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At least 775 records · Page 43Linked to original sources
PubMed1998

Design and implementation of a patient education center for the Childhood Asthma Management Program. Childhood Asthma Management Program Research Group.

OBJECTIVES: To design, develop, and distribute asthma education materials relevant to the Childhood Asthma Management Program (CAMP), a National Heart, Lung and Blood Institute sponsored comprehensive clinical trial. This trial is designed to evaluate the relative efficacy of three treatment strategies on asthma control, and lung growth and development in children with asthma. APPROACH: A Patient Education Center (PEC) was established to prepare CAMP-specific asthma educational materials that would promote consistent implementation of the CAMP protocol, adherence to study medications and record keeping requirements and retention in the trial. The PEC has the responsibility to design the asthma education program and to provide support to the study clinical center coordinators/educators who maintain direct and ongoing contact with the participants. PARTICIPANTS: A total of 1,041 children with asthma age 5 through 12 years were enrolled in the trial between November 1993 and September 1995 at 8 clinical centers. PROCESS: The three major tenets of self-management were highlighted in the CAMP patient education program: anticipate problems before they arise, determine the appropriate responses, and rehearse and practice behaviors that are effective solutions. CAMP education was standardized across centers to provide consistency in the implementation of the protocol. The program was structured to be comprehensive in order to address the various issues encountered by the participants and their caretakers, including background information on asthma and asthma therapy, instructions on following the study protocol (taking medication and monitoring symptoms and peak flow), and clear steps for handling asthma exacerbations. Materials were prepared in the form of handouts, handbooks, and videos. Instructional manuals were also prepared on the use of these materials for the nurse coordinators at each clinical center. CONCLUSIONS: The CAMP approach to asthma education was planned with the realization that patient education is essential to successful treatment and must be fully integrated into the patient's routine care. The CAMP education materials are readily available in a national repository and could be used for asthma education programs in a practice setting or another clinical research effort.

Asthma↗
PubMedDate not supplied

Linking outcomes management and practice improvement. The link between outcomes management and JCAHO functions.

Staff participating in the CABG outcomes management program continue to examine the effectiveness and efficiency of care processes and to redesign care to improve patient and organizational outcomes. In fact, this quality enhancement program is neverending as we strive continually to improve the care of CABG patients. The success, measured through improved process and outcome variables, has promoted the implementation of similar programs for other patient populations. Using foresight in the development of outcomes management programs to ensure inclusiveness of regulatory body or agency criteria encourages comprehensive programs that yield positive outcomes for both patients and organizations.

Coronary Artery Bypass↗
PubMed1998

Managing care through managing information: are we headed in the right direction?

Healthcare organizations adopt HIMS to manage the large amount of data available in the patient medical record. The CPR, however, must be more than a mirror image of the paper record to yield analyzable data necessary to answer the consumer's questions about cost and quality of care. Although organizations strive to achieve standardization of medical recording required for analysis, they must also be attuned to factors necessary to achieve end-user compliance and comfort with data input. The closer organizations move to ease of conversion to computerized medical records, the further they may be moving away from data integrity. What is more, the optimal balance point may be different for each organization.

Attitude to Computers↗
PubMedDate not supplied

[Practice guidelines for cancer pain management. Task Force for Cancer Pain Management].

Cancer pain is a frequent medical problem in our society. This syndrome affects from 80 to 90% of cancer patients and can be solved with relatively simple measures in 90% of the cases. Approximately 40% of cancer patients reported to be unsatisfied with the physician or nurse about their pain management. For these reasons, we gathered a task force in order to generate practice guidelines based on medical evidence and on the opinion of experts in this area. These guidelines were generated by a task force of 31 physicians who were leaders in this field and based on 599 papers selected by a previous literature search. This group evaluated the results of this search in three work sessions, during which a level of evidence was assigned to each recommendation.

Adjuvants, Pharmaceutic↗
PubMed1995

Prevention, diagnosis, and management of viral hepatitis. A guide for primary care physicians. AMA Advisory Group on Prevention, Diagnosis, and Management of Viral Hepatitis.

This guide was developed to provide the primary care physician with essential practice information on viral hepatitis in a concise and useful format. An American Medical Association advisory panel, representative of all primary care specialty associations and nationally recognized experts, conducted a systematic review of the medical literature and prepared this physician guide with an emphasis on prevention, diagnosis, and management. The guide also underwent extensive peer review. Practical information on viral characteristics and epidemiology, clinical manifestations, diagnosis, management, and prevention is provided.

Adolescent↗
PubMed1995

Incidence and management of pancreatic and enteric fistulas after surgical management of severe necrotizing pancreatitis.

OBJECTIVE: To determine the incidence, type, and outcome of complications of necrotizing pancreatitis. SETTING: Major tertiary referral center (Mayo Clinic, Rochester, Minn). PATIENTS: Sixty-one patients seen from 1985 to 1994 who underwent surgical management of severe necrotizing pancreatitis and who developed pancreatic or gastrointestinal fistulas. MAIN OUTCOME MEASURES: Incidence, management, and outcome of pancreatic and gastrointestinal fistulas. RESULTS: Twenty-five patients (41%) developed pancreatic (14 patients) and/or gastrointestinal tract cutaneous (19 patients) fistulas. While three duodenal fistulas and one colonic fistula were recognized at the initial operation for pancreatic necrosectomy, the remainder developed 4 to 60 days after the initial operation. Spontaneous closure occurred in nine of 14 pancreatic, two of two gastric, two of four enteric, two of eight colonic, and four of five duodenal fistulas. Mortality of the group with fistulas was 24% (6/25) and was not different from the mortality of the patients with necrotizing pancreatitis without fistulas (28% [10/36]). CONCLUSIONS: Pancreatic and gastrointestinal tract fistulas are common complications of surgical treatment of severe necrotizing pancreatitis. Well-controlled gastric, pancreatic, and enteric fistulas have the greatest likelihood of spontaneous closure. Duodenal and colonic fistulas may need surgical intervention for control or repair. Mortality in these patients parallels the mortality for severe necrotizing pancreatitis.

Colonic Diseases↗
PubMed2000

Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma.

BACKGROUND: Inhaled corticosteroids are the cornerstone of anti-inflammatory asthma treatment. Anti-leukotrienes agents are currently being studied as alternative first line agents in the management of mild to moderate chronic asthma. OBJECTIVES: The aims of this review study are to compare the safety and efficacy of anti-leukotriene agents with inhaled glucocorticoids and to determine the dose-equivalence of anti-leukotrienes in mcg of inhaled corticosteroids in the management of chronic asthma. SEARCH STRATEGY: The searched Medline (1966 to 1999), Embase (1980 to 1999), Cinahl (1982 to 1999) and reference lists of review articles and trials; we contacted colleagues and international headquarters of anti-leukotrienes producers. SELECTION CRITERIA: Randomised controlled trials were included if they compared leukotriene antagonists with inhaled corticosteroids during a minimal 30-day intervention period in asthmatic patients aged 2 years and older, and if measures of effectiveness other than compliance were included. DATA COLLECTION AND ANALYSIS: Assessments of methodological quality and data extraction were performed independently and blindly by two reviewers. The primary outcome was the rate of exacerbations requiring systemic corticosteroids. Secondary outcomes included lung function, indices of chronic asthma control, adverse effects and withdrawal rates. MAIN RESULTS: Of 137 identified studies, ten met the inclusion criteria. Two are currently published in full-text. Most focused on subjects with mild-to-moderate chronic asthma; two included children. Trial duration was 6 to 12 weeks with a few un-blinded trials lasting several months. Daily dose of inhaled corticosteroids varied from 250 to 400 mcg of beclomethasone-equivalent; various anti-leukotriene preparation were tested. There was no difference in the rate of patients with exacerbations that required systemic steroids [4 trials, Relative Risk (RR)=1.3, (95% Confidence Interval (CI): 0.9, 1.9)]. Few trials contributed data to other outcomes. Improvement in lung function (FEV1 [N=3 trials, Standardised Mean Difference (SMD)=0.3 (95% CI: 0. 2, 0.4)]: morning PEFR [3 trials, SMD=0.4, (95% CI: 0.2, 0.5)]) and in quality of life [N=3 trials, WMD=0.3, (95% CI: 0.1, 0.4)] favoured inhaled corticosteroids. A difference in favour of inhaled corticosteroids was observed for symptoms [N=3 trials, SMD=0.3, (95% CI: = 0.2, 0.4)], night awakenings [N=2 trials, WMD= 0.6, (95% CI: 0. 3, 0.9)], and rescue beta2-agonists [N=3 trials, SMD= 0.3, (95% CI: 0.2, 0.4)] Side effects were not different between groups, but anti-leukotriene therapy was associated with increase risk of "withdrawals for any cause" [N=3 trials, RR=1.4, (95% CI: 1.1, 1.9)] and "withdrawals due to adverse effects" [N=3 trials, RR=1.9, (95% CI: 1.1, 3.3)] REVIEWER'S CONCLUSIONS: Anti-leukotriene agents had a similar rate of exacerbations compared to inhaled corticosteroids, but inhaled steroids produced better lung function and quality of life as well as reduced symptoms, night awakenings and need for rescue beta2-agonist. Reliable conclusions cannot yet be drawn regarding the efficacy of this treatment due to the paucity of trials published in full text.

Administration, Inhalation↗
PubMed1981

Comparative results of surgical management of single carcinomas of the colon and rectum: a series of 1939 patients managed by one surgeon.

A comparative analysis has been made of the results of surgical management of single carcinomas of the colon and rectum in a series of 1939 patients treated by one surgeon. The data were prospectively collected, with 99 per cent follow-up. Cancer specific survival did not differ significantly between patients with colonic or rectal cancer. Survival prospects were better for women (P = 0.02) and for patients less than 40 years of age (P = 0.03). Survival was significantly related to tumour staging (P less than 0.002). Cancer specific survival was better after curative resection for colonic than rectal carcinoma (P = 0.003). Five-year survival for patients with colonic tumours was 76 per cent and for rectal tumours 69 per cent. The 10-year survival figures were 73 per cent and 51 per cent respectively. This difference was accounted for by a higher proportion of Dukes' stage C tumours in the rectum (P less than 0.001) and better survival prospects for colonic compared to rectal stage C1 tumours (P = 0.02). Sphincter-saving resections were performed in 64 per cent of rectal cancer patients managed by curative resection. Survival tended to be better than after sphincter-sacrificing operations. After palliative resection, median survival for colonic and rectal cancer was 14 and 13 months respectively. After palliative bypass operations the corresponding figures were 4 and 8 months.

Adenocarcinoma↗
PubMedDate not supplied

Health systems in developing countries: public sector managers and the management of contradictions and change.

Health sector reform in the past decade has tended to focus on remodelling institutional relations and changing methods of health system financing. Little attention has been paid to human resources. This paper focuses on one category of health sector staff, health managers and planners, and the tensions they face in carrying out their roles. An understanding of these tensions has been neglected in the policy-making process. The paper is divided into two parts. Firstly, it will set out the nature of three tensions that public sector health managers and planners face: changes in the health care system; the contradictions between public interest and private gain; and changes in the forms of accountability. Secondly, it will suggest ways forward in relation to these problems, paying particular attention to the role of international agencies.

Delivery of Health Care↗
PubMed2002

Management practices that concentrate visitor activities: camping impact management at Isle Royale National Park, USA.

This study assessed campsite conditions and the effectiveness of campsite impact management strategies at Isle Royale National Park, USA. Protocols for assessing indicators of vegetation and soil conditions were developed and applied to 156 campsites and 88 shelters within 36 backcountry campgrounds. The average site was 68 m2 and 83% of sites lost vegetation over areas less than 47 m2. We believe that management actions implemented to spatially concentrate camping activities and reduce camping disturbance have been highly successful. Comparisons of disturbed area/overnight stay among other protected areas reinforces this assertion. These reductions in area of camping disturbance are attributed to a designated site camping policy, limitation on site numbers, construction of sites in sloping terrain, use of facilities, and an ongoing program of campsite maintenance. Such actions are most appropriate in higher use backcountry and wilderness settings.

Camping↗
PubMed1994

Progressive cord compression secondary to thoracic disc lesions in Scheuermann's kyphosis managed by posterolateral decompression, interbody fusion and pedicular fixation. A new approach to management of a rare clinical entity.

During a brief period of 21 months (November 1988 to August 1990) the neurospinal unit of our institution registered three cases of Scheuermann's kyphosis with herniation of the thoracic discs. Local and intercostal pain, progressive spasticity with gait disturbance and urinary hesitancy were the most common presenting symptoms. All of the patients were surgically managed by posterolateral decompression, interbody fusion (posterolateral approach) and pedicular screw plate fixation. The average length of follow-up was 25 months. Results were excellent in two patients and good in one. All patients had improvement in neurological status, were pain-free and demonstrated sound fusion within 5 months. A new approach to management of this rare clinical entity is documented.

Adolescent↗
PubMed1980

Results of operative management of Crohn's disease: A series of 50 patients managed by one surgeon.

A computer analysis has been made of clinical experience of Crohn's disease in Australian patients. Between 1950 and 1978, 50 patients were managed for Crohn's disease by one of the authors (E.S.R.H.). This group represented 3.1 per cent of 1608 patients treated during the same period for primary inflammatory bowel disease. The mean follow-up period was 8.4 years. Thirty-nine of the 50 patients were female and 11 male. The small intestine was involved in seven patients, large intestine in 17 and both small and large intestine in 26. Symptoms were related to the anatomic localization of disease. Four patients have died (two postoperative deaths and two unrelated to Crohn's disease). Forty-nine of the 50 patients required operative procedures and 36 underwent one or more definitive operations with curative intention. A total of 124 operations was performed, 70 of which were definitive. Twenty-nine of the 36 patients managed by a definitive operation developed recurrence, defined to include reactivation of disease in intestinal segments left in situ. Ten patients developed two or more recurrences. Multiple recurrences were most frequent after operation for combined small- and large-intestinal Crohn's disease. No patient with large-intestinal Crohn's disease alone developed more than one recurrence. Each patient undergoing subtotal colectomy with ileorectal anastomosis (six patients) or ileostomy (nine patients) required one or more further definitive operations. Recurrence was more frequent after the first than second definitive operation (P = 0.007), the median recurrence-free intervals being 11 and 23 months, respectively.

Australia↗
PubMed2000

Conservation and Management for Multiple Species: Integrating Field Research and Modeling into Management Decisions.

Multiple-species reserves aim at supporting viable populations of selected species. Population viability analysis (PVA) is a group of methods for predicting such measures as extinction risk based on species-specific data. These methods include models that simulate the dynamics of a population or a metapopulation. A PVA model for the California gnatcatcher in Orange County was developed with landscape (GIS) data on the habitat characteristics and requirements and demographic data on population dynamics of the species. The potential applications of this model include sensitivity analysis that provides guidance for planning fieldwork, designing reserves, evaluating management options, and assessing human impact. The method can be extended to multiple species by combining habitat suitability maps for selected species with weights based on the threat faced by each species, and the contribution of habitat patches to the persistence of each species. These applications and extensions, together with the ability of the model to combine habitat and demographic data, make PVA a powerful tool for the design, conservation, and management of multiple species reserves.

Journal Article↗
PubMed1993

Ruptured ectopic pregnancy after medical management: current conservative management strategies.

A case of hypotension caused by hemorrhage in a patient receiving systemic methotrexate to treat a known ectopic pregnancy is presented. A primary goal of gynecologic practice in the 1990s is to conserve tubal patency and fertility. Consequently, ectopic pregnancy is more frequently being managed by conservative strategies. The emergency physician must be familiar with conservative methods for the management of ectopic pregnancy and the complications that may cause emergency presentations in these patients.

Adult↗
PubMed2005

Are speed enforcement cameras more effective than other speed management measures? The impact of speed management schemes on 30 mph roads.

This paper presents the results of an evaluation of the impact of various types of speed management schemes on both traffic speeds and accidents. The study controls for general trends in accidents, regression-to-mean effects and migration, separately estimating the accident changes attributable to the impact of the schemes on traffic speed and on traffic volume. It was found that, when judged in absolute terms, all types of speed management scheme have remarkably similar effects on accidents, with an average fall in personal injury accidents of about 1 accident/km/year. In terms of the percentage accident reduction, however, engineering schemes incorporating vertical deflections (such as speed humps or cushions) offer the largest benefits: at 44%, the average reduction in personal injury accidents attributable to such schemes, is twice that at sites where safety cameras were used to control speeds (22%) and they were the only type of scheme to have a significant impact on fatal and serious accidents. Other types of engineering scheme (with a fall of 29% in personal injury accidents) were on average less effective in reducing accidents than schemes with vertical features but more effective than cameras. All types of scheme were generally effective in reducing speeds, with the largest reductions tending to be obtained with vertical deflections and the smallest with other types of engineering schemes.

Accidents, Traffic↗
PubMed2005

Comparison of management patterns and clinical outcomes in patients with atrial fibrillation in Canada and the United States (from the analysis of the Atrial Fibrillation Follow-up Investigation of Rhythm Management [AFFIRM] database).

Little is known about differences in practice patterns or outcomes in the management of patients who have atrial fibrillation in Canada compared with those in the United States (US). We evaluated the effect that the country of enrollment may have on the management patterns and clinical outcomes in patients who participated in the AFFIRM study. Three thousand four hundred patients came from the US and 660 from Canada. In the US, patients were more likely to have a history of coronary artery disease (39% vs 35%, p = 0.03), hypertension (72% vs 67%, p = 0.01), or congestive heart failure (24% vs 18%, p = 0.0002). More US participants were <65 years of age (25% vs 19%, p = 0.003). Although at randomization the use of warfarin was comparable, during follow-up Canadians were more likely to be treated with warfarin and to be therapeutically anticoagulated. Mortality rate at 5 years was higher in US patients (24% vs 16%, p = 0.001), and the composite end point (death, disabling stroke, major bleeding, cardiac arrest, or anoxic encephalopathy) was also higher in US patients (30% vs 22%, p = 0.0005). Even after adjusting for known differences in baseline characteristics, the risk of death was lower in Canada (hazard ratio 0.70, p = 0.02). In conclusion, in the AFFIRM study, US subjects were more likely to have preexisting cardiovascular diseases despite being younger (<65 years old) than those in Canada. Effective warfarin therapy was more commonly employed in Canada. After correcting for the known differences in baseline characteristics, Canadian patients who had atrial fibrillation had a lower mortality risk.

Aged↗
PubMed2006

Knowledge management: a core skill for surgeons who manage.

The yawning gap between what we know and what we do has major implications for patients. By putting into practice what we know now, we will have a bigger impact on the health of individuals and populations than any drug or technology discovered in the new decade. The assumption underlying this article is that the gap can be closed by thinking, planning, analyzing, mobilizing,managing, personalizing, and using knowledge. There is, however,a risk that the attempted solution may perpetuate or aggravate the problem, and surgeons must be aware of the dangers of substituting thought for action, when knowledge management becomes an industry of its own, remote from the core activities of the organization and those who deliver them.

Clinical Competence↗