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PubMed1995

Choosing practice management software. How sophisticated should you get?

In order to make informed purchasing decisions about practice management software, dental professionals must first assess their needs by determining the types of tasks they expect from a system and then compare that list against the features offered by each system. Because technology is changing rapidly, much of what was advanced a few years ago is now considered basic. Three general levels of sophistication are discussed, with attention to the complexity of features that can be expected to be found at each level.

Appointments and Schedules↗
PubMed1997

Outpatient management practices associated with reduced risk of pediatric asthma hospitalization and emergency department visits.

OBJECTIVES: Effective outpatient care is believed to prevent hospitalization and emergency department (ED) visits resulting from childhood asthma. The aim of this study was to suggest priority areas for intervention by identifying outpatient management practices associated with the risk of these adverse outcomes in a large population. METHODS: This case-control study included children aged 0 to 14 years with asthma who were members of a regional health maintenance organization. Cases were children undergoing either a hospitalization or an ED visit for asthma during the study period. Control subjects were children with asthma without a hospitalization or an ED visit during the study period who were matched to patients on age, gender, and number of asthma-related hospitalizations in the past 24 months. Data on provider and parent asthma management practices were collected using chart review, closed-ended telephone interviews with parents, and computerized use databases. Multivariate analyses were conducted using conditional logistic regression models. RESULTS: Data were collected on 508 cases and 990 control subjects. A total of 43% of cases were reported by their parents to have moderately severe or severe asthma, compared with 20% of control subjects. Parents of cases with hospitalization were less likely than control subjects to have a written asthma management plan (44% vs 51%) and to report washing bedsheets in hot water at least twice a month (77% vs 86%). Cases with hospitalization were more likely to have a nebulizer (74% vs 56%). In the final multivariate model, race/ethnicity was not associated with having had either a hospitalization or an ED visit, as was lower socioeconomic status. Having a written asthma management plan [odds ratio (OR): 0.54; 95% confidence interval (CI): 0.30, 0.99] and washing bedsheets in hot water at least twice a month (OR: 0.45; 95% CI: 0.21, 0.94) were associated with reduced odds of hospitalization. Having a written asthma management plan (OR: 0.45; 95% CI: 0.27, 0.76) and starting or increasing medications at the onset of a cold or flu were associated with reduced odds of making an ED visit. CONCLUSIONS: Practices that support early intervention for asthma flare-ups by parents at home, particularly written management plans, are strongly associated with reduced risk of adverse outcomes among children with asthma.

Adolescent↗
PubMedDate not supplied

Pediatric nurses' pain management practice: barriers to change.

A qualitative, descriptive design was used to examine factors that influence pediatric nurses' pain management practices. Staff nurses from one pediatric unit (N = 16) at a community-based hospital attended from one to six discussion groups. Detailed content analysis of transcripts from each discussion group was conducted. Several themes emerged in the analysis. Some themes are based on the nurses clinical practice of pain assessment and management, while others reflect the organizational issues and changes staff experienced. Themes identified included: barriers/solutions to clinical practice change, organizational barriers to practice change, and staff commitment toward pain management. Staff attendance and commitment to participation in this research was commendable considering the external pressures they felt and expressed about job insecurity and poor unit morale. It seemed that their commitment to attend and participate was, in part, based on the value they placed upon clinical skills and knowledge. The opportunity to talk about the effects of organizational change, both individually and collectively, on their work environment was also considered beneficial.

Adult↗
PubMed2005

Dairy management practices associated with incidence rate of clinical mastitis in low somatic cell score herds in France.

An epidemiological prospective study was carried out in French dairy herds with Holstein, Montbéliarde, or Normande cows and with low herd somatic cell scores. The objective was to identify dairy management practices associated with herd incidence rate of clinical mastitis. The studied herds were selected on a national basis, clinical cases were recorded through a standardized system, and a stable dairy management system existed. In the surveyed herds, mean milk yield was 7420 kg/cow per yr and mean milk somatic cell score was 2.04 (132,000 cells/mL). Overdispersion Poisson models were performed to investigate risk factors for mastitis incidence rate. From the final model, the herds with the following characteristics had lower incidence rates of clinical mastitis: 1) culling of cows with more than 3 cases of clinical mastitis within a lactation; 2) more than 2 person-years assigned to dairy herd management; 3) balanced concentrate in the cow basal diet. Moreover, herds with the following characteristics had higher incidence rates of clinical mastitis: 1) milking cows loose-housed in a straw yard; 2) no mastitis therapy performed when a single clot was observed in the milk; 3) clusters rinsed using water or soapy water after milking a cow with high somatic cell count; 4) 305-d milk yield >7435 kg; 5) herd located in the South region; 6) herd located in the North region; 7) cows with at least 1 nonfunctional quarter; and 8) premilking holding area with a slippery surface. The underlying mechanisms of some highlighted risk factors, such as milk production level and dietary management practices, should be investigated more thoroughly through international collaboration.

Animals↗
PubMed2001

Veterinary practice management: teaching needs as viewed by consultants and teachers.

A study was conducted to assess veterinary practice management (VPM) educational and research needs from the perspective of consultants and teachers. An online focus group discussion was designed, involving two separate groups (consultants and teachers). One week was allocated to each group, with five to eight questions posed per day. Pseudonyms were used to provide confidentiality. Teachers were selected by inviting the primary VPM course coordinator at each AAVMC school. Consultants required at least two recommendations and were selected in a stratified, non-random manner to achieve both geographic and disciplinary diversity. Participation was stronger within the consultant group: 98 pages of data were generated by the consultants and 35 pages by teachers. Participants agreed that the sub-optimal economic conditions that characterize the veterinary profession are reflective of relatively low-level management skills. This situation establishes the need to strengthen VPM educational and research programs. Many specific suggestions were provided. It was recommended that a cooperative effort between academia and the private sector be employed. However, participants recognized that successful DVM education programs in VPM will be difficult to achieve and sustain without strong support from college administrators and faculties.

Consultants↗
PubMed2004

Experimental analysis of the influence of pest management practice on the efficacy of an endemic arthropod natural enemy complex of the diamondback moth.

Maximizing the contribution of endemic natural enemies to integrated pest management (IPM), programs requires a detailed knowledge of their interactions with the target pest. This experimental field study evaluated the impact of the endemic natural enemy complex of Plutella xylostella (L.) (Lepidoptera: Yponomeutidae) on pest populations in commercial cabbage crops in southeastern Queensland, Australia. Management data were used to score pest management practices at experimental sites on independent Brassica farms practicing a range of pest management strategies, and mechanical methods of natural enemy exclusion were used to assess the impact of natural enemies on introduced cohorts of P. xylostella at each site. Natural enemy impact was greatest at sites adopting IPM and least at sites practicing conventional pest management strategies. At IPM sites, the contribution of natural enemies to P. xylostella mortality permitted the cultivation of marketable crops with no yield loss but with a substantial reduction in insecticide inputs. Three species of larval parasitoids (Diadegma semiclausum Hellén [Hymenoptera: Ichneumonidae], Apanteles ippeus Nixon [Hymenoptera: Braconidae], and Oomyzus sokolowskii Kurdjumov [Hymenoptera: Eulophidae]) and one species of pupal parasitoid Diadromus collaris Gravenhorst (Hymenoptera: Ichneumonidae) attacked immature P. xylostella. The most abundant groups of predatory arthropods caught in pitfall traps were Araneae (Lycosidae) > Coleoptera (Carabidae, Coccinelidae, Staphylinidae) > Neuroptera (Chrysopidae) > Formicidae, whereas on crop foliage Araneae (Clubionidae, Oxyopidae) > Coleoptera (Coccinelidae) > Neuroptera (Chrysopidae) were most common. The abundance and diversity of natural enemies was greatest at sites that adopted IPM, correlating greater P. xylostella mortality at these sites. The efficacy of the natural enemy complex to pest mortality under different pest management regimes and appropriate strategies to optimize this important natural resource are discussed.

Agriculture↗
PubMed1999

Relationships between bulk-tank antibodies to Ostertagia ostertagi and herd-management practices and measures of milk production in Nova Scotia dairy herds.

Monthly bulk-tank milk samples were obtained from 415 Nova Scotia dairy herds in each of the months of July-September 1998 and tested using an indirect microtitre ELISA against a crude saline-extract, whole-worm Ostertagia ostertagi antigen. ELISA results (optical densities (ODs)) were consistent across months (r=0.85) but there was considerable variation among herds. A questionnaire was sent by mail to all producers; information on management factors that would potentially influence parasite burdens in the herds was obtained from 239 farms. Data on annual milk production, summer milk production (July-September) and seasonal decline in milk production were obtained from the Animal Productivity and Health Information Network (APHIN) database. Associations between management practices and ODs, and between ODs and milk-production parameters were studied. Some management practices known to be associated with parasite burdens had expected directions of association with the ODs, giving supporting evidence that the ELISA is a reasonable measure of parasite burden. Most notably, ODs were increased with greater exposure of heifers or milking cows to pasture. ODs were not associated with either annual milk production or seasonal decline in milk production. However, there was a substantial relationship between the herd OD value and the level of milk production during the summer. An increase in the OD from 0.58 to 0.83 (the interquartile range of ODs) was associated with a reduction in production of 1.25kg/cow/day.

Animal Husbandry↗
PubMedDate not supplied

The equity market for physician practice management companies.

Initial public offerings or selling out to physician practice management (PPM) firms may be an option for raising capital in large physician groups. This article will address whether this is an accurate perception, whether the markets have cooled and if the heat will return, and the various equity-based options by which physicians can raise equity capital and the advantages and disadvantages of each alternative approach.

Capital Financing↗
PubMed2005

Leaching of glyphosate and AMPA under two soil management practices in Burgundy vineyards (Vosne-Romanée, 21-France).

Some drinking water reservoirs under the vineyards of Burgundy are contaminated with herbicides. Thus the effectiveness of alternative soil management practices, such as grass cover, for reducing the leaching of glyphosate and its metabolite, AMPA, through soils was studied. The leaching of both molecules was studied in structured soil columns under outdoor conditions for 1 year. The soil was managed under two vineyard soil practices: a chemically treated bare calcosol, and a vegetated calcosol. After 680 mm of rainfall, the vegetated calcosol leachates contained lower amounts of glyphosate and AMPA (0.02% and 0.03%, respectively) than the bare calcosol leachates (0.06% and 0.15%, respectively). No glyphosate and only low amounts of AMPA (<0.01%) were extracted from the soil. Glyphosate, and to a greater extent, AMPA, leach through the soils; thus, both molecules may be potential contaminants of groundwater. However, the alternative soil management practice of grass cover could reduce groundwater contamination by the pesticide.

Agriculture↗
PubMed1993

Effect of management practices on the Streptococcus suis carrier rate in nursery swine.

Management practices on swine farms were analyzed to determine factor(s) associated with high prevalence of pigs that were carriers of Streptococcus suis. Samples were obtained for bacteriologic culture via direct swabbing of palatine tonsils of healthy nursery pigs on 35 farms throughout the United States. Overall, 36.7% of the pigs were determined to be carriers. Isolates of S suis were serotyped, and antimicrobial susceptibility tests were performed by use of Kirby-Bauer techniques. Streptococcus suis types 1 and 2 were most commonly isolated. All isolates were susceptible to enrofloxacin, 97% of the isolates were susceptible to ceftiofur, and 94% were susceptible to ampicillin. However, only 80% of the isolates were susceptible to penicillin, and only 18% were susceptible to tetracycline. Environmental, managerial, nutritional, and health factors were measured on each farm. Excessive temperature fluctuation, high relative humidity, crowding, and an age spread of > 2 weeks between pigs in the same room were the 4 most commonly encountered problems on farms with higher-than-average percentages of carrier pigs. Continuous flow facilities were found on 50% of these farms, and various disease problems, vitamin E/selenium deficiency, inadequate vaccination programs (attributable to the presence of atypical serotypes), and penicillin-resistant strains were found on 6 to 28% of these farms. Overall, 83% (15/18) of farms with higher-than-average percentages of carrier pigs also had a history of clinical S suis disease.

Animal Husbandry↗