Horner syndrome is suspected in a pediatric patient, physical examination of the neck and abdomen for masses, as well as spot urine catecholamines, vanillylmandelic acid and homovanillic acid, and varying degrees of imaging are recommended as part of the initial evaluation. These evaluations may be performed in the ED or may require hospitalization, depending on the suspected anatomical localization and diagnostic considerations. A 21-month-old, normally developed girl presented to the University Hospital ED with a 2-h history of right-sided eyelid drooping in the setting of a febrile illness. An eventual diagnosis of Horner syndrome from cervical lymph node compression was made on the basis of history, examination, and imaging findings. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ED evaluations of pediatric patients differ from adults. Evaluation and work-up of Horner syndrome in children can be challenging and can require varying degrees of assessment and evaluation, depending on the diagnostic considerations. This article will address the common pathologies responsible for isolated pediatric Horner syndrome and the recommended ED evaluation. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Estimating the Benefits of the Air Force Purchasing and Supply Chain Management Initiative

    DTIC Science & Technology

    2008-01-01

    sector, known as strategic sourcing.6 The Customer Relationship Management initiative ( CRM ) pro- vides a single customer point of contact for all... Customer Relationship Management initiative. commodity council A term used to describe a cross-functional sourc- ing group charged with formulating a...initiative has four major components, all based on commercial best practices (Gabreski, 2004): commodity councils customer relationship management

  19. 94-A13 Native American Initiative Short Course Management Plan

    SciTech Connect

    Carroll, Herbert B.; Johnson, William I.; Kokesh, Judith H.

    1999-04-27

    A training program conducted in Bartlesville by BDM-Oklahoma technical staff, which included geologists, geophysicists, exploration and drilling specialists, and environmental policy experts. The proposed training schedule offered four courses per year and included those coursed identified by the tribes in the survey. The training program was outlined for members of Native American Tribes whose lands have oil and gas resources. The proposed program contributed to meeting the goals of the U.S. Department of Energy's (DOE) Domestic Oil and Gas Initiative to help Native American tribes become more self-sufficient in developing and managing their resources through training in cost-effective, improved technologies for hydrocarbon production that will meet environmental regulations. The training program outlined was for adult tribal representatives who are responsible for managing tribal mineral holdings or setting policy, or who work in the oil and gas industry. The course content is in response to a survey that was developed by BDM-Oklahoma and sent in the Spring of 1995 to 26 tribal agencies identified through previous contact with DOE. Tribes were asked to indicate course content needs, levels, preferred time of year, and location. Six tribes responded with specific recommendations and needs. These tribes, were the Creek, Pueblo, Cherokee, St. Regis Mohawk, Northern Arapho, and Ute Mountain Ute.

  20. Initial assessment and management of pediatric trauma patients

    PubMed Central

    McFadyen, J Grant; Ramaiah, Ramesh; Bhananker, Sanjay M

    2012-01-01

    Injury is the leading cause of death and disability in children. Each year, almost one in six children in the United States require emergency department (ED) care for the treatment of injuries, and more than 10,000 children die from injuries. Severely injured children need to be transported to a facility that is staffed 24/7 by personnel experienced in the management of children, and that has all the appropriate equipment to diagnose and manage injuries in children. Anatomical, physiological, and emotional differences between adults and children mean that children are not just scaled-down adults. Facilities receiving injured children need to be child and family friendly, in order to minimize the psychological impact of injury on the child and their family/carers. Early recognition and treatment of life-threatening airway obstruction, inadequate breathing, and intra-abdominal and intra-cranial hemorrhage significantly increases survival rate after major trauma. The initial assessment and management of the injured child follows the same ATLS® sequence as adults: primary survey and resuscitation, followed by secondary survey. A well-organized trauma team has a leader who designates roles to team members and facilitates clear, unambiguous communication between team members. The team leader stands where he/she can observe the entire team and monitor the “bigger picture.” Working together as a cohesive team, the members perform the primary survey in just a few minutes. Life-threatening conditions are dealt with as soon as they are identified. Necessary imaging studies are obtained early. Constant reassessment ensures that any deterioration in the child's condition is picked up immediately. The secondary survey identifies other injuries, such as intra-abdominal injuries and long-bone fractures, which can result in significant hemorrhage. The relief of pain is an important part of the treatment of an injured child. PMID:23181205

  1. 13 CFR 107.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... initial Management Expenses. If you plan to obtain Leverage, you must have your Management Expenses approved by SBA at the time of licensing. (See § 107.520 for the definition of Management Expenses.) ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA approval of initial Management...

  2. 13 CFR 108.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... SBA approval of initial Management Expenses. A NMVC Company must have its Management Expenses approved by SBA at the time of designation as a NMVC Company. (See § 108.520 for the definition of Management... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA approval of initial Management...

  3. The NOAH Initiative: Disaster Management Using WebGIS

    NASA Astrophysics Data System (ADS)

    Alconis, J. A.; Eco, R. C.; Lagmay, A.; Aracan, K.; Seveses, L.

    2013-12-01

    The Philippines is beset by many natural hazards that result in disasters costing huge amount of lives and millions worth of economic damages. In response to these perennial problems, the Philippine government, through the Department of Science and Technology, launched the Nationwide Operational Assessment of Hazards (NOAH) in July 2012 to integrate government resources and various initiatives, and develop technologies aimed at mitigating disasters. Among the current activities are high-resolution mapping of critical watersheds using LiDAR to serve as base maps for geohazard models, deployment of automated rain gauges and water level sensors across the country, and use of Doppler radar data and satellite imagery to quantify and downscale weather forecasts among others. A critical component of this initiative is the development of a near real-time web-based spatial data infrastructure which integrates all disaster-related datasets from different agencies from both government and non-government institutions. The program is designed to utilize the latest communication technologies to process, analyze, and disseminate both spatial and non-spatial information with temporal components and their associated metadata to come up with a centralized hazards decision support system for disaster management. It is now being utilized by end-users such as government agencies, local government units, academic institutions, and non-government organizations. More importantly, since its launch, thousands of lives have been saved from severe floods brought by the August 2012 Southwest Monsoon rains and the onslaught of Supertyphoon Bopha in December 2012. Though much work still remains, this is a needed step in the right direction.

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

    PubMed

    Davies, Deborah J

    2015-01-01

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

  5. Management initiatives to waste management decisions and environmental compliance in Oak Ridge, Tennessee

    SciTech Connect

    Jones, C.G.

    1988-01-01

    Martin Marietta Energy Systems, Inc. (MMES) has been the operating contractor for the nuclear production and research facilities at Oak Ridge, Tennessee and Paducah, Kentucky for about four and one-half years. Environmental compliance, regulatory interaction, and public confidence have been very significant issues during this time. This presentation will review the environmental situation in Oak Ridge in 1984 and will discuss management initiatives and experience in the development and implementation of effective environmental and waste management and health and safety programs committed to the protection of the environment, our workers and the public with an overall goal of full compliance with all current and anticipated regulations.

  6. Radiological work-up after mass casualty incidents: are ATLS guidelines applicable?

    PubMed

    Postma, Ingri L E; Beenen, L F M; Bijlsma, T S; Berger, F H; Heetveld, M J; Bloemers, F W; Goslings, J C

    2014-03-01

    In mass casualty incidents (MCI) a large number of patients need to be evaluated and treated fast. Well-designed radiological guidelines can save lives. The purpose of this study was to evaluate the Advanced Trauma Life Support (ATLS) radiological guidelines in the MCI of an aeroplane crash. Medical data of all 126 survivors of an aeroplane crash were analysed. Data included type and body region of the radiological studies performed on the survivors, Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) codes and trauma care level of the hospitals. Ninety patients (72 %) underwent one or more imaging studies: in total 297 radiographs, 148 CTs and 18 ultrasounds were performed. Only 18 % received diagnostic imaging of all four body regions as recommended by ATLS. Compliance with ATLS was highest (73.3 %) in severely injured victims (ISS ≥16); this group underwent two thirds of the (near) total body CTs, all performed in level I trauma centres. Overall compliance with ATLS radiological guidelines was low, although high in severely injured patients. Level I trauma centres frequently used (near) total body CT. Deviation from ATLS guidelines in radiological work-up in less severely injured patients can be safe and did not result in delayed diagnosis of serious injury. • Radiological imaging protocols can assist the management of mass casualty incidents needs. • Advanced Trauma Life Support (ATLS) radiological guidelines have been developed. • But radiological guidelines have not frequently been applied in aeroplane crashes. • Aircraft accidents are of high energy so ATLS guidelines should be applied. • Following mass casualty incidents total body CT seems appropriate within ATLS protocols.

  7. It's Not Really Over: Thurston County, Washington's Vegetation Management Initiative.

    ERIC Educational Resources Information Center

    MacGregor, Jean

    1992-01-01

    Describes the establishment and results of a study committee asked to review existing pesticide policy, vegetation management programs and provide improvement recommendations in Thurston County, Washington. (MCO)

  8. Results of comprehensive diagnostic work-up in ‘idiopathic’ dilated cardiomyopathy

    PubMed Central

    Broch, Kaspar; Andreassen, Arne K; Hopp, Einar; Leren, Trond P; Scott, Helge; Müller, Fredrik; Aakhus, Svend; Gullestad, Lars

    2015-01-01

    Objective Dilated cardiomyopathy (DCM) is characterised by left ventricular dilation and dysfunction not caused by coronary disease, valvular disease or hypertension. Owing to the considerable aetiological and prognostic heterogeneity in DCM, an extensive diagnostic work-up is recommended. We aimed to assess the value of diagnostic testing beyond careful physical examination, blood tests, echocardiography and coronary angiography. Methods From October 2008 to November 2012, we prospectively recruited 102 patients referred to our tertiary care hospital with a diagnosis of ‘idiopathic’ DCM based on patient history, physical examination, routine blood tests, echocardiography and coronary angiography. Extended work-up included cardiac MRI, exercise testing, right-sided catheterisation with biopsies, 24 h ECG and genetic testing. Results In 15 patients (15%), a diagnosis other than ‘idiopathic’ DCM was made based on additional tests. In 10 patients (10%), a possibly disease-causing mutation was detected. 2 patients were found to have non-compaction cardiomyopathy based on MRI findings; 2 patients had systemic inflammatory disease with cardiac involvement; and in 1 patient, cardiac amyloidosis was diagnosed by endomyocardial biopsy. Only in 5 cases did the results of the extended work-up have direct therapeutic consequences. Conclusions In patients with DCM, in whom patient history and routine work-up carry no clues to the aetiology, the diagnostic and therapeutic yield of extensive additional testing is modest. PMID:26468400

  9. Should sperm DNA fragmentation testing be included in the male infertility work-up?

    PubMed

    Lewis, Sheena E M

    2015-08-01

    A response to the editorial 'Are we ready to incorporate sperm DNA fragmentation testing into our male infertility work-up? A plea for more robust studies' by Erma Drobnis and Martin Johnson. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  10. Results of comprehensive diagnostic work-up in 'idiopathic' dilated cardiomyopathy.

    PubMed

    Broch, Kaspar; Andreassen, Arne K; Hopp, Einar; Leren, Trond P; Scott, Helge; Müller, Fredrik; Aakhus, Svend; Gullestad, Lars

    2015-01-01

    Dilated cardiomyopathy (DCM) is characterised by left ventricular dilation and dysfunction not caused by coronary disease, valvular disease or hypertension. Owing to the considerable aetiological and prognostic heterogeneity in DCM, an extensive diagnostic work-up is recommended. We aimed to assess the value of diagnostic testing beyond careful physical examination, blood tests, echocardiography and coronary angiography. From October 2008 to November 2012, we prospectively recruited 102 patients referred to our tertiary care hospital with a diagnosis of 'idiopathic' DCM based on patient history, physical examination, routine blood tests, echocardiography and coronary angiography. Extended work-up included cardiac MRI, exercise testing, right-sided catheterisation with biopsies, 24 h ECG and genetic testing. In 15 patients (15%), a diagnosis other than 'idiopathic' DCM was made based on additional tests. In 10 patients (10%), a possibly disease-causing mutation was detected. 2 patients were found to have non-compaction cardiomyopathy based on MRI findings; 2 patients had systemic inflammatory disease with cardiac involvement; and in 1 patient, cardiac amyloidosis was diagnosed by endomyocardial biopsy. Only in 5 cases did the results of the extended work-up have direct therapeutic consequences. In patients with DCM, in whom patient history and routine work-up carry no clues to the aetiology, the diagnostic and therapeutic yield of extensive additional testing is modest.

  11. The Experience of Initial Management Training in ELT

    ERIC Educational Resources Information Center

    Rimmer, Wayne

    2016-01-01

    Management training in ELT organizations is often inadequate. New managers are in severe need of training, especially for tasks which are non-pedagogical, yet they operate in a milieu where there are few opportunities for support compared with colleagues in mainstream education. The purpose of this case study, a rare evidence-based contribution to…

  12. The Experience of Initial Management Training in ELT

    ERIC Educational Resources Information Center

    Rimmer, Wayne

    2016-01-01

    Management training in ELT organizations is often inadequate. New managers are in severe need of training, especially for tasks which are non-pedagogical, yet they operate in a milieu where there are few opportunities for support compared with colleagues in mainstream education. The purpose of this case study, a rare evidence-based contribution to…

  13. Disease management. A global cost-containing initiative?

    PubMed

    Bloor, K; Maynard, A

    2000-06-01

    Disease management has been marketed by healthcare industry providers as a way of improving resource allocation in healthcare and containing costs. However, to achieve improved efficiency in healthcare requires the guidelines and protocols in the disease management process to be based on sound evidence of effectiveness and cost effectiveness. This has not always been the case. The approach itself has an inadequate evidence base in terms of randomised controlled trials, other rigorous methods of evaluation and the results of economic evaluation. Disease management can be viewed as an attempt by pharmaceutical companies to undertake forward vertical integration into other parts of the healthcare process. This could reduce uncertainty for purchasers and reduce transaction costs, thereby potentially facilitating both healthcare expenditure control and efficiency. However, such cost savings may be outweighed by a concentration of power in disease management (pharmaceutical) companies, and the exploitation of such power to inflate expenditure and misallocate resources. Disease management must be appraised with care.

  14. "Deja Vu All over Again" Initiatives in Academic Management.

    ERIC Educational Resources Information Center

    Bilik, Laurie J.; Blum, Mark C.

    1989-01-01

    While colleges and universities are increasingly retreating to management models already considered counterproductive in industry, corporations are beginning to appreciate the principles of shared authority and are developing collegial-style cultures. (MSE)

  15. Searching for Extended Identity: The Problematised Role of Managing People Development, as Illuminated by the Frontline Management Initiative.

    ERIC Educational Resources Information Center

    Barratt-Pugh, Llandis

    Australia's Frontline Management Initiative (FMI) marks a political move toward workplace learning and provides evidence concerning development of managing identities and management of such workplace learning. The FMI was examined as a technology of identity within the discourse of enterprise and an instrument of textualization of the workplace.…

  16. The Healthy Learner Model for Student Chronic Condition Management--Part II: The Asthma Initiative

    ERIC Educational Resources Information Center

    Erickson, Cecelia DuPlessis; Splett, Patricia L.; Mullett, Sara Stoltzfus; Jensen, Charlotte; Belseth, Stephanie Bisson

    2006-01-01

    The Healthy Learner Asthma Initiative (HLAI) was designed as a comprehensive, school-community initiative to improve asthma management and produce healthy learners. National asthma guidelines were translated into components of asthma management in the school setting that defined performance expectations and lead to greater quality and consistency…

  17. Greening of a Campus through Waste Management Initiatives: Experience from a Higher Education Institution in Thailand

    ERIC Educational Resources Information Center

    Tangwanichagapong, Siwaporn; Nitivattananon, Vilas; Mohanty, Brahmanand; Visvanathan, Chettiyappan

    2017-01-01

    Purpose: This paper aims to describe the effects of 3R (reduce, reuse and recycle) waste management initiatives on a campus community. It ascertains the environmental attitudes and opinions of the residents and investigates their behavioral responses to waste management initiatives. Practical implications for enhancing sustainable waste management…

  18. Status of the Department of Defense Corporate Information Management (CIM) Initiative.

    DTIC Science & Technology

    1992-10-27

    The purpose of this report is to update the status of the Department of Defense (DOD) Corporate Information Management (CIM) initiative through the...into more depth in the areas of business process improvement, financial information management , and data administration. Subsequent CIM status report will highlight other facets of the initiative.

  19. Greening of a Campus through Waste Management Initiatives: Experience from a Higher Education Institution in Thailand

    ERIC Educational Resources Information Center

    Tangwanichagapong, Siwaporn; Nitivattananon, Vilas; Mohanty, Brahmanand; Visvanathan, Chettiyappan

    2017-01-01

    Purpose: This paper aims to describe the effects of 3R (reduce, reuse and recycle) waste management initiatives on a campus community. It ascertains the environmental attitudes and opinions of the residents and investigates their behavioral responses to waste management initiatives. Practical implications for enhancing sustainable waste management…

  20. Management of the Commercial Operations and Support Savings Initiative Program

    DTIC Science & Technology

    2007-11-02

    7,882 $ 8,399 0 $ 16,281 systems management tools FltCast program N00039-97-C- 8002 6,927 8,499 $ 12,570 27,996 Marine Corps signal intelligence...1998 12 0 Stage 1 complete, Stage 2 not planned or budgeted N00039-97-C- 8002 September 4, 1997 June 4, 1998 9 0 Stage 1 complete, Stage 2 not planned or...Science and Technology) on Finding A and Audit Response 50 F. Report Distribution 56 Management Comments Deputy Under Secretary of Defense (Science

  1. Managing the Complexities of a Statewide Reading Initiative.

    ERIC Educational Resources Information Center

    Morgan, Denise N.; Saylor-Crowder, Karin; Stephens, Diane; Donnelly, Amy; DeFord, Diane E.; Hamel, Erin

    2003-01-01

    Working with the National Council of Teachers of English, South Carolina has taken the bold step of focusing professional development in reading on teachers, rather than programs. The state created the South Carolina Reading Initiative (SCRI), a multi-year, research-based professional development model. (MLF)

  2. Initial evaluation and management of the critical burn patient.

    PubMed

    Vivó, C; Galeiras, R; del Caz, Ma D P

    2016-01-01

    The major improvement in burn therapy is likely to focus on the early management of hemodynamic and respiratory failures in combination with an aggressive and early surgical excision and skin grafting for full-thickness burns. Immediate burn care by first care providers is important and can vastly alter outcomes, and it can significantly limit burn progression and depth. The goal of prehospital care should be to cease the burning process as well as prevent future complications and secondary injuries for burn shock. Identifying burn patients appropriate for immediate or subacute transfer is an important step in reducing morbidity and mortality. Delays in transport to Burn Unit should be minimized. The emergency management follows the principles of the Advanced Trauma Life Support Guidelines for assessment and stabilization of airway, breathing, circulation, disability, exposure and environment control. All patients with suspected inhalation injury must be removed from the enclosure as soon as possible, and immediately administer high-flow oxygen. Any patient with stridor, shortness of breath, facial burns, singed nasal hairs, cough, soot in the oral cavity, and history of being in a fire in an enclosed space should be strongly considered for early intubation. Fibroscopy may also be useful if airway damage is suspected and to assess known lung damage. Secondary evaluation following admission to the Burn Unit of a burned patient suffering a severe thermal injury includes continuation of respiratory support and management and treatment of inhalation injury, fluid resuscitation and cardiovascular stabilization, pain control and management of burn wound.

  3. Recent Initiatives to Manage Sediment in US Reservoirs

    NASA Astrophysics Data System (ADS)

    Wegner, D. L.

    2014-12-01

    Sediment has long been either ignored or considered unimportant in the planning and management of federal and state water resources across the United States. All reservoirs trap sediment that had previously been transported downriver to either the ocean or larger bodies of water. The trapping of reservoirs has implications for reservoir longevity and downstream channel geomorphology or ecology. Concerns associated with reservoir sedimentation include the loss of reservoir storage capacity, river channel incisement and degradation downstream from dams, loss of channel capacity downstream, impacts to reservoir and river ecology and water chemistry, and impacts to cultureal resources and municipal water supplies. Climate change with resulting impacts to hydrologic and sediment dynamics could have profound management implications for water agencies. To date, little effort has been made by the federal water management agencies to include reservoir sedimentation in their planning or operational considerations. In recent years sediment management in rivers has become more important, especially in the Missouri, Columbia, Snake, Colorado, Mississippi and Susquehanna river systems.

  4. Live or computerized simulation of clinical encounters: do clinicians work up patient cases differently?

    PubMed

    Nendaz, Mathieu R; Ponte, Belen; Gut, Anne M; Perrier, Arnaud; Louis-Simonet, Martine; Junod, Alain F; Vu, Nu V

    2006-03-01

    Computer simulation of clinical encounters is increasingly used in clinical settings to train patient work-up. The aim of this prospective, controlled study was to compare the characteristics of data collection and diagnostic exploration of physicians working up cases with a standardized patient and in a computerized simulation. Six clinicians of different clinical experience in internal medicine worked up three cases with a standardized patient and through a computer simulation allowing free inquiry. After each encounter, we asked the subjects to justify the information collected and to comment on their working diagnoses. The characteristics of data collected and working diagnoses generated were assessed and compared, according to the simulation method used. In the computer simulation, physicians limited their data collection and focused earlier and more specifically on information and working diagnoses with high levels of relevance. They reached a similar diagnostic accuracy and made decisions of a similar relevance. Computer simulation with a free-inquiry approach reproduces the data collection and the diagnostic exploration observed in a standardized-patient simulation and promotes an early collection of relevant data. Its contribution to extend the competence of learners in clinical settings should be further evaluated.

  5. 75 FR 10865 - Shoreline Management Initiative, Reservoirs in Alabama, Georgia, Kentucky, Mississippi, North...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-09

    ... Environmental Policy Act. In 1999, TVA adopted its current Shoreline Management Policy (SMP) to implement the preferred alternative in the November 1998 environmental impact statement (EIS) for the Shoreline Management... Shoreline Management Initiative, Reservoirs in Alabama, Georgia, Kentucky, Mississippi, North Carolina...

  6. A Cost Management Control Procedure for Initial Training in Surface Ship Acquisition Programs. Final Report.

    ERIC Educational Resources Information Center

    Nutter, Roger V.; And Others

    A study was conducted to develop a cost management control procedure to assist Navy managers in making decisions about initial training development and implementation in surface ship acquisition programs. Objectives were (1) develop and illustrate a cost management control procedure for centralized collection, storage, and control of cost data for…

  7. 7 CFR 4290.360 - Initial review of Applicant's management team's qualifications.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Initial review of Applicant's management team's...'s management team's qualifications. The Secretary will review the information submitted by the Applicant concerning the qualifications of the Applicant's management team to determine in his or her sole...

  8. Defense Infrastructure: Army Has a Process to Manage Litigation Costs for the Military Housing Privatization Initiative

    DTIC Science & Technology

    2014-04-01

    DEFENSE INFRASTRUCTURE Army Has a Process to Manage Litigation Costs for the Military Housing Privatization...DEFENSE INFRASTRUCTURE Army Has a Process to Manage Litigation Costs for the Military Housing Privatization Initiative Why GAO Did This Study In 1996...financing and management to repair, renovate, construct, and operate military family housing . The Army has invested $1.97 billion and the private

  9. Managing TMD patients: initial therapy is the key.

    PubMed

    Greene, C S

    1992-06-01

    It has been the intention of this brief paper to help dentists respond quickly and effectively to patients with TMD. (In lieu of a detailed bibliography, a brief list of articles and books that deal with diagnosis and therapy for TMD follows.) Several present actual guidelines for practice, while others discuss concepts in greater detail. Knowing how to help these troubled patients by using contemporary basic principles of pain management should make every practicing dentist feel a well-deserved sense of fulfillment.

  10. Initial pretreatment module safety management plan. Revision 1

    SciTech Connect

    Smith, D.A.

    1995-01-30

    The IPM Safety Management Plan establishes the approach to be utilized for integrating the responsibilities for safety documentation and review with the design, construction and start-up activities. The plan defines the requirements for the safety analysis documentation and the independent safety review to ensure that the design for the facility operation will not present undue risk to the health and safety of the employees, visitors, or members of the public and provides adequate protection of the environment.

  11. Technology Integration Initiative In Support of Outage Management

    SciTech Connect

    Gregory Weatherby; David Gertman

    2012-07-01

    Plant outage management is a high priority concern for the nuclear industry from cost and safety perspectives. Often, command and control during outages is maintained in the outage control center where many of the underlying technologies supporting outage control are the same as those used in the 1980’s. This research reports on the use of advanced integrating software technologies and hand held mobile devices as a means by which to reduce cycle time, improve accuracy, and enhance transparency among outage team members. This paper reports on the first phase of research supported by the DOE Light Water Reactor Sustainability (LWRS) Program that is performed in close collaboration with industry to examine the introduction of newly available technology allowing for safe and efficient outage performance. It is thought that this research will result in: improved resource management among various plant stakeholder groups, reduced paper work, and enhanced overall situation awareness for the outage control center management team. A description of field data collection methods, including personnel interview data, success factors, end-user evaluation and integration of hand held devices in achieving an integrated design are also evaluated. Finally, the necessity of obtaining operations cooperation support in field studies and technology evaluation is acknowledged.

  12. Quality initiatives: measuring and managing the procedural competency of radiologists.

    PubMed

    Mendiratta-Lala, Mishal; Eisenberg, Ronald L; Steele, Joseph R; Boiselle, Phillip M; Kruskal, Jonathan B

    2011-01-01

    Many regulatory and oversight groups require that the professional performance of radiologists be evaluated on an ongoing basis. Although the diagnostic accuracy of radiologists is routinely measured at most institutions by means of peer review processes, systems for evaluating procedural competency are not widely available. Consequently, technical skills are seldom, if ever, evaluated or managed. The key elements of a system for evaluating procedural competency include the following: (a) clear definition of all elements of a transparent evaluation process; (b) definition of standards for training and credentialing and options for maintenance of competency certification in interventional procedures; (c) collection and analysis of process and outcomes metrics; (d) multisource feedback on procedural, patient care, and safety skills; and (e) an effective, anonymous process for managing radiologists in whom deficiencies are identified. Although no ideal system for evaluating procedural competency currently exists, inclusion of these elements goes a long way toward facilitating the introduction of a simple process for providing appropriate feedback to procedural radiologists, acknowledging excellence, and identifying and managing deficiencies if they occur.

  13. Informing the Design and Evaluation of Superuser Care Management Initiatives

    PubMed Central

    Cantor, Joel C.

    2016-01-01

    Background: Health care spending is concentrated among a small number of high-cost patients, and the popularity of initiatives to improve care and reduce cost among such “superusers” (SUs) is growing. However, SU costs decline naturally over time, even without intervention, a statistical phenomenon known as regression-to-the-mean (RTM). Objectives: We assess the magnitude of RTM in hospital costs for cohorts of hospital SUs identified on the basis of high inpatient (IP) or emergency department (ED) utilization. We further examine how cost and RTM are associated with patient characteristics including behavioral health (BH) problems, multiple chronic conditions, and indicators of vulnerability. Study Design: Using longitudinally linked all-payer hospital billing data, we selected patient cohorts with ≥2 IP stays (IP SUs) or ≥6 ED visits (ED SUs) during a 6-month baseline period, and additional subgroups defined by combinations of IP and ED superuse. Population Studied: A total of 289,060 NJ hospital IP and treat-and-release ED patients over 2009–2011. Results: Hospital costs among IP and ED SUs declined 70% and 38%, respectively, over 8 quarters following the baseline period. The decrease occurs more quickly for IP SUs compared with ED SUs. Presence of BH problems was positively associated with costs among patients overall, but the relationship varied by SU cohort. Conclusions: Understanding patterns of RTM among SU populations is important for designing intervention strategies, as there is greater potential for savings among patients with more persistent costs (less RTM). Further, as many SU initiatives lack resources for rigorous evaluation, quantifying the extent of RTM is vital for interpreting program outcomes. PMID:27219632

  14. Initial Conservative Management of Exomphalos Major with Gentian Violet

    PubMed Central

    Ferdous, KMN

    2012-01-01

    Aim: The purpose of the study was to assess the results of topical use of gentian violet (GV), among the babies with exomphalos major in our institute. Methods: The study was carried out retrospectively in a tertiary care hospital during the period from 2005 to 2010 inclusive. Exomphalos patients were classified as major if diameter was >5 cm and/or had liver in the sac as content. These patients were initially preferentially treated conservatively with topical 1% GV over the sac resultig a ventral hernia to be repaired later. Results: A total of 84 exomphalos patients were admitted during the study period. Among them, 37 neonates (26 males and 11 females) had exomphalos major (EM). Ten of them were prenatally diagnosed. The mean gestational age at delivery was 35 weeks, and mean birth weight was 2.1 Kg. Mean age at presentation was 3.7 days. Thirty (81%) had other associated anomalies, mostly cardiac (66.6%) and pulmonary (46.6%). Ten patients with EM needed early operation because of ruptured sac, and other anomalies. There were 2 pre-operative and 8 postoperative deaths in this subgroup. Twenty seven patients were treated conservatively, among these 4 died of overwhelming sepsis. Remaining 23 patients left the hospital with a ventral hernia planned to be repaired at 1 year of age. Overall mortality in our series was 37.83%. Conclusion: Initial conservative treatment of the sac with GV results in satisfactory outcome for infants with EM who cannot undergo immediate closure. PMID:26023410

  15. Diagnosis and initial management of musculoskeletal coccidioidomycosis in children.

    PubMed

    Ho, Aaron K; Shrader, M Wade; Falk, Miranda N; Segal, Lee S

    2014-01-01

    Coccidioidomycosis is an invasive fungal infection caused by the inhalation of aerosolized spores of Coccidioides spp., which reside in the arid soil of the southwestern United States and northern Mexico. Approximately two thirds of cases are asymptomatic, and the remainder usually present with mild flu-like symptoms. Dissemination of coccidioidomycosis is rare, and can lead to extrapulmonic diseases including meningitis, osteomyelitis, and skin and soft-tissue involvement. The purpose of this study is to report our experience with musculoskeletal coccidioidomycosis in children. This was a retrospective chart review of patients with musculoskeletal infection with Coccidioides spp. at a tertiary care pediatric hospital from 1997 to 2010, identified by a search of ICD-9 codes and hospital diagnoses. Demographic and clinical data were collected from medical records, including the age of the patient, sex, white blood cell count, immunocompetence, length of stay, location of involvement, and initial treatment. In total, 20 children were identified with musculoskeletal coccidioidomycosis. The mean age was 12.3 years (range, 2 to 17 y) at time of diagnosis. Diagnostic criteria included positive imaging tests (plain film+MRI), serologic positive titers, and/or biopsy with positive cultures. The most common presenting symptom was bone pain (100%); only 3 (15%) patients had accompanying signs/symptoms of pulmonary infection. Only 2 (5%) patients had a white blood cell count >15×10/L (5%). Locations of infection included the foot (28%), knee (14%), spine (12%), forearm (10%), lower leg (6%), and other sites (30%). Fluconazole was the most common antifungal agent used (75%). Surgical intervention was required in 10 (50%) patients. This is the first series that has described musculoskeletal coccidioidomycosis exclusively in children. This study suggests that the initial presentation of this disease can be nonspecific and difficult to recognize in children. Clinicians should

  16. INTEGRATED SAFETY MANAGEMENT SYSTEM SAFETY CULTURE IMPROVEMENT INITIATIVE

    SciTech Connect

    MCDONALD JA JR

    2009-01-16

    In 2007, the Department of Energy (DOE) identified safety culture as one of their top Integrated Safety Management System (ISMS) related priorities. A team was formed to address this issue. The team identified a consensus set of safety culture principles, along with implementation practices that could be used by DOE, NNSA, and their contractors. Documented improvement tools were identified and communicated to contractors participating in a year long pilot project. After a year, lessons learned will be collected and a path forward determined. The goal of this effort was to achieve improved safety and mission performance through ISMS continuous improvement. The focus of ISMS improvement was safety culture improvement building on operating experience from similar industries such as the domestic and international commercial nuclear and chemical industry.

  17. Haematuria work-up in general care-A German observational study.

    PubMed

    Eisenhardt, Andreas; Heinemann, Daniel; Rübben, Herbert; Heß, Jochen

    2017-08-01

    Haematuria is a common finding in the population and the diagnostic workflow of this symptom represents a large proportion of "work-load" in the urological outpatient clinic. The intention of this study was to verify if the intensive diagnostic procedures of haematuria patients is justified by detection of a significant proportion of genito-urinary tract cancers. In a retrospective design 1049 consecutive patients, who presented themselves with macro- or microhaematuria in the outpatient clinic PURR in the time from 2011 to 2012, were included in the study and the diagnostic procedures including ultrasound, intravenous urography, computed tomography of the abdomen and urethrocystoscopy as well as therapeutic consequences with its results were analysed. The study group comprised 570 women (54.3%) and 479 men (45.7%) with a median age of 58 years and macrohaematuria occurred in 89 patients. Diagnostics revealed seven patients with renal cell cancer, six patients with urothelial cell cancer of the renal pelvis, four patients with urothelial cell cancer of the ureter, 65 patients with urothelial cell cancer of the lower urinary tract and 17 patients with prostate cancer. Age, male gender and macrohaematuria were associated with a higher risk of cancer. The high incidence of urinary tract cancer in the data presented here support the rationale for diagnostic work-up of patients with micro- or macrohaematuria. Prospective randomised trials are necessary to identify index patients for second work-up after a primarily negative investigation as well as the role of molecular markers, which possibly enable to omit invasive work-up. © 2017 John Wiley & Sons Ltd.

  18. Implementing a Case Management Initiative in High-Need Schools

    PubMed Central

    Gifford, Elizabeth J.

    2013-01-01

    States continue to experiment with ways of improving health and human service use by people with complex needs. Such efforts have often sought to increase individual and family control over services as well as to enhance coordination among providers. Paths to achieving these goals are not well understood. This study draws on two previously distinct conceptual frameworks to examine how 71 public schools implemented a team approach to increasing family and agency engagement for children at risk. Results from longitudinal data fit the core components expected to affect implementation and also indicated sustainability, but in ways distinctive to the initiative's public school settings. Accountability to the state appeared to be a major catalyst, yet in some respects also constrained local agencies from participating as intended. School inertia may have both undermined the program through some evaluation practices and gaps in administrative support, and supported integration into organizational routines and successful experimentation over time in increasing caregiver involvement. Family hesitation about sharing information with multiple agencies may also help explain why the goal of seamless coordination remains elusive. PMID:23976809

  19. Vascular injury associated with extremity trauma: initial diagnosis and management.

    PubMed

    Halvorson, Jason J; Anz, Adam; Langfitt, Maxwell; Deonanan, Joel K; Scott, Aaron; Teasdall, Robert D; Carroll, E A

    2011-08-01

    Vascular injury associated with extremity trauma occurs in <1% of patients with long bone fracture, although vascular injury may be seen in up to 16% of patients with knee dislocation. In the absence of obvious signs of vascular compromise, limb-threatening injuries are easily missed, with potentially devastating consequences. A thorough vascular assessment is essential; an arterial pressure index <0.90 is indicative of potential vascular compromise. Advances in CT and duplex ultrasonography are sensitive and specific in screening for vascular injury. Communication between the orthopaedic surgeon and the vascular or general trauma surgeon is essential in determining whether to address the vascular lesion or the orthopaedic injury first. Quality evidence regarding the optimal fixation method is scarce. Open vascular repair, such as direct repair with or without arteriorrhaphy, interposition replacement, and bypass graft with an autologous vein or polytetrafluoroethylene, remains the standard of care in managing vascular injury associated with extremity trauma. Although surgical technique affects outcome, results are primarily dependent on early detection of vascular injury followed by immediate treatment.

  20. Laparoscopic managment of common bile duct stones: our initial experience.

    PubMed

    Aroori, S; Bell, J C

    2002-05-01

    The management of choledocholithiasis has changed radically since the introduction of laparoscopic cholecystectomy. However, perceived technical difficulties have deterred many surgeons from treating common bile duct stones laparoscopically at the time of cholecystectomy. This has lead to reliance on endoscopic retrograde cholangiopancreatography followed by endoscopic sphincterotomy to deal with common bile duct stones. We retrospectively reviewed the charts of patients who had laparoscopic common bile duct exploration at Downe Hospital between December 1999 and August 2001. Among 149 laparoscopic cholecystectomies done by our group in this period, 10 patients (6.7%) underwent laparoscopic CBD exploration, three by the transcystic technique and seven by choledochotomy. Three patients (2%) had unsuspected stones found on routine per- operative cholangiogram. The mean operative time was 2.34hrs (range 1.50-3.30hrs). The mean hospital post- operative stay was 3 days (range 1-6 days). Post-operative morbidity was zero. Stone clearance was achieved in all cases. We conclude, laparoscopic exploration of the common bile duct is relatively safe and straightforward method. The key skill required is the ability to perform laparoscopic suturing with confidence.

  1. Laparoscopic managment of common bile duct stones: our initial experience.

    PubMed Central

    Aroori, S.; Bell, J. C.

    2002-01-01

    The management of choledocholithiasis has changed radically since the introduction of laparoscopic cholecystectomy. However, perceived technical difficulties have deterred many surgeons from treating common bile duct stones laparoscopically at the time of cholecystectomy. This has lead to reliance on endoscopic retrograde cholangiopancreatography followed by endoscopic sphincterotomy to deal with common bile duct stones. We retrospectively reviewed the charts of patients who had laparoscopic common bile duct exploration at Downe Hospital between December 1999 and August 2001. Among 149 laparoscopic cholecystectomies done by our group in this period, 10 patients (6.7%) underwent laparoscopic CBD exploration, three by the transcystic technique and seven by choledochotomy. Three patients (2%) had unsuspected stones found on routine per- operative cholangiogram. The mean operative time was 2.34hrs (range 1.50-3.30hrs). The mean hospital post- operative stay was 3 days (range 1-6 days). Post-operative morbidity was zero. Stone clearance was achieved in all cases. We conclude, laparoscopic exploration of the common bile duct is relatively safe and straightforward method. The key skill required is the ability to perform laparoscopic suturing with confidence. PMID:12137159

  2. How effective leaders achieve success in critical change initiatives, Part 2: why change leadership must transcend project management for complex initiatives to be successful.

    PubMed

    King, Sharon; Peterson, Larry

    2007-01-01

    This article is the second in a series outlining how effective leaders achieve success in critical change initiatives. This article focuses on why change leadership must transcend project management for complex initiatives to be successful.

  3. The role local initiatives in community based disaster risk management in Kemijen, Semarang City

    NASA Astrophysics Data System (ADS)

    Fauzie, W. Z.; Sariffudin, S.

    2017-06-01

    Community-based disaster risk reduction is one of the homegrown initiatives efforts and community empowerment oriented in disaster management. This approach is very important because no one can understand the conditions in a region better than the local communities. Therefore, the implementation of CBDRM always emphasize local initiatives in decision making. The existence of local initiative is necessary specially to anticipate the impact of climate change which is increasingly affecting towns in coastal areas, including settlements in Semarang. Kemijen Urban Village is one of the informal settlements in Semarang, which has the highest intensity of flood that is 12 times during 5 years (2011-2015). The research question is how the level of local initiatives in flood disaster management in Kemijen, Semarang? This study aims to assess the level of local initiatives in Kemijen as the community adaptive capacity of flood prevention in pre-disaster, emergency response, and post-disaster. Local initiatives assessed on water supply, sanitation, food, shelter, health, drainage maintenance and waste management. This study shows the level of local initiatives in pre-disaster and post-disaster is almost same and bigger than the response phase. Scoring results showed that pre-disaster is 35.002, 27.9577 for emergency response, and post-disaster is 34.9862 with each category that is independent, empowered, and independent. This study also shows that local initiatives in Kemijen largely formed by individual initiative and only a few were formed by a collective initiative.

  4. The Pacific Northwest Research Station biodiversity initiative: scooping out the challenges in managing for biodiversity.

    Treesearch

    Rachel White; Randy. Molina

    2006-01-01

    The USDA Forest Service Pacific Northwest Research Station's Biodiversity Initiative seeks to determine the types of science tools needed by natural resource professionals to meet diverse and complex biodiversity goals. During the scoping phase of this Initiative, we asked a broad cross-section of people whose work involves managing for biodiversity, from state...

  5. The Pacific Northwest Research Station biodiversity initiative: collaborating for biodiversity management.

    Treesearch

    Peter Nelson; Rachel White; Randy. Molina

    2006-01-01

    The Pacific Northwest Research Station launched a biodiversity initiative to assist natural resource professionals in integrating complex biodiversity concepts into natural resource management processes. We canvassed clients from various affiliations to determine the main challenges they face in biodiversity management, to define their information needs, and to...

  6. Paradise nearly Gained. Volume 2: Case Studies of Impact and Diversity for Frontline Management Initiative Practice.

    ERIC Educational Resources Information Center

    Barratt-Pugh, Llandis; Soutar, Geoffrey N.

    This document presents the case studies from a multi-phase study of the impact of Australia's Frontline Management Initiative (FMI), which provides a framework for competency-based development of frontline managers in Australian enterprises. Nineteen organizational case studies and one individual case study of the FMI's impacts are included. The…

  7. Northern Gulf of Mexico (NGOM) Regional Sediment Management Demonstration Program Initiatives

    DTIC Science & Technology

    2005-09-01

    Gulf of Mexico (NGOM) Regional Sediment Management (RSM) Demonstration Program (DP), which was led by the US Army Corps of Engineers Mobile District. Mobile s demonstration identified and prioritized projects and associated issues that could quickly realize the benefits resulting from a regional management approach. The experience gained from these initiatives has been extended and applied to other Mobile District projects throughout the

  8. Paradise nearly Gained. Volume 2: Case Studies of Impact and Diversity for Frontline Management Initiative Practice.

    ERIC Educational Resources Information Center

    Barratt-Pugh, Llandis; Soutar, Geoffrey N.

    This document presents the case studies from a multi-phase study of the impact of Australia's Frontline Management Initiative (FMI), which provides a framework for competency-based development of frontline managers in Australian enterprises. Nineteen organizational case studies and one individual case study of the FMI's impacts are included. The…

  9. The Appropriate Use of Neuroimaging in the Diagnostic Work-Up of Dementia

    PubMed Central

    2014-01-01

    Background Diagnosis of dementia is challenging and requires both ruling out potentially treatable underlying causes and ruling in a diagnosis of dementia subtype to manage patients and suitably plan for the future. Objectives This analysis sought to determine the appropriate use of neuroimaging during the diagnostic work-up of dementia, including indications for neuroimaging and comparative accuracy of alternative technologies. Data Sources A literature search was performed using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published between 2000 and 2013. Review Methods Data on diagnostic accuracy and impact on clinical decision making were abstracted from included studies. Quality of evidence was assessed using GRADE. Results The search yielded 5,374 citations and 15 studies were included. Approximately 10% of dementia cases are potentially treatable, though less than 1% reverse partially or fully. Neither prediction rules nor clinical indications reliably select the subset of patients who will likely benefit from neuroimaging. Clinical utility is highest in ambiguous cases or where dementia may be mixed, and lowest for clinically diagnosed Alzheimer disease or clinically excluded vascular dementia. There is a lack of evidence that MRI is superior to CT in detecting a vascular component to dementia. Accuracy of structural imaging is moderate to high for discriminating different types of dementia. Limitations There was significant heterogeneity in estimates of diagnostic accuracy, which often prohibited a statistical summary of findings. The quality of data reported by studies prohibited calculation of likelihood ratios in the present analysis. No studies from primary care were found; thus, generalizability beyond tertiary care settings may be limited. Conclusions A diagnosis of reversible dementia is rare. Imaging has the most

  10. Status of the Department of Defense Corporate Information Management (CIM) Initiative.

    DTIC Science & Technology

    Information Management (CIM) Initiative are updated in detail. Implementation goals, strategies and structures put into place to pursue these goals are described as are current progress and the timetable for foreseeable events. A synopsis of the tracking of the $1 billion allocated to CIM in the FY 1991 Defense Appropriations Act is included. Corporate Information Management (CIM), CIM (collection), Business Process Redesign, Functional Economic Analysis, CIM (Corporate Information Management

  11. How to Tackle Tremor – Systematic Review of the Literature and Diagnostic Work-Up

    PubMed Central

    Buijink, A. W. G.; Contarino, M. F.; Koelman, J. H. T. M.; Speelman, J. D.; van Rootselaar, A. F.

    2012-01-01

    Background: Tremor is the most prevalent movement disorder in clinical practice. It is defined as involuntary, rhythmic, oscillatory movements. The diagnostic process of patients with tremor can be laborious and challenging, and a clear, systematic overview of available diagnostic techniques is lacking. Tremor can be a symptom of many diseases, but can also represent a distinct disease entity. Objective: The objective of this review is to give a clear, systematic and step-wise overview of the diagnostic work-up of a patient with tremor. The clinical relevance and value of available laboratory tests in patients with tremor will be explored. Methods: We systematically searched through EMBASE. The retrieved articles were supplemented by articles containing relevant data or provided important background information. Studies that were included investigated the value and/or usability of diagnostic tests for tremor. Results: In most patients, history and clinical examination by an experienced movement disorders neurologist are sufficient to establish a correct diagnosis, and further ancillary examinations will not be needed. Ancillary investigation should always be guided by tremor type(s) present and other associated signs and symptoms. The main ancillary examination techniques currently are electromyography and SPECT imaging. Unfortunately, many techniques have not been studied in large prospective, diagnostic studies to be able to determine important variables like sensitivity and specificity. Conclusion: When encountering a patient with tremor, history, and careful clinical examination should guide the diagnostic process. Adherence to the diagnostic work-up provided in this review will help the diagnostic process of these patients. PMID:23109928

  12. The disparity of frontline clinical staff and managers' perceptions of a quality and patient safety initiative.

    PubMed

    Parand, Anam; Burnett, Susan; Benn, Jonathan; Pinto, Anna; Iskander, Sandra; Vincent, Charles

    2011-12-01

    Arguably, a shared perspective between managers and their clinical staff on an improvement initiative would allow for most effective implementation and increase programme success. However, it has been reported that research has failed to differentiate between managers and line employees on quality management implementation and examine their differences in perceptions of quality and safety initiatives. The aim of this study was to compare clinical frontline staff and senior managers' perceptions on the importance of an organization-wide quality and safety collaborative: the Safer Patients Initiative (SPI). A quantitative study obtained 635 surveys at 20 trusts participating in SPI. Participants included the teams and frontline staff involved within the programme at each organization. Independent T-tests were carried out between frontline staff and senior managers' perceptions of SPI programme elements, success factors and impact & sustainability. Statistically significant differences were found between the perceptions of frontline staff and senior managers on a wide number of issues, including the frontline perceiving a significantly larger improvement on the timeliness of care delivery (t = 2.943, P = 0.004), while managers perceived larger improvement on the culture within the organization for safe, effective and reliable care (t = -2.454, P = 0.014). This study has identified statistically significant disparities in perceptions of an organization-wide improvement initiative between frontline staff and senior managers. This holds valuable implications for the importance of getting both frontline and management perspectives when designing such interventions, in monitoring their performance, and in evaluating their impact. © 2010 Blackwell Publishing Ltd.

  13. The healthy learner model for student chronic condition management--part II: the asthma initiative.

    PubMed

    Erickson, Cecelia DuPlessis; Splett, Patricia L; Mullett, Sara Stoltzfus; Jensen, Charlotte; Belseth, Stephanie Bisson

    2006-12-01

    The Healthy Learner Asthma Initiative (HLAI) was designed as a comprehensive, school-community initiative to improve asthma management and produce healthy learners. National asthma guidelines were translated into components of asthma management in the school setting that defined performance expectations and lead to greater quality and consistency of asthma care. The HLAI incorporated evidence-based practice and introduced the role of the asthma resource nurse. Leadership, capacity building, and strong partnerships among school nurses, students, families, and health care providers were essential to the implementation and sustainability of the HLAI. Professional school nursing and evaluation were defined as key requisites to a successful initiative. Evaluation results indicated positive effects on nursing practice, fewer asthma visits to the health office, and better attendance among students who received asthma care in the school health office. The HLAI provided the basis for development of the Healthy Learner Model for Student Chronic Condition Management.

  14. Diagnostic work-up and laparoscopic correction of an ectopic ureter.

    PubMed

    Cezarino, B N; Lopes, R I; Oliveira, L M; Dénes, F T; Srougi, M

    2015-10-01

    A duplex renal collecting system is a common congenital anomaly in children. Continuous dribbling (especially if after the toilet-training period) should raise suspicion of the presence of an ectopic ureter, which is most often associated with ureteral duplication. This video will demonstrate the complete diagnostic work-up necessary in these cases. A 10-year-old girl presented with continuous dribbling. Ultrasonography and computerized tomography depicted a duplex system on the left side, with the upper pole ureter ectopically inserting into the vaginal cavity and good upper pole renal parenchyma. A careful urethrocystoscopy showed a topic right ureteral orifice and a topic lower pole left ureteral orifice. Retrograde pyelography was performed and displayed normal left lower pole anatomy. A vaginography was performed, which showed reflux to the ectopic ureter. Vaginoscopy clearly identified the ectopic ureteral orifice. A guide wire was introduced through this meatus and retrograde contrast injection confirmed the diagnosis of an ectopic ureter. At laparoscopy, a larger upper pole ureter and a normal lower pole ureter on the left side were identified. A termino-lateral ureteroureteral anastomosis was performed. After the procedure, the child reported immediate resolution of urinary dribbling. In order to optimize its surgical correction, efforts should be made to appropriate localization of the ectopic ureter. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  15. Clinical utility of BOLD fMRI in preoperative work-up of epilepsy

    PubMed Central

    Ganesan, Karthik; Ursekar, Meher

    2014-01-01

    Surgical techniques have emerged as a viable therapeutic option in patients with drug refractory epilepsy. Pre-surgical evaluation of epilepsy requires a comprehensive, multiparametric, and multimodal approach for precise localization of the epileptogenic focus. Various non-invasive techniques are available at the disposal of the treating physician to detect the epileptogenic focus, which include electroencephalography (EEG), video-EEG, magnetic resonance imaging (MRI), functional MRI including blood oxygen level dependent (BOLD) techniques, single photon emission tomography (SPECT), and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). Currently, non-invasive high-resolution MR imaging techniques play pivotal roles in the preoperative detection of the seizure focus, and represent the foundation for successful epilepsy surgery. BOLD functional magnetic resonance imaging (fMRI) maps allow for precise localization of the eloquent cortex in relation to the seizure focus. This review article focuses on the clinical utility of BOLD (fMRI) in the pre-surgical work-up of epilepsy patients. PMID:24851002

  16. [Importance of an initial check-up for diagnostic radiology apparatus management].

    PubMed

    Ishida, Hideki; Take, Toshio; Okabe, Keigo; Saitoh, Hajime; Asanuma, Shinichi; Akiyama, Masayuki; Nakazawa, Yasuo

    2006-11-20

    The management of apparatus for diagnostic imaging is an important job for radiological technologists. In the last 10 years we have encountered 2227 malfunctions in 3652 days. We detected 163 cases at the initial check-up, which accounted for 7.3% of total cases. By performing an initial check-up, we detected one malfunction every 21 days and were able to keep the effects of mishaps to a minimum, prevent accidents, and obtain stable-quality images.

  17. Nephrocutaneous fistula as the initial manifestation of asymptomatic nephrolithiasis: A call for radical management.

    PubMed

    Tanwar, Raman; Rathore, Kirti Vijay; Rohilla, Mahesh Kumar

    2015-01-01

    Renal stones are a common affliction presenting in an acute setting. We report a case of asymptomatic renal stone in an elderly gentleman presenting initially as a discharging lumbar sinus managed by subcapsular nephrectomy and radical excision of the fistula tract. Nephrocutaneous fistula is most commonly associated with tuberculosis, xanthogranulomatous pyelonephritis, and rarely with complicated calyceal stones, and its occurrence with asymptomatic pelvic stones is rare. We present the points in favor of radical open surgery in the management of such patients.

  18. Systems Engineering Plan and project record Configuration Management Plan for the Mixed Waste Disposal Initiative

    SciTech Connect

    Bryan, W.E.; Oakley, L.B.

    1993-04-01

    This document summarizes the systems engineering assessment that was performed for the Mixed Waste Disposal Initiative (MWDI) Project to determine what types of documentation are required for the success of the project. The report also identifies the documents that will make up the MWDI Project Record and describes the Configuration Management Plan describes the responsibilities and process for making changes to project documentation.

  19. 76 FR 81487 - Application of the Energy Planning and Management Program Power Marketing Initiative to the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-28

    ... Area Power Administration Application of the Energy Planning and Management Program Power Marketing Initiative to the Boulder Canyon Project Post-2017 Remarketing AGENCY: Western Area Power Administration... withdrawing its decisions and proposals relating to its Boulder Canyon Project (BCP) Post-2017...

  20. 78 FR 8551 - Federal Housing Administration (FHA) Risk Management Initiatives: Changes to Maximum Loan-to...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-06

    ... URBAN DEVELOPMENT Federal Housing Administration (FHA) Risk Management Initiatives: Changes to Maximum...--Federal Housing Commissioner, HUD. ACTION: Notice. SUMMARY: This proposed notice would make changes to the... long-term outlook. HUD has determined that this proposed change to the LTV requirements is necessary...

  1. The Culturally Responsive Classroom Management Self-Efficacy Scale: Development and Initial Validation

    ERIC Educational Resources Information Center

    Siwatu, Kamau Oginga; Putman, S. Michael; Starker-Glass, Tehia V.; Lewis, Chance W.

    2017-01-01

    This article reports on the development and initial validation of the Culturally Responsive Classroom Management Self-Efficacy Scale. Data from 380 preservice and inservice teachers were used to examine the psychometric properties of the instrument. Exploratory factor analysis results suggested a one-factor structure consisting of 35 items and the…

  2. Technology Transfer and Innovation Initiatives in Strategic Management: Generating an Alternative Perspective

    ERIC Educational Resources Information Center

    Major, E.

    2003-01-01

    This paper taps the strategic management discipline to inform our understanding of technology transfer and innovation (TTI) initiatives. With special focus on the UK Foresight programme it considers the impacts that the resource-based and core competence approaches to strategy can have on understanding the nature and effectiveness of TTI…

  3. Self-Management of Social Initiations by Kindergarten Students with Disabilities in the General Education Classroom

    ERIC Educational Resources Information Center

    Reynolds, Brooke M.; Gast, David L.; Luscre, Deanna

    2014-01-01

    The effectiveness of a self-management intervention on social interaction behaviors was evaluated for students with disabilities and social deficits. Four students enrolled in a general education kindergarten classroom were taught to self-monitor social initiations during nonstructured social time via a digital wrist counter. The number of social…

  4. Designing a Feasibility Study: A Starting Point for Considering New Management Initiatives for Working Parents.

    ERIC Educational Resources Information Center

    Friedman, Dana E.

    This brief paper was prepared as a starting point for employers considering the adoption of a new management initiative for working parents. It is not an exhaustive outline of all considerations in the decision-making process, nor does it provide solutions to all the known pitfalls. It does, however, suggest the potential scope and complexity of…

  5. Statewide Adoption and Initial Implementation of Contingency Management for Substance-Abusing Adolescents

    ERIC Educational Resources Information Center

    Henggeler, Scott W.; Chapman, Jason E.; Rowland, Melisa D.; Halliday-Boykins, Colleen A.; Randall, Jeff; Shackelford, Jennifer; Schoenwald, Sonja K.

    2008-01-01

    Four hundred thirty-two public sector therapists attended a workshop in contingency management (CM) and were interviewed monthly for the following 6 months to assess their adoption and initial implementation of CM to treat substance-abusing adolescent clients. Results showed that 58% (n = 131) of the practitioners with at least one…

  6. 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…

  7. Building chronic disease management capacity in General Practice: The South Australian GP Plus Practice Nurse Initiative.

    PubMed

    Fuller, Jeffrey; Koehne, Kristy; Verrall, Claire C; Szabo, Natalie; Bollen, Chris; Parker, Sharon

    2015-01-01

    This paper draws on the implementation experience of the South Australian GP Plus Practice Nurse Initiative in order to establish what is needed to support the development of the chronic disease management role of practice nurses. The Initiative was delivered between 2007 and 2010 to recruit, train and place 157 nurses across 147 General Practices in Adelaide. The purpose was to improve chronic disease management in General Practice, by equipping nurses to work as practice nurses who would coordinate care and establish chronic disease management systems. Secondary analysis of qualitative data contained in the Initiative evaluation report, specifically drawing on quarterly project records and four focus groups conducted with practice nurses, practice nurse coordinators and practice nurse mentors. As evidenced by the need to increase the amount of support provided during the implementation of the Initiative, nurses new to General Practice faced challenges in their new role. Nurses described a big learning curve as they dealt with role transition to a new work environment and learning a range of new skills while developing chronic disease management systems. Informants valued the skills development and support offered by the Initiative, however the ongoing difficulties in implementing the role suggested that change is also needed at the level of the Practice. While just over a half of the placement positions were retained, practice nurses expressed concern with having to negotiate the conditions of their employment. In order to advance the role of practice nurses as managers of chronic disease support is needed at two levels. At one level support is needed to assist practice nurses to build their own skills. At the level of the Practice, and in the wider health workforce system, support is also needed to ensure that Practices are organisationally ready to include the practice nurse within the practice team.

  8. New mechanism under International Flood Initiative toward robustness for flood management in the Asia Pacific region

    NASA Astrophysics Data System (ADS)

    Murase, M.; Yoshitani, J.; Takeuchi, K.; Koike, T.

    2015-12-01

    Climate change is likely to result in increases in the frequency or intensity of extreme weather events. It is imperative that a good understanding is developed of how climate change affects the events that are reflected in hydrological extremes such as floods and how practitioners in water resources management deal with them. Since there is still major uncertainty as to how the impact of climate change affect actual water resources management, it is important to build robustness into management schemes and communities. Flood management under such variety of uncertainty favors the flexible and adaptive implementation both in top-down and bottom-up approaches. The former uses projections of global or spatially downscaled models to drive resource models and project resource impacts. The latter utilizes policy or planning tools to identify what changes in climate would be most threatening to their long-range operations. Especially for the bottom-up approaches, it is essential to identify the gap between what should be done and what has not been achieved for disaster risks. Indicators or index are appropriate tools to measure such gaps, but they are still in progress to cover the whole world. The International Flood Initiative (IFI), initiated in January 2005 by UNESCO and WMO in close cooperation with UNU and ISDR, IAHS and IAHR, has promoted an integrated approach to flood management to take advantage of floods and use of flood plains while reducing the social, environmental and economic risks. Its secretariat is located in ICHARM. The initiative objective is to support national platforms to practice evidence-based disaster risk reduction through mobilizing scientific and research networks at national, regional and international levels. The initiative is now preparing for a new mechanism to facilitate the integrated approach for flood management on the ground regionally in the Asia Pacific (IFI-AP) through monitoring, assessment and capacity building.

  9. Waste Management Improvement Initiatives at Atomic Energy of Canada Limited - 13091

    SciTech Connect

    Chan, Nicholas; Adams, Lynne; Wong, Pierre

    2013-07-01

    Atomic Energy of Canada Limited's (AECL) Chalk River Laboratories (CRL) has been in operation for over 60 years. Radioactive, mixed, hazardous and non-hazardous wastes have been and continue to be generated at CRL as a result of research and development, radioisotope production, reactor operation and facility decommissioning activities. AECL has implemented several improvement initiatives at CRL to simplify the interface between waste generators and waste receivers: - Introduction of trained Waste Officers representing their facilities or activities at CRL; - Establishment of a Waste Management Customer Support Service as a Single-Point of Contact to provide guidance to waste generators for all waste management processes; and - Implementation of a streamlined approach for waste identification with emphasis on early identification of waste types and potential disposition paths. As a result of implementing these improvement initiatives, improvements in waste management and waste transfer efficiencies have been realized at CRL. These included: 1) waste generators contacting the Customer Support Service for information or guidance instead of various waste receivers; 2) more clear and consistent guidance provided to waste generators for waste management through the Customer Support Service; 3) more consistent and correct waste information provided to waste receivers through Waste Officers, resulting in reduced time and resources required for waste management (i.e., overall cost); 4) improved waste minimization and segregation approaches, as identified by in-house Waste Officers; and 5) enhanced communication between waste generators and waste management groups. (authors)

  10. A European initiative to define research needs and foster the adoption of Managed Aquifer Recharge into river basin management

    NASA Astrophysics Data System (ADS)

    Kneppers, Angeline; Grützmacher, Gesche; Kazner, Christian; Zojer, Hans

    2010-05-01

    The European Technology Platform for Water (WssTP) was initiated by the European Commission to federate a highly fragmented sector with the aim to foster competitive innovations and promote sustainable solutions. To achieve this, pilot programmes endorsing a bottom-up approach were launched in 2007 with a variety of stakeholders having representative water issues to solve. Integrated Water Resources Management (IWRM) was adopted as a balancing process for the safe and sustainable development, allocation and monitoring of water resource use in the context of current and future social, economic and environmental objectives. As a result key drivers were selected and a methodology was followed to identify and validate the needs with stakeholders and experts, and demonstrate solutions as an integrated part of the river basin management plans. Managed Aquifer Recharge (MAR) was identified as a key component of integrated water resources management, especially in water scarce regions and an area relevant for further research. The paper shall summarize the process followed by the WssTP, initiating a Task Force with 36 representatives from European research institutes and industry partners with participation of a few international experts. During a workshop conducted in Graz in June 2009 these experts developed the basis for a report that has now been submitted to the European Commission for consideration in future research calls. Implementing IWRM and MAR is made difficult by the number of different water bodies, but also by the large number of stakeholders, policies, legislations and conflicting interests. The results of the MAR Task Force initiative set the basis for further discussions with the international MAR community on the relevance of the identified research needs but also on the importance and process to associate the institutional and managerial entities for capacity building and the adoption of MAR into the overall management strategies.

  11. The National Oncology Working Group (NOW) initiative: payer and provider collaborations in oncology benefits management.

    PubMed

    Soper, Aileen M; Reeder, C E; Brown, Loreen M; Stojanovska, Ana; Lennert, Barbara J

    2010-04-01

    Payers recognize the need to expand benefits management for oncology but struggle to find effective solutions amid the complexity of available therapies and skepticism from oncologists, who are facing their own set of economic pressures. An effort called the National Oncology Working Group (NOW) Initiative is trying to change the sometimes adversarial relationship between payers and oncologists through a collaborative model. The group, which is supported by pharmaceutical manufacturer sanofi-aventis, is developing patient-centered strategies for successful and sustainable oncology benefits management. The focus includes finding consensus between payers and providers and devising solutions for oncology management such as decreasing variability of cancer care and improving end-of-life care for patients with terminal illness. NOW is designing tools that will be tested in small-scale regional demonstration projects, which NOW participants anticipate will set an example for successful oncology benefits management that can be replicated and expanded.

  12. Pain Management in Long-Term Care Communities: A Quality Improvement Initiative

    PubMed Central

    Reid, M C; O’Neil, Kevin W.; Dancy, JaNeen; Berry, Carolyn A.; Stowell, Stephanie A.

    2015-01-01

    Pain is underrecognized and undertreated in the long-term care (LTC) setting. To improve the management of pain for LTC residents, the authors implemented a quality improvement (QI) initiative at one LTC facility. They conducted a needs assessment to identify areas for improvement and designed a 2-hour educational workshop for facility staff and local clinicians. Participants were asked to complete a survey before and after the workshop, which showed significant improvement in their knowledge of pain management and confidence in their ability to recognize and manage residents’ pain. To measure the effectiveness of the QI initiative, the authors performed a chart review at baseline and at 3 and 8 months after the workshop and evaluated relevant indicators of adequate pain assessment and management. The post-workshop chart reviews showed significant improvement in how consistently employees documented pain characteristics (ie, location, intensity, duration) in resident charts and in their use of targeted pain assessments for residents with cognitive dysfunction. The proportion of charts that included a documented plan for pain assessment was high at baseline and remained stable throughout the study. Overall, the findings suggest a QI initiative is an effective way to improve pain care practices in the LTC setting. PMID:25949232

  13. A systematic review of recommendations and guidelines for the management of osteoarthritis: The chronic osteoarthritis management initiative of the U.S. bone and joint initiative.

    PubMed

    Nelson, Amanda E; Allen, Kelli D; Golightly, Yvonne M; Goode, Adam P; Jordan, Joanne M

    2014-06-01

    Although a number of osteoarthritis (OA) management guidelines exist, uptake has been suboptimal. Our aim was to review and critically evaluate existing OA management guidelines to better understand potential issues and barriers. A systematic review of the literature in MEDLINE published from January 1, 2000 to April 1, 2013 was performed and supplemented by bibliographic reviews, following PRISMA guidelines and a written protocol. Following initial title and abstract screening, 2 authors independently reviewed full-text articles; a third settled disagreements. Two independent reviewers extracted data into a standardized form. Two authors independently assessed guideline quality using the AGREE II instrument; three generated summary recommendations based on the extracted guideline data. Overall, 16 articles were included in the final review. There was broad agreement on recommendations by the various organizations. For non-pharmacologic modalities, education/self-management, exercise, weight loss if overweight, walking aids as indicated, and thermal modalities were widely recommended. For appropriate patients, joint replacement was recommended; arthroscopy with debridement was not recommended for symptomatic knee OA. Pharmacologic modalities most recommended included acetaminophen/paracetamol (first line) and NSAIDs (topical or oral, second line). Intra-articular corticosteroids were generally recommended for hip and knee OA. Controversy remains about the use of acupuncture, knee braces, heel wedges, intra-articular hyaluronans, and glucosamine/chondroitin. The relative agreement on many OA management recommendations across organizations indicates a problem with dissemination and implementation rather than a lack of quality guidelines. Future efforts should focus on optimizing implementation in primary care settings, where the majority of OA care occurs. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Risk Stratification Methods and Provision of Care Management Services in Comprehensive Primary Care Initiative Practices.

    PubMed

    Reddy, Ashok; Sessums, Laura; Gupta, Reshma; Jin, Janel; Day, Tim; Finke, Bruce; Bitton, Asaf

    2017-09-01

    Risk-stratified care management is essential to improving population health in primary care settings, but evidence is limited on the type of risk stratification method and its association with care management services. We describe risk stratification patterns and association with care management services for primary care practices in the Comprehensive Primary Care (CPC) initiative. We undertook a qualitative approach to categorize risk stratification methods being used by CPC practices and tested whether these stratification methods were associated with delivery of care management services. CPC practices reported using 4 primary methods to stratify risk for their patient populations: a practice-developed algorithm (n = 215), the American Academy of Family Physicians' clinical algorithm (n = 155), payer claims and electronic health records (n = 62), and clinical intuition (n = 52). CPC practices using practice-developed algorithm identified the most number of high-risk patients per primary care physician (282 patients, P = .006). CPC practices using clinical intuition had the most high-risk patients in care management and a greater proportion of high-risk patients receiving care management per primary care physician (91 patients and 48%, P =.036 and P =.128, respectively). CPC practices used 4 primary methods to identify high-risk patients. Although practices that developed their own algorithm identified the greatest number of high-risk patients, practices that used clinical intuition connected the greatest proportion of patients to care management services. © 2017 Annals of Family Medicine, Inc.

  15. Initial development of a practical safety audit tool to assess fleet safety management practices.

    PubMed

    Mitchell, Rebecca; Friswell, Rena; Mooren, Lori

    2012-07-01

    Work-related vehicle crashes are a common cause of occupational injury. Yet, there are few studies that investigate management practices used for light vehicle fleets (i.e. vehicles less than 4.5 tonnes). One of the impediments to obtaining and sharing information on effective fleet safety management is the lack of an evidence-based, standardised measurement tool. This article describes the initial development of an audit tool to assess fleet safety management practices in light vehicle fleets. The audit tool was developed by triangulating information from a review of the literature on fleet safety management practices and from semi-structured interviews with 15 fleet managers and 21 fleet drivers. A preliminary useability assessment was conducted with 5 organisations. The audit tool assesses the management of fleet safety against five core categories: (1) management, systems and processes; (2) monitoring and assessment; (3) employee recruitment, training and education; (4) vehicle technology, selection and maintenance; and (5) vehicle journeys. Each of these core categories has between 1 and 3 sub-categories. Organisations are rated at one of 4 levels on each sub-category. The fleet safety management audit tool is designed to identify the extent to which fleet safety is managed in an organisation against best practice. It is intended that the audit tool be used to conduct audits within an organisation to provide an indicator of progress in managing fleet safety and to consistently benchmark performance against other organisations. Application of the tool by fleet safety researchers is now needed to inform its further development and refinement and to permit psychometric evaluation. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Nephrocutaneous fistula as the initial manifestation of asymptomatic nephrolithiasis: A call for radical management

    PubMed Central

    Tanwar, Raman; Rathore, Kirti Vijay; Rohilla, Mahesh Kumar

    2015-01-01

    Renal stones are a common affliction presenting in an acute setting. We report a case of asymptomatic renal stone in an elderly gentleman presenting initially as a discharging lumbar sinus managed by subcapsular nephrectomy and radical excision of the fistula tract. Nephrocutaneous fistula is most commonly associated with tuberculosis, xanthogranulomatous pyelonephritis, and rarely with complicated calyceal stones, and its occurrence with asymptomatic pelvic stones is rare. We present the points in favor of radical open surgery in the management of such patients. PMID:25657555

  17. [Potentials of cooperative quality management initiatives: BQS Institute projects, January 2010 - July 2013].

    PubMed

    Veit, Christof; Bungard, Sven; Hertle, Dagmar; Grothaus, Franz-Josef; Kötting, Joachim; Arnold, Nicolai

    2013-01-01

    Alongside the projects of internal quality management and mandatory quality assurance there is a variety of quality driven projects across institutions initiated and run by various partners to continuously improve the quality of care. The multiplicity and characteristics of these projects are discussed on the basis of projects run by the BQS Institute between 2010 and 2013. In addition, useful interactions and linking with mandatory quality benchmarking and with internal quality management are discussed. (As supplied by publisher). Copyright © 2013. Published by Elsevier GmbH.

  18. [Key messages for the initial management of the elderly patient with acute heart failure].

    PubMed

    Martín-Sánchez, F Javier; Rodríguez-Adrada, Esther; Llorens, Pere; Formiga, Francesc

    2015-01-01

    Acute heart failure is a high prevalence geriatric syndrome that has become one of the most frequent causes of visits to emergency departments, as well as hospital admission, and is associated with high morbidity, mortality and functional impairment. There has been an increasing amount of information published in recent years on the initial management of acute heart failure and the results of the short-term outcomes, as well as the natural history of the disease. The objective of this study is to provide several recommendations that should be taken into account in the initial management of the elderly patient with acute heart failure in the emergency departments, and to review the most interesting currently on-going clinical trials.

  19. Knee Dislocation: A Case Report, Diagnostic Vascular Work-Up, and Literature Review

    PubMed Central

    Burg, Michael D.; Dijkstra, Björn L.

    2017-01-01

    Knee dislocation is an uncommon, potentially limb-threatening, knee injury. Most often caused by high-velocity trauma, it can also result from low- or even ultra-low-velocity trauma. Rapid identification of the injury, reduction, and definitive management are necessary to minimize neurovascular damage. We present a case of rotatory anterolateral knee dislocation sustained during a twisting sports-related event. Special emphasis is placed on diagnosing vascular injuries associated with knee dislocations. PMID:28321343

  20. DoD CPB-ECMO Initiative - A Suspended Animation Front Lines Casualty Management System

    DTIC Science & Technology

    2004-12-01

    DOD CPB- ECMO INITIATIVE – A SUSPENDED ANIMATION FRONT LINES CASUALTY MANAGEMENT SYSTEM Fernando Casas*1, Andrew Reeves1, David Dudzinski1...adjacent main blood vessels. Extracorporeal membrane oxygenation ( ECMO ) uses similar equipment, with the primary goal of temporary pulmonary support by...low cost CPB/ ECMO components to treat front lines emergency trauma casualties. By cooling the patient to a low temperature of about 10°C and

  1. Percutaneous Necrosectomy and Sinus Tract Endoscopy in the Management of Infected Pancreatic Necrosis: An Initial Experience

    PubMed Central

    Carter, C. Ross; McKay, Colin J.; Imrie, Clement W.

    2000-01-01

    Objective To describe the development of a minimally invasive technique aimed at surgical debridement in addition to simple drainage of the abscess cavity. Summary Background Data Surgical intervention for secondary infection of pancreatic necrosis is associated with a death rate of 25% to 40%. Although percutaneous approaches may drain the abscess, they have often failed in the long term as a result of inability to remove the necrotic material adequately. Methods Fourteen consecutive patients with infected necrosis secondary to acute pancreatitis were studied. The initial four patients underwent sinus tract endoscopy along a drainage tract for secondary sepsis after prior open necrosectomy. This technique was then modified to allow primary debridement for proven sepsis to be carried out percutaneously in a further 10 patients. The techniques and initial results are described. Results Additional surgery for sepsis was successfully avoided in the initial four patients managed by sinus tract endoscopy, and none died. Of the following 10 patients managed by percutaneous necrosectomy, 2 died. The median inpatient stay was 42 days. There was one conversion for intraoperative bleeding. Eight patients recovered and were discharged from the hospital after a median of three percutaneous explorations. Only 40% of patients required intensive care management after surgery. Conclusions These initial results in an unselected group of patients are encouraging and show that unlike with percutaneous or endoscopic techniques, both resolution of sepsis and adequate necrosectomy can be achieved. The authors’ initial impression of a reduction in postoperative organ dysfunction is particularly interesting; however, the technique requires further evaluation in a larger prospective series. PMID:10903593

  2. First-line nurse leaders' health-care change management initiatives.

    PubMed

    Macphee, Maura; Suryaprakash, Nitya

    2012-03-01

    To examine nurse leaders' change management projects within British Columbia, Canada. British Columbia Nursing Leadership Institute 2007-10 attendees worked on year-long change management initiatives/projects of importance to their respective health-care institutions. Most leaders were in first-line positions with <3 years' experience. Consenting leaders' project reports (N = 133) were content analysed for specific themes: types of projects; scope of projects (e.g. unit or local level, departmental, institutional); influence targets or key stakeholder groups targeted by the projects; leadership successes and challenges. Of study participants, 77% successfully completed their projects. Staff tool and resource development and existing services improvement were major project types. Care delivery teams were the major influence targets. Only 25% of projects were at the unit level. Many projects had broader scopes, such as institutional levels. Participants cited multiple leadership successes, including enhanced leadership styles and organizational skills. First-line nurse leaders were able to successfully manage projects beyond their traditional scope of responsibilities. The majority of projects dealt with staff needs and healthcare restructuring initiatives. Constant change is a global reality. Change management, a universal competency, must be included in leadership development programmes. © 2011 Blackwell Publishing Ltd.

  3. Setting the stage: measure selection, coordination, and data collection for a national self-management initiative.

    PubMed

    Kulinski, Kristie P; Boutaugh, Michele; Smith, Matthew Lee; Ory, Marcia G; Lorig, Kate

    2014-01-01

    This paper describes the history and rationale behind the development of a centralized data collection system for the national rollout of the Chronic Disease Self-Management Program (CDSMP) through the American Recovery and Reinvestment Act of 2009 Communities Putting Prevention to Work: CDSMP initiative. In addition to justifying the need for solutions to the burgeoning burden of chronic disease in the United States, this paper provides details about CDSMP and related self-management education programs, including their structure, facilitator training, and effectiveness. These topics set the stage for the processes and procedures to create and manage the database for use at the national, state, and local levels. Furthermore, this paper describes the processes related to selecting variables, coordinating data collection, and utilizing data to inform research and policy.

  4. "Endovascular embolic hemispherectomy": a strategy for the initial management of catastrophic holohemispheric epilepsy in the neonate.

    PubMed

    Oluigbo, Chima; Pearl, Monica S; Tsuchida, Tammy N; Chang, Taeun; Ho, Cheng-Ying; Gaillard, William D

    2017-03-01

    Conflicting challenges abound in the management of the newborn with intractable epilepsy related to hemimegalencephaly. Early hemispherectomy to stop seizures and prevent deleterious consequences to future neurocognitive development must be weighed against the technical and anesthetic challenges of performing major hemispheric surgery in the neonate. We hereby present our experience with two neonates with hemimegalencephaly and intractable seizures who were managed using a strategy of initial minimally invasive embolization of the cerebral blood supply to the involved hemisphere. Immediate significant seizure control was achieved after embolization of the cerebral blood supply to the involved hemisphere followed by delayed ipsilateral hemispheric resection at a later optimal age. The considerations and challenges encountered in the course of the management of these patients are discussed, and a literature review is presented.

  5. Coagulation disorders and their cutaneous presentations: Diagnostic work-up and treatment.

    PubMed

    Dabiri, Ganary; Damstetter, Elizabeth; Chang, Yunyoung; Baiyee Ebot, Emily; Powers, Jennifer Gloeckner; Phillips, Tania

    2016-05-01

    Both inherited and acquired hypercoagulable states can present with nonspecific clinical manifestations, such as petechiae, purpura, livedo reticularis, and ulcerations. A good history and physical examination are crucial to diagnoses of these conditions. Inherited conditions tend to present either in neonatal period or later in life, while acquired conditions typically occur later in life. Diagnostic studies are performed to identify the coagulation cascade deficiency or defect. Treatment primarily hinges on anticoagulation and wound care. In this article, we provide an in-depth analysis of the clinical manifestations, diagnostic considerations, and management options of patients in hypercoagulable states. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  6. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours

    PubMed Central

    2011-01-01

    Esophageal perforation is a rare and potentially life-threatening condition. Early clinical suspicion and imaging is important for case management to achieve a good outcome. However, recent studies continue to report high morbidity and mortality greater than 20% from esophageal perforation. At least half of the perforations are iatrogenic, mostly related to endoscopic instrumentation used in the upper gastrointestinal tract, while about a third are spontaneous perforations. Surgical treatment remains an important option for many patients, but a non-operative approach, with or without use of an endoscopic stent or placement of internal or external drains, should be considered when the clinical situation allows for a less invasive approach. The rarity of this emergency makes it difficult for a physician to obtain extensive individual clinical experience; it is also challenging to obtain firm scientific evidence that informs patient management and clinical decision-making. Improved attention to non-specific symptoms and signs and early diagnosis based on imaging may translate into better outcomes for this group of patients, many of whom are elderly with significant comorbidity. PMID:22035338

  7. The Family Medicine Residency Training Initiative in Miscarriage Management: Impact on Practice in Washington State

    PubMed Central

    Darney, Blair G.; Weaver, Marcia R.; Stevens, Nancy; Kimball, Jeana; Prager, Sarah W.

    2013-01-01

    BACKGROUND AND OBJECTIVES Non-complicated spontaneous abortion cases should be counseled about the full range of management approaches, including uterine evacuation using manual vacuum aspiration (MVA). The Residency Training Initiative in Miscarriage Management (RTI-MM) is an intensive, multidimensional intervention designed to facilitate implementation of office-based management of spontaneous abortion using MVA in family medicine residency settings. The purpose of this study was to test the impact of the RTI-MM on self-reported use of MVA for management of spontaneous abortion. METHODS We used a pretest/posttest one group study design and a web-based, anonymous survey to collect data on knowledge, attitudes, perceived barriers, and practice of office-based management of spontaneous abortion. We used multivariable models to estimate incident relative risks and accounted for data clustering at the residency site level. RESULTS Our sample included 441 residents and faculty from 10 family medicine residency sites. Our findings show a positive association between the RTI-MM and self-reported use of MVA for management of spontaneous abortion (adjusted RR=9.11 [CI=4.20-19.78]) and were robust to model specification. Male gender, doing any type of management of spontaneous abortion (eg, expectant, medication), other on-site reproductive health training interventions, and support staff knowledge scores were also significant correlates of physician practice of MVA. CONCLUSIONS Our findings suggest that the RTI-MM was successful in influencing the practice of management of spontaneous abortion using MVA in this population and that support staff knowledge may impact physician practice. Integrating MVA into family medicine settings would potentially improve access to evidence-based, comprehensive care for women. PMID:23378077

  8. Children with Developmental Language Delay at 24 Months of Age: Results of a Diagnostic Work-Up

    ERIC Educational Resources Information Center

    Buschmann, Anke; Jooss, Bettina; Rupp, Andre; Dockter, Sonja; Blaschtikowitz, Heike; Heggen, Iris; Pietz, Joachim

    2008-01-01

    The aim of this study was to evaluate if a diagnostic work-up should be recommended for 2-year-old children with developmental language delay (LD), or if the widely chosen "wait and see" strategy is adequate. Children with LD were identified in paediatric practices during routine developmental check-ups using a German parent-report…

  9. Transjugular Intrahepatic Portosystemic Shunt: Indications, Contraindications, and Patient Work-Up

    PubMed Central

    Copelan, Alexander; Kapoor, Baljendra; Sands, Mark

    2014-01-01

    The transjugular intrahepatic portosystemic shunt (TIPS) procedure is effective in achieving portal decompression and in managing some of the major complications of portal hypertension. While many clinicians are familiar with the two most common indications for TIPS placement, secondary prophylaxis of esophageal variceal hemorrhage and treatment of refractory ascites, evidence for its usefulness is growing in other entities, where it has been less extensively studied but demonstrates promising results. Newer indications include early utilization in the treatment of esophageal variceal hemorrhage, Budd–Chiari syndrome, ectopic varices, and portal vein thrombosis. The referring clinician and interventionist must remain cognizant of the contraindications to the procedure to avoid complications and potential harm to the patient. This review is designed to provide an in-depth analysis of the most common as well as less typical indications for TIPS placement, and to discuss the contraindications and appropriate patient evaluation for this procedure. PMID:25177083

  10. Culture, management and finances as key aspects for healthy workplace initiatives.

    PubMed

    Waterworth, Pippa; Pescud, Melanie; Chappell, Stacie; Davies, Christina; Roche, Dee; Shilton, Trevor; Ledger, Melissa; Slevin, Terry; Rosenberg, Michael

    2016-08-19

    The aim of this study was to qualitatively explore the barriers and enablers to implementing healthy workplace initiatives in a sample of workplaces based in Perth, Western Australia. In-depth interviews were conducted with representatives from 31 organizations representing small, medium and large businesses in the Perth metropolitan area which reported having healthy workplace initiatives. In total, 43 factors were mentioned as influencing the implementation of healthy workplace initiatives. Factors appearing to exert the most influence on the implementation of health promoting initiatives in this sample were culture; support from managers and staff; collaboration with industry providers; financial resources circumstances and the physical environment. These factors appeared to be mutually reinforcing and interconnected. Findings suggest there may be merit in applying an organizational development lens to the implementation of workplace health promotion initiatives as this could assist in leveraging enablers and minimizing barriers. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. The Business Change Initiative: A Novel Approach to Improved Cost and Schedule Management

    NASA Technical Reports Server (NTRS)

    Shinn, Stephen A.; Bryson, Jonathan; Klein, Gerald; Lunz-Ruark, Val; Majerowicz, Walt; McKeever, J.; Nair, Param

    2016-01-01

    Goddard Space Flight Center's Flight Projects Directorate employed a Business Change Initiative (BCI) to infuse a series of activities coordinated to drive improved cost and schedule performance across Goddard's missions. This sustaining change framework provides a platform to manage and implement cost and schedule control techniques throughout the project portfolio. The BCI concluded in December 2014, deploying over 100 cost and schedule management changes including best practices, tools, methods, training, and knowledge sharing. The new business approach has driven the portfolio to improved programmatic performance. The last eight launched GSFC missions have optimized cost, schedule, and technical performance on a sustained basis to deliver on time and within budget, returning funds in many cases. While not every future mission will boast such strong performance, improved cost and schedule tools, management practices, and ongoing comprehensive evaluations of program planning and control methods to refine and implement best practices will continue to provide a framework for sustained performance. This paper will describe the tools, techniques, and processes developed during the BCI and the utilization of collaborative content management tools to disseminate project planning and control techniques to ensure continuous collaboration and optimization of cost and schedule management in the future.

  12. Wyoming Landscape Conservation Initiative Science and Management Workshop Proceedings, May 12-14, 2009, Laramie, Wyoming

    USGS Publications Warehouse

    Nuccio, Vito F.; D'Erchia, Frank D.; Parady, K.(compiler); Mellinger, A.

    2010-01-01

    The U.S. Geological Survey (USGS) hosted the second Wyoming Landscape Conservation Initiative (WLCI) Science and Management Workshop at the University of Wyoming Conference Center and Hilton Garden Inn on May 12, 13, and 14, 2009, in Laramie, Wyo. The workshop focused on six topics seen as relevant to ongoing WLCI science and management activities: mapping and modeling resources for decisionmaking; data information and management; fish and wildlife research; changing landscapes; monitoring; and reclamation and offsite mitigation. Panelists gave presentations on ongoing research in these six areas during plenary sessions followed by audience discussions. Three breakout groups focused on discussing wildlife, reclamation, and monitoring. Throughout the plenary sessions, audience discussions, and breakout groups, several needs were repeatedly emphasized by panelists and workshop participants: developing a conservation plan and identifying priority areas and species for conservation actions; gaining a deeper understanding of sagebrush ecology; identifying thresholds for wildlife that can be used to create an 'early warning system' for managers; continuing to collect basic data across the landscape; facilitating even greater communication and partnership across agencies and between scientists and land managers; and engaging proactively in understanding new changes on the landscape such as wind energy development and climate change. Detailed proceedings from the workshop are captured and summarized in this report.

  13. Health sector initiatives for disaster risk management in ethiopia: a narrative review.

    PubMed

    Tadesse, Luche; Ardalan, Ali

    2014-04-01

    Natural and man-made disasters are prevailing in Ethiopia mainly due to drought, floods, landslides, earthquake, volcanic eruptions, and disease epidemics. Few studies so far have critically reviewed about medical responses to disasters and little information exists pertaining to the initiatives being undertaken by health sector from the perspective of basic disaster management cycle. This article aimed to review emergency health responses to disasters and other related interventions which have been undertaken in the health sector. Relevant documents were identified by searches in the websites of different sectors in Ethiopian and international non-governmental organizations and United Nations agencies. Using selected keywords, articles were also searched in the data bases of Medline, CINAHL, Scopus, and Google Scholar. In addition, pertinent articles from non-indexed journals were referred to. Disaster management system in Ethiopia focused on response, recovery, and rehabilitation from 1974 to 1988; while the period between 1988 and 1993 marked the transition phase towards a more comprehensive approach. Theoretically, from 1993 onwards, the disaster management system has fully integrated the mitigation, prevention, and preparedness phases into already existing response and recovery approach, particularly for drought. This policy has changed the emergency response practices and the health sector has taken some initiatives in the area of emergency health care. Hence, drought early warning system, therapeutic feeding program in hospitals, health centers and posts in drought prone areas to manage promptly acute malnutrition cases have all been put in place. In addition, public health disease emergencies have been responded to at all levels of health care system. Emergency health responses to drought and its ramifications such as acute malnutrition and epidemics have become more comprehensive in the context of basic disaster management phases; and impacts of drought

  14. A Contingency-Management Intervention to Promote Initial Smoking Cessation Among Opioid-Maintained Patients

    PubMed Central

    Dunn, Kelly E.; Sigmon, Stacey C.; Reimann, Edward F.; Badger, Gary J.; Heil, Sarah H.; Higgins, Stephen T.

    2013-01-01

    Prevalence of cigarette smoking among opioid-maintained patients is more than threefold that of the general population and associated with increased morbidity and mortality. Relatively few studies have evaluated smoking interventions in this population. The purpose of the present study was to examine the efficacy of contingency management for promoting initial smoking abstinence. Forty methadone- or buprenorphine-maintained cigarette smokers were randomly assigned to a contingent (n = 20) or noncontingent (n = 20) experimental group and visited the clinic for 14 consecutive days. Contingent participants received vouchers based on breath carbon monoxide levels during Study Days 1 to 5 and urinary cotinine levels during Days 6 to 14. Voucher earnings began at $9.00 and increased by $1.50 with each subsequent negative sample for maximum possible of $362.50. Noncontingent participants earned vouchers independent of smoking status. Although not a primary focus, participants who were interested and medically eligible could also receive bupropion (Zyban). Contingent participants achieved significantly more initial smoking abstinence, as evidenced by a greater percentage of smoking-negative samples (55% vs. 17%) and longer duration of continuous abstinence (7.7 vs. 2.4 days) during the 2 week quit attempt than noncontingent participants, respectively. Bupropion did not significantly influence abstinence outcomes. Results from this randomized clinical trial support the efficacy of contingency management interventions in promoting initial smoking abstinence in this challenging population. PMID:20158293

  15. Sustaining the Bamako Initiative in the Gambia--some management implications.

    PubMed

    Ceesay, N; Kalliecharan, R V

    1994-01-01

    There is increasing pressure in developing countries to improve the social, political and economic status of their people. For former colonies such as the Gambia, pre-independence promises of equity in health, education, water supply and sanitation were vaguely presented in political manifestos. Some of these promises were not translated into concrete plans because of the economic difficulties that the countries experienced. The Alma Ata Declaration on Primary Health Care in 1978 was seen as a strategy to improve the deteriorating health status in developing countries. The economic crisis however, which these countries were facing forced them into implementing Structural Adjustment Programmes (SAP). This resulted in a search for alternative methods of financing health care including that of the Bamako Initiative in 1987 to strengthen the implementation of PHC. The Gambia adopted The Bamako Initiative in 1993 to help in strengthening its already well-developed PHC infrastructure. The Bamako Initiative, like any other form of financing health services, is however not without shortcomings. This paper assesses the structural bottlenecks likely to affect the sustainability of the programme in the Gambia. It examines the political and operational management issues such as political stability, donor commitment and support, effective community management, health sector support and the availability of financial resources.

  16. An assessment of technology alternatives for telecommunications and information management for the space exploration initiative

    NASA Technical Reports Server (NTRS)

    Ponchak, Denise S.; Zuzek, John E.

    1991-01-01

    On the 20th anniversary of the Apollo 11 lunar landing, President Bush set forth ambitious goals for expanding human presence in the solar system. The Space Exploration Initiative (SEI) addresses these goals beginning with Space Station Freedom, followed by a permanent return to the Moon, and a manned mission to Mars. A well designed, adaptive Telecommunications, Navigation, and Information Management (TNIM) infrastructure is vital to the success of these missions. Utilizing initial projections of user requirements, a team under the direction of NASA's Office of Space Operations developed overall architectures and point designs to implement the TNIM functions for the Lunar and Mars mission scenarios. Based on these designs, an assessment of technology alternatives for the telecommunications and information management functions was performed. This technology assessment identifies technology developments necessary to meet the telecommunications and information management system requirements for SEI. Technology requirements, technology needs and alternatives, the present level of technology readiness in each area, and a schedule for development are presented.

  17. Optimizing management in autoimmune hepatitis with liver failure at initial presentation

    PubMed Central

    Potts, Jonathan R; Verma, Sumita

    2011-01-01

    Autoimmune hepatitis (AIH) is a disease of unknown etiology, its hallmark being ongoing hepatic inflammation. By its very nature, it is a chronic condition, although increasingly, we are becoming aware of patients with acute presentations, some of whom may have liver failure. There are very limited published data on patients with AIH with liver failure at initial diagnosis, which consist mostly of small retrospective studies. As a consequence, the clinical features and optimal management of this cohort remain poorly defined. A subset of patients with AIH who present with liver failure do respond to corticosteroids, but for the vast majority, an urgent liver transplantation may offer the only hope of long-term survival. At present, there is uncertainty on how best to stratify such a cohort into responders and non- responders to corticosteroids as soon as possible after hospitalization, thus optimizing their management. This editorial attempts to answer some of the unresolved issues relating to management of patients with AIH with liver failure at initial presentation. However, it must be emphasized that, at present, this editorial is based mostly on small retrospective studies, and it is an understatement that multicenter prospective studies are urgently needed to address this important clinical issue. PMID:21547124

  18. Hypertension management initiative prospective cohort study: comparison between immediate and delayed intervention groups.

    PubMed

    Tobe, S W; Moy Lum-Kwong, M; Von Sychowski, S; Kandukur, K; Kiss, A; Flintoft, V

    2014-01-01

    The Heart and Stroke Foundation of Ontario's Hypertension Management Initiative (HMI) was a pragmatic implementation of clinical practice guidelines for hypertension management in primary care clinics. The HMI was a prospective delayed phase cohort study of 11 sites enrolling patients in two blocks starting 9 months apart in 2007. The intervention was an evidence-informed chronic disease management program consisting of an interprofessional educational intervention with practice tools to implement the Canadian Hypertension Education Program's clinical practice guidelines. This study compares the change in blood pressure (BP) from baseline to 9 months after the intervention between groups. In the immediate intervention group, the mean BP at baseline was 134.6/79.1 mm Hg (18.2/11.5) and in the delayed intervention group 134.2/77.1 mm Hg (18.9/11.8). The fall in BP in the immediate intervention group from baseline to 9 months after the intervention was 7.3/3.6 mm Hg (95% confidence interval (CI): 5.9-8.7/2.6-4.5) and in the delayed group 8.1/3.3 mm Hg (95% CI: 7.0-9.3/2.5-4.1) (all P<0.0001 were compared from baseline to the end of 9 months of the program in both groups). This study is the first to demonstrate that implementation of an interprofessional knowledge integration initiative for the control of hypertension can rapidly lead to lower BP levels.

  19. [News in the work-up of deep vein thrombosis (DVT)].

    PubMed

    Wautrecht, J-C

    2015-09-01

    Deep vein thrombosis (DVT) is a component of venous thromboembolism (VTE), the other being pulmonary embolism (PE). Its incidence is 1 to 2/1.000/year and nearly 1/100/year after 80 years. The major complication of DVT is PE which occurs in about 1/3 of cases, is often asymptomatic but can be fatal. Another common complication, occurring in 20-50 % of cases is the post-thrombotic syndrome (PTS) which is likely to alter the quality of life. Several issues remain unanswered when considering DVT. The optimal management of distal DVT versus proximal DVT is not well codified. The diagnostic approach to DVT is essential : it is based on the estimation of clinical probability, the possible use of D-dimer test and compression ultrasonography. The new direct oral anticoagulants (NOACs) have been proven effective in the phase 3 studies but when to use them and which to choose in the real life ? Wearing compression stockings to prevent the SPT is recommended: what is the definition of compression stockings and is there some evidence of their efficacy ? The purpose of this article is to provide some useful information to primary care physicians to address a DVT.

  20. Limb Salvage After Failed Initial Operative Management of Bimalleolar Ankle Fractures in Diabetic Neuropathy.

    PubMed

    Vaudreuil, Nicholas J; Fourman, Mitchell S; Wukich, Dane K

    2017-03-01

    Ankle fractures in patients with diabetes mellitus (DM) can be difficult to manage, especially in the presence of peripheral neuropathy. In patients who fail initial operative management, attempts at limb salvage can be challenging, and no clear treatment algorithm exists. This study examined outcomes of different procedures performed for limb salvage in this population. This study retrospectively reviewed 17 patients with DM complicated by peripheral neuropathy who sustained a bimalleolar ankle fracture and failed initial operative management. Patients were treated with revision open reduction internal fixation (ORIF) (3/17), closed reduction external fixation (CREF) (8/17), or primary ankle joint fusion (3/17 tibiotalocalcaneal fusion with hindfoot nail [TTCN] and 3/17 with tibiotalar arthrodesis using plates and screws [TTA]). Median follow-up was 20 months. The overall rate of limb salvage was 82.3% (14/17). All patients who went on to amputation presented with infection and were treated initially with CREF (3/3). All patients who achieved successful limb salvage ended up with a clinically fused ankle joint (14/14); 9 underwent a primary or delayed formal fusion and 5 had a clinically fused ankle joint at study conclusion after undergoing revision ORIF or CREF with adjunctive procedures. This small study suggests that in this complicated group of patients it is difficult to achieve limb salvage with an end result of a functional ankle joint. CREF can be a viable option in cases where underlying infection or poor bone quality is present. Treatment with revision ORIF frequently requires supplementary external fixator or tibiotalar Steinman pin placement for additional stability. All patients who underwent revision ORIF ended up with clinically fused ankle joints at the end of the study period. Primary fusion procedures (TTA, TTCN) were associated with a high rate of limb salvage and a decreased number of operations. Level III, retrospective case series.

  1. Initiatives and outcomes of green supply chain management implementation by Chinese manufacturers.

    PubMed

    Zhu, Qinghua; Sarkis, Joseph; Lai, Kee-hung

    2007-10-01

    This paper aims to explore the green supply chain management (GSCM) initiatives (implementation) of various manufacturing industrial sectors in China and examine the links between GSCM initiatives and performance outcomes. We conducted a survey to collect data from four typical manufacturing industrial sectors in China, namely, power generating, chemical/petroleum, electrical/electronic and automobile, and received 171 valid organizational responses for data analysis. Analysis of variance (ANOVA) was used to analyze the data. The results are consistent with our prediction that the different manufacturing industry types display different levels of GSCM implementation and outcomes. We specifically found that the electrical/electronic industry has relatively higher levels of GSCM implementation and achieves better performance outcomes than the other three manufacturer types. Implications of the results are discussed and suggestions for further research on the implementation of GSCM are offered.

  2. Crew resource management and VTE prophylaxis in surgery: a quality improvement initiative.

    PubMed

    Tapson, Victor F; Karcher, Rachel Bongiorno; Weeks, Randy

    2011-01-01

    Despite the availability of safe and effective prophylaxis, appropriate use of venous thromboembolism (VTE) prophylaxis in surgical patients remains suboptimal. Multifaceted quality improvement (QI) activities are needed for sustained improvement at the individual institution level. This work describes a QI initiative for VTE prophylaxis in surgery that combined clinical education with Crew Resource Management (CRM)--a set of principles and techniques for communication, teamwork, and error avoidance used in the aviation industry. Surveys of clinicians participating in the initiative demonstrated immediate and retained confidence and increased knowledge in identifying process-related factors leading to errors, applying CRM to patient care, and identifying VTE prophylaxis candidates and guideline-recommended prophylaxis regimens. Reviews of patient charts preinitiative and postinitiative demonstrated performance improvement in meeting guideline recommendations for the timing, inpatient duration, and use of VTE prophylaxis beyond discharge. This new model joins continuing medical education with CRM to improve the appropriate use of VTE prophylaxis in surgery.

  3. Training for quality management: report on a nationwide distance learning initiative for physicians in Spain.

    PubMed

    Saturno, P J

    1999-02-01

    Under the sponsorship of a pharmaceutical firm, a distance-learning course on Quality Management methods was developed at the University of Murcia (Spain) and offered nationwide to primary health care physicians working in the public system. A total of 7104 physicians (47.7% of the census) signed up (at least one in 92.2% of the health centres). The course content follows the author's model of quality improvement, monitoring and design trilogy, but focuses mainly on methods for a quality improvement cycle using a learning-by-doing and problem-solving approach. The unexpected success of this initiative has led us to reflect on the interest in learning about quality improvement methods shown by physicians, the usefulness of the distance-learning approach, and also to continue the project with new initiatives such as: a summary poster, software containing all the necessary tools and data analysis for quality improvement, and a manual.

  4. Herbal Medicine Offered as an Initiative Therapeutic Option for the Management of Hepatocellular Carcinoma.

    PubMed

    Chen, Shao-Ru; Qiu, Hong-Cong; Hu, Yang; Wang, Ying; Wang, Yi-Tao

    2016-06-01

    Hepatocellular carcinoma (HCC) is a common malignant cancer and is the third leading cause of death worldwide. Effective treatment of this disease is limited by the complicated molecular mechanism underlying HCC pathogenesis. Thus, therapeutic options for HCC management are urgently needed. Targeting the Wnt/β-catenin, Hedgehog, Notch, and Hippo-YAP signaling pathways in cancer stem cell development has been extensively investigated as an alternative treatment. Herbal medicine has emerged as an initiative therapeutic option for HCC management because of its multi-level, multi-target, and coordinated intervention effects. In this article, we summarized the recent progress and clinical benefits of targeting the above mentioned signaling pathways and using natural products such as herbal medicine formulas to treat HCC. Proving the clinical success of herbal medicine is expected to deepen the knowledge on herbal medicine efficiency and hasten the adoption of new therapies. Copyright © 2016 John Wiley & Sons, Ltd.

  5. Advanced Monitoring Systems Initiative Project Achievements for Environmental Restoration and Waste Management

    SciTech Connect

    Hohman, E.H.; Lohrstorfer, C.L.; Venedam, R.J.; Weeks, S.J.; Fannin, C.R.

    2006-07-01

    The Advanced Monitoring Systems Initiative (AMSI) project has been in existence since 2002. In this short time period, AMSI has successfully developed, tested and/or demonstrated over 30 advanced sensors and monitoring systems for applications in environmental restoration, waste management and other areas of national interest. This presentation summarizes the AMSI project, and gives examples of recent successes. The purpose of the presentation is to make Symposium attendees aware of AMSI's capabilities and experience, for possible use in the future. Example successes include the following: - Automated hexavalent chromium (Cr(VI)) monitoring in wells alongside the Columbia River; - Atmospheric chemical sensor array for remote, real-time plume tracking; - Wireless sensor platform for long-term monitoring of subsurface moisture; - Embedded piezo-resistive micro-cantilever (EPM) units for carbon tetrachloride (CCl{sub 4}) and hydrogen cyanide (HCN) detection; - 'iHistorian' for efficient, real-time data management of chemical releases. (authors)

  6. Evaluation of leadership skills during the simulation education course for the initial management of blunt trauma.

    PubMed

    Schott, Eric; Brautigam, Robert T; Smola, Jacqueline; Burns, Karyl J

    2012-04-01

    Leadership skills of senior residents, trauma fellows, and a nurse practitioner were assessed during simulation training for the initial management of blunt trauma. This was a pilot, observational study, that in addition to skill development and assessment also sought to determine the need for a dedicated leadership training course for surgical residents. The study evaluated the leadership skills and adherence to Advance Trauma Life Support (ATLS) guidelines of the team leaders during simulation training. The team leaders' performances on criteria regarding prearrival planning, critical actions based on ATLS, injury identification, patient management, and communication were evaluated for each of five blunt-trauma scenarios. Although there was a statistically significant increase in leadership skills for performing ATLS critical actions, P < 0.05, there were 10 adverse events. A structured simulation program dedicated to developing skills for team leadership willbe a worthwhile endeavor at our institution.

  7. A science and technology initiative within the office of civilian radioactive waste management

    USGS Publications Warehouse

    Budnitz, R.J.; Kiess, T.E.; Peters, M.; Duncan, D.

    2003-01-01

    In 2002, by following a national decision-making process that had been specified in the 1982 Nuclear Waste Policy Act, Yucca Mountain (YM) was designated as the site for the nation's geologic repository for commercial spent nuclear fuel (SNF). The U.S. Department of Energy's (DOE's) Office of Civilian Radioactive Waste Management (OCRWM) must now obtain regulatory approval to construct and operate a repository there, and to develop transportation and infrastructure needed to support operations. The OCRWM has also recently begun a separate Science and Technology (S&T) initiative, whose purposes, beginnings, current projects, and future plans are described here.

  8. Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections

    PubMed Central

    Hoffmann, Charles; Zak, Matthew; Avery, Lisa; Brown, Jack

    2016-01-01

    Antimicrobial stewardship programs (ASPs) focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs) commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics. PMID:27025526

  9. Development of the BUILDER Engineered Management System for Building Maintenance: Initial Decision and Concept Report

    DTIC Science & Technology

    1990-07-01

    Laboratory AD- A225 950 Development of the BUILDER Engineered Management System for Building Maintenance: Initial Decision and Concept Report DT C by ELECTE...identification of the MDR value and the subcomponent condition ratings, the computer assigns a building component Condition Rating ( CR ) based on the...8217 CR = 3 F2.2 WALLS $ 0 CR = 4 F2.3 PAINTING S 9000 CR = 3 F2.4 DOORS/HARDWARE S 1000 CR = 3 F2.5 WINDOWS $ 0 CR = 4 F2.6 ROOF S 100000 CR = 2 F2.7 SITE

  10. Initial manifestation of primary hyperoxaluria type I in adults-- recognition, diagnosis, and management.

    PubMed Central

    Kuiper, J J

    1996-01-01

    Primary hyperoxaluria type I may initially manifest as urolithiasis, renal insufficiency, or symptoms of systemic oxalosis. This hereditary disorder was fatal until effective therapies evolved during the past two decades. Difficulty in recognizing and diagnosing this disorder in adults is illustrated in a report of a patient eventually restored to good health by high-flux dialysis and combined renal and hepatic transplantation. I explore the molecular processes of the genetic defect and discuss clinical indicators of primary hyperoxaluria type I, manifestations of oxalosis, the pathogenesis of chronic oxalate nephropathy, and the diagnosis and management of this disease. Images Figure 2. Figure 3. Figure 4. PMID:8779202

  11. Establishment of government-initiated comprehensive stroke centers for acute ischemic stroke management in South Korea.

    PubMed

    Kim, Jei; Hwang, Yang-Ha; Kim, Joon-Tae; Choi, Nack-Cheon; Kang, Sa-Yoon; Cha, Jae-Kwan; Ha, Yeon Soo; Shin, Dong-Ick; Kim, Seongheon; Lim, Byeong-Hoon

    2014-08-01

    In 2008, the Ministry of Health and Welfare of South Korea initiated the Regional Comprehensive Stroke Center (CSC) program to decrease the incidence and mortality of stroke nationwide. We evaluated the performance of acute ischemic stroke management after the Regional CSC program was introduced. The Ministry of Health and Welfare established 9 Regional CSCs in different provinces from 2008 to 2010. All Regional CSCs have been able to execute the critical processes independently for stroke management since 2011. The Ministry of Health and Welfare was responsible for program development and financial support, the Regional CSC for program execution, and the Korea Centers for Disease Control and Prevention for auditing the execution. We analyzed prospectively collected data on the required indices from 2011 and repeated the analysis the following year for comparison. After the Regional CSCs were established, the first brain image was taken within 1 hour from arrival at the emergency room for all patients with stroke; the length of hospital stay decreased from 14 to 12 days; for the rapid execution of thrombolysis, the first brain image was taken within 12 minutes; intravenous and intra-arterial thrombolysis were started within 40 and 110 minutes, respectively, after emergency room arrival; and the hospital stay of thrombolytic patients decreased from 19 to 15 days. The Regional CSC program has improved the performance of acute stroke management in South Korea and can be used as a model for rapidly improving stroke management. © 2014 American Heart Association, Inc.

  12. Conservative management as an initial approach for post-operative voiding dysfunction.

    PubMed

    Bailey, Claire; Matharu, Gurminder

    2012-01-01

    The management of voiding dysfunction after tension-free vaginal tape (TVT) remains controversial. Timing of surgical intervention is debatable and the role of conservative management is not well researched. This study aims to determine whether self catheterisation is an effective first line management option for these patients. 389 women underwent a TVT operation over a five year period. Twenty-two (5.6%) developed post-operative voiding dysfunction. Twenty women commenced CISC and their progress was monitored by recording voided volumes and residual urine volumes in a voiding diary and uroflowmetry. Residual volumes of less than 100 ml s were considered normal. Voiding function returned to normal with self catheterisation in 72% of patients and of these, 85% were cured in less than 12 weeks. CISC is a suitable and effective initial approach to managing the majority of cases of voiding dysfunction and avoids the risks associated with further surgery, including the recurrence of stress incontinence. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  13. Management of the open abdomen: from initial operation to definitive closure.

    PubMed

    Campbell, Andre; Chang, Michael; Fabian, Timothy; Franz, Michael; Kaplan, Mark; Moore, Frederick; Reed, R Lawrence; Scott, Bradford; Silverman, Ronald

    2009-11-01

    The open abdomen is a relatively new and increasingly common strategy for the management of abdominal emergencies in both trauma and general surgery. The use of an abbreviated laparotomy can reduce mortality associated with conditions such as abdominal compartment syndrome; however, the resulting open abdomen is a complex clinical problem. Modern techniques and technologies are now available that allow for improved management of the open abdomen and the progressive reduction of the fascial defect. Indeed, recent evidence indicates that a large proportion of patients treated with open abdomen can now be closed within the initial hospitalization. These techniques and technologies include the appropriate use of negative pressure therapy and synthetic or biologic repair materials. It is essential that general and trauma surgeons understand the core principles underlying the need for and management of the open abdomen. Toward this goal, an Open Abdomen Advisory Panel was established to identify core principles in the management of the open abdomen and to develop a set of recommendations based on the best available evidence. This review presents the principles and recommendations identified by the Open Abdomen Advisory Panel and provides brief case studies for the illustration of these concepts.

  14. Scandinavian guidelines for initial management of minor and moderate head trauma in children.

    PubMed

    Astrand, Ramona; Rosenlund, Christina; Undén, Johan

    2016-02-18

    The management of minor and moderate head trauma in children differs widely between countries. Presently, there are no existing guidelines for management of these children in Scandinavia. The purpose of this study was to produce new evidence-based guidelines for the initial management of head trauma in the paediatric population in Scandinavia. The primary aim was to detect all children in need of neurosurgical intervention. Detection of any traumatic intracranial injury on CT scan was an important secondary aim. General methodology according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used. Systematic evidence-based review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and based upon relevant clinical questions with respect to patient-important outcomes. Quality ratings of the included studies were performed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 and Centre of Evidence Based Medicine (CEBM)-2 tools. Based upon the results, GRADE recommendations, a guideline, discharge instructions and in-hospital observation instructions were drafted. For elements with low evidence, a modified Delphi process was used for consensus, which included relevant clinical stakeholders. The guidelines include criteria for selecting children for CT scans, in-hospital observation or early discharge, and suggestions for monitoring routines and discharge advice for children and guardians. The guidelines separate mild head trauma patients into high-, medium- and low-risk categories, favouring observation for mild, low-risk patients as an attempt to reduce CT scans in children. We present new evidence and consensus based Scandinavian Neurotrauma Committee guidelines for initial management of minor and moderate head trauma in children. These guidelines should be validated before

  15. Initiation and engagement in chronic disease management care for substance dependence.

    PubMed

    Kim, Theresa W; Saitz, Richard; Cheng, Debbie M; Winter, Michael R; Witas, Julie; Samet, Jeffrey H

    2011-05-01

    Substance dependence treatment is often episodic and not well coordinated with healthcare for common comorbidities. Chronic disease/care management (CDM), longitudinal, patient-centered care delivered by multidisciplinary health professionals, may be well suited to treat substance dependence (SD). To examine initiation and engagement with CDM care for SD located in a primary medical setting. We prospectively studied substance dependent participants enrolled in a trial of CDM addiction care. Primary study outcomes, based upon Washington Circle performance measures, were 14-day initiation of CDM care and 30-day engagement with CDM care. Factors associated with these outcomes were determined using multivariable logistic regression models. We also estimated the proportion of participants who eventually attended at least two visits and four visits by the end of the study (Kaplan-Meier method). Of 282 participants, approximately half of the cohort (45%, 95% Confidence Interval [CI] 39-51%) met criteria for 14-day initiation and 23% (95% CI 18-28%) for 30-day engagement with CDM care. Most participants attended two or more (81%, 95% CI 76-85%) and four or more CDM visits (62%, 95% CI 56-68%). Major depressive episode (AOR 2.60, 95% CI 1.39, 4.87) was associated with higher odds of 14-day initiation; younger age, female sex, and higher alcohol addiction severity were associated with lower odds of 30-day engagement with CDM care. People with SD appear to be willing to initiate and engage with CDM care in a primary medical care setting. CDM care has the potential to improve the quality of care for people with addictions. Copyright © 2010. Published by Elsevier Ireland Ltd.

  16. Critical care considerations in the management of the trauma patient following initial resuscitation

    PubMed Central

    2012-01-01

    Background Care of the polytrauma patient does not end in the operating room or resuscitation bay. The patient presenting to the intensive care unit following initial resuscitation and damage control surgery may be far from stable with ongoing hemorrhage, resuscitation needs, and injuries still requiring definitive repair. The intensive care physician must understand the respiratory, cardiovascular, metabolic, and immunologic consequences of trauma resuscitation and massive transfusion in order to evaluate and adjust the ongoing resuscitative needs of the patient and address potential complications. In this review, we address ongoing resuscitation in the intensive care unit along with potential complications in the trauma patient after initial resuscitation. Complications such as abdominal compartment syndrome, transfusion related patterns of acute lung injury and metabolic consequences subsequent to post-trauma resuscitation are presented. Methods A non-systematic literature search was conducted using PubMed and the Cochrane Database of Systematic Reviews up to May 2012. Results and conclusion Polytrauma patients with severe shock from hemorrhage and massive tissue injury present major challenges for management and resuscitation in the intensive care setting. Many of the current recommendations for “damage control resuscitation” including the use of fixed ratios in the treatment of trauma induced coagulopathy remain controversial. A lack of large, randomized, controlled trials leaves most recommendations at the level of consensus, expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients. PMID:22989116

  17. Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.

    PubMed

    Jeffs, Lianne P; Lo, Joyce; Beswick, Susan; Campbell, Heather

    2013-01-01

    With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

  18. CIOMS and ICH initiatives in pharmacovigilance and risk management: overview and implications.

    PubMed

    Tsintis, Panos; La Mache, Edith

    2004-01-01

    In this article we review the current initiatives by the Council for International Organizations of Medical Sciences (CIOMS) and the International Conference on Harmonisation (ICH) on pharmacovigilance planning that are due for general release during 2004. These initiatives could form the basis for applying concepts of risk management to medicines throughout their life cycle, from preclinical and clinical development to marketed use. The CIOMS VI Working Group (with 28 senior scientists worldwide from drug regulatory authorities and pharmaceutical companies) is currently developing scientific guidance that relates to clinical trials for medicines during development. It recommends a developmental pharmacovigilance concept - a 'living' concept that would start early in drug development supporting the science and ethics of research leading up to licensing (marketing authorisation) and continuing to post-authorisation (postmarketing) pharmacovigilance. This approach is seen as complementary to current ICH initiatives called 'Pharmacovigilance Planning'. ICH will introduce two concepts in pharmacovigilance management of medicinal products: the 'Pharmacovigilance Specification' and the 'Pharmacovigilance Plan'. The 'Pharmacovigilance Specification' will summarise important knowns and unknowns about the medicine. It will include safety risks identified at the licensing stage, potential risks and any key missing information. These elements will be essential to the formulation of pharmacovigilance plans. Dialogue and common understanding between regulators and the pharmaceutical industry will be a key factor for developing pharmacovigilance plans during the life cycle of medicines. Appropriate interaction with health professionals and patients should also be planned for the future as regulatory systems become more transparent. Where no significant issues are apparent at the licensing (marketing authorisation) stage, routine pharmacovigilance practices will be followed

  19. The Data Management System for the Shipboard Automated Meteorological and Oceanographic System (SAMOS) Initiative

    NASA Astrophysics Data System (ADS)

    Smith, S. R.; Arko, R. A.; Bourassa, M. A.; Hu, J.; McDonald, M.; Rettig, J.; Rolph, J.

    2009-12-01

    The data assembly center (DAC) for the SAMOS initiative has developed and implemented an automated data management system that collects, formats, quality controls, distributes, and archives near real-time surface marine data from research vessels. A SAMOS is a computerized data logging system that continuously records navigational (ship’s position, course, speed, and heading), meteorological (winds, air temperature, pressure, moisture, rainfall, and radiation), and near-surface oceanographic (sea temperature, salinity, conductivity, florescence) parameters while the vessel is at sea. The SAMOS initiative relies on the high-quality instrumentation purchased and deployed by the research vessel operators and does not provide instrumentation to the vessels. Currently, the SAMOS initiative receives measurements recorded at 1-min intervals and derived from higher frequency samples (on the order of 1 Hz). As of 2009, 21 research vessels provide routine SAMOS observations to the DAC. The data management system automatically tracks progress of the daily data acquisition and quality processing, stores metadata on instrumentation and ships, and provides data monitoring capability via a user-friendly web interface. An SQL database stores essential parameters to support tracking, data quality control, and version control for each file throughout the process. Presently, SAMOS data are acquired directly from research vessels at sea via a daily email transfer protocol. The steps of this NOAA funded protocol will be described along with lessons learned through the development process. A new DAC initiative, funded by NSF, to develop a 2nd SAMOS data acquisition protocol, via collaboration with the Rolling deck to Repository (R2R) project, will be outlined. The new protocol is envisioned to include transmission of the higher frequency meteorological and surface oceanic samples from participating vessels to real-time servers at R2R. The SAMOS DAC will access these samples for data

  20. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography

    PubMed Central

    Jenssen, Christian; Annema, Jouke Tabe; Clementsen, Paul; Cui, Xin-Wu; Borst, Mathias Maximilian

    2015-01-01

    Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [endoscopic ultrasound fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all MLNs can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review in two integrative parts is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part 1 deals with an introduction into ultrasound techniques, MLN anatomy and diagnostic reach of ultrasound techniques and part 2 with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. PMID:26623120

  1. Should PET/CT be implemented in the routine imaging work-up of locally advanced head and neck squamous cell carcinoma? A prospective analysis.

    PubMed

    Cacicedo, Jon; Fernandez, Iratxe; Del Hoyo, Olga; Dolado, Ainara; Gómez-Suarez, Javier; Hortelano, Eduardo; Sancho, Aintzane; Pijoan, Jose I; Alvarez, Julio; Espinosa, Jose M; Gaafar, Ayman; Bilbao, Pedro

    2015-08-01

    The objective of this study was to determine the incremental staging information provided by positron emission tomography/computed tomography (PET/CT) and its impact on management plans in patients with untreated stage III-IV head and neck squamous cell carcinoma (HNSCC). We prospectively studied, between September 2011 and February 2013, 84 consecutive patients [median age 63.5 years (39-84); 73 men] with histologically confirmed HNSCC. First, based on a conventional work-up (physical examination, CT imaging of the head, neck and chest), the multidisciplinary Head and Neck Tumour Board documented the TNM stage and a management plan for each patient, outlining the modalities to be used, including surgery, radiation therapy (RT), chemotherapy or a combination. After release of the PET/CT results, new TNM staging and management plans were agreed on by the multidisciplinary Tumour Board. Any changes in stage or intended management due to the PET/CT findings were then analysed. The impact on patient management was classified as: low (treatment modality, delivery and intent unchanged), moderate (change within the same treatment modality: type of surgery, radiation technique/dose) or high (change in treatment intent and/or treatment modality → curative to palliative, or surgery to chemoradiation or detection of unknown primary tumour or a synchronous second primary tumour). TNM stage was validated by histopathological analysis, additional imaging or follow-up. Accuracy of the conventional and PET/CT-based staging was compared using McNemar's test. Conventional and PET/CT stages were discordant in 32/84 (38 %) cases: the T stage in 2/32 (6.2 %), the N stage in 21/32 (65.7 %) and the M stage 9/32 (28.1 %). Patient management was altered in 22/84 (26 %) patients, with a moderate impact in 8 (9.5 %) patients and high impact in 14 (16.6 %) patients. PET/CT TNM classification was significantly more accurate (92.5 vs 73.7 %) than conventional staging with a p value < 0

  2. NORTH AMERICA'S SOUND MANAGEMENT OF CHEMICALS INITIATIVE: APPLICATION OF SELECTION CRITERIA TO DIOXINS/FURANS, HEXACHLOROBENZENE, AND HEXACHLOROCYCLOHEXANES

    EPA Science Inventory

    In October 1997, the North American Commission for Environmental Cooperation finalized its process for identifying candidate substances for regional action under the Sound Management of Chemicals Initiative. Regional action plans will be prepared if substantive risk to human he...

  3. NORTH AMERICA'S SOUND MANAGEMENT OF CHEMICALS INITIATIVE: APPLICATION OF SELECTION CRITERIA TO DIOXINS/FURANS, HEXACHLOROBENZENE, AND HEXACHLOROCYCLOHEXANES

    EPA Science Inventory

    In October 1997, the North American Commission for Environmental Cooperation finalized its process for identifying candidate substances for regional action under the Sound Management of Chemicals Initiative. Regional action plans will be prepared if substantive risk to human he...

  4. Initial management of hospital evacuations caused by Hurricane Rita: a systematic investigation.

    PubMed

    Downey, Erin L; Andress, Knox; Schultz, Carl H

    2013-06-01

    Hurricanes remain a major threat to hospitals throughout the world. The authors attempted to identify the planning areas that impact hospital management of evacuations and the challenges faced when sheltering-in-place. This observational, retrospective cohort study examined acute care institutions from one hospital system impacted by Hurricane Rita in 2005. Investigators used a standardized survey instrument and interview process, previously used in the hospital evacuation context, to examine hospitals' initial internal situational awareness and subsequent decision making that resulted in evacuation due to Hurricane Rita. Participants from each hospital included representatives from senior leadership and clinical and nonclinical staff that comprised the Incident Management Team (IMT). The main measured outcomes were responses to 95 questions contained in the survey. Seven of ten eligible hospitals participated in the study. All facilities evacuated the sickest patients first. The most significant factors prompting evacuation were the issuing of mandatory evacuation orders, storm dynamics (category, projected path, storm surge), and loss of regional communications. Hospitals that sheltered-in-place experienced staff shortages, interruptions to electrical power, and loss of water supplies. Three fully-evacuated institutions experienced understaffing of 40%-60%, and four hospitals sustained depressed staffing levels for over four weeks. Five hospitals lost electricity for a mean of 4.8 days (range .5-11 days). All facilities continued to receive patients to their Emergency Departments (EDs) while conducting their own evacuation. Hospital EDs should plan for continuous patient arrival during evacuation. Emergency Operation Plans (EOPs) that anticipate challenges associated with evacuation will help to maximize initial decision making and management during a crisis situation. Hospitals that shelter-in-place face critical shortages and must provide independent patient

  5. Factors predicting Behavior Management Problems during Initial Dental Examination in Children Aged 2 to 8 Years

    PubMed Central

    Kumar, Dipanshu; Anand, Ashish; Mittal, Vipula; Singh, Aparna; Aggarwal, Nidhi

    2017-01-01

    Aim The aim of the present study was to identify the various background variables and its influence on behavior management problems (BMP) in children. Materials and methods The study included 165 children aged 2 to 8 years. During the initial dental visit, an experienced operator obtained each child’s background variables from accompanying guardians using a standardized questionnaire. Children’s dental behavior was rated by Frankel behavior rating scale. The behavior was then analyzed in relation to the answers of the questionnaire, and a logistic regression model was used to determine the power of the variables, separately or combined, to predict BMP. Results The logistic regression analysis considering differences in background variables between children with negative or positive behavior. Four variables turned out to be as predictors: Age, the guardian’s expectation of the child’s behavior at the dental examination, the child’s anxiety when meeting unfamiliar people, and the presence and absence of toothache. Conclusion The present study concluded that by means of simple questionnaire BMP in children may be expected if one of these attributes is found. Clinical significance Information on the origin of dental fear and uncooperative behavior in a child patient prior to treatment process may help the pediatric dentist plan appropriate behavior management and treatment strategy. How to cite this article Sharma A, Kumar D, Anand A, Mittal V, Singh A, Aggarwal N. Factors predicting Behavior Management Problems during Initial Dental Examination in Children Aged 2 to 8 Years. Int J Clin Pediatr Dent 2017;10(1):5-9. PMID:28377646

  6. Marshall Space Flight Center Propulsion Systems Department (PSD) Knowledge Management (KM) Initiative

    NASA Technical Reports Server (NTRS)

    Caraccioli, Paul; Varnedoe, Tom; Smith, Randy; McCarter, Mike; Wilson, Barry; Porter, Richard

    2006-01-01

    NASA Marshall Space Flight Center's Propulsion Systems Department (PSD) is four months into a fifteen month Knowledge Management (KM) initiative to support enhanced engineering decision making and analyses, faster resolution of anomalies (near-term) and effective, efficient knowledge infused engineering processes, reduced knowledge attrition, and reduced anomaly occurrences (long-term). The near-term objective of this initiative is developing a KM Pilot project, within the context of a 3-5 year KM strategy, to introduce and evaluate the use of KM within PSD. An internal NASA/MSFC PSD KM team was established early in project formulation to maintain a practitioner, user-centric focus throughout the conceptual development, planning and deployment of KM technologies and capabilities within the PSD. The PSD internal team is supported by the University of Alabama's Aging Infrastructure Systems Center of Excellence (AISCE), lntergraph Corporation, and The Knowledge Institute. The principle product of the initial four month effort has been strategic planning of PSD KNI implementation by first determining the "as is" state of KM capabilities and developing, planning and documenting the roadmap to achieve the desired "to be" state. Activities undertaken to suppoth e planning phase have included data gathering; cultural surveys, group work-sessions, interviews, documentation review, and independent research. Assessments and analyses have beon pedormed including industry benchmarking, related local and Agency initiatives, specific tools and techniques used and strategies for leveraging existing resources, people and technology to achieve common KM goals. Key findings captured in the PSD KM Strategic Plan include the system vision, purpose, stakeholders, prioritized strategic objectives mapped to the top ten practitioner needs and analysis of current resource usage. Opportunities identified from research, analyses, cultural1KM surveys and practitioner interviews include

  7. New perspectives on sea use management: initial findings from European experience with marine spatial planning.

    PubMed

    Douvere, Fanny; Ehler, Charles N

    2009-01-01

    Increased development pressures on the marine environment and the potential for multiple use conflicts, arising as a result of the current expansion of offshore wind energy, fishing and aquaculture, dredging, mineral extraction, shipping, and the need to meet international and national commitments to biodiversity conservation, have led to increased interest in sea use planning with particular emphasis on marine spatial planning. Several European countries, on their own initiative or driven by the European Union's Marine Strategy and Maritime Policy, the Bergen Declaration of the North Sea Conference, and the EU Recommendation on Integrated Coastal Zone Management, have taken global leadership in implementing marine spatial planning. Belgium, The Netherlands, and Germany in the North Sea, and the United Kingdom in the Irish Sea, have already completed preliminary sea use plans and zoning proposals for marine areas within their national jurisdictions. This paper discusses the nature and context of marine spatial planning, the international legal and policy framework, and the increasing need for marine spatial planning in Europe. In addition, the authors review briefly three marine spatial planning initiatives in the North Sea and conclude with some initial lessons learned from these experiences.

  8. MRI compared to conventional diagnostic work-up in the detection and evaluation of invasive lobular carcinoma of the breast: a review of existing literature

    PubMed Central

    Hoogeveen, Yvonne L.; Blickman, Johan G.; Boetes, Carla

    2007-01-01

    Purpose The clinical diagnosis and management of invasive lobular carcinoma (ILC) of the breast presents difficulties. Magnetic resonance imaging (MRI) has been proposed as the imaging modality of choice for the evaluation of ILC. Small studies addressing different aspects of MRI in ILC have been presented but no large series to date. To address the usefulness of MRI in the work-up of ILC, we performed a review of the currently published literature. Materials and methods We performed a literature search using the query “lobular AND (MRI OR MR OR MRT OR magnetic)” in the Cochrane library, PubMed and scholar.google.com, to retrieve all articles that dealt with the use of MRI in patients with ILC. We addressed sensitivity, morphologic appearance, correlation with pathology, detection of additional lesions, and impact of MRI on surgery as different endpoints. Whenever possible we performed meta-analysis of the pooled data. Results Sensitivity is 93.3% and equal to overall sensitivity of MRI for malignancy in the breast. Morphologic appearance is highly heterogeneous and probably heavily influenced by interreader variability. Correlation with pathology ranges from 0.81 to 0.97; overestimation of lesion size occurs but is rare. In 32% of patients, additional ipsilateral lesions are detected and in 7% contralateral lesions are only detected by MRI. Consequently, MRI induces change in surgical management in 28.3% of cases. Conclusion This analysis indicates MRI to be valuable in the work-up of ILC. It provides additional knowledge that cannot be obtained by conventional imaging modalities which can be helpful in patient treatment. PMID:18043894

  9. Health Sector Initiatives for Disaster Risk Management in Ethiopia: A Narrative Review

    PubMed Central

    Tadesse, Luche; Ardalan, Ali

    2014-01-01

    Background: Natural and man-made disasters are prevailing in Ethiopia mainly due to drought, floods, landslides, earthquake, volcanic eruptions, and disease epidemics. Few studies so far have critically reviewed about medical responses to disasters and little information exists pertaining to the initiatives being undertaken by health sector from the perspective of basic disaster management cycle. This article aimed to review emergency health responses to disasters and other related interventions which have been undertaken in the health sector. Methods: Relevant documents were identified by searches in the websites of different sectors in Ethiopian and international non-governmental organizations and United Nations agencies. Using selected keywords, articles were also searched in the data bases of Medline, CINAHL, Scopus, and Google Scholar. In addition, pertinent articles from non-indexed journals were referred to. Results: Disaster management system in Ethiopia focused on response, recovery, and rehabilitation from 1974 to 1988; while the period between 1988 and 1993 marked the transition phase towards a more comprehensive approach. Theoretically, from 1993 onwards, the disaster management system has fully integrated the mitigation, prevention, and preparedness phases into already existing response and recovery approach, particularly for drought. This policy has changed the emergency response practices and the health sector has taken some initiatives in the area of emergency health care. Hence, drought early warning system, therapeutic feeding program in hospitals, health centers and posts in drought prone areas to manage promptly acute malnutrition cases have all been put in place. In addition, public health disease emergencies have been responded to at all levels of health care system. Conclusions: Emergency health responses to drought and its ramifications such as acute malnutrition and epidemics have become more comprehensive in the context of basic disaster

  10. Efficacy and safety of a pharmacist-managed inpatient anticoagulation service for warfarin initiation and titration.

    PubMed

    Wong, Y M; Quek, Y-N; Tay, J C; Chadachan, V; Lee, H K

    2011-10-01

    Anticoagulation consultations provided by a pharmacist-staffed inpatient service, similar to the experience reported in outpatient anticoagulation clinics, can potentially improve anticoagulation control and outcomes. At Tan Tock Seng Hospital, a 1200-bed acute care teaching hospital in Singapore, pharmacist-managed anticoagulation clinics have been in place since 1997. Pharmacist-managed services were extended to inpatient consultations in anticoagulation management from April 2006. Our objective was to assess the effect of implementing a pharmacist-managed inpatient anticoagulation service. This was a single-centre cohort study. Baseline data from 1 January 2006 to 31 March 2006 were collected and compared with post-implementation data from 1 April 2006 to 31 March 2007. Patients newly started on warfarin for deep vein thrombosis, pulmonary embolism or atrial fibrillation in general medicine and surgery departments were included. The three endpoints were as follows: (i) percentage of international normalized ratios (INRs) achieving therapeutic range within 5 days, (ii) INRs more than 4 during titration and (iii) subtherapeutic INRs on discharge. A total of 26 patients in the control period were compared with 144 patients who had received dosing consultations by a pharmacist during the initiation of warfarin. The provision of pharmacist consult resulted in 88% compared to 38% (P < 0·001) of INR values achieving therapeutic range within 5 days. There was a reduction in INR values of more than 4 during titration from 27% to 2% (P < 0·001), and subtherapeutic INR values on discharge without low molecular weight heparin from 15% to 0% (P < 0·001). The mean time to therapeutic INR was reduced from 6·5 to 3·9 days (P < 0·001) and mean length of stay after initiation of warfarin from 11 to 7·7 days (P = 0·004). Inpatient anticoagulation care and outcomes were significantly improved by a pharmacist-managed anticoagulation service. The time to therapeutic INR was

  11. Research Initiatives and Preliminary Results In Automation Design In Airspace Management in Free Flight

    NASA Technical Reports Server (NTRS)

    Corker, Kevin; Lebacqz, J. Victor (Technical Monitor)

    1997-01-01

    The NASA and the FAA have entered into a joint venture to explore, define, design and implement a new airspace management operating concept. The fundamental premise of that concept is that technologies and procedures need to be developed for flight deck and ground operations to improve the efficiency, the predictability, the flexibility and the safety of airspace management and operations. To that end NASA Ames has undertaken an initial development and exploration of "key concepts" in the free flight airspace management technology development. Human Factors issues in automation aiding design, coupled aiding systems between air and ground, communication protocols in distributed decision making, and analytic techniques for definition of concepts of airspace density and operator cognitive load have been undertaken. This paper reports the progress of these efforts, which are not intended to definitively solve the many evolving issues of design for future ATM systems, but to provide preliminary results to chart the parameters of performance and the topology of the analytic effort required. The preliminary research in provision of cockpit display of traffic information, dynamic density definition, distributed decision making, situation awareness models and human performance models is discussed as they focus on the theme of "design requirements".

  12. [Acute myocardial infarction in women. Initial characteristics, management and early outcome. The FAST-MI registry].

    PubMed

    Simon, T; Puymirat, E; Lucke, V; Bouabdallaoui, N; Lognoné, T; Aissaoui, N; Cohen, S; Ashrafpoor, G; Roul, G; Jouve, B; Levy, G; Charpentier, S; Grollier, G; Ferrières, J; Danchin, N

    2013-08-01

    To assess gender differences in characteristics, management, and hospital outcomes in patients participating in the French FAST-MI 2010 registry. Three thousand and seventy-nine patients hospitalised for ST-elevation (STEMI) or non-ST-elevation (NSTEMI) myocardial infarction in 213 French centres during a 1-month period at the end of 2010. Women account for 27% of the population and more frequently present with NSTEMI. They are 9 years older than men on average, although 25% of women with STEMI are less than 60 years of age. Management of STEMI is similar, after adjustment for baseline characteristics. However, fewer women are treated with primary percutaneous coronary angioplasty. In NSTEMI, although use of coronary angiography is similar, fewer women get treated with angioplasty. Most medications are used in a similar way in men and women, except thienopyridines, with fewer women receive prasugrel. After adjustment, in-hospital mortality is similar for men and women. Myocardial infarction is not specific to men: one out of four patients admitted for myocardial infarction is a woman. Initial management is rather similar for men and women, after taking into account differences in baseline characteristics. Percutaneous coronary angioplasty, however, remains less frequently used in women. In-hospital complications have become rarer and do not differ according to sex. Copyright © 2013. Published by Elsevier SAS.

  13. Research Initiatives and Preliminary Results In Automation Design In Airspace Management in Free Flight

    NASA Technical Reports Server (NTRS)

    Corker, Kevin; Lebacqz, J. Victor (Technical Monitor)

    1997-01-01

    The NASA and the FAA have entered into a joint venture to explore, define, design and implement a new airspace management operating concept. The fundamental premise of that concept is that technologies and procedures need to be developed for flight deck and ground operations to improve the efficiency, the predictability, the flexibility and the safety of airspace management and operations. To that end NASA Ames has undertaken an initial development and exploration of "key concepts" in the free flight airspace management technology development. Human Factors issues in automation aiding design, coupled aiding systems between air and ground, communication protocols in distributed decision making, and analytic techniques for definition of concepts of airspace density and operator cognitive load have been undertaken. This paper reports the progress of these efforts, which are not intended to definitively solve the many evolving issues of design for future ATM systems, but to provide preliminary results to chart the parameters of performance and the topology of the analytic effort required. The preliminary research in provision of cockpit display of traffic information, dynamic density definition, distributed decision making, situation awareness models and human performance models is discussed as they focus on the theme of "design requirements".

  14. Laboratory information management system for membrane protein structure initiative--from gene to crystal.

    PubMed

    Troshin, Petr V; Morris, Chris; Prince, Stephen M; Papiz, Miroslav Z

    2008-12-01

    Membrane Protein Structure Initiative (MPSI) exploits laboratory competencies to work collaboratively and distribute work among the different sites. This is possible as protein structure determination requires a series of steps, starting with target selection, through cloning, expression, purification, crystallization and finally structure determination. Distributed sites create a unique set of challenges for integrating and passing on information on the progress of targets. This role is played by the Protein Information Management System (PIMS), which is a laboratory information management system (LIMS), serving as a hub for MPSI, allowing collaborative structural proteomics to be carried out in a distributed fashion. It holds key information on the progress of cloning, expression, purification and crystallization of proteins. PIMS is employed to track the status of protein targets and to manage constructs, primers, experiments, protocols, sample locations and their detailed histories: thus playing a key role in MPSI data exchange. It also serves as the centre of a federation of interoperable information resources such as local laboratory information systems and international archival resources, like PDB or NCBI. During the challenging task of PIMS integration, within the MPSI, we discovered a number of prerequisites for successful PIMS integration. In this article we share our experiences and provide invaluable insights into the process of LIMS adaptation. This information should be of interest to partners who are thinking about using LIMS as a data centre for their collaborative efforts.

  15. Targeted Temperature Management: Effects of Initial Protocol Implementation on Patient Outcomes.

    PubMed

    Wyse, Jessica; McNett, Molly

    2016-01-01

    Targeted temperature management (TTM) is a strategy used by critical care nurses to mitigate negative effects of out-of-hospital cardiac arrest (OHCA); however, integration and compliance of TTM protocols into routine clinical practice can be challenging. The aims of this study are to (1) investigate the effects of initial TTM protocol implementation on patient mortality, length of stay, and discharge disposition among patients who experience OHCA and (2) evaluate initial compliance and potential barriers to newly implemented TTM protocol. A retrospective cohort design was used. Data were gathered on adult patients experiencing OHCA before and after immediate implementation of a TTM protocol within a large academic public hospital. Demographic and clinical data were abstracted from medical records of both TTM and non-TTM groups. Additional compliance data were gathered on the TTM group. Outcome variables included hospital mortality, length of stay, and discharge disposition. Total accrual was 259. Mortality decreased after protocol implementation (89.4%, 75%, P < .05), which was supported in the regression analyses (P = .05; odds ratio, 2.8). A higher proportion of subjects were discharged home after the TTM protocol (21.5% discharged home after protocol implementation vs 5.1% discharged home before protocol implementation; P < .05). Full protocol compliance was 30%. Protocol documentation was inconsistent across units and personnel. Findings suggest that even initial implementation of TTM protocols can result in positive patient outcomes. Full compliance with protocols remains difficult. Critical care nurses are integral to initiation of and adherence to therapeutic hypothermia protocols and are in a key position to develop strategies for improved compliance across departments.

  16. Economic analysis of Heart and Stroke Foundation of Ontario's Hypertension Management Initiative.

    PubMed

    de Oliveira, Claire; Wijeysundera, Harindra C; Tobe, Sheldon W; Lum-Kwong, Margaret Moy; Von Sychowski, Shirley; Wang, Xuesong; Tu, Jack V; Krahn, Murray D

    2012-01-01

    Hypertension is suboptimally treated in primary care settings. We evaluated the cost-effectiveness of the Heart and Stroke Foundation of Ontario's Hypertension Management Initiative (HMI), an interdisciplinary, evidence-informed chronic disease management model for primary care that focuses on improving blood pressure management and control by primary care providers and patients according to clinical best practice guidelines. The perspective of our analysis was that of the Ontario Ministry of Health and Long-Term Care with a lifetime horizon and 5% annual discount rate. Using data from a prospective cohort study from the HMI, we created two matched groups: pre-HMI (standard care), and post-HMI (n = 1720). For each patient, we estimated the 10-year risk of cardiovascular disease (CVD) using the Framingham risk equation and life expectancy from life tables. Long-term health care costs incurred with physician visits, acute and chronic care hospitalizations, emergency department visits, same-day surgeries, and medication use were determined through linkage to administrative databases, using a bottom-up approach. The HMI intervention was associated with significant reductions in systolic blood pressure (126 mmHg vs 134 mmHg with standard care; P-value < 0.001). These improvements were associated with a reduction in the 10-year risk of CVD (9.5% risk vs 10.7% in standard care; P-value < 0.001) and a statistically significant improvement in discounted life expectancy (9.536 years vs 9.516 in standard care; P-value < 0.001). The HMI cohort had a discounted mean lifetime cost of $22,884 CAD vs $22,786 CAD for standard care, with an incremental cost-effectiveness ratio of $4939 CAD per life-year gained. We found that the HMI is a cost-effective means of providing evidence-informed, chronic disease management in primary care to patients with hypertension.

  17. 77 FR 74224 - OSHA Data Initiative (ODI); Extension of the Office of Management and Budget's (OMB) Approval of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-13

    ... Occupational Safety and Health Administration OSHA Data Initiative (ODI); Extension of the Office of Management... requirements for OSHA's Data Initiative program. DATES: Comments must be submitted (postmarked, sent, or... injury and illness data and information on the number of workers employed and the number of hours...

  18. 75 FR 54020 - Federal Housing Administration Risk Management Initiatives: New Loan-to-Value and Credit Score...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-03

    ... [Docket No. FR-5404-N-02] Federal Housing Administration Risk Management Initiatives: New Loan-to-Value... scores present higher risk of default and mortgage insurance claim. Such transactions that lack the... initiatives that HUD proposed would contribute to the restoration of the Mutual Mortgage Insurance Fund (MMIF...

  19. 75 FR 74038 - Twin Eagle Resource Management, LLC; Supplemental Notice That Initial Market-Based Rate Filing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-30

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Twin Eagle Resource Management, LLC; Supplemental Notice That Initial Market... supplemental notice in the above-referenced proceeding, of Twin Eagle Resource Management, LLC's ]...

  20. 78 FR 34372 - TGP Energy Management, LLC; Supplemental Notice That Initial Market-Based Rate Filing Includes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-07

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission TGP Energy Management, LLC; Supplemental Notice That Initial Market-Based... above-referenced proceeding, of TGP Energy Management, LLC's application for market-based rate...

  1. Bit by Bit: A Series of Trends, Tools, and Initiatives Are Aimed at Improving Electronic Resource Management

    ERIC Educational Resources Information Center

    Webster, Peter

    2006-01-01

    Electronic resources are more prominent than ever in library collections, yet they resist easy management. A range of tools and cooperative efforts are emerging to improve the management and evaluation of electronic resources. Initiatives are underway to standardize and automate the harvesting of usage statistics and e-journal title and holdings…

  2. 76 FR 65718 - Tenaska Power Management, LLC; Supplemental Notice That Initial Market-Based Rate Filing Includes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-24

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Tenaska Power Management, LLC; Supplemental Notice That Initial Market-Based... above-referenced proceeding of Tenaska Power Management, LLC's application for market-based...

  3. 75 FR 25234 - EquiPower Resources Management, LLC; Supplemental Notice That Initial Market-Based Rate Filing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-07

    ... Energy Regulatory Commission EquiPower Resources Management, LLC; Supplemental Notice That Initial Market... supplemental notice in the above-referenced proceeding of EquiPower Resources Management, LLC's application for market-based rate authority, with an accompanying rate ] tariff, noting that such application includes...

  4. Associations of race and ethnicity with anemia management among patients initiating renal replacement therapy.

    PubMed Central

    Weisbord, Steven D.; Fried, Linda F.; Mor, Maria K.; Resnick, Abby L.; Kimmel, Paul L.; Palevsky, Paul M.; Fine, Michael J.

    2007-01-01

    BACKGROUND: Many patients initiate renal replacement therapy with suboptimal anemia management. The factors contributing to this remain largely unknown. The aim of this study was to assess the associations of race and ethnicity with anemia care prior to the initiation of renal replacement therapy. METHODS: Using data from the medical evidence form filed for patients who initiated renal replacement therapy between 1995-2003, we assessed racial and ethnic differences in pre-end-stage renal disease hematocrit levels, the use of erythropoiesis stimulation agents (ESAs), the proportion of patients with hematocrit levels > or = 33% and the proportion of patients with hematocrit levels < 33% that did not receive ESA. We also examined secular trends in racial and ethnic differences in these parameters. RESULTS: In multivariable analyses, non-Hispanic blacks had lower hematocrit levels (delta hematocrit = -0.97%, 95% CI: -1.00-0.94%), and were less likely to receive ESA (OR = 0.82, 95% CI: 0.81-0.84), to initiate renal replacement therapy with hematocrit > or = 33% (OR = 0.78, 95% CI: 0.77-0.79) or to receive ESA if the hematocrit was < 33% (OR = 0.79, 95% CI: 0.77-0.80) than non-Hispanic whites. White Hispanics also had lower hematocrit levels (delta hematocrit = -0.42%, 95% CI:-0.47% to -0.37%), and were less likely to receive ESA (OR = 0.86, 95% CI: 0.85-0.88), to have hematocrit levels > or = 33% (OR = 0.91, 95% CI: 0.89-0.93) or to receive ESA if the hematocrit was < 33% (OR = 0.85, 95% CI: 0.83-0.87) than non-Hispanic whites. These disparities persisted over the eight-year study period. CONCLUSIONS: African-American race and Hispanic ethnicity are associated with suboptimal pre-end-stage renal disease anemia management. Efforts to improve anemia care should incorporate targeted interventions to decrease these disparities. PMID:18020096

  5. Impact of Initial Central Venous Pressure on Outcomes of Conservative versus Liberal Fluid Management in Acute Respiratory Distress Syndrome

    PubMed Central

    Semler, Matthew W.; Wheeler, Arthur P.; Thompson, B. Taylor; Bernard, Gordon R.; Wiedemann, Herbert P.; Rice, Todd W.

    2016-01-01

    Objective In acute respiratory distress syndrome (ARDS), conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients’ initial central venous pressure (CVP). We hypothesized initial CVP would modify the effect of fluid management on outcomes. Design Retrospective analysis of the Fluid and Catheter Treatment Trial, a multicenter randomized trial comparing conservative to liberal fluid management in ARDS. We examined the relationship between initial CVP, fluid strategy, and 60-day mortality in univariate and multivariable analysis. Setting Twenty acute care hospitals. Patients Nine hundred and thirty-four ventilated ARDS patients with a CVP available at enrollment, 609 without baseline shock (for whom fluid balance was managed by study protocol). Interventions None. Measurements and Main Results Among patients without baseline shock, those with initial CVP > 8 mmHg experienced similar mortality with conservative and liberal fluid management (18% versus 18%, p=0.928), whereas those with CVP ≤8 mmHg experienced lower mortality with a conservative strategy (17% versus 36%, p=0.005). Multivariable analysis demonstrated an interaction between initial CVP and the effect of fluid strategy on mortality (p=0.031). At higher initial CVPs, the difference in treatment between arms was predominantly furosemide administration, which was not associated with mortality (p=0.122). At lower initial CVPs, the difference between arms was predominantly fluid administration, with additional fluid associated with increased mortality (p=0.013). Conclusions Conservative fluid management decreases mortality for ARDS patients with a low initial central venous pressure. In this population, the administration of intravenous fluids appears to increase mortality. PMID:26741580

  6. Diagnostic Work-up and Follow-up in Children with Tall Stature: A Simplified Algorithm for Clinical Practice

    PubMed Central

    Stalman, Susanne E.; Pons, Anke; Wit, Jan M.; Kamp, Gerdine A.; Plötz, Frans B.

    2015-01-01

    Objective: No evidence-based guideline has been published about optimal referral criteria and diagnostic work-up for tall stature in children. The aim of our study was to describe auxological and clinical characteristics of a cohort of children referred for tall stature, to identify potential candidates for adult height reduction, and to use these observations for developing a simple algorithm for diagnostic work-up and follow-up in clinical practice. Methods: Data regarding family and medical history, auxological measurements, bone age development, physical examination, additional diagnostic work-up, and final diagnosis were collected from all children referred for tall stature, irrespective of their actual height standard deviation score (HSDS). Predicted adult height (PAH) was calculated in children above 10 years. Characteristics of patients with an indication for adult height reduction were determined. Results: Hundred thirty-two children (43 boys) with a mean ± SD age of 10.9±3.2 (range 0.5-16.9) years were included in the study. Fifty percent of the referred children had an HSDS ≤2.0 (n=66). Two pathological cases (1.5%) were found (HSDS 2.3 and 0.9). Tall children without pathology were diagnosed as idiopathic tall, further classified as familial tall stature (80%), constitutional advancement of growth (5%), or unexplained non-familial tall stature (15%). Of the 74 children in whom PAH was calculated, epiphysiodesis was considered in six (8%) and performed in four (5%) patients. Conclusion: The incidence of pathology was very low in children referred for tall stature, and few children were potential candidates for adult height reduction. We propose a simple diagnostic algorithm for clinical practice. PMID:26777036

  7. Role of 3.0 Tesla magnetic resonance hysterosalpingography in the diagnostic work-up of female infertility.

    PubMed

    Cipolla, Valentina; Guerrieri, Daniele; Pietrangeli, Daniela; Santucci, Domiziana; Argirò, Renato; de Felice, Carlo

    2016-09-01

    Imaging evaluation plays a crucial role in the diagnostic work-up of female infertility. In recent years, the possibility to evaluate tubal patency using 1.5 Tesla magnetic resonance (1.5T MR) has been studied. To assess the feasibility of 3.0 Tesla magnetic resonance (3.0T MR) hysterosalpingography and its role in the diagnostic work-up of female infertility and to evaluate if this fast "one-stop-shop" imaging approach should be proposed as a first-line examination. A total of 116 infertile women were enrolled in this prospective study; all underwent 3.0T MR hysterosalpingography. After standard imaging of the pelvis, tubal patency was assessed by acquiring 3D dynamic time-resolved T1-weighted (T1W) sequences during manual injection of 4-5 mL of contrast solution consisting of gadolinium and normal sterile saline. Images were evaluated by two radiologists with different experience in MR imaging (MRI). The examination was successfully completed in 96.5% of cases, failure rate was 3.5%. Dynamic sequences showed bilateral tubal patency in 64.3%, unilateral tubal patency in 25.9%, and bilateral tubal occlusion in 9.8%. Extratubal abnormalities were found in 69.9% of patients. Comprehensive analysis of morphological and dynamic sequences showed extratubal abnormalities in 43.1% of patients with bilateral tubal patency. 3.0T MR hysterosalpingography is a feasible, simple, fast, safe, and well-tolerated examination, which allows evaluation of tubal patency and other pelvic causes of female infertility in a single session, and it may thus represent a "one-stop-shop" solution in female infertility diagnostic work-up. © The Foundation Acta Radiologica 2015.

  8. IGES/RIM Parser/Converter users guide. [Initial Graphics Exchange Specification/Relational Information Manager

    SciTech Connect

    Isler, R.E.

    1985-05-01

    Sandia National Laboratories has been assigned Lead Lab responsibility by the Department of Energy (DOE) for integrating the communications among computer-aided design/computer-aided manufacturing (CAD/CAM) activities throughout DOE's Nuclear Weapons Complex (NWC). A primary objective is to provide a capability for the exchange of digital data between dissimilar CAD systems within the NWC. A subset of the Initial Graphics Exchange Specification (IGES) will be the data exchange format. The IGES/RIM Parser/Converter is the first in a series of programs being developed within the NWC to carry out this automated exchange. The Parser/Converter program converts an IGES file into a file of input commands to a Relational Information Manager (RIM) database.

  9. Sustaining practice change one year after completion of the national depression management leadership initiative.

    PubMed

    Chung, Henry; Duffy, Farifteh Firoozmand; Katzelnick, David J; Williams, Mark D; Trivedi, Madhukar H; Rae, Donald S; Regier, Darrel A

    2013-07-01

    This report describes the sustainability of quality improvement interventions for depression care in psychiatric practice one year after the completion of the National Depression Management Leadership Initiative (NDMLI) in 2006. The main intervention involved continued use of the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) for routine care of patients with depressive disorders. One year after project completion, lead psychiatrists from the 17 participating practices were surveyed about the sustainability of key practice interventions and dissemination of the interventions. All 14 practices that provided baseline and follow-up data reported sustained use of the PHQ-9 for screening, diagnosis, or monitoring purposes. Moreover, practices reported dissemination of this approach to clinicians within and outside their practices. Psychiatrists reported sustainability and dissemination of PHQ-9 use one year after the conclusion of the NDMLI. The model has potential as a depression care improvement strategy and is worthy of additional study.

  10. Time-honored treatments for the initial management of acute coronary syndromes: Challenging the status quo.

    PubMed

    McCarthy, Cian P; Donnellan, Eoin; Wasfy, Jason H; Bhatt, Deepak L; McEvoy, John W

    2017-10-01

    Morphine, oxygen, and nitrates are time-honored therapies for the initial management of acute coronary syndrome (ACS). The traditional goal of these agents in ACS has been to (1) relieve symptoms, (2) prevent infarction or limit its size, and (3) improve outcomes, both acutely and during follow-up. Despite their ongoing use in routine ACS care, nitrates, morphine, and oxygen have no evidence of clinical outcomes benefit from randomized trials. Furthermore, emerging data have recently suggested that, in certain situations, morphine and oxygen may actually be associated with harm in the setting of ACS. In this review article, we thoroughly examine updated evidence for each of these acute-phase ACS agents with respect to their individual risks and benefits. We review guideline recommendations for these therapies and outline future directions for their use in clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. [The initial management in intensive care of pelvic ring injury patients].

    PubMed

    Vardon, F; Harrois, A; Duranteau, J; Geeraerts, T

    2014-05-01

    Pelvic trauma care is complex since it is frequently associated with multiple injuries and may lead to dramatic and uncontrollable haemorrhage. After pelvic trauma, the mortality, around 8 to 10%, is mainly related to severe pelvic hemorrhage but also to extrapelvic injuries (thoracic, abdominal or brain injuries). It is therefore crucial to manage pelvic trauma in specialized trauma center. The initial trauma assessment aims to determine the role of the pelvic injury in hemorrhage to define the therapeutic strategy of pelvic trauma care (arterial embolisation/pelvic ring stabilisation). This review was performed with a systematic review of the literature; it describes the pelvic fracture pathophysiology, and the efficacy and safety of haemostatic procedures and with their respective indications. A decision making algorithm is proposed for the treatment of trauma patients with pelvic fracture. Copyright © 2014. Published by Elsevier SAS.

  12. Environmental Management Technology Leveraging Initiative. Topical report, October 1, 1995--September 30, 1996

    SciTech Connect

    1996-12-31

    The ``Environmental Management Technology Leveraging Initiative,`` a cooperative agreement between the Global Environment and Technology Foundation and the Department of Energy-Morgantown Energy Technology Center, has completed its second year. This program, referred to as the Global Environmental Technology Enterprise (GETE) is an experiment to bring together the public and private sectors to identify, formulate, promote and refine methods to develop more cost-effective clean-up treatments. Working closely with Department of Energy officials, National Laboratory representatives, business people, academia, community groups, and other stakeholders, this program attempts to commercialize innovative, DOE-developed technologies. The methodology to do so incorporates three elements: business assistance, information, and outreach. A key advance this year was the development of a commercialization guidance document which can be used to diagnose the commercialization level and needs for innovative technologies.

  13. A simulation education course for the initial management of blunt trauma.

    PubMed

    Brautigam, Robert T; Schott, Eric; Burns, Karyl J

    2009-05-01

    A simulation education course was developed at Hartford Hospital to teach members of the trauma team the initial management of blunt trauma. Five educational scenarios were created using Sim-Man (Laerdal) with injuries to the 1. head, 2. chest, 3. abdomen, 4. extremities, and 5. multiple injuries. Students were assessed on self-efficacy and knowledge before and after participation in the scenarios, debriefing, and PowerPoint lectures. Self-efficacy increased significantly from pre- to posttesting for each of the five scenarios. Knowledge increased significantly from pre- to post-testing for the head, chest and extremities scenarios. The Simulation Education Course for Blunt Trauma is a worthwhile educational program. As with all educational efforts, attention must be given to course content, delivery, and evaluation.

  14. Post-game analysis: An initial experiment for heuristic-based resource management in concurrent systems

    NASA Technical Reports Server (NTRS)

    Yan, Jerry C.

    1987-01-01

    In concurrent systems, a major responsibility of the resource management system is to decide how the application program is to be mapped onto the multi-processor. Instead of using abstract program and machine models, a generate-and-test framework known as 'post-game analysis' that is based on data gathered during program execution is proposed. Each iteration consists of (1) (a simulation of) an execution of the program; (2) analysis of the data gathered; and (3) the proposal of a new mapping that would have a smaller execution time. These heuristics are applied to predict execution time changes in response to small perturbations applied to the current mapping. An initial experiment was carried out using simple strategies on 'pipeline-like' applications. The results obtained from four simple strategies demonstrated that for this kind of application, even simple strategies can produce acceptable speed-up with a small number of iterations.

  15. Hemophilia Management via Data Collection and Reporting: Initial Findings from the Comprehensive Care Sustainability Collaborative.

    PubMed

    Tarantino, Michael D; Pindolia, Vanita K

    2017-01-01

    Despite being a rare disorder, hemophilia represents a significant driver of health care resource utilization and requires expert hematologic and multidisciplinary services to achieve optimal outcomes. Since their inception nearly 40 years ago, hemophilia treatment centers (HTCs) have served as centers of excellence in providing the intensive care and ancillary services necessary for this unique patient base; however, the full capabilities of these centers may be underused in the current framework of managed care, largely because of a lack of communication and information shared between payers and HTC stakeholders. In an effort to enact tangible change toward improving the quality of care for bleeding disorders, the National Hemophilia Foundation developed an ongoing initiative among 18 leading clinicians and managed care decision makers called the Comprehensive Care Sustainability Collaborative (CCSC). The primary aim of the CCSC is to develop a framework for quality improvement pilot programs that can be replicated across the United States between payers and HTCs to facilitate cost-effective hemophilia management by integrating the HTC comprehensive care model. After CCSC committee members shared perspectives on care delivery, quality, and value, actionable data points were reviewed at length in order to develop meaningful metrics to facilitate information sharing between HTC and payer stakeholders. The following pragmatic measures will be reported by HTCs and payers via a series of pilot programs (reporting group is indicated in brackets): (a) patient classification by diagnosis (type, severity, and inhibitor status) [HTC]; (b) total cost of clotting factor [payer]; (c) prescribed factor dose/dispensed dose/patient weight (± range) [payer and HTC]; (d) emergency department visits/hospitalizations [payer and HTC]; (e) home infusion of clotting factor (%) [HTC]; (f) total cost per patient [payer]; and (g) patient contacts (e.g., clinic visits, follow

  16. Integrating risk management data in quality improvement initiatives within an academic neurosurgery department.

    PubMed

    McLaughlin, Nancy; Garrett, Matthew C; Emami, Leila; Foss, Sarah K; Klohn, Johanna L; Martin, Neil A

    2016-01-01

    OBJECT While malpractice litigation has had many negative impacts on health care delivery systems, information extracted from lawsuits could potentially guide toward venues to improve care. The authors present a comprehensive review of lawsuits within a tertiary academic neurosurgical department and report institutional and departmental strategies to mitigate liability by integrating risk management data with quality improvement initiatives. METHODS The Comprehensive Risk Intelligence Tool database was interrogated to extract claims/suits abstracts concerning neurosurgical cases that were closed from January 2008 to December 2012. Variables included demographics of the claimant, type of procedure performed (if any), claim description, insured information, case outcome, clinical summary, contributing factors and subfactors, amount incurred for indemnity and expenses, and independent expert opinion in regard to whether the standard of care was met. RESULTS During the study period, the Department of Neurosurgery received the most lawsuits of all surgical specialties (30 of 172), leading to a total incurred payment of $4,949,867. Of these lawsuits, 21 involved spinal pathologies and 9 cranial pathologies. The largest group of suits was from patients with challenging medical conditions who underwent uneventful surgeries and postoperative courses but filed lawsuits when they did not see the benefits for which they were hoping; 85% of these claims were withdrawn by the plaintiffs. The most commonly cited contributing factors included clinical judgment (20 of 30), technical skill (19 of 30), and communication (6 of 30). CONCLUSIONS While all medical and surgical subspecialties must deal with the issue of malpractice and liability, neurosurgery is most affected both in terms of the number of suits filed as well as monetary amounts awarded. To use the suits as learning tools for the faculty and residents and minimize the associated costs, quality initiatives addressing the

  17. Suicide risk of your client: initial identification and management for the allied health professional.

    PubMed

    Donley, Euan

    2013-01-01

    Allied health professionals treat clients in varying degrees of distress with complex needs in a wide range of services. A client could be experiencing a chronic or life-changing illness, have a trauma from a critical event, have preexisting mental illness, be dealing with significant health or personal loss, be using substances, or experiencing a depression. At some point an allied health professional will treat a client who may have a diagnosed depression, appear depressed, or have thoughts of suicide. Mental health of clients is everyone's responsibility, especially those working in health. This article aims to increase allied health professionals' understanding of some risk factors and clinical features a client at risk may have and will discuss some initial options of management. It is recommended the allied health professional and organisation be aware of risk factors for suicide but not rely too heavily on risk screening. The worker should have basic skills in recognising poor mood and have a list of useful questions to ask in a crisis. Know your local crisis and supportive mental health services, create links with them, have ongoing professional education and protocols for managing clients at-risk, and be acutely aware of your role and limitations.

  18. [Profile and initial management of infection in elderly patients in an Emergency Department].

    PubMed

    Martín-Sánchez, Francisco Javier; Julián-Jiménez, Agustín; Candel González, Francisco Javier; Llopis Roca, Ferrán; Martínez Ortiz de Zárate, Mikel; González Del Castillo, Juan

    To determine the clinical profile and the initial management of elderly patients with acute infections attending Spanish Emergency Departments (EDs), and to analyse whether there are any differences compared to younger adults. A descriptive, cross-sectional, multicentre study using the data recorded in the INFURG-SEMES register. It included a total of 79,654 of 15 years or over treated for an acute infection in 49 Spanish EDs between 10 October 2010 and 20 September 2011. Demographic variables, clinical profile, and care in the ED, were collected. The classifying variable was to be 65 years or over. Of the total of 11,399 cases, 4,255 (37.3%) were 65 years or over. Statistically significant differences were found on comparing the elderly with the younger adults as regards the presence of a high comorbidity (P<.001), of at least one risk factor for multidrug resistance (P<.001), or septic syndrome (P<.001), type of infection (P<.001), taking of the specimen for blood culture (P<.001), determination of antigens in urine (P<.001), the antibiotic prescribed in the ED (P<.001), and final destination (P<.001). There are significant age-dependent differences in the profile and management of patients with infections that attend Spanish EDs, which must be taken into account when developing strategies for improving quality, as well as for future lines of research. Copyright © 2016 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Technical report—Diagnosis and management of an initial UTI in febrile infants and young children.

    PubMed

    Finnell, S Maria E; Carroll, Aaron E; Downs, Stephen M

    2011-09-01

    The diagnosis and management of urinary tract infections (UTIs) in young children are clinically challenging. This report was developed to inform the revised, evidence-based, clinical guideline regarding the diagnosis and management of initial UTIs in febrile infants and young children, 2 to 24 months of age, from the American Academy of Pediatrics Subcommittee on Urinary Tract Infection. The conceptual model presented in the 1999 technical report was updated after a comprehensive review of published literature. Studies with potentially new information or with evidence that reinforced the 1999 technical report were retained. Meta-analyses on the effectiveness of antimicrobial prophylaxis to prevent recurrent UTI were performed. Review of recent literature revealed new evidence in the following areas. Certain clinical findings and new urinalysis methods can help clinicians identify febrile children at very low risk of UTI. Oral antimicrobial therapy is as effective as parenteral therapy in treating UTI. Data from published, randomized controlled trials do not support antimicrobial prophylaxis to prevent febrile UTI when vesicoureteral reflux is found through voiding cystourethrography. Ultrasonography of the urinary tract after the first UTI has poor sensitivity. Early antimicrobial treatment may decrease the risk of renal damage from UTI. Recent literature agrees with most of the evidence presented in the 1999 technical report, but meta-analyses of data from recent, randomized controlled trials do not support antimicrobial prophylaxis to prevent febrile UTI. This finding argues against voiding cystourethrography after the first UTI.

  20. Project W-211, initial tank retrieval systems, retrieval control system software configuration management plan

    SciTech Connect

    RIECK, C.A.

    1999-02-23

    This Software Configuration Management Plan (SCMP) provides the instructions for change control of the W-211 Project, Retrieval Control System (RCS) software after initial approval/release but prior to the transfer of custody to the waste tank operations contractor. This plan applies to the W-211 system software developed by the project, consisting of the computer human-machine interface (HMI) and programmable logic controller (PLC) software source and executable code, for production use by the waste tank operations contractor. The plan encompasses that portion of the W-211 RCS software represented on project-specific AUTOCAD drawings that are released as part of the C1 definitive design package (these drawings are identified on the drawing list associated with each C-1 package), and the associated software code. Implementation of the plan is required for formal acceptance testing and production release. The software configuration management plan does not apply to reports and data generated by the software except where specifically identified. Control of information produced by the software once it has been transferred for operation is the responsibility of the receiving organization.

  1. Common Ground: An Investigation of Environmental Management Alcohol Prevention Initiatives in a College Community*

    PubMed Central

    Wood, Mark D.; DeJong, William; Fairlie, Anne M.; Lawson, Doreen; Lavigne, Andrea M.; Cohen, Fran

    2009-01-01

    Objective: This article presents an evaluation of Common Ground, a media campaign-supported prevention program featuring increased enforcement, decreased alcohol access, and other environmental management initiatives targeting college student drinking. Method: Phase 1 of the media campaign addressed student resistance to environmentally focused prevention by reporting majority student support for alcohol policy and enforcement initiatives. Phase 2 informed students about state laws, university policies, and environmental initiatives. We conducted student telephone surveys, with samples stratified by gender and year in school, for 4 consecutive years at the intervention campus and 3 years at a comparison campus. We did a series of one-way between-subjects analyses of variance and analyses of covariance, followed by tests of linear trend and planned comparisons. Targeted outcomes included perceptions of enforcement and alcohol availability, alcohol use, and alcohol-impaired driving. We examined archived police reports for student incidents, primarily those resulting from loud parties. Results: There were increases at the intervention campus in students' awareness of formal alcohol-control efforts and perceptions of the alcohol environment, likelihood of apprehension for underage drinking, consequences for alcohol-impaired driving, and responsible alcohol service practices. There were decreases in the perceived likelihood of other students' negative behavior at off-campus parties. Police-reported incidents decreased over time; however, perceived consequences for off-campus parties decreased. No changes were observed for difficulty finding an off-campus party, self-reported alcohol use, or alcohol-impaired driving. Conclusions: The intervention successfully altered perceptions of alcohol enforcement, alcohol access, and the local alcohol environment. This study provides important preliminary information to researchers and practitioners engaged in collaborative

  2. Prevalence and predictors of early cardiovascular events after kidney transplantation: evaluation of pre-transplant cardiovascular work-up.

    PubMed

    Delville, Marianne; Sabbah, Laurent; Girard, Delphine; Elie, Caroline; Manceau, Sandra; Piketty, Marie; Martinez, Frank; Méjean, Arnaud; Legendre, Christophe; Sberro-Soussan, Rebecca

    2015-01-01

    Cardiovascular disease is the leading cause of mortality after renal transplantation. The purpose of this study was to analyze cardiovascular risk factors at transplantation, occurrence of cardiovascular events in the first year after transplantation and evaluate pre-transplant work-up. In total, 244 renal transplant recipients older than 50 years were included. The results of pre-transplant work-up, including clinical evaluation, electrocardiogram, echocardiography, myocardial perfusion testing and coronary angiography were analyzed. Patients had multiple risk factors at inclusion on renal transplantation waiting list as high blood pressure (94.7%), dyslipidemia (81.1%), smoking (45.3%), diabetes (23.6%), past history of cardiovascular disease (21.3%) and obesity (12.7%). Following transplantation, 15.5% (n = 38) of patients experienced a cardiovascular event, including 2.8% (n = 7) acute coronary syndrome, 5.8% (n = 14) isolated increase in troponin level and 5.3% (n = 13) new onset atrial fibrillation. The pre-transplant parameters associated with a cardiovascular event were a past medical history of cardiovascular disease (HR = 2.06 [1.06-4.03], p = 0.03), echocardiographic left ventricular hypertrophy (HR = 2.04 [1.04-3.98], p = 0.037) and abnormal myocardial perfusion testing (HR = 2.25 [1.09 -5.96], p = 0.03). Pre-transplantation evaluation allowed the diagnosis of unknown coronary artery lesions in 8.9% of patients.

  3. Diagnostic work up for language testing in patients undergoing awake craniotomy for brain lesions in language areas.

    PubMed

    Bilotta, Federico; Stazi, Elisabetta; Titi, Luca; Lalli, Diana; Delfini, Roberto; Santoro, Antonio; Rosa, Giovanni

    2014-06-01

    Awake craniotomy is the technique of choice in patients with brain tumours adjacent to primary and accessory language areas (Broca's and Wernicke's areas). Language testing should be aimed to detect preoperative deficits, to promptly identify the occurrence of new intraoperative impairments and to establish the course of postoperative language status. Aim of this case series is to describe our experience with a dedicated language testing work up to evaluate patients with or at risk for language disturbances undergoing awake craniotomy for brain tumour resection. Pre- and intra operative testing was accomplished with 8 tests. Intraoperative evaluation was accomplished when patients were fully cooperative (Ramsey < 3). Postoperative evaluation was scheduled at early (within 21 days) and long-term follow-up (3-6 months). Twenty consecutive patients were prospectively recruited. Preoperative language testings were normal in 9 patients (45%), showed mild to moderate language deficit in 8 (40%) and severe language deficit or aphasic disorders in 3 (15%). Broca's area was identified in 15 patients, in all cases by counting arrest during stimulation and in 12 cases by naming arrest. In this article we describe our experience using a language testing work up to evaluate - pre, intra and postoperatively - patients undergoing awake craniotomy for brain tumour resection with preoperative language disturbances or at risk for postoperative language deficits. This approach allows a systematic evaluation and recording of language function status and can be accomplished even when a neuropsychologist or speech therapist are not involved in the operation crew.

  4. Knowledge Management Initiatives Used to Maintain Regulatory Expertise in Transportation and Storage of Radioactive Materials - 12177

    SciTech Connect

    Lindsay, Haile; Garcia-Santos, Norma; Saverot, Pierre; Day, Neil; Gambone Rodriguez, Kimberly; Cruz, Luis; Sotomayor-Rivera, Alexis; Vechioli, Lucieann; Vera, John; Pstrak, David

    2012-07-01

    The U.S. Nuclear Regulatory Commission (NRC) was established in 1974 with the mission to license and regulate the civilian use of nuclear materials for commercial, industrial, academic, and medical uses in order to protect public health and safety, and the environment, and promote the common defense and security. Currently, approximately half (∼49%) of the workforce at the NRC has been with the Agency for less than six years. As part of the Agency's mission, the NRC has partial responsibility for the oversight of the transportation and storage of radioactive materials. The NRC has experienced a significant level of expertise leaving the Agency due to staff attrition. Factors that contribute to this attrition include retirement of the experienced nuclear workforce and mobility of staff within or outside the Agency. Several knowledge management (KM) initiatives have been implemented within the Agency, with one of them including the formation of a Division of Spent Fuel Storage and Transportation (SFST) KM team. The team, which was formed in the fall of 2008, facilitates capturing, transferring, and documenting regulatory knowledge for staff to effectively perform their safety oversight of transportation and storage of radioactive materials, regulated under Title 10 of the Code of Federal Regulations (10 CFR) Part 71 and Part 72. In terms of KM, the SFST goal is to share critical information among the staff to reduce the impact from staff's mobility and attrition. KM strategies in place to achieve this goal are: (1) development of communities of practice (CoP) (SFST Qualification Journal and the Packaging and Storing Radioactive Material) in the on-line NRC Knowledge Center (NKC); (2) implementation of a SFST seminar program where the seminars are recorded and placed in the Agency's repository, Agency-wide Documents Access and Management System (ADAMS); (3) meeting of technical discipline group programs to share knowledge within specialty areas; (4) development of

  5. Ongoing follow-up and support for chronic disease management in the Robert Wood Johnson Foundation Diabetes Initiative.

    PubMed

    Fisher, Edwin B; Brownson, Carol A; O'Toole, Mary L; Anwuri, Victoria V

    2007-06-01

    The purpose of this article is to identify approaches to providing ongoing follow-up and support for diabetes self-management based on the experience of 14 self-management projects of the Diabetes Initiative of the Robert Wood Johnson Foundation. This study is a collaboration with grantees of the Diabetes Initiative of the Robert Wood Johnson Foundation, a program focused on diabetes self-management in primary care and community settings. Grantees and national program staff identified key functions that ongoing follow-up and support need to fill and key features of programs that do so. Key functions of ongoing follow-up and support include monitoring of status and self-management, encouragement and facilitation of regular clinical care, encouragement and motivation of self-management, and facilitating skills for coping with changes in circumstances or emergent problems. Key features of ongoing follow-up and support to fill these functions are being available on demand; being proactive in maintaining contact and preventing individuals from "falling between the cracks"; having personal, motivational, and consistent key messages; not being limited to diabetes; and being inclusive of a wide range of resources and settings. Initial characterization of key features of ongoing follow-up and support has been accomplished. This should facilitate research to clarify how it may best be provided and systematic approaches to doing so. These should lead to health service and policy initiatives supporting this critical dimension of programs to promote self-management and lifelong healthy living patterns.

  6. The Gulf of Mexico Research Initiative: Managing a Multidisciplinary Data Explosion

    NASA Astrophysics Data System (ADS)

    Howard, M. K.; Gibeaut, J. C.; Reed, D.

    2011-12-01

    On April 20, 2010 the Deepwater Horizon drilling unit located in the northeastern Gulf of Mexico, experienced a catastrophic wellhead blowout. Roughly 5 billion barrels of oil and 1 million U.S. gallons of dispersant were released near the wellhead over the next three months. Within weeks of the blowout, BP announced the Gulf of Mexico Research Initiative (GRI) and pledged 50M/yr over 10 years for independent scientific research on the spill's impact on the ecosystem. Two months after the blowout three institutions were awarded a total of 25M in fast-track grants (Louisiana State University, Northern Gulf Institute, and Florida Institute of Oceanography). Soon after the Alabama Marine Environmental Sciences Consortium and the National Institutes of Health were awarded 5M and 10M, respectively. These five institutions began to generate data almost immediately. First year grants funded 100's of researchers from nearly 100 research units. Their activities included numerical modeling, field data collection, and laboratory experiments. Measured parameters included those associated with chemical analyses of oil, gas, and dispersants, studies of bacteria, plants and animals -from phytoplankton to marsh grasses, from zooplankton to cetaceans. Studies were conducted from estuaries to the deep Gulf, from atmosphere to sediments. Parameters from physical oceanography, marine meteorology, and biogeochemistry were measured in abundance. Additionally, impact studies on human mental, physical health and businesses were made. Proposals for years 2-4 of the program were to be awarded in August 2011 supporting 4-8 research consortia. Consortia may have up to 20 named researchers. In aggregate, these studies yielded a multidisciplinary data explosion. Following the fast-track awards the GRI Administrative Unit (AU) was established and a data management activity initiated. That activity became the GRI Information and Data Cooperative (GRIIDC). "Cooperative" emphasizes the

  7. The Western Energy Corridor Initiative: Unconventional Fuel Development Issues, Impacts, and Management Assessment

    NASA Astrophysics Data System (ADS)

    Wolfsberg, A.; Hagood, M.; Pasqualini, D.; Wood, T.; Wilson, C.; Witkowski, M.; Levitt, D.; Pawar, R.; Keating, G.; Ziock, H.

    2008-12-01

    The United States is increasingly dependent on imported oil and gas; commodities for which other nations are competing and for which future supply may be inadequate to support our transportation fuel needs. Therefore, a renewed interest in 'harder-to-get' unconventional fuels has emerged in both industry and government with directed focus on world class hydrocarbon resources within a corridor extending from Canada southward through the Rocky Mountain States. Within this Western Energy Corridor, co-located with significant conventional hydrocarbon and renewable energy resources, lie some of the world's richest unconventional hydrocarbon resources in oil shales, oil sands and coal for coal-to-liquid conversion. However, development of these resources poses substantial environmental concerns as well as increasing competition for limited resources of water and habitat. With large-scale energy development in the predominantly rural region, local communities, infrastructures, and economies will face increasing demands for roads, electricity, law enforcement, labor, and other support services. The Western Energy Corridor Initiative (WECI) seeks to develop an integrated assessment of the impacts of unconventional fuel development, the interrelationships of planned energy developments in different basins, and the resultant demands placed on the region. This initial WECI study focuses on two of the most important current issues for industry, regulators, and stakeholders -- the assessment of carbon and water resources issues, impacts, and management strategies. Through scenario analyses using coupled systems and process level models, this study investigates the viability of integrated development of multiple energy resources in a carbon neutral and environmentally acceptable manner, and the interrelationships of various energy resource development plans. The modeling framework is designed to extend to include infrastructure, employment, training, fiscal and economic demands

  8. Canadian pediatric emergency physician knowledge of concussion diagnosis and initial management.

    PubMed

    Zemek, Roger; Eady, Kaylee; Moreau, Katherine; Farion, Ken J; Solomon, Beverly; Weiser, Margaret; Dematteo, Carol

    2015-03-01

    Introduction The diagnosis of concussion is a critical step in the appropriate management of patients following minor head trauma. The authors hypothesized that wide practice variation exists among pediatric emergency medicine physicians in the application of physical and cognitive rest recommendations following an acute concussion. The authors developed a 35-item questionnaire incorporating case vignettes to examine pediatric emergency physician knowledge of concussion diagnosis, understanding of initial management using return-to-play/school/work guidelines, use of existing concussion protocols, and perceived barriers to protocol use. Using a modified Dillman technique, the authors distributed an online survey to members of Pediatric Emergency Research Canada, a national association of pediatric emergency physicians. Of 176 potential participants, 115 (65%) responded to the questionnaire, 89% (95% confidence interval [CI]: 0.81, 0.93) of whom reported having diagnosed 20 or more concussions annually. Although 90% (95% CI: 0.83, 0.94) of respondents adequately diagnosed concussion, only 64% (95% CI: 0.54, 0.72) correctly applied graduated return-to-play guidelines. Cognitive rest recommendations were also frequently limited: 40% (95% CI: 0.31, 0.49) did not recommend school absence, 30% (95% CI: 0.22, 0.39) did not recommend schoolwork reduction, and 35% (95% CI: 0.27, 0.45) did not recommend limiting screen time. Eighty percent (95% CI: 0.72, 0.87) of respondents reported having used guidelines frequently or always to guide clinical decisions regarding concussion. Despite a proficiency in the diagnosis of concussion, pediatric emergency physicians exhibit wide variation in recommending the graduated return to play and cognitive rest following concussion.

  9. Which Triple Aim related measures are being used to evaluate population management initiatives? An international comparative analysis.

    PubMed

    Hendrikx, Roy J P; Drewes, Hanneke W; Spreeuwenberg, Marieke; Ruwaard, Dirk; Struijs, Jeroen N; Baan, Caroline A

    2016-05-01

    Population management (PM) initiatives are introduced in order to create sustainable health care systems. These initiatives should focus on the continuum of health and well-being of a population by introducing interventions that integrate various services. To be successful they should pursue the Triple Aim, i.e. simultaneously improve population health and quality of care while reducing costs per capita. This study explores how PM initiatives measure the Triple Aim in practice. An exploratory search was combined with expert consultations to identify relevant PM initiatives. These were analyzed based on general characteristics, utilized measures and related selection criteria. In total 865 measures were used by 20 PM initiatives. All quality of care domains were included by at least 11 PM initiatives, while most domains of population health and costs were included by less than 7 PM initiatives. Although their goals showed substantial overlap, the measures applied showed few similarities between PM initiatives and were predominantly selected based on local priority areas and data availability. Most PM initiatives do not measure the full scope of the Triple Aim. Additionally, variety between measures limits comparability between PM initiatives. Consensus on the coverage of Triple Aim domains and a set of standardized measures could further both the inclusion of the various domains as well as the comparability between PM initiatives. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. Bivalved fiberglass cast compared with plaster splint immobilization for initial management of ankle fracture-dislocations: a treatment algorithm.

    PubMed

    Baker, Jeffrey R; Patel, Shail N; Teichman, Adam J; Bochat, Summer E S; Fleischer, Adam E; Knight, Jessica M

    2012-06-01

    The initial management of ankle fracture-dislocations is the crucial step in the treatment of these emergent traumatic injuries. A stepwise approach is necessary to properly evaluate, diagnose, and treat ankle fracture-dislocations. The goal of initial management is to evaluate the vascular status of the extremity and then restore proper alignment of the talus underneath the tibia. A retrospective review was performed on 40 patients, who presented to a community-based hospital emergency room, treated by the foot and ankle service for ankle fracture-dislocation. An analysis of patient demographics, injury pattern/classification, number of reduction attempts, and immobilization method was performed and evaluated. This analysis was correlated with a review of the literature to develop an algorithm for the initial management of ankle fracture-dislocations recommending the use of a bivalved below-the-knee fiberglass cast for maintained stabilization post reduction. Therapeutic Level IV.

  11. Second primary cancers after cancer of unknown primary in Sweden and Germany: efficacy of the modern work-up.

    PubMed

    Liu, Hao; Hemminki, Kari; Sundquist, Jan; Holleczek, Bernd; Katalinic, Alexander; Emrich, Katharina; Brenner, Hermann

    2013-05-01

    In unsparing efforts to find the hidden primaries, second primary cancers (SPCs) unrelated to cancer of unknown primary (CUP) are found. The detection rates of SPCs after CUP can be considered as measures for the effectiveness of modern diagnostic techniques in finding tumors. We aimed to compare the rates of specific SPCs found after the work-up of CUP and the more sign/symptom-directed diagnostic approaches applied after any other cancer. The number of CUP patients identified in the nationwide Swedish database and nine German cancer registries was 24 641 from 1997 through 2006, and rate ratios (RRs) for SPCs were recorded in two follow-up periods. The detection rate of SPCs immediately after any other cancer was about two times higher in Germany than in Sweden, but the rate immediately after CUP was almost the same for the two datasets. In the joint analyses after CUP, the RRs of liver, lung, breast, and kidney cancers were higher than after any other cancer, whereas the RRs of prostate, urinary bladder, and connective tissue cancers as well as non-Hodgkin's lymphoma were not significantly different; the RR of cancers of upper aerodigestive tract was lower after CUP than after any other cancer. The joint data indicate that the work-up is efficient in detecting tumors in the thoracoabdominal organs that are screened by computed tomography. For some other organ sites, the more sign/symptom-directed diagnostic approaches may be equally efficient. However, none of the applied techniques could detect all tumors immediately after the first diagnosis.

  12. Children with developmental language delay at 24 months of age: results of a diagnostic work-up.

    PubMed

    Buschmann, Anke; Jooss, Bettina; Rupp, André; Dockter, Sonja; Blaschtikowitz, Heike; Heggen, Iris; Pietz, Joachim

    2008-03-01

    The aim of this study was to evaluate if a diagnostic work-up should be recommended for 2-year-old children with developmental language delay (LD), or if the widely chosen 'wait and see' strategy is adequate. Children with LD were identified in paediatric practices during routine developmental check-ups using a German parent-report screening questionnaire (adapted from the MacArthur Communicative Development Inventories). A standardized German instrument and the Netherlands version of Bayley Scales of Infant Development (2nd ed.) were used to assess language ability and nonverbal cognitive development respectively in 100 children with LD (65 males, 35 females; mean age 24.7 mo [SD 0.9]) and a control group of 53 children with normal language development (33 males, 20 females; mean age 24.6 mo [SD 0.8]). Neurological and audiometric testing were also performed. Sixty-one per cent of the LD group had specific expressive LD and 17% specific receptive-expressive LD. In 22%, LD was associated with other neurodevelopmental problems, 6% showed significant deficits in nonverbal cognitive abilities, and in 12%, nonverbal cognitive abilities were borderline. Four per cent fulfilled the criteria of childhood autism. LD at 2 years proved to represent a sensitive marker for different developmental problems. Adequate early intervention requires a clear distinction between specific expressive or receptive-expressive LD and LD associated with other neurodevelopmental problems. Though catch-up development is to be expected in a substantial proportion of 'late talkers', our data demonstrate that a general 'wait and see' approach is not justified in young children with LD. A proposal for a rational diagnostic work-up is presented.

  13. Safety analysis of holmium-166 microsphere scout dose imaging during radioembolisation work-up: A cohort study.

    PubMed

    Braat, Arthur J A T; Prince, Jip F; van Rooij, Rob; Bruijnen, Rutger C G; van den Bosch, Maurice A A J; Lam, Marnix G E H

    2017-08-07

    Radioembolisation is generally preceded by a scout dose of technetium-99m-macroaggregated albumin to estimate extrahepatic shunting of activity. Holmium-166 microspheres can be used as a scout dose (±250 MBq) and as a therapeutic dose. The general toxicity of a holmium-166 scout dose ((166)Ho-SD) and safety concerns of an accidental extrahepatic deposition of (166)Ho-SD were investigated. All patients who received a (166)Ho-SD in our institute were reviewed for general toxicity and extrahepatic depositions. The absorbed dose in extrahepatic tissue was calculated on SPECT/CT and correlated to clinical toxicities. In total, 82 patients were included. No relevant clinical toxicity occurred. Six patients had an extrahepatic deposition of (166)Ho-SD (median administered activity 270 MBq). The extrahepatic depositions (median activity 3.7 MBq) were located in the duodenum (3x), gastric fundus, falciform ligament and the lesser curvature of the stomach, and were deposited in a median volume of 15.3 ml, which resulted in an estimated median absorbed dose of 3.6 Gy (range 0.3-13.8 Gy). No adverse events related to the extrahepatic deposition of the (166)Ho-SD occurred after a median follow-up of 4 months (range 1-12 months). These results support the safety of 250 MBq (166)Ho-SD in a clinical setting. • A holmium-166 scout dose is safe in a clinical setting. • Holmium-166 scout dose is a safe alternative for (99m) Tc-MAA for radioembolisation work-up. • Holmium-166 scout dose potentially has several benefits over (99m) Tc-MAA for radioembolisation work-up.

  14. Knowledge management as a mediator for the efficacy of transformational leadership and quality management initiatives in U.S. health care.

    PubMed

    Gowen, Charles R; Henagan, Stephanie C; McFadden, Kathleen L

    2009-01-01

    The health care industry has become one of the largest sectors of the U.S. economy and provides the greatest job growth of any industry. With such growth, effective leadership, knowledge management, and quality programs can ameliorate patient safety outcomes and improve organizational performance. This exploratory study examines the efficacy of transformational leadership, knowledge management, and quality initiatives, each of which has been proven effective in health care organizations. The literature has neglected the relationships among these three types of programs, although they are increasingly implemented simultaneously now. This research tests the degree to which knowledge management could act as a mediator of the effects transformational leadership and quality management have on organizational performance for hospitals. Our survey of U.S. hospitals utilizes validated scales from the literature. By calling and e-mailing quality and other department directors, the data set includes responses from all 50 states in our sample of 370 U.S. hospitals. Statistical tests confirmed acceptable regional distribution, interrater reliability, and control variable characteristics for our sample. Structural equation modeling is used to test the research hypotheses. These preliminary results reveal that transformational leadership and quality management improve knowledge management. In addition, transformational leadership is fully mediated by knowledge responsiveness and quality management is partially mediated by knowledge responsiveness for their effects on organizational performance. The unique contribution of this study includes the suggestion that greater transformational leadership skills are important for health care executives to motivate successful knowledge management initiatives. Secondly, continuous improvements in quality management programs have significant positive impacts on knowledge management and organizational outcomes in hospitals. Finally, successful

  15. Why don’t families initiate treatment? A qualitative multicentre study investigating parents’ reasons for declining paediatric weight management

    PubMed Central

    Perez, Arnaldo; Holt, Nicholas; Gokiert, Rebecca; Chanoine, Jean-Pierre; Legault, Laurent; Morrison, Katherine; Sharma, Arya; Ball, Geoff

    2015-01-01

    BACKGROUND: Many families referred to specialized health services for managing paediatric obesity do not initiate treatment; however, reasons for noninitiation are poorly understood. OBJECTIVE: To understand parents’ reasons for declining tertiary-level health services for paediatric weight management. METHOD: Interviews were conducted with 18 parents of children (10 to 17 years of age; body mass index ≥85th percentile) who were referred for weight management, but did not initiate treatment at one of three Canadian multidisciplinary weight management clinics. A semi-structured interview guide was used to elicit parents’ responses about reasons for noninitiation. Interviews were audio-recorded and transcribed verbatim. Data were managed using NVivo 9 (QSR International, Australia) and analyzed thematically. RESULTS: Most parents (mean age 44.1 years; range 34 to 55 years) were female (n=16 [89%]), obese (n=12 [66%]) and had a university degree (n=13 [71%]). Parents’ reasons for not initiating health services were grouped into five themes: no perceived need for paediatric weight management (eg, perceived children did not have a weight or health problem); no perceived need for further actions (eg, perceived children already had a healthy lifestyle); no intention to initiate recommended care (eg, perceived clinical program was not efficacious); participation barriers (eg, children’s lack of motivation); and situational factors (eg, weather). CONCLUSION: Physicians should not only discuss the need for and value of specialized care for managing paediatric obesity, but also explore parents’ intention to initiate treatment and address reasons for noninitiation that are within their control. PMID:26038633

  16. Extending stakeholder theory to promote resource management initiatives to key stakeholders: a case study of water transfers in Alberta, Canada.

    PubMed

    Lafreniere, Katherine C; Deshpande, Sameer; Bjornlund, Henning; Hunter, M Gordon

    2013-11-15

    Many attempts to implement resource management initiatives in Canadian and international communities have been resisted by stakeholders despite inclusion of their representatives in the decision-making process. Managers' failure to understand stakeholders' perspectives when proposing initiatives is a potential cause of this resistance. Our study uses marketing thought to enhance stakeholder theory by bringing in an audience-centric perspective. We attempt to understand how stakeholders perceive their interests in an organization and consequently decide how to influence that organization. By doing so, we investigate whether a disconnect exists between the perceptions of managers and those of stakeholders. Natural resource managers can utilize this knowledge to garner stakeholder support for the organization and its activities. We support this claim with findings from a water transfer plebiscite held in the Canadian province of Alberta. Sixteen personal interviews employing narrative inquiry were conducted to document voters' (i.e., irrigators') interpretations. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Current trends in initial management of oropharyngeal cancer: the declining use of open surgery.

    PubMed

    Haigentz, Missak; Silver, Carl E; Corry, June; Genden, Eric M; Takes, Robert P; Rinaldo, Alessandra; Ferlito, Alfio

    2009-12-01

    The widespread availability of novel primary treatment approaches against oropharyngeal cancers has provided several potentially curative surgical and nonsurgical treatment options for patients, generating both hope and controversy. As treatment is usually curative in intent, management considerations must include consideration of primary tumor and nodal disease control as well as long-term toxicities and functional outcomes. Anatomical and functional organ preservation (speech and deglutition) remains of paramount importance to patients with oropharyngeal cancer and the physicians involved in their care, accounting for the growing popularity of chemoradiotherapy and transoral surgical techniques for this indication. These novel approaches have greatly diminished the role of open surgery as initial therapy for oropharyngeal cancers. Open surgery which is often reserved for salvage on relapse, may still be an appropriate therapy for certain early stage primary lesions. The growing treatment armamentarium requires careful consideration for optimal individualized care. The identification of oncogenic human papillomavirus as a predictive and prognostic marker in patients with oropharyngeal cancer has great potential to further optimize the choice of treatment. In this review, novel primary therapies against oropharyngeal squamous cell carcinoma are presented in the context of anatomical, quality of life, and emerging biological considerations.

  18. [The clinical risk management: an initial experience of incident reporting in a surgical department].

    PubMed

    Savà, Giuseppina; Rumi, Tiziana; Meneghini, Antonella

    2010-01-01

    With the aim of adverse events monitoring in a critical care area, an initial experience of a near miss events registration in a department of surgery at Fondazione IRCCS Cà Granda Ospedale Policlinico di Milano is reported in this article. A period of time of two weeks for the anonymous compilation of reporting forms has been scheduled. Data derived from this survey focused the attention on two main problems: the drug prescribing and administration errors and those related to the clinical management of the patient. The second main issue that deserves to be discussed is the incident reporting interruption during the second week, due to a perception of futility of this procedure still linked to a mentality not adequately prepared to learn from errors. The thinking about adverse events has shifted from the person approach-blaming individuals for errors-to the system approach. The experience here reported underlines the importance of training courses and adequate preparation of health personnel on the aims and how to communicate an adverse event, in order to resume an effective and continuous incident reporting activity in a critical care area.

  19. Clinitest tablet ingestion: an in vitro investigation concerned with initial emergency management.

    PubMed

    Lacouture, P G; Gaudreault, P; Lovejoy, F H

    1986-02-01

    To help establish a rational approach to the initial management of Clinitest tablet ingestion, we investigated the effect of number of tablets, volume of diluent, and type of diluent on dissolution time (TD), temperature generation (delta T), and pH. Dissolution time was independent of the number of tablets and the volume of fluid; however, it was dependent on the type of fluid used. The thermal generation (delta T) was dependent on the number of tablets and volume of fluid, but was independent of the type of fluid used. The pH changes were independent of the number of tablets and volume of fluid; however, they were greatly dependent on the type of fluid. These data suggest that dissolution is rapid (in seconds) and, therefore, the most effective intervention may occur shortly after ingestion of the tablets; the larger the volume of diluting fluid, the smaller the risk of thermal damage from these ingestions; and orange juice should be considered as a possible diluent because it is capable of reducing the pH of the Clinitest tablet without increasing thermal generation.

  20. Antacids in the initial management of metallic zinc ingestion in dogs.

    PubMed

    van der Merwe, D; Tawde, S

    2009-04-01

    Zinc poisoning in dogs, following ingestion of post-1982 U.S. one cent coins is an increasingly common toxicological syndrome causing gastrointestinal abnormalities, hemolytic anemia, pancreatitis and renal failure. Thermodynamic laws predict that the rate of the chemical reaction between HCl and metallic zinc, which releases absorbable zinc anions, is dependent on pH. The significance of the relation between pH and dissolution is, however, apparently contradicted by the fact that recent veterinary toxicology texts are silent on the use of antacids in the early management of zinc ingestion in dogs. A series of experiments were conducted to test the hypotheses that the degree to which zinc dissolution is pH dependent is likely to be of clinical importance and that the use of antacids will be of benefit in preventing zinc poisoning in dogs that had ingested metallic zinc. Zinc dissolution was strongly dependent on pH in an exponential manner, indicating that clinically achievable upward adjustment of gastric pH using antacids is likely to have significant effects on the rate of zinc absorption in dogs. These data clearly support the use of antacids during the initial treatment of metallic zinc ingestion in dogs.

  1. Global Threat Reduction Initiative Fuel Thermo-Physical Characterization Project: Sample Management Plan

    SciTech Connect

    Casella, Amanda J.; Pereira, Mario M.; Steen, Franciska H.

    2013-01-01

    This sample management plan provides guidelines for sectioning, preparation, acceptance criteria, analytical path, and end-of-life disposal for the fuel element segments utilized in the Global Threat Reduction Initiative (GTRI), Fuel Thermo-Physical Characterization Project. The Fuel Thermo-Physical Characterization Project is tasked with analysis of irradiated Low Enriched Uranium (LEU) Molybdenum (U-Mo) fuel element samples to support the GTRI conversion program. Sample analysis may include optical microscopy (OM), scanning electron microscopy (SEM) fuel-surface interface analysis, gas pycnometry (density) measurements, laser flash analysis (LFA), differential scanning calorimetry (DSC), thermogravimetry and differential thermal analysis with mass spectroscopy (TG /DTA-MS), Inductively Coupled Plasma Spectrophotometry (ICP), alpha spectroscopy, and Thermal Ionization Mass Spectroscopy (TIMS). The project will utilize existing Radiochemical Processing Laboratory (RPL) operating, technical, and administrative procedures for sample receipt, processing, and analyses. Test instructions (TIs), which are documents used to provide specific details regarding the implementation of an existing RPL approved technical or operational procedure, will also be used to communicate to staff project specific parameters requested by the Principal Investigator (PI). TIs will be developed, reviewed, and issued in accordance with the latest revision of the RPL-PLN-700, RPL Operations Plan. Additionally, the PI must approve all project test instructions and red-line changes to test instructions.

  2. Implementation of Motivational Interviewing in a diabetes care management initiative in The Netherlands.

    PubMed

    van Eijk-Hustings, Yvonne J L; Daemen, Lianne; Schaper, Nicolaas C; Vrijhoef, Hubertus J M

    2011-07-01

    Motivational Interviewing (MI) is a counseling approach to support behavioural change. The objective of the present study was to examine the uptake of MI in daily practice by health care professionals in a care management initiative for patients with diabetes in the region of Maastricht, the Netherlands. MI was implemented by means of a training. Directly and six months after the training, the application of MI was measured objectively (MITI) and subjectively (questionnaire). In focus interviews, MI-trained professionals (n=10) and MI untrained professionals (n=10) were asked about facilitators and barriers for implementation. Additionally, data on patient characteristics (n=141) were collected. Spirit of MI was present among professionals directly after the training and increased during follow-up. Mostly uncomplicated techniques were applied. Professionals stated the need for training and practice to be able to apply more complicated techniques. The applicability of MI in daily practice was found feasible, with various degrees of uptake. Relevant conditions to further improve the implementation of MI in daily practice were identified. In daily practice, a phased training in MI is recommended, with sufficient time and support by colleagues as essential conditions to profit most from the training sessions. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  3. Initial Study of an Effective Fast-Time Simulation Platform for Unmanned Aircraft System Traffic Management

    NASA Technical Reports Server (NTRS)

    Xue, Min; Rios, Joseph

    2017-01-01

    Small Unmanned Aerial Vehicles (sUAVs), typically 55 lbs and below, are envisioned to play a major role in surveilling critical assets, collecting important information, and delivering goods. Large scale small UAV operations are expected to happen in low altitude airspace in the near future. Many static and dynamic constraints exist in low altitude airspace because of manned aircraft or helicopter activities, various wind conditions, restricted airspace, terrain and man-made buildings, and conflict-avoidance among sUAVs. High sensitivity and high maneuverability are unique characteristics of sUAVs that bring challenges to effective system evaluations and mandate such a simulation platform different from existing simulations that were built for manned air traffic system and large unmanned fixed aircraft. NASA's Unmanned aircraft system Traffic Management (UTM) research initiative focuses on enabling safe and efficient sUAV operations in the future. In order to help define requirements and policies for a safe and efficient UTM system to accommodate a large amount of sUAV operations, it is necessary to develop a fast-time simulation platform that can effectively evaluate requirements, policies, and concepts in a close-to-reality environment. This work analyzed the impacts of some key factors including aforementioned sUAV's characteristics and demonstrated the importance of these factors in a successful UTM fast-time simulation platform.

  4. Acute subdural haematoma in the conscious patient: outcome with initial non-operative management.

    PubMed

    Mathew, P; Oluoch-Olunya, D L; Condon, B R; Bullock, R

    1993-01-01

    We have retrospectively reviewed 23 conscious patients, in whom a CT scan diagnosis of acute subdural haematoma was made, and in whom craniotomy for evacuation was not initially performed. These highly selected patients represent 3% of 837 patients with acute subdural haematoma, presenting over a five year, eight month period to the Institute of Neurological Sciences, in Glasgow (1986-1991). Patients with any other associated intracranial abnormalities, such as cerebral contusions, as shown on CT, were excluded from this report. All patients were followed by serial CT scanning, and neurological assessments. Cerebral atrophy was present in over half of the sample. In 17 of our patients, the acute subdural haematoma resolved spontaneously, without evidence of damage to the underlying brain, as shown by CT or neurological findings. Six subsequently required burr hole drainage of a hypodense liquid subdural haematoma. In each of these patients, haematoma thickness was greater than 10 mm. Haematoma volume was significantly larger (53 +/- 6 ml versus 32 +/- 2 ml) in the group who came to operation. The mean delay between injury and operation in this group was 15 days. We conclude that certain conscious patients with small acute subdural haematomas, without mass effect on CT, may be safely managed conservatively.

  5. Incremental and infrequent hemodialysis: a new paradigm for both dialysis initiation and conservative management.

    PubMed

    Rhee, Connie M; Ghahremani-Ghajar, Mehrdad; Obi, Yoshitsugu; Kalantar-Zadeh, Kamyar

    2017-06-01

    Registry or national dialysis data show that a sizeable proportion of contemporary dialysis patients have substantial levels of residual kidney function especially upon transitioning to dialysis therapy. However, among incident hemodialysis patients, the prevailing paradigm has been to initiate "full-dose" triweekly treatment schedules irrespective of native kidney function in most developed countries. Recognizing the benefits of residual kidney function upon the health and survival of dialysis patients, there has been growing interest in incremental hemodialysis, in which dialysis frequency and dose are tailored according to the degree of patients' residual kidney function. Infrequent hemodialysis can also be used for those who prefer a more conservative approach in managing uremia. Clinical practice guidelines support the use of twice-weekly hemodialysis among patients with adequate residual kidney function (renal urea clearance >3 mL/min/1.73 m2), and a growing body of evidence indicates that incremental hemodialysis is associated with better preservation of residual kidney function without adversely impacting survival. Nonetheless, incremental hemodialysis remains an underutilized approach in this population. In this review, we will discuss the history of the twice- versus triweekly hemodialysis schedules; current clinical practice guidelines regarding infrequent hemodialysis; emerging data on incremental treatment regimens and outcomes; and guidelines for the practical implementation of incremental and infrequent hemodialysis in the clinical setting.

  6. The Zymark BenchMate™. A compact, fully-automated solution-phase reaction work-up facility for multiple parallel synthesis

    PubMed Central

    Hamlin, Gordon A.

    2000-01-01

    The rapid growth of multiple parallel synthesis in our laboratories has created a demand for a robust, easily accessed automated system for solution-phase reaction work-up, since the manual work-up of large numbers of small-scale reactions is both time-consuming and tedious, and is a rate limiting step in the generation of large numbers of compounds for test. Work-up in chemical organic synthesis consists of a series of post-reaction operations designed using differential chemical properties to remove excess reagent or starting material, reagent products and, where possible reaction by-products. Careful consideration of post-reaction operations as a clean-up step can obviate the requirement for purification. Generally, work-up can be resolved into four operations: filtration, solvent addition (dilution, trituration), washing and separation (partition) and it is the selection and ordering of these four basic operations that constitutes a chemical work-up. Following the proven success of centralized Zymate robotic systems in the compilation, execution and work-up of complex reaction sequences, a centralized chemical work-up service has been in operation for over 12 months. It now seemed prudent that the needs of multiple parallel synthesis would be better served by the development of a compact, automated system, capable of operating in a standard chemistry laboratory fume-hood. A Zymark BenchMate platform has been configured to perform the four basic operations of chemical solution work-up. A custom-built filtration station, incorporating an integrated tipping facility for the sample tube has also been developed. Compilation of each work-up is through a set of Visual Basic procedure screens, each dedicated to a particular work-up scenario. Methods are compiled at the chemist's own PC and transferred to the BenchMate via a diskette. PMID:18924692

  7. Singapore Cancer Network (SCAN) Guidelines for the Initial Evaluation, Diagnosis and Management of Retroperitoneal Soft Tissue Sarcoma.

    PubMed

    2015-10-01

    The SCAN sarcoma workgroup aimed to develop Singapore Cancer Network (SCAN) clinical practice guidelines for the initial evaluation, diagnosis and management of patients with retroperitoneal soft tissue sarcoma. The workgroup utilised a consensus approach to create high quality evidence-based clinical practice guidelines suited for our local setting. Various international guidelines from the fields of radiology, pathology, surgical, medical and radiation oncology were reviewed. Recommendations on the role of radiological imaging, pathology, surgery, radiotherapy and systemic therapy in the management of retroperitoneal soft tissue sarcoma were developed. These guidelines form the SCAN Guidelines 2015 for the diagnosis, staging and optimal management of patients with retroperitoneal soft tissue sarcoma.

  8. Case management process improvement protocol: transcribing an initial summary for the oncology geriatric patient in a rural satellite office.

    PubMed

    Henry, Regina A; Stanton, Marietta P

    2005-01-01

    This case management improvement project involved the provision of a transcribed summary of an initial clinic visit for elderly oncology patients at a rural satellite clinic. The aim of this project was to provide elderly patients at a rural satellite oncology clinic with a transcription of their encounter with the doctor and case manager when their diagnosis and treatment options were discussed. This project was introduced to improve communication and enhance satisfaction of the patients with their case management services. This low-cost intervention was implemented with 25 patients. Results demonstrated that the patient did express a high degree of satisfaction with this intervention.

  9. Initial urological evaluation and management of children with neurogenic bladder due to myelomeningocele.

    PubMed

    Sager, Cristian; Burek, Carol; Corbetta, Juan Pablo; Weller, Santiago; Ruiz, Javier; Perea, Ramiro; Lago, Enrique; Gomez, Yesica; Durán, Victor; López, Juan Carlos

    2017-06-01

    The proactive management of children with myelomeningocele (MMC) has contributed to decreasing their progression to end-stage renal disease, thanks to early urological evaluation and timing implementation of treatments. To demonstrate that early urological evaluation of the urinary tract in MMC shows functional alterations in most cases, and that it requires medical intervention, even when in some cases the complementary imaging studies do not show any abnormalities. A retrospective study including 60 patients aged <1 year with MMC who were followed by a multidisciplinary team. All of them underwent renal/bladder ultrasound, videourodynamic studies, renal scintigraphy/dimercaptosuccinic acid (DMSA), and laboratory tests for kidney function. The studied variables were: bladder capacity and pressure, presence of overactivity, vesicoureteral reflux (VUR), urinary dilations and abnormalities on renal scintigraphy/DMSA. All the patients received clean intermittent catheterization (CIC). See Summary Table all the patients showed alterations in at least some of the assessed urodynamic variables: reduced cystometric capacity, 21.6%; detrusor overactivity, 55%; end filling detrusor pressure >20 cm H2O, 43.3%; inefficient bladder voiding, 98.3%; indirect dyssynergic patterns, 28.8%. The high-risk videourodynamic findings were observed in 28 cases (46.6%). DMSA was abnormal in 30%. Renal impairment was detected in 6.6% of cases. A total of 66% of cases received oxybutynin. Almost all the children in this sample population showed urinary dysfunction, and approximately half of them had high-risk videourodynamic findings. Although many cases showed reflex urinary contractions, almost the entire sample had inefficient bladder voiding. An important limitation of this work was the lack of simultaneity in obtaining each of the requested studies. In the initial urological evaluation of patients with myelomeningocele, almost all the urodynamic studies showed abnormalities and one

  10. 30 CFR 250.522 - How do I manage the thermal effects caused by initial production on a newly completed or...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 2 2014-07-01 2014-07-01 false How do I manage the thermal effects caused by... Management § 250.522 How do I manage the thermal effects caused by initial production on a newly completed or recompleted well? A newly completed or recompleted well often has thermal casing pressure during initial...

  11. 30 CFR 250.521 - How do I manage the thermal effects caused by initial production on a newly completed or...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 2 2012-07-01 2012-07-01 false How do I manage the thermal effects caused by... Management § 250.521 How do I manage the thermal effects caused by initial production on a newly completed or recompleted well? A newly completed or recompleted well often has thermal casing pressure during initial...

  12. 30 CFR 250.522 - How do I manage the thermal effects caused by initial production on a newly completed or...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 2 2013-07-01 2013-07-01 false How do I manage the thermal effects caused by... Management § 250.522 How do I manage the thermal effects caused by initial production on a newly completed or recompleted well? A newly completed or recompleted well often has thermal casing pressure during initial...

  13. SDIO (Strategic Defense Initiative Office) Technical Information Management Center Bibliography of unclassified books: January-December 1986

    SciTech Connect

    Not Available

    1986-12-01

    This bibliography lists the Strategic Defense Initiative Organization Technical Information Management Center's holdings of publications pertaining to such topics as ballistic missile defense, arms control impact statements, beam weapons, strategic decision making, aluminum-lithium alloys, laser weapons, military space policy, and radar electronic counter countermeasures.

  14. Modeling the effects of irrigation frequencies, initial water and nitrogen on corn yield responses for best management

    USDA-ARS?s Scientific Manuscript database

    Competing demands for fresh water resources necessitate adaptation of limited water irrigations in agriculture. In this context, the Crop Water Production Functions (CWPF) used in limited water irrigation management need to integrate the effects of climate, initial soil water content at planting, an...

  15. Evaluation of the Pilot Program of the Truancy Case Management Partnership Initiative in the District of Columbia, 2011-12

    ERIC Educational Resources Information Center

    Liberman, Akiva; Cahill, Meagan

    2012-01-01

    This evaluation of the Case Management Partnership Initiative (CPMI) found that the program successfully linked high-need families with services designed to prevent truancy. The truancy prevention program, implemented at Anacostia and Ballou High Schools in 2011-2012, links chronically truant ninth graders and their families to social services and…

  16. Prospects for Learning in River Management: Exploring the Initial Implementation of the Water Framework Directive in a Swedish River Basin

    ERIC Educational Resources Information Center

    Lundmark, Carina; Jonsson, Gunnar

    2014-01-01

    This case study explores the initial implementation of the EU Water Framework Directive (WFD) in the Lule River basin, Sweden, examining how and to what extent administrative procedures enable learning through dialogue and stakeholder collaboration. Theorising on adaptive co-management and social learning is used to structure what is to be learnt,…

  17. "Life Could Be a Dream": What US-Based Management PhD Students Desire in an Initial Academic Appointment

    ERIC Educational Resources Information Center

    Flynn, C. Brian; Feild, Hubert S.; Bedeian, Arthur G.

    2011-01-01

    Purpose: The purpose of this paper is to first identify the work- and non-work-related criteria US-based management doctoral students consider important in selecting an initial academic appointment, and second, to explore whether gender and race/ethnicity are associated with the importance attached to these criteria. Design/methodology/approach:…

  18. SDIO (Strategic Defense Initiative Office) Technical Information Management Center Bibliography of unclassified reports: January-December 1985

    SciTech Connect

    Not Available

    1985-12-01

    This bibliography lists to Strategic Defense Initiative Organization Technical Information Management Centers holdings of publications pertaining to such topics as Liquid Droplet Radiators, Relay Lasers, Precision-Guided Munitions, Short-Wavelength Chemical Laser, Electromagnetic Rocket Guns, Space Weapon, and Antimissile Defense Systems.

  19. A Randomized Trial Adapting Contingency Management Targets Based on Initial Abstinence Status of Cocaine-Dependent Patients

    ERIC Educational Resources Information Center

    Petry, Nancy M.; Barry, Danielle; Alessi, Sheila M.; Rounsaville, Bruce J.; Carroll, Kathleen M.

    2012-01-01

    Objective: Contingency management (CM) reduces drug use, but questions remain regarding optimal targets and magnitudes of reinforcement. We evaluated the efficacy of CM reinforcing attendance in patients who initiated treatment with cocaine-negative samples, and of higher magnitude abstinence-based CM in patients who began treatment positive.…

  20. A Randomized Trial Adapting Contingency Management Targets Based on Initial Abstinence Status of Cocaine-Dependent Patients

    ERIC Educational Resources Information Center

    Petry, Nancy M.; Barry, Danielle; Alessi, Sheila M.; Rounsaville, Bruce J.; Carroll, Kathleen M.

    2012-01-01

    Objective: Contingency management (CM) reduces drug use, but questions remain regarding optimal targets and magnitudes of reinforcement. We evaluated the efficacy of CM reinforcing attendance in patients who initiated treatment with cocaine-negative samples, and of higher magnitude abstinence-based CM in patients who began treatment positive.…

  1. "Life Could Be a Dream": What US-Based Management PhD Students Desire in an Initial Academic Appointment

    ERIC Educational Resources Information Center

    Flynn, C. Brian; Feild, Hubert S.; Bedeian, Arthur G.

    2011-01-01

    Purpose: The purpose of this paper is to first identify the work- and non-work-related criteria US-based management doctoral students consider important in selecting an initial academic appointment, and second, to explore whether gender and race/ethnicity are associated with the importance attached to these criteria. Design/methodology/approach:…

  2. Prospects for Learning in River Management: Exploring the Initial Implementation of the Water Framework Directive in a Swedish River Basin

    ERIC Educational Resources Information Center

    Lundmark, Carina; Jonsson, Gunnar

    2014-01-01

    This case study explores the initial implementation of the EU Water Framework Directive (WFD) in the Lule River basin, Sweden, examining how and to what extent administrative procedures enable learning through dialogue and stakeholder collaboration. Theorising on adaptive co-management and social learning is used to structure what is to be learnt,…

  3. Hydrologic modification to improve habitat in riverine lakes: Management objectives, experimental approach, and initial conditions

    USGS Publications Warehouse

    Johnson, Barry L.; Barko, John W.; Gerasimov, Yuri; James, William F.; Litvinov, Alexander; Naimo, Teresa J.; Wiener, James G.; Gaugush, Robert F.; Rogala, James T.; Rogers, Sara J.; Schoettger, R.A.

    1996-01-01

    The Finger Lakes habitat-rehabilitation project is intended to improve physical and chemical conditions for fish in six connected back water lakes in Navigation Pool 5 of the upper Missouri River. The primary management objective is to improve water temperature, dissolved oxygen concentration and current velocity during winter for bluegills, Lepomis macrochirus, and black crappies, Pomoxis nigromaculatus, two of the primary sport fishes in the lakes. The lakes will be hydrologically altered by Installing culverts to Introduce controlled flows of oxygenated water into four lakes, and an existing unregulated culvert on a fifth lake will be equipped with a control gate to regulate inflow. These habitat modifications constitute a manipulative field experiment that will compare pre-project (1991 to summer 1993) and post-project (fall 1993 to 1996) conditions in the lakes, including hydrology, chemistry, rooted vegetation, and fish and macroinvertebrate communities. Initial data indicate that the Finger Lakes differ in water chemistry, hydrology, and macrophyte abundance. Macroinvertebrate communities also differed among lakes: species diversity was highest in lakes with dense aquatic macrophytes. The system seems to support a single fish community, although some species concentrated in individual lakes at different times. The introduction of similar flows into five of the lakes will probably reduce the existing physical and chemical differences among lakes. However, our ability to predict the effects of hydrologic modification on fish populations is limited by uncertainties concerning both the interactions of temperature, oxygen and current in winter and the biological responses of primary and secondary producers. Results from this study should provide guidance for similar habitat-rehabilitation projects in large rivers.

  4. Managing Curriculum: Rapid Implementation and Sustainability of a Districtwide Data Initiative

    ERIC Educational Resources Information Center

    Wayman, Jeffrey C.; Conoly, Katherine

    2006-01-01

    In March 2003, the Corpus Christi Independent School District (CCISD) received a Curriculum Management Audit report from the Texas Curriculum Management Audit Center of the Texas Association of School Administrators. One of the findings of this audit was that CCISD lacked a clear comprehensive management plan to define and guide the design,…

  5. The Effects of a State-Wide Conflict Management Initiative in Schools.

    ERIC Educational Resources Information Center

    Tschannen-Moran, Megan

    2001-01-01

    Describes qualitative and quantitative study of the impact of statewide grant program to implement conflict-management education programs in 50 high schools. Reports three approaches to conflict-management education: Curriculum infusion, peer mediation, and special events. Finds significant positive effects of conflict-management programs on…

  6. The value of the Thomas-plot in the diagnostic work up of anemic patients referred by general practitioners.

    PubMed

    Leers, M P G; Keuren, J F W; Oosterhuis, W P

    2010-12-01

    In patients with inflammatory conditions, diagnosing classic iron deficiency or anemia of chronic disease is challenging. In this study, we assessed the diagnostic value of the so-called Thomas'-plot [soluble transferrin receptor (sTfR)/log ferritin (sTfr/log Ferr) and the reticulocyte hemoglobin equivalent (Ret-HE)] in the anemia work up of patients referred by general practitioners. During July 2008-March 2009, 337 consecutive patients were included because of lowered Hb values. The laboratory results of the first 133 consecutive patients were used to determine the cut-off values for the diagnostic plot. The laboratory results of these patients were assessed and interpreted independently by two investigators, blinded from sTfR/log Ferr and Ret-HE values. The following 204 patients were used to test the plot in practice. In 32% of the first 133 patients, no indication of the cause of anemia could be found. However, when using the diagnostic plot in the following 204 patients, this fraction decreased to 14%. The 'Thomas'-plot is of diagnostic value for distinguishing functional iron deficiency from classic iron deficiency in a patient population referred by general practitioners.

  7. The immunophenotype of mast cells and its utility in the diagnostic work-up of systemic mastocytosis.

    PubMed

    Teodosio, Cristina; Mayado, Andrea; Sánchez-Muñoz, Laura; Morgado, José M; Jara-Acevedo, María; Álvarez-Twose, Ivan; García-Montero, Andrés C; Matito, Almudena; Caldas, Caldas; Escribano, Luis; Orfao, Alberto

    2015-01-01

    SM comprises a heterogeneous group of disorders, characterized by an abnormal accumulation of clonal MCs in 1 or more tissues, frequently involving the skin and BM. Despite the fact that most adult patients (>90%) carry the same genetic lesion (D816V KIT mutation), the disease presents with multiple variants with very distinct clinical and biologic features, a diverse prognosis, and different therapeutic requirements. Recent advances in the standardization of the study of BM MC by MFC allowed reproducible identification and characterization of normal/reactive MCs and their precursors, as well as the establishment of the normal MC maturational profiles. Analysis of large groups of patients versus normal/reactive samples has highlighted the existence of aberrant MC phenotypes in SM, which are essential for the diagnosis of the disease. In turn, 3 clearly distinct and altered maturation-associated immunophenotypic profiles have been reported recently in SM, which provide criteria for the distinction between ISM patients with MC-restricted and multilineage KIT mutation; thus, immunphenotyping also contributes to prognostic stratification of ISM, particularly when analysis of the KIT mutation on highly purified BM cells is not routinely available in the diagnostic work-up of the disease. © Society for Leukocyte Biology.

  8. Monozygotic twins with fetal akinesia: the importance of clinicopathological work-up in predicting risks of recurrence.

    PubMed

    Ho, N C

    2000-10-01

    Fetal Akinesia Deformation Sequence (FADS) or Pena-Shokeir Sequence is a heterogeneous group of disorders in which prolonged decrease or absence of fetal movements results in a series of deformational anomalies: multiple contractures, pulmonary hypoplasia, craniofacial anomalies, polyhydramnios, intrauterine growth retardation, and short umbilical cord. Three sets of monozygotic twins, and their affected sibs, are presented. Detailed pathological work-up established that the two pairs of twins concordant for FADS were of myogenic etiology while the set discordant was due to anoxic-ischemic damage. In the myogenic cases, the rate of recurrence was high, in agreement with the findings from the study on arthrogryposis multiplex congenita of myogenic origin. In light of these findings, in sporadic cases of myogenic FADS, counselling, a recurrence risk of 25% seems prudent. In neurogenic cases associated with primary cerebral malformations, there are cases cited in the literature that are clearly recessive as indicated by affected sibs, but many reported are isolated occurrences. Therefore, in this scenario, giving a recurrent risk of 10-15% appears appropriate. In light of autosomal recessive spinal muscular atrophy and reports of familial FADS due to primary anterior horn cell loss, counselling a 25% risk seems prudent. In cases due to anoxic-ischemic damage, offering a low recurrent risk of 1% appears justified.

  9. The yield of diagnostic work-up of patients presenting with myalgia, exercise intolerance, or fatigue: A prospective observational study.

    PubMed

    Te Riele, M G E; Schreuder, T H A; van Alfen, N; Bergman, M; Pillen, S; Smits, B W; van der Wilt, G J; Groenewoud, H; Voermans, N C; van Engelen, B G M

    2017-03-01

    Myalgia, fatigue, and exercise intolerance are cause for referral to a neurologist. However, the diagnostic value of history, neurological examination, and ancillary investigations in patients with these symptoms is unknown. This study provides a sound footing for deciding which ancillary investigations should be conducted. A prospective observational study of the diagnostic approach in 187 patients with myalgia, exercise intolerance, or fatigue as their predominant symptom was performed. The primary outcomes were independent contribution of referral letter, history, examination, and ancillary investigations to a myopathy diagnosis. The secondary outcome was diagnostic value of combined ancillary investigations. 27% of patients had a myopathy. Positive family history (OR 3.2), progressive symptoms (OR 2.2), atrophy (OR 9.7), weakness (OR 10.9), and hyporeflexia (OR 4.4) were associated with a myopathy. Positive predictive values for myopathy were calculated for CK (0.32), EMG (0.66), ultrasound (0.47), and muscle biopsy (0.78). All contributed significantly in predicting myopathy. Multivariate analysis yielded a diagnostic algorithm facilitating a more efficient work-up in future patients. CK levels, EMG, ultrasound, and muscle biopsy independently contribute to predicting a myopathy. The diagnostic algorithm shows which combination of ancillary investigations should be employed in different subgroups and when to omit invasive techniques. This algorithm may drastically improve diagnostic efficiency.

  10. Angiographic CT with intravenous contrast injection compared with conventional rotational angiography in the diagnostic work-up of cerebral aneurysms.

    PubMed

    Gölitz, P; Struffert, T; Knossalla, F; Saake, M; Ott, S; Ganslandt, O; Doerfler, A

    2012-05-01

    Noninvasive imaging of cerebral aneurysms is still considered inferior to conventional angiography. The purpose of this study was to evaluate the diagnostic accuracy of ivACT in the assessment of intracranial aneurysms compared with 3D-DSA. We included 13 patients with 15 incidental unruptured saccular aneurysms scheduled for diagnostic angiographic work-up in our study. In each patient, we performed an ivACT and a conventional angiography including a 3D rotational run. During postprocessing, MPR images were generated for each technique. Maximal aneurysm diameter, neck diameter, aneurysm height, maximum width, bulge height, parent artery diameter, and angle between the parent artery and aneurysm apex were measured for each aneurysm. 3D-DSA and ivACT both provided images of high quality without artificial disturbances (ie, motion artifacts). Measurements of all parameters resulted in comparable values for both modalities with a strong correlation (P ≤ .001). ivACT is feasible for the noninvasive visualization of saccular cerebral aneurysms and may provide reliable diagnostic information for the assessment of aneurysm size and geometry comparable with conventional intra-arterial 3D rotational angiography. These preliminary results might be a first promising step to replacing conventional angiography in preinterventional aneurysm imaging.

  11. The Gulf of Mexico Research Initiative Information and Data Cooperative: Multidisciplinary data management from the ground up

    NASA Astrophysics Data System (ADS)

    Showalter, L. M.; Gibeaut, J. C.

    2015-12-01

    As more journals and funding organizations require data to be made available, more and more scientists are being exposed to the world of data science, metadata development, and data standards so they can ensure future funding and publishing success. The Gulf of Mexico Research Initiative Information and Data Cooperative (GRIIDC) is the vehicle by which the Gulf of Mexico Research Initiative (GOMRI) is making all data collected in this program publically available. This varied group of researchers all have different levels of experience with data management standards and protocols, thus GRIIDC has evolved to embrace the cooperative nature of our work and develop a number of tools and training materials to help ensure data managers and researchers in the GoMRI program are submitting high quality data and metadata that will be useful for years to come. GRIIDC began with a group of 8 data managers many of which had only ever managed their own data, who were then expected to manage the data of a large group of geographically distant researchers. As the program continued to evolve these data managers worked with the GRIIDC team to help identify and develop much needed resources for training and communication for themselves and the scientists they represented. This essential cooperation has developed a team of highly motivated scientists, computer programmers and data scientists who are working to ensure a data and information legacy that promotes continual scientific discovery and public awareness of the Gulf of Mexico Ecosystem and beyond.

  12. Race/ethnicity and the receipt of watchful waiting for the initial management of prostate cancer.

    PubMed

    Shavers, Vickie L; Brown, Martin L; Potosky, Arnold L; Klabunde, Carrie N; Davis, W W; Moul, Judd W; Fahey, Angela

    2004-02-01

    Several recent studies have noted that African Americans disproportionately receive "watchful waiting" for the initial management of their prostate cancer. To determine whether racial/ethnic differences in the receipt of watchful waiting are explained by differences in clinical presentation and life expectancy at the time of diagnosis, we examined Surveillance, Epidemiology, and End Results (SEER)-Medicare data for men diagnosed with prostate cancer in 1994 to 1996. Race/ethnicity, comorbidity, stage, grade, age, and expected lifespan and their association with the receipt of watchful waiting were examined in multivariate logistic regression analyses. Race-stratified logistic regression analyses were also used to examine racial/ethnic variation in the association of clinical and demographic factors with the receipt of watchful waiting among African-American, Hispanic, and non-Hispanic white men. African-American (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.3 to 1.6) and Hispanic men (OR, 1.3; 95% CI, 1.1 to 1.5) were significantly more likely than non-Hispanic white men to receive watchful waiting in a multivariate model adjusted for age, comorbidity, stage, grade, and life expectancy. Advanced stage and grade, lower life expectancy, older age, and high comorbidity indices were also significantly associated with an increase in the odds of receipt of watchful waiting in multivariate analyses. In general, the association between the receipt of watchful waiting and the clinical characteristics (i.e., stage, grade, and age) were similar for the three racial/ethnic groups. In race-stratified logistic regression analyses, life expectancy was associated with an increase in the odds of receiving watchful waiting but results were statistically significant for whites only. There was also a statistically significant increase in the odds of receiving watchful waiting for African-American and white men with high comorbidity indices but not Hispanic men. The odds of

  13. Race/Ethnicity and the Receipt of Watchful Waiting for the Initial Management of Prostate Cancer

    PubMed Central

    Shavers, Vickie L; Brown, Martin L; Potosky, Arnold L; Klabunde, Carrie N; Davis, WW; Moul, Judd W; Fahey, Angela

    2004-01-01

    INTRODUCTION Several recent studies have noted that African Americans disproportionately receive “watchful waiting” for the initial management of their prostate cancer. To determine whether racial/ethnic differences in the receipt of watchful waiting are explained by differences in clinical presentation and life expectancy at the time of diagnosis, we examined Surveillance, Epidemiology, and End Results (SEER)-Medicare data for men diagnosed with prostate cancer in 1994 to 1996. METHODS Race/ethnicity, comorbidity, stage, grade, age, and expected lifespan and their association with the receipt of watchful waiting were examined in multivariate logistic regression analyses. Race-stratified logistic regression analyses were also used to examine racial/ethnic variation in the association of clinical and demographic factors with the receipt of watchful waiting among African-American, Hispanic, and non-Hispanic white men. RESULTS African-American (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.3 to 1.6) and Hispanic men (OR, 1.3; 95% CI, 1.1 to 1.5) were significantly more likely than non-Hispanic white men to receive watchful waiting in a multivariate model adjusted for age, comorbidity, stage, grade, and life expectancy. Advanced stage and grade, lower life expectancy, older age, and high comorbidity indices were also significantly associated with an increase in the odds of receipt of watchful waiting in multivariate analyses. In general, the association between the receipt of watchful waiting and the clinical characteristics (i.e., stage, grade, and age) were similar for the three racial/ethnic groups. In race-stratified logistic regression analyses, life expectancy was associated with an increase in the odds of receiving watchful waiting but results were statistically significant for whites only. There was also a statistically significant increase in the odds of receiving watchful waiting for African-American and white men with high comorbidity indices but

  14. The Han River watershed management initiative for the South-to-North Water Transfer project (Middle Route) of China.

    PubMed

    Zhang, Quanfa; Xu, Zhifang; Shen, Zehao; Li, Siyue; Wang, Shusen

    2009-01-01

    The South-to-North Water Transfer (SNWT) Project of China is the largest of its kind ever implemented. Of its three routes (i.e., East, Middle and West), the middle one will transfer 14 billion m(3) of water annually from the Han River, a tributary of the Yangtze and the water supplying area, to Beijing by 2030. Thus water quality in the 95,000 km(2) upper Han River basin is of great concern. A watershed management initiative has been implemented in the basin, and the ultimate objectives are to quantify basin's ecosystem functioning and to develop an integrated management system with respect to water resources conservation. Specifically, the program includes five activities: characterization of riparian ecosystems, detection of land use and land cover change, quantification of nutrient cycling of representative ecosystems, determination of spatial and temporal variations of water quality, and finally development of a watershed management system for water conservation. This article provides the justifications of the watershed management initiative and the initial results are comprehended with respect to the water conservation in the Han River basin.

  15. A diabetes management mentor program: outcomes of a clinical nurse specialist initiative to empower staff nurses.

    PubMed

    Modic, Mary Beth; Canfield, Christina; Kaser, Nancy; Sauvey, Rebecca; Kukla, Aniko

    2012-01-01

    The purpose of this project was to enhance the knowledge of the bedside nurse in diabetes management. A forum for ongoing support and exploration of clinical problems, along with the distribution of educational tools were the components of this program. Diabetes accounts for 30% of patients admitted to the hospital. It has become more challenging to manage as the treatment choices have increased. There are a number of researchers who have identified nurse and physician knowledge of diabetes management principles as suboptimal. DESCRIPTION OF THE INNOVATION: Staff nurses are educated for a role as a Diabetes Management Mentor and are expected to educate/dialogue with peers monthly, model advocacy and diabetes patient education skills, facilitate referrals for diabetes education, and direct staff to resources for diabetes management. Diabetes Management Mentors feel more confident in their knowledge of diabetes and their ability to resolve clinical issues as they arise. The Diabetes Management Mentor role is another avenue for nurses to refine their clinical knowledge base and acquire skills to share with colleagues while remaining at the bedside. The clinical nurse specialist is expertly prepared to foster the professional development of bedside nurses while simultaneously making a positive impact on disease management. Opportunity for future investigation includes efficacy of teaching tools on diabetes mastery, the effect of clinical nurse specialist mentoring on a select group of bedside nurses, and the Diabetes Management Mentor's impact on prevention of near-miss events.

  16. 40 CFR 63.11584 - What are my initial and continuous compliance management practice requirements?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... condition. (iii) An initial inspection of the internal components of a wet or dry particulate control system... activities in paragraph (a)(2) of this section. (1) Initial vent collection system and particulate control... wet particulate control system, you must verify the presence of water flow to the control...

  17. Goal Specificity and Difficulty and Leader Initiating Structure as Strategies for Managing Role Stress.

    ERIC Educational Resources Information Center

    Lee, Cynthia; Schuler, Randall S.

    1980-01-01

    Presents a role perception model of goal setting content and leader initiating structure to examine their effectiveness as strategies to reduce role stress and to increase employee satisfaction. Results indicated that both goal setting content and leader initiating structure are related to employee satisfaction. (Author)

  18. A Survey of Digital Cultural Heritage Initiatives and Their Sustainability Concerns. Managing Economic Challenges.

    ERIC Educational Resources Information Center

    Zorich, Diane M.

    In September 2002, the Council on Library and Information Re-sources (CLIR) commissioned a survey of North American-based digital cultural heritage initiatives (DCHIs). The purpose of the survey was to identify the scope, financing, organizational structure, and sustainability of DCHIs. To gain a funder's perspective on these initiatives, the…

  19. Understanding the experience of care managers and relationship with patient outcomes: the COMPASS initiative.

    PubMed

    Coleman, Karen J; Hemmila, Tani; Valenti, Mark D; Smith, Nasya; Quarrell, Rachel; Ruona, Lynnice K; Brandenfels, Emily; Hann, Barbara; Hinnenkamp, Todd; Parra, Margarita D; Monkman, Jeyn; Vos, Sue; Rossom, Rebecca C

    To understand how care managers implemented COMPASS and if this was related to patient health outcomes. A total of 96 COMPASS care managers were approached to participate in the online survey and 93 (97%) provided responses. Correlations were generated between key survey responses and the average number of care management contacts, patient depression, blood pressure and glycosylated hemoglobin outcomes. Patients of care managers who reported spending more time on COMPASS-related tasks had higher rates of depression improvement (r=0.34; P=.002) and remission (r=0.27; P=.02) as well as higher rates of blood pressure control (r=0.29; P=.03). To improve the effectiveness of care management in collaborative care models, particularly for patients with comorbid conditions and complex nonmedical needs, care managers need the support of social work and administrative support staff. Care managers for this patient population would also benefit from more intensive training in nonpharmacological depression treatment, such as motivational interviewing and behavioral activation. Additionally, systems support is needed such as education for primary care teams and psychiatry on the value of collaborative care models and integration of population management tools into electronic medical records. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Misfit and Match: The Frontline Management Initiative in the Community Services and Health Industry.

    ERIC Educational Resources Information Center

    Roos, Ian; Smith, Chris Selby; Wright, Liz

    The application of frontline management training in the community and health services (CS&H) industry in Victoria, Australia, was examined through interviews with managers of 11 user and 11 provider organizations in the public and private sectors. The study focused on the following topics: (1) the appropriateness of the Frontline Management…

  1. Pre-hospital and initial management of head injury patients: An update.

    PubMed

    Chowdhury, Tumul; Kowalski, Stephen; Arabi, Yaseen; Dash, Hari Hara

    2014-01-01

    Most of the bad outcomes in patients with severe traumatic brain injury (TBI) are related to the presence of a high incidence of pre-hospital secondary brain insults. Therefore, knowledge of these variables and timely management of the disease at the pre-hospital period can significantly improve the outcome and decrease the mortality. The Brain Trauma Foundation guideline on "Prehospital Management" published in 2008 could provide the standardized protocols for the management of patients with TBI; however, this guideline has included the relevant papers up to 2006. A PubMed search for relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic, was conducted. Based on the evidence, majority of the management strategies comprise of rapid correction of hypoxemia and hypotension, the two most important predictors for mortality. However, there is still a need to define the goals for the management of hypotension and inclusion of newer difficult airway carts as well as proper monitoring devices for ensuring better intubation and ventilatory management. Isotonic saline should be used as the first choice for fluid resuscitation. The pre-hospital hypothermia has more adverse effects; therefore, this should be avoided. Most of the management trials published after 2007 have focused mainly on the treatment as well as the prevention strategies for secondary brain injury. The results of these trials would be certainly adopted by new standardized guidelines and therefore may have a substantial impact on the pre-hospital management in patients with TBI.

  2. Managing and Creating an Image in the Interview: The Role of Interviewee Initial Impressions

    ERIC Educational Resources Information Center

    Swider, Brian W.; Barrick, Murray R.; Harris, T. Brad; Stoverink, Adam C.

    2011-01-01

    In employment interviews, individuals use impression management tactics to present themselves as suitable candidates to interviewers. However, not all impression management tactics, or the interviewees who employ them, are effective at positively influencing interview scores. Results of this study indicate that the relationship between impression…

  3. Predictors of Outcomes in Diabetic Foot Osteomyelitis Treated Initially With Conservative (Nonsurgical) Medical Management: A Retrospective Study.

    PubMed

    Zeun, Paul; Gooday, Catherine; Nunney, Ian; Dhatariya, Ketan

    2016-03-01

    The optimal way to manage diabetic foot osteomyelitis remains uncertain, with debate in the literature as to whether it should be managed conservatively (ie, nonsurgically) or surgically. We aimed to identify clinical variables that influence outcomes of nonsurgical management in diabetic foot osteomyelitis. We conducted a retrospective study of consecutive patients with diabetes presenting to a tertiary center between 2007 and 2011 with foot osteomyelitis initially treated with nonsurgical management. Remission was defined as wound healing with no clinical or radiological signs of osteomyelitis at the initial or contiguous sites 12 months after clinical and/or radiological resolution. Nine demographic and clinical variables including osteomyelitis site and presence of foot pulses were analyzed. We identified 100 cases, of which 85 fulfilled the criteria for analysis. After a 12-month follow-up period, 54 (63.5%) had achieved remission with nonsurgical management alone with a median (interquartile range) duration of antibiotic treatment of 10.8 (10.1) weeks. Of these, 14 (26%) were admitted for intravenous antibiotics. The absence of pedal pulses in the affected foot (n = 34) was associated with a significantly longer duration of antibiotic therapy to achieve remission, 8.7 (7.1) versus 15.9 (13.3) weeks (P = .003). Osteomyelitis affecting the metatarsal was more likely to be amputated than other sites of the foot (P = .016). In line with previous data, we have shown that almost two thirds of patients presenting with osteomyelitis healed without undergoing surgical bone resection.

  4. Enhancing patient engagement in chronic disease self-management support initiatives in Australia: the need for an integrated approach.

    PubMed

    Jordan, Joanne E; Briggs, Andrew M; Brand, Caroline A; Osborne, Richard H

    2008-11-17

    Although emphasis on the prevention of chronic disease is important, governments in Australia need to balance this with continued assistance to the 77% of Australians reported to have at least one long-term medical condition. Self-management support is provided by health care and community services to enhance patients' ability to care for their chronic conditions in a cooperative framework. In Australia, there is a range of self-management support initiatives that have targeted patients (most notably, chronic disease self-management education programs) and health professionals (financial incentives, education and training). To date, there has been little coordination or integration of these self-management initiatives to enhance the patient-health professional clinical encounter. If self-management support is to work, there is a need to better understand the infrastructure, systems and training that are required to engage the key stakeholders - patients, carers, health professionals, and health care organisations. A coordinated approach is required in implementing these elements within existing and new health service models to enhance uptake and sustainability.

  5. Including policy and management in socio-hydrology models: initial conceptualizations

    NASA Astrophysics Data System (ADS)

    Hermans, Leon; Korbee, Dorien

    2017-04-01

    Socio-hydrology studies the interactions in coupled human-water systems. So far, the use of dynamic models that capture the direct feedback between societal and hydrological systems has been dominant. What has not yet been included with any particular emphasis, is the policy or management layer, which is a central element in for instance integrated water resources management (IWRM) or adaptive delta management (ADM). Studying the direct interactions between human-water systems generates knowledges that eventually helps influence these interactions in ways that may ensure better outcomes - for society and for the health and sustainability of water systems. This influence sometimes occurs through spontaneous emergence, uncoordinated by societal agents - private sector, citizens, consumers, water users. However, the term 'management' in IWRM and ADM also implies an additional coordinated attempt through various public actors. This contribution is a call to include the policy and management dimension more prominently into the research focus of the socio-hydrology field, and offers first conceptual variables that should be considered in attempts to include this policy or management layer in socio-hydrology models. This is done by drawing on existing frameworks to study policy processes throughout both planning and implementation phases. These include frameworks such as the advocacy coalition framework, collective learning and policy arrangements, which all emphasis longer-term dynamics and feedbacks between actor coalitions in strategic planning and implementation processes. A case about longter-term dynamics in the management of the Haringvliet in the Netherlands is used to illustrate the paper.

  6. Education and training initiatives for crisis management in the European Union: a web-based analysis of available programs.

    PubMed

    Ingrassia, Pier Luigi; Foletti, Marco; Djalali, Ahmadreza; Scarone, Piercarlo; Ragazzoni, Luca; Corte, Francesco Della; Kaptan, Kubilay; Lupescu, Olivera; Arculeo, Chris; von Arnim, Gotz; Friedl, Tom; Ashkenazi, Michael; Heselmann, Deike; Hreckovski, Boris; Khorram-Manesh, Amir; Khorrram-Manesh, Amir; Komadina, Radko; Lechner, Kostanze; Patru, Cristina; Burkle, Frederick M; Fisher, Philipp

    2014-04-01

    Education and training are key elements of disaster management. Despite national and international educational programs in disaster management, there is no standardized curriculum available to guide the European Union (EU) member states. European- based Disaster Training Curriculum (DITAC), a multiple university-based project financially supported by the EU, is charged with developing a holistic and highly-structured curriculum and courses for responders and crisis managers at a strategic and tactical level. The purpose of this study is to qualitatively assess the prevailing preferences and characteristics of disaster management educational and training initiatives (ETIs) at a postgraduate level that currently exist in the EU countries. An Internet-based qualitative search was conducted in 2012 to identify and analyze the current training programs in disaster management. The course characteristics were evaluated for curriculum, teaching methods, modality of delivery, target groups, and funding. The literature search identified 140 ETIs, the majority (78%) located in United Kingdom, France, and Germany. Master level degrees were the primary certificates granted to graduates. Face-to-face education was the most common teaching method (84%). Approximately 80% of the training initiatives offered multi- and cross-disciplinary disaster management content. A competency-based approach to curriculum content was present in 61% of the programs. Emergency responders at the tactical level were the main target group. Almost all programs were self-funded. Although ETIs currently exist, they are not broadly available in all 27 EU countries. Also, the curricula do not cover all key elements of disaster management in a standardized and competency-based structure. This study has identified the need to develop a standardized competency-based educational and training program for all European countries that will ensure the practice and policies that meet both the standards of care and

  7. Singapore Cancer Network (SCAN) Guidelines for the Initial Evaluation, Diagnosis, and Management of Extremity Soft Tissue Sarcoma and Osteosarcoma.

    PubMed

    2015-10-01

    The SCAN sarcoma workgroup aimed to develop Singapore Cancer Network (SCAN) clinical practice guidelines for the initial evaluation, diagnosis, and management of extremity soft tissue sarcoma and osteosarcoma. The workgroup utilised a consensus approach to create high quality evidence-based clinical practice guidelines suited for our local setting. Various international guidelines from the fields of radiology, pathology, orthopaedic surgery, medical, radiation and paediatric oncology were reviewed, including those developed by von Mehren Metal (J Natl Compr Canc Netw 2014), the National Collaborating Centre for Cancer (2006), the European Sarcoma Network Working Group (2012) and Grimer RJ et al (Sarcoma 2008). Our clinical practice guidelines contextualised to the local patient will streamline care and improve clinical outcomes for patients with extremity soft tissue and osteosarcoma. These guidelines form the SCAN Guidelines 2015 for the initial evaluation, diagnosis, and management of extremity soft tissue sarcoma and osteosarcoma.

  8. White-nose Syndrome management: Report on structured decision making initiative

    USGS Publications Warehouse

    Szymanski, Jennifer A.; Runge, Michael C.; Parkin, Mary J.; Armstrong, Mike

    2009-01-01

    This report describes an analysis undertaken to assist state and federal natural resources managers in addressing the following question: What management measures should be taken this year within a given area to control the spread and minimize the effects of white-nose syndrome (WNS) on hibernating bats at the individual and population levels? The answer depends upon specific characteristics of the bat species, the hibernacula, and the syndrome itself, all of which could vary across the geographic extent of WNS and change over time. It also depends on a large number of agency and societal judgments concerning how to balance disease management against other objectives.

  9. [Rehabilitation management system of the German Social Accident Insurance. Initial medical experiences].

    PubMed

    Lugeder, A; Berkenbrink, A; Zeichen, J

    2013-03-01

    To improve outcome quality of rehabilitation, the German Social Accident Insurance implemented a rehabilitation management system. A rehabilitation manager operates as active supervisor of the rehabilitation process of severely injured persons beginning from the time when the accident happened. The sequence is recorded on a rehabilitation schedule by the physician, rehabilitation manager and patient together. The concept has not yet been fully accepted by all insurers. Furthermore there is no uniform approach in compiling the rehabilitation schedule which can lead to delays in the process and insecurity of patients. In the following article these aspects are illustrated and improvement suggestions are highlighted.

  10. Army Justified Initial Production Plan for the Paladin Integrated Management Program but Has Not Resolved Two Vehicle Performance Deficiencies (Redacted)

    DTIC Science & Technology

    2016-08-05

    DODIG-2016-118 ( Project No. D2016-D000AU-0003.000) │ i Results in Brief Army Justified Initial Production Plan for the Paladin Integrated Management...that adding more AFES coverage to the crew Finding (cont’d) FOR OFFICIAL USE ONLY FOR OFFICIAL USE ONLY ii │ DODIG-2016-118 ( Project No. D2016...Deputy did not take into account the results and recommendations of the AFES engineering project or include a specific timeline for planned

  11. Image gently campaign back to basics initiative: ten steps to help manage radiation dose in pediatric digital radiography.

    PubMed

    Don, Steven; Macdougall, Robert; Strauss, Keith; Moore, Quentin T; Goske, Marilyn J; Cohen, Mervyn; Herrmann, Tracy; John, Susan D; Noble, Lauren; Morrison, Greg; Lehman, Lois; Whiting, Bruce R

    2013-05-01

    The purpose of this review is to summarize 10 steps a practice can take to manage radiation exposure in pediatric digital radiography. The Image Gently campaign raises awareness of opportunities for lowering radiation dose while maintaining diagnostic quality of images of children. The newest initiative in the campaign, Back to Basics, addresses methods for standardizing the approach to pediatric digital radiography, highlighting challenges related to the technology in imaging of patients of widely varying body sizes.

  12. 7 CFR 4290.360 - Initial review of Applicant's management team's qualifications.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... successful venture capital investing. In making this determination, the Secretary will consider, among other... Applicants considered to have a management team qualified for venture capital investing will be further...

  13. Evaluation of Transitioning Management of the Nuclear Hydrogen Initiative to Idaho National Laboratory

    SciTech Connect

    Charles Park; Mike Patterson

    2009-08-01

    This report describes the current capabilities of the INL to manage the NHI, the planned increases in capability to support NHI, and the cost and schedule and strategy for developing a commercially viable hydrogen production technology for deployment with NGNP.

  14. The Pain Associates' International Network Initiative: a novel practical approach to the challenge of chronic pain management in Europe.

    PubMed

    Morlion, Bart; Walch, Heribert; Yihune, Gabriel; Vielvoye-Kerkmeer, Ans; de Jong, Zuzana; Castro-Lopes, José; Stanton-Hicks, Michael

    2008-01-01

    Chronic pain is a debilitating condition with a multidimensional impact on the lives of patients, their families and communities. The public health burden of chronic pain is gathering recognition as a major healthcare problem in its own right and deserves closer attention. The challenge in treating chronic pain is to provide effective clinical management of a complex, multifaceted set of conditions that require a coordinated strategy of care. Epidemiological data and patient surveys have highlighted the areas of pain management that might be improved. These include a need for better understanding and documentation of the symptoms of chronic pain, standardized levels of care, improved communication among clinical personnel and with patients, and an updated education program for clinicians. For these reasons, new strategies aimed at improving the standards of pain management are needed. The Pain Associates' International Network (P.A.I.N.) Initiative was set up to devise practical methods for improving the quality of pain management for patients. These strategies have recently been put into practice through a number of activities: P.A.I.N. Workshops are meetings of international pain management professionals dedicated to discussing current management strategies and producing consensus recommendations for improving standards of care; P.A.I.N. Quality is a unique software program designed to help treating clinicians to document patient data and derive effective treatment plans; P.A.I.N. Online provides a web site forum for discussion of pain management topics; and P.A.I.N. Management is a clinician education program providing up-to-date training in pain management.

  15. Diagnostic work-up for detection of paroxysmal atrial fibrillation after acute ischemic stroke: cross-sectional survey on German stroke units.

    PubMed

    Rizos, Timolaos; Quilitzsch, Anika; Busse, Otto; Haeusler, Karl Georg; Endres, Matthias; Heuschmann, Peter; Veltkamp, Roland

    2015-06-01

    Multiple methods to detect paroxysmal atrial fibrillation (pAF) in patients with acute stroke are available. However, it is unknown which approaches are currently used in clinical routine and guidelines remain vague to the extent of cardiac monitoring. We characterize diagnostic efforts for pAF detection on German stroke units (SU). A standardized anonymous questionnaire was sent to all clinical leads of certified SUs in Germany. The questionnaire focused on basic characteristics of SUs, procedures to detect AF, and estimates on AF detection. One hundred seventy-nine SU leads participated (response rate 71.6%). All patients undergo continuous bedside ECG monitoring. A percentage of 77.6 SUs initiate additional 24-hour Holter ECG in >50% of patients without known AF. Patients with transient ischemic attack are monitored significantly shorter than patients with ischemic stroke. Independent of SU type or size, 67.6% of leads assumed to fail detecting pAF in 5% to 20% of patients. In cryptogenic stroke, additional ECG monitoring is recommended by 90.2% but only 13.8% of SUs perform routine ECG follow-up visits. The use of implanted event recorders is low (1-10 patients/y by 60.7% of SUs; 28.1%: no use). A percentage of 83.9 do not use external event recorders. Our survey demonstrates substantial heterogeneity among German SUs on diagnostic work-up for pAF. Future prospective multicenter studies should systematically evaluate the impact of different methods to uncover pAF. © 2015 American Heart Association, Inc.

  16. USMA Study of the Residential Communities Initiative (RCI) Portfolio and Asset Management (PAM)

    DTIC Science & Technology

    2006-03-01

    changes to this management structure should only be undertaken, if at all, after a careful and cautious examination of their impact on the host of...privatization program exists within a dynamically evolving environment whose perturbations have varying degrees of impact on the future success of the program...particularly true where installation staffs continue to own some of the functions on a project, such as managing the waiting list, which directly impacts the

  17. Chemical & Material Risk Management Initiatives: Reach & Cr6+ Strategies (Briefing Charts)

    DTIC Science & Technology

    2011-02-01

    voluntary program • Evolving Risk Assessment Science & Process • Strict Chemical Management – Cradle to grave • Green Chemistry • International...Federal, & State Toxic Substances Laws – Restrictions or banning of chemicals/materials (e.g., BPA) – California Green Chemistry Law – Minnesota “Toxic...Directorate Portfolio • Emerging Contaminants Program • Green Chemistry & DoD Chemical Management Program – DoD REACH Strategic Plan signed in July 2010

  18. Is current medical education adequately preparing future physicians to manage concussion: an initial evaluation.

    PubMed

    Donaworth, Michael A; Grandhi, Ravi K; Logan, Kelsey; Gubanich, Paul J; Myer, Gregory D

    2016-01-01

    In 2010, there were 2.5 million hospitalizations, emergency room visits, or deaths associated with concussions in the United States.[1] Knowledge deficits exist among physicians regarding concussion management, which can lead to severe repercussions, including poor patient outcomes, poor patient satisfaction, and potential medical-legal issues. While concussion is a prevalent condition evaluated in the medical field, medical students continue to have a knowledge deficit regarding concussion diagnosis, prognosis, medical management, and return to play guidelines. Medical students from a mid-western medical school completed a survey on concussion diagnosis, prognosis, medical management, and return to play guidelines. The response rate was 40%. The data suggests that the vast majority of medical students are able to define concussion; however, most reported never having a lecture dedicated to concussion during medical school and also lacked clinical experience with acute concussion and post-concussive syndrome. There are clear areas of deficiency as noted by the inability of students to correctly identify symptoms and appropriate management of concussion. The current study indicates that at an individual, mid-western, top 50 medical school, current medical trainees may not be adequately educated to identify and manage concussion. Future research is warranted to determine the optimal guidelines to educate future physicians as it pertains to concussion diagnosis, management, prognosis, and return to play guidelines.

  19. The Saudi Initiative for Asthma - 2016 update: Guidelines for the diagnosis and management of asthma in adults and children

    PubMed Central

    Al-Moamary, Mohamed S.; Alhaider, Sami A.; Idrees, Majdy M.; Al Ghobain, Mohammed O.; Zeitouni, Mohammed O.; Al-Harbi, Adel S.; Yousef, Abdullah A.; Al-Matar, Hussain; Alorainy, Hassan S.; Al-Hajjaj, Mohamed S.

    2016-01-01

    This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan. PMID:26933455

  20. [Management of patients with end-stage renal disease prior to initiation of renal replacement therapy in 2013 in France].

    PubMed

    Tuppin, Philippe; Cuerq, Anne; Torre, Sylvie; Couchoud, Cécile; Fagot-Campagna, Anne

    2017-04-01

    This study evaluated the management of patients with end-stage renal disease prior to initiation of renal replacement therapy. Among the 51 million national health insurance general scheme beneficiaries (77% of the population), persons 18 years and older, starting dialysis or undergoing preemptive renal transplantation in 2013, were included in this study. Data were derived from the French national health insurance system (SNIIRAM). In this population of 6674 patients (median age: 68 years), 88% initiated renal replacement therapy by haemodialysis, 8% by peritoneal dialysis, and 4% by renal transplantation. During the year preceding initiation of dialysis, 76% of patients had been hospitalised with at least one diagnostic code for renal disease in 83% of cases, 16% had not received any reimbursements for serum creatinine assay and 32% had not seen a nephrologist; 87% were taking at least one antihypertensive drug (60% were taking at least a renin-angiotensin system inhibitor) and 30% were taking a combination of 4 or more classes of antihypertensive drugs. For patients initiating haemodialysis in a haemodialysis centre, 39% had undergone a procedure related to arteriovenous fistula and 10% had been admitted to an intensive care unit. This study, based on the available reimbursement data, shows that, despite frequent use of the health care system by this population, there is still room for improvement of screening and management of patients with end-stage renal disease and preparation for renal replacement therapy.

  1. Impact of initial FDG PET/CT in the management plan of patients with locally advanced head and neck cancer.

    PubMed

    Arias, F; Chicata, V; García-Velloso, M J; Asín, G; Uzcanga, M; Eito, C; Quilez, I; Viudez, A; Saenz, J; Hernández, I; Caicedo, C; Errasti, M; Barrado, M; García-Bragado, F

    2015-02-01

    To determine the impact of initial FDG PET/CT staging on clinical stage and the management plan in patients with locally advanced head and neck cancer (LAHNC). We retrospectively reviewed the records of 72 consecutive patients (2007-2010) staged with PET/CT and conventional CT with tumours of hypopharynx/larynx (26 patients, 36 %), oral cavity (17 patients, 24 %), oropharynx (16 patients, 22 %), nasopharynx (12 patients, 17 %), and others (2 %). The impact of PET/CT on management plans was considered high when PET/CT changed the planned treatment modality or treatment intent, and intramodality changes were considered as minor changes with low impact. FDG PET/CT changed the stage in 27 patients and had high impact on the management plan in 12 % of patients (detection of distant metastases in 6 patients and stage II in 2 patients). Intramodality changes were more frequent: FDG PET/CT altered the TNM stage in 18/72 (25 %) of patients, upstaging N stage in 90 % of patients with low impact. Initial FDG PET/CT staging not only improves stage but also affects the management plan in LAHNC patients.

  2. The Joint Military Medical Executive Skills initiative: an impressive response to changing human resource management rules of engagement.

    PubMed

    Kerr, Bernard J

    2007-01-01

    Confronted with a sudden and substantial change in the rules regarding who could command a military medical treatment facility (MTF), the Military Health System (MHS) responded to the challenge with an impressive human resource management solution-the Joint Medical Executive Skills Program. The history, emergence, and continuing role of this initiative exemplifies the MHS's capacity to fulfill the spirit and intent of an arduous Congressional mandate while enhancing professional development and sustaining the career opportunities of medical officers. The MHS response to the Congressional requirement that candidates for MTF command demonstrate professional administrative skills was decisive, creative, and consistent with the basic principles of human resource management. The Joint Medical Executive Skills Program is a management success story that demonstrates how strategic planning, well-defined skills requirements, and structured training can assure a ready supply of qualified commanders for the military's MTFs.

  3. Management of Barrett's high-grade dysplasia: initial results from a population-based national audit.

    PubMed

    Chadwick, Georgina; Groene, Oliver; Taylor, Angelina; Riley, Stuart; Hardwick, Richard H; Crosby, Tom; Greenaway, Kimberley; Cromwell, David A

    2016-04-01

    Previous studies reported significant variation in the management of patients with Barrett's esophagus. However, these are based on self-reported clinical practice. The aim of this study was to examine the management of high-grade dysplasia in Barrett's esophagus in England by using patient-level data and to compare practice with guidelines. From April 2012 to March 2013, National Health Service (NHS) trusts in England prospectively collected data on patients newly diagnosed with high-grade dysplasia (HGD) of the esophagus as part of the National Oesophago-Gastric Cancer Audit. Data were collected on patient characteristics, diagnosis and endoscopic findings, treatment planning, and therapy. Between April 2012 and March 2013, NHS trusts reported 465 cases of HGD. Diagnosis was confirmed by a second pathologist in 79.4% of cases (270/340), and 86.0% (374/465) had their treatment planned at a multidisciplinary team meeting. A total of 290 patients (62.4%) were managed endoscopically (frequently with endoscopic resection or radiofrequency ablation), whereas 26 patients (5.6%) had esophagectomy. The proportion of patients managed by surveillance varied by age (P < .001), ranging from 19.5% in patients aged <65 years to 63.8% in patients aged ≥85 years. More patients received active treatment if their cases were discussed at a multidisciplinary meeting (73.5% vs 44.3%; P < .001) or managed at higher-volume trusts (87.8% vs 55.4%; P < .001). There was marked variation in the management of HGD across England, with a third of patients receiving no active treatment. Patients discussed at a specialist multidisciplinary meeting or managed in high-volume trusts were more likely to receive active treatment. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  4. Comprehensive allergy work-up is mandatory in cystic fibrosis patients who report a history suggestive of drug allergy to beta-lactam antibiotics

    PubMed Central

    2012-01-01

    Background In the general population, reports on suspected ß-lactam hypersensitivity are common. After a drug allergy work-up at best 20% of the selected patients are positive. However, these considerations have not been explored in cystic fibrosis patients for whom antibiotics are even more crucial. Methods The study, part of the Drug Allergy and Hypersensitivity (DAHD) cohort, was performed in the regional cystic fibrosis center of Montpellier, France. After identifying patients with a clinical history suggestive of drug allergy to ß-lactams, a complete drug allergy work-up, was carried out according to the EAACI recommendations. Results Among the 171 patients involved, 23 reported clinical manifestations potentially compatible with a drug allergy to ß-lactams. After performing the complete drug-allergy work-up, 7 were considered as drug hypersensitive (3 had positive skin tests, 1 a positive provocation test, 3 declined the tests). Excluding the latter 3 patients with incomplete drug allergy work-up, the rate of proven drug allergy was 2.3%. Conclusions Drug allergy to ß-lactams in cystic fibrosis patients is of importance. A full drug allergy work-up is mandatory in case of suspicion, because ß-lactam responsibility is often ruled out. PMID:22697261

  5. Medical Management of Parkinson's Disease after Initiation of Deep Brain Stimulation.

    PubMed

    Fasano, Alfonso; Appel-Cresswell, Silke; Jog, Mandar; Zurowkski, Mateusz; Duff-Canning, Sarah; Cohn, Melanie; Picillo, Marina; Honey, Christopher R; Panisset, Michel; Munhoz, Renato Puppi

    2016-09-01

    In this review, we have gathered all the available evidence to guide medication management after deep brain stimulation (DBS) in Parkinson's disease (PD). Surprisingly, we found that almost no study addressed drug-based management in the postoperative period. Dopaminergic medications are usually reduced, but whether the levodopa or dopamine agonist is to be reduced is left to the personal preference of the treating physician. We have summarized the pros and cons of both approaches. No study on the management of cognitive problems after DBS has been done, and only a few studies have explored the pharmacological management of such DBS-resistant symptoms as voice (amantadine), balance (donepezil) or gait disorders (amantadine, methylphenidate). As for the psychiatric problems so frequently reported in PD patients, researchers have directed their attention to the complex interplay between stimulation and reduction of dopaminergic drugs only recently. In conclusion, studies addressing medical management following DBS are still needed and will certainly contribute to the ultimate success of DBS procedures.

  6. A Prospective Assessment of Clinical and Patient-Reported Outcomes of Initial Non-Operative Management of Ventral Hernias.

    PubMed

    Holihan, Julie L; Flores-Gonzalez, Juan R; Mo, Jiandi; Ko, Tien C; Kao, Lillian S; Liang, Mike K

    2017-05-01

    Little is known about the clinical or patient-reported outcomes with non-operative management of ventral hernias. The aim of this prospective study is to determine the clinical and patient-reported outcomes of patients undergoing initial non-operative treatment of their ventral hernia. This was a prospective observational study of patients undergoing non-operative management of ventral hernias. Primary outcome was rate of surgical repair of the ventral hernias. Secondary outcomes included rate of emergency repair, elective repair, and emergency room visits. In addition, validated measurement tools for patient satisfaction and cosmetic satisfaction with their abdomen, abdominal pain, and patient function (modified Activities Assessment Scale, AAS) were utilized. Of 128 patients who underwent non-operative management of a ventral hernia, 99(77.3%) patients were followed for a median (interquartile range) of 12.2(10.4-13.5) months. Twenty (20.2%) patients had at least 1 emergency room visit associated with their hernia. One-quarter (n = 2323.2%) underwent ventral hernia repair following enrollment. Twenty (20.2%) underwent elective repair, and 3 (3.0%) underwent emergent repair. Based on the modified AAS survey, patients who were managed non-operatively experienced no change in patient centered outcomes, while patients converted to operative management had improved scores. While the short-term risk of emergency surgery with non-operative management of ventral hernias is moderate, the chance of an emergency room visit and surgery is high. Patients who undergo non-operative management of their ventral hernias have no change in patient-reported outcomes at one year, while those converted to operative management experience improvement.

  7. Supporting 'Baby Friendly': a quality improvement initiative for the management of transitional neonatal hypoglycaemia.

    PubMed

    Stewart, Claire Elizabeth; Sage, Emma Louise Maitland; Reynolds, Peter

    2016-07-01

    We describe a quality improvement initiative conducted in a medium-sized district general hospital with a neonatal intensive care unit, which involved working with the multidisciplinary team to create a 'Baby Friendly' neonatal hypoglycaemia pathway with implementation of dextrose gel as a first-line treatment. As a result of the project, formula supplementation rates and admissions for transitional hypoglycaemia were reduced and breastfeeding rates at 3 months improved. This initiative demonstrates that evidence-based guidelines with multidisciplinary team input can improve standards of care.

  8. NSF/DARPA/NASA Digital Libraries Initiative: A Program Manager's Perspective.

    ERIC Educational Resources Information Center

    Griffin, Stephen M.

    1998-01-01

    Discusses the National Science Foundation (NSF)/United States Defense Advanced Research Projects Agency (DARPA)/National Aeronautics and Space Agency (NASA) Research in Digital Libraries Initiative (DLI). Highlights include benefits of digital libraries; the Federal High Performance Computing and Communications Program (HPCC); and program…

  9. An Assessment of the Air Force Weather Agency’s Readiness for Knowledge Management Initiatives

    DTIC Science & Technology

    2009-03-01

    within the context of this paper. KM initiatives are typically organizational endeavors that seek to leverage the value of knowledge as an intangible ... asset (Liebowitz & Megbolugbe, 1998). “Such projects are attempts to do something useful with knowledge, to accomplish organizational objectives

  10. From Restaurants to Board Rooms: How Initiating Negotiations Teaches Management Principles and Theory

    ERIC Educational Resources Information Center

    Volkema, Roger J.; Kapoutsis, Ilias

    2016-01-01

    Negotiation is an interpersonal process common to everyday personal and professional success. Yet individuals often fail to recognize opportunities for initiating negotiations and the immediate and long-term implications of these oversights for themselves and others. This article describes a simple yet rich negotiation exercise that learners can…

  11. NSF/DARPA/NASA Digital Libraries Initiative: A Program Manager's Perspective.

    ERIC Educational Resources Information Center

    Griffin, Stephen M.

    1998-01-01

    Discusses the National Science Foundation (NSF)/United States Defense Advanced Research Projects Agency (DARPA)/National Aeronautics and Space Agency (NASA) Research in Digital Libraries Initiative (DLI). Highlights include benefits of digital libraries; the Federal High Performance Computing and Communications Program (HPCC); and program…

  12. Managing School Curriculum/Program/System Change: Initial Identification of Criteria.

    ERIC Educational Resources Information Center

    Gress, James R.

    Five empirically based literature sources that identify variables potentially associated with successful implementation of curriculum change are synthesized and identified in a lengthy summary table. Some initial generalizations made from the literature sources are summarized. Curricula that are responsive to real local problems and do not deviate…

  13. The Implementation of Quality Management Initiatives in the Context of Organisational Learning.

    ERIC Educational Resources Information Center

    Roche, Evelyn

    2002-01-01

    An Irish company embarked on implementing a business excellence model and continuous improvement initiatives. Some employees' reluctance to participate impeded organizational learning, but the creation of a culture that encouraged, facilitated, and rewarded learning enabled movement toward excellence. (Contains 64 references.) (SK)

  14. From Restaurants to Board Rooms: How Initiating Negotiations Teaches Management Principles and Theory

    ERIC Educational Resources Information Center

    Volkema, Roger J.; Kapoutsis, Ilias

    2016-01-01

    Negotiation is an interpersonal process common to everyday personal and professional success. Yet individuals often fail to recognize opportunities for initiating negotiations and the immediate and long-term implications of these oversights for themselves and others. This article describes a simple yet rich negotiation exercise that learners can…

  15. 75 FR 12570 - Presence Sensing Device Initiation (PSDI); Extension of the Office of Management and Budget's...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-16

    ... devices (``PSDs'') used to initiate the operation of mechanical power presses; a PSD (e.g., a photoelectric field or curtain) automatically stops the stroke of a mechanical power press when the device detects an operator entering a danger zone near the press. A mechanical power press using Presence...

  16. Getting Results: Outcomes Management and the Annie E. Casey Foundations Jobs Initiative.

    ERIC Educational Resources Information Center

    Giloth, Robert; Phillips, William

    The Anne E. Casey Foundation (AECF) funded replications of effective jobs projects to achieve better job placement and retention for low-income, young adults. The six projects funded, collectively called the Jobs Initiative (JI), in Denver, Milwaukee, New Orleans, Philadelphia, Seattle, and St. Louis, used an outcomes framework developed by The…

  17. Quality Circle Effectiveness as a Function of Upper-Management Support, Circle Initiation, and Collar Color.

    ERIC Educational Resources Information Center

    Tang, Thomas Li-Ping; And Others

    Japanese management practices have attracted much interest in the United States. The use of quality circles (QCs) common in Japan, has been considered a promising approach to improving Americn workers' productivity. A quality circle is made up of workers from the same group who meet to discuss quality problems, recommend solutions, and implement…

  18. [Materials management system in interventional radiology -- initial experience with a computer-supported program].

    PubMed

    Clevert, D-A; Jung, E M; Reiser, M; Rupp, N

    2004-10-01

    To perform a cost analysis for assessing options of reorganizing material supplies and reducing costs of the radiology division through the introduction of a materials management system. A materials management system (Piranha, Boston Scientific) was installed on an existing computer system. All consumables were inventoried and entered into the system. An ABC analysis determined further action. On the basis of order frequencies and availability requirements for emergencies, safety levels were agreed with physicians and other medical staff. Inventory costs were computed using these data. The interest rate for the capital tied up in the inventory was 8 % per year. The inventory showed that the capital tied up in stocks was euro 260,000 in 2001 and euro 190,000 in 2002. A change in supply strategy reduced inventory cost in 2001 and 2002. Annual interest expense was lowered by euro 18,420. Another saving of euro 2,700 was achieved by a reduction in storage cost. Annual inventory turnover totaled euro 298,000. The total cost cut through improved inventory management was euro 21,120 per year, which is equivalent to 7 % of the annual expenses. Adding the decline in the cost of shelf time overruns equal to 5 % of the annual expenses, the saving was approximately 12 % of total interventional radiology cost in 2001 and some 11 % in 2002. Flexible supply strategies and the introduction of a materials management program can help to reduce inventory costs in interventional radiology divisions without any impact on service levels.

  19. Establishing a research and demonstration area initiated by managers: the Sharkey Restoration Research and Demonstration Site

    Treesearch

    E. Gardiner; J. Stanturf; T. Leininger; P. Hamel; L. Jr. Dorris; J. Portwood; J. Shepard

    2008-01-01

    As forest scientists increase their role in the process of science delivery, many research organizations are searching for novel methods to effectively build collaboration with managers to produce valued results. This article documents our experience with establishment of a forest restoration research and demonstration area in the Lower Mississippi Alluvial Valley (...

  20. Culturally Competent Diabetes Self-Management Education for Mexican Americans: The Starr County Border Health Initiative.

    ERIC Educational Resources Information Center

    Brown, Sharon A.; Garcia, Alexandra A.; Kouzekanani, Kamiar; Hanis, Craig L.

    2002-01-01

    In a culturally competent diabetes self-management intervention in Starr County, Texas, bilingual Mexican American nurses, dieticians, and community workers provided weekly instruction on nutrition, self-monitoring, exercise and other self-care topics. A biweekly support group promoted behavior change. Interviews and examinations with 256 Mexican…

  1. A Developmental Perspective of State Policy Initiatives in Instructional Management in the State of Mississippi.

    ERIC Educational Resources Information Center

    Woodruff, Jane Bruner

    This paper traces the evolution of curriculum reform in Mississippi from a state level, norm-referenced accountability system to a performance-based, centralized accreditation system that integrates instructional management requirements into improvement standards. Accountability legislation has primarily been concerned with quality of student…

  2. 76 FR 30147 - Application of the Energy Planning and Management Program Power Marketing Initiative to the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-24

    ... Area Power Administration Application of the Energy Planning and Management Program Power Marketing... Power Administration (Western), a Federal power marketing agency of the Department of Energy (DOE), is... General Consolidated Power Marketing Criteria or Regulations for Boulder City Area Projects (Conformed...

  3. 78 FR 75238 - Federal Housing Administration (FHA) Risk Management Initiatives: New Manual Underwriting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-11

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 24 CFR Chapter II RIN 2502-AJ07 Federal Housing Administration (FHA) Risk Management...--Federal Housing Commissioner, HUD. ACTION: Final notice of new manual underwriting requirements. SUMMARY...

  4. [Evaluation of disease management programmes--assessing methods and initial outcomes from a health economic perspective].

    PubMed

    Birnbaum, Dana Sophie; Braun, Sebastian

    2010-01-01

    Evaluation represents a substantial component of the concept of Disease Management Programmes. This and the fact that the implementation of Disease Management Programmes constitutes a major change in the German healthcare system require that the criteria established by the German Federal Social Insurance Authority (Bundesversicherungsamt) be carefully reviewed. The present paper focuses on the evaluation method and the economic data. The pre-/-post study design used in the evaluation is known to be vulnerable to threats to internal validity. The objective of this paper is to analyze whether these threats to internal validity which have been known theoretically are confirmed by the results of the final reports. A review of the final reports of health insurance companies like the AOK, Barmer and a group of the BKK in Westfalen-Lippe shows that this question can be answered in the affirmative. The pre-/-post design without control groups is unable to recognize the failure or success of the Disease Management concept. The reasons include a high drop-out rate as well as the lack of consideration of the characteristics of chronic disease. Hence the evaluation method has failed to prove the quality of Disease Management Programmes in Germany. This is why consistent further development is needed.

  5. Initiation and management of adult veno-arterial extracorporeal life support

    PubMed Central

    Shukrallah, Bassam N.; Kilic, Arman; Whitson, Bryan A.

    2017-01-01

    Extracorporeal life support (ECLS) for patients suffering from acute cardiopulmonary collapse is the penultimate therapy to provide hemodynamic stability. Although it can be a life sustaining as well as life-saving therapy, there are important factors that contribute to its success. In this review, we will describe the indications, management, pitfalls and limitations of ECLS. PMID:28275612

  6. Culturally Competent Diabetes Self-Management Education for Mexican Americans: The Starr County Border Health Initiative.

    ERIC Educational Resources Information Center

    Brown, Sharon A.; Garcia, Alexandra A.; Kouzekanani, Kamiar; Hanis, Craig L.

    2002-01-01

    In a culturally competent diabetes self-management intervention in Starr County, Texas, bilingual Mexican American nurses, dieticians, and community workers provided weekly instruction on nutrition, self-monitoring, exercise and other self-care topics. A biweekly support group promoted behavior change. Interviews and examinations with 256 Mexican…

  7. The Saudi initiative for asthma – 2012 update: Guidelines for the diagnosis and management of asthma in adults and children

    PubMed Central

    Al-Moamary, Mohamed S.; Alhaider, Sami A.; Al-Hajjaj, Mohamed S.; Al-Ghobain, Mohammed O.; Idrees, Majdy M.; Zeitouni, Mohammed O.; Al-Harbi, Adel S.; Al Dabbagh, Maha M.; Al-Matar, Hussain; Alorainy, Hassan S.

    2012-01-01

    This an updated guidelines for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have updated guidelines, which are simple to understand and easy to use by non-asthma specialists, including primary care and general practice physicians. This new version includes updates of acute and chronic asthma management, with more emphasis on the use of Asthma Control Test in the management of asthma, and a new section on “difficult-to-treat asthma.” Further, the section on asthma in children was re-written to cover different aspects in this age group. The SINA panel is a group of Saudi experts with well-respected academic backgrounds and experience in the field of asthma. The guidelines are formatted based on the available evidence, local literature, and the current situation in Saudi Arabia. There was an emphasis on patient–doctor partnership in the management that also includes a self-management plan. The approach adopted by the SINA group is mainly based on disease control as it is the ultimate goal of treatment. PMID:23189095

  8. Quality of care in patients with psoriasis: an initial clinical study of an international disease management programme.

    PubMed

    de Korte, J; Van Onselen, J; Kownacki, S; Sprangers, M A G; Bos, J D

    2005-01-01

    Patients with psoriasis have to cope with their disease for many years or even throughout their entire life. To provide optimal care, a disease management programme was developed. This programme consisted of disease education, disease management training, and psychological support, together with topical treatment. To test a disease management programme in dermatological practice, to assess patients' satisfaction with this programme, and adherence to topical treatment. Additionally, disease severity and quality of life were assessed. An initial clinical investigation was conducted in 10 European treatment centres. A total of 330 patients were included. Patient satisfaction, adherence, disease severity and quality of life were measured with study-specific and standardized self-report questionnaires. Patients reported a high degree of satisfaction with the programme, and a high degree of adherence to topical treatment. Disease severity and quality of life significantly improved. The programme was well received by the participating professionals. The disease management programme was found to be a useful tool in the management of psoriasis, providing patients with relief from the burden of psoriasis in everyday life. A full-scale evaluation is recommended.

  9. Management practices to support donor transition: lessons from Avahan, the India AIDS Initiative.

    PubMed

    Bennett, Sara; Rodriguez, Daniela; Ozawa, Sachiko; Singh, Kriti; Bohren, Meghan; Chhabra, Vibha; Singh, Suneeta

    2015-06-13

    During 2009-2012, Avahan, a large donor funded HIV/AIDS prevention program in India was transferred from donor support and operation to government. This transition of approximately 200 targeted interventions (TIs), occurred in three tranches in 2009, 2011 and 2012. This paper reports on the management practices pursued in support of a smooth transition of the program, and addresses the extent to which standard change management practices were employed, and were useful in supporting transition. We conducted structured surveys of a sample of 80 TIs from the 2011 and 2012 rounds of transition. One survey was administered directly before transition and the second survey 12 month after transition. These surveys assessed readiness for transition and practices post-transition. We also conducted 15 case studies of transitioning TIs from all three rounds, and re-visited 4 of these 1-3 years later. Considerable evolution in the nature of relationships between key actors was observed between transition rounds, moving from considerable mistrust and lack of collaboration in 2009 toward a shared vision of transition and mutually respectful relationships between Avahan and government in later transition rounds. Management practices also evolved with the gradual development of clear implementation plans, establishment of the post of "transition manager" at state and national levels, identified budgets to support transition, and a common minimum programme for transition. Staff engagement was important, and was carried out relatively effectively in later rounds. While the change management literature suggests short-term wins are important, this did not appear to be the case for Avahan, instead a difficult first round of transition seemed to signal the seriousness of intentions regarding transition. In the Avahan case a number of management practices supported a smooth transition these included: an extended and sequenced time frame for transition; co-ownership and planning of

  10. Information Technology: Leveraging Best Practices and Reform Initiatives Can Help Defense Manage Major Investments

    DTIC Science & Technology

    2014-02-26

    per year beginning in fiscal year 2016 . With a continued focus on this important effort, including obtaining support for estimated cost savings...remaining $34 billion, about one-quarter is to be spent on acquiring new investments, and the rest is to be spent operating and maintaining existing or...additional potential duplication within Defense’s health care and dental management investments, totaling over $30 million.20 We recently reported

  11. [The management by the processes in a cancer center, an utopian initiative?].

    PubMed

    Verger, David; Mihura, Jeanne; Sallé, Françoise; Sarini, Jérôme; Colin, Valérie

    2008-01-01

    The process approach is a mode of quality improvement. It leans on the cartography's establishment, allows to redefine organization around patients trajectory, the measure of defects and their correction. The process pilot is a new actor in the management of the establishment. It is developed since 3 years in the Institute Claudius Regaud, regional cancer center treatment of Midi-Pyrénées.

  12. Care pathways in thrombosis management: the INNOVATE peer-to-peer educational initiative.

    PubMed

    Patel, Raj K

    2017-01-01

    Anticoagulant options for the management of venous thromboembolism (VTE) now include the non-vitamin K antagonist oral anticoagulants (NOACs). The safe and effective integration of these agents into routine clinical practice within different health care settings presents common challenges. Bayer AG created the INternational Network fOr Venous and Arterial Thrombosis Excellence in practice (INNOVATE) program as a professional education network to foster best practice in thrombosis management in the NOAC era. Since 2013, INNOVATE has been run as a series of educational 1.5-day global meetings at VTE centers of excellence. The format is based on expert-led discussion rather than lectures; all participants are encouraged to share their own expertise and experience. Through peer-to-peer exchange, less experienced professionals from an array of specialties learn from others in a small-group interactive setting. This format encourages positive engagement and discussion, and the establishment of relationships between health care professionals from different countries. INNOVATE has successfully expanded to cover a broad spectrum of thromboembolic disorders in which anticoagulation with NOACs plays an important role; now including specific meetings focusing on the management of patients in the community. Local meetings are run in many countries in the local language, facilitating discussion and ensuring applicability to local or regional issues. INNOVATE delegates have provided consistently positive feedback and have used their attendance to create and improve thrombosis management pathways in their own institutions. Overseen by a Steering Committee, the program responds to feedback, evolving to meet the needs of participants. By showcasing best practice in the care of patients requiring anticoagulation, INNOVATE provides a model for the non-promotional support of medical education by industry. The objectives are to encourage the responsible use of new drugs (specifically

  13. Care pathways in thrombosis management: the INNOVATE peer-to-peer educational initiative

    PubMed Central

    Patel, Raj K

    2017-01-01

    Context Anticoagulant options for the management of venous thromboembolism (VTE) now include the non-vitamin K antagonist oral anticoagulants (NOACs). The safe and effective integration of these agents into routine clinical practice within different health care settings presents common challenges. Bayer AG created the INternational Network fOr Venous and Arterial Thrombosis Excellence in practice (INNOVATE) program as a professional education network to foster best practice in thrombosis management in the NOAC era. Concept and format Since 2013, INNOVATE has been run as a series of educational 1.5-day global meetings at VTE centers of excellence. The format is based on expert-led discussion rather than lectures; all participants are encouraged to share their own expertise and experience. Through peer-to-peer exchange, less experienced professionals from an array of specialties learn from others in a small-group interactive setting. This format encourages positive engagement and discussion, and the establishment of relationships between health care professionals from different countries. Expansion and localization INNOVATE has successfully expanded to cover a broad spectrum of thromboembolic disorders in which anticoagulation with NOACs plays an important role; now including specific meetings focusing on the management of patients in the community. Local meetings are run in many countries in the local language, facilitating discussion and ensuring applicability to local or regional issues. Implementing learnings INNOVATE delegates have provided consistently positive feedback and have used their attendance to create and improve thrombosis management pathways in their own institutions. Overseen by a Steering Committee, the program responds to feedback, evolving to meet the needs of participants. Conclusion By showcasing best practice in the care of patients requiring anticoagulation, INNOVATE provides a model for the non-promotional support of medical education by

  14. Identification and initial management of intoxication by alcohol and other drugs in the pediatric emergency room.

    PubMed

    Pianca, Thiago Gatti; Sordi, Anne Orgle; Hartmann, Thiago Casarin; von Diemen, Lisia

    2017-09-05

    To review the screening, diagnosis, evaluation, and treatment of intoxication by alcohol and other drugs in children and adolescents in the emergency scenario. This was a narrative literature review. The detection of this problem in the emergency room can be a challenge, especially when its assessment is not standardized. The intentional and episodic use of large amounts of psychoactive substances by adolescents is a usual occurrence, and unintentional intoxication is more common in children younger than 12 years. The clinical picture in adolescents and children differs from that in adults and some particularities are important in the emergency scenario. After management of the acute condition, interventions targeting the adolescent at risk may be effective. The diagnosis and treatment of intoxication by alcohol and other drugs in adolescents and children in the emergency scenario requires a systematic evaluation of the use of these drugs. There are few specific treatments for intoxication, and the management comprehends support measures and management of related clinical complications. Copyright © 2017. Published by Elsevier Editora Ltda.

  15. The efficacy of a self-managed Acceptance and Commitment Therapy intervention DVD for physical activity initiation.

    PubMed

    Moffitt, Robyn; Mohr, Philip

    2015-02-01

    Initiating and maintaining physical activity presents the individual with challenges of inconvenience, discomfort, and counteractive energy. Addressing these challenges requires an intervention that elicits motivation to engage in this activity, minimizes the direct relationship between unwanted internal experiences and inaction, and is also in itself accessible and convenient. Accordingly, this study investigated the efficacy of a self-managed Acceptance and Commitment Therapy (ACT) intervention delivered via DVD and tailored for physical activity initiation. Fifty-nine minimally active community participants were randomly allocated to receive a 12-week pedometer-based walking programme, or the same walking programme with the additional provision of the ACT DVD. The primary outcome was overall physical activity level (assessed at baseline and post-intervention), and the secondary outcome was pedometer-assessed step count (measured at 4-weekly intervals throughout the intervention period). Participants who received the ACT DVD achieved a significantly greater increase in physical activity levels post-intervention, were more likely to achieve the goals specified in the programme, and reported a higher average step count than participants who received the walking programme in isolation. The ACT intervention, delivered via DVD for the promotion of physical activity, proved a simple, efficient, and accessible method to encourage positive short-term increases in an important health-promoting behaviour. Statement of contribution What is already known? ACT interventions can increase physical activity levels through augmenting initiatory self-regulatory control. Face-to-face delivery presents challenges of accessibility and feasibility for community implementation. There is a need for effective interventions that maximize impact while minimizing inconvenience. What does this study add? Supplementing a walking programme with a self-managed ACT DVD produced significant

  16. An Ontology of Quality Initiatives and a Model for Decentralized, Collaborative Quality Management on the (Semantic) World Wide Web

    PubMed Central

    2001-01-01

    This editorial provides a model of how quality initiatives concerned with health information on the World Wide Web may in the future interact with each other. This vision fits into the evolving "Semantic Web" architecture - ie, the prospective that the World Wide Web may evolve from a mess of unstructured, human-readable information sources into a global knowledge base with an additional layer providing richer and more meaningful relationships between resources. One first prerequisite for forming such a "Semantic Web" or "web of trust" among the players active in quality management of health information is that these initiatives make statements about themselves and about each other in a machine-processable language. I present a concrete model on how this collaboration could look, and provide some recommendations on what the role of the World Health Organization (WHO) and other policy makers in this framework could be. PMID:11772549

  17. Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases.

    PubMed

    Schwartz, Jeremy I; Dunkle, Ashley; Akiteng, Ann R; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K; Mutungi, Gerald; Rabin, Tracy L; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet

    2015-01-01

    Background The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Methods Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. Results In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Discussion Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda.

  18. Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases.

    PubMed

    Schwartz, Jeremy I; Dunkle, Ashley; Akiteng, Ann R; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K; Mutungi, Gerald; Rabin, Tracy L; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet

    2015-01-01

    The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda.

  19. Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases

    PubMed Central

    Schwartz, Jeremy I.; Dunkle, Ashley; Akiteng, Ann R.; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K.; Mutungi, Gerald; Rabin, Tracy L.; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet

    2015-01-01

    Background The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Methods Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. Results In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Discussion Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda. PMID:25563451

  20. [Reducing the number of orders for coagulation tests in the standard emergency department blood work-up].

    PubMed

    Ferreras Amez, José María; Sarrat Torres, Marco Antonio; Arribas Entrala, Belén; Carrasco Baraja, Vicente; Pérez Layo, Ángeles; Franco Sorolla, Jóse Miguel

    2017-01-01

    To evaluate the usefulness of a clinical protocol developed to reduce the number of orders for coagulation tests. Quasi-experimental study with historical controls. We retrospectively included all patients whose records showed that a coagulation test had been ordered in the emergency department. We analyzed the number of tests ordered under the protocol and the number ordered during the period of standard practice. Orders for coagulation tests were given for 657 patients (77.2%) when physicians followed standard practices and for 448 (55.5%) when they followed the protocol (P <.001). Unnecessary tests numbered 431 (65.6%) and 227 (50.6%) in the standard-practice and protocol periods, respectively (P <.002). One patient (0.15% [95% CI, 0.004%-0.8%]) had significantly altered coagulation (international normalized ratio, 1.8), but none (0% [95% CI, 0%-0.6%]) required treatment and no treatment plans were changed based on a finding of unexpected coagulation disorder. The protocol to guide the ordering of coagulation tests has managed to reduce unnecessary tests and thus improve management of this health service resource.

  1. Producing a Data Dictionary from an Extensible Markup Language (XML) Schemain the Global Force Management Data Initiative

    DTIC Science & Technology

    2017-02-01

    Schema in the Global Force Management Data Initiative by Frederick S Brundick Computing and Information Sciences Directorate, ARL Approved for public...IEDM) was migrated from Structured Query Language (SQL) to Extensible Markup Language (XML), the new XML Schema Definition (XSD) files were maintained...Background 2 2.1 Documenting XML 2 2.2 Transforming XML 3 3. Processing the XSD 3 3.1 Desired Output 3 3.2 Terminology 4 3.3 Data Sources 5 3.4 New Elements

  2. Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study

    PubMed Central

    Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

    2007-01-01

    Background As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. Methods This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Results The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. Conclusion We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy

  3. War wounds of the foot and ankle: causes, characteristics, and initial management.

    PubMed

    Bluman, Eric M; Ficke, James R; Covey, Dana C

    2010-03-01

    Foot and ankle trauma sustained in the Global War on Terror have unique causes and characteristics. At least one-quarter of all battle injuries involve the lower extremity. These severe lower extremity wounds require specialized early treatment. Ballistic mechanisms cause almost all injuries, and as such, most combat foot and ankle wounds are open in nature. Wounds are characteristically caused by blast mechanisms, but high velocity gunshot injuries are also common. The severe and polytraumatic nature of injuries sustained frequently call for damage control orthopaedics to be utilized. Cautious early treatment of irregular and highly exudative ballistic wounds with subatmospheric wound dressings may ease their early management.

  4. Deep space telecommunications, navigation, and information management - Support of the Space Exploration Initiative

    NASA Technical Reports Server (NTRS)

    Hall, Justin R.; Hastrup, Rolf C.

    1990-01-01

    The principal challenges in providing effective deep space navigation, telecommunications, and information management architectures and designs for Mars exploration support are presented. The fundamental objectives are to provide the mission with the means to monitor and control mission elements, obtain science, navigation, and engineering data, compute state vectors and navigate, and to move these data efficiently and automatically between mission nodes for timely analysis and decision making. New requirements are summarized, and related issues and challenges including the robust connectivity for manned and robotic links, are identified. Enabling strategies are discussed, and candidate architectures and driving technologies are described.

  5. Deep space telecommunications, navigation, and information management - Support of the Space Exploration Initiative

    NASA Technical Reports Server (NTRS)

    Hall, Justin R.; Hastrup, Rolf C.

    1990-01-01

    The principal challenges in providing effective deep space navigation, telecommunications, and information management architectures and designs for Mars exploration support are presented. The fundamental objectives are to provide the mission with the means to monitor and control mission elements, obtain science, navigation, and engineering data, compute state vectors and navigate, and to move these data efficiently and automatically between mission nodes for timely analysis and decision making. New requirements are summarized, and related issues and challenges including the robust connectivity for manned and robotic links, are identified. Enabling strategies are discussed, and candidate architectures and driving technologies are described.

  6. Expert initial review of Columbia River Basin salmonid management models: Summary report

    SciTech Connect

    Barnthouse, L.W.

    1993-10-01

    Over the past years, several fish passage models have been developed to examine the downstream survival of salmon during their annual migration through the Columbia River reservoir system to below Bonneville Dam. More recently, models have been created to simulate the survival of salmon throughout the entire life cycle. The models are used by various regional agencies and native American tribes to assess impacts of dam operation, harvesting, and predation on salmonid abundance. These models are now also being used to assess extinction probabilities and evaluate restoration alternatives for threatened and endangered salmonid stocks. Oak Ridge National Laboratory (ORNL) coordinated an initial evaluation of the principal models by a panel of outside, expert reviewers. None of the models were unequivocally endorsed by any reviewer. Significant strengths and weaknesses were noted for each with respect to reasonability of assumptions and equations, adequacy of documentation, adequacy of supporting data, and calibration procedures. Although the models reviewed differ in some important respects, all reflect a common conceptual basis in classical population dynamic theory and a common empirical basis consisting of the available time series of salmonid stock data, hydrographic records, experimental studies of dam passage parameters, and measurements of reservoir mortality. The results of this initial review are not to be construed as a comprehensive scientific peer review of existing Columbia River Basin (CRB) salmon population models and data. The peer review process can be enhanced further by a dynamic exchange regional modelers and scientific panel experts involving interaction and feedback.

  7. Identification and initial assessment of candidate BWR late-phase in-vessel accident management strategies

    SciTech Connect

    Hodge, S.A.

    1991-04-15

    Work sponsored by the United States Nuclear Regulatory Commission (USNRC) to identify and perform preliminary assessments of candidate BWR (boiling water reactor) in-vessel accident management strategies was completed at Oak Ridge National Laboratory (ORNL) during fiscal year 1990. Mitigative strategies for containment events have been the subject of a companion study at Brookhaven National Laboratory. The focus of this Oak Ridge effort was the development of new strategies for mitigation of the late phase events, that is, the events that would occur in-vessel after the onset of significant core damage. The work began with an investigation of the current status of BWR in-vessel accident management procedures and proceeded through a preliminary evaluation of several candidate new strategies. The steps leading to the identification of the candidate strategies are described. The four new candidate late-phase (in-vessel) accident mitigation strategies identified by this study and discussed in the report are: (1) keep the reactor vessel depressurized; (2) restore injection in a controlled manner; (3) inject boron if control blade damage has occurred; and (4) containment flooding to maintain core and structural debris in-vessel. Additional assessments of these strategies are proposed.

  8. Depression Screening in Chronic Disease Management: A Worksite Health Promotion Initiative.

    PubMed

    Jensen, Elizabeth; Dumas, Bonnie P; Edlund, Barbara J

    2016-03-01

    This pilot project aimed to improve depression symptoms and quality-of-life measures for individuals in a worksite disease management program. Two hundred forty-three individuals were invited to participate, out of which 69 enrolled. The participants had a history of diabetes, hypertension, or hyperlipidemia, and demonstrated depression using the Patient Health Questionnaire-9 (PHQ-9). The project consisted of counseling sessions provided every 2 to 4 weeks by a family nurse practitioner. PHQ-9 scores and those of an instrument that measures quality of life, the Veteran's Rand-12 (VR-12), were compared pre-intervention and post-intervention to evaluate the effectiveness of the project. PHQ-9 and VR-12 Mental Health Component (MHC) scores improved significantly after 3 months of nurse practitioner-led individual counseling sessions. This project demonstrated that depression screening and therapeutic management, facilitated by a nurse practitioner, can improve depression and perceived quality of life in individuals with hypertension, hyperlipidemia, or type 2 diabetes.

  9. Medication knowledge: an initial step in self-management for youth with inflammatory bowel disease.

    PubMed

    Fishman, Laurie N; Houtman, Dirk; van Groningen, Julia; Arnold, Janis; Ziniel, Sonja

    2011-12-01

    Adolescents with chronic illness need to develop skills to independently manage their own health. Knowledge of medication is an early step in this process. We explored which factors affect acquisition of medication knowledge in adolescents with inflammatory bowel disease (IBD). Consecutive patients with IBD older than 10 years received a confidential survey at an outpatient visit including questions regarding medication name, dose, and adverse effects. Results were compared with the medical record. Demographic characteristics obtained included age, sex, disease duration, and type of IBD. Completed surveys were returned by 294 patients (65% of those approached). Overall, 95% of patients could name their medication and 54% could identify their correct dose. Of 95 patients receiving biologics, 88% could identify the medicine and 50% could report either dose or timing. Of 139 patients on immunomodulator therapy, 94% could name medicine and 68% reported correct dose. Sex, type, or duration of disease did not affect name or dose knowledge. Generally, older patients did not demonstrate better medication or dosage knowledge than younger patients, although there was a significant trend toward improved knowledge of side effects for older patients. However, <32% of all of the patients could report a single major medication side effect. Medication knowledge is an early stage of self-management, yet many adolescents cannot report the dose of IBD medications, nor know the side effects of immunosuppression. This finding persists into late adolescence, which has ramifications for patients as they separate from parents for college or work.

  10. Evolving trends in the initial locoregional management of male breast cancer.

    PubMed

    Bratman, Scott V; Kapp, Daniel S; Horst, Kathleen C

    2012-06-01

    The locoregional management of breast cancer in men has evolved over time. Multimodality treatment regimens currently in use are based primarily on large randomized trials that exclusively enrolled women with breast cancer. We retrospectively reviewed cases of male breast cancer treated with radiotherapy at Stanford University Medical Center with an emphasis on 22 patients treated with surgery and locoregional radiotherapy. We report trends in the surgical techniques as well as in the use of adjuvant radiotherapy, chemotherapy, and hormonal therapy. There were no isolated locoregional failures in this cohort, and 5-year disease-free survival was 65%. The use of contemporary surgical and radiotherapeutic techniques in men is discussed. We conclude that treatment guidelines designed for women should be applied to the locoregional management of breast cancer in men. However, large international prospective registries and inclusion of men in cooperative group randomized trials will be important to confirm the safety and efficacy of modern treatment modalities for male breast cancer. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Investigation of the infertile couple: a basic fertility work-up performed within 12 months of trying to conceive generates costs and complications for no particular benefit.

    PubMed

    van der Steeg, Jan W; Steures, Pieternel; Hompes, Peter G A; Eijkemans, Marinus J C; van der Veen, Fulco; Mol, Ben W J

    2005-10-01

    The current approach of the basic fertility work-up has been questioned recently in this journal. Based on new data on human fecundity, the authors advocated starting the fertility work-up after just 6 months of trying to conceive instead of the usual 12 months. In women younger than 39 years and with a regular cycle, there are several arguments why the basic fertility work-up should not be done earlier than after 12 months of child wish. Firstly, 50% of couples who have tried to conceive for 6 months without success will conceive in the next 6 months without any treatment. Secondly, the prevalence of fertility diseases is lower in couples who have been trying to conceive for 6 months as compared with those who have been trying for 12 months. Performance of a fertility work-up at this stage will lead to an increase in false-positive diagnoses compared with performing them at 12 months of subfertility. Thirdly, fertility treatment will have fewer additional effects in couples with good spontaneous conception prospects (6-12 months child wish), compared with subfertile couples who have poor prospects. At present, none of the available fertility treatments have success rates comparable with no intervention in these women, and postponement of treatment in such couples will prevent complications such as ovarian hyperstimulation syndrome and multiple pregnancies. We argue that the fertility work-up should not be offered to couples with a duration of child wish of <12 months, except for women with ovulation disorders and women of 39 years and older.

  12. Additive value of amyloid-PET in routine cases of clinical dementia work-up after FDG-PET.

    PubMed

    Brendel, Matthias; Schnabel, Jonas; Schönecker, Sonja; Wagner, Leonie; Brendel, Eva; Meyer-Wilmes, Johanna; Unterrainer, Marcus; Schildan, Andreas; Patt, Marianne; Prix, Catharina; Ackl, Nibal; Catak, Cihan; Pogarell, Oliver; Levin, Johannes; Danek, Adrian; Buerger, Katharina; Bartenstein, Peter; Barthel, Henryk; Sabri, Osama; Rominger, Axel

    2017-09-20

    In recent years, several [(18)F]-labeled amyloid-PET tracers have been developed and have obtained clinical approval. Despite their widespread scientific use, studies in routine clinical settings are limited. We therefore investigated the impact of [(18)F]-florbetaben (FBB)-PET on the diagnostic management of patients with suspected dementia that was still unclarified after [(18)F]-fluordeoxyglucose (FDG)-PET. All subjects were referred in-house with a suspected dementia syndrome due to neurodegenerative disease. After undergoing an FDG-PET exam, the cases were discussed by the interdisciplinary dementia board, where the most likely diagnosis as well as potential differential diagnoses were documented. Because of persistent diagnostic uncertainty, the patients received an additional FBB-PET exam. Results were interpreted visually and classified as amyloid-positive or amyloid-negative, and we then compared the individual clinical diagnoses before and after additional FBB-PET. A total of 107 patients (mean age 69.4 ± 9.7y) were included in the study. The FBB-PET was rated as amyloid-positive in 65/107. In 83% of the formerly unclear cases, a final diagnosis was reached through FBB-PET, and the most likely prior diagnosis was changed in 28% of cases. The highest impact was observed for distinguishing Alzheimer's dementia (AD) from fronto-temporal dementia (FTLD), where FBB-PET altered the most likely diagnosis in 41% of cases. FBB-PET has a high additive value in establishing a final diagnosis in suspected dementia cases when prior investigations such as FDG-PET are inconclusive. The differentiation between AD and FTLD was particularly facilitated by amyloid-PET, predicting a considerable impact on patient management, especially in the light of upcoming disease-modifying therapies.

  13. Adverse Outcomes After Initial Non-surgical Management of Subdural Hematoma: A Population-Based Study.

    PubMed

    Morris, Nicholas A; Merkler, Alexander E; Parker, Whitney E; Claassen, Jan; Connolly, E Sander; Sheth, Kevin N; Kamel, Hooman

    2016-04-01

    Little is known about the natural history of non-surgically managed subdural hematoma (SDH). The purpose of this study is to determine rates of adverse events after non-surgical management of SDH and whether these outcomes differ depending on traumatic versus nontraumatic etiology. A retrospective cohort study was conducted using administrative claims data on all emergency department visits and acute care hospitalizations at nonfederal facilities in California from 2005 to 2011, Florida from 2005 to 2012, and New York from 2006 to 2011. We included patients who were discharged home after hospitalization with a first-recorded diagnosis of SDH and no record of surgical hematoma evacuation. Patients were followed for readmission with SDH, readmission for surgical SDH evacuation, and fatal readmission with SDH. Survival statistics and the log-rank test were used to compare rates of these adverse events after traumatic versus nontraumatic SDH. Multivariable Cox regression analysis was used to compare hazards for traumatic versus nontraumatic etiology while adjusting for age, sex, race, insurance status, presence of dementia, alcohol use, acquired abnormalities in coagulation, acquired abnormalities in platelet function, hypertension, atrial fibrillation, venous thromboembolism, ischemic stroke, coronary heart disease, and valvular disease. We identified 27,502 conservatively treated patients with SDH, of which 70.9% were traumatic and 29.1% nontraumatic. Compared to patients with traumatic SDH, patients with nontraumatic SDH had significantly higher rates of subsequent hospitalization with SDH (cumulative 90-day rates: 15.3 % [95% CI 14.5-16.1%] vs. 10.3% [95% CI 9.9-10.8%]), surgical SDH evacuation (7.8% [95% CI 7.3-8.5%] vs. 5.5% [95% CI 5.2-5.8%]), and SDH-related in-hospital death (1.0% [95% CI 0.8-1.2%] vs. 0.4% [95 % CI 0.3-0.5%]). In multivariable Cox regression analysis, nontraumatic etiology was associated with a higher hazard of readmission with SDH (HR 1

  14. Medtronic Sprint Fidelis lead recall: determining the initial 5-year management cost to Medicare.

    PubMed

    Mehrotra, Amit K; Knight, Bradley P; Smelley, Matthew P; Shah, Dipak P; Weisberg, Ian; Baez-Escudero, Jose; Beshai, John F; Burke, Martin C

    2011-08-01

    The Medtronic Sprint Fidelis defibrillator lead has a high failure rate and was recalled in October 2007. The purpose of this study was to determine the incremental cost of the management of this lead to Medicare. Real hospital cost data in U.S. dollars were collected on 32 patients with a Medtronic Sprint Fidelis lead who underwent lead revision. Of these patients, 15 were excluded because they had insurance coverage other than that provided by the Centers for Medicare & Medicaid Services. Seventeen patients with Medicare or Medicaid coverage underwent lead revision either electively (n = 6) or after being hospitalized for multiple shocks caused by a lead fracture (n = 11). Eighty-eight percent of the patients underwent extraction of the Fidelis lead at the time of lead revision. A decision model was made that outlines the potential management of the lead recall over time. The existing literature and Medtronic data were reviewed for parameters included in the decision model. The model assumed that 175,000 patients were alive with an implanted Fidelis lead at the time of the recall and that the annual failure rate will be 1.8% over the first 5 years. It was also assumed that 1% of patients without a lead fracture would also undergo elective lead revision each year and that the proportion of patients who would have the Fidelis lead extracted rather than abandoned would be 20:80. Estimates with ranges were used for parameters for which no data are available. The industry standard rate of lead failure was estimated based on the Sprint Quattro model 6947 lead, and this was subtracted from the estimated rates for the Sprint Fidelis lead such that the incremental cost of the lead failure could be estimated. The cost of lead revision trended higher when the Fidelis lead was extracted rather than abandoned ($45,077 ± $11,693 vs $33,802 ± $33, P = .20). In 5 years, the estimated cost impact of the Medtronic Sprint Fidelis lead recall to Medicare will be $287

  15. Telecommunications, navigation and information management concept overview for the Space Exploration Initiative program

    NASA Technical Reports Server (NTRS)

    Bell, Jerome A.; Stephens, Elaine; Barton, Gregg

    1991-01-01

    An overview is provided of the Space Exploration Initiative (SEI) concepts for telecommunications, information systems, and navigation (TISN), and engineering and architecture issues are discussed. The SEI program data system is reviewed to identify mission TISN interfaces, and reference TISN concepts are described for nominal, degraded, and mission-critical data services. The infrastructures reviewed include telecommunications for robotics support, autonomous navigation without earth-based support, and information networks for tracking and data acquisition. Four options for TISN support architectures are examined which relate to unique SEI exploration strategies. Detailed support estimates are given for: (1) a manned stay on Mars; (2) permanent lunar and Martian settlements; short-duration missions; and (4) systematic exploration of the moon and Mars.

  16. Telecommunications, navigation and information management concept overview for the Space Exploration Initiative program

    NASA Technical Reports Server (NTRS)

    Bell, Jerome A.; Stephens, Elaine; Barton, Gregg

    1991-01-01

    An overview is provided of the Space Exploration Initiative (SEI) concepts for telecommunications, information systems, and navigation (TISN), and engineering and architecture issues are discussed. The SEI program data system is reviewed to identify mission TISN interfaces, and reference TISN concepts are described for nominal, degraded, and mission-critical data services. The infrastructures reviewed include telecommunications for robotics support, autonomous navigation without earth-based support, and information networks for tracking and data acquisition. Four options for TISN support architectures are examined which relate to unique SEI exploration strategies. Detailed support estimates are given for: (1) a manned stay on Mars; (2) permanent lunar and Martian settlements; short-duration missions; and (4) systematic exploration of the moon and Mars.

  17. An initially unnoticed piece of nasal jewelry in a parturient: implications for intraoperative airway management.

    PubMed

    Kuczkowski, Krzysztof M; Benumof, Jonathan L; Moeller-Bertram, Tobias; Kotzur, Andreas

    2003-08-01

    The literature documenting the anesthetic implications of body piercing consists only of a few case reports that focus exclusively on interference with airway management by oral jewelry. To date, no case reports documenting anesthetic problems resulting from the presence of nasal jewelry have been reported. We present a case of a parturient who presented for an emergency cesarean section with nasal jewelry in situ, which was unnoticed preoperatively and then became externally loosened intraoperatively. This situation necessitated fiberoptic examination of the nasopharyngeal and oropharyngeal cavities and radiologic imaging studies to rule out aerodigestive tract aspiration of retained and missing piece(s) of the jewelry. Based on this experience, we now advise all laboring parturients with nasal or oral jewelry in situ to remove the hardware on admission to Labor and Delivery for safety precautions.

  18. Community Health Workers as Drivers of a Successful Community-Based Disease Management Initiative

    PubMed Central

    Peretz, Patricia J.; Matiz, Luz Adriana; Findley, Sally; Lizardo, Maria; Evans, David; McCord, Mary

    2012-01-01

    In 2005, local leaders in New York City developed the Washington Heights/Inwood Network for Asthma Program to address the burden of asthma in their community. Bilingual community health workers based in community organizations and the local hospital provided culturally appropriate education and support to families who needed help managing asthma. Families participating in the yearlong care coordination program received comprehensive asthma education, home environmental assessments, trigger reduction strategies, and clinical and social referrals. Since 2006, 472 families have enrolled in the yearlong program. After 12 months, hospitalizations and emergency department visits decreased by more than 50%, and caregiver confidence in controlling the child's asthma increased to nearly 100%. Key to the program's success was the commitment and involvement of community partners from program inception to date. PMID:22515859

  19. The case for computed tomographic angiography for initial management of lower gastrointestinal hemorrhage

    PubMed Central

    Cura, Marco

    2017-01-01

    Lower gastrointestinal hemorrhage remains a common disease, frequently presenting with acute life-threatening symptoms. Although prompt detection and treatment are imperative, it is difficult to diagnose lower gastrointestinal hemorrhage in an accurate and efficient manner. Most available modalities are time consuming. Computed tomographic angiography of the abdomen and pelvis, on the other hand, has the unique capability of rapidly detecting whether life-threatening hemorrhage is occurring and accurately localizing it, thus facilitating definitive treatment. We present a case in which computed tomographic angiography was invaluable in the detection and subsequent empirical transarterial embolization of a lower gastrointestinal hemorrhage and offer evidence as to why it should be a first-line tool in the management of these patients. PMID:28670085

  20. The case for computed tomographic angiography for initial management of lower gastrointestinal hemorrhage.

    PubMed

    Gupton, Theodore; Cura, Marco

    2017-07-01

    Lower gastrointestinal hemorrhage remains a common disease, frequently presenting with acute life-threatening symptoms. Although prompt detection and treatment are imperative, it is difficult to diagnose lower gastrointestinal hemorrhage in an accurate and efficient manner. Most available modalities are time consuming. Computed tomographic angiography of the abdomen and pelvis, on the other hand, has the unique capability of rapidly detecting whether life-threatening hemorrhage is occurring and accurately localizing it, thus facilitating definitive treatment. We present a case in which computed tomographic angiography was invaluable in the detection and subsequent empirical transarterial embolization of a lower gastrointestinal hemorrhage and offer evidence as to why it should be a first-line tool in the management of these patients.

  1. An initial assessment of the risk approach to antenatal management in Malaysia.

    PubMed

    Somboonsook, B; Wakerman, J; Hattch, C T; Collison, M; Barnes, A; Kyi, W; Karim, R

    1995-09-01

    This study was the first assessment of a nationwide risk approach system to antenatal management introduced to Malaysia in 1989. Three rapid, record-based surveys on three different study groups were conducted to determine risk factor prevalence, accuracy of risk assignment, action after risk assignment and the relationship of risk level and place of delivery. The most frequent risk factors were short birth interval, high parity and first pregnancy. Accuracy of risk assignment was highest at the lowest levels of risk and poorest at the highest levels. Women at the lowest levels of risk were more likely to be seen by a doctor than women at highest risk. These was a trend to deliver in hospital, rather than at home, as level of risk increased; but many women at high risk still delivered at home. Recommendations are made on modifications to the system prior to future evaluation.

  2. Clinical presentations of critical cardiac defects in the newborn: Decision making and initial management

    PubMed Central

    2010-01-01

    The risk of mortality and morbidity of patients with congenital heart defects (CHDs) is highest during neonatal period and increases when diagnosis and proper management are delayed. Neonates with critical CHDs may present with severe cyanosis, respiratory distress, shock, or collapse, all of which are also frequent clinical presentations of various respiratory problems or sepsis in the newborn. Early diagnosis and stabilization and timely referral to a tertiary cardiac center are crucial to improve the outcomes in neonates with CHDs. In this review, the clinical presentation of critical and potentially life-threatening CHDs is discussed along with brief case reviews to help understand the hemodynamics of these defects and ensure proper decision-making in critically ill patients. PMID:21189937

  3. An integrated knowledge management system for the clinical laboratories: an initial application of an architectural model.

    PubMed

    Bountis, Christos; Kay, Jonathan D S

    2002-01-01

    eLABook is a web-distributed knowledge management system designed to support the needs of clinicians and laboratory staff in the selection and interpretation of investigations in laboratory medicine. Access can be by hyperlinks at any point through the request-report cycle, by browsing down a hierarchy, and by various search approaches. The information describes service issues, which are predominantly locally determined, and clinical implications, which may be local, national, governmental and international. The application has been implemented across the Oxford Clinical Intranet to support secondary care in the four hospital sites of the Oxford Radcliffe Hospitals and by general practitioners in Oxfordshire. The knowledge base is capable of rapid changes in response to input from both developers and users. It supports authoring, editing and a full audit trail of changes. The selected architecture allows very large scale hierarchical structures and is designed to accommodate future needs for an object-distributed processing deployment.

  4. International Atomic Energy Agency (IAEA) initiatives: Records management for deep and near surface geologic repositories

    SciTech Connect

    Warner, P.J.

    1996-09-01

    The international scientific community has long had an interest in determining methods by which information regarding nuclear waste repositories, and the inherent danger to humanity, could be passed from generation to generation and society to society. Because nuclear waste will remain radioactive for thousands of years future generations must be warned of the dangers thus eliminating intentional or inadvertent intrusion. Member States of the IAEA have determined that the principle safety of such sites must not rely solely on long term institutional arrangements for the retention of information. It is believed that repository siting, design, operation and postoperation information should be gathered, managed and retained so that this information remains accessible to future societies over a very long period of time. The radionuclide life is 10,000 years; thus the retention of information continues beyond current societies, cultures and languages, and must be continually migrated to new retrieval technologies to assure access.

  5. Community health workers as drivers of a successful community-based disease management initiative.

    PubMed

    Peretz, Patricia J; Matiz, Luz Adriana; Findley, Sally; Lizardo, Maria; Evans, David; McCord, Mary

    2012-08-01

    In 2005, local leaders in New York City developed the Washington Heights/Inwood Network for Asthma Program to address the burden of asthma in their community. Bilingual community health workers based in community organizations and the local hospital provided culturally appropriate education and support to families who needed help managing asthma. Families participating in the yearlong care coordination program received comprehensive asthma education, home environmental assessments, trigger reduction strategies, and clinical and social referrals. Since 2006, 472 families have enrolled in the yearlong program. After 12 months, hospitalizations and emergency department visits decreased by more than 50%, and caregiver confidence in controlling the child's asthma increased to nearly 100%. Key to the program's success was the commitment and involvement of community partners from program inception to date.

  6. Culturally Competent Diabetes Self-Management Education for Mexican Americans: The Starr County Border Health Initiative

    PubMed Central

    Brown, Sharon A.; Dougherty, James R.; Garcia, Alexandra A.; Kouzekanani, Kamiar; Hanis, Craig L.

    2007-01-01

    Objective To determine in Mexican Americans with type 2 diabetes the effects of a culturally competent diabetes self-management intervention. Research Design and Methods A prospective, randomized, repeated measures study was conducted on the Texas-Mexico border in Starr County. 256 randomly selected persons with type 2 diabetes were: (1) between 35 and 70 years of age; (2) diagnosed with type 2 diabetes after the age of 35 years; and (3) accompanied by a family member or friend. The intervention consisted of 52 contact hours over 12 months and was provided by bilingual Mexican American nurses, dietitians, and community workers. The intervention involved : (1) 3 months of weekly instructional sessions on nutrition, self-monitoring of blood glucose, exercise, and other self-care topics; and (2) 6 months of biweekly support group sessions to promote behavior changes. The approach was culturally competent in terms of language, diet, social emphasis, family participation, and incorporation of cultural health beliefs. Indicators of metabolic control (HbA1c and FBS), diabetes knowledge, and diabetes-related health beliefs. Results Experimental groups showed significantly lower levels of HbA1c and FBS at 6 months and at 12 months and higher diabetes knowledge scores. At 6 months, the mean HbA1c of the experimental subjects was 1.4% below the mean of the control group; however, the mean level of the experimental subjects was still high (over 10%). Conclusions This study confirms the effectiveness of culturally competent diabetes self-management education on improving health outcomes of Mexican Americans, particularly for those individuals with HbA1c levels above 10%. PMID:11815493

  7. Channel and perennial flow initiation in headwater streams: management implications of variability in source-area size.

    PubMed

    Jaeger, Kristin L; Montgomery, David R; Bolton, Susan M

    2007-11-01

    Despite increasing attention to management of headwater streams as sources of water, sediment, and wood to downstream rivers, the extent of headwater channels and perennial flow remain poorly known and inaccurately depicted on topographic maps and in digital hydrographic data. This study reports field mapping of channel head and perennial flow initiation locations in forested landscapes underlain by sandstone and basalt lithologies in Washington State, USA. Contributing source areas were delineated for each feature using a digital elevation model (DEM) as well as a Global Positioning System device in the field. Systematic source area-slope relationships described in other landscapes were not evident for channel heads in either lithology. In addition, substantial variability in DEM-derived source area sizes relative to field-delineated source areas indicates that in this area, identification of an area-slope relationship, should one even exist, would be difficult. However, channel heads and stream heads, here defined as the start of perennial flow, appear to be co-located within both of the lithologies, which together with lateral expansion and contraction of surface water around channel heads on a seasonal cycle in the basalt lithology, suggest a controlling influence of bedrock springs for that location. While management strategies for determining locations of channel heads and perennial flow initiation in comparable areas could assign standard source area sizes based on limited field data collection within that landscape, field-mapped source areas that support perennial flow are much smaller than recognized by current Washington State regulations.

  8. Insulin therapy for management of type 2 diabetes mellitus: strategies for initiation and long-term patient adherence.

    PubMed

    Barag, Steven H

    2011-07-01

    Effective glycemic control is essential to minimize the long-term complications of type 2 diabetes mellitus (T2DM). However, it is well documented that many patients spend prolonged periods outside of the optimal glycemic range. The use of insulin is important to effectively control the disease process in patients with T2DM. Even so, resistance to insulin use among patients and healthcare providers often limits initiation and intensification of insulin therapy. With the increasing prevalence of T2DM across all socioeconomic strata, an expanded viewpoint of early and sustained insulin use is crucial to enhance glycemic control in patients. To manage the effects of T2DM on cardiovascular disease in the aging population, physicians can promote insulin therapy as an affordable and effective treatment option. The author reviews beliefs and myths about the use of insulin in the management of T2DM and discusses strategies to overcome barriers to initiation of insulin therapy in the primary care setting.

  9. Calculation of intercepted runoff depth based on stormwater quality and environmental capacity of receiving waters for initial stormwater pollution management.

    PubMed

    Peng, Hai-Qin; Liu, Yan; Gao, Xue-Long; Wang, Hong-Wu; Chen, Yi; Cai, Hui-Yi

    2017-09-14

    While point source pollutions have gradually been controlled in recent years, the non-point source pollution problem has become increasingly prominent. The receiving waters are frequently polluted by the initial stormwater from the separate stormwater system and the wastewater from sewage pipes through stormwater pipes. Consequently, calculating the intercepted runoff depth has become a problem that must be resolved immediately for initial stormwater pollution management. The accurate calculation of intercepted runoff depth provides a solid foundation for selecting the appropriate size of intercepting facilities in drainage and interception projects. This study establishes a separate stormwater system for the Yishan Building watershed of Fuzhou City using the InfoWorks Integrated Catchment Management (InfoWorks ICM), which can predict the stormwater flow velocity and the flow of discharge outlet after each rainfall. The intercepted runoff depth is calculated from the stormwater quality and environmental capacity of the receiving waters. The average intercepted runoff depth from six rainfall events is calculated as 4.1 mm based on stormwater quality. The average intercepted runoff depth from six rainfall events is calculated as 4.4 mm based on the environmental capacity of the receiving waters. The intercepted runoff depth differs when calculated from various aspects. The selection of the intercepted runoff depth depends on the goal of water quality control, the self-purification capacity of the water bodies, and other factors of the region.

  10. In view of standardization: comparison and analysis of initial management of severely burned patients in Germany, Austria and Switzerland.

    PubMed

    Münzberg, Matthias; Ziegler, Benjamin; Fischer, Sebastian; Wölfl, Christoph Georg; Grützner, Paul Alfred; Kremer, Thomas; Kneser, Ulrich; Hirche, Christoph

    2015-02-01

    Initial treatment of severely injured patients in German speaking trauma centers follows precise sequences. Several guidelines and training courses ensure a constant quality in providing evidence-based treatment for these patients. Similar standards, algorithms and guidelines for the treatment of severely burned patients are lacking. This raises the question about the current standard of care for burn victims in German speaking burn centers. In order to achieve standardization, as a first step this study surveys principles of burn room organization and management in these burn centers. A questionnaire including 40 questions regarding burn room organization, personnel structure and qualification, infrastructural conditions and quality management was developed and sent to 21 level one burn centers in Germany, Austria and Switzerland. The rate of returned questionnaires was 81%. The analysis revealed varying personnel and infrastructural conditions in participating burn centers. Indications for admission to the burn room and admission procedures itself are different throughout surveyed hospitals. Individual standard operating procedure (SOP) for burn trauma admissions was available in most burn centers and nearly all participants register their burn trauma cases using an in-house burn register. The survey suggests a lack of standardization in personnel structure, infrastructure and treatment approach for the initial clinical care of severely burned patients in burn centers across the German speaking countries. Further evaluation of existing protocols and international standards in burn care is inevitable to develop standardized guidelines for burn care and to improve quality of care. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  11. First aid and initial management for childhood burns in Vietnam--an appeal for public and continuing medical education.

    PubMed

    Lam, Nguyen Nhu; Dung, Nguyen Tien

    2008-02-01

    A prospective study to investigate first aid and initial management for 247 paediatric burn patients from 1 June, 2004 to 31 June, 2006 at the Burn Intensive Care Unit, National Institute of Burns (NIB), Hanoi. Data were collected from documents from referring hospitals and direct interview of patients, relative and transport team as guided by the International Society for Burn Injury (ISBI) and the World Health Organization (WHO). Results showed that cooling the burn surface by cold water was applied in 27.17%. Among 132 patients transferred from other hospitals, fluid resuscitation was given in 102 patients (77.28%) before transferring and over a half of these patients were not given intravenous fluid during the time of transfer, especially for children under 1 year of age (p<0.05). Dressings were applied in 36.36% of transferred patients. Burn surface area was accurately diagnosed in only 21.90% of total cases. In conclusion, first aid and initial management in Vietnam are still far from ideal. Further public education and continuing medical education should be applied in Vietnam.

  12. The Philadelphia Glaucoma Detection and Treatment Project: Detection Rates and Initial Management.

    PubMed

    Waisbourd, Michael; Pruzan, Noelle L; Johnson, Deiana; Ugorets, Angela; Crews, John E; Saaddine, Jinan B; Henderer, Jeffery D; Hark, Lisa A; Katz, L Jay

    2016-08-01

    To evaluate the detection rates of glaucoma-related diagnoses and the initial treatments received in the Philadelphia Glaucoma Detection and Treatment Project, a community-based initiative aimed at improving the detection, treatment, and follow-up care of individuals at risk for glaucoma. Retrospective analysis. A total of 1649 individuals at risk for glaucoma who were examined and treated in 43 community centers located in underserved communities of Philadelphia. Individuals were enrolled if they were African American aged ≥50 years, were any other adult aged ≥60 years, or had a family history of glaucoma. After attending an informational glaucoma workshop, participants underwent a targeted glaucoma examination including an ocular, medical, and family history; visual acuity testing, intraocular pressure (IOP) measurement, and corneal pachymetry; slit-lamp and optic nerve examination; automated visual field testing; and fundus color photography. If indicated, treatments included selective laser trabeculoplasty (SLT), laser peripheral iridotomy (LPI), or IOP-lowering medications. Follow-up examinations were scheduled at the community sites after 4 to 6 weeks or 4 to 6 months, depending on the clinical scenario. Detection rates of glaucoma-related diagnoses and types of treatments administered. Of the 1649 individuals enrolled, 645 (39.1%) received a glaucoma-related diagnosis; 20.0% (n = 330) were identified as open-angle glaucoma (OAG) suspects, 9.2% (n = 151) were identified as having narrow angles (or as a primary angle closure/suspect), and 10.0% (n = 164) were diagnosed with glaucoma, including 9.0% (n = 148) with OAG and 1.0% (n = 16) with angle-closure glaucoma. Overall, 39.0% (n = 64 of 164) of those diagnosed with glaucoma were unaware of their diagnosis. A total of 196 patients (11.9%) received glaucoma-related treatment, including 84 (5.1%) who underwent LPI, 13 (0.8%) who underwent SLT, and 103 (6.2%) who were prescribed IOP

  13. Healthy sand : a farmers initiative on soil protection and ecosystem service management

    NASA Astrophysics Data System (ADS)

    Smit, Annemieke; Verzandvoort, Simone; Kuikman, Peter; Stuka, Jason; Morari, Francesco; Rienks, Willem; Stokkers, Jan; Hesselink, Bertus; Lever, Henk

    2015-04-01

    In a small region in the Netherlands a group of dairy farmers (cooperated in a foundation HOE Duurzaam) cooperates with the drinking water company and together aim for a more healthy soil. They farm a sandy soil, which is in most of the parcels low in organic matter. The local farmers perceive loss of soil fertility and blame loss of soil organic matter for that. All farmers expect that increasing the soil organic matter content will retain more nitrates in the soil, leading to a reduction in nitrate leaching and a higher nutrient availability for the crops, forage and grass and probably low urgency for grassland renewal. The drinking water company in the area also has high expectations that a higher SOM content does relate to higher quality of the (drinking) water and lower costs to clean and filter the water to meet drinking water quality requirements. Most farmers in the area face suboptimal moisture conditions and thrive for increasing the soil organic matter content and improving the soil structure as key factors to relieve, soil moisture problems both in dry (drought) and wet (flooding) periods. A better water holding capacity of the soil provides benefits for the regional water board as this reduces leaching and run-off. The case study, which is part of the Recare-project, at first glance deals with soil management and technology to improve soil quality. However, the casus in fact deals with social innovation. The real challenge to this group of neighbours, farmers within a small region, and to science is how to combine knowledge and experience on soil management for increasing the content of soil organic matter and how to recognize the ecosystem services that are provided by the adapted and more 'healthy' soils. And also how to formalize relations between costs and benefits of measures taken in the field and how these could be financially rewarded from an agreed and acceptable financial awarding scheme based on payments for securing soil carbon stocks and

  14. A quality improvement initiative on the management of osteoporosis in older people with Parkinsonism

    PubMed Central

    Singh, Inderpal; Fletcher, Rachel; Scanlon, Linda; Tyler, Mandy; Aithal, Shridhar

    2016-01-01

    The risk of falls is higher in patients with people with Parkinsonism (PwP) compared to those without Parkinsonism, and leads to adverse outcomes including fragility fractures. Osteoporosis is under-recognised, and the prevalence of fragility fractures in not well studied. The primary aim of this project is for 100% of new patient referrals to, and 80% of follow up patients within the movement disorder (MD) service with osteoporosis to be treated in accordance with evidence based osteoporosis guidance. Routinely captured information regarding demographics and fragility fractures was retrospectively extracted from the clinical workstation, clinic letters, and clinical coding between July and November 2015. The prevalence of fragility fracture was 22.6% (68/300), and only 40% (27/68) were on appropriate treatment for osteoporosis. A quality improvement (QI) methodology based on the model of improvement, Plan-Do-Study-Act (PDSA) cycles were used, and a monthly multidisciplinary team (MDT) meeting was introduced. This QI initiative has shown that MDT input can reduce referrals to physiotherapists; and also 100% of new patients, and 91% of follow up patients received evidence based osteoporosis treatment. PMID:27933155

  15. Mandatory palliative care education for surgical residents: initial focus on teaching pain management.

    PubMed

    Oya, Hisaharu; Matoba, Motohiro; Murakami, Satoshi; Ohshiro, Taihei; Kishino, Takayoshi; Satoh, Yuya; Tsukahara, Tetsuo; Hori, Syutarou; Maeda, Masahiro; Makino, Takashi; Maeda, Takashi

    2013-02-01

    Knowledge concerning palliative care and the associated skills, including effective pain control, is essential for surgeons who treat cancer patients in daily practice. This study focuses on a palliative care training course that has been mandatorily conducted for all surgical residents of our hospital since 2009. We evaluated the effectiveness of our mandatory palliative care training course by conducting a retrospective study of the patients' medical records and participants' questionnaire results and discussed the importance of palliative care education for surgical residents. All 12 surgical residents who participated in the course in 2009 had graduated 4-9 years back. They were assigned to look after a total of 92 cases (average, 7.66 cases per resident) during the course. The purpose of care in most cases (92.3%) was to mitigate pain. Introducing analgesic adjuvants such as gabapentin or amitriptyline accounted for the largest part of initial interventions (23.9%) aimed at controlling cancer pain, followed by changes in route of administration or doses of prior opioid analgesics (21.7%). Interventions with opioid analgesics were conducted most frequently (47.7%). The overall pain improvement rate was 89.1%. We used a questionnaire after the course to evaluate its effectiveness. The surgical residents stated that it was a meaningful course through which they gained practical knowledge on palliative care and that the experience would change their approach to home care.

  16. Mandatory Palliative Care Education for Surgical Residents: Initial Focus on Teaching Pain Management

    PubMed Central

    Oya, Hisaharu; Matoba, Motohiro; Murakami, Satoshi; Ohshiro, Taihei; Kishino, Takayoshi; Satoh, Yuya; Tsukahara, Tetsuo; Hori, Syutarou; Maeda, Masahiro; Makino, Takashi; Maeda, Takashi

    2013-01-01

    Background Knowledge concerning palliative care and the associated skills, including effective pain control, is essential for surgeons who treat cancer patients in daily practice. This study focuses on a palliative care training course that has been mandatorily conducted for all surgical residents of our hospital since 2009. Methods We evaluated the effectiveness of our mandatory palliative care training course by conducting a retrospective study of the patients' medical records and participants' questionnaire results and discussed the importance of palliative care education for surgical residents. Results All 12 surgical residents who participated in the course in 2009 had graduated 4–9 years back. They were assigned to look after a total of 92 cases (average, 7.66 cases per resident) during the course. The purpose of care in most cases (92.3%) was to mitigate pain. Introducing analgesic adjuvants such as gabapentin or amitriptyline accounted for the largest part of initial interventions (23.9%) aimed at controlling cancer pain, followed by changes in route of administration or doses of prior opioid analgesics (21.7%). Interventions with opioid analgesics were conducted most frequently (47.7%). The overall pain improvement rate was 89.1%. We used a questionnaire after the course to evaluate its effectiveness. Conclusions The surgical residents stated that it was a meaningful course through which they gained practical knowledge on palliative care and that the experience would change their approach to home care. PMID:23275645

  17. Self-initiated tobacco cessation and substance use outcomes among adolescents entering substance use treatment in a managed care organization

    PubMed Central

    Campbell, Cynthia I.; Chi, Felicia; Sterling, Stacy; Kohn, Carolyn; Weisner, Constance

    2009-01-01

    Purpose Adolescents with substance use (SU) problems have high rates of tobacco use, yet SU treatment has historically ignored treatment for tobacco use. Barriers to such efforts include the belief that tobacco cessation could compromise other SU abstinence. This study examines self-initiated tobacco cessation and 12-month alcohol and drug abstinence in adolescents entering SU treatment in a private, managed care organization. Results Self-initiated tobacco cessation at 6 months, and at both 6 and 12 months, were related to higher odds of drug abstinence but not alcohol abstinence. Conclusion Self-initiated tobacco cessation was not related to poor SU outcomes, and may be important to maintaining drug abstinence. Implementing tobacco cessation efforts in SU treatment can be challenging, but comprised SU outcomes may not be a barrier. The positive associations for drug abstinence and lack of associations for alcohol abstinence could be due to differences in motivation, medical conditions, or to the illicit nature of drug use. Tobacco use has serious long-term health consequences, and tobacco cessation efforts in adolescent SU treatment programs need further research. PMID:19010600

  18. Peroral endoscopic myotomy—initial experience with anesthetic management of 24 procedures and systematic review

    PubMed Central

    Goudra, Basavana; Singh, Preet Mohinder; Gouda, Gowri; Sinha, Ashish C.

    2016-01-01

    Background: Peroral endoscopic myotomy (POEM) is a novel method of treating achalasia of the esophagus. Very little data are available to guide the anesthesia providers caring for these patients. The anesthetic challenges are primarily related to the risk of pulmonary aspiration. There is also a potential risk of pneumomediastinum, pneumoperitoneum, subcutaneous, or submucosal emphysema, as a result of carbon dioxide tracking into the soft tissues surrounding the esophagus and lower esophageal sphincter. Methods: In this retrospective study, electronic charts of 24 patients who underwent POEM over 18 months were reviewed. Demographic data, fasting status, relevant aspiration risks, anesthetic technique, and postoperative care measures were extracted. Results: Fasting times for both solids and liquids were variable. None of the patients underwent preprocedural esophageal emptying. Standard induction and intubation were performed in 16, rapid sequence induction (RSI) with cricoid pressure in seven, and modified rapid sequence without application of cricoid pressure in one of the patients. One of the patients aspirated at induction, and the procedure was aborted. However, the procedure was performed successfully after a few weeks, this time a RSI with cricoid pressure was chosen. Conclusion: As there are no guidelines for the perioperative management of patients presenting for POEM presently, certain recommendations can be made. Preprocedural esophageal emptying should be considered in patients considered as high-risk, although cultural factors might preclude such an approach. Induction and intubation in a semi-reclining position might be useful. Although debatable, use of RSI with cricoid pressure should be strongly considered. PMID:27212764

  19. School of pharmacy-based medication therapy management program: development and initial experience.

    PubMed

    Lam, Annie; Odegard, Peggy Soule; Gardner, Jacqueline

    2012-01-01

    To describe a school of pharmacy-community pharmacy collaborative model for medication therapy management (MTM) service and training. University of Washington (UW) School of Pharmacy (Seattle), from July to December 2008. MTM services and training. A campus-based MTM pharmacy was established for teaching, practice, and collaboration with community pharmacies to provide comprehensive medication reviews (CMRs) and MTM training. Number of collaborating pharmacies, number of patients contacted, number of CMRs conducted, and estimated cost avoidance (ECA). UW Pharmacy Cares was licensed as a Class A pharmacy (nondispensing) and signed "business associate" agreements with six community pharmacies. During July to December 2008, 10 faculty pharmacists completed training and 5 provided CMR services to 17 patients (5 telephonic and 12 face-to-face interviews). A total of 67 claims (17 CMRs and 50 CMR-generated claims) were submitted for reimbursement of $1,642 ($96.58/CMR case). Total ECA was $54,250, averaging $3,191.19 per patient. Seven student pharmacists gained CMR interview training. Interest in collaboration by community pharmacies was lower than expected; however, the campus-community practice model addressed unmet patient care needs, reduced outstanding MTM CMR case loads, increased ECA, and facilitated faculty development and training of student pharmacists.

  20. Initial Validation of a Knowledge-Based Measure of Social Information Processing and Anger Management

    PubMed Central

    Cassano, Michael; MacEvoy, Julie Paquette; Costigan, Tracy

    2010-01-01

    Over the past fifteen years many schools have utilized aggression prevention programs. Despite these apparent advances, many programs are not examined systematically to determine the areas in which they are most effective. One reason for this is that many programs, especially those in urban under-resourced areas, do not utilize outcome measures that are sensitive to the needs of ethnic minority students. The current study illustrates how a new knowledge-based measure of social information processing and anger management techniques was designed through a partnership-based process to ensure that it would be sensitive to the needs of urban, predominately African American youngsters, while also having broad potential applicability for use as an outcome assessment tool for aggression prevention programs focusing upon social information processing. The new measure was found to have strong psychometric properties within a sample of urban predominately African American youth, as item analyses suggested that almost all items discriminate well between more and less knowledgeable individuals, that the test-retest reliability of the measure is strong, and that the measure appears to be sensitive to treatment changes over time. In addition, the overall score of this new measure is moderately associated with attributions of hostility on two measures (negative correlations) and demonstrates a low to moderate negative association with peer and teacher report measures of overt and relational aggression. More research is needed to determine the measure's utility outside of the urban school context. PMID:20449645

  1. Organ donation education initiatives: A report of the Donor Management Task Force.

    PubMed

    Michetti, Christopher P; Nakagawa, Thomas A; Malinoski, Darren; Wright, Charles; Swanson, LeAnn

    2016-10-01

    It is essential that hospitals and health professionals establish systems to facilitate patients' organ donation wishes. Donation education has been neither standardized nor systematic, and resources related to donation processes have not been widely accessible. This report describes 2 free, publicly available educational resources about the organ donation process created to advance the mission of basic education and improve donation processes within hospitals and health care systems. Members of the Donor Management Task Force of the Organ Donation and Transplantation Alliance (the Alliance) and the Health Resources and Services Administration of the US Department of Health and Human Services convened annually in person and by teleconferencing during the year to develop 2 educational vehicles on organ donation. Two educational products were developed: the Organ Donation Toolbox, an online repository of documents and resources covering all aspects of the donation process, and the Educational Training Video that reviews the basic foundations of a successful hospital donation system. There is a need for more research and education about the process of organ donation as it relates to the medical and psychosocial care of patients and families before the end of life. The educational products described can help fill this critical need. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Day surgery management model in china: practical experience and initial evaluation

    PubMed Central

    Jiang, Huiyong; Han, Junyi; Lu, Aiguo; Liu, Xiufeng

    2014-01-01

    Objectives: Day surgery has been increasingly performed in some major teaching hospitals in China. We aimed to evaluate the current day surgery management model (DSMM) and compare the clinical outcome and health service utility of day surgery with inpatient surgery. Methods: We reviewed 14482 day surgery cases under the DSMM and 2591 inpatient surgery cases under the non-DSMM between September 2006 and September 2012 in Shanghai East Hospital. The endpoints of interest were hospitalization days, incision infection rate and hospital cost. Results: Among 14482 day surgery cases, only 52 (0.4%) were converted to hospitalization. The average hospitalization time of the patients was 2-10 hours. None of them had incision infection. Hospital cost of DSMM was less than 50% of non-DSMM (inpatient surgery). The most common postoperative complications were nausea, vomiting and dizziness. Nearly half of patients had mild to moderate pain after surgery. Conclusions: DSMM optimizes the utilization of healthcare resources by reducing hospital admission, hospital cost and incision infection in China. PMID:25550971

  3. Current Practice in the Management of Open Fractures Among Orthopaedic Trauma Surgeons. Part A: Initial Management. A Survey of Orthopaedic Trauma Surgeons.

    PubMed

    Obremskey, William; Molina, Cesar; Collinge, Cory; Nana, Arvind; Tornetta, Paul; Sagi, Claude; Schmidt, Andrew; Probe, Robert; Ahn, Jaimo; Browner, Bruce D

    2014-08-01

    Open fractures are one of the injuries with the highest rate of infection that orthopaedic trauma surgeons treat. The main purpose of this survey was to determine current practice and practice variation among Orthopaedic Trauma Association (OTA) members and make treatment recommendations based on previously published resources. Survey. Web-based survey. Three hundred seventy-nine orthopaedic trauma surgeons. A 15-item questionnaire-based study titled "OTA Open Fracture Survey" was constructed. The survey was delivered to all OTA membership categories. Different components of the data charts were used to analyze numerous aspects of open fracture management, focusing on parameters of initial and definitive treatment. Eighty-six percent of participants responded that a period of time of less than 1 hour is the optimal time to antibiotic administration after identification of open fracture. Despite concerns with nephrotoxicity, 24.0%-76.3% of respondents reported the use of aminoglycosides in management of open fractures. A little over half of survey respondents continue antibiotics until next debridement in wounds that were not definitively closed after initial debridement and stabilization. Rapid administration of antibiotics in open fracture management is important. Aminoglycoside use is still prevalent despite evidence questioning efficacy and toxicity concerns. Time to debridement of open fractures is controversial among OTA members. Antibiotic administration is commonly continued >48 hours despite concerns raised by Surgical Infection Society and The Eastern Association of the Surgery of Trauma. Regarding study logistics, survey participation reminders should be used when conducting this type of study as it can increase data accrual by 50%. Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

  4. Process Improvement Initiative for the Perioperative Management of Patients With a Cardiovascular Implantable Electronic Device.

    PubMed

    Ellis, Margaret K Menzel; Treggiari, Miriam M; Robertson, Jamie M; Rozner, Marc A; Graven, Peter F; Aziz, Michael F; Merkel, Matthias J; Kahl, Edward A; Cohen, Norman A; Stecker, Eric C; Schulman, Peter M

    2017-07-01

    Economic, personnel, and procedural challenges often complicate and interfere with efficient and safe perioperative care of patients with cardiovascular implantable electronic devices (CIEDs). In the context of a process improvement initiative, we created and implemented a comprehensive anesthesiologist-run perioperative CIED service to respond to all routine requests for perioperative CIED consultations at a large academic medical center. This study was designed to determine whether this new care model was associated with improved operating room efficiency, reduced institutional cost, and adequate patient safety. We included patients with a CIED and a concurrent cohort of patients with the same eligibility criteria but without a CIED who underwent first-case-of-the-day surgery during the periods between February 1, 2008, and August 17, 2010 (preintervention) and between March 4, 2012, and August 1, 2014 (postintervention). The primary end point was delay in first-case-of-the day start time. We used multiple linear regression to compare delays in start times during the preintervention and postintervention periods and to adjust for potential confounders. A patient safety database was queried for CIED-related complications. Cost analysis was based on labor minutes saved and was calculated using nationally published administrative estimates. A total of 18,148 first-case surgical procedures were performed in 15,100 patients (preintervention period-7293 patients and postintervention period-7807 patients). Of those, 151 (2.1%) patients had a CIED in the preintervention period, and 146 (1.9%) had a CIED in the postintervention period. After adjustment for imbalances in baseline characteristics (age, American Society of Anesthesiologists physical status, and surgical specialty), the difference in mean first-case start delay between the postintervention and preintervention periods in the cohort of patients with a CIED was -16.7 minutes (95% confidence interval [CI], -26

  5. Current and future initiatives for vascular health management in clinical practice

    PubMed Central

    Cameron, James D; Asmar, Roland; Struijker-Boudier, Harry; Shirai, Kohji; Sirenko, Yuriy; Kotovskaya, Yulia; Topouchian, Jirar

    2013-01-01

    Central arterial structure and function comprise a primary determinant of vascular health, and are integral to the important concept of ventriculo-vascular coupling or interaction. Central aortic stiffening is a major influence on central blood pressure, and directly relates to coronary perfusion. The joint session of the International Society of Vascular Health (Eastern Region) and the Ukrainian Congress of Cardiology was held in Kiev, Ukraine, on September 23, 2011; it provided an expert forum to discuss arterial evaluations, clinical applications, and progress toward translating arterial protection into cardiovascular benefits. The conclusions of the expert panel were: Aortic stiffness is not presently a treatment target but may be useful for substratifying cardiovascular risk in individuals in order to better target the intensity of conventional therapy, and it may be useful in assessing response to treatment.Crosstalk between macro- and microcirculation in hypertension has important implications for pharmacological treatment. An antihypertensive regimen should abolish the vicious cycle between the increased resistance in the microcirculation and the increased stiffness of the larger arteries. Such treatment should be based on drugs with multiple actions on the vascular tree, or on drug combinations that target the various segments of the arterial system.Several blood pressure-independent mechanisms of large artery stiffness exist. Future considerations for clinical understanding of large artery stiffness should involve new drugs and new evaluation methods – with a focus on vascular health, for the initiation of cardiovascular prevention, for newly designed studies for treatment evaluation, and for new studies of drug combinations.Arterial stiffening is a sign of cardiovascular aging and is a major factor affecting the biomechanics of large arteries. Arterial stiffness is an attractive therapeutic target in terms of vascular aging. Healthy lifestyle, physical

  6. A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds.

    PubMed

    Bhandari, Mohit; Jeray, Kyle J; Petrisor, Brad A; Devereaux, P J; Heels-Ansdell, Diane; Schemitsch, Emil H; Anglen, Jeff; Della Rocca, Gregory J; Jones, Clifford; Kreder, Hans; Liew, Susan; McKay, Paula; Papp, Steven; Sancheti, Parag; Sprague, Sheila; Stone, Trevor B; Sun, Xin; Tanner, Stephanie L; Tornetta, Paul; Tufescu, Ted; Walter, Stephen; Guyatt, Gordon H

    2015-12-31

    The management of open fractures requires wound irrigation and débridement to remove contaminants, but the effectiveness of various pressures and solutions for irrigation remains controversial. We investigated the effects of castile soap versus normal saline irrigation delivered by means of high, low, or very low irrigation pressure. In this study with a 2-by-3 factorial design, conducted at 41 clinical centers, we randomly assigned patients who had an open fracture of an extremity to undergo irrigation with one of three irrigation pressures (high pressure [>20 psi], low pressure [5 to 10 psi], or very low pressure [1 to 2 psi]) and one of two irrigation solutions (castile soap or normal saline). The primary end point was reoperation within 12 months after the index surgery for promotion of wound or bone healing or treatment of a wound infection. A total of 2551 patients underwent randomization, of whom 2447 were deemed eligible and included in the final analyses. Reoperation occurred in 109 of 826 patients (13.2%) in the high-pressure group, 103 of 809 (12.7%) in the low-pressure group, and 111 of 812 (13.7%) in the very-low-pressure group. Hazard ratios for the three pairwise comparisons were as follows: for low versus high pressure, 0.92 (95% confidence interval [CI], 0.70 to 1.20; P=0.53), for high versus very low pressure, 1.02 (95% CI, 0.78 to 1.33; P=0.89), and for low versus very low pressure, 0.93 (95% CI, 0.71 to 1.23; P=0.62). Reoperation occurred in 182 of 1229 patients (14.8%) in the soap group and in 141 of 1218 (11.6%) in the saline group (hazard ratio, 1.32, 95% CI, 1.06 to 1.66; P=0.01). The rates of reoperation were similar regardless of irrigation pressure, a finding that indicates that very low pressure is an acceptable, low-cost alternative for the irrigation of open fractures. The reoperation rate was higher in the soap group than in the saline group. (Funded by the Canadian Institutes of Health Research and others; FLOW Clinical

  7. Prospective pilot trial of PerMIT versus standard anticoagulation service management of patients initiating oral anticoagulation.

    PubMed

    Borgman, Mark P; Pendleton, Robert C; McMillin, Gwendolyn A; Reynolds, Kristen K; Vazquez, Sara; Freeman, Andrew; Wilson, Andrew; Valdes, Roland; Linder, Mark W

    2012-09-01

    We performed a randomised pilot trial of PerMIT, a novel decision support tool for genotype-based warfarin initiation and maintenance dosing, to assess its efficacy for improving warfarin management. We prospectively studied 26 subjects to compare PerMIT-guided management with routine anticoagulation service management. CYP2C9 and VKORC1 genotype results for 13 subjects randomly assigned to the PerMIT arm were recorded within 24 hours of enrolment. To aid in INR interpretation, PerMIT calculates estimated loading and maintenance doses based on a patient's genetic and clinical characteristics and displays calculated S-warfarin plasma concentrations based on planned or administered dosages. In comparison to control subjects, patients in the PerMIT study arm demonstrated a 3.6-day decrease in the time to reach a stabilised INR within the target therapeutic range (4.7 vs. 8.3 days, p = 0.015); a 12.8% increase in time spent within the therapeutic interval over the first 25 days of therapy (64.3% vs. 55.3%, p = 0.180); and a 32.9% decrease in the frequency of warfarin dose adjustments per INR measurement (38.3% vs. 57.1%, p = 0.007). Serial measurements of plasma S-warfarin concentrations were also obtained to prospectively evaluate the accuracy of the pharmacokinetic model during induction therapy. The PerMIT S-warfarin plasma concentration model estimated 62.8% of concentrations within 0.15 mg/l. These pilot data suggest that the PerMIT method and its incorporation of genotype/phenotype information may help practitioners increase the safety, efficacy, and efficiency of warfarin therapeutic management.

  8. Initial Assessment, Surveillance, and Management of Blood Pressure in Patients Receiving Vascular Endothelial Growth Factor Signaling Pathway Inhibitors

    PubMed Central

    Bakris, George L.; Black, Henry R.; Chen, Helen X.; Durand, Jean-Bernard; Elliott, William J.; Ivy, S. Percy; Leier, Carl V.; Lindenfeld, JoAnn; Liu, Glenn; Remick, Scot C.; Steingart, Richard; Tang, W. H. Wilson

    2010-01-01

    Hypertension is a mechanism-based toxic effect of drugs that inhibit the vascular endothelial growth factor signaling pathway (VSP). Substantial evidence exists for managing hypertension as a chronic condition, but there are few prospectively collected data on managing acute hypertension caused by VSP inhibitors. The Investigational Drug Steering Committee of the National Cancer Institute convened an interdisciplinary cardiovascular toxicities expert panel to evaluate this problem, to make recommendations to the Cancer Therapy Evaluation Program on further study, and to structure an approach for safe management by treating physicians. The panel reviewed: the published literature on blood pressure (BP), hypertension, and specific VSP inhibitors; abstracts from major meetings; shared experience with the development of VSP inhibitors; and established principles of hypertension care. The panel generated a consensus report including the recommendations on clinical concerns summarized here. To support the greatest possible number of patients to receive VSP inhibitors safely and effectively, the panel had four recommendations: 1) conduct and document a formal risk assessment for potential cardiovascular complications, 2) recognize that preexisting hypertension will be common in cancer patients and should be identified and addressed before initiation of VSP inhibitor therapy, 3) actively monitor BP throughout treatment with more frequent assessments during the first cycle of treatment, and 4) manage BP with a goal of less than 140/90 mmHg for most patients (and to lower, prespecified goals in patients with specific preexisting cardiovascular risk factors). Proper agent selection, dosing, and scheduling of follow-up should enable maintaining VSP inhibition while avoiding the complications associated with excessive or prolonged elevation in BP. PMID:20351338

  9. Audit of the association between length of time spent on diagnostic work-up and tumour stage in patients with symptomatic colon cancer.

    PubMed

    Tiong, Jimmy; Gray, Andrew; Jackson, Christopher; Thompson-Fawcett, Mark; Schultz, Michael

    2017-03-01

    Colorectal cancer is one of the most incident cancers in New Zealand. Due to resource limitations, some patients experienced protracted wait times before reaching a definitive diagnosis. We analysed the relationship between time to diagnosis and clinical stage and reviewed the length of time for components of the diagnostic work-up to identify priority areas for service improvement. We benchmarked our timeliness against introduced standards. This retrospective study included all patients with colonic (not rectal) cancer between October 2007 and September 2009. Patients were stratified into an early and advanced group. Types of delay were calculated from the onset of symptoms to the administration of treatment. The compliance with target waiting times was assessed. Fifty-eight patients were included in the early group and 83 patients in the advanced group. There were no significant differences in demographics or symptoms. The work-up was longer than international benchmarks, but with wide variations. There was no statistical difference between lengths of work-up in the groups. The advanced group had increased utilization of private and emergency investigations. Forty-four per cent met the diagnostic colonoscopy target waiting time of 42 days with a trend in favour of the advanced group and 21% received treatment within 62 days (non-significant). Current systems are not sophisticated enough to predict the stage of colon cancer. Here, long waiting times were not associated with cancer stage in symptomatic patients. Resources need to be directed to diagnostic colonic imaging. © 2014 Royal Australasian College of Surgeons.

  10. Strategies for selecting optimal sampling and work-up procedures for analysing alkylphenol polyethoxylates in effluents from non-activated sludge biofilm reactors.

    PubMed

    Stenholm, Ake; Holmström, Sara; Hjärthag, Sandra; Lind, Ola

    2012-01-01

    Trace-level analysis of alkylphenol polyethoxylates (APEOs) in wastewater containing sludge requires the prior removal of contaminants and preconcentration. In this study, the effects on optimal work-up procedures of the types of alkylphenols present, their degree of ethoxylation, the biofilm wastewater treatment and the sample matrix were investigated for these purposes. The sampling spot for APEO-containing specimens from an industrial wastewater treatment plant was optimized, including a box that surrounded the tubing outlet carrying the wastewater, to prevent sedimented sludge contaminating the collected samples. Following these changes, the sampling precision (in terms of dry matter content) at a point just under the tubing leading from the biofilm reactors was 0.7% RSD. The findings were applied to develop a work-up procedure for use prior to a high-performance liquid chromatography-fluorescence detection analysis method capable of quantifying nonylphenol polyethoxylates (NPEOs) and poorly investigated dinonylphenol polyethoxylates (DNPEOs) at low microg L(-1) concentrations in effluents from non-activated sludge biofilm reactors. The selected multi-step work-up procedure includes lyophilization and pressurized fluid extraction (PFE) followed by strong ion exchange solid phase extraction (SPE). The yields of the combined procedure, according to tests with NP10EO-spiked effluent from a wastewater treatment plant, were in the 62-78% range.

  11. Managing the initiation and early implementation of health promotion interventions: a study of a parental support programme in primary care.

    PubMed

    Westerlund, Anna; Garvare, Rickard; Nyström, Monica E; Eurenius, Eva; Lindkvist, Marie; Ivarsson, Anneli

    2017-03-01

    Mental health problems are increasing among children and adolescents worldwide, and parental support programmes have been suggested as one preventive intervention. However, the actual impact and low rates of adoption and sustainability of prevention programmes have proven to be a concern, and thus, further studies on their implementation are needed. This study focused on the initial implementation of the International Child Development Programme (ICDP) in primary care. The aim was to investigate the involved actors' views on factors likely to affect implementation and the strategies used to manage them. A case study design with a mixed-methods approach combining quantitative and qualitative data from questionnaires and interviews was used. Eighty-two professionals at different positions in the involved organisations participated. Directed content analysis was used for analyses, focusing on perceived levels of importance and the manifestation of implementation factors. Interviews and questionnaires provided descriptions of factors influencing the initial ICDP implementation. Uncertainty on how to manage important factors and vague change strategies was reported. Discrepancies in the perceived levels of importance versus manifestation were found regarding several factors, including hands-on support, time and resources, communication and information, a comprehensive plan of action, follow-ups, and external and internal collaborations. Manifested factors were a need for change, motivation and the ICDP's compatibility with existing norms, values and practices. Implementing a parental support programme in a complex setting will benefit from being preceded by a thorough examination of the intervention and the target context and the development of clear implementation strategies based on the results of that examination. This study provides insights into how and by whom knowledge on implementation is applied during the launch of a health promotion programme, and these

  12. Mammographic findings of women recalled for diagnostic work-up in digital versus screen-film mammography in a population-based screening program.

    PubMed

    Lipasti, Seppo; Anttila, Ahti; Pamilo, Martti

    2010-06-01

    Limited information is available concerning differences in the radiological findings of women recalled for diagnostic work-up in digital mammography (DM) versus screen-film mammography (SFM) screening. To compare the radiological findings, their positive predictive values (PPVs) for cancer and other process indicators of DM screening performed by computed radiography (CR) technology and SFM screening in a population-based program. The material consisted of women, 50-59 years of age, who were invited for screening: 30 153 women with DM in 2007-2008 and 32 939 women with SFM in 1999-2000. The attendance rate was 77.7% (23 440) in the DM arm and 83.8% (27 593) in the SFM arm. In the DM arm, 1.71% of those screened (401) and in the SFM arm 1.59% (438) were recalled for further work-up. The images resulting in the recall were classified as: 1) tumor-like mass, 2) parenchymal distortion/asymmetry, 3) calcifications, and 4) combination of mass and calcifications. The distributions of the various radiological findings and their PPVs for cancer were compared in both study groups. The recall rates, cancer detection rates, test specificities, and PPVs of the DM and SFM groups were also compared. Women were recalled for diagnostic work-up most often due to tumor-like mass. It was more common in SFM (1.08% per woman screened) than in DM (0.93%). The second most common finding was parenchymal distortion and asymmetry, more often in DM (0.58%) than in SFM (0.37%). Calcifications were the third most common finding. DM exposed calcifications more often (0.49%) than SFM (0.26%). The PPVs for cancer of the recalls were higher in DM than in SFM in all subgroups of radiological findings. The test specificities were similar (DM 98.9%, SFM 98.8%). Significantly more cancers were detected by DM (cancer detection rate 0.623% per woman screened, n=146) than by SFM (cancer detection rate 0.406% per woman screened, n=112). The PPVs for cancer of all recalls for diagnostic work-up were

  13. Initial insights on the performances and management of dairy cattle herds combining two breeds with contrasting features.

    PubMed

    Magne, M A; Thénard, V; Mihout, S

    2016-05-01

    contents and had a slightly longer lactation rank. Our results also focus on the farmers' management of multi-breed dairy herds underlying herd performances. Three strategies of management were identified and structured along two main axes. The first differentiates farmers according to their animal-selection practices in relation with their objectives of production: adapting animal to produce milk with low-feeding inputs v. focussing on milk yield trait to intensify milk production. The second refers to the purpose farmers give to multi-breed dairy herds: milk v. milk/meat production. These initial insights on the performances and management of multi-breed dairy herds contribute to better understanding the functioning of ruminant livestock systems based on individual variability.

  14. New initiatives for pharmacovigilance in South Korea: introducing the Korea Institute of Drug Safety and Risk Management (KIDS).

    PubMed

    Shin, Ju-Young; Jung, Sun-Young; Ahn, So-Hyeon; Lee, Shin Haeng; Kim, Su-Jin; Seong, Jong-Mi; Chung, Soo-Youn; Park, Byung-Joo

    2014-11-01

    Pharmacovigilance plays a vital role in ensuring that patients receive appropriate medical products that are safe and effective. This paper aims to describe the history of pharmacovigilance in Korea and introduce the establishment and goal of the KIDS. In Korea, the adverse drug reactions (ADR) reporting system was launched in 1988 by the Korea Ministry of Food and Drug Safety (MFDS) and spontaneous ADR reports have been collected from health care professionals and the general public. Although the ADR reporting system has begun, the reporting rate was very low in the first 10 years, and safety actions were done passively in response to the US Food and Drug Administration (FDA) or European Medicines Agency (EMA)'s safety alert and communications. Therefore, the Korea Institute of Drug Safety and Risk Management (KIDS) was established in April 2012 as a new initiative for pharmacovigilance. The KIDS will continue to contribute to the improvement of Korean pharmacovigilance by collecting, managing, and analyzing consumer-centered drug safety information. Copyright © 2014 John Wiley & Sons, Ltd.

  15. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.

    PubMed

    Dejaco, Christian; Singh, Yogesh P; Perel, Pablo; Hutchings, Andrew; Camellino, Dario; Mackie, Sarah; Abril, Andy; Bachta, Artur; Balint, Peter; Barraclough, Kevin; Bianconi, Lina; Buttgereit, Frank; Carsons, Steven; Ching, Daniel; Cid, Maria; Cimmino, Marco; Diamantopoulos, Andreas; Docken, William; Duftner, Christina; Fashanu, Billy; Gilbert, Kate; Hildreth, Pamela; Hollywood, Jane; Jayne, David; Lima, Manuella; Maharaj, Ajesh; Mallen, Christian; Martinez-Taboada, Victor; Maz, Mehrdad; Merry, Steven; Miller, Jean; Mori, Shunsuke; Neill, Lorna; Nordborg, Elisabeth; Nott, Jennifer; Padbury, Hannah; Pease, Colin; Salvarani, Carlo; Schirmer, Michael; Schmidt, Wolfgang; Spiera, Robert; Tronnier, David; Wagner, Alexandre; Whitlock, Madeline; Matteson, Eric L; Dasgupta, Bhaskar

    2015-10-01

    Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.

  16. An education and motivation intervention to change clinical management of the third stage of labor - the GIRMMAHP Initiative.

    PubMed

    Figueras, Albert; Narváez, Edgar; Valsecia, Mabel; Vásquez, Susana; Rojas, Germán; Camilo, Angiolina; del Valle, José-María; Aguilera, Cristina

    2008-12-01

    Hemorrhage and hypertensive disorders are major contributors to death after delivery in developing countries. The GIRMMAHP Initiative was designed to describe the actual delivery care in five Latin American countries and to educate and motivate clinical staff at 17 hospitals with the purpose of implementing their own clinical practice guidelines to prevent postpartum hemorrhage. A multicountry education intervention was developed in four consecutive stages, using two analyses: (a) an observational study of the clinical records in eight teaching and nine nonteaching hospitals and (b) a study of the long-term changes measured 12 months after completion of an education intervention and writing a local clinical guideline. Data from 2,247 pregnant women showed that only 23.3 percent had an active management of the third stage of labor and that 22.7 percent received no prenatal care visit. These data were used to prepare local clinical practice guidelines in each participant hospital. The proportion of active management increased to 72.6 percent of deliveries at 3 months and 58.7 percent 1 year later. Use of oxytocin during the third stage of labor increased to 85.9 percent of included deliveries. The proportion of women who had postpartum hemorrhage decreased from 12.7 percent at baseline to 5 percent at 1 year after the intervention. An education intervention and discussion of actual clinical practice problems with health professionals and their involvement in drafting clinical guidelines helped improve health care quality and practitioners' adherence to these guidelines.

  17. [Initial management of advanced ovarian cancer: What radiological, pathological and surgical information are important for optimal therapeutic strategy?].

    PubMed

    Heudel, Pierre-Etienne; Selle, Frédéric; Morice, Philippe; Rouzier, Roman; Taieb, Sophie; Devouassoux-Shisheboran, Mojgan; Genestie, Catherine; Balleyguier, Corinne; Ray-Coquard, Isabelle

    2015-09-01

    Because the majority of patients present advanced disease at diagnosis, the management of epithelial ovarian cancer needs specialist multidisciplinary teamwork. Expertise in surgery, chemotherapy, imaging and histopathology is essential to achieve optimum outcomes. Computed tomography scans are routinely used to determine the extent of disease and to aid in surgical planning. The histologic classification is crucial to plan the best therapeutic strategy and to define the prognosis of disease. Pathological prognostic factors, such as degree of differentiation, FIGO-stage, and histological type have to be described. This report is fundamental to assessing prognosis and selection of appropriate treatment strategy. An adequate staging procedure is an extensive staging by an experienced gynecological oncologist, exploring the entire upper abdomen, and the pelvic and para-aortic lymph node regions to define the Peritoneal Cancer Index (PCI). The final assessment is the completeness of cytoreduction (CC) score, which is an assessment of residual disease after a maximal surgical effort. Initial management of advanced ovarian cancer is best provided by a specialist multidisciplinary team, including a radiologist, a pathologist, a gynecologic oncologist and a medical oncologist. Copyright © 2015 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  18. Medical Image Communication System: Plan, Management And Initial Experience In Prototype At The University Of North Carolina

    NASA Astrophysics Data System (ADS)

    Staab, E. V.; Anderson, D. J.; Chaney, E. L.; Delany, D. J.; DiBianca, F. A.; Guilford, W. B.; Jaques, P. F.; Johnston, R. E.; McCartney, W. H.; Pizer, S. M.; Scatliff, J. H.; Thompson, B. G.; Washburn, D. B.

    1982-01-01

    The revolution in data handling associated with digital systems has excited the medical world into considering replacing existing methods. The integration of digital with analogue video systems into a complete electronic communications network holds tremendous promise. One area where these changes will have significant impact is in medical imaging. The potential of more and better information being,obtained from current studies, more rapid access to studies, intercomparison of images from different modalities, savings in space and equipment, reduced procedure time, improved communication in a distributed department, remote image consultation, and timely data base for management are only some of the advantages that can accrue from proper use of electronic systems. In the hospital, the traditional radiology department is becoming a medical imaging de-partment. To effect a change from the ubiquitous silver halide film base system into a more electronic department will necessitate much experimentation. At the University of North Carolina we are attempting to involve the entire department in these endeavors as well as others such as biomedical engineering, computer science and traditional clinical areas. To facilitate this, a management system has been developed and is being used. The system, our architectural draft of a future department and the initial problems and questions which have arisen from implementing a prototype system will be the subject of this report.

  19. Together - a couples' program to improve communication, coping, and financial management skills: development and initial pilot-testing.

    PubMed

    Falconier, Mariana K

    2015-04-01

    The accumulated knowledge about the negative impact of financial strain on couple's relationship functioning and the magnitude of the latest economic downturn have brought together the fields of financial counseling and couples' therapy. This article describes the development of a new interdisciplinary program that aims at helping couples under financial strain improve their financial management, communication, and dyadic coping skills. The article also reports the results from its initial pilot-testing with data collected from 18 financially distressed couples before and after participation in the program and 3 months later. Results from repeated measures ANOVAs suggest that the program may help reduce both partners' financial strain and the male negative communication and improve both partners' financial management skills and strategies to cope together with financial strain, and the male relationship satisfaction. These findings together with the high satisfaction reported by participants regarding the structure and content of the sessions and homework suggest that this program may be a promising approach to help couples experiencing financial strain. Gender differences, clinical implications, and possibilities for further research are also discussed.

  20. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.

    PubMed

    Dejaco, Christian; Singh, Yogesh P; Perel, Pablo; Hutchings, Andrew; Camellino, Dario; Mackie, Sarah; Abril, Andy; Bachta, Artur; Balint, Peter; Barraclough, Kevin; Bianconi, Lina; Buttgereit, Frank; Carsons, Steven; Ching, Daniel; Cid, Maria; Cimmino, Marco; Diamantopoulos, Andreas; Docken, William; Duftner, Christina; Fashanu, Billy; Gilbert, Kate; Hildreth, Pamela; Hollywood, Jane; Jayne, David; Lima, Manuella; Maharaj, Ajesh; Mallen, Christian; Martinez-Taboada, Victor; Maz, Mehrdad; Merry, Steven; Miller, Jean; Mori, Shunsuke; Neill, Lorna; Nordborg, Elisabeth; Nott, Jennifer; Padbury, Hannah; Pease, Colin; Salvarani, Carlo; Schirmer, Michael; Schmidt, Wolfgang; Spiera, Robert; Tronnier, David; Wagner, Alexandre; Whitlock, Madeline; Matteson, Eric L; Dasgupta, Bhaskar

    2015-10-01

    Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Advanced Air Traffic Management Research (Human Factors and Automation): NASA Research Initiatives in Human-Centered Automation Design in Airspace Management

    NASA Technical Reports Server (NTRS)

    Corker, Kevin M.; Condon, Gregory W. (Technical Monitor)

    1996-01-01

    NASA has initiated a significant thrust of research and development focused on providing the flight crew and air traffic managers automation aids to increase capacity in en route and terminal area operations through the use of flexible, more fuel-efficient routing, while improving the level of safety in commercial carrier operations. In that system development, definition of cognitive requirements for integrated multi-operator dynamic aiding systems is fundamental. The core processes of control and the distribution of decision making in that control are undergoing extensive analysis. From our perspective, the human operators and the procedures by which they interact are the fundamental determinants of the safe, efficient, and flexible operation of the system. In that perspective, we have begun to explore what our experience has taught will be the most challenging aspects of designing and integrating human-centered automation in the advanced system. We have performed a full mission simulation looking at the role shift to self-separation on board the aircraft with the rules of the air guiding behavior and the provision of a cockpit display of traffic information and an on-board traffic alert system that seamlessly integrates into the TCAS operations. We have performed and initial investigation of the operational impact of "Dynamic Density" metrics on controller relinquishing and reestablishing full separation authority. (We follow the assumption that responsibility at all times resides with the controller.) This presentation will describe those efforts as well as describe the process by which we will guide the development of error tolerant systems that are sensitive to shifts in operator work load levels and dynamic shifts in the operating point of air traffic management.

  2. Advanced Air Traffic Management Research (Human Factors and Automation): NASA Research Initiatives in Human-Centered Automation Design in Airspace Management

    NASA Technical Reports Server (NTRS)

    Corker, Kevin M.; Condon, Gregory W. (Technical Monitor)

    1996-01-01

    NASA has initiated a significant thrust of research and development focused on providing the flight crew and air traffic managers automation aids to increase capacity in en route and terminal area operations through the use of flexible, more fuel-efficient routing, while improving the level of safety in commercial carrier operations. In that system development, definition of cognitive requirements for integrated multi-operator dynamic aiding systems is fundamental. The core processes of control and the distribution of decision making in that control are undergoing extensive analysis. From our perspective, the human operators and the procedures by which they interact are the fundamental determinants of the safe, efficient, and flexible operation of the system. In that perspective, we have begun to explore what our experience has taught will be the most challenging aspects of designing and integrating human-centered automation in the advanced system. We have performed a full mission simulation looking at the role shift to self-separation on board the aircraft with the rules of the air guiding behavior and the provision of a cockpit display of traffic information and an on-board traffic alert system that seamlessly integrates into the TCAS operations. We have performed and initial investigation of the operational impact of "Dynamic Density" metrics on controller relinquishing and reestablishing full separation authority. (We follow the assumption that responsibility at all times resides with the controller.) This presentation will describe those efforts as well as describe the process by which we will guide the development of error tolerant systems that are sensitive to shifts in operator work load levels and dynamic shifts in the operating point of air traffic management.

  3. Economic and Clinical Outcomes Resulting From the Stage 4 Chronic Kidney Disease Case Management Quality Improvement Initiative.

    PubMed

    Everett, Beverly; Castel, Liana D; McGinnis, Matthew; Beresky, Amy; Cane, Rudolph C; Cooper, Tasha; Davda, Rajesh K; Farmer, Donna; John, Stella M; Sollars, Denise L; Rausch, John F

    2017-09-11

    Chronic kidney disease (CKD) is a costly and burdensome public health concern. The goal of this study was to evaluate the impact on outcomes and utilization of a pilot program to identify and engage beneficiaries with CKD at risk for progression from Stage 4 to Stage 5. A quality improvement initiative was conducted to assess the impact of case management on costs and outcomes among 7,720 Cigna commercial medical beneficiaries with Stage 4 CKD enrolled in the United States between January 2012 and October 2012. Claims data were analyzed to compare 3,861 beneficiaries randomized to receive condition-focused case management with 3,859 controls, with follow-up through July 2013. After using an algorithm to identify beneficiaries at highest risk of progression, a case management team implemented, among those assigned to the intervention, an evidence-based assessment tool, provided education and follow-up, engaged nephrologists and other providers, and conducted weekly rounds. Primary outcome measures were hospital admissions, emergency department visits, nephrologist visits, dialysis, arteriovenous (AV) fistula creation, and total medical costs. Analysis of variance techniques were used to test group differences. As compared with controls, intervention beneficiaries were 12% more likely to have fistula creation (p = .004). Intervention beneficiaries were observed to have savings of $199 per member per month (PMPM), F = 23.05, p = .04. This difference equated to 6% lower total medical costs in the intervention group. Savings observed were derived half from improved in-network utilization and half from reduced hospital costs. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  4. Initially non-diagnostic ultrasound-guided fine needle aspiration cytology of thyroid nodules: value and management.

    PubMed

    Chung, Jin; Youk, Ji Hyun; Kim, Jeong-Ah; Kwak, Jin Young; Kim, Eun-kyung; Ryu, Young Hoon; Son, Eun Ju

    2012-03-01

    Ultrasound (US)-guided fine needle aspiration cytology (FNAC) is an accurate, reliable, and simple method to identify a thyroid nodule as benign or malignant. However, non-diagnostic cytology results for thyroid nodules are a major limitation of US-guided FNAC. To investigate the incidence of thyroid cancer among cases with non-diagnostic results on FNAC and to provide suggestions for the management of thyroid nodules that are initially non-diagnostic by FNAC according to ultrasonographic findings. From July 2006 to December 2009, 10,317 thyroid nodules in 6684 consecutive patients underwent US-guided FNAC at our institute. Among these, 871 thyroid nodules (8.4%) were diagnosed as non-diagnostic on initial cytologic evaluation and 196 underwent a second or third FNAC. Twenty-seven thyroid nodules (18.9%) underwent surgery, while 116 thyroid nodules were cytologically confirmed as benign with no remarkable change on follow-up US were included. We retrospectively reviewed the US findings for a total of 143 thyroid nodules (123 benign nodules and 20 malignant nodules). The US features that we compared included composition, echogenicity, margin, calcifications, shape, and underlying echogenicity. In total, thyroid cancer was diagnosed in 20 nodules (14.0%). The size of the nodule was significantly associated with malignancy (P < 0.05). Most of the sonographically probable benign nodules were found to be benign (97.6%). Suspicious nodules on US were thyroid cancer in 43.2% of cases. Marked hypoechogenicity, microlobulated or irregular margin, microcalcifications, and taller-than-wide shape were significant US findings that correlated with malignancy (P < 0.05). The diagnostic performance of ultrasound for initially non-diagnostic thyroid nodules was as follows: sensitivity of 90.0%, specificity of 65.0%, positive predictive value of 29.5%, and negative predictive value of 97.6%. In terms of management of thyroid nodules with non-diagnostic FNAC cytology, US evaluation

  5. Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: a qualitative process evaluation of the STRETCH trial.

    PubMed

    Georgeu, Daniella; Colvin, Christopher J; Lewin, Simon; Fairall, Lara; Bachmann, Max O; Uebel, Kerry; Zwarenstein, Merrick; Draper, Beverly; Bateman, Eric D

    2012-07-16

    Task-shifting is promoted widely as a mechanism for expanding antiretroviral treatment (ART) access. However, the evidence for nurse-initiated and managed ART (NIMART) in Africa is limited, and little is known about the key barriers and enablers to implementing NIMART programmes on a large scale. The STRETCH (Streamlining Tasks and Roles to Expand Treatment and Care for HIV) programme was a complex educational and organisational intervention implemented in the Free State Province of South Africa to enable nurses providing primary HIV/AIDS care to expand their roles and include aspects of care and treatment usually provided by physicians. STRETCH used a phased implementation approach and ART treatment guidelines tailored specifically to nurses. The effects of STRETCH on pre-ART mortality, ART provision, and the quality of HIV/ART care were evaluated through a randomised controlled trial. This study was conducted alongside the trial to develop a contextualised understanding of factors affecting the implementation of the programme. This study was a qualitative process evaluation using in-depth interviews and focus group discussions with patients, health workers, health managers, and other key informants as well as observation in clinics. Research questions focused on perceptions of STRETCH, changes in health provider roles, attitudes and patient relationships, and impact of the implementation context on trial outcomes. Data were analysed collaboratively by the research team using thematic analysis. NIMART appears to be highly acceptable among nurses, patients, and physicians. Managers and nurses expressed confidence in their ability to deliver ART successfully. This confidence developed slowly and unevenly, through a phased and well-supported approach that guided nurses through training, re-prescription, and initiation. The research also shows that NIMART changes the working and referral relationships between health staff, demands significant training and support, and

  6. Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: a qualitative process evaluation of the STRETCH trial

    PubMed Central

    2012-01-01

    Background Task-shifting is promoted widely as a mechanism for expanding antiretroviral treatment (ART) access. However, the evidence for nurse-initiated and managed ART (NIMART) in Africa is limited, and little is known about the key barriers and enablers to implementing NIMART programmes on a large scale. The STRETCH (Streamlining Tasks and Roles to Expand Treatment and Care for HIV) programme was a complex educational and organisational intervention implemented in the Free State Province of South Africa to enable nurses providing primary HIV/AIDS care to expand their roles and include aspects of care and treatment usually provided by physicians. STRETCH used a phased implementation approach and ART treatment guidelines tailored specifically to nurses. The effects of STRETCH on pre-ART mortality, ART provision, and the quality of HIV/ART care were evaluated through a randomised controlled trial. This study was conducted alongside the trial to develop a contextualised understanding of factors affecting the implementation of the programme. Methods This study was a qualitative process evaluation using in-depth interviews and focus group discussions with patients, health workers, health managers, and other key informants as well as observation in clinics. Research questions focused on perceptions of STRETCH, changes in health provider roles, attitudes and patient relationships, and impact of the implementation context on trial outcomes. Data were analysed collaboratively by the research team using thematic analysis. Results NIMART appears to be highly acceptable among nurses, patients, and physicians. Managers and nurses expressed confidence in their ability to deliver ART successfully. This confidence developed slowly and unevenly, through a phased and well-supported approach that guided nurses through training, re-prescription, and initiation. The research also shows that NIMART changes the working and referral relationships between health staff, demands

  7. Integrating Blue Carbon Initiatives with the Management of Wildlife Cobenefits: a Case Study at the Nisqually River Delta, WA

    NASA Astrophysics Data System (ADS)

    Woo, I.; De La Cruz, S.; Windham-Myers, L.; Thorne, K.; Drexler, J. Z.; Byrd, K. B.; Bergamaschi, B. A.; Davis, M.; Anderson, F. E.; Ballanti, L.; Zhu, Z.; Schmerfeld, J.; Johnson, K.; Nakai, G.

    2016-12-01

    Carbon transport, cycling, and storage within coastal wetlands are amongst the most fundamental processes that support estuarine ecosystem services. In addition to providing habitat and trophic support for wildlife populations and fisheries, coastal wetlands accumulate and store carbon at significant rates. By capturing and storing carbon in soils, coastal wetland can play a vital role in offsetting greenhouse gasses, thereby helping mitigate the impacts of climate change. Estuarine restoration has significant potential to simultaneously increase carbon sequestration and ecosystem functioning for wildlife, linking traditional objectives of protecting, restoring, and managing diverse wetlands to support a broad array of species and their habitats with carbon sequestration initiatives. The Nisqually River Delta is the largest wetland restoration in the Pacific Northwest and is an ideal site to document the carbon co-benefits of a restoring and natural marsh. We compared the sources of carbon that enter food webs to carbon that has accumulated in soils. Juvenile Chinook foodwebs incorporated freshwater/brackish as well as estuarine-derived carbon sources. Soil carbon inputs reflected relatively recent estuarine restoration and a century of diked agricultural and fallow field land use history. A Net Ecosystem Carbon Balance will use EC flux towers to quantify CO2 and CH4 atmospheric flux and constrain aqueous dissolved carbon flux in channels. Ultimately, we will assess the resiliency of tidal marsh under past, present, and future sediment delivery scenarios. Past and present sedimentation data will be analyzed from our soil cores. Future scenarios incorporating potential management strategies to increase sediment delivery onto the delta will be leveraged with existing studies of hydrodynamics and sedimentation models. These scenarios will be used as model inputs to assess the viability of marshes as a result of prospective management strategies and sea-level rise

  8. Identify-Isolate-Inform: A Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department

    PubMed Central

    Koenig, Kristi L.; Almadhyan, Abdulmajeed; Burns, Michael J.

    2016-01-01

    First isolated in 1947 from a monkey in the Zika forest in Uganda, and from mosquitoes in the same forest the following year, Zika virus has gained international attention due to concerns for infection in pregnant women potentially causing fetal microcephaly. More than one million people have been infected since the appearance of the virus in Brazil in 2015. Approximately 80% of infected patients are asymptomatic. An association with microcephaly and other birth defects as well as Guillain-Barre Syndrome has led to a World Health Organization declaration of Zika virus as a Public Health Emergency of International Concern in February 2016. Zika virus is a vector-borne disease transmitted primarily by the Aedes aegypti mosquito. Male to female sexual transmission has been reported and there is potential for transmission via blood transfusions. After an incubation period of 2–7 days, symptomatic patients develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, often associated with headache and myalgias. Emergency department (ED) personnel must be prepared to address concerns from patients presenting with symptoms consistent with acute Zika virus infection, especially those who are pregnant or planning travel to Zika-endemic regions, as well as those women planning to become pregnant and their partners. The identify-isolate-inform (3I) tool, originally conceived for initial detection and management of Ebola virus disease patients in the ED, and later adjusted for measles and Middle East Respiratory Syndrome, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for initial detection and management of patients under investigation for Zika virus. Following an assessment of epidemiologic risk, including travel to countries with mosquitoes that transmit Zika virus, patients are further investigated if clinically indicated. If after a rapid evaluation, Zika or other arthropod

  9. Identify-Isolate-Inform: A Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department.

    PubMed

    Koenig, Kristi L; Almadhyan, Abdulmajeed; Burns, Michael J

    2016-05-01

    First isolated in 1947 from a monkey in the Zika forest in Uganda, and from mosquitoes in the same forest the following year, Zika virus has gained international attention due to concerns for infection in pregnant women potentially causing fetal microcephaly. More than one million people have been infected since the appearance of the virus in Brazil in 2015. Approximately 80% of infected patients are asymptomatic. An association with microcephaly and other birth defects as well as Guillain-Barre Syndrome has led to a World Health Organization declaration of Zika virus as a Public Health Emergency of International Concern in February 2016. Zika virus is a vector-borne disease transmitted primarily by the Aedes aegypti mosquito. Male to female sexual transmission has been reported and there is potential for transmission via blood transfusions. After an incubation period of 2-7 days, symptomatic patients develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, often associated with headache and myalgias. Emergency department (ED) personnel must be prepared to address concerns from patients presenting with symptoms consistent with acute Zika virus infection, especially those who are pregnant or planning travel to Zika-endemic regions, as well as those women planning to become pregnant and their partners. The identify-isolate-inform (3I) tool, originally conceived for initial detection and management of Ebola virus disease patients in the ED, and later adjusted for measles and Middle East Respiratory Syndrome, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for initial detection and management of patients under investigation for Zika virus. Following an assessment of epidemiologic risk, including travel to countries with mosquitoes that transmit Zika virus, patients are further investigated if clinically indicated. If after a rapid evaluation, Zika or other arthropod

  10. Patient and professional views of open access hysterosalpingography for the initial management of infertility in primary care.

    PubMed

    Wilkes, Scott; Rubin, Greg; Crosland, Ann; Hall, Nicola; Murdoch, Alison

    2009-05-01

    Hysterosalpingography (HSG) is recommended as a first-line investigation for tubal assessment of infertile women. This investigation is not routinely available to GPs. To explore the perceptions and attitudes of patients and health professionals to open access HSG for the initial management of infertile couples in general practice. A nested qualitative study using in-depth interviews with GPs, fertility specialists, and infertile couples. Northumberland, Newcastle upon Tyne, North Tyneside, South Tyneside, and Gateshead. Participants were 39 interviewees: 12 GPs, five fertility specialists, and 13 infertile couples (nine interviewed with their partner). Four themes emerged: personal factors; will it benefit patients, GPs, and fertility specialists?; professional factors; does it fit the role of a GP?; local context; do the skills exist in general practice?; and wider context; will it benefit the NHS? GPs who had used open access HSG, felt it was appropriate for general practice and would continue to use the service. All GPs, fertility specialists, and infertile couples who had experienced open access HSG wished the service to remain in place. The main barriers to its uptake were: infrequency with which infertility presents; lack of clarity on perceived responsibilities; difficulty keeping up to date, including assimilating guidelines; low clinical priority; and lack of support in authoritative guidance. Providing GPs with open access to HSG would allow a full initial assessment of the infertile couple and refer women with blocked tubes directly to tertiary care. While there is general support for the provision of such a facility, the majority of GPs perceive its use as being by a limited number of GPs who have a special interest in infertility. The study findings can inform future development of infertility services at the interface between primary and secondary/tertiary care.

  11. [Evaluation of initial antibiotic therapy for bacteremia and role of an antibiotic management team for antibiotic stewardship].

    PubMed

    Diamantis, S; Rioux, C; Bonnal, C; Papy, E; Farfour, É; Andremont, A; Yeni, P; Bouvet, É; Lucet, J-C

    2010-11-01

    Antibiotic management teams (AMTs) are recommended, but they are rarely implemented in France and their activity seldom evaluated. The study was made to evaluate the appropriateness of antibiotic therapy (AT) for bloodstream infections (BSI) and to assess the role of an AMT for improving AT in a 950-bed teaching hospital. A prospective analysis was made of all significant BSIs outside ICU in 2008. AT was assessed by the AMT and change was suggested if deemed necessary: effective if at least one prescribed antibiotic was effective in vitro, and appropriate if consistent with local recommendations. Of 875 +BCs, 560 were significant, 383 were outside ICU and 344 could be evaluated (170 community-acquired, 124 nosocomial, and 50 healthcare-associated [HCA]). The clinical ward has already initiated an effective and appropriate AT in 128 (37%), inappropriate but effective in 104 (30%), and ineffective or absent in 112 (33%) BSIs. The only independent variable associated with ineffective/absent AT was nosocomial and/or HCA BSI (aOR: 2.71; 95%CI: 1.72-4.27; p<0.001). A recommendation was given and followed in 177/190 (93%) BSIs requiring an intervention. The AMT intervened on the day of the +BC in 256 (84%) cases, the day before the +BC in 12 (4%) cases, and one day later or more in 37 (12%) BSI cases. Two third of BSIs were not initially treated by appropriate AT, more often in nosocomial BSI. Recommendation provided by the AMT was followed in 93% of cases. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  12. Intensive vs. conventional insulin management initiated at diagnosis in children with diabetes: should payer source influence the choice of therapy?

    PubMed

    Beck, Joni K; Lewis, Teresa V; Logan, Kathy J; Harrison, Donald L; Gardner, Andrew W; Copeland, Kenneth C

    2009-09-01

    Intensive insulin management (IIM) in type 1 diabetes facilitates improved glycemic control and a reduction in long-term diabetes complications. We hypothesized that IIM can be started at diagnosis without deleterious effects on hemoglobin A1c (A1c), body mass index (BMI), and severe hypoglycemia regardless of payer source. Type 1 diabetes patients aged 0-18 yrs, in an academic endocrinology practice were identified for a retrospective chart review. Fifty-four patients on conventional insulin management (CIM) were compared to 51 on IIM. Insulin regimens, payer, and A1c values were compared at baseline, 12, 15, and 18 months. Secondary analyses included BMI changes and hypoglycemia frequency. Overall mean A1c values for the IIM group (8.15 +/- 1.41) were lower across all time periods compared to the CIM group (8.57 +/- 1.52). Repeated measures anova revealed a significant treatment group effect (p = 0.01) with no time effect (p = 0.87) or interaction (group by time) effect (p = 0.65). Private insurance patients had lower mean A1C values than Medicaid patients (chi(2) = 4.5186, p < 0.05), regardless of regimen. A1c values between IIM and CIM were not statistically different within the Medicaid group. BMI changes between groups were not different. Chi-square analysis for severe hypoglycemia revealed no group differences. In conclusion, IIM had improved glycemic control. Private insurance vs. Medicaid patients had lower mean A1c values regardless of treatment group. Considering Medicaid patients only, IIM was not inferior, and for those with private insurance, IIM was superior. IIM, initiated at diagnosis, is a reasonable approach for newly diagnosed children with diabetes regardless of payer source.

  13. Re-presentations and recurrent events following initial management of the acute paediatric scrotum: a 5-year review.

    PubMed

    Lala, Shareena; Price, Neil; Upadhyay, Vipul

    2017-02-27

    Previous reviews report relatively low rates of post-operative complications for acute scrotal exploration. The aim of this study was to evaluate the re-presentation to hospital in boys with previous acute scrotal pathology, reviewing contralateral symptoms, post-operative complications, testicular torsion following fixation and failure of conservative management of testicular appendage (TA) torsion. All boys under 16 years presenting to our unit with an acute scrotum from January 2008 to December 2012 (5-year period) were identified. A retrospective review of clinical records was performed. A total of 683 boys presented over this 5-year period, with an overall re-presentation rate of 10%. Seventeen (25%) re-presentations were metachronous. Post-operative complication rate was 2.2%. Testicular torsion rate following orchiopexy was 0.3% (1/292). Thirty-three percent of those managed conservatively for TA torsion returned with ongoing pain; 80% underwent scrotal exploration on return. Eight boys returned following excision of a torted TA with contralateral torted TA confirmed, accounting for 2.6% (8/308) of boys with a torted TA at first presentation. This gives a number-needed-to-treat of 39 for bilateral scrotal exploration and prophylactic excision of contralateral non-torted TA, to prevent one boy from returning to hospital with a metachronous presentation. Further prolonged follow-up is needed to adequately assess recurrence rates of testicular torsion following orchiopexy to validate routine orchiopexy. Post-operative complication rates equal that of the return rate for a contralateral torted TA; this needs to be considered in proceeding to bilateral scrotal exploration on finding a torted TA at initial presentation. © 2017 Royal Australasian College of Surgeons.

  14. Systematic review and meta-analysis of initial management of pneumothorax in adults: Intercostal tube drainage versus other invasive methods.

    PubMed

    Kim, Min Joung; Park, Incheol; Park, Joon Min; Kim, Kyung Hwan; Park, Junseok; Shin, Dong Wun

    2017-01-01

    The ideal invasive management as initial approach for pneumothorax (PTX) is still under debate. The purpose of this systematic review and meta-analysis was to examine the evidence for the effectiveness of intercostal tube drainage and other various invasive methods as the initial approach to all subtypes of PTX in adults. Three databases were searched from inception to May 29, 2016: MEDLINE, EMBASE, and the Cochrane CENTRAL. Randomised controlled trials that evaluated intercostal tube drainage as the control and various invasive methods as the intervention for the initial approach to PTX in adults were included. The primary outcome was the early success rate of each method, and the risk ratios (RRs) were used for an effect size measure. The secondary outcomes were recurrence rate, hospitalization rate, hospital stay, and complications. Seven studies met our inclusion criteria. Interventions were aspiration in six studies and catheterization connected to a one-way valve in one study. Meta-analyses were conducted for early success rate, recurrence rate, hospitalization rate, and hospital stay. Aspiration was inferior to intercostal tube drainage in terms of early success rate (RR = 0.82, confidence interval [CI] = 0.72 to 0.95, I2 = 0%). While aspiration and intercostal tube drainage showed no significant difference in the recurrence rate (RR = 0.84, CI = 0.57 to 1.23, I2 = 0%), aspiration had shorter hospital stay than intercostal tube drainage (mean difference = -1.73, CI = -2.33 to -1.13, I2 = 0%). Aspiration had lower hospitalization rate than intercostal tube drainage, but marked heterogeneity was present (RR = 0.38, CI = 0.19 to 0.76, I2 = 85%). Aspiration was inferior to intercostal tube drainage in terms of early resolution, but it had shorter hospital stay. The recurrence rate of aspiration and intercostal tube drainage did not differ significantly. The efficacy of catheterization connected to a one-way valve was inconclusive because of the small number of

  15. National project seeking to improve pain management in the emergency department setting: findings from the NHMRC-NICS National Pain Management Initiative.

    PubMed

    Doherty, Steven; Knott, Jonathan; Bennetts, Scott; Jazayeri, Mitra; Huckson, Sue

    2013-04-01

    The National Pain Management Initiative was established by the National Institute of Clinical Studies to improve analgesic practice across Australian EDs. A barrier analysis provided information to better implement changes in analgesic practice. A working party was established and developed a multifaceted intervention strategy and clinical indicators. An online data collection system was developed and sites collected data at three monthly intervals for 18 months. A stepped-wedge design was chosen to manage the number of hospitals involved. Clinical indicators included documentation of pain score, time to analgesia, appropriate use of parenteral narcotics and effectiveness of analgesia for severe pain. A total of 16,627 patient datasets were entered from 45 metropolitan and regional hospitals. There was an increase from 41% to 64% in documented pain score (difference in proportions 23%, 95% confidence interval: 20-26) and median time to analgesia fell from 61 min (interquartile range: 23-122) to 41 min (interquartile range: 15-95). Appropriate parenteral narcotic use was over 90% for all time points combined. For all patients with severe pain there was no significant change in the proportion with a documented reduction of pain within 1 h of presentation. Significant improvements in documentation of pain score and time to analgesia were demonstrated through a national project of targeted improvement. Parenteral narcotic use has a high level of adherence to recommended practice. An improvement in the effectiveness of analgesia in severe pain has not been clearly demonstrated in this study. © 2012 NHMRC. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  16. Initial presentation of acute transverse myelitis in systemic lupus erythematosus: demographics, diagnosis, management and comparison to idiopathic cases.

    PubMed

    Schulz, Steffan W; Shenin, Max; Mehta, Amy; Kebede, Amal; Fluerant, Marshall; Derk, Chris T

    2012-09-01

    To describe and compare the diagnosis, demographics and management of systemic lupus erythematosus (SLE) related versus idiopathic acute transverse myelitis during the initial presentation of the disease. We undertook a chart review of the hospital records of patients admitted to our hospital from 1994 until 2007 and had the diagnosis of SLE related and idiopathic acute transverse myelitis. Demographics, laboratory and imaging studies, diagnosis and treatment were recorded in both groups and analyzed in a case control fashion. We identified 15 patients with SLE-related acute transverse myelitis (SLE-ATM) and 39 idiopathic (I-ATM) cases between 1994 and 2007. Patients with SLE were more likely to be African American, have CNS demyelinating lesions on MRI, a high IgG% on their CSF analysis and a higher sedimentation rate on presentation. Treatment with high-dose steroids was instituted in both groups of patients, though SLE patients had a longer hospital stay by an average of 5 days. SLE-ATM patients were more likely to be African American as compared to I-ATM patients, have CNS demyelinating lesions on MRI, a high IgG% on CSF analysis and a higher sedimentation rate on presentation. The hospital stay for SLE patients was 5 days longer than the idiopathic patients. This study underlines the importance of early diagnosis of patients who develop ATM related to SLE.

  17. Outpatient evaluation, recognition, and initial management of pediatric overweight and obesity in U.S. military medical treatment facilities.

    PubMed

    Dickey, Wayne; Arday, David R; Kelly, Joseph; Carnahan, Col David

    2017-02-01

    As childhood obesity is a concern in many communities, this study investigated outpatient evaluation and initial management of overweight and obese pediatric patients in U.S. military medical treatment facilities (MTFs). Samples of 579 overweight and 341 obese patients (as determined by body mass index [BMI]) aged 3-17 years were drawn from MTFs. All available FY2011 outpatient records were searched for documentation of BMI assessment, overweight/obesity diagnosis, and counseling. Administrative data for these patients were merged to assess coded diagnostic and counseling rates and receipt of recommended laboratory screenings. Generic BMI documentation was high, but BMI percentile assessments were found among fewer than half the patients. Diagnostic recording or recognition totaled 10.9% of overweight and 32.0% of obese. Counseling rates were higher, with 46.4% and 61.0% of overweight and obese patients, respectively, receiving weight related counseling. Among patients 10 years of age or older, rates of recommended lab screenings for diabetes, liver abnormality, and dyslipidemia were not greater than 33%. BMI percentile recording was strongly associated with diagnostic recording, and diagnostic recording was strongly associated with counseling. Improvements to electronic health records or implementation of local procedures to facilitate better diagnostic recording would likely improve adherence to clinical practice guidelines. ©2016 American Association of Nurse Practitioners.

  18. Characterizing the Assessment and Management of Vitamin D Levels in Patients with Osteoporosis in Clinical Practice: A Chart Review Initiative

    PubMed Central

    Adachi, Jonathan D.; Brown, Jacques P.; Ioannidis, George

    2015-01-01

    Though vitamin D is important for bone health, little is known about the monitoring and management of vitamin D levels in patients with osteoporosis in clinical practice—a deficit this chart review initiative aimed to remedy. A total of 52 physicians completed profiles for 983 patients being treated for osteoporosis between November 2008 and April 2009. Information collected included demographics; fracture risk factors; availability and level of serum vitamin D measurements; and information on osteoporosis medications and calcium and vitamin D supplementation. Physicians also evaluated patients' current regimens and detailed proposed changes, if applicable. Nearly 85% of patients were prescribed calcium and vitamin D supplements. Serum 25-hydroxy vitamin D levels were available for 73% of patients. Of these patients, approximately 50% had levels less than 80 nmol/L, which contrasts with the 37% thought to have “unsatisfactory” vitamin D levels based on physician perceptions. Physicians felt 26% of patients would benefit from additional vitamin D supplementation. However, no changes to the osteoporosis regimen were suggested for 48% of patients perceived to have “unsatisfactory” vitamin D levels. The results underscore the importance of considering vitamin D status when looking to optimize bone health. PMID:25709852

  19. Full Life-Cycle Defect Management Assessment: Initial Inspection Data Collection Results and Research Questions for Further Study

    NASA Technical Reports Server (NTRS)

    Shull, Forrest; Feldmann, Raimund; Haingaertner, Ralf; Regardie, Myrna; Seaman, Carolyn

    2007-01-01

    It is often the case in software projects that when schedule and budget resources are limited, the Verification and Validation (V&V) activities suffer. Fewer V&V activities can be afforded and moreover, short-term challenges can result in V&V activities being scaled back or dropped altogether. As a result, too often the default solution is to save activities for improving software quality until too late in the life-cycle, relying on late-term code inspections followed by thorough testing activities to reduce defect counts to acceptable levels. As many project managers realize, however, this is a resource-intensive way of achieving the required quality for software. The Full Life-cycle Defect Management Assessment Initiative, funded by NASA s Office of Safety and Mission Assurance under the Software Assurance Research Program, aims to address these problems by: Improving the effectiveness of early life-cycle V&V activities to make their benefits more attractive to team leads. Specifically, we focus on software inspection, a proven method that can be applied to any software work product, long before executable code has been developed; Better communicating this effectiveness to software development teams, along with suggestions for parameters to improve in the future to increase effectiveness; Analyzing the impact of early life-cycle V&V on the effectiveness and cost required for late life-cycle V&V activities, such as testing, in order to make the tradeoffs more apparent. This white paper reports on an initial milestone in this work, the development of a preliminary model of inspection effectiveness across multiple NASA Centers. This model contributes toward reaching our project goals by: Allowing an examination of inspection parameters, across different types of projects and different work products, for an analysis of factors that impact defect detection effectiveness. Allowing a comparison of this NASA-specific model to existing recommendations in the literature

  20. Preliminary results on the role of PET/CT in initial staging, restaging, and management of lung cancer

    NASA Astrophysics Data System (ADS)

    Malamitsi, J.; Valotassiou, B.; Iliadis, K.; Kosmidis, P.; Laspas, F.; Vasilaki, M.; Pipini, E.; Petounis, A.; Gogou, L.; Pagou, M.; Dalianis, K.; Efthimiadou, R.; Andreou, J.

    2006-12-01

    AimTo determine true-positive and true-negative rates of PET/CT studies in the staging of lung cancer as compared with conventional imaging (CT and bone scan and occasionally MRI) and the impact of PET/CT on the treatment strategy in patients with lung cancer. Materials and methodTwenty patients (21 studies) with known or suspected lung cancer (14 patients with non-small-cell lung cancer (NSCLC), three patients with small-cell lung cancer (SCLC), three patients with solitary pulmonary nodule underwent initial staging (seven studies) or restaging (14 studies) with combined FDG PET and CT scans on a PET/CT tomograph. PET/CT images were evaluated separately by two nuclear medicine physicians and two radiologists specialized on PET, CT, and MRI. Histology results and a more than 6 months follow-up served as the reference standards. ResultsAccurate diagnosis was achieved on 16 studies. Site-by-site analysis gave the following results: 16 true-positive sites (seven on histology, nine on >6 months follow-up), six true-negative sites (two on histology, four on >6 months follow-up). On PET/CT, six patients were correctly down-staged, three patients were correctly upstaged and seven patients were diagnosed correctly as being on the same stage (2/7 with increase of extent of disease, 5/7 with the same extent of disease). One patient was falsely upstaged and three patients were falsely down-staged. On the basis of PET/CT results, change of management was induced in six patients, while in 14 patients there was no change induced. In five cases PET/CT was partially accurate: on site-by-site analysis, four sites proved true positive (on histology), one site false positive (on histology), and four sites false negative (one on histology, three on >6 months follow-up). ConclusionIn our early experience, PET/CT contributed significantly to correct staging and management of patients with lung cancer.

  1. Value of computed tomography arthrography with delayed acquisitions in the work-up of ganglion cysts of the tarsal tunnel: report of three cases.

    PubMed

    Omoumi, Patrick; de Gheldere, Antoine; Leemrijse, Thibaut; Galant, Christine; Van den Bergh, Peter; Malghem, Jacques; Simoni, Paolo; Vande Berg, Bruno C; Lecouvet, Frédéric E

    2010-04-01

    Ganglion cysts are a common cause of tarsal tunnel syndrome. As in other locations, these cysts are believed to communicate with neighboring joints. The positive diagnosis and preoperative work-up of these cysts require identification and location of the cyst pedicles so that they may be excised and the risk of recurrence decreased. This can be challenging with ultrasonography and magnetic resonance (MR) imaging. We present three cases of symptomatic ganglion cysts of the tarsal tunnel, diagnosed by MR imaging, where computed tomography (CT) arthrography with delayed acquisitions helped to confirm the diagnosis and identify precisely the topography of the communication with the subtalar joint. These cases provide new evidence of the articular origin of ganglion cysts developing in the tarsal tunnel.

  2. Treatment pattern changes in high-risk patients newly initiated on statin monotherapy in a managed care setting.

    PubMed

    Simpson, Ross J; Tunceli, Kaan; Ramey, Dena R; Neff, David R; Kern, David M; Hsieh, Hui-Min; Wertz, Debra A; Stephenson, Judith J; Marrett, Elizabeth; Tomassini, Joanne E; Jacobson, Terry A

    2013-01-01

    For high-risk patients who do not achieve guideline-recommended LDL-C levels, more intensive treatment including statin-uptitration to higher doses or potency, as well as combination therapy may be considered. A better understanding of statin treatment patterns in real-world clinical practice may contribute to improved lipid-lowering management in these patients. We determined treatment pattern changes among patients with high risk of cardiovascular disease who were not at low-density lipoprotein cholesterol (LDL-C) goal on statin monotherapy. Treatment pattern changes were evaluated among patients newly initiated on statins between January 1, 2006, and August 31, 2009, in the HealthCore Integrated Research Database. Rates and mean time to first and second treatment changes were examined in patients with claims for coronary heart disease (CHD), atherosclerotic vascular disease (AVD), and diabetes mellitus during 12 months before index, who were not at LDL-C <70 mg/dL at their first-eligible LDL-C test (≥ 4 weeks after index). Therapy change was assessed for 12 months after the LDL-C result. Of 11,473 eligible subjects, 61.3% had diabetes, 26.6% had CHD and AVD, and 12.1% had CHD and AVD and diabetes. At index, patients were prescribed medium-potency levels of statins, including simvastatin (44.7%), atorvastatin (31.5%), and other statins (23.8%). Mean ± SD LDL-C before statin initiation was 138 ± 34 mg/dL, and at the first-eligible LDL-C result after index, it was 101 ± 25 mg/dL. During follow-up, 7444 subjects (64.9%) experienced a first treatment change, with mean time to change of 93.8 ± 92 days, whereas 4029 (36.1%) had no treatment change. Discontinuation of index therapy occurred in 46.9% of subjects and medication switches or titration in 18.0% (index statin titration, switch to other statins, other lipid-lowering therapies [LLT], including ezetimibe). Of the discontinuers, 27.4% restarted LLT. Of subjects with a first treatment change who did not

  3. A questionnaire survey of resuscitation equipment carried by general practitioners and their initial management of ventricular fibrillation.

    PubMed Central

    West, R J; Penfold, N

    1997-01-01

    BACKGROUND: The early defibrillation of patients having a cardiac arrest and who are in ventricular fibrillation has been shown to increase survival and is recommended by the European Resuscitation Council (ERC) and the American Heart Association. General practitioners (GPs) may expect to encounter a cardiac arrest in 5% of patients they attend who have a suspected acute myocardial infarction. AIM: To establish whether GPs on call were equipped to treat a patient in ventricular fibrillation, and to investigate their knowledge of the early stages of the current ERC guidelines for this cardiac rhythm. METHOD: A postal questionnaire was sent to all the 175 GPs who regularly admit patients to the West Suffolk Hospital. It asked for details of equipment and drugs carried when on call, recognition of a cardiac rhythm strip of ventricular fibrillation, and treatment to be given for this rhythm. RESULTS: A total of 105 replies were returned (representing a 60% response rate). The distribution of practice size and location reflected primary health care in this area. Fourteen GPs (13%) had attended an advanced cardiac life-support course at some time, and 44 (41.9%) had read the current ERC guidelines. The majority of GPs (60%) carried advanced airway management equipment to allow endotracheal intubation, but only 37 (35%) would have been able to administer additional oxygen. Again, most (82%) would have been able to establish intravenous access, but only 39% carried 2 mg or more of adrenaline, the only recommended drug in the initial stages of resuscitation from ventricular fibrillation. A defibrillator was carried by 37 GPs (35%) when on call, but out of these only 14 had an integral monitor screen and 3 were semi-automatic defibrillators. Ninety-five GPs (91%) successfully identified ventricular fibrillation, but only 32 (31%) were able to state correctly the initial recommended treatment, and only 17 (16%) were able to quote the first two stages of the ERC guidelines of

  4. Levels of Participation of the School Stakeholders to the Different School-Initiated Activities and the Implementation of School-Based Management

    ERIC Educational Resources Information Center

    Cabardo, Jimmy Rey Opong

    2016-01-01

    This study aimed to evaluate the levels of participation of the school stakeholders to the different school-initiated activities and the implementation of school-based management (SBM) in selected schools in the Division of Davao del Sur for the school year 2014-2015 using a descriptive-correlational survey research design. A…

  5. Recommendations for the management of intracranial haemorrhage - part I: spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee.

    PubMed

    Steiner, Thorsten; Kaste, Markku; Katse, Markku; Forsting, Michael; Mendelow, David; Kwiecinski, Hubert; Szikora, Istvan; Juvela, Seppo; Marchel, Andrzej; Chapot, René; Cognard, Christophe; Unterberg, Andreas; Hacke, Werner

    2006-01-01

    This article represents the recommendations for the management of spontaneous intracerebral haemorrhage of the European Stroke Initiative (EUSI). These recommendations are endorsed by the 3 European societies which are represented in the EUSI: the European Stroke Council, the European Neurological Society and the European Federation of Neurological Societies.

  6. U.S. Policy Response to the Fuels Management Problem: An Analysis of the Public Debate About the Healthy Forests Initiative and the Healthy Forests Restoration Act

    Treesearch

    Jayne Fingerman Johnson; David N. Bengston; David P. Fan; Kristen C. Nelson

    2006-01-01

    The Healthy Forests Initiative (HFI) and Healthy Forests Restoration Act (HFRA) represent major policy and legislative responses to the fuels management problem in the United States. This study examined the nature and evolution of the public discussion and debate about these policy responses. Computer content analysis was used to analyze favorable and unfavorable...

  7. Assistive Technology as a Self-Management Tool for Prompting Students with Intellectual Disabilities to Initiate and Complete Daily Tasks: A Literature Review

    ERIC Educational Resources Information Center

    Mechling, Linda C.

    2007-01-01

    This paper summarizes the results of a review of the empirical literature (1990-2005) focusing on use of assistive technology as a self-management tool for persons with intellectual disabilities. Forty investigations were identified which provided information on assistive technology to assist persons with disabilities to initiate and complete…

  8. The Breast Health Global Initiative: clinical practice guidelines for management of breast cancer in low- and middle-income countries.

    PubMed

    Yip, Cheng Har; Anderson, Benjamin O

    2007-08-01

    Breast cancer is an increasingly urgent problem in low- and mid-level resource countries of the world. Despite knowing the optimal management strategy based on guidelines developed in wealthy countries, clinicians are forced to provide less-than-optimal care to patients when diagnostic and/or treatment resources are lacking. For this reason, it is important to identify which resources commonly applied in resource-abundant countries most effectively fill the healthcare needs in limited-resource regions, where patients commonly present with more advanced disease at diagnosis, and to provide guidance on how new resource allocations should be made in order to maximize improvement in outcome. Established in 2002, the Breast Health Global Initiative (BHGI) created an international health alliance to develop evidence-based guidelines for countries with limited resources (low- and middle-income countries) to improve breast health outcomes. The BHGI serves as a program for international guideline development and as a hub for linkage among clinicians, governmental health agencies and advocacy groups to translate guidelines into policy and practice. The BHGI collaborated with 12 national and international health organizations, cancer societies and nongovernmental organizations to host two BHGI international summits. The evidence-based BHGI Guidelines, developed at the 2002 Global Summit, were published in 2003 as a theoretical treatise on international breast healthcare. These guidelines were then updated and expanded at the 2005 Global Summit into a fully comprehensive and flexible framework to permit incremental improvements in healthcare delivery, based upon outcomes, cost, cost-effectiveness and use of healthcare services.

  9. Public health incident management: Logistical and operational aspects of the 2009 initial outbreak of H1N1 influenza in Mexico.

    PubMed

    Cruz, Miguel A; Hawk, Nicole M; Poulet, Christopher; Rovira, Jose; Rouse, Edward N

    2015-01-01

    Hosting an international outbreak response team can pose a challenge to jurisdictions not familiar with incident management frameworks. Basic principles of team forming, organizing, and executing mission critical activities require simple and flexible communication that can be easily understood by the host country's public health leadership and international support agencies. Familiarity with incident command system principles before a public health emergency could save time and effort during the initial phases of the response and aid in operationalizing and sustaining complex field activities throughout the response. The 2009 initial outbreak of H1N1 in Mexico highlighted the importance of adequately organizing and managing limited resources and expertise using incident management principles. This case study describes logistical and operational aspects of the response and highlights challenges faced during this response that may be relevant to the organization of public health responses and incidents requiring international assistance and cooperation.

  10. Public health incident management: logistical and operational aspects of the 2009 initial outbreak of H1N1 influenza in Mexico.

    PubMed

    Cruz, Miguel A; Hawk, Nicole M; Poulet, Christopher; Rovira, Jose; Rouse, Edward N

    2015-01-01

    Hosting an international outbreak response team can pose a challenge to jurisdictions not familiar with incident management frameworks. Basic principles of team forming, organizing, and executing mission critical activities require simple and flexible communication that can be easily understood by the host country's public health leadership and international support agencies. Familiarity with incident command system principles before a public health emergency could save time and effort during the initial phases of the response and aid in operationalizing and sustaining complex field activities throughout the response. The 2009 initial outbreak of H1N1 in Mexico highlighted the importance of adequately organizing and managing limited resources and expertise using incident management principles. This case study describes logistical and operational aspects of the response and highlights challenges faced during this response that may be relevant to the organization of public health responses and incidents requiring international assistance and cooperation.

  11. Initial Experience of an Anesthesiology-based Service for Perioperative Management of Pacemakers and Implantable Cardioverter Defibrillators.

    PubMed

    Rooke, G Alec; Lombaard, Stefan A; Van Norman, Gail A; Dziersk, Jörg; Natrajan, Krishna M; Larson, Lyle W; Poole, Jeanne E

    2015-11-01

    Management of cardiovascular implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators, for surgical procedures is challenging due to the increasing number of patients with CIEDs and limited availability of trained providers. At the authors' institution, a small group of anesthesiologists were trained to interrogate CIEDs, devise a management plan, and perform preoperative and postoperative programming and device testing whenever necessary. Patients undergoing surgery between October 1, 2009 and June 30, 2013 at the University of Washington Medical Center were included in a retrospective chart review to determine the number of devices actively managed by the Electrophysiology/Cardiology Service (EPCS) versus the Anesthesiology Device Service (ADS), changes in workload over time, surgical case delays due to device management, and errors and problems encountered in device programming. The EPCS managed 254 CIEDs, the ADS managed 548, and 227 by neither service. Over time, the ADS providers managed an increasing percentage of devices with decreasing supervision from the EPCS. Only two CIEDs managed by the ADS required immediate assistance from the EPCS. Patients who were unstable postoperatively were referred to the EPCS. Although numerous issues in programming were encountered, primarily when restoring demand pacing after programming asynchronous pacing for surgery, no patient harm resulted from ADS or EPCS management of CIEDs. An ADS can provide safe CIED management for surgery, but it requires specialized provider training and strong support from the EPCS. Due to the complexity of CIED management, an ADS will likely only be feasible in high-volume settings.

  12. In view of standardization Part 2: Management of challenges in the initial treatment of burn patients in Burn Centers in Germany, Austria and Switzerland.

    PubMed

    Ziegler, Benjamin; Hirche, Christoph; Horter, Johannes; Kiefer, Jurij; Grützner, Paul Alfred; Kremer, Thomas; Kneser, Ulrich; Münzberg, Matthias

    2017-03-01

    Initial therapy of severe burns in specialized burn trauma centers is a challenging task faced by the treating multi-professional and interdisciplinary team. A lack of consistent operating procedures and varying structural conditions was recently demonstrated in preliminary data of our group. These results raised the question on how specific treatment measures in acute burn care are met in the absence of standardized guidelines. A specific questionnaire containing 57 multiple-choice questions was sent to all 22 major burn centers in Germany, Austria and Switzerland. The survey included standards of airway management and ventilation, fluid management and circulation, body temperature monitoring and management, topical burn wound treatment and a microbiological surveillance. Additionally, the distribution of standardized course systems was covered. 17 out of 22 questionnaires (77%) were returned completed. Regarding volume resuscitation, results showed a similar approach in estimating initial fluid while discrepancies persisted in the use of colloidal fluid and human albumin. Elective tracheostomy and the need for bronchoscopy with suspected inhalation injury were the most controversial issues revealed by the survey. Topical treatment of burned body surface also followed different principles regarding the use of synthetic epidermal skin substitutes or enzymatic wound debridement. Less discrepancy was found in basic diagnostic measures, body temperature management, estimation of the extent of burns and microbiological surveillance. While many burn-related issues are clearly not questionable and managed in a similar way in most participating facilities, we were able to show that the most contentious issues in burn trauma management involve initial volume resuscitation, management of inhalation trauma and topical burn wound treatment. Further research is required to address these topics and evaluate a potential superiority of a regime in order to increase the level of

  13. Lesson of the month 2: Catecholamine-induced cardiomyopathy - pitfalls in diagnosis and medical management.

    PubMed

    Mamoojee, Yaasir; Arham, Munawar; Elsaify, Wael; Nag, Sath

    2016-04-01

    Cardiomyopathy as the initial presentation of phaeochromocytoma (PCA) is uncommon. Diagnostic work-up and perioperative management may be challenging within this context. We report three cases of PCA presenting with cardiomyopathy to illustrate the pitfalls in diagnosis and management. None of the patients had typical adrenergic symptoms and all three were established on beta-blockers prior to diagnosis. Their fractionated plasma catecholamine levels were elevated and the diagnosis of PCA was confirmed with various imaging modalities and post adrenalectomy. Interpretation of fractionated catecholamine levels in the context of established cardiomyopathy is difficult as cardiac failure of any aetiology generates an adrenergic response. Hence screening all patients with idiopathic cardiomyopathy is likely to generate a high false-positive rate. However, a high index of suspicion should prompt further diagnostic work-up in patients with idiopathic cardiomyopathy for occult PCAs. Peer-reviewed guidelines are required to guide the investigation and management of suspected catecholamine-induced cardiomyopathy.

  14. SDI (Strategic Defense Initiative) Battle Management/C3 (Command, Control, and Communications) Networking Technology Program Plan

    DTIC Science & Technology

    1988-12-01

    Copy 20 o5o 00 IDA MEMORANDUM REPORT M-305 CDNN N 3 SDI BATTLE MANAGEMENT/C NETWORKING ! TECHNOLOGY PROGRAM PLAN Robert Botta Sharon Noll December...Battle Management/C3 Networking Technology Program Plan 12. PERSONAL AUTHOR(S). Robert Botta, Sharon Noll 12. TYPE OF REPORT 3b. TIME COVERED 14. DATE OF...The Institute for Defense Analyses (IDA) has collected and analyzed information on network technology that is relevant to Battle Management Command

  15. Managing in the trenches of consumer care: the challenges of understanding and initiating the advance care planning process.

    PubMed

    Baughman, Kristin R; Aultman, Julie; Hazelett, Susan; Palmisano, Barbara; O'Neill, Anne; Ludwick, Ruth; Sanders, Margaret

    2012-01-01

    To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.

  16. The PRISMS taxonomy of self-management support: derivation of a novel taxonomy and initial testing of its utility.

    PubMed

    Pearce, Gemma; Parke, Hannah L; Pinnock, Hilary; Epiphaniou, Eleni; Bourne, Claire L A; Sheikh, Aziz; Taylor, Stephanie J C

    2016-04-01

    Supporting self-management is a core response of health care systems globally to the increasing prevalence of long-term conditions. Lack of a comprehensive taxonomy (or classification) of self-management support components hinders characterization and, ultimately, understanding of these frequently complex, multi-component interventions. To develop a comprehensive, descriptive taxonomy of self-management support components. Components were derived from the 969 unique randomized controlled trials described in the 102 systematic reviews and 61 implementation trials, examining 14 diverse long-term conditions included in the Practical Reviews in Self-Management Support (PRISMS) project followed by discussion at an expert stakeholder workshop. The utility of the taxonomy was then tested using a self-management support intervention for cancer survivors. The PRISMS taxonomy comprises 14 components that might be used to support self-management (e.g. information about condition/management, provision of equipment, social support), when delivered to someone with a long-term condition or their carer. Overarching dimensions are delivery mode; personnel delivering the support; intervention targeting; and intensity, frequency and duration of the intervention. The taxonomy does not consider the effectiveness or otherwise of the different components or the overarching dimensions. The PRISMS taxonomy offers a framework to researchers describing self-management support interventions, to reviewers synthesizing evidence and to developers of health services for people with long-term conditions. © The Author(s) 2015.

  17. [Clinical value of cardiovascular magnetic resonance imaging in the diagnostic work-up of patients with suspected arrhythmogenic right ventricular dysplasia].

    PubMed

    Sánchez-Rubio, Juan; Carreras, Francesc; Pujadas, Sandra; Leta, Rubén; Guillaumet, Eva; Grande, Carlos; Viñolas, Xavier; Pons-Lladó, Guillem

    2005-09-01

    To analyze retrospectively the usefulness of cardiovascular magnetic resonance imaging in the assessment of patients with clinically suspected arrhythmogenic right ventricular dysplasia. We reviewed retrospectively findings from 46 consecutive patients (mean age, 42+/-19 years; 25 male) who were referred for investigation to rule out right ventricular dysplasia. Abnormal findings were classified according to the general diagnostic criteria established by the European Society of Cardiology. Evaluable images were available for all patients. Abnormal right ventricular findings were reported in 24 patients (52%), but only 5 were given a definite diagnosis of right ventricular dysplasia. Fatty infiltration was observed in 9 patients; it was an isolated finding in 6 but was associated with right ventricular contractile dysfunction in 3. These latter patients belonged to the group with confirmed dysplasia. None of the 22 patients (48%) with normal findings on magnetic resonance imaging was given a diagnosis of dysplasia. Cardiovascular magnetic resonance imaging enabled the right ventricle to be assessed in all patients. In those with clinically suspected dysplasia, normal findings ruled out the diagnosis. However, only 21% of those with abnormal findings on magnetic resonance imaging were finally given a confirmed diagnosis of dysplasia. Fatty infiltration of the right ventricular wall does not imply dysplasia unless it is associated with other abnormalities in right ventricular morphology or contractility. Cardiovascular magnetic resonance imaging is useful in the work-up of patients with clinically suspected arrhythmogenic right ventricular dysplasia.

  18. [Surgical managment of colorectal liver metastasis].

    PubMed

    Prot, Thomas; Halkic, Nermin; Demartines, Nicolas

    2007-06-27

    Surgery offer the only curative treatment for colorectal hepatic metastasis. Nowadays, five-year survival increases up to 58% in selected cases, due to the improvement and combination of chemotherapy, surgery and ablative treatment like embolisation, radio-frequency or cryoablation. Surgery should be integrated in a multi disciplinary approach and initial work-up must take in account patient general conditions, tumor location, and possible extra hepatic extension. Thus, a surgical resection may be performed immediately or after preparation with chemotherapy or selective portal embolization. Management of liver metastasis should be carried out in oncological hepato-biliary centre.

  19. Opportunities and Challenges in Training Elementary School Teachers in Classroom Management: Initial Results from Classroom Management in Action, an Online Professional Development Program

    ERIC Educational Resources Information Center

    Marquez, Brion; Vincent, Claudia; Marquez, Jessie; Pennefather, Jordan; Smolkowski, Keith; Sprague, Jeffrey

    2016-01-01

    Classroom management remains a challenge for many teachers. The approach and delivery of professional development (PD) in classroom management may determine how well teachers are able to apply evidence-based approaches in their classrooms. We use existing literature to identify the key features that make in-service PD effective and present them as…

  20. Factors associated with the decision of the rheumatologist to order sacroiliac joints magnetic resonance imaging (SI-MRI) or HLA-B27 testing in the diagnostic work-up of patients with spondyloarthritis in clinical practice.

    PubMed

    Bautista-Molano, Wilson; Landewé, Robert B M; Serna, Cesar; Valle-Oñate, Rafael; van der Heijde, Désirée

    2017-01-01

    To evaluate the patients' characteristics associated with the clinical decision to request SI-MRI and/or HLA-B27 in patients with SpA in daily practice. Patients referred to a rheumatology outpatient-clinic in a national referral-centre were selected. Patients with a clinical diagnosis of SpA according to the rheumatologist were included. SI-MRI and HLA-B27 was available for patients in whom the rheumatologists had ordered these tests. Characteristics associated with ordering SI-MRI or HLA-B27 were identified with univariable analyses. Variables with p-value <0.05 and >80% completeness were selected for further analysis. A multivariable logistic regression analysis was used to evaluate the determinants related with the decision to perform SI-MRI and/or HLA-B27 and odds ratios with 95% confidence intervals were calculated. In total, 581 patients with SpA were included in the cohort, 72% were men, mean age 34.6±12.1 and disease duration 7.3±9.7 years. Of these patients, 24% (n=137) had SI-MRI and 77% (n=441) had HLA-B27 tests ordered. Independently predictive factors for ordering a SI-MRI were the presence of IBP (OR=1.81), enthesitis (OR=1.57) and the number of initial-symptoms at presentation (OR=1.27 per additional symptom present). Independently predictive factors of HLA-B27 testing were the number of initial-symptoms (OR=1.45 per symptom) and uveitis (OR=3.19). This study strongly suggests that rheumatologists use certain clinical clues to decide if they order expensive and scarce tests in the diagnostic work-up of SpA patients. These manifestations may increase the efficiency of these tests in clinical practice and suggest that clinical reasoning follows principles of Bayesian theory.

  1. Initial Management of Low-Risk Pediatric Fever and Neutropenia: Efficacy and Safety, Costs, Quality-of-Life Considerations, and Preferences.

    PubMed

    Sung, Lillian

    2012-01-01

    Initial management options for pediatric low-risk fever and neutropenia (FN) include outpatient compared with inpatient management and oral compared with intravenous therapy. Single-arm and randomized trials have been conducted in children. Meta-analyses provide support for the equivalence of outpatient and inpatient approaches. Outpatient oral management may be associated with a higher risk of readmission compared with outpatient intravenous management in children with FN, although other outcomes such as treatment failure and discontinuation of the regimen because of adverse effects were similar. Importantly, there have been no reported deaths among low-risk children treated as outpatients or with oral antibiotics. Costs, whether derived directly or through cost-effectiveness analysis, are consistently reduced when an outpatient approach is used. Quality of life (QoL) and preferences should be considered in order to evaluate different strategies, plan programs, and anticipate uptake of outpatient programs. Using parent-proxy report, child QoL is consistently higher with outpatient approaches, although research evaluating child self-report is limited. Preferences incorporate estimated QoL, but, in addition, factor in issues such as costs, fear, anxiety, and logistical issues. Only approximately 50% of parents prefer outpatient management. Future research should develop tools to facilitate outpatient care and to measure caregiver burden associated with this strategy. Additional work should also focus on eliciting child preferences for outpatient management. Finally, studies of effectiveness of an ambulatory approach in the real-world setting outside of clinical trials are important.

  2. Current practice patterns of rectal suction biopsy in the diagnostic work-up of Hirschsprung's disease: results from an international survey.

    PubMed

    Friedmacher, Florian; Puri, Prem

    2016-08-01

    The diagnosis of Hirschsprung's disease (HD) was revolutionized by the introduction of rectal suction biopsy (RSB), allowing specimens to be taken without general anesthesia on the ward or as an out-patient procedure. However, insufficient tissue samples are not uncommon, and subsequently histopathologists often remain reluctant to confirm the presence or absence of enteric ganglion cells merely on the basis of submucosal RSBs. The aim of this study was to evaluate the current usage of RSB in the diagnostic work-up of HD based on an international survey. A 15-item questionnaire was distributed among participants and faculty members at the 21st International Meeting of the Pediatric Colorectal Society. Eighty-seven pediatric surgeons from 30 countries completed the anonymous survey (response rate 70.2 %), grouped into 68 (78.2 %) staff surgeons and 19 (21.8 %) trainees, with a median work experience of 18 years (range 2-45 years). Of these, 74 (85.1 %) use RSB in the diagnostic work-up of patients with suspected HD, whereas 13 (14.9 %) prefer open full-thickness biopsy under general anesthesia. In total, 47 (63.5 %) respondents perform ≥20 RSBs (range 3-100 RSBs) per year. Five different RSB instruments were reported, the most common ones being rbi2 (65.0 %), Solo-RBT (15.0 %) and multipurpose suction biopsy kit (8.3 %). Only 22 (29.7 %) of the respondents use a defined negative suction pressure, with a median of 10 mL air (range 6-25 mL air). The most proximal reported biopsy site was located at a median of 2 cm (range 1-15 cm) above the pectinate line and a median of 2 (range 1-5) specimens are routinely taken, mainly from the posterior rectal wall. Insufficient tissue samples with need for repeat RSB were encountered in a median of 10 % (range 0-40 %). Most frequently used staining methods for rectal biopsies are hematoxylin/eosin (75.9 %), acetylcholinesterase (73.6 %), and calretinin (33.3 %). Overall, 36 (48.6 %) respondents had

  3. Multicenter study on the diagnostic value of a new RIA for the detection of free plasma metanephrines in the work-up for pheochromocytoma.

    PubMed

    Lenz, Tomas; Zorner, Joachim; Kirchmaier, Carl; Pillitteri, Daniele; Badenhoop, Klaus; Bartel, Christine; Geiger, Helmut; Hasselbacher, Katrin; Tuschy, Ulrich; Westermann, Jürgen; Salewski, Lothar

    2006-08-01

    Available laboratory test methods for the detection of elevated concentrations of catecholamines and their metabolites in urine and/or plasma are not always sensitive enough for the detection of pheochromocytoma. High-quality immunoassays for these compounds appear to be as accurate as high-pressure liquid chromatography (HPLC) or gas chromatography/mass spectrometry (GC-MS). Therefore, the current project aims to establish a new sensitive radioimmunoassay (RIA) for the measurement of free metanephrines in the plasma of patients in the work-up for pheochromocytoma. We report first results of an ongoing multicenter clinico-chemical evaluation study in hypertensive patients and normotensive volunteers. After an overnight fast plasma samples were collected on ice in EDTA- and heparin-coated tubes after insertion of an indwelling venous line and resting in the supine (patients) or sitting position (normal volunteers) for 30 min. Plasma metanephrines were measured by a newly developed RIA from IBL, Hamburg, Germany. Good agreement of the assay with the tandem mass spectrometry (LC-MS/MS) method for normetanephrine (r2=0.975) and for metanephrine (r2=0.985) could be demonstrated. Both specimens, EDTA and heparin plasma, can be used with the same results. The RIA has a good precision of <15% in the normal range and of <10% in the elevated concentration range. Our preliminary data suggest a high validity of the newly developed RIA for measuring free metanephrine and normetanephrine in hypertensive subjects in both EDTA and heparin plasma. Further work is required to determine the accuracy of the test in larger patient populations and in patients with pheochromocytoma.

  4. High resolution MRI for preoperative work-up of neonates with an anorectal malformation: a direct comparison with distal pressure colostography/fistulography.

    PubMed

    Thomeer, Maarten G; Devos, Annick; Lequin, Maarten; De Graaf, Nanko; Meeussen, Conny J H M; Meradji, Morteza; De Blaauw, Ivo; Sloots, Cornelius E J

    2015-12-01

    To compare MRI and colostography/fistulography in neonates with anorectal malformations (ARM), using surgery as reference standard. Thirty-three neonates (22 boys) with ARM were included. All patients underwent both preoperative high-resolution MRI (without sedation or contrast instillation) and colostography/fistulography. The Krickenbeck classification was used to classify anorectal malformations, and the level of the rectal ending in relation to the levator muscle was evaluated. Subjects included nine patients with a bulbar recto-urethral fistula, six with a prostatic recto-urethral fistula, five with a vestibular fistula, five with a cloacal malformation, four without fistula, one with a H-type fistula, one with anal stenosis, one with a rectoperineal fistula and one with a bladderneck fistula. MRI and colostography/fistulography predicted anatomy in 88 % (29/33) and 61 % (20/33) of cases, respectively (p = 0.012). The distal end of the rectal pouch was correctly predicted in 88 % (29/33) and 67 % (22/33) of cases, respectively (p = 0.065). The length of the common channel in cloacal malformation was predicted with MRI in all (100 %, 5/5) and in 80 % of cases (4/5) with colostography/fistulography. Two bowel perforations occurred during colostography/fistulography. MRI provides the most accurate evaluation of ARM and should be considered a serious alternative to colostography/fistulography during preoperative work-up. • High-resolution MRI is feasible without the use of sedation or anaesthesia. • MRI is more accurate than colostography/fistulography in visualising the type of ARM. • MRI is as reliable as colostography/fistulography in predicting the level of the rectal pouch. • Colostography/fistulography can be complicated by bowel perforation.

  5. A generic, flexible protocol for preimplantation human leukocyte antigen typing alone or in combination with a monogenic disease, for rapid case work-up and application.

    PubMed

    Kakourou, Georgia; Destouni, Aspasia; Vrettou, Christina; Traeger-Synodinos, Jan; Kanavakis, Emmanuel

    2014-01-01

    Human leukocyte antigen (HLA) typing of in vitro fertilization (IVF) embryos, aims to establish a pregnancy that is HLA compatible with an affected sibling who requires hematopoietic stem cell transplantation (HSCT). It can be performed with or without preimplantation genetic diagnosis (PGD) for exclusion of a single-gene disorder (SGD) and it is a multistep, technically challenging procedure at every stage. Our purpose was to address the difficulties of genetic analysis by developing a fast, reliable and accurate PGD-HLA protocol, to simplify patient work-up and PGD application, while providing high flexibility for combination with any SGD. Requests included PGD-HLA for β-thalassemia (β-thal)/sickle cell disease (most common request), Diamond-Blackfan anemia (DBA), chronic granulomatous disease (CGD) and preimplantation-HLA typing only. For HLA haplotyping, we selected a panel of 26 short tandem repeats (STRs) distributed across the entire HLA locus, following PGD guidelines. When required, mutation detection was performed by both a direct and indirect approach. To support concurrent SGD exclusion and HLA typing, a one-step, single-tube, multiplex fluorescent touchdown-polymerase chain reaction (PCR) was optimized. The described touchdown-PCR was successfully applied for all PGD-HLA protocols. Eight clinical cycles were performed with a diagnosis achieved for 94.7% of amplified biopsied blastomeres. Embryo transfer took place in six cycles, with two pregnancies achieved and two healthy female infants (from a twin pregnancy) born so far. Our protocol enables HLA typing in a single PCR, reducing the risk of contamination and the cost, and providing faster results. It requires minimum optimization before clinical application, irrespective of the SGD involved, decreasing the waiting time from referral to treatment for all PGD-HLA cases.

  6. Highly sensitive assays are mandatory for the differential diagnosis of patients presenting with symptoms of mast cell activation: diagnostic work-up of 38 patients.

    PubMed

    Van den Poel, Bea; Kochuyt, Anne-Marie; Del Biondo, Elke; Dewaele, Barbara; Lierman, Els; Tousseyn, Thomas; de Hertogh, Gert; Vandenberghe, Peter; Boeckx, Nancy

    2017-04-01

    Mastocytosis is a heterogeneous disease caused by excessive mast cell (MC) proliferation. Diagnosis of systemic mastocytosis (SM) is based on the presence of major and minor criteria defined by the World Health Organization. Symptoms of MC activation can also occur in patients without SM or without allergic or inflammatory disease. These MC activation syndromes (MCAS) can be divided into primary (monoclonal) MCAS (MMAS) vs. secondary and idiopathic MCAS. In this single center study, the diagnostic work-up of 38 patients with a clinical suspicion of SM and/or with elevated basic tryptase levels is presented. Clinical symptoms, biochemical parameters, results of bone marrow investigation, flow cytometric immunophenotyping, and molecular analysis were retrospectively reviewed. Twenty-three patients were found to have a monoclonal MC disorder of which 19 were diagnosed with SM and 4 with MMAS. In 13/19 SM patients, multifocal MC infiltrates in the bone marrow were found (major criterion), while in 6 the diagnosis was based on the presence of ≥3 minor criteria. Flow cytometric analysis of bone marrow showed CD25 expression of MCs in all patients with SM and MMAS (range: 0.002-0.3% of cells). In bone marrow, the KIT D816V mutation was detected in all SM patients but in only 2 patients with MMAS (range: 0.007-9% mutated cells). Basic tryptase elevation was demonstrated in 16/19 patients with SM but also in 9/19 patients without SM. Our study reveals the heterogeneity of primary MC disorders and the importance of sensitive assays in patients suspected of having SM.

  7. Who cares for the oral health of dependent elderly and disabled persons living at home? A qualitative study of case managers' knowledge, attitudes and initiatives.

    PubMed

    Hagman-Gustafsson, Marie-Louise; Holmén, Annette; Strömberg, Ella; Gabre, Pia; Wårdh, Inger

    2008-01-01

    In 1999 a new law in Sweden granted people receiving a certain level of supportive care from the community the right to receive a free, in-home oral health assessment. Subsequent appraisal has disclosed that far from all eligible people, especially those living at home, have undergone such an assessment. Of fundamental importance to the success of this scheme is the active involvement of case managers in identifying those who are eligible for assessment. The aim of this study was to investigate case managers' knowledge of and attitudes to the oral health of their clients and the initiatives they take to ensure that dependent elderly and disabled persons living at home have access to oral health care. In qualitative in-depth interviews, 24 case managers from three Swedish counties were questioned about their perceptions of oral health care for their clients. The transcribed text was analysed by manifest and latent qualitative content analysis. The manifest analysis was based on the three content areas knowledge, attitudes and initiatives. During this process a theme emerged which disclosed the case managers' perceptions of their role in oral health care among elderly and disabled persons, a latent analysis. The case managers' age, education, experience and breadth of responsibilities varied. Their knowledge of the 1999 law was limited. In general there were no procedures in place to ensure that the oral assessments were undertaken and that records were kept. The case managers considered that they should not be responsible, although they could not suggest a more appropriate instance. The potential role of regular oral health assessment in prevention of oral diseases was not discussed at all in the interviews. The current systems for monitoring oral health are tailored primarily to institutionalised care. In future many more dependent people will continue to live at home with support from community home care assistants and relatives. It is important that oral health

  8. Timing of Physical Therapy Initiation for Nonsurgical Management of Musculoskeletal Disorders and Effects on Patient Outcomes: A Systematic Review.

    PubMed

    Ojha, Heidi A; Wyrsta, Nadia J; Davenport, Todd E; Egan, William E; Gellhorn, Alfred C

    2016-02-01

    Systematic review. Current US practice guidelines suggest an initial "wait-and-see" approach following onset of musculoskeletal pain, particularly for spinal pain. Several studies suggest that early, compared with delayed, initiation of physical therapy for musculoskeletal conditions may decrease health costs and improve outcomes. To compare early and delayed initiation of physical therapy for individuals with musculoskeletal conditions and to assess effects on patient-important outcomes and cost. MEDLINE (Ovid), CINAHL (EBSCO), Web of Science, and PEDro were the data sources. We included studies that compared early and delayed initiation of physical therapy for patients with musculoskeletal disorders. Studies in which early and delayed interventions differed were excluded. Two independent reviewers extracted study characteristics and outcomes, and determined eligibility and quality through consensus with a third reviewer. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in summary conclusions. Standardized effect sizes (d) and odds ratios were calculated to assess the effect strength of early versus delayed physical therapy for each included study. Of the 3855 articles initially screened, 14 studies were included. The majority of articles studied low back pain (only 2 articles studied cervical pain). For spinal pain, there was low-quality evidence that early versus delayed physical therapy was associated with decreased cost and decreased frequency of opioid prescriptions, advanced imaging, and surgeries without compromising patient-important outcomes. One subgroup analyzed showed improved function/disability with early physical therapy in an occupational health setting. Although there were consistent results across studies favoring early physical therapy for decreased cost and medical utilization, quality was limited. Preliminary evidence suggests that early physical therapy may decrease cost without compromising

  9. Initial Impressions of Community-Dwelling Older Adults and Case Managers about Community-Based Telehealth Kiosks

    PubMed Central

    Courtney, Karen L.; Lingler, Jennifer H.; Mecca, Laurel Person; Garlock, Laurie A.; Schulz, Richard; Dick, Andrew W.; Olshansky, Ellen

    2010-01-01

    Community-based (multi-user) telehealth interventions may be beneficial for older adults, but there is little research regarding community-based telehealth. We used a qualitative descriptive approach to examine the acceptability and perceived value of community-based telehealth kiosks with regard to current health self-management practices of community-dwelling older adults as a first step in feasibility assessment. Participants included residents (n=6) and community agency case managers (n=3) of a HUD-subsidized senior apartment building. Both positive impressions and concerns of each group are presented. Findings helped guide the plans for future telehealth kiosk implementation and training. PMID:20509594

  10. Initial Cholecystectomy with Cholangiography Decreases Length of Stay Compared to Preoperative MRCP or ERCP in the Management of Choledocholithiasis.

    PubMed

    Lin, Christine; Collins, Jay N; Britt, Rebecca C; Britt, Lunzy D

    2015-07-01

    There are several treatments available for choledocholithiasis, but the optimal treatment is highly debated. Some advocate preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) with cholangiography (IOC). Others advocate initial LC + IOC followed by common bile duct exploration or ERCP. The purpose of this study was to determine whether initial LC + IOC had a shorter length of stay (LOS) compared with preoperative magnetic resonance cholangiopancreatography (MRCP) or ERCP. Patients who underwent cholecystectomy between 2012 and 2013 at two institutions were reviewed. Patients were selected if they had suspected choledocholithiasis, indicated by dilated CBD and/or elevated bilirubin, or confirmed choledocholithiasis. They were excluded if they had pancreatitis or cholangitis. There were 126 patients with suspected choledocholithiasis in this study. Of these, 97 patients underwent initial LC ± IOC with an average LOS of 3.9 days. IOC was negative in 47.4 per cent patients, and they had a shorter LOS compared with positive IOC patients (2.93 vs 4.82, P < 0.001). Laparoscopic common bile duct exploration was successful in 64.7 per cent and had a shorter LOS compared with postoperative ERCP patients (P = 0.01). Preoperative MRCP was performed in 21 patients with an average LOS of 6.48 days. Preoperative ERCP was performed in eight patients with an average LOS of seven days. Initial LC+IOC is associated with a shorter LOS compared to preoperative MRCP or ERCP. It is recommended as the optimal treatment choice for suspected choledocholithiasis.

  11. 75 FR 40759 - Initiation of Review of Management Plan/Regulations of the Hawaiian Islands Humpback Whale...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-14

    .../Regulations of the Hawaiian Islands Humpback Whale National Marine Sanctuary; Intent To Prepare Draft...) has initiated a review of the Hawaiian Islands Humpback Whale National Marine Sanctuary (HIHWNMS or... Hawaiian Islands Humpback Whale National Marine Sanctuary will be considered if received on or...

  12. Effect of time to initiation of postoperative radiation therapy on survival in surgically managed head and neck cancer.

    PubMed

    Graboyes, Evan M; Garrett-Mayer, Elizabeth; Ellis, Mark A; Sharma, Anand K; Wahlquist, Amy E; Lentsch, Eric J; Nussenbaum, Brian; Day, Terry A

    2017-08-25

    The objective of this study was to determine the effects of National Comprehensive Cancer Network (NCCN) guideline-adherent initiation of postoperative radiation therapy (PORT) and different time-to-PORT intervals on the overall survival (OS) of patients with head and neck squamous cell carcinoma (HNSCC). The National Cancer Data Base was reviewed for the period of 2006-2014, and patients with HNSCC undergoing surgery and PORT were identified. Kaplan-Meier survival estimates, Cox regression analysis, and propensity score matching were used to determine the effects of initiating PORT within 6 weeks of surgery and different time-to-PORT intervals on survival. This study included 41,291 patients. After adjustments for covariates, starting PORT >6 weeks postoperatively was associated with decreased OS (adjusted hazard ratio [aHR], 1.13; 99% confidence interval [CI], 1.08-1.19). This finding remained in the propensity score-matched subset (hazard ratio, 1.21; 99% CI, 1.15-1.28). In comparison with starting PORT 5 to 6 weeks postoperatively, initiating PORT earlier was not associated with improved survival (aHR for ≤ 4 weeks, 0.93; 99% CI, 0.85-1.02; aHR for 4-5 weeks, 0.92; 99% CI, 0.84-1.01). Increasing durations of delay beyond 7 weeks were associated with small, progressive survival decrements (aHR, 1.09, 1.10, and 1.12 for 7-8, 8-10, and >10 weeks, respectively). Nonadherence to NCCN guidelines for initiating PORT within 6 weeks of surgery was associated with decreased survival. There was no survival benefit to initiating PORT earlier within the recommended 6-week timeframe. Increasing durations of delay beyond 7 weeks were associated with small, progressive survival decrements. Cancer 2017. © 2017 American Cancer Society. © 2017 American Cancer Society.

  13. Using a Spend Analysis to Help Identify Prospective Air Force Purchasing and Supply Management Initiatives. Summary of Selected Findings

    DTIC Science & Technology

    2004-04-01

    Core Competence of the Corporation ,” Harvard Business Review, May/June 1990, pp. 79–91. Rajagopal, Shan, and Kenneth N. Bernard, “Strategic...Alignment: Best Practices in Supply Chain Management, Gower, England: Andersen Consulting, 1988, pp. 285–301. Prahalad, C. K., and Gary Hamel, “ The

  14. Student-Initiated Use of Multilingual Resources in English-Language Classroom Interaction: Next-Turn Management

    ERIC Educational Resources Information Center

    Ziegler, Gudrun; Sert, Olcay; Durus, Natalia

    2012-01-01

    This paper investigates the use of multilingual resources by plurilingual participants in two English language classrooms in Luxembourg. Using Conversation Analysis and drawing on transcriptions of video-recordings, we present three examples of student use of multilingual resources and their respective teacher next turn management (through…

  15. Determinants of "Community Participation": The Tradition of Local Initiatives and the Institutionalisation of School Management Committees in Oromia Region, Ethiopia

    ERIC Educational Resources Information Center

    Yamada, Shoko

    2014-01-01

    A School Management Committee (SMC) is an administrative tool adopted in many developing countries to decentralise administrative and financial responsibilities at school level, while involving local people in decision-making and making education more responsive to demands. I question the assumption linking administrative decentralisation and…

  16. An initial evaluation of potential options for managing riparian reserves of the Aquatic Conservation Strategy of the Northwest Forest Plan

    Treesearch

    Gordon H. Reeves; Brian R. Pickard; K. Norman. Johnson

    2016-01-01

    The Aquatic Conservation Strategy (ACS) of the Northwest Forest Plan guides management of riparian and aquatic ecosystems on federal lands in western Oregon, western Washington, and northern California. We applied new scientific findings and tools to evaluate two potential options, A and B, for refining interim riparian reserves to meet ACS goals and likely challenges...

  17. Determinants of "Community Participation": The Tradition of Local Initiatives and the Institutionalisation of School Management Committees in Oromia Region, Ethiopia

    ERIC Educational Resources Information Center

    Yamada, Shoko

    2014-01-01

    A School Management Committee (SMC) is an administrative tool adopted in many developing countries to decentralise administrative and financial responsibilities at school level, while involving local people in decision-making and making education more responsive to demands. I question the assumption linking administrative decentralisation and…

  18. Toward Excellence in Secondary Special Education: A Plan for Statewide Initiatives in Oregon. Management Issues and Guidelines.

    ERIC Educational Resources Information Center

    Halpern, Andrew S.; Byrne, Andrew R.

    Management issues, guidelines, policies, and procedures for implementing a statewide plan in Oregon for improving secondary school special education and transition programs for students with mild or severe disabilities are described. An overview is given of the development of the plan, including discussion of: background events; general underlying…

  19. On the development and implementation of ecosystem management plans for water resources in the Great Lakes: A case study of the RAP initiative

    SciTech Connect

    MacKenzie, S.H.

    1991-01-01

    The ecosystem approach to water resource management is deceptively simple: one must recognize the interrelationships among water, land, air, and all living things and undertake resource planning in such a way that the integrity of the natural system is preserved. Significant features of the ecosystem approach include its watershed boundaries, its holistic orientation, and its assumption that humans should be viewed as part of, rather than apart from, the natural system. A theme of environmental ethics and education underlies the approach. Although it seems straightforward, the ecosystem approach has important implications for water management. In 1985, the International Joint Commission challenged government agencies to utilize the ecosystem approach to develop Remedial Action Plans to rehabilitate forty-two hotspots across the Great Lakes Basin. This initiative represented a first effort to implement the ecosystem approach in the Great Lakes. The research questions were: what does ecosystem management mean in the context of the RAP process, and how can one increase the likelihood of successful implementation of ecosystem management plans The research proposition suggests that there are three preconditions to ecosystem management: participation; decision making; and legitimacy. Comparative case studies of Green Bay, Wisconsin; Saginaw Bay, Michigan; and Hamilton Harbor, Ontario were undertaken. Thirty-five RAP participants were chosen for on-site indepth interviews. Data were arrayed by respondent, question, and case, and were analyzed for content.

  20. Development and initial validation of primary care provider mental illness management and team-based care self-efficacy scales.

    PubMed

    Loeb, Danielle F; Crane, Lori A; Leister, Erin; Bayliss, Elizabeth A; Ludman, Evette; Binswanger, Ingrid A; Kline, Danielle M; Smith, Meredith; deGruy, Frank V; Nease, Donald E; Dickinson, L Miriam

    Develop and validate self-efficacy scales for primary care provider (PCP) mental illness management and team-based care participation. We developed three self-efficacy scales: team-based care (TBC), mental illness management (MIM), and chronic medical illness (CMI). We developed the scales using Bandura's Social Cognitive Theory as a guide. The survey instrument included items from previously validated scales on team-based care and mental illness management. We administered a mail survey to 900 randomly selected Colorado physicians. We conducted exploratory principal factor analysis with oblique rotation. We constructed self-efficacy scales and calculated standardized Cronbach's alpha coefficients to test internal consistency. We calculated correlation coefficients between the MIM and TBC scales and previously validated measures related to each scale to evaluate convergent validity. We tested correlations between the TBC and the measures expected to correlate with the MIM scale and vice versa to evaluate discriminant validity. PCPs (n=402, response rate=49%) from diverse practice settings completed surveys. Items grouped into factors as expected. Cronbach's alphas were 0.94, 0.88, and 0.83 for TBC, MIM, and CMI scales respectively. In convergent validity testing, the TBC scale was correlated as predicted with scales assessing communications strategies, attitudes toward teams, and other teamwork indicators (r=0.25 to 0.40, all statistically significant). Likewise, the MIM scale was significantly correlated with several items about knowledge and experience managing mental illness (r=0.24 to 41, all statistically significant). As expected in discriminant validity testing, the TBC scale had only very weak correlations with the mental illness knowledge and experience managing mental illness items (r=0.03 to 0.12). Likewise, the MIM scale was only weakly correlated with measures of team-based care (r=0.09 to.17). This validation study of MIM and TBC self-efficacy scales

  1. Added value of semi-quantitative breast-specific gamma imaging in the work-up of suspicious breast lesions compared to mammography, ultrasound and 3-T MRI.

    PubMed

    Meissnitzer, T; Seymer, A; Keinrath, P; Holzmannhofer, J; Pirich, C; Hergan, K; Meissnitzer, M W

    2015-07-01

    To prospectively analyse the diagnostic value of semi-quantitative breast-specific gamma imaging (BSGI) in the work-up of suspicious breast lesions compared with that of mammography (MG), breast ultrasound and MRI of the breast. Within a 15-month period, 67 patients with 92 breast lesions rated as Category IV or V according to the breast imaging reporting and data system detected with MG and/or ultrasound were included into the study. After the injection of 740-1110 MBq of Technetium-99m ((99m)Tc) SestaMIBI intravenously, scintigrams were obtained in two projections comparable to MG. The BSGI was analysed visually and semi-quantitatively by calculating a relative uptake factor (X). With the exception of two patients with cardiac pacemakers, all patients underwent 3-T breast MRI. Biopsy results were obtained as the reference standard in all patients. Sensitivity, specificity, positive- and negative-predictive values, accuracy and area under the curve were calculated for each modality. Among the 92 lesions, 67 (72.8%) were malignant. 60 of the 67 cancers of any size were detected by BSGI with an overall sensitivity of 90%, only exceeded by ultrasound with a sensitivity of 99%. The sensitivity of BSGI for lesions <1 cm declined significantly to 60%. Overall specificity of ultrasound was only 20%. Specificity, accuracy and positive-predictive value were the highest for BSGI (56%, 80% and 85%, respectively). X was significantly higher for malignant lesions (mean, 4.27) and differed significantly between ductal types (mean, 4.53) and the other histopathological entities (mean, 3.12). Semi-quantitative BSGI with calculation of the relative uptake factor (X) can help to characterize breast lesions. BSGI negativity may obviate the need for biopsy of breast lesions >1 cm with low or intermediate prevalence for malignancy. Compared with morphological imaging modalities, specificity, positive-predictive value for malignancy and accuracy were the highest for BSGI in our

  2. Staging of Cervical Lymph Nodes in Oral Squamous Cell Carcinoma: Adding Ultrasound in Clinically Lymph Node Negative Patients May Improve Diagnostic Work-Up

    PubMed Central

    Norling, Rikke; Buron, Birgitte Marie Due; Therkildsen, Marianne Hamilton; Henriksen, Birthe Merete; von Buchwald, Christian; Nielsen, Michael Bachmann

    2014-01-01

    Introduction Clinical staging of patients with oral squamous cell carcinoma (OSCC) is crucial for the choice of treatment. Computed tomography (CT) and/or magnetic resonance imaging (MRI) are typically recommended and used for staging of the cervical lymph nodes (LNs). Although ultrasonography (US) is a non-expensive, accessible and non-ionising imaging modality this method is not consistently used. This study aimed to investigate if addition of US of patients classified as clinically LN negative (cN0) by CT and/or MRI, increases the detection of LN metastases. Also, we aimed to identify which of the sonographic characteristics: echogenicity, border, shape, appearance of hilum and nodal blood-flow pattern best detect metastases in this patient group. Method Fifty-one patients with OSCC classified as cN0 by CT/MRI were consecutively included and prospectively examined with US prior to sentinel node biopsy or selective neck dissection. Localisation, size and sonographic characteristics were registered for each LN and compared with the pathological findings. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for different size measurements and sonographic characteristics. Results We found that short axial diameter was the best size criterion for detection of metastases. However, the sonographic characteristics were better predictors than size and the presence at least four of the sonographic characteristics: hypo-echoic or heterogeneous appearance; irregular border; spherical shape; absence of nodal hilum; and peripheral nodal blood-flow resulted in a sensitivity of 43.8; specificity 91.4; PPV 70.0; and NPV 78.0. The number of patients with occult metastases decreased from 16 out of 51 (31%) to nine out of 51 (18%). Three patients (6%) were over-staged by US. Conclusion The addition of US to the clinical work-up of patients with cN0 OSCC increases the detection of metastases, thus US potentially reduces the

  3. Added value of semi-quantitative breast-specific gamma imaging in the work-up of suspicious breast lesions compared to mammography, ultrasound and 3-T MRI

    PubMed Central

    Seymer, A; Keinrath, P; Holzmannhofer, J; Pirich, C; Hergan, K; Meissnitzer, M W

    2015-01-01

    Objective: To prospectively analyse the diagnostic value of semi-quantitative breast-specific gamma imaging (BSGI) in the work-up of suspicious breast lesions compared with that of mammography (MG), breast ultrasound and MRI of the breast. Methods: Within a 15-month period, 67 patients with 92 breast lesions rated as Category IV or V according to the breast imaging reporting and data system detected with MG and/or ultrasound were included into the study. After the injection of 740–1110 MBq of Technetium-99m (99mTc) SestaMIBI intravenously, scintigrams were obtained in two projections comparable to MG. The BSGI was analysed visually and semi-quantitatively by calculating a relative uptake factor (X). With the exception of two patients with cardiac pacemakers, all patients underwent 3-T breast MRI. Biopsy results were obtained as the reference standard in all patients. Sensitivity, specificity, positive- and negative-predictive values, accuracy and area under the curve were calculated for each modality. Results: Among the 92 lesions, 67 (72.8%) were malignant. 60 of the 67 cancers of any size were detected by BSGI with an overall sensitivity of 90%, only exceeded by ultrasound with a sensitivity of 99%. The sensitivity of BSGI for lesions <1 cm declined significantly to 60%. Overall specificity of ultrasound was only 20%. Specificity, accuracy and positive-predictive value were the highest for BSGI (56%, 80% and 85%, respectively). X was significantly higher for malignant lesions (mean, 4.27) and differed significantly between ductal types (mean, 4.53) and the other histopathological entities (mean, 3.12). Conclusion: Semi-quantitative BSGI with calculation of the relative uptake factor (X) can help to characterize breast lesions. BSGI negativity may obviate the need for biopsy of breast lesions >1 cm with low or intermediate prevalence for malignancy. Advances in knowledge: Compared with morphological imaging modalities, specificity, positive

  4. False positives in breast cancer screening with one-view breast tomosynthesis: An analysis of findings leading to recall, work-up and biopsy rates in the Malmö Breast Tomosynthesis Screening Trial.

    PubMed

    Lång, Kristina; Nergården, Matilda; Andersson, Ingvar; Rosso, Aldana; Zackrisson, Sophia

    2016-11-01

    To analyse false positives (FPs) in breast cancer screening with tomosynthesis (BT) vs. mammography (DM). The Malmö Breast Tomosynthesis Screening Trial (MBTST) is a prospective population-based study comparing one-view BT to DM in screening. This study is based on the first half of the MBTST population (n = 7,500). Differences in FP recall rate, findings leading to recall, work-up and biopsy rate between cases recalled on BT alone, DM alone and BT+DM were analysed. The FP recall rate was 1.7 % for BT alone (n = 131), 0.9 % for DM alone (n = 69) and 1.1 % for BT + DM (n = 81). The FP recall rate for BT alone was halved after the initial phase of the trial, stabilising at 1.5 %. BT doubled the recall of stellate distortions compared to DM (n = 64 vs. n = 33). There were fewer fibroadenomas and cysts, and the biopsy rate was slightly lower for FP recalled on BT alone compared to DM alone (15.3 % vs. 27.6 %: p = 0.037 and 33.8 % vs. 36.2 %; p = 0.641, respectively). FPs increased with BT screening mainly due to the recall of stellate distortions. The FP recall rate was still well within the European guidelines and showed evidence of a learning curve. Characterisation of rounded lesions was improved with BT. • Tomosynthesis screening gave a higher false-positive recall rate than mammography • There was a decline in the false-positive recall rate for tomosynthesis • The recall due to stellate distortions simulating malignancy was doubled with tomosynthesis • Tomosynthesis found more radial and postoperative scar tissue than mammography • Tomosynthesis is better at characterising rounded lesions.

  5. Management strategies to effect change in intensive care units: lessons from the world of business. Part I. Targeting quality improvement initiatives.

    PubMed

    Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

    2014-02-01

    The business community has developed strategies to ensure the quality of the goods or services they produce and to improve the management of multidisciplinary work teams. With modification, many of these techniques can be imported into intensive care units (ICUs) to improve clinical operations and patient safety. In Part I of a three-part ATS Seminar series, we argue for adopting business management strategies in ICUs and set forth strategies for targeting selected quality improvement initiatives. These tools are relevant to health care today as focus is placed on limiting low-value care and measuring, reporting, and improving quality. In the ICU, the complexity of illness and the need to standardize processes make these tools even more appealing. Herein, we highlight four techniques to help prioritize initiatives. First, the "80/20 rule" mandates focus on the few (20%) interventions likely to drive the majority (80%) of improvement. Second, benchmarking--a process of comparison with peer units or institutions--is essential to identifying areas of strength and weakness. Third, root cause analyses, in which structured retrospective reviews of negative events are performed, can be used to identify and fix systems errors. Finally, failure mode and effects analysis--a process aimed at prospectively identifying potential sources of error--allows for systems fixes to be instituted in advance to prevent negative outcomes. These techniques originated in fields other than health care, yet adoption has and can help ICU managers prioritize issues for quality improvement.

  6. An examination of the Total Quality Management (TQM) concept given current Federal/DoD competition initiatives

    NASA Astrophysics Data System (ADS)

    Stabile, Michael E.

    1992-06-01

    Quality is vital to our defense and quality improvement is key to increasing productivity. The Department of Defense (DoD) Total Quality Management (TQM) effort has been given top priority by the Secretary of Defense. Many questions exist concerning the problems encountered when implementing TQM throughout DoD. This thesis looks at the compatibility of the TQM philosophy with current Federal Acquisition Regulation competition requirements. The writer concludes that the TQM philosophy implementation is compatible with existing competition policy.

  7. An analysis of the effect of STEM initiatives on socially responsible diversity management in the US aerospace and defense industry

    NASA Astrophysics Data System (ADS)

    Johnson-Oliver, Patrick

    Workforce diversity is a growing concern at a global level and enlightened economic self-interest and corporate image compels industries to leverage it as a competitive advantage. The US aerospace and defense industry (US ADI) addresses workforce diversity through socially responsible diversity management. Prior research into the topic of approaching workforce diversity as a business rationale and a moral imperative has been limited. Scharmer and Kaufer's (2013) Theory U guided this longitudinal explanatory quantitative study, leading from the future as it emerged relative to socially responsible diversity management to compel industry to remove blind spots and co-create an economy that benefits all by promoting workforce diversity as a dual agenda. This study filled a research gap investigating the business case for diversity as a dual agenda in aerospace industry science, technology, engineering, and mathematics (STEM) disciplines. The study also investigated the America COMPETES Act as a moderator of the relationship between historically black colleges and universities (HBCUs) and industry. Data was retrieved for secondary data analysis from the National Science Foundation (NSF) and other public government services and agency websites. Two hypotheses were tested using quantitative analysis including descriptive statistics, linear regression, ANOVA, and two factor analysis. The statistical results were analyzed and deductive logic employed to develop conclusions for the study. There was a significant relationship found between both predictors and socially responsible diversity management. The results reinforce the necessity for the aerospace defense industry to promote the dual agenda of the business case for diversity as complementary; not as competing mandates.

  8. Demographic and Clinical Profiles of Type 2 Diabetes Mellitus Patients Initiating Canagliflozin Versus DPP-4 Inhibitors in a Large U.S. Managed Care Population.

    PubMed

    Grabner, Michael; Peng, Xiaomei; Geremakis, Caroline; Bae, Jay

    2015-12-01

    Canagliflozin is the first sodium-glucose co-transporter-2 (SGLT-2) inhibitor-a new class of oral antidiabetic (OAD) medication-approved for type 2 diabetes mellitus (T2DM) treatment in the United States. Approved less than 2 years ago, use of canagliflozin is largely uncharacterized. To investigate and compare baseline demographic, clinical, and economic characteristics of patients initiating canagliflozin and dipeptidyl peptidase-4 (DPP-4) inhibitors in the real-world setting. Using administrative claims data from a large, geographically diverse U.S. managed care organization, this retrospective study assessed adult T2DM patients (aged ≥ 18 years) initiating treatment with canagli-flozin or DPP-4 agents. Eligible patients had ≥1 medical claim with a T2DM diagnosis and ≥ 1 outpatient pharmacy claim for canagliflozin or a DPP-4 agent between January 1, 2011, and September 30, 2013. Patients with ≥ 1 canagliflozin fill were selected first and assigned to the canagliflozin cohort following a hierarchical approach; the date of the earliest canagliflozin fill was defined as the index date. Remaining patients with DPP-4 fills were then assigned to the DPP-4 cohort, with the index date as the first DPP-4 fill. Only patients with at least 12 months of pre-index (baseline) enrollment were included. Patients with fills for their cohort-defining drug over 3 months before the index date were excluded in order to focus on new initiators. A subset of patients with ≥ 3 months of continuous enrollment following their index dates was used to examine medication patterns after initiation. Patients with hyperglycemia; type 1, gestational, or nonclinical diabetes; or diabetes with hyperosmolar coma were excluded. Demographic, clinical, and economic characteristics were assessed over baseline and compared using two-sample t-tests or chi-square/Fisher's exact tests. Multivariable logistic regression models were built to assess baseline factors associated with

  9. The views and experiences of nurses and midwives in the provision and management of provider-initiated HIV testing and counseling: a systematic review of qualitative evidence.

    PubMed

    Evans, Catrin; Nalubega, Sylivia; McLuskey, John; Darlington, Nicola; Croston, Michelle; Bath-Hextall, Fiona

    2016-01-15

    Global progress towards HIV prevention and care is contingent upon increasing the number of those aware of their status through HIV testing. Provider-initiated HIV testing and counseling is recommended globally as a strategy to enhance uptake of HIV testing and is primarily conducted by nurses and midwives. Research shows that provider-initiated HIV testing and counseling implementation is sub-optimal. The reasons for this are unclear. The review aimed to explore nurses' and midwives' views and experiences of the provision and management of provider-initiated HIV testing and counseling. All cadres of nurses and midwives were considered, including those who undertake routine HIV testing as part of a diverse role and those who are specifically trained as HIV counselors. Types of phenomenon of interest: The review sought to understand the views and experiences of the provision and management of provider-initiated HIV testing and counseling (including perceptions, opinions, beliefs, practices and strategies related to HIV testing and its implementation in practice). The review included only provider-initiated HIV testing and counseling. It excluded all other models of HIV testing. The review included all countries and all healthcare settings. Types of studies: This review considered all forms of qualitative study design and methodology. Qualitative elements of a mixed method study were included if they were presented separately within the publication. A three-step search strategy was utilized. Eight databases were searched for papers published from 1996 to October 2014, followed by hand searching of reference lists. Only studies published in the English language were considered. Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Qualitative research findings were pooled

  10. Implementation of novel biomarkers in the diagnosis, prognosis, and management of acute kidney injury: executive summary from the tenth consensus conference of the Acute Dialysis Quality Initiative (ADQI).

    PubMed

    McCullough, Peter A; Bouchard, Josee; Waikar, Sushrut S; Siew, Edward D; Endre, Zoltan H; Goldstein, Stuart L; Koyner, Jay L; Macedo, Etienne; Doi, Kent; Di Somma, Salvatore; Lewington, Andrew; Thadhani, Ravi; Chakravarthi, Raj; Ice, Can; Okusa, Mark D; Duranteau, Jacques; Doran, Peter; Yang, Li; Jaber, Bertrand L; Meehan, Shane; Kellum, John A; Haase, Michael; Murray, Patrick T; Cruz, Dinna; Maisel, Alan; Bagshaw, Sean M; Chawla, Lakhmir S; Mehta, Ravindra L; Shaw, Andrew D; Ronco, Claudio

    2013-01-01

    Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allowing greater, earlier, and more accurate determination of diagnosis, prognosis, and with powerful implication for management. Biomarkers can be broadly considered as any measurable biologic entity or process that allows differentiation between normal function and injury or disease. The ADQI (Acute Dialysis Quality Initiative) had its Ninth Consensus Conference dedicated to synthesis and formulation of the existing literature on biomarkers for the detection of acute kidney injury in a variety of settings. In the papers that accompany this summary, ADQI workgroups fully develop key concepts from a summary of the literature in the domains of early diagnosis, differential diagnosis, prognosis and management, and concurrent physiologic and imaging measures.

  11. Implementation of Novel Biomarkers in the Diagnosis, Prognosis, and Management of Acute Kidney Injury: Executive Summary from the Tenth Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

    PubMed Central

    McCullough, Peter A.; Bouchard, Josee; Waikar, Sushrut S.; Siew, Edward D.; Endre, Zoltan H.; Goldstein, Stuart L.; Koyner, Jay L.; Macedo, Etienne; Doi, Kent; Di Somma, Salvatore; Lewington, Andrew; Thadhani, Ravi; Chakravarthi, Raj; Ice, Can; Okusa, Mark D.; Duranteau, Jacques; Doran, Peter; Yang, Li; Jaber, Bertrand L.; Meehan, Shane; Kellum, John A.; Haase, Michael; Murray, Patrick T.; Cruz, Dinna; Maisel, Alan; Bagshaw, Sean M.; Chawla, Lakhmir S.; Mehta, Ravindra L.; Shaw, Andrew D.; Ronco, Claudio

    2013-01-01

    Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allowing greater, earlier, and more accurate determination of diagnosis, prognosis, and with powerful implication for management. Biomarkers can be broadly considered as any measurable biologic entity or process that allows differentiation between normal function and injury or disease. The ADQI (Acute Dialysis Quality Initiative) had its Ninth Consensus Conference dedicated to synthesis and formulation of the existing literature on biomarkers for the detection of acute kidney injury in a variety of settings. In the papers that accompany this summary, ADQI workgroups fully develop key concepts from a summary of the literature in the domains of early diagnosis, differential diagnosis, prognosis and management, and concurrent physiologic and imaging measures. PMID:23689652

  12. Minimal intervention dentistry II: part 3. Management of non-cavitated (initial) occlusal caries lesions--non-invasive approaches through remineralisation and therapeutic sealants.

    PubMed

    Holmgren, C; Gaucher, C; Decerle, N; Doméjean, S

    2014-03-01

    Epidemiological data on dental caries show that prevention and treatment needs have evolved significantly over the past two decades. In younger patients the distribution of caries lesions is mainly found on the occlusal surfaces. The treatment approaches utilised by dentists must evolve to integrate preventive and treatment solutions tailored to the care needs, which are straightforward to implement in the dental office and whose effectiveness is underpinned by scientific evidence. This article aims to describe the principles of non-invasive management of non-cavitated (initial) occlusal caries lesions, based on evidence from recent studies published in the international literature.

  13. Defining the Role of the Tibial Tubercle-Trochlear Groove and Tibial Tubercle-Posterior Cruciate Ligament Distances in the Work-up of Patients With Patellofemoral Disorders.

    PubMed

    Anley, Cameron Michael; Morris, Guy Vernon; Saithna, Adnan; James, Steven Laurence; Snow, Martyn

    2015-06-01

    The radiological work-up of patients with patellofemoral disorders continues to be debated. The interchangeability of the tibial tubercle-trochlear groove (TT-TG) distance between computed tomography (CT) and magnetic resonance imaging (MRI) has recently been questioned. In addition, a new measurement-the tibial tubercle-posterior cruciate ligament (TT-PCL) distance-has shown that not all patients with a pathological TT-TG distance (>20 mm) have lateralization of the tibial tubercle. Another factor to consider when looking at the position of the tibial tubercle is the knee joint rotation, defined as the angle between the femoral dorsal condylar line and the tibial dorsal condylar line. To determine, with a larger population, if the TT-TG measurements can be used interchangeably between CT and MRI and to confirm the correlation between the TT-PCL and TT-TG distances in determining tibial tubercle lateralization. Cohort study (diagnosis); Level of evidence, 2. Patients with patellofemoral disorders and MRI and CT scans of the same knee (n = 141) were identified. The TT-PCL, the knee joint rotation, and TT-TG were measured independently by 2 fellowship-trained orthopaedic surgeons. Thirty measurements were repeated on a separate occasion to allow for an assessment of the intrarater reliability. The intraclass correlation coefficient (ICC) was used to assess reliability of the measurements. The mean TT-TG was 4.16 mm less on MRI (P < .05), with the mean TT-TG ± SD being 17.72 ± 5.15 mm on CT (range, 6.97-31.33 mm) and 13.56 ± 6.07 mm on MRI (range, 2-30.04 mm). The ICC for each rater comparing the 2 imaging modalities was only fair (0.54 and 0.48). The mean TT-PCL measurement was 20.32 ± 3.45 mm (range, 10.11-32.01 mm) with excellent interobserver and intraobserver reliability (>0.75). Based on the TT-TG and TT-PCL measurements, 4 groups of patients can be established. When knee joint rotation is compared among groups, an increased TT-TG may result from true

  14. Initial Usability and Feasibility Evaluation of a Personal Health Record-Based Self-Management System for Older Adults.

    PubMed

    Sheehan, Barbara; Lucero, Robert J

    2015-01-01

    Electronic personal health record-based (ePHR-based) self-management systems can improve patient engagement and have an impact on health outcomes. In order to realize the benefits of these systems, there is a need to develop and evaluate heath information technology from the same theoretical underpinnings. Using an innovative usability approach based in human-centered distributed information design (HCDID), we tested an ePHR-based falls-prevention self-management system-Self-Assessment via a Personal Health Record (i.e., SAPHeR)-designed using HCDID principles in a laboratory. And we later evaluated SAPHeR's use by community-dwelling older adults at home. The innovative approach used in this study supported the analysis of four components: tasks, users, representations, and functions. Tasks were easily learned and features such as text-associated images facilitated task completion. Task performance times were slow, however user satisfaction was high. Nearly seven out of every ten features desired by design participants were evaluated in our usability testing of the SAPHeR system. The in vivo evaluation suggests that older adults could improve their confidence in performing indoor and outdoor activities after using the SAPHeR system. We have applied an innovative consumer-usability evaluation. Our approach addresses the limitations of other usability testing methods that do not utilize consistent theoretically based methods for designing and testing technology. We have successfully demonstrated the utility of testing consumer technology use across multiple components (i.e., task, user, representational, functional) to evaluate the usefulness, usability, and satisfaction of an ePHR-based self-management system.

  15. Municipal initiatives for managing dunes in coastal residential areas: a case study of Avalon, New Jersey, USA

    NASA Astrophysics Data System (ADS)

    Nordstrom, Karl F.; Jackson, Nancy L.; Bruno, Michael S.; de Butts, Harry A.

    2002-10-01

    The characteristics of foredunes created in a municipal management program on a developed barrier island are evaluated to identify how landforms used as protection structures can be natural in appearance and function yet compatible with human values. Shoreline management zones include a naturally evolving, undeveloped segment; a noneroding, developed segment; eroding and noneroding segments of an "improved beach" where dunes have been built by artificial nourishment; and a privately built, artificially nourished dune on the shoreline of an inlet. A disastrous storm in 1962 resulted in an aggressive program for building dunes using sand fences, vegetation plantings, purchase of undeveloped lots, and sediment backpassing to maintain beach widths and dune elevations. The present nourished and shaped foredune in the improved beach is higher, wider, and closer to the berm crest than the natural dune. Restricted inputs of aeolian sand keep the surface flat and poorly vegetated. A stable section of this engineered shore has a wider beach, and sand fences have created a higher foredune with greater topographic diversity. The cross shore zonation of vegetation here is more typical of natural dunes, but the environmental gradient is much narrower. The privately built dune is low, narrow, and located where it could not be created naturally. Foreshore and aeolian sediments in the undeveloped segment and the improved beach are similar in mean grain size (0.16-0.21 mm) and sorting (0.31-0.39 φ), but sediment on the surface of the nourished dune is coarser (28.1% gravel) with a more poorly sorted sand fraction (1.30 φ) representing lag elements on the deflation surface. Willingness to enhance beaches and dunes for protection has reduced insurance premiums and allowed the municipality to qualify for funds from the Federal Emergency Management Agency (FEMA) to replace lost sediment, thus placing an economic value on dunes. Success of the management program is attributed to: (i

  16. Whole-body magnetic resonance imaging: an essential tool for diagnosis and work up of non-oncological systemic diseases in children.

    PubMed

    Korchi, A M; Hanquinet, S; Anooshiravani, M; Merlini, L

    2014-06-01

    Whole-body MRI (WBMRI) is a non-irradiating imaging technique, suitable to investigate the extent of multisystemic diseases in pediatric patients. However its real impact on diagnosis and management of non-oncological pediatric diseases remains unclear. We present our experience of pediatric WBMRI in various pathologies. We retrospectively reviewed medical files of all non- oncologic patients who underwent WBMRI from January 2008 to November 2012. The MRI protocol included T1 weighted and 3D SPACE Inversion Recovery (IR) and fat saturated diffusion weighted (DWI) sequence. We reviewed medical records in order to determine if performing WBMRI added useful information for diagnostic purposes and/or changed clinical management. Forty-two children were included in the study (19 F, 23 M) (median age 4.7 years). Twenty-one children underwent general anesthesia. WBMRI was a useful tool to provide correct diagnosis in chronic recurrent multifocal osteomyelitis (CRMO), and to identify the origin of fever or arthralgia of unknown etiology. WBMRI allowed to determine the extent of disease in juvenile idiopathic arthritis (JIA), chronic granulomatous disorder, enchondromatosis, Langerhans cell histiocytosis, and in the assessment of tumor burden in neurofibromatosis type I. For the battered child syndrome, the influence on management was rather minimal. For each of these pathologies we performed a review of recent literature. WBMRI is easy to perform in children and allows the assessment of systemic diseases or discovery of lesions ignored by clinical examination. WBMRI influenced the decisional process and clinical management of various pathologies in our series.

  17. Feasibility of a wait-and-scan period as initial management strategy for head and neck paraganglioma.

    PubMed

    Jansen, Thijs T G; Timmers, Henri J L M; Marres, Henri A M; Kunst, Henricus P M

    2017-10-01

    The main goal of head and neck paraganglioma (PGL) management is reduction of treatment-induced and tumor-induced complications. In the current study, tumor growth rates and tumor-induced complications during a wait-and-scan period are evaluated. This was a retrospective cohort study. Tumor growth was measured in axial plane diameter and tumor volume. Of 59 jugulotympanic tumors, 71 carotid body tumors, and 29 vagal body tumors, 44% were growing (median follow-up of 63.6 months). Median growth rates were 0.41 mm/year (range 0-439 mm), 1.6 mm/year (range 0-23.68 mm), and 1.6 mm/year (range 0-23.68 mm) respectively. Growth was significantly correlated to age at presentation (odds ratio [OR] = 0.974; P < .05). Seventeen tumors induced 20 complications. Six of these tumors were growing, and growth rates were higher than in tumors not inducing complications (P = .016; F = 6.496). These results illustrate the feasibility of a wait-and-scan strategy for head and neck PGL. The management strategy could not prevent tumor-induced complications in 16% of nongrowing tumors. © 2017 Wiley Periodicals, Inc.

  18. Colloids for the Initial Management of Severe Sepsis and Septic Shock in Pediatric Patients: A Systematic Review.

    PubMed

    Medeiros, Daniela Nasu Monteiro; Ferranti, Juliana Ferreira; Delgado, Artur Figueiredo; de Carvalho, Werther Brunow

    2015-11-01

    The goal of this study was to perform a systematic review of the literature assessing the use of colloids for the initial treatment of severe sepsis and septic shock in pediatric patients. The PICO [Patient, Intervention, Comparison, Outcome] method was used for the selection of studies, and the Cochrane Bias Tool was used to analyze the quality of the selected studies. Relevant studies were sought using the following databases: EMBASE (1980 to March 2014), PubMed (1970 to March 2014), Cochrane (1980 to March 2014), Web of Science, and Scopus. Searches used the following key words: isotonic solution, crystalloid, saline solution, colloid, resuscitation, fluid therapy, sepsis and septic shock, starch, and gelatin. The filters children and clinical trial were used when possible. Study selection was performed by 1 examiner. The selected articles were analyzed by 2 examiners who validated the articles according to the Cochrane Bias Tool. Discrepancies were resolved by consensus or by a third examiner. A total of 110 articles were selected based on the key words. Of these, 99 were excluded because they assessed postoperative follow-up, burn cases, cardiac surgery, or nutritional therapy or were review articles, guidelines, or editorials. One study was included after an analysis of previous reviews. A total of 12 articles were selected for analysis because they were reports of clinical trials conducted with prospective cohorts and they analyzed the use of crystalloids and colloids or colloids only in the initial treatment of severe sepsis or septic shock in children and adolescents. The total number of patients was 4375, and they ranged in age from 2 months to 15 years, with most patients between 5 and 15 years. Five studies assessed patients diagnosed with malaria, 5 assessed patients with dengue shock syndrome, 1 studied febrile diseases, and 1 examined the progression of patients with septic shock caused by various causes. The studies analyzed did not find evidence to

  19. Informing the Design and Evaluation of Superuser Care Management Initiatives: Accounting for Regression-to-the-Mean.

    PubMed

    Chakravarty, Sujoy; Cantor, Joel C

    2016-09-01

    Health care spending is concentrated among a small number of high-cost patients, and the popularity of initiatives to improve care and reduce cost among such "superusers" (SUs) is growing. However, SU costs decline naturally over time, even without intervention, a statistical phenomenon known as regression-to-the-mean (RTM). We assess the magnitude of RTM in hospital costs for cohorts of hospital SUs identified on the basis of high inpatient (IP) or emergency department (ED) utilization. We further examine how cost and RTM are associated with patient characteristics including behavioral health (BH) problems, multiple chronic conditions, and indicators of vulnerability. Using longitudinally linked all-payer hospital billing data, we selected patient cohorts with ≥2 IP stays (IP SUs) or ≥6 ED visits (ED SUs) during a 6-month baseline period, and additional subgroups defined by combinations of IP and ED superuse. A total of 289,060 NJ hospital IP and treat-and-release ED patients over 2009-2011. Hospital costs among IP and ED SUs declined 70% and 38%, respectively, over 8 quarters following the baseline period. The decrease occurs more quickly for IP SUs compared with ED SUs. Presence of BH problems was positively associated with costs among patients overall, but the relationship varied by SU cohort. Understanding patterns of RTM among SU populations is important for designing intervention strategies, as there is greater potential for savings among patients with more persistent costs (less RTM). Further, as many SU initiatives lack resources for rigorous evaluation, quantifying the extent of RTM is vital for interpreting program outcomes.

  20. Identify-isolate-inform: a tool for initial detection and management of measles patients in the emergency department.

    PubMed

    Koenig, Kristi L; Alassaf, Wajdan; Burns, Michael J

    2015-03-01

    Measles (rubeola) is a highly contagious airborne disease that was declared eliminated in the U.S. in the year 2000. Only sporadic U.S. cases and minor outbreaks occurred until the larger outbreak beginning in 2014 that has become a public health emergency. The "Identify-Isolate-Inform" tool will assist emergency physicians to be better prepared to detect and manage measles patients presenting to the emergency department. Measles typically presents with a prodrome of high fever, and cough/coryza/conjunctivitis, sometimes accompanied by the pathognomonic Koplik spots. Two to four days later, an erythematous maculopapular rash begins on the face and spreads down the body. Suspect patients must be immediately isolated with airborne precautions while awaiting laboratory confirmation of disease. Emergency physicians must rapidly inform the local public health department and hospital infection control personnel of suspected measles cases.