Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Management”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 955 records · Page 53Linked to original sources
PubMed2003

Noninvasive management of Rh partial null (D--) to supplement traditional management of Rh isoimmunization.

BACKGROUND: Rh partial null (D--) is a rare cause of Rh sensitization in an Rh-positive patient. Noninvasive management for this condition using middle cerebral artery Doppler studies was used to reduce invasive testing. CASE: An Rh D+ woman had an antibody titer of 1:512 to Rh-17, the Rh Cc/Ee protein. Rh typing revealed absence of any antigens at the Cc/Ee locus. Her husband was Rh D--, ccee. Middle cerebral artery Doppler studies and serial amniocenteses for Delta OD(450) were performed. When testing suggested severe fetal anemia, two intrauterine transfusions were performed. CONCLUSION: Middle cerebral artery Doppler studies can be used to predict fetal anemia before the first transfusion. However, the cutoff to predict subsequent anemia in Rh D-- after transfusion remains to be defined.

Adult↗
PubMed2002

Managing selenium-contaminated agricultural drainage water by the integrated on-farm drainage management system: role of selenium volatilization.

The Integrated on-Farm Drainage Management (IFDM) system was designed to dispose of selenium (Se)-contaminated agricultural irrigation drainage water through the sequential reuse of saline drainage water to grow crops having different salt tolerance. This study quantified the extent of biological volatilization in Se removal from the IFDM system located in the western San Joaquin Valley, California. Selenium volatilization from selected treatment areas, including pickleweed (Salicornia bigelovii Torr.), saltgrass (Distichlis spicata L.), bare soil, and the solar evaporator, was monitored biweekly using an open-flow sampling chamber system during the pickleweed growing season from February to September 1997, and monthly from September 1997 to January 1998. Biological volatilization from the pickleweed section removed 62.0 +/- 3.6 mg Se m(-2) y(-1) to the atmosphere, which was 5.5-fold greater than the Se accumulated in pickleweed tissues (i.e., phytoextraction). The total Se removed by volatilization from the bare soil, saltgrass, and the solar evaporator was 16.7 +/- 1.1, 4.8 +/- 0.3, and 4.3 +/- 0.9mg Se m(-2) y(-1), respectively. Selenium removal by volatilization accounted for 6.5% of the annual total Se input (957.7mg Sem(-2) y(-1)) in the pickleweed field, and about 1% of the total Se input (432.7 mg Se m(-2) y(-1)) in the solar evaporator. We concluded that Se volatilization under naturally occurring field conditions represented a relatively minor, but environmentally important pathway of Se removal from the IFDM system.

Agriculture↗
PubMed2004

Review of antibiotic drug use in a surgical ICU: management with a patient data management system for additional outcome analysis in patients staying more than 24 hours.

BACKGROUND: A number of developments have been made in computerized patient data management systems (PDMSs), making them of interest to medical and nursing staff as a means of improving patient care. OBJECTIVES: The aim of this study was to assess the capability of a PDMS to record and provide drug-administration data and to investigate whether the PDMS may be used as a means of support for clinical audits and quality control. Furthermore, we assessed whether antibiotic therapy as a surrogate for infections correlates with hospital mortality in patients staying >24 hours in a surgical intensive care unit (SICU). METHODS: Because of its medical and economic importance in ICU treatment, we chose to use the field of antibiotic therapy as an example. A PDMS was used in a 14-bed SICU (Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Giessen, Giessen, Germany) to record relevant patient data, including therapeutic, diagnostic, and nursing actions. During a 15-month period (April 1, 2000 to June 30, 2001), antibiotic drug therapy was electronically analyzed and presented using the anatomic therapeutic chemical (ATC) category for antibacterials (ATC group, J01) with daily defined doses. Furthermore, the correlation of antibiotic therapy with patient outcome (hospital mortality) was tested using logistic regression analysis. RESULTS: A total of 2053 patients were treated in the SICU. Of these, 58.0% (1190 patients) received antibiotics (4479 treatment days; 13,145 single doses). Cephalosporins (ATC category, J01DA) were used most frequently (1785 treatment days [39.9% of treatment days]), followed by combinations of penicillins with beta-lactam inhibitors (ATC category, J01CR; 1478 treatment days [33.0%]) and imidazole derivatives (ATC category, J01XD; 667 treatment days [14.9%]). The antibiotic therapy lasted <3 days in 65.6% of cases. In 13.8% of cases, the treatment lasted >1 week. A total of 36.7% of cases were treated with only 1 antibiotic agent, 14.1% were given a combination of 2, and 7.2% were given a combination of > or =3 antibiotic agents. Seven hundred twenty-six patients remained in the SICU for >24 hours; 143 (19.7%) died during their hospital stay; 110 (15.2%) in the SICU. The duration of antibiotic therapy (odds ratio [OR], 1.46) and number of different antibiotic drugs used (OR, 2.15) significantly correlated with hospital mortality. CONCLUSIONS: Antibiotic therapy in a SICU can be assessed and analyzed in detail using a PDMS. Furthermore, in this study, the duration of antibiotic therapy and the number of antibiotic agents used correlated with hospital mortality. In further developing PDMSs, it is important for quality-assurance purposes to document the reasons for giving antibiotics and for changing prescriptions. It would also be helpful to integrate certain therapy standards and reminder functions for the duration of therapy in the PDMS.

Adult↗
PubMed1999

How does managed care manage the frail elderly? The case of hospital readmissions in fee-for-service versus HMO systems.

OBJECTIVES: This study examined whether hospital readmissions varied among the frail elderly in managed care versus fee-for-service (FFS) systems. SETTING AND PARTICIPANTS: Random sample of 450 patients, aged 65 and over, from a large vertically integrated health care system in San Diego, California. Participants were receiving physician-authorized home health and survived and 18-month follow-up period. MAIN OUTCOME MEASURES: Multiple logistic regression analyses were used to conduct comparisons of readmissions and preventable readmissions by plan type. Two methods to identify preventable readmissions were developed, one based on a computerized algorithm of service use patterns, and another based on blind clinical review. RESULTS: The odds of having a preventable hospital readmission within 90 days of an index admission were 3.51 (P = 0.06) to 5.82 (P = 0.02) times as high for Medicare HMO enrollees compared to Medicare FFS participants, depending on the method used to assess preventability. Readmission patterns were similar for Medicare HMO enrollees and FFS study participants dually enrolled in Medicare and Medicaid. CONCLUSION: In this group of frail elderly Medicare beneficiaries, those enrolled in an HMO were more likely to have a preventable hospital readmission than those receiving care under FFS. These results suggest that policies promoting stringent approaches to utilization control (e.g., early hospital discharge, reduced levels of post-acute care, and restricted use of home health services) may be problematic for the frail elderly.

Aged↗
PubMed1998

Training schizophrenic patients to manage their symptoms: predictors of treatment response to the German version of the Symptom Management Module.

This study examined whether patient demographic and clinical characteristics were predictors of differential treatment response in a sample of 57 schizophrenic patients who received the German version of the Symptom Management Module. Psychopathology, global functioning and knowledge about schizophrenia were assessed as dependent variables. Overall, patients improved over the treatment period on most dimensions of psychopathology as well as knowledge about psychosis. There was little evidence of differential treatment response as a function of either sociodemographic or clinical variables. However, gender was related to changes in psychopathology from pre- to posttreatment, with females improving less than males. Possible implications of these findings were discussed.

Adaptation, Psychological↗
PubMed1996

Management of bullying and bullying in management.

Bullying can be defined as 'the improper and frequent use of power to affect someone's life adversely' (Patchett 1992) or simply coercion by fear (Adams 1992). Bullying is thought to be a significant problem within the National Health Service (NHS) but this is based on anecdotal literature by Adams (1992), Turnbull (1995) and Kline (1994). There is no clear evidence as to its exact prevalence. This is not least due to the nature of the problem that inhibits reports of the incidence of bullying. Bullying may manifest itself as a problem within a department as well as a misinformed management style. Recommendations are made to call for more awareness of the issue by research and the formation of written policies. Research based information may provide the impetus needed to introduce measures against bullying.

Aggression↗
PubMed2000

Who's in charge here anyway? Managing the management split in mental health organizations.

Most mental health organizations are run by chief executive officers (CEOs) who are not physicians, with medical directors reporting to the CEOs. In this article the historical and organizational origins of this arrangement are reviewed. The well known disadvantages of shared management are discussed, as are the less obvious advantages. Through case vignettes the authors illustrate how bifurcated leadership can promote productive and creative administrative decisions. Guidelines are offered for strengthening collaborations between non-medical and medical mental health program directors.

Conflict, Psychological↗
PubMed2002

Medical management of pituitary adenomas: the special case of management of the pregnant woman.

The development of efficacious surgical and medical therapies for pituitary adenomas as well as the improvement of hormone therapy for ovulation induction has made pregnancy possible for women harboring pituitary tumors. However, gestational risks due to the possibility of tumor growth during pregnancy, mainly in women with macroadenomas, raise a concern. Bromocriptine has a well-established role for prolactinoma treatment before and during pregnancy, even when a symptomatic tumor increase occurs. It can also be used in acromegaly, despite its poorer results. Somatostatin analogs have been used in acromegaly even during pregnancy with uneventful outcomes, but their safety in pregnancy is not well established, yet. The largest experience with medical treatment for Cushing's disease during pregnancy involves metyrapone, a steroidogenesis inhibitor, without descriptions of congenital abnormalities. Concerning clinically non-functioning pituitary tumors, ovulation induction or even in vitro fertilization are frequently needed. The purpose of this review is to provide an update on therapeutic strategies to restore fertility as well as gestational and post-gestational management of patients with pituitary adenomas, focusing mainly on the role of medical treatment for different tumor types.

Acromegaly↗
PubMed2000

Complex management issues: management of HCV in the atypical patient.

Some patients with chronic hepatitis C virus (HCV) infection demonstrate atypical features of presentation and clinical course. These features may be due to direct or indirect effects of the underlying HCV infection or may be part of a separate clinical syndrome. Patients that can be categorized as 'atypical' include immunosuppressed individuals (hypogammaglobulinaemic, co-infected with human immunodeficiency virus, recipients of solid organ or haematopoietic cell transplants, those with associated disease requiring chronic immunosuppressive therapy and patients with chronic renal failure on haemodialysis) as well as patients with various extra-hepatic (HCV-associated mixed cryoglobulinaemia, membranoproliferative glomerulonephritis etc) or autoimmune manifestations. Since many of these patients have been excluded from the large trials evaluating the efficacy of interferon-alpha alone or in combination with ribavirin, data regarding management are limited. In this chapter, the available information regarding the treatment of these patients is reviewed and the frequently encountered therapeutic dilemmas discussed. Finally, some reasonable therapeutic approaches are suggested while the need for controlled studies for these groups of patients is emphasized.

Agammaglobulinemia↗
PubMed2005

Minimally invasive management of ependymoma of the aqueduct of Sylvius: therapeutic considerations and management.

A major concern in the neuroendoscopic approach to an intraventricular tumor is the histological confirmation from a limited biopsy. However, the effort to excise the whole bulk of the tumor should be made for the minimally invasive management of selected intraventricular tumors. The case of an adult male with focal aqueductal ependymoma who presented with the clinical syndrome of hydrocephalus is reported. This may be of particular interest because it represents the first case of aqueductal ependymoma that has been successfully treated with endoscopic surgery.

Brain Neoplasms↗
PubMed2006

[New forms of management in dermatology. Integrated in-patient-out-patient prevention of severe occupational dermatoses: cornerstones for an effective integrated management in clinics and practices].

Occupational dermatoses (OD) are the most frequent occupational diseases in Germany and amount to more than 25% of all suspected occupational diseases. Preventive measures have proven to be very effective in recent years, especially measures of primary and secondary prevention as components of a complex hierarchical prevention concept in wet work occupations. If employees are in danger of loosing their job due to a severe OD, intensive interdisciplinary measures of tertiary individual prevention (TIP) are required. TIP comprises 2-3 weeks of in-patient treatment plus intensive health-pedagogic counselling, followed by 3 consecutive weeks (or longer) of out-patient treatment by the local dermatologists ("Osnabrueck model"). Each patient will stay off work for a total of at least 6 weeks to allow full barrier-recovery. It could be shown that 2/3 of the patients successfully remained in their workplaces because of TIP. TIP reveals remarkable pertinent options for interdisciplinary disease management in severe OD in all risk professions. In Germany recently, a multi-centre study was started which will further standardise such preventive measures and evaluate their long-term success.

Ambulatory Care↗
PubMed1997

Workplace in fluency management: factoring the workplace into fluency management.

This article addresses competency-based standards and guidelines for the involvement of speech-language pathologists in the workplace of clients who stutter. It advocates broadening customary practices in stuttering treatment and suggests that speech-language pathologists should extend their scope of service delivery to the workplace. It presents a sequence for the collaborative involvement of the employer and other workplace members and proposes strategies for evaluating workplace based fluency programs. Issues of fluency management, transfer, maintenance, and efficacy are discussed in the workplace context. Also addressed is workplace communication as well as such factors as stereotypes, discrimination, and resistance to change which may impinge on workplace intervention. It is argued that structured intervention, transfer, and generalization within a collaborative workplace framework facilitates best practice for the fluency clinician and more appropriate outcomes for the diversity of clients who stutter.

Clinical Protocols↗
PubMed2000

Neurocognitive functioning in children with mild and moderate asthma in the childhood asthma management program. The Childhood Asthma Management Program (CAMP) Research Group.

BACKGROUND: The Childhood Asthma Management Program (CAMP) is a multicenter double-blind, randomized, placebo-controlled, clinical trial of two anti-inflammatory agents and placebo in children with mild and moderate asthma. OBJECTIVE: The interrelationship between asthma severity and neurocognitive functioning among 1041 children (age range, 5-12 years) enrolled in the CAMP trial was examined. METHODS: Asthma severity was established at baseline with a clinical history of asthma symptomatology and measures of lung function (spirometry and methacholine challenge). Diary cards were used in a screening to record nighttime awakenings and doctor contacts caused by asthma symptoms, symptom severity, and number of puffs from a rescue inhaler. All children received a comprehensive neurocognitive assessment at the end of the 28-day screening period (before randomization), including measures of intelligence, attention, memory, and academic achievement. RESULTS: Significant differences were found between children with mild and moderate asthma on lung function and symptom outcome variables (log(e)FEV(1)PC(20), DeltaFEV(1) percent predicted, change in peak flow percent predicted, nighttime awakenings caused by asthma, average symptom severity score, and average daily number of puffs from a rescue inhaler) but not on neurocognitive variables. Multiple regression analyses revealed that asthma outcomes could not be predicted by neurocognitive variables despite controlling for socioeconomic status. The prevalence of neurocognitive dysfunction, as indicated by the use of psychostimulant medication, was found to be consistent with that found in the existing literature. CONCLUSION: Mild and moderate asthma symptoms are not related to neurocognitive functioning in the children enrolled in CAMP. Mean performance on neurocognitive variables was found to be similar to that of national normative data.

Asthma↗
PubMed2004

Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies. A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition.

Overweight and obesity are important risk factors for type 2 diabetes. The marked increase in the prevalence of overweight and obesity is presumably responsible for the recent increase in the prevalence of type 2 diabetes. Lifestyle modification aimed at reducing energy intake and increasing physical activity is the principal therapy for overweight and obese patients with type 2 diabetes. Even moderate weight loss in combination with increased activity can improve insulin sensitivity and glycemic control in patients with type 2 diabetes and prevent the development of type 2 diabetes in high-risk persons (ie, those with impaired glucose tolerance). The American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition have joined together to issue this statement on the use of lifestyle modification in the prevention and management of type 2 diabetes.

Adult↗
PubMed2005

The initial management of stable angina in Europe, from the Euro Heart Survey: a description of pharmacological management and revascularization strategies initiated within the first month of presentation to a cardiologist in the Euro Heart Survey of Stable Angina.

AIMS: In order to assess adherence to guidelines and international variability in management, the Euro Heart Survey of Newly Presenting Angina prospectively studied medical therapy, percutaneous coronary intervention (PCI), and surgery in patients with new-onset stable angina in Europe. METHODS AND RESULTS: Consecutive patients, 3779 in total, with a clinical diagnosis of stable angina by a cardiologist were enrolled. After initial assessment by a cardiologist, 78% were treated with aspirin, 48% with a statin, and 67% with a beta-blocker. ACE-inhibitors were prescribed by the cardiologist in 37% overall. Revascularization rates were low, with only 501 (13%) patients having PCI or coronary bypass surgery performed or planned. However, when restricted to patients with coronary disease documented within 4 weeks of assessment, over 50% had revascularization performed or planned. Among other factors, the national rate of angiography and availability of invasive facilities significantly predicted the likelihood of revascularization, OR 2.4 and 2.0, respectively. CONCLUSION: This survey shows a shortfall between guidelines and practice with regard to the use of evidence-based drug therapy and evidence that revascularization rates are strongly influenced by non-clinical, in addition to clinical, factors.

Analysis of Variance↗
PubMed1991

Managing miscarriage: the management of the emotional sequelae of miscarriage in training practices in the West of Scotland.

Miscarriage is a very common event which is rarely a medical emergency, and which, from a biomedical perspective, may justifiably be viewed as a 'normal' complication of early pregnancy. From the mother's point of view however, the loss of a wanted pregnancy may be viewed quite differently. A number of studies have identified significant levels of dissatisfaction with the medical care which women have received at the time of a miscarriage. This paper describes a survey of the management of miscarriage by general practitioner trainees and trainers in the West of Scotland and on the basis of responses to a series of MEQ-type questions, indicates GPs views on the importance of counselling, sympathetic listening and good information in this area. The translation of these attitudes and beliefs into practice is, of course, a different issue, and one which may be affected by the task-oriented approach of the new contract.

Abortion, Spontaneous↗
PubMed2002

Integrated pest management of Rhagoletis mendax (Diptera: Tephritidae) in lowbush blueberry using vegetative field management.

Economic control of Rhagoletis mendax was achieved by applying insecticidal sprays to commercial lowbush blueberry vegetative fields, in a biennial production system, rather than to the fruiting fields, when the threshold was exceeded. The viability of this integrated pest management of R. mendax for lowbush blueberries was demonstrated over a 9-yr interval in New Brunswick where three sites were monitored for 2 yr, eight sites for 4 yr, and one site for 9 yr. Control of R. mendax in lowbush blueberry fields was achieved in 2 yr when the fields were isolated, and in 3 yr when there were adjacent lowbush blueberry fields.

Agriculture↗