Science.gov

Sample records for primary management choice

  1. Key policy choices in groundwater quality management

    SciTech Connect

    Batie, S.S.; Diebel, P.L. )

    1990-01-01

    The fundamental policy choice of who has the right to do what to whom is a pivotal issue of governance. Over the last few decades, the answer to that question has become more restrictive to those who own and use natural resources as inputs into production processes. Increasingly, the beneficiaries of new policy initiatives are those who desire higher protection of groundwater quality. With respect to groundwater management, policy design increasingly reflects such diverse interests as agriculturists, industrialists, homeowners, local government officials and state officials. Policy design is becoming complex, in part because of this diversity and in part because scientific uncertainty hampers informed policy design. No umbrella federal legislation exists for managing groundwater resources. EPA's role has been mainly an advisory one on groundwater issues. The difficulties and responsibilities of protecting groundwater thus remain with the states. For the near future, it is the states that will address key policy choices with respect to groundwater quality management issues.

  2. Perspectives on "Choice and Challenge" in Primary Schools

    ERIC Educational Resources Information Center

    Bragg, Sara

    2016-01-01

    This article discusses "Choice and Challenge" as a tool for school improvement and as a "practicable pedagogy" that attempts to embody the principles of "learning without limits," rejecting ability grouping and labelling. As considered here, "Choice and Challenge" emerges specifically from practice at the…

  3. Choice-Based Segmentation as an Enrollment Management Tool

    ERIC Educational Resources Information Center

    Young, Mark R.

    2002-01-01

    This article presents an approach to enrollment management based on target marketing strategies developed from a choice-based segmentation methodology. Students are classified into "switchable" or "non-switchable" segments based on their probability of selecting specific majors. A modified multinomial logit choice model is used to identify…

  4. Factors Influencing Career Choice of Management Students in India

    ERIC Educational Resources Information Center

    Agarwala, Tanuja

    2008-01-01

    Purpose: This paper aims to explore the influence of a range of factors on the career choice of management students in India. The importance of different individuals in the family and at work in making career choices among these students is also to be explored. In addition, the study seeks to address the relationship of the cultural values of…

  5. Management of primary sclerosing cholangitis

    PubMed Central

    Lutz, Holger H; Tischendorf, Jens JW

    2011-01-01

    Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease with major morbidity and mortality. Therapeutic management is difficult, due to lack of conclusive data and individual disease progression. High-dose UDCA was used for years as a pharmacotherapeutic agent to prevent disease progression, based on a positive trend in pilot studies, but has recently been proven to have a negative effect in advanced disease. Immunosuppressants might be useful in patients with overlap syndromes. Dominant bile duct stenoses should be treated endoscopically, and cholangiocellular carcinoma (CCC) still remains a therapeutic challenge in PSC patients. Early diagnosis of CCC must be improved and new strategies such as neoadjuvant radiochemotherapy with subsequent liver transplantation in selected patients are further options to be considered. PMID:21860672

  6. Children as Researchers in Primary Schools: Choice, Voice and Participation

    ERIC Educational Resources Information Center

    Bucknall, Sue

    2012-01-01

    "Children as Researchers in Primary Schools" is an innovative and unique resource for practitioners supporting children to become "real world" researchers in the primary classroom. It will supply you with the skills and ideas you need to implement a "children as researchers" framework in your school that can be adapted for different ages and…

  7. School Choice or Schools' Choice? Managing in an Era of Accountability

    ERIC Educational Resources Information Center

    Jennings, Jennifer L.

    2010-01-01

    Drawing on a year and a half of ethnographic research in three New York City small high schools, this study examines the role of the school in managing school choice and asks what social processes are associated with principals' disparate approaches. Although district policy did not allow principals to select students based on their performance,…

  8. Choosing Schools: Explorations in Post-Primary School Choice in an Urban Irish Working Class Community

    ERIC Educational Resources Information Center

    Cahill, Kevin; Hall, Kathy

    2014-01-01

    This paper examines post-primary school choice processes in the urban Irish working-class community of Portown. Here, there is an awareness of hegemonic neoliberal ideals and how school choice becomes a significantly classed space characterised by market ideologies and structural inequality. This critical ethnography explored the world through…

  9. Primary focal hyperhidrosis: diagnosis and management. .

    PubMed

    Wang, Rena; Solish, Nowell; Murray, Christian A

    2008-12-01

    Primary focal hyperhidrosis is a common and serious medical condition that causes considerable psychosocial morbidity. Diagnostic and effective management strategies can improve patients' quality of living dramatically.

  10. Choice.

    PubMed

    Greenberg, Jay

    2008-09-01

    Understanding how and why analysands make the choices they do is central to both the clinical and the theoretical projects of psychoanalysis. And yet we know very little about the process of choice or about the relationship between choices and motives. A striking parallel is to be found between the ways choice is narrated in ancient Greek texts and the experience of analysts as they observe patients making choices in everyday clinical work. Pursuing this convergence of classical and contemporary sensibilities will illuminate crucial elements of the various meanings of choice, and of the way that these meanings change over the course of psychoanalytic treatment.

  11. Choice.

    PubMed

    Greenberg, Jay

    2008-09-01

    Understanding how and why analysands make the choices they do is central to both the clinical and the theoretical projects of psychoanalysis. And yet we know very little about the process of choice or about the relationship between choices and motives. A striking parallel is to be found between the ways choice is narrated in ancient Greek texts and the experience of analysts as they observe patients making choices in everyday clinical work. Pursuing this convergence of classical and contemporary sensibilities will illuminate crucial elements of the various meanings of choice, and of the way that these meanings change over the course of psychoanalytic treatment. PMID:18802123

  12. Career Choice in Management: Findings from US MBA Students

    ERIC Educational Resources Information Center

    Ng, Eddy S. W.; Burke, Ronald J.; Fiksenbaum, Lisa

    2008-01-01

    Purpose: This research aims to explore the role of values, family, and non-family influences on career choice in management among a sample of US MBA students. Design/methodology/approach: Data were collected using self-reported questionnaires from 109 students in a mid-sized university located on the west coast of the USA. The respondents were in…

  13. Choosing a doctor: an exploratory study of factors influencing patients' choice of a primary care doctor.

    PubMed

    Bornstein, B H; Marcus, D; Cassidy, W

    2000-08-01

    We assessed the relative importance healthcare consumers attach to various factors in choosing a primary care doctor (PCD) in a cross-sectional, in-person survey. Three survey locations were used: doctors' offices, a public shopping area, and meetings of a women's organization. A total of 636 community residents, varying across major demographic categories, participated. Participants completed a 23-item survey, designed to assess which factors consumers perceive as most relevant in choosing a PCD. Participants perceived professionally relevant factors (e.g. whether the doctor is board certified, office appearance) and management practices (e.g. time to get an appointment, evening and weekend hours) as more important than the doctor's personal characteristics (race, age, gender, etc.). Participants' own characteristics bore little relationship to the perceived importance of doctor characteristics. Factors patients perceive as most important to their choice of a PCD are also those that have the greatest effect on the quality of healthcare they will receive. However, they do not always have access to this information. A better understanding of the factors that influence people's choice of a PCD can contribute to efforts to provide them with the resources to make well-informed decisions in selecting among healthcare options. PMID:11083036

  14. Valuing Choice as an Alternative to Fixed-Ability Thinking and Teaching in Primary Mathematics

    ERIC Educational Resources Information Center

    Milik, Amy; Boylan, Mark

    2013-01-01

    This article offers a personal account of a primary mathematics teacher's current practice and how it developed through participation in a professional development programme. This alternative to fixed-ability teaching is based on creating opportunities for learners to exercise choice and on an understanding of mathematics as connected. Key…

  15. French national wound management survey: choice criteria of dressings.

    PubMed

    Meaume, Sylvie; Barrois, Brigitte; Faucher, Nathalie

    Across Europe, wound care management is organized differently, and in some countries such as the UK or Denmark, wound healing centres have been implemented. In France, a large number of health professionals are not sufficiently educated in wound care management during their vocational training. The rapid evolution of dressings has changed wound management practices and has given rise to new professional recommendations. This national survey was carried out in France in 2009, including 465 health professionals, to determine the criteria they use to choose a dressing and their habits of care with acute or chronic wounds. Around 73% of respondents were nurses and, on average, participants took care of 43 wounds per month. It was also found that 89% of the health professionals who took part prefer the sequential treatment of the wound based on its appearance. Regardless of whether the wound is acute or chronic, the priorities for wound care and the choice of dressing are the management of the exudate and the prevention or treatment of infection. These results put into evidence the adequacy of the recommendations by these practitioners and the good correlation between the choice of dressing and the local therapeutic goal. To reach the same level of expertise, the professional training for health professionals who are less frequently involved in wound care is necessary.

  16. Managing coastal area resources by stated choice experiments

    NASA Astrophysics Data System (ADS)

    Liu, Xin; Wirtz, Kai W.

    2010-02-01

    In many coastal regions, oil spills can be considered as one of the most important and certainly the most noticeable forms of marine pollution. Efficient contingency management responding to oil spills on waters, which aims at minimizing pollution effects on coastal resources, turns out to be critically important. Such a decision making highly depends on the importance attributed to different coastal economic and ecological resources. Economic uses can, in principal, be addressed by standard measures such as value added. However, there is a missing of market in the real world for natural goods. Coastal resources such as waters and beach cannot be directly measured in money terms, which increases the risk of being neglected in a decision making process. This paper evaluates these natural goods of coastal environment in a hypothetical market by employing stated choice experiments. Oil spill management practice in German North Sea is used as an example. Results from a pilot survey show that during a combat process, beach and eider ducks are of key concerns for households. An environmental friendly combat option has to be a minor cost for households. Moreover, households with less children, higher monthly income and a membership of environmental organization are more likely to state that they are willing to pay for combat option to prevent coastal resources from an oil pollution. Despite that choice experiments require knowledge of designing questionnaire and statistical skills to deal with discrete choices and conducting a survey is time consumed, the results have important implications for oil spill contingency management. Overall, such a stated preference method can offer useful information for decision makers to consider coastal resources into a decision making process and can further contribute to finding a cost-effective oil preventive measure, also has a wide application potential in the field of Integrated Coastal Zone Management (ICZM).

  17. Medical students' attitudes toward underserved populations: changing associations with choice of primary care versus non-primary care residency.

    PubMed

    Wayne, Sharon; Timm, Craig; Serna, Lisa; Solan, Brian; Kalishman, Summers

    2010-05-01

    The number of medical students entering primary care residencies continues to decrease. The association between student attitudes toward underserved populations and residency choice has received little attention even though primary care physicians see a larger proportion of underserved patients than most other specialists. We evaluated attitudes toward underserved populations in 826 medical students using a standardized survey, and used logistic regression to assess the effect of attitudes, along with other variables, on selection of a primary care residency. We compared results between two groups defined by year of entry to medical school (1993-99 and 2000-05) to determine whether associations differed by time period. Students' attitudes regarding professional responsibility toward underserved populations remained high over the study period; however, there was a statistically. significant association between positive attitudes and primary care residency in the early cohort only. This association was not found in the more recent group.

  18. Management of primary blast injury.

    PubMed

    Argyros, G J

    1997-07-25

    Blast waves are produced following the detonation of munitions, the firing of large caliber guns, or from any type of explosion. These blast waves can be powerful enough to injure the individuals exposed to them. This type of injury is called primary blast injury (PBI) and the organs most vulnerable to PBI are the gas-filled organs, namely the ear, the lungs and the gastrointestinal tract. The approach to the casualty with PBI is the same as it would be for any trauma victim, i.e. the initiation of life support measures. Attention should be directed to the common life-threatening manifestation of thoracic and abdominal PBI. Pulmonary manifestations would include hemorrhage, barotrauma and arterial air embolism, while abdominal manifestations would include hemorrhage and hollow organ rupture. Therapy is directed at the specific manifestations as well as avoiding additional iatrogenic injury. PMID:9217319

  19. Expanding Medicaid managed care: the right choice for Texas?

    PubMed

    Reddy, Swapna; Finley, Marisa; Posey, Dan; Rohack, James J

    2012-10-01

    We set out to determine whether expanding Medicaid managed care in Texas is the solution to the challenges faced by the state of meeting the healthcare needs of a rapidly growing Medicaid population while addressing its own fiscal limitations. We reviewed the Texas Medicaid program, the potential effects of federal healthcare reform, and the state political climate through the perspectives (advantages and disadvantages) of the primary stakeholders: patients, practitioners, hospitals, and insurers. Research was performed through online, federal and state regulatory, and legislative review. In addition, we reviewed government and peer-reviewed reports and articles pertaining to issues related to Medicaid populations, healthcare practitioners, and hospitals that serve them. Each primary stakeholder had potential advantages and disadvantages associated with the expansion of Medicaid managed care. We conclude that expanding Medicaid managed care, if done in a manner responsive to the needs of recipients, can meet enrollees' healthcare needs while controlling the state's costs.

  20. Expanding Medicaid managed care: the right choice for Texas?

    PubMed

    Reddy, Swapna; Finley, Marisa; Posey, Dan; Rohack, James J

    2012-10-01

    We set out to determine whether expanding Medicaid managed care in Texas is the solution to the challenges faced by the state of meeting the healthcare needs of a rapidly growing Medicaid population while addressing its own fiscal limitations. We reviewed the Texas Medicaid program, the potential effects of federal healthcare reform, and the state political climate through the perspectives (advantages and disadvantages) of the primary stakeholders: patients, practitioners, hospitals, and insurers. Research was performed through online, federal and state regulatory, and legislative review. In addition, we reviewed government and peer-reviewed reports and articles pertaining to issues related to Medicaid populations, healthcare practitioners, and hospitals that serve them. Each primary stakeholder had potential advantages and disadvantages associated with the expansion of Medicaid managed care. We conclude that expanding Medicaid managed care, if done in a manner responsive to the needs of recipients, can meet enrollees' healthcare needs while controlling the state's costs. PMID:23038487

  1. 25 CFR 502.19 - Primary management official.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 2 2011-04-01 2011-04-01 false Primary management official. 502.19 Section 502.19... THIS CHAPTER § 502.19 Primary management official. Primary management official means: (a) The person... designated by the tribe as a primary management official....

  2. 25 CFR 502.19 - Primary management official.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Primary management official. 502.19 Section 502.19... THIS CHAPTER § 502.19 Primary management official. Primary management official means: (a) The person... designated by the tribe as a primary management official....

  3. Choice of biodiversity index drives optimal fire management decisions.

    PubMed

    Giljohann, K M; McCarthy, M A; Kelly, L T; Regan, T J

    2015-01-01

    Preservation of biodiversity is a central goal of conservation management, yet the conditions that promote persistence may differ for the species in the community. For systems subject to stochastic disturbances such as fire, understanding which management practices promote persistence for all species in a community is complex. Before deciding on the best course of action, an objective must be specified. Yet an overarching goal of species persistence can be specified into a measureable objective many different ways. We investigated four alternative management objectives for maximizing species persistence that use common biodiversity indices: (1) attaining the minimally acceptable mix of successional vegetation states to support species' relative abundances, (2) maximizing the arithmetic mean abundance of species, (3) maximizing the geometric mean abundance of species, and (4) minimizing the average extinction risk of species. We used stochastic dynamic programming to model successional changes in vegetation in the presence of both planned and unplanned fires, and utilize an extensive data set on the occurrence of birds, reptiles, and small mammals in different successional states in semiarid Australia. We investigated the influence the choice of objective function and taxonomic focus has on the optimal fire management recommendations. We also evaluated a recent hazard reduction policy to annually burn a fixed amount of the landscape and compare results to the optimal solution. The optimal management strategy to maximize species persistence over a 100-year period is predominantly to minimize wildfires. This is because the majority of species are more likely to occur in intermediate, and late successional vegetation. However the optimal solution showed sensitivity to the objective and the species included in the analysis. These results highlight the need for careful consideration when specifying an objective to represent overarching conservation goals. Using the

  4. CHOICES: promoting early access to end-of-life care through home-based transition management.

    PubMed

    Stuart, Brad; D'Onofrio, Carol N; Boatman, Susanne; Feigelman, Glen

    2003-08-01

    CHOICES is a comprehensive home-based care coordination program designed to bridge the gap between home health and hospice for Medicare + Choice enrollees with advanced chronic illness in San Francisco's East Bay region. Key elements of the program include physician education, enrollment of patients with high disease burden who may not be terminally ill, co-management of care with the primary physician, and an advanced practice clinical team that provides comprehensive in-home assessments, a flexible mix of life-prolonging and palliative care that evolves with disease progression, focused education and advance planning, and caregiver support. During a 42-month demonstration, 208 patients were enrolled in the program. Eighty percent had a non-cancer diagnosis; 40% were people of color. After an 8-month follow-up, 44% of the study cohort had died in the program or after transfer to hospice, 51% had been discharged, and 5% remained active. Median length of stay for decedents was 260 days. Preliminary evidence supports the program's feasibility and acceptability to patients, families, physicians, and agency partners. However, the uncertain future of Medicare + Choice and of managed care may jeopardize the program's sustainability. Policymakers and taxpayers will need to determine how to care for the growing number of chronically ill elderly who wish to remain at home as illness advances. The care needs of these patients and their families may overwhelm a health system organized around hospital treatment of acute illness.

  5. [Management of psychological trauma in primary care].

    PubMed

    Figueroa, Rodrigo A; Cortés, Paula F; Accatino, Luigi; Sorensen, Richard

    2016-05-01

    Exposure to traumatic events is frequent in the general population and psychiatric sequelae such as post-traumatic stress disorders are common. The symptoms of psychiatric sequelae after trauma are vague, with multiple psychological and physical symptoms, which can confuse the health care professional. This paper seeks to facilitate the work in primary care, providing practical information about the diagnosis, initial management and referral of patients who have suffered traumatic experiences. Some early interventions and treatments are suggested. PMID:27552016

  6. Risk preferences in strategic wildfire decision making: a choice experiment with U.S. wildfire managers.

    PubMed

    Wibbenmeyer, Matthew J; Hand, Michael S; Calkin, David E; Venn, Tyron J; Thompson, Matthew P

    2013-06-01

    Federal policy has embraced risa management as an appropriate paradigm for wildfire management. Economic theory suggests that over repeated wildfire events, potential economic costs and risas of ecological damage are optimally balanced when management decisions are free from biases, risa aversion, and risa seeking. Of primary concern in this article is how managers respond to wildfire risa, including the potential effect of wildfires (on ecological values, structures, and safety) and the likelihood of different fire outcomes. We use responses to a choice experiment questionnaire of U.S. federal wildfire managers to measure attitudes toward several components of wildfire risa and to test whether observed risa attitudes are consistent with the efficient allocation of wildfire suppression resources. Our results indicate that fire managers' decisions are consistent with nonexpected utility theories of decisions under risa. Managers may overallocate firefighting resources when the likelihood or potential magnitude of damage from fires is low, and sensitivity to changes in the probability of fire outcomes depends on whether probabilities are close to one or zero and the magnitude of the potential harm.

  7. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... care case management services. (a) Primary care case management services means case management related services that— (1) Include location, coordination, and monitoring of primary health care services; and (2... 42 Public Health 4 2010-10-01 2010-10-01 false Primary care case management services....

  8. Knowledge of primary health care and career choice at primary health care settings among final year medical students - challenges to human resources for health in Vietnam.

    PubMed

    Giang, Kim Bao; Minh, Hoang Van; Hien, Nguyen Van; Ngoc, Nguyen Minh; Hinh, Nguyen Duc

    2015-01-01

    There is a shortage of medical doctors in primary health care (PHC) settings in Vietnam. Evidence about the knowledge medical students have about PHC and their career decision-making is important for making policy in human resources for health. The objective of this study was to analyse knowledge and attitudes about PHC among medical students in their final year and their choice to work in PHC after graduation. A cross-sectional study was conducted among 400 final year general medical students from Hanoi Medical University. Self-administered interviews were conducted. Key variables were knowledge, awareness of the importance of PHC and PHC career choices. Descriptive and analytic statistics were performed. Students had essential knowledge of the concept and elements of PHC and were well aware of its importance. However, only one-third to one half of them valued PHC with regard to their professional development or management opportunities. Less than 1% of students would work at commune or district health facilities after graduation. This study evidences challenges related to increasing the number of medical doctors working in PHC settings. Immediate and effective interventions are needed to make PHC settings more attractive and to encourage medical graduates to start and continue a career in PHC.

  9. Preferred Primary Healthcare Provider Choice Among Insured Persons in Ashanti Region, Ghana

    PubMed Central

    Boachie, Micheal Kofi

    2016-01-01

    Background: In early 2012, National Health Insurance Scheme (NHIS) members in Ashanti Region were allowed to choose their own primary healthcare providers. This paper investigates the factors that enrolees in the Ashanti Region considered in choosing preferred primary healthcare providers (PPPs) and direction of association of such factors with the choice of PPP. Methods: Using a cross-sectional study design, the study sampled 600 NHIS enrolees in Kumasi Metro area and Kwabre East district. The sampling methods were a combination of simple random and systematic sampling techniques at different stages. Descriptive statistics were used to analyse demographic information and the criteria for selecting PPP. Multinomial logistic regression technique was used to ascertain the direction of association of the factors and the choice of PPP using mission PPPs as the base outcome. Results: Out of the 600 questionnaires administered, 496 were retained for further analysis. The results show that availability of essential drugs (53.63%) and doctors (39.92%), distance or proximity (49.60%), provider reputation (39.52%), waiting time (39.92), additional charges (37.10%), and recommendations (48.79%) were the main criteria adopted by enrolees in selecting PPPs. In the regression, income (-0.0027), availability of doctors (-1.82), additional charges (-2.14) and reputation (-2.09) were statistically significant at 1% in influencing the choice of government PPPs. On the part of private PPPs, availability of drugs (2.59), waiting time (1.45), residence (-2.62), gender (-2.89), and reputation (-2.69) were statistically significant at 1% level. Presence of additional charges (-1.29) was statistically significant at 5% level. Conclusion: Enrolees select their PPPs based on such factors as availability of doctors and essential drugs, reputation, waiting time, income, and their residence. Based on these findings, there is the need for healthcare providers to improve on their quality levels

  10. Design and analysis of simple choice surveys for natural resource management

    USGS Publications Warehouse

    Fieberg, John; Cornicelli, Louis; Fulton, David C.; Grund, Marrett D.

    2010-01-01

    We used a simple yet powerful method for judging public support for management actions from randomized surveys. We asked respondents to rank choices (representing management regulations under consideration) according to their preference, and we then used discrete choice models to estimate probability of choosing among options (conditional on the set of options presented to respondents). Because choices may share similar unmodeled characteristics, the multinomial logit model, commonly applied to discrete choice data, may not be appropriate. We introduced the nested logit model, which offers a simple approach for incorporating correlation among choices. This forced choice survey approach provides a useful method of gathering public input; it is relatively easy to apply in practice, and the data are likely to be more informative than asking constituents to rate attractiveness of each option separately.

  11. Management of hypertension in primary aldosteronism.

    PubMed

    Aronova, Anna; Iii, Thomas J Fahey; Zarnegar, Rasa

    2014-05-26

    Hypertension causes significant morbidity and mortality worldwide, owing to its deleterious effects on the cardiovascular and renal systems. Primary hyperaldosteronism (PA) is the most common cause of reversible hypertension, affecting 5%-18% of adults with hypertension. PA is estimated to result from bilateral adrenal hyperplasia in two-thirds of patients, and from unilateral aldosterone-secreting adenoma in approximately one-third. Suspected cases are initially screened by measurement of the plasma aldosterone-renin-ratio, and may be confirmed by additional noninvasive tests. Localization of aldostosterone hypersecretion is then determined by computed tomography imaging, and in selective cases with adrenal vein sampling. Solitary adenomas are managed by laparoscopic or robotic resection, while bilateral hyperplasia is treated with mineralocorticoid antagonists. Biochemical cure following adrenalectomy occurs in 99% of patients, and hemodynamic improvement is seen in over 90%, prompting a reduction in quantity of anti-hypertensive medications in most patients. End-organ damage secondary to hypertension and excess aldosterone is significantly improved by both surgical and medical treatment, as manifested by decreased left ventricular hypertrophy, arterial stiffness, and proteinuria, highlighting the importance of proper diagnosis and treatment of primary hyperaldosteronism. Although numerous independent predictors of resolution of hypertension after adrenalectomy for unilateral adenomas have been described, the Aldosteronoma Resolution Score is a validated multifactorial model convenient for use in daily clinical practice. PMID:24944753

  12. Management of hypertension in primary aldosteronism

    PubMed Central

    Aronova, Anna; III, Thomas J Fahey; Zarnegar, Rasa

    2014-01-01

    Hypertension causes significant morbidity and mortality worldwide, owing to its deleterious effects on the cardiovascular and renal systems. Primary hyperaldosteronism (PA) is the most common cause of reversible hypertension, affecting 5%-18% of adults with hypertension. PA is estimated to result from bilateral adrenal hyperplasia in two-thirds of patients, and from unilateral aldosterone-secreting adenoma in approximately one-third. Suspected cases are initially screened by measurement of the plasma aldosterone-renin-ratio, and may be confirmed by additional noninvasive tests. Localization of aldostosterone hypersecretion is then determined by computed tomography imaging, and in selective cases with adrenal vein sampling. Solitary adenomas are managed by laparoscopic or robotic resection, while bilateral hyperplasia is treated with mineralocorticoid antagonists. Biochemical cure following adrenalectomy occurs in 99% of patients, and hemodynamic improvement is seen in over 90%, prompting a reduction in quantity of anti-hypertensive medications in most patients. End-organ damage secondary to hypertension and excess aldosterone is significantly improved by both surgical and medical treatment, as manifested by decreased left ventricular hypertrophy, arterial stiffness, and proteinuria, highlighting the importance of proper diagnosis and treatment of primary hyperaldosteronism. Although numerous independent predictors of resolution of hypertension after adrenalectomy for unilateral adenomas have been described, the Aldosteronoma Resolution Score is a validated multifactorial model convenient for use in daily clinical practice. PMID:24944753

  13. Free Choice of Learning Management Systems: Do Student Habits Override Inherent System Quality?

    ERIC Educational Resources Information Center

    Porter, Gavin W.

    2013-01-01

    Purpose: Although multiple studies examine institutional transitions of learning management systems (LMS) or compare their merits, studies examining students' free choice of access on parallel LMSs for the same course are absent from the literature. In order to investigate usage in a free-choice situation, identical content was posted at the…

  14. Parent Management of School Choice in a Large Urban District

    ERIC Educational Resources Information Center

    Neild, Ruth Curran

    2005-01-01

    With No Child Left Behind legislation permitting students to switch from so-called failing schools, key questions are whether parents will act to select another school and which schools they will choose. Long-standing school choice systems provide evidence about low-income parents' strategies to gather information and negotiate the application…

  15. Women in construction management: Creating a theory of career choice and development

    NASA Astrophysics Data System (ADS)

    Moore, Jennifer Dawn

    2006-12-01

    The purpose of this study was to create a theory of women's career choice and development in the context of the construction industry. Focused on female constructors, or those engaged in the management of construction projects or companies, this study investigated the relevant factors, processes, and experiences of women who choose to enter the construction industry through construction management degree programs. The goal was to communicate as a theoretically and practically grounded theory of career choice and development an understanding of who female constructors are and those factors which led them to the construction industry and those influencing their career development. As a grounded theory research design, qualitative research methods were employed as the primary means of collecting and analyzing data. Purposive and snowball sampling were used to garner a sample of 24 women who had graduated within a ten year period and were actively employed as constructors. Participants' views and experiences, captured through small focus group interviews, were analyzed with quantitative data of demographics, education, construction experience, self-efficacy, personality, and career satisfaction and commitment gathered from a written questionnaire, to create a profile of female constructors used in this theory. The profiles completed from these data are complex, providing for an extensive understanding of their career choice and development process. The strongest common characteristic in the career development of these women was a mentor. This influence in cannot be overlooked, especially in light of the rather constant sense of isolation many of these women expressed as a significant minority in every facet of their careers. Recommendations for academia and industry are in many ways related to these findings. Recommendations for recruitment center on educating youth and those able to influence the career choice making process of youth about the career paths available

  16. Condom Tamponade in the Management of Primary Postpartum Haemorrhage: A Report of three cases in Ghana.

    PubMed

    Maya, Ernest T; Buntugu, Kennedy A; Aki, Lovelace; Srofenyoh, Emmanuel K

    2015-09-01

    Postpartum haemorrhage is one of the major causes of maternal mortality worldwide. The leading cause of primary postpartum haemorrhage is uterine atony and active management of the third stage of labour with oxytocin is recommended for preventing primary postpartum haemorrhage. Parenteral oxytocin is also the drug of choice for medical management of postpartum haemorrhage secondary to uterine atony. Condom uterine balloon tamponade is .a low cost technique that can be used as a second-line option for treatment. We report retrospectively three cases of primary PPH secondary to uterine atony which were managed successfully with condom tamponade. Condom tamponade is effective in managing post partum haemorrhage secondary to uterine atony and we advocate for the training of all skilled attendants on how to insert the condom tamponade.

  17. Primary care paradigm for management of sarcoidosis, Part 2.

    PubMed Central

    Young, R. C.; Rachal, R. E.; Nelson-Knuckles, B.; Arthur, C. N.; Nevels, H. V.

    1997-01-01

    Sarcoidosis is a systemic granulomatous disease of undetermined etiology in which the immune system is overstimulated. Management of the patient with sarcoidosis entails continuity of patient care far beyond disease, even into remission. Care is comprehensive, including all involved organ systems, coordination of specialty consultations and services, and includes diagnostic tests. Therapeutic decisions are the responsibility of the primary care practitioner. Prognosis of sarcoidosis is not uniformly good. Patients can die. Subacute sarcoidosis patients usually do not require pharmacologic therapy. Chronic sarcoidosis may require long-term treatment for years to indefinitely. Corticosteroids are still the drugs of choice and other therapy is now available. Health organizations and private nonprofit support groups are available for patient education and assistance. Close support must still come from the family unit. Sarcoidosis may occur in family members in different cohorts at all ages in life and in any racial or ethnic group. The second in a two-part series on management of the patient with sarcoidosis, this article describes coordination of care and considers community, prevention, and family aspects of the disease. Images Figure 1 Figure 2 Figure 3 PMID:9145629

  18. Management of Primary Angle-Closure Glaucoma.

    PubMed

    Lai, Jimmy; Choy, Bonnie N K; Shum, Jennifer W H

    2016-01-01

    Primary angle-closure glaucoma (PACG) is a progressive optic nerve degeneration and is defined as a glaucomatous optic neuropathy with associated characteristic enlargement of optic disc cupping and visual field loss that is secondary to ocular hypertension caused by closure of the drainage angle. Angle closure is caused by appositional approximation or adhesion between the iris and the trabecular meshwork. The main treatment strategy for PACG lies in the reduction of intraocular pressure, reopening of the closed angle, and possible prevention of further angle closure. There is no universally agreed best surgical treatment for PACG. Trabeculectomy, goniosynechialysis (GSL), glaucoma implant, and cyclodestructive procedures are effective surgical options. Each of them plays an important role in the management of PACG with its own pros and cons. Accumulating evidence is available to show the effectiveness of visually significant and visually nonsignificant cataract extraction in the treatment of PACG. Trabeculectomy and GSL are often combined with cataract extraction, which may offer additional pressure control benefits to patients with PACG. This review article will discuss laser peripheral iridotomy, argon laser peripheral iridoplasty, and surgeries such as GSL, phacoemulsification, and phaco plus glaucoma surgeries that lower intraocular pressure and also alter the anterior segment and/or drainage angle anatomy. Currently, glaucoma implants and cyclodestruction are mainly reserved for PACG patients who have failed previous filtering operations. Their role as initial surgical treatment for PACG will not be discussed. PMID:26886121

  19. Rumour Has It: The Impact of Maternal Talk on Primary School Choice for Children Diagnosed with Autism

    ERIC Educational Resources Information Center

    Lilley, Rozanna

    2015-01-01

    This article explores the pivotal role of rumour in shaping primary school choice decisions for parents of children diagnosed with autism. Drawing on semi-structured interviews with 22 mothers conducted in Sydney, Australia, this study points to the varied functions of grapevine knowledge about schools gleaned in diverse contexts, including early…

  20. Better Choices: Evaluating the Effectiveness of Behavior Management Programs

    ERIC Educational Resources Information Center

    Acuna, Miguel T.

    2011-01-01

    Managing student behavior is often looked upon as a sidebar in teaching. The lack of formal classroom management training in teacher education programs reveals the low importance placed on this skill. As a result, teachers are often very well prepared to instruct, but in terms of effectively understanding the behavior of students--particularly…

  1. Caries Management Strategies for Primary Molars

    PubMed Central

    Santamaria, R.M.; Innes, N.P.T.; Machiulskiene, V.; Evans, D.J.P.; Splieth, C.H.

    2014-01-01

    Minimal invasive approaches to managing caries, such as partial caries removal techniques, are showing increasing evidence of improved outcomes over the conventional complete caries removal. There is also increasing interest in techniques where no caries is removed. We present the 1-yr results of clinical efficacy for 3 caries management options for occlusoproximal cavitated lesions in primary molars: conventional restorations (CR; complete caries removal and compomer restoration), Hall technique (HT; no caries removal, sealing in with stainless steel crowns), and nonrestorative caries treatment (NRCT; no caries removal, opening up the cavity, teaching brushing and fluoride application). In sum, 169 children (3-8 yr old; mean, 5.56 ± 1.45 yr) were enrolled in this secondary care–based, 3-arm, parallel-group, randomized clinical trial. Treatments were carried out by specialist pediatric dentists or postgraduate trainees. One lesion per child received CR, HT, or NRCT. Outcome measures were clinical failure rates, grouped as minor failure (restoration loss/need for replacement, reversible pulpitis, caries progression, etc.) and major failure (irreversible pulpitis, abscess, etc.). There were 148 children (87.6%) with a minimum follow-up of 11 mo (mean, 12.23 ± 0.98 mo). Twenty teeth were recorded as having at least 1 minor failure: NRCT, n = 8 (5%); CR, n = 11 (7%); HT, n = 1 (1%) (p = .002, 95% CI = 0.001 to 0.003). Only the comparison between NRCT and CR showed no significant difference (p = .79, 95% CI = 0.78 to 0.80). Nine (6%) experienced at least 1 major failure: NRCT, n = 4 (2%); CR, n = 5 (3%); HT, n = 0 (0%) (p = .002, 95% CI = 0.001 to 0.003). Individual comparison of NRCT and CR showed no statistically significant difference in major failures (p = .75, 95% CI = 0.73 to 0.76). Success and failure rates were not significantly affected by pediatric dentists’ level of experience (p = .13, 95% CI = 0.12 to 0.14). The HT was significantly more successful

  2. Making Choices: Self-Directed Teams or Total Quality Management?

    ERIC Educational Resources Information Center

    Holpp, Lawrence

    1992-01-01

    Describes differences between total quality management and self-directed teams in terms of job design, decision making, flexibility, supervision, labor relations, quality, customers, and training. Offers suggestions for which method to choose when. (SK)

  3. School Management Information Systems in Primary Schools

    ERIC Educational Resources Information Center

    Demir, Kamile

    2006-01-01

    Developments in information technologies have been impacting upon educational organizations. Principals have been using management information systems to improve the efficiency of administrative services. The aim of this research is to explore principals' perceptions about management information systems and how school management information…

  4. Diagnosis and management of primary open-angle glaucoma.

    PubMed

    Alexander, L J

    1991-01-01

    Primary open-angle glaucoma offers a significant diagnostic and management challenge for primary care providers. Uncertainty clouds the definition of the disease, its prevalence, the sensitivity and accuracy of the clinical tests used for its diagnosis, the efficacy of antiglaucoma medications, the compliance of patients with these drug regimens, the appropriate use of follow-up examinations, and the use of surgical techniques in lieu of medical management. This discussion addresses these many vexing issues for the purpose of assisting primary care providers to better diagnose and manage glaucoma patients.

  5. The health plan choices of retirees under managed competition.

    PubMed Central

    Buchmueller, T C

    2000-01-01

    OBJECTIVE: To investigate the effect of price on the health insurance decisions of Medicare-eligible retirees in a managed competition setting. DATA SOURCE: The study is based on four years of administrative data from the University of California (UC) Retiree Health Benefits Program, which closely resembles the managed competition model upon which several leading Medicare reform proposals are based. STUDY DESIGN: A change in UC's premium contribution policy between 1993 and 1994 created a unique natural experiment for investigating the effect of price on retirees' health insurance decisions. This study consists of two related analyses. First, I estimate the effect of changes in out-of-pocket premiums between 1993 and 1994 on the decision to switch plans during open enrollment. Second, using data from 1993 to 1996, I examine the extent to which rising premiums for fee-for-service Medigap coverage increased HMO enrollment among Medicare-eligible UC retirees. PRINCIPLE FINDINGS: Price is a significant factor affecting the health plan decisions of Medicare-eligible UC retirees. However, these retirees are substantially less price sensitive than active UC employees and the non-elderly in other similar programs. This result is likely attributable to higher nonpecuniary switching costs facing older individuals. CONCLUSIONS: Although it is not clear exactly how price sensitive enrollees must be in order to generate price competition among health plans, the behavioral differences between retirees and active employees suggest that caution should be taken in extrapolating from research on the non-elderly to the Medicare program. PMID:11130806

  6. Crisis Management in a Primary School

    ERIC Educational Resources Information Center

    Barclay, Colette

    2004-01-01

    Dunblane Primary School, Scotland, and Columbine High School, USA. Two headline tragedies that have led to trauma for their pupils and staff. Trauma that could be devastating because of the psychological impact and the practical requirements a crisis brings. Children's social and personal development can be negatively affected, their academic…

  7. Surgical management of primary and recurrent melanoma.

    PubMed

    Farma, Jeffrey M; Kulkarni, Nandini; Hsu, Cary

    2015-04-01

    Melanoma accounts for less than 2% of skin cancer cases but causes most skin cancer-related deaths. Surgery continues to be the cornerstone of treatment of melanoma and surgical principles are guided by data derived from clinical research. This article examines the evolution of surgical techniques for the diagnosis and treatment of primary and locally recurrent melanoma.

  8. How to manage burns in primary care.

    PubMed Central

    Waitzman, A. A.; Neligan, P. C.

    1993-01-01

    Burns are common injuries; more than 200,000 occur in Canada annually. Nearly all burn injuries can be managed on on outpatient basis. Appropriate treatment depends on burn depth, extent, and location. Special types of burns, such as chemical, tar, and electrical injuries, need specific management strategies. Prevention through education is important to reduce the incidence of burns. Images Figure 2 Figure 3 PMID:8268745

  9. Primary cicatricial alopecia: clinical features and management.

    PubMed

    Ross, Elizabeth K

    2007-04-01

    The primary cicatricial alopecias are an uncommon, complex group of disorders that result in permanent destruction of the hair follicle, usually involving scalp hair alone. Prompt diagnosis and treatment are needed to help thwart continued hair loss and the distress that often accompanies this hair loss. Nurses can facilitate the diagnostic and treatment process and, through educational and emotionally supportive measures, have a meaningful, positive impact on the patient's well being.

  10. Management of psoriasis and its comorbidities in primary care.

    PubMed

    Aldeen, Taha; Basra, Mohammad

    Psoriasis is a common chronic disfiguring skin disease. Its management depends on the extent of disease, sites affected, comorbidities, and patient's background or lifestyle. In the UK, psoriasis treatment starts in the primary care with range of topical applications, including steroids, vitamin D analogues and coal tar. However, psoriasis is associated with physical, psychological and metabolic comorbidities which could not be improved by topical therapy. The aim of this review is to address the challenge in managing these comorbidities within primary care.

  11. Primary Inadequate Management of Dental Trauma.

    PubMed

    Agrafioti, Anastasia; Tsatsoulis, Ioannis N; Papanakou-Tzanetaki, Styliani I; Kontakiotis, Evangelos G

    2016-07-01

    Tooth fractures are common complications due to trauma in the oral cavity. Tooth fragments and foreign bodies may be embedded in soft tissues as a result of dentofacial trauma and go unnoticed in emergency situations. The inadequate management of such cases may lead to complications, such as foreign-body reaction and scarring. This report describes two cases with dental fragments embedded in the lower lip, which went unnoticed until the patients presented later for completely different treatments and emphasizes the importance of clinical and radiographic examination of soft tissues, even in cases that present late for dental trauma management. PMID:27630967

  12. Primary Inadequate Management of Dental Trauma

    PubMed Central

    Agrafioti, Anastasia; Tsatsoulis, Ioannis N.; Papanakou-Tzanetaki, Styliani I.

    2016-01-01

    Tooth fractures are common complications due to trauma in the oral cavity. Tooth fragments and foreign bodies may be embedded in soft tissues as a result of dentofacial trauma and go unnoticed in emergency situations. The inadequate management of such cases may lead to complications, such as foreign-body reaction and scarring. This report describes two cases with dental fragments embedded in the lower lip, which went unnoticed until the patients presented later for completely different treatments and emphasizes the importance of clinical and radiographic examination of soft tissues, even in cases that present late for dental trauma management. PMID:27630967

  13. Management of a Compound Odontoma in the Primary Dentition.

    PubMed

    Altay, Mehmet Ali; Ozgur, Beste; Cehreli, Zafer C

    2016-01-01

    Odontomas are the most common benign odontogenic tumors of the oral cavity; however, their occurrence in the primary dentition is an extremely rare condition. When associated with primary teeth, odontomas may lead to disturbances in tooth eruption, which often requires a multidisciplinary treatment approach. The purpose of this paper is to review the literature on odontomas of the primary dentition and discuss the management of a compound odontoma in a pediatric patient.

  14. Management of a Compound Odontoma in the Primary Dentition.

    PubMed

    Altay, Mehmet Ali; Ozgur, Beste; Cehreli, Zafer C

    2016-01-01

    Odontomas are the most common benign odontogenic tumors of the oral cavity; however, their occurrence in the primary dentition is an extremely rare condition. When associated with primary teeth, odontomas may lead to disturbances in tooth eruption, which often requires a multidisciplinary treatment approach. The purpose of this paper is to review the literature on odontomas of the primary dentition and discuss the management of a compound odontoma in a pediatric patient. PMID:27620522

  15. Application of Total Quality Management System in Thai Primary Schools

    ERIC Educational Resources Information Center

    Prueangphitchayathon, Setthiya; Tesaputa, Kowat; Somprach, Kanokorn

    2015-01-01

    The present study seeks to develop a total quality management (TQM) system that can be applied to primary schools. The approach focuses on customer orientation, total involvement of all constituencies and continuous improvement. TQM principles were studied and synthesized according to case studies of the best practices in 3 primary schools (small,…

  16. Rare bleeding disorders in children: identification and primary care management.

    PubMed

    Acharya, Suchitra S

    2013-11-01

    Bleeding symptoms are common in healthy children but occasionally may indicate an underlying congenital or acquired bleeding diathesis. The rare bleeding disorders (RBDs) comprise inherited deficiencies of coagulation factors I (congenital fibrinogen deficiencies), II, V, VII, X, XI, and XIII and combined factor deficiencies, most notably of factors V and VIII and of vitamin K-dependent factors. These disorders often manifest during childhood and may present with recurrent or even serious or life-threatening bleeding episodes, particularly during the neonatal period. Accordingly, primary care and other nonhematologist pediatric providers should be familiar with the clinical presentation and initial evaluation of these rare disorders. Bleeding manifestations generally vary within the same RBD and may be indistinguishable from 1 RBD to another or from other more common bleeding disorders. Serious bleeding events such as intracranial hemorrhage may be heralded by less serious bleeding symptoms. The results of initial coagulation studies, especially prothrombin time and activated partial thromboplastin time, are often helpful in narrowing down the potential factor deficiency, with factor XIII deficiency being an exception. Consultation with a hematologist is advised to facilitate accurate diagnosis and to ensure proper management and follow-up. The approach to bleeding episodes and invasive procedures is individualized and depends on the severity, frequency, and, in the case of procedures, likelihood of bleeding. Prophylaxis may be appropriate in children with recurrent serious bleeding and specifically after life-threatening bleeding episodes. When available, specific purified plasma-derived or recombinant factor concentrates, rather than fresh frozen plasma or cryoprecipitate, are the treatment of choice.

  17. The Organization and Management of Schools Under a System of Parent Choice.

    ERIC Educational Resources Information Center

    Rasmussen, Roger L.

    This paper describes some aspects of the organization and management of 14 schools that have been participating in the voucher demonstration in Alum Rock, California. The kinds of alternative programs being offered, the allocation of decision-making within the participating schools, and the effects of parent choice are briefly discussed. An…

  18. The Role of Culture and Gender in the Choice of a Career in Management

    ERIC Educational Resources Information Center

    Malach-Pines, Ayala; Kaspi-Baruch, Oshrit

    2008-01-01

    Purpose: The paper addresses the influence of culture and gender on the choice of a management career among men and women MBA students in Israel, the USA, the UK, Turkey, Cyprus, Hungary and India. The culture by gender comparison enabled an examination of five theories: two that focused on culture (Hofstede's and an application of Schneider's ASA…

  19. Using choice experiments to understand household tradeoffs regarding pineapple production and environmental management in Costa Rica.

    PubMed

    Richardson, Robert B; Kellon, Delanie; Leon, Ramon G; Arvai, Joseph

    2013-09-30

    Choices among environmental management alternatives involve tradeoffs where, for example, the benefits of environmental protection may be offset by economic costs or welfare losses to individual agents. Understanding individual or household-level preferences regarding these tradeoffs is not always straightforward, and it often requires an analysis of choices under alternative scenarios. A household survey was used to gather data for a choice experiment, where respondents were asked to choose among pairs of alternative management scenarios about pineapple production in Costa Rica. The experimental design consisted of six attributes that varied on between two and five attribute levels, and the experiment and accompanying survey were administered orally in Spanish. The results show that respondents are willing to make tradeoffs with respect to the management attributes in order to see an overall improvement in environmental quality. Respondents were willing to accept a moderate level of pesticide application, presumably in exchange for paying a lower cost or seeing a gain in another area, such as monitoring or soil conservation. Buffer zones were significant only in the case of large farms. The results have implications for policy decisions that aim to reflect public attitudes, particularly the aspects of pineapple production that matter most to people living near pineapple plantations. The study also highlights the effectiveness of the choice experiment approach in examining household preferences about environmental management in a rural development context.

  20. Using choice experiments to understand household tradeoffs regarding pineapple production and environmental management in Costa Rica.

    PubMed

    Richardson, Robert B; Kellon, Delanie; Leon, Ramon G; Arvai, Joseph

    2013-09-30

    Choices among environmental management alternatives involve tradeoffs where, for example, the benefits of environmental protection may be offset by economic costs or welfare losses to individual agents. Understanding individual or household-level preferences regarding these tradeoffs is not always straightforward, and it often requires an analysis of choices under alternative scenarios. A household survey was used to gather data for a choice experiment, where respondents were asked to choose among pairs of alternative management scenarios about pineapple production in Costa Rica. The experimental design consisted of six attributes that varied on between two and five attribute levels, and the experiment and accompanying survey were administered orally in Spanish. The results show that respondents are willing to make tradeoffs with respect to the management attributes in order to see an overall improvement in environmental quality. Respondents were willing to accept a moderate level of pesticide application, presumably in exchange for paying a lower cost or seeing a gain in another area, such as monitoring or soil conservation. Buffer zones were significant only in the case of large farms. The results have implications for policy decisions that aim to reflect public attitudes, particularly the aspects of pineapple production that matter most to people living near pineapple plantations. The study also highlights the effectiveness of the choice experiment approach in examining household preferences about environmental management in a rural development context. PMID:23807434

  1. Teaching Teachers about Supply Chain Management to Influence Students' Career and Education Choices

    ERIC Educational Resources Information Center

    Gardner, Leslie L.

    2013-01-01

    Since teachers are influential in high school students' career choices, enabling high school teachers to introduce educational and career opportunities in supply chain management is a viable strategy for reaching high school students about these opportunities. This article presents a pilot program of supply chain workshops to educate high school…

  2. Perceived stress and dietary choices: The moderating role of stress management.

    PubMed

    Errisuriz, Vanessa L; Pasch, Keryn E; Perry, Cheryl L

    2016-08-01

    Many college students exhibit unhealthy eating behaviors, consuming large quantities of high-fat foods and few fruits and vegetables. Perceived stress has been linked to daily dietary choices among college students; however, this work has been conducted among predominantly white, female populations. The role of perceived stress management in moderating this relationship is unclear. This study investigated the relationship between perceived stress and dietary choices among a diverse sample of male and female college freshmen and assessed whether perceived ability to manage stress moderated this relationship. 613 students from a large, public university completed an online survey which assessed past week consumption of various foods and beverages (e.g. soda, fast food, fruits, vegetables), as well as perceived stress and ability to manage stress. Hierarchical linear regression examined the association between perceived stress and past week dietary choices, and the moderating effect of perceived ability to manage stress, controlling for demographic variables. Perceived stress was positively associated with past week soda, coffee, energy drink, salty snack, frozen food, and fast food consumption (p<0.05). Perceived stress management moderated the relationship between stress and sweet snack consumption. Individuals who reported low ability to manage stress consumed greater amounts. Findings indicate greater stress is associated with poor dietary choices among college freshmen. The relationship between stress and sweet snack consumption was exacerbated among those who reported low ability to manage stress. It may be important for college nutrition education programs to focus on the relationship between stress and diet and promote effective stress management techniques. PMID:27310611

  3. Chronic disease management: the primary care perspective.

    PubMed

    Bragaglia, Pauline; O'Brien, Lewis

    2007-01-01

    This response to the essay is a "view from the trenches" by two doctors who have worked over 23 years at the Group Health Centre in Sault Ste. Marie, Ontario. We would agree wholeheartedly that reducing wait times for selected procedures will not transform our health system, although they are a start that does provide improved quality of life for a relatively small number of people. We have struggled with the care gap between known best practices and the reality of care provided, from the perspectives of both prevention and chronic disease management. This has resulted in an acute awareness of the need for an across-the-system, "bottom-up" approach to the prevention of disease and management of healthcare. Limited resources must be carefully leveraged in innovative ways if we are to eliminate this care gap, decrease morbidity and minimize expensive "rescue" procedures that make our system increasingly unaffordable.

  4. Primary Care Management of Plantar Fasciitis.

    PubMed

    Melvin, Thomas J; Tankersley, Zach J; Qazi, Zain N; Jasko, John J; Odono, Russell; Shuler, Franklin D

    2015-01-01

    Plantar fasciitis (PF) is present in 10% of the population and is the most common cause of plantar heel pain. PF is painful, can alter daily activities and presents as a sharp pain localized to the plantar foot and medial heel. The underlying etiology involves microtrauma to the plantar fascia, specifically at its insertion point on the calcaneus. Successful management of plantar fasciitis is typically achieved with the conservative therapy approaches discussed.

  5. Primary Care Management of Plantar Fasciitis.

    PubMed

    Melvin, Thomas J; Tankersley, Zach J; Qazi, Zain N; Jasko, John J; Odono, Russell; Shuler, Franklin D

    2015-01-01

    Plantar fasciitis (PF) is present in 10% of the population and is the most common cause of plantar heel pain. PF is painful, can alter daily activities and presents as a sharp pain localized to the plantar foot and medial heel. The underlying etiology involves microtrauma to the plantar fascia, specifically at its insertion point on the calcaneus. Successful management of plantar fasciitis is typically achieved with the conservative therapy approaches discussed. PMID:26665894

  6. Diagnosis and management of primary ciliary dyskinesia

    PubMed Central

    Lucas, Jane S; Burgess, Andrea; Mitchison, Hannah M; Moya, Eduardo; Williamson, Michael; Hogg, Claire

    2014-01-01

    Primary ciliary dyskinesia (PCD) is an inherited autosomal-recessive disorder of motile cilia characterised by chronic lung disease, rhinosinusitis, hearing impairment and subfertility. Nasal symptoms and respiratory distress usually start soon after birth, and by adulthood bronchiectasis is invariable. Organ laterality defects, usually situs inversus, occur in ∼50% of cases. The estimated prevalence of PCD is up to ∼1 per 10 000 births, but it is more common in populations where consanguinity is common. This review examines who to refer for diagnostic testing. It describes the limitations surrounding diagnosis using currently available techniques and considers whether recent advances to genotype patients with PCD will lead to genetic testing and screening to aid diagnosis in the near future. It discusses the challenges of monitoring and treating respiratory and ENT disease in children with PCD. PMID:24771309

  7. Diagnosis and management of primary ciliary dyskinesia.

    PubMed

    Lucas, Jane S; Burgess, Andrea; Mitchison, Hannah M; Moya, Eduardo; Williamson, Michael; Hogg, Claire

    2014-09-01

    Primary ciliary dyskinesia (PCD) is an inherited autosomal-recessive disorder of motile cilia characterised by chronic lung disease, rhinosinusitis, hearing impairment and subfertility. Nasal symptoms and respiratory distress usually start soon after birth, and by adulthood bronchiectasis is invariable. Organ laterality defects, usually situs inversus, occur in ∼50% of cases. The estimated prevalence of PCD is up to ∼1 per 10,000 births, but it is more common in populations where consanguinity is common. This review examines who to refer for diagnostic testing. It describes the limitations surrounding diagnosis using currently available techniques and considers whether recent advances to genotype patients with PCD will lead to genetic testing and screening to aid diagnosis in the near future. It discusses the challenges of monitoring and treating respiratory and ENT disease in children with PCD.

  8. Diagnosis and management of primary pulmonary hypertension.

    PubMed

    Krishnan, U

    2000-03-01

    Pulmonary arterial hypertension in children can occur secondary to shunt lesion like ventricular septal defect, patent ductus arteriosus or it may be idiopathic, the so called primary pulmonary hypertension (PPH). The progression of PPH is usually rapid in children as compared to adults and the mean survival is 2-3 years after the diagnosis is made. Histological changes in the form of medical muscular hypertrophy, intinal hyperplasia and later angiomatous, plexiform lesions occur in pulmonary vasculature. The pulmonary vasculature normally is a high flow, low resistance circuit and allows large blood flow without marked increase in pulmonary arterial pressure. However, with prolonged increased flow or any other vasoconstrictor stimulus, histological changes start occurring in the pulmonary bed resulting in increasing pressure in pulmonary artery. Right ventricular hypertension follows resulting in right ventricular hyypertrophy and later dysfunction. Life threatening arrhythmias may result in sudden death in some of these patients. Clinical presentation is in the form of exertional dyspnoea with syncope at times. Over 50% of children with PPH are helped by vasodilators. They may be treated with calcium channel blockers (e.g. nifedipine, dose titrated to blood pressure) orally. Those not responding to oral vasodilators can be put on chronic inhaled nitric oxide or continuous intravenous prostacyclin infusion. Chronic anticoagulation therapy may also increase survival. In symptomatic cases, blade/balloon atrial septostomy may increase survival in patients of PPH with intact atrial sptum. For children not responding to medical therapy, lung transplantation may be the answer in near future.

  9. Pathogenesis and management of primary CNS lymphoma.

    PubMed

    Roth, Patrick; Korfel, Agnieszka; Martus, Peter; Weller, Michael

    2012-05-01

    Primary CNS lymphoma (PCNSL), a rare variant of extranodal non-Hodgkin's lymphoma, may cause various neurological symptoms and signs. The best therapeutic strategy is still a matter of debate. High-dose methotrexate (HD-MTX) is the most active compound and should be used as the backbone for any chemotherapy applied. Several other chemotherapeutic drugs have been assessed in combination with HD-MTX, but no standard has yet been defined. Whole-brain radiotherapy is active against PCNSL, but typically does not confer long-lasting remission and is associated with significant neurotoxicity in many patients. The recently published G-PCNSL-SG1 trial has shown that consolidating whole-brain radiotherapy after HD-MTX-based chemotherapy does not prolong overall survival and may therefore be deferred. Combined systemic and intraventricular polychemotherapy, or high-dose chemotherapy followed by stem cell transplantation may offer cures to younger patients. Improving treatment regimens without adding significant (neuro-)toxicity should be the focus of ongoing and future studies.

  10. Influencing dressing choice and supporting wound management using remote 'tele-wound care'.

    PubMed

    King, Brenda

    2014-06-01

    This article describes a local involvement in a project to evaluate a remote system of wound management, incorporating the use of digital and mobile technology. It outlines how this involvement influenced the current system of 'tele wound care' (remote wound management) in a large community organisation. The system allows remote wound assessment, management advice and ongoing monitoring of wounds to ensure that the dressing choice remains appropriate and that timely wound care support can be provided to community nurses, practice nurses and GPs. PMID:24912832

  11. Contraceptive introduction and the management of choice: the role of Cyclofem in Indonesia.

    PubMed

    Simmons, R; Fajans, P; Lubis, F

    1994-05-01

    This paper presents a programmatic perspective on the relationship between the introduction of new contraceptive technology and expanding contraceptive options, using the example of Cyclofem in Indonesia. Past approaches to contraceptive introduction have considered only the characteristics of the new method in the decision-making process. In assessing whether the introduction of a new method actually expands contraceptive choice for women and whether the program has the managerial capabilities to assure quality of care in this process, the authors argue that consideration must be given to all methods within a delivery system and how new technology relates to the management of contraceptive choice. Using this perspective, the authors suggest that choice would not necessarily be expanded with scaled-up service delivery of a new once-a month injectable in the Indonesian public sector context.

  12. Impact of an informed choice invitation on uptake of screening for diabetes in primary care (DICISION): trial protocol

    PubMed Central

    Mann, Eleanor; Prevost, A Toby; Griffin, Simon; Kellar, Ian; Sutton, Stephen; Parker, Michael; Sanderson, Simon; Kinmonth, Ann Louise; Marteau, Theresa M

    2009-01-01

    Background Screening invitations have traditionally been brief, providing information only about population benefits. Presenting information about the limited individual benefits and potential harms of screening to inform choice may reduce attendance, particularly in the more socially deprived. At the same time, amongst those who attend, it might increase motivation to change behavior to reduce risks. This trial assesses the impact on attendance and motivation to change behavior of an invitation that facilitates informed choices about participating in diabetes screening in general practice. Three hypotheses are tested: 1. Attendance at screening for diabetes is lower following an informed choice compared with a standard invitation. 2. There is an interaction between the type of invitation and social deprivation: attendance following an informed choice compared with a standard invitation is lower in those who are more rather than less socially deprived. 3. Amongst those who attend for screening, intentions to change behavior to reduce risks of complications in those subsequently diagnosed with diabetes are stronger following an informed choice invitation compared with a standard invitation. Method/Design 1500 people aged 40–69 years without known diabetes but at high risk are identified from four general practice registers in the east of England. 1200 participants are randomized by households to receive one of two invitations to attend for diabetes screening at their general practices. The intervention invitation is designed to facilitate informed choices, and comprises detailed information and a decision aid. A comparison invitation is based on those currently in use. Screening involves a finger-prick blood glucose test. The primary outcome is attendance for diabetes screening. The secondary outcome is intention to change health related behaviors in those attenders diagnosed with diabetes. A sample size of 1200 ensures 90% power to detect a 10% difference in

  13. Managing violence in primary care: an evidence-based approach.

    PubMed Central

    Wright, Nat M; Dixon, Cath A; Tompkins, Charlotte N

    2003-01-01

    An understanding of the risk factors for violence can help primary care staff to evaluate and manage risk in the primary care setting. They will be able to acknowledge that risk factors are not static but can vary according to time, place, situation, and support networks. General practitioners (GPs) should not ignore their clinical acumen, but should use their knowledge of the patient to form part of a risk assessment. Managing violence in primary care should focus on the individual; for example, in the training of primary care staff. It should also involve an examination of the wider structure of primary care; for example, the safe design of buildings, avoiding long waiting times, and having 'no intoxication' policies for practices. There is a pressing need for primary care-based research in this area. We acknowledge that in our understanding of this topic there are two extremes that should be avoided. The first is that our perceived risk of violence often exceeds the real, absolute risk. Where our perceptions are overstated, patients run the risk of being excluded from primary care or of being inappropriately detained on psychiatric wards under the Mental Health Act. At the other extreme, where risk is understated, staff can play the 'hero' or the 'martyr' in an attempt to defuse a situation without support from other colleagues. Like many other situations in primary care, working in isolation carries real and important risks. Threats of violence are best managed in primary care by having a collaborative practice approach underpinned by a support ethos from primary care organisations. PMID:14694671

  14. Diagnosing and managing psychosis in primary care.

    PubMed

    Saunders, Kate; Brain, Susannah; Ebmeier, Klaus P

    2011-05-01

    Psychosis is broadly defined as the presence of delusions and hallucinations. It can be organic or functional. The former is secondary to an underlying medical condition, such as delirium or dementia, the latter to a psychiatric disorder, such as schizophrenia or bipolar disorder. The identification and treatment of psychosis is vital as it is associated with a 10% lifetime risk of suicide and significant social exclusion. Psychosis can be recognised by taking a thorough history, examining the patient's mental state and obtaining a collateral history. The history usually enables a distinction to be made between bipolar disorder, schizophrenia and other causes. Early symptoms often include low mood, declining educational or occupational functioning, poor motivation, changes in sleep, perceptual changes, suspiciousness and mistrust. The patient's appearance, e.g. unkempt or inappropriately attired, may reflect their predominant mental state. There may be signs of agitation, hostility or distractibility. Speech may be disorganised and difficult to follow or there may be evidence of decreased speech. Mood may be depressed or elated or change rapidly. Patients may describe abnormal thoughts and enquiry into thoughts of suicide should be routine. Disturbances of thought such as insertion or withdrawal may be present along with perceptual abnormalities i.e. illusions, hallucinations. Insight varies during the course of a psychotic illness but should be explored as it has implications for management. All patients presenting with first episode psychosis for which no organic cause can be found should be referred to the local early intervention service. In patients with a known diagnosis consider referral if there is: poor response or nonadherence to treatment; intolerable side effects; comorbid substance misuse; risk to self or others. PMID:21714473

  15. Management of alcoholism in the primary care setting.

    PubMed Central

    Bradley, K. A.

    1992-01-01

    Primary care physicians can play an important role in managing alcoholic patients. Identifying and treating alcoholism early, before it has interfered with patients' relationships and work, may increase the likelihood of prolonged recovery. Simple office interventions can help motivate patients to abstain and seek treatment. People who abuse alcohol and are unwilling to abstain can benefit from a recommendation to reduce their intake of alcohol. For alcohol-dependent patients who decide to stop drinking, primary care physicians often can manage withdrawal on an outpatient basis. Selecting an appropriate treatment program for each alcoholic patient is important, and referral to a specialist to assist in matching patients to treatments is often necessary. Primary care physicians also can help prevent relapse. Although disulfiram is of limited value, primary care physicians can support recovery by identifying coexistent psychosocial problems, helping patients to restructure their lives, and ensuring continuity of care. PMID:1595243

  16. Modeling Distributed Leadership and Management Effectiveness: Primary School Senior Management Teams in England and Wales.

    ERIC Educational Resources Information Center

    Wallace, Mike

    2002-01-01

    Discusses the significance of distributed leadership and management effectiveness; provides background for primary-school senior management teams research; reports headmasters' criteria for judging the effectiveness of senior management teams; reports findings from case studies of four senior management teams; discusses an inductively derived…

  17. Primary Sclerosing Cholangitis: Therapeutic Options and Surveillance Management

    PubMed Central

    Kumar, Aditi; Wheatley, Daniel; Puttanna, Amar

    2016-01-01

    Primary sclerosing cholangitis is a chronic immune-mediated liver disease. Though rare, it poses several clinical concerns for the managing physician. There are currently limited therapeutic options in the management of the condition and weak evidence base behind them. Endoscopic intervention is limited to those patients with obstructing stricture-related disease, and even liver transplantation has a risk of disease recurrence. Surveillance for inflammatory bowel disorders, metabolic bone disease, and malignancy is paramount when managing such patients. This article provides an overview of the condition with further focus on current therapeutic options and guidance on surveillance management. PMID:27330336

  18. Evaluation of the Arkansas Medicaid Primary Care Physician Management Program

    PubMed Central

    Muller, Andreas; Baker, John A.

    1996-01-01

    Arkansas implemented a primary-care case-management program in February 1994. This study evaluates the program during its first 17 months. Using quarterly data collected for the Health Care Financing Administration (HCFA), a pooled cross-sectional time series analysis (1991:4-1995:2) estimates the effect of eligibles' program enrollment on expenditure (total, inpatient hospital, outpatient hospital, physicians, prescription drugs, laboratory and X-ray) and utilization measures (outpatient visits, physician visits, prescription drugs). The Arkansas Medicaid managed care program appears to have somewhat reduced growth in total vendor payments and also appears to have improved access to primary medical services. PMID:10165704

  19. Headache in primary care: how important is diagnosis to management?

    PubMed Central

    O'Flynn, Norma; Ridsdale, Leone

    2002-01-01

    Headache is a common presentation in primary care. The classification of headache was overhauled by the International Headache Society (IHS) in 1988, and the past decade has seen rapid growth in the understanding of headache disorders. The IHS places particular importance on precise headache diagnosis. This paper discusses the relevance of such an approach to primary care. A review of the literature revealed a dearth of evidence regarding headache management in primary care settings. The evidence from other settings is considered and gaps in the literature highlighted. PMID:12120731

  20. Administration to innovation: the evolving management challenge in primary care.

    PubMed

    Laing, A; Marnoch, G; McKee, L; Joshi, R; Reid, J

    1997-01-01

    The concept of the primary health-care team involving an increasingly diverse range of health care professionals is widely recognized as central to the pursuit of a primary care-led health service in the UK. Although GPs are formally recognized as the team leaders, there is little by way of policy prescription as to how team roles and relationships should be developed, or evidence as to how their roles have in fact evolved. Thus the notion of the primary health-care team while commonly employed, is in reality lacking definition with the current contribution of practice managers to the operation of this team being poorly understood. Focusing on the career backgrounds of practice managers, their range of responsibilities, and their involvement in innovation in general practice, presents a preliminary account of a chief scientist office-funded project examining the role being played by practice managers in primary health-care innovation. More specifically, utilizing data gained from the ongoing study, contextualizes the role played by practice managers in the primary health-care team. By exploring the business environment surrounding the NHS general practice, the research seeks to understand the evolving world of the practice manager. Drawing on questionnaire data, reinforced by qualitative data from the current interview phase, describes the role played by practice managers in differing practice contexts. This facilitates a discussion of a set of ideal type general practice organizational and managerial structures. Discusses the relationships and skills required by practice managers in each of these organizational types with reference to data gathered to date in the research.

  1. Choice, Cost and Community: The Hidden Complexities of the Rural Primary School Market

    ERIC Educational Resources Information Center

    Walker, Marion

    2010-01-01

    National rural policy places the local primary school as a key resource within the rural community, yet as a consequence of countywide financial constraints, some small schools are undergoing reorganization, involving amalgamation, federation and school closure. This article considers the complexities involved in the workings of the English rural…

  2. Modern approaches to caries management of the primary dentition.

    PubMed

    Innes, N P T; Evans, D J P

    2013-06-01

    When prevention of dental caries fails, and a child is exposed to the risk of pain and infection, the disease must be managed to reduce this risk. There is growing evidence supporting more 'biological' and fewer 'surgical' approaches to managing dental caries in primary teeth. These biological methods include partial and stepwise caries removal procedures, as well as techniques where no caries is removed. An overview of clinical trials comparing these biological methods to complete caries removal shows that they perform as well as traditional methods and have the advantage of reducing the incidence of iatrogenic pulpal exposures. The Hall Technique is one biological approach to managing caries in primary molars which involves sealing caries beneath preformed metal (stainless steel) crowns. The crown is cemented over the tooth without caries removal, tooth preparation or use of local anaesthesia. The clinical steps for the Hall Technique are straightforward but, as with all dental care provision, appropriate treatment planning for the procedure requires skill. The Hall Technique offers another method of managing early to moderately advanced, active carious lesions in primary molars, with good evidence of effectiveness and acceptability. This evidence aligns with the positive findings of other studies on biological strategies for managing caries in primary teeth.

  3. Disagreement between Human Papillomavirus Assays: An Unexpected Challenge for the Choice of an Assay in Primary Cervical Screening

    PubMed Central

    Ejegod, Ditte Møller; Rygaard, Carsten; Lynge, Elsebeth; Bonde, Jesper

    2014-01-01

    We aimed to determine the disagreement in primary cervical screening between four human papillomavirus assays: Hybrid Capture 2, cobas, CLART, and APTIMA. Material from 5,064 SurePath samples of women participating in routine cervical screening in Copenhagen, Denmark, was tested with the four assays. Positive agreement between the assays was measured as the conditional probability that the results of all compared assays were positive given that at least one assay returned a positive result. Of all 5,064 samples, 1,679 (33.2%) tested positive on at least one of the assays. Among these, 41% tested positive on all four. Agreement was lower in women aged ≥30 years (30%, vs. 49% at <30 years), in primary screening samples (29%, vs. 38% in follow-up samples), and in women with concurrent normal cytology (22%, vs. 68% with abnormal cytology). Among primary screening samples from women aged 30–65 years (n = 2,881), 23% tested positive on at least one assay, and 42 to 58% of these showed positive agreement on any compared pair of the assays. While 4% of primary screening samples showed abnormal cytology, 6 to 10% were discordant on any pair of assays. A literature review corroborated our findings of considerable disagreement between human papillomavirus assays. This suggested that the extent of disagreement in primary screening is neither population- nor storage media-specific, leaving assay design differences as the most probable cause. The substantially different selection of women testing positive on the various human papillomavirus assays represents an unexpected challenge for the choice of an assay in primary cervical screening, and for follow up of in particular HPV positive/cytology normal women. PMID:24466262

  4. Nurse/physician conflict management mode choices: implications for improved collaborative practice.

    PubMed

    Hendel, Tova; Fish, Miri; Berger, Ornit

    2007-01-01

    In today's complex healthcare organizations, conflicts between physicians and nurses occur daily. Consequently, organizational conflict has grown into a major subfield of organizational behavior. Researchers have claimed that conflict has a beneficial effect on work group function and identified collaboration as one of the intervening variables that may explain the relationship between magnet hospitals and positive patient outcomes. The purpose of this study was to identify and compare conflict mode choices of physicians and head nurses in acute care hospitals and examine the relationship of conflict mode choices with their background characteristics. In a cross-sectional correlational study, 75 physicians and 54 head nurses in 5 hospitals were surveyed, using the Thomas-Kilmann Conflict Mode Instrument. No difference was found between physicians and nurses in choice of the most frequently used mode in conflict management. The compromising mode was found to be the significantly most commonly chosen mode (P = .00) by both. Collaborating was chosen significantly more frequently among head nurses (P = .001) and least frequently among physicians (P = .00). Most of the respondents' characteristics were not found to be correlated with mode choices. The findings indicate a need to enhance partnerships in the clinical environment to ensure quality patient care and staff satisfaction.

  5. Nurse/physician conflict management mode choices: implications for improved collaborative practice.

    PubMed

    Hendel, Tova; Fish, Miri; Berger, Ornit

    2007-01-01

    In today's complex healthcare organizations, conflicts between physicians and nurses occur daily. Consequently, organizational conflict has grown into a major subfield of organizational behavior. Researchers have claimed that conflict has a beneficial effect on work group function and identified collaboration as one of the intervening variables that may explain the relationship between magnet hospitals and positive patient outcomes. The purpose of this study was to identify and compare conflict mode choices of physicians and head nurses in acute care hospitals and examine the relationship of conflict mode choices with their background characteristics. In a cross-sectional correlational study, 75 physicians and 54 head nurses in 5 hospitals were surveyed, using the Thomas-Kilmann Conflict Mode Instrument. No difference was found between physicians and nurses in choice of the most frequently used mode in conflict management. The compromising mode was found to be the significantly most commonly chosen mode (P = .00) by both. Collaborating was chosen significantly more frequently among head nurses (P = .001) and least frequently among physicians (P = .00). Most of the respondents' characteristics were not found to be correlated with mode choices. The findings indicate a need to enhance partnerships in the clinical environment to ensure quality patient care and staff satisfaction. PMID:17607137

  6. The management of new primary care organizations: an international perspective.

    PubMed

    Meads, Geoffrey; Wild, Andrea; Griffiths, Frances; Iwami, Michiyo; Moore, Phillipa

    2006-08-01

    Management practice arising from parallel policies for modernizing health systems is examined across a purposive sample of 16 countries. In each, novel organizational developments in primary care are a defining feature of the proposed future direction. Semistructured interviews with national leaders in primary care policy development and local service implementation indicate that management strategies, which effectively address the organized resistance of medical professions to modernizing policies, have these four consistent characteristics: extended community and patient participation models; national frameworks for interprofessional education and representation; mechanisms for multiple funding and accountabilities; and the diversification of non-governmental organizations and their roles. The research, based on a two-year fieldwork programme, indicates that at the meso-level of management planning and practice, there is a considerable potential for exchange and transferable learning between previously unconnected countries. The effectiveness of management strategies abroad, for example, in contexts where for the first time alternative but comparable new primary care organizations are exercising responsibilities for local resource utilization, may be understood through the application of stakeholder analyses, such as those employed to promote parity of relationships in NHS primary care trusts.

  7. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Primary care case management services. 440.168 Section 440.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.168...

  8. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Primary care case management services. 440.168 Section 440.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.168...

  9. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Primary care case management services. 440.168 Section 440.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.168...

  10. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Primary care case management services. 440.168 Section 440.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.168...

  11. Total Quality Management Practices in Turkish Primary Schools

    ERIC Educational Resources Information Center

    Toremen, Fatih; Karakus, Mehmet; Yasan, Tezcan

    2009-01-01

    Purpose: The purpose of this paper is to determine the extent of total quality management (TQM) practices in primary schools based on teachers' perceptions, and how their perceptions are related to different variables. Design/methodology/approach: In this study, a survey based descriptive scanning model was used. This study was carried out in…

  12. Laparoscopic management of a large primary retroperitoneal hydatid cyst.

    PubMed

    Marwah, Sanjay; Kamal, Hemant; Marwah, Nisha

    2010-10-01

    Hydatid cysts usually involve the liver and lungs, but any other organ can potentially be involved and these can mimic numerous pathologies; however, primary involvement of the retroperitoneum and presentation as a left-sided abdominal mass is quite unusual. A 30-year-old male presented with a large cystic lump in the left side of the abdomen that was diagnosed as a primary retroperitoneal hydatid cyst by a computed tomography scan and serology. The patient was managed successfully by minimal access surgery. This report highlights that a primary retroperitoneal hydatid cyst is a rare clinical entity and should be considered as one of the differential diagnoses in patients presenting with a cystic mass in the retroperitoneum. In the present era of minimal access surgery, it can be safely managed with a laparoscopic approach.

  13. The Management of Sarcoidosis: A Primary Care Approach.

    PubMed

    Shinn, Justin; Paauw, Douglas S

    2015-09-01

    Sarcoidosis is an idiopathic inflammatory disorder characterized by noncaseating granulomas, which can affect any organ system. The lungs are most commonly affected but extrapulmonary sites may cause the initial and/or sole symptoms. In this review, the disease manifestations and treatment are described, with particular emphasis on the management of each affected organ system. Diagnosis and management can be difficult and greatly affect quality of life, but despite these challenges, it is possible to successfully manage patients with sarcoidosis in the primary care setting.

  14. Factors associated with health care professionals' choice of written asthma management plans.

    PubMed

    Bibb, Sandra C; Norwood, Ricky; Meyer, John F

    2007-10-01

    The objective of this descriptive-comparative study was to determine what factors were associated with health care professionals' choice of written asthma management plans (WAMP) for health care practice. A convenience sample of medical and nursing students and practicing health care professionals was asked to choose the preferred WAMP and give a brief explanation for the choice on the questionnaire. Comparative groups were formed based on the WAMP choice. Independent sample chi2 and content analysis were used to analyze data. Ninety-five percent (n = 192) of all survey respondents (N = 202) preferred the highly readable Global Initiative for Asthma Sample Patient Asthma Management Plan, as compared to the Veterans Administration/Department of Defense (DoD) WAMP. Major themes as to why respondents preferred the Global Initiative for Asthma WAMP include "pictures," "readability," "user-friendliness," and "simplicity." Use of the current DoD/Veterans Health Administration WAMP within the DoD Military Health System may need to be re-evaluated.

  15. Sustainable Assessment for Large Science Classes: Non-Multiple Choice, Randomised Assignments through a Learning Management System

    ERIC Educational Resources Information Center

    Schultz, Madeleine

    2011-01-01

    This paper reports on the development of a tool that generates randomised, non-multiple choice assessment within the BlackBoard Learning Management System interface. An accepted weakness of multiple-choice assessment is that it cannot elicit learning outcomes from upper levels of Biggs' SOLO taxonomy. However, written assessment items require…

  16. Primary lens extraction for glaucoma management: A review article

    PubMed Central

    Eid, Tarek M.

    2011-01-01

    Recently, primary lens extraction alone gained more acceptance as an alternative surgical approach for glaucoma management. This view was supported by the advances in phacoemulsification and intraocular lenses with greater safety and visual recovery, in addition to a substantial reduction of intraocular pressure and deepening of the anterior chamber and filtration angle. The decrease in IOP after cataract surgery in primary open-angle glaucoma (POAG) is mild, less predictable, related to baseline levels, and may return to presurgical values after an initial period of reduction. Therefore, the IOP-lowering effect of primary cataract extraction in POAG may be insufficient to achieve adequate IOP control. The IOP reduction after lens extraction is consistently greater in eyes with primary angle closure glaucoma (PACG) than in eyes with POAG. Primary lens extraction in acute PACG eliminates, or at least, reduces the risk of recurrence of acute attacks and deepens the anterior chamber and widens the angle which reduces the risk of progression of peripheral anterior synechiae and development of chronic PACG. Primary lens extraction may be more preferable to glaucoma incisional surgery in mild to moderate PACG eyes with appositional angle closure. The decision to do lens extraction as a primary treatment for glaucoma should be individualized based upon several factors other than the effect on IOP. These factors include patients’ characteristics, surgeons’ skills and preferences, status of glaucoma control, type of cataract and intraocular lens implanted, and potential harm of laser treatment for late capsular opacification and fibrosis. PMID:23960947

  17. Managed Medicare: an overview for the primary care physician.

    PubMed

    Colenda, C C; Sherman, F T

    1998-01-01

    Medicare is looking to managed care to help solve its financial burden. Because managed care plans offer a number of advantages for Medicare enrollees, the number of plans and of enrollees are increasing dramatically. With some exceptions, the Medicare population appears to do as well or better in HMOs as in fee-for-service care, despite differences in utilization of services. For the primary care physician, the key to success in managed Medicare is finding and aggressively managing your frail or near frail patients. Basic tools for survival are the use of prevention strategies, screening of enrollees and targeting for needed services, geriatric assessment, use of alternate care settings to avoid or limit costly hospital care, and monitoring of medication use for compliance and adverse reactions.

  18. Management of Patients with Subclinical Hypothyroidism in Primary Care.

    PubMed

    McCarthy, E; Russell, A; Kearney, P M

    2016-01-01

    Subclinical hypothyroidism (SCH) is defined as a raised serum thyroid stimulating hormone level with normal thyroxine. Despite a prevalence of up to 9% of the adult population there is widespread uncertainty on how to manage it. The aim of this study was to assess how older adults with SCH are managed in primary care. A retrospective case-note review was carried out on patients attending Mallow Primary Healthcare Centre. This study identified patients 65 years and over meeting the criteria for SCH in one year. The prevalence of SCH in this study was calculated as 2.9%. 22.2% of patients were treated with thyroxine. 6.1% of untreated patients progressed to clinical hypothyroidism within the study period while 18.2% spontaneously reverted to normal TSH levels. PMID:26904793

  19. Management of Patients with Subclinical Hypothyroidism in Primary Care.

    PubMed

    McCarthy, E; Russell, A; Kearney, P M

    2016-01-01

    Subclinical hypothyroidism (SCH) is defined as a raised serum thyroid stimulating hormone level with normal thyroxine. Despite a prevalence of up to 9% of the adult population there is widespread uncertainty on how to manage it. The aim of this study was to assess how older adults with SCH are managed in primary care. A retrospective case-note review was carried out on patients attending Mallow Primary Healthcare Centre. This study identified patients 65 years and over meeting the criteria for SCH in one year. The prevalence of SCH in this study was calculated as 2.9%. 22.2% of patients were treated with thyroxine. 6.1% of untreated patients progressed to clinical hypothyroidism within the study period while 18.2% spontaneously reverted to normal TSH levels.

  20. Guideline for primary care management of headache in adults

    PubMed Central

    Becker, Werner J.; Findlay, Ted; Moga, Carmen; Scott, N. Ann; Harstall, Christa; Taenzer, Paul

    2015-01-01

    Abstract Objective To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. Quality of evidence A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. Main message A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. Conclusion A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache. PMID:26273080

  1. Management of liver cirrhosis between primary care and specialists

    PubMed Central

    Grattagliano, Ignazio; Ubaldi, Enzo; Bonfrate, Leonilde; Portincasa, Piero

    2011-01-01

    This article discusses a practical, evidence-based approach to the diagnosis and management of liver cirrhosis by focusing on etiology, severity, presence of complications, and potential home-managed treatments. Relevant literature from 1985 to 2010 (PubMed) was reviewed. The search criteria were peer-reviewed full papers published in English using the following MESH headings alone or in combination: “ascites”, “liver fibrosis”, “cirrhosis”, “chronic hepatitis”, “chronic liver disease”, “decompensated cirrhosis”, “hepatic encephalopathy”, “hypertransaminasemia”, “liver transplantation” and “portal hypertension”. Forty-nine papers were selected based on the highest quality of evidence for each section and type (original, randomized controlled trial, guideline, and review article), with respect to specialist setting (Gastroenterology, Hepatology, and Internal Medicine) and primary care. Liver cirrhosis from any cause represents an emerging health issue due to the increasing prevalence of the disease and its complications worldwide. Primary care physicians play a key role in early identification of risk factors, in the management of patients for improving quality and length of life, and for preventing complications. Specialists, by contrast, should guide specific treatments, especially in the case of complications and for selecting patient candidates for liver transplantation. An integrated approach between specialists and primary care physicians is essential for providing better outcomes and appropriate home care for patients with liver cirrhosis. PMID:21633593

  2. Huge nasopharyngeal angiofibroma with intracranial extension: change in the dura mater and choice of surgical management.

    PubMed

    Yi, Z X; Li, Z C; Cheng, J M; Zhang, R; Lin, Chang; Zhou, A D; Fan, Z M

    2007-11-01

    We aimed to review (1) the imaging changes in the dura mater in cases of huge, lobulated juvenile nasopharyngeal angiofibroma, and (2) the choice of surgical management. Imaging from four cases of juvenile nasopharyngeal angiofibroma showed extrapharyngeal extension of the tumour. The sphenoid sinus, sella turcica and clivus were extensively eroded, and the tumour had spread deep into the cranial fossa. In three cases, intracranial exploration was performed to treat the intracranial tumour lobule. Subsequently, the tumours were removed using extracranial approaches. No perforation of the dura mater was found in these three cases, although the dura mater in the superior orbital fissure was congested, haemorrhagic and solid. Pre-operative imaging for two cases (i.e. the first operation for one and the second operation for the other) revealed no dura mater perforation. A transantral approach via a midfacial degloving incision was used to remove these tumours completely. We conclude that change in the dura mater is a crucial indication for the choice of management. If the dura mater is intact, a transantral approach via a midfacial degloving incision may remove the tumour successfully.

  3. Changing concepts in management of primary obstructive megaureter

    SciTech Connect

    Keating, M.A.; Escala, J.; Snyder, H.M. III; Heyman, S.; Duckett, J.W.

    1989-08-01

    The management of neonatal urinary tract dilatations represents one of the most challenging dilemmas in pediatric urology today. We have been confronted with 44 renal units in 35 neonates diagnosed as having primary obstructive megaureter during the last 6 years. Of these units 23 in 17 infants were diagnosed antenatally and 20 (87 per cent) have been managed without surgical intervention. Notably, 16 renal units were graded as moderate to severe megaureters by an excretory urogram. The decision to manage conservatively was based on the initial extraction of the /sup 99m/diethylenetriaminepentaacetic acid renal scan (the extraction factor). This estimate of absolute renal function has been used to differentiate dilatations with obstructive implications for the renal parenchyma from those without. Significantly, expectant treatment has resulted in improvement of dilatation on sequential excretory urograms in 15 megaureters and none has shown a deterioration of function by renal scan. Similar diagnostic criterion also has resulted in conservative management for 12 of 21 additional neonatal megaureters seen during this period with symptoms or they were discovered serendipitously. Only 2 of these 12 megaureters required surgical correction. The neonatal primary megaureter appears in many cases to represent a different entity than those that commonly presented before the advent of antenatal and perinatal diagnosis.

  4. Making Choices about the Use of the Outdoors in Manager and Management Development.

    ERIC Educational Resources Information Center

    Mossman, Alan

    1983-01-01

    The purpose of this paper is to suggest a framework for analyzing "outdoor management development" so as to help potential consumers assess the compatibility of provider organizations and their own. (Author/SSH)

  5. Controversies in the management of primary sclerosing cholangitis.

    PubMed

    Nayagam, Jeremy S; Pereira, Stephen P; Devlin, John; Harrison, Phillip M; Joshi, Deepak

    2016-02-18

    Primary sclerosing cholangitis (PSC) remains a rare but significant disease, which affects mainly young males in association with inflammatory bowel disease. There have been few advances in the understanding of the pathogenesis of the condition and no therapeutics with proven mortality benefit aside from liver transplantation. There remain areas of controversy in the management of PSC which include the differentiation from other cholangiopathies, in particular immunoglobulin G4 related sclerosing cholangitis, the management of dominant biliary strictures, and the role of ursodeoxycholic acid. In addition, the timing of liver transplantation in PSC remains difficult to predict with standard liver severity scores. In this review, we address these controversies and highlight the latest evidence base in the management of PSC. PMID:26925200

  6. Controversies in the management of primary sclerosing cholangitis.

    PubMed

    Nayagam, Jeremy S; Pereira, Stephen P; Devlin, John; Harrison, Phillip M; Joshi, Deepak

    2016-02-18

    Primary sclerosing cholangitis (PSC) remains a rare but significant disease, which affects mainly young males in association with inflammatory bowel disease. There have been few advances in the understanding of the pathogenesis of the condition and no therapeutics with proven mortality benefit aside from liver transplantation. There remain areas of controversy in the management of PSC which include the differentiation from other cholangiopathies, in particular immunoglobulin G4 related sclerosing cholangitis, the management of dominant biliary strictures, and the role of ursodeoxycholic acid. In addition, the timing of liver transplantation in PSC remains difficult to predict with standard liver severity scores. In this review, we address these controversies and highlight the latest evidence base in the management of PSC.

  7. Infectious disease management in primary care: perceptions of GPs

    PubMed Central

    2011-01-01

    Background It is important to keep the level of antibiotic prescribing low to contain the development of resistant bacteria. This study was conducted to reveal new knowledge about how GPs think in relation to the prescribing of antibiotics - knowledge that could be used in efforts toward rational treatment of infectious diseases in primary care. The aim was to explore and describe the variations in GPs' perceptions of infectious disease management, with special reference to antibiotic prescribing. Methods Twenty GPs working at primary care centres in a county in south-west Sweden were purposively selected based on the strategy of including GPs with different kinds of experience. The GPs were interviewed and perceptions among GPs were analysed by a phenomenographic approach. Results Five qualitatively different perceptions of infectious disease management were identified. They were: (A) the GP must help the patient to achieve health and well-being; (B) the management must meet the GP's perceived personal, professional and organisational demands; (C) restrictive antibiotic prescribing is time-consuming; (D) restrictive antibiotic prescribing can protect the effectiveness of antibiotics; and (E) patients benefit personally from restrictive antibiotic prescribing. Conclusions Restrictive antibiotic prescribing was considered important in two perceptions, was not an issue as such in two others, and was considered in one perception although the actual prescribing was greatly influenced by the interaction between patient and GP. Accordingly, to encourage restrictive antibiotic prescribing several aspects must be addressed. Furthermore, different GPs need various kinds of support. Infectious disease management in primary care is complex and time-consuming, which must be acknowledged in healthcare organisation and planning. PMID:21223592

  8. Potential benefits of integrated COPD management in primary care.

    PubMed

    Kruis, A L; Chavannes, N H

    2010-09-01

    Chronic obstructive pulmonary disease (COPD) represents a major and progressive cause of morbidity and mortality worldwide, resulting in an important financial and health burden in coming decades. Pulmonary rehabilitation (PR) has been proven to be the most effective treatment in all patients in whom respiratory symptoms are associated with diminished functional capacity or reduced quality of life. Nevertheless, despite wide recommendation and proven efficacy, the use of PR is limited in daily practice. Reasons for these include low accessibility and availability, high costs, and lack of motivation to continue a healthy life style after treatment. By contrast, it has been demonstrated that primary care patients can be reactivated by formulating personal targets and designing individualized treatment plans in collaboration with their general practitioner or practice nurse. Based on these personal plans and targets, specific education must be provided and development of self management skills should be actively encouraged. Ideally, elements of pulmonary rehabilitation are tailored into a comprehensive primary care integrated disease management program. In that way, the benefits of PR can be extended to a substantially larger part of the COPD population, to reach even those with milder stages of disease. Favorable long-term effects on exercise tolerance and quality of life in a number of studies have been demonstrated in recent years, but broad introduction in the primary care setting still needs further justification in the form of a proper cost effectiveness analysis. PMID:21214043

  9. [Management of the esophageal candidiasis by the primary care physician].

    PubMed

    Behrens, Garance; Bocherens, Astrid; Senn, Nicolas

    2014-05-14

    Esophageal candidiasis is one of the most common opportunistic infections in patients infected by human immunodeficiency virus (HIV). This pathology is also found in patients without overt immunodeficiency. Other risk factors are known to be associated with this disease like inhaled or systemic corticosteroid treatment or proton-pump inhibitors and H2 receptor antagonists. In the absence of identified risk factors, a primary immune deficiency should be sought. Prevention of esophageal candidiasis is based primarily on the identification of risk factors, and a better control of them. This article presents a review of the physiopathology, clinical presentation and management of esophageal candidiasis by primary care physicians. We will also discuss ways of preventing esophageal candidiasis when necessary.

  10. Parental Choice of Schools and Parents' Perceptions of Multicultural and Co-Existence Education: The Case of the Israeli Palestinian-Jewish Bilingual Primary Schools

    ERIC Educational Resources Information Center

    Bekerman, Zvi; Tatar, Moshe

    2009-01-01

    The present research effort aims to better understand parental choice of the Israeli Palestinian-Jewish bilingual primary schools and its implications in contributing (or not) to fostering multicultural and co-existence educational efforts in conflict-ridden societies. The manuscript offers a short description of the educational initiative under…

  11. Parental Choice of Schooling, Learning Processes and Inter-Ethnic Friendship Patterns: The Case of Malay Students in Chinese Primary Schools in Malaysia

    ERIC Educational Resources Information Center

    Sua, Tan Yao; Ngah, Kamarudin; Darit, Sezali Md.

    2013-01-01

    This study surveys 200 Malay students enrolled in three Chinese primary schools in relation to three issues, i.e., parental choice of schooling, learning processes and inter-ethnic friendship patterns. The three issues are explored through a combination of quantitative and qualitative research methodologies. Parental expectations for their…

  12. Choice of Scottish Gaelic-Medium and Welsh-Medium Education at the Primary and Secondary School Stages: Parent and Pupil Perspectives

    ERIC Educational Resources Information Center

    O'Hanlon, Fiona

    2015-01-01

    Results are presented of a comparative study of the reasons for parental choice of Scottish Gaelic-medium and Welsh-medium primary education in the year 2000 and of the reasons for pupils' decisions to continue with Gaelic or Welsh-medium education at secondary school in 2007. Parents in both contexts cited the quality of Celtic-medium…

  13. Current Management of Primary Central Nervous System Lymphoma

    SciTech Connect

    Schultz, Christopher J.; Bovi, Joseph

    2010-03-01

    Primary central nervous cell lymphoma (PCNSL) is an uncommon neoplasm of the brain, leptomeninges, and rarely the spinal cord. Initially thought to be characteristically associated with congenital, iatrogenic, or acquired immunosuppression, PCNSL is now recognized with increasing frequency in immunocompetent individuals. The role of surgery is limited to establishing diagnosis, as PCNSL is often multifocal with a propensity to involve the subarachnoid space. A whole-brain radiation volume has empirically been used to adequately address the multifocal tumor frequently encountered at the time of PCNSL diagnosis. Despite high rates of response after whole-brain radiotherapy (WBRT), rapid recurrence is common and long-term survival is the exception. Chemotherapy alone or in combination with WBRT has more recently become the treatment of choice. Most effective regimens contain high-dose methotrexate and or other agents that are capable of penetrating the blood-brain barrier. High response rates and improved survival with the use of chemotherapy has led to treatment strategies that defer or eliminate WBRT in hopes of lessening the risk of neurotoxicity attributed to WBRT. Unfortunately, elimination of WBRT is also associated with a higher rate of relapse. Combined chemotherapy and WBRT regimens are now being explored that use lower total doses of radiation and altered fractionation schedules with the aim of maintaining high rates of tumor control while minimizing neurotoxicity. Pretreatment, multifactor prognostic indices have recently been described that may allow selection of treatment regimens that strike an appropriate balance of risk and benefit for the individual PCNSL patient.

  14. Reducing uncertainty in managing respiratory tract infections in primary care

    PubMed Central

    Stanton, Naomi; Francis, Nick A; Butler, Chris C

    2010-01-01

    Respiratory tract infections (RTIs) remain the commonest reason for acute consultations in primary care in resource-rich countries. Their spectrum and severity has changed from the time that antibiotics were discovered, largely from improvements in the socioeconomic determinants of health as well as vaccination. The benefits from antibiotic treatment for common RTIs have been shown to be largely overstated. Nevertheless, serious infections do occur. Currently, no clinical features or diagnostic test, alone or in combination, adequately determine diagnosis, aetiology, prognosis, or response to treatment. This narrative review focuses on emerging evidence aimed at helping clinicians reduce and manage uncertainty in treating RTIs. Consultation rate and prescribing rate trends are described, evidence of increasing rates of complications are discussed, and studies and the association with antibiotic prescribing are examined. Methods of improving diagnosis and identifying those patients who are at increased risk of complications from RTIs, using clinical scoring systems, biomarkers, and point of care tests are also discussed. The evidence for alternative management options for RTIs are summarised and the methods for changing public and clinicians' beliefs about antibiotics, including ways in which we can improve clinician–patient communication skills for management of RTIs, are described. PMID:21144191

  15. Academy of Medicine-Ministry of Health Clinical Practice Guidelines: Assessment and Management of Infertility at Primary Healthcare Level

    PubMed Central

    Loh, Seong Feei; Agarwal, Rachna; Chan, Jerry; Chia, Sing Joo; Cho, Li Wei; Lim, Lean Huat; Lau, Matthew Sie Kuei; Loh, Sheila Kia Ee; Hendricks, Marianne Sybille; Nair, Suresh; Quah, Joanne Hui Min; Tan, Heng Hao; Wong, PC; Yeong, Cheng Toh; Yu, Su Ling

    2014-01-01

    The Academy of Medicine (AMS) and Ministry of Health (MOH) have developed the clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level to provide doctors and patients in Singapore with evidence-based treatment for infertility. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the AMS-MOH clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_ medical/2013/cpgmed_infertility.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:24570313

  16. Academy of Medicine-Ministry of Health Clinical Practice Guidelines: assessment and management of infertility at primary healthcare level.

    PubMed

    Loh, Seong Feei; Agarwal, Rachna; Chan, Jerry K; Chia, Sing Joo; Cho, Li Wei; Lim, Lean Huat; Lau, Matthew Sie Kuei; Loh, Sheila Kia Ee; Hendricks, Marianne Sybille; Nair, Suresh; Quah, Joanne Hui Min; Tan, Heng Hao; Wong, P C; Yeong, Cheng Toh; Yu, Su Ling

    2014-02-01

    The Academy of Medicine (AMS) and Ministry of Health (MOH) have developed the clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level to provide doctors and patients in Singapore with evidence-based treatment for infertility. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the AMS-MOH clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical/2013/cpgmed_infertility.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

  17. Optimizing the management of depression: primary care experience.

    PubMed

    Cameron, Catherine; Habert, Jeff; Anand, Leena; Furtado, Melissa

    2014-12-01

    This article is intended to identify some of the most important challenges faced by family physicians when treating MDD and to provide practical solutions. Key issues, reviewed from a primary care view point will include: treating to remission (and not just response), identification of high-risk groups, diagnosis, acute treatment approaches (including pharmacotherapy and the management of related side effects), the use of psychotherapy and somatic therapies, assessment of the adequacy of treatment including the assessment of remission, response measurement, optimal follow-up care throughout the phase of treatment, the key components of patient education and strategies for partial/limited response to the first-line antidepressant (switching, augmentation and combination strategies), how to provide support for improved treatment adherence, and approaches to prevent the recurrence of depressive episodes.

  18. Practice parameter for the diagnosis and management of primary immunodeficiency.

    PubMed

    Bonilla, Francisco A; Khan, David A; Ballas, Zuhair K; Chinen, Javier; Frank, Michael M; Hsu, Joyce T; Keller, Michael; Kobrynski, Lisa J; Komarow, Hirsh D; Mazer, Bruce; Nelson, Robert P; Orange, Jordan S; Routes, John M; Shearer, William T; Sorensen, Ricardo U; Verbsky, James W; Bernstein, David I; Blessing-Moore, Joann; Lang, David; Nicklas, Richard A; Oppenheimer, John; Portnoy, Jay M; Randolph, Christopher R; Schuller, Diane; Spector, Sheldon L; Tilles, Stephen; Wallace, Dana

    2015-11-01

    The American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma & Immunology (ACAAI) have jointly accepted responsibility for establishing the "Practice parameter for the diagnosis and management of primary immunodeficiency." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion.

  19. Contemporary management of primary immune thrombocytopenia in adults.

    PubMed

    Lakshmanan, S; Cuker, A

    2012-10-01

    Immune thrombocytopenia (ITP) comprises a syndrome of diverse disorders that have in common immune-mediated thrombocytopenia, but that differ with respect to pathogenesis, natural history and response to therapy. ITP may occur in the absence of an evident predisposing etiology (primary ITP) or as a sequela of a growing list of associated conditions (secondary ITP). Primary ITP remains a diagnosis of exclusion and must be differentiated from non-autoimmune etiologies of thrombocytopenia and secondary causes of ITP. The traditional objective of management is to provide a hemostatic platelet count (> 20-30 × 10(9) L(-1) in most cases) while minimizing treatment-related toxicity, although treatment goals should be tailored to the individual patient and clinical setting. Corticosteroids, supplemented with either intravenous immune globulin G or anti-Rh(D) as needed, are used as upfront therapy to stop bleeding and raise the platelet count acutely in patients with newly diagnosed or newly relapsed disease. Although most adults with primary ITP respond to first-line therapy, the majority relapse after treatment is tapered and require a second-line approach to maintain a hemostatic platelet count. Standard second-line options include splenectomy, rituximab and the thrombopoietin receptor agonists, romiplostim and eltrombopag. Studies that directly compare the efficacy, safety and cost-effectiveness of these approaches are lacking. In the absence of such data, we do not favor a single second-line approach for all patients. Rather, we consider the pros and cons of each option with our patients and engage them in the decision-making process.

  20. Review on the Management of Primary Congenital Glaucoma

    PubMed Central

    Yu Chan, Julia Yan; Choy, Bonnie NK; Ng, Alex LK

    2015-01-01

    ABSTRACT Despite being documented in medical history from over 2400 years ago, primary congenital glaucoma (PCG), being a disease with low incidence rate, remains a challenge to ophthalmologists. The article provides a broad overview on the pathophysiology and diagnostic approach to PCG with major emphasis on the treatment options of PCG. While reviewing on the well-established treatment options, namely goniotomy, trabeculo-tomy and combined trabeculotomy-trabeculectomy, emphasis has also been made to recent updates on secondary treatments: trabeculectomy, antimetabolites, glaucoma-drainage devices and cyclodestructive procedures. It is, however, important to note that the rarity of PCG places limitations on study design, most studies are, thus, retrospective, nonrandomized and have different definitions of surgical success. Ophthalmologists need to interpret the results with critical thinking and formulate individual treatment plans for each patient. How to cite this article: Yu Chan JY, Choy BNK, Alex LK Ng, Shum JWH. Review on the Management of Primary Congenital Glaucoma. J Curr Glaucoma Pract 2015;9(3):92-99. PMID:26997844

  1. Anxiety and diabetes: Innovative approaches to management in primary care.

    PubMed

    Bickett, Allison; Tapp, Hazel

    2016-09-01

    Type 2 diabetes mellitus is a chief concern for patients, healthcare providers, and health care systems in America, and around the globe. Individuals with type 2 diabetes mellitus exhibit clinical and subclinical symptoms of anxiety more frequently than people without diabetes. Anxiety is traditionally associated with poor metabolic outcomes and increased medical complications among those with type 2 diabetes mellitus. Collaborative care models have been utilized in the multidisciplinary treatment of mental health problems and chronic disease, and have demonstrated success in managing the pathology of depression which often accompanies diabetes. However, no specific treatment model has been published that links the treatment of anxiety to the treatment of type 2 diabetes mellitus. Given the success of collaborative care models in treating depression associated with diabetes, and anxiety unrelated to chronic disease, it is possible that the collaborative care treatment of primary care patients who suffer from both anxiety and diabetes could be met with the same success. The key issue is determining how to implement and sustain these models in practice. This review summarizes the proposed link between anxiety and diabetes, and offers an innovative and evidence-based collaborative care model for anxiety and diabetes in primary care. PMID:27390262

  2. Diagnosis and management of primary intraocular lymphoma: an update

    PubMed Central

    Jahnke, Kristoph; Thiel, Eckhard; Abrey, Lauren E; Neuwelt, Edward A; Korfel, Agnieszka

    2007-01-01

    Despite recent advances in diagnosis and treatment, the prognosis of primary intraocular lymphoma (PIOL) remains poor, and the optimal treatment has yet to be defined. This review presents an overview of the current status of PIOL with a focus on recent advances in diagnosis and treatment. Recent studies show a decreasing time interval from symptom presentation to diagnosis, likely due to increased awareness of the disease and improved diagnostic tools. Advances in the pathologic characterization of PIOL have been made over the past years, and the development of PIOL animal models can offer the opportunity to study aspects of PIOL pathology, pathogenesis and treatment. Regarding treatment of PIOL, recent larger case series favor the use of systemic chemotherapy plus local ocular treatment as first-line management for patients with concomitant PIOL and PCNSL. For patients with isolated PIOL, the current trend focuses on local first-line treatment and early diagnosis of PIOL. Future studies are needed to confirm these trends. Future directions in the management of PIOL should include studies about pathogenesis, prognostic factors, and treatment optimization. In the future, monoclonal antibodies and radioimmunotherapy could prove useful for PIOL treatment. PMID:19668478

  3. Primary headaches interfere with the efficacy of temporomandibular disorders management

    PubMed Central

    PORPORATTI, André Luís; COSTA, Yuri Martins; CONTI, Paulo César Rodrigues; BONJARDIM, Leonardo Rigoldi; CALDERON, Patrícia dos Santos

    2015-01-01

    OBJECTIVES: This cross-sectional study aimed to evaluate the influence of Primary Headache (PH) on efficacy of a Temporomandibular Disorders (TMD) conservative therapy and its association with the presence of self-reported parafunctional habits. SAMPLE AND METHODS: Sample was composed of 400 medical records, divided into four groups: I) Muscular TMD (n=64); II) Muscular TMD+PH (n=48); III) Muscular TMD+Articular TMD (n=173); IV) Muscular TMD+Articular TMD+PH (n=115). All groups had undergone a TMD therapy for three months with a stabilization appliance and counseling for habits and behavioral changes, with no specific headache management. Current pain intensity and existence or not of self-reported bruxism were assessed. Repeated measures ANOVA and Chi-Square test followed by Odds were used for statistical analysis, with a significance level of 5%. RESULTS: results of this study showed that: (1) A conservative therapy with stabilization appliance and counseling for habits and behavioral changes was effective in the TMD pain relief; (2) Groups with an additional diagnosis of PH had worsened the pain improvement significantly; and (3) no association between the presence of self-reported bruxism and PH was found. CONCLUSIONS: this study could elucidate the important effect that headache may have on the TMD management. PMID:25004051

  4. Simplified stepwise management of primary spontaneous pneumothorax: a pilot study.

    PubMed

    Marquette, C-H; Marx, A; Leroy, S; Vaniet, F; Ramon, P; Caussade, S; Smaiti, N; Bonfils, C

    2006-03-01

    In primary spontaneous pneumothorax (PSP) requiring intervention, removal of air from the pleural space can be achieved by manual needle aspiration or by pleural drainage after insertion of a chest tube. This study aimed to evaluate the efficacy and safety of a serial-steps approach with a single system (small-calibre catheter/Heimlich valve) in a homogeneous population of patients with a first episode of PSP. All patients had an 8.5 F distally multiperforated polyurethane pigtail catheter inserted via the anterior route, at the bedside without any guidance, using the Seldinger technique. A one-way Heimlich valve was connected to the catheter, allowing the air to flow spontaneously outwards for 24-48 h. Thereafter, if the lung failed to re-expand wall suction was applied. Patients with an air leak persisting for >4 days were referred for surgery. Primary end-points were success rates at 24 h and 1 week, and 1 yr recurrence-free survival. In total, 41 consecutive patients entered the study. They were typically thin, young, smoking males. No procedure-related complications were observed. The need for pain relief medication was minimal. Within the first 24 h, most of the patients were able to walk around and half of them were able to take a shower with their catheter in place. The 24-h and 1-week success rates were 61 and 85%, respectively, and the actuarial 1-yr recurrence rate was 24%. Four patients underwent surgical pleurodesis because of a persistent air leak. The length of stay when excluding the four surgical cases was 2.3+/-1.3 days. When 24-h and 1-week success rates and recurrence at 12 months were taken as end-points, the method described here is as effective as simple manual needle aspiration or a conventional chest tube thoracotomy. These results support further studies assessing this "one system, serial-steps approach" in an outpatient management algorithm.

  5. Expanding the Reach of Participatory Risk Management: Testing an Online Decision-Aiding Framework for Informing Internally Consistent Choices.

    PubMed

    Bessette, Douglas L; Campbell-Arvai, Victoria; Arvai, Joseph

    2016-05-01

    This article presents research aimed at developing and testing an online, multistakeholder decision-aiding framework for informing multiattribute risk management choices associated with energy development and climate change. The framework was designed to provide necessary background information and facilitate internally consistent choices, or choices that are in line with users' prioritized objectives. In order to test different components of the decision-aiding framework, a six-part, 2 × 2 × 2 factorial experiment was conducted, yielding eight treatment scenarios. The three factors included: (1) whether or not users could construct their own alternatives; (2) the level of detail regarding the composition of alternatives users would evaluate; and (3) the way in which a final choice between users' own constructed (or highest-ranked) portfolio and an internally consistent portfolio was presented. Participants' self-reports revealed the framework was easy to use and providing an opportunity to develop one's own risk-management alternatives (Factor 1) led to the highest knowledge gains. Empirical measures showed the internal consistency of users' decisions across all treatments to be lower than expected and confirmed that providing information about alternatives' composition (Factor 2) resulted in the least internally consistent choices. At the same time, those users who did not develop their own alternatives and were not shown detailed information about the composition of alternatives believed their choices to be the most internally consistent. These results raise concerns about how the amount of information provided and the ability to construct alternatives may inversely affect users' real and perceived internal consistency. PMID:26381043

  6. Benign prostatic hyperplasia (BPH) management in the primary care setting.

    PubMed

    Kapoor, Anil

    2012-10-01

    Benign prostate hyperplasia (BPH) occurs in up to 50% of men by age 50, and the incidence increases with age. This common clinical problem is diagnosed by history, including the International Prostate Symptom Score (IPSS) questionnaire, and physical examination by digital rectal examination (DRE). Initial management for BPH includes lifestyle modification, and smooth muscle relaxant alpha blocker therapy. Alpha blockers usually take effect quickly within 3-5 days, and have minimal side effects. Current commonly used alpha blockers include the selective alpha blockers tamsulosin (Flomax), alfusosin (Xatral), and silodosin (Rapaflo). For patients with larger prostates, the 5-alpha reductase inhibitor class (finasteride (Proscar) and dutasteride (Avodart)) work effectively to shrink prostate stroma resulting in improved voiding. The 5-ARI class of drugs, in addition to reducing prostate size, also reduce the need for future BPH-related surgery, and reduce the risk of future urinary retention. Drugs from the phosphodiesterase-5 (PDE-5) inhibitor class may now be considered for treating BPH. Once daily 5 mg tadalafil has been shown to improve BPH-related symptoms and is currently approved to treat patients with BPH. Referral to a urologist can be considered for patients with a rising prostate-specific antigen (PSA), especially while on 5-ARI, failure of urinary symptom control despite maximal medical therapy, suspicion of prostate cancer, hematuria, recurrent urinary infections, urinary retention, or renal failure. Currently the primary care physician is armed with multiple treatment options to effectively treat men with symptomatic BPH. PMID:23089343

  7. Rosacea: recognition and management for the primary care provider.

    PubMed

    Chalmers, D A

    1997-10-01

    Rosacea is a common facial dermatitis that currently affects an estimated 13 million Americans. It is a chronic and progressive cutaneous vascular disorder, primarily involving the malar and nasal areas of the face. Rosacea is characterized by flushing, erythema, papules, pustules, telanglectasia, facial edema, ocular lesions, and, in its most advanced and severe form, rhinophyma. Ocular lesions are common, including mild conjunctivitis, burning, and grittiness. Blepharitis, the most common ocular manifestation, is a nonulcerative condition of the lid margins. Rosacea most commonly occurs between the ages of 30 to 60, and may be seen in women experiencing hormonal changes associated with menopause. Women are more frequently affected than men; the most severe cases, however, are seen in men. Fair complexioned individuals of Northern European descent are most likely to be at risk for rosacea; most appear to be pre-disposed to flushing and blushing. Alcohol, stress, spicy foods, and extremes of temperature have all been implicated, but have not been found to actually cause rosacea. Early diagnosis by the primary care practitioner, management with systemic antibiotics such as tetracycline, and topical agents such as metronidazole, in conjunction with patient education and lifestyle modifications, can achieve remission in most instances. PMID:9355115

  8. Approach to management of the patient with primary or secondary intrathoracic goiter.

    PubMed

    Hegedüs, Laszlo; Bonnema, Steen J

    2010-12-01

    Intrathoracic (substernal) goiter, depending on definition, is seen in up to 45% of all patients operated for goiter. It can either be primary (ectopic thyroid tissue detached from a cervical thyroid mass), which is very rare (1%), or (more commonly) secondary, where a portion of the goiter extends retrosternally. There is no consensus on diagnostic or therapeutic management, partly because many are asymptomatic. Classification involves functional characterization with serum TSH and morphological characterization with diagnostic imaging and cytology to rule out malignancy, which is not more common than in cervical goiters. Pulmonary function is often affected in asymptomatic individuals also. Therefore, but also because natural history is continuous growth and evolution from euthyroidism to hyperthyroidism, most experts recommend therapy. In primary as well as secondary intrathoracic goiter, the therapy of choice is total/near-total thyroidectomy and subsequent levothyroxine substitution. Data suggest that complications are only slightly more prevalent than in cervical goiters. Although levothyroxine is not recommended for goiter shrinkage, there is increasing focus on radioactive iodine as an alternative to surgery in secondary intrathoracic goiters. Here it can reduce thyroid size by on average 40% after 1 yr and improve respiratory function and quality of life. Recent studies show that recombinant human TSH, currently used off-label, can augment the radioiodine-related goiter shrinkage by 30-50%. With currently used doses of recombinant human TSH, the side effects, besides hypothyroidism, are rare and mild. Future studies should also explore the use of radioiodine in primary intrathoracic goiter and compare surgery and radioiodine, head to head. PMID:21131536

  9. Primary care by desire or default? Specialty choices of minority graduates of US medical schools in 1983.

    PubMed Central

    Babbott, D.; Weaver, S. O.; Baldwin, D. C.

    1994-01-01

    This study was undertaken to determine if US medical school students of different racial/ethnic backgrounds demonstrate similar patterns of evolution of specialty choice between their senior year of medical school and their third postgraduate year. The study identified the specialty choices of US medical school seniors in 1983 through their responses to the Association of American Medical Colleges Graduating Medical Student Questionnaire (GQ). The cohort was classified into three groups: underrepresented minorities, non-underrepresented minorities, and whites. Using these AAMC data as baseline, each racial/ethnic background group was tracked through their third residency year. Comparisons were made between anticipated specialty choices as senior medical students and actual specialties as revealed through residency tracking. The study found that more than 95% of the cohort began residencies in specialties compatible with their GQ choices. Unexpectedly, almost 20% of blacks, Commonwealth Puerto Ricans, and other Hispanics were not in graduate medical education in their third postgraduate year. This group needs to be studied further in order to learn the proportion of these physicians who subsequently completed residency training and the reason(s) for attrition in physicians who did not fulfill minimum training requirements for board certification. PMID:8064901

  10. Preschool Education and Primary School Pre-Service Teachers' Perceptions about Classroom Management: A Metaphorical Analysis

    ERIC Educational Resources Information Center

    Uysal, Hatice; Burçak, Firdevs; Tepetas, Gülüzar Sule; Akman, Berrin

    2014-01-01

    The aim of the research was to determine the perceptions of preschool and primary school teachers about classroom management by means of metaphors. The sample which selected by the use of convenience sampling techniques was drawn from preschool and primary school undergraduate students who had taken the "Classroom Management" course in…

  11. Working capital management, corporate performance, and strategic choices of the wholesale and retail industry in China.

    PubMed

    Li, Chuan-guo; Dong, Hui-min; Chen, Shou; Yang, Yan

    2014-01-01

    We examine the influence of strategic choice on working capital configurations and observe how the relationship between working capital ratio and operational performance differs depending on strategy. By clustering the strategic factors of the wholesale and retail industry, we find three categories of strategies: terminal market strategy, middle market strategy, and hybrid strategy. Using the panel data of the listed companies of the wholesale and retail industry as our sample, we analyze the differences in the ways companies configure working capital, the speed with which working capital adjusts to its target, and the effects of working capital on performance for companies that make different strategic choices. The empirical results suggest that working capital is configured and adjusted to its target in different ways under different competitive strategic choices. This effect is finally transferred to influence the relationship between working capital configuration and operational performance. PMID:25121141

  12. Working capital management, corporate performance, and strategic choices of the wholesale and retail industry in China.

    PubMed

    Li, Chuan-guo; Dong, Hui-min; Chen, Shou; Yang, Yan

    2014-01-01

    We examine the influence of strategic choice on working capital configurations and observe how the relationship between working capital ratio and operational performance differs depending on strategy. By clustering the strategic factors of the wholesale and retail industry, we find three categories of strategies: terminal market strategy, middle market strategy, and hybrid strategy. Using the panel data of the listed companies of the wholesale and retail industry as our sample, we analyze the differences in the ways companies configure working capital, the speed with which working capital adjusts to its target, and the effects of working capital on performance for companies that make different strategic choices. The empirical results suggest that working capital is configured and adjusted to its target in different ways under different competitive strategic choices. This effect is finally transferred to influence the relationship between working capital configuration and operational performance.

  13. Working Capital Management, Corporate Performance, and Strategic Choices of the Wholesale and Retail Industry in China

    PubMed Central

    Li, Chuan-guo; Dong, Hui-min; Chen, Shou; Yang, Yan

    2014-01-01

    We examine the influence of strategic choice on working capital configurations and observe how the relationship between working capital ratio and operational performance differs depending on strategy. By clustering the strategic factors of the wholesale and retail industry, we find three categories of strategies: terminal market strategy, middle market strategy, and hybrid strategy. Using the panel data of the listed companies of the wholesale and retail industry as our sample, we analyze the differences in the ways companies configure working capital, the speed with which working capital adjusts to its target, and the effects of working capital on performance for companies that make different strategic choices. The empirical results suggest that working capital is configured and adjusted to its target in different ways under different competitive strategic choices. This effect is finally transferred to influence the relationship between working capital configuration and operational performance. PMID:25121141

  14. Clinical features and management of primary sclerosing cholangitis

    PubMed Central

    Silveira, Marina G; Lindor, Keith D

    2008-01-01

    Primary sclerosing cholangitis is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the bile ducts, resulting in cirrhosis and need for liver transplantation and reduced life expectancy. The majority of cases occur in young and middle-aged men, often in association with inflammatory bowel disease. The etiology of primary sclerosing cholangitis includes immune-mediated components and elements of undefined nature. No effective medical therapy has been identified. The multiple complications of primary sclerosing cholangitis include metabolic bone disease, dominant strictures, bacterial cholangitis, and malignancy, particularly cholangiocarcinoma, which is the most lethal complication of primary sclerosing cholangitis. Liver transplantation is currently the only life-extending therapeutic alternative for patients with end-stage disease, although recurrence in the allografted liver has been described. A PSC-like variant attracting attention is cholangitis marked by raised levels of the immunoglobulin G4 subclass, prominence of plasma cells within the lesions, and steroid responsiveness. PMID:18528931

  15. Primary care management of depression in children and adolescents.

    PubMed

    Haefner, Judy

    2016-06-19

    Depression is the most common mental health disorder in children and adolescents, and primary care is often the first point of contact for children and adolescents with depression. Depression impacts all areas of life, impairing academics and interactions with family and friends. The purpose of this article is to help NPs identify and treat children and adolescents presenting with depression in the primary care setting. PMID:27214067

  16. Newcomers Navigating Language Choice and Seeking Voice: Peer Talk in a Multilingual Primary School Classroom in Finland

    ERIC Educational Resources Information Center

    Mokkonen, Alicia Copp

    2013-01-01

    This article investigates how two young newcomers navigate an institutional policy of "English only" in a Finnish primary school and how this policy impacts opportunities for voice. From a discourse analytic and sociolinguistic perspective, the analysis takes an ethnographic path to a focal event of language conflict in the classroom. The analysis…

  17. School Management Related Knowledge Levels of Primary School Teachers

    ERIC Educational Resources Information Center

    Ugurlu, Celal Teyyar

    2013-01-01

    The knowledge levels of the teachers affect the qualifications of operations and transactions in schools. School management related knowledge of the teachers is an essential tool to reach the targets of the school. The objective of this study was to determine the school management related knowledge levels of the teachers. Qualitative and…

  18. A multi-stakeholder framework for urban runoff quality management: Application of social choice and bargaining techniques.

    PubMed

    Ghodsi, Seyed Hamed; Kerachian, Reza; Zahmatkesh, Zahra

    2016-04-15

    In this paper, an integrated framework is proposed for urban runoff management. To control and improve runoff quality and quantity, Low Impact Development (LID) practices are utilized. In order to determine the LIDs' areas and locations, the Non-dominated Sorting Genetic Algorithm-II (NSGA-II), which considers three objective functions of minimizing runoff volume, runoff pollution and implementation cost of LIDs, is utilized. In this framework, the Storm Water Management Model (SWMM) is used for stream flow simulation. The non-dominated solutions provided by the NSGA-II are considered as management scenarios. To select the most preferred scenario, interactions among the main stakeholders in the study area with conflicting utilities are incorporated by utilizing bargaining models including a non-cooperative game, Nash model and social choice procedures of Borda count and approval voting. Moreover, a new social choice procedure, named pairwise voting method, is proposed and applied. Based on each conflict resolution approach, a scenario is identified as the ideal solution providing the LIDs' areas, locations and implementation cost. The proposed framework is applied for urban water quality and quantity management in the northern part of Tehran metropolitan city, Iran. Results show that the proposed pairwise voting method tends to select a scenario with a higher percentage of reduction in TSS (Total Suspended Solid) load and runoff volume, in comparison with the Borda count and approval voting methods. Besides, the Nash method presents a management scenario with the highest cost for LIDs' implementation and the maximum values for percentage of runoff volume reduction and TSS removal. The results also signify that selection of an appropriate management scenario by stakeholders in the study area depends on the available financial resources and the relative importance of runoff quality improvement in comparison with reducing the runoff volume.

  19. A multi-stakeholder framework for urban runoff quality management: Application of social choice and bargaining techniques.

    PubMed

    Ghodsi, Seyed Hamed; Kerachian, Reza; Zahmatkesh, Zahra

    2016-04-15

    In this paper, an integrated framework is proposed for urban runoff management. To control and improve runoff quality and quantity, Low Impact Development (LID) practices are utilized. In order to determine the LIDs' areas and locations, the Non-dominated Sorting Genetic Algorithm-II (NSGA-II), which considers three objective functions of minimizing runoff volume, runoff pollution and implementation cost of LIDs, is utilized. In this framework, the Storm Water Management Model (SWMM) is used for stream flow simulation. The non-dominated solutions provided by the NSGA-II are considered as management scenarios. To select the most preferred scenario, interactions among the main stakeholders in the study area with conflicting utilities are incorporated by utilizing bargaining models including a non-cooperative game, Nash model and social choice procedures of Borda count and approval voting. Moreover, a new social choice procedure, named pairwise voting method, is proposed and applied. Based on each conflict resolution approach, a scenario is identified as the ideal solution providing the LIDs' areas, locations and implementation cost. The proposed framework is applied for urban water quality and quantity management in the northern part of Tehran metropolitan city, Iran. Results show that the proposed pairwise voting method tends to select a scenario with a higher percentage of reduction in TSS (Total Suspended Solid) load and runoff volume, in comparison with the Borda count and approval voting methods. Besides, the Nash method presents a management scenario with the highest cost for LIDs' implementation and the maximum values for percentage of runoff volume reduction and TSS removal. The results also signify that selection of an appropriate management scenario by stakeholders in the study area depends on the available financial resources and the relative importance of runoff quality improvement in comparison with reducing the runoff volume. PMID:26849322

  20. Roles of primary care physicians in managing bipolar disorders in adults.

    PubMed

    Awaluddin, A; Jali, N; Bahari, R; Jamil, Z; Haron, N

    2015-01-01

    Management of bipolar disorder (BD) is challenging due to its multiple and complex facets of presentations as well as various levels of interventions. There is also limitation of treatment accessibility especially at the primary care level. Local evidence-based clinical practice guidelines address the importance of integrated care of BD at various levels. Primary care physicians hold pertinent role in maintaining remission and preventing relapse by providing systematic monitoring of people with BD. Pharmacological treatment in particular mood stabilisers remain the most effective management with psychosocial interventions as adjunct. This paper highlights the role of primary care physicians in the management of BD.

  1. Enhancing the Effectiveness of Self-Managed Learning Groups: Understanding Students' Choices and Concerns

    ERIC Educational Resources Information Center

    Lizzio, Alf; Wilson, Keithia

    2006-01-01

    Self-managed learning groups are regularly used in higher education. However, there is little direct evidence as to strategies that can enhance their efficacy, or the factors that influence students' engagement with the process of self-management. If students are expected to manage their out-of-class collaborative learning experiences, then…

  2. Public choice in water resource management: two case studies of the small-scale hydroelectric controversy

    SciTech Connect

    Soden, D.L.

    1985-01-01

    Hydroelectric issues have a long history in the Pacific Northwest, and more recently have come to focus on developing environmentally less-obtrusive means of hydroelectric generation. Small-scale hydroelectric represents perhaps the most important of these means of developing new sources of renewable resources to lessen the nation's dependence on foreign sources of energy. Each potential small-scale hydroelectric project, however, manifests a unique history which provides a highly useful opportunity to study the process of collective social choice in the area of new energy uses of water resources. Utilizing the basic concepts of public choice theory, a highly developed and increasingly widely accepted approach in the social sciences, the politicalization of small-scale hydroelectric proposals is analyzed. Through the use of secondary analysis of archival public opinion data collected from residents of the State of Idaho, and through the development of the two case studies - one on the Palouse River in Eastern Washington and the other at Elk Creek Falls in Northern Idaho, the policy relevant behavior and influence of major actors is assessed. Results provide a useful test of the utility of public-choice theory for the study of cases of natural-resources development when public involvement is high.

  3. Identifying Primary Care Skills and Competencies in Opioid Risk Management

    ERIC Educational Resources Information Center

    Chiauzzi, Emil; Trudeau, Kimberlee J.; Zacharoff, Kevin; Bond, Kathleen

    2011-01-01

    Introduction: Primary care physicians (PCPs) treat a high proportion of chronic pain patients but often lack training about how to assess and address issues associated with prescribing opioids when they are an appropriate component of therapy. The result may be that they may avoid treating these patients, which can lead to an undertreatment of…

  4. The role of primary care providers in managing falls.

    PubMed

    Demons, Jamehl L; Duncan, Pamela W

    2014-01-01

    Falls threaten the ability of older adults to live independently in the community. Fortunately, national and state organizations have created tools that allow primary care providers to easily assess fall risk, and small changes in practice patterns can provide patients with the resources necessary to prevent falls, thus helping to reverse a costly, deadly epidemic. PMID:25237872

  5. Impact of chronic disease self-management programs on type 2 diabetes management in primary care

    PubMed Central

    Forjuoh, Samuel N; Ory, Marcia G; Jiang, Luohua; Vuong, Ann M; Bolin, Jane N

    2014-01-01

    AIM: To assess the effectiveness of the Chronic Disease Self-Management Program (CDSMP) on glycated hemoglobin A1c (HbA1c) and selected self-reported measures. METHODS: We compared patients who received a diabetes self-care behavioral intervention, the CDSMP developed at the Stanford University, with controls who received usual care on their HbA1c and selected self-reported measures, including diabetes self-care activities, health-related quality of life (HRQOL), pain and fatigue. The subjects were a subset of participants enrolled in a randomized controlled trial that took place at seven regional clinics of a university-affiliated integrated healthcare system of a multi-specialty group practice between January 2009 and June 2011. The primary outcome was change in HbA1c from randomization to 12 mo. Data were analyzed using multilevel statistical models and linear mixed models to provide unbiased estimates of intervention effects. RESULTS: Demographic and baseline clinical characteristics were generally comparable between the two groups. The average baseline HbA1c values in the CDSMP and control groups were 9.4% and 9.2%, respectively. Significant reductions in HbA1c were seen at 12 mo for the two groups, with adjusted changes around 0.6% (P < 0.0001), but the reductions did not differ significantly between the two groups (P = 0.885). Few significant differences were observed in participants’ diabetes self-care activities. No significant differences were observed in the participants’ HRQOL, pain, or fatigue measures. CONCLUSION: The CDSMP intervention may not lower HbA1c any better than good routine care in an integrated healthcare system. More research is needed to understand the benefits of self-management programs in primary care in different settings and populations. PMID:24936263

  6. Answers to Clinical Questions in the Primary Care Management of People with Obesity: Priniciples of Patient Management.

    PubMed

    Horn, Deborah Bade; Ryan, Donna

    2016-07-01

    Although improvement of physical appearance is a primary motivating factor for patients, the fundamental purpose of weight loss is to improve health. Patients should be managed in the context of a chronic disease, taking a systematic approach to treatment. Lifestyle modification is the cornerstone of weight management. PMID:27565111

  7. Primary Sclerosing Cholangitis: Current and Future Management Strategies

    PubMed Central

    Eaton, John E.; Talwalkar, Jayant A.

    2013-01-01

    Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease. The etiology of this disorder is unknown and there are no effective medical therapies. PSC is associated with inflammatory bowel disease and an increased risk for hepatobiliary and colorectal malignancies. The aim of this review is to highlight the clinical features and diagnostic approach to patients with suspected PSC, characterize associated comorbidities, review screening strategies for PSC associated malignancies and review contemporary and future therapies. PMID:23682242

  8. Management of premature primary tooth loss in the child patient.

    PubMed

    Law, Clarice S

    2013-08-01

    Premature loss of primary teeth can result in a loss of arch length and have a negative effect on occlusion and alignment, often increasing the need for orthodontic treatment. Use of space maintainers can reduce the severity of problems such as crowding, ectopic eruption, tooth impaction and poor molar relationship. This article presents a review of the consequences of premature tooth loss and discusses the appliances commonly used for space maintenance.

  9. Presentation and Management of Bipolar Affective Disorders in Primary Care

    PubMed Central

    Latimer, Elizabeth

    1982-01-01

    The author reviews four case summaries of patients presenting to her family practice within a 12 month period. Each patient presented unique features, which on careful history review, fit the pattern of bipolar affective disorder, the features of which are described. Management of these patients includes mandatory psychiatric consultation and lithium for treatment of acute mania, and prophylaxis of mania and depression. Guidelines for lithium therapy are presented. The family physician is in an ideal position to detect bipolar illness and to manage patients once stabilized on longterm lithium therapy. PMID:21289854

  10. Managing Self-Governing Primary Schools in the Locally Maintained, Grant-Maintained and Private Sectors.

    ERIC Educational Resources Information Center

    Bell, Les; And Others

    1996-01-01

    Discusses a study that surveyed heads of locally maintained, grant-maintained, and private sector (British) primary schools concerning their management styles. Questionnaire and interview data suggest that autonomous primary schools are characterized by collective decision making and high job satisfaction levels. Private sector school heads'…

  11. Missing an opportunity: the embedded nature of weight management in primary care

    PubMed Central

    Osunlana, A. M.; Ogunleye, A. A.; Sharma, A. M.; Campbell‐Scherer, D.

    2015-01-01

    Summary The 5As Team study was designed to create, implement and evaluate a flexible intervention to improve the quality and quantity of weight management visits in primary care. The objective of this portion of the study was to explore how primary care providers incorporate weight management in their practice. 5AsT is a randomized controlled trial (RCT) on the implementation of a 6‐month 5 As Team (5AsT) intervention designed to operationalize the 5As of obesity management in primary care. Data for the qualitative portion of the study presented here included semi‐structured interviews with 29 multidisciplinary team providers and field notes of intervention sessions. Thematic analysis was undertaken. A key pattern that emerged from the data was that healthcare providers usually do not address obesity as a primary focus for a visit. Rather, obesity is embedded in a wide range of primary care encounters for other conditions. Implications were it can take extra time to discuss weight, it can be inappropriate to bring up weight as a topic, and treating risk factors and root causes of obesity have indirect benefits to patient weight management. Our findings have implications for obesity treatment approaches and tools that assume a discreet weight management visit. The embedded nature of obesity management in primary care can be harnessed to leverage multiple opportunities for asking and assessing root causes of obesity, and working longitudinally towards individual health goals. PMID:26303812

  12. Classroom Behaviour Management Content in Australian Undergraduate Primary Teaching Programmes

    ERIC Educational Resources Information Center

    O'Neill, Sue; Stephenson, Jennifer

    2012-01-01

    The ability to differentiate classroom behaviour management (CBM) strategies is an important skill for novice teachers in increasingly diverse classrooms. Worldwide, little is known about the curriculum content offered to pre-service teachers in the area of CBM. This article reports the findings from the first nationwide survey of Australian…

  13. Primary surgical management of the deeply burned hand in children.

    PubMed

    Bondoc, C C; Quinby, W C; Burke, J F

    1976-06-01

    Primary burn excision with immediate wound closure by skin grafting was used as the initial definitive treatment for deep burns of the hand in 30 consecutive children. The results are compared with an additional group of 30 children whose burns were treated with AgNO3 alone. There is a significant difference in all categories examined between the excised and the nonexcised group. Hand deformities, secondary reconstructive procedures, and morbidity were significantly reduced in the excised group. Excision provided improved functional and cosmetic results.

  14. Primary extracorporeal shockwave lithotripsy in management of large bladder calculi.

    PubMed

    Husain, I; el-Faqih, S R; Shamsuddin, A B; Atassi, R

    1994-06-01

    Large bladder calculi are often outside the range of treatment with conventional endoscopic lithotrites because of either anatomic factors or the mechanical limits of available instruments. Alternative methods of cystolithotripsy: ultrasonic, electrohydraulic, or laser, can prove time-consuming or even hazardous, so that open surgery is often the most expeditious option. We report our experience using Dornier HM3 extracorporeal shockwave lithotripsy (SWL) for initial bladder stone reduction preparatory to transurethral litholapaxy and definitive treatment of any underlying obstructive pathology. Primary cystolitholapaxy was judged impractical in these 24 patients (21 adults and 3 children) presenting 31 large bladder stones (mean size 35.6 mm). In all patients, primary transpelvic SWL was followed immediately by endoscopic evacuation of stone debris or cystolitholapaxy. In addition, 10 of the 24 patients (42%) underwent a definitive endoscopic operation for treatment of an underlying obstructive lesion at either the same or a follow-on session. Morbidity was minimal, and the mean hospital stay after the initial SWL treatment was 3.5 days. In our experience, Dornier SWL has proved invaluable in enabling cystolitholapaxy of very large bladder calculi that would otherwise require protracted and difficult endoscopic manipulation or open surgery.

  15. Riverine threat indices to assess watershed condition and identify primary management capacity of agriculture natural resource management agencies.

    PubMed

    Fore, Jeffrey D; Sowa, Scott P; Galat, David L; Annis, Gust M; Diamond, David D; Rewa, Charles

    2014-03-01

    Managers can improve conservation of lotic systems over large geographies if they have tools to assess total watershed conditions for individual stream segments and can identify segments where conservation practices are most likely to be successful (i.e., primary management capacity). The goal of this research was to develop a suite of threat indices to help agriculture resource management agencies select and prioritize watersheds across Missouri River basin in which to implement agriculture conservation practices. We quantified watershed percentages or densities of 17 threat metrics that represent major sources of ecological stress to stream communities into five threat indices: agriculture, urban, point-source pollution, infrastructure, and all non-agriculture threats. We identified stream segments where agriculture management agencies had primary management capacity. Agriculture watershed condition differed by ecoregion and considerable local variation was observed among stream segments in ecoregions of high agriculture threats. Stream segments with high non-agriculture threats were most concentrated near urban areas, but showed high local variability. 60 % of stream segments in the basin were classified as under U.S. Department of Agriculture's Natural Resources Conservation Service (NRCS) primary management capacity and most segments were in regions of high agricultural threats. NRCS primary management capacity was locally variable which highlights the importance of assessing total watershed condition for multiple threats. Our threat indices can be used by agriculture resource management agencies to prioritize conservation actions and investments based on: (a) relative severity of all threats, (b) relative severity of agricultural threats, and (c) and degree of primary management capacity.

  16. Primary Care Management of Chronic Nonmalignant Pain in Veterans: A Qualitative Study

    ERIC Educational Resources Information Center

    Ruiz, Jorge G.; Qadri, S. Sobiya; Nader, Samir; Wang, Jia; Lawler, Timothy; Hagenlocker, Brian; Roos, Bernard A.

    2010-01-01

    Clinicians managing older patients with chronic pain play an important role. This paper explores the attitudes of primary care clinicians (PCPs) toward chronic nonmalignant pain management and their experiences using a clinical decision support system. Our investigation followed a qualitative approach based on grounded theory. Twenty-one PCPs…

  17. Responsibility for Financial Management in Primary Schools: Evidence from an English Local Authority

    ERIC Educational Resources Information Center

    Fitzgerald, Sarah; Drake, Julie

    2013-01-01

    Financial management in primary schools has changed in the UK with the introduction of the Schools Financial Value Standard (SFVS). There is increasing delegation of financial responsibility to the management team in the school, increasing the role of the head teacher and the governing body as part of overall responsibility for the strategic…

  18. Development of an Academic Consortium for Nurse-Managed Primary Care.

    ERIC Educational Resources Information Center

    Pohl, Joanne M.; Bostrom, Andrea C.; Talarczyk, Geraldine; Cavanagh, Stephen

    2001-01-01

    The Michigan Academic Consortium brought together four universities' nursing schools to address advanced practice issues in nurse-managed primary health care. The collaboration enabled participants to leverage financial resources and take advantage of partnership opportunities. Challenges included multiple management practices, competition, and…

  19. Teacher Classroom Behaviour Management Preparation in Undergraduate Primary Education in Australia: A Web-Based Investigation

    ERIC Educational Resources Information Center

    O'Neill, Sue C.; Stephensen, Jennifer

    2011-01-01

    Classroom behaviour management is an essential skill required by all teacher graduates to facilitate instruction in curriculum content. This article describes the classroom behaviour management (CBM) content on offer in Australian undergraduate primary education programs. To date, no nationwide studies exist that report the CBM instruction on…

  20. Collaborative Classroom Management in a Co-Taught Primary School Classroom

    ERIC Educational Resources Information Center

    Rytivaara, Anna

    2012-01-01

    The purpose of this study was to examine how teachers manage their classroom in co-taught lessons. The data were collected by observing and interviewing a pair of primary school teachers. The most important influence of collaboration on classroom management seemed to be the emotional support of another adult, and the opportunity to use different…

  1. Managing Change in Small Scottish Primary Schools. SCRE Research Report Series.

    ERIC Educational Resources Information Center

    Wilson, Valerie; McPake, Joanna

    This report describes Scottish research on ways in which headteachers in small primary schools managed mandated changes. The research focused on implementation of four recent major initiatives: 5-14 Curriculum Guidelines, School Development Planning, Staff Development and Appraisal, and Devolved School Management. Research methods included a…

  2. Dental Management of Patients with Dementia in Primary Dental Care.

    PubMed

    Moosajee, Sukina; Rafique, Sobia; Daly, Blánaid

    2015-05-01

    Dementia is an umbrella term for a set of symptoms that include memory loss, changes in mood and problems with reasoning, attention and communication. It is a progressive condition and there is ample evidence that oral health declines as the severity of dementia increases. Most of this decline is attributable to the effects of cognitive impairment on oral hygiene capability and/or acceptance of help from others in supporting oral hygiene. Factors such as altered salivary flow, taste change, use of high-energy food supplements and syrup-based medications also contribute to the risk of oral and dental diseases. In its role as part of the wider health and social care network, the primary dental care team can make an important contribution to securing the oral health of people living with dementia. PMID:26556259

  3. Integrating GDM management in primary care: Gulf Cooperation Council (GCC) perspective.

    PubMed

    Anjum, Qudsia; Mumtaz, Shadma

    2016-09-01

    Diabetes is prevailing universally and Gulf Cooperation Council (GCC) is no exception. Pregnancies associated with gestational diabetes place women at high risk of natal complications. Statistics from GCC gives variable figures for GDM. Family Physicians are the first level health care providers and their role in management of GDM can be promising. This has been evident from a focused group study where patients prefer screening for GDM in primary care settings. Strengthening of primary care is important universally. Government should have mandatory primary care registration to be referred to secondary level for obstetric follow up and management. An important issue needing attention is presence of multiple criteria for diagnosing and screening GDM. There is need for a single guideline globally to avoid confusion for primary care providers.10 Primary care centers can better be utilized to screen for GDM at early stages. This will decrease the load on secondary and tertiary care centers and can also maintain continuity of care. PMID:27582140

  4. Improving the identification and management of chronic kidney disease in primary care: lessons from a staged improvement collaborative

    PubMed Central

    Harvey, Gill; Oliver, Kathryn; Humphreys, John; Rothwell, Katy; Hegarty, Janet

    2015-01-01

    Quality problem Undiagnosed chronic kidney disease (CKD) contributes to a high cost and care burden in secondary care. Uptake of evidence-based guidelines in primary care is inconsistent, resulting in variation in the detection and management of CKD. Initial assessment Routinely collected general practice data in one UK region suggested a CKD prevalence of 4.1%, compared with an estimated national prevalence of 8.5%. Of patients on CKD registers, ∼30% were estimated to have suboptimal management according to Public Health Observatory analyses. Choice of solution An evidence-based framework for implementation was developed. This informed the design of an improvement collaborative to work with a sample of 30 general practices. Implementation A two-phase collaborative was implemented between September 2009 and March 2012. Key elements of the intervention included learning events, improvement targets, Plan-Do-Study-Act cycles, benchmarking of audit data, facilitator support and staff time reimbursement. Evaluation Outcomes were evaluated against two indicators: number of patients with CKD on practice registers; percentage of patients achieving evidence-based blood pressure (BP) targets, as a marker for CKD care. In Phase 1, recorded prevalence of CKD in collaborative practices increased ∼2-fold more than that in comparator local practices; in Phase 2, this increased to 4-fold, indicating improved case identification. Management of BP according to guideline recommendations also improved. Lessons learned An improvement collaborative with tailored facilitation support appears to promote the uptake of evidence-based guidance on the identification and management of CKD in primary care. A controlled evaluation study is needed to rigorously evaluate the impact of this promising improvement intervention. PMID:25525148

  5. [Facial palsy: diagnosis and management by primary care physicians].

    PubMed

    Alvarez, V; Dussoix, P; Gaspoz, J-M

    2009-01-28

    The incidence of facial palsy is about 50/100000/year, i.e. 210 cases/year in Geneva. Clinicians can be puzzled by it, because it encompasses aetiologies with very diverse prognoses. Most patients suffer from Bell palsy that evolves favourably. Some, however, suffer from diseases such as meningitis, HIV infection, Lyme's disease, CVA, that require fast identification because of their severity and of the need for specific treatments. This article proposes an algorithm for pragmatic and evidence-based management of facial palsy.

  6. Community-based primary care: improving and assessing diabetes management.

    PubMed

    Gannon, Meghan; Qaseem, Amir; Snow, Vincenza

    2010-01-01

    Morbidity and mortality associated with diabetes make it a prime target for quality improvement research. Quality gaps and racial/gender disparities persist throughout this population of patients necessitating a sustainable improvement in the clinical management of diabetes. The authors of this study sought (1) to provide a population perspective on diabetes management, and (2) to reinforce evidence-based clinical guidelines through a Web-based educational module.The project also aimed to gain insight into working remotely with a community of rural physicians. This longitudinal pre-post intervention study involved 18 internal medicine physicians and included 3 points of medical record data abstraction over 24 months. A Web-based educational module was introduced after the baseline data abstraction. This module contained chapters on clinical education, practice tools, and self-assessment. The results showed a sustained improvement in most clinical outcomes and demonstrated the effectiveness of using Web-based mediums to reinforce clinical guidelines and change physician behavior.

  7. Advances in non-surgical management of primary liver cancer

    PubMed Central

    Chen, Xiao; Liu, Hai-Peng; Li, Mei; Qiao, Liang

    2014-01-01

    Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third most common cause of cancer-related death worldwide. There have been great improvements in the diagnosis and treatment of HCC in recent years, but the problems, including difficult diagnosis at early stage, quick progression, and poor prognosis remain unsolved. Surgical resection is the mainstay of the treatment for HCC. However, 70%-80% of HCC patients are diagnosed at an advanced stage when most are ineligible for potentially curative therapies such as surgical resection and liver transplantation. In recent years, non-surgical management for unrespectable HCC, such as percutaneous ethanol injection, percutaneous microwave coagulation therapy, percutaneous radiofrequency ablation, transcatheter arterial chemoembolization, radiotherapy, chemotherapy, biotherapy, and hormonal therapy have been developed. These therapeutic options, either alone or in combination, have been shown to control tumor growth, prolong survival time, and improve quality of life to some extent. This review covers the current status and progress of non-surgical management for HCC. PMID:25469032

  8. Dental management of a talon cusp on a primary incisor.

    PubMed

    Yoon, Richard K; Chussid, Steven

    2007-01-01

    There are many treatment options for the pediatric patient with a talon cusp (TC). The purpose of this paper was to report the case of a TC involving a primary maxillary right central incisor in a 14-month-old male causing displacement of the affected tooth. The etiology of a TC is thought to be a disturbance during the morphodifferentiation stage of tooth development. Clinical problems include: (1) occlusal interferences; (2) esthetic disturbances; (3) accidental cusp fracture; (4) tongue irritation; (5) nursing difficulty; (6) caries; and (7) displacement of the affected tooth. The TC affecting the central incisor was reduced over a period of 4 visits, followed by immediate placement of a 5% sodium fluoride varnish at the conclusion of each reduction visit. Restoration of esthetics and function was evident within 1 month following complete cusp reduction. There were no clinical signs of any problems related to the reduction, and the prognosis was considered to be guarded. The pediatric patient was placed on a 6-month oral hygiene maintenance follow-up.

  9. Primary Sclerosing Cholangitis – Diagnosis, Prognosis and Management

    PubMed Central

    Singh, Siddharth; Talwalkar, Jayant A.

    2013-01-01

    Primary sclerosing cholangitis (PSC) is a chronic immune-mediated disease of the liver of unclear etiology, characterized by chronic inflammation and fibrosis of bile ducts. It primarily affects middle aged men, and is associated with 4-fold increased mortality as compared to ageand gender-matched population. Progressive biliary and hepatic damage results in portal hypertension and hepatic failure in a significant majority of patients over a 10–15 year period from initial diagnosis. In addition, PSC confers a markedly increased risk of hepatobiliary cancer, including cholangiocarcinoma and gallbladder cancer as compared to the general population, and cancer is the leading cause of mortality in patients with PSC. It is associated with inflammatory bowel disease in 70% patients, and increases the risk of colorectal cancer almost 10-fold. Despite significant research efforts in this field, the pathogenic mechanisms of PSC are still incompletely understood, although growing evidence supports the role of genetic and immunologic factors. There are no proven medical therapies that alter the natural course of the disease. Thus, liver transplantation is the only available treatment for patients with advanced PSC, with excellent outcomes in this population. PMID:23454027

  10. Complications in primary total hip arthroplasty: avoidance and management: wear.

    PubMed

    Ries, Michael D

    2003-01-01

    Many factors, including polyethylene processing, sterilization method, counterface material, femoral head size, femoral offset, acetabular component position, implant design, and patient activity level, affect the rate of wear in total hip arthroplasty. For patients with life expectancy that exceeds the longevity of the conventional implant materials, an alternative bearing surface (highly cross-linked polyethylene, metal-on-metal, or ceramic-on-ceramic) may be considered. Although laboratory wear tests with these materials are very favorable, clinical outcomes have not been clearly established. When osteolysis does develop in response to particulate debris, the location and progression of the lesions may be quite variable. Asymptomatic stable lesions can be followed clinically and radiographically while symptomatic or enlarging lesions or those that may compromise the integrity of the periprosthetic bone stock require surgery. If acetabular component revision is necessary and an adequate rim of host bone is maintained to support a revision acetabular component, defects can be filled with particulate bone graft. Large segmental defects generally require structural allografts. If the acetabular shell is well fixed in good position and the osteolytic defects are accessible, treatment with curettage and bone grafting of the lesions with liner revision is appropriate to avoid use of a structural allograft. Proximal femoral defects around a well-fixed stem can be managed in a similar manner with curettage and bone grafting. Distal lesions associated with risk of periprosthetic femur fracture or implant loosening require stem revision. Osteoclastic resportion of bone in response to particulate debris can be impaired with use of some drugs such as alendronate. However, the safety and efficacy of alendronate in the clinical management of osteolysis associated with total hip arthroplasty has not been established. PMID:12690853

  11. A decision-making framework for river water quality management under uncertainty: Application of social choice rules.

    PubMed

    Zolfagharipoor, Mohammad Amin; Ahmadi, Azadeh

    2016-12-01

    An important issue in river water quality management is taking into account the role played by wastewater dischargers in the decision-making process and in the implementation of any proposed waste load allocation program in a given region. In this study, a new decision-making methodology, called 'stochastic social choice rules' (SSCR), was developed for modeling the bargaining process among different wastewater dischargers into shared environments. For this purpose, the costs associated with each treatment strategy were initially calculated as the sum of treatment cost and the fines incurred due to violation of water quality standards. The qualitative simulation model (QUAL2Kw) was then used to determine the penalty function. The uncertainty associated with the implementation of strategies under the economic costs (i.e., the sum of treatment and penalty costs) was dealt with by a Monte-Carlo selection method. This method was coupled with different social choice methods to identify the best solution for the waste load allocation problem. Finally, using the extended trading-ratio system (ETRS), the most preferred treatment strategy was exchanged among dischargers as the initial set of discharge permits aimed at reducing the costs and encouraging dischargers to participate in the river water quality protection scheme. The proposed model was finally applied to the Zarjoub River in Gilan Province, northern Iran, as a case study. Results showed the efficiency of the proposed model in developing waste load allocation strategies for rivers. PMID:27589917

  12. A Collaborative Approach to Diabetes Management: The Choice Made for Colorado Schools

    ERIC Educational Resources Information Center

    Bobo, Nichole; Wyckoff, Leah; Patrick, Kathleen; White, Cathy; Glass, Sue; Carlson, Jessie Parker; Perreault, Christine

    2011-01-01

    Students with diabetes deserve a school nurse who can effectively manage the disease. Tensions between the school and families sometimes emerge when a child with diabetes goes to school. To resolve these tensions in Colorado, stakeholders collaborated to implement a statewide program to meet the needs of students with diabetes. Colorado school…

  13. Chinese Postgraduate Choices When Considering a UK Business and Management Programme

    ERIC Educational Resources Information Center

    Manns, Yihan; Swift, Jonathan

    2016-01-01

    This research investigated Chinese students' decision making processes for enrolling on a postgraduate taught business and management programme in a UK university, based on structured interviews, followed by a survey of just over 450 respondents. The validity and reliability of the research instrument were assessed prior to issuing the survey.…

  14. Tough Choices: A Guide to Administrative Cost Management in Colleges and Universities.

    ERIC Educational Resources Information Center

    Cresap, Rosslyn, VA.

    This guide is a product of a study conducted as part of a broader effort by the Department of Education to identify the causes of rising college costs and find and disseminate ways to contain these costs. In institutions of higher education most costs are manageable and can be contained without jeopardizing key services. This can be achieved by…

  15. Managing Minor Ailments; The Public’s Preferences for Attributes of Community Pharmacies. A Discrete Choice Experiment

    PubMed Central

    Ryan, Mandy; Bond, Christine; Watson, Margaret

    2016-01-01

    Background Demand for health services continues to rise. Greater use of community pharmacy services instead of medical services for minor ailments could help relieve pressure on healthcare providers in high-cost settings. Community pharmacies are recognised sources of treatment and advice for people wishing to manage these ailments. However, increasing the public’s use of pharmacy services may depend on attributes of pharmacies and their staff. This study aimed to determine the general public’s relative preferences for community pharmacy attributes using a discrete choice experiment (DCE). Method A UK-wide DCE survey of the general public was conducted using face-to-face computer-assisted personal interviews. Attributes and levels for the DCE were informed by a literature review and a cohort study of community pharmacy customers. The context for the experiment was a minor ailment scenario describing flu-like symptoms. The DCE choice sets described two hypothetical community pharmacy services; respondents were asked to choose which (if either) of the two pharmacies they would prefer to help them manage symptoms. Data from 1,049 interviews were analysed using an error components logit model. Willingness to pay (WTP), a monetary measure of benefit, was estimated for the different attribute levels. Results When seeking help or treatment for flu-like symptoms, respondents most valued a pharmacy service that would improve their understanding and management of symptoms (WTP = £6.28), provided by staff who are trained (WTP (pharmacist) = £2.63: WTP(trained assistant) = £3.22), friendly and approachable (WTP = £3.38). Waiting time, pharmacy location and availability of parking also contributed to respondents’ preferences. WTP for a service comprising the best possible combination of attributes and levels was calculated as £55.43. Conclusion Attributes of a community pharmacy and its staff may influence people’s decisions about which pharmacy they would visit to

  16. Approach to the surgical management of primary aldosteronism

    PubMed Central

    Citton, Marilisa; Viel, Giovanni; Rossi, Gian Paolo; Nitti, Donato

    2015-01-01

    Primary aldosteronism (PA) is the most common cause of endocrine hypertension; it has been reported in more than 11% of referred hypertensive patients. PA may be caused by unilateral adrenal involvement [aldosterone producing adenoma (APA) or unilateral adrenal hyperplasia (UAH)], and bilateral disease (idiopathic adrenal hyperplasia). Only patients with unilateral adrenal hypersecretion may be cured by unilateral adrenalectomy, while patients with bilateral and non-surgically correctable PA are usually treated by mineralocorticoid receptor antagonists; thus the distinction between unilateral and bilateral aldosterone hypersecretion is crucial. Most experts agree that the referral diagnostic test for lateralization of aldosterone hypersecretion should be adrenal venous sampling (AVS) because the interpretation of other imaging techniques [computed tomography (CT), magnetic resonance imaging (MRI) and scintigraphy] may lead to inappropriate treatment. Adrenalectomy represents the elective treatment in unilateral PA variants. Laparoscopic surgery, using transperitoneal or retroperitoneal approaches, is the preferred strategy. Otherwise, the indications to laparoscopic unilateral total or partial adrenalectomy in patients with unilateral PA remain controversial. Adrenalectomy is highly successful in curing the PA, with correction of hypokalemia in virtually all patients, cure of hypertension in about 30-60% of cases, and a marked improvement of blood pressure values in the remaining patients. Interestingly, in several papers the outcomes of surgery focus only on blood pressure changes and the normalization of serum potassium levels is often used as a surrogate of PA recovery. However, the goal of surgery is the normalization of aldosterone, because chronically elevated levels of this hormone can lead to cardiovascular complications, independently from blood pressure levels. Thus, we strongly advocate the need of considering the postoperative normalization of

  17. Systematic review of guidelines for the management of suspected lung cancer in primary care

    PubMed Central

    Giudice, M. Elisabeth Del; Young, Sheila-Mae; Vella, Emily T.; Ash, Marla; Bansal, Praveen; Robinson, Andrew; Skrastins, Roland; Ung, Yee; Zeldin, Robert; Levitt, Cheryl

    2014-01-01

    Abstract Objective To systematically review the literature and provide an update and integration of existing peer-reviewed guidelines with recent systematic reviews and with primary studies related to the early recognition and management of lung cancer in primary care. Data sources MEDLINE and EMBASE were searched for relevant articles. The quality of the evidence to support existing guideline recommendations, and the consistency of recommendations with updated evidence, were assessed. Applicability in a Canadian primary care setting was also evaluated. Study selection All studies that explored signs or symptoms of or risk factors for lung cancer in the primary care setting were included. All diagnostic studies in which symptomatic primary care patients underwent 1 or more investigations were also searched. Synthesis Recommendations were consistent among guidelines despite a paucity of supporting evidence. Updated evidence provided further support for the recommendations. Recommendations for identifying signs and symptoms of lung cancer presenting in primary care and for initial management can be adopted and applied within a Canadian primary care setting. Conclusion This updated review of recommendations might help promote evidence-based practice and, ultimately, more timely management and improved prognosis for lung cancer patients. It might also assist in the development of lung cancer diagnostic assessment programs. PMID:25122830

  18. Managing risk in cancer presentation, detection and referral: a qualitative study of primary care staff views

    PubMed Central

    Cook, Neil; Thomson, Gillian; Dey, Paola

    2014-01-01

    Objectives In the UK, there have been a number of national initiatives to promote earlier detection and prompt referral of patients presenting to primary care with signs and symptoms of cancer. The aim of the study was to explore the experiences of a range of primary care staff in promoting earlier presentation, detection and referral of patients with symptoms suggestive of cancer. Setting Six primary care practices in northwest England. Participants: 39 primary care staff from a variety of disciplines took part in five group and four individual interviews. Results The global theme to emerge from the interviews was ‘managing risk’, which had three underpinning organising themes: ‘complexity’, relating to uncertainty of cancer diagnoses, service fragmentation and plethora of guidelines; ‘continuity’, relating to relationships between practice staff and their patients and between primary and secondary care; ‘conflict’ relating to policy drivers and staff role boundaries. A key concern of staff was that policymakers and those implementing cancer initiatives did not fully understand how risk was managed within primary care. Conclusions Primary care staff expressed a range of views and opinions on the benefits of cancer initiatives. National initiatives did not appear to wholly resolve issues in managing risk for all practitioners. Staff were concerned about the number of guidelines and priorities they were expected to implement. These issues need to be considered by policymakers when developing and implementing new initiatives. PMID:24928585

  19. Choice of Health Plan: Implications for Access and Satisfaction

    PubMed Central

    Schur, Claudia L.; Berk, Marc L.

    1998-01-01

    In this article, the authors examine why low-income persons choose a managed care plan and the effects of choice on access and satisfaction, using data from the 1995-96 Kaiser/Commonwealth Five-State Low-Income Survey. Two-thirds of those choosing a managed care plan cited costs or benefits as their primary reason. Logistic regressions indicate that choice of plan had a neutral or positive effect on access and satisfaction. Medicaid enrollees with choice were less likely than those without to have difficulty obtaining particular services, more likely to rate plan quality highly, and less likely to report major problems with plan rules. PMID:10387423

  20. Ranolazine: Drug overview and possible role in primary microvascular angina management.

    PubMed

    Cattaneo, Mattia; Porretta, Alessandra Pia; Gallino, Augusto

    2015-02-15

    Ranolazine is a novel well-tolerated anti-ischemic drug, which selectively inhibits late sodium current and exerts metabolic properties without any hemodynamic effect. Ranolazine has been approved as a second-line medical treatment for symptomatic stable coronary artery disease. Primary microvascular angina (MVA) is suspected when angina symptoms occur in patients with demonstrated myocardial ischemia, absence of myocardial disease and normal coronary artery angiography. Recent clinical data suggest that MVA represents a complex entity, which has been increasingly recognized as a significant cause of morbidity. High variability and low response to traditional anti-anginal treatment characterize primary MVA. Despite the fact that clinical and preclinical evidence provides information regarding ranolazine usefulness in primary MVA management, only three recent small randomized trials have investigated this issue. By selecting peer-reviewed literature in Pubmed and Cochrane Library, this review provides an overview on ranolazine pharmacology and efficacy, focusing on recent evidence suggesting its usefulness in management of primary MVA.

  1. Created versus natural coastal islands: Atlantic waterbird populations, habitat choices, and management implications

    USGS Publications Warehouse

    Erwin, R.M.; Allen, D.H.; Jenkins, D.

    2003-01-01

    Nesting colonial waterbirds along the Atlantic Coast of the United States face a number of landscape-level threats including human disturbance, mammalian predator expansion, and habitat alteration. There have been changes from 1977 to the mid-1990s in use of nesting habitats and populations of a number of seabird species of concern in the region, including black skimmers Rynchops niger Linnaeaus, common terns Sterna hirundo Linnaeaus, gull-billed terns Sterna nilotica Linnaeaus, least terns Sterna antillarum Lesson, royal terns Sterna maxima Boddaert, and sandwich terns Sterna sandvicensis Cabot. These species form colonies primarily on the following habitat types: large, sandy barrier or shoal islands, natural estuarine or bay islands (mostly marsh), man-made islands of dredged deposition materials (from navigation channels), and the mainland. Significant changes in the use of the dredged material islands have occurred for these species in New Jersey and North Carolina, but not in Virginia. Population declines and changes in bird habitat use appear to be at least partially associated with the conditions and management of the existing dredged material islands, coastal policy changes associated with creating new dredged material islands, and competing demands for sand for beach augmentation by coastal communities. As these and other coastal habitats become less suitable for colonial waterbirds, other manmade sites, such as bridges and buildings have become increasingly more important. In regions with intense recreational demands, coastal wildlife managers need to take a more aggressive role in managing natural and man-made habitats areas and as stakeholders in the decision-making process involving dredged materials and beach sand allocation.

  2. Evaluation and management of head and neck squamous cell carcinoma of unknown primary.

    PubMed

    Martin, Jeffrey M; Galloway, Thomas J

    2015-07-01

    The diagnostic evaluation and therapeutic management of a patient with squamous cell carcinoma of an unknown primary (SCCUP) has considerably evolved over recent decades and will likely continue to change as a result of the improving ability to identify small primary tumors and better tailor the implementation of multimodality therapy. By application of the general principles of head and neck oncology, physicians and surgeons are often able to achieve satisfactory control of the disease in patients with SCCUP.

  3. Tools for primary care management of inflammatory bowel disease: do they exist?

    PubMed

    Bennett, Alice L; Munkholm, Pia; Andrews, Jane M

    2015-04-21

    Healthcare systems throughout the world continue to face emerging challenges associated with chronic disease management. Due to the likely increase in chronic conditions in the future it is now vital that cooperation and support between specialists, generalists and primary health care physicians is conducted. Inflammatory bowel disease (IBD) is one such chronic disease. Despite specialist care being essential, much IBD care could and probably should be delivered in primary care with continued collaboration between all stakeholders. Whilst most primary care physicians only have few patients currently affected by IBD in their caseload, the proportion of patients with IBD-related healthcare issues cared for in the primary care setting appears to be widespread. Data suggests however, that primary care physician's IBD knowledge and comfort in management is suboptimal. Current treatment guidelines for IBD are helpful but they are not designed for the primary care setting. Few non-expert IBD management tools or guidelines exist compared with those used for other chronic diseases such as asthma and scant data have been published regarding the usefulness of such tools including IBD action plans and associated supportive literature. The purpose of this review is to investigate what non-specialist tools, action plans or guidelines for IBD are published in readily searchable medical literature and compare these to those which exist for other chronic conditions. PMID:25914455

  4. Managing major depression: improving the interface between psychiatrists and primary care.

    PubMed

    Thompson, C

    2001-01-01

    Responsibility for identifying and managing most people with major depressive disorder (MDD) rests firmly within the primary care setting. Unfortunately, circumstances continue to have a negative impact on depression outcomes, with low recognition rates, inadequate levels of treatment and poor follow-up all contributing to the provision of a less than optimal service for patients. The Hampshire Depression Project confirmed that improved primary care education, in isolation, does not have any long-term benefits for patients with MDD. However, many other studies have shown that stronger collaboration between psychiatrists and primary care can significantly improve the quality of care provided in the primary care setting, and ensure that most patients are managed effectively and in accordance with international and national guidelines. Simple collaborative care models, which encourage mental health specialists to work within the primary care system, have had a dramatic impact on the outcomes for patients, and significantly enhanced the satisfaction of both patients and physicians with treatment. These interventions could easily and cost-effectively be applied more broadly and would ensure that effective management of MDD in primary care becomes the rule and not just the exception. ( Int J Psych Clin Pract 2001; 5 (Suppl 1): S11-S18). PMID:24936989

  5. Tools for primary care management of inflammatory bowel disease: Do they exist?

    PubMed Central

    Bennett, Alice L; Munkholm, Pia; Andrews, Jane M

    2015-01-01

    Healthcare systems throughout the world continue to face emerging challenges associated with chronic disease management. Due to the likely increase in chronic conditions in the future it is now vital that cooperation and support between specialists, generalists and primary health care physicians is conducted. Inflammatory bowel disease (IBD) is one such chronic disease. Despite specialist care being essential, much IBD care could and probably should be delivered in primary care with continued collaboration between all stakeholders. Whilst most primary care physicians only have few patients currently affected by IBD in their caseload, the proportion of patients with IBD-related healthcare issues cared for in the primary care setting appears to be widespread. Data suggests however, that primary care physician’s IBD knowledge and comfort in management is suboptimal. Current treatment guidelines for IBD are helpful but they are not designed for the primary care setting. Few non-expert IBD management tools or guidelines exist compared with those used for other chronic diseases such as asthma and scant data have been published regarding the usefulness of such tools including IBD action plans and associated supportive literature. The purpose of this review is to investigate what non-specialist tools, action plans or guidelines for IBD are published in readily searchable medical literature and compare these to those which exist for other chronic conditions. PMID:25914455

  6. Tools for primary care management of inflammatory bowel disease: do they exist?

    PubMed

    Bennett, Alice L; Munkholm, Pia; Andrews, Jane M

    2015-04-21

    Healthcare systems throughout the world continue to face emerging challenges associated with chronic disease management. Due to the likely increase in chronic conditions in the future it is now vital that cooperation and support between specialists, generalists and primary health care physicians is conducted. Inflammatory bowel disease (IBD) is one such chronic disease. Despite specialist care being essential, much IBD care could and probably should be delivered in primary care with continued collaboration between all stakeholders. Whilst most primary care physicians only have few patients currently affected by IBD in their caseload, the proportion of patients with IBD-related healthcare issues cared for in the primary care setting appears to be widespread. Data suggests however, that primary care physician's IBD knowledge and comfort in management is suboptimal. Current treatment guidelines for IBD are helpful but they are not designed for the primary care setting. Few non-expert IBD management tools or guidelines exist compared with those used for other chronic diseases such as asthma and scant data have been published regarding the usefulness of such tools including IBD action plans and associated supportive literature. The purpose of this review is to investigate what non-specialist tools, action plans or guidelines for IBD are published in readily searchable medical literature and compare these to those which exist for other chronic conditions.

  7. Control, choice, and assessments of the value of behavioral management to nonhuman primates in captivity.

    PubMed

    Schapiro, Steven J; Lambeth, Susan P

    2007-01-01

    Many people have devoted considerable effort to enhancing the environments of nonhuman primates in captivity. There is substantial motivation to develop experimental, analytical, and interpretational frameworks to enable objective measurements of the value of environmental enrichment/behavioral management efforts. The consumer-demand approach is a framework not frequently implemented in studies of nonhuman primate welfare but profitably used in studies of the welfare of nonhuman animals in agriculture. Preference studies, in which primates can voluntarily choose to socialize or to participate in training, may be the best current examples of a consumer-demand-like approach to assessing the effects of captive management strategies on primate welfare. Additional work in this area would be beneficial; however, there are potential ethical constraints on purposefully subjecting primates to adverse circumstances to measure their demand for a resource. Primate welfare researchers need to design consumer-demand studies with obstacles that will help measure the relative value of resources to captive primates without compromising the welfare they are attempting to evaluate and enhance.

  8. Positive practice environments influence job satisfaction of primary health care clinic nursing managers in two South African provinces

    PubMed Central

    2014-01-01

    Background Nurses constitute the majority of the health workforce in South Africa and they play a major role in providing primary health care (PHC) services. Job satisfaction influences nurse retention and successful implementation of health system reforms. This study was conducted in light of renewed government commitment to reforms at the PHC level, and to contribute to the development of solutions to the challenges faced by the South African nursing workforce. The objective of the study was to determine overall job satisfaction of PHC clinic nursing managers and the predictors of their job satisfaction in two South African provinces. Methods During 2012, a cross-sectional study was conducted in two South African provinces. Stratified random sampling was used to survey a total of 111 nursing managers working in PHC clinics. These managers completed a pre-tested Measure of Job Satisfaction questionnaire with subscales on personal satisfaction, workload, professional support, training, pay, career prospects and standards of care. Mean scores were used to measure overall job satisfaction and various subscales. Predictors of job satisfaction were determined through multiple logistic regression analysis. Results A total of 108 nursing managers completed the survey representing a 97% response rate. The mean age of respondents was 49 years (SD = 7.9) and the majority of them (92%) were female. Seventy-six percent had a PHC clinical training qualification. Overall mean job satisfaction scores were 142.80 (SD = 24.3) and 143.41 (SD = 25.6) for Gauteng and Free State provinces respectively out of a maximum possible score of 215. Predictors of job satisfaction were: working in a clinic of choice (RRR = 3.10 (95% CI: 1.11 to 8.62, P = 0.030)), being tired at work (RRR = 0.19 (95% CI: 0.08 to 0.50, P = 0.001)) and experience of verbal abuse (RRR = 0.18 (95% CI: 0.06 to 0.55, P = 0.001). Conclusion Allowing nurses greater choice of clinic

  9. Parental perspectives regarding primary-care weight-management strategies for school-age children.

    PubMed

    Turer, Christy Boling; Mehta, Megha; Durante, Richard; Wazni, Fatima; Flores, Glenn

    2016-04-01

    To identify parental perspectives regarding weight-management strategies for school-age children, focus groups were conducted of parents of overweight and obese (body mass index ≥ 85th percentile) 6-12-year-old children recruited from primary-care clinics. Questions focused on the role of the primary-care provider, effective components of weight-management strategies and feasibility of specific dietary strategies. Focus groups were recorded, transcribed and analysed using margin coding and grounded theory. Six focus groups were held. The mean age (in years) for parents was 32, and for children, eight; 44% of participants were Latino, 33%, African-American and 23%, white. Parents' recommendations on the primary-care provider's role in weight management included monitoring weight, providing guidance regarding health risks and lifestyle changes, consistent follow-up and using discretion during weight discussions. Weight-management components identified as key included emphasising healthy lifestyles and enjoyment, small changes to routines and parental role modelling. Parents prefer guidance regarding healthy dietary practices rather than specific weight-loss diets, but identified principles that could enhance the acceptability of these diets. For dietary guidance to be feasible, parents recommended easy-to-follow instructions and emphasising servings over counting calories. Effective weight-management strategies identified by parents include primary-care provider engagement in weight management, simple instructions regarding healthy lifestyle changes, parental involvement and deemphasising specific weight-loss diets. These findings may prove useful in developing primary-care weight-management strategies for children that maximise parental acceptance. PMID:24720565

  10. Parental perspectives regarding primary-care weight-management strategies for school-age children.

    PubMed

    Turer, Christy Boling; Mehta, Megha; Durante, Richard; Wazni, Fatima; Flores, Glenn

    2016-04-01

    To identify parental perspectives regarding weight-management strategies for school-age children, focus groups were conducted of parents of overweight and obese (body mass index ≥ 85th percentile) 6-12-year-old children recruited from primary-care clinics. Questions focused on the role of the primary-care provider, effective components of weight-management strategies and feasibility of specific dietary strategies. Focus groups were recorded, transcribed and analysed using margin coding and grounded theory. Six focus groups were held. The mean age (in years) for parents was 32, and for children, eight; 44% of participants were Latino, 33%, African-American and 23%, white. Parents' recommendations on the primary-care provider's role in weight management included monitoring weight, providing guidance regarding health risks and lifestyle changes, consistent follow-up and using discretion during weight discussions. Weight-management components identified as key included emphasising healthy lifestyles and enjoyment, small changes to routines and parental role modelling. Parents prefer guidance regarding healthy dietary practices rather than specific weight-loss diets, but identified principles that could enhance the acceptability of these diets. For dietary guidance to be feasible, parents recommended easy-to-follow instructions and emphasising servings over counting calories. Effective weight-management strategies identified by parents include primary-care provider engagement in weight management, simple instructions regarding healthy lifestyle changes, parental involvement and deemphasising specific weight-loss diets. These findings may prove useful in developing primary-care weight-management strategies for children that maximise parental acceptance.

  11. Instructional Leadership for Quality Learning: An Assessment of the Impact of the Primary School Management Development Project in Botswana

    ERIC Educational Resources Information Center

    Pansiri, Nkobi Owen

    2008-01-01

    A descriptive study using questionnaires was conducted in 2004 to assess the effectiveness of instructional leadership displayed by primary school management teams following the implementation of the Primary School Management Project in Botswana. Leadership skills, Coordination of instructional activities, management of curriculum and quality of…

  12. Understanding the Intersection of Individual Needs and Choices with Organizational Practices: The Case of Medication Management in Assisted Living

    ERIC Educational Resources Information Center

    Carder, Paula C.; Zimmerman, Sheryl; Schumacher, John G.

    2009-01-01

    Purpose: Making choices about everyday activities is a normal event for many adults. However, when an adult moves into an assisted living (AL) community, making choices becomes complicated by perceived needs and community practices. This study examines the relationship between choice and need in the context of practices, using medication…

  13. Carbon--making the right choice for waste management in developing countries.

    PubMed

    Barton, J R; Issaias, I; Stentiford, E I

    2008-01-01

    Due to initiatives such as the clean development mechanism (CDM), reducing greenhouse gas emissions for a developing country can offer an important route to attracting investment in a variety of qualifying project areas, including waste management. To date CDM projects have been largely confined to schemes that control emission from landfill, but projects that avoid landfilling are beginning to be submitted. In considering the waste options which might be suitable for developing countries certain ones, such as energy from waste, have been discounted for a range of reasons related primarily to the lack of technical and other support services required for these more sophisticated process trains. The paper focuses on six options: the base case of open dumping; three options for landfill (passive venting, gas capture with flaring, and gas capture with energy production), composting and anaerobic digestion with electricity production and composting of the digestate. A range of assumptions were necessary for making the comparisons based on the effective carbon emissions, and these assumptions will change from project to project. The highest impact in terms of carbon emissions was from using a sanitary landfill without either gas flaring or electricity production; this was worse than the baseline case using open dumpsites. Landfills with either flaring or energy production from the collected gas both produced similar positive carbon emissions, but these were substantially lower than both open dumping and sanitary landfill without flaring or energy production. Composting or anaerobic digestion with energy production and composting of the digestate were the two best options with composting being neutral in terms of carbon emissions and anaerobic digestion being carbon negative. These generic conclusions were tested for sensitivity by modifying the input waste composition and were found to be robust, suggesting that subject to local study to confirm assumptions made, the

  14. Managing tradeoffs in geoengineering through optimal choice of non-uniform radiative forcing

    NASA Astrophysics Data System (ADS)

    MacMartin, D. G.; Keith, D.; Kravitz, B.; Caldeira, K.

    2012-12-01

    Solar radiation management (SRM) could be used to offset some or all anthropogenic radiative forcing, with the goal of reducing some of the associated climatic change. However, the degree of compensation will vary, with residual climate changes larger in some regions than others. Similarly, the insolation reduction that best compensates climate changes in one region may not be the same as for another, leading to concerns about equity. We show that optimizing the latitudinal and seasonal distribution of insolation reduction can improve the fidelity with which SRM offsets anthropogenic climate change. Using the HadCM3L general circulation model, we consider three trade-offs: the trade-off between minimizing global rms climate changes and minimizing residual changes at the worst-off location, the trade-off between minimizing global rms climate changes and the average solar reduction required to do so, and the trade-off between minimizing global rms climate changes and maximizing Northern Hemisphere September sea ice, for a given average solar reduction. First, the residual temperature and precipitation changes in the worst-off region can be reduced by 30% relative to uniform insolation reduction, with only a modest impact on global root-mean-square (rms) changes; this has implications for managing regional inequalities. Second, the same rms residual climate changes can be obtained with up to 30% less insolation reduction than with a uniform distribution, implying that it may be possible to reduce side effects and risks of SRM (e.g., ozone depletion from sulfate). Finally, allowing spatial and temporal variability increases the range of trade-offs to be considered, such as the relative importance of restoring Northern Hemisphere sea ice versus minimizing overall climate impacts, or the relative weighting between temperature and precipitation residuals. This raises the question of how to weight different objectives. In summary, decisions involving SRM do not need to be

  15. Transformation management of primary health care services in two selected local authorities in Gauteng.

    PubMed

    Sibaya, W; Muller, M

    2000-12-01

    The transformation of health services in South Africa today is governed by the political, policy and legislative frameworks. This article focuses on the transformation of a primary health care service within a local authority in Gauteng. The purpose with this article is to explore and describe the perceptions (expectations and fears) of selected managers employed in this primary health care service. The results are utilised to compile a strategy (framework) for transformation management and leadership within the primary health care service. A qualitative research design was utilised and the data was collected by means of individual interviews with selected managers in the service, followed by a content analysis. The expectations and fears of managers focus mainly on personnel matters, community participation/satisfaction, salaries and parity, inadequate stocks/supplies and medication, the deterioration of quality service delivery and the need for training and empowerment. These results are divided into structure, process and outcome dimensions and are embodied in the conceptual framework for the transformation and leadership strategy. It is recommended that standards for transformation management be formulated and that the quality of transformation management be evaluated accordingly.

  16. A study of litter and waste management policies at (primary) eco-schools in Istanbul.

    PubMed

    Kayihan, Kutlu Sevinç; Tönük, Seda

    2012-01-01

    In addition to environmental and economic benefits, systematic application of sustainable waste management in elementary education buildings also makes a positive contribution to the education of future generations. This study examines elementary schools in Istanbul, which are part of the Eco-Schools International Programme. This programme was established in 1994 with European Union support and it aims to introduce environmental management systems into primary schools within the scope of ISO 14001/EMAS. A questionnaire study was administered on the theme of litter management and sustainable waste management within elementary schools located in the Asian and European parts of Istanbul city, and the findings of a field survey were examined. Questionnaire findings were gathered under five themes: litter management, composting of organic waste, re-use of school materials, reducing consumption-selection of recycled products, waste management and sorting of recyclable materials.

  17. Surgical management for Hirschsprung disease: A review for primary care providers.

    PubMed

    Green, Holly L; Rizzolo, Denise; Austin, Mary

    2016-04-01

    Primary care providers may encounter infants and children with Hirschsprung disease, a congenital colonic defect. Although primarily a surgical problem, the disease requires extensive supportive care and a multidisciplinary approach that often extends beyond surgical correction. This article reviews the management of Hirschsprung disease.

  18. Using a Learning Management System to Personalise Learning for Primary School Students

    ERIC Educational Resources Information Center

    Edmunds, Bronwyn; Hartnett, Maggie

    2014-01-01

    This paper reports on one aspect of a descriptive multiple-case study which set out to explore the role of a learning management system (LMS) in personalising learning for students from the perspective of three teachers in one primary school in New Zealand. The intention was to provide insight into the role the LMS could play in classrooms when…

  19. Management of Primary Dysmenorrhea by School Adolescents in ILE-IFE, Nigeria

    ERIC Educational Resources Information Center

    Ogunfowokan, Adesola A.; Babatunde, Oluwayemisi A.

    2010-01-01

    Dysmenorrhea is a problem that girls and women face and often manage themselves with or without support from health professionals. A cross-sectional, descriptive study was conducted among adolescents with dysmenorrhea (N = 150) in Ile-Ife, Nigeria. The aims of the study were to determine their knowledge of menstruation and primary dysmenorrhea,…

  20. Globalization and Leadership and Management: A Comparative Analysis of Primary Schools in England and Finland

    ERIC Educational Resources Information Center

    Webb, Rosemary; Vulliamy, Graham; Sarja, Anneli; Hamalainen, Seppo

    2006-01-01

    This article analyses the impact of processes of globalization on both policy and practice in relation to primary school leadership and management in England and Finland. Data are drawn from case study research carried out from 1994-1996 in six schools in Finland and six schools in England and a follow-up study on teacher professionalism…

  1. Primary care management of the female patient presenting with nipple discharge.

    PubMed

    Morgan, Hilary S

    2015-03-12

    Nipple discharge is a common primary care finding in female patients. The nurse practitioner must possess the skills and knowledge to correctly and safely manage this clinical finding. The following is a review of the etiology of nipple discharge, the differential diagnoses, and treatment modalities.

  2. The Perceptions of Senior Management Teams' (SMTs) Dominant Leadership Styles in Selected Botswana Primary Schools

    ERIC Educational Resources Information Center

    Mhozya, C. M.

    2010-01-01

    This study, which was funded by the office of research and development (ORD) in the University of Botswana, surveyed 65 primary schools in South Central region in Botswana, which aimed at establishing the perceptions of senior management teams dominant leadership style. The study was done in three phases; the first phase started in June 2008 to…

  3. Importance of the Primary Radioactivity Standard Laboratory and Implementation of its Quality Management

    NASA Astrophysics Data System (ADS)

    Sahagia, Maria; Razdolescu, Anamaria Cristina; Luca, Aurelian; Ivan, Constantin

    2007-04-01

    The paper presents some specific aspects of the implementation of the quality management in the Radionuclide Metrology Laboratory, from IFIN-HH, the owner of the primary Romanian standard in radioactivity. The description of the accreditation, according to the EN ISO/IEC 17025:2005, is presented.

  4. Analysis of Classroom Management Problems in Primary Schools in Delta State, Nigeria

    ERIC Educational Resources Information Center

    Oghuvbu, Enamiroro Patrick; Atakpo, Theresa Edirin

    2008-01-01

    This article identifies classroom management problems, their causes, and possible ways to reduce these problems in primary schools located in Delta State, Nigeria. A total of 600 teachers selected from twelve local government areas participated in this study. Data were collected in a checklist containing 27 items and a two section questionnaire…

  5. Successful childhood obesity management in primary care in Canada: what are the odds?

    PubMed Central

    Kuhle, Stefan; Doucette, Rachel; Piccinini-Vallis, Helena

    2015-01-01

    Background. The management of a child presenting with obesity in a primary care setting can be viewed as a multi-step behavioral process with many perceived and actual barriers for families and primary care providers. In order to achieve the goal of behavior change and, ultimately, clinically meaningful weight management outcomes in a child who is considered obese, all steps in this process should ideally be completed. We sought to review the evidence for completing each step, and to estimate the population effect of secondary prevention of childhood obesity in Canada. Methods. Data from the 2009/2010 Canadian Community Health Survey and from a review of the literature were used to estimate the probabilities for completion of each step. A flow chart based on these probabilities was used to determine the proportion of children with obesity that would undergo and achieve clinically meaningful weight management outcomes each year in Canada. Results. We estimated that the probability of a child in Canada who presents with obesity achieving clinically meaningful weight management outcomes through secondary prevention in primary care is around 0.6% per year, with a range from 0.01% to 7.2% per year. The lack of accessible and effective weight management programs appeared to be the most important bottleneck in the process. Conclusions. In order to make progress towards supporting effective pediatric obesity management, efforts should focus on population-based primary prevention and a systems approach to change our obesogenic society, alongside the allocation of resources toward weight management approaches that are comprehensively offered, equitably distributed and robustly evaluated. PMID:26623175

  6. Musculoskeletal conditions in children and adolescents managed in Australian primary care

    PubMed Central

    2014-01-01

    Background Primary care settings play a vital role in the early detection and appropriate management of musculoskeletal conditions in paediatric populations. However, little data exist regarding these conditions in a primary care context or on the presentation of specific musculoskeletal disorders in children. The aim of this study was to estimate the caseload and describe typical management of musculoskeletal conditions in children and adolescents presenting to primary care in Australia. Methods An analysis of data from the Bettering the Evaluation and Care of Health (BEACH) study was performed. The BEACH study is a continuous national study of general practice (GP) activity in Australia. We identified all GP encounters with children and adolescents over the past five years and extracted data on demographic details, the problems managed, and GP management of each problem. SAS statistical software was used to calculate robust proportions and after adjustment for the cluster, the 95% confidence intervals (CIs). Results From the period April 2006 to March 2011, there were 65,279 encounters with children and adolescents in the BEACH database. Of the 77,830 problems managed at these encounters, 4.9% (95%CI 4.7% to 5.1%) were musculoskeletal problems. The rate of musculoskeletal problems managed increased significantly with age, however there was a significant decrease for girls aged 15–17 years. Upper and lower limb conditions were the most common, followed by spine and trunk conditions. Spine and trunk conditions were significantly more likely to be managed with medication, but less likely to receive imaging, than upper or lower limb problems. Conclusions Musculoskeletal problems in children and adolescents present a significant burden and an important challenge to the primary health care system in Australia. There is variability in rates of presentation between different age groups, gender and affected body region. PMID:24885231

  7. Managed care can be better care for all citizens: a primary care perspective.

    PubMed

    Bartholow, T

    1997-01-01

    The CPN seeks to enhance the care of patients by judicious expenditure of health care dollars, currently for the Unit "Community" Network, but ultimately also for other insurers who would enter risk-sharing relationships with the CPN. Improvements in health care delivery will be made in enhanced access to primary care, including telephone access to nurse triage; in collaboration and communication between the selected consultant and the referring primary care giver, including an electronic network allowing for selected information sharing; and in renewing medicine's collective commitment to care provided as close to home as possible, or in the home if this is the highest quality. The care of the uninsured remains a challenge and a normal obligation from which the CPN does not shrink. The economic realities of primary care delivery must be improved, with additional resources allocated being substantially rededicated to patient care. The patient's control of the selection of the site of health care and the absence of incentives to their primary care provider for a referral pattern different than the patient's choice will remain important to the CPN. The CPN hopes to provide the diplomacy between third party payers to enhance collaboration and minimize competition in the delivery of care in communities.

  8. ADHD in school-aged youth: Management and special treatment considerations in the primary care setting.

    PubMed

    Weed, Elizabeth D

    2016-01-01

    Attention-deficit/hyperactivity disorder is considered one of the most common neurodevelopmental disorders of childhood. Primary care providers are in the unique position of providing comprehensive care-routine care, well child visits, immunizations, and other healthcare needs-to a majority of children and adolescents with attention-deficit/hyperactivity disorder. As such, primary care providers are pivotal in the diagnosis, management, and treatment of this population. This article will address special treatment considerations to aid in the management of attention-deficit/hyperactivity disorder in the primary care setting, including substance use disorders and diversion, cardiac issues and stimulant medication, medication holidays and follow-up monitoring. The database of PubMed was searched using keywords that included attention-deficit/hyperactivity disorder, children, prevalence, medication holidays, safety, cardiovascular, cardiac, blood pressure, substance use, diversion, adverse drug reactions; inclusion dates were January 1, 2011 to September 30, 2015.

  9. Management of patients with respiratory infections in primary care: procalcitonin, C-reactive protein or both?

    PubMed

    Meili, Marc; Müller, Beat; Kulkarni, Prasad; Schütz, Philipp

    2015-10-01

    Use of inflammatory biomarkers to guide antibiotic decisions has shown promising results in the risk-adapted management of respiratory tract infections, mainly in the inpatient setting. Several observational and interventional trials have investigated the benefits of procalcitonin (PCT) and C-reactive protein (CRP) testing in primary care. Both markers have shown promising results, although CRP is an inflammatory biomarker while PCT is more specific for bacterial infections. For CRP, point-of-care testing is widely established. Recently, sensitive point-of-care testing for PCT has also become available. A high-quality trial comparing these two markers for the management of patients in primary care is currently lacking. The aim of this paper is to review the existing literature investigating the use of PCT and CRP in primary care. The authors compare their performance for guiding antibiotic stewardship and analyze the cut-off values and endpoints to put these parameters into context in a low-acuity environment.

  10. When Government Is No Longer Employer of Choice: What May the Sector Perceptions of Public Managers Be Like after the Economy Recovers?

    ERIC Educational Resources Information Center

    Boardman, Craig; Ponomariov, Branco

    2012-01-01

    In today's economic climate, government is now considered by many to be the "employer of choice." However, employers at all levels of government may eventually lose their recent gains in the war for talent, as the economy improves. Accordingly, it is important to explain how public sector managers viewed the relative advantages and…

  11. Medical management of the kidney transplant recipient: a practical approach for the primary care provider.

    PubMed

    Pedraza, Fernando; Roth, David

    2014-12-01

    Kidney transplant recipients (KTRs) commonly present with complex medical issues that are best managed jointly by both their primary care physician and the kidney transplant center. Hypertension, diabetes, dyslipidemias, and obesity are frequently present in the KTR population and the successful management of these comorbidities is essential in achieving excellent posttransplant outcomes. Cardiovascular disease is the leading cause of mortality in KTRs, and interventions that mitigate the risk factors that contribute to these adverse outcomes are an important part of the long-term management of a KTR.

  12. Changing Climate, Challenging Choices: Identifying and Evaluating Climate Change Adaptation Options for Protected Areas Management in Ontario, Canada

    NASA Astrophysics Data System (ADS)

    Lemieux, Christopher J.; Scott, Daniel J.

    2011-10-01

    Climate change will pose increasingly significant challenges to managers of parks and other forms of protected areas around the world. Over the past two decades, numerous scientific publications have identified potential adaptations, but their suitability from legal, policy, financial, internal capacity, and other management perspectives has not been evaluated for any protected area agency or organization. In this study, a panel of protected area experts applied a Policy Delphi methodology to identify and evaluate climate change adaptation options across the primary management areas of a protected area agency in Canada. The panel identified and evaluated one hundred and sixty five (165) adaptation options for their perceived desirability and feasibility. While the results revealed a high level of agreement with respect to the desirability of adaptation options and a moderate level of capacity pertaining to policy formulation and management direction, a perception of low capacity for implementation in most other program areas was identified. A separate panel of senior park agency decision-makers used a multiple criterion decision-facilitation matrix to further evaluate the institutional feasibility of the 56 most desirable adaptation options identified by the initial expert panel and to prioritize them for consideration in a climate change action plan. Critically, only two of the 56 adaptation options evaluated by senior decision-makers were deemed definitely implementable, due largely to fiscal and internal capacity limitations. These challenges are common to protected area agencies in developed countries and pervade those in developing countries, revealing that limited adaptive capacity represents a substantive barrier to biodiversity conservation and other protected area management objectives in an era of rapid climate change.

  13. International Primary Care Respiratory Group (IPCRG) Guidelines: management of chronic obstructive pulmonary disease (COPD).

    PubMed

    Bellamy, David; Bouchard, Jacques; Henrichsen, Svein; Johansson, Gunnar; Langhammer, Arnulf; Reid, Jim; van Weel, Chris; Buist, Sonia

    2006-02-01

    COPD is a common and under-diagnosed disease which is increasing in prevalence worldwide. A more aggressive and optimistic approach must be adopted towards its management in primary care. This IPCRG Guideline on the management of COPD in primary care is fully consistent with GOLD guidelines. It highlights the goals of COPD treatment and the need for spirometric testing to make the diagnosis. It covers the classification of the disease according to disease severity, non-pharmacologic therapy including smoking cessation, avoidance of risk factors, patient education, pharmacologic therapy including the use of oxygen treatment, the management of exacerbations, the role of pulmonary rehabilitation, and the need for monitoring and ongoing care for COPD patients. PMID:16701758

  14. Sigmoid Volvulus Complicating Pregnancy Managed by Resection and Primary Anastomosis: Case report with literature review.

    PubMed

    Machado, Norman O; Machado, Lovina S M

    2009-04-01

    Sigmoid volvulus is an extremely rare cause of intestinal obstruction in pregnancy. The rarity of the condition and the fact that pregnancy itself clouds the clinical picture invariably leads to a delay in diagnosis with an increased risk of gangrene of the gut. The majority of these patients would then require resection and colostomy. However, an early diagnosis and intervention as in our patient, which would require a high index of clinical suspicion, could significantly improve the outcome of the foetus and the mother. A case of sigmoid volvulus in pregnancy is reported which was managed by resection and primary anastomosis. A review of literature revealed no previous reports of sigmoid volvulus in pregnancy managed by primary anastomosis following resection of the sigmoid volvulus. The literature is also reviewed regarding predisposing factors, management options and the outcome of sigmoid volvulus complicating pregnancy.

  15. "We will not rest." Filipino women want a fertility management program that respects women's dignity, women's bodies and women's choices.

    PubMed

    Alvarez, R O

    1993-03-01

    The program officer for the Institute for Social Studies and Action presents 1) her views on women's fertility management under different political administrations in the Philippines, 2) the political postures of influential groups, 3) the goals of women's and health groups, and 4) the actions taken by Filipino women. Under Ferdinand Marcos, the official family planning (FP) program emphasized reduction of population growth and established a quota system and incentives for the number of new acceptors. Women, as a result, became victims; e.g. IUDs were inserted without prior knowledge, and inadequate information and follow-up were provided on oral contraceptive use. Efforts were criticized for treating women as program targets and not as individuals capable of making choices. Under Corazon Aquino, the Roman Catholic hierarchy dominated and would have banned all forms of artificial contraception had women's and health groups not blocked the effort. Only in 1989 did President Aquino finally announce that multiple methods of family planning (FP) would be promoted. There was a transition in program services during the transfer to the Department of Health. Currently the government promotes FP within the safe motherhood and child survival context, but adolescents and unmarried women and couples are excluded from FP services. Population control advocates believe FP is a health issue. The Roman Catholic Church accepts only natural methods and believes artificial methods interfere with the natural processes of procreation. Anti-FP groups promote only natural FP methods and wage campaigns to discredit contraceptive methods. Women's and FP groups contend that it is a woman's right to regulate her own fertility. Safe abortion should be made available to those who need it. Women's networks are mobilizing to talk about the issues, to hold public activities to change laws and policies and to encourage women's involvement in decision making affecting their lives, and to conduct

  16. Management of allergic and non-allergic rhinitis: a primary care summary of the BSACI guideline.

    PubMed

    Angier, Elizabeth; Willington, Jenny; Scadding, Glenis; Holmes, Steve; Walker, Samantha

    2010-09-01

    Rhinitis is a common problem in primary care which is often managed sub-optimally. It causes considerable morbidity and has been shown to have a detrimental impact on people's ability to concentrate at school and at work. Rhinitis and asthma often present together, and symptomatic rhinitis can be associated with poor asthma control and increased risk of exacerbations. There is therefore a clear need to recognise and treat rhinitis according to guideline recommendations. This article is a primary care summary of the British Society for Allergy & Clinical Immunology (BSACI) Standards of Care Committee guideline on the management of rhinitis, written by a multi-disciplinary group of clinicians. It takes into account the time restrictions on assessment and the tests and equipment available in primary care, as well as the need for practical, clear and intuitive strategies for investigation and management. It recommends a stepwise approach to treatment, and highlights the relevance of less frequently prescribed treatments, including nasal douching leukotriene receptor antagonists and anticholinergics. Red flag symptoms are identified, together with indicators for referral. As with many other long term conditions, good communication between primary and secondary care in terms of timely and appropriate referral is a key factor for success.

  17. How do primary health-care practitioners identify and manage communication impairments in preschool children?

    PubMed

    Woolfenden, Sue; Short, Kate; Blackmore, Roger; Pennock, Rene; Moore, Michael

    2015-01-01

    Communication impairments (CIs) in preschool children are common and can have long-term adverse consequences if not detected and treated early. This study investigated the knowledge, training and practice of primary health-care practitioners in the identification and management of CIs in preschool-aged children. A cross-sectional survey of 277 primary health-care practitioners in the Inner West and South West Sydney was undertaken. The majority of practitioners surveyed understood the importance of early identification of CIs. Eight per cent ofpractitioners correctly identified all of the 'red flags' for verbal and non-verbal communication. The majority (80%) correctly described the management of a typical case presentation. Two-thirds of practitioners reported using a tool in their practice for developmental surveillance, but the quality of surveillance tools was variable. One-third felt their training in this area was poor and 90% indicated they would like further training. Barriers to referral included waiting times, availability and cost of services. We concluded that primary health-care practitioners are aware that CIs are significant and they need to be identified early. There are opportunities for further training and promoting high-quality developmental surveillance in primary care. In addition, there are broader health system issues that include promotion of an integrated response to the detection and management of CIs.

  18. How do primary health-care practitioners identify and manage communication impairments in preschool children?

    PubMed

    Woolfenden, Sue; Short, Kate; Blackmore, Roger; Pennock, Rene; Moore, Michael

    2015-01-01

    Communication impairments (CIs) in preschool children are common and can have long-term adverse consequences if not detected and treated early. This study investigated the knowledge, training and practice of primary health-care practitioners in the identification and management of CIs in preschool-aged children. A cross-sectional survey of 277 primary health-care practitioners in the Inner West and South West Sydney was undertaken. The majority of practitioners surveyed understood the importance of early identification of CIs. Eight per cent ofpractitioners correctly identified all of the 'red flags' for verbal and non-verbal communication. The majority (80%) correctly described the management of a typical case presentation. Two-thirds of practitioners reported using a tool in their practice for developmental surveillance, but the quality of surveillance tools was variable. One-third felt their training in this area was poor and 90% indicated they would like further training. Barriers to referral included waiting times, availability and cost of services. We concluded that primary health-care practitioners are aware that CIs are significant and they need to be identified early. There are opportunities for further training and promoting high-quality developmental surveillance in primary care. In addition, there are broader health system issues that include promotion of an integrated response to the detection and management of CIs. PMID:26509204

  19. Medicaid Managed Care Model of Primary Care and Health Care Management for Individuals with Developmental Disabilities

    ERIC Educational Resources Information Center

    Kastner, Theodore A.; Walsh, Kevin K.

    2006-01-01

    Lack of sufficient accessible community-based health care services for individuals with developmental disabilities has led to disparities in health outcomes and an overreliance on expensive models of care delivered in hospitals and other safety net or state-subsidized providers. A functioning community-based primary health care model, with an…

  20. Dyslipidemia management in primary prevention of cardiovascular disease: Current guidelines and strategies

    PubMed Central

    Hendrani, Aditya D; Adesiyun, Tolulope; Quispe, Renato; Jones, Steven R; Stone, Neil J; Blumenthal, Roger S; Martin, Seth S

    2016-01-01

    Cardiovascular disease is the leading cause of death in the United States. In 2010, the Centers for Disease Control and Prevention estimated that $444 billion was spent on cardiovascular diseases alone, about $1 of every $6 spent on health care. As life expectancy continues to increase, this annual cost will also increase, making cost-effective primary prevention of cardiovascular disease highly desirable. Because of its role in development of atherosclerosis and clinical events, dyslipidemia management is a high priority in cardiovascular prevention. Multiple major dyslipidemia guidelines have been published around the world recently, four of them by independent organizations in the United States alone. They share the goal of providing clinical guidance on optimal dyslipidemia management, but guidelines differ in their emphasis on pharmacotherapy, stratification of groups, emphasis on lifestyle modification, and use of a fixed target or percentage reduction in low density lipoprotein cholesterol. This review summarizes eight major guidelines for dyslipidemia management and considers the basis for their recommendations. Our primary aim is to enhance understanding of dyslipidemia management guidelines in patient care for primary prevention of future cardiovascular risk. PMID:26981215

  1. Dyslipidemia management in primary prevention of cardiovascular disease: Current guidelines and strategies.

    PubMed

    Hendrani, Aditya D; Adesiyun, Tolulope; Quispe, Renato; Jones, Steven R; Stone, Neil J; Blumenthal, Roger S; Martin, Seth S

    2016-02-26

    Cardiovascular disease is the leading cause of death in the United States. In 2010, the Centers for Disease Control and Prevention estimated that $444 billion was spent on cardiovascular diseases alone, about $1 of every $6 spent on health care. As life expectancy continues to increase, this annual cost will also increase, making cost-effective primary prevention of cardiovascular disease highly desirable. Because of its role in development of atherosclerosis and clinical events, dyslipidemia management is a high priority in cardiovascular prevention. Multiple major dyslipidemia guidelines have been published around the world recently, four of them by independent organizations in the United States alone. They share the goal of providing clinical guidance on optimal dyslipidemia management, but guidelines differ in their emphasis on pharmacotherapy, stratification of groups, emphasis on lifestyle modification, and use of a fixed target or percentage reduction in low density lipoprotein cholesterol. This review summarizes eight major guidelines for dyslipidemia management and considers the basis for their recommendations. Our primary aim is to enhance understanding of dyslipidemia management guidelines in patient care for primary prevention of future cardiovascular risk.

  2. Management commitments and primary care: another lesson from Costa Rica for the world?

    PubMed

    Soors, Werner; De Paepe, Pierre; Unger, Jean-Pierre

    2014-01-01

    Maintained dedication to primary care has fostered a public health delivery system with exceptional outcomes in Costa Rica. For more than a decade, management commitments have been part of Costa Rican health reform. We assessed the effect of the Costa Rican management commitments on access and quality of care and on compliance with their intended objectives. We constructed seven hypotheses on opinions of primary care providers. Through a mixed qualitative and quantitative approach, we tested these hypotheses and interpreted the research findings. Management commitments consume an excessive proportion of consultation time, inflate recordkeeping, reduce comprehensiveness in primary care consultations, and induce a disproportionate consumption of hospital emergency services. Their formulation relies on norms in need of optimization, their control on unreliable sources. They also affect professionalism. In Costa Rica, management commitments negatively affect access and quality of care and pose a threat to the public service delivery system. The failures of this pay-for-performance-like initiative in an otherwise well-performing health system cast doubts on the appropriateness of pay-for-performance for health systems strengthening in less advanced environments.

  3. 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

  4. Late-Onset Primary Intestinal Lymphangiectasia Successfully Managed with Octreotide: A Case Report

    PubMed Central

    Suehiro, Kotaro; Morikage, Noriyasu; Murakami, Masanori; Yamashita, Osamu; Hamano,, Kimikazu

    2012-01-01

    We report a case of a patient with late-onset primary lymphangiectasia whose persistent diarrhoea was successfully managed with octreotide. A 63 year-old man visited our clinic with a complaint of worsening general edema. Gastrointestinal endoscopy revealed typical whitish jejunal villi, which suggested primary intestinal lymphangiectasia. Despite a diet, supplemented with medium-chain triglycerides; antiplasmin therapy; oral corticosteroids; and surgery, including pericardial window and lymphaticovenous anastomoses; his symptoms, including watery diarrhoea, showed no improvement. After administration of octreotide, his persistent diarrhoea resolved within a couple of days. Octreotide was continued for 2 months. Thereafter, his diarrhoea has not recurred for 6 months. PMID:23555496

  5. Managing Osteoporosis: A Survey of Knowledge, Attitudes and Practices among Primary Care Physicians in Israel

    PubMed Central

    Segal, Elena; Ish-Shalom, Sofia

    2016-01-01

    Background Osteoporosis is a systemic skeletal disorder characterized by impaired bone quality and microstructural deterioration leading to an increased propensity to fractures. This is a major health problem for older adults, which comprise an increasingly greater proportion of the general population. Due to a large number of patients and the insufficient availability of specialists in Israel and worldwide, osteoporosis is treated in large part by primary care physicians. We assessed the knowledge of primary care physicians on the diagnosis and treatment of osteoporosis. Methods Physician's knowledge, sources of knowledge acquisition and self-evaluation of knowledge were assessed using a multiple choice questionnaire. Professional and demographic characteristics were assessed as well. Results Of 490 physicians attending a conference, 363 filled the questionnaires (74% response rate). The physicians demonstrated better expertise in diagnosis than in medications (mechanism of action, side effects or contra-indications) but less than for other treatment related decisions. Overall, 50% demonstrated adequate knowledge of calcium and vitamin D supplementation, 51% were aware of the main therapeutic purpose of osteoporosis pharmacotherapy and 3% were aware that bisphosphonates should be avoided in patients with impaired renal function. Respondents stated frontal lectures at meetings as their main source of information on the subject. Conclusion The study indicates the need to intensify efforts to improve the knowledge of primary care physicians regarding osteoporosis, in general; and osteoporosis pharmacotherapy, in particular. PMID:27494284

  6. Understanding the management of early-stage chronic kidney disease in primary care: a qualitative study

    PubMed Central

    Blakeman, Tom; Protheroe, Joanne; Chew-Graham, Carolyn; Rogers, Anne; Kennedy, Anne

    2012-01-01

    Background Primary care is recognised to have an important role in the delivery of care for people with chronic kidney disease (CKD). However, there is evidence that CKD management is currently suboptimal, with a range of practitioner concerns about its management. Aim To explore processes underpinning the implementation of CKD management in primary care. Design and setting Qualitative study in general practices participating in a chronic kidney disease collaborative undertaken as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester. Method Semi-structured interviews were conducted with GPs and practice nurses (n = 21). Normalisation Process Theory provided a framework for generation and analysis of the data. Results A predominant theme was anxiety about the disclosure of early-stage CKD with patients. The tensions experienced related to identifying and discussing CKD in older people and patients with stage 3A, embedding early-stage CKD within vascular care, and the distribution of work within the practice team. Participants provided accounts of work undertaken to resolve the difficulties encountered, with efforts having tended to focus on reassuring patients. Analysis also highlighted how anxiety surrounding disclosure influenced, and was shaped by, the organisation of care for people with CKD and associated long-term conditions. Conclusion Offering reassurance alone may be of limited benefit, and current management of early-stage CKD in primary care may miss opportunities to address susceptibility to kidney injury, improve self-management of vascular conditions, and improve the management of multimorbidity. PMID:22520910

  7. Practical suicide-risk management for the busy primary care physician.

    PubMed

    McDowell, Anna K; Lineberry, Timothy W; Bostwick, J Michael

    2011-08-01

    Suicide is a public health problem and a leading cause of death. The number of people thinking seriously about suicide, making plans, and attempting suicide is surprisingly high. In total, primary care clinicians write more prescriptions for antidepressants than mental health clinicians and see patients more often in the month before their death by suicide. Treatment of depression by primary care physicians is improving, but opportunities remain in addressing suicide-related treatment variables. Collaborative care models for treating depression have the potential both to improve depression outcomes and decrease suicide risk. Alcohol use disorders and anxiety symptoms are important comorbid conditions to identify and treat. Management of suicide risk includes understanding the difference between risk factors and warning signs, developing a suicide risk assessment, and practically managing suicidal crises. PMID:21709131

  8. Pressure-ulcer management and prevention in acute and primary care.

    PubMed

    Newham, Roger; Hudgell, Lynne

    This article describes a study to ascertain what it is like to follow the processes in practice for prevention and management of pressure ulcers as one aspect of care among others. The participants in this study were bands 5 and 6 staff nurses and healthcare assistants (HCAs) (n=72) recruited from two acute and two primary NHS trusts. Data were gathered from open-ended questions via an online survey (n=61) and interviews (n=11). The interviews were transcribed and all the data were analysed by thematic analysis. The findings show that participants believe there has been a high-profile imposition of guidelines and policies by management during at least the past 18 months, resulting in perceived good outcomes in the form of fewer pressure ulcers generally and less fragmentation of care, particularly within primary care. However, a number of perceived obstacles to the implementation of recommended interventions remain, notably lack of time and lack of knowledge.

  9. Practical Suicide-Risk Management for the Busy Primary Care Physician

    PubMed Central

    McDowell, Anna K.; Lineberry, Timothy W.; Bostwick, J. Michael

    2011-01-01

    Suicide is a public health problem and a leading cause of death. The number of people thinking seriously about suicide, making plans, and attempting suicide is surprisingly high. In total, primary care clinicians write more prescriptions for antidepressants than mental health clinicians and see patients more often in the month before their death by suicide. Treatment of depression by primary care physicians is improving, but opportunities remain in addressing suicide-related treatment variables. Collaborative care models for treating depression have the potential both to improve depression outcomes and decrease suicide risk. Alcohol use disorders and anxiety symptoms are important comorbid conditions to identify and treat. Management of suicide risk includes understanding the difference between risk factors and warning signs, developing a suicide risk assessment, and practically managing suicidal crises. PMID:21709131

  10. Medical Assistants as Flow Managers in Primary Care: Challenges and Recommendations.

    PubMed

    Gray, Caroline P; Harrison, Michael I; Hung, Dorothy

    2016-01-01

    As healthcare organizations look for ways to reduce costs and improve quality, many rely increasingly on allied healthcare professionals and, in particular, medical assistants (MAs) to supplement the work of physicians and other health professionals. MAs usually work in primary care, where they often play important roles on healthcare teams. Drawing on an empirical study of a large, multispecialty delivery system engaged in reconfiguration of primary care, we found that using MAs as flow managers required overcoming several challenges. These included entrenched social and occupational hierarchies between physicians and MAs, a lack of adequate training and mentorship, and difficulty attracting and retaining talented MAs. We offer several recommendations for healthcare organizations interested in using MAs as flow managers in their practices. PMID:27356444

  11. Suicide Risk in Primary Care: Identification and Management in Older Adults

    PubMed Central

    Raue, Patrick J.; Ghesquiere, Angela R.; Bruce, Martha L.

    2014-01-01

    The National Strategy for Suicide Prevention (2012) has set a goal to reduce suicides by 20% within 5 years. Suicide rates are higher in older adults compared to most other age groups, and the majority of suicide completers have visited their primary care physician in the year before suicide. Primary care is an ideal setting to identify suicide risk and initiate mental health care. We review risk factors for late-life suicide; methods to assess for different levels of suicidality; and recent research developments regarding both effective assessment and management of suicide risk among older primary care patients. We highlight that broader scale screening of suicide risk may be considered in light of findings that suicidality can occur even in the absence of major risk factors like depression. We also highlight collaborative care models targeting suicide risk, and recent innovative interventions that aim to prevent the development of suicidal ideation and suicidal behavior. PMID:25030971

  12. Nurse managed center: access to primary health care for urban Native Americans.

    PubMed

    Neff, Donna Felber; Kinion, Elizabeth S; Cardina, Christen

    2007-01-01

    Urban Native Americans represent a small, diverse minority with unique health needs. The purposes of this descriptive retrospective study were to describe (a) the characteristics and primary health problems of urban Native Americans who receive primary health care at an urban nurse managed center (NMC) and (b) the nursing interventions provided at an urban NMC to urban Native Americans. A sample of 334 participants patient data were abstracted from a computerized clinical data set and coded based on the Omaha Classification System. The majority were over 40 years of age, were female, were single, completed high school, and were poor and uninsured, and many were unemployed. The most frequent health problems were related to pain, cardiovascular symptoms, dentition problems, and respiratory illnesses. The most frequent nursing interventions were for surveillance of physical signs and symptoms. The NMC was an accessible source of primary health care for urban Native Americans in northeastern Ohio. PMID:17266403

  13. Suicide risk in primary care: identification and management in older adults.

    PubMed

    Raue, Patrick J; Ghesquiere, Angela R; Bruce, Martha L

    2014-09-01

    The National Strategy for Suicide Prevention (2012) has set a goal to reduce suicides by 20% within 5 years. Suicide rates are higher in older adults compared to most other age groups, and the majority of suicide completers have visited their primary care physician in the year before suicide. Primary care is an ideal setting to identify suicide risk and initiate mental health care. We review risk factors for late-life suicide; methods to assess for different levels of suicidality; and recent research developments regarding both effective assessment and management of suicide risk among older primary care patients. We highlight that broader scale screening of suicide risk may be considered in light of findings that suicidality can occur even in the absence of major risk factors like depression. We also highlight collaborative care models targeting suicide risk, and recent innovative interventions that aim to prevent the development of suicidal ideation and suicidal behavior.

  14. Improving population management through pharmacist-primary care integration: a pilot study.

    PubMed

    Kennedy, Amanda G; Chen, Harry; Corriveau, Michele; MacLean, Charles D

    2015-02-01

    Pharmacists have unique skills that may benefit primary care practices. The objective of this demonstration project was to determine the impact of integrating pharmacists into patient-centered medical homes, with a focus on population management. Pharmacists were partnered into 5 primary care practices in Vermont 1 day per week to provide direct patient care, population-based medication management, and prescriber education. The main measures included a description of drug therapy problems identified and cost avoidance models. The pharmacists identified 708 drug therapy problems through direct patient care (336/708; 47.5%), population-based strategies (276/708; 38.9%), and education (96/708; 13.6%). Common population-based strategies included adjusting doses and discontinuing unnecessary medications. Pharmacists' recommendations to correct drug therapy problems were accepted by prescribers 86% of the time, when data about acceptance were known. Of the 49 recommendations not accepted, 47/49 (96%) were population-based and 2/49 (4%) were related to direct patient care. The cost avoidance model suggests $2.11 in cost was avoided for every $1.00 spent on a pharmacist ($373,092/$176,690). There was clear value in integrating pharmacists into primary care teams. Their inclusion prevented adverse drug events, avoided costs, and improved patient outcomes. Primary care providers should consider pharmacists well suited to offer direct patient care, population-based management, and prescriber education to their practices. To be successful, pharmacists must have full permission to document findings in the primary care practices' electronic health records. Given that many pharmacist services do not involve billable activities, sustainability requires identifying alternative funding mechanisms that do not rely on a traditional fee-for-service approach. PMID:25029631

  15. Transitioning to routine breast cancer risk assessment and management in primary care: what can we learn from cardiovascular disease?

    PubMed

    Phillips, Kelly-Anne; Steel, Emma J; Collins, Ian; Emery, Jon; Pirotta, Marie; Mann, G Bruce; Butow, Phyllis; Hopper, John L; Trainer, Alison; Moreton, Jane; Antoniou, Antonis C; Cuzick, Jack; Keogh, Louise

    2016-01-01

    To capitalise on advances in breast cancer prevention, all women would need to have their breast cancer risk formally assessed. With ~85% of Australians attending primary care clinics at least once a year, primary care is an opportune location for formal breast cancer risk assessment and management. This study assessed the current practice and needs of primary care clinicians regarding assessment and management of breast cancer risk. Two facilitated focus group discussions were held with 17 primary care clinicians (12 GPs and 5 practice nurses (PNs)) as part of a larger needs assessment. Primary care clinicians viewed assessment and management of cardiovascular risk as an intrinsic, expected part of their role, often triggered by practice software prompts and facilitated by use of an online tool. Conversely, assessment of breast cancer risk was not routine and was generally patient- (not clinician-) initiated, and risk management (apart from routine screening) was considered outside the primary care domain. Clinicians suggested that routine assessment and management of breast cancer risk might be achieved if it were widely endorsed as within the remit of primary care and supported by an online risk-assessment and decision aid tool that was integrated into primary care software. This study identified several key issues that would need to be addressed to facilitate the transition to routine assessment and management of breast cancer risk in primary care, based largely on the model used for cardiovascular disease.

  16. Managing early childhood obesity in the primary care setting: a behavior modification approach.

    PubMed

    Drohan, Samantha H

    2002-01-01

    The purpose of this article is to encourage primary care pediatric nurses to begin behavioral-based obesity treatment efforts as early as the preschool years. By examining the critical periods for obesity development and how the formation of food and activity behaviors interacts with those critical periods during the preschool years, the value of initiating early obesity treatment will be highlighted. Furthermore, the theory of behavior modification is presented and core principles are applied to early childhood weight management efforts.

  17. Esthetic management of a primary double tooth using a silicone putty guide: a case report.

    PubMed

    Agarwal, Ravi; Chaudhry, Kalpna; Yeluri, Ramakrishna; Munshi, Autar Krishen

    2013-03-01

    The term double tooth is often used to describe fusion and gemination. The development of isolated large or joined teeth is not rare, but the literature is confusing when the appropriate terminology is presented. The objective of this paper is to present a case of a primary double tooth in a 5-year-old girl with a history of trauma. The tooth was endodontically treated and esthetic management was carried out using a silicone putty guide. PMID:23600163

  18. Esthetic management of a primary double tooth using a silicone putty guide: a case report.

    PubMed

    Agarwal, Ravi; Chaudhry, Kalpna; Yeluri, Ramakrishna; Munshi, Autar Krishen

    2013-03-01

    The term double tooth is often used to describe fusion and gemination. The development of isolated large or joined teeth is not rare, but the literature is confusing when the appropriate terminology is presented. The objective of this paper is to present a case of a primary double tooth in a 5-year-old girl with a history of trauma. The tooth was endodontically treated and esthetic management was carried out using a silicone putty guide.

  19. Weight management in primary care: how can it be made more effective?

    PubMed

    Maryon-Davis, Alan

    2005-02-01

    Obesity is often difficult to tackle in primary care. Pressure of time in the consultation, a lack of appropriately-trained primary care staff, a shortage of community dietitians or nutritionists, the potentially enormous caseload, language or cultural barriers and the sheer intractability of patients' eating habits, exercise behaviour and their clinical condition, all conspire to make general practitioners, other team members and often the patients themselves lose heart and stop even trying. However, there are ways of overcoming these difficulties. Examples of changes that evidence suggests are able to support and enhance basic one-to-one interventions in general practice include: improved clinical guidelines; better training of primary care staff; at-risk patient registers; smarter database search tools; new quality incentives; closer working with dietitians, counsellors and pharmacists; more hospital outreach clinics; designated general practitioner specialists and practice clustering; expanded exercise referral schemes and links with leisure providers; subsidised referral to commercial slimming groups; better use of patient groups and voluntary and community workers. The present paper describes a proposed 'triple-tier' pathway for weight management incorporating most of the elements mentioned earlier. With a more joined-up and creative approach to the development and organisation of primary care, more comprehensive training and workforce planning, and better integration with social care, voluntary groups and the commercial sector, weight management in general practice has the potential to be much more effective. PMID:15877928

  20. Chile: Acceptability of a Training Program for Depression Management in Primary Care

    PubMed Central

    Marín, Rigoberto; Martínez, Pablo; Cornejo, Juan P.; Díaz, Berta; Peralta, José; Tala, Álvaro; Rojas, Graciela

    2016-01-01

    Background: In Chile, there are inconsistencies in the management of depression in primary care settings, and the National Depression Program, currently in effect, was implemented without a standardized training program. The objective of this study is to evaluate the acceptability of a training program on the management of depression for primary care health teams. Methods: The study was a randomized controlled trial, and two primary centers from the Metropolitan Region of Santiago were randomly selected to carry out the intervention training program. Pre-post surveys were applied, to evaluate expectations and satisfaction with the intervention, respectively. Descriptive and content analysis was carried out. Result: The sample consisted of 41 health professionals, 56.1% of who reported that their expectations for the intervention were met. All of the training activities were evaluated with scores higher than 6.4 (on a 1–7 scale). The trainers, the methodology, and the learning environment were considered strengths and facilitators of the program, while the limited duration of the training, the logistical problems faced during part of the program, and the lack of educational material were viewed as weaknesses. Conclusion: The intervention was well accepted by primary health care teams. However, the clinical impact in patients still has to be evaluated. PMID:27375531

  1. Physical therapy management of primary lymphedema in the lower extremities: A case report.

    PubMed

    Greene, Revenda; Fowler, Rhonda

    2010-01-01

    Lymphedema is the tissue fluid accumulation that arises as a consequence of impaired lymphatic drainage. Lymphedema can result from either congenital (primary) or acquired (secondary) anomalies. Primary lymphedema affects 1-2 million people in the United States. Women are more affected by this disorder than men. The management of lymphedema by physical therapists usually includes a combination of skin care, external pressure, isotonic exercise, and massage. This case report describes the course of treatment for a 24-year-old female with stages 2 and 3 primary lymphedema. The goals of physical therapy intervention were as follows: 1) to reduce total limb girth circumference for both lower extremities; 2) to improve skin texture; 3) to promote independence with skin care to reduce the risk of infection; and 4) to facilitate independence with self-management. Following intervention, the patient met and exceeded all goals to decrease limb circumference. She had minimal fibrosis in the lower extremities, and she exhibited no signs and/or symptoms of infection. Decongestive lymphedema therapy was effective in treating this patient with primary lymphedema of the lower extremities. Continuous maintenance is required to ensure that the patient's limb size continues to reduce. PMID:20067355

  2. Managing benign prostatic hyperplasia in primary care. Patient-centred approach.

    PubMed Central

    McSherry, J.; Weiss, R.

    2000-01-01

    PROBLEM ADDRESSED: Management of benign prostatic hyperplasia (BPH) is changing from a surgical approach to a medical approach, and the role of primary care physicians is expanding. OBJECTIVE OF PROGRAM: To introduce a patient-centred approach to managing BPH in primary care through a continuing medical education (CME) program. MAIN COMPONENTS OF PROGRAM: A practice-based, small group, peer-led CME program focused on application of the International Prostate Symptom Score and Quality of Life Assessment in four case studies on prostatism, including BPH. At 86 workshops held across Canada, 658 physicians participated in discussions with case materials that included videos and a handbook. A before-after practice behaviour questionnaire was administered at each workshop to evaluate "intent to change." CONCLUSIONS: Participating physicians showed willingness to learn new skills for patient-centred management of BPH. These results suggest that peer-led, small group CME can successfully encourage use of new practice guidelines in primary are and teach physicians practical steps for developing therapeutic alliances with their patients. PMID:10690495

  3. Primary care management of alcohol use disorder and at-risk drinking

    PubMed Central

    Spithoff, Sheryl; Kahan, Meldon

    2015-01-01

    Abstract Objective To provide primary care physicians with evidence-based information and advice on the management of at-risk drinking and alcohol use disorder (AUD). Sources of information We conducted a nonsystematic literature review using search terms that included primary care; screening, interventions, management, and treatment; and at-risk drinking, alcohol use disorders, alcohol dependence, and alcohol abuse; as well as specific medical and counseling interventions of relevance to primary care. Main message For their patients with at-risk drinking and AUD, physicians should counsel and, when indicated (ie, in patients with moderate or severe AUD), prescribe and connect. Counsel: Offer all patients with at-risk drinking a brief counseling session and follow-up. Offer all patients with AUD counseling sessions and ongoing (frequent and regular) follow-up. Prescribe: Offer medications (disulfiram, naltrexone, acamprosate) to all patients with moderate or severe AUD. Connect: Encourage patients with AUD to attend counseling, day or residential treatment programs, and support groups. If indicated, refer patients to an addiction medicine physician, concurrent mental health and addiction services, or specialized trauma therapy. Conclusion Family physicians can effectively manage patients with at-risk drinking and AUD. PMID:26071155

  4. Routine primary care management of acute low back pain: adherence to clinical guidelines.

    PubMed

    González-Urzelai, Violeta; Palacio-Elua, Loreto; López-de-Munain, Josefina

    2003-12-01

    One of the major challenges for general practitioners is to manage individuals with acute low back pain appropriately to reduce the risk of chronicity. A prospective study was designed to assess the actual management of acute low back pain in one primary care setting and to determine whether existing practice patterns conform to published guidelines. Twenty-four family physicians from public primary care centers of the Basque Health Service in Bizkaia, Basque Country (Spain), participated in the study. A total of 105 patients aged 18-65 years presenting with acute low back pain over a 6-month period were included. Immediately after consultation, a research assistant performed a structured clinical interview. The patients' care provided by the general practitioner was compared with the Agency for Health Care Policy and Research (AHCPR) guidelines and guidelines issued by the Royal College of General Practitioners. The diagnostic process showed a low rate of appropriate use of history (27%), physical examination (32%), lumbar radiographs (31%), and referral to specialized care (33%). Although the therapeutic process showed a relatively high rate of appropriateness in earlier mobilization (77%) and educational advice (65%), only 23% of patients were taught about the benign course of back pain. The study revealed that management of acute low back pain in the primary care setting is far from being in conformance with published clinical guidelines. PMID:14605973

  5. Barriers to accurate diagnosis and effective management of heart failure in primary care: qualitative study

    PubMed Central

    Fuat, Ahmet; Hungin, A Pali S; Murphy, Jeremy James

    2003-01-01

    Objective To ascertain the beliefs, current practices, and decision making of general practitioners in the diagnosis and management of suspected heart failure in primary care, with a view to identifying barriers to good care. Design A qualitative approach using focus groups with 30 general practitioners from four primary care groups. The sampling strategy was stratified and purposive. The contents of interviews were transcribed and analysed according to the principles of “pragmatic variant” grounded theory. Setting North east England. Results Three categories of difficulties contribute to variations in medical practice and to the reasons why general practitioners experience difficulties in diagnosing and managing heart failure. The first is uncertainty about clinical practice, including lack of confidence in establishing an accurate diagnosis and worries about using angiotensin converting enzyme inhibitors, β blockers, and spironolactone in patients who are often elderly and frail, with comorbidity and polypharmacy. The second is a lack of awareness of relevant research evidence in what was perceived to be a complex and rapidly changing therapeutic field. Doubts about the applicability of research findings in primary care, and fear of information overload also emerged. The third category consists of influences of individual preference and local organisational factors. Medical training, negative clinical experiences, and outside agencies influenced the behaviour of general practitioners and professional culture. Local factors included the availability of diagnostic services, resources (such as accessible cardiologists), and interactions between professionals in primary or secondary care, and they seemed to shape the practice and decision making processes in primary care. Conclusions The national service framework for coronary heart disease stresses that the substandard care of patients with heart failure is unacceptable. This study identified barriers to be

  6. Study protocol for a randomised controlled trial of invasive versus conservative management of primary spontaneous pneumothorax

    PubMed Central

    Brown, Simon G A; Ball, Emma L; Perrin, Kyle; Read, Catherine A; Asha, Stephen E; Beasley, Richard; Egerton-Warburton, Diana; Jones, Peter G; Keijzers, Gerben; Kinnear, Frances B; Kwan, Ben C H; Lee, Y C Gary; Smith, Julian A; Summers, Quentin A; Simpson, Graham

    2016-01-01

    Introduction Current management of primary spontaneous pneumothorax (PSP) is variable, with little evidence from randomised controlled trials to guide treatment. Guidelines emphasise intervention in many patients, which involves chest drain insertion, hospital admission and occasionally surgery. However, there is evidence that conservative management may be effective and safe, and it may also reduce the risk of recurrence. Significant questions remain regarding the optimal initial approach to the management of PSP. Methods and analysis This multicentre, prospective, randomised, open label, parallel group, non-inferiority study will randomise 342 participants with a first large PSP to conservative or interventional management. To maintain allocation concealment, randomisation will be performed in real time by computer and stratified by study site. Conservative management will involve a period of observation prior to discharge, with intervention for worsening symptoms or physiological instability. Interventional treatment will involve insertion of a small bore drain. If drainage continues after 1 hour, the patient will be admitted. If drainage stops, the drain will be clamped for 4 hours. The patient will be discharged if the lung remains inflated. Otherwise, the patient will be admitted. The primary end point is the proportion of participants with complete lung re-expansion by 8 weeks. Secondary end points are as follows: days in hospital, persistent air leak, predefined complications and adverse events, time to resolution of symptoms, and pneumothorax recurrence during a follow-up period of at least 1 year. The study has 95% power to detect an absolute non-inferiority margin of 9%, assuming 99% successful expansion at 8 weeks in the invasive treatment arm. The primary analysis will be by intention to treat. Ethics and dissemination Local ethics approval has been obtained for all sites. Study findings will be disseminated by publication in a high

  7. Management of asymptomatic primary tumours in stage IV colorectal cancer: Review of outcomes

    PubMed Central

    Wilkinson, Kate Jessica; Chua, Wei; Ng, Weng; Roohullah, Aflah

    2015-01-01

    AIM: To compare outcomes for patients presenting with stage IV colorectal cancer and an asymptomatic primary tumour, undergoing primary tumour resection (PTR) plus palliative chemotherapy vs primary chemotherapy up-front. METHODS: A literature search was conducted using MEDLINE and EMBASE. The primary outcome was overall survival. Secondary outcomes included perioperative mortality, morbidity and delayed surgical intervention rates in patients undergoing PTR and subsequent complication rates in patients with an un-resected primary tumour. Tertiary outcomes included impact on systemic treatment and identification of prognostic factors relevant for survival in this cohort. RESULTS: Twenty non-randomised studies met the inclusion criteria. Eleven studies included comparative overall survival data. Three studies showed an overall survival advantage for PTR, 7 studies showed no statistically significant advantage, and 1 study showed a significant worsening in survival in the surgical group. The perioperative mortality rate ranged from 0% to 8.5%, and post-operative morbidity rate from 10% to 35%, mainly minor complications that did not preclude subsequent chemotherapy. The rate of delayed primary-tumour related symptoms, most commonly obstruction, in patients with an un-resected primary tumour ranged from 3% to 46%. The strongest independent poor prognostic factor was extensive hepatic metastases, in addition to poor performance status, M1b stage and non-use of modern chemotherapy agents. CONCLUSION: Based on the current literature, both PTR and up front chemotherapy appear appropriate initial management strategies, with a trend towards an overall survival advantage with PTR. The procedure has a low post-operative mortality, and most complications are transient and minor. The results of recruiting randomised trials are eagerly anticipated. PMID:26691885

  8. Quality of chronic kidney disease management in primary care: a retrospective study

    PubMed Central

    Van Gelder, Vincent A.; Scherpbier-De Haan, Nynke D.; De Grauw, Wim J.C.; Vervoort, Gerald M.M.; Van Weel, Chris; Biermans, Marion C.J.; Braspenning, Jozé C.C.; Wetzels, Jack F.M.

    2016-01-01

    Background Early detection and appropriate management of chronic kidney disease (CKD) in primary care are essential to reduce morbidity and mortality. Aim To assess the quality of care (QoC) of CKD in primary healthcare in relation to patient and practice characteristics in order to tailor improvement strategies. Design and setting Retrospective study using data between 2008 and 2011 from 47 general practices (207 469 patients of whom 162 562 were adults). Method CKD management of patients under the care of their general practitioner (GP) was qualified using indicators derived from the Dutch interdisciplinary CKD guideline for primary care and nephrology and included (1) monitoring of renal function, albuminuria, blood pressure, and glucose, (2) monitoring of metabolic parameters, and alongside the guideline: (3) recognition of CKD. The outcome indicator was (4) achieving blood pressure targets. Multilevel logistic regression analysis was applied to identify associated patient and practice characteristics. Results Kidney function or albuminuria data were available for 59 728 adult patients; 9288 patients had CKD, of whom 8794 were under GP care. Monitoring of disease progression was complete in 42% of CKD patients, monitoring of metabolic parameters in 2%, and blood pressure target was reached in 43.1%. GPs documented CKD in 31.4% of CKD patients. High QoC was strongly associated with diabetes, and to a lesser extent with hypertension and male sex. Conclusion Room for improvement was found in all aspects of CKD management. As QoC was higher in patients who received structured diabetes care, future CKD care may profit from more structured primary care management, e.g. according to the chronic care model. Key pointsQuality of care for chronic kidney disease patients in primary care can be improved.In comparison with guideline advice, adequate monitoring of disease progression was observed in 42%, of metabolic parameters in 2%, correct recognition of impaired renal

  9. Barriers to obesity management: a pilot study of primary care clinicians

    PubMed Central

    Forman-Hoffman, Valerie; Little, Amanda; Wahls, Terry

    2006-01-01

    Background Obesity is an increasing epidemic in both the US and veteran populations, yet it remains largely understudied in the Veteran's Health Administration (VHA) setting. The purpose of our study was to identify barriers to the effective management of obesity in VHA primary care settings. Methods Three focus groups of clinicians from a Veteran's Affairs Medical Center (VAMC) and an affiliated Community Based Outpatient Center (CBOC) were conducted to identify potential barriers to obesity management. The focus groups and previously published studies then informed the creation of a 47-item survey that was then disseminated and completed by 55 primary care clinicians. Results The focus groups identified provider, system, and patient barriers to obesity care. Lack of obesity training during medical school and residency was associated with lower rates of discussing diet and exercise with obese patients (p < 0.05). Clinicians who watched their own diets vigorously were more likely to calculate BMI for obese patients than other clinicians (42% vs. 13%, p < 0.05). Many barriers identified in previous studies (e.g., attitudes toward obese patients, lack of insurance payments for obesity care) were not prevalent barriers in the current study. Conclusion Many VHA clinicians do not routinely provide weight management services for obese patients. The most prevalent barriers to obesity care were poor education during medical school and residency and the lack of information provided by the VHA to both clinicians and patients about available weight management services. PMID:16756673

  10. Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee.

    PubMed

    Okosieme, Onyebuchi; Gilbert, Jackie; Abraham, Prakash; Boelaert, Kristien; Dayan, Colin; Gurnell, Mark; Leese, Graham; McCabe, Christopher; Perros, Petros; Smith, Vicki; Williams, Graham; Vanderpump, Mark

    2016-06-01

    The management of primary hypothyroidism with levothyroxine (L-T4) is simple, effective and safe, and most patients report improved well-being on initiation of treatment. However, a proportion of individuals continue to suffer with symptoms despite achieving adequate biochemical correction. The management of such individuals has been the subject of controversy and of considerable public interest. The American Thyroid Association (ATA) and the European Thyroid Association (ETA) have recently published guidelines on the diagnosis and management of hypothyroidism. These guidelines have been based on extensive reviews of the medical literature and include sections on the role of combination therapy with L-T4 and liothyronine (L-T3) in individuals who are persistently dissatisfied with L-T4 therapy. This position statement by the British Thyroid Association (BTA) summarises the key points in these guidelines and makes recommendations on the management of primary hypothyroidism based on the current literature, review of the published positions of the ETA and ATA, and in line with best principles of good medical practice. The statement is endorsed by the Association of Clinical Biochemistry, (ACB), British Thyroid Foundation, (BTF), Royal College of Physicians (RCP) and Society for Endocrinology (SFE). PMID:26010808

  11. Understanding the Intersection of Individual Needs and Choices With Organizational Practices: The Case of Medication Management in Assisted Living

    PubMed Central

    Carder, Paula C.; Zimmerman, Sheryl; Schumacher, John G.

    2009-01-01

    Purpose: Making choices about everyday activities is a normal event for many adults. However, when an adult moves into an assisted living (AL) community, making choices becomes complicated by perceived needs and community practices. This study examines the relationship between choice and need in the context of practices, using medication administration practices as the case in point. Design and Methods: A 5-year ethnographic study collected information from 6 AL settings in Maryland. Ethnographic interviews (n = 323) and field notes comprise the data described in this article. Results: AL organizations used practice rationales based on state regulations, professional responsibility, safety concerns, and social model values to describe and explain their setting-specific practices. The result was varying levels of congruence between the setting's practices and individual resident's needs and choices. That is, in some cases, the resident's needs were lost to the organization's practices, and in other cases, organizations adapted to resident need and choices. These findings suggest that individuals and organizations adapt to each other, resulting in practices that are not bound by state requirement or other practice rationales. Implications: AL residences vary due to both internal and external forces, not just the public policies that define them. State regulations need to be responsive to both the needs and the choices of individual residents and to the people who work in an AL. PMID:19491359

  12. Diagnosis and management of primary sclerosing cholangitis-perspectives from a therapeutic endoscopist

    PubMed Central

    Modha, Kunjam; Navaneethan, Udayakumar

    2015-01-01

    Primary sclerosing cholangitis (PSC) is a chronic, cholestatic liver condition characterized by inflammation, fibrosis, and destruction of the intra- and extrahepatic bile ducts. The therapeutic endoscopist plays a key role in the diagnosis and management of PSC. In patients presenting with a cholestatic profile, endoscopic retrograde cholangiopancreatography (ERCP) is warranted for a definite diagnosis of PSC. Dominant strictures of the bile duct occur in 36%-57% of PSC patients. Endoscopic balloon dilatation with or without stenting have been employed in the management of dominant strictures. In addition, PSC patients are at increased risk of developing cholangiocarcinoma with a 20% lifetime risk. Brush cytology obtained during ERCP and use of fluorescence in situ hybridization forms the initial diagnostic step in the investigation of patients with dominant biliary strictures. Our review aims to summarize the current evidence supporting the role of a therapeutic endoscopist in the management of PSC patients. PMID:25914780

  13. Adolescence and asthma management: the perspective of adolescents receiving primary health care☆

    PubMed Central

    Araújo, Alisson; Rocha, Regina Lunardi; Alvim, Cristina Gonçalves

    2014-01-01

    Objective: To study the influence of adolescence characteristics on asthma management. Methods: This was a qualitative study conducted in the city of Divinópolis, Minas Gerais, Southeast Brazil. Data were collected through semistructured interviews guided by a questionnaire with seven asthmatic adolescents followed-up in the primary public health care service of the city. Results: Using content analysis, three thematic categories were observed in the adolescents' responses: 1) family relationships in the treatment of asthma in adolescence; 2) the asthmatic adolescents and their peers; and 3) the role of the school for the asthmatic adolescents. Conclusions: The results demonstrated that peers, family, and school should be more valued by health professionals and by health care services when treating asthmatic adolescents, as these social relationships are closely associated with the adolescent and have an important role in asthma management. Attempts to meet the demands of adolescents contribute to improve asthma management. PMID:25479845

  14. Management of Biochemical Recurrence after Primary Localized Therapy for Prostate Cancer

    PubMed Central

    Darwish, Oussama M.; Raj, Ganesh V.

    2012-01-01

    Clinically localized prostate cancer is typically managed by well established therapies like radical prostatectomy, brachytherapy, and external beam radiation therapy. While many patients can be cured with definitive local therapy, some will have biochemical recurrence (BCR) of disease detected by a rising serum prostate-specific antigen (PSA). Management of these patients is nuanced and controversial. The natural history indicates that a majority of patients with BCR will not die from prostate cancer but from other causes. Despite this, a vast majority of patients with BCR are empirically treated with non-curable systemic androgen deprivation therapy (ADT), with its myriad of real and potential side effects. In this review article, we examined the very definition of BCR after definitive local therapy, the current status of imaging studies in its evaluation, the need for additional therapies, and the factors involved in the decision making in the choice of additional therapies. This review aims to help clinicians with the management of patients with BCR. The assessment of prognostic factors including absolute PSA level, time to recurrence, PSA kinetics, multivariable nomograms, imaging, and biopsy of the prostatic bed may help stratify the patients into localized or systemic recurrence. Patients with low-risk of systemic disease may be cured by a salvage local therapy, while those with higher risk of systemic disease may be offered the option of ADT or a clinical trial. An algorithm incorporating these factors is presented. PMID:22655274

  15. Development of a Knowledge Management Model for the Development of a Quality Public Sector Management System for the Office of the Primary Educational Service Area

    ERIC Educational Resources Information Center

    Khotbancha, Wijitra; Chantarasombat, Chalard; Sriampai, Anan

    2015-01-01

    The objectives of this research were: 1) to study the current situation and problem of Knowledge Management of the office of the primary education service area, 2) to develop a Knowledge Management model, 3) to study the success of the implementation of the Knowledge Management system. There were 25 persons in the target group. There were 2 kinds…

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

    PubMed Central

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

    2011-01-01

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

  17. Noncommunicable disease management in resource-poor settings: a primary care model from rural South Africa.

    PubMed Central

    Coleman, R.; Gill, G.; Wilkinson, D.

    1998-01-01

    Noncommunicable diseases (NCDs) such as hypertension, asthma, diabetes and epilepsy are placing an increasing burden on clinical services in developing countries and innovative strategies are therefore needed to optimize existing services. This article describes the design and implementation of a nurse-led NCD service based on clinical protocols in a resource-poor area of South Africa. Diagnostic and treatment protocols were designed and introduced at all primary care clinics in the district, using only essential drugs and appropriate technology; the convenience of management for the patient was highlighted. The protocols enabled the nurses to control the clinical condition of 68% of patients with hypertension, 82% of those with non-insulin-dependent diabetes, and 84% of those with asthma. The management of NCDs of 79% of patients who came from areas served by village or mobile clinics was transferred from the district hospital to such clinics. Patient-reported adherence to treatment increased from 79% to 87% (P = 0.03) over the 2 years that the service was operating. The use of simple protocols and treatment strategies that were responsive to the local situation enabled the majority of patients to receive convenient and appropriate management of their NCD at their local primary care facility. PMID:10191559

  18. Evaluation of computerized health management information system for primary health care in rural India

    PubMed Central

    2010-01-01

    Background The Comprehensive Rural Health Services Project Ballabgarh, run by All India Institute of Medical Sciences (AIIMS), New Delhi has a computerized Health Management Information System (HMIS) since 1988. The HMIS at Ballabgarh has undergone evolution and is currently in its third version which uses generic and open source software. This study was conducted to evaluate the effectiveness of a computerized Health Management Information System in rural health system in India. Methods The data for evaluation were collected by in-depth interviews of the stakeholders i.e. program managers (authors) and health workers. Health Workers from AIIMS and Non-AIIMS Primary Health Centers were interviewed to compare the manual with computerized HMIS. A cost comparison between the two methods was carried out based on market costs. The resource utilization for both manual and computerized HMIS was identified based on workers' interviews. Results There have been no major hardware problems in use of computerized HMIS. More than 95% of data was found to be accurate. Health workers acknowledge the usefulness of HMIS in service delivery, data storage, generation of workplans and reports. For program managers, it provides a better tool for monitoring and supervision and data management. The initial cost incurred in computerization of two Primary Health Centers was estimated to be Indian National Rupee (INR) 1674,217 (USD 35,622). Equivalent annual incremental cost of capital items was estimated as INR 198,017 (USD 4213). The annual savings is around INR 894,283 (USD 11,924). Conclusion The major advantage of computerization has been in saving of time of health workers in record keeping and report generation. The initial capital costs of computerization can be recovered within two years of implementation if the system is fully operational. Computerization has enabled implementation of a good system for service delivery, monitoring and supervision. PMID:21078203

  19. A review of recent literature - nurse case managers in diabetes care: equivalent or better outcomes compared to primary care providers.

    PubMed

    Watts, Sharon A; Lucatorto, Michelle

    2014-07-01

    Primary care has changed remarkably with chronic disease burden growth. Nurse case managers assist with this chronic disease by providing if not significantly better care, than equivalent care to that provided by usual primary care providers. Chronic disease management requires patient-centered skills and tools, such as registries, panel management, review of home data, communicating with patients outside of face-to-face care, and coordinating multiple services. Evidence reviewed in this article demonstrates that registered nurse care managers (RNCM) perform many actions required for diabetes chronic disease management including initiation and titration of medications with similar or improved physiologic and patient satisfaction outcomes over usual care providers. Selection and training of the nurse case managers is of utmost importance for implementation of a successful chronic disease management program. Evidence based guidelines, algorithms, protocols, and adequate ongoing education and mentoring are generally cited as necessary support tools for the nurse case managers.

  20. Management of the Primary Tumor and Limited Metastases in Patients With Metastatic Pancreatic Cancer.

    PubMed

    Herman, Joseph M; Hoffman, John P; Thayer, Sarah P; Wolff, Robert A

    2015-05-01

    New combinations of cytotoxic chemotherapy have been proven to increase response rates and survival times compared with single-agent gemcitabine for patients with metastatic pancreatic cancer. These responses have been dramatic for a subset of patients, therefore raising questions about the management of limited metastatic disease with surgery or other ablative methods. Similarly, for patients having a complete radiographic response to chemotherapy in the metastatic compartment, whether to consider local therapy in the form of radiation or surgery for the primary tumor is now an appropriate question. Therefore, collaboration among experts in surgery, medical oncology, and radiation oncology has led to the development of guiding principles for local therapies to the primary intact pancreatic tumor for patients with limited metastatic disease and those who have had a significant response after systemic therapy.

  1. A brief intervention for weight management in primary care: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Obesity affects 25% of the UK adult population but modest weight loss can reduce the incidence of obesity-related chronic disease. Some effective weight loss treatments exist but there is no nationally available National Health Service (NHS) treatment service, and general practitioners (GPs) rarely discuss weight management with patients or support behavior change. Evidence shows that commercial weight management services, that most primary care trusts have 'on prescription', are more effective than primary care treatment. Methods/design We propose a controlled trial where patients will be randomized to receive either the offer of help by referral to a weight management service and follow-up to assess progress, or advice to lose weight on medical grounds. The primary outcome will be weight change at 12-months. Other questions are: what actions do people take to manage their weight in response to the two GP intervention types? How do obese patients feel about GPs opportunistically discussing weight management and how does this vary by intervention type? How do GPs feel about raising the issue opportunistically and giving the two types of brief intervention? What is the cost per kg/m2 lost for each intervention? Research assistants visiting GP practices in England (n = 60) would objectively measure weight and height prior to GP consultations and randomize willing patients (body mass index 30+, excess body fat, 18+ years) using sealed envelopes. Full recruitment (n = 1824) is feasible in 46 weeks, requiring six sessions of advice-giving per GP. Participants will be contacted at 3 months (postintervention) via telephone to identify actions they have taken to manage their weight. We will book appointments for participants to be seen at their GP practice for a 12-month follow-up. Discussion Trial results could make the case for brief interventions for obese people consulting their GP and introduce widespread simple treatments akin to the NHS Stop

  2. Cost-Effectiveness of Enhancing Primary Care Depression Management on an Ongoing Basis

    PubMed Central

    Rost, Kathryn; Pyne, Jeffrey M.; Dickinson, L. Miriam; LoSasso, Anthony T.

    2005-01-01

    PURPOSE Although potentially costly, enhancing primary care depression management on an ongoing basis results in substantial long-term treatment effectiveness. The purpose of this article is to compare the cost-effectiveness of this approach with that of usual care. METHODS The study was conducted in 12 community primary care practices randomized to enhanced or usual care after stratification by baseline practice patterns. Practices assigned to enhanced care encouraged depressed patients to engage in active treatment, using practice nurses to provide regularly scheduled care management during the course of 24 months. We analyze outcomes for 211 adults (73.4% of potential eligible patients) beginning a new treatment episode for major depression determined by previsit screening. Outcomes included blinded estimates of days free of depression impairment as well as health care costs for 2 years. RESULTS Enhanced care significantly increased the number of days free of depression impairment for 2 years when compared with usual care (647.6 days vs 588.2 days, P <.01). The incremental cost-effectiveness ratio for enhanced care ranged from $9,592 to $14,306 per quality-adjusted life-year (QALY). The number of incremental days free of depression impairment increased between the first year and the second year (23.0 vs 36.4, respectively, P <.001) while incremental health plan costs decreased significantly ($568 vs -$12, P <.001). CONCLUSIONS Enhancing primary care depression management on an ongoing basis should be considered for adoption by policy and health plan leaders. PMID:15671185

  3. Evaluation of computerized decision support for oral anticoagulation management based in primary care.

    PubMed Central

    Fitzmaurice, D A; Hobbs, F D; Murray, E T; Bradley, C P; Holder, R

    1996-01-01

    BACKGROUND: Increasing indications for oral anticoagulation has led to pressure on general practices to undertake therapeutic monitoring. Computerized decision support (DSS) has been shown to be effective in hospitals for improving clinical management. Its usefulness in primary care has previously not been investigated. AIM: To test the effectiveness of using DSS for oral anticoagulation monitoring in primary care by measuring the proportions of patients adequately controlled, defined as within the appropriate therapeutic range of International Normalised Ratio (INR). METHOD: All patients receiving warfarin from two Birmingham inner city general practices were invited to attend a practice-based anticoagulation clinic. In practice A all patients were managed using DSS. In practice B patients were randomized to receive dosing advice either through DSS or through the local hospital laboratory. Clinical outcomes, adverse events and patient acceptability were recorded. RESULTS: Forty-nine patients were seen in total. There were significant improvements in INR control from 23% to 86% (P > 0.001) in the practice where all patients received dosing through DSS. In the practice where patients were randomized to either DSS or hospital dosing, logistic regression showed a significant trend for improvement in intervention patients which was not apparent in the hospital-dosed patients (P < 0.001). Mean recall times were significantly extended in patients who were dosed by the practice DSS through the full 12 months (24 days to 36 days) (P = 0.033). Adverse events were comparable between hospital and practice-dosed patients, although a number of esoteric events occurred. Patient satisfaction with the practice clinics was high. CONCLUSION: Computerized DSS enables the safe and effective transfer of anticoagulation management from hospital to primary care and may result in improved patient outcome in terms of the level of control, frequency of review and general acceptability. PMID

  4. Diagnosis and management of primary autoimmune neutropenia in children: insights for clinicians

    PubMed Central

    Dufour, Carlo

    2015-01-01

    Autoimmune neutropenia of infancy (AIN), also called primary autoimmune neutropenia, is a disease in which antibodies recognize membrane antigens of neutrophils, mostly located on immunoglobulin G (IgG) Fc receptor type 3b (FcγIIIb receptor), causing their peripheral destruction. It is the most frequent type of neutropenia in children under 3–4 years of age and in most cases shows a benign, self-limited course. The diagnosis is based on evidence of indirect antineutrophil antibodies, whose detection frequently remains difficult. In this review we have analyzed the literature regarding AIN and present our personal experience in diagnosis and management. PMID:25642312

  5. Diagnosis and management of primary autoimmune neutropenia in children: insights for clinicians.

    PubMed

    Farruggia, Piero; Dufour, Carlo

    2015-02-01

    Autoimmune neutropenia of infancy (AIN), also called primary autoimmune neutropenia, is a disease in which antibodies recognize membrane antigens of neutrophils, mostly located on immunoglobulin G (IgG) Fc receptor type 3b (FcγIIIb receptor), causing their peripheral destruction. It is the most frequent type of neutropenia in children under 3-4 years of age and in most cases shows a benign, self-limited course. The diagnosis is based on evidence of indirect antineutrophil antibodies, whose detection frequently remains difficult. In this review we have analyzed the literature regarding AIN and present our personal experience in diagnosis and management. PMID:25642312

  6. Treating anemia of chronic kidney disease in the primary care setting: cardiovascular outcomes and management recommendations.

    PubMed

    Schmidt, Rebecca J; Dalton, Cheryl L

    2007-10-02

    Anemia is an underrecognized but characteristic feature of chronic kidney disease (CKD), associated with significant cardiovascular morbidity, hospitalization, and mortality. Since their inception nearly two decades ago, erythropoiesis-stimulating agents (ESAs) have revolutionized the care of patients with renal anemia, and their use has been associated with improved quality of life and reduced hospitalizations, inpatient costs, and mortality. Hemoglobin targets >/=13 g/dL have been linked with adverse events in recent randomized trials, raising concerns over the proper hemoglobin range for ESA treatment. This review appraises observational and randomized studies of the outcomes of erythropoietic treatment and offers recommendations for managing renal anemia in the primary care setting.

  7. Managing multimorbidity in primary care in patients with chronic respiratory conditions

    PubMed Central

    Morrison, Deborah; Agur, Karolina; Mercer, Stewart; Eiras, Andreia; González-Montalvo, Juan I; Gruffydd-Jones, Kevin

    2016-01-01

    The term multimorbidity is usually defined as the coexistence of two or more chronic conditions within an individual, whereas the term comorbidity traditionally describes patients with an index condition and one or more additional conditions. Multimorbidity of chronic conditions markedly worsens outcomes in patients, increases treatment burden and increases health service costs. Although patients with chronic respiratory disease often have physical comorbidities, they also commonly experience psychological problems such as depression and anxiety. Multimorbidity is associated with increased health-care utilisation and specifically with an increased number of prescription drugs in individuals with multiple chronic conditions such as chronic obstructive pulmonary disease. This npj Primary Care Respiratory Medicine Education Section case study involves a patient in a primary care consultation presenting several common diseases prevalent in people of this age. The patient takes nine different drugs at this moment, one or more pills for each condition, which amounts to polypharmacy. The problems related with polypharmacy recommend that a routine medication review by primary care physicians be performed to reduce the risk of adverse effects of polypharmacy among those with multiple chronic conditions. The primary care physician has the challenging role of integrating all of the clinical problems affecting the patient and reviewing all medicaments (including over-the-counter medications) taken by the patient at any point in time, and has the has the key to prevent the unwanted consequences of polypharmacy. Multimorbid chronic disease management can be achieved with the use of care planning, unified disease templates, use of information technology with appointment reminders and with the help of the wider primary care and community teams. PMID:27629064

  8. Managing multimorbidity in primary care in patients with chronic respiratory conditions.

    PubMed

    Morrison, Deborah; Agur, Karolina; Mercer, Stewart; Eiras, Andreia; González-Montalvo, Juan I; Gruffydd-Jones, Kevin

    2016-01-01

    The term multimorbidity is usually defined as the coexistence of two or more chronic conditions within an individual, whereas the term comorbidity traditionally describes patients with an index condition and one or more additional conditions. Multimorbidity of chronic conditions markedly worsens outcomes in patients, increases treatment burden and increases health service costs. Although patients with chronic respiratory disease often have physical comorbidities, they also commonly experience psychological problems such as depression and anxiety. Multimorbidity is associated with increased health-care utilisation and specifically with an increased number of prescription drugs in individuals with multiple chronic conditions such as chronic obstructive pulmonary disease. This npj Primary Care Respiratory Medicine Education Section case study involves a patient in a primary care consultation presenting several common diseases prevalent in people of this age. The patient takes nine different drugs at this moment, one or more pills for each condition, which amounts to polypharmacy. The problems related with polypharmacy recommend that a routine medication review by primary care physicians be performed to reduce the risk of adverse effects of polypharmacy among those with multiple chronic conditions. The primary care physician has the challenging role of integrating all of the clinical problems affecting the patient and reviewing all medicaments (including over-the-counter medications) taken by the patient at any point in time, and has the has the key to prevent the unwanted consequences of polypharmacy. Multimorbid chronic disease management can be achieved with the use of care planning, unified disease templates, use of information technology with appointment reminders and with the help of the wider primary care and community teams. PMID:27629064

  9. Stress and Primary Headache: Review of the Research and Clinical Management.

    PubMed

    Martin, Paul R

    2016-07-01

    This review begins with a discussion of the nature of stress and then presents the functional model of primary headache as a framework for conceptualizing the complex relationship between stress and headaches. Research is reviewed on stress as a trigger of headaches and how stress can play a role in the developmental and psychosocial context of headaches. Clinical management of headaches from a stress perspective is considered both at the level of trials of behavioral interventions that broadly fit into the stress management category and the additional strategies that might be useful for individual cases based on the research demonstrating associations between stress and headaches. The review concludes by suggesting that although some researchers have questioned whether stress can trigger headaches, overall, the literature is still supportive of such a link. Advances in methodology are discussed, the recent emphasis on protective factors is welcomed, and directions for future research suggested.

  10. 25 CFR 558.3 - Procedures for forwarding applications and reports for key employees and primary management...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... INDIAN GAMING COMMISSION, DEPARTMENT OF THE INTERIOR GAMING LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES FOR KEY EMPLOYEES AND PRIMARY... at a gaming operation, a tribe shall: (1) Forward to the Commission a completed application...

  11. 25 CFR 558.3 - Procedures for forwarding applications and reports for key employees and primary management...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... INDIAN GAMING COMMISSION, DEPARTMENT OF THE INTERIOR GAMING LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES FOR KEY EMPLOYEES AND PRIMARY... at a gaming operation, a tribe shall: (1) Forward to the Commission a completed application...

  12. Education and Training of Nurse Teachers and Managers with Special Regard to Primary Health Care. Technical Report Series 708.

    ERIC Educational Resources Information Center

    World Health Organization, Geneva (Switzerland).

    A 1983 committee report is presented of the World Health Organization Expert Committee on the Education and Training of Nurse Teachers and Managers with Special Regard to Primary Health Care. After discussing the changing context of health care and trends in primary health care, changes required in education and training in health systems based on…

  13. The Testimony of Neoliberal Contradiction in Education Choice and Privatisation in a Poor Country: The Case of a Private, Undocumented Rural Primary School in Uganda

    ERIC Educational Resources Information Center

    Mayengo, Nathaniel; Namusoke, Jane; Dennis, Barbara

    2015-01-01

    With international momentum to achieve "Education for All" by 2015, global attention is being paid to those parts of the world where mass formal primary schooling is relatively new. Uganda is such a place. In the context of ethnographic fieldwork at a poor, undocumented, private primary school in rural Uganda, parents were interviewed in…

  14. Solid waste management in primary healthcare centers: application of a facilitation tool 1

    PubMed Central

    Moreira, Ana Maria Maniero; Günther, Wanda Maria Risso

    2016-01-01

    Abstract Objectives: to propose a tool to facilitate diagnosis, formulation and evaluation of the Waste Management Plan in Primary Healthcare Centers and to present the results of the application in four selected units. Method: descriptive research, covering the stages of formulation /application of the proposed instrument and the evaluation of waste management performance at the units. Results: the tool consists in five forms; specific indicators of waste generation for outpatients healthcare units were proposed, and performance indicators that give scores for compliance with current legislation. In the studied units it is generated common waste (52-60%), infectious-sharps (31-42%) and recyclable (5-17%). The average rates of generation are: 0,09kg of total waste/outpatient assistance and 0,09kg of infectious-sharps waste/outpatient procedure. The compliance with regulations, initially 26-30%, then reached 30-38% a year later. Conclusion: the tool showed to be easy to use, bypassing the existence of a complex range of existing regulatory requirements, allowed to identify non-conformities, pointed out corrective measures and evaluated the performance of waste management. In this sense, it contributes to decision making and management practices relating to waste, tasks usually assigned to nurses. It is recommended that the tool be applied in similar healthcare units for comparative studies, and implementation of necessary adaptations for other medical services. PMID:27556874

  15. A guide to the management of urologic dilemmas for the primary care physician (PCP).

    PubMed

    Barkin, Jack; Rosenberg, Matt T; Miner, Martin

    2014-06-01

    Patients with urologic conditions may present to a primary care physician (PCP) in the emergency department or in the PCP's office. Some conditions are true emergencies that require immediate surgical intervention. Others may require medical treatment or possibly simply reassuring the patient that there is no serious medical problem. Sometimes the diagnosis can be easily made, whereas other times the PCP needs to be able to rule out serious causes for a presenting problem and execute a guideline-recommended patient work up, to make a final diagnosis. Sometimes recommended diagnostic tests may not be readily available. When a PCP believes that a patient may have a serious urologic condition and is unsure of the appropriate patient management strategy, then he or she must quickly refer the patient to a urologist. This article describes common urology-related issues-hematuria, prostate-specific antigen (PSA) test interpretation, phimosis and paraphimosis, acute scrotal pain and masses in the child and adult, urinary tract infection, renal colic, and castration-treatment-induced bone loss. It provides insights into decision-making processes for patient management of some urologic conditions, and information about managing sequelae and side effects of long term treatment. It includes practical diagnostic suggestions and patient management strategies based on the authors' years of urologic clinical practice experience. PMID:24978632

  16. GPs’ views on managing advanced chronic kidney disease in primary care: a qualitative study

    PubMed Central

    Tonkin-Crine, Sarah; Santer, Miriam; Leydon, Geraldine M; Murtagh, Fliss EM; Farrington, Ken; Caskey, Fergus; Rayner, Hugh; Roderick, Paul

    2015-01-01

    Background Chronic kidney disease (CKD) has become a significant part of the GP’s workload since the introduction of the National Institute for Health and Care Excellence guidelines in 2008. Patients with advanced CKD (stages G4 and G5) often have comorbidities, varied disease progression, and are likely to be older. GPs may experience difficulties with management decisions for patients with advanced CKD, including when to refer to nephrology. Aim To explore GPs’ views of managing patients with advanced CKD and referral to secondary care. Design and setting Qualitative study with GPs in four areas of England: London, Bristol, Birmingham, and Stevenage. Method Semi-structured interviews with 19 GPs. Transcribed interviews were thematically analysed. Results GPs had little experience of managing patients with advanced CKD, including those on dialysis or having conservative care (treatment without dialysis or a transplant), and welcomed guidance. Some GPs referred patients based on renal function alone and some used wider criteria including age and multimorbidity. GPs reported a tension between national guidance and local advice, and some had learnt from experience that patients were discharged back to primary care. GPs with more experience of managing CKD referred patients later, or sometimes not at all, if there were no additional problems and if dialysis was seen as not in the patient’s interests. Conclusion GPs want guidance on managing older patients with advanced CKD and comorbidities, which better incorporates agreement between local and national recommendations to clarify referral criteria. GPs are not generally aware of conservative care programmes provided by renal units, however, they appear happy to contribute to such care or alternatively, lead conservative management with input from renal teams. PMID:26120137

  17. Challenges in Identifying and Managing Attention-Deficit/Hyperactivity Disorder in Adults in the Primary Care Setting: A Review of the Literature

    PubMed Central

    Mattingly, Gregory

    2010-01-01

    Objective: To examine how to screen for and establish a correct diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults and to identify the outcomes associated with untreated ADHD. Data Sources: PubMed was searched using the key words ADHD, adult, diagnosis, and primary care from the years 1999 to 2009. Study Selection: This search produced 50 publications. Data Extraction: Publications were screened for data specific to the diagnosis or management of adult patients with ADHD in the primary care setting. Data Synthesis: The estimated prevalence of ADHD in adults throughout the United States is 4.4% or approximately 10 million adults. Adults with ADHD by definition must experience impairment from the symptoms of ADHD in at least 2 areas of their life. Despite significant impairment, only 1 in 10 adults with ADHD have received ADHD treatment within the past year. Given the high rates of undertreatment, primary care physicians, who provide much of the general adult mental health care in the United States, are increasingly charged with making the diagnosis of ADHD in adults. ADHD symptoms are often masked by comorbid psychiatric conditions or patient adaptations such as choice of occupation. One of the ADHD assessment tools, a short 6-item screener, can simplify identification and management of ADHD in adults and help identify which patients may require further evaluation. Conclusions: Primary care physicians should consult with other members of the health care community such as psychiatrists and psychologists when necessary, but should also develop a level of comfort with diagnosing and treating ADHD. PMID:21494335

  18. Choice and conditioned reinforcement.

    PubMed

    Fantino, E; Freed, D; Preston, R A; Williams, W A

    1991-03-01

    A potential weakness of one formulation of delay-reduction theory is its failure to include a term for rate of conditioned reinforcement, that is, the rate at which the terminal-link stimuli occur in concurrent-chains schedules. The present studies assessed whether or not rate of conditioned reinforcement has an independent effect upon choice. Pigeons responded on either modified concurrent-chains schedules or on comparable concurrent-tandem schedules. The initial link was shortened on only one of two concurrent-chains schedules and on only one of two corresponding concurrent-tandem schedules. This manipulation increased rate of conditioned reinforcement sharply in the chain but not in the tandem schedule. According to a formulation of delay-reduction theory, when the outcomes chosen (the terminal links) are equal, as in Experiment 1, choice should depend only on rate of primary reinforcement; thus, choice should be equivalent for the tandem and chain schedules despite a large difference in rate of conditioned reinforcement. When the outcomes chosen are unequal, however, as in Experiment 2, choice should depend upon both rate of primary reinforcement and relative signaled delay reduction; thus, larger preferences should occur in the chain than in the tandem schedules. These predictions were confirmed, suggesting that increasing the rate of conditioned reinforcement on concurrent-chains schedules may have no independent effect on choice.

  19. The Role of the Primary Care Clinician in the Management of Erectile Dysfunction

    PubMed Central

    Sadovsky, Richard

    2002-01-01

    Although many medical problems commonly seen in the primary care clinician’s office are associated with ED, the majority of men do not discuss sexual difficulties and activities with their clinician. Patients are, however, appreciative of the clinician’s willingness to listen and initiate discussions. Often a new level of patient-doctor relationship is thereby reached, which provides for comanagement of sexual and other disorders. The acronym “ALLOW” defines a 5-step proactive management plan for the primary care clinician to follow in order to improve his or her flexibility and sensitivity of response to the patient’s ED; at the same time, “ALLOW” helps the clinician to recognize possible limitations in managing sexual health problems. More overall communication has been related to greater patient satisfaction, which in turn results in patients who are more involved in following through on their care, who have increased confidence in their clinician, and who continue to see one physician for their health care needs. PMID:16986015

  20. Managing and monitoring chronic non-communicable diseases in a primary health care clinic, Lilongwe, Malawi

    PubMed Central

    Manjomo, R. C.; Mwagomba, B.; Ade, S.; Ali, E.; Ben-Smith, A.; Khomani, P.; Bondwe, P.; Nkhoma, D.; Douglas, G. P.; Tayler-Smith, K.; Chikosi, L.; Gadabu, O. J.

    2016-01-01

    Setting: Patients with chronic non-communicable diseases attending a primary health care centre, Lilongwe, Malawi. Objective: Using an electronic medical record monitoring system, to describe the quarterly and cumulative disease burden, management and outcomes of patients registered between March 2014 and June 2015. Design: A cross-sectional study. Results: Of 1135 patients, with new registrations increasing each quarter, 66% were female, 21% were aged ⩾65 years, 20% were obese, 53% had hypertension alone, 18% had diabetes alone, 12% had asthma, 10% had epilepsy and 7% had both hypertension and diabetes. In every quarter, about 30% of patients did not attend the clinic and 19% were registered as lost to follow-up (not seen for ⩾1 year) in the last quarter. Of those attending, over 90% were prescribed medication, and 80–90% with hypertension and/or diabetes had blood pressure/blood glucose measured. Over 85% of those with epilepsy had no seizures and 60–75% with asthma had no severe attacks. Control of blood pressure (41–51%) and diabetes (15–38%) was poor. Conclusion: It is feasible to manage patients with non-communicable diseases in a primary health care setting in Malawi, although more attention is needed to improve clinic attendance and the control of hypertension and diabetes. PMID:27358797

  1. Evaluability of the Program to Value Primary Healthcare Professionals (PROVAB): management challenges.

    PubMed

    Oliveira, Catia Martins; Cruz, Marly Marques da; Kanso, Solange; Reis, Ana Cristina; Lima, Antônio; Torres, Raquel Maria Cardoso; Gonçalves, Aline Leal; Carvalho, Silvia Cristina de; Grabois, Victor

    2015-10-01

    The objective of this article is to present the results of a study on the evaluability of the Program to Value Primary Healthcare Professionals (PROVAB in the Portuguese) that was created by the Brazilian Ministry of Health in 2011. The Program is part of the Manage Healthcare Work and Educationstrategy which seeks to invest in a number of measures aimed at improving and valuing the work carried out by primary healthcare teams. The research, which used qualitative methods, was carried out between February and November 2013 and involved five stages: (a) analysis of documents; (b) identification of potential users; (c) strategic analysis; (d) modelling of the intervention; (e) sharing of lessons learned. Data collection took place in three iterative phases: document analysis, key informant interviews and a workshop. The activities of the program were grouped into three areas: functional and working conditions, teaching/learning and management. The results showed that the program can be evaluated, since it was possible to specify its feasibility by means of a logical model. The potential and priority areas were mapped for future evaluations, whose central focus is to address the problem of unequal distribution of Brazilian health professionals.

  2. Role of Uttara Vasti with Trivrit and Lasuna oil in the management of primary dysmenorrhea

    PubMed Central

    Jahan, Shabnam; Sujatha, N.; Neelam

    2010-01-01

    Dysmenorrhea is one of the most common clinical entities encountered in regular practice by the gynecologists. Dysmenorrhea means painful menstruation. Fifty percent of the women suffer from dysmenorrhea. Primary dysmenorrhea is correlated with Udavartini yonivyapad in Ayurveda. No successful advances have been made in the line of management till today by western medicine. Therefore, a complete, comprehensive and holistic approach toward its understanding and treatment is the need of the age. In this series, Uttar Vasti, a unique panchakarma procedure, is studied for its role in yonivyapads. A research study was conductedto evaluate the efficacy of Uttar Vasti with Trivrit and Lasuna oil in Primary dysmenorrhea. Thirty-six diagnosed cases of Udavartini Yonivyapad, viz., primary (spasmodic) dysmenorrhea, were selected and randomly allocated into two groups. The effect of Uttar Vasti was compared with the commonly used non steroidal anti inflammatory drug (control group). Uttar Vasti with Operculina turpethum (Trivrit) and Allium sativum (Lasuna) oil has shown encouraging results in Udavartini yonivyapad. Statistically significant relief was seen in the intensity of pain and the successive cycles were less painful in the treated group as compared to control group. The mode of action can be attributed to anti-inflammatory (vatahara), vasodilatory (ushna virya) antispasmodic and laxative (anulomana) properties of the trial drugs. The present study shows Uttar Vasti as a safe and easy technique to treat dysmenorrhea like conditions without any side effects. PMID:22131715

  3. Weight management services for adults--highlighting the role of primary care.

    PubMed

    Hassan, S J; O'Shea, D

    2012-01-01

    Ireland has the fourth highest prevalence of overweight and obese men in the European Union and the seventh highest prevalence among women. This study focuses on 777 referrals on the waiting list for Ireland's only fully funded hospital-based adult weight management service with special emphasis on the role of primary care in the referral process. Since our last review two years ago, we found that patients are now being referred at a younger age (mean 43 years). The mean BMI at referral has increased from 44 to 46. Five hundred and forty eight (70%) referrals were from primary care with males accounting for 163 (30%) of these, despite male obesity being more prevalent. Interestingly, as the distance from Dublin increased, the number of referrals decreased. Overall this is a concerning trend showing the increasing burden of obesity on a younger population and a health system inadequately equipped to deal with the problem. It also highlights the central role of the primary care physician in the timely and appropriate referral to optimise use of our available resources.

  4. Incremental Benefits and Cost of Coordinated Anxiety Learning and Management for Anxiety Treatment in Primary Care

    PubMed Central

    Joesch, Jutta M.; Sherbourne, Cathy D.; Sullivan, Greer; Stein, Murray B.; Craske, Michelle G.; Roy-Byrne, Peter

    2012-01-01

    Background Improving the quality of mental health care requires integrating successful research interventions into “real-world” practice settings. Coordinated Anxiety Learning and Management (CALM) is a treatment-delivery model for anxiety disorders encountered in primary care. CALM offers cognitive behavioral therapy (CBT), medication, or both; non-expert care managers assisting primary care clinicians with adherence promotion and medication optimization; computer-assisted CBT delivery; and outcome monitoring. This study describes incremental benefits, costs, and net benefits of CALM versus usual care. Methods The CALM randomized, controlled effectiveness trial was conducted in 17 primary care clinics in 4 US cities from 2006 to 2009. Of 1,062 eligible patients, 1,004 English- or Spanish-speaking patients age 18–75 years with panic, generalized anxiety, social anxiety, and/or posttraumatic stress disorder with or without major depression were randomized. Anxiety-free days, quality-adjusted life years (QALYs), and expenditures for outpatient visits, emergency room visits, inpatient stays, and psychiatric medications were estimated based on blinded telephone assessments at baseline, 6, 12, and 18 months. Results Over 18 months, CALM participants, on average, experienced 57.1 more anxiety-free days [95% confidence interval (CI) 31–83] and $245 additional medical expenses (95% CI $ −733 to $1,223). The mean incremental net benefit of CALM versus usual care was positive when an anxiety-free day was valued ≥ $4. For QALYs based on the Short-Form Health Survey-12 and the EQ-5D the mean incremental net benefit was positive at ≥ $5,000. Conclusions Compared with usual care, CALM provides significant benefits with modest increases in health care expenditures. PMID:22152230

  5. The Effect of Improving Primary Care Depression Management on Employee Absenteeism and Productivity A Randomized Trial

    PubMed Central

    Rost, Kathryn; Smith, Jeffrey L.; Dickinson, Miriam

    2005-01-01

    Objective: To test whether an intervention to improve primary care depression management significantly improves productivity at work and absenteeism over 2 years. Setting and Subjects: Twelve community primary care practices recruiting depressed primary care patients identified in a previsit screening. Research Design: Practices were stratified by depression treatment patterns before randomization to enhanced or usual care. After delivering brief training, enhanced care clinicians provided improved depression management over 24 months. The research team evaluated productivity and absenteeism at baseline, 6, 12, 18, and 24 months in 326 patients who reported full-or part-time work at one or more completed waves. Results: Employed patients in the enhanced care condition reported 6.1% greater productivity and 22.8% less absenteeism over 2 years. Consistent with its impact on depression severity and emotional role functioning, intervention effects were more observable in consistently employed subjects where the intervention improved productivity by 8.2% over 2 years at an estimated annual value of $1982 per depressed full-time equivalent and reduced absenteeism by 28.4% or 12.3 days over 2 years at an estimated annual value of $619 per depressed full-time equivalent. Conclusions: This trial, which is the first to our knowledge to demonstrate that improving the quality of care for any chronic disease has positive consequences for productivity and absenteeism, encourages formal cost-benefit research to assess the potential return-on-investment employers of stable workforces can realize from using their purchasing power to encourage better depression treatment for their employees. PMID:15550800

  6. Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

    PubMed Central

    Odusola, Aina O.; Stronks, Karien; Hendriks, Marleen E.; Schultsz, Constance; Akande, Tanimola; Osibogun, Akin; van Weert, Henk; Haafkens, Joke A.

    2016-01-01

    Background Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. Objective We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Design Qualitative study using semi-structured individual interviews with primary care staff (n = 11) and health insurance managers (n=4). Data were analysed using standard qualitative techniques. Results Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider–insurer relationships; automated administration systems; and tailoring guidelines/patient education. Conclusions By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA. PMID:26880152

  7. Transcutaneous electrical nerve stimulation as adjunct to primary care management for tennis elbow: pragmatic randomised controlled trial (TATE trial)

    PubMed Central

    Lewis, A Martyn; Sim, Julius; Mallen, Christian D; Mason, Elizabeth E; Hay, Elaine M; van der Windt, Daniëlle A

    2013-01-01

    Objective To investigate the effectiveness of supplementing information and advice on analgesia and exercise from a general practitioner with transcutaneous electrical nerve stimulation (TENS) as a non-drug form of analgesia to reduce pain intensity in patients with tennis elbow. Design Pragmatic randomised controlled trial in primary care. Setting and 38 general practices in the West Midlands, UK. Participants 241 adults consulting with a first or new (no consultation in previous six months) clinical diagnosis of tennis elbow. Interventions Participants were randomly allocated to either primary care management alone, consisting of a consultation with a general practitioner followed by information and advice on exercises, or primary care management plus TENS to be used once a day for 45 minutes over six weeks (or until symptom resolution) for pain relief. Outcome measures The primary outcome was self reported intensity of elbow pain (0-10 rating scale) at six weeks. Primary and secondary outcomes were measured at baseline and at six weeks, six months, and 12 months by postal questionnaire. Analysis was by intention to treat. Results 121 participants were randomised to primary care management plus TENS and 120 to primary care management only (first episode, n=197 (82%); duration <1-3 months, n=138 (57%)). Adherence to exercise and TENS recommendations reported at six weeks was low; only 42 participants in the primary care management plus TENS group met a priori defined adherence criteria. Both intervention groups showed large improvements in pain and secondary outcomes, especially during the first six weeks of follow-up. However, no clinically or statistically significant differences were seen between groups at any follow-up timepoint. At the primary endpoint (six weeks), the between group difference in improvement of pain was −0.33 (95% confidence interval −0.96 to 0.31; P=0.31) in favour of the primary care management only group, with adjustment for age, sex

  8. Evaluating and Managing Acute Low Back Pain in the Primary Care Setting

    PubMed Central

    Atlas, Steven J; Deyo, Richard A

    2001-01-01

    Acute low back pain is a common reason for patient calls or visits to a primary care clinician. Despite a large differential diagnosis, the precise etiology is rarely identified, although musculoligamentous processes are usually suspected. For most patients, back symptoms are nonspecific, meaning that there is no evidence for radicular symptoms or underlying systemic disease. Because episodes of acute, nonspecific low back pain are usually self-limited, many patients treat themselves without contacting their primary care clinician. When patients do call or schedule a visit, evaluation and management by primary care clinicians is appropriate. The history and physical examination usually provide clues to the rare but potentially serious causes of low back pain, as well as to identify patients at risk for prolonged recovery. Diagnostic testing, including plain x-rays, is often unnecessary during the initial evaluation. For patients with acute, nonspecific low back pain, the primary emphasis of treatment should be conservative care, time, reassurance, and education. Current recommendations focus on activity as tolerated (though not active exercise while pain is severe) and minimal if any bed rest. Referral for physical treatments is most appropriate for patients whose symptoms are not improving over 2 to 4 weeks. Specialty referral should be considered for patients with a progressive neurologic deficit, failure of conservative therapy, or an uncertain or serious diagnosis. The prognosis for most patients is good, although recurrence is common. Thus, educating patients about the natural history of acute low back pain and how to prevent future episodes can help ensure reasonable expectations. PMID:11251764

  9. How do patients referred to neurologists for headache differ from those managed in primary care?

    PubMed Central

    Ridsdale, Leone; Clark, Lucy V; Dowson, Andrew J; Goldstein, Laura H; Jenkins, Linda; McCrone, Paul; Morgan, Myfanwy; Seed, Paul T

    2007-01-01

    Background Headache is the neurological symptom most frequently presented to GPs and referred to neurologists, but little is known about how referred patients differ from patients managed by GPs. Aim To describe and compare headache patients managed in primary care with those referred to neurologists. Design of study Prospective study. Setting Eighteen general practices in south-east England. Method This study examined 488 eligible patients consulting GPs with primary headache over 7 weeks and 81 patients referred to neurologists over 1 year. Headache disability was measured by the Migraine Disability Assessment Score, headache impact by the Headache Impact Test, emotional distress by the Hospital Anxiety and Depression Scale and illness perception was assessed using the Illness Perception Questionnaire. Results Participants were 303 patients who agreed to participate. Both groups reported severe disability and very severe impact on functioning. Referred patients consulted more frequently than those not referred in the 3 months before referral (P = 0.003). There was no significant difference between GP-managed and referred groups in mean headache disability, impact, anxiety, depression, or satisfaction with care. The referred group were more likely to link an increased number of symptoms to their headaches (P = 0.01), to have stronger emotional representations of their headaches (P = 0.006), to worry more (P = 0.001), and were made anxious by their headache symptoms (P = 0.044). Conclusion Patients who consult for headache experience severe disability and impact, and up to a third report anxiety and/or depression. Referral is not related to clinical severity of headaches, but is associated with higher consultation frequency and patients' anxiety and concern about their headache symptoms. PMID:17504590

  10. [Management problems of improving the quality and efficiency of primary health care system of Georgia].

    PubMed

    Dzhakeli, I V; Edzhibadze, O I; Gerzmava, O Kh

    2009-01-01

    Improving the quality and efficiency of primary health care system is a key challenge. In this regard, problems that have accumulated in the system over the past decade - a weak material base of outpatient-polyclinic institutions, especially in rural areas; a surplus of medical personnel; lack of control by local, regional and central authorities--still remain as serious obstacle. The issue of financing the provided health services, is also particularly important, given the fact that a significant portion of the cost of medical services is covered by the patient directly. And as a consequence, the low level of applications for outpatient-polyclinic assistance due to declining affordability of medical services. In connection with the foregoing, the authors of the paper raise the question of implementing strict, multi-component system of quality control of medical care for patients. In particular, they propose: to base modern organization works on improving the quality of primary health care system on the principles of general management theory; Modern management of service quality should be clearly oriented towards the needs of the population in health care, its structure and dynamics; accessibility, incentives, determined by economic and technological competition characteristic to the market; Modern quality management, regardless of ownership and scale of outpatient-polyclinic establishment should optimally combine the actions, methods and tools that provide, on the one hand--the organization of diagnostic and therapeutic-prophylactic processes meeting the needs of the people, and on the other--the introduction of new methods and means to ensure the modern level of medical care; Schematic diagram of quality control mechanism organically interacts with the market research and includes a block of policy development in terms of quality.

  11. Choice Plans: A Glossary.

    ERIC Educational Resources Information Center

    Heleen, Owen

    1992-01-01

    Choice plans include private schools (voucher plans, tax credits and deductions, and contract services and charter plans) and public schools (intradistrict choice, interdistrict choice, and statewide choice). Issues spanning both areas are those of curricular choice and residential choice. (SLD)

  12. Innovation in Management of Primary School Construction: Multi-Purpose Primary School Buildings in Bangladesh. Educational Building Report 18.

    ERIC Educational Resources Information Center

    Constantinos, Fecadu

    This report deals with school building construction utilizing technology carried out by the Lutheran World Service/Rangpur Dinajpur Rehabilitation Service in Bangladesh. The purpose was to develop an alternative design for primary school constructions. The design, construction, and multipurpose use of the school buildings are described. Appended…

  13. Primary Care Providers' Knowledge and Practices of Diabetes Management During Ramadan.

    PubMed

    Ali, Mujtaba; Adams, Alexandra; Hossain, Md Anwar; Sutin, David; Han, Benjamin Hyun

    2016-01-01

    There are an estimated 3.5 million Muslims in North America. During the holy month of Ramadan, healthy adult Muslims are to fast from predawn to after sunset. While there are exemptions for older and sick adults, many adults with diabetes fast during Ramadan. However, there are risks associated with fasting and specific management considerations for patients with diabetes. We evaluated provider practices and knowledge regarding the management of patients with diabetes who fast during Ramadan. A 15-question quality improvement survey based on a literature review and the American Diabetes Association guidelines was developed and offered to providers at the outpatient primary care and geriatric clinics at an inner-city hospital in New York City. Forty-five providers completed the survey. Most respondents did not ask their Muslim patients with diabetes if they were fasting during the previous Ramadan. Knowledge of fasting practices during Ramadan was variable, and most felt uncomfortable managing patients with diabetes during Ramadan. There is room for improvement in educating providers about specific cultural and medical issues regarding fasting for patients with diabetes during Ramadan.

  14. The Role of Surgery in the Clinical Management of Primary Gastrointestinal Non-Hodgkin's Lymphoma.

    PubMed

    MacQueen, Ian T; Shannon, Evan M; Dawes, Aaron J; Ostrzega, Nora; Russell, Marcia M; Maggard-Gibbons, Melinda

    2015-10-01

    Primary gastrointestinal non-Hodgkin's lymphoma (PGINHL) is a heterogeneous family of tumors, with treatment modalities including chemotherapy, surgery, and radiotherapy. Because the role of surgery in PGINHL remains disputed, this study aims to assess the impact of operative resection on survival. We used a pathology database to identify all cases of PGINHL diagnosed at a single academic-affiliated medical center from 1988 to 2013. Demographic and clinical data were abstracted from the medical record. We summarized the clinical courses of patients with PGINHL and then performed a survival analysis to compare overall and disease-free survival, stratified by demographic and clinical variables. We identified 33 patients diagnosed with PGINHL during the study period. Of 29 who subsequently received treatment at the institution, 15 initially underwent chemotherapy, 10 underwent surgical resection, and 4 underwent surgery for other reasons such as diagnosis without resection or management of disease complications. Three patients suffered surgical complications and two of these patients died. We found no difference in overall survival between patients receiving surgical resection and patients managed initially with chemotherapy. This case series supports a continued role for surgical resection in the management of patients with PGINHL, though anticipated benefits should be weighed against the risk of complications.

  15. Using an established telehealth model to train urban primary care providers on hypertension management.

    PubMed

    Masi, Christopher; Hamlish, Tamara; Davis, Andrew; Bordenave, Kristine; Brown, Stephen; Perea, Brenda; Aduana, Glen; Wolfe, Marcus; Bakris, George; Johnson, Daniel

    2012-01-01

    The objective of this study was to determine whether a videoconference-based telehealth network can increase hypertension management knowledge and self-assessed competency among primary care providers (PCPs) working in urban Federally Qualified Health Centers (FQHCs). We created a telehealth network among 6 urban FQHCs and our institution to support a 12-session educational program designed to teach state-of-the-art hypertension management. Each 1-hour session included a brief lecture by a university-based hypertension specialist, case presentations by PCPs, and interactive discussions among the specialist and PCPs. Twelve PCPs (9 intervention and 3 controls) were surveyed at baseline and immediately following the curriculum. The mean number of correct answers on the 26-item hypertension knowledge questionnaire increased in the intervention group (13.11 [standard deviation (SD)]=3.06) to 17.44 [SD=1.59], P<.01) but not among controls (14.33 [SD=3.21] to 13.00 [SD=3.46], P=.06). Similarly, the mean score on a 7-item hypertension management self-assessed competency scale increased in the intervention group (4.68 [SD=0.94] to 5.41 [SD=0.89], P<.01) but not among controls (5.28 [SD=0.43] to 5.62 [SD=0.67], P=.64). This model holds promise for enhancing hypertension care provided by urban FQHC providers.

  16. The role of public relations activities in hospital choice.

    PubMed

    Tengilimoglu, Dilaver; Yesiltas, Mehmet; Kisa, Adnan; Dziegielewski, Sophia F

    2007-01-01

    Public relations activities for all organizations can have an important effect on consumer decision-making when buying goods or services. This study examines the effect that public relations activities can have regarding consumer decisions and choice. To explore exemplify this relationship a questionnaire was given to 971 patients within public, university and private hospitals in Ankara, Turkey. Study results show that public relations activities were a crucial factor in determining consumer hospital choice. The majority of respondents reported that the behaviors and attitude of personnel as public relations activities that support the hospital's reputation within the public were the primary variables in hospital choice. Health care managers can use these findings to further understand how patients make informed choices related to usage of a health care facility and to develop and/or improve public relations activities.

  17. The role of public relations activities in hospital choice.

    PubMed

    Tengilimoglu, Dilaver; Yesiltas, Mehmet; Kisa, Adnan; Dziegielewski, Sophia F

    2007-01-01

    Public relations activities for all organizations can have an important effect on consumer decision-making when buying goods or services. This study examines the effect that public relations activities can have regarding consumer decisions and choice. To explore exemplify this relationship a questionnaire was given to 971 patients within public, university and private hospitals in Ankara, Turkey. Study results show that public relations activities were a crucial factor in determining consumer hospital choice. The majority of respondents reported that the behaviors and attitude of personnel as public relations activities that support the hospital's reputation within the public were the primary variables in hospital choice. Health care managers can use these findings to further understand how patients make informed choices related to usage of a health care facility and to develop and/or improve public relations activities. PMID:19042526

  18. A Collaborative Paradigm for Improving Management of Sleep Disorders in Primary Care: A Randomized Clinical Trial

    PubMed Central

    Edinger, Jack D.; Grubber, Janet; Ulmer, Christi; Zervakis, Jennifer; Olsen, Maren

    2016-01-01

    Objectives: To test a collaborative care model for interfacing sleep specialists with primary care providers to enhance patients' sleep disorders management. Methods: This study used a randomized, parallel group, clinical intervention trial design. A total of 137 adult (29 women) VA outpatients with sleep complaints were enrolled and randomly assigned to (1) an intervention (INT) consisting of a one-time consultation with a sleep specialist who provided diagnostic feedback and treatment recommendations to the patient and the patient's primary care provider; or (2) a control condition consisting of their usual primary care (UPC). Provider-focused outcomes included rates of adherence to recommended diagnostic procedures and sleep-focused interventions. Patient-focused outcomes included measures taken from sleep diaries and actigraphy; Pittsburgh Sleep Quality Index (PSQI) scores; and self-report measures of sleepiness, fatigue, mood, quality of life, and satisfaction with health care. Results: The proportions of provider-initiated sleep-focused interventions were significantly higher in the INT group than in the UPC group for polysomnography referrals (49% versus 6%; P < 0.001) and mental health clinic referrals (19% versus 6%; P = 0.02). At the 10-mo follow up, INT recipients showed greater estimated mean reductions in diary total wake time (−17.0 min; 95% confidence interval [CI]: −30.9, −3.1; P = 0.02) and greater increases in sleep efficiency (+3.7%; 95% CI: 0.8, 6.5; P = 0.01) than did UPC participants. A greater proportion of the INT group showed ≥ 1 standard deviation decline on the PSQI from baseline to the 10-mo follow-up (41% versus 21%; P = 0.02). Moreover, 69% of the INT group had normal (≤ 10) Epworth Sleepiness Scale scores at the 10-mo follow-up, whereas only 50% of the UPC group fell below this clinical cutoff (P = 0.03). Conclusions: A one-time sleep consultation significantly increased healthcare providers' attention to sleep problems and

  19. Choice and control: how involved are people with epilepsy and their families in the management of their epilepsy? Results from an Australian survey in the disability sector.

    PubMed

    Bellon, Michelle; Pfeiffer, Wayne; Maurici, Vanessa

    2014-08-01

    This study explored the extent to which people with epilepsy and their families have choice and control over the management of their epilepsy and the support provided in the Australian disability sector. It measured the level of direct involvement in planning and recording of their epilepsy health-care needs and support required through the use of epilepsy management plans. An Australian online survey was completed by 118 adults with epilepsy and 171 family members of children and adults with epilepsy, providing demographic and diagnostic data and details of their epilepsy management plan, whether they were involved in writing the plan and the extent to which it included their views on how they want to be supported. Results indicate that just over half of all respondents had an epilepsy management plan, with 83% revised within the past 12 months. Although the majority of respondents were directly involved in writing their plan (87%), only two-thirds (66%) felt that their plan included their views on how they wanted to be supported. Open-ended comments from 111 respondents indicated their desire to be actively involved in this process, as either collaborative team members or 'in charge' of the process. In spite of a move towards person-centered approaches and greater choice and control, further emphasis must be placed on actively involving the person with epilepsy and their family in writing and incorporating their views on support within their epilepsy management plans. This research was undertaken by the Epilepsy Foundation to inform the development of epilepsy support resources for the newly introduced Australian National Disability Insurance Scheme.

  20. Choice and control: how involved are people with epilepsy and their families in the management of their epilepsy? Results from an Australian survey in the disability sector.

    PubMed

    Bellon, Michelle; Pfeiffer, Wayne; Maurici, Vanessa

    2014-08-01

    This study explored the extent to which people with epilepsy and their families have choice and control over the management of their epilepsy and the support provided in the Australian disability sector. It measured the level of direct involvement in planning and recording of their epilepsy health-care needs and support required through the use of epilepsy management plans. An Australian online survey was completed by 118 adults with epilepsy and 171 family members of children and adults with epilepsy, providing demographic and diagnostic data and details of their epilepsy management plan, whether they were involved in writing the plan and the extent to which it included their views on how they want to be supported. Results indicate that just over half of all respondents had an epilepsy management plan, with 83% revised within the past 12 months. Although the majority of respondents were directly involved in writing their plan (87%), only two-thirds (66%) felt that their plan included their views on how they wanted to be supported. Open-ended comments from 111 respondents indicated their desire to be actively involved in this process, as either collaborative team members or 'in charge' of the process. In spite of a move towards person-centered approaches and greater choice and control, further emphasis must be placed on actively involving the person with epilepsy and their family in writing and incorporating their views on support within their epilepsy management plans. This research was undertaken by the Epilepsy Foundation to inform the development of epilepsy support resources for the newly introduced Australian National Disability Insurance Scheme. PMID:25090655

  1. Prevalence and management of dementia in primary care practices with electronic medical records: a report from the Canadian Primary Care Sentinel Surveillance Network

    PubMed Central

    Drummond, Neil; Birtwhistle, Richard; Williamson, Tyler; Khan, Shahriar; Garies, Stephanie; Molnar, Frank

    2016-01-01

    Background: The proportion of Canadians living with Alzheimer disease and related dementias is projected to rise, with an increased burden on the primary health care system in particular. Our objective was to describe the prevalence and management of dementia in a community-dwelling sample using electronic medical record (EMR) data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), which consists of validated, national, point-of-care data from primary care practices. Methods: We used CPCSSN data as of Dec. 31, 2012, for patients 65 years and older with at least 1 clinical encounter in the previous 2 years. A validated case definition for dementia was used to calculate the national and provincial prevalence rates, to examine variations in prevalence according to age, sex, body mass index, rural or urban residence, and select comorbid conditions, and to describe patterns in the pharmacologic management of dementia over time at the provincial level. Results: The age-standardized prevalence of dementia among community-dwelling patients 65 years and older was 7.3%. Prevalence estimates increased with age; they also varied between provinces, and upward trends were observed. Dementia was found to be associated with comorbid diabetes, depression, epilepsy and parkinsonism. Most of the patients with dementia did not have a prescription for a dementia-related medication recorded in their EMR between 2008 and 2012 inclusive. Those who had a prescription were most often prescribed donepezil by their primary care provider. Interpretation: Overall prevalence estimates for dementia based on EMR data in this sample managed in primary care were generally in line with previous estimates based on administrative data, survey results or clinical sources. PMID:27398361

  2. Measuring improved patient choice.

    PubMed

    Holmes-Rovner, M; Rovner, D R

    2000-08-01

    Patient decision support (PDS) tools or decision aids have been developed as adjuncts to the clinical encounter. Their aim is to support evidence-based patient choice. Clinical trials of PDS tools have used an array of outcome measures to determine efficacy, including knowledge, satisfaction, health status and consistency between patient choice and values. This paper proposes that the correlation between 'subjective expected utility' (SEU) and decision may be the best primary endpoint for trials. SEU is a measure usually used in behavioural decision theory. The paper first describes how decision support tools may use decision analysis to structure the presentation of evidence and guide patient decision-making. Uses of expected utility (EU) are suggested for evaluating PDS tools when improving population health status is the objective. SEU is the theoretically better measure when internal consistency of patient choices is the objective. PMID:11083037

  3. Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 2. Results: Primary care management and community orientation.

    PubMed

    Hummers-Pradier, Eva; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri Ejh; Topsever, Pinar; Ungan, Mehmet; van Royen, Paul

    2010-03-01

    At the WONCA Europe conference 2009 the recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' was presented. It is a background paper and reference manual, providing advocacy of general practice/family medicine (GP/FM) in Europe. The Research Agenda summarizes the evidence relating to the core competencies and characteristics of the WONCA Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In this second article, the results for the core competencies 'primary care management' and 'community orientation' are presented. Though there is a large body of research on various aspects of 'primary care management', it represents a very scattered rather than a meta view. Many studies focus on care for specific diseases, the primary/secondary care interface, or the implications of electronic patient records. Cost efficiency or process indicators of quality are current outcomes. Current literature on community orientation is mainly descriptive, and focuses on either care for specific diseases, or specific patient populations, or on the uptake of preventive services. Most papers correspond poorly to the WONCA concept. For both core competencies, there is a lack of research with a longitudinal perspective and/or relevant health or quality of life outcomes as well as research on patients' preferences and education for organizational aspects of GP/FM.

  4. Treating anemia of chronic kidney disease in the primary care setting: cardiovascular outcomes and management recommendations

    PubMed Central

    Schmidt, Rebecca J; Dalton, Cheryl L

    2007-01-01

    Anemia is an underrecognized but characteristic feature of chronic kidney disease (CKD), associated with significant cardiovascular morbidity, hospitalization, and mortality. Since their inception nearly two decades ago, erythropoiesis-stimulating agents (ESAs) have revolutionized the care of patients with renal anemia, and their use has been associated with improved quality of life and reduced hospitalizations, inpatient costs, and mortality. Hemoglobin targets ≥13 g/dL have been linked with adverse events in recent randomized trials, raising concerns over the proper hemoglobin range for ESA treatment. This review appraises observational and randomized studies of the outcomes of erythropoietic treatment and offers recommendations for managing renal anemia in the primary care setting. PMID:17910755

  5. Patient and provider relationships: consent, confidentiality, and managing mistakes in integrated primary care settings.

    PubMed

    Hodgson, Jennifer; Mendenhall, Tai; Lamson, Angela

    2013-03-01

    Health care in the United States is advancing toward increasingly integrated primary care systems. With this evolution comes a responsibility for providers to carefully consider a variety of issues related to ethical conduct. While working within the same teams on behalf of the same patients and families, professionals representing different disciplines are guided by different sets of baseline ethics guidelines and codes-and the overlap and differences between these principles can easily translate into ethical breaches. Using a clinical vignette as the basis for our discussion, we address issues of informed consent, confidentiality, and grievance procedures specifically. We review extant literature and formal ethics codes upheld by nine leading professional organizations across these foci, offer recommendations about how to manage this clinical scenario, and highlight what is needed to advance our understanding of integration ethics. PMID:23566125

  6. [Management of sudden neurosensory hearing loss in a Primary Care Centre].

    PubMed

    Muñoz-Proto, F; Carnevale, C; Bejarano-Panadés, N; Ferrán-de la Cierva, L; Mas-Mercant, S; Sarría-Echegaray, P

    2014-04-01

    Sudden hearing loss is a rapid loss of neurosensory hearing that may occur within hours or days in an apparently healthy patient. Its origins are variable and multifactorial. Most patients do not recover hearing if not treated, and some even develop cophosis (deafness) in the affected ear. It is an otological emergency, as early therapeutic management offers a better hearing prognosis. As there is limited knowledge on this condition, it may be underdiagnosed in Primary Health Care Centers. It should be suspected in patients with abrupt hearing loss or tinnitus. Sophisticated instruments are not required for its diagnosis, just a detailed history, basic otoscopy, and proper interpretation of the hearing test. In this way, an accurate diagnosis is achieved in most cases, which is confirmed by audiometry.

  7. An evaluation of a primary care-based weight management initiative.

    PubMed

    Muckle, Sarah

    2007-07-01

    Obesity is a significant issue in public health. There is a wealth of research that will be discussed as part of this article that identifies what has been effective in helping obese people reach a healthy weight. Health visitors and practice nurses are ideally situated to provide evidence-based support and monitoring to those living with obesity who want to improve their health and well-being. This article evaluates a primary-care-based weight management programme that was devised from the research evidence available. A total of nine women were offered a combination of interactive group education sessions, monitoring and supoort over a period of six months. Success was measured using quantitative and qualitative measures. The intervention effectively reduced the BMI of participants and demonstrated the adverse effects obesity has on individual quality of life.

  8. Management of an intruded primary central incisor with a natural crown under general anesthesia

    PubMed Central

    Altunsoy, Mustafa; Bilgin, Mehmet Selim

    2014-01-01

    Tooth intrusion is the most common trauma during early infancy. Primary maxillary central incisors are the most affected teeth. There are a few treatment approaches which depend upon the severity of the trauma, and the treatment must be managed professionally. In this case report, a 3-year-old girl with a history of trauma 40 days before referring to our pediatric clinic is presented. Deciduous maxillary right central incisor was intruded through labial and alveolar socket and completely covered with soft tissue. The intruded deciduous incisor tooth was surgically extracted and impression was taken under general anesthesia. The removable partial prosthesis was completed by using the patient's own extracted tooth. Using natural crown on removable prosthesis gives psychological satisfaction to the patient and his/her family, and can be better tolerated since its shape, size, and color are exactly in harmony. PMID:24966781

  9. Managing externally financed projects: the Integrated Primary Health Care Project in Bolivia.

    PubMed

    Homedes, N

    2001-12-01

    Bolivia is one of the poorest countries in Latin America. Health indicators are very poor, communicable diseases are prevalent and, coupled with malnutrition, remain the major killers of children under 5 years old. The Integrated Primary Health Care Project (PROISS) was a US$39 million project executed by the Ministry of Health (MOH), 50% financed by the World Bank and aimed at improving primary health care in the four largest Bolivian municipalities. The implementation of the project started in 1990 and ended in 1997. During implementation it went through three distinct phases: Phase 1 (1990-94) was a period characterized by conflict and confusion; Phase 2 (1995-mid-1996) documented major improvements in coverage and service quality; and Phase 3 (mid-1996-97) witnessed the decline of the project. This paper explores the factors that contributed to the success and the decline of the project, draws lessons for project managers and international agencies involved in the definition and implementation of social sector projects, and discusses the unlikelihood that externally financed projects can have a sustainable impact on the development of the health sector of recipient countries. PMID:11739363

  10. Choice Matters.

    ERIC Educational Resources Information Center

    Hicks, Darcy

    2001-01-01

    Describes how the author allows the children to make choices about their art and writing, enabling them to make connections between their own lives and work. Suggests that educators need to provide doorways to the things that give students ideas: books, music, objects, pictures, smells, sounds, and textures. (SG)

  11. Practice Characteristics of Graduates of East Tennessee State University Quillen College of Medicine: Factors Related to Career Choices in Primary Care

    ERIC Educational Resources Information Center

    Click, Ivy A.

    2013-01-01

    The nation is facing a physician shortage, specifically in relation to primary care and in rural underserved areas. The most basic function of a medical school is to educate physicians to care for the national population. The purpose of this study was to examine the physician practicing characteristics of the graduates of East Tennessee State…

  12. School Choice for the Poor? The Limits of Marketisation of Primary Education in Rural India. CREATE Pathways to Access. Research Monograph No. 23

    ERIC Educational Resources Information Center

    Harma, Joanna

    2010-01-01

    In recent years India has seen an explosion in low-fee private (LFP) schooling aimed at the poorer strata of society. This marketisation of primary education is a reaction to the well-documented failings of the government system. This paper looks at LFP schooling in one rural district of Uttar Pradesh, and compares government to low cost private…

  13. Pharmacotherapeutic management of chronic noncancer pain in primary care: lessons for pharmacists

    PubMed Central

    Jouini, Ghaya; Choinière, Manon; Martin, Elisabeth; Perreault, Sylvie; Berbiche, Djamal; Lussier, David; Hudon, Eveline; Lalonde, Lyne

    2014-01-01

    Purpose Describe the pharmacotherapeutic management of primary-care patients with chronic noncancer pain, assess their satisfaction with pain treatment, and identify the determinants of their satisfaction. Methods A cohort study was conducted in Quebec (Canada). Patients reporting chronic noncancer pain with an average pain intensity of at least 4 on a 0–10 scale (10= worst possible pain) and having an active analgesic prescription from a primary-care physician were recruited. They completed a telephone interview and a self-administered questionnaire to document their pain, emotional well-being, satisfaction with treatment, and barriers/beliefs/attitudes about pain and its treatment. Information on pharmacotherapy was based on an administrative provincial database and pharmacies’ charts. Determinants of patients’ satisfaction were identified using multivariate linear regression models. Results Four hundred and eighty six patients participated. Their mean age was 58.4 years and they had had pain for a mean of 11.7 years (standard deviation, ±11.1) at an average pain intensity of 6.5 in the past week. Although 90% reported adverse gastrointestinal effects, 36.4% and 54.4% of these patients took no over-the-counter or prescribed medication for constipation or nausea, respectively. On a scale from 0–100, the mean overall satisfaction score was 64.7 (95% confidence interval [CI] =63.5–65.9). Patient satisfaction was low, particularly regarding the “information about pain and its treatment” (mean 50.6; 95% CI =47.6–53.7) and “treatment efficacy” (mean 53.6; 95% CI =51.5–55.6) subscales. The overall treatment satisfaction score decreased with more pain disability, probable depression and anxiety, more barriers to pain treatment, higher incidence of nausea, and use of over-the-counter analgesics. Conclusion In primary care, patients’ level of satisfaction with their pain treatment is not optimal. This study underlines how the expanded scope of

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

    PubMed Central

    2012-01-01

    Background Effective implementation of change in healthcare organisations involves multiple professional and organisational groups and is often impeded by professional and organisational boundaries that present relatively impermeable barriers to sharing knowledge and spreading work practices. Informed by the theory of communities of practice (CoPs), this study explored the effects of intra-organisational and inter-organisational boundaries on the implementation of service improvement within and across primary healthcare settings and on the development of multiprofessional and multi-organisational CoPs during this process. Methods The study was conducted within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester—a collaborative partnership between the University of Manchester and local National Health Service organisations aiming to undertake applied health research and enhance its implementation in clinical practice. It deployed a qualitative embedded case study design, encompassing semistructured interviews, direct observation and documentary analysis, conducted in 2010–2011. The sample included practice doctors, nurses, managers and members of the CLAHRC implementation team. Findings The study showed that in spite of epistemic and status differences, professional boundaries between general practitioners, practice nurses and practice managers co-located in the same practice over a relatively long period of time could be successfully bridged, leading to the formation of multiprofessional CoPs. While knowledge circulated relatively easily within these CoPs, barriers to knowledge sharing emerged at the boundary separating them from other groups existing in the same primary care setting. The strongest boundaries, however, lay between individual general practices, with inter-organisational knowledge sharing and collaboration between them remaining unequally developed across different areas due to historical factors

  15. School Choice: To What End?

    ERIC Educational Resources Information Center

    Wagner, Tony

    1996-01-01

    Debunks two fantasies: the feasibility of a free-market educational system and the idea that greater choice automatically means better schools. Public education is too labor-intensive and undercapitalized to be profitable. Communities need "skunk works" schools of choice to do research and development and smaller, collaboratively managed schools…

  16. The management of type 1 diabetes in primary school: review of the literature.

    PubMed

    Marks, Anne; Wilson, Valerie; Crisp, Jackie

    2013-01-01

    Type 1 diabetes is one of the most common chronic health conditions in childhood. The introduction of intensive insulin therapy and the rising prevalence of diabetes in younger children has increased the need for involvement of diabetes educators and school personnel in school diabetes care. School encompasses a significant proportion of a child's day, therefore diabetes treatment at school needs to be optimal or the child will have poor metabolic control. The aim of this literature review is to examine diabetes management in the early primary school setting. The main areas of diabetes management explored are: type, provision, and location of treatment, the impact on the child, and the role of the credentialed diabetes educator. The review identifies that the majority of children are not receiving intensive diabetes treatment at school. Younger children require more assistance with care and may be disadvantaged due to lack of appropriate school staff support. Most schools do not have nurses to assist with diabetes care, therefore teaching and administration staff are utilized. The use of insulin pump therapy may increase access to insulin at school, as children and teaching staff appear more confident with this method of delivery than injections. Treatment is frequently performed away from the classroom and can impact on class attendance, metabolic control, and emergencies. Diabetes educators need to work in collaboration with children, parents, and school personnel to ensure diabetes care is fully integrated into the school day. PMID:23597278

  17. The primary health care physician and the cancer patient: tips and strategies for managing sexual health

    PubMed Central

    Zhou, Eric S.; Nekhlyudov, Larissa

    2015-01-01

    There is a large and growing population of long-term cancer survivors. Primary care physicians (PCPs) are playing an increasingly greater role in the care of these patients across the continuum of cancer survivorship. In this role, PCPs are faced with the responsibility of managing a range of medical and psychosocial late effects of cancer treatment. In particular, the sexual side effects of treatment which are common and have significant impact on quality of life for the cancer survivor, often go unaddressed. This is an area of clinical care and research that has received increasing attention, highlighted by the presentation of this special issue on Cancer and Sexual Health. The aims of this review are 3-fold. First, we seek to overview common presentations of sexual dysfunction related to major cancer diagnoses in order to give the PCP a sense of the medical issues that the survivor may present with. Barriers to communication about sexual health issues between patient/PCPs in order are also described in order to emphasize the importance of PCPs initiating this important conversation. Next, we provide strategies and resources to help guide the PCP in the management of sexual dysfunction in cancer survivors. Finally, we discuss case examples of survivorship sexual health issues and highlight the role that a PCP can play in each of these case examples. PMID:26816826

  18. Brazilian primary school teachers' knowledge about immediate management of dental trauma

    PubMed Central

    Pithon, Matheus Melo; dos Santos, Rogério Lacerda; Magalhães, Pedro Henrique Bomfim; Coqueiro, Raildo da Silva

    2014-01-01

    OBJECTIVE: To assess the level of knowledge of primary school teachers in the public school network of Northeastern Brazil with respect to management of dental trauma and its relationship with prognosis. METHODS: A questionnaire was applied to 195 school teachers of public schools in Northeastern Brazil. The questionnaire comprised 12 objective questions about dental trauma and methods for its prevention and management. Data were submitted to chi-square test and Poisson regression test (P > 0.05). RESULTS: Out of the 141 teachers who responded the questionnaires, the majority were women (70.2%) and most of them had experienced previous dental accidents involving a child (53.2%). The majority (84.4%) had incomplete college education and few were given some training on how to deal with emergency situations during their undergraduate course (13.5%) or after it (38.3%). Their level of knowledge about dental trauma and emergency protocols showed that unsatisfactory knowledge level was associated with the male sex: 46% higher for men in comparison to women (P = 0.025). CONCLUSIONS: Approximately half of teachers evaluated had unsatisfactory knowledge about dental trauma and emergency protocols, with female teachers showing more knowledge than men. PMID:25715724

  19. Nurse-patient communication in primary care diabetes management: an exploratory study

    PubMed Central

    2013-01-01

    Background Diabetes is a major health issue for individuals and for health services. There is a considerable literature on the management of diabetes and also on communication in primary care consultations. However, few studies combine these two topics and specifically in relation to nurse communication. This paper describes the nature of nurse-patient communication in diabetes management. Methods Thirty-five primary health care consultations involving 18 patients and 10 nurses were video-recorded as part of a larger multi-site study tracking health care interactions between health professionals and patients who were newly diagnosed with Type 2 diabetes. Patients and nurses were interviewed separately at the end of the 6-month study period and asked to describe their experience of managing diabetes. The analysis used ethnography and interaction analysis. In addition to analysis of the recorded consultations and interviews, the number of consultations for each patient and total time spent with nurses and other health professionals were quantified and compared. Results This study showed that initial consultations with nurses often incorporated completion of extensive checklists, physical examination, referral to other health professionals and distribution of written material, and were typically longer than consultations with other health professionals. The consultations were driven more by the nurses’ clinical agenda than by what the patient already knew or wanted to know. Interactional analysis showed that protocols and checklists both help and hinder the communication process. This contradictory outcome was also evident at a health systems level: although organisational targets may have been met, the patient did not always feel that their priorities were attended to. Both nurses and patients reported a sense of being overwhelmed arising from the sheer volume of information exchanged along with a mismatch in expectations. Conclusions Conscientious nursing work was

  20. Assessment of medical waste management at a primary health-care center in Sao Paulo, Brazil

    SciTech Connect

    Moreira, A.M.M.; Guenther, W.M.R.

    2013-01-15

    Highlights: Black-Right-Pointing-Pointer Assessment of medical waste management at health-care center before/after intervention. Black-Right-Pointing-Pointer Qualitative and quantitative results of medical waste management plan are presented. Black-Right-Pointing-Pointer Adjustments to comply with regulation were adopted and reduction of waste was observed. Black-Right-Pointing-Pointer The method applied could be useful for similar establishments. - Abstract: According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of Sao Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized

  1. Estimation and Analysis of Gross Primary Production of Soybean Under Various Management Practices and Drought Conditions

    NASA Astrophysics Data System (ADS)

    Wagle, P.; Xiao, X.; Suyker, A.

    2014-12-01

    Gross primary production (GPP) of croplands may be used to quantify crop productivity and evaluate a range of management practices. Eddy flux data from three soybean (Glycine max L.) fields under different management practices (no-till vs till; rainfed vs irrigated) and Moderate Resolution Imaging Spectroradiometer (MODIS) derived vegetation indices (VIs) were used to evaluate the biophysical performance of VIs and crop phenology, and to model GPP using a satellite-based vegetation photosynthesis model (VPM). The VIs tracked soybean phenology well and delineated the growing season length. The results show that the carbon uptake period and seasonal sums of net ecosystem CO2 exchange (NEE) and GPP can be inferred from the length of the vegetation activity period from satellite remote sensing data. Land surface water index (LSWI) tracked drought-impacted vegetation well. On a seasonal scale, NEE of the soybean sites ranged from -37 to -264 g C m-2. The result suggests that rainfed soybean fields needed about 450-500 mm of well-distributed seasonal rainfall to maximize the net carbon sink. During non-drought conditions, VPM accurately estimated seasonal dynamics and interannual variation of GPP of soybean under different management practices. However, some large discrepancies between GPPVPM and GPPEC were observed under drought conditions as the VI did not reflect the corresponding decrease in GPP. Diurnal GPP dynamics showed a bimodal distribution with a pronounced midday depression at the period of higher water vapor pressure deficit (> 1.2 kPa). A modified Wscalar based on LSWI, to account for the water stress, in VPM helped quantify the reduction in GPP during severe drought and the model's performance improved substantially. The results of this study demonstrate the potential use of remotely sensed VIs for better understanding of carbon dynamics and extrapolation of GPP of soybean croplands.

  2. Improving management of gout in primary care using a customised electronic records template.

    PubMed

    Moffat, Keith; McNab, Duncan

    2015-01-01

    It is known that the management of chronic gout in relation to serum uric acid (SUA) monitoring, allopurinol dosing, and lifestyle advice is often sub-optimal in primary care.[1] A quality improvement project in the form of a criterion based audit was carried out in an urban general practice to improve the care of patients being treated for gout. Baseline searching of EMIS confirmed that management of patients with gout who were taking allopurinol was not in line with current guidance. 51(40%) had a SUA checked in the past 12 months, 88(25%) had a SUA below target level, and gout lifestyle advice was not being recorded. An audit was performed to measure and improve the following criteria: Monitoring of SUA levels in the past 12 monthsTitration of urate lowering therapy to bring the SUA below target levelLifestyle advice in the past 12 months An audit standard of 60% achievement at 2 months and 80% achievement at 4 months was set. The intervention consisted of a custom electronic template within EMIS which allowed guidance of gout management to be displayed and for data to be entered. All members of the team including GPs and administrative staff were educated regarding the intervention. This resulted in a sustained improvement over a 6 month period in all 3 components of the audit with 112(84%) having a SUA level checked, 79(51%) having a SUA below target level and 76(57%) receiving lifestyle advice. Although the improvement did not reach the audit standard in 2 of the criteria it would be expected that outcomes would continue given the systems changes which have been made. PMID:26734335

  3. Primary care-based, targeted screening programme to promote sustained weight management

    PubMed Central

    Järvenpää, Salme; Kautiainen, Hannu

    2014-01-01

    Abstract Objective. To identify overweight and obese subjects at increased cardiovascular risk in the community, and provide them with lifestyle counselling that is possible to implement in real life. Design. Longitudinal cohort study. Setting. The communities of Harjavalta and Kokemäki in south-western Finland. Subjects. A tape for measurement of waist and a risk factor questionnaire was mailed to home-dwelling inhabitants aged 45–70 years (n = 6013). Of the 4421 respondents, 2752 with at least one cardiovascular risk factor were examined by a public health nurse. For the subjects with high cardiovascular risk (n = 1950), an appointment with a physician was scheduled. The main goal of lifestyle counselling for the 1608 high-risk subjects with BMI ≥ 25 kg/m2 was weight reduction of at least 5%. Among these, 906 had completed self-administrated questionnaires at baseline and form the present study population. Main outcome measure. Success in weight management. Results. At the three-year follow-up visit, 18% of subjects had lost ≥ 5% of their initial weight and 70% had stabilized their weight, while 12% had gained weight ≥ 5%. Newly diagnosed glucose disorder (OR 1.37 [95% CI 1.02–1.84]) predicted success in weight management, whereas depressive symptoms (OR 0.61 [95% CI 0.42–0.90]), excess alcohol use (OR 0.63 [95% CI 0.44–0.90]), and number of drugs used (OR 0.91 [95% CI 0.83–0.99]) at baseline predicted poor outcome. Conclusions. A primary care screening programme to identify overweight or obese individuals can promote sustained weight management. Psychological factors, especially depressive symptoms, are a critical component to consider before attempts to change the lifestyle of an individual. PMID:24592894

  4. Primary Dysmenorrhea and Menstrual Symptoms in Indian Female Students: Prevalence, Impact and Management

    PubMed Central

    Omidvar, Shabnam; Bakouei, Fatemeh; Amiri, Fatemeh Nasiri; Begum, Khyrunnisa

    2016-01-01

    Background: Dysmenorrhea is the most common gynecological problem among females and it is defined as cramping pain in the lower abdomen occurring just before or during menstruation. Menstrual symptoms are a broad collection of affective and somatic concerns that occur around the time of menses. The effect and importance of dysmenorrhea is very wide, therefore managing the problem is important. Objective: To ascertain the prevalence, and impact of primary dysmenorrhea in student girls and their management behaviors. Methods and Materials: A Cross-sectional study was conducted on 1000 healthy females aged 11-28 years. Standardized Self-reporting questionnaires were used to obtain relevant data. Pain intensity was assessed by using the Numerical Pain Scale (NPS). Data was analyzed by SPSS version 16. Results: Prevalence of dysmenorrhea was 70.2%. Majority of the subjects experienced pain for one or 1-2 days during menstruation. 23.2% of the dysmenorrheic girls experienced pain for 2-3 days. The most common symptom in both dysmenorrheic and non dysmenorrheic girls during the menstrual periods was tiredness and second most prevalent symptom was back pain. Females experiencing mild pain on an average absented for one and half day a month while 2.1±1.2 and 2.5±1.3 days for those who experienced moderate and severe forms of dysmenorrhea respectively. A small proportion of girls sought pharmacological management (25.5%) and 83.2% depended on non-pharmacological methods. Only 14.2% had sought medical advice. Conclusion: Sub optimal use of the medical advice and the barriers to seek medical attention by dysmenorrheic females need exploration. It is important that health education on puberty and menstruation is regarded as inadequate for many girls in India.

  5. Assessment of a primary and tertiary care integrated management model for chronic obstructive pulmonary disease

    PubMed Central

    Bolíbar, Ignasi; Plaza, Vicente; Llauger, Mariantònia; Amado, Ester; Antón, Pedro A; Espinosa, Ana; Domínguez, Leandra; Fraga, Mar; Freixas, Montserrat; de la Fuente, Josep A; Liguerre, Iskra; Medrano, Casimira; Peiro, Meritxell; Pou, Mariantònia; Sanchis, Joaquin; Solanes, Ingrid; Valero, Carles; Valverde, Pepi

    2009-01-01

    Background The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD) in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1) improvement in the rational utilization of health-care services and 2) benefits reflected in improved health status and quality of life for patients. Methods/Design A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients) and the other the control group (n = 32,114 patients). The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts. Discussion The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of complex cases. PMID

  6. Influence of walking route choice on primary school children's exposure to air pollution--A proof of concept study using simulation.

    PubMed

    Mölter, Anna; Lindley, Sarah

    2015-10-15

    This study developed a walking network for the Greater Manchester area (UK). The walking network allows routes to be calculated either based on the shortest duration or based on the lowest cumulative nitrogen dioxide (NO2) or particulate matter (PM10) exposure. The aim of this study was to analyse the costs and benefits of faster routes versus lower pollution exposure for walking routes to primary schools. Random samples of primary schools and residential addresses were used to generate 100,000 hypothetical school routes. For 60% (59,992) and 40% (40,460) an alternative low NO2 and PM10 route was found, respectively. The median change in travel time (NO2: 4.5s, PM10: 0.5s) and average route exposure (NO2: -0.40 μg/m(3), PM10: -0.03 μg/m(3)) was small. However, quantile regression analysis indicated that for 50% of routes a 1% increase in travel time was associated with a 1.5% decrease in NO2 and PM10 exposure. The results of this study suggest that the relative decrease in pollution exposure on low pollution routes tends to be greater than the relative increase in route length. This supports the idea that a route planning tool identifying less polluted routes to primary schools could help deliver potential health benefits for children.

  7. Influence of walking route choice on primary school children's exposure to air pollution--A proof of concept study using simulation.

    PubMed

    Mölter, Anna; Lindley, Sarah

    2015-10-15

    This study developed a walking network for the Greater Manchester area (UK). The walking network allows routes to be calculated either based on the shortest duration or based on the lowest cumulative nitrogen dioxide (NO2) or particulate matter (PM10) exposure. The aim of this study was to analyse the costs and benefits of faster routes versus lower pollution exposure for walking routes to primary schools. Random samples of primary schools and residential addresses were used to generate 100,000 hypothetical school routes. For 60% (59,992) and 40% (40,460) an alternative low NO2 and PM10 route was found, respectively. The median change in travel time (NO2: 4.5s, PM10: 0.5s) and average route exposure (NO2: -0.40 μg/m(3), PM10: -0.03 μg/m(3)) was small. However, quantile regression analysis indicated that for 50% of routes a 1% increase in travel time was associated with a 1.5% decrease in NO2 and PM10 exposure. The results of this study suggest that the relative decrease in pollution exposure on low pollution routes tends to be greater than the relative increase in route length. This supports the idea that a route planning tool identifying less polluted routes to primary schools could help deliver potential health benefits for children. PMID:26047859

  8. Care Management Processes Used Less Often For Depression Than For Other Chronic Conditions In US Primary Care Practices.

    PubMed

    Bishop, Tara F; Ramsay, Patricia P; Casalino, Lawrence P; Bao, Yuhua; Pincus, Harold A; Shortell, Stephen M

    2016-03-01

    Primary care physicians play an important role in the diagnosis and management of depression. Yet little is known about their use of care management processes for depression. Using national survey data for the period 2006-13, we assessed the use of five care management processes for depression and other chronic illnesses among primary care practices in the United States. We found significantly less use for depression than for asthma, congestive heart failure, or diabetes in 2012-13. On average, practices used fewer than one care management process for depression, and this level of use has not changed since 2006-07, regardless of practice size. In contrast, use of diabetes care management processes has increased significantly among larger practices. These findings may indicate that US primary care practices are not well equipped to manage depression as a chronic illness, despite the high proportion of depression care they provide. Policies that incentivize depression care management, including additional quality metrics, should be considered. PMID:26953291

  9. Management of low velocity gunshot wounds to the anterior urethra: the role of primary repair versus urinary diversion alone.

    PubMed

    Husmann, D A; Boone, T B; Wilson, W T

    1993-07-01

    The management of partial transection of the anterior urethra following penetrating penile injuries is controversial. Optional therapeutic techniques range from a primary sutured reapproximation to urinary diversion alone. We recently managed 17 low velocity gunshot wounds to the external genitalia in which the missile traversed the penile corpus cavernosum, and was associated with less than 40% transection of the corpus spongiosum and anterior urethra. Nine patients were managed with suprapubic diversion, skin débridement and corporeal closure along with placement of a urethral catheter. Eight patients were managed by suprapubic diversion, débridement, closure of the corporeal bodies and a primary sutured reapproximation of the anterior urethra. Urethral strictures developed in 7 patients (78%) managed by a suprapubic tube and urethral stenting during an average followup of 20 months (range 18 to 24). In contrast, 1 patient (12%) managed by a sutured urethral approximation had a urethral stricture during an average followup of 20 months (range 18 to 30, p < 0.01). Our data support a significantly better prognosis for partial transection of the anterior urethra secondary to low velocity gunshot wounds if managed by aggressive wound débridement, corporeal repair, placement of a suprapubic catheter and primary repair of the urethra. PMID:8510278

  10. Choosing health, constrained choices.

    PubMed

    Chee Khoon Chan

    2009-12-01

    In parallel with the neo-liberal retrenchment of the welfarist state, an increasing emphasis on the responsibility of individuals in managing their own affairs and their well-being has been evident. In the health arena for instance, this was a major theme permeating the UK government's White Paper Choosing Health: Making Healthy Choices Easier (2004), which appealed to an ethos of autonomy and self-actualization through activity and consumption which merited esteem. As a counterpoint to this growing trend of informed responsibilization, constrained choices (constrained agency) provides a useful framework for a judicious balance and sense of proportion between an individual behavioural focus and a focus on societal, systemic, and structural determinants of health and well-being. Constrained choices is also a conceptual bridge between responsibilization and population health which could be further developed within an integrative biosocial perspective one might refer to as the social ecology of health and disease.

  11. The Humelock Hemiarthoplasty Device for Both Primary and Failed Management of Proximal Humerus Fractures: A Case Series

    PubMed Central

    A, Ikram; J, Singh; S, Jagarnauth; W.S, Khan; J, Hambidge

    2015-01-01

    Fractures of the proximal humerus account for 4-5% of all fractures. Managing proximal humerus fractures operatively and non-operatively have their respective complications both short- and long-term. We present our experience using the Humelock hemiarthoplasty device for both primary and failed management of proximal humeral fractures. We present four different examples from ten cases that include a failure of internal fixation, a failure of intramedullary nailing, a complex case in a patient with multiple co-morbidities, and a failure of nonoperative management. The patients in our series had multiple injuries and the device allowed early mobilization and produced good results. We suggest that this device has a role in the failure of primary and secondary management of proximal humeral fractures in a district general hospital setting. PMID:25674183

  12. Review of experimental studies in social psychology of small groups when an optimal choice exists and application to operating room management decision-making.

    PubMed

    Prahl, Andrew; Dexter, Franklin; Braun, Michael T; Van Swol, Lyn

    2013-11-01

    Because operating room (OR) management decisions with optimal choices are made with ubiquitous biases, decisions are improved with decision-support systems. We reviewed experimental social-psychology studies to explore what an OR leader can do when working with stakeholders lacking interest in learning the OR management science but expressing opinions about decisions, nonetheless. We considered shared information to include the rules-of-thumb (heuristics) that make intuitive sense and often seem "close enough" (e.g., staffing is planned based on the average workload). We considered unshared information to include the relevant mathematics (e.g., staffing calculations). Multiple studies have shown that group discussions focus more on shared than unshared information. Quality decisions are more likely when all group participants share knowledge (e.g., have taken a course in OR management science). Several biases in OR management are caused by humans' limited abilities to estimate tails of probability distributions in their heads. Groups are more susceptible to analogous biases than are educated individuals. Since optimal solutions are not demonstrable without groups sharing common language, only with education of most group members can a knowledgeable individual influence the group. The appropriate model of decision-making is autocratic, with information obtained from stakeholders. Although such decisions are good quality, the leaders often are disliked and the decisions considered unjust. In conclusion, leaders will find the most success if they do not bring OR management operational decisions to groups, but instead act autocratically while obtaining necessary information in 1:1 conversations. The only known route for the leader making such decisions to be considered likable and for the decisions to be considered fair is through colleagues and subordinates learning the management science. PMID:24108254

  13. Review of experimental studies in social psychology of small groups when an optimal choice exists and application to operating room management decision-making.

    PubMed

    Prahl, Andrew; Dexter, Franklin; Braun, Michael T; Van Swol, Lyn

    2013-11-01

    Because operating room (OR) management decisions with optimal choices are made with ubiquitous biases, decisions are improved with decision-support systems. We reviewed experimental social-psychology studies to explore what an OR leader can do when working with stakeholders lacking interest in learning the OR management science but expressing opinions about decisions, nonetheless. We considered shared information to include the rules-of-thumb (heuristics) that make intuitive sense and often seem "close enough" (e.g., staffing is planned based on the average workload). We considered unshared information to include the relevant mathematics (e.g., staffing calculations). Multiple studies have shown that group discussions focus more on shared than unshared information. Quality decisions are more likely when all group participants share knowledge (e.g., have taken a course in OR management science). Several biases in OR management are caused by humans' limited abilities to estimate tails of probability distributions in their heads. Groups are more susceptible to analogous biases than are educated individuals. Since optimal solutions are not demonstrable without groups sharing common language, only with education of most group members can a knowledgeable individual influence the group. The appropriate model of decision-making is autocratic, with information obtained from stakeholders. Although such decisions are good quality, the leaders often are disliked and the decisions considered unjust. In conclusion, leaders will find the most success if they do not bring OR management operational decisions to groups, but instead act autocratically while obtaining necessary information in 1:1 conversations. The only known route for the leader making such decisions to be considered likable and for the decisions to be considered fair is through colleagues and subordinates learning the management science.

  14. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings

    PubMed Central

    Soubhi, Hassan; Fortin, Martin; Hudon, Catherine; O’Dowd, Tom

    2012-01-01

    Objective To determine the effectiveness of interventions designed to improve outcomes in patients with multimorbidity in primary care and community settings. Design Systematic review. Data sources Medline, Embase, CINAHL, CAB Health, Cochrane central register of controlled trials, the database of abstracts of reviews of effectiveness, and the Cochrane EPOC (effective practice and organisation of care) register (searches updated in April 2011). Eligibility criteria Randomised controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series analyses reporting on interventions to improve outcomes for people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. Outcomes included any validated measure of physical or mental health and psychosocial status, including quality of life outcomes, wellbeing, and measures of disability or functional status. Also included were measures of patient and provider behaviour, including drug adherence, utilisation of health services, acceptability of services, and costs. Data selection Two reviewers independently assessed studies for eligibility, extracted data, and assessed study quality. As meta-analysis of results was not possible owing to heterogeneity in participants and interventions, a narrative synthesis of the results from the included studies was carried out. Results 10 studies examining a range of complex interventions totalling 3407 patients with multimorbidity were identified. All were randomised controlled trials with a low risk of bias. Two studies described interventions for patients with specific comorbidities. The remaining eight studies focused on multimorbidity, generally in older patients. Consideration of the impact of socioeconomic deprivation was minimal. All studies involved complex interventions with multiple components. In six of the 10 studies the predominant component was

  15. On the choice of farm management practices after the reform of the Common Agricultural Policy in 2003.

    PubMed

    Schmid, Erwin; Sinabell, Franz

    2007-02-01

    The Common Agricultural Policy (CAP) was fundamentally reformed in 2003. From 2005, farmers will receive decoupled income support payments instead of production premiums if basic standards for environment, food safety, animal health and welfare are met. Farmers are likely to adjust production and management practices to the new policy framework. We describe how this reform fits into the EU strategy of making agricultural production more environmentally friendly by concentrating on the financial aspects of the reforms. Using an agricultural sector model for Austria, we show that the reform will further decrease agricultural outputs, reduce farm inputs, lessen nitrogen surpluses and make environmentally friendly management practices more attractive for farmers.

  16. Practical Approach to Detection and Management of Chronic Kidney Disease for the Primary Care Clinician.

    PubMed

    Vassalotti, Joseph A; Centor, Robert; Turner, Barbara J; Greer, Raquel C; Choi, Michael; Sequist, Thomas D

    2016-02-01

    A panel of internists and nephrologists developed this practical approach for the Kidney Disease Outcomes Quality Initiative to guide assessment and care of chronic kidney disease (CKD) by primary care clinicians. Chronic kidney disease is defined as a glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) and/or markers of kidney damage for at least 3 months. In clinical practice the most common tests for CKD include GFR estimated from the serum creatinine concentration (eGFR) and albuminuria from the urinary albumin-to-creatinine ratio. Assessment of eGFR and albuminuria should be performed for persons with diabetes and/or hypertension but is not recommended for the general population. Management of CKD includes reducing the patient's risk of CKD progression and risk of associated complications, such as acute kidney injury and cardiovascular disease, anemia, and metabolic acidosis, as well as mineral and bone disorder. Prevention of CKD progression requires blood pressure <140/90 mm Hg, use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for patients with albuminuria and hypertension, hemoglobin A1c ≤7% for patients with diabetes, and correction of CKD-associated metabolic acidosis. To reduce patient safety hazards from medications, the level of eGFR should be considered when prescribing, and nephrotoxins should be avoided, such as nonsteroidal anti-inflammatory drugs. The main reasons to refer to nephrology specialists are eGFR <30 mL/min/1.73 m(2), severe albuminuria, and acute kidney injury. The ultimate goal of CKD management is to prevent disease progression, minimize complications, and promote quality of life.

  17. Update and Review on the Surgical Management of Primary Cutaneous Melanoma.

    PubMed

    Leilabadi, Solmaz Niknam; Chen, Amie; Tsai, Stacy; Soundararajan, Vinaya; Silberman, Howard; Wong, Alex K

    2014-06-10

    The surgical management of malignant melanoma historically called for wide excision of skin and subcutaneous tissue for any given lesion, but has evolved to be rationally-based on pathological staging. Breslow and Clark independently described level and thickness as determinant in prognosis and margin of excision. The American Joint Committee of Cancer (AJCC) in 1988 combined features from each of these histologic classifications, generating a new system, which is continuously updated and improved. The National Comprehensive Cancer Network (NCCN) has also combined several large randomized prospective trials to generate current guidelines for melanoma excision as well. In this article, we reviewed: (1) Breslow and Clark classifications, AJCC and NCCN guidelines, the World Health Organization's 1988 study, and the Intergroup Melanoma Surgical Trial; (2) Experimental use of Mohs surgery for in situ melanoma; and (3) Surgical margins and utility and indications for sentinel lymph node biopsy (SLNB) and lymphadenectomy. Current guidelines for the surgical management of a primary melanoma of the skin is based on Breslow microstaging and call for cutaneous margins of resection of 0.5 cm for MIS, 1.0 cm for melanomas ≤1.0 mm thick, 1-2 cm for melanoma thickness of 1.01-2 mm, 2 cm margins for melanoma thickness of 2.01-4 mm, and 2 cm margins for melanomas >4 mm thick. Although the role of SLNB, CLND, and TLND continue to be studied, current recommendations include SLNB for Stage IB (includes T1b lesions ≤1.0 with the adverse features of ulceration or ≥1 mitoses/mm²) and Stage II melanomas. CLND is recommended when sentinel nodes contain metastatic deposits.

  18. Comparison of primary health-care models in the management of chronic kidney disease.

    PubMed

    Cueto-Manzano, Alfonso M; Martínez-Ramírez, Héctor R; Cortés-Sanabria, Laura

    2013-05-01

    Negative lifestyle habits (potential risks for chronic kidney disease, CKD) are rarely modified by physicians in a conventional health-care model (CHCM). Multidisciplinary strategies may have better results; however, there is no information on their application in the early stages of CKD. Thus, the aim of this study was to compare a multiple intervention model versus CHCM on lifestyle and renal function in patients with type 2 diabetes mellitus and CKD stage 1-2. In a prospective cohort study, a family medicine unit (FMU) was assigned a multiple intervention model (MIM) and another continued with conventional health-care model (CHCM). MIM patients received an educational intervention guided by a multidisciplinary team (family physician (FP), social worker, dietitian, physical trainer); self-help groups functioned with free activities throughout the study. CHCM patients were managed only by the FP, who decided if patients needed referral to other professionals. Thirty-nine patients were studied in each cohort. According to a lifestyle questionnaire, no baseline differences were found between cohorts, but results reflected an unhealthy lifestyle. After 6 months of follow-up, both cohorts showed significant improvement in their dietary habits. Compared to CHCM diet, exercise, emotional management, knowledge of disease, and adherence to treatment showed greater improvement in the MIM. Blood pressure decreased in both cohorts, but body mass index, waist circumference, and HbA1C significantly decreased only in MIM. Glomerular filtration rate (GFR) was maintained equally in both cohorts, but albuminuria significantly decreased only in MIM. In conclusion, MIM achieves better control of lifestyle-related variables and CKD risk factors in type 2 diabetes mellitus (DM2) patients with CKD stage 1-2. Broadly, implementation of a MIM in primary health care may produce superior results that might assist in preventing the progression of CKD.

  19. Comparison of primary health-care models in the management of chronic kidney disease

    PubMed Central

    Cueto-Manzano, Alfonso M; Martínez-Ramírez, Héctor R; Cortés-Sanabria, Laura

    2013-01-01

    Negative lifestyle habits (potential risks for chronic kidney disease, CKD) are rarely modified by physicians in a conventional health-care model (CHCM). Multidisciplinary strategies may have better results; however, there is no information on their application in the early stages of CKD. Thus, the aim of this study was to compare a multiple intervention model versus CHCM on lifestyle and renal function in patients with type 2 diabetes mellitus and CKD stage 1–2. In a prospective cohort study, a family medicine unit (FMU) was assigned a multiple intervention model (MIM) and another continued with conventional health-care model (CHCM). MIM patients received an educational intervention guided by a multidisciplinary team (family physician (FP), social worker, dietitian, physical trainer); self-help groups functioned with free activities throughout the study. CHCM patients were managed only by the FP, who decided if patients needed referral to other professionals. Thirty-nine patients were studied in each cohort. According to a lifestyle questionnaire, no baseline differences were found between cohorts, but results reflected an unhealthy lifestyle. After 6 months of follow-up, both cohorts showed significant improvement in their dietary habits. Compared to CHCM diet, exercise, emotional management, knowledge of disease, and adherence to treatment showed greater improvement in the MIM. Blood pressure decreased in both cohorts, but body mass index, waist circumference, and HbA1C significantly decreased only in MIM. Glomerular filtration rate (GFR) was maintained equally in both cohorts, but albuminuria significantly decreased only in MIM. In conclusion, MIM achieves better control of lifestyle-related variables and CKD risk factors in type 2 diabetes mellitus (DM2) patients with CKD stage 1–2. Broadly, implementation of a MIM in primary health care may produce superior results that might assist in preventing the progression of CKD. PMID:25018986

  20. Industrial hazardous waste management in Turkey: current state of the field and primary challenges.

    PubMed

    Salihoglu, Güray

    2010-05-15

    A holistic evaluation of a country's hazardous waste management (HWM) practices is useful in identifying the necessary actions to focus on. Based on an analysis of industrial hazardous waste (HW) generation in Turkey, this paper attempts to critically evaluate and report current Turkish HWM practices and discuss the primary challenges to be addressed. The generation of industrial HW for Turkey reported in 2004 was 1.195 million tons, which accounted for 7% of the total industrial solid waste (ISW) generated by the manufacturing industry, and for nearly 4.9% of the total solid waste generated in the country. The HW generated by the top five manufacturing product categories--basic metals, chemicals and chemical products, food and beverages, coke and refined petroleum, motor vehicles and trailers--accounted for 89.0% of total industrial HW. 21% of the HW generated in 2004 was recycled or reused, and 6% was sold or donated, whereas 73% was sent to ultimate disposal. 67% of the HW sent to ultimate disposal was disposed of at municipal landfills. The total capacity of the existing regional HW facilities is 212,500 tons/year, which accounts for about 24% of the HW to be disposed. Turkey has identified the HW problem in the country and enacted legislation, designated a lead agency, and promulgated rules and regulations. Several new initiatives are planned for improving HW management nationally; however, some HWM problems will be persistent due to previous and existing industrial development plans. These development policies led to the concentration of industry in regions marked by precious agricultural fields and high population density. This occurred because the government previously exhibited a default prioritization towards industrial development, leading to insufficient implementation of regulations on HW generators. Some of the problems may also be rooted in other countries that allow illegal trans boundary HW movements despite international regulations.

  1. The Influence of Individual and Situational Factors on Children's Choice of a Conflict Management Strategy

    ERIC Educational Resources Information Center

    Tamm, Anni; Tõugu, Pirko; Tulviste, Tiia

    2014-01-01

    Research Findings: The aim of the present study was to investigate the influence of individual and situational factors on nursery school children's conflict management strategies. This observational study of triadic interaction was carried out among 69 children whose mean age was 48 months. The video-recorded data were coded for the type of…

  2. Intra-annual variation in habitat choice by an endemic woodpecker: Implications for forest management and conservation

    NASA Astrophysics Data System (ADS)

    Garcia-del-Rey, Eduardo; Fernández-Palacios, José María; Muñoz, Pascual Gil

    2009-09-01

    The Canary Islands great spotted woodpecker Dendrocopos major canariensis is an endemic bird restricted to the Pinus canariensis forests of Tenerife and Gran Canaria. Classification tree models were applied to explore the relationship of the occurrence of this picid and habitat variables between two contrasting periods (breeding vs. non-breeding seasons) and for the entire annual cycle. During the reproductive period the availability of mature trees (DBH > 60 cm), and snags (dead trees), for nesting and roosting, characterize the breeding territory. Outside the breeding season the choice of locations was driven by a tree cover larger than 28.5% and the presence of trees taller than 8.5 m on average, a pattern explained by the availability of pine seeds in the cones of well-developed canopies, and less so by predation risk. Overall, during the annual cycle, well-developed canopy sites influenced the presence of this picidae (tree cover > 38%) and on more open sites (<38%) the presence of mature trees (DBH> 60 cm) became the second most important predictor of occurrence. We suggest that food abundance and availability could be the ultimate factor explaining the intra-annual variation observed, with the availability of snags being an important factor during nesting. In the range of this endemic, we recommend selective cuts in pine plantations, to allow the trees to set seed and improve their crops, minimizing the elimination of snags, and killing some large pine trees if the priority is to expand the distributional range of the woodpecker.

  3. Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis

    PubMed Central

    Stokes, Jonathan; Panagioti, Maria; Alam, Rahul; Checkland, Kath; Cheraghi-Sohi, Sudeh; Bower, Peter

    2015-01-01

    Background An ageing population with multimorbidity is putting pressure on health systems. A popular method of managing this pressure is identification of patients in primary care ‘at-risk’ of hospitalisation, and delivering case management to improve outcomes and avoid admissions. However, the effectiveness of this model has not been subjected to rigorous quantitative synthesis. Methods and Findings We carried out a systematic review and meta-analysis of the effectiveness of case management for ‘at-risk’ patients in primary care. Six bibliographic databases were searched using terms for ‘case management’, ‘primary care’, and a methodology filter (Cochrane EPOC group). Effectiveness compared to usual care was measured across a number of relevant outcomes: Health – self-assessed health status, mortality; Cost – total cost of care, healthcare utilisation (primary and non-specialist care and secondary care separately), and; Satisfaction – patient satisfaction. We conducted secondary subgroup analyses to assess whether effectiveness was moderated by the particular model of case management, context, and study design. A total of 15,327 titles and abstracts were screened, 36 unique studies were included. Meta-analyses showed no significant differences in total cost, mortality, utilisation of primary or secondary care. A very small significant effect favouring case management was found for self-reported health status in the short-term (0.07, 95% CI 0.00 to 0.14). A small significant effect favouring case management was found for patient satisfaction in the short- (0.26, 0.16 to 0.36) and long-term (0.35, 0.04 to 0.66). Secondary subgroup analyses suggested the effectiveness of case management may be increased when delivered by a multidisciplinary team, when a social worker was involved, and when delivered in a setting rated as low in initial ‘strength’ of primary care. Conclusions This was the first meta-analytic review which examined the effects

  4. The interaction between research and practice: a pan-European approach to managing H.pylori infection in primary care.

    PubMed

    Hungin, A P

    2000-08-01

    The transposition of evidence into clinical care presents many challenges. New knowledge may be immediately translatable to the practice setting, with barriers to be overcome before implementation. The early guidelines on Helicobacter pylori management presented an overview but were not able to take into account local factors and health care traditions, such as the non-availability of tests and established primary-secondary care relationships. Primary care is a specific specialty across most of Europe, existing within different health care systems and clinical traditions. The creation of H. pylori management guidelines, aimed at European primary care but adaptable to local national circumstances, presented a challenge in methodology and formulation. The process exposed similarities but also tensions between differing health care systems, as well as variations in the conditions in which GPs practise. Clinical differences, such as varying ulcer prevalence and drug resistance rates, highlighted the importance of guidelines being adaptable. This paper analyses the European Society for Primary Care Gastroenterology process of pan-European primary care agreement towards H.pylori management and how diverse views, traditions and national settings were reconciled through an evidence-based approach.

  5. Managing Celiac Disease for Women: Implications for the Primary Care Provider.

    PubMed

    Peterson, Megan; Grossman, Sheila

    2016-01-01

    Although many people have symptoms of celiac disease, it can take a while to diagnose. Villous atrophy may be present long before any gastrointestinal symptoms. An important point to acknowledge is that celiac disease could be identified earlier in some women with a positive family history. The disease also could be the cause of some women's reproductive problems. Primary care providers, using comprehensive history taking, are in the unique position to identify individuals who may have celiac disease, assist women in gaining knowledge about a gluten-free diet, order diagnostic testing, and refer to a gastroenterologist. The positive change in fertility with a simultaneous improvement of nutrient deficiencies shortly after adopting a gluten-free diet indicates a possible link between such nutrients and sex hormone function. High levels of homocysteine, which can negatively impact fertility, have also been linked to individuals with problems, such as celiac disease, that decrease vitamin B12 absorption. The purpose of this article is to review the literature and the evidence-based care guidelines for comprehensive screening, diagnostics, and pathophysiology of celiac disease, with a specific focus on the female reproductive system, anemia management, and gluten-free diet integration. PMID:27258459

  6. Assessment of Primary Production of Horticultural Safety Management Systems of Mushroom Farms in South Africa.

    PubMed

    Dzingirayi, Garikayi; Korsten, Lise

    2016-07-01

    Growing global consumer concern over food safety in the fresh produce industry requires producers to implement necessary quality assurance systems. Varying effectiveness has been noted in how countries and food companies interpret and implement food safety standards. A diagnostic instrument (DI) for global fresh produce industries was developed to measure the compliancy of companies with implemented food safety standards. The DI is made up of indicators and descriptive grids for context factors and control and assurance activities to measure food safety output. The instrument can be used in primary production to assess food safety performance. This study applied the DI to measure food safety standard compliancy of mushroom farming in South Africa. Ten farms representing almost half of the industry farms and more than 80% of production were independently assessed for their horticultural safety management system (HSMS) compliance via in-depth interviews with each farm's quality assurance personnel. The data were processed using Microsoft Office Excel 2010 and are represented in frequency tables. The diagnosis revealed that the mushroom farming industry had an average food safety output. The farms were implementing an average-toadvanced HSMS and operating in a medium-risk context. Insufficient performance areas in HSMSs included inadequate hazard analysis and analysis of control points, low specificity of pesticide assessment, and inadequate control of suppliers and incoming materials. Recommendations to the industry and current shortcomings are suggested for realization of an improved industry-wide food safety assurance system.

  7. [Pain management in patients with chronic rheumatic pain--a model for primary medical care].

    PubMed

    Häuser, W; Biewer, W

    1997-04-18

    A rheumatologist and a medical psychotherapist collaborate in offering periodically a cognitive behavioral treatment program for pain control for the patients of a rheumatological practice. The program consists of a biopsychosocial model of chronic pain, individualized relaxation training combining progressive muscle relaxation and some elements of autogenous training and meditation, several attention-related techniques and cognitive restructuring. From 1993 to 1995, 50 patients took part in five training courses. The compliance of the patients was satisfactory and the drop-out rate low (8%). In a post hoc interview 4 weeks later and another 2 years after the end of the training most of the patients assessed the program as useful for reduction of pain, increase of activity and enhancement of mood. Psychotherapeutic experience in group therapy or special training for non-psychotherapeutic physicians with continuous supervision is necessary in order to conduct a qualified treatment program. Within medical primary care, rheumatologists can motivate their patients towards active pain management, which can help to prepare patients for further psychotherapy in cases with psychiatric disorders and/or severe psychosocial strains.

  8. An exploration of opioid medication management for non-malignant pain in primary care

    PubMed Central

    Foell, Jens

    2015-01-01

    The present study aimed to explore how prescription of opioid medication for chronic non-malignant pain (CNMP) is managed in primary care. We used audit as a research tool, and one general practitioner (GP) practice in West London acted as an exemplar. Of the practice population with CNMP, 1% had repeat prescription of at least 12 months duration for opioid analgesics at the time of data collection. These 1% are on highly controlled opioids. Our study showed the following: (1) long-term opioid prescription appears to follow a fluctuating course as opposed to staying the same; (2) we found that medication reviews were done in most cases (85.7%), but the quality of the process is difficult to assess and ascertain; and (3) we identified two incidences where opioid contract was implemented. In both cases, contracts were used as a last chance warning for patients who were already problematic, suggesting that opioid contracts served as a disciplinary tool rather than a preventative measure. Our findings highlight a need for a more structured and specific review of analgesic medication, and a need for a simple and effective way to identify patients at high risk of developing problematic use, to ensure better monitoring and early presentations. PMID:26516575

  9. Physician Acceptance of a Physician-Pharmacist Collaborative Treatment Model for Hypertension Management in Primary Care.

    PubMed

    Smith, Steven M; Hasan, Michaela; Huebschmann, Amy G; Penaloza, Richard; Schorr-Ratzlaff, Wagner; Sieja, Amber; Roscoe, Nicholai; Trinkley, Katy E

    2015-09-01

    Physician-pharmacist collaborative care (PPCC) is effective in improving blood pressure (BP) control, but primary care provider (PCP) engagement in such models has not been well-studied. The authors analyzed data from PPCC referrals to 108 PCPs, for patients with uncontrolled hypertension, assessing the proportion of referral requests approved, disapproved, and not responded to, and reasons for disapproval. Of 2232 persons with uncontrolled hypertension, PPCC referral requests were sent for 1516 (67.9%): 950 (62.7%) were approved, 406 (26.8%) were disapproved, and 160 (10.6%) received no response. Approval rates differed widely by PCP with a median approval rate of 75% (interquartile range, 41%-100%). The most common reasons for disapproval were: PCP prefers to manage hypertension (19%), and BP controlled per PCP (18%); 8% of cases were considered too complex for PPCC. Provider acceptance of a PPCC hypertension clinic was generally high and sustained but varied widely among PCPs. No single reason for disapproval predominated.

  10. Assessment of Primary Production of Horticultural Safety Management Systems of Mushroom Farms in South Africa.

    PubMed

    Dzingirayi, Garikayi; Korsten, Lise

    2016-07-01

    Growing global consumer concern over food safety in the fresh produce industry requires producers to implement necessary quality assurance systems. Varying effectiveness has been noted in how countries and food companies interpret and implement food safety standards. A diagnostic instrument (DI) for global fresh produce industries was developed to measure the compliancy of companies with implemented food safety standards. The DI is made up of indicators and descriptive grids for context factors and control and assurance activities to measure food safety output. The instrument can be used in primary production to assess food safety performance. This study applied the DI to measure food safety standard compliancy of mushroom farming in South Africa. Ten farms representing almost half of the industry farms and more than 80% of production were independently assessed for their horticultural safety management system (HSMS) compliance via in-depth interviews with each farm's quality assurance personnel. The data were processed using Microsoft Office Excel 2010 and are represented in frequency tables. The diagnosis revealed that the mushroom farming industry had an average food safety output. The farms were implementing an average-toadvanced HSMS and operating in a medium-risk context. Insufficient performance areas in HSMSs included inadequate hazard analysis and analysis of control points, low specificity of pesticide assessment, and inadequate control of suppliers and incoming materials. Recommendations to the industry and current shortcomings are suggested for realization of an improved industry-wide food safety assurance system. PMID:27357039

  11. Conflicts in Schools, Conflict Management Styles and the Role of the School Leader: A Study of Greek Primary School Educators

    ERIC Educational Resources Information Center

    Saiti, Anna

    2015-01-01

    Conflict may occur in any organization (and hence school) and, for schools, conflict management style is a joint activity and the degree of its effectiveness determines the type of impact of conflict on school performance. This empirical study investigates the potential sources of conflict in Greek primary schools, determine appropriate approaches…

  12. Challenges to the Implementation of PLAP in Primary Schools: Perceptions of ZOU Bachelor of Educational Management Students

    ERIC Educational Resources Information Center

    Mercy, Kurebwa; Mabhanda, Wilson

    2015-01-01

    The study explored the challenges that impact on the implementation of PLAP in the Primary schools. The research was conducted with teachers who study towards the BEd Management degree with Zimbabwe Open University (ZOU) in the Midlands Region. The study used a qualitative research approach and collected data through open ended questionnaires and…

  13. Are managed care organizations in the United States impeding the delivery of primary care by nurse practitioners? A 2012 update on managed care organization credentialing and reimbursement practices.

    PubMed

    Hansen-Turton, Tine; Ware, Jamie; Bond, Lisa; Doria, Natalie; Cunningham, Patrick

    2013-10-01

    In 2014, the Affordable Care Act will create an estimated 16 million newly insured people. Coupled with an estimated shortage of over 60,000 primary care physicians, the country's public health care system will be at a challenging crossroads, as there will be more patients waiting to see fewer doctors. Nurse practitioners (NPs) can help to ease this crisis. NPs are health care professionals with the capability to provide important and critical access to primary care, particularly for vulnerable populations. However, despite convincing data about the quality of care provided by NPs, many managed care organizations (MCOs) across the country do not credential NPs as primary care providers, limiting the ability of NPs to be reimbursed by private insurers. To assess current credentialing practices of health plans across the United States, a brief telephone survey was administered to 258 of the largest health maintenance organizations (HMOs) in the United States, operated by 98 different MCOs. Results indicated that 74% of these HMOs currently credential NPs as primary care providers. Although this represents progress over prior assessments, findings suggest that just over one fourth of major HMOs still do not recognize NPs as primary care providers. Given the documented shortage of primary care physicians in low-income communities in the United States, these credentialing policies continue to diminish the ability of NPs to deliver primary care to vulnerable populations. Furthermore, these policies could negatively impact access to care for thousands of newly insured Americans who will be seeking a primary care provider in 2014.

  14. Estimation and analysis of gross primary production of soybean under various management practices and drought conditions

    NASA Astrophysics Data System (ADS)

    Wagle, Pradeep; Xiao, Xiangming; Suyker, Andrew E.

    2015-01-01

    Gross primary production (GPP) of croplands may be used to quantify crop productivity and evaluate a range of management practices. Eddy flux data from three soybean (Glycine max L.) fields under different management practices (no-till vs. till; rainfed vs. irrigated) and Moderate Resolution Imaging Spectroradiometer (MODIS) derived vegetation indices (VIs) were used to test the capabilities of remotely sensed VIs and soybean phenology to estimate the seasonal dynamics of carbon fluxes. The modeled GPP (GPPVPM) using vegetation photosynthesis model (VPM) was compared with the GPP (GPPEC) estimated from eddy covariance measurements. The VIs tracked soybean phenology well and delineated the growing season length (GSL), which was closely related to carbon uptake period (CUP, R2 = 0.84), seasonal sums of net ecosystem CO2 exchange (NEE, R2 = 0.78), and GPPEC (R2 = 0.54). Land surface water index (LSWI) tracked drought-impacted vegetation well, as the LSWI values were positive during non-drought periods and negative during severe droughts within the soybean growing season. On a seasonal scale, NEE of the soybean sites ranged from -37 to -264 g C m-2. The result suggests that rainfed soybean fields needed about 450-500 mm of well-distributed seasonal rainfall to maximize the net carbon sink. During non-drought conditions, VPM accurately estimated seasonal dynamics and interannual variation of GPP of soybean under different management practices. However, some large discrepancies between GPPVPM and GPPEC were observed under drought conditions as the VI did not reflect the corresponding decrease in GPPEC. Diurnal GPPEC dynamics showed a bimodal distribution with a pronounced midday depression at the period of higher water vapor pressure deficit (>1.2 kPa). A modified Wscalar based on LSWI to account for the water stress in VPM helped quantify the reduction in GPP during severe drought and the model's performance improved substantially. In conclusion, this study demonstrates

  15. Energy-Smart Building Choices: How School Facilities Managers and Business Officials Are Reducing Operating Costs and Saving Money (Revision)

    SciTech Connect

    Not Available

    2002-02-01

    Operating a typical school today is no easy task for facilities managers and business officials. You're expected to deliver increased services with constrained operating budgets. Many schools stay open for longer hours to accommodate community use of the facilities. Dilapidated buildings and systems gobble up energy, yet in many districts, maintenance needs are overshadowed by the need for expansion or new construction to serve growing student populations and changing educational needs.

  16. Hypothetical intertemporal choice and real economic behavior: delay discounting predicts voucher redemptions during contingency-management procedures.

    PubMed

    Bickel, Warren K; Jones, Bryan A; Landes, Reid D; Christensen, Darren R; Jackson, Lisa; Mancino, Michael

    2010-12-01

    Delay discounting rates are predictive of drug use status, the likelihood of becoming abstinent, and a variety of health behaviors. Rates of delay discounting may also be related to other relevant behaviors associated with addiction, such as the frequency at which individuals redeem contingency management voucher earnings. This study examined the discounting rates of 152 participants in a buprenorphine treatment program for opioid abuse. Participants received up to 12 weeks of buprenorphine treatment combined with contingency management. Participant's drug use was measured via urine specimens submitted three times a week. Successive negative urine specimens were reinforced with increasing amounts of money. After each negative urine specimen, a participant could either redeem his or her earnings or accumulate it in an account. Analysis of the frequency of redemptions showed that participants with higher rates of delay discounting at study intake redeemed their earnings significantly more often than participants with lower rates of discounting. Age and income also predicted redemption rates. We suggest that delay discounting rates can be used to predict redemption behaviors in a contingency management treatment program and that these findings are consistent with the recent theory of the competing neurobehavioral decision systems.

  17. Hypothetical Intertemporal Choice and Real Economic Behavior: Delay Discounting Predicts Voucher Redemptions During Contingency-Management Procedures

    PubMed Central

    Bickel, Warren K.; Jones, Bryan A.; Landes, Reid D.; Christensen, Darren R.; Jackson, Lisa; Mancino, Michael

    2014-01-01

    Delay discounting rates are predictive of drug use status, the likelihood of becoming abstinent, and a variety of health behaviors. Rates of delay discounting may also be related to other relevant behaviors associated with addiction, such as the frequency at which individuals redeem contingency management voucher earnings. This study examined the discounting rates of 152 participants in a buprenorphine treatment program for opioid abuse. Participants received up to 12 weeks of buprenorphine treatment combined with contingency management. Participant’s drug use was measured via urine specimens submitted 3 times a week. Successive negative urine specimens were reinforced with increasing amounts of money. After each negative urine specimen, a participant could either redeem his or her earnings or accumulate it in an account. Analysis of the frequency of redemptions showed that participants with higher rates of delay discounting at study intake redeemed their earnings significantly more often than participants with lower rates of discounting. Age and income also predicted redemption rates. We suggest that delay discounting rates can be used to predict redemption behaviors in a contingency management treatment program and that these findings are consistent with the recent theory of the competing neurobehavioral decision systems. PMID:21186929

  18. Guideline concordant detection and management of depression among Alaska Native and American Indian people in primary care

    PubMed Central

    Hiratsuka, Vanessa Y.; Smith, Julia J.; Norman, Sara M.; Manson, Spero M.; Dillard, Denise A.

    2015-01-01

    Background A tribal health organization in Alaska implemented a primary care depression screening, detection and management initiative amongst 55,000 Alaska Native/American Indian people (AN/AIs). Objectives (a) To describe the proportion of AN/AIs screening positive for depression with depression noted or diagnosed and proportion with guideline concordant management and (b) to assess whether management varied by patient and provider factors. Research design Secondary analysis of electronic and paper medical record information of 400 AN/AIs. Measures Provider variables, patient demographics and patient clinical factors were electronically queried. Manual chart audits assessed depression notation, diagnoses and management within 12 weeks of positive screening. Multilevel ordinal logistic modelling assessed management by patient and provider factors. Results A depression diagnosis was present in 141 (35%) charts and 151 (38%) had depressive symptoms noted. Detection was higher among AN/AIs with moderate and severe depression (p<0.001). In total, 258 patients (66%) received guideline concordant management, 32 (8%) had some management, and 110 (28%) received no management. Younger patient age and increased provider tenure increased odds of management. Conclusions Most AN/AIs screening positive for depression received initial guideline concordant management. Additional outreach to older patients and additional support for providers newer to practices appears warranted. PMID:26519359

  19. A Retrospective Study of 40 Cases of Pilonidal Sinus with Excision of Tract and Z-plasty as Treatment of Choice for Both Primary and Recurrent Cases.

    PubMed

    Rao, Jagdeep; Deora, Harsh; Mandia, Rajendra

    2015-12-01

    Pilonidal sinus is a common chronic disease of the sacrococcygeal region. The treatment varies according to the clinical presentation of the disease. Although many surgical methods have been suggested, an ideal method is still lacking because of high recurrence rates. The aim of this work is to assess the role of Z-plasty in promoting primary healing in pilonidal disease and to evaluate morbidity and recurrence. This study included 40 patients (36 males and 4 females) who underwent excision of sinus and Z-plasty closure for sacrococcygeal pilonidal sinus. The follow-up period ranged from 6 to 12 months. There were 36 males and 4 females with a median age of 25 years. The mean hospital stay was 2 days. The mean time to return to work after discharge from the hospital was 14 days. There were no recurrences, and all patients were satisfied with the cosmesis. Two patients (5 %) had numbness over the flap. Necrosis of flaps did not occur in any patient. Only three patients were noticed to have wound infection (7.5 %). Five patients (12.5 %) developed wound seroma. Although requiring some technical expertise, excision of sinus and Z-plasty offer superior results with respect to recurrence in the hospital stay and cosmesis of patients with pilonidal sinus. PMID:26730090

  20. Conservation Reserve Program (CRP) contributions to wildlife habitat, management issues, challenges and policy choices--an annotated bibliography

    USGS Publications Warehouse

    Allen, Arthur W.; Vandever, Mark W.

    2012-01-01

    The following bibliography presents brief summaries of documents relevant to Conservation Reserve Program relations to wildlife habitat, habitat management in agriculturally dominated landscapes, and conservation policies potentially affecting wildlife habitats in agricultural ecosystems. Because the literature summaries furnished provide only sweeping overviews, users are urged to obtain and evaluate those papers appearing useful to obtain a more complete understanding of study findings and their implications to conservation in agricultural ecosystems. The bibliography contains references to reports that reach beyond topics that directly relate to the Conservation Reserve Program. Sections addressing grassland management and landowner surveys/opinions, for example, furnish information useful for enhancing development and administration of conservation policies affecting lands beyond those enrolled in conservation programs. Some sections of the bibliography (for example, agricultural conservation policy, economics, soils) are far from inclusive of all relevant material written on the subject. Hopefully, these sections will serve as fundamental introductions to related issues. In a few instances, references may be presented in more than one section of the bibliography. For example, individual papers specifically addressing both non-game and game birds are included in respective sections of the bibliography. Duplication of citations and associated notes has, however, been kept to a minimum.

  1. Localized Orbital Mucosa-Associated Lymphoma Tissue Lymphoma Managed With Primary Radiation Therapy: Efficacy and Toxicity

    SciTech Connect

    Goda, Jayant Sastri; Le, Lisa W.; Lapperriere, Normand J.; Millar, Barbara-Ann; Payne, David; Gospodarowicz, Mary K.; Wells, Woodrow; Hodgson, David C.; Sun, Alexander; Simpson, Rand; Tsang, Richard W.

    2011-11-15

    Purpose: To evaluate the clinical outcomes and late effects of radiation therapy (RT) in localized primary orbital mucosa-associated lymphoma tissue (MALT) lymphoma (POML). Methods and Materials: From 1989 to 2007, 89 patients with Stage IE POML received RT. The median age was 56 years old. Sites involved conjunctiva (59 patients [66%]), lacrimal gland (20 patients [23%]), and soft tissue (10 patients [11%]). Megavoltage beam(s) was used in 91%, electrons in 7%, and orthovoltage in 2% of cases. The dose given was 25 Gy in 97% and 30 Gy in 3% of patients. Lens shielding was possible in 57% of patients. Results: The median follow-up was 5.9 years. Complete response or unconfirmed complete response was seen in 88 patients (99%). Relapse occurred in 22 patients (25%). First relapse sites were local (2 patients [9%]), in the contralateral orbit (5 patients [23%]), and distant (15 patients [68%]). The 7-year overall survival (OS), cause-specific survival (CSS), relapse-free survival (RFS), and local control (LC) rates were 91%, 96%, 64%, and 97%, respectively. Radiation-related late sequelae were documented in 40 patients (45%). Cataracts were observed in 22 patients (Grade 1 in 2 patients; Grade 3 in 20 patients). The incidence of Grade 3 cataract at 7 years was 25%. Other late sequelae (n = 28) were dry eye(s) (22 patients [Grade 1 in 14 patients; Grade 2 in 2 patients; Grade 3 in 2 patients; n/s in 4 patients), keratitis (3 patients), macular degeneration/cystoid edema (2 patients), and vitreous detachment (1 patient). Five patients developed Grade 3 noncataract late effects. Lens shielding reduced the incidence of Grade 3 cataract and all Grade {>=}2 late sequelae. Seventeen patients (16 with cataracts) underwent surgery; 23 patients were treated conservatively. The outcome for managing late effects was generally successful, with 30 patients completely improved, and 9 patients with persisting late sequelae (10%). Conclusions: POML responds favorably to moderate doses

  2. Awareness in Primary School Teachers regarding Traumatic Dental Injuries in Children and Their Emergency Management: A Survey in South Jaipur

    PubMed Central

    Syed, Ather Ahmed; Chaturvedi, Shefali; Goenka, Puneet; Sharma, Swati

    2016-01-01

    ABSTRACT Introduction: Trauma to primary and permanent teeth and their supporting structures is one of the most common dental problems seen in children. The prognosis of traumatized teeth depends on timely attention with prompt and appropriate treatment, which often relies on knowledge of the teachers who may be present at the place of accidents. Thus, the aim of this study was to evaluate via a questionnaire the knowledge level of primary school teachers in South Jaipur regarding dental trauma. Design: Questionnaire survey. Materials and methods: A self-designed questionnaire was administered to 300 primary school teachers from 20 randomly selected private and semi-aided schools of South Jaipur. Results: A total of 278 teachers responded to the survey. The collected data were subjected to statistical analysis. It was found that most of the respondents had accepted poor knowledge regarding dental trauma, with a mean knowledge of 10.56 ± 2.58. Conclusion: This study highlighted inadequate knowledge regarding emergency management of traumatic dental injuries, and teachers felt the need for training in the management of dental trauma as part of their training program. How to cite this article: Nirwan M, Syed AA, Chaturvedi S, Goenka P, Sharma S. Awareness in Primary School Teachers regarding Traumatic Dental Injuries in Children and Their Emergency Management: A Survey in South Jaipur. Int J Clin Pediatr Dent 2016;9(1):62-66. PMID:27274158

  3. Management of the primary obstructed megaureter (POM) and indication for operative treatment.

    PubMed

    Stehr, M; Metzger, R; Schuster, T; Porn, U; Dietz, H-G

    2002-02-01

    Presented is the diagnostic and therapeutic management of the primary obstructed megaureter (POM). 42 patients presented with 53 ureteral units (UU) of POM (5 females, 37 males, 36 neonates and 6 children aged 3 to 8 years). Of the 53 megaureters 10 UU (19%) were on the right and 27 UU(51 %)were on the left. 8 patients (19%)with 16 UU (30%)showed a bilateral abnormality. In 41% of the patients, hydronephrosis had been discovered by prenatal ultrasound. All patients were evaluated postnatally by ultrasound (US), voiding cysturethrogram (VCUG), intravenous pyelogram (IVP) and diuresis renogram (MAG-3) (DR). Due to the percentage of urinary drainage,the renogram results were classified into different categories:no obstruction, functional obstruction, equivocal and obstruction. A partial renal function was also calculated. Follow-up of the patients ranges between 5 to 48 months (mean: 22.1). All patients underwent serial US and serial DR were obtained in 36 patients. Initially, 9 (17%) UU showed a functional obstruction, 34 (64.2%) an equivocal and 10 (18.8%) an obstructive urinary drainage pattern. 2 kidneys showed a significant decreased partial function of 20, respectively 26%. Surgery was performed in an initial im-paired renal function with an obstructive pattern or in cases with normal function and at least equivocal urinary drainage pattern with no improvement or deterioration of the urinary drainage and/or function in the follow-up. Considering these criteria, 5(9.6%) patients needed surgery. No loss of kidney function has been observed in follow-up. DR is the most valuable diagnostic tool. Criteria interpreting the results are demonstrated in this article. PMID:11967757

  4. Management of the primary obstructed megaureter (POM) and indication for operative treatment.

    PubMed

    Stehr, M; Metzger, R; Schuster, T; Porn, U; Dietz, H-G

    2002-02-01

    Presented is the diagnostic and therapeutic management of the primary obstructed megaureter (POM). 42 patients presented with 53 ureteral units (UU) of POM (5 females, 37 males, 36 neonates and 6 children aged 3 to 8 years). Of the 53 megaureters 10 UU (19%) were on the right and 27 UU(51 %)were on the left. 8 patients (19%)with 16 UU (30%)showed a bilateral abnormality. In 41% of the patients, hydronephrosis had been discovered by prenatal ultrasound. All patients were evaluated postnatally by ultrasound (US), voiding cysturethrogram (VCUG), intravenous pyelogram (IVP) and diuresis renogram (MAG-3) (DR). Due to the percentage of urinary drainage,the renogram results were classified into different categories:no obstruction, functional obstruction, equivocal and obstruction. A partial renal function was also calculated. Follow-up of the patients ranges between 5 to 48 months (mean: 22.1). All patients underwent serial US and serial DR were obtained in 36 patients. Initially, 9 (17%) UU showed a functional obstruction, 34 (64.2%) an equivocal and 10 (18.8%) an obstructive urinary drainage pattern. 2 kidneys showed a significant decreased partial function of 20, respectively 26%. Surgery was performed in an initial im-paired renal function with an obstructive pattern or in cases with normal function and at least equivocal urinary drainage pattern with no improvement or deterioration of the urinary drainage and/or function in the follow-up. Considering these criteria, 5(9.6%) patients needed surgery. No loss of kidney function has been observed in follow-up. DR is the most valuable diagnostic tool. Criteria interpreting the results are demonstrated in this article.

  5. Development of an Automated Healthcare Kiosk for the Management of Chronic Disease Patients in the Primary Care Setting.

    PubMed

    Ng, Grace; Tan, Nicolette; Bahadin, Juliana; Shum, Eugene; Tan, Sze Wee

    2016-07-01

    An increase in the prevalence of chronic disease has led to a rise in the demand for primary healthcare services in many developed countries. Healthcare technology tools may provide the leverage to alleviate the shortage of primary care providers. Here we describe the development and usage of an automated healthcare kiosk for the management of patients with stable chronic disease in the primary care setting. One-hundred patients with stable chronic disease were recruited from a primary care clinic. They used a kiosk in place of doctors' consultations for two subsequent follow-up visits. Patient and physician satisfaction with kiosk usage were measured on a Likert scale. Kiosk blood pressure measurements and triage decisions were validated and optimized. Patients were assessed if they could use the kiosk independently. Patients and physicians were satisfied with all areas of kiosk usage. Kiosk triage decisions were accurate by the 2nd month of the study. Blood pressure measurements by the kiosk were equivalent to that taken by a nurse (p = 0.30, 0.14). Independent kiosk usage depended on patients' language skills and educational levels. Healthcare kiosks represent an alternative way to manage patients with stable chronic disease. They have the potential to replace physician visits and improve access to primary healthcare. Patients welcome the use of healthcare technology tools, including those with limited literacy and education. Optimization of environmental and patient factors may be required prior to the implementation of kiosk-based technology in the healthcare setting. PMID:27240840

  6. Prostate disease: management options for the primary healthcare team. Report of a working party of the British Prostate Group.

    PubMed Central

    Chisholm, G. D.; Carne, S. J.; Fitzpatrick, J. M.; George, N. J.; Gingell, J. C.; Keen, J. W.; Kirby, R. S.; Kirk, D.; O'Donoghue, E. P.; Peeling, W. B.

    1995-01-01

    The prostate gland has attracted a remarkable increase in interest in the past few years. The two most common diseases of this gland, benign prostatic hyperplasia and carcinoma of the prostate, have been brought into greater prominence by new diagnostic methods, public interest, and a wider choice of surgical and non-surgical treatments. Uncertainty about the significance of these changes has occurred because of the rapidity of change, the profusion of statements, opinions and promotions, and the relatively little guidance available from the profession. Ten urologists and two general practitioners have reviewed the relevant evidence about these two prostate diseases and the newer diagnostic methods; their conclusions are summarised here. Management options and guidance on clinical practice are also discussed. Because of a number of unresolved diagnostic and management issues, detailed requirements for practice guidelines have not been specified. PMID:7538216

  7. Improving equity in the provision of primary health care: lessons from decentralized planning and management in Namibia.

    PubMed Central

    Bell, Ruth; Ithindi, Taathi; Low, Anne

    2002-01-01

    This paper draws lessons from a review of primary health care services in Windhoek, the capital of Namibia, undertaken by a regional health management team. The review was carried out because of perceived increases in workload and inadequate staffing levels, arising from the rapid expansion of the city associated with inward migration. A survey of the utilization of government clinics was used to develop a more equitable allocation of primary health care services between localities. The survey revealed disparities between patterns of utilization of the services and the allocation of staff: the poorer localities were relatively underprovided. Decisions made centrally on resource allocation had reinforced the inequities. On the basis of the results of the review, the regional health management team redistributed nursing and medical staff and argued for a shift in the allocation of capital expenditure towards the poorer communities. The review demonstrates the potential for regional and provincial health management teams to make effective assessments of the needs of their populations and to promote the equitable delivery of primary health care services. In order to achieve this they need not only to become effective managers, but also to develop population-based planning skills and the confidence and authority to influence the allocation of resources between and within their regions and provinces. PMID:12219160

  8. A Comparative Study of the Influence of Head Teachers Management Styles on Pupils Performance in KCPE in Public and Private Primary Schools in Nakuru Municipality, Kenya

    ERIC Educational Resources Information Center

    Shibo, Margaret Nekesa

    2016-01-01

    The purpose of this study was to compare the influence of management styles of head teacher's on pupils' performance in private and public primary schools in Nakuru municipality at Kenya Certificate of Primary Education level. The population comprised of teachers and head teachers in public primary schools. The study adopted the ex post facto…

  9. Enlightened Choices

    ERIC Educational Resources Information Center

    Craig, Will

    2006-01-01

    In this article, the author has taken a little excursion back in time to illustrate the importance of two vital concepts in the minds of smart IT project managers, when they begin to consider smart-classroom installations and implementations, and the technologies they will choose. Those watchwords are: "standardization" and "boring." Certainly,…

  10. The Primary School in Changing Times: The Australian Experience. Educational Management Series.

    ERIC Educational Resources Information Center

    Townsend, Tony, Ed.

    Following substantial changes throughout the Australian education system, primary schools are no longer in the protected position of having a regulated flow of clients, a predetermined curriculum, and marginal levels of staff development. This book reviews the impact of this change on Australian primary schools, the people who are involved with…

  11. Primary care as a platform for full continuum health care risk management.

    PubMed

    Klepper, Brian

    2013-01-01

    Health care clinical and financial risk is a multivectored problem, requiring multivectored solutions that extend beyond primary care. Worksite clinics have emerged that leverage empowered primary care, but incorporate a range of tactics aimed at driving appropriate care and cost by disrupting health care's perverse incentives. This article describes some of those approaches and shows evidence of the performance that can result. PMID:24402068

  12. Classroom Management: A Study on the Training Needs of Primary School Teachers

    ERIC Educational Resources Information Center

    El Warfali, Faida Imhemid Salem; Yusoff, Nik Mohd Rahimi Nik

    2014-01-01

    This study aimed to identify the training needs of the in-service primary school teachers in the city of Benghazi, Libya. Data collection involved the administration of a set of questionnaire to 420 teachers and interviews with ten of them. The study found that the most important training needs of the primary school teachers in terms of classroom…

  13. Primary care physician perceptions on the diagnosis and management of chronic obstructive pulmonary disease in diverse regions of the world

    PubMed Central

    Aisanov, Zaurbek; Bai, Chunxue; Bauerle, Otto; Colodenco, Federico D; Feldman, Charles; Hashimoto, Shu; Jardim, Jose; Lai, Christopher KW; Laniado-Laborin, Rafael; Nadeau, Gilbert; Sayiner, Abdullah; Shim, Jae Jeong; Tsai, Ying Huang; Walters, Richard D; Waterer, Grant

    2012-01-01

    Chronic obstructive pulmonary disease (COPD) is a multicomponent disorder that leads to substantial disability, impaired quality of life, and increased mortality. Although the majority of COPD patients are first diagnosed and treated in primary care practices, there is comparatively little information on the management of COPD patients in primary care. A web-based pilot survey was conducted to evaluate the primary care physician’s, or general practitioner’s (GP’s), knowledge, understanding, and management of COPD in twelve territories across the Asia-Pacific region, Africa, eastern Europe, and Latin America, using a 10-minute questionnaire comprising 20 questions and translated into the native language of each participating territory. The questionnaire was administered to a total of 600 GPs (50 from each territory) involved in the management of COPD patients and all data were collated and analyzed by an independent health care research consultant. This survey demonstrated that the GPs’ understanding of COPD was variable across the territories, with large numbers of GPs having very limited knowledge of COPD and its management. A consistent finding across all territories was the underutilization of spirometry (median 26%; range 10%–48%) and reliance on X-rays (median 14%; range 5%–22%) for COPD diagnosis, whereas overuse of blood tests (unspecified) was particularly high in Russia and South Africa. Similarly, there was considerable underrecognition of the importance of exacerbation history as an important factor of COPD and its initial management in most territories (median 4%; range 0%–22%). Management of COPD was well below guideline-recommended levels in most of the regions investigated. The findings of this survey suggest there is a need for more ongoing education and information, specifically directed towards GPs outside of Europe and North America, and that global COPD guidelines appear to have limited reach and application in most of the areas

  14. Primary care physician perceptions on the diagnosis and management of chronic obstructive pulmonary disease in diverse regions of the world.

    PubMed

    Aisanov, Zaurbek; Bai, Chunxue; Bauerle, Otto; Colodenco, Federico D; Feldman, Charles; Hashimoto, Shu; Jardim, Jose; Lai, Christopher K W; Laniado-Laborin, Rafael; Nadeau, Gilbert; Sayiner, Abdullah; Shim, Jae Jeong; Tsai, Ying Huang; Walters, Richard D; Waterer, Grant

    2012-01-01

    Chronic obstructive pulmonary disease (COPD) is a multicomponent disorder that leads to substantial disability, impaired quality of life, and increased mortality. Although the majority of COPD patients are first diagnosed and treated in primary care practices, there is comparatively little information on the management of COPD patients in primary care. A web-based pilot survey was conducted to evaluate the primary care physician's, or general practitioner's (GP's), knowledge, understanding, and management of COPD in twelve territories across the Asia-Pacific region, Africa, eastern Europe, and Latin America, using a 10-minute questionnaire comprising 20 questions and translated into the native language of each participating territory. The questionnaire was administered to a total of 600 GPs (50 from each territory) involved in the management of COPD patients and all data were collated and analyzed by an independent health care research consultant. This survey demonstrated that the GPs' understanding of COPD was variable across the territories, with large numbers of GPs having very limited knowledge of COPD and its management. A consistent finding across all territories was the underutilization of spirometry (median 26%; range 10%-48%) and reliance on X-rays (median 14%; range 5%-22%) for COPD diagnosis, whereas overuse of blood tests (unspecified) was particularly high in Russia and South Africa. Similarly, there was considerable underrecognition of the importance of exacerbation history as an important factor of COPD and its initial management in most territories (median 4%; range 0%-22%). Management of COPD was well below guideline-recommended levels in most of the regions investigated. The findings of this survey suggest there is a need for more ongoing education and information, specifically directed towards GPs outside of Europe and North America, and that global COPD guidelines appear to have limited reach and application in most of the areas studied.

  15. Drinking water management: health risk perceptions and choices in First Nations and non-First Nations communities in Canada.

    PubMed

    Dupont, Diane; Waldner, Cheryl; Bharadwaj, Lalita; Plummer, Ryan; Carter, Blair; Cave, Kate; Zagozewski, Rebecca

    2014-05-30

    The relationship between tap water and health has been a topic of public concern and calls for better management in Canada since well-publicized contamination events in two provinces (Ontario and Saskatchewan) in 2000-2001. This study reports the perspectives on health risks from tap water and corresponding use of, and spending on, bottled water in a number of different communities in Canada. In 2009-2010, four First Nations communities (three from Ontario and one from Saskatchewan) and a geographically diverse sample of non-First Nations Canadians were surveyed about their beliefs concerning health risks from tap water and their spending practices for bottled water as a substitute. Responses to five identical questions were examined, revealing that survey respondents from Ontario First Nations communities were more likely than non-First Nations Canadians to believe bottled water is safer than tap water (OR 1.6); more likely to report someone became ill from tap water (OR 3.6); more likely to express water and health concerns related to tap water consumption (OR 2.4); and more likely to spend more on bottled water (OR 4.9). On the other hand, participants from one Saskatchewan First Nations community were less likely than non-First Nations Canadians to believe that someone had become ill from drinking tap water (OR 3.8), less likely to believe bottled water is safer than tap (OR 2.0), and less likely to have health concerns with tap water (OR 1.5). These differences, however, did not translate into differences in the likelihood of high bottled water expenditures or being a 100% bottled water consumer. The paper discusses how the differences observed may be related to water supply and regulation, trust, perceived control, cultural background, location, and past experience.

  16. Model for understanding consumer textural food choice.

    PubMed

    Jeltema, Melissa; Beckley, Jacqueline; Vahalik, Jennifer

    2015-05-01

    The current paradigm for developing products that will match the marketing messaging is flawed because the drivers of product choice and satisfaction based on texture are misunderstood. Qualitative research across 10 years has led to the thesis explored in this research that individuals have a preferred way to manipulate food in their mouths (i.e., mouth behavior) and that this behavior is a major driver of food choice, satisfaction, and the desire to repurchase. Texture, which is currently thought to be a major driver of product choice, is a secondary factor, and is important only in that it supports the primary driver-mouth behavior. A model for mouth behavior is proposed and the qualitative research supporting the identification of different mouth behaviors is presented. The development of a trademarked typing tool for characterizing mouth behavior is described along with quantitative substantiation of the tool's ability to group individuals by mouth behavior. The use of these four groups to understand textural preferences and the implications for a variety of areas including product design and weight management are explored. PMID:25987995

  17. Model for understanding consumer textural food choice

    PubMed Central

    Jeltema, Melissa; Beckley, Jacqueline; Vahalik, Jennifer

    2015-01-01

    The current paradigm for developing products that will match the marketing messaging is flawed because the drivers of product choice and satisfaction based on texture are misunderstood. Qualitative research across 10 years has led to the thesis explored in this research that individuals have a preferred way to manipulate food in their mouths (i.e., mouth behavior) and that this behavior is a major driver of food choice, satisfaction, and the desire to repurchase. Texture, which is currently thought to be a major driver of product choice, is a secondary factor, and is important only in that it supports the primary driver—mouth behavior. A model for mouth behavior is proposed and the qualitative research supporting the identification of different mouth behaviors is presented. The development of a trademarked typing tool for characterizing mouth behavior is described along with quantitative substantiation of the tool's ability to group individuals by mouth behavior. The use of these four groups to understand textural preferences and the implications for a variety of areas including product design and weight management are explored. PMID:25987995

  18. Integrated primary and mental health care: evaluating a nurse-managed center for clients with serious and persistent mental illness.

    PubMed

    McDevitt, Judith; Braun, Susan; Noyes, Margaret; Snyder, Marsha; Marion, Lucy

    2005-12-01

    Nurse-managed centers have been at the forefront of providing ambulatory care alternatives for underserved populations lacking access to care. Following this model, the Center for Integrated Health Care of the College of Nursing at the University of Illinois in Chicago delivers primary and mental health care services to a population of people with serious and persistent mental illness. The authors' experience illustrates the many rewards and challenges that nurse-managed centers face. This article describes their center's model of integrated care, examines selected performance indicators, and discusses the implications, opportunities, and challenges ahead.

  19. Role of primary substrate composition and concentration on attenuation of trace organic chemicals in managed aquifer recharge systems.

    PubMed

    Alidina, Mazahirali; Li, Dong; Ouf, Mohamed; Drewes, Jörg E

    2014-11-01

    This study was undertaken to investigate the role of primary substrate composition and concentration on the attenuation of biodegradable emerging trace organic chemicals (TOrCs) in simulated managed aquifer recharge (MAR) systems. Four sets of soil columns were established in the laboratory, each receiving synthetic feed solutions comprising different ratios and concentrations of peptone-yeast and humic acid as the primary substrate to investigate the effect on removal of six TOrCs (atenolol, caffeine, diclofenac, gemfibrozil, primidone, and trimethoprim). Based on abiotic control experiments, adsorption was not identified as a significant attenuation mechanism for primidone, gemfibrozil and diclofenac. Caffeine, atenolol and trimethoprim displayed initial adsorptive losses, however, adsorption coefficients derived from batch tests confirmed that adsorption was limited and in the long-term experiment, biodegradation was the dominant attenuation process. Within a travel time of 16 h, caffeine - an easily degradable compound exhibited removal exceeding 75% regardless of composition or concentration of the primary substrate. Primidone - a poorly degradable compound, showed no removal in any column regardless of the nature of the primary substrate. The composition and concentration of the primary substrate, however, had an effect on attenuation of moderately degradable TOrCs, such as atenolol, gemfibrozil and diclofenac, with the primary substrate composition seeming to have a larger impact on TOrC attenuation than its concentration. When the primary substrate consisted mainly of refractory substrate (humic acid), higher removal of the moderately degradable TOrCs was observed. The microbial communities in the columns receiving more refractory carbon, were noted to be more diverse and hence likely able to express a wider range of enzymes, which were more suitable for TOrC transformation. The effect of the primary substrate on microbial community composition, diversity

  20. Role of primary substrate composition and concentration on attenuation of trace organic chemicals in managed aquifer recharge systems.

    PubMed

    Alidina, Mazahirali; Li, Dong; Ouf, Mohamed; Drewes, Jörg E

    2014-11-01

    This study was undertaken to investigate the role of primary substrate composition and concentration on the attenuation of biodegradable emerging trace organic chemicals (TOrCs) in simulated managed aquifer recharge (MAR) systems. Four sets of soil columns were established in the laboratory, each receiving synthetic feed solutions comprising different ratios and concentrations of peptone-yeast and humic acid as the primary substrate to investigate the effect on removal of six TOrCs (atenolol, caffeine, diclofenac, gemfibrozil, primidone, and trimethoprim). Based on abiotic control experiments, adsorption was not identified as a significant attenuation mechanism for primidone, gemfibrozil and diclofenac. Caffeine, atenolol and trimethoprim displayed initial adsorptive losses, however, adsorption coefficients derived from batch tests confirmed that adsorption was limited and in the long-term experiment, biodegradation was the dominant attenuation process. Within a travel time of 16 h, caffeine - an easily degradable compound exhibited removal exceeding 75% regardless of composition or concentration of the primary substrate. Primidone - a poorly degradable compound, showed no removal in any column regardless of the nature of the primary substrate. The composition and concentration of the primary substrate, however, had an effect on attenuation of moderately degradable TOrCs, such as atenolol, gemfibrozil and diclofenac, with the primary substrate composition seeming to have a larger impact on TOrC attenuation than its concentration. When the primary substrate consisted mainly of refractory substrate (humic acid), higher removal of the moderately degradable TOrCs was observed. The microbial communities in the columns receiving more refractory carbon, were noted to be more diverse and hence likely able to express a wider range of enzymes, which were more suitable for TOrC transformation. The effect of the primary substrate on microbial community composition, diversity

  1. Primary care summary of the British Thoracic Society Guideline on the management of non-cystic fibrosis bronchiectasis.

    PubMed

    Hill, Adam T; Pasteur, Mark; Cornford, Charles; Welham, Sally; Bilton, Diana

    2011-06-01

    The British Thoracic Society (BTS) has recently published a guideline for the management of non-cystic fibrosis (non-CF) bronchiectasis in children and adults. This paper summarises the key recommendations applicable to the primary care setting. The key points are: • Think of the diagnosis of bronchiectasis in adults and children who present with a chronic productive cough or unexplained haemoptysis, and in children with asthma which responds poorly to treatment; • High resolution computed tomography (HRCT) scanning is needed to confirm the diagnosis • Sputum culture should be obtained at the start of an exacerbation prior to initiating treatment with antibiotics; Treatment should be started whilst awaiting the sputum result and should be continued for 14 days; • Patients with bronchiectasis have significant morbidity. Management in primary care is aimed at improving morbidity, and includes; patient education, treatment and monitoring, as well as appropriate referral to secondary care including assessment for long term antibiotics.

  2. Problems of management of medical solid waste at primary health care centres in the Palestinian Territory and their remedial measures.

    PubMed

    Al-Khatib, I A

    2014-01-09

    This study was conducted to investigate the management aspects of medical solid waste (MSW) at primary health care centres in Nablus and Salfit governorates in the West Bank, Palestine. We interviewed 190 health care staff from primary health care centres in this area. The most frequent type of waste produced was sharps waste: only 5.3% of respondents said this was never produced. Infectious waste was the second most frequent type produced. Only 40.4% of the respondents stated that hazardous MSW was always treated. Over 80% said that non-sharps MSW was separated into its different components, but almost 20% said that sharps were not placed in special containers. We recorded a mean of 34 g of hazardous solid waste and 55 g of non-hazardous solid waste generated per outpatient per day. Staff awareness and training, separation of MSW, establishment of simple treatment facilities are the major measures suggested for improvement of the waste management practices.

  3. The Implementation of a Positive Behaviour Management Programme in a Primary Classroom: A Case Study.

    ERIC Educational Resources Information Center

    Atherley, Carole

    1990-01-01

    Positive behavior management has been recommended as a more acceptable form of classroom management than traditional behavioral modification. This paper discusses the application of stimulus and contingency control methods (positive behavior management) to elicit more socially and academically acceptable behavior from elementary school children.…

  4. A Study of the Outcome of Primary Excision and Closure Technique in the Management of Lip Leukoderma in 30 Patients

    PubMed Central

    Shilpa, Kanathur; Sacchidanand, S.; Savitha, Somaiah; Ranjitha, Ramamurthy; Lakshmi, DV; Divya, Gorur

    2016-01-01

    Context: Lips being one of the graceful cosmetic units of the face, any disfigurement, including depigmentation, can be embarrassing, psychologically distressing, and socially stigmatizing. Even with the evolution of various surgical modalities, none of the techniques ensure 100% pigmentation with a good cosmetic appearance. With this background, this study was undertaken to study the efficacy of the technique—primary excision and closure in treatment of lip leukoderma (LL). Aims: To study the efficacy, cosmetic outcome, and recurrence following primary excision and closure technique in the management of LL. Settings and Design: A prospective single-center open-label uncontrolled study. Materials and Methods: Thirty patients with LL involving inner margin of the lower lip and those who fulfilled inclusion and exclusion criteria were included in the study. After obtaining consent and physician fitness, patients were posted for primary excision and closure of the vitiliginous area of the lip. Patients were followed up at the immediate postoperative period and 6 months later. Patient satisfaction scale was done by asking the patient to grade the response between one and ten. Statistical Analysis Used: Mean and percentiles. Results: Out of 30 patients, 29 patients achieved complete clearance that was cosmetically acceptable. Only one patient showed recurrence at the end of 6 months. Average patient satisfaction scale showed an average of 9.66. Conclusions: Primary excision and closure technique is one of the safe, inexpensive modality in the management of LL involving the inner margin of the lip with immediate result. PMID:27081245

  5. Improved migraine management in primary care: results of a patient treatment experience study using zolmitriptan orally disintegrating tablet

    PubMed Central

    SHAPERO, G; DOWSON, A; LACOSTE, J-P; ALMQVIST, P

    2006-01-01

    The ‘Zomig Appropriate for Primary care’ programme was developed to address the needs of primary care physicians (PCPs) to improve migraine management. As part of the programme, an international, open-label, 6-month clinical study was performed. The study included new and tangible outcome variables relevant to PCPs and recruited patients presenting in primary care with an established migraine diagnosis. Patients treated up to three migraine attacks per month with zolmitriptan orally disintegrating tablet (ODT) 2.5 mg. All other migraine attacks occurring during the study period were treated with the patient's usual migraine medication (including other triptans). Questionnaires were used to record patient treatment experiences at the study end. The primary end-point was the proportion of patients wanting to continue using zolmitriptan ODT. Some 595 patients treated 7171 migraine attacks with zolmitriptan ODT. Of the 504 patients who completed the 6-month questionnaire, 380 (75.4%) wished to continue using zolmitriptan ODT. The results of the study indicate that patient-orientated end-points are more motivational and meaningful to physicians than traditional end-points used in controlled clinical trials, allowing them to make informed decisions regarding migraine management. PMID:17109663

  6. Management Choices in an Uncertain Future: Navigating Snow, Precipitation, and Temperature Projections in the Pacific Northwest U.S. to Assess Water Management Alternatives

    NASA Astrophysics Data System (ADS)

    Luce, C.

    2014-12-01

    Climate and hydrology models are regularly applied to assess potential changes in water resources and to inform adaptation decisions. An increasingly common question is, "What if we are wrong?" While climate models show substantial agreement on metrics such as pressure, temperature, and wind, they are notoriously uncertain in projecting precipitation change. The response to that uncertainty varies depending on the water management context and the nature of the uncertainty. In the southwestern U.S., large storage reservoirs (relative to annual supply) and general expectations of decreasing precipitation have guided extensive discussion on water management towards uncertainties in annual-scale water balances, precipitation, and evapotranspiration. In contrast, smaller reservoirs and little expectation for change in annual precipitation have focused discussions of Pacific Northwest water management toward shifts in runoff seasonality. The relative certainty of temperature impacts on snowpacks compared to the substantial uncertainty in precipitation has yielded a consistent narrative on earlier snowmelt. This narrative has been reinforced by a perception of essentially the same behavior in the historical record. This perception has led to calls in the political arena for more reservoir storage to replace snowpack storage for water supplies. Recent findings on differences in trends in precipitation at high versus low elevations, however, has recalled the uncertainty in precipitation futures and generated questions about alternative water management strategies. An important question with respect to snowpacks is whether the precipitation changes matter in the context of such substantial projections for temperature change. Here we apply an empirical snowpack model to analyze spatial differences in the uncertainty of snowpack responses to temperature and precipitation forcing across the Pacific Northwest U.S. The analysis reveals a strong geographic gradient in uncertainty

  7. Population management, systems-based practice, and planned chronic illness care: integrating disease management competencies into primary care to improve composite diabetes quality measures.

    PubMed

    Kimura, Joe; DaSilva, Karen; Marshall, Richard

    2008-02-01

    The increasing prevalence of chronic illnesses in the United States requires a fundamental redesign of the primary care delivery system's structure and processes in order to meet the changing needs and expectations of patients. Population management, systems-based practice, and planned chronic illness care are 3 potential processes that can be integrated into primary care and are compatible with the Chronic Care Model. In 2003, Harvard Vanguard Medical Associates, a multispecialty ambulatory physician group practice based in Boston, Massachusetts, began implementing all 3 processes across its primary care practices. From 2004 to 2006, the overall diabetes composite quality measures improved from 51% to 58% for screening (HgA1c x 2, low-density lipoprotein, blood pressure in 12 months) and from 13% to 17% for intermediate outcomes (HgA1c management functions into the front lines of primary care and the positive impact of those changes on overall diabetes quality of care.

  8. School Choice and Ethnic Segregation.

    ERIC Educational Resources Information Center

    Karsten, Sjoerd; Ledoux, Guuske; Roeleveld, Jaap; Felix, Charles; Elshof, Dorothe

    2003-01-01

    Explores how school choice has influenced ethnic segregation in Dutch primary schools. Shows that native Dutch parents are significantly more interested in a match between their social and cultural background and the pupil composition of schools than ethnic minority parents. Both groups of parents generally reject predominately "non-White"…

  9. Evolution, current structure, and role of a primary care clinical pharmacy service in an integrated managed care organization.

    PubMed

    Heilmann, Rachel M F; Campbell, Stephanie M; Kroner, Beverly A; Proksel, Jenel R; Billups, Sarah J; Witt, Daniel M; Helling, Dennis K

    2013-01-01

    The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described.

  10. The role of primary plastic surgery in the management of open fractures.

    PubMed

    Court-Brown, Charles M; Honeyman, Calum S; Clement, Nick D; Hamilton, Stuart A; McQueen, Margaret M

    2015-12-01

    A study was undertaken to determine the requirement for primary plastic surgery in the treatment of open fractures. We reviewed 3297 consecutive open fractures in a 22-year period in a defined population. Analysis showed that 12.6% of patients required primary plastic surgery with 5.6% being treated with split skin grafting and 7.2% with a flap. Only 3.5% of open upper limb fractures required primary plastic surgery compared to 27.9% of open lower limb fractures. The fractures that required most primary plastic surgery were those of the femoral diaphysis and all fractures between the proximal tibia and the midfoot. The incidence of open fractures that require primary plastic surgery was 28/10(6)/year. The incidence in open upper and lower limb fractures was 5.3/10(6)/year and 22.7/10(6)/year respectively. Using these figures it is possible to estimate the numbers of open fractures that will require primary plastic surgery each year in the United Kingdom.

  11. Optimising the detection and management of familial hypercholesterolaemia: central role of primary care and its integration with specialist services.

    PubMed

    Vickery, Alistair W; Bell, Damon; Garton-Smith, Jacquie; Kirke, Andrew B; Pang, Jing; Watts, Gerald F

    2014-12-01

    Familial hypercholesterolaemia (FH) is the most common monogenic lipid disorder associated with premature coronary heart disease (CHD). However, the majority of people with FH are undiagnosed or undertreated. Early cholesterol lowering therapy reduces cardiovascular disease mortality in FH. Low awareness and knowledge of FH in specialty and general practice highlights the need for strategies to improve the detection and management of FH. We present an algorithm describing a multidisciplinary approach to FH detection and management. We highlight the role of primary care, and where GPs can work with preventive cardiologists to improve care of FH. Novel strategies to detect index cases with FH are presented including the community laboratory, highlighting patients at high risk of FH, and targeted FH detection through searching the general practice database. General practitioners request over 90% of LDL cholesterol measurements in the community. Once an individual with FH is detected only a small proportion of patients require specialty management with the majority of patients suitably managed in primary care. However, it is crucial to screen family members, as 50% of first-degree family members are expected to have FH due to the autosomal dominant inheritance. PMID:25130889

  12. How do primary health care teams learn to integrate intimate partner violence (IPV) management? A realist evaluation protocol

    PubMed Central

    2013-01-01

    Background Despite the existence of ample literature dealing, on the one hand, with the integration of innovations within health systems and team learning, and, on the other hand, with different aspects of the detection and management of intimate partner violence (IPV) within healthcare facilities, research that explores how health innovations that go beyond biomedical issues—such as IPV management—get integrated into health systems, and that focuses on healthcare teams’ learning processes is, to the best of our knowledge, very scarce if not absent. This realist evaluation protocol aims to ascertain: why, how, and under what circumstances primary healthcare teams engage (if at all) in a learning process to integrate IPV management in their practices; and why, how, and under what circumstances team learning processes lead to the development of organizational culture and values regarding IPV management, and the delivery of IPV management services. Methods This study will be conducted in Spain using a multiple-case study design. Data will be collected from selected cases (primary healthcare teams) through different methods: individual and group interviews, routinely collected statistical data, documentary review, and observation. Cases will be purposively selected in order to enable testing the initial middle-range theory (MRT). After in-depth exploration of a limited number of cases, additional cases will be chosen for their ability to contribute to refining the emerging MRT to explain how primary healthcare learn to integrate intimate partner violence management. Discussion Evaluations of health sector responses to IPV are scarce, and even fewer focus on why, how, and when the healthcare services integrate IPV management. There is a consensus that healthcare professionals and healthcare teams play a key role in this integration, and that training is important in order to realize changes. However, little is known about team learning of IPV management, both in

  13. One Year On: First-Year Primary Teachers' Perceptions of Preparedness to Manage Misbehaviour and Their Confidence in the Strategies They Use

    ERIC Educational Resources Information Center

    O'Neill, Sue; Stephenson, Jennifer

    2013-01-01

    This article reports the findings of a one-year follow-up study of Australian beginning primary teachers' perceived preparedness to manage a variety of problematic student behaviours, and their confidence and use of behaviour management strategies based on their preservice coursework in classroom behaviour management. A total of 216 primary…

  14. Whole School Behaviour Management and Perceptions of Behaviour Problems in Australian Primary Schools

    ERIC Educational Resources Information Center

    De Nobile, John; London, Teola; El Baba, Mariam

    2015-01-01

    Over the past decade and a half, whole school behaviour management systems have been implemented in many Australian schools in efforts to reduce undesirable behaviours and improve outcomes for students with behaviour problems. There is evidence in the literature suggesting that whole school approaches are more effective at managing student…

  15. The Integration of Pedagogical Aspects in Environmental Management Systems in Selected South African Primary Schools

    ERIC Educational Resources Information Center

    Kanyimba, Alex; Richter, Barry; Raath, Schalk

    2015-01-01

    Environmental management systems implemented in schools are regarded by many as a mechanism for the integration of environmental matters in all the operational functions of the school. The links, however, between environmental management and curriculum practice have not been adequately addressed in the literature. This article reports on the…

  16. Management of the early and late presentations of rheumatoid arthritis: a survey of Ontario primary care physicians.

    PubMed Central

    Glazier, R H; Dalby, D M; Badley, E M; Hawker, G A; Bell, M J; Buchbinder, R; Lineker, S C

    1996-01-01

    OBJECTIVE: To examine primary care physicians' management of rheumatoid arthritis, ascertain the determinants of management and compare management with that recommended by a current practice panel. DESIGN: Mail survey (self-administered questionnaire). SETTING: Ontario. PARTICIPANTS: A stratified computer-generated random sample of 798 members of the College of Family Physicians of Canada. OUTCOME MEASURES: Proportions of respondents who chose various items in the management of two hypothetical patients, one with early rheumatoid arthritis and one with late rheumatoid arthritis. Scores for investigations, interventions and referrals for each scenario were generated by summing the recommended items chosen by respondents and then dividing by the total number of items recommended in that category. The scores were examined for their association with physician and practice characteristics and physician attitudes. RESULTS: The response rate was 68.3% (529/775 eligible physicians). Recommended investigations were chosen by more than two thirds of the respondents for both scenarios. Referrals to physiotherapy, occupational therapy and rheumatology, all recommended by the panel, were chosen by 206 (38.9%), 72 (13.6%) and 309 (58.4%) physicians respectively for early rheumatoid arthritis. These proportions were significantly higher for late rheumatoid arthritis (p < 0.01). In multiple regression analysis, for early rheumatoid arthritis, internship or residency training in rheumatology was associated with higher investigation and intervention scores, for late rheumatoid arthritis, older physicians had higher intervention scores and female physicians had higher referral scores. CONCLUSIONS: Primary care physicians' investigation of rheumatoid arthritis was in accord with panel recommendations. However, rates of referral to rheumatologists and other health care professionals were very low, especially for the early presentation of rheumatoid arthritis. More exposure to

  17. Management of Gastrointestinal Disorders in Central and Eastern Europe: Self-Reported Practice of Primary Care Physicians

    PubMed Central

    PALKA, Małgorzata; KRZTOŃ-KRÓLEWIECKA, Anna; TOMASIK, Tomasz; SEIFERT, Bohumil; WÓJTOWICZ, Ewa; WINDAK, Adam

    2014-01-01

    Background Gastrointestinal disorders account for 7–10% of all consultations in primary care. General practitioners’ management of digestive disorders in Central and Eastern European countries is largely unknown. Aims To identify and compare variations in the self-perceived responsibilities of general practitioners in the management of digestive disorders in Central and Eastern Europe. Methods A cross-sectional survey of a randomized sample of primary care physicians from 9 countries was conducted. An anonymous questionnaire was sent via post to primary care doctors. Results We received 867 responses; the response rate was 28.9%. Over 70% of respondents reported familiarity with available guidelines for gastrointestinal diseases. For uninvestigated dyspepsia in patients under 45 years, the “test and treat” strategy was twice as popular as “test and scope”. The majority (59.8%) of family physicians would refer patients with rectal bleeding without alarm symptoms to a specialist (from 7.6% of doctors in Slovenia to 85.1% of doctors in Bulgaria; p<0.001). 93.4% of respondents declared their involvement in colorectal cancer screening. In the majority of countries, responding doctors most often reported that they order fecal occult blood tests. The exceptions were Estonia and Hungary, where the majority of family physicians referred patients to a specialist (p<0.001). Conclusions Physicians from Central and Eastern European countries understood the need for the use of guidelines for the care of patients with gastrointestinal problems, but there is broad variation between countries in their management. Numerous efforts should be undertaken to establish and implement international standards for digestive disorders’ management in general practice.

  18. Primary Care Provider Perceptions of the Effectiveness of Two Self-Management Support Programs for Vulnerable Patients with Diabetes

    PubMed Central

    Ratanawongsa, Neda; Bhandari, Vijay K; Handley, Margaret; Rundall, Thomas; Hammer, Hali; Schillinger, Dean

    2012-01-01

    Background Primary care providers (PCPs) in safety net settings face barriers to optimizing care for patients with diabetes. We conducted this study to assess PCPs' perspectives on the effectiveness of two language-concordant diabetes self-management support programs. Methods One year postintervention, we surveyed PCPs whose patients with diabetes participated in a three-arm multiclinic randomized controlled trial comparing usual care (UC), weekly automated telephone self-management (ATSM) support with nurse care management, and monthly group medical visits (GMVs). We compared PCP perspectives on patient activation to create and achieve goals, quality of care, and barriers to care using regression models accounting for within-PCP clustering. Results Of 113 eligible PCPs caring for 330 enrolled patients, 87 PCPs (77%) responded to surveys about 245 (74%) enrolled patients. Intervention patients were more likely to be perceived by PCPs as activated to create and achieve goals for chronic care when compared with UC patients (standardized effect size, ATSM vs UC, +0.41, p = 0.01; GMV vs UC, +0.31, p = 0.05). Primary care providers rated quality of care as higher for patients exposed to ATSM compared to UC (odds ratio 3.6, p < 0.01). Compared with GMV patients, ATSM patients were more likely to be perceived by PCPs as overcoming barriers related to limited English proficiency (82% ATSM vs 44% GMV, p = 0.01) and managing medications (80% ATSM vs 53% GMV, p = 0.01). Conclusions Primary care providers perceived that patients receiving ATSM support had overcome barriers, participated more actively, and received higher quality diabetes care. These views of clinician stakeholders lend additional evidence for the potential to upscale ATSM more broadly to support PCPs in their care of diverse, multilinguistic populations. PMID:22401329

  19. Barriers and enablers in primary care clinicians' management of osteoarthritis: protocol for a systematic review and qualitative evidence synthesis

    PubMed Central

    Buchbinder, R; Bennell, K; Slade, S C

    2016-01-01

    Introduction Osteoarthritis is a highly prevalent and disabling condition. Primary care management of osteoarthritis is generally suboptimal despite evidence for several modestly effective interventions and the availability of high-quality clinical practice guidelines. This report describes a planned study to synthesise the views of primary care clinicians on the barriers and enablers to following recommended management of osteoarthritis, with the aim of providing new interpretations that may facilitate the uptake of recommended treatments, and in turn improve patient care. Methods and analysis A systematic review and meta-synthesis of qualitative studies. 5 databases will be searched using key search terms for qualitative research, evidence-based practice, clinical practice guidelines, osteoarthritis, beliefs, perceptions, barriers, enablers and adherence. A priori inclusion/exclusion criteria include availability of data from primary care clinicians, reports on views regarding management of osteoarthritis, and studies using qualitative methods for both data collection and analysis. At least 2 independent reviewers will identify eligible reports, conduct a critical appraisal of study conduct, extract data and synthesise reported findings and interpretations. Synthesis will follow thematic analysis within a grounded theory framework of inductive coding and iterative theme identification. The reviewers plus co-authors will contribute to the meta-synthesis to find new themes and theories. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach will be used to determine a confidence profile of each finding from the meta-synthesis. The protocol has been registered on PROSPERO and is reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) guidelines. Ethics and dissemination Ethical approval is not required. The systematic review will be published in a peer-reviewed journal. The results

  20. Managing behavioral health needs of veterans with traumatic brain injury (TBI) in primary care.

    PubMed

    King, Paul R; Wray, Laura O

    2012-12-01

    Traumatic brain injury (TBI) is a frequent occurrence in the United States, and has been given particular attention in the veteran population. Recent accounts have estimated TBI incidence rates as high as 20 % among US veterans who served in Afghanistan or Iraq, and many of these veterans experience a host of co-morbid concerns, including psychiatric complaints (such as depression and post-traumatic stress disorder), sleep disturbance, and substance abuse which may warrant referral to behavioral health specialists working in primary care settings. This paper reviews many common behavioral health concerns co-morbid with TBI, and suggests areas in which behavioral health specialists may assess, intervene, and help to facilitate holistic patient care beyond the acute phase of injury. The primary focus is on sequelae common to mild and moderate TBI which may more readily present in primary care clinics.

  1. Conservative management of severe intrusion in a primary tooth: a 4-year follow-up.

    PubMed

    Ruviére, Denise Belucio; Costa, Mariana Machado Teixeira de Moraes; Cunha, Robson Frederico

    2009-01-01

    The purpose of this report was to describe the case of an 18-month-old boy who was referred to the pediatric clinic of the School of Dentistry of Araçatuba, São Paulo State University, Araçatuba, São Paulo, Brazil, 3 days after sustaining severe trauma that led to the complete intrusion of the primary maxillary right lateral incisor, a crown fracture of the primary maxillary right central incisor without pulp involvement, and disruption of the superior labial frenum. Four months later, spontaneous re-eruption was observed in the intruded tooth and no endodontic intervention was necessary in either traumatized teeth. Four years after the trauma, a morphological change in the germ of the permanent successor was noted. Clinical follow-up and periodic radiographies are necessary after traumatic intrusion of primary teeth to monitor possible sequelae in the permanent successors.

  2. Primary prostate sarcoma: how to manage following diagnosis at transurethral resection

    PubMed Central

    Hicks, Natalie; Gurung, Pratik M.S.; Deshmukh, Nayneeta; Apakama, Ikechukwu; Patel, Prashant

    2016-01-01

    Primary prostate sarcomas are rare, reportedly comprising just 0.7% of all prostate malignancies. Here, we present the case of a 66-year-old man who was diagnosed with prostate stromal sarcoma after undergoing a routine transurethral resection of prostate for bladder outflow obstruction. Primary prostate sarcoma can be aggressive even when low-grade, with a high risk of local recurrence and, high malignant potential when high-grade. They require aggressive multimodality treatment with surgery, chemotherapy and radiotherapy for durable survival outcomes. They also require close surveillance with long-term follow-up. PMID:27147716

  3. Primary prostate sarcoma: how to manage following diagnosis at transurethral resection.

    PubMed

    Hicks, Natalie; Gurung, Pratik M S; Deshmukh, Nayneeta; Apakama, Ikechukwu; Patel, Prashant

    2016-05-03

    Primary prostate sarcomas are rare, reportedly comprising just 0.7% of all prostate malignancies. Here, we present the case of a 66-year-old man who was diagnosed with prostate stromal sarcoma after undergoing a routine transurethral resection of prostate for bladder outflow obstruction. Primary prostate sarcoma can be aggressive even when low-grade, with a high risk of local recurrence and, high malignant potential when high-grade. They require aggressive multimodality treatment with surgery, chemotherapy and radiotherapy for durable survival outcomes. They also require close surveillance with long-term follow-up.

  4. Splenic trauma. Choice of management.

    PubMed Central

    Lucas, C E

    1991-01-01

    The modern era for splenic surgery for injury began in 1892 when Riegner reported a splenectomy in a 14-year-old construction worker who fell from a height and presented with abdominal pain, distension, tachycardia, and oliguria. This report set the stage for routine splenectomy, which was performed for all splenic injury in the next two generations. Despite early reports by Pearce and by Morris and Bullock that splenectomy in animals caused impaired defenses against infection, little challenge to routine splenectomy was made until King and Schumacker in 1952 reported a syndrome of "overwhelming postsplenectomy infection" (OPSI). Many studies have since demonstrated the importance of the spleen in preventing infections, particularly from the encapsulated organisms. Overwhelming postsplenectomy infection occurs in about 0.6% of children and 0.3% of adults. Intraoperative splenic salvage has become more popular and can be achieved safely in most patients by delivering the spleen with the pancreas to the incision, carefully repairing the spleen under direct vision, and using the many adjuncts to suture repair, including hemostatic agents and splenic wrapping. Intraoperative splenic salvage is not indicated in patients actively bleeding from other organs or in the presence of alcoholic cirrhosis. The role of splenic replantation in those patients requiring operative splenectomy needs further study but may provide significant long-term splenic function. Although nonoperative splenic salvage was first suggested more than 100 years ago by Billroth, this modality did not become popular in children until the 1960s or in adults until the latter 1980s. Patients with intrasplenic hematomas or with splenic fractures that do not extend to the hilum as judged by computed tomography usually can be observed successfully without operative intervention and without blood transfusion. Nonoperative splenic salvage is less likely with fractures that involve the splenic hilum and with the severely shattered spleen; these patients usually are treated best by early operative intervention. Following splenectomy for injury, polyvalent pneumococcal vaccine decreases the likelihood of OPSI and should be used routinely. The role of prophylactic penicillin is uncertain but the use of antibiotics for minor infectious problems is indicated after splenectomy. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. Fig. 8. Fig. 9. Fig. 10. Fig. 11. Fig. 12. PMID:1992948

  5. Using diaries to explore the work experiences of primary health care nursing managers in two South African provinces

    PubMed Central

    Munyewende, Pascalia O.; Rispel, Laetitia C.

    2014-01-01

    Background South Africa is on the brink of another wave of major health system reforms that underscore the centrality of primary health care (PHC). Nursing managers will play a critical role in these reforms. Objective The aim of the study was to explore the work experiences of PHC clinic nursing managers through the use of reflective diaries, a method hitherto under-utilised in health systems research in low- and middle-income countries. Design During 2012, a sub-set of 22 PHC nursing managers was selected randomly from a larger nurses’ survey in two South African provinces. After informed consent, participants were requested to keep individual diaries for a period of 6 weeks, using a clear set of diary entry guidelines. Reminders consisted of weekly short message service reminders and telephone calls. Diary entries were analysed using thematic content analysis. A diary feedback meeting was held with all the participants to validate the findings. Results Fifteen diaries were received, representing a 68% response rate. The majority of respondents (14/15) were female, each with between 5 and 15 years of nursing experience. Most participants made their diary entries at home. Diaries proved to be cathartic for individual nursing managers. Although inter-related and not mutually exclusive, the main themes that emerged from the diary analysis were health system deficiencies; human resource challenges; unsupportive management environment; leadership and governance; and the emotional impact of clinic management. Conclusions Diaries are an innovative method of capturing the work experiences of managers at the PHC level, as they allow for confidentiality and anonymity, often not possible with other qualitative research methods. The expressed concerns of nursing managers must be addressed to ensure the success of South Africa's health sector reforms, particularly at the PHC level. PMID:25537937

  6. Inter-Professional Primary Care Practices Addressing Diabetes Prevention and Management

    ERIC Educational Resources Information Center

    Beagrie, Lesley

    2011-01-01

    Imagine a partnership of university and community which addresses the needs of the community to keep its citizens healthy as long as possible. Through a planning exercise to address the community's needs in primary health care and health promotion, the university has developed key strategic directions to help support the needs of the community it…

  7. Whole Abdominal-Pelvic Radiotherapy in the Management of Primary Ewing Sarcoma of the Peritoneal Cavity

    PubMed Central

    Garant, Aurelie; Shakir, Shakir; Brossard, Josee; Garde-Granger, Perrine; Freeman, Carolyn

    2016-01-01

    Ewing sarcoma of the abdomen is a rare entity in pediatric oncology and represents a technical challenge both for surgeons and radiation oncologists. We document the case of a young female patient with primary disseminated, intraperitoneal Ewing sarcoma who after an excellent response to chemotherapy received preoperative whole abdominal-pelvic radiotherapy with good tolerance. PMID:26918223

  8. The Talent Managing Work of the Balaton-Felvideki Szin-Vonal Primary Art School

    ERIC Educational Resources Information Center

    Baranyai, Valeria

    2013-01-01

    In recent years, art education has been recognized as a suitable tool for enhancing emotional intelligence and nurturing a child's creative development. However, it seems that the education of art has lost the race against other primary school subjects, with only a minimal number of lessons being taught. The establishment of the afternoon art…

  9. A new approach: oblique excision and primary closure in the management of acute pilonidal disease

    PubMed Central

    Ciftci, Fatih; Abdurrahman, Ibrahim; Tosun, Mirhan; Bas, Gurhan

    2014-01-01

    Aim: To compare incision and drainage with oblique excision and primary closure in the treatment of pilonidal abscesses. Materials and methods: In this prospective study, one of two surgeons at the same hospital performed incision and drainage as the treatment method for patients presenting with pilonidal abscesses. (Group A). The other surgeon performed oblique excision and primary closure (Group B). The rate of development of chronic pilonidal sinus and time to return to active work were assessed using the chi-square and Student’s t-tests to compare the two methods of treatment. Of the 128 patients, incision and simple drainage was applied to 69 patients and primary closure was applied to 59 patients. Results: The rate of development of chronic pilonidal sinus was 78.8% in Group A and 6.0% in Group B (P < 0.001). In Group A, the average healing time and time to return to active work were 18 and 25 days, respectively. In Group B, these times were 22 and 27 days, respectively (P < 0.001). Conclusion: Oblique excision and primary closure may be a preferable treatment for acute pilonidal abscesses because of its low rate of chronic sinus development. PMID:25664095

  10. Investigating Students Misbehavior in Classroom Management in State and Private Primary Schools with a Comparative Approach

    ERIC Educational Resources Information Center

    Durmuscelebi, Mustafa

    2010-01-01

    The research aims to showing the students misbehaviors in formal and private primary schools according to the perceptions of class teachers working in Kayseri in 2006-2007 academic year The data has been collected with the questionnaire developed by the researcher based on review survey and expert ideas. Questionnaire is applied to 245 teachers in…

  11. Construing Systems of Management among Primary Headteachers: Moving Forward from Work Activity Studies.

    ERIC Educational Resources Information Center

    Jones, Norah; Connolly, Michael

    2001-01-01

    A study used a Personal Construct Theory/Repertory Grid approach to examine the work of 12 Welsh primary headteachers. Analysis of thematic work-activity grids suggests principals have a more coherent view of their work (as centered on children and education) than Henry Mintzberg's observational studies portrayed. (Contains 36 references.) (MLH)

  12. Setting Priorities for Comparative Effectiveness Research on Management of Primary Angle Closure: A Survey of Asia-Pacific Clinicians

    PubMed Central

    Yu, Tsung; Li, Tianjing; Lee, Kinbo J.; Friedman, David S.; Dickersin, Kay; Puhan, Milo A.

    2013-01-01

    Purpose To set priorities for new systematic reviews and randomized clinical trials (RCTs) on the management of primary angle closure (PAC) using clinical practice guidelines and a survey of Asia-Pacific clinicians. Methods We restated the American Academy of Ophthalmology’s Preferred Practice Patterns recommendations for management of PAC into answerable clinical questions. We asked participants at the Asia-Pacific Joint Glaucoma Congress 2010 in Taipei to rate the importance of having an answer to each question for providing effective patient care, using a Likert-type scale and scoring from 0 (not important at all) to 10 (highly important). We identified relevant systematic reviews and mapped the evidence to clinical questions to identify evidence gaps. Results We generated 42 clinical questions. One hundred seventy five individuals agreed to participate in the survey, 132 responded (75.4% response rate) and 96 completed the questionnaire (54.9% usable response rate). Questions rated important include laser iridotomy for the prevention of angle closure in primary angle-closure suspects, further therapies in eyes with plateau iris syndrome after laser iridotomy, and evaluation of the fellow eye in acute angle-closure patients for improving prognosis. Up-to-date and conclusive systematic review evidence was not available for any of the 42 clinical questions. Conclusion We identified high priority clinical questions on the management of PAC, none of which had reliable systematic review evidence available. New systematic reviews and RCTs can be initiated to address these evidence gaps. PMID:23835674

  13. Attitudes to and management of fertility among primary health care physicians in Turkey: An epidemiological study

    PubMed Central

    Hassa, Hikmet; Ayranci, Unal; Unluoglu, Ilhami; Metintas, Selma; Unsal, Alaeddin

    2005-01-01

    Background The subject of infertility has taken its place in the health sector at the top level. Since primary health care services are insufficient, most people, especially women, keep on suffering from it all over the world, namely in underdeveloped or developing countries. The aim of this study was to determine primary care physicians' opinions about the approach to infertility cases and their place within primary health care services (PHCSs). Methods The study was conducted between October 2003 and April 2004. The study group comprised 748 physicians working in PHCSs. They were asked to fill in a questionnaire with questions pertaining to infertility support, laboratory and treatment algorithms, as well as the demographic characteristics. The data was evaluated using the chi square test, percentage rates and a logistic regression model. Results The multivariate analyses showed that having a previous interest in infertility and having worked for a postgraduate period of between 5–9 years and ≥10 years were the variables that most positively influenced them in their approach to cases of infertility (p < 0.05, each one). Just 28.7% of the physicians indicated that they believed cases of infertility could be evaluated at the primary care level. The most frequently proposed reason for indicating 'difficulty in practice' (n = 533) was inadequate provision of equipment in PHCSs (55.7%). The physicians reported that they were able to perform most of the supportive treatments and proposals (between 64.6%–87.7%). The most requested laboratory investigations were the instruction of patients in taking basal body temperatures and semen analysis (89.7% and 88.7%, respectively). The most preferential course of treatment was that of sexually transmitted diseases (95.5%). Conclusion It is clear that not enough importance is attached to the provision of care to infertile couples within PHCSs. This leads us to conclude that an integration of infertility services in primary

  14. Evaluation and management of the pregnant patient with suspected primary musculoskeletal tumor or metastatic carcinoma to bone.

    PubMed

    Puvanesarajah, Varun; Spiker, Andrea M; Shannon, Brett A; Grundy, Maureen; Levin, Adam S; Morris, Carol D

    2016-09-01

    Primary musculoskeletal cancer and metastatic disease to bone in pregnant patients presents major treatment challenges. Although uncommon, musculoskeletal malignancies in pregnant women have been reported. When diagnosing and treating these patients, the mother's health must be managed appropriately while ensuring that fetal development is not deleteriously affected. Extensive radiographic imaging and more advanced techniques are often necessary to fully characterize the extent of disease. When possible, magnetic resonance imaging should be used instead of computed tomography to limit exposure of the conceptus to radiation. If treatment is needed, therapeutic radiation, chemotherapy, and surgery should be considered. Surgical resection is the foundation of treatment of early-stage primary bone tumors and soft-tissue sarcomas during pregnancy. With surgery, anesthesia and thromboprophylaxis are important considerations. If chemotherapy is required, administration should be avoided in the first trimester to limit harm to the fetus. Therapeutic radiation should similarly be avoided during the first trimester and often can be postponed until after delivery. PMID:27566025

  15. Prevention, early detection and team management of skin cancer in primary care: contribution to The health of the nation objectives.

    PubMed

    Jackson, A

    1995-02-01

    The incidence of all skin cancers is increasing. If The health of the nation targets are to be addressed, incidence figures need to be more accurate. Solar damage is the major causal factor in all skin cancers. Certain individual risk factors also play an important part, especially in the development of malignant melanoma. Prevention and early detection are crucial in reducing morbidity and mortality from skin cancer. This paper considers the role of primary care skin screening clinics and cutaneous surgery facilities in the early detection and management of skin cancer. It also illustrates the value of a team approach in primary care in the prevention and early detection of skin cancer and in the more accurate recording of incidence rates.

  16. Effectiveness of integrated disease management for primary care chronic obstructive pulmonary disease patients: results of cluster randomised trial

    PubMed Central

    Boland, Melinde R S; Assendelft, Willem J J; Gussekloo, Jacobijn; Tsiachristas, Apostolos; Stijnen, Theo; Blom, Coert; Sont, Jacob K; Rutten-van Mölken, Maureen P H M; Chavannes, Niels H

    2014-01-01

    Objective To investigate the long term effectiveness of integrated disease management delivered in primary care on quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with usual care. Design 24 month, multicentre, pragmatic cluster randomised controlled trial Setting 40 general practices in the western part of the Netherlands Participants Patients with COPD according to GOLD (Global Initiative for COPD) criteria. Exclusion criteria were terminal illness, cognitive impairment, alcohol or drug misuse, and inability to fill in Dutch questionnaires. Practices were included if they were willing to create a multidisciplinary COPD team. Intervention General practitioners, practice nurses, and specialised physiotherapists in the intervention group received a two day training course on incorporating integrated disease management in practice, including early recognition of exacerbations and self management, smoking cessation, physiotherapeutic reactivation, optimal diagnosis, and drug adherence. Additionally, the course served as a network platform and collaborating healthcare providers designed an individual practice plan to integrate integrated disease management into daily practice. The control group continued usual care (based on international guidelines). Main outcome measures The primary outcome was difference in health status at 12 months, measured by the Clinical COPD Questionnaire (CCQ); quality of life, Medical Research Council dyspnoea, exacerbation related outcomes, self management, physical activity, and level of integrated care (PACIC) were also assessed as secondary outcomes. Results Of a total of 1086 patients from 40 clusters, 20 practices (554 patients) were randomly assigned to the intervention group and 20 clusters (532 patients) to the usual care group. No difference was seen between groups in the CCQ at 12 months (mean difference –0.01, 95% confidence interval –0.10 to 0.08; P=0.8). After 12 months, no differences

  17. Primary hyperoxaluria.

    PubMed

    Lorenzo, Víctor; Torres, Armando; Salido, Eduardo

    2014-05-21

    Primary hyperoxaluria (PH) occurs due to an autosomal recessive hereditary disorder of the metabolism of glyoxylate, which causes excessive oxalate production. The most frequent and serious disorder is due to enzyme deficit of alanine-glyoxylate aminotransferase (PH type I) specific to hepatic peroxisome. As oxalate is not metabolised in humans and is excreted through the kidneys, the kidney is the first organ affected, causing recurrent lithiasis, nephrocalcinosis and early renal failure. With advance of renal failure, particularly in patients on haemodialysis (HD), calcium oxalate is massively deposited in tissues, which is known as oxalosis. Diagnosis is based on family history, the presence of urolithiasis and/or nephrocalcinosis, hyperoxaluria, oxalate deposits in tissue forming granulomas, molecular analysis of DNA and enzyme analysis if applicable. High diagnostic suspicion is required; therefore, unfortunately, in many cases it is diagnosed after its recurrence following kidney transplantation. Conservative management of this disease (high liquid intake, pyridoxine and crystallisation inhibitors) needs to be adopted early in order to delay kidney damage. Treatment by dialysis is ineffective in treating excess oxalate. After the kidney transplant, we normally observe a rapid appearance of oxalate deposits in the graft and the results of this technique are discouraging, with very few exceptions. Pre-emptive liver transplantation, or simultaneous liver and kidney transplants when there is already irreversible damage to the kidney, is the treatment of choice to treat the underlying disease and suppress oxalate overproduction. Given its condition as a rare disease and its genetic and clinical heterogeneity, it is not possible to gain evidence through randomised clinical trials. As a result, the recommendations are established by groups of experts based on publications of renowned scientific rigour. In this regard, a group of European experts (OxalEurope) has

  18. 5As Team obesity intervention in primary care: development and evaluation of shared decision-making weight management tools.

    PubMed

    Osunlana, A M; Asselin, J; Anderson, R; Ogunleye, A A; Cave, A; Sharma, A M; Campbell-Scherer, D L

    2015-08-01

    Despite several clinical practice guidelines, there remains a considerable gap in prevention and management of obesity in primary care. To address the need for changing provider behaviour, a randomized controlled trial with convergent mixed method evaluation, the 5As Team (5AsT) study, was conducted. As part of the 5AsT intervention, the 5AsT tool kit was developed. This paper describes the development process and evaluation of these tools. Tools were co-developed by the multidisciplinary research team and the 5AsT, which included registered nurses/nurse practitioners (n = 15), mental health workers (n = 7) and registered dieticians (n = 7), who were previously randomized to the 5AsT intervention group at a primary care network in Edmonton, Alberta, Canada. The 5AsT tool development occurred through a practice/implementation-oriented, need-based, iterative process during learning collaborative sessions of the 5AsT intervention. Feedback during tool development was received through field notes and final provider evaluation was carried out through anonymous questionnaires. Twelve tools were co-developed with 5AsT. All tools were evaluated as either 'most useful' or 'moderately useful' in primary care practice by the 5AsT. Four key findings during 5AsT tool development were the need for: tools that were adaptive, tools to facilitate interdisciplinary practice, tools to help patients understand realistic expectations for weight loss and shared decision-making tools for goal setting and relapse prevention. The 5AsT tools are primary care tools which extend the utility of the 5As of obesity management framework in clinical practice.

  19. System Factors Affect the Recognition and Management of Post-Traumatic Stress Disorder by Primary Care Clinicians

    PubMed Central

    Meredith, Lisa S; Eisenman, David P; Green, Bonnie L; Basurto-Dávila, Ricardo; Cassells, Andrea; Tobin, Jonathan

    2009-01-01

    Background Post-traumatic stress disorder (PTSD) is common with an estimated prevalence of 8% in the general population and up to 17% in primary care patients. Yet, little is known about what determines primary care clinician’s (PCC) provision of PTSD care. Objective To describe PCC’s reported recognition and management of PTSD and identify how system factors affect the likelihood of performing clinical actions with regard to patients with PTSD or “PTSD treatment proclivity.” Design Linked cross-sectional surveys of medical directors and PCCs. Participants Forty-six medical directors and 154 PCCs in community health centers (CHCs) within a practice-based research network in New York and New Jersey. Measurements Two system factors (degree of integration between primary care and mental health services, and existence of linkages with other community, social, and legal services) as reported by medical directors, and PCC reports of self-confidence, perceived barriers, and PTSD treatment proclivity. Results Surveys from 47 (of 58) medical directors (81% response rate) and 154 PCCs (86% response rate). PCCs from CHCs with better mental health integration reported greater confidence, fewer barriers, and higher PTSD treatment proclivity (all p<.05). PCCs in CHCs with better community linkages reported greater confidence, fewer barriers, higher PTSD treatment proclivity, and lower proclivity to refer patients to mental health specialists or to use a “watch and wait” approach (all p<.05). Conclusion System factors play an important role in PCC PTSD management. Interventions are needed that restructure primary care practices by making mental health services more integrated and community linkages stronger. PMID:19433999

  20. 5As Team obesity intervention in primary care: development and evaluation of shared decision‐making weight management tools

    PubMed Central

    Asselin, J.; Anderson, R.; Ogunleye, A. A.; Cave, A.; Sharma, A. M.; Campbell‐Scherer, D. L.

    2015-01-01

    Summary Despite several clinical practice guidelines, there remains a considerable gap in prevention and management of obesity in primary care. To address the need for changing provider behaviour, a randomized controlled trial with convergent mixed method evaluation, the 5As Team (5AsT) study, was conducted. As part of the 5AsT intervention, the 5AsT tool kit was developed. This paper describes the development process and evaluation of these tools. Tools were co‐developed by the multidisciplinary research team and the 5AsT, which included registered nurses/nurse practitioners (n = 15), mental health workers (n = 7) and registered dieticians (n = 7), who were previously randomized to the 5AsT intervention group at a primary care network in Edmonton, Alberta, Canada. The 5AsT tool development occurred through a practice/implementation‐oriented, need‐based, iterative process during learning collaborative sessions of the 5AsT intervention. Feedback during tool development was received through field notes and final provider evaluation was carried out through anonymous questionnaires. Twelve tools were co‐developed with 5AsT. All tools were evaluated as either ‘most useful’ or ‘moderately useful’ in primary care practice by the 5AsT. Four key findings during 5AsT tool development were the need for: tools that were adaptive, tools to facilitate interdisciplinary practice, tools to help patients understand realistic expectations for weight loss and shared decision‐making tools for goal setting and relapse prevention. The 5AsT tools are primary care tools which extend the utility of the 5As of obesity management framework in clinical practice. PMID:26129630

  1. Agenesis of multiple primary and permanent teeth unilaterally and its possible management.

    PubMed

    Ephraim, Rena; Rajamani, T; Feroz, Tp Mohammed; Abraham, Sajith

    2015-05-01

    Oligodontia is the agenesis of numerous teeth (more than six teeth). Agenesis of teeth in primary and permanent dentition is a rare incidence and very few are reported in the dental literature. Although the etiology of congenital agenesis of teeth is unclear, several factors such as a tendency toward genetic predilection, metabolic disorders, trauma, infection, radiation or idiopathic reasons are found to be responsible. Available literature reports agenesis most often of third molars, maxillary lateral incisors, mandibular central and lateral incisors, and mandibular second premolars in decreasing order of frequency of occurrence. Males are more often affected than females. Maxillary primary teeth are more often found affected by agenesis than mandibular primary teeth. Available literature reports missing teeth to be found unilaterally or orbilaterally with a predisposition toward a similar phenomenon occurring in the permanent dentition. In congenital agenesis impaired growth of the alveolar process, reduced lower facial height, speech impairment, deep bite, restriction in the movement of the tongue due to ankyloglossia, asymmetry of the affected side of the face are clinical features evident. There has been no report of complete agenesis of primary and permanent teeth in a whole mandibular quadrant in conjunction with the absence of maxillary second and third molars on the affected side. Here, we report an incidence of a rare occurrence of complete agenesis of more than 10 primary and permanent teeth, unilaterally, in the right mandibular quadrant, in a child of 10 years presenting with a chief complaint of several missing primary teeth and difficulty in speech due to its complete absence. Treatment strategies included various orthodontic and restorative procedures to improve esthetics and function. The orthodontic procedures involved expansion of the narrow maxillary arch to obtain a functionally adapted occlusion and creation of space for future alignment, and

  2. Development of a questionnaire to evaluate practitioners’ confidence and knowledge in primary care in managing chronic kidney disease

    PubMed Central

    2014-01-01

    Background In the UK, chronic disease, including chronic kidney disease (CKD) is largely managed in primary care. We developed a tool to assess practitioner confidence and knowledge in managing CKD compared to other chronic diseases. This questionnaire was part of a cluster randomised quality improvement interventions in chronic kidney disease (QICKD; ISRCTN56023731). Methods The questionnaire was developed by family physicians, primary care nurses, academics and renal specialists. We conducted three focus groups (n = 7, 6, and 8) to refine the questionnaire using groups of general practitioners, practice nurses and trainees in general practice. We used paper based versions to develop the questionnaire and online surveys to test it. Practitioners in a group of volunteer, trial practices received the questionnaire twice. We measured its reliability using Cohen’s Kappa (K). Results The practitioners in the focus groups reached a consensus as to the key elements to include in the instrument. We achieved a 73.1% (n = 57/78) initial response rate for our questionnaire; of these 57, 54 completed the questionnaire a second time. Family physicians made up the largest single group of respondents (47.4%, n = 27). Initial response showed more female (64.9%, n = 37) than male (35.1%, n = 20) respondents. The reliability results from retesting showed that there was moderate agreement (k > 0.4) on all questions; with many showing substantial agreement (k > 0.6). There was substantial agreement in the questions about loop diuretics (k = 0.608, CI 0.432-0.784, p < 0.001), confidence in managing hypertension (k = 0.628, 95%CI 0.452-0.804, p < 0.001), diastolic blood pressure treatment thresholds in CKD (k = 0.608, 95%CI 0.436-0.780, p < 0.001) and the rate of decline of eGFR that would prompt referral (k = 0.764, 95%CI 0.603-0.925, p < 0.001). Conclusion The QICKD-CCQ is a reliable instrument for measuring confidence and

  3. Temporary management of permanent central incisors loss caused by trauma in primary dentition with natural crowns: a case report.

    PubMed

    Tüzüner, Tamer; Kuşgöz, Adem; Nur, Bilge Gülsüm

    2009-10-01

    Primary teeth injuries may cause developmental disturbances in the permanent dentition and loss of permanent incisors could be treated with different options. In this case report, an 11-year-old boy, with a history of trauma at the age of 4 years, is presented. Premature loss of permanent upper right central and upper left central teeth because of the mobility and arrest in root development were treated using patient's own natural crowns on a removable appliance. This treatment option could be considered as an esthetic and functional temporary management of permanent central incisors loss until the definitive treatment will be completed in the future.

  4. Alternative approach to management of early loss of second primary molar: a clinical case report.

    PubMed

    Agarwal, Ravi; Chaudhry, Kalpna; Yeluri, Ramakrishna; Singh, Chanchal; Munshi, Autar K

    2014-05-01

    Preservation of space after premature loss of the second primary molar is essential to prevent mesial drifting of the permanent first molar. Various modifications of distal shoe space maintainers, which have been documented, are all nonfunctional in nature. This paper describes an innovative design of a functional distal shoe space maintainer that is intended to overcome the disadvantages of conventional non-functional space maintainers and that does not hamper the periodontal status of the abutment tooth.

  5. Managing an Online Survey about Influenza Vaccination in Primary Healthcare Workers

    PubMed Central

    Toledo, Diana; Aerny, Nicole; Soldevila, Núria; Baricot, Maretva; Godoy, Pere; Castilla, Jesús; García-Gutierrez, Susana; Torner, Núria; Astray, Jenaro; Mayoral, José María; Tamames, Sonia; González-Candelas, Fernando; Martín, Vicente; Díaz, José; Domíguez, Angela

    2015-01-01

    Online surveys are increasingly used due to their speed and efficiency. The aim of this study was to analyze factors that may have contributed to the quality and speed of response of an online survey on influenza vaccination in primary healthcare workers. A multicenter study including family physicians, nurses and pediatricians from primary healthcare teams from seven Spanish Autonomous Communities was designed. The centers were selected by simple random sampling. The survey remained active and accessible for 56 days and four reminders were sent. The odds ratios (OR) and their 95% confidence intervals (CI) were calculated to assess the association of sociodemographic variables and responding to the survey before the second reminder. Complete, validated information was obtained from 1965 primary healthcare workers. The total response rate was 36.2%. More nurses (46.3%) responded before the second reminder and more family physicians (52.8%) after the second reminder. The adjusted OR shows that family physicians responded later (AOR 1.46, 95% CI 1.2–1.8) than nurses. The responses obtained in the first 24 h after the initial sending and the reminders accounted for 41.7% of the completed surveys, indicating the importance of reminders. PMID:25584421

  6. Electronic clinical records in primary care for estimating disease burden and management. An example of COPD.

    PubMed

    Verde-Remeseiro, Luis; López-Pardo, Estrella; Ruano-Ravina, Alberto; Gude-Sampedro, Francisco; Castro-Calvo, Ramón

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a significant health problem in developed countries. We aimed to estimate the prevalence of COPD in a single Spanish healthcare area. We also aimed to assess if there are any differences in prevalence and spirometry use among primary care services by utilizing already registered information. We designed a cross-sectional study to determine the prevalence of COPD and the performance of spirometries in each primary care service. A total of 8,444 patients were diagnosed with COPD, with a prevalence of 2.6% for individuals older than 39 years. The prevalence increased with age and was much higher in men. Significant heterogeneity was found in the prevalence of COPD and spirometry use among primary care services. COPD was underdiagnosed and there was wide variability in spirometry use in our area. Greater efforts are needed to diagnose COPD in order to improve its clinical outcomes and to refine registries so that they can be used as reliable sources of information.

  7. The differential diagnosis and management of headaches in primary care and their relevance in the UK Armed Forces.

    PubMed

    Laird, J; Evershed, M C

    2014-01-01

    As with the general population, headaches are commonly suffered by members of the United Kingdom Armed Forces. These are often managed by patients with over-the-counter medication without the involvement of healthcare professionals. Patients may present to medical teams when deployed because of limited access to over-the-counter medication or because of concerns about the cause of the headache. This article will examine the differential diagnosis and management of headaches in primary care as well as considering the occupational and operational aspects related to the Royal Navy (RN). The aim is to equip General Practitioners (GPs) and General Duties Medical Officers (GDMOs) with the clinical knowledge to diagnose various common forms of headaches and to detect the red flag symptoms that warrant further investigation. This article will also make specific reference to the service person and the impact of headaches on occupational functioning and operational capability.

  8. A Primary Care Approach to the Diagnosis and Management of Peripheral Arterial Disease

    NASA Technical Reports Server (NTRS)

    Dawson, David L.

    2000-01-01

    The objectives of this work are: (1) Be able to recognize characteristic symptoms of intermittent claudication (2) Diagnose PAD on the basis of history, physical exam, and simple limb blood pressure measurements (3) Recognize the significance of peripheral artery disease as a marker for coronary or cerebrovascular atherosclerosis (4) Provide appropriate medical management of atherosclerosis risk factors-- including use of antiplatelet therapy to reduce risk of myocardial infarction, stroke and death (5) Manage symptoms of intermittent claudication with program of smoking cessation, exercise, and medication The diagnosis of intermittent claudication secondary to peripheral artery disease (PAD) can often be made on the basis of history and physical examination. Additional evaluation of PAD is multi-modal and the techniques used will vary depending on the nature and severity of the patient's presenting problem. Most patients can be appropriately managed without referral for specialized diagnostic services or interventions.

  9. The intrinsic features of Environmental Management Systems that facilitate adoption and encourage innovation in primary industries.

    PubMed

    Carruthers, Genevieve; Vanclay, Frank

    2012-11-15

    This paper examines the theoretical underpinnings of the adoption of innovations, and applies this knowledge to the uptake of Environmental Management Systems (EMS) amongst Australian farmers. We examine the specific features of the EMS process that might encourage or inhibit EMS adoption. We also consider elements of the EMS process to assess their utility in promoting adoption of various other innovations. We evaluate the EMS process in the light of two characteristics previously found to influence adoption of improved natural resource management practices - 'relative advantage' and 'trialability'. Drawing on literature, and our research and experience with farmers, we conclude that there are inherent features of EMS that promote the adoption of new practices, and that the elements of the EMS process actually create an on-going process of culture change as it is implemented. We believe that the EMS process offers significant advantages to farmers seeking to improve production whilst simultaneously meeting societal expectations for enhanced natural resource management. PMID:22776757

  10. A randomized pragmatic trial of primary care based pharmacist-physician collaborative medication therapy management for hypertension

    PubMed Central

    Hirsch, Jan D.; Steers, Neil; Adler, David S.; Kuo, Grace M.; Morello, Candis M.; Lang, Megan; Singh, Renu F.; Wood, Yelena; Kaplan, Robert M.; Mangione, Carol M.

    2014-01-01

    Purpose A collaborative pharmacist-physician (PharmD-MD) team approach to medication therapy management (MTM), with pharmacists initiating and changing medications at separate office visits, holds promise for cost-effective management of blood pressure (BP), but has not been evaluated in many systematic trials. The primary objective of this study was to examine BP control for hypertensive patients managed by a newly formed PharmD-MD MTM team vs. versus usual care (UC) in a university primary care clinic. Methods This was a randomized, pragmatic, clinical trial of hypertensive patients randomly selected for the PharmD-MD MTM team or UC. In the PharmD-MD MTM group pharmacists managed drug therapy initiation, monitoring, medication adjustments, biometric assessments, laboratory tests, and patient education. In the UC group, patients continued to see their primary care provider (PCP). Participants were age 18 years or over, diagnosed with hypertension, most recent BP ≥140/90 mmHg or ≥130/80 mmHg if co-diagnosed with diabetes mellitus, on at least one anti-hypertensive medication, and English speaking. Primary outcome was the difference in mean change in systolic BP (SBP) at 6 months. Secondary outcomes included percent achieving therapeutic BP goal, mean change in diastolic BP, LDL and HDL cholesterol. Findings A total of 75 patients were in the PharmD-PCP MTM group and 91 in the UC group. Mean reduction in SBP was significantly greater in the PharmD-PCP MTM group at 6 months [−7.1 (SD=19.4) vs. +1.6 (SD=21.0) mm Hg, (p=0.008)] but the difference was no longer statistically significant at 9 months [−5.2 (SD=16.9) vs. −1.7 (SD=17.7) mmHg, (p=0.22)] based on intent to treat analysis. In the intervention group, a greater percentage of patients who continued to see the MTM pharmacist vs. those who returned to their PCP were at goal at 6 months (88.5% vs. 63.6%) and 9 months (78.9% vs. 47.4%). No significant difference in change of LDL or HDL was detected at 6 or

  11. SELF-MANAGEMENT COUNSELING IN PATIENTS WITH HEART FAILURE: PRIMARY RESULTS FROM THE HEART FAILURE ADHERENCE AND RETENTION TRIAL (HART)

    PubMed Central

    Powell, Lynda H.; Calvin, James E.; Richardson, Dejuran; Janssen, Imke; Mendes de Leon, Carlos F.; Flynn, Kristin J.; Grady, Kathleen L.; Rucker-Whitaker, Cheryl S.; Eaton, Claudia; Avery, Elizabeth

    2013-01-01

    Context Activating patients with heart failure (HF) to adhere to physician advice has not translated into clinical benefit, but past trials have had methodologic limitations. Objective To determine the value of self-management counseling plus HF education, over HF education alone, on the primary endpoint of death or HF hospitalization. Design, Setting, and Patients A single center behavioral efficacy trial in 902 patients with mild to moderate systolic or diastolic dysfunction, randomized between 2001–2004. Interventions All patients were offered 18 contacts and 18 HF educational tip sheets over the course of 1 year. Patients randomized to education received tip sheets in the mail and phone calls to check comprehension. Patients randomized to self-management received tip sheets in groups and were taught self-management skills to implement the advice. Main Outcome Measure Death or HF hospitalization, blindly adjudicated by cardiologists. Intent-to-treat results were analyzed as time-to-event and accelerated failure time models were used for non-proportional hazards. Results Patients were an average of 63.6 years, 47% female, 40% minority, 52% with family income <$30,000/year, and 23% with diastolic dysfunction. The self-management arm was no different from the education arm on the primary endpoint (Wilcoxon p=0.58). Post-hoc analyses on pre-specified subgroups revealed a significant income x treatment interaction (log-logistic estimate=0.64, p=0.02). Patients with income <$30,000 in self-management had a slower time to event than those in education (p=0.05) and were no different than higher income patients in either treatment arm. Conclusions The addition of self-management counseling to HF education does not reduce death or HF hospitalizations in patients with mild to moderate HF. Future trials should evaluate tailored outpatient HF management featuring ongoing education and comprehension checks for all, augmented by group-based skill development for those more

  12. Does a Year Make a Difference? The Classroom Management Practices of Primary Student Teachers before and after a One-Year Teacher Education Programme

    ERIC Educational Resources Information Center

    Reupert, Andrea; Woodcock, Stuart

    2015-01-01

    The purpose of this study was to examine primary student teachers' use, confidence and success in various classroom management strategies at the start and at the end of a one-year teaching programme and ascertain any significant differences between the two time periods. One hundred and twenty-four English primary student teachers were surveyed at…

  13. Primary School Environment Trend, Class-Ratio and Head Teachers Overcrowded Classrooms Management Strategies in Northern Senatorial District of Ondo State, Nigeria

    ERIC Educational Resources Information Center

    Babatunde, Ehinola Gabriel

    2015-01-01

    Primary school Enrolment Trend, Class-Ratio and Head Teachers overcrowded classrooms management strategies in Northern Senatorial District of Ondo State, Nigeria was investigated. The purpose of the study is to examine the current enrolment trend in public primary schools in northern senatorial District of Ondo State. Also, is to ascertain the…

  14. Real-life management of primary immune thrombocytopenia (ITP) in adult patients and adherence to practice guidelines.

    PubMed

    Lozano, María Luisa; Revilla, N; Gonzalez-Lopez, T J; Novelli, S; González-Porras, J R; Sánchez-Gonzalez, B; Bermejo, N; Pérez, S; Lucas, F J; Álvarez, M T; Arilla, M J; Perera, M; do Nascimento, J; Campos, R M; Casado, L F; Vicente, V

    2016-06-01

    Very few data exist on the management of adult patients diagnosed with primary immune thrombocytopenia (ITP). The objectives of this study were to describe the diagnostic and treatment patterns for ITP and to compare the findings to recent ITP guidelines. We retrospectively analyzed the medical records of adult ITP patients diagnosed with primary ITP between January 2011 and June 2012 and examined whether management strategies were consistent or not with eight recent guideline-recommended practices. Overall, median age at the diagnosis of the disease (n = 101) was 58 years and median platelet count 12 × 10(9)/L with 75.2 % of patients having symptoms of ITP. The study perceived two major shortcomings in the diagnostic approach: (1) failure to perform peripheral blood film examination in 22.8 % of patients, a test that is mandatory by all guidelines, and (2) ordinary bone marrow assessment in more than half of the patients at diagnosis (50.5 %), a test not routinely recommended by guidelines. Low appropriateness in therapeutic management of patients included (1) unjustified use of intravenous immunoglobulin in the absence of bleeding in 54.8 % of patients and (2) splenectomy not being deferred until 6-12 months from diagnosis (median 161 days). Data also reflect a trend towards the early use of thrombopoietin receptor agonists in the treatment of patients who are refractory to any first-line therapy. We have recognized important areas of inapropriateness in the diagnostic and therapeutic management of adult ITP patients. Compliance with established guidelines should be encouraged in order to improve patient outcomes. PMID:27098812

  15. Self-management support in primary care: enactments, disruptions, and conversational consequences.

    PubMed

    Thille, Patricia; Ward, Natalie; Russell, Grant

    2014-05-01

    A common refrain in chronic disease management is that patients and clinicians need to enact new roles: patients as their own caregivers; clinicians as professional supporters of patient self-management activities. These roles are central to self-management support (SMS), an approach that emphasizes a clinical partnership, and promotes patient identification and achievement of realistic and short-term behavioral goals. With SMS, behavior change is the desired end, not the means to a desired biomedical end. Shifting SMS concepts into clinical practice has proven to be difficult and inconsistent, creating potential, unknown risks or harms to patients. We completed a discourse analysis of 16 clinical dialogues between diabetic patients and clinicians, collected during a study of six Ontario Family Health Teams, to explore the questions of risks and harms relating to SMS implementation. We observed varying degrees of incomplete implementation of SMS, as well as interactions that actively negated the core principles. Contrary to SMS principles, clinicians tended to emphasize behavioral changes as means to achieve biomedical ends, though to varying degrees. We present two appointments in detail, highlighting how linking behavior change closely with biomedical measures often elicited face-saving defenses from patients. The subsequent dialogue shifted attention away from problem solving and behavior change into active negotiation of responsibility and identity. Interactions that oriented more to SMS concepts elicited fewer defensive maneuvers from patients. Our analysis helps explicate one additional mechanism by which self-management talk threatens the clinical relationship, and highlights a promising method to mitigate this threat.

  16. Dietary Management in Gastrointestinal Diseases. Nutrition in Primary Care Series, Number 13.

    ERIC Educational Resources Information Center

    Stein, Joan Z.; Gallagher-Allred, Charlette R.

    Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

  17. Dietary Management for Alcoholic Patients. Nutrition in Primary Care Series, Number 14.

    ERIC Educational Resources Information Center

    Hurley, Roberta Smith; Gallagher-Allred, Charlette R.

    Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

  18. Dietary Management in Hypertension. Nutrition in Primary Care Series, Number 11.

    ERIC Educational Resources Information Center

    Molleson, Ann L.; Gallagher-Allred, Charlette R.

    Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

  19. Primary and Secondary Contamination Mechanisms for Consideration in ASR Modeling and Practical Management

    EPA Science Inventory

    Aquifer storage and recovery (ASR) is a useful water resource management option for water storage and reuse. Its increased use is recognized in adaptation to the ever increasing problem of water availability, both in timing and flow. Challenges in the ASR process may arise from...

  20. Primary and Secondary Contamination Mechanisms in ASR Modeling and Design of Practical Management

    EPA Science Inventory

    Aquifer storage and recovery (ASR) is a useful water resource management option for water storage and reuse. Its increased use is recognized in adaptation to the ever increasing problem of water availability, both in timing and flow. Challenges in the ASR process may arise from...

  1. Dietary Management in Hyperlipidemia. Nutrition in Primary Care Series, Number 12.

    ERIC Educational Resources Information Center

    Gallagher-Allred, Charlette R.; Townley, Nancy A.

    Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

  2. The Hepatitis C Self-Management Program: Sustainability of Primary Outcomes at 1 Year

    ERIC Educational Resources Information Center

    Groessl, Erik J.; Ho, Samuel B.; Asch, Steven M.; Stepnowsky, Carl J.; Laurent, Diana; Gifford, Allen L.

    2013-01-01

    Objective: Chronic hepatitis C infection afflicts millions of people worldwide. Although antiviral treatments are increasingly effective, many hepatitis C virus (HCV) patients avoid treatment, do not complete or respond to treatment, or have contraindications. Self-management interventions are one option for promoting behavioral changes leading to…

  3. On Being in Charge: A Guide to Management in Primary Health Care. Second Edition.

    ERIC Educational Resources Information Center

    McMahon, Rosemary; And Others

    This revised training guide is designed to help health workers, including nurses, midwives, and medical assistants, improve managerial skills. The book is divided into four main parts, each dealing with a different aspect of management. An opening exercise helps readers diagnose managerial weaknesses and turn to appropriate chapters for study.…

  4. Dietary Management in Obesity. Nutrition in Primary Care Series, Number 9.

    ERIC Educational Resources Information Center

    Gallagher-Allred, Charlette R.; Townley, Nancy A.

    Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

  5. Facilitating Primary Head Teacher Succession in England: The Role of the School Business Manager

    ERIC Educational Resources Information Center

    Woods, Charlotte; Armstrong, Paul; Pearson, Diana

    2012-01-01

    School leadership is significant for student learning, but increased workload and complexity are believed to be in part responsible for the difficulties internationally in managing succession, with experienced leaders leaving the profession prematurely and potential future leaders reluctant to take on the role. This article draws on a national…

  6. Answers to Clinical Questions in the Primary Care Management of People with Obesity: Bariatric Surgery.

    PubMed

    Braverman-Panza, Jill; Horn, Deborah Bade

    2016-07-01

    The role of bariatric surgery in the management of patients with obesity is expanding owing to the amount of data that are accumulating; these data demonstrate significant short- and long-term health benefits, including control or remission of obesity-related complications, as well as acceptable long-term safety. PMID:27565108

  7. Dietary Management in Diabetes Mellitus. Nutrition in Primary Care Series, Number 10.

    ERIC Educational Resources Information Center

    Bossetti, Brenda; Gallagher-Allred, Charlette R.

    Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

  8. Integrated palmer amaranth management in glufosinate-resistant cotton: II. primary, secondary, and conservation tillage

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A three-year field experiment was conducted to evaluate the role of inversion tillage, cover crops and spring tillage methods for Palmer amaranth between-row (BR) and within-row (WR) management in glufosinate-resistant cotton. Main plots were two inversion tillage systems: fall inversion tillage (IT...

  9. Sports injuries. Practical diagnostic and management concerns for primary care physicians.

    PubMed

    Sellers, R G

    1992-08-01

    Both recreational and elite athletes often sustain musculoskeletal injuries. Common problems--muscle cramps, burners (or stingers), and ankle and shoulder injuries--can be managed effectively with certain basic techniques. Initial measures are particularly important in facilitating the injured athlete's rapid return to activity.

  10. Choice in Public Education.

    ERIC Educational Resources Information Center

    Young, Timothy W.; Clinchy, Evans

    There has been much recent debate in both educational and political circles about the utility of choice as a means of improving the educational system. This book argues that any discussion of choice must address choice in public schools. The book is organized into seven chapters. Chapter 1 provides an overview of choice in public education,…

  11. Analysis of benzodiazepine withdrawal program managed by primary care nurses in Spain

    PubMed Central

    2012-01-01

    Background Benzodiazepine (BZD), the long-term treatment of which is harmful for cognitive function, is widely prescribed by General Practitioners in Spain. Based on studies performed in other countries we designed a nurse-led BZD withdrawal program adapted to Spanish Primary Care working conditions. Results A pseudo-experimental (before-after) study took place in two Primary Care Centres in Barcelona. From a sample of 1150 patients, 79 were identified. They were over 44 years old and had been daily users of BZD for a period exceeding six months. Out of the target group 51 patients agreed to participate. BZD dosage was reduced every 2-4 weeks by 25% of the initial dose with the optional support of Hydroxyzine or Valerian. The rating measurements were: reduction of BZD prescription, demographic variables, the Short-Form Health Survey (SF-12) to measure quality of life, the Medical Outcomes Study (MOS) Sleep Scale, and the Goldberg Depression and Anxiety Scale. By the end of the six-month intervention, 80.4% of the patients had discontinued BZD and 64% maintained abstinence at one year. An improvement in all parameters of the Goldberg scale (p <0.05) and in the mental component of SF-12 at 3.3 points (p = 0.024), as well as in most components of the MOS scale, was observed in the group that had discontinued BZD. No significant differences in these scales before and after the intervention were observed in the group that had not discontinued. Conclusions At one year approximately 2/3 of the patients had ceased taking BZD. They showed an overall improvement in depression and anxiety scales, and in the mental component of the quality of life scale. There was no apparent reduction in the sleep quality indicators in most of the analysed components. Nurses in a Primary Care setting can successfully implement a BZD withdrawal program. PMID:23237104

  12. Innovations in Primary Health Care: the use of communications technology and information tools to support local management.

    PubMed

    Pinto, Luiz Felipe; Rocha, Cristianne Maria Famer

    2016-05-01

    Social media has been used in different contexts as a way to streamline the flow of data and information for decision making. This has contributed to the issue of knowledge production in networks and the expansion of communication channels so that there is greater access to health services. This article describes the results of research done on 16 Information Technology and Communications Observatories in Health Care - OTICS Network in Rio - covering the Municipal Health Secretariat in Rio de Janeiro which supported the integration of primary health care and promoted the monitoring of health. It is a descriptive case study. The results relate to the support given to employees in training covering the dissemination of information, communication, training and information management in primary health care. This innovative means of communication in public health, with very little cost to the Unified Health System (SUS), allowed for a weekly registering of work processes for teams that worked in 193 primary health care units (APS) using blogs, whose total accesses reached the seven million mark in mid-2015. In the future there is a possibility that distance learning tools could be used to assist in training processes and in the continuing education of professionals in family health teams.

  13. Innovations in Primary Health Care: the use of communications technology and information tools to support local management.

    PubMed

    Pinto, Luiz Felipe; Rocha, Cristianne Maria Famer

    2016-05-01

    Social media has been used in different contexts as a way to streamline the flow of data and information for decision making. This has contributed to the issue of knowledge production in networks and the expansion of communication channels so that there is greater access to health services. This article describes the results of research done on 16 Information Technology and Communications Observatories in Health Care - OTICS Network in Rio - covering the Municipal Health Secretariat in Rio de Janeiro which supported the integration of primary health care and promoted the monitoring of health. It is a descriptive case study. The results relate to the support given to employees in training covering the dissemination of information, communication, training and information management in primary health care. This innovative means of communication in public health, with very little cost to the Unified Health System (SUS), allowed for a weekly registering of work processes for teams that worked in 193 primary health care units (APS) using blogs, whose total accesses reached the seven million mark in mid-2015. In the future there is a possibility that distance learning tools could be used to assist in training processes and in the continuing education of professionals in family health teams. PMID:27166893

  14. AB042. Allergy Working Group Update: the burden and management of rhinitis and rhinosinusitis in UK primary care

    PubMed Central

    Fokkens, Wytske; Nibber, Anjan; Chisholm, Alison; Hellings, Peter; Skinner, Derek; Price, David

    2016-01-01

    Background Rhinitis and rhinosinusitis are diseases of the upper airways with a high prevalence and when they are chronic with a high quality of life burden on patients and costs for society. To date, data on the primary care burden of rhinitis and rhinosinusitis are limited as is knowledge of how primary care physicians currently manage these patients. This study aims to quantify the burden of CRS and characterize related management approaches in UK primary care. Methods Patients with diagnostic codes for rhinitis and rhinosinusitis were identified within the UK’s Optimum Patient Care Research Database (OPCRD), a respiratory enriched primary care database. Consultations over a 5-year period (latest for each patient) code for rhinitis and rhinosinusitis symptoms resulting in prescriptions for antibiotics, oral steroids and/or antihistamines were identified. Diagnostic codes were used to further categorize patients into acute/chronic rhinitis/rhinosinusitis and allergic/non allergic chronic rhinitis subgroups. Prescribed therapies were categorized as: antibiotics (all); steroids (oral, injectable, nasal) and antihistamines, nasal spray and eye drops and mapped across rhinitis/rhinosinusitis and allergic/non-allergic patient subgroups. Results A total of 685,429 patients were identified with rhinitis and rhinosinusitis diagnostic codes. Of these patients: 80,900 (5%) had a diagnostic code for acute rhinitis (common cold); 176,353 (26%) for acute rhinosinusitis; 65,610 (10%) for chronic rhinosinusitis; 306,030 (45%) for chronic allergic rhinitis; 4,747 (1%) for chronic non-allergic rhinitis and 51,790 (8%) undefined chronic rhinitis. A total of 1,664,068 consultations for rhinitis and rhinosinusitis symptoms were identified, of which 185,730 (27%) resulted in an antibiotic prescription, 5,597 (0.8%) in an oral steroid prescription and 1,898 (0.3%) in an antibiotic and oral steroid prescription. Drug prescribing varied markedly across diagnostic subgroups with

  15. Pruritus in primary myelofibrosis: management options in the era of JAK inhibitors.

    PubMed

    Vaa, Brianna E; Tefferi, Ayalew; Gangat, Naseema; Pardanani, Animesh; Lasho, Terra L; Finke, Christy M; Wolanskyj, Alexandra P

    2016-06-01

    Primary myelofibrosis (PMF)-associated pruritus is often severe and requires treatment. Fifty-one patients with bone marrow-proven PMF with associated pruritus were identified from a primary cohort of patients with PMF (n = 566) seen at our institution. We conducted a retrospective review of the clinical characteristics, severity of pruritus, type of treatment, and response of these patients. Thirty-two out of 51 patients (63 %) reported severe PMF-associated pruritus and required a total of 108 treatment episodes, with complete response (CR), partial response (PR) and no response (NR) observed in 22, 23, and 55 % of episodes, respectively. The most common treatment categories included JAK inhibitors (n = 19), anti-depressants (n = 18), and antihistamines (n = 17). Highest CR rates were observed in patients treated with a JAK inhibitor (53 %) and immunomodulatory drugs (IMiDS (50 %)). Emerging targeted therapies may result in better symptom control and higher response rates in patients suffering from severe PMF-associated pruritus. PMID:27106700

  16. Perceptions of culturally competent diabetes management in a primary care practice.

    PubMed

    Kirk, Julienne K; Hildebrandt, Carol; Davis, Stephen; Crandall, Sonia J; Siciliano, Alissa B; Marion, Gail S

    2014-01-01

    To evaluate whether clinicians consider the impact of culture on diabetes management, a survey was mailed to 300 randomly selected patients > or = 50 years with type 2 diabetes and 153 surveys were returned. Data were correlated with A1C values. African Americans (AA) and non-Hispanic whites (NHW), (91.9%, 97.0%) respectively, reported clinicians discussed benefits of controlling blood sugar but did not discuss effects of cultural issues on glucose control (< or = 50%). AAs perceived clinicians were more accommodating of their cultural preferences than did NHWs (49.2% versus 30.6%) (P < .05). Females (51.9%) (P < .01) reported that clinicians acknowledged the importance of their cultural beliefs with a slightly higher percentage for African American females (54.8%) versus non-Hispanic White females (48.6%). Understanding the patient's and clinician's views of cultural beliefs as they relate to diabetes self-management can provide perspectives to guide care.

  17. Part 1: The Theoretical Basis for Recovery-Oriented Management of Substance Use Disorders in Primary Care.

    PubMed

    Fornili, Katherine S

    2016-01-01

    There is strong evidence in the literature that screening and brief counseling interventions are effective in detecting alcohol problems and decreasing alcohol consumption among patients in primary care settings but somewhat weaker evidence regarding screening and brief intervention for drug problems. In 2014, two published studies made news and caused concern among proponents of substance Screening, Brief Intervention and Referral to Treatment (SBIRT) programs, when their authors concluded that brief interventions were not effective for decreasing drug use among primary care patients identified through screening, and advised that widespread adoption of screening and brief intervention for drug use was not warranted.An evaluation of the theoretical foundations for evidence-based SBIRT services was conducted to produce possible explanations for why traditional SBIRT works well for individuals with unhealthy alcohol use but not as well for those with more serious substance use disorders, including drug use and alcohol/drug dependence. Smith and Liehr's evaluation framework for middle-range theory was utilized to analyze the Chronic Care Model, which was featured prominently in early SBIRT literature, and the newer Recovery Management model, which provides a philosophical framework for organizing modern addictions services and quality-of-life enhancements (Part 1 of this two-part series).Programs are more likely to succeed if guided by theory, and examination of relevant components of theory-based interventions can be useful in developing practical strategies for meeting program objectives. A new, theory-based, recovery-oriented framework for primary care SBIRT is introduced in Part 2 ("SBIRT+RM(C): A Proposed Model for Recovery-Oriented Primary Care").

  18. Part 1: The Theoretical Basis for Recovery-Oriented Management of Substance Use Disorders in Primary Care.

    PubMed

    Fornili, Katherine S

    2016-01-01

    There is strong evidence in the literature that screening and brief counseling interventions are effective in detecting alcohol problems and decreasing alcohol consumption among patients in primary care settings but somewhat weaker evidence regarding screening and brief intervention for drug problems. In 2014, two published studies made news and caused concern among proponents of substance Screening, Brief Intervention and Referral to Treatment (SBIRT) programs, when their authors concluded that brief interventions were not effective for decreasing drug use among primary care patients identified through screening, and advised that widespread adoption of screening and brief intervention for drug use was not warranted.An evaluation of the theoretical foundations for evidence-based SBIRT services was conducted to produce possible explanations for why traditional SBIRT works well for individuals with unhealthy alcohol use but not as well for those with more serious substance use disorders, including drug use and alcohol/drug dependence. Smith and Liehr's evaluation framework for middle-range theory was utilized to analyze the Chronic Care Model, which was featured prominently in early SBIRT literature, and the newer Recovery Management model, which provides a philosophical framework for organizing modern addictions services and quality-of-life enhancements (Part 1 of this two-part series).Programs are more likely to succeed if guided by theory, and examination of relevant components of theory-based interventions can be useful in developing practical strategies for meeting program objectives. A new, theory-based, recovery-oriented framework for primary care SBIRT is introduced in Part 2 ("SBIRT+RM(C): A Proposed Model for Recovery-Oriented Primary Care"). PMID:27272991

  19. Managing Mental Health Problems Among Immigrant Women Attending Primary Health Care Services.

    PubMed

    Straiton, Melanie L; Powell, Kathryn; Reneflot, Anne; Diaz, Esperanza

    2016-01-01

    Researchers in Norway explore treatment options in primary care for immigrant women with mental health problems compared with nonimmigrant women. Three national registers were linked together for 2008. Immigrant women from Sweden, Poland, the Philippines, Thailand, Pakistan, and Russia were selected for analysis and compared with Norwegian women. Using logistic regression, we investigated whether treatment type varied by country of origin. Rates of sickness leave and psychiatric referrals were similar across all groups. Conversational therapy and use of antidepressants and anxiolytics were lower among Filipina, Thai, Pakistani, and Russian women than among Norwegians. Using the broad term "immigrants" masks important differences in treatment and health service use. By closely examining mental health treatment differences by country of origin, gaps in service provision and treatment uptake may be identified and addressed with more success. PMID:26251953

  20. Antiphospholipase A2 Receptor Autoantibodies: A Step Forward in the Management of Primary Membranous Nephropathy

    PubMed Central

    Obrisca, Bogdan; Ismail, Gener; Jurubita, Roxana; Baston, Catalin; Andronesi, Andreea; Mircescu, Gabriel

    2015-01-01

    Since the identification of PLA2R (M-type phospholipase A2 receptor) as the first human antigenic target in primary membranous nephropathy (MN), perpetual progress has been made in understanding the pathogenesis of this disease. Accumulating clinical data support a pathogenic role for the anti-PLA2R antibodies (PLA2R ABs), but confirmation in an animal model is still lacking. However, PLA2R ABs were related to disease activity and outcome, as well as to response therapy. Accordingly, PLA2R ABs assay seems to be promising tool not only to diagnose MN but also to predict the course of the disease and could open the way to personalize therapy. Nevertheless, validation of a universal assay with high precision and definition of cut-off levels, followed by larger studies with a prolonged follow-up period, are needed to confirm these prospects. PMID:26576418

  1. Pathogenesis of Primary Sclerosing Cholangitis and Advances in Diagnosis and Management

    PubMed Central

    Eaton, John E.; Talwalkar, Jayant A.; Lazaridis, Konstantinos N.; Gores, Gregory J.; Lindor, Keith D.

    2013-01-01

    Primary sclerosing cholangitis (PSC), first described in the mid-1850’s, is a complex liver that is heterogeneous in its presentation. PSC is characterized by chronic cholestasis, associated with chronic inflammation of the biliary epithelium, resulting in multi-focal bile duct strictures that can affect the entire biliary tree. Chronic inflammation leads to fibrosis involving the hepatic parenchyma and biliary tree, which can lead to cirrhosis and malignancy. The etiology of PSC is not fully understood which in part explains a lack of effective medical therapy for this condition. However, we have begun to better understand the molecular pathogenesis of PSC. The recognition of specific clinical subtypes and their pattern of progression could improve phenotypic and genotypic classification of the disease. We review our current understanding of this enigmatic disorder and discuss important topics for future studies. PMID:23827861

  2. [Zoledronic Acid Administration is Effective for Hematopoiesis Management in a Patient with Primary Myelofibrosis].

    PubMed

    Sugama, Yusuke; Kuroda, Hiroyuki; Horiguchi, Hiroto; Yamauchi, Natsumi; Sato, Ken; Yamada, Michiko; Hamaguchi, Kohta; Nakamura, Hajime; Abe, Tomoyuki; Fujii, Shigeyuki; Maeda, Masahiro; Fujita, Miri; Koguma, Masato; Koguma, Tetsuhiko; Kato, Junji

    2016-09-01

    An 80-year-old man received a diagnosis of anemia and a decreased platelet count from his physician in 2008, and was referred to our department where primary myelofibrosis was diagnosed.The patient was classified into the lower risk group according to the International Prognostic Scoring System(IPSS), and was followed up without treatment.In June 2010, pancytopenia progressed, and the patient was reclassified into the higher risk group.Blood count did not increase with metenolone treatment, but increased with zoledronic acid(ZA)that he started receiving from January 2012. After ZA treatment, circulating levels of vascular endothelial growth factor(VEGF)and transforming growth factor-b(TGF-b)decreased, and bone marrow biopsy showed an absence of reticular fibers and collagen fibers.In the present case, we observed that the blood count increased because of ZA-induced improvements in myelofibrosis. PMID:27628559

  3. Antiphospholipase A2 Receptor Autoantibodies: A Step Forward in the Management of Primary Membranous Nephropathy.

    PubMed

    Obrisca, Bogdan; Ismail, Gener; Jurubita, Roxana; Baston, Catalin; Andronesi, Andreea; Mircescu, Gabriel

    2015-01-01

    Since the identification of PLA2R (M-type phospholipase A2 receptor) as the first human antigenic target in primary membranous nephropathy (MN), perpetual progress has been made in understanding the pathogenesis of this disease. Accumulating clinical data support a pathogenic role for the anti-PLA2R antibodies (PLA2R ABs), but confirmation in an animal model is still lacking. However, PLA2R ABs were related to disease activity and outcome, as well as to response therapy. Accordingly, PLA2R ABs assay seems to be promising tool not only to diagnose MN but also to predict the course of the disease and could open the way to personalize therapy. Nevertheless, validation of a universal assay with high precision and definition of cut-off levels, followed by larger studies with a prolonged follow-up period, are needed to confirm these prospects.

  4. [Use of evaluation by primary healthcare managers: a case study in southern Brazil].

    PubMed

    Nickel, Daniela Alba; Natal, Sonia; Hartz, Zulmira Maria de Araújo; Calvo, Maria Cristina Marino

    2014-12-01

    This article reports on a meta-evaluation, focused on utilization, in a state in southern Brazil. This was a single case study with primary data collection using semi-structured interviews with health department administrators and staff. Content analysis used categories defined in the evaluation matrix: political and organizational context and implementation of evaluation. The political and organizational context revealed weaknesses in the items on experience, evaluation team, and time and space for reflection. Technical autonomy was verified in the State and in one municipality. In the implementation of evaluation, evaluative quality met the established criteria, but there was no prior definition of the uses and users of evaluation. One report referred to use for planning actions and political use. The study concluded that evaluation produced important information for stakeholders, with the political and organizational context as the principal limiting factor for use.

  5. Prescribing drugs for Alzheimer's disease in primary care: managing cognitive symptoms.

    PubMed

    2014-06-01

    There are currently no interventions that cure or even alter the progressive course of dementia. In the UK, donepezil, galantamine and rivastigmine are licensed for symptomatic treatment of mild to moderate Alzheimer's disease, and memantine is licensed for use in moderate to severe Alzheimer's disease.1-4 These drugs improve cognitive function by a modest amount compared with placebo.5 Although the National Institute for Health and Care Excellence (NICE) stipulates that such treatment should be initiated by a specialist, in many parts of the UK responsibility for continued prescription of these drugs is being transferred to primary care. Here we review the evidence for drugs prescribed for cognitive symptoms in Alzheimer's disease and highlight key issues for those who are prescribing them. PMID:24924683

  6. Managing Mental Health Problems Among Immigrant Women Attending Primary Health Care Services.

    PubMed

    Straiton, Melanie L; Powell, Kathryn; Reneflot, Anne; Diaz, Esperanza

    2016-01-01

    Researchers in Norway explore treatment options in primary care for immigrant women with mental health problems compared with nonimmigrant women. Three national registers were linked together for 2008. Immigrant women from Sweden, Poland, the Philippines, Thailand, Pakistan, and Russia were selected for analysis and compared with Norwegian women. Using logistic regression, we investigated whether treatment type varied by country of origin. Rates of sickness leave and psychiatric referrals were similar across all groups. Conversational therapy and use of antidepressants and anxiolytics were lower among Filipina, Thai, Pakistani, and Russian women than among Norwegians. Using the broad term "immigrants" masks important differences in treatment and health service use. By closely examining mental health treatment differences by country of origin, gaps in service provision and treatment uptake may be identified and addressed with more success.

  7. Does patient experience of multimorbidity predict self-management and health outcomes in a prospective study in primary care?

    PubMed Central

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

    2015-01-01

    Background. There is a need to better understand the mechanisms which lead to poor outcomes in patients with multimorbidity, especially those factors that might be amenable to intervention. Objective. This research aims to explore what factors predict self-management behaviour and health outcomes in patients with multimorbidity in primary care in the UK. Methods. A prospective study design was used. Questionnaires were mailed out to 1460 patients with multimorbidity. Patients were asked to complete a range of self-report measures including measures of multimorbidity, measures of their experience of multimorbidity and service delivery and outcomes (three measures of self-management: behaviours, Self-monitoring and Insight and medication adherence; and a measure of self-reported health). Results. In total, 36% (n = 499) of patients responded to the baseline survey and 80% of those respondents completed follow-up. Self-management behaviour at 4 months was predicted by illness perceptions around the consequences of individual conditions. Self-monitoring and Insight at 4 months was predicted by patient experience of ‘Hassles’ in health services. Self-reported medication adherence at 4 months was predicted by health status, Self-monitoring and Insight and ‘Hassles’ in health services. Perceived health status at 4 months was predicted by age and patient experience of multimorbidity. Conclusions. This research shows that different factors, particularly around patients’ experiences of health care and control over their treatment, impact on various types of self-management. Patient experience of multimorbidity was not a critical predictor of self-management but did predict health status in the short term. The findings can help to develop and target interventions that might improve outcomes in patients with multimorbidity. PMID:25715962

  8. Physicians' view of primary care-based case management for patients with heart failure: a qualitative study

    PubMed Central

    Peters-Klimm, Frank; Olbort, Rebecca; Campbell, Stephen; Mahler, Cornelia; Miksch, Antje; Baldauf, Annika; Szecsenyi, Joachim

    2009-01-01

    Background As part of a trial aiming to improve care for patients with chronic (systolic) heart failure, a standardized, multifaceted case management approach was evaluated in German general practices. It consisted of regular telephone monitoring, home visits, health counselling, diagnostic screening and booklets for patients. Practice-based doctors' assistants (equivalent to a nursing role) adopted these new tasks and reported regularly to the employing general practitioner (GP). Objective To explore GPs' perceptions of case management, subsequent changes in relationships within the practice team and the potential future role. Method Twenty-four GPs participated in five moderated, semi-structured, audio-taped focus groups. Full transcription and thematic content analysis was undertaken. Results GPs rated all elements and instruments of case management conducted by doctors' assistants feasible, except for the geriatric assessment as patients had not been at risk. GPs perceived difficulties in their own role in delivering health behaviour counselling. Relationships between doctors' assistants and patients and between GPs and patients or doctors' assistants remained stable or improved. All GPs perceived a variety of role changes in doctors' assistants including more in-depth medical knowledge and higher responsibilities yielding more recognition by patients and GPs. Some GPs suggested transferring the case management programme to other chronic conditions and that it should form part of a further education curriculum for doctors' assistants. Conclusion This primary care-based case management model characterized by the orchestrated delegation of tasks to doctors' assistants offers a promising strategy of enhanced chronic illness care, but it needs further adaptation and evaluation. PMID:19684033

  9. Variations in the management of fibromyalgia by physician specialty: rheumatology versus primary care

    PubMed Central

    Able, Stephen L; Robinson, Rebecca L; Kroenke, Kurt; Mease, Philip; Williams, David A; Chen, Yi; Wohlreich, Madelaine; McCarberg, Bill H

    2016-01-01

    Purpose To evaluate the effect of physician specialty regarding diagnosis and treatment of fibromyalgia (FM) and assess the clinical status of patients initiating new treatment for FM using data from Real-World Examination of Fibromyalgia: Longitudinal Evaluation of Costs and Treatments. Patients and methods Outpatients from 58 sites in the United States were enrolled. Data were collected via in-office surveys and telephone interviews. Pairwise comparisons by specialty were made using chi-square, Fisher’s exact tests, and Student’s t-tests. Results Physician specialist cohorts included rheumatologists (n=54), primary care physicians (n=25), and a heterogeneous group of physicians practicing pain or physical medicine, psychiatry, neurology, obstetrics and gynecology, osteopathy, or an unspecified specialty (n=12). The rheumatologists expressed higher confidence diagnosing FM (4.5 on a five-point scale) than primary care physicians (4.1) (P=0.037). All cohorts strongly agreed that recognizing FM is their responsibility. They agreed that psychological aspects of FM are important, but disagreed that symptoms are psychosomatic. All physician cohorts agreed with a multidisciplinary approach including nonpharmacological and pharmacological treatments, although physicians were more confident prescribing medications than alternative therapies. Most patients reported moderate to severe pain, multiple comorbidities, and treatment with several medications and nonpharmacologic therapies. Conclusion Physician practice characteristics, physician attitudes, and FM patient profiles were broadly similar across specialties. The small but significant differences reported by physicians and patients across physician cohorts suggest that despite published guidelines, treatment of FM still contains important variance across specialties. PMID:27799842

  10. Management of primary hyperhidrosis: a summary of the different treatment modalities.

    PubMed

    Connolly, Maureen; de Berker, David

    2003-01-01

    Hyperhidrosis is a common and distressing condition involving increased production of sweat. A variety of treatment modalities are used to try to control or reduce sweating. Sweat is secreted by eccrine glands innervated by cholinergic fibers from the sympathetic nervous system. Primary hyperhidrosis most commonly affects palms, axillae and soles. Secondary hyperhidrosis is caused by an underlying condition, and treatment involves the removal or control of this condition. The treatment options for primary hyperhidrosis involve a range of topical or systemic medications, psychotherapy and surgical or non-surgical invasive techniques. Topical antiperspirants are quick and easy to apply but they can cause skin irritation and have a short half life. Systemic medications, in particular anticholinergics, reduce sweating but the dose required to control sweating can cause significant adverse effects, thus, limiting the medications' effectiveness. Iontophoresis is a simple and well tolerated method for the treatment of hyperhidrosis without long-term adverse effects; however, long-term maintenance treatments are required to keep patients symptom free. Botulinum toxin A has emerged as a treatment for hyperhidrosis over the past 5-6 years with studies showing good results. Unfortunately, botulinum toxin A is not a permanent solution, and patients require repeat injections every 6-8 months to maintain benefits. Psychotherapy has been beneficial in a small number of cases. Percutaneous computed tomography-guided phenol sympathicolysis achieved good results but has a high long-term failure rate. Surgery has also been shown to successfully reduce hyperhidrosis but, like other therapies, has several complications and patients need to be informed of these prior to undergoing surgery. The excision of axillary sweat glands can cause unsightly scarring and transthoracic sympathectomy (either open or endoscopic) can be associated with complications of compensatory and gustatory

  11. [Structured medication management in primary care - a tool to promote medication safety].

    PubMed

    Mahler, Cornelia; Freund, Tobias; Baldauf, Annika; Jank, Susanne; Ludt, Sabine; Peters-Klimm, Frank; Haefeli, Walter Emil; Szecsenyi, Joachim

    2014-01-01

    Patients with chronic disease usually need to take multiple medications. Drug-related interactions, adverse events, suboptimal adherence, and self-medication are components that can affect medication safety and lead to serious consequences for the patient. At present, regular medication reviews to check what medicines have been prescribed and what medicines are actually taken by the patient or the structured evaluation of drug-related problems rarely take place in Germany. The process of "medication reconciliation" or "medication review" as developed in the USA and the UK aim at increasing medication safety and therefore represent an instrument of quality assurance. Within the HeiCare(®) project a structured medication management was developed for general practice, with medical assistants playing a major role in the implementation of the process. Both the structured medication management and the tools developed for the medication check and medication counselling will be outlined in this article; also, findings on feasibility and acceptance in various projects and experiences from a total of 200 general practices (56 HeiCare(®), 29 HiCMan,115 PraCMan) will be described. The results were obtained from questionnaires and focus group discussions. The implementation of a structured medication management intervention into daily routine was seen as a challenge. Due to the high relevance of medication reconciliation for daily clinical practice, however, the checklists - once implemented successfully - have been applied even after the end of the project. They have led to the regular review and reconciliation of the physicians' documentation of the medicines prescribed (medication chart) with the medicines actually taken by the patient.

  12. KEY ITEMS OF INNOVATION MANAGEMENT IN THE PRIMARY HEALTHCARE CENTRES CASE STUDY: FINLAND.

    PubMed

    Aslani, Alireza; Zolfagharzadeh, Mohammad Mahdi; Naaranoja, Marja

    2015-09-01

    Trends such as aging populations, excess costs, rising public expectations, and progress in medical science and technologies point out the necessity of adaptation and development of innovation in the healthcare systems particularly in developed countries. The main objective of this article is to review diffusion of innovation in the healthcare sector. Different types of innovation, diffusion characteristics, and adoption mechanisms are the subjects that are discussed in the selected case study, Finland. Finally, the key items of innovation management in the Finnish health system are introduced. The results can be implemented in other countries as well.

  13. Providing care to transgender persons: a clinical approach to primary care, hormones, and HIV management.

    PubMed

    Williamson, Catherine

    2010-01-01

    Transgender (TG) persons have had historically difficult interactions with health care providers, leading to limited care and risks for a broad spectrum of health problems. This is of particular concern for TG persons with or at risk for HIV infection. This article discusses care providers' roles in establishing TG-friendly clinical care sites; conducting appropriate and thorough physical examinations for TG patients; managing hormones, especially in conjunction with antiretroviral therapy; and engaging TG persons in education about prevention and treatment of HIV. PMID:20363651

  14. Simple algorithms for the management of genital ulcers: evaluation in a primary health care centre in Kigali, Rwanda.

    PubMed Central

    Bogaerts, J.; Vuylsteke, B.; Martinez Tello, W.; Mukantabana, V.; Akingeneye, J.; Laga, M.; Piot, P.

    1995-01-01

    A cross-sectional study was conducted among 395 patients presenting with genital ulcers at a primary health care centre in Kigali, Rwanda. Using clinical data and the results of a rapid plasma reagin (RPR) test, we simulated the diagnostic outcome of two simple WHO flowcharts for the management of genital ulcers. These outcomes and a clinical diagnosis were then compared with the laboratory diagnosis based on culture for genital herpes and Haemophilus ducreyi and serology for syphilis. The prevalence of HIV infection was high (73%) but there was no difference between HIV-positive and HIV-negative patients in the clinical presentation and etiology of genital ulcer disease. The proportion of correctly managed chancroid and/or syphilis cases was 99% using a syndromic approach, 82.1% using a hierarchical algorithm including an RPR test, and 38.3% with a clinical diagnosis. In situations where no laboratory support is available, a simple syndromic approach is preferable to the clinical approach for the management of genital ulcer. If an RPR test can be included in the diagnostic strategy, patients with a reactive RPR test should be treated for both syphilis and chancroid infection. PMID:8907769

  15. Simple algorithms for the management of genital ulcers: evaluation in a primary health care centre in Kigali, Rwanda.

    PubMed

    Bogaerts, J; Vuylsteke, B; Martinez Tello, W; Mukantabana, V; Akingeneye, J; Laga, M; Piot, P

    1995-01-01

    A cross-sectional study was conducted among 395 patients presenting with genital ulcers at a primary health care centre in Kigali, Rwanda. Using clinical data and the results of a rapid plasma reagin (RPR) test, we simulated the diagnostic outcome of two simple WHO flowcharts for the management of genital ulcers. These outcomes and a clinical diagnosis were then compared with the laboratory diagnosis based on culture for genital herpes and Haemophilus ducreyi and serology for syphilis. The prevalence of HIV infection was high (73%) but there was no difference between HIV-positive and HIV-negative patients in the clinical presentation and etiology of genital ulcer disease. The proportion of correctly managed chancroid and/or syphilis cases was 99% using a syndromic approach, 82.1% using a hierarchical algorithm including an RPR test, and 38.3% with a clinical diagnosis. In situations where no laboratory support is available, a simple syndromic approach is preferable to the clinical approach for the management of genital ulcer. If an RPR test can be included in the diagnostic strategy, patients with a reactive RPR test should be treated for both syphilis and chancroid infection.

  16. Evolution and management of Lennox-Gastaut syndrome through adolescence and into adulthood: are seizures always the primary issue?

    PubMed

    Kerr, Michael; Kluger, Gerhard; Philip, Sunny

    2011-05-01

    Although Lennox-Gastaut syndrome (LGS) typically begins during childhood, it frequently persists through adolescence and on into adulthood. It may also, rarely, have late onset during adolescence or adulthood. Longitudinal studies have highlighted that the "typical" features of LGS observed during childhood evolve and change over time, so that by adulthood it might be difficult to recognise LGS in previously undiagnosed patients. Approaches to treatment must therefore adapt to the changes in a patient's condition as they progress through life. Effective management of LGS requires a global approach to care that not only encompasses seizure control, but also the management of co-morbidities associated with the condition, such as cognitive and behavioural problems, sleep disturbances and physical disability, together with the specific educational and psychosocial needs of the individual. This is particularly relevant during adolescence, when patients have to cope with a host of additional issues alongside those relating to their epilepsy. During all stages of life, management of LGS must carefully balance the need for treatment against its side effects, with the patient's overall quality of life always being the primary focus. The transition of care from paediatric to adult services presents important challenges for patients, their families and healthcare providers, and requires particular consideration to ensure that it is as smooth as possible. It also presents an important opportunity to review and reappraise a patient's condition, treatment and other longer-term needs as they journey into adulthood. PMID:21669559

  17. Interpractice audit of diagnosis and management of hypertension in primary care: educational intervention and review of medical records.

    PubMed Central

    Mashru, M.; Lant, A.

    1997-01-01

    OBJECTIVE: To determine whether peer review medical audit in a primary care setting changes clinical behaviour in relation to the management of hypertension. DESIGN: Review of medical records in general practices to identify hypertensive patients followed up by assessment of the pre-educational and post-educational management of interventions. SETTING: Six general practices in north west London picked at random within defined criteria of geography and size. SUBJECTS: 740 hypertensive patients managed by 25 different general practitioners. MAIN OUTCOME MEASURES: Improved level of care in terms of better diagnosis by having at least three blood pressure readings before the start of drug treatment, better level of recordings of lifestyle parameters as shown by the level of recordings of body mass index and total lipid values, and better control of blood pressure and harm minimisation as shown by the level of recordings of urea and electrolyte values. RESULTS: Improvement was noted in the level of recordings of body mass index, total lipid concentrations, and urea and electrolyte values but not in better diagnosis or blood pressure control. CONCLUSION: Clinical behaviour of general practitioners can be changed by peer review but more complex behavioural changes which require the cooperation of the patients and cognitive actions by the general practitioners need further investigation. PMID:9099120

  18. Management of Normal Tissue Toxicity Associated With Chemoradiation (Primary Skin, Esophagus, and Lung)

    PubMed Central

    Yazbeck, Victor Y.; Villaruz, Liza; Haley, Marsha; Socinski, Mark A.

    2016-01-01

    Nearly one quarter of patients with lung cancer present with locally advanced disease where concurrent chemoradiotherapy is the current standard of care for patients with good performance status. Cisplatin-based concurrent chemoradiotherapy consistently showed an improvement in survival compared with sequential chemoradiotherapy, at the expense of an increase in the toxicity profile. Over the past decades, several encouraging biomarkers such as transforming growth factor-beta and radioprotective agents such as amifostine were studied but without reaching approval for patient care. We reviewed the prevalence and risk factors for different adverse effects associated with the combined chemoradiotherapy modality, especially dermatitis, mucositis, esophagitis, and pneumonitis. These adverse effects can further be divided into acute, subacute, and chronic. Dermatitis is usually rare and responds well to topical steroids and usual skin care. Acute esophagitis occurs in 30% of patients and is treated with proton pump inhibitors, promotility agents, local anesthetic, and dietary changes. Radiation pneumonitis is a subacute complication seen in 15% of patients and is usually managed with steroids. Chronic adverse effects such as radiation fibrosis and esophageal stricture occur approximately 6 months after completion of radiation therapy and are usually permanent. In this review, complications of chemoradiotherapy for patients with locally advanced lung cancer are delineated, and approaches to their management are described. Given that treatment interruption is associated with a worse outcome, patients are aggressively treated with a curative intent. Therefore, planning for treatment adverse effects improves patient tolerance, compliance, and outcome. PMID:23708070

  19. Kidney disease management in UK primary care: guidelines, incentives and information technology.

    PubMed

    Klebe, Bernhard; Farmer, Chris; Cooley, Roger; de Lusignan, Simon; Middleton, Rachel; O'Donoghue, Donal; New, John; Stevens, Paul

    2007-09-01

    The last few years have seen new developments to understand and tackle the significant public health issue posed by chronic kidney disease (CKD). Established renal disease currently consumes 2% of the UK National Health Service budget and predictions are that this figure will increase significantly due to the rising number of people requiring renal replacement therapy fuelled by the ageing population and the diabetes mellitus epidemic. This paper reviews the scale of CKD and discusses the new developments such as staging, referral guidelines and new Department of Health incentives brought about to improve awareness. The importance of Information Technology in assisting the management of renal disease is also outlined. We identify various types of intervention which might be used to do this: feedback in an educational context, the establishment of computerized decision support and enhancement of the patient journey. Many principles may be extended to the management of any chronic disease. While new developments are necessary to improve care, wider implementation is required to be able to see if improved outcomes are achieved.

  20. Trauma bleeding management: the concept of goal-directed primary care.

    PubMed

    Schöchl, Herbert; Schlimp, Christoph J

    2014-11-01

    The early and aggressive high-volume administration of fresh frozen plasma, platelet concentrates, and red blood cells (RBCs), using ratio-driven massive transfusion protocols, has been adopted by many for the treatment of trauma-induced coagulopathy and hemorrhagic shock. However, the optimal ratio of RBC: fresh frozen plasma and RBC:platelet concentrate is still under investigation. In some European trauma centers, hemostatic agents such as fibrinogen concentrate, prothrombin complex concentrates, and antifibrinolytics are integral parts of goal-directed massive transfusion protocols. Both a ratio-driven coagulation therapy and a point-of-care-guided coagulation management based on coagulation factor concentrates aim for the same target-the rapid prevention and treatment of shock and coagulopathy to prevent death from traumatic hemorrhage. In this review, we compare the evidence relating to the effectiveness and safety of the ratio-driven and goal-directed approaches to trauma-induced coagulopathy to draw attention to the potential benefits and drawbacks associated with these management strategies.

  1. [Promoting Self-Management in Primary Care - the Association of Motivation for Change, Self-Efficacy and Psychological Distress Prior to the Onset of Intervention].

    PubMed

    Zimmermann, Thomas; Puschmann, Egina; Porzelt, Sarah; Ebersbach, Martin; Ernst, Annette; Thomsen, Patricia; Scherer, Martin

    2015-07-01

    Anxiety, depressive and somatoform disorders are highly prevalent in primary care. Managing these disorders is time-consuming and requires strong commitment on behalf of the general practitioners (GPs). Furthermore, the resources for the management of these patients are limited by the increasing workload in primary care practices, especially in the German health care system. In order to address the SMADS-study within psychenet - the Hamburg Network for Mental Health (NCT01726387) implements and evaluates a complex, low-threshold, nurse-led intervention using a goal-oriented set of case management and counseling techniques to promote self-management in these patients. This paper investigates the association of the patients' motivation for change and their perceived self-efficacy, the primary outcome - to get to know whether the intervention will target the appropriate population.

  2. [Promoting Self-Management in Primary Care - the Association of Motivation for Change, Self-Efficacy and Psychological Distress Prior to the Onset of Intervention].

    PubMed

    Zimmermann, Thomas; Puschmann, Egina; Porzelt, Sarah; Ebersbach, Martin; Ernst, Annette; Thomsen, Patricia; Scherer, Martin

    2015-07-01

    Anxiety, depressive and somatoform disorders are highly prevalent in primary care. Managing these disorders is time-consuming and requires strong commitment on behalf of the general practitioners (GPs). Furthermore, the resources for the management of these patients are limited by the increasing workload in primary care practices, especially in the German health care system. In order to address the SMADS-study within psychenet - the Hamburg Network for Mental Health (NCT01726387) implements and evaluates a complex, low-threshold, nurse-led intervention using a goal-oriented set of case management and counseling techniques to promote self-management in these patients. This paper investigates the association of the patients' motivation for change and their perceived self-efficacy, the primary outcome - to get to know whether the intervention will target the appropriate population. PMID:26135280

  3. Adoption of a Portal for the Primary Care Management of Pediatric Asthma: A Mixed-Methods Implementation Study

    PubMed Central

    DuRivage, Nathalie; Mayne, Stephanie L; Finch, Stacia; Ross, Michelle E; Giacomini, Kelli; Suh, Andrew; McCarn, Banita; Brandt, Elias; Karavite, Dean; Staton, Elizabeth W; Shone, Laura P; McGoldrick, Valerie; Noonan, Kathleen; Miller, Dorothy; Lehmann, Christoph U; Pace, Wilson D; Grundmeier, Robert W

    2016-01-01

    Background Patient portals may improve communication between families of children with asthma and their primary care providers and improve outcomes. However, the feasibility of using portals to collect patient-reported outcomes from families and the barriers and facilitators of portal implementation across diverse pediatric primary care settings have not been established. Objective We evaluated the feasibility of using a patient portal for pediatric asthma in primary care, its impact on management, and barriers and facilitators of implementation success. Methods We conducted a mixed-methods implementation study in 20 practices (11 states). Using the portal, parents of children with asthma aged 6-12 years completed monthly surveys to communicate treatment concerns, treatment goals, symptom control, medication use, and side effects. We used logistic regression to evaluate the association of portal use with child characteristics and changes to asthma management. Ten clinician focus groups and 22 semistructured parent interviews explored barriers and facilitators of use in the context of an evidence-based implementation framework. Results We invited 9133 families to enroll and 237 (2.59%) used the portal (range by practice, 0.6%-13.6%). Children of parents or guardians who used the portal were significantly more likely than nonusers to be aged 6-9 years (vs 10-12, P=.02), have mild or moderate/severe persistent asthma (P=.009 and P=.04), have a prescription of a controller medication (P<.001), and have private insurance (P=.002). Portal users with uncontrolled asthma had significantly more medication changes and primary care asthma visits after using the portal relative to the year earlier (increases of 14% and 16%, respectively). Qualitative results revealed the importance of practice organization (coordinated workflows) as well as family (asthma severity) and innovation (facilitated communication and ease of use) characteristics for implementation success

  4. The presentation, recognition and management of bipolar depression in primary care.

    PubMed

    Cerimele, Joseph M; Chwastiak, Lydia A; Chan, Ya-Fen; Harrison, David A; Unützer, Jürgen

    2013-12-01

    Bipolar disorder is a mood disorder characterized by episodes of major depression and mania or hypomania. Most patients experience chronic symptoms of bipolar disorder approximately half of the time, most commonly subsyndromal depressive symptoms or a full depressive episode with concurrent manic symptoms. Consequently, patients with bipolar depression are often misdiagnosed with major depressive disorder. Individual patient characteristics and population screening tools may be helpful in improving recognition of bipolar depression in primary care. Health risk behaviors including tobacco use, sedentary activity level and weight gain are highly prevalent in patients with bipolar disorder, as are the comorbid chronic diseases such as diabetes mellitus and cardiovascular disease. Patients with bipolar illness have about an eight-fold higher risk of suicide and a two-fold increased risk of death from chronic medical illnesses. Recognition of bipolar depression and its associated health risk behaviors and chronic medical problems can lead to the use of appropriate interventions for patients with bipolar disorder, which differ in important ways from the treatments used for major depressive disorder. The above topics are reviewed in detail in this article. PMID:23835789

  5. Primary Care Management of Chronic Constipation in Asia: The ANMA Chronic Constipation Tool

    PubMed Central

    Ghoshal, Uday C; Gonlachanvit, Sutep; Chua, Andrew Seng Boon; Myung, Seung-Jae; Rajindrajith, Shaman; Patcharatrakul, Tanisa; Choi, Myung-Gyu; Wu, Justin C Y; Chen, Min-Hu; Gong, Xiao-Rong; Lu, Ching-Liang; Chen, Chien-Lin; Pratap, Nitesh; Abraham, Philip; Hou, Xiao-Hua; Ke, Meiyun; Ricaforte-Campos, Jane D; Syam, Ari Fahrial; Abdullah, Murdani

    2013-01-01

    Chronic constipation (CC) may impact on quality of life. There is substantial patient dissatisfaction; possible reasons are failure to recognize underlying constipation, inappropriate dietary advice and inadequate treatment. The aim of these practical guidelines intended for primary care physicians, and which are based on Asian perspectives, is to provide an approach to CC that is relevant to the existing health-care infrastructure. Physicians should not rely on infrequent bowel movements to diagnose CC as many patients have one or more bowel movement a day. More commonly, patients present with hard stool, straining, incomplete feeling, bloating and other dyspeptic symptoms. Physicians should consider CC in these situations and when patients are found to use laxative containing supplements. In the absence of alarm features physicians may start with a 2-4 week therapeutic trial of available pharmacological agents including osmotic, stimulant and enterokinetic agents. Where safe to do so, physicians should consider regular (as opposed to on demand dosing), combination treatment and continuous treatment for at least 4 weeks. If patients do not achieve satisfactory response, they should be referred to tertiary centers for physiological evaluation of colonic transit and pelvic floor function. Surgical referral is a last resort, which should be considered only after a thorough physiological and psychological evaluation. PMID:23667746

  6. Pushed monocanalicular intubation versus probing as a primary management for congenital nasolacrimal obstruction

    PubMed Central

    Elsawaby, Emad Abdelaal; El Essawy, Rania Assem; Abdelbaky, Sameh Hassan; Ismail, Yomna Magdy

    2016-01-01

    Purpose Evaluation of efficiency, complications, and advantages of pushed monocanalicular intubation using Masterka® tube versus simple probing in patients with congenital nasolacrimal duct obstruction (CNLDO). Patients and methods This is a case-controlled study that included 60 eyes (of 53 patients); 30 eyes underwent probing and 30 eyes intubation using the Masterka tube as a primary treatment for CNLDO. The children were aged between 6 months and 36 months at the time of surgery, with no previous nasolacrimal surgical procedure, and had one or more of the following clinical signs of nasolacrimal duct obstruction: epiphora, mucous discharge, and/or increased tear lake. Results We defined success by absence of epiphora, mucous discharge, or increased tear lake 1 month after tube removal. The overall success rate in the probing group was 80%, while it was 83.3% in the intubation group. Conclusion Pushed monocanalicular intubation is an effective method for treatment of CNLDO; it requires only mask inhalation anesthesia and could be considered as an appropriate alternative procedure with imperceptible complications. PMID:27660407

  7. Pushed monocanalicular intubation versus probing as a primary management for congenital nasolacrimal obstruction

    PubMed Central

    Elsawaby, Emad Abdelaal; El Essawy, Rania Assem; Abdelbaky, Sameh Hassan; Ismail, Yomna Magdy

    2016-01-01

    Purpose Evaluation of efficiency, complications, and advantages of pushed monocanalicular intubation using Masterka® tube versus simple probing in patients with congenital nasolacrimal duct obstruction (CNLDO). Patients and methods This is a case-controlled study that included 60 eyes (of 53 patients); 30 eyes underwent probing and 30 eyes intubation using the Masterka tube as a primary treatment for CNLDO. The children were aged between 6 months and 36 months at the time of surgery, with no previous nasolacrimal surgical procedure, and had one or more of the following clinical signs of nasolacrimal duct obstruction: epiphora, mucous discharge, and/or increased tear lake. Results We defined success by absence of epiphora, mucous discharge, or increased tear lake 1 month after tube removal. The overall success rate in the probing group was 80%, while it was 83.3% in the intubation group. Conclusion Pushed monocanalicular intubation is an effective method for treatment of CNLDO; it requires only mask inhalation anesthesia and could be considered as an appropriate alternative procedure with imperceptible complications.

  8. Management of Primary Headache in the Emergency Department and Inpatient Headache Unit.

    PubMed

    Kabbouche, Marielle; Khoury, Chaouki K

    2016-02-01

    Migraine is a chronic disorder with debilitating exacerbations throughout the lifetime of migraineurs. Children and adolescents are significantly affected. The prevalence of migraine in this age group is higher than predicted in the last decade. Fortunately, this chronic disease is getting more attention and recognition, and better treatments are now being offered to these patients. Different medications are available, mostly for the outpatient management of an attack and include the use of over-the-counter anti-inflammatory medications as well as prescribed medications like the triptans group. These therapies do sometime fail and the exacerbations can last days to weeks. Early aggressive intravenous treatment can be very effective in breaking the attack and allowing the child to be functional faster and sometimes may prevent chronification of an attack. PMID:27017021

  9. Managing bleeding and emergency reversal of newer oral anticoagulants: a review for primary care providers.

    PubMed

    Peacock, W Frank

    2014-10-01

    The therapeutic landscape for anticoagulation management is undergoing a shift from the use of traditional anticlotting agents such as heparins and warfarin as the only options to the growing adoption of newer target-specific oral anticoagulants (TSOACs) with novel mechanisms of action. Dabigatran, the first TSOAC approved for use in the United States, is a direct competitive inhibitor of thrombin. It has predictable kinetics, with an elimination half-life of 12 to 17 hours in healthy volunteers. Apixaban and rivaroxaban are selective inhibitors of factor Xa, and also display first-order kinetics. In younger healthy individuals, apixaban has an apparent half-life of approximately 12 hours, whereas rivaroxaban has an elimination half-life of 5 to 9 hours. Understanding the pharmacologic properties of these newer drugs can lead to better insights regarding their respective safety and efficacy profiles and their application in clinical practice. Laboratory assessments have been developed to measure the anticoagulant efficacy of these newer agents. However, the results of these tests can be highly variable, and are therefore not always useful for monitoring the anticoagulation effects of these agents. In addition, several strategies have been documented for the potential reversal of the anticoagulant effects of these drugs, from the temporary discontinuation of an agent before elective surgery to suggested emergency procedures in the case of major bleeding events. New, specific reversal agents for dabigatran, apixaban, and rivaroxaban are currently being developed, and dabigatran has received fast-track designation from the US Food and Drug Administration. Until comprehensive clinical guidelines are developed, institutions involved in emergency care should establish their own procedures for the management of patients undergoing anticoagulation who require emergency treatment. These protocols should include appropriate laboratory testing to assess anticoagulant activity

  10. Managing bleeding and emergency reversal of newer oral anticoagulants: a review for primary care providers.

    PubMed

    Peacock, W Frank

    2014-10-01

    The therapeutic landscape for anticoagulation management is undergoing a shift from the use of traditional anticlotting agents such as heparins and warfarin as the only options to the growing adoption of newer target-specific oral anticoagulants (TSOACs) with novel mechanisms of action. Dabigatran, the first TSOAC approved for use in the United States, is a direct competitive inhibitor of thrombin. It has predictable kinetics, with an elimination half-life of 12 to 17 hours in healthy volunteers. Apixaban and rivaroxaban are selective inhibitors of factor Xa, and also display first-order kinetics. In younger healthy individuals, apixaban has an apparent half-life of approximately 12 hours, whereas rivaroxaban has an elimination half-life of 5 to 9 hours. Understanding the pharmacologic properties of these newer drugs can lead to better insights regarding their respective safety and efficacy profiles and their application in clinical practice. Laboratory assessments have been developed to measure the anticoagulant efficacy of these newer agents. However, the results of these tests can be highly variable, and are therefore not always useful for monitoring the anticoagulation effects of these agents. In addition, several strategies have been documented for the potential reversal of the anticoagulant effects of these drugs, from the temporary discontinuation of an agent before elective surgery to suggested emergency procedures in the case of major bleeding events. New, specific reversal agents for dabigatran, apixaban, and rivaroxaban are currently being developed, and dabigatran has received fast-track designation from the US Food and Drug Administration. Until comprehensive clinical guidelines are developed, institutions involved in emergency care should establish their own procedures for the management of patients undergoing anticoagulation who require emergency treatment. These protocols should include appropriate laboratory testing to assess anticoagulant activity

  11. Preventing and managing aberrant drug-related behavior in primary care: systematic review of outcomes evidence.

    PubMed

    Argoff, Charles E; Kahan, Meldon; Sellers, Edward M

    2014-01-01

    Several strategies for preventing, identifying, and responding to aberrant opioid-related behaviors are recommended in pain management guidelines. This systematic review evaluated data supporting basic strategies for addressing aberrant opioid-related behaviors. Risk reduction strategies were identified via a review of available guidelines. Systematic literature searches of PubMed (May 1, 2007-January 18, 2013) identified articles with evidence relevant to nine basic strategies. Reference lists from relevant articles were reviewed for additional references of interest. Levels of evidence for articles identified were graded on a four-point scale (strongest evidence = level 1; weakest evidence = level 4) using Oxford Centre for Evidence-Based Medicine Levels of Evidence criteria. Weak to moderate evidence supports the value of thorough patient assessment, risk-screening tools, controlled-substance agreements, careful dose titration, opioid dose ceilings, compliance monitoring, and adherence to practice guidelines. Moderate to strong evidence suggests that prescribing tamper-resistant opioids may help prevent misuse but may also have the unintended consequence of prompting a migration of users to other marketed opioids, heroin, or other substances. Similarly, preliminary evidence suggests that although recent regulatory and legal efforts may reduce misuse, they also impose barriers to the legitimate treatment of pain. Despite an absence of consistent, strong supporting evidence, clinicians are advised to use each of the available risk-mitigation strategies in combination in an attempt to minimize the risk of abuse in opioid treatment patients. Physicians must critically evaluate their opioid prescribing and not only increase their efforts to prevent substance abuse but also not compromise pain management in patients who benefit from it.

  12. Peer Support for Diabetes Management in Primary Care and Community Settings in Anhui Province, China

    PubMed Central

    Zhong, Xuefeng; Wang, Zhimin; Fisher, Edwin B.; Tanasugarn, Chanuantong

    2015-01-01

    PURPOSE We evaluated a peer leader–support program (PLSP) for diabetes self-management in China in terms of acceptability and feasibility; implementation; perceived advantages; disadvantages and barriers; reach and recruitment; effectiveness in terms of diabetes knowledge and clinical impacts; adoption; and sustainability. METHODS Within each of 3 cities in Anhui Province, 2 subcommunities were randomly assigned to usual care or PLSP. Peer leaders and staff of Community Health Service Centers (CHSCs) co-led biweekly educational meetings. Peer leaders also led biweekly discussion meetings, promoted regular care through the CHSCs, organized informal health promotion activities (eg, walking and tai chi groups), and provided informal individual support to participants through casual contact. RESULTS Qualitative evaluations indicated acceptance of and positive responses to the program among patients, peer leaders, and CHSC staff. Implementation was successful in 2 of 3 subcommunities, the third failing for lack of staff resources. Reported advantages included peer support as a bridge between CHSCs and their patients. In 2 sites where the PLSP was implemented, analyses controlling for baseline differences and site showed significant benefits for PLSP relative to controls (P <0.05) for knowledge, self-efficacy, BMI, systolic blood pressure, diastolic blood pressure, and both fasting and 2-hour post-prandial blood glucose. The Anhui Provincial Health Bureau has extended the PLSP model to other communities and to cardiovascular disease prevention and management. CONCLUSION The PLSP was well accepted, feasible given sufficient administrative and staff resources, effective for those who participated, and generalizable to other sites and health problems. PMID:26304972

  13. Pediatricians’ and health visitors’ views towards detection and management of maternal depression in the context of a weak primary health care system: a qualitative study

    PubMed Central

    2014-01-01

    Background The present study’s aim has been to investigate, identify and interpret the views of pediatric primary healthcare providers on the recognition and management of maternal depression in the context of a weak primary healthcare system. Methods Twenty six pediatricians and health visitors were selected by using purposive sampling. Face to face in-depth interviews of approximately 45 minutes duration were conducted. The data were analyzed by using the framework analysis approach which includes five main steps: familiarization, identifying a thematic framework, indexing, charting, mapping and interpretation. Results Fear of stigmatization came across as a key barrier for detection and management of maternal depression. Pediatric primary health care providers linked their hesitation to start a conversation about depression with stigma. They highlighted that mothers were not receptive to discussing depression and accepting a referral. It was also revealed that the fragmented primary health care system and the lack of collaboration between health and mental health services have resulted in an unfavorable situation towards maternal mental health. Conclusions Even though pediatricians and health visitors are aware about maternal depression and the importance of maternal mental health, however they fail to implement detection and management practices successfully. The inefficiently decentralized psychiatric services but also stigmatization and misconceptions about maternal depression have impeded the integration of maternal mental health into primary care and prevent pediatric primary health care providers from implementing detection and management practices. PMID:24725738

  14. Marketplace reforms and primary care career decisions.

    PubMed

    Retchin, S M; Boling, P A; Nettleman, M D; Mick, S S

    2001-04-01

    A dramatic shift in the postgraduate career choices of medical school graduates toward primary care occurred during the mid-1990s. While some attributed this shift to changes in medical school curricula, perceptions stemming from marketplace reforms were probably responsible. For the most part, these perceptions were probably generated through informal communications among medical students and through the media. More recently, additional marketplace influences, such as the consumer backlash toward managed care and unrealized gains in primary care physicians' personal incomes, may have fostered contrasting perceptions among medical students, leading to career choices away from primary care, particularly family practice. The authors offer two recommendations for enhancing the knowledge of medical students concerning workforce supply and career opportunities: an educational seminar in the second or third year of medical school, and a public-private partnership between the Bureau of Health Professions and the Association of American Medical Colleges to create a national database about the shape of the primary care and specialty workforces, accessible through the Internet for educators, students, and policymakers. The authors conclude that appropriate career counseling through these efficient methods could avoid future abrupt swings in specialty choices of medical school graduates and may facilitate a more predictable physician workforce supply. PMID:11299142

  15. Critical appraisal of laropiprant and extended-release niacin combination in the management of mixed dyslipidemias and primary hypercholesterolemia.

    PubMed

    Hussein, Ayman A; Nicholls, Stephen J

    2010-04-15

    Niacin is a B-complex vitamin which has been used for decades for the management of mixed dyslipidemias and primary hypercholesterolemia. It decreases the risk of cardiovascular events either when used as a monotherapy or in combination with other lipid lowering medications. However, a major limitation to its use is niacin-induced flushing occurring even with the extended-release formulations. Laropiprant, a selective prostaglandin-2 receptor inhibitor, specifically targets the cascade of events causing the flushing. It has been recently used in combination with extended-release niacin. This article will review the early experience with this combination with focus on efficacy, safety, tolerability and current place in therapy. Early data are promising and suggest that more patients in clinical practice will benefit from niacin combined with laropiprant. Ongoing clinical trials will provide a better insight on the long-term safety of the drug and its efficacy for reducing cardiovascular events.

  16. Endodontic treatment and esthetic management of a primary double tooth with direct composite using silicone buildup guide

    PubMed Central

    Kulkarni, Vinaya Kumar; Ragavendra, T. Raju; Deshmukh, Jeevanand; Vanka, Amit; Duddu, Mahesh Kumar; Patil, Anand Kumar G.

    2012-01-01

    Gemination and fusion are morphological dental anomalies, characterized by the formation of a clinically wide tooth. Gemination occurs when one tooth bud tries to divide, while fusion occurs if two buds unite. The terms double teeth, double formation, conjoined teeth, geminifusion, vicinifusion and dental twinning are often used to describe fusion and gemination. Double teeth are associated with clinical problems such as poor esthetics, spacing problems and caries susceptibility. Management of such cases requires a comprehensive knowledge of the clinical entity as well as the problems associated with it. This report presents a case of primary double tooth in a 6-year-old boy involving maxillary left central incisor. The anomalous tooth was carious and pulpally involved. This was treated conservatively by endodontic treatment and esthetic rehabilitation was done with direct composite restoration using a silicone buildup guide. The treated tooth was followed up until exfoliation. PMID:22629077

  17. The management of breast carcinoma by primary radiotherapy of Mount Sinai hospital from 1962-1979. [/sup 60/Co; Betatron

    SciTech Connect

    Balawajder, I.; Antich, P.P.; Boland, J.

    1982-04-15

    Two-hundred eight patients with carcinoma of the breast were treated with megavoltage irradiation as the primary method of local management at Mount Sinai Hospital between 1962-1979. The effects of treatment volume, technique, and other parameters are discussed for the Stage I and II patients, together with the importance of tumor size and nodal status in control of local disease and distant metastases. In this series the cumulative probability of freedom from metastases is 93 +/- 5% when the irradiation is confined to the breast and axilla as compared with 72 +/- 9% when extended fields are used, with no difference in local control. Based on these results it was decided to confine irradiation to the breast and axilla alone in the majority of early stage cancer patients. Recommendations are made for radiation techniques and dosages to optimize control of the disease, minimize complications, and facilitate systemic therapy in patients with positive nodes.

  18. Robotic-assisted total mesorectal excision: should it be considered as the technique of choice in the management of rectal cancer?

    PubMed

    Clark, J; Shetty, K; Sodergren, M H; James, D R C; Purkayastha, S; Athanasiou, T; Yang, G-Z; Darzi, A

    2012-06-01

    The feasibility of robotic surgery has been extensively explored over the past decade with a more recent shift towards defining focused clinical applications for which quantifiable patient benefits can be directly attributed to its use. The aim of this article is to review the current literature on the use of daVinci robotic surgery for the management of rectal cancer and identify the potential benefits, if any, that robotic-assisted total mesorectal excision (RTME) may provide over the current conventional approach. A comprehensive search strategy was used to identify relevant evidence in order to explore the oncological, operative and functional outcome measures for the RTME in addition to quantifying the level of evidence which describes the clinical effectiveness of the daVinci robot in oncological surgery. Both robotic assisted techniques and the primary outcomes are discussed. In total, 23 studies were reviewed across 11 institutions, including one pilot randomised control trial. When data repetition is disregarded, a total of 452 robotic assisted laparoscopic anterior resections and 60 robotic-assisted laparoscopic abdomino-perineal excision of the rectum have been published since the introduction of the daVinci into clinical practice. Feasibility of the daVinci robotic assisted total mesorectal excision is demonstrated, with comparable oncological outcomes presented for rectal cancer excision. A demonstration of a reduced open conversion rate as well as of reduced hospital stay with the use of the robot is highlighted, although further trials are required to confirm both these findings. No functional benefit in using the daVinci could be confirmed due to the lack of focused trials in this area. PMID:27628273

  19. The management of children with chronic fatigue syndrome-like illness in primary care: a cross-sectional study

    PubMed Central

    Saidi, Guitta; Haines, Linda

    2006-01-01

    Background Most studies on children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) have been undertaken in tertiary care and little is known about their management in primary care. Aim To describe the characteristics of patients aged 5–19 years with CFS-like illness in primary care and to examine how GPs investigate and manage patients. Design of study Descriptive retrospective questionnaire study. Setting Sixty-two UK GP practices in the MRC General Practice Research Framework (GPRF). Method One hundred and twenty-two practices were approached; 62 identified 116 patients consulting a GP with severe fatigue lasting over 3 months. Practice nurses and GPs completed questionnaires from medical notes and patients completed postal questionnaires. Results Ninety-four patients were considered by a clinical panel, blind to diagnosis, to meet the Oxford CFS criteria with a fatigue duration of 3 months. Seventy-three per cent were girls, 94% white, mean age was 12.9 years and median illness duration 3.3 years. GPs had principal responsibility for 62%. A diagnosis of CFS/ME was made in 55%, 30% of these within 6 months. Fifty per cent had a moderate illness severity. Paediatric referrals were made in 82% and psychiatric referrals in 46% (median time of 2 and 13 months respectively). Advice given included setting activity goals, pacing, rest and graded exercise. Conclusions Patient characteristics are comparable to those reported in tertiary care, although fewer are severe cases. GPs have responsibility for the majority of patients, are diagnosing CFS/ME within a short time and applying a range of referral and advice strategies. PMID:16438814

  20. Computer visualisation of patient safety in primary care: a systems approach adapted from management science and engineering.

    PubMed

    Singh, Ranjit; Singh, Ashok; Fox, Chester; Seldan Taylor, John; Rosenthal, Thomas; Singh, Gurdev

    2005-01-01

    Patient safety and medical errors in ambulatory primary care are receiving increasing attention from policy makers, accreditation bodies and researchers, as well as by practising family physicians and their patients. While a great deal of progress has been made in understanding errors in hospital settings, it is important to recognise that ambulatory settings pose a very large and different set of challenges and that the types of hazards that exist and the strategies required to reduce them are very different. What is needed is a logical theoretical model for understanding the causes of errors in primary care, the role of healthcare systems in contributing to errors, the propagation of errors through complex systems and, importantly, for understanding ambulatory primary care in the context of the larger healthcare system. The authors have developed such a model using a formal 'systems engineering' approach borrowed from the management sciences and engineering. This approach has not previously been formally described in the medical literature.This paper outlines the formal systems approach, presents our visual model of the system, and describes some experiences with and potential applications of the model for monitoring and improving safety. Applications include providing a framework to help focus research efforts, creation of new (visual) error reporting and taxonomy systems, furnishing a common and unambiguous vision for the healthcare team, and facilitating retrospective and prospective analyses of errors and adverse events. It is aimed at system redesign for safety improvement through a computer-based patient-centred safety enhancement and monitoring instrument (SEMI-P). This model can be integrated with electronic medical records (EMRs).