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PubMed1981

Implementation of state assistance program for training and education in emergency management--Federal Emergency Management Agency. Final rule.

This rule sets forth a description of the FEMA training and education assistance program to the States. The program functions through State Cooperative Agreements and is designed to further comprehensive emergency management training including emergency preparedness planning, hazard mitigation, and disaster response and recovery. In response to State and local expressed needs, FEMA was formed to coordinate and manage all disaster planning and response in one Agency. The combined training responsibilities of predecessor agencies are now being administered by the Training and Education Office of FEMA using the State Cooperative Agreements and Regional Support Contracts as the vehicle to meet individual State training needs. This rule defines the objectives and elements of the program, the funding approach, and the State application/proposal.

Disaster Planning↗
PubMed1999

An evidence-based guideline for the management of heavy menstrual bleeding. Working Party for Guidelines for the Management of Heavy Menstrual Bleeding.

AIMS: The objective of this guideline is to provide evidence-based recommendations for the management of regular heavy menstrual bleeding in women with no detectable pathology. METHODS: A multidisciplinary working party was formed which met on four occasions over a 12 month period. The evidence from randomised controlled trials was summarised into evidence tables and guidelines were developed. A draft report was circulated in November 1997 prior to the final report which was published in July 1998. RESULTS: A diagnostic and treatment algorithm was produced (Figure 1) as well as a full text report. The cost of implementing the guideline was considered and overall net savings of $6 million were likely. CONCLUSIONS: An explicit evidence-based guideline on the management of heavy menstrual bleeding was produced. Both the Royal New Zealand College of Obstetricians and Gynaecologists and the Royal New Zealand College of General Practitioners endorsed this guideline.

Adult↗
PubMed1999

1999 Canadian recommendations for the management of hypertension. Task Force for the Development of the 1999 Canadian Recommendations for the Management of Hypertension.

OBJECTIVE: To provide updated, evidence-based recommendations for health care professionals on the management of hypertension in adults. OPTIONS: For patients with hypertension, there are both lifestyle options and pharmacological therapy options that may control blood pressure. For those patients who are using pharmacological therapy, a range of antihypertensive drugs is available. The choice of a specific antihypertensive drug is dependent upon the severity of the hypertension and the presence of other cardiovascular risk factors and concurrent diseases. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: MEDLINE searches were conducted from the period of the last revision of the Canadian Recommendations for the Management of Hypertension (January 1993 to May 1998). Reference lists were scanned, experts were polled and the personal files of the authors were used to identify other studies. All relevant articles were reviewed, classified according to study design and graded according to levels of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS: Harms and costs: The diagnosis and treatment of hypertension with pharmacological therapy will reduce the blood pressure of patients with sustained hypertension. In certain settings, and for specific drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity and mortality. RECOMMENDATIONS: This document contains detailed recommendations pertaining to all aspects of the diagnosis and pharmacological therapy of hypertensive patients. With respect to diagnosis, the recommendations endorse the greater use of non-office-based measures of blood pressure control (i.e., using home blood pressure and automatic ambulatory blood pressure monitoring equipment) and greater emphasis on the identification of other cardiovascular risk factors, both in the assessment of prognosis in hypertension and in the choice of therapy. On the treatment side, lower targets for blood pressure control are advocated for some subgroups of hypertensive patients, in particular, those with diabetes and renal disease. Implicit in the recommendations for therapy is the principle that for the vast majority of hypertensive patients treated pharmacologically, practitioners should not follow a stepped-care approach. Instead, therapy should be individualized, based on consideration of concurrent diseases, both cardiovascular and noncardiovascular. VALIDATION: All recommendations were graded according to the strength of the evidence and the consensus of all relevant stakeholders. SPONSORS: The Canadian Hypertension Society and the Canadian Coalition for High Blood Pressure Prevention and Control.

Adult↗
PubMed2000

The management of depression: the implications for managed care--roundtable discussion: Part 1.

Depression affects not only the patient and the provider, but the employer as well. Up to 25% of all women experience major depressive disorder, compared with perhaps as many as 12% of all men. It is highly prevalent in patients with other acute and chronic disease. On October 4, 1999, a panel of managed care medical directors, pharmacy directors, clinicians, researchers, and health economists was convened in San Diego to discuss the optimal treatment of the disorder. This roundtable discussion is presented in three parts. The first portion lays the clinical foundation for the management of this critical disorder.

Antidepressive Agents↗
PubMed2001

Current guidelines for the management of unstable angina: a new diagnostic and management paradigm.

The new guidelines reflect a worldwide change to more sensitive diagnostic strategies and more aggressive management of unstable angina. Stratification to high risk now includes those patients with only a minor degree of electrocardiographic ST depression (0.5 mm) or a significant elevation of cardiac troponin. High-risk patients are recommended to be treated with intensive medical and invasive management. Intermediate-risk patients may be best evaluated using an accelerated diagnostic strategy over an 8-12 h period before being reclassified as high or low risk.

Adrenergic beta-Antagonists↗
PubMed2001

Dentistry's role in the management of sleep disorders. Recognition and management.

Nearly every practitioner in dentistry, no matter what his or her specialty or special interest, may have a potential role in the management of patients with a sleep disorder, particularly snoring and sleep apnea. More important, every dentist as a practitioner in the health care field should be able to assist the patient who is identified with a potential sleep disorder by making recommendations, referrals, or participating in the overall management. Sleep is essential to life and to overall health. Involvement by dentists is another step in the development of a closer relationship between dentists and their medical colleagues. The treatment of sleep apnea may be more successful, both in efficacy and compliance, if dentists and sleep specialists collaborate closely. The importance of this collaboration is certainly indicated by the creation of a Section on Oral Appliances within the American Academy of Sleep Medicine (AASM), which further unifies dentistry and medicine. Many dentists are not familiar with sleep medicine, its magnitude, and the prevalence of sleep disorders. To assist those looking to expand their knowledge, the pertinent organizations are listed in Appendix A, and a number of sleep-related organizations and websites are listed in Appendix B. It is up to each individual practitioner, in medicine and dentistry, to develop a better awareness of the field of sleep, its effect on a person's overall health, and how a person's quality of life can be improved by a better night's rest.

Humans↗
PubMed2002

The role of lifestyle management in the overall treatment plan for prevention and management of hypertension.

Hypertension is the most common cardiovascular risk factor in the U.S. population, and hypertensive nephrosclerosis is a common cause of progressive renal disease. Dietary and lifestyle modifications have shown promise in enhancing the effectiveness of blood pressure (BP) management. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNCVI) includes recommendations for prevention and management of hypertension. Recommendations include reducing sodium intake, increasing potassium, calcium, and magnesium intake, controlling obesity, and avoiding heavy alcohol intake, along with aggressive BP control. JNCVI guidelines provide a reasonable approach to lifestyle interventions, the benefits of which would outweigh the antihypertensive effects. The data suggest that such guidelines would benefit normotensive people as well.

Alcohol Drinking↗
PubMed1998

Clinical management guidelines for osteoporosis in Hong Kong The working group for formulating clinical management guidelines for osteoporosis in Hong Kong.

The following guidelines provide a basis for the management of osteoporosis for the practising physician in Hong Kong. The guidelines have been compiled by a working group that represents the specialties concerned with osteoporosis and summarise the current management of osteoporosis based on available published evidence and relevant local experience.

Journal Article↗
PubMed2002

Storm water management in an urban catchment: effects of source control and real-time management of sewer systems on receiving water quality.

For the examination of the effects of different storm water management strategies in an urban catchment area on receiving water quality, an integrated simulation of the sewer system, wastewater treatment plant and receiving water is carried out. In the sewer system real-time control measures are implemented. As examples of source control measures the reduction of wastewater and the reduction of the amount of impervious surfaces producing storm water discharges are examined. The surface runoff calculation and the simulation of the sewer system and the WWTP are based on a MATLAB/SIMULINK simulation environment. The impact of the measures on the receiving water is simulated using AQUASIM. It can be shown that the examined storm water management measures, especially the source control measures, can reduce the combined sewer overflow volume and the pollutant discharge load considerably. All examined measures also have positive effects on the receiving water quality. Moreover, the reduction of impervious surfaces avoids combined sewer overflow activities, and in consequence prevents pollutants from discharging into the receiving water after small rainfall events. However, the receiving water quality improvement may not be seen as important enough to avoid acute receiving water effects in general.

Automation↗
PubMed2002

[Social skills training in psychosocial therapy of schizophrenia: a multicenter study for symptom management and medication management modules].

OBJECTIVE: It is known that psychosocial skills training programs increase the efficacy of schizophrenia treatment. The aim of this study was to carry out the Turkish version of two modules of a commonly used program, Social Skills Training (Medication Management and Symptom Management Modules), and to determine its possible benefits. METHOD: The study was carried out at three sites. Fifty schizophrenic patients who were at least literate and who did not have language problems or organic mental diseases, aged 18-60, using antipsychotic agents in a standard dose and in a stable phase were included in the study. Eight training groups were formed. Each group consisted of 5-7 individuals and the study took approximately eight months. The Brief Psychiatric Rating Scale, the Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome, the Drug Treatment Compliance Scale and Pre- and Post-Tests of Social Skills Training were applied to the patients before and after the group education The scores of the rating scales were compared. RESULTS: Thirty-eight (76%) patients completed the study. The mean age of the patients was 32 +/- 7, 84% were men, 58% had received less than 11 years, of education 84% had never married, and 97% were living with their families. The mean age of illness onset was 20 +/- 5 years, and the mean duration of the illness was 12 +/- 7 years. At the end of the study, the Brief Psychiatric Rating Scale scores (baseline 42.0, after the training 37.1, p<0.02), and the Quality of Life Scale scores (baseline 67.5, after the training 75.3, p<0.01) were significantly changed. The level of knowledge of the patients about the medication and symptoms of schizophrenia increased 20.6%. Drug treatment compliance had also increased by the end of the study. CONCLUSION: The results show that this program contributed to the treatment compliance and treatment efficacy in schizophrenia. Increased treatment efficacy might have played a role in increasing of the quality of life a long with the group milieu. It may be concluded that this social skills training program, which did not encounter any problems in application, may contribute significantly to the treatment of schizophrenia.

English Abstract↗
PubMed1992

[Management of liver trauma in adults: the results of selective nonoperative management and operative treatment].

The liver trauma is still one of the major injury in thoracoabdominal trauma, with increasing numbers and incidence in Taiwan. There is a trend toward a more conservative approach in the treatment of liver trauma. Nonoperative management for the stable patients with blunt liver trauma has been advocated in literature recently. In Veterans General Hospital-Taipei, forty-five patients with liver trauma have been admitted to Emergency Department after accident in past four years. Eighty-three percent of the trauma mechanism was blunt injury, and seventeen percent penetrating. There were ten patients selected as nonoperative management, and eight of them succeeded without operation. Retrospective analyzing various factors including age, trauma score, revised trauma score, injury severity score, amount of hemoperitoneum, blood loss and transfusion, morbidity and hospitalization, there are no statistic significances between nonoperative and operative groups, except that nonoperative group are less amount of blood transfusion. We suggest that the decision to treat the patient without laparotomy is not based on the degree of hemoperitoneum or the grade of liver injury, but rather on the stability of the patient. And further evaluation is needed.

Adolescent↗
PubMed1992

What nurse managers can learn from Japanese management style.

1. Significant differences have developed between Japanese and American work settings since World War II. Today, the Japanese appear to have a unique understanding of the way decisions are made; a large part of decision making is entrusted to middle, rather than top, management. 2. In the nemawashi process, all official decision-making procedures are preceded by an unofficial process whereby all those affected by a decision, both vertically and horizontally, are involved in the decision before it is made. 3. The nursing process is based on decision making, and group process has been described as an effective way of making decisions. However, nurse managers lack definitive group decision making processes for their nursing practice.

Cross-Cultural Comparison↗
PubMed2004

Hypertension management in primary care: standard care and attitude towards a disease management model.

INTRODUCTION: Cardiovascular risk control has become one of the hallmarks in the treatment of diabetes and coronary heart disease, yet assessment of individual risk factors is suboptimal. We have designed a new Hypertension Screening Facility (HSF) for the evaluation of cardiovascular risk in hypertensive patients, based on 1) systematic, protocol-driven (WHO/ISH-based) analysis by nurse practitioners, 2) computer-assisted reporting of results and advice, 3) risk assessment using a Decision Support System (DSS), 4) maintenance of the autonomy of the GP. In a pilot study we wanted to investigate this HSF. METHODS: Survey 1 addressed a. how general practitioners deal with hypertension, b. whether they intend to and do use existing clinical guidelines, c. what their opinions are towards changes in the current process of care. In survey 2, we evaluated the attitude of GPs using the HSF. Responses were 43% (51 out of 120) to the first survey and 100% (20 out of 20) to the second. RESULTS: The majority of physicians included lifestyle in their assessment of risk factors and management of hypertension. Consideration of age and a positive family history was extremely high. In contrast, vision disturbances, ECG and microalbuminuria were not often considered. In the absence of additional risk factors, drug treatment was initiated in patients with a mean systolic blood pressure of 162+/-6 over 99+/-4 mmHg. In the presence of risk factors (obesity, smoking and a positive family history of cardiovascular disease) treatment is started at an average blood pressure of 154+/-8 over 96+/-4 mmHg. Opinions towards a change in management of hypertensive patients were generally positive. The opinions about the new HSF and the cardiovascular risk were reported to the general practitioner and considered useful or very useful by 79%. CONCLUSION: The present study thus confirms that cardiovascular risk evaluation by GPs is suboptimal, but there is a positive attitude towards an improvement in their assessment by HSF. The novelty of the HSF is that it respects the autonomy of the GP and brings the expertise to the GP.

Attitude of Health Personnel↗
PubMed2001

Tetanus managed in a peripheral hospital--a case report and a review of management.

Tetanus has become increasingly uncommon. However, with many people failing to maintain adequate levels of immunisation it will continue to present sporadically, with patients who are affected frequently requiring intensive care management. A case of tetanus, and its management in a peripheral hospital in New Zealand, is described. Current treatment options are reviewed.

Journal Article↗
PubMed1992

[Family practice management in urethritis. II. Comparison of clinical management to the protocol].

OBJECTIVE: To describe general practitioners' approach to and management of urethritis in men, and to compare this with a general practice protocol for urethritis. DESIGN: Descriptive. SETTING: General practices in Amsterdam. PATIENTS AND METHODS: In 13 general practices in Amsterdam (23,510 patients, of whom 11,627 men) all episodes of urethritis in men (n = 55) were recorded during one year (complaints, medical management, diagnosis, medication, follow-up). OUTCOME MEASURES: Description of the diagnostic and therapeutic approach and the course of episodes; rough comparison with the urethritis protocol. RESULTS: In 25% the urine sediment was examined; other office tests were rarely performed. In 30 to 40% out of office microbiological tests were performed. In 50% of new diagnoses medication was underdosed, in some cases medication was wrong or not broad enough. In 25% explicit education was offered. In 22% new medication was given in the follow-up encounter. CONCLUSIONS: (Comparison with protocol.) Urine sediment examination as an effective test is performed insufficiently often. Other office tests are rarely performed, in accordance with the protocol. Out of office microbiological tests are performed too often, judged by the few changes of diagnosis and the character of new medication in the follow-up. First treatment is often underdosed and sometimes wrong. First treatment should preferably be broad, adequately dosed and independent of out of office microbiology. Too little education is given concerning the risks of ascending infections in female partners and of HIV infection. The referral rate is very low. It is important to pay attention to the outcome of this study in (postgraduate) education for general practitioners, as they treat the vast majority of urethritis patients.

Anti-Infective Agents, Urinary↗
PubMed1988

Office management of sexually transmitted disease and management of pelvic inflammatory disease in the ambulatory patient.

Sexually transmitted disease poses an increasing challenge for the clinician in the 1980s, with increasing numbers of pathogens and diseases. This article discusses the diagnosis and outpatient management of gonorrhea, herpes virus type II, chlamydia trachomatis, and condyloma accuminatum. In addition, the diagnosis and outpatient management of pelvic inflammatory disease is reviewed.

Family Practice↗
PubMed1987

Changes in the management of labour: 1. Length and management of the second stage.

An analysis of 18,940 deliveries between 1981 and 1984 in a large British obstetric unit showed marked changes in the management of the second stage of labour. These changes included an increase in the length of the second stage (especially among primiparous women), a rise in the rate of spontaneous delivery and a large decline in the rate of episiotomy. There was no change in neonatal outcome or in the rate of maternal postpartum complications. These findings may have resulted from a more conservative approach to the management of the second stage. They may also reflect a better understanding among obstetric professionals of what constitutes a normal second stage and therefore better decisions about when to act and when to wait.

Analgesia↗