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PubMed2005

Practice management for the fee-for-service pediatric dentist.

In conclusion, good practice management in pediatric dentistry is not sporadic or a series of random, uncoordinated activities. Instead, it encompasses the philosophy of the practice, is centered around the patient and is a fluid, consistent management function. It begins with the pediatric dentist as the leader and continues in all phases of daily activity. It is a well-developed and highly functioning system. It results in staff and patient loyalty and high patient satisfaction. The challenge is to make the practice an ongoing, continuously active, evolutionary process for many years to come.

Delegation, Professional↗
PubMed2006

Exposure risk assessment and evaluation of the best management practice for controlling pesticide runoff from paddy fields. Part 1: Paddy watershed monitoring.

Rice pesticide concentrations in surface water along with hydrological balance and water management conditions were investigated in a paddy watershed of about 100 ha at the Sakura river basin in Tsukuba, Japan, for 3 years from April 2002. Monitoring on different hydrological scales ranging from a paddy plot up to a watershed determined the importance of water management associated with rainfall events and the cyclic irrigation for reducing pesticide discharge into aquatic environments. Surface drainage significantly increased as a response to rainfall events greater than about 1.5 cm day(-1). A total of 16 herbicides were detected in the stream water and their peak concentrations mostly occurred from early to mid-May following the pesticide application period. Two water management factors influencing the pesticide runoff from paddy fields were defined: excess water storage capacity (EWSC) and water holding period (WHP). Uncertainty analyses of pesticide discharge from a paddy plot for dymron (daimuron) and imazosulfuron (IMS) were performed using Monte Carlo simulation (MCS) with prescribed probability of rainfall and water management practice from observations over a period of 3 years. Application of an intermittent irrigation scheme with shallow water depth practice and high drainage gate to maintain the EWSC > 2 cm and increasing WHP from the current Japanese Agricultural Chemicals Regulation law of 3-4 days to at least 10 days were recommended for reducing the pesticide runoff from paddy fields in a monsoon region such as in Japan. The combination of good water management in field plots and small-scale water cycling is the best management practice for controlling pesticide discharge from paddy watersheds.

Agriculture↗
PubMed1996

Effect of participation by veterinarians in a dairy production medicine continuing education course on management practices and performance of client herds.

OBJECTIVE: To determine what effect participation by veterinarians in a dairy production medicine continuing education course would have on herd performance and management practices of client herds. DESIGN: Cohort study. SAMPLE POPULATION: 56 dairy herds for which health services were provided by veterinarians enrolled in a dairy production medicine continuing education program (treatment herds) and 97 dairy herds for which health services were provided by veterinarians not enrolled in the program (control herds). PROCEDURE: Management practices were evaluated every year for 4 years (1991 through 1994) by mail questionnaire. Herd performance was evaluated by reviewing Dairy Herd Improvement Association records. RESULTS: Mean age at first calving for the treatment herds decreased by 2 months over the course of the study. At the end of the study, treatment herds were 3 times more likely to review herd performance with their veterinarian and monitor heifer growth, and 2 times more likely to set goals and conduct adequate estrus detection than were control herds. CLINICAL IMPLICATIONS: Effective professional continuing education in production medicine can have a positive impact on health and performance of client herds.

Animal Husbandry↗
PubMed2003

Practice management: telephone triage in an otolaryngology practice.

Telephone triage is not a new healthcare concept, but it is an idea that is gaining momentum as Americans move into today's "e-technology, e-health" world. In fact, many companies are creating systems and protocols to improve efficiency and increase access to "triage" personnel.

Hotlines↗
PubMed1988

Management practices, physician autonomy, and satisfaction. Evidence from mental health institutions in the Federal Republic of Germany.

Physicians are moving into organized settings where their autonomy is more constrained and where management has more responsibility for physician satisfaction. The relationship of management practices to physician autonomy and satisfaction was explored in a survey of 185 psychiatrists in the State of Hessen in the Federal Republic of Germany (FRG). Analysis revealed that controlling for physician and institutional characteristics, management practices in relationship to participative activities, supportive communication, and peer review activities were the most important predictors both of perceived clinical autonomy and of work satisfaction. Gender was also a factor in that male physicians experienced greater perceived autonomy. Perceived clinical autonomy was an important factor in explaining satisfaction, whereas a few other physician and institutional characteristics were significant in predicting satisfaction. Unexpectedly, there was more perceived clinical autonomy among psychiatrists in larger, less well funded, more managerially constrained, state institutions than in smaller, community general hospitals and private organizations. Implications for further research are discussed.

Cross-Sectional Studies↗
PubMed2001

A multivariate analysis of biophysical parameters of tallgrass prairie among land management practices and years.

Six treatments of eastern Kansas tallgrass prairie--native prairie, hayed, mowed, grazed, burned and untreated--were studied to examine the biophysical effects of land management practices on grasslands. On each treatment, measurements of plant biomass, leaf area index, plant cover, leaf moisture and soil moisture were collected. In addition, measurements were taken of the Normalized Difference Vegetation Index (NDVI), which is derived from spectral reflectance measurements. Measurements were taken in mid-June, mid-July and late summer of 1990 and 1991. Multivariate analysis of variance was used to determine whether there were differences in the set of variables among treatments and years. Follow-up tests included univariate t-tests to determine which variables were contributing to any significant difference. Results showed a significant difference (p < 0.0005) among treatments in the composite of parameters during each of the months sampled. In most treatment types, there was a significant difference between years within each month. The univariate tests showed, however, that only some variables, primarily soil moisture, were contributing to this difference. We conclude that biomass and % plant cover show the best potential to serve as longterm indicators of grassland condition as they generally were sensitive to effects of different land management practices but not to yearly change in weather conditions. NDVI was insensitive to precipitation differences between years in July for most treatments, but was not in the native prairie. Choice of sampling time is important for these parameters to serve effectively as indicators.

Agriculture↗
PubMed1977

A competency-based curriculum in business practice management.

Business management skills are an essential part of an efficient medical practice, but they are largely neglected or ignored in residency training programs. In order to realistically prepare physicians for their future community practices, the Family Practice Residency Training Program at the University of California, Los Angeles, includes a business practice management curriculum based on 12 behavioral objectives. Through observation, seminars, consultation, and practice design, the resident becomes competent in the skills and behaviors necessary for effective management. Over the three-year period, the resident completes a handbook with research findings, and designs elements of his/her own future practice. The instructor's manual is included to illustrate and clarify methods of implementation and evaluation of the curriculum.

California↗
PubMed2004

Use of 137Cs measurements to estimate changes in soil erosion rates associated with changes in soil management practices on cultivated land.

Intensification of agricultural production in south-central Chile since the 1970s has caused problems of increased soil erosion and associated soil degradation. These problems have prompted a shift from conventional tillage to no-till management practices. Faced with the need to establish the impact of this shift in soil management on rates of soil loss, the use of caesium-137 (137Cs) measurements has been explored. A novel procedure for using measurements of the 137Cs depth distribution to estimate rates of soil loss at a sampling point under the original conventional tillage and after the shift to no-till management has been developed. This procedure has been successfully applied to a study site at Buenos Aires farm near Carahue in the 9th region of Chile. The results obtained indicate that the shift from conventional tillage to no-till management has caused net rates of soil loss to decrease to about 40% of those existing under conventional tillage. This assessment of the impact of introducing no-till management at the study site must, however, be seen as provisional, since only a limited number of sampling points were used. A simplified procedure aimed at documenting the reduction in erosion rates at additional sampling points, based solely on measurements of the 137Cs inventory of bulk cores and the 137Cs activity in the upper part of the soil has been developed and successfully tested at the study site. Previous application of 137Cs measurements to estimate erosion rates has been limited to estimation of medium-term erosion rates during the period extending from the beginning of fallout receipt to the time of sampling. The procedures described in this paper, which permits estimation of the change in erosion rates associated with a shift in land management practices, must be seen as representing a novel application of 137Cs measurements in soil erosion investigations.

Agriculture↗
PubMed2001

Impact of human resource management practices on nursing home performance.

Management scholars and practitioners alike have become increasingly interested in learning more about the ability of certain 'progressive' or 'high-performance' human resource management (HRM) practices to enhance organizational effectiveness. There is growing evidence to suggest that the contribution of various HRM practices to impact firm performance may be synergistic in effect yet contingent on a number of contextual factors, including workplace climate. A contingency theory perspective suggests that in order to be effective, HMR policies and practices must be consistent with other aspects of the organization, including its environment. This paper reports on empirical findings from research that examines the relationship between HRM practices, workplace climate and perceptions of organizational performance, in a large sample of Canadian nursing homes. Data from 283 nursing homes were collected by means of a mail survey that included questions on HRM practices, programmes, and policies, on human resource aspects of workplace climate, as well as a variety of indicators that include employee, customer/resident and facility measures of organizational performance. Results derived from ordered probit analysis suggest that nursing homes in our sample which had implemented more 'progressive' HRM practices and which reported a workplace climate that strongly values employee participation, empowerment and accountability tended to be perceived to generally perform better on a number of valued organizational outcomes. Nursing homes in our sample that performed best overall were found to be more likely to not only have implemented more of these HRM practices, but also to report having a workplace climate that reflects the seminal value that it places on its human resources. This finding is consistent with the conclusion that simply introducing HRM practices or programmes, in the absence of an appropriately supportive workplace climate, will be insufficient to attain optimal organizational performance.

Canada↗
PubMedDate not supplied

Asthma management practices among children in Georgia.

BACKGROUND: Asthma self-management, the involvement of patients or their caregivers in the management of their disease, reduces healthcare visits and costs. We assessed selected asthma self-management practices among a representative sample of children in Georgia to guide statewide asthma control programs. METHODS: A random-digit-dialed telephone survey of 2,121 households with 3,896 children 17 years of age or younger was conducted. Primary caretakers were asked about asthma and medication use of their children. Child data were weighted according to the number of telephone lines in the household and to the 2000 Georgia Census population. RESULTS: Approximately 10 percent of children in Georgia had asthma. Among children with asthma, 30 percent did not have regular asthma checkups and 66 percent did not have a written management plan; 19 percent filled 2 or more prescriptions per year for quick-relief medicine but did not take control medication. For children with asthma for whom tobacco exposure was a known trigger, 35 percent were exposed to tobacco smoke in the home. CONCLUSIONS: Opportunities exist to improve self-management, pharmacotherapy, and exposure to triggers for children with asthma. These data can be used to guide organizations and agencies working to reduce the burden of asthma.

Adolescent↗
PubMed1999

Physician practice management organizations: their prospects and performance.

As physician organizations adapt their incentives, processes, and structures to accommodate the demands of an increasingly competitive and performance-sensitive external environment, the development of more effective administrative and managerial mechanisms becomes critical to success. The emergence of physician practice management companies (PPMCs) represents a potentially positive step for physician practices seeking increased economies of scale through consolidation, as well as enhanced access to financial capital. However, economic and finance theory, coupled with some empirical "arithmetic" regarding the financial and operational performance of leading publicly traded PPMCs, suggest caution in one's forecasts of the future prospects for these evolving corporate forms.

Contract Services↗
PubMed2005

Modelling non-structural best management practices--focus on reductions in stormwater pollution.

This paper describes a modelling approach for evaluating the efficiency of different non-structural best management practices for stormwater management. A scenario with a set of source reduction practices was simulated using the substance flow model SEWSYS for an urban catchment in the city of Göteborg, Sweden. The scenario is based on a hypothetical control program that includes prevention, education and regulations. The simulation shows relatively high reductions of copper and PAH, 77% and 50%, respectively. The reduction in copper is mainly due to less copper roof corrosion and brake wear, while reduced road wear has the greatest effect for PAH. An important result from this study is that the nonstructural BMPs applied did not give a sufficient reduction in pollution to meet the desirable environmental quality criteria. To meet these criteria, additional BMPs must be implemented, preferably a combination of both non-structural and structural measures.

Conservation of Natural Resources↗
PubMed2001

Monitoring and improving pain management practices. A quality improvement approach.

The development of a multidisciplinary pain management committee is a critical step in monitoring and improving pain management practices. The systematic evaluation of the quality of pain management using the principles of QI establishes a process that can lead to improvements in the care that patients receive. Clinicians need to develop a 1- to 2-year plan to improve the quality of pain management. Changes in clinicians' behaviors occur slowly; thus, members of pain management committees should not become discouraged but continue to move forward one step at a time.

Guidelines as Topic↗
PubMed1993

Do clinical guidelines improve general practice management and referral of infertile couples?

OBJECTIVE: To evaluate guidelines for general practice management and referral of infertile couples. Guidelines were implemented with a disease specific reminder at the time of consultation (the guidelines were embedded within a structured infertility management sheet for each couple). DESIGN: Pragmatic randomised controlled trial. Participating practices were randomised to a group that received the guidelines and a control group. SETTING: 82 general practices in Grampian region. SUBJECTS: 100 couples referred by general practitioners receiving the guideline and 100 couples referred by control general practitioners. MAIN OUTCOME MEASURES: Whether the general practitioner had taken a full sexual history and examined and investigated both partners appropriately. RESULTS: Characteristics of patients referred by study and control general practitioners did not differ significantly at baseline. Compliance with the guidelines increased for all targeted activities. General practitioners in the study group were more likely to take a sexual history (for example, couples' use of fertile period, 85% v 69%, p < 0.01); examine both partners (female partner, 68% v 52%, p < 0.05; male partner 39% v 13%, p < 0.01); and investigate both partners (day 21 progesterone, 72% v 41%, p < 0.001; semen analysis, 51% v 41%, p > 0.05). Improvements were greater when general practitioners used the disease specific reminder. CONCLUSION: Receiving guidelines led to improvements in the process of care of infertile couples within general practice. This effect was enhanced when the guidelines were embedded in a structured infertility management sheet for each couple.

Adolescent↗