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PubMed1994

Self management practices in adult asthmatics.

AIM: To examine how adherence to medications and use of competencies (eg, avoiding personal precipitants and managing an acute attack) vary by age, sex, education and number of symptoms in a sample of adult asthmatics. METHODS: 412 adult asthmatics, members of two asthma societies, participated in a mailed survey. The questionnaire contained measures of asthma medication adherence, asthma health competencies, asthma symptoms, and demographic characteristics. RESULTS: Older asthmatics were more likely to adhere and to use more competencies. Females used more competencies than males. Asthmatics with higher numbers of symptoms used more competencies. No differences were found by educational level. CONCLUSIONS: Better adherence in older asthmatics may be due to their having developed greater recognition of the efficacy of medications. The more extensive use of competencies by older people and by women reflects previous findings that these groups value health more and engage in less health threatening behaviours in general. The results also suggest that experiencing asthma symptoms motivates better self management practices. The study raises awareness of the role of competencies in controlling asthma, and should assist health professionals to identify specific differences in self management.

Adult↗
PubMed2005

Wheezing in Chinese schoolchildren: disease severity distribution and management practices, a community-based study in Hong Kong and Guangzhou.

BACKGROUND: Asthma is a common chronic disease and information on its management practices at the community level is helpful in identifying problems and improving asthma care. OBJECTIVE: To assess the severity status and management of the asthma symptom of wheeze of children at the community level in Hong Kong (HK) and Guangzhou (GZ). METHODS: Cross-sectional study of children aged 10 years using the International Study of Asthma and Allergic disease in Childhood (ISAAC Phase II protocol). Asthma management and lung function were assessed in 178 (98 from HK and 80 from GZ) randomly selected children with wheeze over the past 12 months. RESULTS: Eighty-three percent, 11%, 6% and 0% of children suffered from intermittent, mild persistent, moderate persistent and severe persistent asthma, respectively, according to the frequency of their symptoms. Addition of spirometric parameter only changed the asthma severity classification in 2.8% of children. Medications were used by 30.6% and 71.3% of children for wheeze in HK and GZ, respectively. In HK, inhaled beta(2)-agonist (73.3% among the drug users) was the commonest medication used followed by inhaled corticosteroid (ICS) (23.3%). In GZ, inhaled beta(2)-agonist was used by 75.4% of children, but use of ICS (26.3%), oral beta(2)-agonist (26.3%), oral theophylline (45.6%), oral ketotifen (36.8%) and oral steroid (35.1%) were also common. ICS was only used by 11.4% of children with persistent asthma. Ten percent and 18.7% of children in HK and GZ, respectively, had emergency department visits, while 16.3% and 11.6% of children in HK and GZ, respectively, had missed school secondary to asthma over the past 1 year. CONCLUSIONS: Most children in the community had intermittent asthma and addition of lung function to symptoms did not significantly affect classification of asthma severity. Significant morbidity was seen even in this group of children with mostly intermittent and mild persistent asthma.

Administration, Inhalation↗
PubMedDate not supplied

The effect of etomidate on airway management practices of an air medical transport service.

OBJECTIVE: The authors studied the effect of introducing etomidate on the airway management practices of their air transport crew and specifically considered the need for paralytic agents during rapid-sequence intubation. METHODS: A prospective observational review of the transport records for all patients aged greater than 10 years who required intubation transported by the air medical crew before (PRE) and after (POST) the introduction of etomidate into the authors' rapid-sequence induction protocol was conducted. Data were collected, including the method of intubation, indications for intubation, and complications from the procedure. The following outcomes were measured: the method used for intubation (nasotracheal or orotracheal), oral intubation success rate, number of attempts for oral intubation, need for paralytic agents, and complications with the procedure. RESULTS: Comparing the PRE and POST periods, nasotracheal intubation was performed in 27 of 70 (38.6%) versus 33 of 71 (46.4%; p=0.237997). The overall success rate for intubation in the PRE period was 67 of 70 (95.7%), with 95.3% of orotracheal intubations being successful. In the POST period, the overall success rate was 65 of 71 (91.5%), with 94.7% of orotracheal intubations being successful. Complication rates were similar between the groups. Etomidate reduced the use of paralytic agents from 46 of 62 (74.6%) of patients receiving midazolam to 10 of 22 (45.5%) intubated with etomidate (p=0.02). CONCLUSIONS: Etomidate did not appear to have an impact on the selection of intubation methods by the air medical transport crew. Etomidate significantly reduced the need for administration of paralytic agents used in an RSI.

Adult↗
PubMed1998

Hyperlipidaemia: differences in management practices and attitudes in two regions in Europe--Sicily and the Stockholm area.

In order to compare attitudes and management concerning hyperlipidaemia and risk factors for coronary heart disease among doctors in northern and in southern Europe, a questionnaire study was undertaken among doctors in primary health care and departments of internal medicine in Sicily and Stockholm. The regions differed in culture and health-care structure. Guidelines were similar, but screening of healthy individuals was recommended in Sicily, and not in Sweden. One hundred and fifty-three general practitioners in Sicily and 120 in Stockholm, 211 internists in Sicily and 83 in Stockholm participated. Main outcome measures were management policies for investigation and treatment and also attitudes. Routine lipid checks at first visits were done by few doctors in Stockholm but by a majority in Sicily (p < 0.001); in the presence of general cardiovascular risk factors (other than heredity, diabetes, cardiovascular disease and hypertension), routine checks were carried out more often by both general practitioners (p < 0.001) and internists (p < 0.005) in Stockholm. Drug treatment was initiated at lower cholesterol levels for secondary and primary intervention, cardiovascular disease, cardiovascular risk factors and hereditary hyperlipidaemia by both groups in Sicily (p < 0.001), as was dietary treatment. Secondary prevention was considered important by all groups, but primary prevention only by Sicilian doctors. We concluded that there were differences in views and management practice between doctors in Sicily and in Stockholm on the investigation and treatment of patients with hyperlipidaemia. Doctors tested lipids at first visits in Sicily but not in Stockholm. Treatment was initiated at lower levels of cholesterol in Sicily.

Drug Utilization↗
PubMedDate not supplied

Modeling the effects of tillage management practices on herbicide runoff in northern Italy.

The need to quantitatively predict pesticide runoff and erosion under cropping system management has gained increasing importance. In Europe, predictive models have not yet been fully validated because of the lack of field data sets. The objective of this study was to validate the capability of PRZM (Pesticide Root Zone Model) 3.12 to predict water runoff, sediment erosion, and associated transport of atrazine (6-chloro-N(2)-ethyl-N(4)-isopropyl-1,3,5-triazine-2,4-diamine), terbuthylazine (N(2)-tert-butyl-6-chloro-N(4)-ethyl-1,3,5-triazine-2,4-diamine), and metolachlor [2-chloro-6'-ethyl-N-(2-methoxy-l-methylethyl)acet-o-toluidide] under common tillage management practices found in northern Italy. A 2-yr field data set was used to evaluate the model. Results showed that the model could qualitatively simulate significant differences of water runoff, soil erosion, and associated herbicide losses between conventional tillage (CT) and minimum tillage (MT) for a winter barley (Hordeum vulgare L.) cover crop. For MT, water runoff, soil erosion, herbicide losses in water runoff and eroded sediment, and the proportion of herbicide loss via sediment erosion were significantly lower than for CT. The model failed to correctly simulate event-based herbicide concentration, water runoff, and soil erosion. The model usually underestimated pesticide runoff events with high rainfall intensity and low daily precipitation volume, and overestimated runoff events with low intensity and high volume. The main reason was that the description of runoff and erosion processes is rather empirical in the model and not physically based. Moreover, model calculations do not adequately reflect the relationships between soil erosion intensity and chemical concentration in sediment losses, leading to discrepancies between predictions and field observations.

Agriculture↗
PubMed2003

Sedimentation retention basin utilization for best management practice.

Approaches to the artificial impoundment and theoretical design of sedimentation retention basin are reviewed with particular attention to best management practice (BMP) to control agriculture and surface runoff. Sediments retention basins are the small version of farm pond used where a criteria of farm pond is not met. Such basin traps the pollutants and suspended solids prior to entry into streams and lakes. The study is focused with special reference to the assessment and control of non-point source pollution (NPSP) from the sub-basin area of Tai Lake in the Xishan County of Wuxi City of China. The author suggested two different approaches to conduct this study including theoretical design for sedimentation retention basin and computation of flow, sediment transport and deposition during the artificial impoundment of retention basin for BMP's utilization. Theoretical design will provide a useful function as a first line defense against the movement of sediments and transport of pollutants into the Tai Lake while the assessment of sediments deposition will help to make its proper use and periodic cleanup.

Agriculture↗
PubMed1988

[The relationship between farming management practices and the incidence of wet carcass syndrome in sheep].

Farmers who regularly experience wet carcass syndrome tend to farm on a more extensive scale and apply insufficient management practices evidenced by poor recordkeeping, lower sheep handling frequency and inefficient grazing management. Overgrazing and deterioration of natural pastures are aggravated by drought conditions. Feeding of supplements or the provision of a salt lick is unrelated to wet carcass syndrome. Nor can any connection between transport to and distance from the abattoir, type of feeding in the holding pens, withholding of drinking and overhydration before slaughter to the incidence of wet carcass syndrome be demonstrated. The susceptibility for the development of this condition most probably occurs while the live animal is still on the farm.

Animal Feed↗
PubMedDate not supplied

Clinical insights for office practice management.

This manual is intended to be an easily used reference tool for office nurses who are involved with orthopaedic practice management. The manual can be enhanced with personal annotation, creating a working desk reference. While it is beyond the scope of this publication to be a textbook of ambulatory nursing, concepts will be introduced, ideas shared, and resources listed without pretense of attempting to instruct nurses in the science of ambulatory nursing. Some sections are in question and answer format. This will guide the reader through situations commonly encountered and provide possible solutions applicable to individual settings. Because office/clinic nursing is diversified in setting and clinical focus, it is beyond the scope of this manual to provide answers applicable for all situations. Sections have been included regarding office setup, equipment issues, space requirements, regulations, certification, and accreditation. Contributing authors have provided expert information on managed care issues, CPT/ICD9 coding, risk management, and OSHA regulations. By outlining common areas of concern and pitfalls to avoid, nurses can develop a workbook specific to their own setting.

Humans↗
PubMed2000

Solid waste management practices in U.S. Army medical treatment facilities.

U.S. Army medical treatment facilities (MTFs) will be challenged to reduce waste as the Army internalizes as environmental ethic and privatizes solid waste management. A questionnaire was modified to survey solid waste management practices, participation in waste reduction and recycling programs, and solid waste management problems in 25 MTFs. Questionnaires were returned by 19 (76%) of the sites. Eighteen sites participated in waste reduction and recycling programs. Twelve sites used contractors to disinfect potentially infectious solid waste off site. Mean importance ratings of waste reduction and recycling were 2.00 and 1.83 (1 = very important; 5 = very unimportant), respectively. Limited staffing was ranked as the most significant waste management problem, followed by cost and regulatory compliance. More information on waste generation in MTFs is needed. The Army Medical Department should be presented as a model of environmental and natural resource stewardship for the health care industry.

Conservation of Natural Resources↗
PubMed1990

Management practices and their association with reproductive health and performance in Colorado beef herds.

An observational study was conducted to quantify the effects of management practices on reproductive performance and disorders of beef cows. The study population consisted of 44 randomly selected Colorado cow-calf herds monitored for disease and reproductive events as part of the National Animal Health Monitoring System. The managers of the herds were surveyed with a standardized questionnaire to determine specific management characteristics of their operations. Data were analyzed using the random-effects multiple logistic regression model. Outcomes of interest were calving rate, herd incidence rates of dystocia and combined reproductive disorders, and calf mortality rate. A higher calving rate was associated (P less than .01) with a decreased percentage of replacement females in the herd, a shorter breeding season, a smaller herd size, and a lower percentage of bulls being used as yearlings. Incidence rates of both dystocia and combined reproductive disorders were found to be lower (P less than .01) in herds that were fed cottonseed cake as a winter supplement, but higher (P less than .01) in herds that were fed grass hay as a winter supplement. Herds located in the mountains of Colorado had lower (P less than .01) incidence rates of dystocia and reproductive disorders than herds located in the eastern plains. Calf mortality rate was found to be higher (P less than .05) with calving seasons that began earlier in the year. Higher calf mortality rates were associated (P less than .05) with an increased incidence of dystocia, the commingling of cattle on summer range, and smaller herd size.

Animal Feed↗
PubMed2005

Manure management practices in Lombardy (Italy).

The Lombardy Region of Italy has used a specialised software package, GIARA, to implement an integrated environmental management system that assists farmers in the preparation and submission of nutrient management plans. These are submitted on diskette to a central authority in order to build a regional database of manure utilisation linked to a GIS. At present, the database includes plans for more then 5500 farms representing more then one million cattle and 3.5 million pigs. The information contained in the database allows an evaluation of manure management practices in the Region. Some indicators like nitrogen amount per hectare varies from 100 to 300 kg at the same level of crop requirement and therefore do not seem adequate to evaluate the pollution risk at farm level.

Agriculture↗
PubMed2006

Implementation of a best management practice (BMP) system for a clay mining facility in Taiwan.

The present paper describes the planning and implementation of a best management practice (BMP) system for a clay mining facility in Northern Taiwan. It is a challenge to plan and design BMPs for mitigating the impact of clay mining operations due to the fact that clay mining drainage typically contains very high concentrations of suspended solids (SS), Fe-ions, and [H+] concentrations. In the present study, a field monitoring effort was conducted to collect data for runoff quality and quantity from a clay mining area in Northern Taiwan. A BMP system including holding ponds connected in series was designed and implemented and its pollutant removal performance was assessed. The assessment was based on mass balance computations and an analysis of the relationship between BMP design parameters such as pond depth, detention time, surface loading rate, etc. and the pollutant removal efficiency. Field sampling results showed that the surface-loading rate is exponential related to the removing rate. The results provide the basis for a more comprehensive and efficient BMP implementation plan for clay mining operations.

Aluminum Silicates↗
PubMed2000

Weight management practices among primary care providers.

This pilot study examined how primary care providers manage patients with weight problems, an important component of primary care. A convenience sample of 17 nurse practitioners and 15 physicians were surveyed about assessments and interventions used in practice for weight management along with perceived barriers to providing effective weight management. Practice patterns between gender, profession and practice setting of the nurse practitioners were compared.

Adult↗
PubMed2001

Nurses' attitudes toward pain, pain assessment, and pain management practices in long-term care facilities.

This descriptive study was designed to identify attitudes regarding pain as well as pain assessment and management practices of nurses working with elderly residents in 10 long-term care facilities. Twenty-seven nurses from 10 facilities in the Midwest responded to a questionnaire. Findings indicate that more than half of the respondents reported that residents should be pain free; however, only 5 respondents defined pain free as no pain. Others defined it as being comfortable or able to perform activities of daily living. Nurses reported assessing the following aspects of pain more than three fourths of the time: onset, frequency, location, severity/intensity, facial expression, contortions, and medication effectiveness. Changes in weight, recreational activity, and concentration, as well as coping skills were assessed less than half of the time. When first learning residents were in pain, nurses reported doing further assessments, offering medication, giving emotional reassurance, and changing the resident's position. They reported substantial familiarity with basic nonpharmacologic practices but only asked residents to try these interventions (in addition to medication) an average of 38% of the time.

Adult↗
PubMedDate not supplied

Disparities in diabetes management practice between racial and ethnic groups in the United States.

PURPOSE: The purpose of this study was to evaluate the association between race/ethnicity and self-management practices of people with diabetes. METHODS: Analyses were based on data from the 2001 Behavioral Risk Factor Surveillance System. Contingency tables and multiple logistic regression were used to assess the data. RESULTS: Frequency distributions of selected diabetes management variables significantly varied across levels of race/ethnicity. These differences persisted after adjusting for current age, age at diagnosis, gender, marital status, income, and education. Analyses revealed that Hispanics, compared with whites, were more likely to take oral agents to control their blood glucose, less likely to monitor their blood glucose daily, and less likely to check their feet for sores or irritation. There was no difference among the racial/ethnic groups use having participated in a diabetes education class. CONCLUSIONS: Health literacy and cultural factors, including the influence of family, beliefs about diabetes, and access and utilization of health care, may influence Hispanic diabetes management behaviors. Understanding these influences is essential to the development of programs, policies, and other strategies that are culturally appropriate and relevant.

Blood Glucose↗
PubMed1997

Asthma prevalence, morbidity and management practices in South Australia, 1992-1995.

BACKGROUND: The Spring South Australian Health Omnibus Survey (SSAHOS) has been used to monitor trends in asthma prevalence, asthma morbidity and asthma management practices between 1992 and 1995. AIMS: To determine if self-reported asthma prevalence and availability of asthma action plans were increasing. To identify deficiencies in asthma management and opportunities for intervention. METHODS: Representative population survey by trained interviewers using a multistage, systematic, clustered area sample of 4200 households in South Australia where people aged 15 years or more are living. RESULTS: Over 3000 interviews were conducted each year. Between 1992 and 1995 the self-reported prevalence of asthma in those aged 15 years or more increased significantly from 15.7% to 20.3% (p < 0.0005), and the prevalence of current asthma increased from 9.3% to 11.4% (p < 0.05). The self-reported availability of individual asthma action plans increased from 21.9% in 1992 to 42.2% in 1995 (p < 0.0005). In 1992, 21% had a nebuliser at home, and 10.5% had a peak flow meter. In 1993, 61.4% were using preventive medications, and 35% thought bronchodilators were 'preventer' medications. In 1994 and 1995, between 12.5% and 15.6% had nocturnal awakening weekly or more often, and 31.4% had morning asthma symptoms weekly or more often. Between 20.1% and 20.8% had lost days from usual activities during the last year. Those on incomes below $20,000 had more symptoms, had more admissions to hospital, and required more medication than those on higher incomes. CONCLUSIONS: Self-reported asthma prevalence has increased. There remains a gap between current asthma management and that recommended by the National Asthma Campaign.

Adolescent↗