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PubMed1990

[Effect of health behavior on health status--social medicine problems in family practice management].

Health counselling as a part of the family doctor's practice includes the influence of health behaviour on the state of health. Health behaviour is transmitted by relational persons within everyday social groups. It depends on the scale of values and norms of behaviour within a group and is modified by individual needs. Vital social contacts (family and relational persons) have a higher value than health and serve-depending on the structure of personality-as a motivation of a health-promoting lifestyle. The family doctors strategies of intervention are aimed at winning relational persons, group leaders and local personalities to encourage health promotion and thus achieving that a healthful lifestyle is supported by the public opinion and becomes the social standard.

Germany, East↗
PubMed2001

Veterinary practice management education in the Association of American Veterinary Medical Colleges member colleges during 1999.

Most veterinary students enrolled at AAVMC member institutions take at least 1 VPM course prior to graduation. These courses are characterized by widespread involvement of outside lecturers with business expertise, which likely adds to their strength. However, it remains that wide variation in VPM education exists across the AAVMC with regard to the topics addressed, the specific business expertise of faculty and administrative course specifics. As such, the situation provides several key opportunities. Foremost among these is the immediate need for profession-wide discourse on VPM education to define reasonable expectations with regard to the business skills of veterinary graduates. In addition, outcomes assessment would provide information on which of the widely varying approaches to VPM education is most likely to produce successful graduates. The opportunity also exists for development of academic research programs to support VPM education directly by strengthening the related disciplinary knowledge base. Effective leadership for these efforts will be crucial to their success.

Cross-Sectional Studies↗
PubMed1994

Client flow analysis: a practical management technique for outpatient clinic settings.

Client flow analysis (CFA) is a practical technique to help address one of the most frequently cited causes of patient disquiet with quality of health services--waiting times. It allows clinic managers and workers to look at the way that clients and patients move through the clinic. It gives information on waiting times, time spent in contact with different service providers, bottle-neck areas in services and staff utilization patterns. It is a technique which is simple, quickly performed, cost effective, easy to learn and easily transferrable. This paper gives two illustrative examples of sites where CFA has been initiated in Africa--a free-standing family planning clinic and a provincial hospital outpatient clinic. Waiting times were reduced by over one-half and by one-third, respectively. By reducing waiting times for clients and patients and addressing some of the problems of staff time allocation, the quality of clinic operations can be improved for both providers and clients.

Ambulatory Care Facilities↗
PubMedDate not supplied

Balancing the perfect scorecard. Inquiry as intervention in physician practice management.

We describe how inquiry into several operational aspects of health care delivery in the Division of Medicine at the Cleveland Clinic Foundation improved clinical and administrative functions, demonstrating the principle that inquiry is intervention. The process of inquiry displays data on a "performance wheel" that summarizes several indicators, allowing easy comprehension of performance in various operational aspects and a visual appreciation of the interaction among these operational aspects.

Appointments and Schedules↗
PubMed2004

Community-acquired pneumonia: influence of management practices on length of hospital stay.

AIMS: To identify variation in the management of -community-acquired pneumonia between two New Zealand hospitals and the factors that may account for any differences. METHODS: A 12-month, prospective two-centre study was conducted. Between July 1999 and July 2000, 474 adult patients with community-acquired pneumonia were enrolled: 304 in Christchurch Hospital and 170 in Waikato Hospital. The patients were similar in age, sex, prior antibiotic use and comorbidity. There was no significant difference in the clinical outcomes for the patients at the two centres. RESULTS: The mean duration of i.v. antibiotic therapy was 1.7 versus 3.0 days (P < 0.001) and length of stay (LOS) was 3.0 versus 5.9 days (P < 0.001) for Waikato and Christchurch Hospitals, respectively. Using multivariate analysis, we could account for 61% of the observed variation in LOS. Duration of i.v. antibiotic therapy independently accounted for 16% of variation in LOS compared with age (2%), chronic obstructive pulmonary disease, duration of fever, intensive care unit admission and centre of admission (all <1%). For the duration of i.v. antibiotics, centre of admission, largely reflecting clinician practice at each centre, independently accounted for 13% of variation, compared with duration of fever (5%), admission to the Intensive Care Unit (4%), Pneumonia Severity Index score (3%) and bacteraemia (3%). CONCLUSION: Of the identifiable factors, variations in clinician behaviour outweighed the influence of patient factors on the duration of i.v. antibiotic therapy, which in turn was the major determinant of LOS for patients hospitalised with community-acquired pneumonia. An early switch from i.v. to oral antibiotic therapy in conjunction with early discharge planning may significantly reduce LOS without compromising patient outcomes.

Aged↗
PubMed2003

It's magic: a unique practice management strategy.

For thousands of years prior to the advent of modern dentistry, magic has been used to entertain, impress, and motivate individuals. Today's dental professionals are using the concept of The Magic of a Healthy Smile through their use of modern clinical techniques and as a means for practice marketing, patient education, and the reduction of patient stress and fear. This article describes how dentists/magicians have incorporated magic into their practices and the benefits of this useful patient management strategy. A script of the "Happy Tooth Magic Show" and resources for dentists to create their own dental magic show are provided.

Child↗
PubMed2003

Using satellite imagery to locate innovative forest management practices in Nepal.

There is a critical need to locate innovative forest management institutions that significantly impact forest cover change. This research presents an initial "proof of concept" methodology which combines deforestation theory with satellite image change analysis to identify forested areas that, theoretically, should probably not be there. Ten such "forest anomalies" are identified using temporal analysis of Landsat TM imagery of the Chitwan district in Nepal, linked with a GIS database on roads and a visual estimation of topography. A rapid field reconnaissance is undertaken to determine which of these anomalies exhibit interesting forest management innovations. Based on this information, one case is selected for detailed field study: this turns out to be a major case of community forestry and a premier ecotourism initiative that we were not aware of until we undertook this analysis. The utility and limitations of the method are described for monitoring trends in forest cover change.

Conservation of Natural Resources↗
PubMed2002

Pelvic floor dysfunction management practice patterns: a survey of members of the International Urogynecological Association.

The authors report results of a survey of the practice patterns of International Urogynecological Association (IUGA) members in the management of urinary incontinence and pelvic organ prolapse. A questionnaire regarding current urogynecological clinical practice was developed by the Research and Development Committee of IUGA and mailed to all members of IUGA. Age, specialty, and geographic location factors were used for response comparisons. One hundred and fifty-two surveys (30%) were returned, 35% from North America, 51% from Europe/Australia/New Zealand, and 14% from elsewhere. The average age of respondents was 47.2 years (SD = 9.5), 89% were gynecologists and 11% were urologists. Overall, the procedures of choice for stress incontinence (SUI) were tension-free vaginal tape (TVT; 48.8%) and Burch colposuspension (44%). There were significant geographic variations noted. For SUI with low-pressure urethra/intrinsic sphincteric deficiency, TVT was used by 44.6% and suburethral sling by 32.3%. Various materials are used for suburethral slings, including autologous fascia (46.5%), Marlex mesh (27.8%) and cadaveric fascia lata (11.6%). Bulking agent injection therapy is used for ISD by 75% of respondents. Traditional reconstructive procedures are performed by the majority of respondents, including sacrospinous fixation (78%), abdominal sacrocolpopexy (77%), paravaginal repair (65%) and vaginal enterocele repair (93%); 6.5% use defecography in evaluating rectoceles and 44% use the POP-Q. Seventy-two per cent use urodynamic evaluation routinely in prolapse cases with no manifest SUI. Most IUGA members perform commonly accepted procedures for surgical therapy of urinary incontinence and genital prolapse. IUGA members do not frequently use anorectal physiology and fluoroscopic investigations to evaluate rectoceles prior to repair.

Adult↗
PubMed1999

Practice management. Behind the lines.

The introduction of nurse telephone triage for patients requesting same-day attention in a GP practice has reduced the number of appointments and home visits for these patients. Patients welcome the opportunity to speak to a health professional when they telephone. The practice has found the scheme a useful method of demand management and hopes to expand it.

England↗
PubMed2003

Ownership pattern and management practices of cattle herds in the Gambia: implications for a breeding programme.

A questionnaire and a census were carried out in 1998/99 on 201 cattle herds in 44 villages located in three different areas of The Gambia, in order to obtain information about the ownership pattern, management and breeding practices for optimizing and extending a pure breeding scheme for indigenous N'Dama cattle. The herds had an average of 58.5 head, of which 39.3% were cows, and most of them were multiowner herds, having on average 5.5 owners. Overall, women represented 38.3% of the owners, but they owned only 15.9% of the cattle. Some of the senior herdsmen received no payment, as they were family members, but most of them received payment in kind, i.e. milk off-take from the herd. Payment in cash only or cash as well as milk was rare. In larger herds it was quite common for additional herdsmen to be hired throughout the year, their payment shifting towards cash only or cash and milk. Many small herds had no older bulls or breeding bull and almost all breeding bulls were born within the herd. In most cases, it was the herd owner who was responsible for the selection of the breeding bull. Traits related to the growth and milk production of the dam were considered as most important for a good breeding bull. The results are discussed with respect to the extension of a pure breeding scheme for N'Dama cattle.

Animal Husbandry↗
PubMedDate not supplied

Continuing education outcomes related to pain management practice.

BACKGROUND: Nursing practice outcomes of continuing education need to be measured and reported as one indicator of the value of nursing continuing education. This article makes the case that knowledge gain, the traditional measure of continuing education effectiveness, is not necessarily sufficient to assess changes in nursing practice. METHOD: A pretest/posttest design was used to measure nursing practice outcomes of a continuing education program about pain management. A total of 50 attendees returned both the pretests and posttests and 68 attendees returned the follow-up evaluation. RESULTS: Ninety-four percent of the respondents had improved scores on the posttest. Ninety-one percent of the follow-up evaluation respondents stated they had an opportunity to use the new information and 98% stated the use of this information has improved patient care. CONCLUSION: This study found that a continuing education program triggered practice changes. The results of this study correlate with previous research that supports the need for practice outcome measurements.

Education, Nursing, Continuing↗
PubMed2000

Practical management of hyperinsulinism in infancy.

Hyperinsulinism in infancy is one of the most difficult problems to manage in contemporary paediatric endocrinology. Although the diagnosis can usually be achieved without difficulty, it presents the paediatrician with formidable day to day management problems. Despite recent advances in understanding the pathophysiology of hyperinsulinism, the neurological outcome remains poor, and there is often a choice of unsatisfactory treatments, with life long sequelae for the child and his or her family. This paper presents a state of the art overview on management derived from a consensus workshop held by the European network for research into hyperinsulinism (ENRHI). The consensus is presented as an educational aid for paediatricians and children's nurses. It offers a practical guide to management based on the most up to date knowledge. It presents a proposed management cascade and focuses on the clinical recognition of the disease, the immediate steps that should be taken to stabilise the infant during diagnostic investigations, and the principles of definitive treatment.

Genetic Therapy↗
PubMed2006

Practical management of the parturient with congenital heart disease.

Cardiac disease is becoming more common in women presenting for maternity care and is a major cause of maternal mortality in the UK. We present a review of the management of parturients with congenital heart disease, focusing on practical aspects and the problems that may be expected.

Adult↗