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PubMedDate not supplied

Primary care nursing. Community nursing practice management and teamwork.

The government has announced that GP fundholding is to be extended to include a 'community fundholding' option. In the new scheme, all GPs will be eligible to become community fundholders and buy community nursing services from NHS community trusts. This paper outlines what the National Health Service Executive guidelines will mean for community nurses working in GP practices and describes four models, currently up and running, of new primary health-care team nursing practice management and teamwork.

Community Health Nursing↗
PubMedDate not supplied

Clinical biochemical parameters of the endangered Catalonian donkey breed: normal values and the influence of sex, age, and management practices effect.

Twelve clinical biochemical parameters were determined in 97 animals of all age groups and both sexes of the endangered Catalonian donkey breed. Significant sex differences were observed for phospholipid concentration (P<0.01). Evaluating the effect of management practices on the various parameters showed significant differences for total bilirubin (P<0.001) and creatinine (P<0.05) concentrations and gamma-glutamyltransferase (P<0.05) activity. Moreover, it was observed that inorganic phosphorus concentration decreased with age (P<0.001), whereas albumin and triglyceride concentrations increased with age (P<0.01 and P<0.001, respectively). Comparison of biochemical ranges obtained for the Catalonian donkey breed with reference ranges for other breeds and populations (Mammoth, USA donkeys, UK donkeys, Indian donkeys and Poitou donkeys), indicated that most values were similar, with the exceptions of enzymatic activities mainly. The results reported in the present study could serve as reference ranges for donkey populations.

Age Factors↗
PubMed1999

[Practical management of nosocomial pneumonia].

Among all nosocomial infections, pneumonia is the second most common (after urinary tract infections) but has the highest mortality rate. Proper antibiotic treatment based on adequate diagnostic methods appears to decrease morbidity and mortality. Practical management of nosocomial pneumonia was shown on graphic diagrams.

Bacterial Infections↗
PubMed1990

Relationship of the prevalence of swine helminths to management practices and anthelmintic treatment in Danish sow herds.

During 1982-1984, the occurrence of helminths in 66 sow herds in Denmark was examined by means of faecal samples. The correlations between the prevalences of Ascaris suum and Oesophagostomum spp. and management practices were analysed for fatteners and sows, respectively, resulting in four multivariate models. The helminth prevalences were in general low in large herds, specific pathogen-free (SPF) herds and herds with low weaning age. The multivariate analyses showed that only the two latter correlations were significant. The helminth prevalences of the fatteners were not correlated with anthelmintic treatment. In the sows, anthelmintic treatment was significantly correlated with low prevalences of both helminths, despite samples from recently dewormed sows indicating a rather transitory effect. The prevalences of Oesophagostomum in both fatteners and sows were significantly higher on solid floors with straw bedding than on slatted floors without straw, while this was not the case for Ascaris. Tethering of sows was not significantly correlated with helminth prevalences. Daily cleaning was significantly correlated with low helminth prevalences in fatteners, but not in the sows, while disinfection of the pens was only significantly correlated with low prevalences of Oesophagostomum in fatteners. No correlations to washing of the pens were found. The epidemiology of Ascaris and Oesophagostomum is discussed, especially why the latter is the most sensitive to intensive management.

Animal Husbandry↗
PubMed1984

The correlation of family management practices and delinquency.

Family-management skills of parents of seventh- and tenth-grade boys were related to each of 2 criterion measures of delinquency: police contacts and self-reported delinquency. The measures of family-management skills were monitoring, discipline, problem solving, and reinforcement. The measures of parent monitoring and discipline were shown to correlate significantly with both criterion measures. The monitoring score accounted for the most variance in both criterion measures of delinquency, and the problem solving and reinforcement measures accounted for the least. The monitoring score also differentiated moderate offenders from persistent offenders.

Adolescent↗
PubMed1997

Peer intervention in case management practice.

Using peers as case managers in dealing with current and chronic public health problems such as substance abuse, gang violence, or the HIV/AIDS crisis has been shown to improve outreach efforts, monitoring, and outcomes in hard-to-reach populations. This article focuses on a case management strategy that uses peer modeling interventions to assist people in renegotiating their present life circumstances. Peer modeling engages peers of the client population as case managers and employs group-mediated, social control intervention strategies in the community to bring about positive changes in lifestyle and living conditions. The peer approach is an enhanced version of case management, utilizing the core activities of outreach, assessment, planning, linking, monitoring, and advocacy but adding peer-led, skill-based training activities, coupled with a system of positive incentives designed to encourage a more healthful lifestyle. To clarify this enhanced approach to case management, the authors present a matrix to illustrate how key case management activities might be enhanced through peer modeling interventions. We conclude by suggesting the circumstances in which an organization responsible for service delivery might consider using peer modeling in addressing difficult public health problems, and we discuss the advantages and disadvantages of such a strategy.

Case Management↗
PubMed1994

Survey of pediatricians' management practices for recurrent abdominal pain.

Surveyed general pediatricians (N = 116) regarding six content areas: (a) diagnostic procedures utilized during the initial evaluation sequence of a child with recurrent abdominal pain (RAP); (b) factors that influence decisions to order additional evaluations; (c) management practices following negative evaluation results; (d) factors influencing decisions about consultation with or referral to a mental health professional; (e) attitudes about the etiology of RAP; and (f) the frequency in which pediatricians encountered children with RAP and referred them to mental health services. Results of this survey are presented and discussed from a biopsychosocial perspective. Limitations of the survey, implications of the results for integrating mental health professionals into the evaluation and treatment process of RAP patients, and directions for future research are discussed.

Abdominal Pain↗
PubMed2004

Analysis of disease progress as a basis for evaluating disease management practices.

The relationship between epidemiology and disease management is long-standing but sometimes tenuous. It may seem self-evident that improved understanding of epidemic processes will lead to more effective control practices but this remains a testable proposition rather than demonstrated reality. A wide range of models differing in mathematical sophistication and computational complexity has been proposed as a means of achieving a greater understanding of epidemiology and carrying this through to improved management. The potential exists to align these modeling approaches to evaluation of control practices and prediction of the consequent epidemic outcomes, but these have yet to make a major impact on practical disease management. For the immediate future simpler pragmatic approaches for analysis of disease progress, using nonlinear growth functions and/or integrated measures such as area under disease progress curves, will play a key role in informing tactical and strategic decisions on control treatments. These approaches have proved useful in describing control effectiveness and, in some cases, optimizing or changing control practices.

Agriculture↗
PubMed1998

Water management practices in rural and urban homes: a case study from Bangladesh on ingestion of polluted water.

Although Bangladesh has achieved remarkable success in extending the availability of hand pumped and piped water, unsafe water is still ingested. This brief study attempted to assess water management practices in rural and urban homes in Bangladesh so as to establish the routes by which unsafe water is ingested, to examine methods of collection and storage, and determine why unsafe water sources are used when unsafe supplies are available. Forty-eight rural and forty-five urban slum households were studied. Observations, interviews and water quality investigations were conducted. The results show that the respondents were aware that hand pump/tap water is safe and took care to use these safe sources for drinking purposes. However, they continued to use surface water for non-drinking activities such as bathing, washing and rinsing their mouths. Reasons were given that it was a traditional practice to bathe in surface water and was more enjoyable. One of the reasons given for not using hand pumped water to wash clothing and food was that such groundwater caused staining. Bacteriological results from such ingested water showed the quality, especially in rural areas, to be poor. Results also showed the internal surfaces of the base of storage containers to be heavily contaminated with bacteria. This showed that water that was safe when it was first drawn would became contaminated during storage. This study had a limited scope; much further research is needed to find what determines and how water becomes contaminated in containers. These factors include how to reduce contamination of water, in particular the relationship between growth of bacteria in stored water and the material from which the container is made and how to improve the overall quality of water. On the management side, studies could be conducted as to how to improve people's understanding of the use of water for domestic purposes and its safe management.

Adult↗
PubMed2001

The relationship between tail biting in pigs, docking procedure and other management practices.

The tail length (docked, tipped or undocked) and tail status (bitten or unbitten) of 27,870 pigs from 450 units was recorded at six UK abattoirs. A farm survey of the final finishing stage was used to investigate the relationship between management practice and tail biting. This showed that docking was the most important factor influencing the probability of being not bitten, with 2.4% of docked and 8.5% of long-tailed pigs being tail-bitten. The following factors reduced the probability of long-tailed pigs being tail-bitten; light straw provision, use of natural ventilation or artificially controlled natural ventilation (ACNV), mixed sex grouping, meal or liquid feeding, and use of double or multi-space feeders. Docked and long-tailed pigs provided with light straw and natural ventilation/ACNV had levels of tail biting of 1.2% and 4.3% respectively; 3.9% of docked pigs with artificial ventilation and no straw were tail-bitten. Long-tailed pigs fed via double or multi-space feeders also had 3.9% of tails bitten.

Animal Husbandry↗
PubMedDate not supplied

Challenges of Web-based education in educating nurses about evidence-based acute pain management practices for older adults.

Internet technology holds potential as a valuable educational tool, but several challenges continue to impede its use. This article describes the use of a web-based course to educate staff nurses regarding evidence-based acute pain management practices for older adults. Specific areas highlighted include: the steps involved in creating the web-based course; the materials and support required to disseminate the course; the challenges encountered in promoting use of the course; and responses to and evaluations of the course. The authors' experiences provide knowledge to assist other healthcare professionals on the use of a web-based course to educate staff nurses.

Adult↗
PubMedDate not supplied

Improving pain management practice. A medical center moves beyond education to document and manage patient care.

In 1993 nurses at Providence/ Portland Medical Center, Portland, OR, initiated a quality improvement project to assess pain levels in the facility's inpatients. A convenience sample in April 1993 showed an average pain intensity of 6.30 on a 0-10 scale (where O equals no pain and 10 is the worst pain imaginable). With the nursing administrator's support, pain management nurses presented a four-hour course in the basics of pain assessment and intervention to more than 850 nurses and 100 other professionals. In August 1993 nurses found that the intensity of patient pain had dropped to 5.70 on the 0-10 scale. Still dissatisfied with this situation, the nurses proceeded with a three-pronged approach to improve the medical center's quality of pain management: making the problem visible by better documentation and communication about pain; making an institutional commitment to pain management, including establishing pain management quality improvement as the medical center's first patient outcome institutional objective; eliciting the endorsement of influential committees. In August 1994 a random sample revealed patient pain had decreased to 3.21. The next step focused on empowering patients and families through education (e.g., revising the booklet on patient rights and responsibilities, posting signs in rooms encouraging patients to report pain) and clearing up myths and misconceptions through inservices and posters. A sampling in November 1995 showed that the average pain intensity of inpatients had been reduced to 2.32. Plans for continuous quality improvement interventions will further enhance patient comfort and recovery.

Clinical Nursing Research↗
PubMed1990

Practical management of Bell's palsy.

Bell's palsy is an acute unilateral weakness or paralysis of the face resulting from peripheral facial nerve dysfunction. While there is no readily identifiable cause, there is some recovery of function within 6 months. This article offers practical guidelines for diagnosing and treating Bell's palsy. These guidelines are based on the author's experience with 63 patients over the last 8 years. Physical examination should reveal diffuse nerve involvement, normal otoscopic findings, and no skin blebs or blisters and parotid masses. Other cranial nerve palsies may be present. Diagnostic testing should include basic audiometry if available, and computed tomography or magnetic resonance imaging scanning if paralysis is present. Facial photography is recommended. Topognostic testing is not helpful because it no longer guides the surgical approach, and prognostic tests are not necessary if the face is not paralyzed. The only sufficiently sensitive test to determine the need for possible surgery is electroneurography. Eye care is critical in all but the mildest cases, and steroids may also be helpful. Surgery is rarely needed and should consist only of middle fossa total decompression; simple decompression of the tympanic and mastoid segments is seldom helpful. The natural history of the disease and the limited role of surgery provide new guidelines for practical management of Bell's palsy.

Adolescent↗
PubMed2001

Sustainable soil management practices and quality of potato grown on erodible lands.

Land productivity can decline when top soil is lost. In Kentucky, limited resource farmers often produce vegetable crops on erodible lands. The objectives of this study were 1) to quantify the impact of three soil management practices (SMPs) on quantity of potato produced on erodible land, 2) to evaluate the impact of pyrethrin and azadirachtin insecticides on potato tuber quality, and 3) to assess the impact of yard waste compost on the chemical composition (ascorbic acid, free sugars, phenol contents) of potato tubers. Potatoes (Solanum tuberosum L. cv. Kennebec) were grown in a silty loam soil of 10% slope. Plots (n= 18) were 3.7 m wide and 22 m long (10% slope), with metal borders of 20 cm above ground level. Two botanical insecticides, Multi-Purpose Insecticide (containing pyrethrin 0.2%) and Neemix 4EC (containing 0.25% azadirachtin) were sprayed twice on potato foliage during each of two growing seasons (1997 and 1999) at the recommended rates of 6 lbs and 2 gallons.acre(-1), respectively. The SMPs were tall fescue strips (FS) intercropped between each two potato rows, soil mixed with yard waste compost (COM) and no-mulch (NM) treatment (roto-tilled bare soil). The experimental designwas a 2 x 3 x 3 factorial with main factors of two insecticides and three SMPs replicated three times. Average potato yield was lowest in NM and FS and highest in COM treatments. Yield obtained from the bottom of the plots was greater than that obtained from the top of plots. Tuber defects (rot, scab, sun green, hollow heart, necrosis, and vascular discoloration) were significantly different between the two growing seasons. The two insecticidal treatments did not have much influence on potato yield or tuber defects. Tubers obtained from tall fescue treatments had low levels of ascorbic acid and reducing sugars compared to compost treatments.

Insecticides↗
PubMed2000

Irritable bowel syndrome. Practical management.

BACKGROUND: Irritable bowel syndrome (IBS) is a common problem affecting one in six Australians. In any patient complaining of chronic or recurrent abdominal pain, chronic diarrhoea or constipation or bloating, IBS should top the list of possibilities. OBJECTIVE: To outline an approach to the practical management of patients with IBS. DISCUSSION: A positive diagnosis can be made if a few simple questions are asked, and the diagnosis can be confirmed by a small number of tests to exclude structural disease. Improved understanding of the differences in gut function in patients with IBS is likely to result in the development of some exciting new therapies.

Antidiarrheals↗
PubMedDate not supplied

A study of mastitis bacteria and herd management practices to identify their relationship to high somatic cell counts in bulk tank milk.

Thirty dairy herds, selected to cover a wide range of bulk tank somatic cell count (BTSCC) values, were used to study the relationship between the levels of the principal species of mastitis-causing bacteria, herd management practices and the BTSCC. A good correlation was found between the number of mastitis streptococci (Streptococcus agalactiae, S. dysgalactiae and S. uberis) found in bulk tank milk and the BTSCC. Staphylococcus aureus was less significantly correlated to BTSCC, but was of increasing importance in borderline BTSCC herds, where lower excretion levels into milk were unlikely to trigger hygiene penalties and so alert producers to the presence of a significant mastitis problem. High BTSCC herds had significantly lower yields and were less likely to use a post-milking teat dip or to have a regular programme of milking machine maintenance or automatic cluster removal. These herds also tended to buy in replacements rather than breed their own. Overall the management of high BTSCC herds showed less commitment to implementing mastitis control procedures than herds with a consistently low BTSCC.

Animals↗
PubMed2001

Ownership pattern and management practices of small ruminants in The Gambia - implications for a breeding programme.

In the framework of a genetic improvement scheme a countrywide survey of small ruminant owners was conducted in The Gambia to obtain information about the ownership pattern, reasons for keeping and especially about breeding and management practices including housing and feeding. The main results were the following: women play a major role in small ruminant production, representing 52% of the owners of sheep, 67% of the owners of goats and 43% of the owners of both sheep and goats. The average number of animals owned is quite low (about six head of sheep and goats each, out of which about three are breeding females). Most of the breeding males are born in their respective flock and there are fewer breeding bucks than breeding rams. However, there are sufficient numbers of breeding males around. Animals are mainly left free to roam around during the dry season, and are either tethered or herded in the rainy season. During night animals are housed or tied under a shelter. Supplementary feeding is not common and vaccination against Pest des Petit Ruminants (PPR) and Pasteurellosis is only partly carried out. Implications for the establishment and structure of a multiplication tier within a three tier breeding scheme, nucleus-->multipliers-->farmers are discussed.

Journal Article↗