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PubMedDate not supplied

Performance comparison of structural stormwater best management practices.

This paper describes a method for comparing the pollutant removal of a number of structural stormwater treatment devices, commonly referred to as best management practices (BMPs). Historically, the pollutant removal ability of a BMP has been expressed as a percent reduction in concentration or load. Unfortunately, the calculated percent reduction in pollutant concentration is strongly affected by the influent concentration, with the calculated reduction generally being much lower when the event mean concentrations (EMCs) in the untreated runoff from the test watershed are low. The objective of the proposed methodology is to eliminate this problem by predicting BMP performance for an arbitrary influent concentration, so that BMPs evaluated in different watersheds can be compared as if the influent quality at all sites were the same. This method allows BMPs to be compared based on the quality of effluent produced and the mass reduction. The proposed method uses linear regression as the primary tool to compute the expected effluent concentration from a BMP, given a specific influent concentration of interest and was developed using data collected in the California Department of Transportation BMP Retrofit Pilot Program. This technique reveals that for media filters, the concentration of sediment and other particle-associated pollutants in treated runoff is generally unrelated to influent quality and is relatively constant. Wet basins with large permanent pool volumes also have effluent concentrations that are constant for most constituents and unrelated to influent concentrations. In these situations, the "percent reduction" in a pollutant EMC is not an inherent characteristic of the BMP, but a function of the influent EMC, because the quality of effluent produced is constant. Predicting the effluent quality of several types of conventional BMPs based on a common influent concentration allows an objective comparison of their performance and the selection of a BMP that addresses specific constituents of concern.

Benchmarking↗
PubMed2004

Practice management and patient care: is there an ideal situation for both patients and physician practices in light of legislative reform?

The Medicare reimbursement rules have changed, and urologists must be prepared to change as well. They must take an active role in the management of their office practices, for the alternative will almost certainly have a negative impact on access for many patients, including those with prostate cancer. Urologists need to critically evaluate the daily operation of their practice, with an eye toward eliminating excess and increasing efficiency. This article discusses areas, such as staffing, collections, coding, and ancillary services, which can be optimized to meet the requirements of a successful urology practice in this changing environment.

Delivery of Health Care↗
PubMed1985

Survey of nutritional management practices and metabolic disorders in West Virginia dairy herds.

Sixteen farmers, representing three major dairy counties in West Virginia, were interviewed to determine current dairy management practices. Herd health records were used to determine the incidence of metabolic and digestive disorders. All feedstuffs used on these farms were sampled for chemical analyses. The total number of cows on the 16 farms surveyed was 1870 with an average herd size of 117 and 6387 kg milk produced per cow per year. Fourteen of the 16 farmers used forage testing services, obtained professional advice on feeding and nutrition, and attempted to feed according to production. Eleven of sixteen farmers increased grain 2 weeks prior to calving and all gradually adjusted the intake of grain to cows recently freshened. Ration imbalance problems included both excesses and deficiencies of energy, protein, phosphorus, and calcium. Excess calcium, phosphorous, and crude protein were correlated (P less than .01, r2 = .74) with the incidence of fat cows. The incidence of metabolic disorders in these herds was low to average and the most prevalent management problem encountered was low butter fat.

Animal Husbandry↗
PubMed2003

A study of quality management practices in nursing in universities in Australia.

In Australia, the traditional Quality Assurance approach used in the hospital setting has played an important role in nursing practice. During the past decade, nurses have begun making a paradigm shift from Quality Assurance to Total Quality Management but scant attention has been paid to quality management practices in nursing in the higher education sector. This paper reports on a quantitative study examining the perceptions of nurse academics to the applicability of TQM to nursing in universities. The findings identified how TQM could be applied to suit the nursing culture in the higher education sector.

Australia↗
PubMedDate not supplied

Best practice management strategies for mental health nurses during the clinical application of civil commitment: an overview.

AIM: The aim of this article is to outline best practice management strategies for nurses during the clinical application of civil commitment of mentally ill persons. METHOD: A thorough literature search on 'coercion' and 'civil commitment' was undertaken using MEDLINE, CINAHL and PSYCHINFO. Published and unpublished research undertaken by the authors in New Zealand on this topic was drawn upon. This research considered the use of civil commitment during admission to acute mental health services, acute forensic mental health services and community mental health services. RESULTS: The experience of coercion by service users coincides with the degree of restriction associated with the service they are involved in. Socio-demographic factors, clinical factors and the experience of coercive events have little bearing on the amount of coercion experienced. Rather it is the pattern of communication and the use of 'procedural justice' that has the potential to ameliorate the amount of perceived coercion. CONCLUSIONS: 'Procedural justice' aligns with the emphasis placed on the therapeutic relationship in mental health nursing and is an important consideration for nurses during the clinical application of civil commitment.

Coercion↗
PubMed2004

[Peripheral arterial disease: what management practices for general practitioners?].

OBJECTIVE: The purpose of this study was to analyze the results of the ATTEST study in order to evaluate general medicine management practices for peripheral arterial disease (PAD). Our analysis was based on the guidelines for good practice which recommend measurement of the systolic pressure index (SPI), search for other localizations of atherothrombosis, treatment of risk factors including smoking, walking exercises, and long-term prescription of anti-platelets. METHODS: ATTEST is a cross-sectional multicentric observational epidemiologic study conducted in metropolitan France. The study has recruited 8.475 analyzable patients with symptomatic PAD alone (3811 patients) or associated with other atherothrombotic localizations (2416 patients) or other cardiovascular diseases (2248 patients). These patients were followed by 3020 physicians. The current analysis thus included 6227 patients (81.2% men, 18.8% women, mean age 67.2 years), including 78.8% who had reached the stage of intermittent claudication. Risk factors included current or past smoking (61%), hypercholesterolemia (66.3%), hypertension (63.1%) and diabetes mellitus (26%). RESULTS: Arterial duplex Doppler exams of the lower limbs were performed in 91.2% of the patients but measurement of the SPI for diagnostic purposes had been performed in only 17%. The majority (85.8%) of the patients with proven coronary artery disease or cervico-encephalic involvement had had an ECG and 69.3% had had a duplex Doppler of the supra-aortic trunks. Smoking continued in 39% of the patients and an aid to cease smoking had been prescribed for only 7% of the patients who were non-smokers for less than one year. Nearly two-thirds of the patients analyzed had received advice concerning physical activities. Finally, anti-platelets had been prescribed for 92.2% of the patients. CONCLUSIONS: The general practitioner plays a crucial role in the diagnosis and treatment of PAD. Although measurement of the SPI is recommended as an early diagnostic tool and for evaluation of severity, it had been performed in less than one-third of the patients. Search for another localization of atherothrombosis had been performed in more than half of the patients. The physicians generally delivered advice on physical exercise and prescribed anti-platelets. The fight against smoking was however largely insufficient. The results of this study warrant further optimization of the collaboration between general practitioners and vascular disease specialists.

Adult↗
PubMed2006

Diffuse pollution in Oxford (Ohio, USA) watershed and performance of 'street sweeping' as a 'best management practice' (BMP).

Experimental results are described to evaluate the diffuse pollution profile according to land use in the catchments and street sweeping as a best management practice (BMP). We studied the variation of pollutant concentrations in outfalls discharging runoff from residential, commercial and high-traffic areas and in street sweeping. Pollution profiles varied with the land use in the catchments and seasons along with other factors such as rainfall intensity, construction works and street maintenance. Microbial indicator organisms were relatively high in all three outfalls. Heavy metal concentrations were low with lead (Pb) as the predominant heavy metal. The organic and solid contents were low but non-degradable and persistent. Relatively high quantities of pollutants were found in street sweeps in all catchments suggesting street sweeping as an effective measure to control diffuse pollution. Regular and frequent sweeping is important as a BMP.

Filtration↗
PubMed2004

Information technology in the interventional pain practice: electronic medical records, practice management software, and document management.

Electronic medical records (EMR) can both replace the paper clinical chart and perform scheduling and billing tasks. EMRs are currently used in only a small proportion of medical practices; however, EMR adoption is expected to soar in a few years. Governmental and industry concerns about safety and quality, along with medical practice needs for increased productivity, are fueling this transition. Medical practices are likely to consider transitioning to EMRs. At this point, the marketplace is fragmented in terms of suppliers, and refinement of the software is continuing. Transitioning to an EMR is a step that offers enormous benefits to interventional pain management physicians, in terms of compliance, the ability to maintain quality, and the ability to manage practices, including larger and more complex practices. Transitioning to an EMR is also a major effort in terms of time and expense: the goal is to settle on a specific EMR and continue to use it. This review focuses on (1) why physicians are or are not transitioning to EMRs; (2) the benefits of a transition; and (3) factors to consider in evaluating the various competing software products. Although EMR technology continues to develop, the review also considers areas in which future development is necessary. The most important areas are seen in document management, data input, and outcomes analysis and decision support capability. The EMR market is evolving rapidly. However, this review should in no way serve as an endorsement of any particular system, vendor, or technology.

Journal Article↗
PubMed2006

Incorporating anti-IgE (omalizumab) therapy into pulmonary medicine practice: practice management implications.

Despite aggressive therapy, many asthma patients cannot achieve optimal control, and it is recognized that a small number of patients, generally those with severe persistent asthma, are the most difficult to control and are responsible for a large segment of the costs of asthma. These patients demonstrate a need for additional therapeutic options to achieve enhanced asthma control. Omalizumab should be considered a second-line therapy for patients with moderate-to-severe persistent allergic asthma not fully controlled on standard therapy. This article should not be considered a complete guide to incorporating this therapy into practice but serve as an introduction and a basic review of the practice management aspects of therapy for physicians practicing in the United States.

Antibodies, Anti-Idiotypic↗
PubMed2006

Airway management practices at German university and university-affiliated teaching hospitals--equipment, techniques and training: results of a nationwide survey.

BACKGROUND: Until recently, Germany did not have national airway management guidelines. This survey collected comprehensive data on departmental airway management practices from German teaching institutions to identify weaknesses, and the results are presented here. German national airway guidelines were formulated by an expert group on the basis of these data and the current evidence in the literature. METHODS: Questionnaires were mailed to the directors of 452 university and university-affiliated anaesthesia departments. They were asked to respond to 39 questions on the use of particular equipment and techniques, management of the difficult airway and training in airway management. RESULTS: Two hundred and twelve questionnaires were returned. Many alternative devices for endotracheal intubation, such as the Bullard laryngoscope, the Bonfils laryngoscope and the Trachlight, are not used in the majority (80%) of departments. Thirty-six per cent of departments do not have difficult airway carts. No departmental difficult airway management plan is used in 22% of departments. Patients are not provided with written information on their personal airway management difficulties in 14% of departments. Structured training in the form of block rotation is offered in only 29-40% of departments. Although trainees perform fibreoptic intubation (FOI) in most departments, appropriate training in FOI is not available in some departments (8%). CONCLUSION: There are deficits in various areas of airway management, in particular training and the use of algorithms. International guidelines and recommendations are not followed by a large number of German teaching institutions. The provision of German national airway guidelines should improve this situation.

Anesthesiology↗
PubMed2006

Distribution of pathogenic indicator bacteria in structural best management practices.

This study evaluated the bacterial distribution and the survivability of bacteria associated with different particle size ranges in the sump water and sediments within two structural Best Management Practices (BMPs), called Vortechs, installed at two different sites in Providence, Rhode Island. Ten rain storms were sampled in year 2004. Five pathogenic indicator bacteria, E. coli, enterococci, fecal streptococci, total coliform, fecal coliform, were analyzed for samples in the sump water and sediments within two Vortechs. In both sump water and sediments within Vortechs, most of the bacterial were found to be associated with smaller particles, i.e., 80-95% of all pathogenic indicator bacteria were associated with particles less than 50 micro meter in the sump water, and 60-80% of all indicator bacteria were associated with particles less than 106 micro meter in the sediments. In the sump water, it was found that a surge of all indicator bacteria concentrations happened one-day after the rainfall stopped. This result was most significant for the bacteria associated with smaller particles. On the contrary, in the sediments, no dramatic change of bacterial concentrations was detected over the 5-day dry period following rain. At both sampling sites, much higher bacterial concentrations were detected in the sediments than in the sump water suggesting that sediments may have provided a favorable living environment for bacteria. The two sampling sites showed almost identical results in many aspects. Except the sump water at Site 2 had much lower bacterial concentrations than that at Site 1 suggesting higher bacterial contamination from highway runoff.

Colony Count, Microbial↗
PubMed1994

Human resources management practices and patient satisfaction in home health care.

Patient satisfaction is an important issue for home health providers. This study tested the influence of organizational factors, particularly human resource management practices, on quality of care, as measured by patient satisfaction. Six hundred ninety-six patients of thirteen home health agencies were surveyed to test the influence of organizational factors on five dimensions of patient satisfaction. Organizational variables included size of the agency, staffing characteristics, educational preparation of RNs, continuing education, and compensation. We found that full-time staffing, the number of BSN-prepared RNs, and percent of budget allocated to benefits all predicted high patient satisfaction scores.

Data Collection↗
PubMed1996

Total quality management practices in the NSW hospital system--an overview.

A two-phase descriptive study involving a questionnaire survey was undertaken during 1994 and 1995 to evaluate the extent of implementation of total quality management practices in New South Wales hospitals accredited by the Australian Council on Healthcare Standards. A survey response rate of 72 per cent was attained. Results indicated that most hospitals were aware of and consciously implemented aspects of the total quality management philosophy in some way. There is little evidence that whole systems have embraced the total quality management approach as a fully integrated endeavour.

Community-Institutional Relations↗
PubMed1997

Asthma in Greenwich, UK: impact of the disease and current management practices.

A great deal of the care of patients with asthma takes place in general practices. The aim of the present study was to describe the impact of asthma in the community and to identify current asthma self-management practices. A two-part questionnaire survey was conducted in a random sample (23%; n=24,398) of persons aged 16-50 yrs, registered with one of the 41 general practices in Greenwich, London, UK. The two parts were: a screening questionnaire identifying persons with current asthma (defined as waking with shortness of breath in the last 12 months, attack of asthma in the last 12 months, or currently taking treatment for asthma); and an asthma questionnaire (completed by those with asthma) assessing quality of life, frequency of asthma symptoms, possession and use of self-management tools, and action in the event of an exacerbation of asthma. The crude response rate was 51%, but this may be an underestimate due to errors in the sampling frame. The prevalences of wheeze and asthma in the past 12 months were 26% and 14%, respectively. Among asthma patients: 43% reported symptoms occurring three or more times per week, and 20% were woken by asthma symptoms on three or more nights per week; most had asthma with a mild impact on quality of life; 26% used inhaled steroids on most days in the preceding month; 16% had a peak flow meter at home; and 7% had oral steroids available. Of the 44% of subjects with asthma, who could identify an exacerbation of asthma in the preceding 6 months: 19% had used a peak flow meter during the episode; 19% had changed their treatment without first being told to do so by a doctor; and 50% had sought urgent medical help. Smokers used less appropriate asthma management and subjects whose asthma had a severe impact on quality of life used more treatment and peak flow monitoring. In conclusion, the prevalence of asthma among adults in Greenwich, UK, has increased since a similar survey in 1986. Many people have fairly mild asthma and a smaller number have severe disease. Much remains to be done to promote appropriate strategies for self-management of asthma exacerbations.

Adolescent↗
PubMed2005

Disability management practices in education, hotel/motel, and health care workplaces.

BACKGROUND: The high costs and the impact of work disability have become a growing concern for workplaces. As a result, workplace disability management approaches have been developed to lower disability costs, protect the employability of workers, and promote early return to work. METHODS: A stratified random sample of 455 employers in education (n = 157), hotel/motel (n = 110), and health care (n = 188) sectors who completed a mailed Organizational Policies and Practices (OPP) questionnaire is reported. The OPP questionnaire asked questions about eight workplace disability management practices. The article examined the multi-dimensionality, internal consistency, and discriminant validity of the OPP and compares disability management practices across the three sectors. RESULTS: The OPP questionnaire showed good internal consistency (Cronbach's alpha = 0.95) and discriminant validity. A one-way analysis of variance (ANOVA) for each of the eight subscales demonstrated that there were statistically significant differences between the sectors in ergonomic practices (F (2,452) = 15.8, P < 0.001), disability case management (F (2,452) = 4.6, P < 0.01), return to work (F (2,452) = 10.3, P < 0.001), and people-oriented culture (F (2,452) = 4.5, P < 0.01). CONCLUSIONS: On examining disability management practices in education, hotel/motel, and health care sectors, the OPP seems to be a promising instrument that can be used to assess and monitor how employers are managing disability.

Analysis of Variance↗
PubMed2000

Nebulizer use in inner-city children with asthma: morbidity, medication use, and asthma management practices.

OBJECTIVE: To assess the frequency of nebulizer use, describe morbidity and patterns of medication administration, and examine the potential relationships between inhaled anti-inflammatory medication administration, asthma morbidity, and asthma management practices in children with asthma using a nebulizer compared with children with asthma not using a nebulizer. RESEARCH DESIGN: A cross-sectional, descriptive survey of previous events. SETTING: Elementary schools and participants' homes in Baltimore, Md, and Washington, DC. PARTICIPANTS: Six hundred eighty-six families of children aged 5 to 12 years with a diagnosis of at least mild, persistent asthma. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Asthma morbidity, health care utilization, pattern of asthma medication administration, nebulizer use, and asthma management data were collected by telephone survey administered to caregivers. Nebulizer use was defined as use at least 1 or more days per month during the last 6 months. Of 686 children identified, 231 (33%) reported current nebulizer use. Nebulizer users had significantly increased lifetime hospital admissions, hospitalizations, and emergency department visits in the last 6 months compared with nonnebulizer users. Inhaled corticosteroid administration was low for both groups (nonnebulizer users, 8%; nebulizer users, 15%). In the nebulizer users group, administration of inhaled anti-inflammatory medications was associated with increased asthma morbidity (increased hospitalizations, days and nights with symptoms, and oral steroid use). CONCLUSIONS: Nebulizer use by inner-city children with asthma is higher than anticipated but is not associated with reduced asthma morbidity. This group of high-risk children was undertreated with inhaled corticosteroids for long-term control of asthma despite reports of adequate monitoring by a primary care physician.

Administration, Inhalation↗