Sample records for primary management objective

  1. Configuration management issues and objectives for a real-time research flight test support facility

    NASA Technical Reports Server (NTRS)

    Yergensen, Stephen; Rhea, Donald C.

    1988-01-01

    Presented are some of the critical issues and objectives pertaining to configuration management for the NASA Western Aeronautical Test Range (WATR) of Ames Research Center. The primary mission of the WATR is to provide a capability for the conduct of aeronautical research flight test through real-time processing and display, tracking, and communications systems. In providing this capability, the WATR must maintain and enforce a configuration management plan which is independent of, but complimentary to, various research flight test project configuration management systems. A primary WATR objective is the continued development of generic research flight test project support capability, wherein the reliability of WATR support provided to all project users is a constant priority. Therefore, the processing of configuration change requests for specific research flight test project requirements must be evaluated within a perspective that maintains this primary objective.

  2. Managing North American waterfowl in the face of uncertainty

    USGS Publications Warehouse

    Robbins, C.S.

    1995-01-01

    Informed management of waterfowl (or any animal population) requires management goals and objectives, the ability to implement management actions, periodic information about population and goal-related varlables, and knowledge of effects of management actions on population and goal-related variables. In North America, international treaties mandate a primary objective of protecting migratory bird populations, with a secondary objective of providing hunting opportunity in a manner compatible with such protection. Through the years, annual establishment of hunting regulations and acquisition and man-agement of habitat have been the primary management actions taken by federal agencies. Various information-gathering programs were established and, by the 1960s, had developed into arguably the best monitoring system in the world for continentally distributed animal populations. Retrospective analyses using estimates from this monitoring system have been used to investigate effects of management actions on waterfowl population and harvest dynamics, but key relationships arc still characterized by uncertainty. We recommend actively adaptive management as an approach that can meet short-term harvest objectives, while reducing uncertainty and ensuring sustainable populations over the long-term.

  3. Streamflow Modification Through Management of Eastern Forests

    Treesearch

    James E. Douglass; Wayne T. Swank

    1972-01-01

    Protection of the water resource was a primary objective in establishing the National Forest System in America, and improving quantity, quality, and timing of streamflow is an important objective of forest management in certain regions of the United States.Effective management of the forest for increased streamflow presupposes that impact of various management...

  4. Ace Project as a Project Management Tool

    ERIC Educational Resources Information Center

    Cline, Melinda; Guynes, Carl S.; Simard, Karine

    2010-01-01

    The primary challenge of project management is to achieve the project goals and objectives while adhering to project constraints--usually scope, quality, time and budget. The secondary challenge is to optimize the allocation and integration of resources necessary to meet pre-defined objectives. Project management software provides an active…

  5. The Triumphant Triumvirate: Synergistically Realizing the Purposes of a University through a Core Management Course

    ERIC Educational Resources Information Center

    Kessler, Eric H.

    2017-01-01

    Core management courses bear a particularly challenging curricular as well as pedagogical burden insofar as they are typically the sole or primary vehicle for integrating management principles with larger university and school objectives. Compounding the challenge is that these very objectives are neither universally clear nor necessarily…

  6. Carbon concentrations and carbon pool distributions in dry, moist, and cold mid-aged forests of the Rocky Mountains

    Treesearch

    Theresa B. Jain; Russell T. Graham; David Adams

    2010-01-01

    Although "carbon” management may not be a primary objective in forest management, influencing the distribution, composition, growth, and development of biomass to fulfill multiple objectives is; therefore, given a changing climate, managing carbon could influence future management decisions. Also, typically, the conversion from total biomass to total carbon is 50...

  7. Integrating fuel treatment into ecosystem management: A proposed project planning process

    Treesearch

    Keith D. Stockmann; Kevin D. Hyde; J. Greg Jones; Dan R. Loeffler; Robin P. Silverstein

    2010-01-01

    Concern over increased wildland fire threats on public lands throughout the western United States makes fuel reduction activities the primary driver of many management projects. This single-issue focus recalls a management planning process practiced frequently in recent decades - a least-harm approach where the primary objective is first addressed and then plans are...

  8. 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…

  9. Mapping the implementation of evidence-based nutritional management in primary health care settings: a scoping review protocol.

    PubMed

    Oliveira, Nara Leticia Zandonadi de; Agreli, Heloise Lima Fernandes; Matsumoto, Karen Dos Santos; Peduzzi, Marina

    2018-05-01

    The objective of this scoping review is to systematically map and categorize the wide variety of interventions and programs that might be classified under the umbrella term "evidence-based nutritional management in primary healthcare". The development of this scoping review will provide a better understanding of how evidence-based nutritional management has been implemented by healthcare professionals in primary health care settings, especially of barriers and facilitators to implementing evidence-based nutritional management. Therefore, three research questions were chosen to guide the scoping review.

  10. Forecasting annual aboveground net primary production in the intermountain west

    USDA-ARS?s Scientific Manuscript database

    For many land manager’s annual aboveground net primary production, or plant growth, is a key factor affecting business success, profitability and each land manager's ability to successfully meet land management objectives. The strategy often utilized for forecasting plant growth is to assume every y...

  11. Rating Your Cash Manager?

    ERIC Educational Resources Information Center

    Nielsen, George A.; Johannisson, Eric E.

    1989-01-01

    The primary objective of a public cash management policy should include safety, liquidity, yield, and legality. Contains a cash management policy/procedure checklist, a test for cash managers, and a formula for calculating the rate of return. (MLF)

  12. National Silviculture Meeting: Forestry to meet special objectives (A look at uneven-aged management); Marquette, Michigan; September 10-14, 1973

    Treesearch

    Michael A. Barton; Louis J. Verme; Robert E. Radtke; Berwyn O. Reed; William T. Plass; Stephen G. Boyce

    1973-01-01

    As a matter of policy and good forest resource management, the Forest Service will manage the timber resources on the National Forests to achieve the various multiple use objectives established for the respective management units. In so doing, we are not to be bound to any particular system of management as the primary system, but we are to prescribe and use the system...

  13. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs - Pasadena calibration report : draft report.

    DOT National Transportation Integrated Search

    2017-03-01

    The primary objective of this project is to develop multiple simulation testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active transportation and demand management (ATDM) strategies. The primary pu...

  14. Effective Management Techniques in Tertiary Administration: A Risk Management Framework.

    ERIC Educational Resources Information Center

    McNamara, R. P.; Booth, P.

    1984-01-01

    A management strategy that is potentially more fruitful for the nonprofit sector than traditional management toward a primary objective is a risk management approach to organizational effectiveness. The organization's effectiveness, its survival, can be analyzed by categorizing the risks facing it and assessing its performance in managing these…

  15. An Assessment of the Effectiveness of the AGATE Program Management Model

    NASA Technical Reports Server (NTRS)

    Warner, Timothy P. (Technical Monitor); Masson, Paul

    2005-01-01

    This report describes the collaborative program model chosen to implement an aeronautics research and technology program from 1994 through 2001: the Advanced General Aviation Transport Experiments (AGATE) Program. The Program had one primary objective: to improve the ability of the General Aviation industry to adopt technology as a solution to fulfill public benefit objectives. The primary objective of this report is to assess the program s ability to meet a combination of "effectiveness measures" from multiple stakeholders. The "effectiveness" of any model forms the foundation of legitimate questions for policy makers and professional federal managers. The participants rated AGATE as achieving its primary objectives and rating well on effectiveness in most areas, with high measures for relevance, cost, speed and public benefit, but lower measures for institutional fit and flexibility at dealing with the larger NASA organizational structure. This pattern mirrors private sector surveys and represents a tradeoff between the benefits of tailoring a program using partnering, versus the changes necessary within the institutional structure to support such tailoring.

  16. Measuring primary care practice performance within an integrated delivery system: a case study.

    PubMed

    Stewart, Louis J; Greisler, David

    2002-01-01

    This article examines the use of an integrated performance measurement system to plan and control primary care service delivery within an integrated delivery system. We review a growing body of literature that focuses on the development and implementation of management reporting systems among healthcare providers. Our study extends the existing literature by examining the use of performance information generated by an integrated performance measurement system within a healthcare organization. We conduct our examination through a case study of the WMG Primary Care Medicine Group, the primary care medical group practice of WellSpan Health System. WellSpan Health System is an integrated delivery system that serves south central Pennsylvania and northern Maryland. Our study examines the linkage between WellSpan Health's strategic objectives and its primary care medicine group's integrated performance measurement system. The conceptual design of this integrated performance measurement system combines financial metrics with practice management and clinical operating metrics to provide a more complete picture of medical group performance. Our findings demonstrate that WellSpan Health was able to achieve superior financial results despite a weak linkage between its integrated performance measurement system and its strategic objectives. WellSpan Health achieved this objective for its primary care medicine group by linking clinical performance information to physician compensation and reporting practice management performance through the use of statistical process charts. They found that the combined mechanisms of integrated performance measurement and statistical process control charts improved organizational learning and communications between organizational stakeholders.

  17. Management of Simple Clavicle Fractures by Primary Care Physicians.

    PubMed

    Stepanyan, Hayk; Gendelberg, David; Hennrikus, William

    2017-05-01

    The clavicle is the most commonly fractured bone. Children with simple fractures are often referred to orthopedic surgeons by primary care physician to ensure adequate care. The objective of this study was to show that simple clavicle fractures have excellent outcomes and are within the scope of primary care physician's practice. We performed a retrospective chart review of 16 adolescents with simple clavicle fractures treated with a sling. Primary outcomes were bony union, pain, and function. The patients with simple clavicle fractures had excellent outcomes with no complications or complaints of pain or restriction of their activities of daily living. The outcomes are similar whether treated by an orthopedic surgeon or a primary care physician. The cost to society and the patient is less when the primary care physician manages the fracture. Therefore, primary care physicians should manage simple clavicle fractures.

  18. Applying ecosystem management to urban forestry

    Treesearch

    Wayne C. Zipperer

    2007-01-01

    During the 1990s, the United States Department of Agriculture Forest Service shifted from commodity production management to ecosystem-based management (Overbay, 1992). Although definitions of ecosystem-based management vary by objectives, the principle had four primary elements: (1) maintaining viable populations of native species, (2) representing native ecosystems...

  19. 24 CFR 570.415 - Community Development Work Study Program.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... and economic development, community planning, and community management. The primary objectives of the... economic development, community planning, and community management, and to provide a cadre of well... economic development, community planning, community management, land use and housing activities. Community...

  20. Reservoir management strategy for East Randolph Field, Randolph Township, Portage County, Ohio

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

    Safley, L.E.; Salamy, S.P.; Young, M.A.

    1998-07-01

    The primary objective of the Reservoir Management Field Demonstration Program is to demonstrate that multidisciplinary reservoir management teams using appropriate software and methodologies with efforts scaled to the size of the resource are a cost-effective method for: Increasing current profitability of field operations; Forestalling abandonment of the reservoir; and Improving long-term economic recovery for the company. The primary objective of the Reservoir Management Demonstration Project with Belden and Blake Corporation is to develop a comprehensive reservoir management strategy to improve the operational economics and optimize oil production from East Randolph field, Randolph Township, Portage County, Ohio. This strategy identifies themore » viable improved recovery process options and defines related operational and facility requirements. In addition, strategies are addressed for field operation problems, such as paraffin buildup, hydraulic fracture stimulation, pumping system optimization, and production treatment requirements, with the goal of reducing operating costs and improving oil recovery.« less

  1. Speed management toolbox for rural communities.

    DOT National Transportation Integrated Search

    2013-04-01

    The primary objective of this toolbox is to summarize various known traffic-calming treatments and their effectiveness. This toolbox focuses on roadway-based treatments for speed management, particularly for rural communities with transition zones. E...

  2. Training managers for primary health care.

    PubMed

    Kekki, P

    1994-01-01

    The University of Helsinki has devised a powerful in-service training course for managers of health centres. By working together at the University and their own centres on setting objectives, analysing data and solving problems, the participants greatly enhance their management and teamwork skills.

  3. Tools for Successful Weight Management in Primary Care

    PubMed Central

    Turer, Christy Boling

    2015-01-01

    Obesity is one of the most pervasive and costly public-health problems. Clinicians need effective tools to address weight management in primary care, including evaluation and communication methods, guideline-based weight-management interventions, and safe and effective weight-loss medications and surgery. The objective of this Grand-Rounds presentation is to provide practicing clinicians with the latest information regarding effective ways to care for and communicate with patients about weight loss; evidence-based guidelines for selecting weight-management therapies; and safety, efficacy, and adverse effects of weight-loss medications and surgery. PMID:26218666

  4. A landscape plan based on historical fire regimes for a managed forest ecosystem: the Augusta Creek study.

    Treesearch

    John H. Cissel; Frederick J. Swanson; Gordon E. Grant; Deanna H. Olson; Gregory V. Stanley; Steven L. Garman; Linda R. Ashkenas; Matthew G. Hunter; Jane A. Kertis; James H. Mayo; Michelle D. McSwain; Sam G. Swetland; Keith A. Swindle; David O. Wallin

    1998-01-01

    The Augusta Creek project was initiated to establish and integrate landscape and watershed objectives into a landscape plan to guide management activities within a 7600-hectare (19,000-acre) planning area in western Oregon. Primary objectives included the maintenance of native species, ecosystem processes and structures, and long-term ecosystem productivity in a...

  5. The Cost of Being Accountable: An Objective-Referenced Program Cost Model for Educational Management--A Maryland Perspective.

    ERIC Educational Resources Information Center

    Holowenzak, Stephen P.; Stagmer, Robert A.

    This publication describes in detail an objective-referenced program cost model for educational management that was developed by the Maryland State Department of Education. Primary purpose of the publication is to aid educational decision-makers in developing and refining their own method of cost-pricing educational programs for use in state and…

  6. Evaluation of total purchasing pilots in England and Scotland and implications for primary care groups in England: personal interviews and analysis of routine data

    PubMed Central

    Goodwin, Nicholas; Mays, Nicholas; McLeod, Hugh; Malbon, Gill; Raftery, James

    1998-01-01

    Objectives: To evaluate the reported achievements of the 52 first wave total purchasing pilot schemes in 1996-7 and the factors associated with these; and to consider the implications of these findings for the development of the proposed primary care groups. Design: Face to face interviews with lead general practitioners, project managers, and health authority representatives responsible for each pilot; and analysis of hospital episode statistics. Setting: England and Scotland for evaluation of pilots; England only for consideration of implications for primary care groups. Main outcome measures: The ability of total purchasers to achieve their own objectives and their ability specifically to achieve objectives in the service areas beyond fundholding included in total purchasing. Results: The level of achievement between pilots varied widely. Achievement was more likely to be reported in primary than in secondary care. Reported achievements in reducing length of stay and emergency admissions were corroborated by analysis of hospital episode statistics. Single practice and small multipractice pilots were more likely than large multipractice projects to report achieving their objectives. Achievements were also associated with higher direct management costs per head and the ability to undertake independent contracting. Large multipractice pilots required considerable organisational development before progress could be made. Conclusion: The ability to create effective commissioning organisations the size of the proposed primary care groups should not be underestimated. To be effective commissioners, these care groups will need to invest heavily in their organisational development and in the short term are likely to need an additional development budget rather than the reduction in spending on NHS management that is planned by the government. Key messages The level of reported achievement between the total purchasing pilots in 1996-7 varied widely; achievement was more likely to occur in primary than in secondary care Single practice and small multipractice pilots were more likely than large multipractice pilots to report achieving their objectives in 1996/97; achievements were also associated with higher direct management costs per head Large multipractice pilots needed more time for organisational development before progress could be made Difficulties in creating effective commissioning organisations the size of the proposed primary care groups should not be underestimated Primary care groups will need to invest heavily in organisational development and are likely to need an additional development budget in the short term PMID:9677217

  7. Riparian ecosystems and buffers - multiscale structure, function, and management: introduction

    Treesearch

    Kathleen A. Dwire; Richard R. Lowrance

    2006-01-01

    Given the importance of issues related to improved understanding and management of riparian ecosystems and buffers, the American Water Resources Association (AWRA) sponsored a Summer Specialty Conference in June 2004 at Olympic Valley, California, entitled 'Riparian Ecosystems and Buffers: Multiscale Structure, Function, and Management.' The primary objective...

  8. [Relationship between perceived emotional intelligence and professional quality of life with the achievement of occupational objectives in the costa del sol primary health care district].

    PubMed

    Macías Fernández, Antonio José; Gutiérrez-Castañeda, Carlos; Carmona González, Francisco Jesús; Crespillo Vílchez, Daniel

    2016-05-01

    To examine the relationship between "Quality of Professional Life" and "Perceived Emotional Intelligence" and the relationship of both of these with the level of achievement of occupational objectives in the Costa del Sol Primary Health Care District. Multicentre descriptive cross-sectional observational study. The Costa del Sol Primary Health Care District in the province of Málaga. Sample of Employees of all categories in fixed and contracted employment in the Management Units of the Costa del Sol District. (N=303). Respondents 247 (81.5%) The data collected was that of the percentage of achievement of objectives in 2010 and the socio-demographic data of the participants, using ad hoc designed self-report questionnaires. The TMMS -24 questionnaire was used to measure the "Perceived Emotional Intelligence", with the following dimensions: Perception, comprehension, and emotional control, and the CVP-35 measuring: management support, work demands, and intrinsic motivation. Significant correlationas were observed between Quality of Professional Life and Emotional Intelligence in the Regulation (p<.01) and Comprehension categories (p<0.05). There were also significant correlations between the profession and the type of contract in the achievement of objectives (p<.005), and quality of professional life and type of contract (p<.05). The perceived quality of professional life is related to perception and regulation dimensions of Emotional Intelligence. Knowledge of emotion management methods should be promoted by management organisations for all employees. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  9. Research notes : drainage facility asset management : more than an inventory of pipes.

    DOT National Transportation Integrated Search

    2007-04-01

    The primary objectives for the research project were twofold: 1) To develop and implement an Oregon-specific system for inventorying and evaluating the condition of pipes, culverts, and stormwater facilities based on the FHWA Culvert Management Syste...

  10. Utilizing LIDAR data to analyze access management criteria in Utah.

    DOT National Transportation Integrated Search

    2017-05-01

    The primary objective of this research was to increase understanding of the safety impacts across the state related to access management. This was accomplished by using the Light Detection and Ranging (LiDAR) database to evaluate driveway spacing and...

  11. Beliefs Regarding Classroom Management Style: Relationships to Particular Teacher Personality Characteristics.

    ERIC Educational Resources Information Center

    Martin, Nancy K.; And Others

    This study was a continuation of an in-process research effort to further refine the Inventory of Classroom Management Styles (ICMS), an instrument designed to measure teachers' perceptions of their classroom management beliefs and practices. Using preliminary data analysis based on partial data collection, the primary objective of this study was…

  12. Schooling the Middle Manager. Professional Study No. 5406.

    ERIC Educational Resources Information Center

    Robinson, George D.

    The aim of this study is to evaluate industrial approaches to management development programs to ascertain the applicability of using similar schooling techniques in Air Force managerial development. The primary emphasis is on where the Air Force might benefit from industry's experience in the middle manager area. An additional objective is the…

  13. 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…

  14. DESIGN OF THE DECISION SUPPORT SYSTEM FOR PLACEMENT AND SELECTION OF BEST MANAGEMENT PRACTICES (BMPS) FOR STORMWATER CONTROL IN URBAN WATERSHEDS

    EPA Science Inventory

    A decision support system for selection and placement of best management practices (BMPs) at strategic locations in urban watersheds is being developed. The primary objective of the system is to assist stormwater management practioners and decision makers in developing effective...

  15. The role of metadata in managing large environmental science datasets. Proceedings

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

    Melton, R.B.; DeVaney, D.M.; French, J. C.

    1995-06-01

    The purpose of this workshop was to bring together computer science researchers and environmental sciences data management practitioners to consider the role of metadata in managing large environmental sciences datasets. The objectives included: establishing a common definition of metadata; identifying categories of metadata; defining problems in managing metadata; and defining problems related to linking metadata with primary data.

  16. National Institute of Standards and Technology (NIST) cybersecurity risk management framework applied to modern vehicles

    DOT National Transportation Integrated Search

    2014-10-01

    The primary objective of the work described in this report is to review the National Institute of Science and Technology (NIST) guidelines and foundational publications from an automotive : cybersecurity risk management stand-point. The NIST approach...

  17. Indonesia--Innovation in the Management of Primary School Construction: A Case Study. Education Building Report 8.

    ERIC Educational Resources Information Center

    Hussin

    This UNESCO report describes the progress of primary school building development under the second Five Year Plan of the Government of Indonesia. The main objective of the construction program was to increase the enrollement of children of primary school age to 85 per cent of all eligible children. Chapter I provides an historical perspective on…

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

    PubMed Central

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

    2014-01-01

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

  19. Development and Testing of a Prototype Connected Vehicle Wrong-Way Driving Detection and Management System

    DOT National Transportation Integrated Search

    2018-02-01

    The primary objective of Phase II was to develop a prototype connected vehicle wrong-way driving detection and management system at the Texas A&M University Respect, Excellence, Leadership, Loyalty, Integrity, Selfless Service (RELLIS) campus. The pu...

  20. 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

  1. Overstory and regeneration dynamics in riparian management zones of northern Minnesota forested watersheds

    Treesearch

    Brian. Palik; Michelle. Martin; Erik. Zenner; Charles. Blinn; Randall. Kolka

    2012-01-01

    We quantified tree regeneration under different riparian management zone (RMZ) treatments along first-order streams in Minnesota, USA. A primary objective for long-term management of RMZs in the study region is to maintain some tree cover and promote establishment of later successional tree species and conifers. We also compared regeneration response to contrasting...

  2. Evaluating various areas of process improvement in an effort to improve clinical research: discussions from the 2012 Clinical Translational Science Award (CTSA) Clinical Research Management workshop.

    PubMed

    Strasser, Jane E; Cola, Philip A; Rosenblum, Daniel

    2013-08-01

    Emphasis has been placed on assessing the efficiency of clinical and translational research as part of the National Institutes of Health (NIH) goal to "improve human health." Improvements identified and implemented by individual organizations cannot address the research infrastructure needs of all clinical and translational research conducted. NIH's National Center for Advancing Translational Sciences (NCATS) has brought together 61 Clinical and Translational Science Award (CTSA) sites creating a virtual national laboratory that reflects the diversity and breadth of academic medical centers to collectively improve clinical and translational science. The annual Clinical Research Management workshop is organized by the CTSA consortium with participation from CTSA awardees, NIH, and others with an interest in clinical research management. The primary objective of the workshop is to disseminate information that improves clinical research management although the specific objectives of each workshop evolve within the consortium. The fifth annual workshop entitled "Learning by doing; applying evidence-based tools to re-engineer clinical research management" took place in June 2012. The primary objective of the 2012 workshop was to utilize data to evaluate, modify, and improve clinical research management. This report provides a brief summary of the workshop proceedings and the major themes discussed among the participants. © 2013 Wiley Periodicals, Inc.

  3. 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.

  4. Effects of a Hypertension Management Program by Seongcheon Primary Health Care Post in South Korea: An Analysis of Changes in the Level of Knowledge of Hypertension in the Period from 2004 to 2009

    ERIC Educational Resources Information Center

    Song, In Han; Kim, Sang-A; Park, Woong-Sub

    2012-01-01

    The objective of this study was to examine the effects of a hypertension management program provided by a primary health care post located in a distant rural area in South Korea on the level of knowledge of hypertension. The panel data consisted of a total of 319 people or the entire population aged above 40 years of five villages located in…

  5. 28 CFR 552.30 - Purpose and scope.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Purpose and scope. 552.30 Section 552.30 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CUSTODY Hostage Situation Management § 552.30 Purpose and scope. The Bureau of Prisons primary objectives in all hostage...

  6. 28 CFR 552.30 - Purpose and scope.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Purpose and scope. 552.30 Section 552.30 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CUSTODY Hostage Situation Management § 552.30 Purpose and scope. The Bureau of Prisons primary objectives in all hostage...

  7. 28 CFR 552.30 - Purpose and scope.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Purpose and scope. 552.30 Section 552.30 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CUSTODY Hostage Situation Management § 552.30 Purpose and scope. The Bureau of Prisons primary objectives in all hostage...

  8. 28 CFR 552.30 - Purpose and scope.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Purpose and scope. 552.30 Section 552.30 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CUSTODY Hostage Situation Management § 552.30 Purpose and scope. The Bureau of Prisons primary objectives in all hostage...

  9. 28 CFR 552.30 - Purpose and scope.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Purpose and scope. 552.30 Section 552.30 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT CUSTODY Hostage Situation Management § 552.30 Purpose and scope. The Bureau of Prisons primary objectives in all hostage...

  10. Evaluation of Dry Wells and Cisterns for Stormwater Control: Millburn Township, New Jersey

    EPA Science Inventory

    The primary objective of this project was to investigate the effectiveness of the Township of Millburn’s use of on-site dry wells to limit stormwater flows into the local drainage system. The objective was to examine this stormwater management alternative applicable for mature ur...

  11. 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.

  12. Healthy eating and active living for diabetes in primary care networks (HEALD-PCN): rationale, design, and evaluation of a pragmatic controlled trial for adults with type 2 diabetes

    PubMed Central

    2012-01-01

    Background While strong and consistent evidence supports the role of lifestyle modification in the prevention and management of type 2 diabetes (T2DM), the best strategies for program implementation to support lifestyle modification within primary care remain to be determined. The objective of the study is to evaluate the implementation of an evidence-based self- management program for patients with T2DM within a newly established primary care network (PCN) environment. Method Using a non-randomized design, participants (total N = 110 per group) will be consecutively allocated in bi-monthly blocks to either a 6-month self-management program lead by an Exercise Specialist or to usual care. Our primary outcome is self-reported physical activity and pedometer steps. Discussion The present study will assess whether a diabetes self-management program lead by an Exercise Specialist provided within a newly emerging model of primary care and linked to available community-based resources, can lead to positive changes in self-management behaviours for adults with T2DM. Ultimately, our work will serve as a platform upon which an emerging model of primary care can incorporate effective and efficient chronic disease management practices that are sustainable through partnerships with local community partners. Clinical Trials Registration ClinicalTrials.gov identifier: NCT00991380 PMID:22712881

  13. Primary Care Physicians' Experience with Disease Management Programs

    PubMed Central

    Fernandez, Alicia; Grumbach, Kevin; Vranizan, Karen; Osmond, Dennis H; Bindman, Andrew B

    2001-01-01

    OBJECTIVE To examine primary care physicians' perceptions of how disease management programs affect their practices, their relationships with their patients, and overall patient care. DESIGN Cross-sectional mailed survey. SETTING The 13 largest urban counties in California. PARTICIPANTS General internists, general pediatricians, and family physicians. MEASUREMENTS AND MAIN RESULTS Physicians' self-report of the effects of disease management programs on quality of patient care and their own practices. Respondents included 538 (76%) of 708 physicians: 183 (34%) internists, 199 (38%) family practitioners, and 156 (29%) pediatricians. Disease management programs were available 285 to (53%) physicians; 178 had direct experience with the programs. Three quarters of the 178 physicians believed that disease management programs increased the overall quality of patient care and the quality of care for the targeted disease. Eighty-seven percent continued to provide primary care for their patients in these programs, and 70% reported participating in major patient care decisions. Ninety-one percent reported that the programs had no effect on their income, decreased (38%) or had no effect (48%) on their workload, and increased (48%)) their practice satisfaction. CONCLUSIONS Practicing primary care physicians have generally favorable perceptions of the effect of voluntary, primary care-inclusive, disease management programs on their patients and on their own practice satisfaction. PMID:11318911

  14. Urologic Management of Spina Bifida

    ERIC Educational Resources Information Center

    Clayton, Douglass B.; Brock, John W., III; Joseph, David B.

    2010-01-01

    The urologist plays an important role in the multidisciplinary team of physicians who provide care for patients with spina bifida. We review common strategies for managing the urinary tract in these patients. The primary objective in all phases of life is protecting kidney function by minimizing bladder hostility and establishing a good capacity,…

  15. DESIGN OF A DECISION SUPPORT SYSTEM FOR SELECTION AND PLACEMENT OF BMPS IN URBAN WATERSHEDS

    EPA Science Inventory

    The U.S. Environmental Protection Agency (USEPA) has funded the development of a decision support system for selection and placement of best management practices (BMPs) at strategic locations in urban watersheds. The primary objective of the system is to provide stormwater manag...

  16. Security of Personal Computer Systems: A Management Guide.

    ERIC Educational Resources Information Center

    Steinauer, Dennis D.

    This report describes management and technical security considerations associated with the use of personal computer systems as well as other microprocessor-based systems designed for use in a general office environment. Its primary objective is to identify and discuss several areas of potential vulnerability and associated protective measures. The…

  17. Chapter 6: Managing forests for wildlife communities

    Treesearch

    M North; P. Manley

    2012-01-01

    Forest management to maintain native wildlife communities is an important, yet complex objective. The complexities stem from two primary sources: habitat requirements for native species are diverse and span multiple spatial scales and seral stages, and habitat is a species-specific concept making multispecies community response difficult to predict. Given these...

  18. 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…

  19. The effects of a team-based continuous quality improvement intervention on the management of primary care: a randomised controlled trial

    PubMed Central

    Engels, Yvonne; van den Hombergh, Pieter; Mokkink, Henk; van den Hoogen, Henk; van den Bosch, Wil; Grol, Richard

    2006-01-01

    Aim To study the effects of a team-based model for continuous quality improvement (CQI) on primary care practice management. Design of study Randomised controlled trial. Setting Twenty-six intervention and 23 control primary care practices in the Netherlands. Method Practices interested in taking part in the CQI project were, after assessment of their practice organisation, randomly assigned to the intervention or control groups. During a total of five meetings, a facilitator helped the teams in the intervention group select suitable topics for quality improvement and follow a structured approach to achieve improvement objectives. Checklists completed by an outreach visitor, questionnaires for the GPs, staff and patients were used to assemble data on the number and quality of improvement activities undertaken and on practice management prior to the start of the intervention and 1 year later. Results Pre-test and post-test data were compared for the 26 intervention and 23 control practices. A significant intervention effect was found for the number of improvement objectives actually defined (93 versus 54, P<0.001) and successfully completed (80 versus 69% of the projects, P<0.001). The intervention group also improved on more aspects of practice management, as measured by our practice visit method, than the control group but none of these differences proved statistically significant. Conclusion The intervention exerted a significant effect on the number and quality of improvement projects undertaken and self-defined objectives met. Failure of the effects of the intervention on the other dimensions of practice management to achieve significance may be due to the topics selected for some of the improvement projects being only partly covered by the assessment instrument. PMID:17007709

  20. Evaluating Various Areas of Process Improvement in an Effort to Improve Clinical Research: Discussions from the 2012 Clinical Translational Science Award (CTSA) Clinical Research Management Workshop

    PubMed Central

    Cola, Philip A.; Rosenblum, Daniel

    2013-01-01

    Abstract Emphasis has been placed on assessing the efficiency of clinical and translational research as part of the National Institutes of Health (NIH) goal to “improve human health.” Improvements identified and implemented by individual organizations cannot address the research infrastructure needs of all clinical and translational research conducted. NIH's National Center for Advancing Translational Sciences (NCATS) has brought together 61 Clinical and Translational Science Award (CTSA) sites creating a virtual national laboratory that reflects the diversity and breadth of academic medical centers to collectively improve clinical and translational science. The annual Clinical Research Management workshop is organized by the CTSA consortium with participation from CTSA awardees, NIH, and others with an interest in clinical research management. The primary objective of the workshop is to disseminate information that improves clinical research management although the specific objectives of each workshop evolve within the consortium. The fifth annual workshop entitled “Learning by doing; applying evidence‐based tools to re‐engineer clinical research management” took place in June 2012. The primary objective of the 2012 workshop was to utilize data to evaluate, modify, and improve clinical research management. This report provides a brief summary of the workshop proceedings and the major themes discussed among the participants. PMID:23919369

  1. Leveraging the trusted clinician: documenting disease management program enrollment.

    PubMed

    Frazee, Sharon Glave; Kirkpatrick, Patricia; Fabius, Raymond; Chimera, Joseph

    2007-02-01

    The objective of this study was to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending), which combines telephonic-delivered disease management (TDM) with a worksite-based primary care center and pharmacy delivery, would yield higher contact and enrollment rates than traditional remote disease management alone. IDM is characterized by the combination of standard TDM with a worksite-based primary care and pharmacy delivery protocol led by trusted clinicians. This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols, and compares them on contact and enrollment efficiency. The IDM protocol showed a significant improvement in contact and enrollment rates over traditional TDM. Integrating a worksite-based primary care and pharmacy delivery system led by trusted clinicians with traditional TDM increases contact and enrollment rates, resulting in higher patient engagement. The IDM protocol should be adopted by employers seeking higher returns on their investment in disease management programming.

  2. Three-step management of pneumothorax: time for a re-think on initial management†

    PubMed Central

    Kaneda, Hiroyuki; Nakano, Takahito; Taniguchi, Yohei; Saito, Tomohito; Konobu, Toshifumi; Saito, Yukihito

    2013-01-01

    Pneumothorax is a common disease worldwide, but surprisingly, its initial management remains controversial. There are some published guidelines for the management of spontaneous pneumothorax. However, they differ in some respects, particularly in initial management. In published trials, the objective of treatment has not been clarified and it is not possible to compare the treatment strategies between different trials because of inappropriate evaluations of the air leak. Therefore, there is a need to outline the optimal management strategy for pneumothorax. In this report, we systematically review published randomized controlled trials of the different treatments of primary spontaneous pneumothorax, point out controversial issues and finally propose a three-step strategy for the management of pneumothorax. There are three important characteristics of pneumothorax: potentially lethal respiratory dysfunction; air leak, which is the obvious cause of the disease; frequent recurrence. These three characteristics correspond to the three steps. The central idea of the strategy is that the lung should not be expanded rapidly, unless absolutely necessary. The primary objective of both simple aspiration and chest drainage should be the recovery of acute respiratory dysfunction or the avoidance of respiratory dysfunction and subsequent complications. We believe that this management strategy is simple and clinically relevant and not dependent on the classification of pneumothorax. PMID:23117233

  3. Analysis, Modeling, and Simulation (AMS) Testbed Development and Evaluation to Support Dynamic Mobility Applications (DMA) and Active Transportation and Demand Management (ATDM) Programs - AMS Testbed Detailed Requirements

    DOT National Transportation Integrated Search

    2016-04-20

    The primary objective of this project is to develop multiple simulation Testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  4. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs - Chicago testbed analysis plan.

    DOT National Transportation Integrated Search

    2016-10-01

    The primary objective of this project is to develop multiple simulation Testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  5. Identifying best management practices to minimize P loss in a tile drained landscape

    USDA-ARS?s Scientific Manuscript database

    Phosphorus losses from agriculture have been identified as a primary contributor to harmful algal blooms in Lake Erie. The objectives of this presentation will be to provide estimates of cropping systems management and other conservation practices that can be used to minimize P losses from this land...

  6. The Impact of Supervision on Internal Medicine Residents' Attitudes and Management of Depression in Primary Care: A Pilot Study

    ERIC Educational Resources Information Center

    Milone, Jennifer M.; Gottumukkala, Aruna; Ward, Christopher P.; York, Kaki M.

    2013-01-01

    Objective: The authors examined the effect of supervision on internal medicine residents' attitudes toward and management of depression. Method: Internal medicine residents completed a survey during preclinical conferences. The survey included a published, validated questionnaire, the Depression Attitude Questionnaire, and items developed by the…

  7. A supply chain approach to biochar systems [Chapter 2

    Treesearch

    Nathaniel M. Anderson; Richard D. Bergman; Deborah S. Page-Dumroese

    2017-01-01

    Biochar systems are designed to meet four related primary objectives: improve soils, manage waste, generate renewable energy, and mitigate climate change. Supply chain models provide a holistic framework for examining biochar systems with an emphasis on product life cycle and end use. Drawing on concepts in supply chain management and engineering, this chapter presents...

  8. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs - evaluation plan : draft report.

    DOT National Transportation Integrated Search

    2016-07-13

    The primary objective of this project is to develop multiple simulation Testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  9. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs — evaluation summary for DMA program.

    DOT National Transportation Integrated Search

    2017-07-04

    The primary objective of this project is to develop multiple simulation testbeds/transportation models to evaluate the impacts of Dynamic Mobility Application (DMA) connected vehicle applications and Active Transportation and Demand management (ATDM)...

  10. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs - San Diego calibration report.

    DOT National Transportation Integrated Search

    2016-10-01

    The primary objective of this project is to develop multiple simulation Testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  11. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs : summary report for the Chicago testbed.

    DOT National Transportation Integrated Search

    2017-04-01

    The primary objective of this project is to develop multiple simulation testbeds and transportation models to evaluate the impacts of Connected Vehicle Dynamic Mobility Applications (DMA) and Active Transportation and Demand Management (ATDM) strateg...

  12. Analysis, Modeling, and Simulation (AMS) Testbed Development and Evaluation to Support Dynamic Mobility Applications (DMA) and Active Transportation and Demand Management (ATDM) Programs : Evaluation Report for the Chicago Testbed

    DOT National Transportation Integrated Search

    2017-04-01

    The primary objective of this project is to develop multiple simulation testbeds and transportation models to evaluate the impacts of Connected Vehicle Dynamic Mobility Applications (DMA) and Active Transportation and Demand Management (ATDM) strateg...

  13. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs — Chicago calibration report.

    DOT National Transportation Integrated Search

    2016-10-01

    The primary objective of this project is to develop multiple simulation Testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  14. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs - Pasadena testbed analysis plan : final report.

    DOT National Transportation Integrated Search

    2016-06-30

    The primary objective of this project is to develop multiple simulation Testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  15. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs — evaluation report for ATDM program.

    DOT National Transportation Integrated Search

    2017-07-16

    The primary objective of this project is to develop multiple simulation testbeds/transportation models to evaluate the impacts of Dynamic Mobility Applications (DMA) and the Active Transportation and Demand Management (ATDM) strategies. Specifically,...

  16. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs - San Diego testbed analysis plan.

    DOT National Transportation Integrated Search

    2016-10-01

    The primary objective of this project is to develop multiple simulation Testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  17. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs — evaluation summary for ATDM program.

    DOT National Transportation Integrated Search

    2017-07-04

    The primary objective of this project is to develop multiple simulation testbeds/transportation models to evaluate the impacts of Dynamic Mobility Application (DMA) connected vehicle applications and Active Transportation and Dynamic management (ATDM...

  18. Analysis, Modeling, and Simulation (AMS) Testbed Development and Evaluation to Support Dynamic Mobility Applications (DMA) and Active Transportation and Demand Management (ATDM) Programs - AMS Testbed Selection Criteria

    DOT National Transportation Integrated Search

    2016-06-16

    The primary objective of this project is to develop multiple simulation Testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  19. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs : Dallas testbed analysis plan.

    DOT National Transportation Integrated Search

    2016-06-16

    The primary objective of this project is to develop multiple simulation Testbeds/transportation models to evaluate theimpacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM)strategies. The outputs (mo...

  20. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs — evaluation report for DMA program.

    DOT National Transportation Integrated Search

    2017-02-02

    The primary objective of this project is to develop multiple simulation testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  1. Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study

    PubMed Central

    Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

    2015-01-01

    Objectives To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design Longitudinal study with three points of measurement. Setting Primary care practices in Switzerland. Participants In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: ‘infrastructure’, ‘information’, ‘finance’, and ‘quality and safety’ to examine changes over time. Results Significant improvements were found in three of four domains: ‘quality and safety’ (F=22.81, p<0.01), ‘information’ (F=27.901, p<0.01) and ‘finance’ (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). Conclusions The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. PMID:25900466

  2. 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

  3. A new design to evaluate erosion and sediment control

    Treesearch

    Johnny M. Grace

    2006-01-01

    Water quality issues surrounding sediment movement related to forest operations are a focus in forest management. The forest road system is a primary area of concern related to sediment movement because roads are a component of most forest operations. Controlling sediment movement is a common objective in most forestry best management practices (BMPs). However, there...

  4. Analysis, Modeling, and Simulation (AMS) Testbed Development and Evaluation to Support Dynamic Mobility Applications (DMA) and Active Transportation and Demand Management (ATDM) Programs — Calibration Report for San Mateo Testbed.

    DOT National Transportation Integrated Search

    2016-08-22

    The primary objective of this project is to develop multiple simulation Testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  5. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs - calibration report for Dallas testbed : final report.

    DOT National Transportation Integrated Search

    2016-10-01

    The primary objective of this project is to develop multiple simulation testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  6. Managing Emotion in a Maltreating Context: A Pilot Study Examining Child Neglect

    ERIC Educational Resources Information Center

    Shipman, Kimberly; Edwards, Anna; Brown, Amy; Swisher, Lisa; Jennings, Ernestine

    2005-01-01

    Objective: The primary goal of this pilot study was to examine emotion management skills (i.e., emotional understanding, emotion regulation) in children who had experienced neglect and a control group to determine the ways that neglect may interfere with children's emotional development. Method: Participants included children 6-12 years of age and…

  7. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs — gaps, challenges and future research.

    DOT National Transportation Integrated Search

    2017-05-01

    The primary objective of AMS project is to develop multiple simulation Testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. Through this p...

  8. Analysis, Modeling, and Simulation (AMS) Testbed Development and Evaluation to Support Dynamic Mobility Applications (DMA) and Active Transportation and Demand Management (ATDM) Programs - Evaluation Report for the San Diego Testbed

    DOT National Transportation Integrated Search

    2017-07-01

    The primary objective of this project is to develop multiple simulation testbeds and transportation models to evaluate the impacts of Connected Vehicle Dynamic Mobility Applications (DMA) and Active Transportation and Demand Management (ATDM) strateg...

  9. Analysis, Modeling, and Simulation (AMS) Testbed Development and Evaluation to Support Dynamic Mobility Applications (DMA) and Active Transportation and Demand Management (ATDM) Programs : Evaluation Report for the San Diego Testbed : Draft Report.

    DOT National Transportation Integrated Search

    2017-07-01

    The primary objective of this project is to develop multiple simulation testbeds and transportation models to evaluate the impacts of Connected Vehicle Dynamic Mobility Applications (DMA) and Active Transportation and Demand Management (ATDM) strateg...

  10. Analysis, Modeling, and Simulation (AMS) Testbed Development and Evaluation to Support Dynamic Mobility Applications (DMA) and Active Transportation and Demand Management (ATDM) Programs - calibration Report for Phoenix Testbed : Final Report.

    DOT National Transportation Integrated Search

    2016-10-01

    The primary objective of this project is to develop multiple simulation Testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  11. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic mobility applications (DMA) and active transportation and demand management (ATDM) programs - evaluation summary for the San Diego testbed

    DOT National Transportation Integrated Search

    2017-08-01

    The primary objective of this project is to develop multiple simulation testbeds and transportation models to evaluate the impacts of Connected Vehicle Dynamic Mobility Applications (DMA) and Active Transportation and Demand Management (ATDM) strateg...

  12. Analysis, modeling, and simulation (AMS) testbed development and evaluation to support dynamic applications (DMA) and active transportation and demand management (ATDM) programs — leveraging AMS testbed outputs for ATDM analysis – a primer.

    DOT National Transportation Integrated Search

    2017-08-01

    The primary objective of AMS Testbed project is to develop multiple simulation Testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. Throug...

  13. Analysis, Modeling, and Simulation (AMS) Testbed Development and Evaluation to Support Dynamic Mobility Applications (DMA) and Active Transportation and Demand Management (ATDM) Programs - San Mateo Testbed Analysis Plan : Final Report.

    DOT National Transportation Integrated Search

    2016-06-29

    The primary objective of this project is to develop multiple simulation testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  14. SunLine Expands Horizons with Fuel Cell Bus Demo

    DOT National Transportation Integrated Search

    2006-05-01

    The primary objective of this project is to develop multiple simulation Testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  15. Infrastructure monitoring data management.

    DOT National Transportation Integrated Search

    2015-07-01

    The primary objective of this project is to advance the development of a structural health monitoring : system (SHMS) for the Cut River Bridge. The scope includes performing an analysis from the fiber : optic strain gauge readings and making recommen...

  16. Understanding performance management in primary care.

    PubMed

    Rogan, Lisa; Boaden, Ruth

    2017-02-13

    Purpose Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care. Design/methodology/approach Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management. Findings There are various elements of the principal-agent framework that can be applied in primary care. Goal alignment is relevant, but can only be achieved through clear, strategic direction and consistent interpretation of objectives at all levels. There is confusion between performance measurement and performance management and a tendency to focus on things that are easy to measure whilst omitting aspects of care that are more difficult to capture. Appropriate use of incentives, good communication, clinical engagement, ownership and trust affect the degree to which information asymmetry is overcome and goal alignment achieved. Achieving the right balance between accountability and clinical autonomy is important to ensure governance and financial balance without stifling innovation. Originality/value The principal-agent theoretical framework can be used to attain a better understanding of performance management in primary care; although it is likely that only partial goal alignment will be achieved, dependent on the extent and level of alignment of a range of factors.

  17. [Management of heart failure in cardiology and primary care (MICCAP) program: Improving the management of patients with heart failure].

    PubMed

    Barrios, V; Escobar, C; Pallares, V; Egocheaga, M I; Lobos, J M; Bover, R; Gómez Doblas, J J; Cosín, J

    2018-03-26

    Despite current treatments, morbidity and mortality of patients with heart failure remain high. The late diagnosis of heart failure, the insufficient heart failure treatment (i.e. not using the appropriate drugs, prescribing lower doses of drugs than recommended, etc.), and a poor coordination between different health care levels, may explain, at least in part, these figures. The Management of Heart Failure in Cardiology and Primary Care (MICCAP) program has been developed with the aim of optimising the integrated management of patients with heart failure between Primary Care and Cardiology, through the improvement of coordination between both health care levels. This includes continuous medical education to reinforce the diagnostic and therapeutic skills of general practitioners in the field of heart failure. The rationale and objectives of the MICCAP program are summarised in this article. Copyright © 2018 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  18. The Missing Link: Improving Quality With a Chronic Disease Management Intervention for the Primary Care Office

    PubMed Central

    Zweifler, John

    2007-01-01

    Bold steps are necessary to improve quality of care for patients with chronic diseases and increase satisfaction of both primary care physicians and patients. Office-based chronic disease management (CDM) workers can achieve these objectives by offering self-management support, maintaining disease registries, and monitoring compliance from the point of care. CDM workers can provide the missing link by connecting patients, primary care physicans, and CDM services sponsored by health plans or in the community. CDM workers should be supported financially by Medicare, Medicaid, and commercial health plans through reimbursements to physicians for units of service, analogous to California’s Comprehensive Perinatal Services Program. Care provided by CDM workers should be standardized, and training requirements should be sufficiently flexible to ensure wide dissemination. CDM workers can potentially improve quality while reducing costs for preventable hospitalizations and emergency department visits, but evaluation at multiple levels is recommended. PMID:17893388

  19. [Conflict of interest in medical practice and research].

    PubMed

    Youn, Young Hoon; Lee, Ilhak

    2012-09-25

    In recent years, medical professionals are in charge with multiple roles. They have to work as an educator, researcher, and administrator, as well as medical practitioner. In addition, they experience a conflict between the primary responsibilities that each role requires of them. A conflict of interest (COI) is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest. It occurs when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation for an act in the other. The COI should be managed appropriately to preserve the value of public trust, scientific objectivity, and the benefit and safety of patients. Primary interest of medical professionals refers to the principal goals of the medical profession, such as the health and safety of patients, and the integrity of research. Secondary interest includes not only financial gain but also such motives as the desire for professional advancement and the wish to do favors for family and friends, but COI rules usually focus on financial relationships because they are relatively more objective, fungible, and quantifiable. This article will briefly review the COI in medical practice and research, discuss about what is COI, why we should manage it, and how we can manage it.

  20. Restoration handbook for sagebrush steppe ecosystems with emphasis on greater sage-grouse habitat—Part 2. Landscape level restoration decisions

    USGS Publications Warehouse

    Pyke, David A.; Knick, Steven T.; Chambers, Jeanne C.; Pellant, Mike; Miller, Richard F.; Beck, Jeffrey L.; Doescher, Paul S.; Schupp, Eugene W.; Roundy, Bruce A.; Brunson, Mark; McIver, James D.

    2015-12-07

    Land managers do not have resources to restore all locations because of the extent of the restoration need and because some land uses are not likely to change, therefore, restoration decisions made at the landscape to regional scale may improve the effectiveness of restoration to achieve landscape and local restoration objectives. We present a landscape restoration decision tool intended to assist decision makers in determining landscape objectives, to identify and prioritize landscape areas where sites for priority restoration projects might be located, and to aid in ultimately selecting restoration sites guided by criteria used to define the landscape objectives. The landscape restoration decision tool is structured in five sections that should be addressed sequentially. Each section has a primary question or statement followed by related questions and statements to assist the user in addressing the primary question or statement. This handbook will guide decision makers through the important process steps of identifying appropriate questions, gathering appropriate data, developing landscape objectives, and prioritizing landscape patches where potential sites for restoration projects may be located. Once potential sites are selected, land managers can move to the site-specific decision tool to guide restoration decisions at the site level.

  1. CERT(Restricted) Resilience Management Model (CERT(Restricted)-RMM) V1.1: NIST Special Publication 800-66 Crosswalk

    DTIC Science & Technology

    2013-10-01

    Technology Assets • EXD:SG2 Manage Risks Due to External Dependencies (SP1-SP2) • EXD:SG3.SP4 Formalize Relationships 5 . Data Backup Plan and...Information Access Management (C.E.R. § 164.308(a)(4)) 11 4.5. Security Awareness and Training (C.E.R. § 164.308(a)( 5 )) 13 4.6. Security Incident Procedures...for managing operational resilience. It has two primary objectives: • Establish the convergence of operational risk and resilience management

  2. Proof Rolling of Foundation Soil and Prepared Subgrade During Construction

    DOT National Transportation Integrated Search

    2017-07-04

    The primary objective of this project is to develop multiple simulation testbeds and transportation models to evaluate the impacts of Connected Vehicle Dynamic Mobility Applications (DMA) and Active Transportation and Demand Management (ATDM) strateg...

  3. The Interface between Substance Abuse and Chronic Pain Management in Primary Care: A Curriculum for Medical Residents

    ERIC Educational Resources Information Center

    Gunderson, Erik W.; Coffin, Phillip O.; Chang, Nancy; Polydorou, Soteri; Levin, Frances R.

    2009-01-01

    Objectives: To develop and assess a housestaff curriculum on opioid and other substance abuse among patients with chronic noncancer pain (CNCP). Methods: The two-hour, case-based curriculum delivered to small groups of medical housestaff sought to improve assessment and management of opioid-treated CNCP patients, including those with a substance…

  4. The management of risk. Part 4: Resolving complaints.

    PubMed

    Collier, Andrew

    2014-06-01

    Patient complaints invariably cause concern and distress. Whilst prevention should be the primary objective, this is not always possible. This final article in the series describes strategies for the management and resolution of complaints, as well as the advantages of good complaint handling. Clinical Relevance: Early and efficient resolution of complaints will reduce stress to all members of the dental team.

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

    ERIC Educational Resources Information Center

    Unal, Zafer; Unal, Aslihan

    2009-01-01

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

  6. The project shift: a form of participative management and staffing.

    PubMed

    Puckett, F

    1991-11-01

    North Colorado Medical Center is a 326 bed primary and tertiary care medical center serving northeastern Colorado and southwestern Nebraska. The pharmacy department provides 24-hour-a-day clinical and distributive services to both inpatients and outpatients with a staff of 1 clinical pharmacy coordinator, 10 pharmacists (excluding pharmacy manager), and 11 technicians. Rather than rely on one assistant manager, the pharmacy manager involves all interested staff pharmacists in various administrative, clinical, and distributive projects. These project (P) shifts are scheduled 8-hour shifts with minimal or no drug distribution duties. This staffing system and form of participative management has been used since 1983 and has been successful in achieving three objectives: it provides assistance to the manager in achieving certain departmental objectives; it provides job variety and professional growth/satisfaction for staff pharmacists; and it provides flexible and readily available source of pharmacists to meet personal leave days (vacation, illness, time off) needs.

  7. How to create more supportive supervision for primary healthcare: lessons from Ngamiland district of Botswana: co-operative inquiry group

    PubMed Central

    Nkomazana, Oathokwa; Mash, Robert; Wojczewski, Silvia; Kutalek, Ruth; Phaladze, Nthabiseng

    2016-01-01

    Background Supportive supervision is a way to foster performance, productivity, motivation, and retention of health workforce. Nevertheless there is a dearth of evidence of the impact and acceptability of supportive supervision in low- and middle-income countries. This article describes a participatory process of transforming the supervisory practice of district health managers to create a supportive environment for primary healthcare workers. Objective The objective of the study was to explore how district health managers can change their practice to create a more supportive environment for primary healthcare providers. Design A facilitated co-operative inquiry group (CIG) was formed with Ngamiland health district managers. CIG belongs to the participatory action research paradigm and is characterised by a cyclic process of observation, reflection, planning, and action. The CIG went through three cycles between March 2013 and March 2014. Results Twelve district health managers participated in the inquiry group. The major insights and learning that emerged from the inquiry process included inadequate supervisory practice, perceptions of healthcare workers’ experiences, change in the managers’ supervision paradigm, recognition of the supervisors’ inadequate supervisory skills, and barriers to supportive supervision. Finally, the group developed a 10-point consensus on what they had learnt regarding supportive supervision. Conclusion Ngamiland health district managers have come to appreciate the value of supportive supervision and changed their management style to be more supportive of their subordinates. They also developed a consensus on supportive supervision that could be adapted for use nationally. Supportive supervision should be prioritised at all levels of the health system, and it should be adequately resourced. PMID:27345024

  8. Waste management in primary healthcare centres of Iran.

    PubMed

    Mesdaghinia, Alireza; Naddafi, Kazem; Mahvi, Amir Hossein; Saeedi, Reza

    2009-06-01

    The waste management practices in primary healthcare centres of Iran were investigated in the present study. A total of 120 primary healthcare centres located across the country were selected using the cluster sampling method and the current situation of healthcare waste management was determined through field investigation. The quantities of solid waste and wastewater generation per outpatient were found to be 60 g outpatient(-1) day(-1) and 26 L outpatient(-1) day(-1), respectively. In all of the facilities, sharp objects were separated almost completely, but separation of other types of hazardous healthcare solid waste was only done in 25% of the centres. The separated hazardous solid waste materials were treated by incineration, temporary incineration and open burning methods in 32.5, 8.3 and 42.5% of the healthcare centres, respectively. In 16.7% of the centres the hazardous solid wastes were disposed of without any treatment. These results indicate that the management of waste materials in primary healthcare centres in Iran faced some problems. Staff training and awareness, separation of healthcare solid waste, establishment of the autoclave method for healthcare solid waste treatment and construction of septic tanks and disinfection units in the centres that were without access to a sewer system are the major measures that are suggested for improvement of the waste management practices.

  9. The measurement of adult blood pressure and management of hypertension before elective surgery: Joint Guidelines from the Association of Anaesthetists of Great Britain and Ireland and the British Hypertension Society.

    PubMed

    Hartle, A; McCormack, T; Carlisle, J; Anderson, S; Pichel, A; Beckett, N; Woodcock, T; Heagerty, A

    2016-03-01

    This guideline aims to ensure that patients admitted to hospital for elective surgery are known to have blood pressures below 160 mmHg systolic and 100 mmHg diastolic in primary care. The objective for primary care is to fulfil this criterion before referral to secondary care for elective surgery. The objective for secondary care is to avoid spurious hypertensive measurements. Secondary care should not attempt to diagnose hypertension in patients who are normotensive in primary care. Patients who present to pre-operative assessment clinics without documented primary care blood pressures should proceed to elective surgery if clinic blood pressures are below 180 mmHg systolic and 110 mmHg diastolic. © 2016 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.

  10. Leveraging the trusted clinician: increasing retention in disease management through integrated program delivery.

    PubMed

    Frazee, Sharon Glave; Sherman, Bruce; Fabius, Raymond; Ryan, Pamela; Kirkpatrick, Patricia; Davis, Jeffery

    2008-10-01

    Disease management's (DM's) value largely depends on achieving and maintaining participation. Simply being enrolled in a program does not guarantee engaged participation by enrollees, a necessary factor to achieve the improved health outcomes and subsequent reduced health care costs that are the ultimate objective of DM. The objective of this study is to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending), which combines telephonic-delivered disease management (TDM) with a worksite-based primary care center and pharmacy delivery, yields higher patient retention rates than traditional remote DM alone. An earlier study of the IDM protocol found that integrating a worksite-based primary care and pharmacy delivery system with traditional telephonic-based DM substantially increased contact, enrollment, and engagement rates compared to traditional stand-alone telephonic DM. This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols and compares participation rates at 6- and 12-month intervals as well as measures of continued retention in the DM program. The IDM protocol showed a significant improvement in participation persistence over traditional TDM. Integrating a worksite-based primary care and pharmacy delivery system led by "trusted clinicians at the workplace"trade mark with traditional telephonic-based DM not only increases contact and enrollment rates, but also results in higher patient engagement and retention. These improvements in participation are expected to result in improved outcomes for a larger proportion of the target population than traditional telephonic DM.

  11. LIFE CYCLE DESIGN OF MILK AND JUICE PACKAGING

    EPA Science Inventory

    A life cycle design demonstration project was initiated between the U.S. Environmental Protection Agency, National Risk Management Research Laboratory, Dow Chemical Company, and the University of Michigan to investigate milk and juice packagie design. The primary objective of ...

  12. 48 CFR 49.201 - General.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....201 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TERMINATION OF CONTRACTS Additional Principles for Fixed-Price Contracts Terminated for Convenience 49.201... strict accounting principles, is the heart of a settlement. (b) The primary objective is to negotiate a...

  13. Evaluation of a foam dressing for acute and chronic wound exudate management.

    PubMed

    Bullough, Lindsay; Johnson, Sue; Forder, Rebecca

    2015-09-01

    This article discusses the use of a foam dressing for exudate management in both chronic and acute wounds, such as surgical wounds, pressure ulcers, diabetic ulcers, trauma wounds, and leg ulcers. The primary objective of the study was to observe patients' wound progression in terms of wound size and the condition of the wound bed, when using this foam dressing as either a primary or secondary dressing. The outcome of the evaluation demonstrated that ActivHeal Foam Contact dressing effectively managed exudate. It was also observed that the dressing can assist in autolysis and support improvements in peri-wound status. Choosing an appropriate dressing to manage a wound is essential. Clinicians working in the NHS are under pressure to deliver good-quality clinical outcomes, and the ActivHeal Foam Contact dressing supports this outcome.

  14. Advanced Computing Technologies for Rocket Engine Propulsion Systems: Object-Oriented Design with C++

    NASA Technical Reports Server (NTRS)

    Bekele, Gete

    2002-01-01

    This document explores the use of advanced computer technologies with an emphasis on object-oriented design to be applied in the development of software for a rocket engine to improve vehicle safety and reliability. The primary focus is on phase one of this project, the smart start sequence module. The objectives are: 1) To use current sound software engineering practices, object-orientation; 2) To improve on software development time, maintenance, execution and management; 3) To provide an alternate design choice for control, implementation, and performance.

  15. Using systems science for population health management in primary care.

    PubMed

    Li, Yan; Kong, Nan; Lawley, Mark A; Pagán, José A

    2014-10-01

    Population health management is becoming increasingly important to organizations managing and providing primary care services given ongoing changes in health care delivery and payment systems. The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes. The New York Academy of Medicine Cardiovascular Health Simulation model (an agent-based model) and data from the Behavioral Risk Factor Surveillance System were used to evaluate a lifestyle program that could be implemented in primary care practice settings. The program targeted Medicare-age adults and focused on improving diet and exercise and reducing weight. The simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 years). Similar results were found for the subpopulations with high cholesterol, but the proposed intervention would not have a significant effect in the proportion of the population with hypertension over a time period of <5 years. Systems science methodologies can be useful to compare the health outcomes of different interventions. These tools can become an important component of population health management because they can help managers and other decision makers evaluate alternative programs in primary care settings. © The Author(s) 2014.

  16. Integrating nutrition services into primary care

    PubMed Central

    Crustolo, Anne Marie; Kates, Nick; Ackerman, Sari; Schamehorn, Sherri

    2005-01-01

    PROBLEM BEING ADDRESSED Nutrition services can have an important role in prevention and management of many conditions seen by family physicians, but access to these services in primary care is limited. OBJECTIVE OF PROGRAM To integrate specialized nutrition services into the offices of family physicians in Hamilton, Ont, in order to improve patient access to those services, to expand the range of problems seen in primary care, and to increase collaboration between family physicians and registered dietitians. PROGRAM DESCRIPTION Registered dietitians were integrated into the offices of 80 family physicians. In collaboration with physicians, they assessed, treated, and consulted on a variety of nutrition-related problems. A central management team coordinated the dietitians’ activities. CONCLUSION Registered dietitians can augment and complement family physicians’ activities in preventing, assessing, and treating nutrition-related problems. This model of shared care can be applied to integrating other specialized services into primary care practices. PMID:16805083

  17. 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

  18. Providing Effective Support to Teachers in Addressing Social, Emotional and Behavioural Difficulties in Mainstream Classrooms in a Bangalore Pre-Primary School

    ERIC Educational Resources Information Center

    D'Souza, Mildred; Jament, Johnson

    2015-01-01

    This article reports a study conducted on children's social, emotional and behavioural difficulties (SEBD) in a single pre-primary school in Bangalore, with the objective of developing a behaviour management policy for use by teachers. Limited evidence is available in the Indian literature in the area of SEBD and it remains important to know how…

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

    PubMed

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

    2016-01-01

    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. 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. 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. The intervention was well accepted by primary health care teams. However, the clinical impact in patients still has to be evaluated.

  20. Integrated obesity care management system -implementation and research protocol

    PubMed Central

    Baillargeon, Jean-Patrice; Carpentier, André; Donovan, Denise; Fortin, Martin; Grant, Andrew; Simoneau-Roy, Judith; St-Cyr-Tribble, Denise; Xhignesse, Mariane; Langlois, Marie-France

    2007-01-01

    Background Nearly 50% of Canadians are overweight and their number is increasing rapidly. The majority of obese subjects are treated by primary care physicians (PCPs) who often feel uncomfortable with the management of obesity. The current research proposal is aimed at the development and implementation of an innovative, integrated, interdisciplinary obesity care management system involving both primary and secondary care professionals. Methods We will use both action and evaluative research in order to achieve the following specific objectives. The first one is to develop and implement a preceptorship-based continuing medical education (CME) program complemented by a web site for physicians and nurses working in Family Medicine Groups (FMGs). This CME will be based on needs assessment and will be validated by one FMG using questionnaires and semi structured interviews. Also, references and teaching tools will be available for participants on the web site. Our second objective is to establish a collaborative intra and inter-regional interdisciplinary network to enable on-going expertise update and networking for FMG teams. This tool consists of a discussion forum and monthly virtual meetings of all participants. Our third objective is to evaluate the implementation of our program for its ability to train 8 FMGs per year, the access and utilization of electronic tools and the participants' satisfaction. This will be measured with questionnaires, web logging tools and group interviews. Our fourth objective is to determine the impact for the participants regarding knowledge and expertise, attitudes and perceptions, self-efficacy for the management of obesity, and changes in FMG organization for obesity management. Questionnaires and interviews will be used for this purpose. Our fifth objective is to deliver transferable knowledge for health professionals and decision-makers. Strategies and pitfalls of setting up this program will also be identified. Conclusion This project is relevant to health system's decision-makers who are confronted with an important increase in the prevalence of obesity. It is therefore critical to develop strategies allowing the management of obesity in the 1st line setting. Results of this research project could therefore influence health care organization in the field of obesity but also eventually for other chronic diseases. PMID:17927835

  1. Long-term impacts of even-aged timber management on abundance and body condition of terrestrial amphibians in Northwestern California

    Treesearch

    N.E. Karraker; H.H. Welsh Jr

    2006-01-01

    Conservation needs for amphibians in managed timberlands may differ based upon the species present and the timber harvesting methods employed. Clearcuts have been documented to be detrimental to amphibians but the impacts of associated silvicultural edges and alternative harvesting treatments are not well understood. The primary objective of this study was to determine...

  2. Guidelines for Teaching Personal and Family Money Management (Consumer Education) in Junior and Senior High School Homemaking Classes. Second Edition, Revised.

    ERIC Educational Resources Information Center

    Granberg, Grace, Ed.

    The primary objective of the guide is to help teachers and administrators identify scope and plan for sequence in learning experiences in teaching consumer aspects of personal and family money management in grades 7-12. Behavioral outcomes and principles at the beginning (you), intermediate (your family), and advanced (your future) levels of…

  3. Integrated Corridor Management (ICM) Initiative : ICM Surveillance and Detection Requirements for Arterial and Transit Networks

    DOT National Transportation Integrated Search

    2008-10-01

    The primary objective of the ICM Initiative is to demonstrate how Intelligent Transportation System (ITS) technologies can efficiently and proactively facilitate the movement of people and goods through major transportation corridors that comprise a ...

  4. Performance analysis of Virginia's safety service patrol programs : a case study approach.

    DOT National Transportation Integrated Search

    2006-01-01

    Many state departments of transportation (DOTs) operate safety service patrols (SSPs) as part of their incident management programs. The primary objectives of SSPs are to minimize the duration of freeway incidents, restore full capacity of the freewa...

  5. Developing a network-level structural capacity index for structural evaluation of pavements.

    DOT National Transportation Integrated Search

    2013-03-01

    The objective of this project was to develop a structural index for use in network-level pavement evaluation to facilitate : the inclusion of the pavements structural condition in pavement management applications. The primary goal of network-level...

  6. Biodiesel Research : Alternative Fuels & Life-Cycle Engineering Program : November 29, 2006 to November 28, 2011

    DOT National Transportation Integrated Search

    2011-12-20

    The primary objective of this project is to develop multiple simulation Testbeds/transportation models to evaluate the impacts of DMA connected vehicle applications and the active and dynamic transportation management (ATDM) strategies. The outputs (...

  7. Locomotive Crash Energy Management Coupling Tests

    DOT National Transportation Integrated Search

    2018-04-18

    This paper describes the results of the CEM equipped locomotive coupling tests. In this set of tests, a moving CEM locomotive was coupled to a standing cab car. The primary objective was to demonstrate the robustness of the PBC design and determine t...

  8. [Application of "disease management" to the organization and compensation of professionals in the U.S.A., Germany and England: prospects for France].

    PubMed

    Morin, Ludovic; Christian, Foury; Briot, Pascal; Perrocheau, Antonin; Pascal, Jean

    2010-01-01

    Disease management, developed in the U.S.A. in the 1990s, is a comprehensive integrated approach that aims to incorporate all phases of chronic disease management from prevention to health education. Its main objective is to optimize patient care services by making patients more responsible for the management of their chronic disease. The specificity of its implementation in different countries is reflected by its translation into various concepts, such as: in the United States by the concept of the "Medical Home", in Germany by establishing contracts that encourage GPs and social security funds to support patients with chronic diseases, and in the United Kingdom through programs with measures that support the delegation of tasks and cooperation between primary care professionals. Disease management is accompanied by the introduction of new forms of payment for doctors and primary care facilities that ensure the effective implementation of the underpinning principles of disease management programs. In France, the development of the disease management approach is being promoted and advocated for integration into primary care, as it is gradually becoming an integral part of the French National Health Insurance Fund's strategy to enhance and improve the quality of care.

  9. An algorithm recommendation for the pharmacological management of allergic rhinitis in the UK: a consensus statement from an expert panel.

    PubMed

    Lipworth, Brian; Newton, Jon; Ram, Bhaskar; Small, Iain; Schwarze, Jürgen

    2017-01-23

    Allergic rhinitis is a frequent presenting problem in primary care in the UK, and has increased in prevalence over the last 30 years. When symptomatic, patients report significant reduction in their quality of life and impairment in school and work performance. Achieving adequate symptom control is pivotal to successful allergic rhinitis management, and relies mostly on pharmacotherapy. While it is recognised that most mild-moderate allergic rhinitis symptoms can be managed successfully in primary care, important gaps in general practitioner training in relation to allergic rhinitis have been identified. With the availability of new effective combination therapies, such as the novel intranasal formulation of azelastine hydrochloride and fluticasone propionate in a single device (Dymista®; Meda), the majority of allergic rhinitis symptoms can be treated in the primary care setting. The primary objective of this consensus statement is to improve diagnosis and treatment of allergic rhinitis in primary care, and offer guidance on appropriate referral of difficult-to-treat patients into secondary care. The guidance provided herein outlines a sequential treatment pathway for allergic rhinitis in primary care that incorporates a considered approach to improve the management of allergic rhinitis symptoms and improve compliance and patient satisfaction with therapy. Adherence with this care pathway has the potential to limit the cost of providing effective allergic rhinitis management in the UK by avoiding unnecessary treatments and investigations, and avoiding the need for costly referrals to secondary care in the majority of allergic rhinitis cases. The fundamentals presented in this consensus article should apply in most health-care settings.

  10. A narrative review of medical, chiropractic, and alternative health practices in the treatment of primary dysmenorrhea

    PubMed Central

    Spears, Lolita G.

    2005-01-01

    Abstract Objective Primary dysmenorrhea and related issues are discussed as they influence the gynecological and social health of females during adolescence, adulthood, and senior maturity. Health practitioners are exposed to multiple approaches towards the management of menstrual pain. Clinical and social viewpoints target the causation, development, diagnosis, manifestation and management of primary dysmenorrhea. This narrative review includes the topic of the doctor-patient relationship in efforts of cultivating effectively communicative health practitioners. Controversial topics related to primary dysmenorrhea and the quality of life for women are addressed. Data Sources A search for literature reviews, case studies, laboratory research, and clinical trials from 1985–2004 was performed using the MEDLINE database. Sources of additional information included textbooks, national organizational literature and contemporary articles. Discussion Menstrual pain is a prevalent experience yet it is socially taboo for conversation; as such, it poses a hindrance to its management. The communication between the doctor and patient is a critical barrier point between establishing a diagnosis and determining an appropriate treatment plan. A multi-disciple treatment plan varies as much as patients themselves vary in personal experiences, needs, and preferences. Conclusions Medicinal prophylactics, physical therapeutics, non-acidic diets, herbal supplements, eastern therapies and the chiropractic manual adjustments of the spine are effective methods for the management of primary dysmenorrhea. The non-invasive management of primary dysmenorrhea includes the chiropractic adjustment with complimentary modalities, and other alternative health care practices. Medicinal prophylactics are invasive and pose a higher risk to long-term chemical exposure, side effects or irreversible conditions. PMID:19674650

  11. The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review

    PubMed Central

    Stellefson, Michael; Stopka, Christine

    2013-01-01

    Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: “chronic care model” (and) “diabet*.” We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies. Results The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP office–based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies. Conclusion CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making. PMID:23428085

  12. Recognizing and managing depression in primary care: a standardized patient study.

    PubMed

    Carney, P A; Dietrich, A J; Eliassen, M S; Owen, M; Badger, L W

    1999-12-01

    Guidelines for recognition and management of depression in primary care provide a framework for detailed exploration of physician practice patterns. Our objective was to explore physician diagnosis and management approaches to depressive disorders according to type (major vs. minor) and presenting complaint (difficulty sleeping and concentrating vs. headache). The participants were community primary care internists and family physicians in northern New England, Washington, and Alabama (N = 149) who were randomly assigned to receive a visit from an unannounced actor portraying a standardized patient in 1 of 2 depression scenarios: (A) insomnia and poor concentration meeting Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) criteria for major depressive disorder; or (B) tension headaches meeting the criteria for minor depression. All physicians who were assigned to the standardized patients presenting with scenario A recognized depression, and 49% (38 of 78) of those assigned to scenario B patients diagnosed depression. Of those recognizing depression, 72% and 42% queried patients about anhedonia and mood, respectively. For both scenarios, if fewer than 2 DSM-III-R criteria were explored, depression was not diagnosed. Management for scenario A was compatible with Agency for Health Care Policy and Research guidelines, including the prescription of an antidepressant (94%), scheduling of a follow-up visit within 2 weeks (61%), and exploration of suicidal ideation (69.4%). For scenario B, management included over-the-counter analgesics for the headache (84%), exercise (63%), prescription for an antidepressant (53%), recommendation for ongoing counseling (100%), and follow-up within 2 weeks (42%). Major depression is recognized in primary care at a very high rate. Guidelines for recognizing and managing depression are often followed in primary care. Patients' presentations of depression influence its recognition and management.

  13. Evaluation of diabetes care management in primary clinics based on the guidelines of American Diabetes Association.

    PubMed

    Albarrak, Ahmed Ismail; Mohammed, Rafiuddin; Assery, Bushra; Allam, Dalya; Morit, Sarah Al; Saleh, Reem Al; Zare'a, Reem

    2018-01-01

    There is a rapid increase in the incidence of diabetes mellitus in Saudi Arabia. Diabetes management is an essential constituent to prevent prognosis of diabetes complications. The main objective of this study was to assess diabetes care in primary clinics based on the guidelines of American Diabetes Association (ADA). A retrospective study at King Khaled University Hospitals, Riyadh, Saudi Arabia. A total of 200 patients were randomly selected from the databases of primary care clinics. An evaluation checklist was created based on the ADA treatment guidelines such as medical history, physical examination, laboratory evaluation, and referrals. The result showed that elements achieving the ADA targets for overall care were medical history (44.9%), physical examination (59.6%), laboratory evaluation (36.3%), and referrals (19.3%). The other subelement indicators such as referral to diabetes self-management education clinics (10%), dental examination (2%), HbA1c regular monitoring (33.5%), and blood pressure determination (100%) were documented with adherence to ADA standards. Diabetes management standards are an essential element in the success of the management plan. Most of the elements examined are not in full compliance with the ADA standard. Continues monitoring and self-review are recommended.

  14. Determinants of compliance with nasal continuous positive airway pressure treatment applied in a community setting.

    PubMed

    Ball, E M.; Banks, M B.

    2001-05-01

    Objectives: To assess determinants of nasal continuous positive airway pressure (CPAP) compliance when applied in a community setting.Background: One-third of obstructive sleep apnea patients eventually refuse CPAP therapy. Treatment outcomes may be improved by identifying predictors of CPAP failure, including whether management by primary care physicians without sleep consultation affects results.Methods: Polysomnogram, chart review, and questionnaire results for regular CPAP users (n=123) were compared with those returning the CPAP machine (n=26).Results: Polysomnographic data and the presence of multiple sleep disorders were only modestly predictive of CPAP compliance. Striking differences in questionnaire responses separated CPAP users from non-users, who reported less satisfaction with all phases of their diagnosis and management. Rates of CPAP use were not significantly different between patients managed solely by their primary care physician or by a sleep consultant.Conclusions: Polysomnographic findings are unlikely to identify eventual CPAP non-compliers in a cost-effective fashion. Improvements in sleep apnea management may result from addressing the role of personality factors and multiple sleep disorders in determining compliance. In this practice setting, management by primary care physicians did not significantly degrade CPAP compliance.

  15. Management of orthodontic emergencies in primary care - self-reported confidence of general dental practitioners.

    PubMed

    Popat, H; Thomas, K; Farnell, D J J

    2016-07-08

    Objective To determine general dental practitioners' (GDPs) confidence in managing orthodontic emergencies.Design Cross-sectional study.Setting Primary dental care.Subjects and methods An online survey was distributed to dentists practicing in Wales. The survey collected basic demographic information and included descriptions of ten common orthodontic emergency scenarios.Main outcome measure Respondents' self-reported confidence in managing the orthodontic emergency scenarios on a 5-point Likert scale. Differences between the Likert responses and the demographic variables were investigated using chi-squared tests.Results The median number of orthodontic emergencies encountered by respondents over the previous six months was 1. Overall, the self-reported confidence of respondents was high with 7 of the 10 scenarios presented scoring a median of 4 indicating that GDPs were 'confident' in their management. Statistical analysis revealed that GDPs who saw more orthodontic emergencies in the previous six months were more confident when managing the presented scenarios. Other variables such as age, gender, geographic location of practice and number of years practising dentistry were not associated with self-reported confidence.Conclusions Despite GDPs encountering very few orthodontic emergencies in primary care, they appear to be confident in dealing with commonly arising orthodontic emergency situations.

  16. Role of the family doctor in the management of adults with obesity: a scoping review

    PubMed Central

    Elmitt, Nicholas; Haelser, Emily; Douglas, Kirsty A

    2018-01-01

    Objectives Obesity management is an important issue for the international primary care community. This scoping review examines the literature describing the role of the family doctor in managing adults with obesity. The methods were prospectively published and followed Joanna Briggs Institute methodology. Setting Primary care. Adult patients. Included papers Peer-reviewed and grey literature with the keywords obesity, primary care and family doctors. All literature published up to September 2015. 3294 non-duplicate papers were identified and 225 articles included after full-text review. Primary and secondary outcome measures Data were extracted on the family doctors’ involvement in different aspects of management, and whether whole person and person-centred care were explicitly mentioned. Results 110 papers described interventions in primary care and family doctors were always involved in diagnosing obesity and often in recruitment of participants. A clear description of the provider involved in an intervention was often lacking. It was difficult to determine if interventions took account of whole person and person-centredness. Most opinion papers and clinical overviews described an extensive role for the family doctor in management; in contrast, research on current practices depicted obesity as undermanaged by family doctors. International guidelines varied in their description of the role of the family doctor with a more extensive role suggested by guidelines from family medicine organisations. Conclusions There is a disconnect between how family doctors are involved in primary care interventions, the message in clinical overviews and opinion papers, and observed current practice of family doctors. The role of family doctors in international guidelines for obesity may reflect the strength of primary care in the originating health system. Reporting of primary care interventions could be improved by enhanced descriptions of the providers involved and explanation of how the pillars of primary care are used in intervention development. PMID:29453301

  17. Integrated corridor management (ICM) initiative : ICM surveillance and detection needs analysis for the transit data gap.

    DOT National Transportation Integrated Search

    2008-11-01

    The primary objective of the ICM Initiative is to demonstrate how Intelligent Transportation System (ITS) technologies can efficiently and proactively facilitate the movement of people and goods through major transportation corridors that comprise a ...

  18. LADOTD pavement management system (PMS) for project level applications.

    DOT National Transportation Integrated Search

    2011-06-01

    To fully address the research needs described in the problem statement, the primary objective of this project is to develop guidelines that provide information on how network level PMS data can be used at a project level in activities of pavement eng...

  19. Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services

    DOT National Transportation Integrated Search

    2018-01-11

    Background: Administrators of Emergency Medical Services (EMS) operations lack guidance on how to mitigate workplace fatigue, which affects greater than half of all EMS personnel. The primary objective of the Fatigue in EMS Project was to create an e...

  20. Integrated corridor management (ICM) initiative : ICM surveillance and detection requirements needs analysis for the arterial data gap.

    DOT National Transportation Integrated Search

    2008-11-01

    The primary objective of the ICM Initiative is to demonstrate how Intelligent Transportation System (ITS) technologies can efficiently and proactively facilitate the movement of people and goods through major transportation corridors that comprise a ...

  1. Ecosystem Services in the Gulf of Maine

    EPA Science Inventory

    The primary goal of ecosystem-based management (EBM) is to sustain the long-term capacity of the natural world to provide ecosystem services. A technical workshop was held with the object of moving toward identifying, mapping, quantifying, and valuing ecosystem services in the G...

  2. 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

  3. Are we under-utilizing the talents of primary care personnel? A job analytic examination

    PubMed Central

    Hysong, Sylvia J; Best, Richard G; Moore, Frank I

    2007-01-01

    Background Primary care staffing decisions are often made unsystematically, potentially leading to increased costs, dissatisfaction, turnover, and reduced quality of care. This article aims to (1) catalogue the domain of primary care tasks, (2) explore the complexity associated with these tasks, and (3) examine how tasks performed by different job titles differ in function and complexity, using Functional Job Analysis to develop a new tool for making evidence-based staffing decisions. Methods Seventy-seven primary care personnel from six US Department of Veterans Affairs (VA) Medical Centers, representing six job titles, participated in two-day focus groups to generate 243 unique task statements describing the content of VA primary care. Certified job analysts rated tasks on ten dimensions representing task complexity, skills, autonomy, and error consequence. Two hundred and twenty-four primary care personnel from the same clinics then completed a survey indicating whether they performed each task. Tasks were catalogued using an adaptation of an existing classification scheme; complexity differences were tested via analysis of variance. Results Objective one: Task statements were categorized into four functions: service delivery (65%), administrative duties (15%), logistic support (9%), and workforce management (11%). Objective two: Consistent with expectations, 80% of tasks received ratings at or below the mid-scale value on all ten scales. Objective three: Service delivery and workforce management tasks received higher ratings on eight of ten scales (multiple functional complexity dimensions, autonomy, human error consequence) than administrative and logistic support tasks. Similarly, tasks performed by more highly trained job titles received higher ratings on six of ten scales than tasks performed by lower trained job titles. Contrary to expectations, the distribution of tasks across functions did not significantly vary by job title. Conclusion Primary care personnel are not being utilized to the extent of their training; most personnel perform many tasks that could reasonably be performed by personnel with less training. Primary care clinics should use evidence-based information to optimize job-person fit, adjusting clinic staff mix and allocation of work across staff to enhance efficiency and effectiveness. PMID:17397534

  4. The EROS Data Center

    USGS Publications Warehouse

    ,

    1977-01-01

    The Earth Resources Observation Systems (EROS) Program of the U.S. Department of the Interior, administered by the Geological Survey, was established in 1966 to apply remote-sensing techniques to the inventory, monitoring, and management of natural resources. To meet its primary objective, the EROS Program includes research and training in the interpretation and application of remotely sensed data and provides remotely sensed data at nominal cost to scientists, resource planners, managers, and the public.

  5. The EROS Data Center

    USGS Publications Warehouse

    ,

    1981-01-01

    The Earth Resources Observation Systems (EROS) Program of the U.S. Department of the Interior, administered by the Geological Survey, was established in 1966 to apply remote-sensing techniques to the inventory, monitoring, and management of natural resources. To meet its primary objective, the EROS Program includes research and training in the interpretation and application of remotely sensed data and provides remotely sensed data at nominal cost to scientists, resource planners, managers, and the public.

  6. Organization, management, implementation and value of ehr implementation in a solo pediatric practice.

    PubMed

    Cooper, Jeffrey D

    2004-01-01

    This case study-based on this practice's application for the 2003 HIMSS Davies Award for Primary Care-describes the processes, costs and benefits of the implementation of an EHR in a solo practice. The organization, management and value of an EHR implementation is described, as well as a description of the physician's 15 business objectives, which shows how each objective was met and to what degree and gives specific financial data. An EHR that is implemented in a small practice improves quality of patient care, office efficiency and patient safety. A small practice can realize significant ROI from an EHR.

  7. Innovative Internal Camera Inspection and Data Management for Effective Condition Assessment of Collection Systems

    EPA Science Inventory

    The primary objective of this guidance document is to identify and evaluate innovative closed-circuit television (CCTV) and related technologies currently used by more advanced wastewater utilities to conduct condition assessment programs. The document is intended to facilitate ...

  8. ASSESSING AND MANAGING MERCURY FROM HISTORIC AND CURRENT MINING ACTIVITIES

    EPA Science Inventory

    In order for ORD to address uncertainties resulting from past or historical mining practices a technology transfer workshop was conducted in November, 2000 in San Francisco, CA. Two primary objectives for this workshop were: 1) identify state-of-the-science practices and techniqu...

  9. [Design of an educational tool for Primary Care patients with chronic non-specific low back pain].

    PubMed

    Díaz-Cerrillo, Juan Luis; Rondón-Ramos, Antonio

    2015-02-01

    Current scientific evidence on the management of chronic non-specific low back pain highlights the benefits of physical exercise. This goal is frequently undermined due to lack of education of the subjects on the multifactorial, benign, and non-specific nature of low back pain, which can lead to a chronic disease with genuine psychosocial risk factors. Its influence may not only interfere with individual decision to adopt more adaptive coping behaviors, but also with the endogenous mechanisms of pain neuromodulation. Thus, the educational strategies and control of these factors have become important objectives to be incorporated into the management of the disorder and research guidelines. This paper presents the theoretical models and the scientific basis on which it has based the design of an educational tool for patients with chronic non-specific low back pain treated in Primary Care physiotherapy. Structure, content and objectives are also presented. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  10. Role-play facilitates children's mindreading of those with atypical color perception.

    PubMed

    Furumi, Fumikazu; Koyasu, Masuo

    2014-01-01

    The present study examined the effects of role-play experience on children's mindreading ability. Forty-one primary school children (20 boys, 21 girls, mean age: 9.37 years, range: 8-11 years) were introduced to a communication task in which the use of mindreading was essential. During each trial, participants viewed a shelf, presented on a laptop, which contained several familiar objects, and they were instructed to touch an object on the shelf following an order issued by a "manager" who stood at the opposite side of the shelf. There were two managers: one was a monkey manager with normal color vision, and the other was a dog manager with restricted color vision. The monkey manager could see all the objects in the same colors as the participants, whereas the dog manager saw some objects in different colors. Participants were required to respond according to the manager's instruction. In the restricted color vision condition, the dog manager saw the colors of objects differently; thus, participants had to work out his intentions, according to his different perspective. In the normal color vision condition, all objects were in the same colors as those seen by the monkey manager. Before the test phase, participants in the role-play group were provided a role-play experience in which they assumed the role of the dog manager with restricted color vision. The experimental data were analyzed using a 2 × 2 mixed-design ANOVA (role-play condition × communication partner condition) to examine differences in the error rate. Both main effects and its interaction were significant. According to the post-hoc analyses, participants in the no-role-play condition made significantly more errors in the restricted color vision condition than in the normal color vision condition, whereas no such difference was found among participants in the role-play condition. These results suggest that role-play experience could facilitate mindreading of characters with restricted color vision.

  11. Cockpit management and Specific Behavioral Objectives (SBOs)

    NASA Technical Reports Server (NTRS)

    Mudge, R. W.

    1987-01-01

    One of the primary tools used to accomplish the task of effective training is the specific behavioral objective (SBO). An SBO is simply a statement which specifically identifies a small segment of the final behavior sought, and a little more. The key word is specific. The company pinpoints exactly what it is it wants the pilot to do after completing training, and what it should evaluate from the point of view of both the program and the pilot. It tells the junior crewmember exactly, specifically, what he should monitor and support insofar as the management function is concerned. It gives greater meaning to the term second in command. And finally, it tells the supervisory pilot exactly what he should observe, evaluate, and instruct, insofar as the management function is concerned.

  12. How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis

    PubMed Central

    Moran, Valerie; Allen, Pauline; Checkland, Kath; Warwick-Giles, Lynsey; Gore, Oz; Bramwell, Donna; Coleman, Anna

    2017-01-01

    Objectives From April 2015, NHS England (NHSE) started to devolve responsibility for commissioning primary care services to clinical commissioning groups (CCGs). The aim of this paper is to explore how CCGs are managing potential conflicts of interest associated with groups of GPs commissioning themselves or their practices to provide services. Design We carried out two telephone surveys using a sample of CCGs. We also used a qualitative case study approach and collected data using interviews and meeting observations in four sites (CCGs). Setting/participants We conducted 57 telephone interviews and 42 face-to-face interviews with general practitioners (GPs) and CCG staff involved in primary care co-commissioning and observed 74 meetings of CCG committees responsible for primary care co-commissioning. Results Conflicts of interest were seen as an inevitable consequence of CCGs commissioning primary care. Particular problems arose with obtaining unbiased clinical input for new incentive schemes and providing support to GP provider federations. Participants in meetings concerning primary care co-commissioning declared conflicts of interest at the outset of meetings. Different approaches were pursued regarding GPs involvement in subsequent discussions and decisions with inconsistency in the exclusion of GPs from meetings. CCG senior management felt confident that the new governance structures and policies dealt adequately with conflicts of interest, but we found these arrangements face limitations. While the revised NHSE statutory guidance on managing conflicts of interest (2016) was seen as an improvement on the original (2014), there still remained some confusion over various terms and concepts contained therein. Conclusions Devolving responsibility for primary care co-commissioning to CCGs created a structural conflict of interest. The NHSE statutory guidance should be refined and clarified so that CCGs can properly manage conflicts of interest. Non-clinician members of committees involved in commissioning primary care require training in order to make decisions requiring clinical input in the absence of GPs. PMID:29122801

  13. Comparison of Primary Care Experiences in Village Clinics with Different Ownership Models in Guangdong Province, China

    PubMed Central

    Feng, Shanshan; Shi, Leiyu; Zeng, Jiazhi; Chen, Wen; Ling, Li

    2017-01-01

    Objectives In order to improve the quality of services at village clinics (VCs), which are important primary care service providers in rural China, the Chinese government has encouraged the township hospitals to own and manage VCs. There are currently three models of ownership and management of VCs: township hospital-owned and -managed (HVC), village committee-owned and -managed (VVC), and private-owned and -managed (PVC). This study aims to examine the association between these ownership models of VCs and patients' primary care experiences. Methods Villagers were selected by multistage stratified sampling and their experiences with primary care were measured using the Primary Care Assessment Tool—Adult Edition (PCAT-AS). Data were collected through face-to-face interviews and the questionnaires administered by investigators in the cross-sectional study from February to April 2015. The PCAT scores were compared among the three models by covariance analysis, and multiple linear regression was used to analyze factors associated with the PCAT total scores. Results A total of 1491 questionnaires were collected. After controlling for covariates, HVCs reported the highest PCAT scores and satisfaction rate. In terms of the domains, HVC reported the highest scores in the coordination and comprehensiveness domains, while PVC had the highest scores in the first contact-accessibility domain. Multivariate linear regression showed that HVC, married participants, aged 60 and older, satisfied with the services, receiving six or more visits, and those with medical expenditures over 20% of their total family expenditures, were also positively associated with better primary care quality. Conclusions This study demonstrates that villagers receiving medical care at HVCs perceived better primary care than those at PVCs and VVCs. In order to improve the quality of primary care at VCs, it is necessary to increase government subsidies for public service packages, tighten the township hospital's supervision of PVCs and VVCs, and develop performance-based incentive plans to motivate improvements in the accessibility of HVCs. PMID:28056038

  14. The Current Practices in Injury Prevention and Safety Helmet Use in an Air Force Medical Center

    DTIC Science & Technology

    2000-05-01

    skateboarding . Findings from the DoD survey (1995) suggest that additional effort is necessary to meet Healthy People 2000 objectives in the area of...rollerblading or skateboarding . Primary care provider A family or individual goes to a primary care provider initially for medical care and the management...related head injury was considered a head injury that occurred while the subject was riding either a bicycle, motorcycle, rollerblading or skateboarding

  15. Designing patient-centric applications for chronic disease management.

    PubMed

    Tsalatsanis, Athanasios; Gil-Herrera, Eleazar; Yalcin, Ali; Djulbegovic, Benjamin; Barnes, Laura

    2011-01-01

    Chronic diseases such as diabetes and heart disease are the leading causes of disability and death in the developed world. Technological interventions such as mobile applications have the ability to facilitate and motivate patients in chronic disease management, but these types of interventions present considerable design challenges. The primary objective of this paper is to present the challenges arising from the design and implementation of software applications aiming to assist patients in chronic disease management. We also outline preliminary results regarding a self-management application currently under development targeting young adults suffering from type 1 diabetes.

  16. 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

  17. Identification, summary and comparison of tools used to measure organizational attributes associated with chronic disease management within primary care settings

    PubMed Central

    Lukewich, Julia; Corbin, Renée; VanDenKerkhof, Elizabeth G; Edge, Dana S; Williamson, Tyler; Tranmer, Joan E

    2014-01-01

    Rationale, aims and objectives Given the increasing emphasis being placed on managing patients with chronic diseases within primary care, there is a need to better understand which primary care organizational attributes affect the quality of care that patients with chronic diseases receive. This study aimed to identify, summarize and compare data collection tools that describe and measure organizational attributes used within the primary care setting worldwide. Methods Systematic search and review methodology consisting of a comprehensive and exhaustive search that is based on a broad question to identify the best available evidence was employed. Results A total of 30 organizational attribute data collection tools that have been used within the primary care setting were identified. The tools varied with respect to overall focus and level of organizational detail captured, theoretical foundations, administration and completion methods, types of questions asked, and the extent to which psychometric property testing had been performed. The tools utilized within the Quality and Costs of Primary Care in Europe study and the Canadian Primary Health Care Practice-Based Surveys were the most recently developed tools. Furthermore, of the 30 tools reviewed, the Canadian Primary Health Care Practice-Based Surveys collected the most information on organizational attributes. Conclusions There is a need to collect primary care organizational attribute information at a national level to better understand factors affecting the quality of chronic disease prevention and management across a given country. The data collection tools identified in this review can be used to establish data collection strategies to collect this important information. PMID:24840066

  18. Quality management of cracking distress survey in flexible pavements using LTRC digital highway data vehicle : research project capsule.

    DOT National Transportation Integrated Search

    2016-04-01

    The primary objectives of this research are to compare and validate cracking survey : results on selected fl exible pavements obtained from the LTRC data collection system : and from the Louisiana current contracted application; to investigate the fe...

  19. Detection, Evaluation, and Treatment of Eating Disorders

    PubMed Central

    Walsh, Judith M E; Wheat, Mary E; Freund, Karen

    2000-01-01

    OBJECTIVE To describe how primary care clinicians can detect an eating disorder and identify and manage the associated medical complications. DESIGN A review of literature from 1994 to 1999 identified by a medlinesearch on epidemiology, diagnosis, and therapy of eating disorders, including anorexia nervosa and bulimia nervosa. MEASUREMENTS AND MAIN RESULTS Detection requires awareness of risk factors for, and symptoms and signs of, anorexia nervosa (e.g., participation in activities valuing thinness, family history of an eating disorder, amenorrhea, lanugo hair) and bulimia nervosa (e.g., unsuccessful attempts at weight loss, history of childhood sexual abuse, family history of depression, erosion of tooth enamel from vomiting, partoid gland swelling, and gastroesophageal reflux). Providers must also remain alert for disordered eating in female athletes (the female athlete triad) and disordered eating in diabetics. Treatment requires a multidisciplinary team including a primary care practitioner, nutritionist, and mental health professional. The role of the primary care practitioner is to help determine the need for hospitalization and to manage medical complications (e.g., arrhythmias, refeeding syndrome, osteoporosis, and electrolyte abnormalities such as hypokalemia). CONCLUSION Primary care providers have an important role in detecting and managing eating disorders. PMID:10940151

  20. Configuration management issues and objectives for a real-time research flight test support facility

    NASA Technical Reports Server (NTRS)

    Yergensen, Stephen; Rhea, Donald C.

    1988-01-01

    An account is given of configuration management activities for the Western Aeronautical Test Range (WATR) at NASA-Ames, whose primary function is the conduct of aeronautical research flight testing through real-time processing and display, tracking, and communications systems. The processing of WATR configuration change requests for specific research flight test projects must be conducted in such a way as to refrain from compromising the reliability of WATR support to all project users. Configuration management's scope ranges from mission planning to operations monitoring and performance trend analysis.

  1. Program and Project Management Framework

    NASA Technical Reports Server (NTRS)

    Butler, Cassandra D.

    2002-01-01

    The primary objective of this project was to develop a framework and system architecture for integrating program and project management tools that may be applied consistently throughout Kennedy Space Center (KSC) to optimize planning, cost estimating, risk management, and project control. Project management methodology used in building interactive systems to accommodate the needs of the project managers is applied as a key component in assessing the usefulness and applicability of the framework and tools developed. Research for the project included investigation and analysis of industrial practices, KSC standards, policies, and techniques, Systems Management Office (SMO) personnel, and other documented experiences of project management experts. In addition, this project documents best practices derived from the literature as well as new or developing project management models, practices, and techniques.

  2. Remission in Depressed Geriatric Primary Care Patients: A Report From the PROSPECT Study

    PubMed Central

    Alexopoulos, George S.; Katz, Ira R.; Bruce, Martha L.; Heo, Moonseong; Have, Thomas Ten; Raue, Patrick; Bogner, Hillary R.; Schulberg, Herbert C.; Mulsant, Benoit H.; Reynolds, Charles F.

    2009-01-01

    Objective This study compared time to first remission for elderly depressed patients in primary care for practices that implemented a care management model versus those providing usual care. In addition, it sought to identify risk factors for nonremission that could guide treatment planning and referral to care managers or specialists. Method Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) data were analyzed. Participants were older patients (≥60 years) selected following screening of 9,072 randomly identified primary care patients. The present analysis examined patients with major depression and a 24-item Hamilton Depression Rating Scale score of 18 or greater who were followed for at least 4 months (N=215). Primary care practices were randomly assigned to offer the PROSPECT intervention or usual care. The intervention consisted of services of trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 18 months. Results First remission occurred earlier and was more common among patients receiving the intervention than among those receiving usual care. For all patients, limitations in physical and emotional functions predicted poor remission rate. Patients experiencing hopelessness were more likely to achieve remission if treated in intervention practices. Similarly, the intervention was more effective in patients with low baseline anxiety. Conclusions Longitudinal assessment of depression, hopelessness, anxiety, and physical and emotional functional limitations in depressed older primary care patients is critical. Patients with prominent symptoms or impairment in these areas may be candidates for care management or mental health care, since they are at risk for remaining depressed and disabled. PMID:15800144

  3. 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

  4. Can symptom relief be provided in the home to palliative care cancer patients by the primary caregivers? An Indian study.

    PubMed

    Chellappan, Sheeba; Ezhilarasu, Punitha; Gnanadurai, Angela; George, Reena; Christopher, Solomon

    2014-01-01

    A large proportion of cancer deaths occur in the developing world, with limited resources for palliative care. Many patients dying at home experience difficult symptoms. The objective of this study was to assess the feasibility of a structured training program on symptom management along with an acute symptom management kit for primary caregivers of cancer patients receiving home care. Descriptive design was used. Thirty primary caregivers of cancer patients attending the palliative care clinic in Vellore, South India, were provided training on the administration of drugs for acute symptoms. A plastic box with partitions for drugs specific to symptom was provided. On follow-up visits, the usage of the kit, drugs used, and routes of administration were noted. A structured questionnaire with a 4-point scale was used to assess primary caregiver views and satisfaction. Of primary caregivers, 96.7% used a kit. The common medications used were morphine, metoclopramide, dexamethasone, and benzodiazepines. Seventy-three percent of primary caregivers administered subcutaneous injections at home. Hospital visits for acute symptoms reduced by 80%; 90% were satisfied with the training received; 73% stated it was not a burden to treat the patient at home. The training program and acute symptom management kit were favorably received and appropriately used by caregivers of diverse backgrounds. Rural backgrounds and illiteracy were not barriers to acceptance. Healthcare professionals should train caregivers during hospital visits, empowering them to manage acute symptoms and provide simple nursing care. This is doubly important in countries where resources are limited and palliative care facilities scarce.

  5. Establishment and outcomes of a model primary care pharmacy service system.

    PubMed

    Carmichael, Jannet M; Alvarez, Autumn; Chaput, Ryan; DiMaggio, Jennifer; Magallon, Heather; Mambourg, Scott

    2004-03-01

    The establishment and outcomes of a model primary care pharmacy service system are described. A primary care pharmacy practice model was established at a government health care facility in March 1996. The original objective was to establish a primary pharmacy practice model that would demonstrate improved patient outcomes and maximize the pharmacist's contributions to drug therapy. Since its inception, many improvements have been realized and supported by advanced computer and automated systems, expanded disease state management practices, and unique practitioner and administrative support. Many outcomes studies have been performed on the pharmacist-initiated and -managed clinics, leading to improved patient care and conveying the quality-conscious and cost-effective role pharmacists can play as independent practitioners in this environment. These activities demonstrate cutting-edge leadership in health-system pharmacy. Redesign has been used to improve consistent access to a medication expert and has significantly improved the quality of patient care while easing physicians' workload without increasing health care costs. A system using pharmacists as independent practitioners to promote primary care has achieved high-quality and cost-effective patient care.

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

    PubMed

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

    2016-01-01

    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. 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. 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. 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.

  7. Designing the role of the embedded care manager.

    PubMed

    Hines, Patricia; Mercury, Marge

    2013-01-01

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

  8. Investigation of Primary Class Teachers' Conflict Approaches by Gender

    ERIC Educational Resources Information Center

    Habaci, Ibrahim

    2015-01-01

    The objective of this study is to identify the relationships between disagreements and conflicts that surface with respect to gender in educational institutions and the reasons behind them; to expose the relationship between personal variables and conflict management strategies; to determine how individuals adopt a particular attitude in regard to…

  9. Remarks of Mark S. Fowler, Chairman, Federal Communications Commission.

    ERIC Educational Resources Information Center

    Fowler, Mark S.

    This paper contains transcripts of two speeches given by the chairperson of the Federal Communications Commission (FCC) outlining his philosophy concerning the function of that agency and its relationship to the telecommunications industry. The first transcript discusses the primary management objectives identified by the FCC as follows: (1) to…

  10. Restoring riparian forests in the Missouri Ozarks

    Treesearch

    Kyle L. Steele; John M. Kabrick; Daniel C. Dey; Randy G. Jensen

    2013-01-01

    Restoring the function of riparian forest ecosystems has become a primary objective of many land management agencies throughout the central hardwood region, and consequently, much emphasis has been placed on planting native hardwood tree species in former bottomland agricultural fields. However, there is little information providing successful restoration techniques in...

  11. Optimum stand prescriptions for ponderosa pine

    Treesearch

    David W. Hann; J. Douglas Brodie; Kurt H. Riitters

    1983-01-01

    Two examples for a northern Arizona ponderosa pine stand illustrate the usefulness of dynamic programming in making silvicultural decisions. The first example analyzes the optimal planting density for bare land, while the second examines the optimal precommercial thinning intensity for a 43-year-old stand. Bot hexamples assume that the manager's primary objective...

  12. The Shaping of Managers' Security Objectives through Information Security Awareness Training

    ERIC Educational Resources Information Center

    Harris, Mark A.

    2010-01-01

    Information security research states that corporate security policy and information security training should be socio-technical in nature and that corporations should consider training as a primary method of protecting their information systems. However, information security policies and training are predominately technical in nature. In addition,…

  13. 3 CFR - Presidential Determination With Respect to Foreign Governments' Efforts Regarding Trafficking in...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... to advance sustainable natural resource management and biodiversity would promote the purposes of the... a significant adverse effect on vulnerable populations if suspended, would promote the purposes of..., or activity; or (2) has as its primary objective the addressing of basic human needs, as defined by...

  14. IT Portfolio Selection and IT Synergy

    ERIC Educational Resources Information Center

    Cho, Woo Je

    2010-01-01

    This dissertation consists of three chapters. The primary objectives of this dissertation are: (1) to provide a methodological framework of IT (Information Technology) portfolio management, and (2) to identify the effect of IT synergy on IT portfolio selection of a firm. The first chapter presents a methodological framework for IT project…

  15. A user interface development tool for space science systems Transportable Applications Environment (TAE) Plus

    NASA Technical Reports Server (NTRS)

    Szczur, Martha R.

    1990-01-01

    The Transportable Applications Environment Plus (TAE PLUS), developed at NASA's Goddard Space Flight Center, is a portable What You See Is What You Get (WYSIWYG) user interface development and management system. Its primary objective is to provide an integrated software environment that allows interactive prototyping and development that of user interfaces, as well as management of the user interface within the operational domain. Although TAE Plus is applicable to many types of applications, its focus is supporting user interfaces for space applications. This paper discusses what TAE Plus provides and how the implementation has utilized state-of-the-art technologies within graphic workstations, windowing systems and object-oriented programming languages.

  16. Does Physician Education on Depression Management Improve Treatment in Primary Care?

    PubMed Central

    Lin, Elizabeth H B; Simon, Gregory E; Katzelnick, David J; Pearson, Steven D

    2001-01-01

    OBJECTIVE To assess the effect of physician training on management of depression. DESIGN Primary care physicians were randomly assigned to a depression management intervention that included an educational program. A before-and-after design evaluated physician practices for patients not enrolled in the intervention trial. SETTING One hundred nine primary care physicians in 2 health maintenance organizations located in the Midwest and Northwest regions of the United States. PATIENTS/PARTICIPANTS Computerized pharmacy and visit data from a group of 124,893 patients who received visits or prescriptions from intervention and usual care physicians. INTERVENTIONS Primary care physicians received education on diagnosis and optimal management of depression over a 3-month training period. Methods of education included small group interactive discussions, expert demonstrations, role-play, and academic detailing of pharmacotherapy, criteria for urgent psychiatric referrals, and case reviews with psychiatric consultants. MEASUREMENTS AND MAIN RESULTS Pharmacy and visit data provided indicators of physician management of depression: rate of newly diagnosed depression, new prescription of antidepressant medication, and duration of pharmacotherapy. One year after the training period, intervention and usual care physicians did not differ significantly in the rate of new depression diagnosis (P = .95) or new prescription of antidepressant medicines (P = .10). Meanwhile, patients of intervention physicians did not differ from patients of usual care physicians in adequacy of pharmacotherapy (P = .53) as measured by 12 weeks of continuous antidepressant treatment. CONCLUSIONS After education on optimal management of depression, intervention physicians did not differ from their usual care colleagues in depression diagnosis or pharmacotherapy. PMID:11556942

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

    PubMed

    Hanna, Lisa; May, Carl; Fairhurst, Karen

    2011-01-01

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

  18. A Critical Examination of the DOD’s Business Management Modernization Program

    DTIC Science & Technology

    2005-05-01

    Program (BMMP) is a key element of the DoD’s ongoing efforts to transform itself. This paper argues that the BMMP needs to be fundamentally reoriented...communication role it plays in the defense- transformation effort. Introduction The core assumption underlying the DoD’s Business Management... government activities. That this is a core assumption for the BMMP is borne out by the fact that the program’s primary objective is to produce

  19. Management by objectives and its impact on specialist prescription quality at discharge and in external consultations.

    PubMed

    Olmo, M; Galvan, L; Capdevila, J; Serna, C; Mangues, I; Schoenenberger, J A

    2011-01-01

    To verify that implementing a policy of management by objectives, based on collaboration between hospital pharmacy, primary care and specialised medical managers, improves prescription quality indicators in specialised care and reduces unwanted "induced" prescriptions (i.e. those issued by specialists, hospital doctors or the patients themselves) in primary care. A four year quasi-experimental controlled intervention study on prescription at discharge and in outpatient hospital consultations was conducted. In hospital A, a quality cycle was applied: assessment, identifying improvement opportunities, implementing corrective actions and re-assessment. However, it was not applied in control hospital B. The indicators chosen were the percentage of generic medicines prescribed, the percentage of prescriptions for new therapies with no added value and the percentage of prescriptions for ACE inhibitors recommended. In hospital A, an increase in indicators 1 and 3 has been observed, both being statistically significant, between the last year of intervention and the year previous to intervention. Hospital A managed to reduce indicator 2 to 4.5%, while this indicator increased in hospital B to 8.8%. Furthermore, a statistically significant difference in indicators between the two hospitals has been registered. Pay-for-Performance programs in prescription practices of hospital physicians are effective actions to improve quality indicators of medication use. Copyright © 2010 SEFH. Published by Elsevier Espana. All rights reserved.

  20. Salivary dysfunction associated with systemic diseases: systematic review and clinical management recommendations.

    PubMed

    von Bültzingslöwen, Inger; Sollecito, Thomas P; Fox, Philip C; Daniels, Troy; Jonsson, Roland; Lockhart, Peter B; Wray, David; Brennan, Michael T; Carrozzo, Marco; Gandera, Beatrice; Fujibayashi, Takashi; Navazesh, Mahvash; Rhodus, Nelson L; Schiødt, Morten

    2007-03-01

    The objective of this study was to identify systemic diseases associated with hyposalivation and xerostomia and develop evidence-based management recommendations for hyposalivation/xerostomia. Literature searches covered the English language medical literature from 1966 to 2005. An evidence-based review process was applied to management studies published from 2002 to 2005. Several systemic diseases were identified. From studies published 2002 to 2005, 15 were identified as high-quality studies and were used to support management recommendations: pilocarpine and cevimeline are recommended for treating hyposalivation and xerostomia in primary and secondary Sjögren's syndrome (SS). IFN-alpha lozenges may enhance saliva flow in primary SS patients. Anti-TNF-alpha agents, such as infliximab or etanercept, are not recommended to treat hyposalivation in SS. Dehydroepiandrosterone is not recommended to relieve hyposalivation or xerostomia in primary SS. There was not enough evidence to support any recommendations for the use of local stimulants, lubricants, and protectants for hyposalivation/xerostomia. However, professional judgment and patient preferences may support the use of a specific product for an individual patient. These evidence-based management recommendations should guide the clinician's management decisions for patients with salivary dysfunction related to systemic disease. Future treatment strategies may include new formulations of existing drugs, e.g., local application of pilocarpine. Recent discoveries on gene expression and a better understanding of the etiopathogenesis of SS may open new treatment options in the future.

  1. Knowledge and practice related to gestational diabetes among primary health care providers in Morocco: Potential for a defragmentation of care?

    PubMed

    Utz, Bettina; Assarag, Bouchra; Essolbi, Amina; Barkat, Amina; Delamou, Alexandre; De Brouwere, Vincent

    2017-08-01

    The objective of this study was to assess knowledge and practices of general practitioners, nurses and midwives working at primary health care facilities in Morocco regarding screening and management of gestational diabetes (GDM). Structured interviews with 100 doctors, midwives and nurses at 44 randomly selected public health care centers were conducted in Marrakech and Al Haouz. All data were descriptively analyzed. Ethical approval for the study was granted by the institutional review boards in Belgium and Morocco. Public primary health care providers have a basic understanding of gestational diabetes but screening and management practices are not uniform. Although 56.8% of the doctors had some pre-service training on gestational diabetes, most nurses and midwives lack such training. After diagnosing GDM, 88.5% of providers refer patients to specialists, only 11.5% treat them as outpatients. Updating knowledge and skills of providers through both pre- and in-service-training needs to be supported by uniform national standards enabling first line health care workers to manage women with GDM and thus increase access and provide a continuity in care. Findings of this study will be used to pilot a model of GDM screening and initial management through the primary level of care. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  2. Design and Baseline Characteristics from the KAN-QUIT Disease Management Intervention for Rural Smokers in Primary Care

    PubMed Central

    Cox, Lisa Sanderson; Cupertino, Ana-Paula; Mussulman, Laura M.; Nazir, Niaman; Greiner, K. Allen; Mahnken, Jonathan D.; Ahluwalia, Jasjit S.; Ellerbeck, Edward F.

    2008-01-01

    Objective To describe the design, implementation, baseline data, and feasibility of establishing a disease management program for smoking cessation in rural primary care. Method The study is a randomized clinical trial evaluating a disease management program for smoking cessation. The intervention combined pharmacotherapy, telephone counseling, and physician feedback, and repeated intervention over two years. The program began in 2004 and was implemented in 50 primary care clinics across the State of Kansas. Results Of eligible patients, 73% were interested in study participation. 750 enrolled participants were predominantly Caucasian, female, employed, and averaged 47.2 years of age (SD=13.1). In addition to smoking, 427 (57%) had at least one additional major risk factor for cardiovascular disease (diabetes, hypertension, high cholesterol, heart disease or stroke). Participants smoked on average 23.7 (SD=10.4) cigarettes per day, were contemplating (61%) or preparing to quit (30%), were highly motivated and confident of their ability to quit smoking, and reported seeing their physicians multiple times in the past twelve months (Median=3.50; Mean=5.48; SD=6.58). Conclusion Initial findings demonstrate the willingness of patients to enroll in a two-year disease management program to address nicotine dependence, even among patients not ready to make a quit attempt. These findings support the feasibility of identifying and enrolling rural smokers within the primary care setting. PMID:18544464

  3. Engaging stakeholders for adaptive management using structured decision analysis

    USGS Publications Warehouse

    Irwin, Elise R.; Kathryn, D.; Kennedy, Mickett

    2009-01-01

    Adaptive management is different from other types of management in that it includes all stakeholders (versus only policy makers) in the process, uses resource optimization techniques to evaluate competing objectives, and recognizes and attempts to reduce uncertainty inherent in natural resource systems. Management actions are negotiated by stakeholders, monitored results are compared to predictions of how the system should respond, and management strategies are adjusted in a “monitor-compare-adjust” iterative routine. Many adaptive management projects fail because of the lack of stakeholder identification, engagement, and continued involvement. Primary reasons for this vary but are usually related to either stakeholders not having ownership (or representation) in decision processes or disenfranchisement of stakeholders after adaptive management begins. We present an example in which stakeholders participated fully in adaptive management of a southeastern regulated river. Structured decision analysis was used to define management objectives and stakeholder values and to determine initial flow prescriptions. The process was transparent, and the visual nature of the modeling software allowed stakeholders to see how their interests and values were represented in the decision process. The development of a stakeholder governance structure and communication mechanism has been critical to the success of the project.

  4. [Consensus document on the management and follow-up of the male with lower urinary tract symptoms secondary to benign prostate hyperplasia].

    PubMed

    Brenes Bermúdez, F J; Brotons Muntó, F; Castiñeiras Fernández, J; Cozar Olmo, J M; Fernández-Pro Ledesma, A; Martín Jiménez, J A; Martínez-Berganza Asensio, M L; Miñana López, B; Molero García, J M

    Benign prostate hyperplasia (BPH) is a high-incidence condition. Its diagnosis and treatment is shared between urologists and Primary Care physicians. Its management uses up a significant amount of resources. The Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of General Practitioners and Family Doctors (SEMG), the Spanish Society of Family and Community Medicine (semFYC), and the Spanish Association of Urology (AEU) have prepared a document on the management and monitoring of BPH, in which the aim is to incorporate the latest evidence in order to update the previously published guidelines, and present them here in condensed form. The main objective of these new recommendations is to raise the awareness of Primary Care physicians and assist them in its diagnostic evaluation, treatment and monitoring, as well as providing unified consensus criteria for referral to the secondary care level. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Patients' experiences in different models of community health centers in southern China.

    PubMed

    Wang, Harry H X; Wong, Samuel Y S; Wong, Martin C S; Wei, Xiao Lin; Wang, Jia Ji; Li, Donald K T; Tang, Jin Ling; Gao, Gemma Y; Griffiths, Sian M

    2013-01-01

    Current health care reforms in China have an overall goal of strengthening primary care through the establishment and expansion of primary care networks based on community health centers (CHCs). Implementation in urban areas has led to the emergence of different models of ownership and management. The objective of this study was to evaluate the primary care experiences of patients in the Pearl River Delta as measured by the Primary Care Assessment Tool (PCAT) and the relationships with ownership and management in the 3 different models we describe. This cross-sectional study was conducted on-site at CHCs in 3 cities within the Pearl River Delta, China, using a multistage cluster sampling method. A validated Mandarin Chinese version of the PCAT-Adult Edition (short version) was adopted to collect information from adult patients regarding their experiences with primary care sources. PCAT scores for individual primary care attributes and total primary care assessment scores were assessed with respect to sociodemographic characteristics, health characteristics, and health care service utilization across 3 primary care models. One thousand four hundred forty (1,440) primary care patients responded to the survey, for an overall response rate of 86.1%. Respondents gave government-owned and -managed CHCs the highest overall PCAT scores when compared with CHCs either managed by hospitals (95.18 vs 90.81; P = .005) or owned by private and social entities (95.18 vs 90.69; P =.007) as a result of better first-contact care (better first-contact utilization) and coordination of care (better service coordination and information system). Factors that were positively and significantly associated with higher overall assessment scores included the presence of a chronic condition (P <.001), having medical insurance (P = .006), and a self-reported good health status (P <.001). This study suggests that government-owned and -managed CHCs may be able to provide better first-contact care in terms of utilization and coordination of care, and may be better at solving the problem of underutilization of the CHCs as the first-contact point of care, one key problem facing the reforms in China.

  6. Datasets collected in general practice: an international comparison using the example of obesity.

    PubMed

    Sturgiss, Elizabeth; van Boven, Kees

    2018-06-04

    International datasets from general practice enable the comparison of how conditions are managed within consultations in different primary healthcare settings. The Australian Bettering the Evaluation and Care of Health (BEACH) and TransHIS from the Netherlands collect in-consultation general practice data that have been used extensively to inform local policy and practice. Obesity is a global health issue with different countries applying varying approaches to management. The objective of the present paper is to compare the primary care management of obesity in Australia and the Netherlands using data collected from consultations. Despite the different prevalence in obesity in the two countries, the number of patients per 1000 patient-years seen with obesity is similar. Patients in Australia with obesity are referred to allied health practitioners more often than Dutch patients. Without quality general practice data, primary care researchers will not have data about the management of conditions within consultations. We use obesity to highlight the strengths of these general practice data sources and to compare their differences. What is known about the topic? Australia had one of the longest-running consecutive datasets about general practice activity in the world, but it has recently lost government funding. The Netherlands has a longitudinal general practice dataset of information collected within consultations since 1985. What does this paper add? We discuss the benefits of general practice-collected data in two countries. Using obesity as a case example, we compare management in general practice between Australia and the Netherlands. This type of analysis should start all international collaborations of primary care management of any health condition. Having a national general practice dataset allows international comparisons of the management of conditions with primary care. Without a current, quality general practice dataset, primary care researchers will not be able to partake in these kinds of comparison studies. What are the implications for practitioners? Australian primary care researchers and clinicians will be at a disadvantage in any international collaboration if they are unable to accurately describe current general practice management. The Netherlands has developed an impressive dataset that requires within-consultation data collection. These datasets allow for person-centred, symptom-specific, longitudinal understanding of general practice management. The possibilities for the quasi-experimental questions that can be answered with such a dataset are limitless. It is only with the ability to answer clinically driven questions that are relevant to primary care that the clinical care of patients can be measured, developed and improved.

  7. Monitoring in the context of structured decision-making and adaptive management

    USGS Publications Warehouse

    Lyons, J.E.; Runge, M.C.; Laskowski, H.P.; Kendall, W.L.

    2008-01-01

    In a natural resource management setting, monitoring is a crucial component of an informed process for making decisions, and monitoring design should be driven by the decision context and associated uncertainties. Monitoring itself can play >3 roles. First, it is important for state-dependent decision-making, as when managers need to know the system state before deciding on the appropriate course of action during the ensuing management cycle. Second, monitoring is critical for evaluating the effectiveness of management actions relative to objectives. Third, in an adaptive management setting, monitoring provides the feedback loop for learning about the system; learning is sought not for its own sake but primarily to better achieve management objectives. In this case, monitoring should be designed to reduce the critical uncertainties in models of the managed system. The United States Geological Survey and United States Fish and Wildlife Service are conducting a large-scale management experiment on 23 National Wildlife Refuges across the Northeast and Midwest Regions. The primary management objective is to provide habitat for migratory waterbirds, particularly during migration, using water-level manipulations in managed wetlands. Key uncertainties are related to the potential trade-offs created by management for a specific waterbird guild (e.g., migratory shorebirds) and the response of waterbirds, plant communities, and invertebrates to specific experimental hydroperiods. We reviewed the monitoring program associated with this study, and the ways that specific observations fill >1 of the roles identified above. We used observations from our monitoring to improve state-dependent decisions to control undesired plants, to evaluate management performance relative to shallow-water habitat objectives, and to evaluate potential trade-offs between waterfowl and shorebird habitat management. With limited staff and budgets, management agencies need efficient monitoring programs that are used for decision-making, not comprehensive studies that elucidate all manner of ecological relationships.

  8. Implementation of data management and effect on chronic disease coding in a primary care organisation: A parallel cohort observational study.

    PubMed

    Greiver, Michelle; Wintemute, Kimberly; Aliarzadeh, Babak; Martin, Ken; Khan, Shahriar; Jackson, Dave; Leggett, Jannet; Lambert-Lanning, Anita; Siu, Maggie

    2016-10-12

    Consistent and standardized coding for chronic conditions is associated with better care; however, coding may currently be limited in electronic medical records (EMRs) used in Canadian primary care.Objectives To implement data management activities in a community-based primary care organisation and to evaluate the effects on coding for chronic conditions. Fifty-nine family physicians in Toronto, Ontario, belonging to a single primary care organisation, participated in the study. The organisation implemented a central analytical data repository containing their EMR data extracted, cleaned, standardized and returned by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a large validated primary care EMR-based database. They used reporting software provided by CPCSSN to identify selected chronic conditions and standardized codes were then added back to the EMR. We studied four chronic conditions (diabetes, hypertension, chronic obstructive pulmonary disease and dementia). We compared changes in coding over six months for physicians in the organisation with changes for 315 primary care physicians participating in CPCSSN across Canada. Chronic disease coding within the organisation increased significantly more than in other primary care sites. The adjusted difference in the increase of coding was 7.7% (95% confidence interval 7.1%-8.2%, p < 0.01). The use of standard codes, consisting of the most common diagnostic codes for each condition in the CPCSSN database, increased by 8.9% more (95% CI 8.3%-9.5%, p < 0.01). Data management activities were associated with an increase in standardized coding for chronic conditions. Exploring requirements to scale and spread this approach in Canadian primary care organisations may be worthwhile.

  9. Development of the first infrared satellite observatory

    NASA Technical Reports Server (NTRS)

    Smith, G. M.; Squibb, G. F.

    1984-01-01

    A development history is given for the Infrared Astronomical Satelite (IRAS), whose primary mission objective is an unbiased, all-sky survey in the 8-120 micron wavelength range. A point source catalog of more than 200,000 IR sources, to be published later this year, represents the accomplishment of this objective. IRAS has also conducted 10,000 pointed observations of specific objects. Attention is given to the cost increases and schedule slips which resulted from the substantial technical challenges of IRAS hardware and software development, and to the management techniques which had to be employed in this major international project.

  10. Training tomorrow's clinicians today--managed care essentials: a process for curriculum development.

    PubMed

    Colenda, C C; Wadland, W; Hayes, O; Anderson, W; Priester, F; Pearson, R; Keefe, C; Fleck, L

    2000-05-01

    To develop a managed care curriculum for primary care residents. This article outlines a 4-stage curriculum development process focusing on concepts of managed care organization and finance. The stages consist of: (1) identifying the curriculum development work group and framing the scope of the curriculum, (2) identifying stakeholder buy-in and expectations, (3) choosing curricular topics and delivery mechanisms, and (4) outlining the evaluation process. Key elements of building a curriculum development team, content objectives of the curriculum, the rationale for using problem-based learning, and finally, lessons learned from the partnership among the stakeholders are reviewed. The curriculum was delivered to an entering group of postgraduate-year 1 primary care residents. Attitudes among residents toward managed care remained relatively negative and stable over the yearlong curriculum, especially over issues relating to finance, quality of care, control and autonomy of practitioners, time spent with patients, and managed care's impact on the doctor-patient relationship. Residents' baseline knowledge of core concepts about managed care organization and finance improved during the year that the curriculum was delivered. Satisfaction with a problem-based learning approach was high. Problem-based learning, using real-life clinical examples, is a successful approach to resident instruction about managed care.

  11. Clinical utility of indigenously formulated single-vial lyophilized HYNIC-TOC kit in evaluating Gastro-entero Pancreatic neuro endocrine tumours

    PubMed Central

    Shinto, Ajit S; Kamaleshwaran, K; Vyshak, K; Sudhakar, Natarajan; Banerjee, Sharmila; Korde, Aruna; Samuel, Grace; Mallia, Madhav

    2014-01-01

    Objective(s): The objective of this study was to evaluate the performance and utility of 99mTc HYNIC-TOC planar scintigraphy and SPECT/CT in the diagnosis, staging and management of gastroenteropancreatic neuroendocrine tumors (GPNETs). Methods: 22 patients (median age, 46 years) with histologically proven gastro- entero- pancreatic NETs underwent 99mTc HYNIC-TOC whole body scintigraphy and regional SPECT/CT as indicated. Scanning was performed after injection of 370-550 MBq (10-15 mCi) of 99mTc HYNIC-TOC intravenously. Images were evaluated by two experienced nuclear medicine physicians both qualitatively as well as semi quantitatively (tumor to background and tumor to normal liver ratios on SPECT -CT images). Results of SPECT/CT were compared with the results of conventional imaging. Histopathology results and follow-up somatostatin receptor scintigraphy with 99mTc HYNIC TOC or conventional imaging with biochemical markers were considered to be the reference standards. Results: 99mTc HYNIC TOC showed sensitivity and specificity of 87.5% and 85.7%, respectively, for primary tumor and 100% and 86% for metastases. It was better than conventional imaging modalities for the detection of both primary tumor (P<0.001) and metastases (P<0.0001). It changed the management strategy in 6 patients (31.8%) and supported management decisions in 8 patients (36.3%). Conclusion: 99mTc HYNIC TOC SPECT/CT appears to be a highly sensitive and specific modality for the detection and staging of GPNETs. It is better than conventional imaging for the evaluation of GPNETs and can have a significant impact on patient management and planning further therapeutic options. PMID:27408857

  12. Practice management: observations, issues, and empirical evidence.

    PubMed

    Wong, H M; Braithwaite, J

    2001-02-01

    The primary objective of this study is to provide objective, empirical, evidence-based practice management information. This is a hitherto under-researched area of considerable interest for both the practitioner and educator. A questionnaire eliciting a mix of structured and free text responses was administered to a random sample of 480 practitioners who are members of the American Academy of Periodontology. Potential respondents not in private practice were excluded and the next listed person substituted. The results provide demographic and descriptive information about some of the main issues and problems facing practice managers, central to which are information technology (IT), financial, people management, and marketing. Human resource and marketing management appear to represent the biggest challenges. Periodontists running practices would prefer more information, development, and support in dealing with IT, finance, marketing, and people management. The empirical evidence reported here suggests that although tailored educational programs on key management issues at both undergraduate and postgraduate levels have become ubiquitous, nevertheless some respondents seek further training opportunities. Evidence-based practice management information will be invaluable to the clinician considering strategic and marketing planning, and also for those responsible for the design and conduct of predoctoral and postdoctoral programs.

  13. 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.

  14. 76 FR 31968 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-02

    .... Proposed Project: SAMHSA SOAR Web-Based Data Form--NEW In 2009 the Substance Abuse and Mental Health... in all states. SOAR's primary objective is to improve the allowance rate for Social Security... Center under SAMHSA's direction developed a web-based data form that case managers can use to track the...

  15. 76 FR 51044 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-17

    .... Project: SAMHSA SOAR Web-Based Data Form--NEW In 2009 the Substance Abuse and Mental Health Services... states. SOAR's primary objective is to improve the allowance rate for Social Security Administration (SSA... SAMHSA's direction developed a web-based data form that case managers can use to track the progress of...

  16. Community structure of vascular plants, arthropods, amphibians, and mollusks in managed forests of the Pacific Northwest (USA)

    Treesearch

    Stephanie J. Wessell-Kelly; Deanna H. Olson

    2013-01-01

    Increasing global demands on forest resources are driving large-scale shifts toward plantation forestry. Simultaneously balancing resource extraction and ecological sustainability objectives in plantation forests requires the incorporation of innovative silvicultural strategies such as leave islands (green-tree retention clusters). Our primary research goal was to...

  17. In-situ field capacity and soil water retention measurements in two contrasting soil textures

    USDA-ARS?s Scientific Manuscript database

    Knowledge of the in-situ field capacity and soil-water retention curve for soils is important for effective irrigation management and scheduling. The primary objective of this study was to estimate in-situ field capacity and soil water retention curves in the field using continually monitoring soil ...

  18. In-situ Field Capacity and Soil Water Retention Measurements in Two Contrasting Soil Textures

    USDA-ARS?s Scientific Manuscript database

    Knowledge of the in-situ field capacity and soil-water retention curve for soils is important for effective irrigation management and scheduling. The primary objective of this study was to estimate in-situ field capacity and soil water retention curves in the field using continually monitoring soil ...

  19. Glass Science tutorial lecture No. 5: Historical review of USDOE tank waste management

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

    McDaniel, E.W.

    1995-02-01

    This is a two day course whose objective is to present an unbiased historical overview of the DOE tank waste activities. World events which impacted the US nuclear program (or vise versa) will be presented. Liquid, mostly tank waste, and sludge are the primary concerns of this course.

  20. N-Sink: A Tool to Identify Nitrogen Sources and Sinks within aWatershed Framework

    EPA Science Inventory

    N-Sink is a customized ArcMap© program that provides maps of N sourcesand sinks within a watershed, and estimates the delivery efficiency of N movement from sources to the watershed outlet. The primary objective of N-Sink is to assist land use planners, watershed managers, and la...

  1. Wildlife esthetics and auto campers in the Superior National Forest.

    Treesearch

    David. W. Lime; Charles T. Cushwa

    1969-01-01

    Many resource managers feel that a high percentage of excursions to forested areas are planned with the objective of seeing wildlife in mind. However, a study of campers in the Superior National Forest did not show wildlife to be a primary attraction of the area, although it was an important supplementary attraction.

  2. The Tyranny of Bureaucracy: Continuing Challenges of Leading and Managing from the Middle

    ERIC Educational Resources Information Center

    Fitzgerald, Tanya

    2009-01-01

    Fiscal efficiency and organizational effectiveness were the primary objectives that underpinned the reform of educational administration in New Zealand in the late 1980s. The consequent re-organization of schools and schooling located responsibility and accountability for school performance, teachers' work and student outcomes firmly at the door…

  3. QUALITY ASSURANCE AND SYSTEMATIC PLANNING FOR THE EVALUATION OF TWO LANDFILL BIOREACTOR OPERATIONAL TECHNIQUES AT AN EXISTING LANDFILL

    EPA Science Inventory

    A Quality Assurance Project Plan (QAPP) was prepared to document the primary objectives and data collection and interpretation efforts for two landfill bioreactor studies at the Outer Loop Landfill in Louisville, KY, operated by Waste Management, Inc. WMI). The two multi-year stu...

  4. THE ROLE OF QUALITY ASSURANCE IN THE EVALUTION OF TWO LANDFILL BIOREACTOR OPERATIONAL TECHNIQUES AT AN EXISTING LANDFILL

    EPA Science Inventory

    A Quality Assurance Project Plan (QAPP) was prepared to document the primary objectives and data collection and interpretation efforts for two landfill bioreactor studies at the Outer Loop Landfill in Louisville, KY, operated by Waste Management, Inc. WMI). The two multi-year stu...

  5. Genetics/Silviculture Workshop Proceedings; Wenatchee, WA; August 27-31, 1990

    Treesearch

    Richard G. Miller; Dennis D. Murphy

    1990-01-01

    The primary objective of the 1990 Genetics/Silviculture Workshop was to review and discuss the virtues, concerns, and opportunities for applying the five regeneration harvest methods and their variations in forest management. The first two papers discuss population dynamics and the importance of understanding genetic variation. These are followed by the moderator'...

  6. Fluid Acquisition and Resupply Experiments on Space Shuttle Flights STS-53 and STS-57

    NASA Technical Reports Server (NTRS)

    Dominick, S. M.; Tegart, J. R.; Driscoll, S. L.; Sledd, J. D.; Hastings, L. J.

    2011-01-01

    The Fluid Acquisition and Resupply Experiment (FARE) program, managed by the Marshall Space Flight Center Space Propulsion Branch with Martin Marietta Civil Space and Communications as the contractor, consisted of two flights designated FARE I and FARE II. FARE I flew in December 1992 on STS-53 with a screen channel liquid acquisition device (LAD) and FARE II flew in June 1993 on STS-57 with a vane-type LAD. Thus, the FARE I and II flights represent the two basic LAD categories usually considered for in-space fluid management. Although both LAD types have been used extensively, the usefulness of the on-orbit data has been constrained by the lack of experimentation beyond predicted performance limits, including both propellant fill and expulsion. Therefore, the FARE tests were designed to obtain data that would satisfy two primary objectives: (1) Demonstrate the performance of the two types of LADs, screen channel and vane, and (2) support the anchoring of analytical models. Both flights were considered highly successful in meeting these two primary objectives.

  7. Recent Clinical Characteristics of Labors Using Three Japanese Systems of Midwife-Led Primary Delivery Care

    PubMed Central

    Suzuki, Shunji

    2016-01-01

    Objective. The objective of this study was to describe the recent clinical characteristics of labor using 3 systems of Japanese midwife-led primary delivery care, as follows: (1) those intending to give birth at home managed by midwives who do not belong to our hospital, (2) those planning to give birth in our hospital managed by the same midwives, and (3) those planning to give birth managed by midwives who belong to our hospital. Methods. A retrospective cohort study was performed. Results. There were no significant differences in the obstetric or neonatal outcomes among the 3 groups. The rate of transfers during labor with the system involving midwives belonging to our hospital was higher than those with the other 2 systems. In addition, the timing of transfers in the system with the midwives belonging to our hospital was earlier than with the other 2 systems. Among the 3 groups, there were no significant differences in the rate of the main 2 indications for transfers: fetal heart rate abnormality and failure to progress. Conclusion. There were no significant differences in perinatal outcomes among the 3 systems; however, there were some differences in the status of transfers to obstetric shared care. PMID:27034827

  8. Adult Status Epilepticus: A Review of the Prehospital and Emergency Department Management

    PubMed Central

    Billington, Michael; Kandalaft, Osama R.; Aisiku, Imoigele P.

    2016-01-01

    Seizures are a common presentation in the prehospital and emergency department setting and status epilepticus represents an emergency neurologic condition. The classification and various types of seizures are numerous. The objectives of this narrative literature review focuses on adult patients with a presentation of status epilepticus in the prehospital and emergency department setting. In summary, benzodiazepines remain the primary first line therapeutic agent in the management of status epilepticus, however, there are new agents that may be appropriate for the management of status epilepticus as second- and third-line pharmacological agents. PMID:27563928

  9. The role of population monitoring in the management of North American waterfowl

    USGS Publications Warehouse

    Nichols, J.D.; Williams, B.K.; Johnson, F.A.

    2000-01-01

    Despite the effort and expense devoted to large-scale monitoring programs, few existing programs have been designed with specific objectives in mind and few permit strong inferences about the dynamics of monitored systems. The waterfowl population monitoring programs of the U.S. Fish and Wildlife Service, Canadian Wildlife Service and state and provincial agencies provide a nice example with respect to program objectives, design and implementation. The May Breeding Grounds Survey provides an estimate of system state (population size) that serves two primary purposes in the adaptive management process: identifying the appropriate time-specific management actions and updating the information state (model weights) by providing a basis for evaluating predictions of competing models. Other waterfowl monitoring programs (e.g., banding program, hunter questionnaire survey, parts collection survey, winter survey) provide estimates of vital rates (rates of survival, reproduction and movement) associated with system dynamics and variables associated with management objectives (e.g., harvest). The reliability of estimates resulting from monitoring programs depends strongly on whether considerations about spatial variation and detection probability have been adequately incorporated into program design and implementation. Certain waterfowl surveys again provide nice examples of monitoring programs that incorporate these considerations.

  10. Space station systems analysis study. Part 2, Volume 3: Appendixes, Book 1. Program requirements documentation

    NASA Technical Reports Server (NTRS)

    1977-01-01

    The objective elements representative of the kinds of space activities that will be supported by the space construction base (SCB) are discussed in (1) a brief mission overview including the primary purpose and general objectives; (2) descriptions of the processes involved (where applicable), the mission hardware, the principal activities to be undertaken, the test requirements, and the principal tests; and (3) the SCB requirements including such items as special devices (e.g., fabrication modules, assembly or construction fixtures, cranes, and airlocks), power, data management and communications, waste management, environmental control, safety, and logistics. Each program option is then described in terms of the objective elements it supports, its orbit, the general makeup of the SCB, the transportation approach, and the program schedule goals. The specific requirements that are imposed on the SCB in order to support program option L are given.

  11. Statistical analysis plan for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART). A randomized controlled trial

    PubMed Central

    Damiani, Lucas Petri; Berwanger, Otavio; Paisani, Denise; Laranjeira, Ligia Nasi; Suzumura, Erica Aranha; Amato, Marcelo Britto Passos; Carvalho, Carlos Roberto Ribeiro; Cavalcanti, Alexandre Biasi

    2017-01-01

    Background The Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) is an international multicenter randomized pragmatic controlled trial with allocation concealment involving 120 intensive care units in Brazil, Argentina, Colombia, Italy, Poland, Portugal, Malaysia, Spain, and Uruguay. The primary objective of ART is to determine whether maximum stepwise alveolar recruitment associated with PEEP titration, adjusted according to the static compliance of the respiratory system (ART strategy), is able to increase 28-day survival in patients with acute respiratory distress syndrome compared to conventional treatment (ARDSNet strategy). Objective To describe the data management process and statistical analysis plan. Methods The statistical analysis plan was designed by the trial executive committee and reviewed and approved by the trial steering committee. We provide an overview of the trial design with a special focus on describing the primary (28-day survival) and secondary outcomes. We describe our data management process, data monitoring committee, interim analyses, and sample size calculation. We describe our planned statistical analyses for primary and secondary outcomes as well as pre-specified subgroup analyses. We also provide details for presenting results, including mock tables for baseline characteristics, adherence to the protocol and effect on clinical outcomes. Conclusion According to best trial practice, we report our statistical analysis plan and data management plan prior to locking the database and beginning analyses. We anticipate that this document will prevent analysis bias and enhance the utility of the reported results. Trial registration ClinicalTrials.gov number, NCT01374022. PMID:28977255

  12. Protocol for the Rural Engagement in Primary Care for Optimizing Weight Reduction (RE-POWER) Trial: Comparing three obesity treatment models in rural primary care.

    PubMed

    Befort, Christie A; VanWormer, Jeffrey J; DeSouza, Cyrus; Ellerbeck, Edward F; Kimminau, Kim S; Greiner, Allen; Gajewski, Byron; Huang, Terry; Perri, Michael G; Fazzino, Tera L; Christifano, Danielle; Eiland, Leslie; Drincic, Andjela

    2016-03-01

    Obesity disproportionately affects rural residents in the United States, and primary care has the potential to fill a major gap in the provision of weight management services for rural communities. The objective of this cluster-randomized pragmatic trial is to evaluate the comparative effectiveness of three obesity treatment models in rural primary care: the Intensive Behavior Therapy fee-for-service (FFS) model reimbursed by Medicare, a team-based model that recognizes the patient-centered medical home (PCMH) as a preferred delivery approach, and the centralized disease management (DM) model, in which phone-based counseling is provided outside of the primary care practice. We hypothesize that the PCMH and DM treatments will be more effective than FFS in reducing weight at 24 months. Thirty-six practices from the rural Midwestern U.S. are randomized to deliver one of the three interventions to 40 patients (N=1440) age 20 to 75 with a BMI 30-45 kg/m(2). In the FFS arm, primary care providers and their personnel counsel patients to follow evidence-based weight loss guidelines using the Medicare-designated treatment schedule. In the PCMH arm, patients receive a comprehensive weight management intervention delivered locally by practice personnel using a combination of in-person and phone-based group sessions. In the DM arm, the same intervention is delivered remotely by obesity treatment specialists via group conference calls. The primary outcome is weight loss at 24 months. Additional measures include fasting glucose, lipids, quality of life indicators, and implementation process measures. Findings will illuminate effective obesity treatment intervention(s) in rural primary care. Copyright © 2016. Published by Elsevier Inc.

  13. Integration of basic dermatological care into primary health care services in Mali.

    PubMed Central

    Mahé, Antoine; Faye, Ousmane; N'Diaye, Hawa Thiam; Konaré, Habibatou Diawara; Coulibaly, Ibrahima; Kéita, Somita; Traoré, Abdel Kader; Hay, Roderick J.

    2005-01-01

    OBJECTIVE: To evaluate, in a developing country, the effect of a short training programme for general health care workers on the management of common skin diseases--a neglected component of primary health care in such regions. METHODS: We provided a one-day training programme on the management of the skin diseases to 400 health care workers who worked in primary health care centres in the Bamako area. We evaluated their knowledge and practice before and after training. FINDINGS: Before training, knowledge about skin diseases often was poor and practice inadequate. We found a marked improvement in both parameters after training. We analysed the registers of primary health care centres and found that the proportion of patients who presented with skin diseases who benefited from a clear diagnosis and appropriate treatment increased from 42% before the training to 81% after; this was associated with a 25% reduction in prescription costs. Improved levels of knowledge and practice persisted for up to 18 months after training. CONCLUSIONS: The training programme markedly improved the basic dermatological abilities of the health care workers targeted. Specific training may be a reasonable solution to a neglected component of primary health care in many developing countries. PMID:16462986

  14. Debris Mitigation as a Component of Space Traffic Management

    NASA Astrophysics Data System (ADS)

    Kemper Force, M.

    2012-01-01

    The necessity of a traffic management in space is a consequence of our "free use" of it over the past fifty years, during which certain orbits have accumulated a significant amount of debris that may, in the future, threaten the feasibility of their use. This paper encapsulates the primary issues involved in the concept of space traffic management through basic questions, using as a case study the recent alarm caused by two close-misses of the ISS in one week, in order to guide the reader to an understanding of the current need for a space traffic management regime. The paper will describe the fundamental elements of space traffic management, including the tracking of objects, conjunction assessment, collision avoidance and orbital mechanics to understand why Earth-bound systems cannot be extrapolated to space. The paper will then focus on the primary concern of space debris, the acceptance and use of current guidelines in light of the existing corpus juris spatialis and international law, positing that the guidelines may soon develop into a customary norm. The paper will conclude that the latest close calls with the ISS demonstrate we cannot count on the mere vastness of space to reduce the probability of collisions with space objects. Despite the significant political, technical and economic challenges recognized by the International Space University Final Report of 2007, the International Academy of Astronautics' Cosmic Study of 2006 and the IAASS An ICAO for Space?, there is a need for a system to obviate the looming peril before governments and investors will sign on to a comprehensive program which limits their "free" use of space.

  15. Differences in the diagnosis and management of systemic lupus erythematosus by primary care and specialist providers in the American Indian/Alaska Native population.

    PubMed

    McDougall, J A; Helmick, C G; Lim, S S; Johnston, J M; Gaddy, J R; Gordon, C; Ferucci, E D

    2018-06-01

    Objectives The objective of this study is to investigate differences in the diagnosis and management of systemic lupus erythematosus (SLE) by primary care and specialist physicians in a population-based registry. Methods This study includes individuals from the 2009 Indian Health Service lupus registry population with a diagnosis of SLE documented by either a primary care provider or specialist. SLE classification criteria, laboratory testing, and medication use at any time during the course of disease were determined by medical record abstraction. Results Of the 320 individuals with a diagnosis of SLE, 249 had the diagnosis documented by a specialist, with 71 documented by primary care. Individuals with a specialist diagnosis of SLE were more likely to have medical record documentation of meeting criteria for SLE by all criteria sets (American College of Rheumatology, 79% vs 22%; Boston Weighted, 82% vs 32%; and Systemic Lupus International Collaborating Clinics, 83% vs 35%; p < 0.001 for all comparisons). In addition, specialist diagnosis was associated with documentation of ever having been tested for anti-double-stranded DNA antibody and complement 3 and complement 4 ( p < 0.001). Documentation of ever receiving hydroxychloroquine was also more common with specialist diagnosis (86% vs 64%, p < 0.001). Conclusions Within the population studied, specialist diagnosis of SLE was associated with a higher likelihood of having SLE classification criteria documented, being tested for biomarkers of disease, and ever receiving treatment with hydroxychloroquine. These data support efforts both to increase specialist access for patients with suspected SLE and to provide lupus education to primary care providers.

  16. Study protocol of EMPOWER participatory action research (EMPOWER-PAR): a pragmatic cluster randomised controlled trial of multifaceted chronic disease management strategies to improve diabetes and hypertension outcomes in primary care.

    PubMed

    Ramli, Anis S; Lakshmanan, Sharmila; Haniff, Jamaiyah; Selvarajah, Sharmini; Tong, Seng F; Bujang, Mohamad-Adam; Abdul-Razak, Suraya; Shafie, Asrul A; Lee, Verna K M; Abdul-Rahman, Thuhairah H; Daud, Maryam H; Ng, Kien K; Ariffin, Farnaza; Abdul-Hamid, Hasidah; Mazapuspavina, Md-Yasin; Mat-Nasir, Nafiza; Miskan, Maizatullifah; Stanley-Ponniah, Jaya P; Ismail, Mastura; Chan, Chun W; Abdul-Rahman, Yong R; Chew, Boon-How; Low, Wilson H H

    2014-09-13

    Chronic disease management presents enormous challenges to the primary care workforce because of the rising epidemic of cardiovascular risk factors. The chronic care model was proven effective in improving chronic disease outcomes in developed countries, but there is little evidence of its effectiveness in developing countries. The aim of this study was to evaluate the effectiveness of the EMPOWER-PAR intervention (multifaceted chronic disease management strategies based on the chronic care model) in improving outcomes for type 2 diabetes mellitus and hypertension using readily available resources in the Malaysian public primary care setting. This paper presents the study protocol. A pragmatic cluster randomised controlled trial using participatory action research is underway in 10 public primary care clinics in Selangor and Kuala Lumpur, Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. Each clinic consecutively recruits type 2 diabetes mellitus and hypertension patients fulfilling the inclusion and exclusion criteria over a 2-week period. The EMPOWER-PAR intervention consists of creating/strengthening a multidisciplinary chronic disease management team, training the team to use the Global Cardiovascular Risks Self-Management Booklet to support patient care and reinforcing the use of relevant clinical practice guidelines for management and prescribing. For type 2 diabetes mellitus, the primary outcome is the change in the proportion of patients achieving HbA1c < 6.5%. For hypertension without type 2 diabetes mellitus, the primary outcome is the change in the proportion of patients achieving blood pressure < 140/90 mmHg. Secondary outcomes include the proportion of patients achieving targets for serum lipid profile, body mass index and waist circumference. Other outcome measures include medication adherence levels, process of care and prescribing patterns. Patients' assessment of their chronic disease care and providers' perceptions, attitudes and perceived barriers in care delivery and cost-effectiveness of the intervention are also evaluated. Results from this study will provide objective evidence of the effectiveness and cost-effectiveness of a multifaceted intervention based on the chronic care model in resource-constrained public primary care settings. The evidence should instigate crucial primary care system change in Malaysia. ClinicalTrials.gov NCT01545401.

  17. Assessment of the implementation of the primary health care package at selected sites in South Africa.

    PubMed

    Heunis, J C; van Rensburg, H C J; Claassens, D L

    2006-11-01

    A major objective of public health policy in South Africa is to develop a district-based health service focused on the delivery of primary health care. The primary health care package has been developed to promote the delivery of a number of services at the primary level. This paper assesses the implementation of the package in eight historically disadvantaged urban renewal nodes singled out for accelerated development through the government's urban renewal strategy. Data were gathered by way of interviews with primary health care facility managers and programme co-ordinators and through physical observations at facilities. The findings show that while some facilities were able to offer clients most of the services specified by the package, many others were unable do so. The urban renewal nodes differed noticeably in this respect.

  18. [Development and evolution of a balanced scorecard in primary health care: Lessons learned].

    PubMed

    Bartolomé-Benito, E; Jiménez-Carramiñana, J; Sánchez-Perruca, L; Bartolomé-Casado, M S; Dominguez-Mandueño, A B; Marti-Argandoña, M; Hernández-Pascual, M; Miquel-Gómez, A

    To describe the design, implementation, and monitoring of eSOAP (Primary Health Care Balanced Scorecard) and its role in the deployment of strategic objectives and clinical management, as well as to show the lessons learned during six years of follow-up. Descriptive study areas: methodology (conceptual framework, strategic matrix, strategic map, and processes map), technology and standardisation. As of December 2014, 9,046 (78%) professionals are registered in eSOAP. A total of 381 indicators were measured from 16 data sources, of which 36% were of results (EFQM model), 39.1% of clinical management, and 20% were included in the Program Centre Contract. The Balanced Scorecard has enabled to deploy all strategic lines of Primary Health Care, and has enabled the healthcare professionals to evaluate the evolution of results over time, and at patient level (e.g. 16% increase in control of diabetic patients). A total of 295,779 reports were generated and 13,080 professionals were evaluated by goals. There was an increased use of the eSOAP application by the professionals. The Balanced Scorecard was the key in deploying Primary Health Care strategies. It has helped clinical management and improved relevant indicators (health, patient experience, and costs), such as the management models that we used as references (EFQM Kaplan and Norton), and new emerging scenarios (Triple aim). Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Emotional intelligence in nurse management and nurse job satisfaction and retention: a scoping review protocol.

    PubMed

    Phillips, Jacqueline; Harris, Janet

    2017-11-01

    The objective of this review is to map what is known about emotional intelligence (EI) in relation to staff job satisfaction and retention in nursing, and the tools that are used to measure EI in this context. The primary question of this review is: What is known about nurse managers' EI as it relates to staff job satisfaction and retention in nursing?Sub-question 1: What tools are being used to measure nurse managers' EI and what theoretical frameworks are they based on?Sub-question 2: What gaps exist in the research related to nurse managers' EI as it relates to staff job satisfaction and retention in nursing?

  20. 75 FR 48369 - Notice of Intent To Seek Approval To Establish an Information Collection

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-10

    ... INFORMATION: Title of Collection: A Social Network Analysis of the National Science Foundation's Research and... Office of Management and Budget (OMB) for review and approval. A Social Network Analysis of the National... programs. The primary objectives of the study are to conduct a social network analysis of the REESE and DR...

  1. Quality of Care for Childhood Attention-Deficit/Hyperactivity Disorder in a Managed Care Medicaid Program

    ERIC Educational Resources Information Center

    Zima, Bonnie T.; Bussing, Regina; Tang, Lingqi; Zhang, Lily; Ettner, Susan; Belin, Thomas R.; Wells, Kenneth B.

    2010-01-01

    Objective: To examine whether clinical severity is greater among children receiving attention-deficit/hyperactivity disorder (ADHD) care in primary care compared with those in specialty mental health clinics, and to examine how care processes and clinical outcomes vary by sector across three 6-month time intervals. Method: This was a longitudinal…

  2. Digital Mapping, Charting and Geodesy Data Standardization

    DTIC Science & Technology

    1994-12-19

    The primary objective of the audit was to evaluate DMA’s implementation of the Defense Standardization Program. Specifically, the audit determined...interoperability of digital MC&G data. The audit also evaluated DMA’s implementation of the DoD Internal Management Control Program as it pertains to DMA’S implementation of the Defense Standardization Program.

  3. A Phenomenological Study of Autonomous Management Performance Schools (AMPS) in the Chicago Public Schools

    ERIC Educational Resources Information Center

    Moore, Forrest W.

    2009-01-01

    The primary objective of this qualitative study is to explore the impact of autonomy on the relationship between schools and districts of the school level across governance, operations, curriculum and instruction and the decision making that accompanies the each of these factors. More specifically, this study focuses the impact of autonomy within…

  4. The Challenges of Advancing Fiscal Equity in a Resource-Strained Context

    ERIC Educational Resources Information Center

    Malen, Betty; Dayhoff, Justin; Egan, Laura; Croninger, Robert G.

    2017-01-01

    Weighted student funding (WSF) is a multifaceted school finance, management, and governance reform that is gaining attention. While WSF has a number of goals, its primary objective is to redress intra-district funding inequities. This article draws on a mixed-methods study of WSF in Prince George's County Public Schools to examine the initiative's…

  5. The value of intervening for intimate partner violence in South African primary care: project evaluation

    PubMed Central

    Mash, Robert James

    2011-01-01

    Objectives Intimate partner violence (IPV) is an important contributor to the burden of disease in South Africa. Evidence-based approaches to IPV in primary care are lacking. This study evaluated a project that implemented a South African protocol for screening and managing IPV. This article reports primarily on the benefits of this intervention from the perspective of women IPV survivors. Design This was a project evaluation involving two urban and three rural primary care facilities. Over 4–8 weeks primary care providers screened adult women for a history of IPV within the previous 24 months and offered referral to the study nurse. The study nurse assessed and managed the women according to the protocol. Researchers interviewed the participants 1 month later to ascertain adherence to their care plan and their views on the intervention. Results In total, 168 women were assisted and 124 (73.8%) returned for follow-up. Emotional (139, 82.7%), physical (115, 68.5%), sexual (72, 42.9%) and financial abuse (72, 42.9%) was common and 114 (67.9%) were at high/severe risk of harm. Adherence to the management plan ranged from testing for syphilis 10/25 (40.0%) to consulting a psychiatric nurse 28/58 (48.3%) to obtaining a protection order 28/28 (100.0%). Over 75% perceived all aspects of their care as helpful, except for legal advice from a non-profit organisation. Women reported significant benefits to their mental health, reduced alcohol abuse, improved relationships, increased self-efficacy and reduced abusive behaviour. Two characteristics seemed particularly important: the style of interaction with the nurse and the comprehensive nature of the assessment. Conclusion Female IPV survivors in primary care experience benefit from an empathic, comprehensive approach to assessing and assisting with the clinical, mental, social and legal aspects. Primary care managers should find ways to integrate this into primary care services and evaluate it further. PMID:22146888

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

    PubMed Central

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

    2015-01-01

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

  7. How to create more supportive supervision for primary healthcare: lessons from Ngamiland district of Botswana: co-operative inquiry group.

    PubMed

    Nkomazana, Oathokwa; Mash, Robert; Wojczewski, Silvia; Kutalek, Ruth; Phaladze, Nthabiseng

    2016-01-01

    Supportive supervision is a way to foster performance, productivity, motivation, and retention of health workforce. Nevertheless there is a dearth of evidence of the impact and acceptability of supportive supervision in low- and middle-income countries. This article describes a participatory process of transforming the supervisory practice of district health managers to create a supportive environment for primary healthcare workers. The objective of the study was to explore how district health managers can change their practice to create a more supportive environment for primary healthcare providers. A facilitated co-operative inquiry group (CIG) was formed with Ngamiland health district managers. CIG belongs to the participatory action research paradigm and is characterised by a cyclic process of observation, reflection, planning, and action. The CIG went through three cycles between March 2013 and March 2014. Twelve district health managers participated in the inquiry group. The major insights and learning that emerged from the inquiry process included inadequate supervisory practice, perceptions of healthcare workers' experiences, change in the managers' supervision paradigm, recognition of the supervisors' inadequate supervisory skills, and barriers to supportive supervision. Finally, the group developed a 10-point consensus on what they had learnt regarding supportive supervision. Ngamiland health district managers have come to appreciate the value of supportive supervision and changed their management style to be more supportive of their subordinates. They also developed a consensus on supportive supervision that could be adapted for use nationally. Supportive supervision should be prioritised at all levels of the health system, and it should be adequately resourced.

  8. Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial.

    PubMed

    Bischoff, Erik W M A; Akkermans, Reinier; Bourbeau, Jean; van Weel, Chris; Vercoulen, Jan H; Schermer, Tjard R J

    2012-11-28

    To assess the long term effects of two different modes of disease management (comprehensive self management and routine monitoring) on quality of life (primary objective), frequency and patients' management of exacerbations, and self efficacy (secondary objectives) in patients with chronic obstructive pulmonary disease (COPD) in general practice. 24 month, multicentre, investigator blinded, three arm, pragmatic, randomised controlled trial. 15 general practices in the eastern part of the Netherlands. Patients with COPD confirmed by spirometry and treated in general practice. Patients with very severe COPD or treated by a respiratory physician were excluded. A comprehensive self management programme as an adjunct to usual care, consisting of four tailored sessions with ongoing telephone support by a practice nurse; routine monitoring as an adjunct to usual care, consisting of 2-4 structured consultations a year with a practice nurse; or usual care alone (contacts with the general practitioner at the patients' own initiative). The primary outcome was the change in COPD specific quality of life at 24 months as measured with the chronic respiratory questionnaire total score. Secondary outcomes were chronic respiratory questionnaire domain scores, frequency and patients' management of exacerbations measured with the Nijmegen telephonic exacerbation assessment system, and self efficacy measured with the COPD self-efficacy scale. 165 patients were allocated to self management (n=55), routine monitoring (n=55), or usual care alone (n=55). At 24 months, adjusted treatment differences between the three groups in mean chronic respiratory questionnaire total score were not significant. Secondary outcomes did not differ, except for exacerbation management. Compared with usual care, more exacerbations in the self management group were managed with bronchodilators (odds ratio 2.81, 95% confidence interval 1.16 to 6.82) and with prednisolone, antibiotics, or both (3.98, 1.10 to 15.58). Comprehensive self management or routine monitoring did not show long term benefits in terms of quality of life or self efficacy over usual care alone in COPD patients in general practice. Patients in the self management group seemed to be more capable of appropriately managing exacerbations than did those in the usual care group. Clinical trials NCT00128765.

  9. 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.

  10. Pilot Study of Implementation of an Internet-Based Depression Prevention Intervention (CATCH-IT) for Adolescents in 12 US Primary Care Practices: Clinical and Management/Organizational Behavioral Perspectives

    PubMed Central

    Eisen, Jeffrey C.; Marko-Holguin, Monika; Fogel, Joshua; Cardenas, Alonso; Bahn, My; Bradford, Nathan; Fagan, Blake; Wiedmann, Peggy

    2013-01-01

    Objective: To explore the implementation of CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral Humanistic and Interpersonal Training), an Internet-based depression intervention program in 12 primary care sites, occurring as part of a randomized clinical trial comparing 2 versions of the intervention (motivational interview + Internet program versus brief advice + Internet program) in 83 adolescents aged 14 to 21 years recruited from February 1, 2007, to November 31, 2007. Method: The CATCH-IT intervention model consists of primary care screening to assess risk, a primary care physician interview to encourage participation, and 14 online modules of Internet training to teach adolescents how to reduce behaviors that increase vulnerability to depressive disorders. Specifically, we evaluated this program from both a management/organizational behavioral perspective (provider attitudes and demonstrated competence) and a clinical outcomes perspective (depressed mood scores) using the RE-AIM model (Reach, Efficacy, Adoption, Implementation, and Maintenance of the intervention). Results: While results varied by clinic, overall, clinics demonstrated satisfactory reach, efficacy, adoption, implementation, and maintenance of the CATCH-IT depression prevention program. Measures of program implementation and management predicted clinical outcomes at practices in exploratory analyses. Conclusion: Multidisciplinary approaches may be essential to evaluating the impact of complex interventions to prevent depression in community settings. Primary care physicians and nurses can use Internet-based programs to create a feasible and cost-effective model for the prevention of mental disorders in adolescents in primary care settings. Trial Registration: ClinicalTrials.gov identifiers: NCT00152529 and NCT00145912 PMID:24800110

  11. Implementation of an integrated primary care cardiometabolic risk prevention and management network in Montréal: does greater coordination of care with primary care physicians have an impact on health outcomes?

    PubMed

    Provost, Sylvie; Pineault, Raynald; Grimard, Dominique; Pérez, José; Fournier, Michel; Lévesque, Yves; Desforges, Johanne; Tousignant, Pierre; Borgès Da Silva, Roxane

    2017-04-01

    Chronic disease management requires substantial services integration. A cardiometabolic risk management program inspired by the Chronic Care Model was implemented in Montréal for patients with diabetes or hypertension. One of this study's objectives was to assess the impact of care coordination between the interdisciplinary teams and physicians on patient participation in the program, lifestyle improvements and disease control. We obtained data on health outcomes from a register of clinical data, questionnaires completed by patients upon entry into the program and at the 12-month mark, and we drew information on the program's characteristics from the implementation analysis. We conducted multiple regression analyses, controlling for patient sociodemographic and health characteristics, to measure the association between interdisciplinary team coordination with primary care physicians and various health outcomes. A total of 1689 patients took part in the study (60.1% participation rate). Approximately 40% of patients withdrew from the program during the first year. At the 12-month follow-up (n = 992), we observed a significant increase in the proportion of patients achieving the various clinical targets. The perception by the interdisciplinary team of greater care coordination with primary care physicians was associated with increased participation in the program and the achievement of better clinical results. Greater coordination of patient services between interdisciplinary teams and primary care physicians translates into benefits for patients.

  12. Benign Headache Management in the Emergency Department.

    PubMed

    Long, Brit J; Koyfman, Alex

    2018-04-01

    Headache is a common complaint managed in the emergency department (ED), with emergency physicians focusing on evaluation for life-threatening conditions while treating pain and nausea. This review evaluates the treatment of benign, primary headaches in the ED, with recommendations provided based on the literature. Headaches are a major cause of disability in the United States and a common condition managed in the ED. The primary objectives of emergency evaluation of these patients include evaluation for a life-threatening, secondary cause of headache, with treatment of primary headaches. Close evaluation for a secondary cause of headache include consideration of red flags and focused neurologic examination. The diagnosis of primary headaches is clinical. Literature has evaluated medication efficacy in headache treatment, with antidopaminergic medications demonstrating high rates of efficacy when used in combination with nonsteroidal inflammatory drugs or acetaminophen. Dexamethasone can be used for the reduction of headache recurrence. If dehydration is present, intravenous fluids should be provided. Diphenhydramine is not recommended for analgesia but may reduce akathisia associated with prochlorperazine. Ketamine, propofol, and nerve blocks demonstrate promise. Triptan agents are also efficacious, provided absence of contraindications. Most patients are appropriate for discharge with pain improvement. A variety of medications is available for the treatment of primary headaches in the ED. Antidopaminergic agents demonstrate the highest efficacy and should be provided with acetaminophen and nonsteroidal inflammatory drugs. Dexamethasone may reduce headache recurrence. Other treatments include ketamine, propofol, and nerve blocks. Published by Elsevier Inc.

  13. Effective strategies for prevention, control, and treatment of obesity in primary health care setting for adolescents, adults, and elderly people: A protocol for systematic review and meta-analysis.

    PubMed

    Marques, Emanuele Souza; Leite, Tatiana Henriques; Azeredo, Catarina Machado; Cunha, Diana Barbosa; Verly Júnior, Eliseu

    2018-06-01

    It is unquestionable that obesity is a global epidemic and one of the main public health problems in the world. The management of obesity in Primary Health Care has an important role if being considered the magnitude and serious consequence of this problem. Despite this, there is no effective standard protocol for the treatment of this disease. Studies that synthesize and assess the effectiveness of strategies for prevention, control, and treatment of obesity in Primary Health Care setting are still scarce. The objective of this study is review and synthesize study evidence for obesity management strategies among adolescents, adults and elderly developed at the Primary Health Care worldwide. Seven electronic databases (Medline, Lilacs, Embase, Psycinfo, Cochrane, WHOLIS and Open Gray) will be searched with no date limit for identification of clinical trials examining the effectiveness of prevention, control and treatment of obesity in Primary Health Care. As primary outcome will be changes in body weight. As secondary outcomes will be body mass index, body adiposity, waist circumference, and waist-hip ratio. Two independent authors will perform the selection of studies, data extraction, and the assessment of risk of bias. The results will be published in a peer-reviewed journal. This systematic review will be first to synthesize scientific evidence for obesity management strategies at Primary Health Care among adolescents, adults, and elderly. The review will benefit healthcare professionals and policymakers. Ethical approval is not required in this study because the data used include peer-reviewed publications, which do not comprise any information that could identify subjects. PROSPERO (CRD42018092416).

  14. Clinic Services for Persons with AIDS

    PubMed Central

    Markson, Leona E; Turner, Barbara J; Cocroft, Jim; Houchens, Robert; Fanning, Thomas R

    1997-01-01

    OBJECTIVE To profile characteristics of clinics caring for persons with advanced HIV infection. DESIGN AND SETTING Survey of clinic directors in New York State. PARTICIPANTS Newly diagnosed Medicaid-enrolled AIDS patients in New York state in federal fiscal years 1987–1992 (n = 6,184) managed by 62 HIV specialty, 53 hospital-based general medicine/primary care, 36 community-based primary care, and 28 other clinics. MEASUREMENTS AND MAIN RESULTS Telephone survey about clinic hours, emphasis on HIV, staffing, procedures, and directors’ rating of care. Estimates of the number of newly diagnosed, Medicaid-enrolled AIDS patients treated in surveyed clinics were obtained from claims data. We found that community-based clinics were significantly more likely to have longer hours, a physician on call, or to accommodate unscheduled care than were hospital-based general medicine/primary care or other types of clinics. Compared with HIV specialty clinics, general medicine/primary care clinics were less likely to have HIV-specific care attributes such as a director of HIV care (98% vs 72%), multidisciplinary conferences on HIV care (83% vs 32%), or a standard initial HIV workup (90% vs 70%). Of general medicine/primary care clinics, most (83%) were staffed by residents and fellows compared with only 68% of HIV or 25% of community-based clinics (p < .001). General medicine/primary care clinics were less likely than community-based clinics to perform Pap smears (75% vs 94%) or to have case managers on payroll (21% vs 81%). CONCLUSIONS In this sample of clinics, hospital-based general medicine/primary care clinics managing the care of Medicaid enrollees with AIDS appeared to have more limited hours and availability of specific services than HIV specialty or community-based clinics.

  15. Are Anxiety and Depression Addressed in Primary Care Patients With Chronic Obstructive Pulmonary Disease? A Chart Review

    PubMed Central

    Roundy, Kent; Cully, Jeffrey A.; Stanley, Melinda A.; Veazey, Connie; Souchek, Julianne; Wray, Nelda P.; Kunik, Mark E.

    2005-01-01

    Objective: Screening for mental illness in primary care is widely recommended, but little is known about the evaluation, treatment, and long-term management processes that follow screening. The aim of this study was to examine and describe the quality of mental health care for persons with chronic obstructive pulmonary disease (COPD) and anxiety/depressive disorders, as measured by adherence to practice guidelines. Method: This retrospective chart review examined data for 102 primary care and mental health care patients with COPD who were diagnosed, using Structured Clinical Interview for DSM-IV criteria, with major depressive disorder, dysthymia, depression not otherwise specified, generalized anxiety disorder, or anxiety not otherwise specified. Data were gathered from primary care progress notes from the year prior to enrollment in a randomized controlled trial (enrollment was from July 2002 to April 2004). We compared the care received by these patients over 1 year with that recommended by practice guidelines. Charts were abstracted using a checklist of recommended practice guidelines for diagnostic evaluation, acute treatment, and long-term management of anxiety and depressive disorders. Results: Fifty (49%) of the 102 patients were recognized during the review year as having an anxiety or depressive disorder. Eighteen patients were newly assessed for depressive or anxiety disorders during the chart review year. Patients followed in primary care alone, compared with those who were comanaged by mental health care providers, were less likely to have guideline-adherent care. Conclusion: Depressive and anxiety disorders are recognized in about half of patients; however, guideline-supported diagnostic evaluation, acute treatment (except for medications), and long-term management rarely occur in the primary care setting. To improve the treatment of depressive and anxiety disorders in primary care, the process of care delivery must be understood and changed. PMID:16308576

  16. Prevalence of Barriers and Facilitators to Enhancing Conservative Kidney Management for Older Adults in the Primary Care Setting

    PubMed Central

    Tam-Tham, Helen; King-Shier, Kathryn M.; Thomas, Chandra M.; Quinn, Robert R.; Fruetel, Karen; Davison, Sara N.

    2016-01-01

    Background and objectives Conservative management of adults with stage 5 CKD (eGFR<15 ml/min per 1.73 m2) is increasingly being provided in the primary care setting. We aimed to examine perceived barriers and facilitators for conservative management of older adults by primary care physicians. Design, setting, participants, & measurements In 2015, we conducted a cross–sectional, population–based survey of all primary care physicians in Alberta, Canada. Eligible participants had experience caring for adults ages ≥75 years old with stage 5 CKD not planning on initiating dialysis. Questionnaire items were on the basis of a qualitative descriptive study informed by the Behavior Change Wheel and tested for face and content validity. Physicians were contacted via postal mail and/or fax on the basis of a modified Dillman method. Results Four hundred nine eligible primary care physicians completed the questionnaire (9.6% response rate). The majority of respondents were men (61.6%), were ages 40–60 years old (62.6%), and practiced in a large/medium population center (68.0%). The most common barrier to providing conservative care in the primary care setting was the inability to access support to maintain patients in the home setting (39.1% of respondents; 95% confidence interval, 34.6% to 43.6%). The second most common barrier was working with nonphysician providers with limited kidney–specific clinical expertise (32.3%; 95% confidence interval, 28.0% to 36.7%). Primary care physicians indicated that the two most common strategies that would enhance their ability to provide conservative management would be the ability to use the telephone to contact a nephrologist or clinical staff from the conservative care clinic (86.9%; 95% confidence interval, 83.7% to 90.0% and 85.6%; 95% confidence interval, 82.4% to 88.9%, respectively). Conclusions We identified important areas to inform clinical programs to reduce barriers and enhance facilitators to improve primary care physicians’ provision of conservative kidney care. In particular, primary care physicians require additional resources for maintaining patients in their home and telephone access to nephrologists and conservative care specialists. PMID:27551007

  17. Design principles and algorithms for automated air traffic management

    NASA Technical Reports Server (NTRS)

    Erzberger, Heinz

    1995-01-01

    This paper presents design principles and algorithm for building a real time scheduler. The primary objective of the scheduler is to assign arrival aircraft to a favorable landing runway and schedule them to land at times that minimize delays. A further objective of the scheduler is to allocate delays between high altitude airspace far from the airport and low altitude airspace near the airport. A method of delay allocation is described that minimizes the average operating cost in the presence of errors in controlling aircraft to a specified landing time.

  18. Transportable Applications Environment (TAE) Plus: A NASA user interface development and management system

    NASA Technical Reports Server (NTRS)

    Szczur, Martha R.

    1991-01-01

    The transportable Applications Environment Plus (TAE Plus), developed at the NASA Goddard Space FLight Center, is a portable, What you see is what you get (WYSIWYG) user interface development and management system. Its primary objective is to provide an integrated software environment that allows interactive prototyping and development of graphical user interfaces, as well as management of the user interface within the operational domain. TAE Plus is being applied to many types of applications, and what TAE Plus provides, how the implementation has utilizes state-of-the-art technologies within graphic workstations, and how it has been used both within and without NASA are discussed.

  19. Apollo/Skylab suit program management systems study. Volume 2: Cost analysis

    NASA Technical Reports Server (NTRS)

    1974-01-01

    The business management methods employed in the performance of the Apollo-Skylab Suit Program are studied. The data accumulated over the span of the contract as well as the methods used to accumulate the data are examined. Management methods associated with the monitoring and control of resources applied towards the performance of the contract are also studied and recommended upon. The primary objective is the compilation, analysis, and presentation of historical cost performance criteria. Cost data are depicted for all phases of the Apollo-Skylab program in common, meaningful terms, whereby the data may be applicable to future suit program planning efforts.

  20. Evaluation of the quality of care of a multi-disciplinary Risk Factor Assessment and Management Programme for Hypertension (RAMP-HT).

    PubMed

    Yu, Esther Yee Tak; Wan, Eric Yuk Fai; Chan, Karina Hiu Yen; Wong, Carlos King Ho; Kwok, Ruby Lai Ping; Fong, Daniel Yee Tak; Lam, Cindy Lo Kuen

    2015-06-19

    There is some evidence to support a risk-stratified, multi-disciplinary approach to manage patients with hypertension in primary care. The aim of this study is to evaluate the quality of care (QOC) of a multi-disciplinary Risk Assessment and Management Programme for Hypertension (RAMP-HT) for hypertensive patients in busy government-funded primary care clinics in Hong Kong. The objectives are to develop an evidence-based, structured and comprehensive evaluation framework on quality of care, to enhance the QOC of the RAMP-HT through an audit spiral of two evaluation cycles and to determine the effectiveness of the programme in reducing cardiovascular disease (CVD) risk. A longitudinal study is conducted using the Action Learning and Audit Spiral methodologies to measure whether pre-set target standards of care intended by the RAMP-HT are achieved. A structured evaluation framework on the quality of structure, process and outcomes of care has been developed based on the programme objectives and literature review in collaboration with the programme workgroup and health service providers. Each participating clinic is invited to complete a structure of care evaluation questionnaire in each evaluation cycle. The data of all patients who have enrolled into the RAMP-HT in the pre-defined evaluation periods are used for the evaluation of the process and outcomes of care in each evaluation cycle. For evaluation of the effectiveness of RAMP-HT, the primary outcomes including blood pressure (both systolic and diastolic), low-density lipoprotein cholesterol and estimated 10-year CVD risk of RAMP-HT participants are compared to those of hypertensive patients in usual care without RAMP-HT. The QOC and effectiveness of the RAMP-HT in improving clinical and patient-reported outcomes for patients with hypertension in normal primary care will be determined. Possible areas for quality enhancement and standards of good practice will be established to inform service planning and policy decision making.

  1. Biology, ecology, and social aspects of wild edible mushrooms in the forests of the Pacific northwest: A preface to managing commercial harvest. Forest Service general technical report

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

    Molina, R.; O'Dell, T.; Luoma, D.

    1993-02-01

    The commercial harvest of edible, forest fungi has a multimillion dollar industry with several thousand tons harvested annually. The primary objectives of the overview paper are to provide information on the biology of forest fungi, describe the major edible fungi harvested in the Pacific Northwest, integrate a perspective on the social aspects of the mushroom harvest issue, summarize the development of the commercial mushroom industry, and suggest research and monitoring protocols for developing management guidelines.

  2. Measuring the prevalence and impact of poor menstrual hygiene management: a quantitative survey of schoolgirls in rural Uganda

    PubMed Central

    Hennegan, Julie; Wu, Maryalice; Scott, Linda; Montgomery, Paul

    2016-01-01

    Objectives The primary objective was to describe Ugandan schoolgirls’ menstrual hygiene management (MHM) practices and estimate the prevalence of inadequate MHM. Second, to assess the relative contribution of aspects of MHM to health, education and psychosocial outcomes. Design Secondary analysis of survey data collected as part of the final follow-up from a controlled trial of reusable sanitary pad and puberty education provision was used to provide a cross-sectional description of girls’ MHM practices and assess relationships with outcomes. Setting Rural primary schools in the Kamuli district, Uganda. Participants Participants were 205 menstruating schoolgirls (10–19 years) from the eight study sites. Primary and secondary outcome measures The prevalence of adequate MHM, consistent with the concept definition, was estimated using dimensions of absorbent used, frequency of absorbent change, washing and drying procedures and privacy. Self-reported health, education (school attendance and engagement) and psychosocial (shame, insecurity, embarrassment) outcomes hypothesised to result from poor MHM were assessed as primary outcomes. Outcomes were measured through English surveys loaded on iPads and administered verbally in the local language. Results 90.5% (95% CI 85.6% to 93.9%) of girls failed to meet available criteria for adequate MHM, with no significant difference between those using reusable sanitary pads (88.9%, 95% CI 79.0% to 94.4%) and those using existing methods, predominantly cloth (91.5%, 95% CI 85.1% to 95.3%; χ2 (1)=0.12, p=0.729). Aspects of MHM predicted some consequences including shame, not standing in class to answer questions and concerns about odour. Conclusions This study was the first to assess the prevalence of MHM consistent with the concept definition. Results suggest that when all aspects of menstrual hygiene are considered together, the prevalence is much higher than has previously been reported based on absorbents alone. The work demonstrates an urgent need for improved assessment and reporting of MHM, and for primary research testing the links between menstrual management and health, education and psychosocial consequences. PMID:28039290

  3. Aversion to ambiguity and willingness to take risks affect therapeutic decisions in managing atrial fibrillation for stroke prevention: results of a pilot study in family physicians

    PubMed Central

    Saposnik, Florencia; Pelyavskyy, Roman; Liuni, Andrew; Saposnik, Gustavo

    2017-01-01

    Background Anticoagulation is the therapeutic paradigm for stroke prevention in patients with atrial fibrillation (AF). It is unknown how physicians make treatment decisions in primary stroke prevention for patients with AF. Objectives To evaluate the association between family physicians’ risk preferences (aversion risk and ambiguity) and therapeutic recommendations (anticoagulation) in the management of AF for primary stroke prevention by applying concepts from behavioral economics. Methods Overall, 73 family physicians participated and completed the study. Our study comprised seven simulated case vignettes, three behavioral experiments, and two validated surveys. Behavioral experiments and surveys incorporated an economic framework to determine risk preferences and biases (e.g., ambiguity aversion, willingness to take risks). The primary outcome was making the correct decision of anticoagulation therapy. Secondary outcomes included medical errors in the management of AF for stroke prevention. Results Overall, 23.3% (17/73) of the family physicians elected not to escalate the therapy from antiplatelets to anticoagulation when recommended by best practice guidelines. A total of 67.1% of physicians selected the correct therapeutic options in two or more of the three simulated case vignettes. Multivariate analysis showed that aversion to ambiguity was associated with appropriate change to anticoagulation therapy in the management of AF (OR 5.48, 95% CI 1.08–27.85). Physicians’ willingness to take individual risk in multiple domains was associated with lower errors (OR 0.16, 95% CI 0.03–0.86). Conclusion Physicians’ aversion to ambiguity and willingness to take risks are associated with appropriate therapeutic decisions in the management of AF for primary stroke prevention. Further large scale studies are needed. PMID:28979101

  4. Effective Implementation of Collaborative Care for Depression: What is Needed?

    PubMed Central

    Whitebird, Robin R.; Solberg, Leif I.; Jaeckels, Nancy A.; Pietruszewski, Pamela B.; Hadzic, Senka; Unützer, Jürgen; Ohnsorg, Kris A.; Rossom, Rebecca C.; Beck, Arne; Joslyn, Ken; Rubenstein, Lisa V.

    2014-01-01

    Objective To identify the care model factors that were key for successful implementation of collaborative depression care in a statewide Minnesota primary care initiative. Study Design We used a mixed-methods design incorporating both qualitative data from clinic site visits and quantitative measures of patient activation and 6-month remission rates. Methods Care model factors identified from the site visits were tested for association with rates of activation into the program and remission rates. Results Nine factors were identified as important for successful implementation of collaborative care by the consultants who had trained and interviewed participating clinic teams. Factors correlated with higher patient activation rates were: strong leadership support (0.63), well-defined and implemented care manager roles (0.62), a strong primary care physician champion (0.60), and an on-site and accessible care manager (0.59). However, remission rates at six months were correlated with: an engaged psychiatrist (0.62), not seeing operating costs as a barrier to participation (0.56), and face-to-face communication (warm handoffs) between the care-manager and primary care physician for new patients (0.54). Conclusions Care model factors most important for successful program implementation differ for patient activation into the program versus remission at six months. Knowing which implementation factors are most important for successful implementation will be useful for those interested in adopting this evidence-based approach to improve primary care for patients with depression. PMID:25365745

  5. Electrical treatment of atrial arrhythmias in heart failure patients implanted with a dual defibrillator CRT device. Results from the TRADE-HF study.

    PubMed

    Botto, Giovanni Luca; Padeletti, Luigi; Covino, Gregorio; Pieragnoli, Paolo; Liccardo, Mattia; Mariconti, Barbara; Favale, Stefano; Molon, Giulio; De Filippo, Paolo; Bolognese, Leonardo; Landolina, Maurizio; Raciti, Giovanni; Boriani, Giuseppe

    2017-06-01

    Ventricular and atrial arrhythmias commonly occur in heart failure patients and are a significant source of symptoms, morbidity and mortality. Some specific generators referred to as dual defibrillators, Dual CRT-Ds, have the ability to treat atrial and ventricular arrhythmias. TRADE-HF is a prospective two-arm randomized study aimed at assessing the benefits of complete automatic management of atrial arrhythmias in patients implanted with a dual CRT-D. Primary objective of the TRADE-HF study was to document reduction of unplanned hospital admission for cardiac reasons or death for cardiovascular causes or progression to permanent AF, by comparing fully-automatic device driven therapy for atrial tachycardia or fibrillation (AT/AF) to an in-hospital approach for treatment of symptomatic AT/AF. Randomized Patients were followed every 6months for 3years to assess the primary objective. Four-hundred-twenty patients have been enrolled in the study. At the end of the study 30 subjects died for cardiovascular causes, 60 had at least one hospitalization for cardiovascular causes and 14 developed permanent AF. Eighty-seven patients experienced a composite event. Hazard Ratio for device-managed automatic therapy arm compared to traditional was 0.987 (95% CI: 0.684-1.503; p=0.951). The primary endpoint analysis resulted in no difference between the device managed and in-hospital treatment arm. The TRADE-HF study failed to demonstrate a reduction in the composite of unplanned hospitalizations for cardiovascular causes or death for cardiovascular causes or progression to permanent AF using automatic atrial therapy compared to a traditional approach including hospitalization for symptomatic episodes and/or in-hospital treatment of AT/AF. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Proposal for adaptive management to conserve biotic integrity in a regulated segment of the Tallapoosa River, Alabama, U.S.A

    USGS Publications Warehouse

    Irwin, Elise R.; Freeman, Mary C.

    2002-01-01

    Conserving river biota will require innovative approaches that foster and utilize scientific understanding of ecosystem responses to alternative river-management scenarios. We describe ecological and societal issues involved in flow management of a section of the Tallapoosa River (Alabama, U.S.A.) in which a species-rich native fauna is adversely affected by flow alteration by an upstream hydropower dam. We hypothesize that depleted Iow flows, flow instability and thermal alteration resulting from pulsed flow releases at the hydropower dam are most responsible for changes in the Tallapoosa River biota. However, existing data are insufficient to prescribe with certainty minimum flow levels or the frequency and duration of stable flow periods that would be necessary or sufficient to protect riverine biotic integrity. Rather than negotiate a specific change in the flow regime, we propose that stakeholders--including management agencies, the power utility, and river advocates--engage in a process of adaptive-flow management. This process would require that stakeholders (1) develop and agree to management objectives; (2) model hypothesized relations between dam operations and management objectives; (3) implement a change in dam operations; and (4) evaluate biological responses and other stakeholder benefits through an externally reviewed monitoring program. Models would be updated with monitoring data and stakeholders would agree to further modify flow regimes as necessary to achieve management objectives. A primary obstacle to adaptive management will be a perceived uncertainty of future costs for the power utility and other stakeholders. However, an adaptive, iterative approach offers the best opportunity for improving flow regimes for native biota while gaining information critical to guiding management decisions in other flow-regulated rivers.

  7. The Evidence Base for Interventions Delivered to Children in Primary Care: An Overview of Cochrane Systematic Reviews

    PubMed Central

    Gill, Peter J.; Wang, Kay Yee; Mant, David; Hartling, Lisa; Heneghan, Carl; Perera, Rafael; Klassen, Terry; Harnden, Anthony

    2011-01-01

    Background As a first step in developing a framework to evaluate and improve the quality of care of children in primary care there is a need to identify the evidence base underpinning interventions relevant to child health. Our objective was to identify all Cochrane systematic reviews relevant to the management of childhood conditions in primary care and to assess the extent to which Cochrane reviews reflect the burden of childhood illness presenting in primary care. Methodology/Principal Findings We used the Cochrane Child Health Field register of child-relevant systematic reviews to complete an overview of Cochrane reviews related to the management of children in primary care. We compared the proportion of systematic reviews with the proportion of consultations in Australia, US, Dutch and UK general practice in children. We identified 396 relevant systematic reviews; 358 included primary studies on children while 251 undertook a meta-analysis. Most reviews (n = 218, 55%) focused on chronic conditions and over half (n = 216, 57%) evaluated drug interventions. Since 2000, the percentage of pediatric primary care relevant reviews only increased by 2% (7% to 9%) compared to 18% (10% to 28%) in all child relevant reviews. Almost a quarter of reviews (n = 78, 23%) were published on asthma treatments which only account for 3–5% of consultations. Conversely, 15–23% of consultations are due to skin conditions yet they represent only 7% (n = 23) of reviews. Conclusions/Significance Although Cochrane systematic reviews focus on clinical trials and do not provide a comprehensive picture of the evidence base underpinning the management of children in primary care, the mismatch between the focus of the published research and the focus of clinical activity is striking. Clinical trials are an important component of the evidence base and the lack of trial evidence to demonstrate intervention effectiveness in substantial areas of primary care for children should be addressed. PMID:21829691

  8. Medical Data Management in Time-Sharing: Findings of the DIRAC Project.

    ERIC Educational Resources Information Center

    Ludwig, Herbert; Vallee, Jacques

    In terms of examples drawn from clinical and research data files, one of the objectives of this study is to illustrate several factors that have combined to delay the implementation of medical data bases. A primary factor has been inherent in the design of computer software. The languages currently on the market are procedural in nature: they…

  9. Italian National Forest Inventory: methods, state of the project, and future developments

    Treesearch

    Giovanni Tabacchi; Flora De Natale; Antonio Floris; Caterina Gagliano; Patrizia Gasparini; Gianfranco Scrinzi; Vittorio Tosi

    2007-01-01

    A primary objective of the Italian National Forest Inventory (NFI) is to provide information required by the Kyoto Protocol and the Ministerial Conference on the Protection of Forests in Europe in relation to sustainable forest management practices. For this reason, the second Italian NFI was aimed at providing data in a way that is consistent with the international...

  10. Carbon costs of constitutive and expressed resistance to a non-native pathogen in limber pine

    Treesearch

    Patrick J. Vogan; Anna W. Schoettle

    2016-01-01

    Increasing the frequency of resistance to the non-native fungus Cronartium ribicola (causative agent of white pine blister rust, WPBR) in limber pine populations is a primary management objective to sustain high-elevation forest communities. However, it is not known to what extent genetic disease resistance is costly to plant growth or carbon economy. In this...

  11. Implementing Education Reforms in New Zealand, 1987-97: A Case Study. The Education Reform and Management Series, Vol. 1, No. 1.

    ERIC Educational Resources Information Center

    Perris, Lyall

    In 1987 New Zealand faced multiple economic problems and high unemployment. A flexible and responsive education system was needed to produce the skills, attitudes, and learning required for New Zealand's future. The primary objective was decentralizing authority to school level. This book emphasizes the process of successful reform, rather than…

  12. Diabetes-Related Behavior Change Knowledge Transfer to Primary Care Practitioners and Patients: Implementation and Evaluation of a Digital Health Platform

    PubMed Central

    Vallis, Michael; Piccinini-Vallis, Helena; Imran, Syed Ali; Abidi, Syed Sibte Raza

    2018-01-01

    Background Behavioral science is now being integrated into diabetes self-management interventions. However, the challenge that presents itself is how to translate these knowledge resources during care so that primary care practitioners can use them to offer evidence-informed behavior change support and diabetes management recommendations to patients with diabetes. Objective The aim of this study was to develop and evaluate a computerized decision support platform called “Diabetes Web-Centric Information and Support Environment” (DWISE) that assists primary care practitioners in applying standardized behavior change strategies and clinical practice guidelines–based recommendations to an individual patient and empower the patient with the skills and knowledge required to self-manage their diabetes through planned, personalized, and pervasive behavior change strategies. Methods A health care knowledge management approach is used to implement DWISE so that it features the following functionalities: (1) assessment of primary care practitioners’ readiness to administer validated behavior change interventions to patients with diabetes; (2) educational support for primary care practitioners to help them offer behavior change interventions to patients; (3) access to evidence-based material, such as the Canadian Diabetes Association’s (CDA) clinical practice guidelines, to primary care practitioners; (4) development of personalized patient self-management programs to help patients with diabetes achieve healthy behaviors to meet CDA targets for managing type 2 diabetes; (5) educational support for patients to help them achieve behavior change; and (6) monitoring of the patients’ progress to assess their adherence to the behavior change program and motivating them to ensure compliance with their program. DWISE offers these functionalities through an interactive Web-based interface to primary care practitioners, whereas the patient’s self-management program and associated behavior interventions are delivered through a mobile patient diary via mobile phones and tablets. DWISE has been tested for its usability, functionality, usefulness, and acceptance through a series of qualitative studies. Results For the primary care practitioner tool, most usability problems were associated with the navigation of the tool and the presentation, formatting, understandability, and suitability of the content. For the patient tool, most issues were related to the tool’s screen layout, design features, understandability of the content, clarity of the labels used, and navigation across the tool. Facilitators and barriers to DWISE use in a shared decision-making environment have also been identified. Conclusions This work has provided a unique electronic health solution to translate complex health care knowledge in terms of easy-to-use, evidence-informed, point-of-care decision aids for primary care practitioners. Patients’ feedback is now being used to make necessary modification to DWISE. PMID:29669705

  13. Development of management objectives for waterfowl and shorebirds within the Mississippi Alluvial Valley

    USGS Publications Warehouse

    Loesch, C.R.; Twedt, D.J.; Tripp, K.; Hunter, W.C.; Woodrey, M.S.; Bonney, Rick; Pashley, David N.; Cooper, Robert; Niles, Larry

    2000-01-01

    The goal of the Lower Mississippi Valley Joint Venture of the North American Waterfowl Management Plan is to provide sufficient habitat to support 4.3 million wintering ducks and 1.0 million wintering geese annually. Under the assumption that the amount of foraging habitat is the primary limitation to supporting waterfowl population goals in the Mississippi Alluvial Valley (MAV), a habitat objective to make available 285,000 ha of waterfowl foraging habitat is divided among seven states. This habitat objective is further divided between public and private ownership and among three habitat types: Bottomland hardwood forest, moist-soil sites, and agricultural fields. Management objectives for shorebirds within the MAV which provide foraging habitat for 0.5 million shorebirds during their southward migration have been tentatively established. Several as yet unverified assumptions were used in establishing these objectives; consequently, we caution that the objectives are subject to revision as the assumptions are tested. We assumed that 0.5 million shorebirds move through the MAV during late summer and fall, each foraging for an average of 10 days. During this migration period, foraging shorebirds are assumed to require sufficient forage to gain 1 g of biomass per day, in addition to their basal metabolic needs. Given an invertebrate food supply that provides 17.6 kj ? g-1, we calculated that an average 45 g shorebird requires about 8 g of invertebrate forage per day. Further assuming that each ha of managed shorebird habitat can provide 20 kg of invertebrate food resources available to shorebirds, we extrapolated a need for 2000 ha of shorebird foraging habitat. We suggest that the bulk of this foraging habitat be provided on public lands and that it be distributed throughout the MAV.

  14. Toward a whole-landscape approach for sustainable land use in the tropics.

    PubMed

    DeFries, R; Rosenzweig, C

    2010-11-16

    Increasing food production and mitigating climate change are two primary but seemingly contradictory objectives for tropical landscapes. This special feature examines synergies and trade-offs among these objectives. Four themes emerge from the papers: the important roles of both forest and agriculture sectors for climate mitigation in tropical countries; the minor contribution from deforestation-related agricultural expansion to overall food production at global and continental scales; the opportunities for synergies between improved food production and reductions in greenhouse gas emissions through diversion of agricultural expansion to already-cleared lands, improved soil, crop, and livestock management, and agroforestry; and the need for targeted policy and management interventions to make these synergistic opportunities a reality. We conclude that agricultural intensification is a key factor to meet dual objectives of food production and climate mitigation, but there is no single panacea for balancing these objectives in all tropical landscapes. Place-specific strategies for sustainable land use emerge from assessments of current land use, demographics, and other biophysical and socioeconomic characteristics, using a whole-landscape, multisector perspective.

  15. Improved outcomes in the non-operative management of liver injuries

    PubMed Central

    Saltzherr, Teun Peter; van der Vlies, Cees H; van Lienden, Krijn P; Beenen, Ludo F M; Ponsen, Kees Jan; van Gulik, Thomas M; Goslings, J Carel

    2011-01-01

    Objectives Non-operative management has become the treatment of choice in the majority of liver injuries. The aim of this study was to assess the changes in primary treatment and outcomes in a single Dutch Level 1 trauma centre with wide experience in angio-embolisation (AE). Methods The prospective trauma registry was retrospectively analysed for 7-year periods before (Period 1) and after (Period 2) the introduction of AE. The primary outcome was the failure rate of primary treatment defined as liver injury-related death or re-bleeding requiring radiologic or operative (re)interventions. Secondary outcomes were liver injury-related intra-abdominal complications. Results Despite an increase in high-grade liver injuries, the incidence of primary non-operative management more than doubled over the two periods, from 33% (20 of 61 cases) in Period 1 to 72% (84 of 116 cases) in Period 2 (P < 0.001). The failure rate of primary treatment in Period 1 was 18% (11/61), compared with 11% (13/116) in Period 2 (P = 0.21). Complication rates were 23% (14/61) and 16% (18/116) in Periods 1 and 2, respectively (P = 0.22). Liver-related mortality rates were 10% (6/61) and 3% (4/116) in Periods 1 and 2, respectively (P = 0.095). The increase in the frequency of non-operative management was even higher in high-grade injuries, in which outcomes were improved. In high-grade injuries in Periods 1 and 2, failure rates decreased from 45% (9/20) to 20% (11/55) (P = 0.041), liver-related mortality decreased from 30% (6/20) to 7% (4/55) (P = 0.019) and complication rates fell from 60% (12/20) to 27% (15/55) (P = 0.014). Liver infarction or necrosis and abscess formation seemed to occur more frequently with AE. Conclusions Overall, liver-related mortality, treatment failure and complication rates remained constant despite an increase in non-operative management. However, in high-grade injuries outcomes improved after the introduction of AE. PMID:21492335

  16. Developing Effective Collaboration Between Primary Care and Mental Health Providers

    PubMed Central

    Felker, Bradford L.; Chaney, Edmund; Rubenstein, Lisa V.; Bonner, Laura M.; Yano, Elizabeth M.; Parker, Louise E.; Worley, Linda L. M.; Sherman, Scott E.; Ober, Scott

    2006-01-01

    Objective: Improving care for depressed primary care (PC) patients requires system-level interventions based on chronic illness management with collaboration among primary care providers (PCPs) and mental health providers (MHPs). We describe the development of an effective collaboration system for an ongoing multisite Department of Veterans Affairs (VA) study evaluating a multifaceted program to improve management of major depression in PC practices. Method: Translating Initiatives for Depression into Effective Solutions (TIDES) is a research project that helps VA facilities adopt depression care improvements for PC patients with depression. A regional telephone-based depression care management program used Depression Case Managers (DCMs) supervised by MHPs to assist PCPs with patient management. The Collaborative Care Workgroup (CWG) was created to facilitate collaboration between PCPs, MHPs, and DCMs. The CWG used a 3-phase process: (1) identify barriers to better depression treatment, (2) identify target problems and solutions, and (3) institutionalize ongoing problem detection and solution through new policies and procedures. Results: The CWG overcame barriers that exist between PCPs and MHPs, leading to high rates of the following: patients with depression being followed by PCPs (82%), referred PC patients with depression keeping their appointments with MHPs (88%), and PC patients with depression receiving antidepressants (76%). The CWG helped sites implement site-specific protocols for addressing patients with suicidal ideation. Conclusion: By applying these steps in PC practices, collaboration between PCPs and MHPs has been improved and maintained. These steps offer a guide to improving collaborative care to manage depression or other chronic disorders within PC clinics. PMID:16862248

  17. Effectiveness of Educational Poster on Knowledge of Emergency Management of Dental Trauma–Part 1. Cluster Randomised Controlled Trial for Primary and Secondary School Teachers

    PubMed Central

    Young, Cecilia; Wong, Kin Yau; Cheung, Lim K.

    2013-01-01

    Objective To investigate the effectiveness of educational posters in improving the knowledge level of primary and secondary school teachers regarding emergency management of dental trauma. Methods A cluster randomised controlled trial was conducted. 32 schools with a total of 515 teachers were randomised into intervention (poster) and control groups at the school level. Teachers’ baseline levels of knowledge about dental trauma were obtained by using a questionnaire. Posters containing information on dental trauma management were displayed in the school medical room, the common room used by staff, and on a notice board for 2 weeks in each school of the intervention group; in the control group, no posters were displayed. Teachers in both groups completed the questionnaire after 2 weeks. Results The teachers in the intervention schools (where posters were displayed for 2 weeks) showed statistically significant improvement in scores in cases where they had not previously learned about dental emergencies from sources other than first aid training, with an average score increase of 2.6656 (score range of questionnaire, −13 to 9; p-value <0.0001). Conclusion Educational posters on the management of dental trauma can significantly improve the level of knowledge of primary and secondary school teachers in Hong Kong. KClinicalTrials.com HKCTR-1307 ClinicalTrials.gov: NCT01707355 PMID:24147154

  18. On implementing maximum economic yield in commercial fisheries

    PubMed Central

    Dichmont, C. M.; Pascoe, S.; Kompas, T.; Punt, A. E.; Deng, R.

    2009-01-01

    Economists have long argued that a fishery that maximizes its economic potential usually will also satisfy its conservation objectives. Recently, maximum economic yield (MEY) has been identified as a primary management objective for Australian fisheries and is under consideration elsewhere. However, first attempts at estimating MEY as an actual management target for a real fishery (rather than a conceptual or theoretical exercise) have highlighted some substantial complexities generally unconsidered by fisheries economists. Here, we highlight some of the main issues encountered in our experience and their implications for estimating and transitioning to MEY. Using a bioeconomic model of an Australian fishery for which MEY is the management target, we note that unconstrained optimization may result in effort trajectories that would not be acceptable to industry or managers. Different assumptions regarding appropriate constraints result in different outcomes, each of which may be considered a valid MEY. Similarly, alternative treatments of prices and costs may result in differing estimates of MEY and their associated effort trajectories. To develop an implementable management strategy in an adaptive management framework, a set of assumptions must be agreed among scientists, economists, and industry and managers, indicating that operationalizing MEY is not simply a matter of estimating the numbers but requires strong industry commitment and involvement. PMID:20018676

  19. Understanding the implementation of interventions to improve the management of chronic kidney disease in primary care: a rapid realist review.

    PubMed

    Tsang, Jung Yin; Blakeman, Tom; Hegarty, Janet; Humphreys, John; Harvey, Gill

    2016-04-04

    Chronic kidney disease (CKD) is common and a significant marker of morbidity and mortality. Its management in primary care is essential for maintenance of cardiovascular health, avoidance of acute kidney injury (AKI) and delay in progression to end-stage renal disease. Although many guidelines and interventions have been established, there is global evidence of an implementation gap, including variable identification rates and low patient communication and awareness. The objective of this study is to understand the factors enabling and constraining the implementation of CKD interventions in primary care. A rapid realist review was conducted that involved a primary literature search of three databases to identify existing CKD interventions in primary care between the years 2000 and 2014. A secondary search was performed as an iterative process and included bibliographic and grey literature searches of reference lists, authors and research groups. A systematic approach to data extraction using Normalisation Process Theory (NPT) illuminated key mechanisms and contextual factors that affected implementation. Our primary search returned 710 articles that were narrowed down to 18 relevant CKD interventions in primary care. Our findings suggested that effective management of resources (encompassing many types) was a significant contextual factor enabling or constraining the functioning of mechanisms. Three key intervention features were identified from the many that contributed to successful implementation. Firstly, it was important to frame CKD interventions appropriately, such as within the context of cardiovascular health and diabetes. This enabled buy-in and facilitated an understanding of the significance of CKD and the need for intervention. Secondly, interventions that were compatible with existing practices or patients' everyday lives were readily accepted. In contrast, new systems that could not be integrated were abandoned as they were viewed as inconvenient, generating more work. Thirdly, ownership of the feedback process allowed users to make individualised improvements to the intervention to suit their needs. Our rapid realist review identified mechanisms that need to be considered in order to optimise the implementation of interventions to improve the management of CKD in primary care. Further research into the factors that enable prolonged sustainability and cost-effectiveness is required for efficient resource utilisation.

  20. Primary thoracoscopic treatment of empyema in children.

    PubMed

    Cohen, Gordon; Hjortdal, Vibeke; Ricci, Marco; Jaffe, Adam; Wallis, Colin; Dinwiddie, Robert; Elliott, Martin J; de Leval, Marc R

    2003-01-01

    The optimal treatment of pediatric empyema remains controversial. The objective of this study is to compare the use of conventional management versus primary thoracoscopic drainage and decortication in children with empyema. Conventional management has consisted of chest drain insertion under general anesthesia plus intravenous antibiotics. Thoracoscopic drainage and decortication has consisted of primary thoracoscopic drainage and decortication plus antibiotics. The clinical course of 54 patients treated conventionally between 1989 and 1997 was compared with that of 21 patients treated by means of thoracoscopic drainage and decortication between September 2000 and September 2001. Results of the study demonstrated that patients in the drainage-decortication group had fewer invasive interventions per patient than those in the conventional management group (1.0 vs 1.26). Patients undergoing thoracoscopic drainage and decortication also had significantly shorter durations of intravenous antibiotic therapy (7.6 +/- 1.2 vs 18.2 +/- 7.5 days), chest tube drainage (4.0 +/- 0.5 vs 10.2 +/- 6.1 days), and hospital stays (7.4 +/- 0.8 vs 15.4 +/- 7.4). Moreover, there were no open thoracotomies and decortications in the thoracoscopic drainage and decortication group, whereas in the conventional management group 39% (21/54) of patients underwent an open procedure. Although the 2 groups were not prospectively randomized and they were treated in different time periods, the results of this study support the use of thoracoscopic surgery as the primary therapeutic modality in children presenting with pleural empyema. This strategy appears to offer significant benefits over conventional treatment in terms of duration of treatment and the need for more invasive surgery.

  1. [Organization of primary health care in cities belonging to project for expansion and consolidation of the family health strategy in Mato Grosso State, Brazil].

    PubMed

    Melo, Elza Machado de; Paiva, Lúcia; Alvares, Juliana; Flecha, André Luiz Dumont

    2008-01-01

    This article presents part of the results from the Baseline Study on the PROESF. The objective was to evaluate primary health care in the cities of Cuiabá, Várzea Grande, and Rondonópolis, Mato Grosso State, Brazil, based on the inter-subjectivity in human relations (among health workers, users of health services, and the public at large and within institutionalized levels of social control). A qualitative and quantitative methodology was used, including interviews with key informants; short meetings with managers; focal groups with managers; and interviews with users and health professionals from pre-selected health units. Scores were assigned to all the questions that indicated participatory processes in primary care practices in the various municipalities. Despite the geopolitical identity among the municipalities and their similar access to the same public policies, there was a significant difference in their performance of the functions pertaining to the organization of primary care and the Family Health Program, in terms of portal of entry into the system, longitudinality, comprehensiveness, and coordination. Differences were observed in the type of relations that were established (participatory versus non-participatory), corresponding to the previous difference.

  2. Rural self-reliance: the impact on health experiences of people living with type II diabetes in rural Queensland, Australia

    PubMed Central

    Page-Carruth, Althea; Windsor, Carol; Clark, Michele

    2014-01-01

    Objective The objective of the study was to explore whether and how rural culture influences type II diabetes management and to better understand the social processes that rural people construct in coping with diabetes and its complications. In particular, the study aimed to analyse the interface and interactions between rural people with type II diabetes and the Australian health care system, and to develop a theoretical understanding that reflects constructs that may be more broadly applicable. Methods The study applied constructivist grounded theory methods within an interpretive interactionist framework. Data from 39 semi-structured interviews with rural and urban type II diabetes patients and a mix of rural health care providers were analysed to develop a theoretical understanding of the social processes that define diabetes management in that context. Results The analysis suggests that although type II diabetes imposes limitations that require adjustment and adaptation, these processes are actively negotiated by rural people within the environmental context to fit the salient social understandings of autonomy and self-reliance. Thus, people normalized self-reliant diabetes management behaviours because this was congruent with the rural culture. Factors that informed the actions of normalization were relationships between participants and health care professionals, support, and access to individual resources. Conclusions The findings point to ways in which rural self-reliance is conceived as the primary strategy of diabetes management. People face the paradox of engaging with a health care system that at the same time maximizes individual responsibility for health and minimizes the social support by which individuals manage the condition. The emphasis on self-reliance gives some legitimacy to a lack of prevention and chronic care services. Success of diabetes management behaviours is, however, contingent on relative resources. Where there is good primary care, there develops a number of downstream effects including a sense of empowerment to manage difficult rural environmental circumstances. This has particular bearing on health outcomes for people with fewer resources. PMID:24964859

  3. A randomized controlled trial of contingency management for psycho-stimulant use in community mental health outpatients with co-occurring serious mental illness

    PubMed Central

    McDonell, Michael G.; Srebnik, Debra; Angelo, Frank; McPherson, Sterling; Lowe, Jessica M.; Sugar, Andrea; Short, Robert A.; Roll, John M.; Ries, Richard K.

    2014-01-01

    Objective The primary objective of this study was to determine if contingency management was associated with increased stimulant drug abstinence in community mental health outpatients with serious mental illness and stimulant dependence. Secondary objectives were to determine if contingency management was associated with reductions in use of other substances, psychiatric symptoms, HIV-risk behavior, and inpatient service utilization. Method A randomized controlled design compared outcomes of 176 outpatients with serious mental illness and stimulant dependence. Participants were randomized to three months of contingency management for stimulant abstinence plus treatment-as-usual or treatment-as-usual with reinforcement for study participation only. Urine drug tests, self-report, clinician-report, and service utilization outcomes were assessed during three-month treatment and three-month follow-up periods. Results While participants in the contingency management condition were less likely to complete the treatment period (n=38; 42%) than those assigned to the control condition (n=55; 65%), X2(1)=9.8, p=0.02; those assigned to the contingency management condition were 2.4 (CI=1.9-3.0) times more likely to submit a stimulant-negative urine test during treatment. Participants assigned to contingency management experienced significantly lower levels of alcohol use, injection drug use, psychiatric symptoms, and were five times less likely than those assigned to the control condition to be admitted for psychiatric hospitalization, X2(1)=5.4, p=0.02. Contingency management participants reported significantly fewer days of stimulant drug use, relative to controls during the three-month follow-up. Conclusions When added to treatment-as-usual, contingency management is associated with large reductions in stimulant, injection drug, and alcohol use. Reductions in psychiatric symptoms and hospitalizations were important secondary benefits. PMID:23138961

  4. The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

    PubMed Central

    Nehra, Ajay; Jackson, Graham; Miner, Martin; Billups, Kevin L.; Burnett, Arthur L.; Buvat, Jacques; Carson, Culley C.; Cunningham, Glenn R.; Ganz, Peter; Goldstein, Irwin; Guay, Andre T.; Hackett, Geoff; Kloner, Robert A.; Kostis, John; Montorsi, Piero; Ramsey, Melinda; Rosen, Raymond; Sadovsky, Richard; Seftel, Allen D.; Shabsigh, Ridwan; Vlachopoulos, Charalambos; Wu, Frederick C.W.

    2012-01-01

    The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. The third Princeton Consensus met November 8 to 10, 2010, and had 2 primary objectives. The first objective focused on the evaluation and management of cardiovascular risk in men with erectile dysfunction (ED) and no known cardiovascular disease (CVD), with particular emphasis on identification of men with ED who may require additional cardiologic work-up. The second objective focused on reevaluation and modification of previous recommendations for evaluation of cardiac risk associated with sexual activity in men with known CVD. The Panel's recommendations build on those developed during the first and second Princeton Consensus Conferences, first emphasizing the use of exercise ability and stress testing to ensure that each man's cardiovascular health is consistent with the physical demands of sexual activity before prescribing treatment for ED, and second highlighting the link between ED and CVD, which may be asymptomatic and may benefit from cardiovascular risk reduction. PMID:22862865

  5. Clustering-based urbanisation to improve enterprise information systems agility

    NASA Astrophysics Data System (ADS)

    Imache, Rabah; Izza, Said; Ahmed-Nacer, Mohamed

    2015-11-01

    Enterprises are daily facing pressures to demonstrate their ability to adapt quickly to the unpredictable changes of their dynamic in terms of technology, social, legislative, competitiveness and globalisation. Thus, to ensure its place in this hard context, enterprise must always be agile and must ensure its sustainability by a continuous improvement of its information system (IS). Therefore, the agility of enterprise information systems (EISs) can be considered today as a primary objective of any enterprise. One way of achieving this objective is by the urbanisation of the EIS in the context of continuous improvement to make it a real asset servicing enterprise strategy. This paper investigates the benefits of EISs urbanisation based on clustering techniques as a driver for agility production and/or improvement to help managers and IT management departments to improve continuously the performance of the enterprise and make appropriate decisions in the scope of the enterprise objectives and strategy. This approach is applied to the urbanisation of a tour operator EIS.

  6. Streamflow depletion by wells--Understanding and managing the effects of groundwater pumping on streamflow

    USGS Publications Warehouse

    Barlow, Paul M.; Leake, Stanley A.

    2012-11-02

    Groundwater is an important source of water for many human needs, including public supply, agriculture, and industry. With the development of any natural resource, however, adverse consequences may be associated with its use. One of the primary concerns related to the development of groundwater resources is the effect of groundwater pumping on streamflow. Groundwater and surface-water systems are connected, and groundwater discharge is often a substantial component of the total flow of a stream. Groundwater pumping reduces the amount of groundwater that flows to streams and, in some cases, can draw streamflow into the underlying groundwater system. Streamflow reductions (or depletions) caused by pumping have become an important water-resource management issue because of the negative impacts that reduced flows can have on aquatic ecosystems, the availability of surface water, and the quality and aesthetic value of streams and rivers. Scientific research over the past seven decades has made important contributions to the basic understanding of the processes and factors that affect streamflow depletion by wells. Moreover, advances in methods for simulating groundwater systems with computer models provide powerful tools for estimating the rates, locations, and timing of streamflow depletion in response to groundwater pumping and for evaluating alternative approaches for managing streamflow depletion. The primary objective of this report is to summarize these scientific insights and to describe the various field methods and modeling approaches that can be used to understand and manage streamflow depletion. A secondary objective is to highlight several misconceptions concerning streamflow depletion and to explain why these misconceptions are incorrect.

  7. Physicians’ perceptions of capacity building for managing chronic disease in seniors using integrated interprofessional care models

    PubMed Central

    Lee, Linda; Heckman, George; McKelvie, Robert; Jong, Philip; D’Elia, Teresa; Hillier, Loretta M.

    2015-01-01

    Abstract Objective To explore the barriers to and facilitators of adapting and expanding a primary care memory clinic model to integrate care of additional complex chronic geriatric conditions (heart failure, falls, chronic obstructive pulmonary disease, and frailty) into care processes with the goal of improving outcomes for seniors. Design Mixed-methods study using quantitative (questionnaires) and qualitative (interviews) methods. Setting Ontario. Participants Family physicians currently working in primary care memory clinic teams and supporting geriatric specialists. Methods Family physicians currently working in memory clinic teams (n = 29) and supporting geriatric specialists (n = 9) were recruited as survey participants. Interviews were conducted with memory clinic lead physicians (n = 16). Statistical analysis was done to assess differences between family physician ratings and geriatric specialist ratings related to the capacity for managing complex chronic geriatric conditions, the role of interprofessional collaboration within primary care, and funding and staffing to support geriatric care. Results from both study methods were compared to identify common findings. Main findings Results indicate overall support for expanding the memory clinic model to integrate care for other complex conditions. However, the current primary care structure is challenged to support optimal management of patients with multiple comorbidities, particularly as related to limited funding and staffing resources. Structured training, interprofessional teams, and an active role of geriatric specialists within primary care were identified as important facilitators. Conclusion The memory clinic model, as applied to other complex chronic geriatric conditions, has the potential to build capacity for high-quality primary care, improve health outcomes, promote efficient use of health care resources, and reduce health care costs. PMID:25932482

  8. Challenges to Effective Primary Care-Specialty Communication and Coordination in the Mental Health Referral and Care Process for Publicly Insured Children.

    PubMed

    Porras-Javier, Lorena; Bromley, Elizabeth; Lopez, Maria; Coker, Tumaini R

    2018-03-26

    Publicly insured children needing referral to mental health (MH) services often do not access or receive services. The objective of this study was to identify gaps in communication and coordination between primary care providers (PCPs) and MH providers during the MH referral and care process for publicly insured children. Thirteen semi-structured interviews were conducted with 10 PCPs and staff from a federally qualified health center (FQHC) and 6 MH providers and staff from two local MH clinics. Interview participants identified multiple gaps in communication throughout the care process and different phases as priorities for improvement. PCPs described primary care-MH communication challenges during early phases, while MH providers described coordination challenges in transferring patients back to primary care for ongoing mental health management. Strategies are needed to improve primary care-specialty MH communication and coordination throughout all phases of the referral and care process, particularly at initial referral and transfer back to primary care.

  9. Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials

    PubMed Central

    2012-01-01

    Background Osteoarthritis (OA) of the hip and knee are among the most common chronic conditions, resulting in substantial pain and functional limitations. Adequate management of OA requires a combination of medical and behavioral strategies. However, some recommended therapies are under-utilized in clinical settings, and the majority of patients with hip and knee OA are overweight and physically inactive. Consequently, interventions at the provider-level and patient-level both have potential for improving outcomes. This manuscript describes two ongoing randomized clinical trials being conducted in two different health care systems, examining patient-based and provider-based interventions for managing hip and knee OA in primary care. Methods / Design One study is being conducted within the Department of Veterans Affairs (VA) health care system and will compare a Combined Patient and Provider intervention relative to usual care among n = 300 patients (10 from each of 30 primary care providers). Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only, Provider Only, and Combined (Patient + Provider) interventions relative to usual care among n = 560 patients across 10 clinics. Participants in these studies have clinical and / or radiographic evidence of hip or knee osteoarthritis, are overweight, and do not meet current physical activity guidelines. The 12-month, telephone-based patient intervention focuses on physical activity, weight management, and cognitive behavioral pain management. The provider intervention involves provision of patient-specific recommendations for care (e.g., referral to physical therapy, knee brace, joint injection), based on evidence-based guidelines. Outcomes are collected at baseline, 6-months, and 12-months. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function), and secondary outcomes are the Short Physical Performance Test Protocol (objective physical function) and the Patient Health Questionnaire-8 (depressive symptoms). Cost effectiveness of the interventions will also be assessed. Discussion Results of these two studies will further our understanding of the most effective strategies for improving hip and knee OA outcomes in primary care settings. Trial registration NCT01130740 (VA); NCT 01435109 (NIH) PMID:22530979

  10. Primary Care Clinic Re-Design for Prescription Opioid Management.

    PubMed

    Parchman, Michael L; Von Korff, Michael; Baldwin, Laura-Mae; Stephens, Mark; Ike, Brooke; Cromp, DeAnn; Hsu, Clarissa; Wagner, Ed H

    The challenge of responding to prescription opioid overuse within the United States has fallen disproportionately on the primary care clinic setting. Here we describe a framework comprised of 6 Building Blocks to guide efforts within this setting to address the use of opioids for chronic pain. Investigators conducted site visits to thirty primary care clinics across the United States selected for their use of team-based workforce innovations. Site visits included interviews with leadership, clinic tours, observations of clinic processes and team meetings, and interviews with staff and clinicians. Data were reviewed to identify common attributes of clinic system changes around chronic opioid therapy (COT) management. These concepts were reviewed to develop narrative descriptions of key components of changes made to improve COT use. Twenty of the thirty sites had addressed improvements in COT prescribing. Across these sites a common set of 6 Building Blocks were identified: 1) providing leadership support; 2) revising and aligning clinic policies, patient agreements (contracts) and workflows; 3) implementing a registry tracking system; 4) conducting planned, patient-centered visits; 5) identifying resources for complex patients; and 6) measuring progress toward achieving clinic objectives. Common components of clinic policies, patient agreements and data tracked in registries to assess progress are described. In response to prescription opioid overuse and the resulting epidemic of overdose and addiction, primary care clinics are making improvements driven by a common set of best practices that address complex challenges of managing COT patients in primary care settings. © Copyright 2017 by the American Board of Family Medicine.

  11. Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 4. Results: specific problem solving skills.

    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

    2010-09-01

    The 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' 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. The previous articles presented background, objectives, and methodology, as well results on 'primary care management' and 'community orientation' and the person-related core competencies of GP/FM. This article reflects on the general practitioner's 'specific problem solving skills'. These include decision making on diagnosis and therapy of specific diseases, accounting for the properties of primary care, but also research questions related to quality management and resource use, shared decision making, or professional education and development. Clinical research covers most specific diseases, but often lacks pragmatism and primary care relevance. Quality management is a stronghold of GP/FM research. Educational interventions can be effective when well designed for a specific setting and situation. However, their message that 'usual care' by general practitioners is insufficient may be problematic. GP and their patients need more research into diagnostic reasoning with a step-wise approach to increase predictive values in a setting characterized by uncertainty and low prevalence of specific diseases. Pragmatic comparative effectiveness studies of new and established drugs or non-pharmaceutical therapy are needed. Multi-morbidity and complexity should be addressed. Studies on therapy, communication strategies and educational interventions should consider impact on health and sustainability of effects.

  12. Fluid management systems technology summaries

    NASA Technical Reports Server (NTRS)

    Stark, J. A.; Blatt, M. H.; Bennett, F. O., Jr.; Campbell, B. J.

    1974-01-01

    A summarization and categorization of the pertinent literature associated with fluid management systems technology having potential application to in-orbit fluid transfer and/or associated storage are presented. A literature search was conducted to obtain pertinent documents for review. Reports determined to be of primary significance were summarized in the following manner: (1) report identification, (2) objective(s) of the work, (3) description of pertinent work performed, (4) major results, and (5) comments of the reviewer. Pertinent figures are presented on a single facing page separate from the text. Specific areas covered are: fluid line dynamics and thermodynamics, low-g mass gauging, other instrumentation, stratification/pressurization, low-g vent systems, fluid mixing refrigeration and reliquefaction, and low-g interface control and liquid acquisition systems. Reports which were reviewed and not summarized, along with reasons for not summarizing, are also listed.

  13. Mission Operations Report (MOR) for the Solar, Anomalous, and Magnetosphere Particle Explorer (SAMPEX)

    NASA Technical Reports Server (NTRS)

    1992-01-01

    MISSION OPERATIONS REPORTS are published for use by NASA senior management, as required by NASA Headquarters Management Instruction HQMI 8610. lC, effective November 26, 1991. The purpose of these reports is to provide a documentation system that represents an internal discipline to establish critical discriminators selected in advance to measure mission accomplishment, provide a formal written assessment of mission accomplishment, and provide an accountability of technical achievement. Prelaunch reports are prepared and issued for each flight project just prior to launch. Following launch, updating (Post Launch) reports are issued to provide mission status and progress in meeting mission objectives. Primary distribution of these reports is intended for personnel having program/project management responsibilities.

  14. The Effect of Nurse Practitioner Co-Management on the Care of Geriatric Conditions

    PubMed Central

    Reuben, David B.; Ganz, David A.; Roth, Carol P.; McCreath, Heather E.; Ramirez, Karina D.; Wenger, Neil S.

    2013-01-01

    Background/Objectives The quality of care for geriatric conditions remains poor. The Assessing Care of Vulnerable Elders (ACOVE)-2 model (case finding, delegation of data collection, structured visit notes, physician and patient education, and linkage to community resources) improves the quality of care for geriatric conditions when implemented by primary care physicians (PCPs) or by nurse practitioners (NPs) co-managing care with an academic geriatrician. However, it is unclear whether community-based PCP-NP co-management can achieve similar results. Design Case study. Setting Two community-based primary care practices. Participants Patients > 75 years who screened positive for at least one condition: falls, urinary incontinence (UI), dementia, and depression. Intervention The ACOVE-2 model augmented by NP co-management of conditions. Measurements Quality of care by medical record review using ACOVE-3 quality indicators (QIs). Patients receiving co-management were compared with those who received PCP care alone in the same practices. Results Of 1084 screened patients, 658 (61%) screened positive for > 1 condition; 485 of these patients were randomly selected for chart review and triggered a mean of 7 QIs. A NP saw approximately half (49%) for co-management. Overall, patients received 57% of recommended care. Quality scores for all conditions (falls: 80% versus 34%; UI: 66% versus 19%; dementia: 59% versus 38%) except depression (63% versus 60%) were higher for patients seen by a NP. In analyses adjusted for gender, age of patient, number of conditions, site, and a NP estimate of medical management style, NP co-management remained significantly associated with receiving recommended care (p<0.001), as did the NP estimate of medical management style (p=0.02). Conclusion Compared to usual care using the ACOVE-2 model, NP co-management is associated with better quality of care for geriatric conditions in community-based primary care. PMID:23772723

  15. Chest Computed Tomographic Image Screening for Cystic Lung Diseases in Patients with Spontaneous Pneumothorax Is Cost Effective

    PubMed Central

    Langenderfer, Dale; McCormack, Francis X.; Schauer, Daniel P.; Eckman, Mark H.

    2017-01-01

    Rationale: Patients without a known history of lung disease presenting with a spontaneous pneumothorax are generally diagnosed as having primary spontaneous pneumothorax. However, occult diffuse cystic lung diseases such as Birt-Hogg-Dubé syndrome (BHD), lymphangioleiomyomatosis (LAM), and pulmonary Langerhans cell histiocytosis (PLCH) can also first present with a spontaneous pneumothorax, and their early identification by high-resolution computed tomographic (HRCT) chest imaging has implications for subsequent management. Objectives: The objective of our study was to evaluate the cost-effectiveness of HRCT chest imaging to facilitate early diagnosis of LAM, BHD, and PLCH. Methods: We constructed a Markov state-transition model to assess the cost-effectiveness of screening HRCT to facilitate early diagnosis of diffuse cystic lung diseases in patients presenting with an apparent primary spontaneous pneumothorax. Baseline data for prevalence of BHD, LAM, and PLCH and rates of recurrent pneumothoraces in each of these diseases were derived from the literature. Costs were extracted from 2014 Medicare data. We compared a strategy of HRCT screening followed by pleurodesis in patients with LAM, BHD, or PLCH versus conventional management with no HRCT screening. Measurements and Main Results: In our base case analysis, screening for the presence of BHD, LAM, or PLCH in patients presenting with a spontaneous pneumothorax was cost effective, with a marginal cost-effectiveness ratio of $1,427 per quality-adjusted life-year gained. Sensitivity analysis showed that screening HRCT remained cost effective for diffuse cystic lung diseases prevalence as low as 0.01%. Conclusions: HRCT image screening for BHD, LAM, and PLCH in patients with apparent primary spontaneous pneumothorax is cost effective. Clinicians should consider performing a screening HRCT in patients presenting with apparent primary spontaneous pneumothorax. PMID:27737563

  16. CruiseViewer: SIOExplorer Graphical Interface to Metadata and Archives.

    NASA Astrophysics Data System (ADS)

    Sutton, D. W.; Helly, J. J.; Miller, S. P.; Chase, A.; Clark, D.

    2002-12-01

    We are introducing "CruiseViewer" as a prototype graphical interface for the SIOExplorer digital library project, part of the overall NSF National Science Digital Library (NSDL) effort. When complete, CruiseViewer will provide access to nearly 800 cruises, as well as 100 years of documents and images from the archives of the Scripps Institution of Oceanography (SIO). The project emphasizes data object accessibility, a rich metadata format, efficient uploading methods and interoperability with other digital libraries. The primary function of CruiseViewer is to provide a human interface to the metadata database and to storage systems filled with archival data. The system schema is based on the concept of an "arbitrary digital object" (ADO). Arbitrary in that if the object can be stored on a computer system then SIOExplore can manage it. Common examples are a multibeam swath bathymetry file, a .pdf cruise report, or a tar file containing all the processing scripts used on a cruise. We require a metadata file for every ADO in an ascii "metadata interchange format" (MIF), which has proven to be highly useful for operability and extensibility. Bulk ADO storage is managed using the Storage Resource Broker, SRB, data handling middleware developed at the San Diego Supercomputer Center that centralizes management and access to distributed storage devices. MIF metadata are harvested from several sources and housed in a relational (Oracle) database. For CruiseViewer, cgi scripts resident on an Apache server are the primary communication and service request handling tools. Along with the CruiseViewer java application, users can query, access and download objects via a separate method that operates through standard web browsers, http://sioexplorer.ucsd.edu. Both provide the functionability to query and view object metadata, and select and download ADOs. For the CruiseViewer application Java 2D is used to add a geo-referencing feature that allows users to select basemap images and have vector shapes representing query results mapped over the basemap in the image panel. The two methods together address a wide range of user access needs and will allow for widespread use of SIOExplorer.

  17. Adaptive management for soil ecosystem services

    USGS Publications Warehouse

    Birge, Hannah E.; Bevans, Rebecca A.; Allen, Craig R.; Angeler, David G.; Baer, Sara G.; Wall, Diana H.

    2016-01-01

    Ecosystem services provided by soil include regulation of the atmosphere and climate, primary (including agricultural) production, waste processing, decomposition, nutrient conservation, water purification, erosion control, medical resources, pest control, and disease mitigation. The simultaneous production of these multiple services arises from complex interactions among diverse aboveground and belowground communities across multiple scales. When a system is mismanaged, non-linear and persistent losses in ecosystem services can arise. Adaptive management is an approach to management designed to reduce uncertainty as management proceeds. By developing alternative hypotheses, testing these hypotheses and adjusting management in response to outcomes, managers can probe dynamic mechanistic relationships among aboveground and belowground soil system components. In doing so, soil ecosystem services can be preserved and critical ecological thresholds avoided. Here, we present an adaptive management framework designed to reduce uncertainty surrounding the soil system, even when soil ecosystem services production is not the explicit management objective, so that managers can reach their management goals without undermining soil multifunctionality or contributing to an irreversible loss of soil ecosystem services.

  18. Engineering analysis of ERTS data for southeast Asian agriculture

    NASA Technical Reports Server (NTRS)

    Heydt, H. L.; Mcnair, A. J.

    1973-01-01

    The present program focuses on rice because of its importance world-wide as a food. Specifically, the focus is on rice fields in the Philippines. Two primary program objectives are: (1) to establish the feasibility of extracting from ERTS imagery the areas where rice is grown, and (2) to determine those measurements on the imagery which enable the assessment of crop condition. Achieving these objectives with procedures which can be cost-effective can lead the way toward yield prediction, irrigation system management, and similar functions which are known to be important needs in Southeast Asia.

  19. Teachers' knowledge concerning dental trauma and its management in primary schools in Riyadh, Saudi Arabia.

    PubMed

    Alsadhan, Salwa A; Alsayari, Najla F; Abuabat, Mashael F

    2018-02-22

    The main aim of this cross-sectional study was to assess knowledge concerning traumatic dental injuries and their management among primary schoolteachers in Riyadh, Saudi Arabia. The secondary objective was to evaluate the effect of gender, nationality, marital status, school type, geographical area, age group, level of education and years of experience on teachers' knowledge. Data were collected, through a self-administered questionnaire, from both male and female teachers employed in public and private primary schools in the five geographical areas of Riyadh City. The total sample size was 1,520 teachers. Data were entered into the Statistical Package for the Social Sciences. Frequencies and percentages were calculated. An independent t-test and a one-way analysis of variance (ANOVA) were used to calculate significance. The total score for the questions assessing knowledge was calculated out of 9, and the highest score was 7 with an average score of 2.85. Over half of the sampled participants stated that they did not know how to manage soft-tissue injuries. Regarding the management of fractured teeth, 38.8% believed that the fractured part is useless; and for the management of an avulsed permanent tooth, only 6.2% of the respondents selected the correct answer. For the question regarding suitable storage medium of an avulsed tooth, only 19.7% chose milk and 3.2% chose the injured person's saliva. Teachers between 41 and 50 years of age and those with longer years of experience had the highest level of knowledge. Teachers in the north area of Riyadh had a higher level of knowledge than teachers in other areas. There was a lack of knowledge among primary schoolteachers in Riyadh concerning traumatic dental injuries and their management. Statistically significant differences were found among geographical areas, age groups and years of experience; no statistically significant differences were found regarding gender, nationality, marital status, level of education and school type (public/private). © 2018 FDI World Dental Federation.

  20. Short-term stem mortality of 10 deciduous broadleaved species following prescribed burning in upland forests of the southern US

    Treesearch

    Tara L. Keyser; Virginia L. McDaniel; Robert N. Klein; Dan G. Drees; Jesse A. Burton; Melissa M. Forder

    2018-01-01

    In upland forests of the southern US, management is increasingly focussed on the restoration and maintenance of resilient structures and species compositions, with prescribed burning being the primary tool used to achieve these goals and objectives. In this study, we utilised an extensive dataset comprising 91 burn units and 210 plots across 13 National Park Service...

  1. Pancreas Transplantation With Portal-Enteric Drainage for Patients With Endocrine and Exocrine Insufficiency From Extensive Pancreatic Resection.

    PubMed

    Barbas, Andrew S; Al-Adra, David P; Goldaracena, Nicolas; Dib, Martin J; Selzner, Markus; Sapisochin, Gonzalo; Cattral, Mark S; McGilvray, Ian D

    2017-09-01

    Although the primary indication for pancreas transplantation is type I diabetes, a small number of patients requires pancreas transplantation to manage combined endocrine and exocrine insufficiency that develops after extensive native pancreatic resection. The objective of this case report was to describe the operative and clinical course in 3 such patients and present an alternative technical approach.

  2. Using an Augmented Reality Enhanced Tabletop System to Promote Learning of Mathematics: A Case Study with Students with Special Educational Needs

    ERIC Educational Resources Information Center

    Cascales-Martínez, Antonia; Martínez-Segura, María-José; Pérez-López, David; Contero, Manuel

    2017-01-01

    The main objective of this research is to determine the feasibility of using a multi touch tabletop system for applied mathematics learning in primary education with students with special needs (SEN). The instructional content designed on the tabletop focuses on understanding and managing money, coins, and banknotes. The study also analyzes the…

  3. "At Risk of Harm"? An Exploratory Survey of School Counsellors in the UK, Their Perceptions of Confidentiality, Information Sharing and Risk Management

    ERIC Educational Resources Information Center

    Jenkins, Peter; Palmer, Joanne

    2012-01-01

    The primary objective of this study was to explore perceptions of UK school counsellors of confidentiality and information sharing in therapeutic work with children and young people, using qualitative methods. The research design employed a two-stage process, using questionnaires and follow-up interviews, with a small, non-random sample of school…

  4. Who Is Providing and Who Is Getting Asthma Patient Education: An Analysis of 2001 National Ambulatory Medical Care Survey Data

    ERIC Educational Resources Information Center

    Shah, Shaival S.; Lutfiyya, May Nawal; McCullough, Joel Emery; Henley, Eric; Zeitz, Howard Jerome; Lipsky, Martin S.

    2008-01-01

    Patient education in asthma management is important; however, there is little known about the characteristics of patients receiving asthma education or how often primary care physicians provide it. The objective of the study was to identify the characteristics of patients receiving asthma education. It was a cross-sectional study using 2001…

  5. Long-term agroecosystem research in the Central Mississippi River Basin: hydrogeologic controls and crop management influence on nitrates in loess and fractured glacial till

    USDA-ARS?s Scientific Manuscript database

    Nitrogen (N) from agricultural activities has been suspected as a primary source of elevated ground water nitrate (NO3-N). The objective of this research was to assess the impact of common cropping systems on NO3-N levels for a glacial till aquifer underlying claypan soils in a predominantly agricul...

  6. Evaluating a Training Intervention to Prepare Geriatric Case Managers to Assess for Suicide and Firearm Safety

    ERIC Educational Resources Information Center

    Pope, Natalie D.; Slovak, Karen L.; Giger, Jarod T.

    2016-01-01

    The purpose of this article is to report on the implementation and initial evaluation of a 1-day training intervention targeting direct care providers in the Ohio aging services network. A primary objective is to describe the training intervention that consisted of two parts: (a) a gatekeeper training for assessing suicide risk among older adults,…

  7. Basal area growth, carbon isotope discrimination, and intrinsic water use efficiency after fertilization of Douglas-fir in the Oregon Coast Range

    Treesearch

    Eladio H. Cornejo-Oviedo; Steven L. Voelker; Douglas B. Mainwaring; Douglas A. Maguire; Frederick C. Meinzer; J. Renée Brooks

    2017-01-01

    Many hectares of intensively managed Douglas-fir (Pseudotsuga menziesii Mirb. Franco) stands in western North America are fertilized with nitrogen (N) to increase growth rates, but only about ⅔ of all stands respond. Understanding the mechanisms of response facilitates prioritization of stands for treatment. The primary objective of this study was...

  8. Patient Loyalty in a Mature IDS Market: Is Population Health Management Worth It?

    PubMed Central

    Carlin, Caroline S

    2014-01-01

    Objective To understand patient loyalty to providers over time, informing effective population health management. Study Setting Patient care-seeking patterns over a 6-year timeframe in Minnesota, where care systems have a significant portion of their revenue generated by shared-saving contracts with public and private payers. Study Design Weibull duration and probit models were used to examine patterns of patient attribution to a care system and the continuity of patient affiliation with a care system. Clustering of errors within family unit was used to account for within-family correlation in unobserved characteristics that affect patient loyalty. Data Collection The payer provided data from health plan administrative files, matched to U.S. Census-based characteristics of the patient's neighborhood. Patients were retrospectively attributed to health care systems based on patterns of primary care. Principal Findings I find significant patient loyalty, with past loyalty a very strong predictor of future relationship. Relationships were shorter when the patient's health status was complex and when the patient's care system was smaller. Conclusions Population health management can be beneficial to the care system making this investment, particularly for patients exhibiting prior continuity in care system choice. The results suggest that co-located primary and specialty services are important in maintaining primary care loyalty. PMID:24461030

  9. Targeted Molecular Imaging in Adrenal Disease—An Emerging Role for Metomidate PET-CT

    PubMed Central

    Mendichovszky, Iosif A.; Powlson, Andrew S.; Manavaki, Roido; Aigbirhio, Franklin I.; Cheow, Heok; Buscombe, John R.; Gurnell, Mark; Gilbert, Fiona J.

    2016-01-01

    Adrenal lesions present a significant diagnostic burden for both radiologists and endocrinologists, especially with the increasing number of adrenal ‘incidentalomas’ detected on modern computed tomography (CT) or magnetic resonance imaging (MRI). A key objective is the reliable distinction of benign disease from either primary adrenal malignancy (e.g., adrenocortical carcinoma or malignant forms of pheochromocytoma/paraganglioma (PPGL)) or metastases (e.g., bronchial, renal). Benign lesions may still be associated with adverse sequelae through autonomous hormone hypersecretion (e.g., primary aldosteronism, Cushing’s syndrome, phaeochromocytoma). Here, identifying a causative lesion, or lateralising the disease to a single adrenal gland, is key to effective management, as unilateral adrenalectomy may offer the potential for curing conditions that are typically associated with significant excess morbidity and mortality. This review considers the evolving role of positron emission tomography (PET) imaging in addressing the limitations of traditional cross-sectional imaging and adjunctive techniques, such as venous sampling, in the management of adrenal disorders. We review the development of targeted molecular imaging to the adrenocortical enzymes CYP11B1 and CYP11B2 with different radiolabeled metomidate compounds. Particular consideration is given to iodo-metomidate PET tracers for the diagnosis and management of adrenocortical carcinoma, and the increasingly recognized utility of 11C-metomidate PET-CT in primary aldosteronism. PMID:27869719

  10. The Bremerton enrollment capacity model: an enrollment capacity model supporting the military health system optimization plan.

    PubMed

    Helmers, S

    2001-12-01

    The Department of Defense has launched several initiatives to improve efficiency and quality of care in the military health system. The goal of empaneling 1,300 to 1,500 patients per primary care manager did not correlate well with Naval Hospital Bremerton's experience and did not accurately account for military-specific requirements. The Bremerton Model Task Force was chartered to assess current business practices, identify areas for improvement, and develop a capacity model reflecting military readiness and residency training requirements. Methods included a 12-month review of patient visits and staff surveys of how providers spent their day, with time-and-motion analysis to verify assumptions. Our capacity results (average, 791 enrollees per primary care manager) demonstrated that objective measures at the local level do not support enrollment to Department of Defense-specified levels. Significant changes in "corporate culture" are necessary to accomplish the military health system goals.

  11. Management of hyper and hypo thyroid conditions

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

    Locke, W.

    1982-03-01

    In hyperthyroidism, the primary objective of therapy is to reduce secretion of thyroid hormone, which can be accomplished in various ways. The stimulus to hypersecretion can be removed in some causes of hyperthyroidism; in others, hormone synthesis and release can be inhibited by drugs such as thioamides, adrenergic blocking agents, or possibly lithium or glucocorticoids. Radioactive iodine is indicated for primary therapy of uncomplicated hyperthyroidism due to Graves' disease in persons over 30 years of age (myxedema may be a complication) and for treatment of autonomous thyroid adenoma in patients who are not suitable candidates for surgery. Surgical ablation ismore » preferred for some causes of hyperthyroidism but may induce postoperative hypothyroidism. Hypothyroidism due to thyroid failure usually presents few therapeutic difficulties and can be managed simply by long-term hormone replacement. Before hormone replacement is prescribed for secondary or tertiary hypothyroidism, the other pituitary functions should be assessed.« less

  12. Collaborative Behavioral Management for Drug-Involved Parolees: Rationale and Design of the Step'n Out Study

    PubMed Central

    FRIEDMANN, PETER D.; KATZ, ELIZABETH C.; RHODES, ANNE G.; TAXMAN, FAYE S.; O'CONNELL, DANIEL J.; FRISMAN, LINDA K.; BURDON, WILLIAM M.; FLETCHER, BENNETT W.; LITT, MARK D.; CLARKE, JENNIFER; MARTIN, STEVEN S.

    2009-01-01

    This article describes the rationale, study design, and implementation for the Step'n Out study of the Criminal Justice Drug Abuse Treatment Studies. Step'n Out tests the relative effectiveness of collaborative behavioral management of drug-involved parolees. Collaborative behavioral management integrates the roles of parole officers and treatment counselors to provide role induction counseling, contract for pro-social behavior, and deliver contingent reinforcement of behaviors consistent with treatment objectives. The Step'n Out study will randomize 450 drug-involved parolees to collaborative behavioral management or usual parole. Follow-up at 3-and 9-months will assess primary outcomes of rearrest, crime and drug use. If collaborative behavioral management is effective, its wider adoption could improve the outcomes of community reentry of drug-involved ex-offenders. PMID:19809591

  13. Health Sector Reform in the Kurdistan Region - Iraq: Financing Reform, Primary Care, and Patient Safety.

    PubMed

    Anthony, C Ross; Moore, Melinda; Hilborne, Lee H; Mulcahy, Andrew W

    2014-12-30

    In 2010, the Kurdistan Regional Government asked the RAND Corporation to help guide reform of the health care system in the Kurdistan Region of Iraq. The overarching goal of reform was to help establish a health system that would provide high-quality services efficiently to everyone to prevent, treat, and manage physical and mental illnesses and injuries. This article summarizes the second phase of RAND's work, when researchers analyzed three distinct but intertwined health policy issue areas: development of financing policy, implementation of early primary care recommendations, and evaluation of quality and patient safety. For health financing, the researchers reviewed the relevant literature, explored the issue in discussions with key stakeholders, developed and assessed various policy options, and developed plans or approaches to overcome barriers and achieve stated policy objectives. In the area of primary care, they developed and helped to implement a new management information system. In the area of quality and patient safety, they reviewed relevant literature, discussed issues and options with health leaders, and recommended an approach toward incremental implementation.

  14. Practices of depression care in home health care: Home health clinician perspectives

    PubMed Central

    Bao, Yuhua; Eggman, Ashley A.; Richardson, Joshua E.; Sheeran, Thomas; Bruce, Martha L.

    2015-01-01

    Objective To assess any gaps between published best practices and real-world practices of treating depression in home health care (HHC), and barriers to closing any gaps. Methods A qualitative study based on semi-structured interviews with HHC nurses and administrators from five home health agencies in five states (n=20). Audio-recorded interviews were transcribed and analyzed by a multi-disciplinary team using grounded theory method to identify themes. Results Routine home health nursing care overlapped with all functional areas of depression care. However, there were reported gaps between best practices and real-world practices. Gaps were associated with perceived scope of practice by HHC nurses, knowledge gaps and low self-efficacy in depression treatment, stigma attached to depression, poor quality of antidepressant management in primary care, and poor communication between HHC and primary care. Conclusions Strategies to close gaps between typical and best practices need to enhance HHC clinician knowledge and self-efficacy with depression treatment and improve the quality of antidepressant management and communication with primary care. PMID:26423098

  15. Post-operative therapy following transoral robotic surgery for unknown primary cancers of the head and neck.

    PubMed

    Patel, Sapna A; Parvathaneni, Aarthi; Parvathaneni, Upendra; Houlton, Jeffrey J; Karni, Ron J; Liao, Jay J; Futran, Neal D; Méndez, Eduardo

    2017-09-01

    Our primary objective is to describe the post- operative management in patients with an unknown primary squamous cell carcinoma of the head and neck (HNSCC) treated with trans-oral robotic surgery (TORS). We conducted a retrospective multi-institutional case series including all patients diagnosed with an unknown primary HNSCC who underwent TORS to identify the primary site from January 1, 2010 to June 30, 2016. We excluded those with recurrent disease, ≤6months of follow up from TORS, previous history of radiation therapy (RT) to the head and neck, or evidence of primary tumor site based on previous biopsies. Our main outcome measure was receipt of post-operative therapy. The tumor was identified in 26/35 (74.3%) subjects. Post-TORS, 2 subjects did not receive adjuvant therapy due to favorable pathology. Volume reduction of RT mucosal site coverage was achieved in 12/26 (46.1%) subjects who had lateralizing tumors, ie. those confined to the palatine tonsil or glossotonsillar sulcus. In addition, for 8/26 (30.1%), the contralateral neck RT was also avoided. In 9 subjects, no primary was identified (pT0); four of these received RT to the involved ipsilateral neck nodal basin only without pharyngeal mucosal irradiation. Surgical management of an unknown primary with TORS can lead to deintensification of adjuvant therapy including avoidance of chemotherapy and reduction in RT doses and volume. There was no increase in short term treatment failures. Treatment after TORS can vary significantly, thus we advocate adherence to NCCN guideline therapy post-TORS to avoid treatment-associated variability. Published by Elsevier Ltd.

  16. Process and impact of mergers of NHS trusts: multicentre case study and management cost analysis

    PubMed Central

    Fulop, Naomi; Protopsaltis, Gerasimos; Hutchings, Andrew; King, Annette; Allen, Pauline; Normand, Charles; Walters, Rhiannon

    2002-01-01

    Objective To study the processes involved in and impact of mergers between NHS trusts, including the effect on management costs. Design Cross sectional study involving in depth interviews and documentary analysis; case study to compare savings in management costs between case trusts and control trusts. Setting Nine trusts (cross sectional study) and four trusts (case study) in London. Participants 96 interviews with trust board members, other senior managers, clinicians, service managers, and representatives of health authorities, regional office, community health councils, local authorities, other trusts in the area, and primary care groups and trusts. Main outcome measures Stated and unstated drivers, and impact of merger on delivery and development of services, management structures, and staff recruitment, retention, and morale. Effects of difference in trust size before and after the merger. Savings in management costs two years after merger. Results Some important drivers for merger are not publicly stated. Mergers had a negative effect on delivery of services because of a loss of managerial focus on services. Planned developments in services were delayed by at least 18 months. Trusts' larger sizes after mergers had unintended negative consequences, as well as predicted advantages. The tendency for one trust's management team to dominate over the other resulted in tension. No improvement in recruitment or retention of clinical and managerial staff was reported. Perceived differences in organisational culture were an important barrier to bringing together two or more organisations. Two years after merger, merged trusts had not achieved the objective of saving £500 000 a year in management costs. Conclusions Important unintended consequences need to be accounted for when mergers are planned. Mergers can cause considerable disruptions to services, and require greater management support than previously acknowledged. Other organisations undergoing restructuring, such as primary care groups developing into primary care trusts and health authorities merging into strategic health authorities, should take these findings into account. What is already known on this topicResearch suggests that effectiveness increases as the amount of activity by specialised units in certain clinical specialities increasesLittle empirical research has looked at the impact of mergers; most studies focus on financial variablesMergers result in short term disruption caused by difficulties in integrating services and personnelWhat this study addsImportant drivers for NHS mergers that are not stated publicly have implications for the process and impact of mergersMergers have positive effects, as well as unintended negative consequences that disrupt services and set back developments in servicesPerceived differences in organisational culture impede bringing organisations togetherMergers do not achieve target savings in management costs in first two years after merger PMID:12153920

  17. Municipal solid waste management in Malaysia: practices and challenges.

    PubMed

    Manaf, Latifah Abd; Samah, Mohd Armi Abu; Zukki, Nur Ilyana Mohd

    2009-11-01

    Rapid economic development and population growth, inadequate infrastructure and expertise, and land scarcity make the management of municipal solid waste become one of Malaysia's most critical environmental issues. The study is aimed at evaluating the generation, characteristics, and management of solid waste in Malaysia based on published information. In general, the per capita generation rate is about 0.5-0.8 kg/person/day in which domestic waste is the primary source. Currently, solid waste is managed by the Ministry of Housing and Local Government, with the participation of the private sector. A new institutional and legislation framework has been structured with the objectives to establish a holistic, integrated, and cost-effective solid waste management system, with an emphasis on environmental protection and public health. Therefore, the hierarchy of solid waste management has given the highest priority to source reduction through 3R, intermediate treatment and final disposal.

  18. Concussion Management in the Classroom.

    PubMed

    Graff, Danielle M; Caperell, Kerry S

    2016-12-01

    There is a new emphasis on the team approach to pediatric concussion management, particularly in the classroom. However, it is expected that educators are unfamiliar with the "Returning to Learning" recommendations. The authors' primary objective was to assess and improve high school educators' knowledge regarding concussions and management interventions using an online education tool. A total of 247 high school educators completed a 12 question pretest to assess core knowledge of concussions and classroom management followed by a 20-minute online literature-based education module. Participants then completed an identical posttest. The improvement in core knowledge was statistically significant (P < .001). Initial areas of weakness were the description and identification of concussions. Questions regarding concussion classroom management also showed a statistically significant increase in scores (P < .001). This study identifies the deficits in the knowledge of educators regarding concussions and classroom management as well as the significant improvement after an online educational module. © The Author(s) 2016.

  19. Electrolyte disorders with platinum-based chemotherapy: mechanisms, manifestations and management.

    PubMed

    Oronsky, Bryan; Caroen, Scott; Oronsky, Arnold; Dobalian, Vaughn E; Oronsky, Neil; Lybeck, Michelle; Reid, Tony R; Carter, Corey A

    2017-11-01

    Platinum chemotherapy, particularly cisplatin, is commonly associated with electrolyte imbalances, including hypomagnesemia, hypokalemia, hypophosphatemia, hypocalcemia and hyponatremia. The corpus of literature on these dyselectrolytemias is large; the objective of this review is to synthesize the literature and summarize the mechanisms responsible for these particular electrolyte disturbances in the context of platinum-based treatment as well as to present the clinical manifestations and current management strategies for oncologists and primary care physicians, since the latter are increasingly called on to provide care for cancer patients with medical comorbidities. Correct diagnosis and effective treatment are essential to improved patient outcomes.

  20. 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.

  1. Development and assessment of an active strategy for the implementation of a collaborative care approach for depression in primary care (the INDI·i project).

    PubMed

    Aragonès, Enric; Palao, Diego; López-Cortacans, Germán; Caballero, Antonia; Cardoner, Narcís; Casaus, Pilar; Cavero, Myriam; Monreal, José Antonio; Pérez-Sola, Víctor; Cirera, Miquel; Loren, Maite; Bellerino, Eva; Tomé-Pires, Catarina; Palacios, Laura

    2017-12-13

    Primary care is the principal clinical setting for the management of depression. However, significant shortcomings have been detected in its diagnosis and clinical management, as well as in patient outcomes. We developed the INDI collaborative care model to improve the management of depression in primary care. This intervention has been favorably evaluated in terms of clinical efficacy and cost-effectiveness in a clinical trial. Our aim is to bring this intervention from the scientific context into clinical practice. Objective: To test for the feasibility and impact of a strategy for implementing the INDI model for depression in primary care. A quasi-experiment conducted in primary care. Several areas will be established to implement the new program and other, comparable areas will serve as control group. The study constitutes the preliminary phase preceding generalization of the model in the Catalan public healthcare system. The target population of the intervention are patients with major depression. The implementation strategy will also involve healthcare professionals, primary care centers, as well as management departments and the healthcare organization itself in the geographical areas where the study will be conducted: Camp de Tarragona and Vallès Occidental (Catalonia). The INDI model is a program for improving the management of depression involving clinical, instructional, and organizational interventions including the participation of nurses as care managers, the efficacy and efficiency of which has been proven in a clinical trial. We will design an active implementation strategy for this model based on the PARIHS (Promoting Action on Research Implementation in Health Services) framework. Qualitative and quantitative measures will be used to evaluate variables related to the successful implementation of the model: acceptability, utility, penetration, sustainability, and clinical impact. This project tests the transferability of a healthcare intervention supported by scientific research to clinical practice. If implementation is successful in this experimental phase, we will use the information and experience obtained to propose and plan the generalization of the INDI model for depression in the Catalan healthcare system. We expect the program to benefit patients, the healthcare system, and society. ClinicalTrials.gov identifier: NCT03285659 ; Registered 12th September, 2017.

  2. Artificial intelligence - New tools for aerospace project managers

    NASA Technical Reports Server (NTRS)

    Moja, D. C.

    1985-01-01

    Artificial Intelligence (AI) is currently being used for business-oriented, money-making applications, such as medical diagnosis, computer system configuration, and geological exploration. The present paper has the objective to assess new AI tools and techniques which will be available to assist aerospace managers in the accomplishment of their tasks. A study conducted by Brown and Cheeseman (1983) indicates that AI will be employed in all traditional management areas, taking into account goal setting, decision making, policy formulation, evaluation, planning, budgeting, auditing, personnel management, training, legal affairs, and procurement. Artificial intelligence/expert systems are discussed, giving attention to the three primary areas concerned with intelligent robots, natural language interfaces, and expert systems. Aspects of information retrieval are also considered along with the decision support system, and expert systems for project planning and scheduling.

  3. The Saudi Thoracic Society guidelines for diagnosis and management of noncystic fibrosis bronchiectasis

    PubMed Central

    Al-Jahdali, Hamdan; Alshimemeri, Abdullah; Mobeireek, Abdullah; Albanna, Amr S.; Al Shirawi, Nehad N.; Wali, Siraj; Alkattan, Khaled; Alrajhi, Abdulrahman A.; Mobaireek, Khalid; Alorainy, Hassan S.; Al-Hajjaj, Mohamed S.; Chang, Anne B.; Aliberti, Stefano

    2017-01-01

    This is the first guideline developed by the Saudi Thoracic Society for the diagnosis and management of noncystic fibrosis bronchiectasis. Local experts including pulmonologists, infectious disease specialists, thoracic surgeons, respiratory therapists, and others from adult and pediatric departments provided the best practice evidence recommendations based on the available international and local literature. The main objective of this guideline is to utilize the current published evidence to develop recommendations about management of bronchiectasis suitable to our local health-care system and available resources. We aim to provide clinicians with tools to standardize the diagnosis and management of bronchiectasis. This guideline targets primary care physicians, family medicine practitioners, practicing internists and respiratory physicians, and all other health-care providers involved in the care of the patients with bronchiectasis. PMID:28808486

  4. About the necessity to manage events coded with MedDRA prior to statistical analysis: proposal of a strategy with application to a randomized clinical trial, ANRS 099 ALIZE.

    PubMed

    Journot, Valérie; Tabuteau, Sophie; Collin, Fidéline; Molina, Jean-Michel; Chene, Geneviève; Rancinan, Corinne

    2008-03-01

    Since 2003, the Medical Dictionary for Regulatory Activities (MedDRA) is the regulatory standard for safety report in clinical trials in the European Community. Yet, we found no published example of a practical experience for a scientifically oriented statistical analysis of events coded with MedDRA. We took advantage of a randomized trial in HIV-infected patients with MedDRA-coded events to explain the difficulties encountered during the events analysis and the strategy developed to report events consistently with trial-specific objectives. MedDRA has a rich hierarchical structure, which allows the grouping of coded terms into 5 levels, the highest being "System Organ Class" (SOC). Each coded term may be related to several SOCs, among which one primary SOC is defined. We developed a new general 5-step strategy to select a SOC as trial primary SOC, consistently with trial-specific objectives for this analysis. We applied it to the ANRS 099 ALIZE trial, where all events were coded with MedDRA version 3.0. We compared the MedDRA and the ALIZE primary SOCs. In the ANRS 099 ALIZE trial, 355 patients were recruited, and 3,722 events were reported and documented, among which 35% had multiple SOCs (2 to 4). We applied the proposed 5-step strategy. Altogether, 23% of MedDRA primary SOCs were modified, mainly from MedDRA primary SOCs "Investigations" (69%) and "Ear and labyrinth disorders" (6%), for the ALIZE primary SOCs "Hepatobiliary disorders" (35%), "Musculoskeletal and connective tissue disorders" (21%), and "Gastrointestinal disorders" (15%). MedDRA largely enhanced in size and complexity with versioning and the development of Standardized MedDRA Queries. Yet, statisticians should not systematically rely on primary SOCs proposed by MedDRA to report events. A simple general 5-step strategy to re-classify events consistently with the trial-specific objectives might be useful in HIV trials as well as in other fields.

  5. Bisphosphonates and atypical subtrochanteric fractures of the femur

    PubMed Central

    Kharwadkar, N.; Mayne, B.; Lawrence, J. E.

    2017-01-01

    Objectives Bisphosphonates are widely used as first-line treatment for primary and secondary prevention of fragility fractures. Whilst they have proved effective in this role, there is growing concern over their long-term use, with much evidence linking bisphosphonate-related suppression of bone remodelling to an increased risk of atypical subtrochanteric fractures of the femur (AFFs). The objective of this article is to review this evidence, while presenting the current available strategies for the management of AFFs. Methods We present an evaluation of current literature relating to the pathogenesis and treatment of AFFs in the context of bisphosphonate use. Results Six broad themes relating to the pathogenesis and management of bisphosphonate-related AFFs are presented. The key themes in fracture pathogenesis are: bone microdamage accumulation; altered bone mineralisation and altered collagen formation. The key themes in fracture management are: medical therapy and surgical therapy. In addition, primary prevention strategies for AFFs are discussed. Conclusions This article presents current knowledge about the relationship between bisphosphonates and the development of AFFs, and highlights key areas for future research. In particular, studies aimed at identifying at-risk subpopulations and organising surveillance for those on long-term therapy will be crucial in both increasing our understanding of the condition, and improving population outcomes. Cite this article: N. Kharwadkar, B. Mayne, J. E. Lawrence, V. Khanduja. Bisphosphonates and atypical subtrochanteric fractures of the femur. Bone Joint Res 2017;6:144–153. DOI: 10.1302/2046-3758.63.BJR-2016-0125.R1. PMID:28288986

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

    PubMed

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

    2017-05-01

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

  7. Management of pharmaceutical services in the Brazilian primary health care

    PubMed Central

    Gerlack, Letícia Farias; Karnikowski, Margô Gomes de Oliveira; Areda, Camila Alves; Galato, Dayani; de Oliveira, Aline Gomes; Álvares, Juliana; Leite, Silvana Nair; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Costa, Karen Sarmento; Guerra, Augusto Afonso; Acurcio, Francisco de Assis

    2017-01-01

    ABSTRACT OBJECTIVE To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). METHODS This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. RESULTS We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. CONCLUSIONS Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening. PMID:29160449

  8. Overcoming Barriers to Integrating Behavioral Health and Primary Care Services

    PubMed Central

    Grazier, Kyle L.; Smiley, Mary L.; Bondalapati, Kirsten S.

    2016-01-01

    Objective: Despite barriers, organizations with varying characteristics have achieved full integration of primary care services with providers and services that identify, treat, and manage those with mental health and substance use disorders. What are the key factors and common themes in stories of this success? Methods: A systematic literature review and snowball sampling technique was used to identify organizations. Site visits and key informant interviews were conducted with 6 organizations that had over time integrated behavioral health and primary care services. Case studies of each organization were independently coded to identify traits common to multiple organizations. Results: Common characteristics include prioritized vulnerable populations, extensive community collaboration, team approaches that included the patient and family, diversified funding streams, and data-driven approaches and practices. Conclusions: While significant barriers to integrating behavioral health and primary care services exist, case studies of organizations that have successfully overcome these barriers share certain common factors. PMID:27380923

  9. Hospital-Based Clinical Pharmacy Services to Improve Ambulatory Management of Chronic Obstructive Pulmonary Disease

    PubMed Central

    Smith, Amber Lanae; Palmer, Valerie; Farhat, Nada; Kalus, James S.; Thavarajah, Krishna; DiGiovine, Bruno; MacDonald, Nancy C.

    2016-01-01

    Background: No systematic evaluations of a comprehensive clinical pharmacy process measures currently exist to determine an optimal ambulatory care collaboration model for chronic obstructive pulmonary disease (COPD) patients. Objective: Describe the impact of a pharmacist-provided clinical COPD bundle on the management of COPD in a hospital-based ambulatory care clinic. Methods: This retrospective cohort analysis evaluated patients with COPD managed in an outpatient pulmonary clinic. The primary objective of this study was to assess the completion of 4 metrics known to improve the management of COPD: (1) medication therapy management, (2) quality measures including smoking cessation and vaccines, (3) patient adherence, and (4) patient education. The secondary objective was to evaluate the impact of the clinical COPD bundle on clinical and economic outcomes at 30 and 90 days post–initial visit. Results: A total of 138 patients were included in the study; 70 patients served as controls and 68 patients received the COPD bundle from the clinical pharmacist. No patients from the control group had all 4 metrics completed as documented, compared to 66 of the COPD bundle group (P < .0001). Additionally, a statistically significant difference was found in all 4 metrics when evaluated individually. Clinical pharmacy services reduced the number of phone call consults at 90 days (P = .04) but did not have a statistically significant impact on any additional pre-identified clinical outcomes. Conclusion: A pharmacist-driven clinical COPD bundle was associated with significant increases in the completion and documentation of 4 metrics known to improve the outpatient management of COPD.

  10. Emergency management of dental trauma: knowledge of Hong Kong primary and secondary school teachers.

    PubMed

    Young, Cecilia; Wong, K Y; Cheung, L K

    2012-10-01

    OBJECTIVES. To investigate the level of knowledge about emergency management of dental trauma among Hong Kong primary and secondary school teachers. DESIGN. Questionnaire survey. SETTING. A teachers' union that unites 90% of teachers in Hong Kong. PARTICIPANTS. Randomly selected primary and secondary school teachers. RESULTS. Only 32.8% of respondents correctly stated that a person sustaining dental trauma should go to dentists directly. In all, 73.1% of teachers correctly stated that a dental trauma patient should go for treatment immediately. Only 32.5% knew that a fractured tooth should be put in liquid. Even fewer (23.2%) realised that the displaced tooth should be repositioned back to the original position. Relatively more respondents (74.7%) understood that an avulsed baby tooth should not be put back. Disappointingly, only 16.3% of teachers knew that an avulsed permanent tooth should be replanted. Furthermore, only 29.6% of teachers thought that they were able to distinguish between deciduous teeth and permanent teeth, whilst 20.4% correctly identified at least one of the appropriate mediums: milk, physiological saline or saliva, for storing an avulsed tooth. Teachers who previously received first-aid training with dental content or acquired dental injury information from other sources, scored significantly higher than teachers without such training or acquired information. CONCLUSION. The knowledge on emergency management of dental trauma among primary and secondary school teachers in Hong Kong is insufficient, particularly on the handling of permanent tooth avulsion and the appropriate storage medium for avulsed teeth. Receipt of first-aid training with dental contents and acquisition of dental injury information from other sources were positively correlated with knowledge in managing dental trauma.

  11. The impact on sleep of a multidisciplinary cognitive behavioural pain management programme: a pilot study.

    PubMed

    Cunningham, Jennifer M; Blake, Catherine; Power, Camillus K; O'Keeffe, Declan; Kelly, Valerie; Horan, Sheila; Spencer, Orla; Fullen, Brona M

    2011-01-10

    Reduced sleep quality is a common complaint among patients with chronic pain, with 50-80% of patients reporting sleep disturbance. Improvements in pain and quality of life measures have been achieved using a multidisciplinary cognitive behavioural therapy pain management programme (CBT-PMP) that aims to recondition attitudes to pain, and improve patients' self-management of their condition. Despite its high prevalence in patients with chronic pain, there is very limited objective evidence for the effect of this intervention on sleep quality. The primary research objective is to investigate the short-term effect of a multidisciplinary CBT-PMP on subjective (measured by Pittsburg Sleep Quality Index) and objective sleep quality (measured by Actigraphy) in patients with chronic pain by comparison with a control group. The secondary objectives will investigate changes in function and mood, and then explore the relationship between objective and subjective sleep quality and physical and psychological outcome measures. Patients who fulfil the inclusion criteria for attendance on the multidisciplinary CBT-PMP in the Adelaide and Meath Hospital, Tallaght, Dublin and are currently listed on the PMP waiting list will be invited to participate in this pilot study. Potential patients will be screened for sleep disturbance [determined by the Pittsburgh Sleep Quality Index (PSQI)]. Those patients with a sleep disturbance (PSQI >5) will be assigned to either the intervention group (immediate treatment), or control group (deferred treatment, i.e. the PMP they are listed for is more than six months away) based on where they appear on the waiting list. Baseline measures of sleep, function, and mood will be obtained using a combination of self-report questionnaires (the Hospital Anxiety and Depression Scale, the Short Form 36 health survey, the Pittsburgh Sleep Quality Index, the Tampa Scale for Kinesiophobia), and functional outcome measures. Sleep will be measured for seven days using actigraphy (Actiwatch 7). These measures will be repeated after the four week multidisciplinary cognitive behavioural therapy pain management programme, and at a two month follow-up. The waiting list control group will be assessed at baseline, and two months later. Analysis for the primary outcome will include between group differences of subjective and objective sleep parameters from baseline to follow-up using Independent T-tests or Mann-Whitney U tests. The secondary outcomes establishing relationships between the sleep variables and physical and psychological outcome measures will be established using multiple linear regression models. This pilot study will evaluate the impact of a multidisciplinary CBT-PMP on both subjective and objective measures of sleep in patients with chronic pain and provide guidance for a larger clinical trial. Current controlled trial ISRCTN: ISRCTN74913595.

  12. Are primary healthcare organizational attributes associated with patient self-efficacy for managing chronic disease?

    PubMed

    Lemieux, Valérie; Lévesque, Jean-Frédéric; Ehrmann-Feldman, Debbie

    2011-05-01

    Our objective was to explore how individual and primary healthcare (PHC) organizational attributes influence patients' ability in chronic illness self-management. We conducted a cohort study, recruiting 776 adults with chronic disease from 33 PHC settings in the province of Quebec. Organizational data on the PHC clinics were obtained from a prior study. Participants were interviewed at baseline, 6 and 12 months, responding to questionnaires on self-efficacy, health status, socio-demographics, healthcare use and experience of care. Multilevel modelling showed that 52.5% of the variance in self-efficacy occurs at the level of the individual and 4.0% at the organizational level. Controlling for diagnosis, patient factors associated with self-efficacy were self-rated health (B coeff 0.76: CI 0.60; 0.92), concurrent depression (B coeff -1.41: CI 1.96; -0.86) and satisfaction with care (B coeff 0.27: CI 0.15; 0.39). None of the organizational attributes was significantly associated with self-efficacy after adjusting for lower-level variables. Patients generally reported receiving little self-management teaching across organizations.

  13. Are Primary Healthcare Organizational Attributes Associated with Patient Self-Efficacy for Managing Chronic Disease?

    PubMed Central

    Lemieux, Valérie; Lévesque, Jean-Frédéric; Ehrmann-Feldman, Debbie

    2011-01-01

    Our objective was to explore how individual and primary healthcare (PHC) organizational attributes influence patients' ability in chronic illness self-management. We conducted a cohort study, recruiting 776 adults with chronic disease from 33 PHC settings in the province of Quebec. Organizational data on the PHC clinics were obtained from a prior study. Participants were interviewed at baseline, 6 and 12 months, responding to questionnaires on self-efficacy, health status, socio-demographics, healthcare use and experience of care. Multilevel modelling showed that 52.5% of the variance in self-efficacy occurs at the level of the individual and 4.0% at the organizational level. Controlling for diagnosis, patient factors associated with self-efficacy were self-rated health (B coeff 0.76: CI 0.60; 0.92), concurrent depression (B coeff –1.41: CI 1.96; –0.86) and satisfaction with care (B coeff 0.27: CI 0.15; 0.39). None of the organizational attributes was significantly associated with self-efficacy after adjusting for lower-level variables. Patients generally reported receiving little self-management teaching across organizations. PMID:22548102

  14. Evaluation of adjuvant carboplatin chemotherapy in the management of surgically excised anal sac apocrine gland adenocarcinoma in dogs.

    PubMed

    Wouda, R M; Borrego, J; Keuler, N S; Stein, T

    2016-03-01

    There is no widely accepted standard of care for canine anal sac apocrine gland adenocarcinoma (ASAGAC). Surgery alone is inadequate in many cases, but the benefit of adjuvant chemotherapy is not well established. The primary objective of this retrospective study was to evaluate the role of carboplatin chemotherapy in the post-operative management of ASAGAC. Seventy-four dogs with naturally occurring ASAGAC underwent surgery. Forty-four dogs received adjuvant carboplatin and 30 did not. Median overall survival (OS) was 703 days. Median time to progression (TTP) was 384 days. Only primary tumour size and lymph node metastasis at diagnosis significantly impacted the outcome. Differences in OS and TTP, between the dogs that received adjuvant carboplatin and those that did not, failed to reach statistical significance. Treatment of progressive disease, whilst not limited to chemotherapy, significantly prolonged the survival. This study shows that adjuvant carboplatin chemotherapy is well tolerated and may have a role in the management of dogs with ASAGAC. © 2013 John Wiley & Sons Ltd.

  15. Health system challenges of NCDs in Tunisia.

    PubMed

    Ben Romdhane, Habiba; Tlili, Faten; Skhiri, Afef; Zaman, Shahaduz; Phillimore, Peter

    2015-01-01

    The objective of this study was to present a qualitative 'situation analysis' of the healthcare system in Tunisia, as it applies to management of cardiovascular disease (CVD) and diabetes. A primary concern was the institutional capacity to manage non-communicable diseases (NCDs). Research took place during 2010 (analysis of official documents, semi-structured interviews with key informants, and case studies in four clinics). Walt and Gilson's framework (1994) for policy analysis was used: content, actors, context, and process. Problems of integration and coordination have compounded funding pressures. Despite its importance in Tunisian healthcare, primary health is ill-equipped to manage NCDs. With limited funds, and no referral or health information system, staff morale in the public sector was low. Private healthcare has been the main development filling the void. This study highlights major gaps in the implementation of a comprehensive approach to NCDs, which is an urgent task across the region. In strategic planning, research on the health system is vital; but the capacity within Ministries of Health to use research has first to be built, with a commitment to grounding policy change in evidence.

  16. Hypertension management in rural primary care facilities in Zambia: a mixed methods study.

    PubMed

    Yan, Lily D; Chirwa, Cindy; Chi, Benjamin H; Bosomprah, Samuel; Sindano, Ntazana; Mwanza, Moses; Musatwe, Dennis; Mulenga, Mary; Chilengi, Roma

    2017-02-03

    Improved primary health care is needed in developing countries to effectively manage the growing burden of hypertension. Our objective was to evaluate hypertension management in Zambian rural primary care clinics using process and outcome indicators to assess the screening, monitoring, treatment and control of high blood pressure. Better Health Outcomes through Mentoring and Assessment (BHOMA) is a 5-year, randomized stepped-wedge trial of improved clinical service delivery underway in 46 rural Zambian clinics. Clinical data were collected as part of routine patient care from an electronic medical record system, and reviewed for site performance over time according to hypertension related indicators: screening (blood pressure measurement), management (recorded diagnosis, physical exam or urinalysis), treatment (on medication), and control. Quantitative data was used to develop guides for qualitative in-depth interviews, conducted with health care providers at a proportional sample of half (20) of clinics. Qualitative data was iteratively analyzed for thematic content. From January 2011 to December 2014, 318,380 visits to 46 primary care clinics by adults aged ≥ 25 years with blood pressure measurements were included. Blood pressure measurement at vital sign screening was initially high at 89.1% overall (range: 70.1-100%), but decreased to 62.1% (range: 0-100%) by 48 months after intervention start. The majority of hypertensive patients made only one visit to the clinics (57.8%). Out of 9022 patients with at least two visits with an elevated blood pressure, only 49.3% had a chart recorded hypertension diagnosis. Process indicators for monitoring hypertension were <10% and did not improve with time. In in-depth interviews, antihypertensive medication shortages were common, with 15/20 clinics reporting hydrochlorothiazide-amiloride stockouts. Principal challenges in hypertension management included 1) equipment and personnel shortages, 2) provider belief that multiple visits were needed before official management, 3) medication stock-outs, leading to improper prescriptions and 4) poor patient visit attendance. Our findings suggest that numerous barriers stand in the way of hypertension diagnosis and management in Zambian primary health facilities. Future work should focus on performance indicator development and validation in low resource contexts, to facilitate regular and systematic data review to improve patient outcomes. ClinicalTrials.gov, Identifier NCT01942278 . Date of Registration: September 2013.

  17. Earth Science and Applications attached payloads on Space Station

    NASA Technical Reports Server (NTRS)

    Wicks, Thomas G.; Arnold, Ralph R.

    1990-01-01

    This paper describes the Office of Space Science and Applications' process for Attached Payloads on Space Station Freedom from development through on-orbit operations. Its primary objectives are to detail the sequential steps of the attached payload methodology by tracing in particular the selected Earth Science and Applications' payloads through this flow and relate the integral role of Marshall Space Flight Center's Science Utilization Management function of integration and operations.

  18. Self-management practices among primary care patients with musculoskeletal pain and depression.

    PubMed

    Damush, Teresa M; Wu, Jingwei; Bair, Matthew J; Sutherland, Jason M; Kroenke, Kurt

    2008-08-01

    The objective of this study was to assess the effect of clinical depression on pain self-management practices. We employed a cross-sectional analysis of baseline data from the Stepped Care for Affective disorders and Musculoskeletal Pain (SCAMP) study. Participants included 250 patients with pain and comorbid depression and 250 patients with pain only and were enrolled from urban university and VA primary care clinics. Musculoskeletal pain was defined as low back, hip or knee pain present >or=3 months and with at least a moderate, Brief Pain Inventory severity score >or=5. Depression was defined as a PHQ-9 score >or=10. We used multiple logistic and Poisson regression to assess the relationship between individual and combined effects of depression and pain severity on two core pain self-management skills: exercise duration and cognitive strategies. Depressed patients exercised less per week than did nondepressed patients but showed a trend towards more frequent use of cognitive strategies. On multivariable analysis, depression severity substantially decreased the use of exercise as a pain self-management strategy. In contrast, depression and pain severity interacted to increase the use of cognitive strategies. Depression and pain severity have differential effects on self-management practices. Understanding the differences between preferential strategies of pain patients with and without depression may be useful in tailoring pain self-management programs.

  19. Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence.

    PubMed

    Hanekom, Susan D; Brooks, Dina; Denehy, Linda; Fagevik-Olsén, Monika; Hardcastle, Timothy C; Manie, Shamila; Louw, Quinette

    2012-02-06

    Postoperative pulmonary complications remain the most significant cause of morbidity following open upper abdominal surgery despite advances in perioperative care. However, due to the poor quality primary research uncertainty surrounding the value of prophylactic physiotherapy intervention in the management of patients following abdominal surgery persists. The Delphi process has been proposed as a pragmatic methodology to guide clinical practice when evidence is equivocal. The objective was to develop a clinical management algorithm for the post operative management of abdominal surgery patients. Eleven draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by scientist clinicians (n=5) in an electronic three round Delphi process. Algorithm statements which reached a priori defined consensus-semi-interquartile range (SIQR)<0.5-were collated into the algorithm. The five panelists allocated to the abdominal surgery Delphi panel were from Australia, Canada, Sweden, and South Africa. The 11 draft algorithm statements were edited and 5 additional statements were formulated. The panel reached consensus on the rating of all statements. Four statements were rated essential. An expert Delphi panel interpreted the equivocal evidence for the physiotherapeutic management of patients following upper abdominal surgery. Through a process of consensus a clinical management algorithm was formulated. This algorithm can now be used by clinicians to guide clinical practice in this population.

  20. Improving outpatient primary medication adherence with physician guided, automated dispensing

    PubMed Central

    Moroshek, Jacob G

    2017-01-01

    Background Physician dispensing, different from pharmacist dispensing, is a way for practitioners to supply their patients with medications, at the point of care. The InstyMeds dispenser and logistics system can automate much of the dispensing, insurance adjudication, inventory management, and regulatory reporting that is required of physician dispensing. Objective To understand the percentage of patients that exhibit primary adherence to medication in the outpatient setting when choosing InstyMeds. Method The InstyMeds dispensing database was de-identified and analyzed for primary adherence. This is the ratio of patients who dispensed their medication to those who received an eligible prescription. Results The average InstyMeds emergency department installation has a primary adherence rate of 91.7%. The maximum rate for an installed device was 98.5%. Conclusion Although national rates of primary adherence have been found to be in the range of 70%, automated physician dispensing vastly improves the rate of adherence. Improved adherence should lead to better patient outcomes, fewer return visits, and lower healthcare costs. PMID:28115860

  1. Effectiveness of primary conservative management for infants with obstetric brachial plexus palsy.

    PubMed

    Bialocerkowski, Andrea; Kurlowicz, Kirsty; Vladusic, Sharon; Grimmer, Karen

    Obstetric brachial plexus palsy, a complication of childbirth, occurs in 1-3 per 1000 live births internationally. Traction and/or compression of the brachial plexus is thought to be the primary mechanism of injury and this may occur in utero, during the descent through the birth canal or during delivery. This results in a spectrum of injuries that vary in severity, extent of damage and functional use of the affected upper limb. Most infants receive treatment, such as conservative management (physiotherapy, occupational therapy) or surgery; however, there is controversy regarding the most appropriate form of management. To date, no synthesised evidence is available regarding the effectiveness of primary conservative management for obstetric brachial plexus palsy. The objective of this review was to systematically assess the literature and present the best available evidence that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy. A systematic literature search was performed using 14 databases: TRIP, MEDLINE, CINAHL, AMED, Web of Science, Proquest 5000, Evidence Based Medicine Reviews, Expanded Academic ASAP, Meditext, Science Direct, Physiotherapy Evidence Database, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Those studies that were reported in English and published over the last decade (July 1992 to June 2003) were included in this review. Quantitative studies that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy were eligible for inclusion in this review. This excluded studies that solely investigated the effect of primary surgery for these infants, management of secondary deformities and the investigation of the effects of pharmacological agents, such as botulinum toxin. Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion. Studies were assessed for clinical homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format. Eight studies were included in the review. Most were ranked low on the Hierarchy of Evidence (no randomised controlled trials were found), and had only fair methodological quality. Conservative management was variable and could consist of active or passive exercise, splints or traction. All studies lacked a clear description of what constituted conservative management, which would not allow the treatment to be replicated in the clinical setting. A variety of outcome instruments were used, none of which had evidence of validity, reliability or sensitivity to detect change. Furthermore, less severely affected infants were selected to receive conservative management. Therefore, it is difficult to draw conclusions regarding the effectiveness of conservative management for infants with obstetric brachial plexus palsy. There is scant, inconclusive evidence regarding the effectiveness of primary conservative intervention for infants with obstetric brachial plexus palsy. Further research should be directed to develop outcome instruments with sound psychometric properties for infants with obstetric brachial plexus palsy and their families. These outcome instruments should then be used in well-designed comparative studies.

  2. Effectiveness of primary conservative management for infants with obstetric brachial plexus palsy.

    PubMed

    Bialocerkowski, Andrea; Kurlowicz, Kirsty; Vladusic, Sharon; Grimmer, Karen

    2005-03-01

    Background  Obstetric brachial plexus palsy, a complication of childbirth, occurs in 1-3 per 1000 live births internationally. Traction and/or compression of the brachial plexus is thought to be the primary mechanism of injury and this may occur in utero, during the descent through the birth canal or during delivery. This results in a spectrum of injuries that vary in severity, extent of damage and functional use of the affected upper limb. Most infants receive treatment, such as conservative management (physiotherapy, occupational therapy) or surgery; however, there is controversy regarding the most appropriate form of management. To date, no synthesised evidence is available regarding the effectiveness of primary conservative management for obstetric brachial plexus palsy. Objectives  The objective of this review was to systematically assess the literature and present the best available evidence that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy. Search strategy  A systematic literature search was performed using 14 databases: TRIP, MEDLINE, CINAHL, AMED, Web of Science, Proquest 5000, Evidence Based Medicine Reviews, Expanded Academic ASAP, Meditext, Science Direct, Physiotherapy Evidence Database, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Those studies that were reported in English and published over the last decade (July 1992 to June 2003) were included in this review. Selection criteria  Quantitative studies that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy were eligible for inclusion in this review. This excluded studies that solely investigated the effect of primary surgery for these infants, management of secondary deformities and the investigation of the effects of pharmacological agents, such as botulinum toxin. Data collection and analysis  Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion. Studies were assessed for clinical homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format. Results  Eight studies were included in the review. Most were ranked low on the Hierarchy of Evidence (no randomised controlled trials were found), and had only fair methodological quality. Conservative management was variable and could consist of active or passive exercise, splints or traction. All studies lacked a clear description of what constituted conservative management, which would not allow the treatment to be replicated in the clinical setting. A variety of outcome instruments were used, none of which had evidence of validity, reliability or sensitivity to detect change. Furthermore, less severely affected infants were selected to receive conservative management. Therefore, it is difficult to draw conclusions regarding the effectiveness of conservative management for infants with obstetric brachial plexus palsy. Conclusions  There is scant, inconclusive evidence regarding the effectiveness of primary conservative intervention for infants with obstetric brachial plexus palsy. Further research should be directed to develop outcome instruments with sound psychometric properties for infants with obstetric brachial plexus palsy and their families. These outcome instruments should then be used in well-designed comparative studies.

  3. The impact of out-of-hospital models of care on paediatric emergency department presentations.

    PubMed

    Viner, Russell M; Blackburn, Frances; White, Francesca; Mannie, Randy; Parr, Tracy; Nelson, Sara; Lemer, Claire; Riddell, Anna; Watson, Mando; Cleugh, Francesca; Heys, Michelle; Hargreaves, Dougal S

    2018-02-01

    To estimate the potential impact of enhanced primary care and new out-of-hospital models (OOHMs) on emergency department (ED) presentations by children and young people (CYP). Observational study. Data collected prospectively on 3020 CYP 0-17.9 years from 6 London EDs during 14 days by 25 supernumerary clinicians. CYP with transient acute illness, exacerbation of long-term condition (LTC), complex LTC/disability and injury/trauma were considered manageable within OOHM. OOHMs assessed included nurse-led services, multispecialty community provider (MCP), primary and acute care system (PACS) plus current and enhanced primary care. Diagnosis, severity; record of investigations, management and outcome that occurred; objective assessment of clinical need and potential alternative management options/destinations. Of the patients 95.6% had diagnoses appropriate for OOHM. Most presentations required assessment by a clinician with skills in assessing illness (39.6%) or injuries (30.9%). One thousand two hundred and ninety-one (42.75%) required no investigations and 1007 (33.3%) were provided only with reassurance. Of the presentations 42.2% were judged to have been totally avoidable if the family had had better health education.Of the patients 26.1% were judged appropriate for current primary care (community pharmacy or general practice) with 31.5% appropriate for the combination of enhanced general practice and community pharmacy. Proportions suitable for new models were 14.1% for the nurse-led acute illness team, MCP 25.7%, GP federation CYP service 44.6%, comprehensive walk-in centre for CYP 64.3% and 75.5% for a PACS. High proportions of ED presentations by CYP could potentially be managed in new OOHMs or by enhancement of existing primary care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Nurse Practitioner-Physician Comanagement: A Theoretical Model to Alleviate Primary Care Strain.

    PubMed

    Norful, Allison A; de Jacq, Krystyna; Carlino, Richard; Poghosyan, Lusine

    2018-05-01

    Various models of care delivery have been investigated to meet the increasing demands in primary care. One proposed model is comanagement of patients by more than 1 primary care clinician. Comanagement has been investigated in acute care with surgical teams and in outpatient settings with primary care physicians and specialists. Because nurse practitioners are increasingly managing patient care as independent clinicians, our study objective was to propose a model of nurse practitioner-physician comanagement. We conducted a literature search using the following key words: comanagement; primary care; nurse practitioner OR advanced practice nurse. From 156 studies, we extracted information about nurse practitioner-physician comanagement antecedents, attributes, and consequences. A systematic review of the findings helped determine effects of nurse practitioner-physician comanagement on patient care. Then, we performed 26 interviews with nurse practitioners and physicians to obtain their perspectives on nurse practitioner-physician comanagement. Results were compiled to create our conceptual nurse practitioner-physician comanagement model. Our model of nurse practitioner-physician comanagement has 3 elements: effective communication; mutual respect and trust; and clinical alignment/shared philosophy of care. Interviews indicated that successful comanagement can alleviate individual workload, prevent burnout, improve patient care quality, and lead to increased patient access to care. Legal and organizational barriers, however, inhibit the ability of nurse practitioners to practice autonomously or with equal care management resources as primary care physicians. Future research should focus on developing instruments to measure and further assess nurse practitioner-physician comanagement in the primary care practice setting. © 2018 Annals of Family Medicine, Inc.

  5. DIABETES, DEPRESSION, AND DEATH: A RANDOMIZED CONTROLLED TRIAL OF A DEPRESSION TREATMENT PROGRAM FOR OLDER ADULTS BASED IN PRIMARY CARE (PROSPECT)

    PubMed Central

    Bogner, Hillary R; Morales, Knashawn H; Post, Edward P; Bruce, Martha L

    2009-01-01

    OBJECTIVE Our a priori hypothesis was that depressed patients with diabetes in practices implementing a depression management program would have a decreased risk of mortality compared to depressed patients with diabetes in usual care practices. RESEARCH DESIGN AND METHODS Multi-site practice-randomized controlled trial PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) with patient recruitment from 5/99-8/01 and supplemented with a search of the National Death Index. Twenty primary care practices participated from New York City, Philadelphia, and Pittsburgh. In all, 584 participants who were identified though a two-stage, age-stratified (60-74; 75+) depression screening of randomly sampled patients and were classified as depressed with complete information on diabetes status are included in these analyses. Of all the 584 participants, 123 (21.2%) reported a history of diabetes. A depression care manager worked with primary care physicians to provide algorithm-based care. Vital status was assessed at 5 years. RESULTS After a median follow-up of 52.0 months, 110 depressed patients had died. Depressed patients with diabetes in the Intervention Condition were less likely to have died during the 5-year follow-up interval than were depressed persons with diabetes in Usual Care after accounting for baseline differences among patients (adjusted hazard ratio 0.49, 95% CI [0.24, 0.98]). CONCLUSIONS Older depressed primary care patients with diabetes in practices implementing depression care management were less likely to die over the course of a 5-year interval than were depressed patients with diabetes in usual care practices. PMID:17717284

  6. A partnership model for implementing electronic health records in resource-limited primary care settings: experiences from two nurse-managed health centers

    PubMed Central

    Dennehy, Patricia; White, Mary P; Hamilton, Andrew; Pohl, Joanne M; Tanner, Clare; Onifade, Tiffiani J

    2011-01-01

    Objective To present a partnership-based and community-oriented approach designed to ease provider anxiety and facilitate the implementation of electronic health records (EHR) in resource-limited primary care settings. Materials and Methods The approach, referred to as partnership model, was developed and iteratively refined through the research team's previous work on implementing health information technology (HIT) in over 30 safety net practices. This paper uses two case studies to illustrate how the model was applied to help two nurse-managed health centers (NMHC), a particularly vulnerable primary care setting, implement EHR and get prepared to meet the meaningful use criteria. Results The strong focus of the model on continuous quality improvement led to eventual implementation success at both sites, despite difficulties encountered during the initial stages of the project. Discussion There has been a lack of research, particularly in resource-limited primary care settings, on strategies for abating provider anxiety and preparing them to manage complex changes associated with EHR uptake. The partnership model described in this paper may provide useful insights into the work shepherded by HIT regional extension centers dedicated to supporting resource-limited communities disproportionally affected by EHR adoption barriers. Conclusion NMHC, similar to other primary care settings, are often poorly resourced, understaffed, and lack the necessary expertise to deploy EHR and integrate its use into their day-to-day practice. This study demonstrates that implementation of EHR, a prerequisite to meaningful use, can be successfully achieved in this setting, and partnership efforts extending far beyond the initial software deployment stage may be the key. PMID:21828225

  7. Frailty

    PubMed Central

    Lee, Linda; Heckman, George; Molnar, Frank J.

    2015-01-01

    Objective To help family physicians better recognize frailty and its implications for managing elderly patients. Sources of information PubMed-MEDLINE was searched from 1990 to 2013. The search was restricted to English-language articles using the following groups of MeSH headings and key words: frail elderly, frail, frailty; aged, geriatrics, geriatric assessment, health services for the aged; and primary health care, community health services, and family practice. Main message Frailty is common, particularly in elderly persons with complex chronic conditions such as heart failure and chronic obstructive pulmonary disease. Emerging evidence demonstrates the value of frailty as a predictor of adverse outcomes in older persons. While there is currently a lack of consensus as to how best to assess and diagnose frailty in primary care practice, individual markers of frailty such as low gait speed offer a promising feasible means of screening for frailty. Identification of frailty in primary care might provide an opportunity to delay the progression of frailty through proactive interventions such as exercise, and awareness of frailty can guide appropriate counseling and anticipatory preventive measures for patients when considering medical interventions. Recognition of frailty might also help identify and optimize the management of coexisting conditions that might contribute to or be affected by frailty. Further research should be directed at identifying feasible and effective ways to appropriately assess and manage these vulnerable patients at the primary care level. Conclusion Despite its importance, little attention has been given to the concept of frailty in family medicine. Frailty is easily overlooked because its manifestations can be subtle, slowly progressive, and thus dismissed as normal aging; and physician training has been focused on specific medical diseases rather than overall vulnerability. For primary care physicians, recognition of frailty might help them provide appropriate counseling to patients and family members about the risks of medical interventions. PMID:25767167

  8. Primary care models for treating opioid use disorders: What actually works? A systematic review

    PubMed Central

    Klasa, Katarzyna; Bush, Christopher; Heisler, Michele; Chopra, Vineet; Bohnert, Amy

    2017-01-01

    Background Primary care-based models for Medication-Assisted Treatment (MAT) have been shown to reduce mortality for Opioid Use Disorder (OUD) and have equivalent efficacy to MAT in specialty substance treatment facilities. Objective The objective of this study is to systematically analyze current evidence-based, primary care OUD MAT interventions and identify program structures and processes associated with improved patient outcomes in order to guide future policy and implementation in primary care settings. Data sources PubMed, EMBASE, CINAHL, and PsychInfo. Methods We included randomized controlled or quasi experimental trials and observational studies evaluating OUD treatment in primary care settings treating adult patient populations and assessed structural domains using an established systems engineering framework. Results We included 35 interventions (10 RCTs and 25 quasi-experimental interventions) that all tested MAT, buprenorphine or methadone, in primary care settings across 8 countries. Most included interventions used joint multi-disciplinary (specialty addiction services combined with primary care) and coordinated care by physician and non-physician provider delivery models to provide MAT. Despite large variability in reported patient outcomes, processes, and tasks/tools used, similar key design factors arose among successful programs including integrated clinical teams with support staff who were often advanced practice clinicians (nurses and pharmacists) as clinical care managers, incorporating patient “agreements,” and using home inductions to make treatment more convenient for patients and providers. Conclusions The findings suggest that multidisciplinary and coordinated care delivery models are an effective strategy to implement OUD treatment and increase MAT access in primary care, but research directly comparing specific structures and processes of care models is still needed. PMID:29040331

  9. Economic analysis of Heart and Stroke Foundation of Ontario’s Hypertension Management Initiative

    PubMed Central

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

    2012-01-01

    Objectives Hypertension is suboptimally treated in primary care settings. We evaluated the cost-effectiveness of the Heart and Stroke Foundation of Ontario’s Hypertension Management Initiative (HMI), an interdisciplinary, evidence-informed chronic disease management model for primary care that focuses on improving blood pressure management and control by primary care providers and patients according to clinical best practice guidelines. Methods The perspective of our analysis was that of the Ontario Ministry of Health and Long-Term Care with a lifetime horizon and 5% annual discount rate. Using data from a prospective cohort study from the HMI, we created two matched groups: pre-HMI (standard care), and post-HMI (n = 1720). For each patient, we estimated the 10-year risk of cardiovascular disease (CVD) using the Framingham risk equation and life expectancy from life tables. Long-term health care costs incurred with physician visits, acute and chronic care hospitalizations, emergency department visits, same-day surgeries, and medication use were determined through linkage to administrative databases, using a bottom-up approach. Results The HMI intervention was associated with significant reductions in systolic blood pressure (126 mmHg vs 134 mmHg with standard care; P-value < 0.001). These improvements were associated with a reduction in the 10-year risk of CVD (9.5% risk vs 10.7% in standard care; P-value < 0.001) and a statistically significant improvement in discounted life expectancy (9.536 years vs 9.516 in standard care; P-value < 0.001). The HMI cohort had a discounted mean lifetime cost of $22,884 CAD vs $22,786 CAD for standard care, with an incremental cost-effectiveness ratio of $4939 CAD per life-year gained. Conclusion We found that the HMI is a cost-effective means of providing evidence-informed, chronic disease management in primary care to patients with hypertension. PMID:23180969

  10. Rehabilitation and Flood Management Planning in a Steep, Boulder-Bedded Stream

    NASA Astrophysics Data System (ADS)

    Caruso, Brian S.; Downs, Peter W.

    2007-08-01

    This study demonstrates the integration of rehabilitation and flood management planning in a steep, boulder-bedded stream in a coastal urban catchment on the South Island of New Zealand. The Water of Leith, the primary stream flowing through the city of Dunedin, is used as a case study. The catchment is steep, with a short time of concentration and rapid hydrologic response, and the lower stream reaches are highly channelized with floodplain encroachment, a high potential for debris flows, significant flood risks, and severely degraded aquatic habitat. Because the objectives for rehabilitation and flood management in urban catchments are often conflicting, a number of types of analyses at both the catchment and the reach scales and careful planning with stakeholder consultation were needed for successful rehabilitation efforts. This included modeling and analysis of catchment hydrology, fluvial geomorphologic assessment, analysis of water quality and aquatic ecology, hydraulic modeling and flood risk evaluation, detailed feasibility studies, and preliminary design to optimize multiple rehabilitation and flood management objectives. The study showed that all of these analyses were needed for integrated rehabilitation and flood management and that some incremental improvements in stream ecological health, aesthetics, and public recreational opportunities could be achieved in this challenging environment. These methods should be considered in a range of types of stream rehabilitation projects.

  11. Using a data entry clerk to improve data quality in primary care electronic medical records: a pilot study.

    PubMed

    Greiver, Michelle; Barnsley, Jan; Aliarzadeh, Babak; Krueger, Paul; Moineddin, Rahim; Butt, Debra A; Dolabchian, Edita; Jaakkimainen, Liisa; Keshavjee, Karim; White, David; Kaplan, David

    2011-01-01

    The quality of electronic medical record (EMR) data is known to be problematic; research on improving these data is needed. The primary objective was to explore the impact of using a data entry clerk to improve data quality in primary care EMRs. The secondary objective was to evaluate the feasibility of implementing this intervention. We used a before and after design for this pilot study. The participants were 13 community based family physicians and four allied health professionals in Toronto, Canada. Using queries programmed by a data manager, a data clerk was tasked with re-entering EMR information as coded or structured data for chronic obstructive pulmonary disease (COPD), smoking, specialist designations and interprofessional encounter headers. We measured data quality before and three to six months after the intervention. We evaluated feasibility by measuring acceptability to clinicians and workload for the clerk. After the intervention, coded COPD entries increased by 38% (P = 0.0001, 95% CI 23 to 51%); identifiable data on smoking categories increased by 27% (P = 0.0001, 95% CI 26 to 29%); referrals with specialist designations increased by 20% (P = 0.0001, 95% CI 16 to 22%); and identifiable interprofessional headers increased by 10% (P = 0.45, 95 CI -3 to 23%). Overall, the intervention was rated as being at least moderately useful and moderately usable. The data entry clerk spent 127 hours restructuring data for 11 729 patients. Utilising a data manager for queries and a data clerk to re-enter data led to improvements in EMR data quality. Clinicians found this approach to be acceptable.

  12. Improving detection and initial management of gestational diabetes through the primary level of care in Morocco: protocol for a cluster randomized controlled trial.

    PubMed

    Utz, Bettina; Assarag, Bouchra; Essolbi, Amina; Barkat, Amina; El Ansari, Nawal; Fakhir, Bouchra; Delamou, Alexandre; De Brouwere, Vincent

    2017-06-19

    Morocco is facing a growing prevalence of diabetes and according to latest figures of the World Health Organization, already 12.4% of the population are affected. A similar prevalence has been reported for gestational diabetes (GDM) and although it is not yet high on the national agenda, immediate and long-term complications threaten the health of mothers and future generations. A situational analysis on GDM conducted in 2015 revealed difficulties in access to screening and delays in receiving appropriate care. This implementation study has as objective to evaluate a decentralized GDM detection and management approach through the primary level of care and assess its potential for scaling up. We will conduct a hybrid effectiveness-implementation research using a cluster randomized controlled trial design in two districts of Morocco. Using the health center as unit of randomization we randomly selected 20 health centers with 10 serving as intervention and 10 as control facilities. In the intervention arm, providers will screen pregnant women attending antenatal care for GDM by capillary glucose testing during antenatal care. Women tested positive will receive nutritional counselling and will be followed up through the health center. In the control facilities, screening and initial management of GDM will follow standard practice. Primary outcome will be birthweight with weight gain during pregnancy, average glucose levels and pregnancy outcomes including mode of delivery, presence or absence of obstetric or newborn complications and the prevalence of GDM at health center level as secondary outcomes. Furthermore we will assess the quality of life /care experienced by the women in both arms. Qualitative methods will be applied to evaluate the feasibility of the intervention at primary level and its adoption by the health care providers. In Morocco, gestational diabetes screening and its initial management is fragmented and coupled with difficulties in access and treatment delays. Implementation of a strategy that enables detection, management and follow-up of affected women at primary health care level is expected to positively impact on access to care and medical outcomes. The trial has been registered on clininicaltrials.gov ; identifier NCT02979756 ; retrospectively registered 22 November 2016.

  13. Weight management in Canada: an environmental scan of health services for adults with obesity

    PubMed Central

    2014-01-01

    Background Obesity in Canada is a growing concern, but little is known about the available services for managing obesity in adults. Our objectives were to (a) survey and describe programs dedicated to weight management and (b) evaluate program adherence to established recommendations for care. Methods We conducted an online environmental scan in 2011 to identify adult weight management services throughout Canada. We examined the degree to which programs adhered to the 2006 Canadian Clinical Practice Guidelines on the Management and Prevention of Obesity in Adults and Children (CCPGO) and the analysis criteria developed by the Association pour la Santé Publique du Québec (ASPQ). Results A total of 83 non-surgical (34 community-based, 42 primary care-based, 7 hospital-based) and 33 surgical programs were identified. All programs encouraged patient self-management. However, few non-surgical programs adhered to the CCPGO recommendations for assessment and intervention, and there was a general lack of screening for eating disorders, depression and other psychiatric diseases across all programs. Concordance with the ASPQ criteria was best among primary care-based programs, but less common in other settings with deficits most frequently revealed in multidisciplinary health assessment/management and physical activity counselling. Conclusions With more than 60% of Canadians overweight or obese, our findings highlight that availability of weight management services is far outstripped by need. Our observation that evidence-based recommendations are applied inconsistently across the country validates the need for knowledge translation of effective health services for managing obesity in adults. PMID:24521300

  14. Practical Diagnosis and Management of Dementia Due to Alzheimer’s Disease in the Primary Care Setting: An Evidence-Based Approach

    PubMed Central

    Kerwin, Diana R.

    2013-01-01

    Objective: To review evidence-based guidance on the primary care of Alzheimer’s disease and clinical research on models of primary care for Alzheimer’s disease to present a practical summary for the primary care physician regarding the assessment and management of the disease. Data Sources: References were obtained via search using keywords Alzheimer’s disease AND primary care OR collaborative care OR case finding OR caregivers OR guidelines. Articles were limited to English language from January 1, 1990, to January 1, 2013. Study Selection: Articles were reviewed and selected on the basis of study quality and pertinence to this topic, covering a broad range of data and opinion across geographical regions and systems of care. The most recent published guidelines from major organizations were included. Results: Practice guidelines contained numerous points of consensus, with most advocating a central role for the primary care physician in the detection, diagnosis, and treatment of Alzheimer’s disease. Review of the literature indicated that optimal medical and psychosocial care for people with Alzheimer’s disease and their caregivers may be best facilitated through collaborative models of care involving the primary care physician working within a wider interdisciplinary team. Conclusions: Evidence-based guidelines assign the primary care physician a critical role in the care of people with Alzheimer’s disease. Research on models of care suggests the need for an appropriate medical/nonmedical support network to fulfill this role. Given the diversity and breadth of services required and the necessity for close coordination, nationwide implementation of team-based, collaborative care programs may represent the best option for improving care standards for patients with Alzheimer’s disease. PMID:24392252

  15. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Primary care case management services. 440.168... 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...

  16. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 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 2014-10-01 2014-10-01 false Primary care case management services. 440.168...

  17. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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 2011-10-01 2011-10-01 false Primary care case management services. 440.168...

  18. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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 2012-10-01 2012-10-01 false Primary care case management services. 440.168...

  19. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 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 2013-10-01 2013-10-01 false Primary care case management services. 440.168...

  20. 24 CFR 570.901 - Review for compliance with the primary and national objectives and other program requirements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... primary and national objectives and other program requirements. 570.901 Section 570.901 Housing and Urban... primary and national objectives and other program requirements. HUD will review each entitlement, Insular...)(3) that, consistent with the primary objective of the Act, not less than 70 percent of the aggregate...

  1. Use of topographic and climatological models in a geographical data base to improve Landsat MSS classification for Olympic National Park

    NASA Technical Reports Server (NTRS)

    Cibula, William G.; Nyquist, Maurice O.

    1987-01-01

    An unsupervised computer classification of vegetation/landcover of Olympic National Park and surrounding environs was initially carried out using four bands of Landsat MSS data. The primary objective of the project was to derive a level of landcover classifications useful for park management applications while maintaining an acceptably high level of classification accuracy. Initially, nine generalized vegetation/landcover classes were derived. Overall classification accuracy was 91.7 percent. In an attempt to refine the level of classification, a geographic information system (GIS) approach was employed. Topographic data and watershed boundaries (inferred precipitation/temperature) data were registered with the Landsat MSS data. The resultant boolean operations yielded 21 vegetation/landcover classes while maintaining the same level of classification accuracy. The final classification provided much better identification and location of the major forest types within the park at the same high level of accuracy, and these met the project objective. This classification could now become inputs into a GIS system to help provide answers to park management coupled with other ancillary data programs such as fire management.

  2. Objective Structured Assessment of Technical Skills (OSATS) evaluation of theoretical versus hands-on training of vaginal breech delivery management: a randomized trial.

    PubMed

    Buerkle, Bernd; Rueter, Katharina; Hefler, Lukas A; Tempfer-Bentz, Eva-Katrin; Tempfer, Clemens B

    2013-12-01

    To compare the skills of performing a vaginal breech (VB) delivery after hands-on training versus demonstration. We randomized medical students to a 30-min demonstration (group 1) or a 30-min hands-on (group 2) training session using a standardized VB management algorithm on a pelvic training model. Subjects were tested with a 25 item Objective Structured Assessment of Technical Skills (OSATS) scoring system immediately after training and 72 h thereafter. OSATS scores were the primary outcome. Performance time (PT), self assessment (SA), confidence (CON), and global rating scale (GRS) were the secondary outcomes. Statistics were performed using the Mann-Whitney U-test, chi-square test, and multiple linear regression analysis. 172 subjects were randomized. OSATS scores (primary outcome) were significantly higher in group 2 (n=88) compared to group 1 (n=84) (21.18±2.29 vs. 20.19±2.37, respectively; p=0.006). The secondary outcomes GRS (10.31±2.28 vs. 9.17±2.21; p=0.001), PT (214.60±57.97 s vs. 246.98±59.34 s; p<0.0001), and CON (3.14±0.89 vs. 2.85±0.90; p=0.04) were also significantly different between groups, favoring group 2. After 72 h, primary and secondary outcomes were not significantly different between groups. In a multiple linear regression analysis, group assignment (odds ratio [OR] 1.60; 95% confidence interval [CI] 1.14-2.05; p<0.0001) and gender (OR 2.91; 95% CI 2.45-3.38; p<0.0001) independently influenced OSATS scores. Hands-on training leads to a significant improvement of VB management in a pelvic training model, but this effect was only seen in the short term. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  3. Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial.

    PubMed

    Allen, Kelli D; Oddone, Eugene Z; Coffman, Cynthia J; Jeffreys, Amy S; Bosworth, Hayden B; Chatterjee, Ranee; McDuffie, Jennifer; Strauss, Jennifer L; Yancy, William S; Datta, Santanu K; Corsino, Leonor; Dolor, Rowena J

    2017-03-21

    A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions. To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes. Cluster randomized trial with assignment to patient, provider, and patient-provider interventions or usual care. (ClinicalTrials.gov: NCT01435109). 10 Duke University Health System community-based primary care clinics. 537 outpatients with symptomatic hip or knee osteoarthritis. The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved electronic delivery of patient-specific osteoarthritis treatment recommendations to providers. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months. Secondary outcomes were objective physical function (Short Physical Performance Battery) and depressive symptoms (Patient Health Questionnaire). Linear mixed models assessed the difference in improvement among groups. No difference was observed in WOMAC score changes from baseline to 12 months in the patient (-1.5 [95% CI, -5.1 to 2.0]; P = 0.40), provider (2.5 [CI, -0.9 to 5.9]; P = 0.152), or patient-provider (-0.7 [CI, -4.2 to 2.8]; P = 0.69) intervention groups compared with usual care. All groups had improvements in WOMAC scores at 12 months (range, -3.7 to -7.7). In addition, no differences were seen in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care. The study involved 1 health care network. Data on provider referrals were not collected. Contrary to a previous study of a combined patient and provider intervention for osteoarthritis in a Department of Veterans Affairs medical center, this study found no statistically significant improvements in the osteoarthritis intervention groups compared with usual care. National Institute of Arthritis and Musculoskeletal and Skin Diseases.

  4. Adaptive management for soil ecosystem services.

    PubMed

    Birgé, Hannah E; Bevans, Rebecca A; Allen, Craig R; Angeler, David G; Baer, Sara G; Wall, Diana H

    2016-12-01

    Ecosystem services provided by soil include regulation of the atmosphere and climate, primary (including agricultural) production, waste processing, decomposition, nutrient conservation, water purification, erosion control, medical resources, pest control, and disease mitigation. The simultaneous production of these multiple services arises from complex interactions among diverse aboveground and belowground communities across multiple scales. When a system is mismanaged, non-linear and persistent losses in ecosystem services can arise. Adaptive management is an approach to management designed to reduce uncertainty as management proceeds. By developing alternative hypotheses, testing these hypotheses and adjusting management in response to outcomes, managers can probe dynamic mechanistic relationships among aboveground and belowground soil system components. In doing so, soil ecosystem services can be preserved and critical ecological thresholds avoided. Here, we present an adaptive management framework designed to reduce uncertainty surrounding the soil system, even when soil ecosystem services production is not the explicit management objective, so that managers can reach their management goals without undermining soil multifunctionality or contributing to an irreversible loss of soil ecosystem services. Copyright © 2016. Published by Elsevier Ltd.

  5. [Level of knowledge and action on lipaemia among Spanish primary and specialist care doctors. Press cholesterol study].

    PubMed

    Abellán Alemán, José; Leal Hernández, Mariano; Martínez Pastor, Antonio; Hernández Menárguez, Fernando; García-Galbis Marín, José Antonio; Jara Gómez, Purificación

    2006-09-01

    To find the level of knowledge, the guidelines for action and the monitoring of lipaemia by Spanish primary care and specialist doctors. A self-defined questionnaire of 12 items was designed. Data on the population treated and the subjective evaluation of objectives, and on the management and monitoring of lipid parameters were filled in. A total of 1998 doctors from the whole of Spain took part; 68.8% of the doctors interviewed worked in primary health care and 30.2% in specialist centres or hospitals. A 91% of the doctors said they followed international consensus on monitoring lipaemia. The most commonly used objective therapeutic parameter for treating lipaemia was LDL-cholesterol (83%), followed by total cholesterol (62%), HDL-cholesterol (56%) and triglycerides (51%). If the patient's lipaemia was well controlled, then 21.8% of doctors reduced the doses of lipid-lowerers. In general terms, no great differences were appreciated between the criteria followed by PC and by specialist doctors. The criteria for action on lipaemia could be improved. There are no important differences of view or action in clinical and therapeutic criteria for Lipaemia cases between PC and specialist doctors.

  6. Life sciences payload definition and integration study, task C and D. Volume 1: Management summary

    NASA Technical Reports Server (NTRS)

    1973-01-01

    The findings of a study to define the required payloads for conducting life science experiments in space are presented. The primary objectives of the study are: (1) identify research functions to be performed aboard life sciences spacecraft laboratories and necessary equipment, (2) develop conceptual designs of potential payloads, (3) integrate selected laboratory designs with space shuttle configurations, and (4) establish cost analysis of preliminary program planning.

  7. Alcohol abuse management in primary care: an e-learning course.

    PubMed

    Pereira, Celina Andrade; Wen, Chao Lung; Tavares, Hermano

    2015-03-01

    The mental health knowledge gap challenges public health. The Alcohol Abuse Management in Primary Care (AAMPC) is an e-learning course designed to cover alcohol-related problems from the primary care perspective. The goal of this study was to verify if the AAMPC was able to enhance healthcare professionals' alcohol-related problems knowledge. One hundred subscriptions for the AAMPC were offered through the federal telehealth program. The course was instructor-led and had nine weekly classes, delivered synchronously or asynchronously, at the students' convenience, using a varied array of learning tools. At the beginning, students took a test that provided a positive score, related to critical knowledge for clinical management, and a negative score, related to misconceptions about alcohol-related problems. The test was repeated 2 months after course completion. Thirty-three students completed the course. The positive score improved significantly (p<0.001), but not the negative score. Students with previous experience with e-courses presented greater improvement on the positive score (p<0.036). Eighty-percent of the students thought the course excelled in meeting its objectives. Web conferences and video and audio recordings were the most appreciated learning tools. Course satisfaction was negatively related to frequency of Internet access (Spearman's rho=-0.455, p=0.022). E-learning was highly appreciated as a learning tool, especially by students with the least frequency of Internet use. Nonetheless, it worked better for those previously familiar with e-courses. The AAMPC e-course provided effective knowledge transmission and retention. Complementary strategies to reduce misconceptions about alcohol-related problems must be developed for the training of primary care staff.

  8. 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

  9. 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.

  10. Patient level cost of diabetes self-management education programmes: an international evaluation

    PubMed Central

    Doyle, Gerardine; O'Donnell, Shane; Quigley, Etáin; Cullen, Kate; Gibney, Sarah; Levin-Zamir, Diane; Ganahl, Kristin; Müller, Gabriele; Muller, Ingrid; Maindal, Helle Terkildsen; Chang, Wushou Peter; Van Den Broucke, Stephan

    2017-01-01

    Objectives The objective of this study was to examine the value of time-driven activity-based costing (TDABC) in understanding the process and costs of delivering diabetes self-management education (DSME) programmes in a multicountry comparative study. Setting Outpatient settings in five European countries (Austria, Denmark, Germany, Ireland, UK) and two countries outside Europe, Taiwan and Israel. Participants Providers of DSME programmes across participating countries (N=16) including healthcare professionals, administrators and patients taking part in DSME programmes. Primary and secondary measures Primary measure: time spent by providers in the delivery of DSME and resources consumed in order to compute programme costs. Secondary measures: self-report measures of behavioural self-management and diabetes disease/health-related outcomes. Results We found significant variation in costs and the processes of how DSME programmes are provided across and within countries. Variations in costs were driven by a combination of price variances, mix of personnel skill and efficiency variances. Higher cost programmes were not found to have achieved better relative outcomes. The findings highlight the value of TDABC in calculating a patient level cost and potential of the methodology to identify process improvements in guiding the optimal allocation of scarce resources in diabetes care, in particular for DSME that is often underfunded. Conclusions This study is the first to measure programme costs using estimates of the actual resources used to educate patients about managing their medical condition and is the first study to map such costs to self-reported behavioural and disease outcomes. The results of this study will inform clinicians, managers and policy makers seeking to enhance the delivery of DSME programmes. The findings highlight the benefits of adopting a TDABC approach to understanding the drivers of the cost of DSME programmes in a multicountry study to reveal opportunities to bend the cost curve for DSME. PMID:28583913

  11. A nurse-led clinic for patients consulting with osteoarthritis in general practice: development and impact of training in a cluster randomised controlled trial.

    PubMed

    Healey, Emma L; Main, Chris J; Ryan, Sarah; McHugh, Gretl A; Porcheret, Mark; Finney, Andrew G; Morden, Andrew; Dziedzic, Krysia S

    2016-12-21

    Despite a lack of service provision for people with osteoarthritis (OA), each year 1 in 5 of the general population consults a GP about a musculoskeletal condition such as OA. Consequently this may provide an opportunity for practice nurses to take an active role in helping patients manage their condition. A nurse led clinic for supporting patients with OA was developed for the MOSAICS study investigating how to implement the NICE 2014 OA Guideline core recommendations. This paper has two main objectives, firstly to provide an overview of the nurse-led OA clinic, and secondly to describe the development, key learning objectives, content and impact of the training to support its delivery. A training programme was developed and delivered to provide practice nurses with the knowledge and skill set needed to run the nurse-led OA clinic. The impact of the training programme on knowledge, confidence and OA management was evaluated using case report forms and pre and post training questionnaires. The pre-training questionnaire identified a gap between what practice nurses feel they can do and what they should be doing in line with NICE OA guidelines. Evaluation of the training suggests that it enabled practice nurses to feel more knowledgeable and confident in supporting patients to manage their OA and this was reflected in the clinical management patients received in the nurse-led OA clinics. A significant gap between what is recommended and what practice nurses feel they can currently provide in terms of OA management was evident. The development of a nurse training programme goes some way to develop a system in primary care for delivering the core recommendations by NICE. The cluster trial linked to this training was conducted from May 2012 through February 2014 by the Arthritis Research UK Primary Care Centre, Keele University, UK (Trial registration number ISRCTN06984617 ).

  12. Diagnostic Value of MRI in Patients With Implanted Pacemakers and Implantable Cardioverter-Defibrillators Across a Cross Population: Does the Benefit Justify the Risk? A Proof of Concept Study.

    PubMed

    Samar, Huma; Yamrozik, June A; Williams, Ronald B; Doyle, Mark; Shah, Moneal; Bonnet, Christopher A; Biederman, Robert W W

    2017-09-01

    The objective of this study was to assess the diagnostic usefulness of thoracic and nonthoracic magnetic resonance imaging (MRI) imaging in patients with implantable cardiac devices (permanent pacemaker or implantable cardioverter-defibrillators [ICDs]) to determine if there was a substantial benefit to patients with regard to diagnosis and/or management. MRI is infrequently performed on patients with conventional pacemakers or ICDs. Multiple studies have documented the safety of MRI scans in patients with implanted devices, yet the diagnostic value of this approach has not been established. Evaluation data were acquired in 136 patients with implanted cardiac devices who underwent MRIs during a 10-year period at a single institution. Specific criteria were followed for all patients to objectively define if the diagnosis by MRI enhanced patient care; 4 questions were answered after scan interpretation by both MRI technologists and MRI physicians who performed the scan. 1) Did the primary diagnosis change? 2) Did the MRI provide additional information to the existing diagnosis? 3) Was the pre-MRI (tentative) diagnosis confirmed? 4) Did patient management change? If "Yes" was answered to any of the preceding questions, the MRI scan was considered to be of value to patient diagnosis and/or therapy. In 97% (n = 132) of patients, MR added value to patient diagnosis and management. In 49% (n = 67) of patients, MRI added additional valuable information to the primary diagnosis, and in 30% (n = 41) of patients, MRI changed the principle diagnosis and subsequent management of the patient. No safety issues were encountered, and no adverse effects of undergoing the MRI scan were noted in any patient. MRI in patients with implanted pacemakers and defibrillators added value to patient diagnosis and management, which justified the risk of the procedure. Published by Elsevier Inc.

  13. Use of chronic disease management programs for diabetes

    PubMed Central

    Campbell, David J.T.; Sargious, Peter; Lewanczuk, Richard; McBrien, Kerry; Tonelli, Marcello; Hemmelgarn, Brenda; Manns, Braden

    2013-01-01

    Objective To determine the types of chronic disease management (CDM) programs offered for patients with diabetes in Alberta's primary care networks (PCNs). Design A survey was administered to PCNs to determine the types of CDM programs offered for patients with diabetes; CDM programs were organized into categories by their resource intensity and effectiveness. Results of the survey were reported using frequencies and percentages. Setting Alberta has recently created PCNs—groups of family physicians who receive additional funds to enable them to support activities that fall outside the typical physician-based fee-for-service model, but which address specified objectives including CDM. It is currently unknown what additional programs are being provided through the PCN supplemental funding. Participants A survey was administered to the individual responsible for CDM in each PCN. This included executive directors, chronic disease managers, and CDM nurses. Main outcome measures We determined the CDM strategies used in each PCN to care for patients with diabetes, whether they were available to all patients, and whether the services were provided exclusively by the PCN or in conjunction with other agencies. Results There was considerable variation across PCNs with respect to the CDM programs offered for people with diabetes. Nearly all PCNs used multidisciplinary teams (which could include nurses, dietitians, and pharmacists) and patient education. Fewer than half of the PCNs permitted personnel other than the primary physician to write or alter prescriptions for medications. Conclusion Alberta's PCNs have successfully established many different types of CDM programs. Multidisciplinary care teams, which are among the most effective CDM strategies, are currently being used by most of Alberta's PCNs. PMID:23418263

  14. Gaps in Capacity in Primary Care in Low-Resource Settings for Implementation of Essential Noncommunicable Disease Interventions

    PubMed Central

    Mendis, S.; Al Bashir, Igbal; Dissanayake, Lanka; Varghese, Cherian; Fadhil, Ibtihal; Marhe, Esha; Sambo, Boureima; Mehta, Firdosi; Elsayad, Hind; Sow, Idrisa; Algoe, Maltie; Tennakoon, Herbert; Truong, Lai Die; Lan, Le Thi Tuyet; Huiuinato, Dismond; Hewageegana, Neelamni; Fahal, Naiema A. W.; Mebrhatu, Goitom; Tshering, Gado; Chestnov, Oleg

    2012-01-01

    Objective. The objective was to evaluate the capacity of primary care (PC) facilities to implement basic interventions for prevention and management of major noncommunicable diseases (NCDs), including cardiovascular diseases and diabetes. Methods. A cross-sectional survey was done in eight low- and middle-income countries (Benin, Bhutan, Eritrea, Sri Lanka, Sudan, Suriname, Syria, and Vietnam) in 90 PC facilities randomly selected. The survey included questions on the availability of human resources, equipment, infrastructure, medicines, utilization of services, financing, medical information, and referral systems. Results and Conclusions. Major deficits were identified in health financing, access to basic technologies and medicines, medical information systems, and the health workforce. The study has provided the foundation for strengthening PC to address noncommunicable diseases. There are important implications of the findings of this study for all low- and middle-income countries as capacity of PC is fundamental for equitable prevention and control of NCDs. PMID:23251789

  15. Performance indicators used to assess the quality of primary dental care.

    PubMed

    González, Grisel Zacca; Klazinga, Niek; ten Asbroek, Guus; Delnoij, Diana M

    2006-12-01

    An appropriate quality of medical care including dental care should be an objective of every government that aims to improve the oral health of its population. To determine performance indicators that could be used to assess the quality of primary dental care at different levels of a health care system, the sources for data collection and finally, the dimensions of quality measured by these indicators. An explorative study of the international literature was conducted using medical databases, journals and books, and official websites of organisations and associations. This resulted in a set of 57 indicators, which were classified into the following dimensions for each intended user group: For patients: health outcomes and subjective indicators; for professionals: their performance and the rates of success, failure and complications; for health care system managers and policymakers: their resources, finances and health care utilisation. A set of 57 performance indicators were identified to assess the quality of primary dental care at the levels of patients, professionals and the health care system. These indicators could be used by managers and decision-makers at any level of the health care system according to the characteristics of the services.

  16. Medical Home Implementation Gaps for Seniors: Perceptions and Experiences of Primary Care Medical Practices.

    PubMed

    Hoff, Timothy; DePuccio, Matthew

    2018-07-01

    The study objective was to better understand specific implementation gaps for various aspects of patient-centered medical home (PCMH) care delivered to seniors. The study illuminates the physician and staff experience by focusing on how individuals make sense of and respond behaviorally to aspects of PCMH implementation. Qualitative data from 51 in-depth, semi-structured interviews across six different National Committee for Quality Assurance (NCQA)-accredited primary care practices were collected and analyzed. Physicians and staff identified PCMH implementation gaps for their seniors: (a) performing in-depth clinical assessments, (b) identifying seniors' life needs and linking them with community resources, and (c) care management and coordination, in particular self-management support for seniors. Prior experiences trying to perform these aspects of PCMH care for older adults produced collective understandings that led to inaction and avoidance by medical practices around the first two gaps, and proactive behavior that took strategic advantage of external incentives for addressing the third gap. Greater understanding of physician and staff's PCMH implementation experiences, and the learning that accumulates from these experiences, allows for a deeper understanding of how primary care practices choose to enact the medical home model for seniors on an everyday basis.

  17. What can organizations do to improve family physicians’ interprofessional collaboration?

    PubMed Central

    Perreault, Kadija; Pineault, Raynald; Da Silva, Roxane Borgès; Provost, Sylvie; Feldman, Debbie E.

    2017-01-01

    Abstract Objective To assess the degree of collaboration in primary health care organizations between FPs and other health care professionals; and to identify organizational factors associated with such collaboration. Design Cross-sectional survey. Setting Primary health care organizations in the Montreal and Monteregie regions of Quebec. Participants Physicians or administrative managers from 376 organizations. Main outcome measures Degree of collaboration between FPs and other specialists and between FPs and nonphysician health professionals. Results Almost half (47.1%) of organizations reported a high degree of collaboration between FPs and other specialists, but a high degree of collaboration was considerably less common between FPs and nonphysician professionals (16.5%). Clinic collaboration with a hospital and having more patients with at least 1 chronic disease were associated with higher FP collaboration with other specialists. The proportion of patients with at least 1 chronic disease was the only factor associated with collaboration between FPs and nonphysician professionals. Conclusion There is room for improvement regarding interprofessional collaboration in primary health care, especially between FPs and nonphysician professionals. Organizations that manage patients with more chronic diseases collaborate more with both non-FP specialists and nonphysician professionals. PMID:28904048

  18. Introducing quality management into primary health care services in Uganda.

    PubMed Central

    Omaswa, F.; Burnham, G.; Baingana, G.; Mwebesa, H.; Morrow, R.

    1997-01-01

    In 1994, a national quality assurance programme was established in Uganda to strengthen district-level management of primary health care services. Within 18 months both objective and subjective improvements in the quality of services had been observed. In the examples documented here, there was a major reduction in maternal mortality among pregnant women referred to Jinja District Hospital, a reduction in waiting times and increased patient satisfaction at Masaka District Hospital, and a marked reduction in reported cases of measles in Arua District. Beyond these quantitative improvements, increased morale of district health team members, improved satisfaction among patients, and greater involvement of local government in the decisions of district health committees have been observed. At the central level, the increased coordination of activities has led to new guidelines for financial management and the procurement of supplies. District quality management workshops followed up by regular support visits from the Ministry of Health headquarters have led to a greater understanding by central staff of the issues faced at the district level. The quality assurance programme has also fostered improved coordination among national disease-control programmes. Difficulties encountered at the central level have included delays in carrying out district support visits and the failure to provide appropriate support. At the district level, some health teams tackled problems over which they had little control or which were overly complex; others lacked the management capacity for problem solving. PMID:9185368

  19. 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

  20. Challenges in managing elderly people with diabetes in primary care settings in Norway

    PubMed Central

    2013-01-01

    Abstract Objective To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings. Design Focus-group interviews. Subjects and setting Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32–59 years with clinical experience ranging from 1.5 to 38 years. Results Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines. Conclusion Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging. PMID:24205973

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

    PubMed Central

    Eijkelberg, Irmgard M.J.G.; Spreeuwenberg, Cor; Mur-Veeman, Ingrid M.; Wolffenbuttel, Bruce H.R.

    2001-01-01

    Abstract Background In order to improve the quality of care of chronically ill patients the traditional boundaries between primary and secondary care are questioned. To demolish these boundaries so-called ‘shared care’ projects have been initiated in which different ways of substitution of care are applied. When these projects end, disease management may offer a solution to expand the achieved co-operation between primary and secondary care. Objective Answering the question: What key factors influence the development and implementation of shared care projects from a management perspective and how are they linked? Theory The theoretical framework is based on the concept of the learning organisation. Design Reference point is a multiple case study that finally becomes a single case study. Data are collected by means of triangulation. The studied cases concern two interrelated Dutch shared care projects for type 2 diabetic patients, that in the end proceed as one disease management project. Results In these cases the predominant key-influencing factors appear to be the project management, commitment and local context, respectively. The factor project management directly links the latter two, albeit managing both appear prerequisites to its success. In practice this implies managing the factors' interdependency by the application of change strategies and tactics in a committed and skilful way. Conclusion Project management, as the most important and active key factor, is advised to cope with the interrelationships of the influencing factors in a gradually more fundamental way by using strategies and tactics that enable learning processes. Then small-scale shared care projects may change into a disease management network at a large scale, which may yield the future blueprint to proceed. PMID:16896415

  2. [Wound information management system: a standardized scheme for acquisition, storage and management of wound information].

    PubMed

    Liu, Hu; Su, Rong-jia; Wu, Min-jie; Zhang, Yi; Qiu, Xiang-jun; Feng, Jian-gang; Xie, Ting; Lu, Shu-liang

    2012-06-01

    To form a wound information management scheme with objectivity, standardization, and convenience by means of wound information management system. A wound information management system was set up with the acquisition terminal, the defined wound description, the data bank, and related softwares. The efficacy of this system was evaluated in clinical practice. The acquisition terminal was composed of the third generation mobile phone and the software. It was feasible to get access to the wound information, including description, image, and therapeutic plan from the data bank by mobile phone. During 4 months, a collection of a total of 232 wound treatment information was entered, and accordingly standardized data of 38 patients were formed automatically. This system can provide standardized wound information management by standardized techniques of acquisition, transmission, and storage of wound information. It can be used widely in hospitals, especially primary medical institutions. Data resource of the system makes it possible for epidemiological study with large sample size in future.

  3. The Influence of Literacy on Patient-Reported Experiences of Diabetes Self-Management Support

    PubMed Central

    Wallace, Andrea S.; Carlson, John R.; Malone, Robb M.; Joyner, James; DeWalt, Darren A.

    2010-01-01

    Background Variability in disease-related outcomes may relate to how patients experience self-management support in clinical settings. Objectives To identify factors associated with experiences of self-management support during primary care encounters. Method A cross-sectional survey was conducted of 208 patients seen in a multidisciplinary diabetes program in an academic medicine clinic. Multiple regression analysis was used to test associations between patient-rated experiences of self-management support (Patient Assessment of Chronic Illness Care [PACIC]) and race, gender, insurance status, literacy, duration of diabetes, and intensity of care management. Results The PACIC ratings decreased with age (r = −0.235, p = .001), were higher for women than for men (3.95 vs. 3.65, t = 2.612, p = .010), and were greater for those with more education (F = 3.927, p = .009) and greater literacy skills (t = 3.839, p < .001). The ratings did not vary between racial (t = −1.108, p = .269) or insurance (F = 1.045, p = .374) groups and were unaffected by duration of diabetes (r = 0.052, p = .466) and the intensity of care management (F = 1.028, p = .360). In multivariate models, literacy was the only variable contributing significantly to variation in self-management support ratings. Discussion Even when considering the objective intensity of health services delivered, literacy was the sole variable contributing to differences in patient ratings of self-management support. Although conclusions are limited by the cross-sectional nature of this study, the results emphasize the need to consider literacy when developing and communicating treatment plans requiring self-management skills. PMID:20808193

  4. Simplified lipid guidelines

    PubMed Central

    Allan, G. Michael; Lindblad, Adrienne J.; Comeau, Ann; Coppola, John; Hudson, Brianne; Mannarino, Marco; McMinis, Cindy; Padwal, Raj; Schelstraete, Christine; Zarnke, Kelly; Garrison, Scott; Cotton, Candra; Korownyk, Christina; McCormack, James; Nickel, Sharon; Kolber, Michael R.

    2015-01-01

    Abstract Objective To develop clinical practice guidelines for a simplified approach to primary prevention of cardiovascular disease (CVD), concentrating on CVD risk estimation and lipid management for primary care clinicians and their teams; we sought increased contribution from primary care professionals with little or no conflict of interest and focused on the highest level of evidence available. Methods Nine health professionals (4 family physicians, 2 internal medicine specialists, 1 nurse practitioner, 1 registered nurse, and 1 pharmacist) and 1 nonvoting member (pharmacist project manager) comprised the overarching Lipid Pathway Committee (LPC). Member selection was based on profession, practice setting, and location, and members disclosed any actual or potential conflicts of interest. The guideline process was iterative through online posting, detailed evidence review, and telephone and online meetings. The LPC identified 12 priority questions to be addressed. The Evidence Review Group answered these questions. After review of the answers, key recommendations were derived through consensus of the LPC. The guidelines were drafted, refined, and distributed to a group of clinicians (family physicians, other specialists, pharmacists, nurses, and nurse practitioners) and patients for feedback, then refined again and finalized by the LPC. Recommendations Recommendations are provided on screening and testing, risk assessments, interventions, follow-up, and the role of acetylsalicylic acid in primary prevention. Conclusion These simplified lipid guidelines provide practical recommendations for prevention and treatment of CVD for primary care practitioners. All recommendations are intended to assist with, not dictate, decision making in conjunction with patients. PMID:26472792

  5. Safety of repair for severe duodenal injuries.

    PubMed

    Velmahos, George C; Constantinou, Constantinos; Kasotakis, George

    2008-01-01

    There is ongoing debate about the management of severe duodenal injuries (SDIs), and earlier studies have recommended pyloric exclusion. The objective of this study was to compare primary repair with pyloric exclusion to examine if primary repair can be safely used in SDIs. The medical records of 193 consecutive patients who were admitted between August 1992 and January 2004 with duodenal injuries were reviewed. After excluding early deaths (n = 50), low-grade duodenal injuries (n = 81), and pancreatoduodenectomies for catastrophic trauma (n = 12), a total of 50 patients with SDIs (grade III, IV, or V) were analyzed. Primary repair (PR--simple duodenorrhaphy or resection and primary anastomosis) was performed in 34 (68%) and pyloric exclusion (PE) in 16 (32%). Characteristics and outcomes of these two groups were compared. PE and PR patients were similar for age, injury severity score, abdominal abbreviated injury score, physiologic status on admission, time to operation, and most abdominal organs injured. PE patients had more pancreatic injuries (63% vs. 24%, p < 0.01), a higher frequency of injuries to the first and second part of the duodenum (79% vs. 42%, p = 0.02), and a nonsignificant trend toward more grade IV and V injuries (37% vs. 18%, p = 0.11). There was no difference in morbidity (including complications specific to the duodenal repair), mortality, and intensive care unit and hospital length of stay between the two groups. Pyloric exclusion is not necessary for all patients with SDIs, as previously suggested. Selected SDI patients can be safely managed by simple primary repair.

  6. Time perspective and weight management behaviors in newly diagnosed Type 2 diabetes: a mediational analysis.

    PubMed

    Hall, Peter A; Fong, Geoffrey T; Cheng, Alice Y

    2012-12-01

    The primary objective of the current study was to examine the extent to which domain-specific time perspective predicts weight management behaviors (dietary behavior and physical activity) among those newly diagnosed with Type 2 diabetes. A secondary objective was to test potential mediators of the hypothesized effect (behavioral intention, self-efficacy and control beliefs). A total of 204 adults newly diagnosed (≤6 months) with Type 2 diabetes participated in the study, which included a baseline assessment of domain-general and domain-specific time perspective, as well as strength of intention to perform two weight-management behaviors (dietary choice and physical activity); both weight-management behaviors were assessed again at 6 month follow-up. Hierarchical multiple regression analyses revealed a prospective association between domain-specific time perspective and uptake of weight management behaviors. Individuals with newly diagnosed T2DM possessing a future-oriented time perspective reported making less frequent fatty food choices and greater increases in physical activity over the 6-month follow-up interval. These effects were selectively mediated by intention strength, and not competing social cognitive variables. For both behaviors, the total effects and meditational models were robust to adjustments for demographics, body composition and disease variables. A future-oriented time perspective is prospectively associated with superior uptake of weight management behaviors among those with newly diagnosed Type 2 diabetes. The facilitating effect of future-oriented thinking appears to occur via enhanced strength of intentions to perform weight management behaviors.

  7. An object-oriented, technology-adaptive information model

    NASA Technical Reports Server (NTRS)

    Anyiwo, Joshua C.

    1995-01-01

    The primary objective was to develop a computer information system for effectively presenting NASA's technologies to American industries, for appropriate commercialization. To this end a comprehensive information management model, applicable to a wide variety of situations, and immune to computer software/hardware technological gyrations, was developed. The model consists of four main elements: a DATA_STORE, a data PRODUCER/UPDATER_CLIENT and a data PRESENTATION_CLIENT, anchored to a central object-oriented SERVER engine. This server engine facilitates exchanges among the other model elements and safeguards the integrity of the DATA_STORE element. It is designed to support new technologies, as they become available, such as Object Linking and Embedding (OLE), on-demand audio-video data streaming with compression (such as is required for video conferencing), Worldwide Web (WWW) and other information services and browsing, fax-back data requests, presentation of information on CD-ROM, and regular in-house database management, regardless of the data model in place. The four components of this information model interact through a system of intelligent message agents which are customized to specific information exchange needs. This model is at the leading edge of modern information management models. It is independent of technological changes and can be implemented in a variety of ways to meet the specific needs of any communications situation. This summer a partial implementation of the model has been achieved. The structure of the DATA_STORE has been fully specified and successfully tested using Microsoft's FoxPro 2.6 database management system. Data PRODUCER/UPDATER and PRESENTATION architectures have been developed and also successfully implemented in FoxPro; and work has started on a full implementation of the SERVER engine. The model has also been successfully applied to a CD-ROM presentation of NASA's technologies in support of Langley Research Center's TAG efforts.

  8. Should Dental Schools Train Dentists to Routinely Provide Limited Preventive Primary Medical Care? Two Viewpoints: Viewpoint 1: Dentists Should Be Trained to Routinely Provide Limited Preventive Primary Care and Viewpoint 2: Dentists Should Be Trained in Primary Care Medicine to Enable Comprehensive Patient Management Within Their Scope of Practice.

    PubMed

    Giddon, Donald B; Donoff, R Bruce; Edwards, Paul C; Goldblatt, Lawrence I

    2017-05-01

    This Point/Counterpoint acknowledges the transformation of dental practice from a predominantly technically based profession with primary emphasis on restoration of the tooth and its supporting structures to that of a more medically based specialty focusing on the oral and maxillofacial complex. While both viewpoints accept the importance of this transformation, they differ on the ultimate desired outcome and how changes should be implemented during training of dentists as oral health professionals. Viewpoint 1 argues that, in response to a shortage of both primary care providers and access to affordable oral health care, dentists need to be able and willing to provide limited preventive primary care (LPPC), and dental educators should develop and implement training models to prepare them. Among changes proposed are consideration of three types of practitioners: oral physicians with sufficient training to provide LPPC; dentists with excellent technical proficiency but minimal medical and surgical training; and mid-level providers to provide simple restorative and uncomplicated surgical care. Viewpoint 2 argues that the objective of dentists' education in primary care medicine is to help them safely and effectively provide all aspects of oral health care, including appropriate preventive medical care, that already fall within their scope of knowledge and practice. Dental educators should encourage students to use this knowledge to take full ownership of non-tooth-related pathologic conditions of the oral and maxillofacial complex not currently managed in the dental setting, but encouraging graduates to expand into non-dental LPPC outside the recognized scope of practice will only further exacerbate fragmentation of care.

  9. Does your equipment maintenance management program measure up?

    PubMed

    Deinstadt, Deborah C

    2003-01-01

    Identifying a clear maintenance philosophy is the first step toward choosing the right program for your healthcare organization. The second step is gaining a clear understanding of how proposed savings and improvements will be delivered. The third and last step is requiring that the proposed company or manager have specific tools in place for measuring and analyzing program performance. There are three primary philosophies underlying current equipment management options. These include risk-transfer philosophy (e.g., maintenance insurance, service contracts, multi-vendor and outsource programs), asset management philosophy (e.g., programs delivering a management system based on managed time-and-materials), and internal management (in-house managed programs). The last step in selecting the right program is insisting that proper performance measurements be built into the proposed management program. A well-managed program provides results in three general areas: financial outcomes, operational improvements and process improvements. Financial outcomes are the easiest to measure. Operational and process improvements are more challenging to assess but equally important to the program's overall success. To accurately identify results in these three areas, the overall management program should measure the following eight separate components: procedures and support for department staff; equipment inventory, benchmark costs, and budget guidelines; experienced equipment support team; objective, independent analysis of maintenance events; repair documentation and reporting; vendor relations; equipment acquisition analysis; and recommendations for improvement. Do everything you reasonably can to assure that the selected company can work side-by-side with you, providing objective, measurable advice that is ultimately in your best interest. You will then know that you have been thorough in your marketplace selection and can confidently move into implementation, expecting tangible and successful results.

  10. An Update on the Current Management of Perforated Diverticulitis.

    PubMed

    Zoog, Evon; Giles, W Heath; Maxwell, Robert A

    2017-12-01

    The management of perforated diverticulitis is a challenging aspect of general surgery. The prevalence of colonic diverticular disease has increased over the last decade and will continue to increase as the baby boomers add to the elderly population. Improvements in diagnostic imaging modalities, efforts to maintain intestinal continuity, and percutaneous drainage procedures now result in several alternatives when selecting a management strategy for complicated presentations. Specifically, laparoscopic lavage and resection with primary anastomosis have emerged as options for treatment of Hinchey III and IV diverticulitis in place of diversion in the appropriately selected patient. Percutaneous drainage of Hinchey II diverticulitis in centers equipped with interventional radiology provides another minimally invasive adjunct. The objective of this paper is to provide an update on the current management of perforated diverticulitis, with a focus on the advantages and disadvantages of the surgical options for the treatment of Hinchey III and IV diverticulitis.

  11. 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.

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

    PubMed

    Gioia, Gerard A

    2015-01-01

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

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

    PubMed Central

    Gioia, Gerard A.

    2015-01-01

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

  14. [Forms of management of the national school meals program].

    PubMed

    Dos Santos, Sérgio Ribeiro; de Sousa Costa, Maria Bernadete; Torres de Paiva Bandeira, Geovanna

    2016-04-01

    The National School Meals Programme (PNAE in Portuguese initials) is a supplementary program to education that aims to provide school meals for pupils across the school system enrolled in public and philanthropic schools of primary education, secondary education, youth education, adult education and comprehensive education. The principles of the program are the universality and the expansion of student services in order to meet the Organic Law on Food and Nutritional Security (LOSAN), as well as the Food Security and Nutrition System. The objective of this study is to discuss forms of PNAE management to ensure that the students' right to school meals. This study is a reflection on how the resources of school meals are being managed, be it with a centralized, decentralized, semi-centralized or outsourced model. We conclude that the knowledge of the different forms of managing federal resources for food for school communities allows for making an informed choice regarding implementation and enforcement of PNAE.

  15. In the Netherlands, rich interaction among professionals conducting disease management led to better chronic care.

    PubMed

    Cramm, Jane Murray; Nieboer, Anna Petra

    2012-11-01

    Disease management programs based on the Chronic Care Model are expected to improve the quality of chronic care delivery. However, evidence to date for such improvement and how it is achieved is scarce. In 2010 and again in 2011, we surveyed professionals in twenty-two primary care practices in the Netherlands that had implemented the Chronic Care Model of disease management beginning in 2009. The responses showed that, over time, chronic illness care delivery improved to advanced levels. The gains were attributed primarily to improved relational coordination-that is, raising the quality of communication and task integration among professionals from diverse disciplines who share common objectives. These findings may have implications for other disease management efforts by collaborative care teams, in that they suggest that diverse health care professionals must be strongly connected to provide effective, holistic care.

  16. LANDFIRE: Collaboration for National Fire Fuel Assessment

    USGS Publications Warehouse

    Zhu, Zhi-Liang

    2006-01-01

    The implementation of national fire management policies, such as the National Fire Plan and the Healthy Forest Restoration Act, requires geospatial data of vegetation types and structure, wildland fuels, fire risks, and ecosystem fire regime conditions. Presently, no such data sets are available that can meet these requirements. As a result, the U.S. Department of Agriculture (USDA) Forest Service and the Department of the Interior's land management bureaus (Bureau of Indian Affairs (BIA), Bureau of Land Management (BLM), Fish and Wildlife Service (FWS), and National Park Service (NPS)) have jointly sponsored LANDFIRE, a new research and development project. The primary objective of the project is to develop an integrated and repeatable methodology and produce vegetation, fire, and ecosystem information and predictive models for cost-effective national land management applications. The project is conducted collaboratively by the U.S. Geological Survey (USGS), the USDA Forest Service, and The Nature Conservancy.

  17. Self-management support for chronic pain in primary care: a cross-sectional study of patient experiences and nursing roles.

    PubMed

    Lukewich, Julia; Mann, Elizabeth; VanDenKerkhof, Elizabeth; Tranmer, Joan

    2015-11-01

    The aim of this study was to describe chronic pain self-management from the perspective of individuals living with chronic pain in the context of primary care nursing. Self-management is a key chronic pain treatment modality and support for self-managing chronic pain is mainly provided in the context of primary care. Although nurses are optimally suited to facilitate self-management in primary care, there is a need to explore opportunities for optimizing their roles. Two cross-sectional studies. The Chronic Pain Self-Management Survey was conducted in 2011-2012 to explore the epidemiology and self-management of chronic pain in Canadian adults. The questionnaire was distributed to 1504 individuals in Ontario. In 2011, the Primary Care Nursing Roles Survey was distributed to 1911 primary care nurses in Ontario to explore their roles and to determine the extent to which chronic disease management strategies, including support for self-management, were implemented in primary care. Few respondents to the pain survey identified nurses as being the 'most helpful' facilitator of self-management while physicians were most commonly cited. Seventy-six per cent of respondents used medication to manage their chronic pain. Few respondents to the nursing survey worked in practices with specific programmes for individuals with chronic pain. Individuals with chronic pain identified barriers and facilitators to self-managing their pain and nurses identified barriers and facilitators to optimizing their role in primary care. There are several opportunities for primary care practices to facilitate self-management of chronic pain, including the optimization of the primary care nursing role. © 2015 John Wiley & Sons Ltd.

  18. Antecedents to the adoption of ASPS in healthcare.

    PubMed

    Randeree, Ebrahim; Judd, Susan P; Kishore, Rajiv; Rao, H Raghav

    2003-01-01

    The objective of this exploratory study was to identify drivers of adoption for a new form of information technology outsourcing--the ASP model--in the healthcare industry. Primary data were collected in January 2002 from a nationwide survey of senior-level healthcare information technology executives. Cost management (supplier presence, asset specificity, production costs, transaction costs, resource availability) and relative advantage (reliability, customizability, strategic alignment, and magnitude of potential loss) were found to have the largest influences on adoption behavior.

  19. A chronosequence feasibility assessment of emergency fire rehabilitation records within the intermountain western United States-final report to the Joint Fire Science Program-Project 08-S-08

    Treesearch

    Kevin C. Knutson; David A. Pyke; Troy A. Wirth; David S. Pilliod; Matthew L. Brooks; Jeanne C. Chambers

    2009-01-01

    Department of the Interior (DOI) bureaus have invested heavily (for example, the U.S. Bureau of Land Management (BLM) spent more than $60 million in fiscal year 2007) in seeding vegetation for emergency stabilization and burned area rehabilitation of non-forested arid lands over the past 10 years. The primary objectives of these seedings commonly are to (1) reduce the...

  20. Economic crisis and challenges for the Greek healthcare system: the emergent role of nursing management.

    PubMed

    Notara, Venetia; Koupidis, Sotirios A; Vaga, Elissavet; Grammatikopoulos, Ilias A

    2010-07-01

    Despite several reform efforts, the Greek health care system still faces problems related to misdistribution of trained health staff and finance between geographical areas. The objectives of the present study were to describe the current situation of the delivery of the healthcare service in Greece, to explore the basic implications of the economic crisis from a nursing management perspective and to examine future practices opening a debate in policy developments. The principal finding of this study was the serious shortage of trained nurses, the imbalances in nursing personnel, an excess of doctors and the complete absence of a Primary Healthcare System in civil areas provided by general doctors. It is important that health care policy makers become aware and seriously consider rearranging the Health Care System to become more effective and efficient for the population (client). Special attention should be paid to strengthening areas such as primary health care, public health and health promotion in the direction of minimizing the demand of hospital services. Any implementation of major health care reforms should consider seriously the role of the nursing management which formulates the substantial link between the health services and the patient.

  1. Multi-objective sustainable river management: balancing flood control, bio-pysical restoration and socio-economic factors in a Scottish river

    NASA Astrophysics Data System (ADS)

    Moir, H.; Bowles, C.; Campbell, C.; Sawyer, A.; Comins, L.; Werritty, A.

    2010-12-01

    The sustainable management of river corridors requires an understanding of the linkages between geomorphic, hydrologic, ecologic and socio-economic factors across a hierarchy of spatial and temporal scales. Therefore, in order to be genuinely sustainable, management must ideally be set within a catchment/watershed context. However, in practice, this rarely occurs due to obstacles imposed by fragmented land ownership/governance and an incomplete understanding of bio-physical process linkages. We present our experience on a project with the goal of optimising physical objectives at the catchment scale within a framework influenced by environmental legislation and conflicting land-use pressures. The project was carried out on the Eddleston Water in the Scottish Borders and had the primary objective of providing sustainable flood risk management to settlements on the water course while also providing ecological benefit to the river corridor. These co-objectives had to be met while considering the constraints imposed by land-use (predominantly arable agriculture) and transport infrastructure on the floodplain. The Eddleston Water has been heavily impacted by many human activities for over 200 years although a modified upland drainage, markedly canalised main-stem channel and floodplain disconnection are most significant to present-day physical and ecological processes. Catchment-scale restoration plans aim to restore broad-scale hydrological processes in conjunction with re-naturalisation of the river corridor at the reach-scale (including floodbank set-back, floodplain reconnection, regeneration of riparian vegetation, large wood placement). In addition, these measures also had to accommodate the objective of sustainable flood risk management, through the combination of a re-naturalised run-off regime and the encouragement of floodplain water storage. We present the output from 1D and 2D hydraulic models of a 1km stretch of the Eddleston Water that jointly assesses the benefit to flood hydrograph attenuation and bio-physical processes of a suite of restoration designs within the floodplain. Although the models produced an optimised design based on these environmental objectives, the ‘real world’ situation of constraints imposed by ‘socio-economic’ factors (particularly agricultural and urban infrastructure pressures) subsequently modified this. In this way the project demonstrated the compromises that have to be made in implementing these type of idealised physical objectives.

  2. Distributed health care imaging information systems

    NASA Astrophysics Data System (ADS)

    Thompson, Mary R.; Johnston, William E.; Guojun, Jin; Lee, Jason; Tierney, Brian; Terdiman, Joseph F.

    1997-05-01

    We have developed an ATM network-based system to collect and catalogue cardio-angiogram videos from the source at a Kaiser central facility and make them available for viewing by doctors at primary care Kaiser facilities. This an example of the general problem of diagnostic data being generated at tertiary facilities, while the images, or other large data objects they produce, need to be used from a variety of other locations such as doctor's offices or local hospitals. We describe the use of a highly distributed computing and storage architecture to provide all aspects of collecting, storing, analyzing, and accessing such large data-objects in a metropolitan area ATM network. Our large data-object management system provides network interface between the object sources, the data management system and the user of the data. As the data is being stored, a cataloguing system automatically creates and stores condensed versions of the data, textural metadata and pointers to the original data. The catalogue system provides a Web-based graphical interface to the data. The user is able the view the low-resolution data with a standard Internet connection and Web browser. If high-resolution is required, a high-speed connection and special application programs can be used to view the high-resolution original data.

  3. 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

  4. Development of Educational Management System in Small Primary School

    ERIC Educational Resources Information Center

    Alsammarry, Yupayao; Sirisuthi, Chaiyuth; Duangcharthom, Surat

    2016-01-01

    The purposes of the research were: (1) to study the factors of Educational Management System in Small Primary School; (2) to investigate current situations problems and guidelines of developing educational management in small primary school; (3) to develop Educational Management System in Small Primary School; and (4) to examine the results of…

  5. Test plan. GCPS task 7, subtask 7.1: IHM development

    NASA Technical Reports Server (NTRS)

    Greenberg, H. S.

    1994-01-01

    The overall objective of Task 7 is to identify cost-effective life cycle integrated health management (IHM) approaches for a reusable launch vehicle's primary structure. Acceptable IHM approaches must: eliminate and accommodate faults through robust designs, identify optimum inspection/maintenance periods, automate ground and on-board test and check-out, and accommodate and detect structural faults by providing wide and localized area sensor and test coverage as required. These requirements are elements of our targeted primary structure low cost operations approach using airline-like maintenance by exception philosophies. This development plan will follow an evolutionary path paving the way to the ultimate development of flight-quality production, operations, and vehicle systems. This effort will be focused on maturing the recommended sensor technologies required for localized and wide area health monitoring to a technology readiness level (TRL) of 6 and to establish flight ready system design requirements. The following is a brief list of IHM program objectives: design out faults by analyzing material properties, structural geometry, and load and environment variables and identify failure modes and damage tolerance requirements; design in system robustness while meeting performance objectives (weight limitations) of the reusable launch vehicle primary structure; establish structural integrity margins to preclude the need for test and checkout and predict optimum inspection/maintenance periods through life prediction analysis; identify optimum fault protection system concept definitions combining system robustness and integrity margins established above with cost effective health monitoring technologies; and use coupons, panels, and integrated full scale primary structure test articles to identify, evaluate, and characterize the preferred NDE/NDI/IHM sensor technologies that will be a part of the fault protection system.

  6. Impact of Varying Levels of Disease Management on Smoking Cessation: A Randomized Trial

    PubMed Central

    Ellerbeck, Edward F.; Mahnken, Jonathan D.; Cupertino, A. Paula; Cox, Lisa Sanderson; Greiner, K. Allen; Mussulman, Laura M.; Nazir, Niaman; Shireman, Theresa I.; Resnicow, Kenneth; Ahluwalia, Jasjit S.

    2010-01-01

    Background Cigarette smoking is a chronic, relapsing illness that is inadequately addressed in primary care practice. Objective To compare cessation rates among smokers receiving pharmacotherapy management alone or combined with either moderate- or high-intensity disease management that includes counseling and provider feedback. Design Randomized clinical trial from June 2004 to December 2007. Setting 50 rural primary care practices. Patients 750 patients smoking ≥ 10 cigarettes/day. Intervention Participants were randomized to one of three groups: pharmacotherapy management (n = 250); pharmacotherapy management supplemented with up to 2 counseling calls (moderate-intensity disease management (n = 249)); or pharmacotherapy management supplemented with up to 6 counseling calls (high-intensity disease management (n = 251)). Interventions were offered every six months for two years. All participants received offers of free pharmacotherapy; moderate-intensity and high-intensity disease management recipients had post-counseling progress reports faxed to their physicians. Participants and counselors were not blinded to treatment assignment. Measurements Self-reported point-prevalence smoking abstinence at 24 months (primary outcome) and overall (0 to 24 months) analyses of smoking abstinence, utilization of pharmacotherapy, and discussions about smoking with physicians (secondary outcomes). Research assistants, blinded to treatment assignment, conducted outcome assessments. Results Pharmacotherapy utilization was comparable across treatment groups, with 473 of 741 (63.8%), 302 of 739 (40.9%), 175 of 732 (23.9%), and 179 of 726 (24.7%) requesting pharmacotherapy during the 1st, 2nd, 3rd, and 4th 6-month cycles of treatment. Of participants that saw a physician during any given treatment cycle, 37.5 – 59.5% reported that they discussed smoking cessation with their physician, but this did not differ across the treatment groups. Abstinence rates increased throughout the 24-month study and overall (0 to 24 months) analyses demonstrated higher abstinence among recipients of high-intensity versus moderate-intensity disease management (OR, 1.43 [95% CI, 1.00 to 2.03]) and higher abstinence in the combined disease management groups compared to pharmacotherapy management alone (OR, 1.47 [95% CI, 1.08 to 2.00]). The primary outcome, self-reported abstinence at 24 months, was 68 of 244 (27.9%) and 56 of 238 (23.5%) in the high-intensity and moderate-intensity disease management groups, respectively (OR, 1.33 [95% CI, 0.88 to 2.02]) and 56 of 244 (23.0%) in the pharmacotherapy management group (OR, 1.12 [95% CI, 0.78 to 1.61] (combined disease management versus pharmacotherapy management alone)). Limitations The impact of pharmacotherapy management cannot be separated from the provision of free pharmacotherapy. Cessation was validated in only 58% of self-reported quitters. Conclusion Smokers are willing to make repeated pharmacotherapy-assisted quit attempts leading to progressively greater smoking abstinence. Although point-prevalence abstinence was not different at 24 months, analyses that incorporated assessments across the full 24 months of treatment suggest that higher intensity disease management is associated with increased abstinence. PMID:19349629

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

    USGS Publications Warehouse

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

    1996-01-01

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

  8. Role of Social Media in Diabetes Management in the Middle East Region: Systematic Review

    PubMed Central

    2018-01-01

    Background Diabetes is a major health care burden in the Middle East region. Social networking tools can contribute to the management of diabetes with improved educational and care outcomes using these popular tools in the region. Objective The objective of this review was to evaluate the impact of social networking interventions on the improvement of diabetes management and health outcomes in patients with diabetes in the Middle East. Methods Peer-reviewed articles from PubMed (1990-2017) and Google Scholar (1990-2017) were identified using various combinations of predefined terms and search criteria. The main inclusion criterion consisted of the use of social networking apps on mobile phones as the primary intervention. Outcomes were grouped according to study design, type of diabetes, category of technological intervention, location, and sample size. Results This review included 5 articles evaluating the use of social media tools in the management of diabetes in the Middle East. In most studies, the acceptance rate for the use of social networking to optimize the management of diabetes was relatively high. Diabetes-specific management tools such as the Saudi Arabia Networking for Aiding Diabetes and Diabetes Intelligent Management System for Iraq systems helped collect patient information and lower hemoglobin A1c (HbA1c) levels, respectively. Conclusions The reviewed studies demonstrated the potential of social networking tools being adopted in regions in the Middle East to improve the management of diabetes. Future studies consisting of larger sample sizes spanning multiple regions would provide further insight into the use of social media for improving patient outcomes. PMID:29439941

  9. Management of Low-Risk Pulmonary Embolism Patients Without Hospitalization: The Low-Risk Pulmonary Embolism Prospective Management Study.

    PubMed

    Bledsoe, Joseph R; Woller, Scott C; Stevens, Scott M; Aston, Valerie; Patten, Rich; Allen, Todd; Horne, Benjamin D; Dong, Lydia; Lloyd, James; Snow, Greg; Madsen, Troy; Elliott, C Gregory

    2018-02-02

    The efficacy and safety of managing patients with low-risk pulmonary embolism (PE) without hospitalization requires objective data from US medical centers. We sought to determine the 90-day composite rate of recurrent symptomatic VTE, major bleeding events, and all-cause mortality among consecutive patients diagnosed with acute low-risk PE managed without inpatient hospitalization; and to measure patient satisfaction. We performed a prospective cohort single-arm management study conducted from January 2013 to October 2016 in five EDs. We enrolled 200 consecutive adults diagnosed with objectively confirmed acute PE and assessed to have a low risk for mortality using the Pulmonary Embolism Severity Index (PESI) score (< 86), echocardiography, and whole-leg compression ultrasound (CUS). The primary intervention was observation in the ED or hospital (observation status) for > 12 to < 24 h, followed by outpatient management with Food and Drug Administration-approved therapeutic anticoagulation. Patients were excluded for a PESI ≥ 86, echocardiographic signs of right heart strain, DVT proximal to the popliteal vein, hypoxia, hypotension, hepatic or renal failure, contraindication to therapeutic anticoagulation, or another condition requiring hospital admission. The primary outcome was 90-day composite rate of all-cause mortality, recurrent symptomatic VTE, and major bleeding. The composite outcome occurred in one of 200 patients (90-day composite rate = 0.5%; 95% CI, 0.02%-2.36%). No patient suffered recurrent VTE or died during the 90-day follow-up period. A major bleed occurred in one patient. Patients indicated a high level of satisfaction with their care. Treatment of carefully selected patients with acute PE and low risk by PESI < 86, echocardiography, and CUS without inpatient hospitalization is safe and acceptable to patients. Results must be viewed with caution because of the small sample size relative to the end point and the generalizability surrounding availability of emergent echocardiography. ClinicalTrials.gov; No.: NCT02355548; URL: www.clinicaltrials.gov. Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  10. Competing conservation objectives for predators and prey: estimating killer whale prey requirements for Chinook salmon.

    PubMed

    Williams, Rob; Krkošek, Martin; Ashe, Erin; Branch, Trevor A; Clark, Steve; Hammond, Philip S; Hoyt, Erich; Noren, Dawn P; Rosen, David; Winship, Arliss

    2011-01-01

    Ecosystem-based management (EBM) of marine resources attempts to conserve interacting species. In contrast to single-species fisheries management, EBM aims to identify and resolve conflicting objectives for different species. Such a conflict may be emerging in the northeastern Pacific for southern resident killer whales (Orcinus orca) and their primary prey, Chinook salmon (Oncorhynchus tshawytscha). Both species have at-risk conservation status and transboundary (Canada-US) ranges. We modeled individual killer whale prey requirements from feeding and growth records of captive killer whales and morphometric data from historic live-capture fishery and whaling records worldwide. The models, combined with caloric value of salmon, and demographic and diet data for wild killer whales, allow us to predict salmon quantities needed to maintain and recover this killer whale population, which numbered 87 individuals in 2009. Our analyses provide new information on cost of lactation and new parameter estimates for other killer whale populations globally. Prey requirements of southern resident killer whales are difficult to reconcile with fisheries and conservation objectives for Chinook salmon, because the number of fish required is large relative to annual returns and fishery catches. For instance, a U.S. recovery goal (2.3% annual population growth of killer whales over 28 years) implies a 75% increase in energetic requirements. Reducing salmon fisheries may serve as a temporary mitigation measure to allow time for management actions to improve salmon productivity to take effect. As ecosystem-based fishery management becomes more prevalent, trade-offs between conservation objectives for predators and prey will become increasingly necessary. Our approach offers scenarios to compare relative influence of various sources of uncertainty on the resulting consumption estimates to prioritise future research efforts, and a general approach for assessing the extent of conflict between conservation objectives for threatened or protected wildlife where the interaction between affected species can be quantified.

  11. Competing Conservation Objectives for Predators and Prey: Estimating Killer Whale Prey Requirements for Chinook Salmon

    PubMed Central

    Williams, Rob; Krkošek, Martin; Ashe, Erin; Branch, Trevor A.; Clark, Steve; Hammond, Philip S.; Hoyt, Erich; Noren, Dawn P.; Rosen, David; Winship, Arliss

    2011-01-01

    Ecosystem-based management (EBM) of marine resources attempts to conserve interacting species. In contrast to single-species fisheries management, EBM aims to identify and resolve conflicting objectives for different species. Such a conflict may be emerging in the northeastern Pacific for southern resident killer whales (Orcinus orca) and their primary prey, Chinook salmon (Oncorhynchus tshawytscha). Both species have at-risk conservation status and transboundary (Canada–US) ranges. We modeled individual killer whale prey requirements from feeding and growth records of captive killer whales and morphometric data from historic live-capture fishery and whaling records worldwide. The models, combined with caloric value of salmon, and demographic and diet data for wild killer whales, allow us to predict salmon quantities needed to maintain and recover this killer whale population, which numbered 87 individuals in 2009. Our analyses provide new information on cost of lactation and new parameter estimates for other killer whale populations globally. Prey requirements of southern resident killer whales are difficult to reconcile with fisheries and conservation objectives for Chinook salmon, because the number of fish required is large relative to annual returns and fishery catches. For instance, a U.S. recovery goal (2.3% annual population growth of killer whales over 28 years) implies a 75% increase in energetic requirements. Reducing salmon fisheries may serve as a temporary mitigation measure to allow time for management actions to improve salmon productivity to take effect. As ecosystem-based fishery management becomes more prevalent, trade-offs between conservation objectives for predators and prey will become increasingly necessary. Our approach offers scenarios to compare relative influence of various sources of uncertainty on the resulting consumption estimates to prioritise future research efforts, and a general approach for assessing the extent of conflict between conservation objectives for threatened or protected wildlife where the interaction between affected species can be quantified. PMID:22096495

  12. A Cognitive Task Analysis of Information Management Strategies in a Computerized Provider Order Entry Environment

    PubMed Central

    Weir, Charlene R.; Nebeker, Jonathan J.R.; Hicken, Bret L.; Campo, Rebecca; Drews, Frank; LeBar, Beth

    2007-01-01

    Objective Computerized Provider Order Entry (CPOE) with electronic documentation, and computerized decision support dramatically changes the information environment of the practicing clinician. Prior work patterns based on paper, verbal exchange, and manual methods are replaced with automated, computerized, and potentially less flexible systems. The objective of this study is to explore the information management strategies that clinicians use in the process of adapting to a CPOE system using cognitive task analysis techniques. Design Observation and semi-structured interviews were conducted with 88 primary-care clinicians at 10 Veterans Administration Medical Centers. Measurements Interviews were taped, transcribed, and extensively analyzed to identify key information management goals, strategies, and tasks. Tasks were aggregated into groups, common components across tasks were clarified, and underlying goals and strategies identified. Results Nearly half of the identified tasks were not fully supported by the available technology. Six core components of tasks were identified. Four meta-cognitive information management goals emerged: 1) Relevance Screening; 2) Ensuring Accuracy; 3) Minimizing memory load; and 4) Negotiating Responsibility. Strategies used to support these goals are presented. Conclusion Users develop a wide array of information management strategies that allow them to successfully adapt to new technology. Supporting the ability of users to develop adaptive strategies to support meta-cognitive goals is a key component of a successful system. PMID:17068345

  13. Creation of the First French Database in Primary Care Using the ICPC2: Feasibility Study.

    PubMed

    Lacroix-Hugues, V; Darmon, D; Pradier, C; Staccini, P

    2017-01-01

    The objective of our study was to assess the feasibility of gathering data stored in primary care Electronic Health records (EHRs) in order to create a research database (PRIMEGE PACA project). The software for EHR models of two office and patient data management systems were analyzed; anonymized data was extracted and imported into a MySQL database. An ETL procedure to code text in ICPC2 codes was implemented. Eleven general practitioners (GPs) were enrolled as "data producers" and data were extracted from 2012 to 2015. In this paper, we explain the ways to make this process feasible as well as illustrate its utility for estimating epidemiological indicators and professional practice assessments. Other software is currently being analyzed for integration and expansion of this panel of GPs. This experimentation is recognized as a robust framework and is considered to be the technical foundation of the first regional observatory of primary care data.

  14. Group therapy for somatization disorders in primary care: maintenance of treatment goals of short cognitive-behavioural treatment one-and-a-half-year follow-up.

    PubMed

    Lidbeck, J

    2003-06-01

    The objective of this study was to evaluate the maintenance of treatment goals of a short cognitive-behavioural group treatment programme for the management of somatization disorders in primary care. In a previous controlled 6-month follow-up study, patients with somatization disorders (n=32) improved with respect to illness and somatic preoccupation, hypochondriasis, and medication usage. In the present report the same group of patients were also investigated one-and-a-half year after initial treatment. The long-term follow-up manifested maintained improvement with respect to hypochondriasis. There was additional reduction of anxiety and psychosocial preoccupation, whereas somatization and depression-anxiety scores improved progressively. A short cognitive-behavioural group treatment of psychosomatic patients can be useful in primary care and may manifest maintained or progressive beneficial outcome.

  15. Optimization of Water Management of Cranberry Fields under Current and Future Climate Conditions

    NASA Astrophysics Data System (ADS)

    Létourneau, G.; Gumiere, S.; Mailhot, E.; Rousseau, A. N.

    2016-12-01

    In North America, cranberry production is on the rise. Since 2005, land area dedicated to cranberry doubled, principally in Canada. Recent studies have shown that sub-irrigation could lead to improvements in yield, water use efficiency and pumping energy requirements compared to conventional sprinkler irrigation. However, the experimental determination of the optimal water table level of each production site may be expensiveand time-consuming. The primary objective of this study is to optimize the water table level as a function of typical soil properties, and climatic conditions observed in major production areas using a numerical modeling approach. The second objective is to evaluate the impacts of projected climatic conditions on water management of cranberry fields. To that end, cranberry-specific management operations such as harvest flooding, rapid drainage following heavy rainfall, or hydric stress management during dry weather conditions were simulated with the HYDRUS 2D software. Results have shown that maintaining the water table approximately at 60 cm provides optimal results for most of the studied soils. However, under certain extreme climatic conditions, the drainage system design may not allow maintaining optimal hydric conditions for cranberry growth. The long-term benefit of this study has potential to advance the design of drainage/sub-irrigation systems.

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

    Johnson, Gary E.; Diefenderfer, Heida L.; Ebberts, Blaine D.

    The purpose ofthis document is to describe research, monitoring, and evaluation (RME) for the Federal Columbia River Estuary Program. The intent of this RME effort is to provide data and information to evaluate progress toward meeting program goals and objectives and support decision-making in the Estuary Program. The goal of the Estuary Program is to understand, conserve, and restore the estuary ecosystem to improve the performance of listed salmonid populations. The Estuary Program has five general objectives, designed to fulfill the program goal, as follows. 1. Understand the primary stressors affecting ecosystem controlling factors, such as ocean conditions and invasivemore » species. 2. Conserve and restore factors controlling ecosystem structures and processes, such as hydrodynamics and water quality. 3. Increase the quantity and quality of ecosystem structures, i.e., habitats, juvenile salmonids use during migration through the estuary. 4. Maintain the food web to benefit salmonid performance. 5. Improve salmonid performance in terms of life history diversity, foraging success, growth, and survival. The goal of estuary RME is to provide pertinent and timely research and monitoring information to planners, implementers, and managers of the Estuary Program. In conclusion, the estuary RME effort is designed to meet the research and monitoring needs of the estuary Program using an adaptive management process. Estuary RME's success and usefulness will depend on the actual conduct of adaptive management, as embodied in the objectives, implrementation, data, reporting, and synthesis, evaluation, and decision-making described herein.« less

  17. Do On-site Mental Health Professionals Change Pediatricians’ Responses to Children’s Mental Health Problems?

    PubMed Central

    Horwitz, Sarah McCue; Storfer-Isser, Amy; Kerker, Bonnie D.; Szilagyi, Moira; Garner, Andrew S.; O’Connor, Karen G.; Hoagwood, Kimberly E.; Green, Cori M.; Foy, Jane M.; Stein, Ruth E.K.

    2016-01-01

    Objective The objectives were to: assess the availability of on-site mental health professionals (MHP) in primary care; examine practice/pediatrician characteristics associated with on-site MHPs; and determine whether presence of on-site MHPs is related to pediatricians’ co-managing or more frequently identifying, treat/managing or referring MH problems. Methods Analyses included AAP members who participated in an AAP Periodic Survey in 2013 and who practiced general pediatrics (N=321). Measures included socio-demographics, practice characteristics, questions on about on-site MHPs, co-management of MH problems and pediatricians’ behaviors in response to 5 prevalent MH problems. Weighted univariate, bivariate and multivariable analyses were performed. Results Thirty-five percent reported on-site MHPs. Practice characteristics (medical schools/universities/HMOs, <100 visits/week, <80% of patients privately insured), and interactions of practice location (urban) with visits and patient insurance, were associated with on-site MHPs. There was no overall association between co-location and co-management or whether pediatricians usually identified, treat/managed or referred 5 common child MH problems. Among the subset of pediatricians who reported co-managing there was an association with co-management when the on-site MHP was a child psychiatrist, SA counselor, or social worker. Conclusions On-site MHPs are more frequent in settings where low-income children are served and where pediatricians train. Pediatricians who co-manage MH problems are more likely to do so when the on-site MHP is a child psychiatrist, SA counselor, or social worker. Overall, on-site MHPs were not associated with co-management or increased likelihood of pediatricians identifying, treating/managing, or referring children with 5 common child MH problems. PMID:27064141

  18. Management of Brain Metastases.

    PubMed

    Jeyapalan, Suriya A.; Batchelor, Tracy

    2004-07-01

    Advances in neurosurgery and the development of stereotactic radiosurgery have expanded treatment options available for patients with brain metastases. However, despite several randomized clinical trials and multiple uncontrolled studies, there is not a uniform consensus on the best treatment strategy for all patients with brain metastases. The heterogeneity of this patient population in terms of functional status, types of underlying cancers, status of systemic disease control, and number and location of brain metastases make such consensus difficult. Nevertheless, in certain situations, there is Class I evidence that supports one approach or another. The primary objectives in the management of this patient population include improved duration and quality of survival. Very few patients achieve long-term survival after the diagnosis of a brain metastasis.

  19. A Novel Mobile App and Population Management System to Manage Rheumatoid Arthritis Flares: Protocol for a Randomized Controlled Trial

    PubMed Central

    Wang, Penny; Luo, Dee; Lu, Fengxin; Elias, Josephine S; Landman, Adam B; Michaud, Kaleb D

    2018-01-01

    Background Rheumatoid arthritis flares have a profound effect on patients, causing pain and disability. However, flares often occur between regularly scheduled health care provider visits and are, therefore, difficult to monitor and manage. We sought to develop a mobile phone app combined with a population management system to help track RA flares between visits. Objective The objective of this study is to implement the mobile app plus the population management system to monitor rheumatoid arthritis disease activity between scheduled health care provider visits over a period of 6 months. Methods This is a randomized controlled trial that lasts for 6 months for each participant. We aim to recruit 190 patients, randomized 50:50 to the intervention group versus the control group. The intervention group will be assigned the mobile app and be prompted to answer daily questionnaires sent to their mobile devices. Both groups will be assigned a population manager, who will communicate with the participants via telephone at 6 weeks and 18 weeks. The population manager will also communicate with the participants in the intervention group if their responses indicate a sustained increase in rheumatoid arthritis disease activity. To assess patient satisfaction, the primary outcomes will be scores on the Treatment Satisfaction Questionnaire for Medication as well as the Perceived Efficacy in Patient-Physician Interactions questionnaire at 6 months. To determine the effect of the mobile app on rheumatoid arthritis disease activity, the primary outcome will be the Clinical Disease Activity Index at 6 months. Results The trial started in November 2016, and an estimated 2.5 years will be necessary to complete the study. Study results are expected to be published by the end of 2019. Conclusions The completion of this study will provide important data regarding the following: (1) the assessment of validated outcome measures to assess rheumatoid arthritis disease activity with a mobile app between routinely scheduled health care provider visits, (2) patient engagement in monitoring their condition, and (3) communication between patients and health care providers through the population management system. Trial Registration ClinicalTrials.gov NCT02822521, http://clinicaltrials.gov/ct2/show/NCT02822521 (Archived by WebCite at http://www.webcitation.org/6xed3kGPd) PMID:29643053

  20. Activity Pacing Self-Management in Chronic Fatigue Syndrome: A Randomized Controlled Trial

    PubMed Central

    van Eupen, Inge; Meirte, Jill; Van Cauwenbergh, Deborah; Moorkens, Greta; Meeus, Mira; Nijs, Jo

    2015-01-01

    OBJECTIVE. The objective of this study was to evaluate the effectiveness of an activity pacing self-management (APSM) intervention in improving performance of daily life activities in women with chronic fatigue syndrome (CFS). METHOD. A total of 33 women with CFS (age 41.1 ± 11.2 yr) were randomly allocated to APSM (experimental group; n = 16) or relaxation (control group; n = 17). Main outcome measures included the Canadian Occupational Performance Measure (COPM; primary) and Checklist Individual Strength (CIS). RESULTS. COPM scores changed significantly over time in both groups (p = .03). The change in Satisfaction scores showed a significant difference in favor only of APSM (effect size = 0.74 [0.11, 1.4]). CIS scores decreased significantly in the experimental group only (p < .01). CONCLUSION. APSM was found to be feasible and effective in optimizing participation in desired daily life activities in women with CFS. Replication in a larger sample with long-term follow-up is required. PMID:26356665

  1. Delivering Integrated Care to the Frail Elderly: The Impact on Professionals’ Objective Burden and Job Satisfaction

    PubMed Central

    Huijsman, Robbert; de Kuyper, Ruben Dennis Maurice; Fabbricotti, Isabelle Natalina

    2016-01-01

    Background: The impact of integrated working on professionals’ objective burden and job satisfaction was examined. An evidence-based intervention targeting frail elderly patients was implemented in the Walcheren region of the Netherlands in 2010. The intervention involved the primary care practice as a single entry point, and included proactive frailty screening, a comprehensive assessment of patient needs, case management, multidisciplinary teams, care plans and protocols, task delegation and task specialisation, a shared information system, a geriatric care network and integrated funding. Methods: A quasi-experimental design with a control group was used. Data regarding objective burden involved the professionals’ time investments over a 12-month period that were collected from patient medical records (n = 377) time registrations, transcripts of meetings and patient questionnaires. Data regarding job satisfaction were collected using questionnaires that were distributed to primary care and home-care professionals (n = 180) after the intervention’s implementation. Within- and between-groups comparisons and regression analyses were performed. Results: Non-patient related time was significantly higher in the experimental group than in the control group, whereas patient-related time did not differ. Job satisfaction remained unaffected by the intervention. Conclusion and Discussion: Integrated working is likely to increase objective burden as it requires professionals to perform additional activities that are largely unrelated to actual patient care. Implications for research and practice are discussed. [Current Controlled Trials ISRCTN05748494]. PMID:28413364

  2. Non-disclosure of chronic kidney disease in primary care and the limits of instrumental rationality in chronic illness self-management.

    PubMed

    Daker-White, Gavin; Rogers, Anne; Kennedy, Anne; Blakeman, Thomas; Blickem, Christian; Chew-Graham, Carolyn

    2015-04-01

    Early detection of long term conditions is predicated on assumptions that lifestyle changes and medications can be used to reduce or manage the risk of condition progression. However, ambiguity remains about the nature and place of diagnostic disclosure to people in newly recognised or asymptomatic 'pre' conditions such as early stage chronic kidney disease (CKD). The disclosure of a diagnosis is relevant to instigating strategies which rely on actively engaging patients as self-managers of their own care. Whilst primary care routinely records a diagnosis of early stage CKD, little is known about how patients learn about the fact that they have CKD or how they respond to this. This study aimed to explore patients' experiences of disclosure of CKD in primary care settings. A nested qualitative study of participants recruited to a trial of an intervention for CKD patients in Greater Manchester, UK was undertaken. A purposive sample of 26 patients, with a mean age of 72 years (range 59-89, median 71), were interviewed during 2012. Interview transcripts were analysed using constant comparative techniques. Narrative accounts reflected limited or partial disclosure of CKD; often cast in vague terms as "nothing to worry about". How patients described themselves in terms of participation and their tendencies towards 'active' or 'passive' involvement in consultations emerged as important components of narratives around disclosure. The findings illuminate the ways in which diagnosis is oriented in a context where it is possible to meet the requirements for remuneration under a pay for performance system of primary care, whilst apparently not disclosing a label or a diagnosis to patients. This challenges the presumptions inherent in wider health policy objectives that are increasingly built on the notion of responsible patients and the ethos of the active support of self-management for pre-conditions. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. A tale of two audits: statistical process control for improving diabetes care in primary care settings.

    PubMed

    Al-Hussein, Fahad Abdullah

    2008-01-01

    Diabetes constitutes a major burden of disease globally. Both primary and secondary prevention need to improve in order to face this challenge. Improving management of diabetes in primary care is therefore of fundamental importance. The objective of these series of audits was to find means of improving diabetes management in chronic disease mini-clinics in primary health care. In the process, we were able to study the effect and practical usefulness of different audit designs - those measuring clinical outcomes, process of care, or both. King Saud City Family and Community Medicine Centre, Saudi National Guard Health Affairs in Riyadh city, Saudi Arabia. Simple random samples of 30 files were selected every two weeks from a sampling frame of file numbers for all diabetes clients seen over the period. Information was transferred to a form, entered on the computer and an automated response was generated regarding the appropriateness of management, a criterion mutually agreed upon by care providers. The results were plotted on statistical process control charts, p charts, displayed for all employees. Data extraction, archiving, entry, analysis, plotting and design and preparation of p charts were managed by nursing staff specially trained for the purpose by physicians with relevant previous experience. Audit series with mixed outcome and process measures failed to detect any changes in the proportion of non-conforming cases over a period of one year. The process measures series, on the other hand, showed improvement in care corresponding to a reduction in the proportion non-conforming by 10% within a period of 3 months. Non-conformities dropped from a mean of 5.0 to 1.4 over the year (P < 0.001). It is possible to improve providers' behaviour regarding implementation of given guidelines through periodic process audits and feedbacks. Frequent process audits in the context of statistical process control should be supplemented with concurrent outcome audits, once or twice a year.

  4. Iron deficiency intravenous substitution in a Swiss academic primary care division: analysis of practices

    PubMed Central

    Varcher, Monica; Zisimopoulou, Sofia; Braillard, Olivia; Favrat, Bernard; Junod Perron, Noëlle

    2016-01-01

    Background Iron deficiency is a common problem in primary care and is usually treated with oral iron substitution. With the recent simplification of intravenous (IV) iron administration (ferric carboxymaltose) and its approval in many countries for iron deficiency, physicians may be inclined to overutilize it as a first-line substitution. Objective The aim of this study was to evaluate iron deficiency management and substitution practices in an academic primary care division 5 years after ferric carboxymaltose was approved for treatment of iron deficiency in Switzerland. Methods All patients treated for iron deficiency during March and April 2012 at the Geneva University Division of Primary Care were identified. Their medical files were analyzed for information, including initial ferritin value, reasons for the investigation of iron levels, suspected etiology, type of treatment initiated, and clinical and biological follow-up. Findings were assessed using an algorithm for iron deficiency management based on a literature review. Results Out of 1,671 patients, 93 were treated for iron deficiency. Median patients’ age was 40 years and 92.5% (n=86) were female. The average ferritin value was 17.2 μg/L (standard deviation 13.3 μg/L). The reasons for the investigation of iron levels were documented in 82% and the suspected etiology for iron deficiency was reported in 67%. Seventy percent of the patients received oral treatment, 14% IV treatment, and 16% both. The reasons for IV treatment as first- and second-line treatment were reported in 57% and 95%, respectively. Clinical and biological follow-up was planned in less than two-thirds of the cases. Conclusion There was no clear overutilization of IV iron substitution. However, several steps of the iron deficiency management were not optimally documented, suggesting shortcuts in clinical reasoning. PMID:27445502

  5. [Clinical data that are essential for the primary care clinical records: an experience of evaluation and improvement].

    PubMed

    López-Picazo Ferrer, J J; Agulló Roca, F; Villaescusa Pedemonte, M; Cerezo Corbalán, J M

    2002-06-30

    To evaluate and improve the presence of essential clinical data in the clinical records of a primary care management area (PCMA) by means of an intervention programme. Intervention study without a control, using evaluation and improvement-of-quality methods. We chose 4 criteria from the minimum technical standards: personal history (PH), family background (FB), allergies to medicines (AM) and list of problems (LP). We evaluated overall compliance and compliance per primary care team (PCT) through batch quality acceptance of samples (LQAS), designed an intervention to improve the situation, and then re-evaluated. PCMA of Murcia (45 PCTs). Participants. 42 PCTs (3 were excluded because they had poor coverage in their records). These lasted 12 months (October 1999-October 2000) and involved the following: graphic report per PCT; session with the PCT; discussion on results and strategies in the Area Management Council; and inclusion of an explicit objective, with incentives, in the management contracts. Significant improvement of the four criteria of the PCMA (improvements: FB, 48.1%; PH, 51.1%; AM, 55.4%; LP, 50.9%). LQAS analysis: we rejected 24 batches (14.3%) at the 1st evaluation and 15 (9.0%) at the second, with FB being the criterion most rejected in both instances. Defects appeared in 14 PCT (33.3%; 3 PCT accounted for 41.7%) at the 1st evaluation, and 7 PCT at the re-evaluation (16.7%; 2 reaching 46.7%). The presence of essential clinical data in clinical records has improved. LQAS proved to be a rapid and simple method for evaluating, improving and monitoring quality in primary care.

  6. X-33/RLV System Health Management/Vehicle Health Management

    NASA Technical Reports Server (NTRS)

    Mouyos, William; Wangu, Srimal

    1998-01-01

    To reduce operations costs, Reusable Launch Vehicles (RLVS) must include highly reliable robust subsystems which are designed for simple repair access with a simplified servicing infrastructure, and which incorporate expedited decision-making about faults and anomalies. A key component for the Single Stage To Orbit (SSTO) RLV system used to meet these objectives is System Health Management (SHM). SHM incorporates Vehicle Health Management (VHM), ground processing associated with the vehicle fleet (GVHM), and Ground Infrastructure Health Management (GIHM). The primary objective of SHM is to provide an automated and paperless health decision, maintenance, and logistics system. Sanders, a Lockheed Martin Company, is leading the design, development, and integration of the SHM system for RLV and for X-33 (a sub-scale, sub-orbit Advanced Technology Demonstrator). Many critical technologies are necessary to make SHM (and more specifically VHM) practical, reliable, and cost effective. This paper will present the X-33 SHM design which forms the baseline for the RLV SHM, and it will discuss applications of advanced technologies to future RLVs. In addition, this paper will describe a Virtual Design Environment (VDE) which is being developed for RLV. This VDE will allow for system design engineering, as well as program management teams, to accurately and efficiently evaluate system designs, analyze the behavior of current systems, and predict the feasibility of making smooth and cost-efficient transitions from older technologies to newer ones. The RLV SHM design methodology will reduce program costs, decrease total program life-cycle time, and ultimately increase mission success.

  7. Production roll out plan for HANDI 2000 business management system

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

    Adams, D.E.

    The Hanford Data Integration 2000 (HANDI 2000) Project will result in an integrated and comprehensive set of functional applications containing core information necessary to support the Project Hanford Management Contract (PHMC). It is based on the Commercial-Off-The-Shelf (COTS) product solution with commercially proven business processes. The COTS product solution set, of Passport (PP) and PeopleSoft (PS) software, supports finance, supply, human resources, and payroll activities under the current PHMC direction. The PP software is an integrated application for Accounts Payable, Contract Management, Inventory Management, Purchasing and Material Safety Data Sheets (MSDS). The PS software is an integrated application for Projects,more » General Ledger, Human Resources Training, Payroll, and Base Benefits. This set of software constitutes the Business Management System (BMS) and MSDS, a subset of the HANDI 2000 suite of systems. The primary objective of the Production Roll Out Plan is to communicate the methods and schedules for implementation and roll out to end users of BMS.« less

  8. Hydrogeologic and water-quality data used to characterize the Management Systems Evaluation Area near Princeton, Minnesota, 1991

    USGS Publications Warehouse

    Delin, G.N.; Landon, M.K.; Lamb, J.A.; Anderson, J.L.

    1994-01-01

    The Minnesota Management Systems Evaluation Area project is part of a multi-scale, inter-agency initiative to evaluate the effects of agricultural management systems on water quality in the midwest corn belt. The research area is located in the Anoka Sand Plain about 5 kilometers southwest of Princeton, Minnesota. The ground-water-quality monitoring network within and immediately surrounding the research area consists of 29 observation wells and 22 multiport wells. Thirteen observation wells are also located outside the research area. The primary objectives of research by the U.S. Geological Survey at the Princeton Management Systems Evaluation Area are to: (1) determine the relation of the spatial and temporal distribution of agricultural chemicals in ground water to recharge, topography, and subsurface heterogeneities; and (2) determine the effects of the modified and prevailing farming systems on ground-water quality. This report presents geologic logs and water-quality data used to characterize the Princeton Management Systems Evaluation Area.

  9. Primary Health Care: care coordinator in regionalized networks?

    PubMed Central

    de Almeida, Patty Fidelis; dos Santos, Adriano Maia

    2016-01-01

    RESUMO OBJECTIVE To analyze the breadth of care coordination by Primary Health Care in three health regions. METHODS This is a quantitative and qualitative case study. Thirty-one semi-structured interviews with municipal, regional and state managers were carried out, besides a cross-sectional survey with the administration of questionnaires to physicians (74), nurses (127), and a representative sample of users (1,590) of Estratégia Saúde da Família (Family Health Strategy) in three municipal centers of health regions in the state of Bahia. RESULTS Primary Health Care as first contact of preference faced strong competition from hospital outpatient and emergency services outside the network. Issues related to access to and provision of specialized care were aggravated by dependence on the private sector in the regions, despite progress observed in institutionalizing flows starting out from Primary Health Care. The counter-referral system was deficient and interprofessional communication was scarce, especially concerning services provided by the contracted network. CONCLUSIONS Coordination capacity is affected both by the fragmentation of the regional network and intrinsic problems in Primary Health Care, which poorly supported in its essential attributes. Although the health regions have common problems, Primary Health Care remains a subject confined to municipal boundaries. PMID:28099663

  10. Educating resident physicians using virtual case-based simulation improves diabetes management: a randomized controlled trial.

    PubMed

    Sperl-Hillen, JoAnn; O'Connor, Patrick J; Ekstrom, Heidi L; Rush, William A; Asche, Stephen E; Fernandes, Omar D; Appana, Deepika; Amundson, Gerald H; Johnson, Paul E; Curran, Debra M

    2014-12-01

    To test a virtual case-based Simulated Diabetes Education intervention (SimDE) developed to teach primary care residents how to manage diabetes. Nineteen primary care residency programs, with 341 volunteer residents in all postgraduate years (PGY), were randomly assigned to a SimDE intervention group or control group (CG). The Web-based interactive educational intervention used computerized virtual patients who responded to provider actions through programmed simulation models. Eighteen distinct learning cases (L-cases) were assigned to SimDE residents over six months from 2010 to 2011. Impact was assessed using performance on four virtual assessment cases (A-cases), an objective knowledge test, and pre-post changes in self-assessed diabetes knowledge and confidence. Group comparisons were analyzed using generalized linear mixed models, controlling for clustering of residents within residency programs and differences in baseline knowledge. The percentages of residents appropriately achieving A-case composite clinical goals for glucose, blood pressure, and lipids were as follows: A-case 1: SimDE = 21.2%, CG = 1.8%, P = .002; A-case 2: SimDE = 15.7%, CG = 4.7%, P = .02; A-case 3: SimDE = 48.0%, CG = 10.4%, P < .001; and A-case 4: SimDE = 42.1%, CG = 18.7%, P = .004. The mean knowledge score and pre-post changes in self-assessed knowledge and confidence were significantly better for SimDE group than CG participants. A virtual case-based simulated diabetes education intervention improved diabetes management skills, knowledge, and confidence for primary care residents.

  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 economically disadvantaged. Such an approach may be a cost-effective, timely, and simple option for reducing HF costs. PMID:20858878

  12. [Comparing case management care models for people with dementia and their caregivers: the design of the COMPAS study].

    PubMed

    van Hout, H P J; Macneil Vroomen, J L; Van Mierlo, L D; Meiland, F J M; Moll van Charante, E P; Joling, K J; van den Dungen, P; Dröes, R M; van der Horst, H E; de Rooij, S E J A

    2014-04-01

    Dementia care in The Netherlands is shifting from fragmented, ad hoc care to more coordinated and personalized care. Case management contributes to this shift. The linkage model and a combination of intensive case management and joint agency care models were selected based on their emerging prominence in The Netherlands. It is unclear if these different forms of case management are more effective than usual care in improving or preserving the functioning and well-being at the patient and caregiver level and at the societal cost. The objective of this article is to describe the design of a study comparing these two case management care models against usual care. Clinical and cost outcomes are investigated while care processes and the facilitators and barriers for implementation of these models are considered. Mixed methods include a prospective, observational, controlled, cohort study among persons with dementia and their primary informal caregiver in regions of The Netherlands with and without case management including a qualitative process evaluation. Community-dwelling individuals with a dementia diagnosis with an informal caregiver are included. The primary outcome measure is the Neuropsychiatric Inventory for the people with dementia and the General Health Questionnaire for their caregivers. Costs are measured from a societal perspective. Semi-structured interviews with stakeholders based on the theoretical model of adaptive implementation are planned. 521 pairs of persons with dementia and their primary informal caregiver were included and are followed over two years. In the linked model substantially more impeding factors for implementation were identified compared with the model. This article describes the design of an evaluation study of two case management models along with clinical and economic data from persons with dementia and caregivers. The impeding and facilitating factors differed substantially between the two models. Further results on cost-effectiveness are expected by the beginning of 2015. This is a Dutch adaptation of MacNeil Vroomen et al., Comparing Dutch case management care models for people with dementia and their caregivers: The design of the COMPAS study.

  13. Management of Stroke Prevention in Canadian Patients with Atrial Fibrillation at Moderate to High Risk of Stroke

    PubMed Central

    Semchuk, William M; Levac, Brandon; Lara, Muria; Shakespeare, Annabelle; Evers, Thomas; Bolt, Jennifer

    2013-01-01

    Background Many patients with atrial fibrillation who are at moderate to high risk of stroke do not receive anticoagulation with vitamin K antagonists (VKAs) in accordance with recommendations. Objective: To determine (1) why Canadian patients with atrial fibrillation who are potentially eligible for VKA do not receive this therapy, (2) why Canadian primary care physicians discontinue VKA therapy, and (3) why VKA therapy is perceived as difficult to manage. Methods: The study involved a chart review of 3 cohorts of patients with nonvalvular atrial fibrillation at moderate to high risk of stroke: patients who had never received VKA treatment (VKA-naive), those whose treatment had been discontinued, and those whose VKA treatment was considered difficult to manage. Results: Charts for 187 patients (mean age 78.4 years, standard deviation 8.9 years) treated at 39 primary care sites were reviewed (62 treatment-naive, 42 with therapy discontinued, and 83 whose therapy was considered difficult to manage). Atrial fibrillation was paroxysmal in 82 (44%) of the patients, persistent in 47 patients (25%), and permanent in 58 (31%). One patient in each of the 3 cohorts had experienced a stroke during the 6 months before study participation. Bleeding events were more frequent among patients who had discontinued VKA therapy than in the other 2 groups. Among those whose therapy was discontinued and those whose therapy was difficult to manage, the mean time in the therapeutic range was 46.3% and 56.4%, respectively. The most common reason for not initiating VKA therapy in treatment-naive patients was the transient nature of atrial fibrillation (25/62 [40%]). The most common reason for discontinuation of VKA therapy was a bleeding event (10/42 [24%]). The presence of a concomitant chronic disease was the most common reason that a patient’s therapy was considered difficult to manage (46/83 [55%]). Conclusions: VKA therapy was not initiated or was discontinued for various reasons. Multiple comorbid conditions made management of VKA therapy more difficult. These findings reflect the challenges that primary care physicians experience in managing the care of patients with atrial fibrillation. PMID:24159232

  14. Nursing contributions to chronic disease management in primary care.

    PubMed

    Lukewich, Julia; Edge, Dana S; VanDenKerkhof, Elizabeth; Tranmer, Joan

    2014-02-01

    As the prevalence of chronic diseases continues to increase, emphasis is being placed on the development of primary care strategies that enhance healthcare delivery. Innovations include interprofessional healthcare teams and chronic disease management strategies. To determine the roles of nurses working in primary care settings in Ontario and the extent to which chronic disease management strategies have been implemented. We conducted a cross-sectional survey of a random sample of primary care nurses, including registered practical nurses, registered nurses, and nurse practitioners, in Ontario between May and July 2011. Nurses in primary care reported engaging in chronic disease management activities but to different extents depending on their regulatory designation (licensure category). Chronic disease management strategy implementation was not uniform across primary care practices where the nurses worked. There is the potential to optimize and standardize the nursing role within primary care and improve the implementation of chronic disease management strategies.

  15. An Evaluative Study of Primary Education in the Light of Policies and Plans in Pakistan (1947-2006)

    ERIC Educational Resources Information Center

    Parveen, Shahida

    2008-01-01

    The paper is based on a research conducted to evaluate primary education in the light of education policies and plans in Pakistan. This article discusses the objectives of primary education, and analyzes different education policies and plans regarding the achievements of objectives. Results revealed that the objectives of primary education were…

  16. Operational Risk Measurement of Chinese Commercial Banks Based on Extreme Value Theory

    NASA Astrophysics Data System (ADS)

    Song, Jiashan; Li, Yong; Ji, Feng; Peng, Cheng

    The financial institutions and supervision institutions have all agreed on strengthening the measurement and management of operational risks. This paper attempts to build a model on the loss of operational risks basing on Peak Over Threshold model, emphasizing on weighted least square, which improved Hill’s estimation method, while discussing the situation of small sample, and fix the sample threshold more objectively basing on the media-published data of primary banks loss on operational risk from 1994 to 2007.

  17. Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury: Guidance for the Primary Care Manager in Deployed and Non-deployed Settings (BRIEFING SLIDES)

    DTIC Science & Technology

    2014-01-01

    climbing stairs, putting on boots, and bending tasks • NO video games , driving, resistance training, repetitive lifting, sit-ups, push-ups or...NO video games , driving, combatives or collision sports 25 Stage 4: Moderate Activity Objective • Increase in intensity and complexity of exercise...jogging to running as tolerated, light resistance training or non-contact sports • Cognitive activity with greater demand such as video games , land

  18. The use of Bacillus thuringiensis kurstaki for managing gypsy moth populations under the Slow the Spread Program, 1996-2010, relative to the distributional range of threatened and endangered species

    Treesearch

    Laura M. Blackburn; Donna S. Leonard; Patrick C. Tobin

    2011-01-01

    The Slow the Spread Program operates along the expanding population front of the gypsy moth, from Minnesota to North Carolina. The primary objective of the program is to eliminate newly-founded colonies that form ahead of the leading edge to reduce the gypsy moth's rate of spread and delay the costs associated with infestation and outbreaks. Although the majority...

  19. Interceptive management of eruption disturbances: case report.

    PubMed

    Cozza, Paola; Marino, Alessandra; Lagana, Giuseppina

    2004-01-01

    The aim of the present report is to describe a case of a patient with eruption disturbances of an ankylosed lower primary second molar, delayed development of a maxillary permanent canine associated with an odontoma and a class III dental malocclusion. In such a case the objectives of treatment are: to prevent impaction of the lower second premolar and tipping of the lower first molar; to establish correct anterior overbite and overjet and to control the development of the permanent upper canine.

  20. WHO in crisis.

    PubMed Central

    Godlee, F.

    1994-01-01

    Media attention has been focused on the leadership of the World Health Organisation, rather than on the real factors that limit WHO's effectiveness. These factors relate to the organisation's structure and also to its current priorities, methods, and management. This article examines the objectives and strategy of WHO in view of financial constraints and donor countries' demands; WHO's stated goal of integrated primary health care; staff morale; and the growing dislocation between the regions and headquarters. Images p1426-a p1427-a PMID:7819856

  1. The technical editing internship: What makes it work

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

    Caruthers, C.M.; Caruthers, L.E.; Schmidt, B.J.

    1988-01-01

    The following paper presents the experiences and perceptions of the three main participants of a technical editing internship at Argonne National Laboratory during the summer of 1986. Linda Caruthers, Clifford Caruthers, and Bryan Schmidt/emdash/teacher, supervisor, and intern, respectively/emdash/share what they received as their roles and responsibilities in guiding, managing, and becoming an entry-level technical editor. The following discussions demonstrate how the efforts of three people pursuing different objectives achieve the primary goal of all technical writers and editors: high-quality publications.

  2. The 1991 EOS reference handbook

    NASA Technical Reports Server (NTRS)

    Dokken, David (Editor)

    1991-01-01

    The following topics are covered: (1) The Global Change Research Program; (2) The Earth Observing System (EOS) goal and objectives; (3) primary EOS mission requirements; (4) EOS science; (5) EOS Data and Information System (EOSDIS) architecture; (6) data policy; (7) international cooperation; (8) plans and status; (9) the role of the National Oceanic and Atmospheric Administration; (10) The Global Fellowship Program; (11) management of EOS; (12) mission elements; (13) EOS instruments; (14) interdisciplinary science investigations; (15) points of contact; and (16) acronyms and abbreviations.

  3. Do published ADA studies support the ADA-EASD position statement for the management of hyperglycaemia in type 2 diabetics?

    PubMed

    Rimareix, Frédérique; Bauduceau, Bernard

    2013-07-01

    The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published a position statement in 2012 on the management of hyperglycaemia in patients with type 2 diabetes. The Société Francophone du Diabète (SFD) adopted it while awaiting future French recommendations. This new care approach individualises the therapeutic choices and objectives for each patient based on their characteristics, through emphasis on the need for mutual cooperation with the patient in decision-making. Glycaemic management should naturally be considered in the context of overall cardiovascular risk reduction, which should remain the primary objective of treatment. The cornerstone of this treatment is based on lifestyle modifications, with the addition of metformin monotherapy if the desired glycaemic control is not attained. There are multiple second- and third-line treatment possibilities, and insulin therapy is an option that can be considered early in the bitherapy stage. On the whole, large published studies at the ADA conference in Philadelphia in June 2012, which are the subject of this article, support this patient-centred position statement. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  4. Poor health but not absent: prevalence, predictors, and outcomes of presenteeism.

    PubMed

    Robertson, Ivan; Leach, Desmond; Doerner, Nadin; Smeed, Matthew

    2012-11-01

    The objective of this study was to examine the prevalence of presenteeism, to develop and test a model of the relationship between workplace factors and presenteeism, and to assess the perceived influence of manager, coworkers, and self on presenteeism. We used survey data collected for 6309 employees from seven different organizations. Nearly 60% of the sample reported presenteeism during a 3-month period. The model was supported, with presenteeism linking workplace factors and health outcomes to productivity, as predicted. The majority of participants (67%) indicated that the primary pressure to attend work while sick came from themselves. A substantial minority (20%) also indicated the manager as a source of pressure. Psychosocial workplace factors are predictive of presenteeism, and efforts to control them, including the use of more effective management, may impact presenteeism rates and the resulting levels of productivity.

  5. Development of the INEEL Site Wide Vadose Zone Roadmap

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

    Yonk, Alan Keith

    2001-09-01

    The INEEL Vadose Zone Roadmap was developed to identify inadquacies in current knowledge, to assist in contaminant management capabilities relative to the INEEL vadose zone, and to ensure that ongoing and planned Science and Technology developments will meet the risk management challenges facing the INEEL in coming years. The primary objective of the Roadmap is to determine the S&T needs that will facilitate monitoring, characterization, prediction, and assessment activities necessary to support INEEL risk management decisions and to ensure that long-term stewardship of contaminated sites at the INEEL is achieved. The mission of the Roadmap is to insure that themore » long-term S&T strategy is aligned with site programs, that it takes advantage of progress made to date, and that it can assist in meeting the milestones and budgets of operations.« less

  6. Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges

    PubMed Central

    2016-01-01

    Background: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. Objective: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. Method: A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control – usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Results: Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. Conclusion: A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context. PMID:27382427

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

    PubMed Central

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

    2013-01-01

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

  8. Influence of commercial information on prescription quantity in primary care.

    PubMed

    Caamaño, Francisco; Figueiras, Adolfo; Gestal-Otero, Juan Jesus

    2002-09-01

    In the last few years we have witnessed many publicly-financed health services reaching a crisis point. Thus, drug expenditure is nowadays one of the main concerns of health managers, and its containment one of the first goals of health authorities in western countries. The objective of this study is to identify the effect of the perceived quality stated in commercial information, its uses, and how physicians perceive the influence it has on prescription amounts. A cross-sectional study of 405 primary care physicians was conducted in Galicia (north-west Spain). The independent variables physician's education and speciality, physician's perception of the quality of available drug information sources, type of practice, and number of patients were collected, through a postal questionnaire. Environmental characteristics of the practice were obtained from secondary sources. Multiple regression models were constructed using as dependent variables two indicators of prescription volume. The response rate was 75.2%. Prescription amounts was found to be associated with perceived credibility of information provided by medical visitors, regulated physician training, and environmental characteristics of the practice (primary care team practice, urban environment). The study results suggest that in order to decrease prescription amounts it is necessary to limit the role of pharmaceutical companies in physician training, improve physician education and training, and emphasize more objective sources of information.

  9. Scientific Data as the Core Legacy of IPY

    NASA Astrophysics Data System (ADS)

    Parsons, M. A.

    2008-12-01

    The interdisciplinary breadth of the International Polar Year is unprecedented. The IPY has explicit objectives to link researchers across different fields to address questions and issues lying beyond the scope of individual disciplines and to strengthen international coordination of research and enhance international collaboration and cooperation. The IPY Data Policy and Management Subcommittee have developed a policy to help meet these objectives and an international collaboration of investigators and data managers, the IPY Data and Information Service, are working to make IPY data widely available. I will present an overview of the primary data management considerations for IPY and how diverse organizations are making IPY and related data available. Centralized discovery mechanisms for widely distributed data plus targeted access mechanisms for specific disciplines will be presented. These range from near real time access to satellite remote sensing data and GCM output to fair and appropriate access to traditional knowledge of the Arctic. These mechanisms reflect significant advancement in polar data management, but they belie the major challenges that remain. These challenges include fostering a culture change in science that puts greater value on data publication and open data access as well as developing sustained systems and business models for the long-term preservation of IPY data. This will be crucial to ensuring the legacy of IPY, a major objective of IPY sponsors, ICSU and WMO. New efforts to ensure this legacy include the development of the WMO Information System, the Sustained Arctic Observing Network, and the Global Earth Observing System of Systems; the reform of ICSU's World Data Center System; and the results of the Electronic Geophysical Year.

  10. Exploring perceptions and experiences of patients who have chronic pain as state prescription opioid policies change: a qualitative study in Indiana

    PubMed Central

    Al Achkar, Morhaf; Revere, Debra; Dennis, Barbara; MacKie, Palmer; Gupta, Sumedha; Grannis, Shaun

    2017-01-01

    Objectives The misuse and abuse of prescription opioids (POs) is an epidemic in the USA today. Many states have implemented legislation to curb the use of POs resulting from inappropriate prescribing. Indiana legislated opioid prescribing rules that went into effect in December 2013. The rules changed how chronic pain is managed by healthcare providers. This qualitative study aims to evaluate the impact of Indiana’s opioid prescription legislation on the patient experiences around pain management. Setting This is a qualitative study using interviews of patient and primary care providers to obtain triangulated data sources. The patients were recruited from an integrated pain clinic to which chronic pain patients were referred from federally qualified health clinics (FQHCs). The primacy care providers were recruited from the same FQHCs. The study used inductive, emergent thematic analysis. Participants Nine patient participants and five primary care providers were included in the study. Results Living with chronic pain is disruptive to patients’ lives on multiple dimensions. The established pain management practices were disrupted by the change in prescription rules. Patient–provider relationships, which involve power dynamics and decision making, shifted significantly in parallel to the rule change. Conclusions As a result of the changes in pain management practice, some patients experienced significant challenges. Further studies into the magnitude of this change are necessary. In addition, exploring methods for regulating prescribing while assuring adequate access to pain management is crucial. PMID:29133312

  11. Laryngeal Cysts in Adults: Simplifying Classification and Management.

    PubMed

    Heyes, Richard; Lott, David G

    2017-12-01

    Objective Laryngeal cysts may occur at any mucosa-lined location within the larynx and account for 5% to 10% of nonmalignant laryngeal lesions. A number of proposed classifications for laryngeal cysts exist; however, no previously published classification aims to guide management. This review analyzes contemporary laryngeal cyst management and proposes a framework for the terminology and management of cystic lesions in the larynx. Data Sources PubMed/Medline. Review Methods A primary literature search of the entire Medline database was performed for all titles of publications pertaining to laryngeal cysts and reviewed for relevance. Full manuscripts were reviewed per the relevance of their titles and abstracts, and selection into this review was according to their clinical and scientific relevance. Conclusion Laryngeal cysts have been associated with rapid-onset epiglottitis, dyspnea, stridor, and death; therefore, they should not be considered of little significance. Symptoms are varied and nonspecific. Laryngoscopy is the primary initial diagnostic tool. Cross-sectional imaging may be required, and future use of endolaryngeal ultrasound and optical coherence tomography may revolutionize practice. Where possible, cysts should be completely excised, and there is growing evidence that a transoral approach is superior to transcervical excision for nearly all cysts. Histology provides definitive diagnosis, and oncocytic cysts require close follow-up. Implications for Practice A new classification system is proposed that increases clarity in terminology, with the aim of better preparing surgeons and authors for future advances in the understanding and management of laryngeal cysts.

  12. Integration of chronic disease prevention and management services into primary care: a pragmatic randomized controlled trial (PR1MaC).

    PubMed

    Fortin, Martin; Chouinard, Maud-Christine; Dubois, Marie-France; Bélanger, Martin; Almirall, José; Bouhali, Tarek; Sasseville, Maxime

    2016-01-01

    Chronic disease prevention and management programs are usually single-disease oriented. Our objective was to evaluate an intervention that targeted multiple chronic conditions and risk factors. We conducted a pragmatic randomized controlled trial involving patients aged 18-75 years with at least 1 of the targeted chronic conditions or risk factors from 8 primary care practices in the Saguenay region of Quebec, Canada, to evaluate an intervention that included self-management support and patient-centred motivational approaches. Self-management (primary outcome) was evaluated using the Health Education Impact Questionnaire (heiQ). Secondary outcomes included self-efficacy, health-related quality of life, psychological distress and health behaviours. Three hundred thirty-two patients were recruited and randomly assigned ( n = 166 for both intervention and control groups) and evaluated after 3 months. The intervention group showed improvement in 6 of the 8 heiQ domains: health-directed behaviour (relative risk [RR] 1.71, 95% confidence interval [CI] 1.13 to 2.59), emotional well-being (RR 1.73, 95% CI 1.07 to 2.79), self-monitoring and insight (RR 2.40, 95% CI 1.19 to 4.86), constructive attitudes and approaches (RR 2.40, 95% CI 1.37 to 4.21), skill and technique acquisition (RR 1.70, 95% CI 1.14 to 2.53), and health service navigation (RR 1.93, 95% CI 1.08 to 3.47). Improvement was also observed in the Physical Component Summary ( p = 0.017) and the Single Index ( p = 0.041) of the 12-Item Short Form Health Survey (version 2). The intervention group improved in fruit and vegetable consumption (odds ratio [OR] 2.36, 95% CI 1.41 to 3.95) and physical activity (OR 3.81, 95% CI 1.65 to 8.76). One-year improvement was maintained in the intervention group for several outcomes. It is possible to implement an intervention integrating chronic disease prevention and management services into primary care settings. We obtained positive and promising results using this intervention. Trial registration: ClinicalTrials.gov, no.: NCT01319656.

  13. “Post partum hemorrhage: causes and management”

    PubMed Central

    2013-01-01

    Background Post partum hemorrhage is defined as blood loss of 500 ml or above. It is the most common cause of pre-mature mortality of women world wide. Our objective was to evaluate the most common etiology and method of management of Post partum Hemorrhage in a tertiary care hospital of Karachi. Findings It was a cross sectional study conducted at Liaquat National Hospital Karachi, during the period of July 2011 to May 2012. Review include mode of delivery, possible cause of postpartum hemorrhage, supportive, medical and surgical interventions. All the women admitted with post partum hemorrhage or develop PPH in hospital after delivery were included in our study. Bleeding disorder and use of anticoagulants were set as exclusion criteria. Diagnosis was made on the basis of blood loss assessment which was made via subjective and objective evaluation. During the targeted months, out of total 1493 deliveries (26/1493 = 1.741%) 26 cases of post partum hemorrhage were reported with a mean age of 26.153 ± 7.37. No deaths were reported and all cases were referred and unbooked cases. All Patients were conscious, tachycardiac and hypotensive. Most of the women were suffering from hemorrhage during or after the birth of their 1st child. Primary post partum hemorrhage emerge as the most common type of post partum hemorrhage and uterine atony was detected as the most common cause of primary post partum hemorrhage. Retained products of conception was the most common cause of secondary post partum hemorrhage and hysterectomy was found to be the most frequent method of management of post partum hemorrhage. Conclusion This study highlights the existing variable practices for the management of postpartum hemorrhage. Hemorrhage associated morbidity and mortality can be prevented by critical judgment, early referral and resuscitation by attendants. Introduction of an evidence-based management model can potentially reduce the practice variability and improve the quality of care. PMID:23773785

  14. [Community health in primary health care teams: a management objective].

    PubMed

    Nebot Adell, Carme; Pasarin Rua, Maribel; Canela Soler, Jaume; Sala Alvarez, Clara; Escosa Farga, Alex

    2016-12-01

    To describe the process of development of community health in a territory where the Primary Health Care board decided to include it in its roadmap as a strategic line. Evaluative research using qualitative techniques, including SWOT analysis on community health. Two-steps study. Primary care teams (PCT) of the Catalan Health Institute in Barcelona city. The 24 PCT belonging to the Muntanya-Dreta Primary Care Service in Barcelona city, with 904 professionals serving 557,430 inhabitants. Application of qualitative methodology using SWOT analysis in two steps (two-step study). Step 1: Setting up a core group consisting of local PCT professionals; collecting the community projects across the territory; SWOT analysis. Step 2: From the needs identified in the previous phase, a plan was developed, including a set of training activities in community health: basic, advanced, and a workshop to exchange experiences from the PCTs. A total of 80 team professionals received specific training in the 4 workshops held, one of them an advanced level. Two workshops were held to exchange experiences with 165 representatives from the local teams, and 22 PCTs presenting their practices. In 2013, 6 out of 24 PCTs have had a community diagnosis performed. Community health has achieved a good level of development in some areas, but this is not the general situation in the health care system. Its progression depends on the management support they have, the local community dynamics, and the scope of the Primary Health Care. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  15. Innovative approach to patient-centered care coordination in primary care practices.

    PubMed

    Clarke, Robin; Bharmal, Nazleen; Di Capua, Paul; Tseng, Chi-Hong; Mangione, Carol M; Mittman, Brian; Skootsky, Samuel A

    2015-09-01

    Although care coordination is an essential component of the patient-centered medical home structure, current case manager models have limited usefulness to population health because they typically serve a small group of patients defined based on disease or utilization. Our objective was to support our health system's population health by implementing and evaluating a program that embedded nonlicensed coordinators within our primary care practices to support physicians in executing care plans and communicating with patients. Matched case-control differences-in-differences. Comprehensive care coordinators (CCC) were introduced into 14 of the system's 28 practice sites in 2 waves. After a structured training program, CCCs identified, engaged, and intervened among patients within the practice in conjunction with practice primary care providers. We counted and broadly coded CCC activities that were documented in the intervention database. We examined the impact of CCC intervention on emergency department (ED) utilization at the practice level using a negative binomial multivariate regression model controlling for age, gender, and medical complexity. CCCs touched 10,500 unique patients over a 1-year period. CCC interventions included execution of care (38%), coordination of transitions (32%), self-management support/link to community resources (15%), monitor and follow-up (10%), and patient assessment (1%). The CCC intervention group had a 20% greater reduction in its prepost ED visit rate compared with the control group (P < .0001). Our CCC intervention demonstrated a significant reduction in ED visits by focusing on the centrality of the primary care provider and practice. Our model may serve as a cost-effective and scalable alternative for care coordination in primary care.

  16. Comparison of application of 2013 ACC/AHA guideline and 2011 European Society of Cardiology guideline for the management of dyslipidemias for primary prevention in a Turkish cohort

    PubMed Central

    Yılmaz, Mustafa; Atar, İlyas; Hasırcı, Senem; Akyol, Kadirhan; Tekin, Abdullah; Karaçağlar, Emir; Çiftçi, Orçun; Müderrisoğlu, Haldun

    2017-01-01

    Objective: Atherosclerotic cardiovascular disease is a major global cause of death. The common approach in primary prevention of cardiovascular disease is to identify patients at high risk for cardiovascular disease. This article analyzes and compares the application of 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline and the 2011 European Society of Cardiology (ESC) guideline for the management of dyslipidemias for primary prevention in Turkish population. Methods: The study included 833 patients (482 women and 351 men). Risk scores were calculated according to both guidelines and indications for statin treatment were determined according to sex and age group. Variables are presented as mean±SD or median with interquartile range for continuous data and as proportions for categorical data. Variables were analyzed by unpaired t-test, Mann-Whitney U test, chi-square or Fischer’s exact test as appropriate. Results: The ACC/AHA would suggest statin treatment in 415 patients out of 833 (49.5%), while ESC would recommend statin for 193 patients out of 833 (23.1%) (p<0.001). Statins would be recommended for 40.4% of women and 62.6% of men for primary prevention by the ACC/AHA, while this figure was 12% for women and 38.4% for men according to the ESC guideline (p<0.001 for both). Conclusion: When compared to the ESC guideline, the ACC/AHA guideline suggests augmented statin treatment for primary prevention in Turkish population. PMID:27684519

  17. 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. © 2011 Wiley Periodicals, Inc.

  18. Chronic disease management perspectives of colorectal cancer survivors using the Veterans Affairs healthcare system: a qualitative analysis.

    PubMed

    Zullig, Leah L; Goldstein, Karen M; Bosworth, Hayden B; Andrews, Sara M; Danus, Susanne; Jackson, George L; Provenzale, Dawn; Weinberger, Morris; Kelley, Michael J; Voils, Corrine I

    2018-03-09

    Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the US. CRC survivors may have complex healthcare needs requiring care from both specialists and primary care. Our objective was to understand how CRC survivors perceive their survivorship care, especially management of their cardiovascular-related chronic diseases. We identified patients diagnosed with non-metastatic CRC between 10/1/2007 and 12/31/2015 at Veterans Affairs Medical Centers in North Carolina or Virginia. In 2016, we conducted telephone-based, semi-structured interviews to assess survivors' experiences with cancer survivorship and changes in health priorities. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed, and coded. The 25 participants were, on average, 64 years old and approximately 4 years post-CRC diagnosis at the time of interview; most were white (60%), male (92%), and diagnosed with colon cancer (64%) as opposed to rectal cancer. CRC survivors reported: (1) a shift in focus from surviving cancer to reducing cardiovascular disease risk (e.g., by managing weight); (2) challenges with taking medications for CVD-related conditions; (3) new recognition of the importance of engaging with primary care providers. Experiences with cancer shapes how survivors view their health. Management of cardiovascular-related chronic disease is important to veteran CRC survivors. There is a need to deliver cardiovascular disease risk reduction programs tailored for CRC survivors.

  19. Dietitian-general practitioner interface: a pilot study on what influences the provision of effective nutrition management.

    PubMed

    Nicholas, Lisa G; Pond, C Dimity; Roberts, David C K

    2003-04-01

    Effective patient nutrition management can both improve people's health and reduce the cost of health care. In Australia, general practitioners (GPs) and dietitians are in a position to provide this service. However, there is a lack of information available on what influences the provision of the service. The objective was to determine qualitative factors that influence nutrition management by GPs and dietitians. A convenience sample of GPs and dietitians was surveyed using a qualitative questionnaire. The questionnaire related to issues including influences on the GP's decision to initiate nutrition management, barriers to providing nutrition counseling, influences on the GP's decision to refer to a dietitian, and barriers to referral. Fourteen of 20 GPs and 15 of 30 dietitians responded with usable data. The primary influence on a GP's decision to initiate nutrition management (GPs' and dietitians' responses) was the presentation of a patient who required nutrition advice. Barriers to providing nutrition counseling were time and knowledge (GP response), whereas dietitians saw time and lack of patient interest as issues. The primary influence on the GP's decision to refer to a dietitian was a patient presenting with complicated nutrition requirements (GP response), whereas dietitians considered a patient seeking nutrition knowledge as the key influencer. GPs identified cost to the patient as the main barrier to referring to a dietitian, whereas dietitians saw lack of knowledge of where to refer as the key issue. The differing responses suggest that more research is required to understand what influences patient nutrition management by GPs and dietitians in Australia.

  20. Provider Experiences With the Identification, Management, and Treatment of Co-Occurring Chronic Non-cancer Pain and Substance Use in the Safety Net

    PubMed Central

    Chang, Jamie Suki; Kushel, Margot; Miaskowski, Christine; Ceasar, Rachel; Zamora, Kara; Hurstak, Emily; Knight, Kelly R.

    2017-01-01

    Background In the US and internationally, providers have adopted guidelines on the management of prescription opioids for chronic non-cancer pain (CNCP). For “high-risk” patients with co-occurring CNCP and a history of substance use, guidelines advise providers to monitor patients using urine toxicology screening tests, develop opioid management plans, and refer patients to substance use treatment. Objective We report primary care provider experiences in the safety net interpreting and implementing guideline recommendations for patients with CNCP and substance use. Methods We interviewed primary care providers who work in the safety net (N=23) on their experiences managing CNCP and substance use. We analyzed interviews using a content analysis method. Results Providers found management plans and urine toxicology screening tests useful for informing patients about clinic expectations of opioid therapy and substance use. However, they described that guideline-based clinic policies had unintended consequences, such as raising barriers to open, honest dialogue about substance use and treatment. While substance use treatment was recommended for “high-risk” patients, providers described lack of integration with and availability of substance use treatment programs. Conclusions Our findings indicate that clinicians in the safety net found guideline-based clinic policies helpful. However, effective implementation was challenged by barriers to open dialogue about substance use and limited linkages with treatment programs. Further research is needed to examine how the context of safety net settings shapes the management and treatment of co-occurring CNCP and substance use. PMID:27754719

  1. A major trauma course based on posters, audio-guides and simulation improves the management skills of medical students: Evaluation via medical simulator.

    PubMed

    Cuisinier, Adrien; Schilte, Clotilde; Declety, Philippe; Picard, Julien; Berger, Karine; Bouzat, Pierre; Falcon, Dominique; Bosson, Jean Luc; Payen, Jean-François; Albaladejo, Pierre

    2015-12-01

    Medical competence requires the acquisition of theoretical knowledge and technical skills. Severe trauma management teaching is poorly developed during internship. Nevertheless, the basics of major trauma management should be acquired by every future physician. For this reason, the major trauma course (MTC), an educational course in major traumatology, has been developed for medical students. Our objective was to evaluate, via a high fidelity medical simulator, the impact of the MTC on medical student skills concerning major trauma management. The MTC contains 3 teaching modalities: posters with associated audio-guides, a procedural workshop on airway management and a teaching session using a medical simulator. Skills evaluation was performed 1 month before (step 1) and 1 month after (step 3) the MTC (step 2). Nineteen students were individually evaluated on 2 different major trauma scenarios. The primary endpoint was the difference between steps 1 and 3, in a combined score evaluating: admission, equipment, monitoring and safety (skill set 1) and systematic clinical examinations (skill set 2). After the course, the combined primary outcome score improved by 47% (P<0.01). Scenario choice or the order of use had no significant influence on the skill set evaluations. This study shows improvement in student skills for major trauma management, which we attribute mainly to the major trauma course developed in our institution. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  2. Primary repair vs. colostomy in colon injuries.

    PubMed

    Robles-Castillo, Javier; Murillo-Zolezzi, Adrián; Murakami, Pablo Daniel; Silva-Velasco, Jorge

    2009-01-01

    Colon trauma is frequent and its prevalence is difficult to establish because of the different factors that intervene in its origin. In Mexico, traumatic colon injuries, albeit stab wounds or gunshot wounds, are on the rise. Our objective was to evaluate the most appropriate management for traumatic colon injuries. We conducted a retrospective study of 178 case files of patients with abdominal trauma and colon lesions during a 5-year period from January 2003 to June 2008 from the General Hospital of Balbuena, Mexico City. The study compared the use of primary closure vs. colostomy, analyzing variables such as sex, age, type of wound, severity of lesion and mortality. There were a total of 178 patients; 156 were male (87.6%) and 22 were female (12.4%). The most affected age group was between 21 and 30 years; 74 patients (41.6%) had stab wounds and 104 patients (58.4%) had gunshot wounds. Management consisted mainly of primary closure in 92 cases (51.7%) vs. colostomy in 86 patients (48.3%). However, 64% of gunshot wounds were treated with colostomy. Reported mortality was 9.55% and this was due to different factors such as multiple organ injury. Treatment of traumatic colon injury should be case specific, taking into account the mechanism of the lesion, its severity and associated injuries.

  3. Are care plans suitable for the management of multiple conditions?

    PubMed Central

    Young, Charlotte E.; Boyle, Frances M.; Mutch, Allyson J.

    2016-01-01

    Background Care plans have been part of the primary care landscape in Australia for almost two decades. With an increasing number of patients presenting with multiple chronic conditions, it is timely to consider whether care plans meet the needs of patients and clinicians. Objectives To review and benchmark existing care plan templates that include recommendations for comorbid conditions, against four key criteria: (i) patient preferences, (ii) setting priorities, (iii) identifying conflicts and synergies between conditions, and (iv) setting dates for reviewing the care plan. Design Document analysis of Australian care plan templates published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Results Sixteen templates were reviewed. All of the care plan templates addressed patient preference, but this was not done comprehensively. Only three templates included setting priorities. None assisted in identifying conflicts and synergies between conditions. Fifteen templates included setting a date for reviewing the care plan. Conclusions Care plans are a well-used tool in primary care practice, but their current format perpetuates a single-disease approach to care, which works contrary to their intended purpose. Restructuring care plans to incorporate shared decision-making and attention to patient preferences may assist in shifting the focus back to the patient and their care needs. PMID:29090181

  4. International Primary Care Respiratory Group (IPCRG) Guidelines: management of asthma.

    PubMed

    van der Molen, Thys; Østrem, Anders; Stallberg, Bjorn; Østergaard, Marianne Stubbe; Singh, Raj B

    2006-02-01

    Worldwide, most patients with asthma are treated in primary care. Optimal primary care management of asthma is therefore of considerable importance. This IPCRG Guideline paper on the management of asthma in primary care is fully consistent with GINA guidelines. It is split into two sections, the first on the management of adults and schoolchildren, and the second on the management of pre-school children. It highlights the treatment goals for asthma and gives an overview of optimal management including the topics which should be covered by the primary care health professional when educating a patient about asthma. It covers the classification of the disease, the stepwise approach to pharmacologic therapy, disease monitoring, the management of exacerbations, and the identification of patients at risk of asthma death.

  5. An evaluation of the competencies of primary health care clinic nursing managers in two South African provinces

    PubMed Central

    Munyewende, Pascalia O.; Levin, Jonathan; Rispel, Laetitia C.

    2016-01-01

    Background Managerial competencies to enhance individual and organisational performance have gained currency in global efforts to strengthen health systems. Competent managers are essential in the implementation of primary health care (PHC) reforms that aim to achieve universal health coverage. Objective To evaluate the competencies of PHC clinic nursing managers in two South African provinces. Design A cross-sectional study was conducted in two South African provinces. Using stratified random sampling, 111 PHC clinic nursing managers were selected. All supervisors (n=104) and subordinate nurses (n=383) were invited to participate in the survey on the day of data collection. Following informed consent, the nursing managers, their supervisors, and subordinate nurses completed a 40-item, 360-degree competency assessment questionnaire, with six domains: communication, leadership and management, staff management, financial management, planning and priority setting, and problem-solving. Standard deviations, medians, and inter-quartile ranges (IQRs) were computed separately for PHC nursing managers, supervisors, and subordinate nurses for competencies in the six domains. The Tinsley and Weiss index was used to assess agreement between each of the three possible pairs of raters. Results A 95.4% response rate was obtained, with 105 nursing managers in Gauteng and Free State completing the questionnaires. There was a lack of agreement about nursing managers’ competencies among the three groups of raters. Overall, clinic nursing managers rated themselves high on the five domains of communication (8.6), leadership and management (8.67), staff management (8.75), planning and priority setting (8.6), and problem-solving (8.83). The exception was financial management with a median score of 7.94 (IQR 6.33–9.11). Compared to the PHC clinic managers, the supervisors and subordinate nurses gave PHC nursing managers lower ratings on all six competency domains, with the lowest rating for financial management (supervisor median rating 6.56; subordinate median rating 7.31). Conclusion The financial management competencies of PHC clinic nursing managers need to be prioritised in continuing professional development programmes. PMID:27938631

  6. Astronomical telescope with holographic primary objective

    NASA Astrophysics Data System (ADS)

    Ditto, Thomas D.; Friedman, Jeffrey F.; Content, David A.

    2011-09-01

    A dual dispersion telescope with a plane grating primary objective was previously disclosed that can overcome intrinsic chromatic aberration of dispersive optics while allowing for unprecedented features such as million object spectroscopy, extraordinary étendue, flat primary objective with a relaxed figure tolerance, gossamer membrane substrate stowable as an unsegmented roll inside a delivery vehicle, and extensibility past 100 meter aperture at optical wavelengths. The novel design meets many criteria for space deployment. Other embodiments are suitable for airborne platforms as well as terrestrial and lunar sites. One problem with this novel telescope is that the grazing exodus configuration necessary to achieve a large aperture is traded for throughput efficiency. Now we show how the hologram of a point source used in place of the primary objective plane grating can improve efficiency by lowering the diffraction angle below grazing exodus. An intermediate refractive element is used to compensate for wavelength dependent focal lengths of the holographic primary objective.

  7. Marketing Remote Sensing Data for North Pacific Fisheries Development and Management

    NASA Technical Reports Server (NTRS)

    1995-01-01

    Fish poaching, drug trafficking, ocean dumping, and other illegal activities are important problems on the high seas and in national economic zones. The primary thrust of the EOCAP II project, "Marketing Remote Sensing Data for North Pacific Fisheries Development and Management", was to use space-based sensors to improve the effectiveness of marine monitoring, control, and surveillance (MCS). Our initial objectives were to concentrate on the development of MCS tools using Advanced Very High Resolution Radiometry (AVHRR) and Synthetic Aperture Radar (SAR) data. Although we have successfully completed development of an initial version of our SAR-based monitoring tool (OmniVision), project activity has resulted in a much broader application of space-based assets to marine applications. Based in part on work commenced within EOCAP II, a new company, Ocean and Coastal Environmental Sensing, Inc. (OCENS), has been launched and the development of several new software products outside of the MCS arena initiated. One of those products, SeaStation, is near completion with a Fall, 1995 release date. Equity investment in OCENS now totals $70,000-with an additional amount being sought in the first round of financing. One of the pre-eminent objectives of EOCAP II is to make contributions to the US economy and job growth through the expansion of commercial uses of remotely sensed data. OCENS and the software products it is introducing into marine and coastal zone markets responds to this primary object*e. EOCAP II funding leveraged the market and technical know-how of OCENS founders into smart products that benefit marine and coastal zone users. Although technical difficulties and geopolitical shifts damaged the commercial feasibility of initial project objectives, the flexibility of the EOCAP II program now permits long-term business success. This in no small part stems from the fact that the EOCAP program recognizes the realities of small and start-up businesses and does not attempt to force these conditions to fit the apparent needs of big government. Instead, EOCAP works with those who know their market best in order to produce successful products and expanding businesses.

  8. The Effect of Integration of Self-Management Web Platforms on Health Status in Chronic Obstructive Pulmonary Disease Management in Primary Care (e-Vita Study): Interrupted Time Series Design

    PubMed Central

    Verdijk, Noortje A; Kasteleyn, Marise J; Harmans, Lara M; Talboom, Irvin JSH; Looijmans-van den Akker, Ingrid; van Geloven, Nan; Numans, Mattijs E; Chavannes, Niels H

    2017-01-01

    Background Worldwide nearly 3 million people die from chronic obstructive pulmonary disease (COPD) every year. Integrated disease management (IDM) improves quality of life for COPD patients and can reduce hospitalization. Self-management of COPD through eHealth is an effective method to improve IDM and clinical outcomes. Objectives The objective of this implementation study was to investigate the effect of 3 chronic obstructive pulmonary disease eHealth programs applied in primary care on health status. The e-Vita COPD study compares different levels of integration of Web-based self-management platforms in IDM in 3 primary care settings. Patient health status is examined using the Clinical COPD Questionnaire (CCQ). Methods The parallel cohort design includes 3 levels of integration in IDM (groups 1, 2, 3) and randomization of 2 levels of personal assistance for patients (group A, high assistance, group B, low assistance). Interrupted time series (ITS) design was used to collect CCQ data at multiple time points before and after intervention, and multilevel linear regression modeling was used to analyze CCQ data. Results Of the 702 invited patients, 215 (30.6%) registered to a platform. Of these, 82 participated in group 1 (high integration IDM), 36 in group 1A (high assistance), and 46 in group 1B (low assistance); 96 participated in group 2 (medium integration IDM), 44 in group 2A (high assistance) and 52 in group 2B (low assistance); also, 37 participated in group 3 (no integration IDM). In the total group, no significant difference was found in change in CCQ trend (P=.334) before (–0.47% per month) and after the intervention (–0.084% per month). Also, no significant difference was found in CCQ changes before versus after the intervention between the groups with high versus low personal assistance. In all subgroups, there was no significant change in the CCQ trend before and after the intervention (group 1A, P=.237; 1B, P=.991; 2A, P=.120; 2B, P=.166; 3, P=.945). Conclusions The e-Vita eHealth-supported COPD programs had no beneficial impact on the health status of COPD patients. Also, no differences were found between the patient groups receiving different levels of personal assistance. Trial Registration Netherlands Trial Registry NTR4098; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4098 (Archived by WebCite at http://www.webcitation.org/6sbM5PayG) PMID:28814380

  9. Participation in the Cluster Magnetometer Consortium for the Cluster Mission

    NASA Technical Reports Server (NTRS)

    Kivelson, Margaret

    1997-01-01

    Prof. M. G. Kivelson (UCLA) and Dr. R. C. Elphic (LANL) are Co-investigators on the Cluster Magnetometer Consortium (CMC) that provided the fluxgate magnetometers and associated mission support for the Cluster Mission. The CMC designated UCLA as the site with primary responsibility for the inter-calibration of data from the four spacecraft and the production of fully corrected data critical to achieving the mission objectives. UCLA was also charged with distributing magnetometer data to the U.S. Co-investigators. UCLA also supported the Technical Management Team, which was responsible for the detailed design of the instrument and its interface. In this final progress report we detail the progress made by the UCLA team in achieving the mission objectives.

  10. Clinical managers in the primary care sector: do the benefits stack up?

    PubMed

    O'Riordan, Chris; McDermott, Aoife

    2012-01-01

    The purpose of this paper is to explore the nature and value of the clinical management role undertaken by primary care doctors in Ireland. To date, a majority of research has focused on clinical management roles in the acute sector. The paper presents a sub-set of data from a mixed methods study. In total, 14 semi-structured interviews are drawn upon to identify the nature and value of the clinical management role in primary care. Comparison with acute sector research identifies considerable differences in the nature of the clinical management role across sectors--and in the associated value proposition. Structural and role-related contingencies affecting the potential value of clinical management roles in Irish primary care are discussed. Structural influences include the private ownership structure, low complexity and limited requirement for cross-professional coordination. Role-related influences include the primacy of the clinical identity, time constraints and lack of managerial training. The findings provide a limited basis for generalisation, premised on 14 interviews in one national context. However, given the international shift towards the provision of health services in primary care, they provide a research agenda for an important healthcare context. The findings draw attention to the need for policy consideration of the value of the clinical manager role in primary care; how policy can support effective primary care management; and the need for specialised management training, which takes account of the small-firm context. The paper identifies that primary-care clinical-management roles focus on operational management and oversight and discusses the structural and role-related factors which affect their efficacy.

  11. Outpatient Management of Neonatal Abstinence Syndrome: A Quality Improvement Project.

    PubMed

    Chau, Kim T; Nguyen, Jacqueline; Miladinovic, Branko; Lilly, Carol M; Ashmeade, Terri L; Balakrishnan, Maya

    2016-11-01

    An increasing number of infants are diagnosed with neonatal abstinence syndrome (NAS). The study's primary objectives were to describe an academic medical center's level IV neonatal ICU's (NICU's) comprehensive outpatient NAS management effort, measure guideline compliance, and assess its safety. Secondary objectives were to describe the duration and cumulative methadone exposure, and to improve parent and provider knowledge of NAS. The study included 22 infants having a gestational age of 35-41 weeks, diagnosed with NAS, and discharged for outpatient methadone management. Discharges spanned 10 months and included 3 improvement periods. The outpatient program includes comprehensive discharge planning, a focused electronic health record (EHR) template, management guidelines, and parent and provider education. Providers complied with using the outpatient management guideline and EHR template, and assessed weight, NAS symptoms, and methadone dose during appointments. Two infants required NAS-related hospital readmission in the study period. From improvement period 1 to period 3 there was no difference in total outpatient days on methadone (58, 53, 74 days, respectively) or cumulative methadone dose (2.7, 2.6, 3.1mg/kg, respectively). A downward trend pattern in cumulative methadone exposure was noted in improvement period 2. Pre- and postimplementation surveys revealed that after implementation, parents had better understanding of NAS before delivery (71% vs. 100%, p = 0.009), while providers had increased comfort with outpatient management (24% vs. 67%, p < 0.001) and educating parents (48% vs. 82%, p = 0.001). This preliminary study suggests that outpatient NAS management can be safe when a comprehensive management program is implemented and can result in provider compliance with the program. Copyright 2016 The Joint Commission.

  12. Developing a monitoring and evaluation framework to integrate and formalize the informal waste and recycling sector: the case of the Philippine National Framework Plan.

    PubMed

    Serrona, Kevin Roy B; Yu, Jeongsoo; Aguinaldo, Emelita; Florece, Leonardo M

    2014-09-01

    The Philippines has been making inroads in solid waste management with the enactment and implementation of the Republic Act 9003 or the Ecological Waste Management Act of 2000. Said legislation has had tremendous influence in terms of how the national and local government units confront the challenges of waste management in urban and rural areas using the reduce, reuse, recycle and recovery framework or 4Rs. One of the sectors needing assistance is the informal waste sector whose aspiration is legal recognition of their rank and integration of their waste recovery activities in mainstream waste management. To realize this, the Philippine National Solid Waste Management Commission initiated the formulation of the National Framework Plan for the Informal Waste Sector, which stipulates approaches, strategies and methodologies to concretely involve the said sector in different spheres of local waste management, such as collection, recycling and disposal. What needs to be fleshed out is the monitoring and evaluation component in order to gauge qualitative and quantitative achievements vis-a-vis the Framework Plan. In the process of providing an enabling environment for the informal waste sector, progress has to be monitored and verified qualitatively and quantitatively and measured against activities, outputs, objectives and goals. Using the Framework Plan as the reference, this article developed monitoring and evaluation indicators using the logical framework approach in project management. The primary objective is to institutionalize monitoring and evaluation, not just in informal waste sector plans, but in any waste management initiatives to ensure that envisaged goals are achieved. © The Author(s) 2014.

  13. NASA TSRV essential flight control system requirements via object oriented analysis

    NASA Technical Reports Server (NTRS)

    Duffy, Keith S.; Hoza, Bradley J.

    1992-01-01

    The objective was to analyze the baseline flight control system of the Transport Systems Research Vehicle (TSRV) and to develop a system specification that offers high visibility of the essential system requirements in order to facilitate the future development of alternate, more advanced software architectures. The flight control system is defined to be the baseline software for the TSRV research flight deck, including all navigation, guidance, and control functions, and primary pilot displays. The Object Oriented Analysis (OOA) methodology developed is used to develop a system requirement definition. The scope of the requirements definition contained herein is limited to a portion of the Flight Management/Flight Control computer functionality. The development of a partial system requirements definition is documented, and includes a discussion of the tasks required to increase the scope of the requirements definition and recommendations for follow-on research.

  14. Workarounds and Test Results Follow-up in Electronic Health Record-Based Primary Care

    PubMed Central

    Menon, Shailaja; Murphy, Daniel R.; Singh, Hardeep; Meyer, Ashley N. D.

    2016-01-01

    Summary Background Electronic health records (EHRs) have potential to facilitate reliable communication and follow-up of test results. However, limitations in EHR functionality remain, leading practitioners to use workarounds while managing test results. Workarounds can lead to patient safety concerns and signify indications as to how to build better EHR systems that meet provider needs. Objective To understand why primary care practitioners (PCPs) use workarounds to manage test results by analyzing data from a previously conducted national cross-sectional survey on test result management. Methods We conducted a secondary data analysis of quantitative and qualitative data from a national survey of PCPs practicing in the Department of Veterans Affairs (VA) and explored the use of workarounds in test results management. We used multivariate logistic regression analysis to examine the association between key sociotechnical factors that could affect test results follow-up (e.g., both technology-related and those unrelated to technology, such as organizational support for patient notification) and workaround use. We conducted a qualitative content analysis of free text survey data to examine reasons for use of workarounds. Results Of 2554 survey respondents, 1104 (43%) reported using workarounds related to test results management. Of these 1028 (93%) described the type of workaround they were using; 719 (70%) reported paper-based methods, while 230 (22%) used a combination of paper- and computer-based workarounds. Primary care practitioners who self-reported limited administrative support to help them notify patients of test results or described an instance where they personally (or a colleague) missed results, were more likely to use workarounds (p=0.02 and p=0.001, respectively). Qualitative analysis identified three main reasons for workaround use: 1) as a memory aid, 2) for improved efficiency and 3) for facilitating internal and external care coordination. Conclusion Workarounds to manage EHR-based test results are common, and their use results from unmet provider information management needs. Future EHRs and the respective work systems around them need to evolve to meet these needs. PMID:27437060

  15. Involvement of a Case Manager in Palliative Care Reduces Hospitalisations at the End of Life in Cancer Patients; A Mortality Follow-Back Study in Primary Care

    PubMed Central

    van der Plas, Annicka G. M.; Vissers, Kris C.; Francke, Anneke L.; Donker, Gé A.; Jansen, Wim J. J.; Deliens, Luc; Onwuteaka-Philipsen, Bregje D.

    2015-01-01

    Background Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse. Objectives To compare cancer patients with and without additional support from a case manager on: 1) the patients’ general characteristics, 2) characteristics of care and support given by the GP, 3) palliative care outcomes. Methods This article is based on questionnaire data provided by GPs participating in two different studies: the Sentimelc study (280 cancer patients) and the Capalca study (167 cancer patients). The Sentimelc study is a mortality follow-back study amongst a representative sample of GPs that monitors the care provided via GPs to a general population of end-of-life patients. Data from 2011 and 2012 were analysed. The Capalca study is a prospective study investigating the implementation and outcome of the support provided by case managers in primary palliative care. Data were gathered between March 2011 and December 2013. Results The GP is more likely to know the preferred place of death (OR 7.06; CI 3.47-14.36), the place of death is more likely to be at the home (OR 2.16; CI 1.33-3.51) and less likely to be the hospital (OR 0.26; CI 0.13-0.52), and there are fewer hospitalisations in the last 30 days of life (none: OR 1.99; CI 1.12-3.56 and one: OR 0.54; CI 0.30-0.96), when cancer patients receive additional support from a case manager compared with patients receiving the standard GP care. Conclusions Involvement of a case manager has added value in addition to palliative care provided by the GP, even though the role of the case manager is ‘only’ advisory and he or she does not provide hands-on care or prescribe medication. PMID:26208099

  16. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

    PubMed Central

    Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

    2016-01-01

    Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

  17. Timber Resources Inventory and Monitoring Joint Research Project

    NASA Technical Reports Server (NTRS)

    Hill, C. L.

    1985-01-01

    Primary objectives were to develop remote sensing analysis techniques for extracting forest related information from LANDSAT Multispectral Scanner (MMS) and Thematic Mapper data and to determine the extent to which International Paper Company information needs can be addressed with remote sensing information. The company actively manages 8.4 million acres of forest land. Traditionally, their forest inventories, updated on a three year cycle, are conducted through field surveys and aerial photography. The results reside in a digital forest data base containing 240 descriptive parameteres for individual forest stands. The information in the data base is used to develop seasonal and long range management strategies. Forest stand condition assessements (species composition, age, and density stratification) and identification of silvicultural activities (site preparation, planting, thinning, and harvest) are addressed.

  18. An enhanced Ada run-time system for real-time embedded processors

    NASA Technical Reports Server (NTRS)

    Sims, J. T.

    1991-01-01

    An enhanced Ada run-time system has been developed to support real-time embedded processor applications. The primary focus of this development effort has been on the tasking system and the memory management facilities of the run-time system. The tasking system has been extended to support efficient and precise periodic task execution as required for control applications. Event-driven task execution providing a means of task-asynchronous control and communication among Ada tasks is supported in this system. Inter-task control is even provided among tasks distributed on separate physical processors. The memory management system has been enhanced to provide object allocation and protected access support for memory shared between disjoint processors, each of which is executing a distinct Ada program.

  19. Electronic health information system at an opioid treatment programme: roadblocks to implementation

    PubMed Central

    Louie, Ben; Kritz, Steven; Brown, Lawrence S.; Chu, Melissa; Madray, Charles; Zavala, Roberto

    2012-01-01

    Rationale Electronic health systems are commonly included in health care reform discussions. However, their embrace by the health care community has been slow. Methods At Addiction Research and Treatment Corporation, a methadone maintenance programme that also provides primary medical care, HIV medical care and case management, substance abuse counselling and vocational services, we describe our experience in implementing an electronic health information system that encompasses all of these areas. Results We describe the challenges and opportunities of this process in terms of change management, hierarchy of corporate objectives, process mastering, training issues, information technology governance, electronic security, and communication and collaboration. Conclusion This description may provide practical insights to other institutions seeking to pursue this technology. PMID:21414111

  20. Electronic health information system at an opioid treatment programme: roadblocks to implementation.

    PubMed

    Louie, Ben; Kritz, Steven; Brown, Lawrence S; Chu, Melissa; Madray, Charles; Zavala, Roberto

    2012-08-01

    Electronic health systems are commonly included in health care reform discussions. However, their embrace by the health care community has been slow. At Addiction Research and Treatment Corporation, a methadone maintenance programme that also provides primary medical care, HIV medical care and case management, substance abuse counselling and vocational services, we describe our experience in implementing an electronic health information system that encompasses all of these areas. We describe the challenges and opportunities of this process in terms of change management, hierarchy of corporate objectives, process mastering, training issues, information technology governance, electronic security, and communication and collaboration. This description may provide practical insights to other institutions seeking to pursue this technology. © 2011 Blackwell Publishing Ltd.

  1. Design of System Scheme and Operationmechanism on Agricultural Science &Technology Information Service System `110'

    NASA Astrophysics Data System (ADS)

    Wu, Yongchang; Hu, Zhiquan; Xiao, Bilin; Li, Quanxin

    Agricultural science & technology information service system ‘110’ (ASTISS-110), connected through unitary telephone hotline as well as multipurpose service of the network, television and video etc, is one of the most characteristic content of the Chinese rural informatization. ASTISS-110 is a low cost and high efficiency way to make the agricultural science & technology achievements extension and achieve the combination of science & technology with farmers in the rural area. This paper would primary focus on the ASTISS-110 foundation and system principle. On basis of its main functions and system objectives, we put forward the combination of the ‘Sky- Land-People’ technical solution, and analyze the management operation mechanism from commonweal service, enterprise management and commercialization operation.

  2. Wake Management Strategies for Reduction of Turbomachinery Fan Noise

    NASA Technical Reports Server (NTRS)

    Waitz, Ian A.

    1998-01-01

    The primary objective of our work was to evaluate and test several wake management schemes for the reduction of turbomachinery fan noise. Throughout the course of this work we relied on several tools. These include 1) Two-dimensional steady boundary-layer and wake analyses using MISES (a thin-shear layer Navier-Stokes code), 2) Two-dimensional unsteady wake-stator interaction simulations using UNSFLO, 3) Three-dimensional, steady Navier-Stokes rotor simulations using NEWT, 4) Internal blade passage design using quasi-one-dimensional passage flow models developed at MIT, 5) Acoustic modeling using LINSUB, 6) Acoustic modeling using VO72, 7) Experiments in a low-speed cascade wind-tunnel, and 8) ADP fan rig tests in the MIT Blowdown Compressor.

  3. People and Teams Matter in Organizational Change: Professionals’ and Managers’ Experiences of Changing Governance and Incentives in Primary Care

    PubMed Central

    Allan, Helen T; Brearley, Sally; Byng, Richard; Christian, Sara; Clayton, Julie; Mackintosh, Maureen; Price, Linnie; Smith, Pam; Ross, Fiona

    2014-01-01

    ObjectivesTo explore the experiences of governance and incentives during organizational change for managers and clinical staff. Study SettingThree primary care settings in England in 2006–2008. Study DesignData collection involved three group interviews with 32 service users, individual interviews with 32 managers, and 56 frontline professionals in three sites. The Realistic Evaluation framework was used in analysis to examine the effects of new policies and their implementation. Principal FindingsIntegrating new interprofessional teams to work effectively is a slow process, especially if structures in place do not acknowledge the painful feelings involved in change and do not support staff during periods of uncertainty. ConclusionsEliciting multiple perspectives, often dependent on individual occupational positioning or place in new team configurations, illuminates the need to incorporate the emotional as well as technocratic and system factors when implementing change. Some suggestions are made for facilitating change in health care systems. These are discussed in the context of similar health care reform initiatives in the United States. PMID:23829292

  4. Community pharmacy-delivered interventions for public health priorities: a systematic review of interventions for alcohol reduction, smoking cessation and weight management, including meta-analysis for smoking cessation

    PubMed Central

    Brown, Tamara J; Todd, Adam; O'Malley, Claire; Moore, Helen J; Husband, Andrew K; Bambra, Clare; Kasim, Adetayo; Sniehotta, Falko F; Steed, Liz; Smith, Sarah; Nield, Lucie; Summerbell, Carolyn D

    2016-01-01

    Objectives To systematically review the effectiveness of community pharmacy-delivered interventions for alcohol reduction, smoking cessation and weight management. Design Systematic review and meta-analyses. 10 electronic databases were searched from inception to May 2014. Eligibility criteria for selecting studies Study design: randomised and non-randomised controlled trials; controlled before/after studies, interrupted times series. Intervention: any relevant intervention set in a community pharmacy, delivered by the pharmacy team. No restrictions on duration, country, age, or language. Results 19 studies were included: 2 alcohol reduction, 12 smoking cessation and 5 weight management. Study quality rating: 6 ‘strong’, 4 ‘moderate’ and 9 ‘weak’. 8 studies were conducted in the UK, 4 in the USA, 2 in Australia, 1 each in 5 other countries. Evidence from 2 alcohol-reduction interventions was limited. Behavioural support and/or nicotine replacement therapy are effective and cost-effective for smoking cessation: pooled OR was 2.56 (95% CI 1.45 to 4.53) for active intervention vs usual care. Pharmacy-based interventions produced similar weight loss compared with active interventions in other primary care settings; however, weight loss was not sustained longer term in a range of primary care and commercial settings compared with control. Pharmacy-based weight management interventions have similar provider costs to those delivered in other primary care settings, which are greater than those delivered by commercial organisations. Very few studies explored if and how sociodemographic or socioeconomic variables moderated intervention effects. Insufficient information was available to examine relationships between effectiveness and behaviour change strategies, implementation factors, or organisation and delivery of interventions. Conclusions Community pharmacy-delivered interventions are effective for smoking cessation, and demonstrate that the pharmacy is a feasible option for weight management interventions. Given the potential reach, effectiveness and associated costs of these interventions, commissioners should consider using community pharmacies to help deliver public health services. PMID:26928025

  5. Hospitals Negotiating Leverage with Health Plans: How and Why Has It Changed?

    PubMed Central

    Devers, Kelly J; Casalino, Lawrence P; Rudell, Liza S; Stoddard, Jeffrey J; Brewster, Linda R; Lake, Timothy K

    2003-01-01

    Objective To describe how hospitals' negotiating leverage with managed care plans changed from 1996 to 2001 and to identify factors that explain any changes. Data Sources Primary semistructured interviews, and secondary qualitative (e.g., newspaper articles) and quantitative (i.e., InterStudy, American Hospital Association) data. Study Design The Community Tracking Study site visits to a nationally representative sample of 12 communities with more than 200,000 people. These 12 markets have been studied since 1996 using a variety of primary and secondary data sources. Data Collection Methods Semistructured interviews were conducted with a purposive sample of individuals from hospitals, health plans, and knowledgeable market observers. Secondary quantitative data on the 12 markets was also obtained. Principal Findings Our findings suggest that many hospitals' negotiating leverage significantly increased after years of decline. Today, many hospitals are viewed as having the greatest leverage in local markets. Changes in three areas—the policy and purchasing context, managed care plan market, and hospital market—appear to explain why hospitals' leverage increased, particularly over the last two years (2000–2001). Conclusions Hospitals' increased negotiating leverage contributed to higher payment rates, which in turn are likely to increase managed care plan premiums. This trend raises challenging issues for policymakers, purchasers, plans, and consumers. PMID:12650374

  6. Applying the Chronic Care Model to Homeless Veterans: Effect of a Population Approach to Primary Care on Utilization and Clinical Outcomes

    PubMed Central

    Buckel, Lauren; Bourgault, Claire; Blumen, Jonathan; Redihan, Stephen G.; Jiang, Lan; Friedmann, Peter

    2010-01-01

    Objectives. We compared a population-tailored approach to primary care for homeless veterans with a usual care approach. Methods. We conducted a retrospective prolective cohort study of homeless veterans enrolled in a population-tailored primary care clinic matched to a historical sample in general internal medicine clinics. Overall, 177 patients were enrolled: 79 in the Homeless-Oriented Primary Care Clinic and 98 in general internal medicine primary care. Results. Homeless-oriented primary care–enrolled patients had greater improvements in hypertension, diabetes, and lipid control, and primary care use was higher during the first 6 months (5.96 visits per person vs 1.63 for general internal medicine) but stabilized to comparable rates during the second 6 months (2.01 vs 1.31, respectively). Emergency department (ED) use was also higher (2.59 vs 1.89 visits), although with 40% lower odds for nonacute ED visits than for the general internal medicine group (95% confidence interval = 0.2, 0.8). Excluding substance abuse and mental health admissions, hospitalizations were reduced among the homeless veterans between the 2 periods (28.6% vs 10.8%; P < .01) compared with the general internal medicine group (48.2% vs 44.4%; P = .6; difference of differences, P < .01). Conclusions. Tailoring primary care to homeless veterans can decrease unnecessary ED use and medical admissions and improve chronic disease management. PMID:20966377

  7. Supporting nurse practitioners' practice in primary healthcare settings: a three-level qualitative model.

    PubMed

    Chouinard, Véronique; Contandriopoulos, Damien; Perroux, Mélanie; Larouche, Catherine

    2017-06-26

    While greater reliance on nurse practitioners in primary healthcare settings can improve service efficiency and accessibility, their integration is not straightforward, challenging existing role definitions of both registered nurses and physicians. Developing adequate support practices is therefore essential in primary healthcare nurse practitioners' integration. This study's main objective is to examine different structures and mechanisms put in place to support the development of primary healthcare nurse practitioner's practice in different healthcare settings, and develop a practical model for identifying and planning adequate support practices. This study is part of a larger multicentre study on primary healthcare nurse practitioners in the province of Quebec, Canada. It focuses on three healthcare settings into which one or more primary healthcare nurse practitioners have been integrated. Case studies have been selected to cover a maximum of variations in terms of location, organizational setting, and stages of primary healthcare nurse practitioner integration. Findings are based on the analysis of available documentation in each primary healthcare setting and on semi-structured interviews with key actors in each clinical team. Data were analyzed following thematic and cross-sectional analysis approaches. This article identifies three types of support practices: clinical, team, and systemic. This three-level analysis demonstrates that, on the ground, primary healthcare nurse practitioner integration is essentially a team-based, multilevel endeavour. Despite the existence of a provincial implementation plan, the three settings adopted very different implementation structures and practices, and different actors were involved at each of the three levels. The results also indicated that nursing departments played a decisive role at all three levels. Based on these findings, we suggest that support practices should be adapted to each organization's environment and experience and be modified as needed throughout the integration process. We also stress the importance of combining this approach with a strong coordination mechanism involving managers who have in-depth understanding of nursing professional roles and scopes of practice. Making primary healthcare nurse practitioner integration frameworks more flexible and clarifying and strengthening the role of senior nursing managers could be the key to successful integration.

  8. Teleradiology as a foundation for an enterprise-wide health care delivery system.

    PubMed

    Dionisio, J D; Taira, R K; Sinha, U; Johnson, D B; Dai, B Y; Tashima, G H; Blythe, S; Johnson, R; Kangarloo, H

    2000-01-01

    An effective, integrated telemedicine system has been developed that allows (a) teleconsultation between local primary health care providers (primary care physicians and general radiologists) and remote imaging subspecialists and (b) active patient participation related to his or her medical condition and patient education. The initial stage of system development was a traditional teleradiology consultation service between general radiologists and specialists; this established system was expanded to include primary care physicians and patients. The system was developed by using a well-defined process model, resulting in three integrated modules: a patient module, a primary health care provider module, and a specialist module. A middle agent layer enables tailoring and customization of the modules for each specific user type. Implementation by using Java and the Common Object Request Broker Architecture standard facilitates platform independence and interoperability. The system supports (a) teleconsultation between a local primary health care provider and an imaging subspecialist regardless of geographic location and (b) patient education and online scheduling. The developed system can potentially form a foundation for an enterprise-wide health care delivery system. In such a system, the role of radiologist specialists is enhanced from that of a diagnostician to the management of a patient's process of care.

  9. A Regional Approach to Wildlife Monitoring Related to Energy Exploration and Development in Colorado

    USGS Publications Warehouse

    Kotliar, Natasha B.; Bowen, Zachary H.; Ouren, Douglas S.; Farmer, Adrian H.

    2008-01-01

    The U.S. Bureau of Land Management (BLM) is currently developing a National Monitoring Strategy that will guide efforts to create an efficient and effective process for monitoring land health by BLM. To inform the ongoing development of the national strategy, BLM selected two States (Colorado, Alaska) to serve as focal areas on which to base a flexible framework for developing monitoring programs that evaluate wildlife responses to energy development. We developed a three-phase monitoring plan to serve as a template and applied it to the design of a monitoring program for the Colorado focal area (White River and Glenwood Springs Field Offices of the BLM). Phase I is a synthesis and assessment of current conditions that capitalizes on existing but under used data sources. A key component is the use of existing habitat and landscape models to evaluate the cumulative effects of surface disturbance. Phase II is the data collection process that uses information provided in Phase I to refine management objectives and provide a linkage to management decisions. The linkage is established through targeted monitoring, adaptive management, and research. Phase III establishes priorities and strategies for regional and national monitoring, and facilitates coordination among other land management agencies and organizations. The three phases are designed to be flexible and complementary. The monitoring plan guides an iterative process that is performed incrementally, beginning with the highest-priority species and management issues, while building on lessons learned and coordination among administrative levels. The activities associated with each phase can be repeated or updated as new information, data, or tools become available. This allows the development of a monitoring program that expands gradually and allows for rapid implementation. A demonstration application of the three-phase monitoring plan was conducted for a study area encompassing five BLM field offices in Colorado: White River, Glenwood Springs, Kremmling, Grand Junction, and Little Snake. The overall study area was selected to encompass the primary distribution of sagebrush and greater sage-grouse (Centrocercus urophasianus) in Colorado and to provide a larger context for evaluating priority management issues of the White River and Glenwood Springs Field Offices. Within the study area, we selected an additional scale of analysis: the Roan Plateau, an area of increased energy development. We focused our demonstration project on the primary objectives identified by the BLM and other stakeholders: (1) How do we evaluate the cumulative effects of energy development and mitigation activities on species of management interest or concern? (2) How can cumulative effects, including direct and indirect effects, be quantified relative to natural variation? (3) How can we implement compliance and effectiveness monitoring to determine whether lease stipulations are met and restoration/mitigation goals are achieved? We targeted greater sage-grouse because this species was identified as a monitoring priority for the White River Field Office. We also evaluated landscape-level indices to address fragmentation resulting from surface disturbance. The primary purpose of this exercise was to highlight the types of analyses and approaches that could be used to evaluate energy development in an application of the three-phase framework. We provide examples of Phase I products that can be used to guide the refinement of management objectives, development of adaptive management and research frameworks, and planning activities in Phase II. Finally, we report on the BLM's National Sage-Grouse Habitat Conservation Strategy as an example of Phase III activities. The development of an effective monitoring program is a daunting task, and will be difficult to implement by the BLM independently due to the current work load of staff. However, the scientific expertise and experience for developing cr

  10. Management of gout in a South Auckland general practice.

    PubMed

    Reaves, Esther; Arroll, Bruce

    2014-03-01

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

  11. 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.

  12. Global bioanalytical support.

    PubMed

    John Lin, Zhongping; Zhang, Tianyi; Pasas-Farmer, Stephanie; Brooks, Stephen D; Moyer, Michael; Connolly, Ron

    2014-05-01

    With the globalization of drug development, there is an increasing need for global bioanalytical support. Bioanalysis provides pivotal data for toxicokinetic, pharmacokinetic, bioavailability and bioequivalence studies used for regional or global regulatory submission. There are many known complications in building a truly global bioanalytical operation, ranging from lack of global regulatory guidelines and global standard operating procedures to barriers in regional requirements on sample shipping, importation and exportation. The primary objective of this article is to discuss common experiences and challenges facing the biopharmaceutical industry when providing bioanalytical support in a global setting. The key components of global bioanalytical services include the supporting infrastructure, spanning project management, IT support of data management, best practices in bioanalytical method transfer and sample analysis, and comprehensive knowledge of the requirements of bioanalysis guidelines and differences in these guidelines. A case study will highlight best practices for successful management of a global project.

  13. Traffic Management Coordinator Evaluation of the Dynamic Weather Routes Concept and System

    NASA Technical Reports Server (NTRS)

    Gong, Chester

    2014-01-01

    Dynamic Weather Routes (DWR) is a weather-avoidance system for airline dispatchers and FAA traffic managers that continually searches for and advises the user of more efficient routes around convective weather. NASA and American Airlines (AA) have been conducting an operational trial of DWR since July 17, 2012. The objective of this evaluation is to assess DWR from a traffic management coordinator (TMC) perspective, using recently retired TMCs and actual DWR reroutes advisories that were rated acceptable by AA during the operational trial. Results from the evaluation showed that the primary reasons for a TMC to modify or reject airline reroute requests were related to airspace configuration. Approximately 80 percent of the reroutes evaluated required some coordination before implementation. Analysis showed TMCs approved 62 percent of the requested DWR reroutes, resulting in 57 percent of the total requested DWR time savings.

  14. Study on ecological conservation planning of Xianyue Park in Xiamen City, China

    NASA Astrophysics Data System (ADS)

    Xu, Naizhong; Xi, Rong; Ren, Tingyan; Zhao, Peng; Chuai, Zeyao

    2017-08-01

    The paper discusses the current situation and existing problems of ecological restoration and tourist infrastructure development of Xiamen Xianyue Park located in Xiamen Island, China. Issues of ecosystem restoration and landscape improvement, restoring habitats, and ecosystem management system are analyzed. Options of further optimization of the tourist-targeted infrastructure are proposed, which take into account the ecological system and landscape pattern optimization, promotion of ecotourism, and implementation of the ecological management system. The particular solution envisages the park zoning with three primary zones (ecological protection, ecological buffer, and general activity zones) and five secondary ones (scenic landscape, ecotourism, religious activity, buildings and structures, and entertainment zones). By integrating the ecological principles into other land use objectives, taking full advantage of the park ecological and cultural heritage, and improving its ecological management, it is expected to provide the ecological restoration of the park under study and optimize its contribution to the regional economic and social development.

  15. EAF Management Optimization

    NASA Astrophysics Data System (ADS)

    Costoiu, M.; Ioana, A.; Semenescu, A.; Marcu, D.

    2016-11-01

    The article presents the main advantages of electric arc furnace (EAF): it has a great contribution to reintroduce significant quantities of reusable metallic materials in the economic circuit, it constitutes itself as an important part in the Primary Materials and Energy Recovery (PMER), good productivity, good quality / price ratio, the possibility of developing a wide variety of classes and types of steels, including special steels and high alloy. In this paper it is presented some important developments of electric arc furnace: vacuum electric arc furnace, artificial intelligence expert systems for pollution control Steelworks. Another important aspect presented in the article is an original block diagram for optimization the EAF management system. This scheme is based on the original objective function (criterion function) represented by the price / quality ratio. The article presents an original block diagram for optimization the control system of the EAF. For designing this concept of EAF management system, many principles were used.

  16. Health Beliefs of Marshallese Regarding Type 2 Diabetes

    PubMed Central

    McElfish, Pearl Anna; Hallgren, Emily; Henry, L Jean; Ritok, Mandy; Rubon-Chutaro, Jellesen; Kohlor, Peter

    2017-01-01

    Objectives The Marshallese population suffers from disproportionate rates of type 2 diabetes. This study identifies the underlying beliefs and perceptions that affect diabetes self-management behavior among the US Marshallese population living in Arkansas. Methods The study uses qualitative focus groups with a semi-structured interview guide developed using a community-based participatory research (CBPR) approach and the Health Belief Model. Data was collected from a total of N = 41 participants and bilingual community co-investigators provided translation as needed. Results The results show high-perceived threat, with most participants describing diabetes as inevitable and a death sentence. Participants are generally unaware of the benefits of diabetes self-management behaviors, and the Marshallese population faces significant policy, environmental, and systems barriers to diabetes self-management. The primary cue to action is a diagnosis of diabetes, and there are varying levels of self-efficacy. Conclusions The research grounded in the Health Belief Model provides important contributions that can help advance diabetes self-management efforts within Pacific Islander communities. PMID:26931757

  17. "The Doctor Needs to Know": Acceptability of Smartphone Location Tracking for Care Coordination.

    PubMed

    Liss, David T; Serrano, Eloisa; Wakeman, Julie; Nowicki, Christine; Buchanan, David R; Cesan, Ana; Brown, Tiffany

    2018-05-04

    Care coordination can be highly challenging to carry out. When care is fragmented across health systems and providers, there is an increased likelihood of hospital readmissions and wasteful health care spending. During and after care transitions, smartphones have the potential to bolster information transfer and care coordination. However, little research has examined patients' perceptions of using smartphones to coordinate care. This study's primary objective was to explore patient acceptability of a smartphone app that could facilitate care coordination in a safety net setting. Our secondary objective was to identify how clinicians and other members of primary care teams could use this app to coordinate care. This qualitative study was conducted at a federally qualified health center in metropolitan Chicago, IL. We conducted four focus groups (two in English, two in Spanish) with high-risk adults who owned a smartphone and received services from an organizational care management program. We also conducted structured interviews with clinicians and a group interview with care managers. Focus groups elicited patients' perceptions of a smartphone app designed to: (1) identify emergency department (ED) visits and inpatient stays using real-time location data; (2) send automated notifications (ie, alerts) to users' phones, asking whether they were a patient in the hospital; and (3) send automated messages to primary care teams to notify them about patients' confirmed ED visits and inpatient stays. Focus group transcripts were coded based on emergent themes. Clinicians and care managers were asked about messages they would like to receive from the app. Five main themes emerged in patient focus group discussions. First, participants expressed a high degree of willingness to use the proposed app during inpatient stays. Second, participants expressed varying degrees of willingness to use the app during ED visits, particularly for low acuity ED visits. Third, participants stated their willingness to have their location tracked by the proposed app due to its perceived benefits. Fourth, the most frequently mentioned barriers to acceptability were inconveniences such as "false alarm" notifications and smartphone battery drainage. Finally, there was some tension between how to maximize usability without unnecessarily increasing user burden. Both clinicians and care managers expressed interest in receiving messages from the app at the time of hospital arrival and at discharge. Clinicians were particularly interested in conducting outreach during ED visits and inpatient stays, while care managers expressed more interest in coordinating postdischarge care. High-risk primary care patients in a safety net setting reported a willingness to utilize smartphone location tracking technology to facilitate care coordination. Further research is needed on the development and implementation of new smartphone-based approaches to care coordination. ©David T Liss, Eloisa Serrano, Julie Wakeman, Christine Nowicki, David R Buchanan, Ana Cesan, Tiffany Brown. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 04.05.2018.

  18. Provision of care for chronic kidney disease by non-nephrologists in a developing nation: a national survey

    PubMed Central

    Al Shamsi, S; Al Dhanhani, A; Sheek-Hussein, M M

    2016-01-01

    Objectives The prevalence of chronic kidney disease (CKD) in developing countries has increased dramatically. This study aimed to explore the practice patterns of non-dialysis-dependent CKD care in an affluent developing country. Settings Primary and specialised healthcare facilities of public and private sectors in the United Arab Emirates. Participants 159 non-nephrologist physicians practising in the United Arab Emirates. Interventions A 28-item online self-administered questionnaire based on CKD clinical practice guidelines. Primary and secondary outcome measures The physicians' approach to identifying and managing patients with CKD. Results The survey was completed by 159 non-nephrologists, of whom 135 reported having treated patients with CKD. Almost all the respondents screen patients with hypertension and diabetes for CKD, but one-third of them do not screen patients with cardiovascular disease and elderly patients for CKD. The use of accurate CKD screening tests (estimated glomerular filtration rate and albumin/creatinine ratio) was suboptimal (77% and 59% of physicians used the procedures, respectively). One-third of the physicians do not offer treatment with inhibitors of the renin–angiotensin system to patients with CKD, and only 66% offer antilipid treatment. In general, the primary healthcare physicians are more familiar than secondary healthcare physicians with the diagnosis and management of patients with CKD. Conclusions We identified substantial physician-declared deficiencies in the practice of identifying and managing early CKD. Integration of quality CKD care within the healthcare system is required to face the increasing burden of CKD in the United Arab Emirates and possibly in other developing nations. PMID:27481619

  19. Use of chronic disease management programs for diabetes: in Alberta's primary care networks.

    PubMed

    Campbell, David J T; Sargious, Peter; Lewanczuk, Richard; McBrien, Kerry; Tonelli, Marcello; Hemmelgarn, Brenda; Manns, Braden

    2013-02-01

    To determine the types of chronic disease management (CDM) programs offered for patients with diabetes in Alberta's primary care networks (PCNs). A survey was administered to PCNs to determine the types of CDM programs offered for patients with diabetes; CDM programs were organized into categories by their resource intensity and effectiveness. Results of the survey were reported using frequencies and percentages. Alberta has recently created PCNs-groups of family physicians who receive additional funds to enable them to support activities that fall outside the typical physician-based fee-for-service model, but which address specified objectives including CDM. It is currently unknown what additional programs are being provided through the PCN supplemental funding. A survey was administered to the individual responsible for CDM in each PCN. This included executive directors, chronic disease managers, and CDM nurses. We determined the CDM strategies used in each PCN to care for patients with diabetes, whether they were available to all patients, and whether the services were provided exclusively by the PCN or in conjunction with other agencies. There was considerable variation across PCNs with respect to the CDM programs offered for people with diabetes. Nearly all PCNs used multidisciplinary teams (which could include nurses, dietitians, and pharmacists) and patient education. Fewer than half of the PCNs permitted personnel other than the primary physician to write or alter prescriptions for medications. Alberta's PCNs have successfully established many different types of CDM programs. Multidisciplinary care teams, which are among the most effective CDM strategies, are currently being used by most of Alberta's PCNs.

  20. Type 2 diabetes patient education in Reunion Island: perceptions and needs of professionals in advance of the initiation of a primary care management network.

    PubMed

    Balcou-Debussche, M; Debussche, X

    2008-09-01

    This study focused on issues in the education of type 2 diabetes patients in primary care on Reunion Island which, in a medical context, is broadly similar to metropolitan France, but with a much greater prevalence of diabetes. The aim was to assess the perceptions, training, reported practices and needs of health care providers in the field of patient education in advance of the initiation of a health care management network for diabetic patients. A total of 74 physicians and 63 nurses completed a detailed questionnaire comprising 52 items divided into six parts: professional activity, initial and postgraduate training, educational practices, objectives of patient education, perceived barriers and prospects for optimization. Educational activities for patients are almost nonexistent. Information and explanations given during a face-to-face encounter with the physician or nurse that combine technical and caring approaches are the main reasons reported for patient education. The obstacles reported by professionals that need to be overcome are limited available time, patient passivity and inadequate staff training. Practitioners and nurses are poorly taught as regards patient education and self-management of chronic diseases. The suggested improvements include professional acknowledgement, more convenient and available tools and improved postgraduate training. Patient education in primary care is still mostly an illusion, with many gaps that hinder education for both patients and professionals. The training of health professionals needs to meet the challenge of chronic diseases by integrating aspects from the fields of education and the social sciences.

  1. 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…

  2. Teamwork for Oversight of Processes and Systems (TOPS). Implementation guide for TOPS version 2.0, 10 August 1992

    NASA Technical Reports Server (NTRS)

    Strand, Albert A.; Jackson, Darryl J.

    1992-01-01

    As the nation redefines priorities to deal with a rapidly changing world order, both government and industry require new approaches for oversight of management systems, particularly for high technology products. Declining defense budgets will lead to significant reductions in government contract management personnel. Concurrently, defense contractors are reducing administrative and overhead staffing to control costs. These combined pressures require bold approaches for the oversight of management systems. In the Spring of 1991, the DPRO and TRW created a Process Action Team (PAT) to jointly prepare a Performance Based Management (PBM) system titled Teamwork for Oversight of Processes and Systems (TOPS). The primary goal is implementation of a performance based management system based on objective data to review critical TRW processes with an emphasis on continuous improvement. The processes are: Finance and Business Systems, Engineering and Manufacturing Systems, Quality Assurance, and Software Systems. The team established a number of goals: delivery of quality products to contractual terms and conditions; ensure that TRW management systems meet government guidance and good business practices; use of objective data to measure critical processes; elimination of wasteful/duplicative reviews and audits; emphasis on teamwork--all efforts must be perceived to add value by both sides and decisions are made by consensus; and synergy and the creation of a strong working trust between TRW and the DPRO. TOPS permits the adjustment of oversight resources when conditions change or when TRW systems performance indicate either an increase or decrease in surveillance is appropriate. Monthly Contractor Performance Assessments (CPA) are derived from a summary of supporting system level and process-level ratings obtained from objective process-level data. Tiered, objective, data-driven metrics are highly successful in achieving a cooperative and effective method of measuring performance. The teamwork-based culture developed by TOPS proved an unequaled success in removing adversarial relationships and creating an atmosphere of continuous improvement in quality processes at TRW. The new working relationship does not decrease the responsibility or authority of the DPRO to ensure contract compliance and it permits both parties to work more effectively to improve total quality and reduce cost. By emphasizing teamwork in developing a stronger approach to efficient management of the defense industrial base TOPS is a singular success.

  3. Teamwork for Oversight of Processes and Systems (TOPS). Implementation guide for TOPS version 2.0, 10 August 1992

    NASA Astrophysics Data System (ADS)

    Strand, Albert A.; Jackson, Darryl J.

    As the nation redefines priorities to deal with a rapidly changing world order, both government and industry require new approaches for oversight of management systems, particularly for high technology products. Declining defense budgets will lead to significant reductions in government contract management personnel. Concurrently, defense contractors are reducing administrative and overhead staffing to control costs. These combined pressures require bold approaches for the oversight of management systems. In the Spring of 1991, the DPRO and TRW created a Process Action Team (PAT) to jointly prepare a Performance Based Management (PBM) system titled Teamwork for Oversight of Processes and Systems (TOPS). The primary goal is implementation of a performance based management system based on objective data to review critical TRW processes with an emphasis on continuous improvement. The processes are: Finance and Business Systems, Engineering and Manufacturing Systems, Quality Assurance, and Software Systems. The team established a number of goals: delivery of quality products to contractual terms and conditions; ensure that TRW management systems meet government guidance and good business practices; use of objective data to measure critical processes; elimination of wasteful/duplicative reviews and audits; emphasis on teamwork--all efforts must be perceived to add value by both sides and decisions are made by consensus; and synergy and the creation of a strong working trust between TRW and the DPRO. TOPS permits the adjustment of oversight resources when conditions change or when TRW systems performance indicate either an increase or decrease in surveillance is appropriate. Monthly Contractor Performance Assessments (CPA) are derived from a summary of supporting system level and process-level ratings obtained from objective process-level data. Tiered, objective, data-driven metrics are highly successful in achieving a cooperative and effective method of measuring performance. The teamwork-based culture developed by TOPS proved an unequaled success in removing adversarial relationships and creating an atmosphere of continuous improvement in quality processes at TRW. The new working relationship does not decrease the responsibility or authority of the DPRO to ensure contract compliance and it permits both parties to work more effectively to improve total quality and reduce cost. By emphasizing teamwork in developing a stronger approach to efficient management of the defense industrial base TOPS is a singular success.

  4. 25 CFR 556.5 - Tribal eligibility determination.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS BACKGROUND INVESTIGATIONS FOR PRIMARY MANAGEMENT OFFICIALS AND KEY EMPLOYEES § 556.5 Tribal eligibility determination. A tribe shall conduct an... of a key employee or primary management official for granting of a gaming license, an authorized...

  5. Designing for Psychological Change: Individuals’ Reward and Cost Valuations in Weight Management

    PubMed Central

    Blandford, Ann

    2014-01-01

    Background Knowledge of the psychological constructs that underlie behavior offers valuable design opportunities for persuasive systems. We use the decision theory, which describes how behavior is underpinned by reward-cost valuations, as a framework for investigating such psychological constructs to deliver design objectives for weight management technologies. Objective We applied a decision theory–based analysis in the domain of weight management to understand the rewards and costs that surround individuals’ weight management behaviors, with the aim of uncovering design opportunities for weight management technologies. Methods We conducted qualitative interviews with 15 participants who were or had been trying to lose weight. Thematic analysis was used to extract themes that covered the rewards and costs surrounding weight management behaviors. We supplemented our qualitative study with a quantitative survey of 100 respondents investigating the extent to which they agreed with statements reflecting themes from the qualitative study. Results The primary obstacles to weight management were the rewards associated with unhealthy choices, such as the pleasures of unhealthy foods and unrestricted consumption in social situations, and the significant efforts required to change habits, plan, and exercise. Psychological constructs that supported positive weight management included feeling good after making healthy choices, being good to oneself, experiencing healthy yet still delicious foods, and receiving social support and encouraging messages (although opinions about encouraging messages was mixed). Conclusions A rewards-costs driven enquiry revealed a wide range of psychological constructs that contribute to discouraging and supporting weight management. The constructs extracted from our qualitative study were verified by our quantitative survey, in which the majority of respondents also reported similar thoughts and feelings. This understanding of the rewards and costs surrounding weight management offers a range of new opportunities for the design of weight management technologies that enhance the encouraging factors and alleviate the discouraging ones. PMID:24972304

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

    PubMed Central

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

    2016-01-01

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

  7. Moving upstream or muddying the waters? Incentives for managing for health.

    PubMed

    Marks, Linda; Hunter, David J

    2005-11-01

    The objective of this study was to identify factors influencing the capacity of NHS managers to 'manage for health'. Semi-structured interviews (32) were carried out over the telephone or face to face with national stakeholders (15) and NHS senior managers (17) from four Strategic Health Authorities (SHAs) and five Primary Care Trusts (PCTs) in England. Interviews were transcribed and a qualitative analysis carried out. The current system of targets and incentives prioritised access to acute services, public health skills were too thinly spread, baseline data were inadequate, decision-making for public health investment was fragmented and evidence for effective interventions was scanty. Health improvement targets should be plausible, longer term and locally owned, but key factors in creating a proactive public health organisation were a strong public health ethos, and effective management and leadership skills. Strengthening the NHS's role in managing for health was welcomed, but enthusiasm was tempered by concurrent NHS policy initiatives and incentives pulling in opposing directions. Key NHS policy initiatives have been developed in isolation from each other. While their combined effect remains unpredictable, they may serve to threaten the welcome shift towards managing for health improvement.

  8. Make your company a talent factory.

    PubMed

    Ready, Douglas A; Conger, Jay A

    2007-06-01

    Despite the great sums of money companies dedicate to talent management systems, many still struggle to fill key positions - limiting their potential for growth in the process. Virtually all the human resource executives in the authors' 2005 survey of 40 companies around the world said that their pipeline of high-potential employees was insufficient to fill strategic management roles. The survey revealed two primary reasons for this. First, the formal procedures for identifying and developing next-generation leaders have fallen out of sync with what companies need to grow or expand into new markets. To save money, for example, some firms have eliminated positions that would expose high-potential employees to a broad range of problems, thus sacrificing future development opportunities that would far outweigh any initial savings from the job cuts. Second, HR executives often have trouble keeping top leaders' attention on talent issues, despite those leaders' vigorous assertions that obtaining and keeping the best people is a major priority. If passion for that objective doesn't start at the top and infuse the culture, say the authors, talent management can easily deteriorate into the management of bureaucratic routines. Yet there are companies that can face the future with confidence. These firms don't just manage talent, they build talent factories. The authors describe the experiences of two such corporations - consumer products icon Procter & Gamble and financial services giant HSBC Group -that figured out how to develop and retain key employees and fill positions quickly to meet evolving business needs. Though each company approached talent management from a different direction, they both maintained a twin focus on functionality (rigorous talent processes that support strategic and cultural objectives) and vitality (management's emotional commitment, which is reflected in daily actions).

  9. Referral Patterns, Diagnosis, and Disease Management of Patients With Axial Spondyloarthritis

    PubMed Central

    van der Heijde, Désirée; Sieper, Joachim; Elewaut, Dirk; Deodhar, Atul; Pangan, Aileen L.; Dorr, Alexander P.

    2014-01-01

    Background Recognition, diagnosis, and management of axial spondyloarthritis (axial SpA) continue to advance. Objectives The objectives of this study were to compare referrals, diagnosis, and management of axial SpA in Western Europe (WE), North America (US and Canada), and the rest of world (RoW) in academic and community rheumatology practices and to identify areas for further education. Methods Rheumatologists responded online to the MAXIMA (Management of Axial SpA International and Multicentric Approaches) survey. Questions pertained to referral, diagnosis, and management of axial SpA. Results Rheumatologists (N = 809) from 56 countries completed the survey about patients with chronic back pain (≥3 months) starting before age 45 years. Responses from academic and community practice rheumatologists were generally similar. Most referrals were from primary care providers. Symptom duration of 3 years or more at referral was reported more frequently by WE and RoW than US respondents. More WE and RoW than US rheumatologists referred to the Assessment of SpondyloArthritis International Society criteria for axial SpA in clinical practice. Rheumatologists reported prescribing disease-modifying antirheumatic drugs for the management of axial SpA. Sulfasalazine was frequently prescribed across regions; methotrexate was more commonly prescribed by US rheumatologists compared with other regions. Conclusions Referral patterns, diagnosis, and disease management for axial SpA were similar among WE, North America, and RoW rheumatologists and in academic/community practices, although more WE and RoW rheumatologists referred to Assessment of SpondyloArthritis International Society criteria in clinical practice. Disease-modifying antirheumatic drugs were commonly prescribed for axial SpA patients, although it was unclear whether these were prescribed for axial or peripheral symptoms. PMID:25417676

  10. Implications of the introduction of laboratory demand management at primary care clinics in South Africa on laboratory expenditure

    PubMed Central

    Lekalakala, Ruth; Asmall, Shaidah; Cassim, Naseem

    2016-01-01

    Background Diagnostic health laboratory services are regarded as an integral part of the national health infrastructure across all countries. Clinical laboratory tests contribute substantially to health system goals of increasing quality of care and improving patient outcomes. Objectives This study aimed to analyse current laboratory expenditures at the primary healthcare (PHC) level in South Africa as processed by the National Health Laboratory Service and to determine the potential cost savings of introducing laboratory demand management. Methods A retrospective cross-sectional analysis of laboratory expenditures for the 2013/2014 financial year across 11 pilot National Health Insurance health districts was conducted. Laboratory expenditure tariff codes were cross-tabulated to the PHC essential laboratory tests list (ELL) to determine inappropriate testing. Data were analysed using a Microsoft Access database and Excel software. Results Approximately R35 million South African Rand (10%) of the estimated R339 million in expenditures was for tests that were not listed within the ELL. Approximately 47% of expenditure was for laboratory tests that were indicated in the algorithmic management of patients on antiretroviral treatment. The other main cost drivers for non-ELL testing included full blood count and urea, as well as electrolyte profiles usually requested to support management of patients on antiretroviral treatment. Conclusions Considerable annual savings of up to 10% in laboratory expenditure are possible at the PHC level by implementing laboratory demand management. In addition, to achieve these savings, a standardised PHC laboratory request form and some form of electronic gatekeeping system that must be supported by an educational component should be implemented. PMID:28879107

  11. Factors associated with reporting of abuse against children and adolescents by nurses within Primary Health Care1

    PubMed Central

    Rolim, Ana Carine Arruda; Moreira, Gracyelle Alves Remigio; Gondim, Sarah Maria Mendes; Paz, Soraya da Silva; Vieira, Luiza Jane Eyre de Souza

    2014-01-01

    OBJECTIVE: to analyze the factors associated with the underreporting on the part of nurses within Primary Health Care of abuse against children and adolescents. METHOD: cross-sectional study with 616 nurses. A questionnaire addressed socio-demographic data, profession, instrumentation and knowledge on the topic, identification and reporting of abuse cases. Bivariate and multivariate logistic regression was used. RESULTS: female nurses, aged between 21 and 32 years old, not married, with five or more years since graduation, with graduate studies, and working for five or more years in PHC predominated. The final regression model showed that factors such as working for five or more years, having a reporting form within the PHC unit, and believing that reporting within Primary Health Care is an advantage, facilitate reporting. CONCLUSION: the study's results may, in addition to sensitizing nurses, support management professionals in establishing strategies intended to produce compliance with reporting as a legal device that ensures the rights of children and adolescents. PMID:25591102

  12. [A method for the implementation and promotion of access to comprehensive and complementary primary healthcare practices].

    PubMed

    Santos, Melissa Costa; Tesser, Charles Dalcanale

    2012-11-01

    The rendering of integrated and complementary practices in the Brazilian Unified Health System is fostered to increase the comprehensiveness of care and access to same, though it is a challenge to incorporate them into the services. Our objective is to provide a simple method of implementation of such practices in Primary Healthcare, derived from analysis of experiences in municipalities, using partial results of a master's thesis that employed research-action methodology. The method involves four stages: 1 - defininition of a nucleus responsible for implementation and consolidation thereof; 2 - situational analysis, with definition of the existing competent professionals; 3 - regulation, organization of access and legitimation; and 4 - implementation cycle: local plans, mentoring and ongoing education in health. The phases are described, justified and briefly discussed. The method encourages the development of rational and sustainable actions, sponsors participatory management, the creation of comprehensivenessand the broadening of care provided in Primary Healthcare by offering progressive and sustainable comprehensive and complementary practices.

  13. Strategic management of Public Hospitals' medical services.

    PubMed

    Hao, Aimin; Yi, Tao; Li, Xia; Wei, Lei; Huang, Pei; Xu, Xinzhou; Yi, Lihua

    2016-01-01

    Purpose: The quality of medical services provided by competing public hospitals is the primary consideration of the public in determining the selection of a specific hospital for treatment. The main objective of strategic planning is to improve the quality of public hospital medical services. This paper provides an introduction to the history, significance, principles and practices of public hospital medical service strategy, as well as advancing the opinion that public hospital service strategy must not merely aim to produce but actually result in the highest possible level of quality, convenience, efficiency and patient satisfaction.

  14. Architecture and Initial Development of a Digital Library Platform for Computable Knowledge Objects for Health.

    PubMed

    Flynn, Allen J; Bahulekar, Namita; Boisvert, Peter; Lagoze, Carl; Meng, George; Rampton, James; Friedman, Charles P

    2017-01-01

    Throughout the world, biomedical knowledge is routinely generated and shared through primary and secondary scientific publications. However, there is too much latency between publication of knowledge and its routine use in practice. To address this latency, what is actionable in scientific publications can be encoded to make it computable. We have created a purpose-built digital library platform to hold, manage, and share actionable, computable knowledge for health called the Knowledge Grid Library. Here we present it with its system architecture.

  15. Educational attainment has a limited impact on disease management outcomes in heart failure.

    PubMed

    Smith, Brad; Forkner, Emma; Krasuski, Richard A; Galbreath, Autumn Dawn; Freeman, Gregory L

    2006-06-01

    The objective of this study was to assess whether educational attainment moderates outcomes in the intervention group in a trial of disease management in heart failure (HF). Data were collected from a sample of 654 patients enrolled in the disease management arm of a community- based study of HF patients. The full sample was used to analyze two primary outcomes- all-cause mortality and cardiac event-free survival. Two other primary outcomes- rates of HF-related emergency department (ED) visits and inpatient admissions-and secondary outcomes (patient self-confidence in managing HF symptoms and daily dietary sodium intake in milligrams) were analyzed in a smaller sample of 602 patients who completed at least 6 months of disease management. One-way analysis of variance and chi (2) tests were used to assess differences in baseline demographic and clinical characteristics. Survival analyses were conducted with proportional hazards regression, while negative binomial regression was used to assess educational differences in ED usage and inpatient admissions. Repeated measures analysis of variance models were used to assess whether secondary outcomes differed across educational strata and/or over time. All outcome analyses were adjusted for confounders. Patients with the least education fared the poorest for all-cause mortality, but education- related differences failed to achieve statistical significance. No education-related differences were observed for cardiac event-free survival, or for the rates of inpatient admission and ED usage. For secondary outcomes, sodium intake differed significantly by education (p = 0.04), with the largest drop (-838 mg/day) observed in the least well-educated group. Confidence increased an approximately equal amount (2.1-3.0 points on a 100-point scale) across all educational strata (p = ns). Low educational attainment may not be a barrier to effective disease management.

  16. Diabetes self-management in a low-income population: impacts of social support and relationships with the health care system

    PubMed Central

    Vest, Bonnie M; Kahn, Linda S; Danzo, Andrew; Tumiel-Berhalter, Laurene; Schuster, Roseanne C; Karl, Renée; Taylor, Robert; Glaser, Kathryn; Danakas, Alexandra; Fox, Chester H

    2014-01-01

    Objectives This article reports on results of a qualitative study of social supports and institutional resources utilized by individuals living with diabetes in a high-poverty urban setting. The goal was to examine how access to social capital among low-income populations facilitates and impedes their self-efficacy in diabetes self-management. Methods Semi-structured interviews were conducted with 34 patients with diabetes from a safety net primary care practice in Buffalo, New York. Results Facilitators and barriers to successful self-management were identified in three broad areas: (1) the influence of social support networks; (2) the nature of the doctor-patient relationship; and (3) the nature of patient-health care system relationship. Patients' unmet needs were also highlighted across these three areas. Discussion Participants identified barriers to effective diabetes self-management directly related to their low-income status, such as inadequate insurance, and mistrust of the medical system. It may be necessary for patients to activate social capital from multiple social spheres to achieve the most effective diabetes management. PMID:23585634

  17. Emergency department management of pain and anxiety related to orthopedic fracture care: a guide to analgesic techniques and procedural sedation in children.

    PubMed

    Kennedy, Robert M; Luhmann, Jan D; Luhmann, Scott J

    2004-01-01

    Orthopedic fractures and joint dislocations are among the most painful pediatric emergencies. Safe and effective management of fracture-related pain and anxiety in the emergency department reduces patient distress during initial evaluation and often allows definitive management of the fracture. No consensus exists on which pharmacologic regimens for procedural sedation/analgesia are safest and most effective. For some children, control of fracture pain is the primary goal, whereas for others, relief from anxiety is an additionally important objective. Furthermore, strategies for the management of fracture pain may vary by fracture location and patient characteristics; thus, no single regimen is likely to provide the best means of analgesia and anxiolysis for all patients. Effective analgesia can be provided by local or regional anesthesia, such as hematoma, Bier, or nerve blocks. Alternatively, induction of deep sedation with analgesic agents such as ketamine or fentanyl, often combined with sedative-anxiolytic agents such as midazolam, may be used to manage distress associated with fracture reduction. A combination of local anesthesia with moderate sedation, for example nitrous oxide, is another attractive option.

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

    PubMed

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

    2017-09-01

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

  19. Pivotal ERIVANCE basal cell carcinoma (BCC) study: 12-month update of efficacy and safety of vismodegib in advanced BCC.

    PubMed

    Sekulic, Aleksandar; Migden, Michael R; Lewis, Karl; Hainsworth, John D; Solomon, James A; Yoo, Simon; Arron, Sarah T; Friedlander, Philip A; Marmur, Ellen; Rudin, Charles M; Chang, Anne Lynn S; Dirix, Luc; Hou, Jeannie; Yue, Huibin; Hauschild, Axel

    2015-06-01

    Primary analysis from the pivotal ERIVANCE BCC study resulted in approval of vismodegib, a Hedgehog pathway inhibitor indicated for treatment of adults with metastatic or locally advanced basal cell carcinoma (BCC) that has recurred after surgery or for patients who are not candidates for surgery or radiation. An efficacy and safety analysis was conducted 12 months after primary analysis. This was a multinational, multicenter, nonrandomized, 2-cohort study in patients with measurable and histologically confirmed locally advanced or metastatic BCC taking oral vismodegib (150 mg/d). Primary outcome measure was objective response rate (complete and partial responses) assessed by independent review facility. After 12 months of additional follow-up, median duration of exposure to vismodegib was 12.9 months. Objective response rate increased from 30.3% to 33.3% in patients with metastatic disease, and from 42.9% to 47.6% in patients with the locally advanced form. Median duration of response in patients with locally advanced BCC increased from 7.6 to 9.5 months. No new safety signals emerged with extended treatment duration. Limitations include low prevalence of advanced BCC and challenges of designing a study with heterogenous manifestations. The 12-month update of the study confirms the efficacy and safety of vismodegib in management of advanced BCC. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  20. Perceptions of health managers and professionals about mental health and primary care integration in Rio de Janeiro: a mixed methods study.

    PubMed

    Athié, Karen; Menezes, Alice Lopes do Amaral; da Silva, Angela Machado; Campos, Monica; Delgado, Pedro Gabriel; Fortes, Sandra; Dowrick, Christopher

    2016-09-30

    Community-based primary mental health care is recommended in low and middle-income countries. The Brazilian Health System has been restructuring primary care by expanding its Family Health Strategy. Due to mental health problems, psychosocial vulnerability and accessibility, Matrix Support teams are being set up to broaden the professional scope of primary care. This paper aims to analyse the perceptions of health professionals and managers about the integration of primary care and mental health. In this mixed-method study 18 health managers and 24 professionals were interviewed from different primary and mental health care services in Rio de Janeiro. A semi-structured survey was conducted with 185 closed questions ranging from 1 to 5 and one open-ended question, to evaluate: access, gateway, trust, family focus, primary mental health interventions, mental health records, mental health problems, team collaboration, integration with community resources and primary mental health education. Two comparisons were made: health managers and professionals' (Mann-Whitney non-parametric test) and health managers' perceptions (Kruskall-Wallis non parametric-test) in 4 service designs (General Traditional Outpatients, Mental Health Specialised Outpatients, Psychosocial Community Centre and Family Health Strategy)(SPSS version 17.0). Qualitative data were subjected to Framework Analysis. Firstly, health managers and professionals' perceptions converged in all components, except the health record system. Secondly, managers' perceptions in traditional services contrasted with managers' perceptions in community-based services in components such as mental health interventions and team collaboration, and converged in gateway, trust, record system and primary mental health education. Qualitative data revealed an acceptance of mental health and primary care integration, but a lack of communication between institutions. The Mixed Method demonstrated that interviewees consider mental health and primary care integration as a requirement of the system, while their perceptions and the model of work produced by the institutional culture are inextricably linked. There is a gap between health managers' and professionals' understanding of community-based primary mental health care. The integration of different processes of work entails both rethinking workforce actions and institutional support to help make changes.

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