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PubMed1997

Management practices associated with high mortality among preweaned dairy heifers.

In a national survey of US dairy operations, 1685 dairy operations reported 47,057 new dairy heifers (either births or acquisitions) and 4427 deaths (9.4%) of preweaned dairy heifer calves over a 3 month period. Stepwise logistic regression was used to identify management practices associated with high mortality among preweaned heifers in dairy operations where at least three dairy heifer calves were born alive or moved on to the operation. Analysis was done twice: once by separating all operations by size into high or low mortality; again using only operations with < 2 and > 10% mortality to eliminate dairy operations with intermediate levels of mortality from the comparisons. Results were similar. Dairy operations in the West were more likely to fall in the high mortality category than dairy operations in the rest of the country. In addition, the following dairy operation characteristics were associated with high death levels in both models: rolling herd average milk production < 7710 kg. preweaned heifers placed in groups of seven or more, a male having primary responsibility for the care and feeding of preweaned heifers, calves not receiving hay or other roughages until > 20 d old, calves fed on mastitic or antibiotic milk after colostrum and calves not given whole milk after colostrum.

Animal Feed↗
PubMedDate not supplied

Statistics as a tool in practice management.

As managers, dentists must be concerned with the daily control of their practices. Traditional management reports and graphs are not capable of indicating when specific action or intervention has become necessary. They fail to recognize that all processes--including the administrative functions of a dental office--exhibit variability. Only a control technique that can differentiate unacceptable from tolerable variation will offer any help with day-to-day managing. A simple application of statistics and probabilities is required to provide a workable solution. With results from an actual dental office, this article describes the steps for creating and using a statistical "control chart" to monitor a key practice variable--production revenue per hour.

Humans↗
PubMed1995

Harris P. Mosher Award thesis. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines.

Currently there is no agreement on the treatment of patients who develop a peritonsillar abscess (PTA). This lack of consensus results in highly variable and possibly expensive therapeutic regimens that may not provide optimum quality patient care at reasonable cost. The present study evaluates surgical, medical, diagnostic, and cost factors that affect the management of PTA based on the following: 1. a cohort study of 123 patients with PTA treated using needle aspiration as the initial surgical drainage; 2. a national survey of the PTA management practices of otolaryngologists; and 3. meta-analyses of various components of the treatment regimen for PTA. In the cohort study, patients diagnosed with PTA were treated by both otolaryngologists and emergency medicine specialists with needle aspiration as the primary surgical modality resulting in a 96% acute resolution rate for PTA. In the national survey, questionnaires were sent to 2000 randomly selected members of the American Academy of Otolaryngology-Head and Neck Surgery regarding their management of PTA. The return rate was 73%. Ninety-six percent of the physicians who returned survey forms treated an average of seven PTAs per year using either needle aspiration, incision and drainage, or abscess tonsillectomy to drain the abscess initially. The incidence of PTA in the United States and Puerto Rico among patients 5 to 59 years of age treated by survey practitioners is 30.1 per 100,000 person years, accounting for approximately 45,000 cases per year. Four meta-analyses were completed to quantify the success rate of needle aspiration in the treatment of PTA (94%), the recurrence rate of PTA (10% to 15%), the rate at which penicillin-resistant microorganisms are found in patients with PTA (0% to 56%), and the rate of prior oropharyngeal infections associated with PTA (11% to 56%). The recurrence rate for PTA in the United States is 10%, which is significantly different from the recurrence rate of 15% reported from the rest of the world (P < .002). A clinical intervention for PTA is proposed based on the clinical series, the national survey data, and the meta-analyses. These clinical guidelines recommend that needle aspiration be used as the initial surgical drainage procedure for all patients with a PTA other than those who have indications for abscess tonsillectomy. Patients should be treated in an outpatient setting, should receive penicillin if they are not allergic to it, and should receive adequate pain medication. The evidence does not suggest that there is any benefit in examining the abscess contents for microorganisms. Approximately 30% of patients with PTA can be expected to exhibit relative indications for a tonsillectomy.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2005

Use of drinking water treatment residuals as a potential best management practice to reduce phosphorus risk index scores.

The P risk index system has been developed to identify agricultural fields vulnerable to P loss as a step toward protecting surface water. Because of their high Langmuir phosphorus adsorption maxima (P(max)), use of drinking water treatment residuals (WTRs) should be considered as a best management practice (BMP) to lower P risk index scores. This work discusses three WTR application methods that can be used to reduce P risk scores: (i) enhanced buffer strip, (ii) incorporation into a high soil test phosphorus (STP) soil, and (iii) co-blending with manure or biosolids. The relationship between WTR P(max) and reduction in P extractability and runoff P was investigated. In a simulated rainfall experiment, using a buffer strip enhanced with 20 Mg WTR ha(-1), runoff P was reduced by from 66.8 to 86.2% and reductions were related to the WTR P(max). When 25 g kg(-1) WTR was incorporated into a high STP soil of 315 mg kg(-1) determined using Mehlich-3 extraction, 0.01 M calcium chloride-extractable phosphorus (CaCl(2)-P) reductions ranged from 60.9 to 96.0% and were strongly (P < 0.01) related to WTR P(max). At a 100 g kg(-1) WTR addition, Mehlich 3-extractable P reductions ranged from 41.1 to 86.7% and were strongly (P < 0.01) related to WTR P(max). Co-blending WTR at 250 g kg(-1) to manure or biosolids reduced CaCl(2)-P by >75%. The WTR P(max) normalized across WTR application rates (P(max) x WTR application) was significantly related to reductions in CaCl(2)-P or STP. Using WTR as a P risk index modifying factor will promote effective use of WTR as a BMP to reduce P loss from agricultural land.

Adsorption↗
PubMed2006

Farm management practices associated with macrocyclic lactone resistance on sheep farms in New Zealand.

AIM: To identify farm practices associated with the presence of resistance to a macrocyclic lactone (ML) anthelmintic on sheep farms in New Zealand. METHODS: A cross-sectional study was conducted to test for associations between the presence of resistance to an ML anthelmintic (ivermectin) and management practices on sheep farms in New Zealand. Selection of farms was both random (n=80) and purposive (n=32; being farms with a history of suspected ML resistance). Resistance was inferred from faecal nematode egg count (FEC) reduction (FECR) tests (FECRTs) when there was <95% reduction in FEC 7-10 days after treatment with a half dose of ivermectin (0.1 mg/kg). A logistic regression model was built to identify farm-level factors that were associated with the presence or absence of ML resistance. RESULTS: Of the 112 flock managers that were approached for interview, 103 (92%) returned useable questionnaires. The odds of ML resistance were increased: on farms that had used long-acting ML products in ewes as a pre-lambing treatment for > or =3 of the previous 5 years (odds ratio (OR) = 7.2; 95% confidence interval (CI) = 1.7-30.3); on farms where <70% of the total stock units mid-winter were from sheep (OR=6.5; 95% CI=1.6-25.6); on farms which over the year purchased >10% of the number of sheep present mid-winter (OR=7.1; 95% CI=1.5-34.7); and on farms where the average wool diameter of the main flock was <37 (OR=4.1; 95% CI=1.1-14.7) microns. The model provided a good fit to the data (pseudo R2=0.64; Hosmer-Lemeshow statistic = 0.38). CONCLUSIONS: Explanatory factors identified as associated with the presence of ML (ivermectin) resistance on farms included the use of long-acting anthelmintic formulations in ewes pre-lambing, sources of refugia of unselected parasites on the farm, breed of sheep and their requirements for anthelmintic treatments, and the importing of resistant parasites with purchased stock. The study provides support for controls that aim to provide refugia of susceptible worms and that minimise the risk of introduction of resistance through effective quarantine drenching.

Animal Husbandry↗
PubMed1993

Hospital waste management practice in the Czech Republic.

Hospital wastes pose a serious problem. This is primarily caused by the diversity of the individual components of the waste which constitute a risk to health if inadequately handled. It is evident that economic and technical conditions for both a safe disposal as well as efficient steam sterilization and management practice based on legal regulations consequently will contribute to protections of both human health and the environment.

Containment of Biohazards↗
PubMedDate not supplied

Perioperative blood management practices in elective orthopaedic surgery.

Concern about the cost and safety of allogenic blood transfusion, including the risk of viral infection and immunosuppression, has led to refinements in and new approaches to blood conservation, including the development of transfusion practice standards and improvements in surgical practice. Preoperative autologous blood collection, the use of hemostatic agents, perioperative blood salvage, and the use of recombinant human erythropoietin (epoetin alfa) to stimulate erythropoiesis have contributed to decreased use of allogenic blood services. Development of appropriate blood management strategies to help reduce or eliminate exposure to allogenic blood requires a preoperative assessment of the likelihood of transfusion and of the risks as well as costs associated with conservation and replacement options. The informed selection of alternatives based on preoperative assessment of hematologic status, estimated blood loss, and sources for blood replacement may enhance blood management practices in major elective orthopaedic surgery.

Anemia↗
PubMed2000

Effects of management practices prior to and during ensiling and concentrate type on nitrogen utilization in dairy cows.

Three experiments with a total of 18 multiparous Holstein-Friesian dairy cows in early to mid lactation were used in incomplete changeover designs with four periods consisting of 4 wk each. The objectives of the experiments were to investigate the effects of 1) grass management practices prior to ensiling and 2) concentrate energy sources on animal performance and N utilization and suggest ways in which the annual N excretion can be reduced. In the first experiment, four silages were prepared as early-cut material from grass that was fertilized with either 75 or 150 kg of N/ha. Two other silages were prepared from the latter but harvested 2 wk later. Within each silage type, both direct cut and wilted silages were produced. In the second experiment, starch-based and fiber-based concentrates were offered with the three wilted silages used in the previous experiment. In the third experiment, barley-based and corn-based concentrates were offered with three silages that had been treated with different additives at the time of ensiling. Neither dry matter intake nor milk yield were significantly affected by either silage or concentrate type. Milk protein content and yield, however, were higher in silages made from medium fertilized grass and also increased with increased starch content of the concentrate. Grass management and diet affected the amount and form of N excreted. Use of nitrogen fertilizer at lower than 75 kg of N/ha and feeding less degradable starch concentrate is recommended for mitigation of N pollution, especially in the form of urine N by dairy cows in intensive farming.

Animals↗
PubMed2006

Improving effectiveness and evaluation techniques of stormwater best management practices.

This paper presents results of an extensive field monitoring program of a proprietary stormwater treatment technology called the Stormvault. Analysis of 39 storms indicates that the system effectively and consistently reduced total suspended solids (TSS) average event mean concentration (EMC) from 70.6+/-17.0 mg/L to 41.2+/-3.7 mg/L. Results were comparable to or better than conventional best management practices (BMPs). Multiple linear regression indicated that interactions between site and storm characteristics significantly effect effluent EMC. The simple regression equation can be used to directly compare multiple systems for a given site and/or between watersheds.

Rain↗
PubMed1995

Curriculum Guidelines in Implant Dentistry for Dental Hygiene Programs. Consensus Conference sponsored by the International Congress of Oral Implantologists, the American College of Oral Implantology, the American Society of Osseointegration, and the Association of Dental Implant Auxiliaries & Practice Management. Monterey, California, June 16, 1995.

A consensus conference to develop curriculum guidelines in implant dentistry for dental hygiene programs was held on June 16, 1995 in Monterey, California. The conference was sponsored by the International Congress of Oral Implantologists, the American College of Oral Implantology, the American Society of Osseointegration, and the Association of Dental Implant Auxiliaries & Practice Management. The guidelines, which will be distributed to dental hygiene program directors, are printed in their entirety.

Curriculum↗
PubMed2006

Agricultural land use and best management practices to control nonpoint water pollution.

In recent years, improvements in point-source depuration technologies have highlighted the problems regarding agricultural nonpoint (diffuse) sources, and this issue has become highly relevant from the environmental point of view. The considerable extension of the areas responsible for this kind of pollution, together with the scarcity of funds available to local managers, make minimizing the impacts of nonpoint sources on a whole basin a virtually impossible task. This article presents the results of a study intended to pinpoint those agricultural areas, within a basin, that contribute most to water pollution, so that operations aimed at preventing and/or reducing this kind of pollution can be focused on them. With this aim, an innovative approach is presented that integrates a field-scale management model, a simple regression model, and a geographic information system (GIS). The Lake Vico basin, where recent studies highlighted a considerable increase in the trophic state, mainly caused by phosphorus (P) compounds deriving principally from the intensive cultivation of hazelnut trees in the lake basin, was chosen as the study site. Using the management model Groundwater Loading Effects of Agricultural Management Systems (GLEAMS), the consequences, in terms of sediment yield and phosphorus export, of hazelnut tree cultivation were estimated on different areas of the basin with and without the application of a best management practice (BMP) that consists of growing meadow under the trees. The GLEAMS results were successively extended to basin scale thanks to the application of a purposely designed regression model and of a GIS. The main conclusions can be summarized as follows: The effectiveness of the above-mentioned BMP is always greater for erosion reduction than for particulate P reduction, whatever the slope value considered; moreover, the effectiveness with reference to both particulate P and sediment yield production decreases as the slope increases. The proposed approach, being completely distributed, represents a considerable step ahead compared to the semidistributed or lumped approaches, which are traditionally employed in research into tools to support the decision-making process for land-use planning aimed at water pollution control.

Agriculture↗
PubMed2006

Practical management: nonsteroidal antiinflammatory drug (NSAID) use in athletic injuries.

Nonsteroidal antiinflammatory drugs (NSAIDs) are frequently used in the treatment of acute athletic injuries, often for analgesic purposes as the evidence to support enhanced healing is limited. However, the current evidence on NSAID use in athletic injury is slowly growing. On the basis of animal models and limited human studies, some practical management guidelines can be drawn to assist the sports physician. Specifically, NSAIDs are not recommended in the treatment of completed fractures, stress fractures at higher risk of nonunion, or in the setting of chronic muscle injury. The only exception may be very short-term use (eg, a few days) for analgesic purposes only. Judicious use of NSAIDs may be more appropriate in the management of acute ligament sprains, muscle strains, tendinitis, and eccentric muscle injury. However, length of treatment should always be kept as short as possible, with consideration of the specific type of injury, level of dysfunction, and pain.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2006

Practical management strategies for diaper dermatitis.

Common diaper dermatitis is an irritant contact diaper dermatitis (IDD) created by the combined influence of moisture, warmth, urine, feces, friction, and secondary infection. It is difficult to completely eradicate these predisposing factors in a diapered child. Thus, IDD presents an ongoing therapeutic challenge for parents, family physicians, pediatricians, and dermatologists. This article will focus on practical management strategies for IDD.

Candidiasis↗
PubMed2003

External auditory canal foreign body removal: management practices and outcomes.

OBJECTIVES/HYPOTHESIS: The purpose of the study was to evaluate the effectiveness of external auditory canal foreign body removal attempts by health care practitioners and to explore outcomes of patients with unsuccessful initial removal attempts. STUDY DESIGN: Retrospective case series. METHODS: A case series of patients presenting with external auditory canal foreign body to the emergency department of the authors' institution (Strong Memorial Hospital, University of Rochester Medical Center) over a 3-year period was studied retrospectively. Medical records were reviewed, and information including age at presentation, type of foreign body, side of presentation, length of time in place, signs and symptoms at presentation, management practices, and outcomes was recorded. RESULTS: One hundred sixty-two patients with a diagnosis of external auditory canal foreign body were identified. Emergency personnel successfully managed 67% of patients using direct visualization techniques, and 33% required otolaryngological consultation. Otolaryngologists used otomicroscopy with standard otological instruments as their mainstay of management. Analysis of successfully managed emergency department cases revealed that 82% of foreign bodies were irregularly shaped objects with soft, graspable parts. Conversely, 72% of foreign bodies in otolaryngology referrals were firm, rounded objects such as beads and beans. Analysis of patients referred to otolaryngologists revealed a requirement for removal under anesthesia of 19%. Patients with a history of one or more removal attempts before emergency department evaluation universally failed further direct visualization techniques. A disproportionate number of these patients eventually required operative intervention and/or had tympanic membrane perforation. Patients with a history of previous removal attempt(s) who were referred directly to otolaryngologists were more likely to be successfully managed without general anesthesia. CONCLUSION: Emergency room personnel successfully manage the majority of patients with foreign bodies of the external auditory canal. For patients with firm, rounded objects, direct otolaryngology consultation without further manipulation should be strongly considered. Patients who have had previous removal attempts should not undergo further manipulation in the emergency department but rather should be referred directly to an otolaryngologist.

Adolescent↗
PubMed2006

Childhood diarrhoea management practices in Bangladesh: private sector dominance and continued inequities in care.

BACKGROUND: Monitoring for disparities in health and services received based upon gender, income, and geography should continue as renewed efforts to reduce under-five mortality are made in response to millennium development goal #4. The purpose of this survey was to provide a nationally representative description of current childhood diarrhoea management practices and disparities in Bangladesh. METHODS: A nationally representative, cross-sectional, cluster-sample survey was carried out in randomly selected rural and urban populations across Bangladesh. The survey was completed over an 8 month period between November 2003 and June 2004. RESULTS: A total of 7308 children with a prevalent diarrhoeal illness episode within 560 clusters were identified and enrolled in the survey. In 61% of the cases help was sought from a health care provider, with over 90% practicing in the private sector. Caretaker practice disparities favouring males and higher income households were identified. Significant trends (P < 0.001) favouring higher income households were found for having sought help from any provider or a licensed doctor and for treating their child with oral rehydration solution or an antibiotic. Female children in urban households were less likely to be seen by a licensed allopath, adj OR 0.73 (95% CI 0.57, 0.94). Among rural households gender disparities were limited to females being less likely to receive an antibiotic, adj OR 0.74 (95% CI 0.65, 0.86). CONCLUSION: Households seeking help from a health provider overwhelmingly utilize the private sector in Bangladesh. Gender inequities in the utilization of licensed providers and purchase of antibiotics, favouring males were identified. Findings suggest that higher income, urban households tend to practice greater gender discrimination. In order to better understand health dynamics in urban populations, in particular slum-dwellers, there is a need to disaggregate survey data by household location.

Anti-Infective Agents↗
PubMed2000

Improving egg production in two indigenous communities through the adaptation of management practices and local knowledge. The results of participative research.

Free-ranging poultry (FRP) are known to be efficient in the recycling of residues of agroforestry systems. The objective of this paper is to present the results of participative applied research on the improvement of egg production in two indigenous communities in Costa Rica. This involved a dialectic process of adaptation between indigenous knowledge and introduced management practices. We report an increase in egg production through the use of nests and improved diets.

Animal Feed↗
PubMedDate not supplied

The Transtheoretical Model and stress management practices in women at risk for, or infected with, HIV.

Although scientific inquiry using the Transtheoretical Model of Behavior (TTM) supports various behavior changes in multiple samples, no research was found that examined this model with women already infected with HIV. This article provides a brief overview of the related literature and describes a pilot study that evaluated TTM concepts in women at risk for, or infected with, HIV. The pilot study examined preliminary psychometrics of the research measures in women at risk for (n = 9), or infected with, HIV (n = 10), and examined predicted differences in situational confidence and stress management practices by HIV serostatus (positive vs. negative) and stage of change (precontemplation and contemplation vs. preparation, action, and maintenance) implied by the TTM. This pilot study supports use of the TTM to examine readiness to use stress management behavior in women regardless of their HIV serostatus. Further TTM stress management inquiry is encouraged to extend the knowledge base needed in caring for this vulnerable population.

Adaptation, Psychological↗
PubMed2002

A survey of Australian general practice management of hepatitis C-infected patients from non-English-speaking backgrounds.

BACKGROUND: Australia receives many migrants from countries with a high prevalence of hepatitis C infection. General practitioners, who are often the first health professionals consulted, need to be aware of risk factors and complications associated with hepatitis C in this group. METHODS: Four hundred and forty-seven general practitioners, obtained from registries at two Melbourne teaching hospitals serving large non-English-speaking migrant populations, were sent a questionnaire. Two hundred and forty-one returned a completed questionnaire. The survey attempted to assess knowledge of risk factors, complications, currently recommended antiviral therapy, referral practice to specialists and difficulties encountered by practitioners and patients in accessing information about HCV. RESULTS: Sexual and vertical transmission were listed as more common risk factors than iatrogenic causes or injecting drug use. Most respondents interpreted basic diagnostic tests correctly but there was a range of estimates regarding progression to cirrhosis and hepatocellular carcinoma with many seriously overestimating these aspects of natural history. Interferon and ribavirin were commonly listed as optimal therapy, but both interferon monotherapy and lamivudine, a treatment for hepatitis B, were stated as optimal therapy by 25% of respondents. Considerable frustration was expressed regarding access to reliable information about treatment outcomes and to linguistically and culturally appropriate patient information. CONCLUSIONS: The wide response range regarding modes of acquisition of HCV in patients from non-English-speaking backgrounds, rates of progression to cirrhosis and hepatocellular carcinoma and optimal antiviral therapy suggests a need to improve provision of appropriate educational resources that will facilitate general practice management of a common and important public health problem.

Anti-HIV Agents↗