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

Hemoglobin variability: impact on anemia management practices.

Data indicate that a wide range of factors can contribute to inter- and intrapatient variability in hemoglobin (Hb) levels in dialysis patients. Some of these factors are controllable and can be minimized by implementing nursing practices that encourage consistent and accurate Hb assessments and management. However, many of these factors are difficult or impossible to modify, and natural intrapatient variations are therefore expected and unavoidable. When natural variability leads to Hb levels that temporarily exceed 12 g/dL, appropriate protocol-guided nursing responses should include long-term, patient-specific laboratory trend analyses, data-driven adjustments in the anemia management prescription, and accurate nursing documentation of assessments, interventions, and outcomes.

Aged↗
PubMed2006

Safety and efficacy of blood glucose management practices at a diabetes camp.

AIM: Camps are an important part of diabetic management in children yet data on the safety and efficacy of camps are limited. We assessed the safety and efficacy of blood glucose management guidelines at summer camps for diabetic children. METHODS: Consistent management guidelines were implemented during 10 consecutive diabetes camps held in the same facility between 1998 and 2002. Using the entire sample of campers aged 9-13 years, we analysed insulin dosage alterations, the frequency of hypoglycaemia (<4 mmol/L), hyperglycaemia (>15 mmol/L) and ketosis and evaluated our overnight management guidelines. The effects of sex, year, age, insulin regimen and duration of diagnosis on hypoglycaemia frequency were determined. RESULTS: Mean insulin doses decreased 19.2% (95% confidence interval 16.9-21.6%) by the last day of camp (day 6) relative to the day prior to camp. Mean blood glucose levels were 11.4 mmol/L before breakfast and the main evening meal, 11.3 mmol/L before bed, 10.8 mmol/L at midnight and 9.4 mmol/L at 3 am. Of the 10 839 readings analysed, 984 (9.1%) were below 4 mmol/L (0.5 per camper/day) with no clinical grade 3 (seizure or coma) hypoglycaemia. Hypoglycaemia frequency was independent of sex, year, age, insulin regimen and duration of diagnosis (all P > 0.05). There were 2570 (23.7%) readings above 15 mmol/L (1.4 per camper/day) but only 42 (0.4%) were associated with significant ketosis. CONCLUSION: Children at diabetes camps experience considerable blood glucose variability; however, the careful application of monitoring and management guidelines can avoid serious adverse events.

Adolescent↗
PubMed2003

Practice management: billing for nurse practitioner services.

Utilization of Nurse Practitioners (NPs) in otolaryngology practices is increasing. Otolaryngologists now employ NPs to assist with patient care responsibilities in a variety of settings, from solo practice to large academic groups. This article addresses the appropriate third-party billing methods for NP services.

Accounting↗
PubMed2005

Disability management practices in Ontario workplaces: employees' perceptions.

PURPOSE: The purpose of this study was to obtain employees' perceptions about disability management (DM) at their workplaces. METHODS: Data were obtained from focus group interviews and individual telephone interviews with 58 employees who had sustained a work-related injury or disability in Ontario, Canada. Participants also completed a 22-item Organizational Policies and Practices (OPP) Questionnaire that asked questions about workplace DM practices. RESULTS: Respondents emphasized the need for job accommodation, the importance of open and clear communication and the necessity of job retraining. The provision of ergonomic modifications to their worksites and the development of meaningful and specific DM policies and procedures were seen as key to a comprehensive workplace DM program. Education about health and safety also was identified as an important component of creating a supportive workplace environment. The OPP questionnaire showed good internal consistency (Cronbach's alpha=0.95) and discriminant validity. CONCLUSION: This study demonstrates the importance of workplaces communicating with their employees and respecting their opinions when establishing and carrying out DM policies and practices. The OPP Questionnaire is useful in determining how DM is managed in the workplace.

Adult↗
PubMedDate not supplied

A multinational comparison of aphasia management practices.

The effect of restructuring of healthcare on the quality, quantity, and nature of aphasia management is largely unknown. The current study is the first to examine access, diagnostic, treatment, and discharge patterns of patients with aphasia in Australia, Canada, the UK, the US private sector (US-Private), and the US Veterans Health Administration in the Department of Veterans Affairs (US-VA). The authors developed a 37-item survey to be completed by clinicians working with aphasic patients. The survey focused on eight areas: access to care, evaluation procedures, group treatment, number and duration of treatment sessions, limitations of the number of sessions, termination of treatment, follow-up practices, and resumption of treatment. 394 surveys were distributed and 175 were returned completed (44% return rate). Respondents represented a range of ages, work experiences, and work settings. There was considerable consistency among respondents from our five healthcare systems. Results suggest that patients may be routinely denied treatment in direct contradiction to the research literature. Just as we carefully monitor the progress of patients receiving our treatment, we are obliged to monitor the effects of managed care on our patients, fellow clinicians, and our profession.

Americas↗
PubMed2006

Practical management of medication-overuse headache.

Epidemiological studies suggest that medication-overuse as defined by the International Headache Society is extremely common in patients with chronic daily headache. If all medication-overuse produces medication-overuse headache (MOH) in headache patients, it would be the third most frequent form of headache, after tension-type headache and migraine. Treatment of MOH is hindered by the absence of placebo-controlled, double-blind, randomised clinical trials. Nevertheless, several headache centers worldwide have developed expertise in the treatment of this syndrome, and have been quite successful. Here, we summarize available data on MOH, including clinical features, drugs used in withdrawal, as well as withdrawal strategies that have been described in the literature. We also include a detailed description of an in-patient and out-patient withdrawal procedure, reflecting personal experience and opinion of the authors.

Disease Management↗
PubMed2001

Best management practices for airport deicing stormwater.

With the advent of new regulations concerning aircraft deicing and management of spent aircraft deicing fluids (ADFs), many airports now face the dual challenges of simultaneously maintaining public safety and protecting the environment. This paper provides a theoretical assessment of the potential environmental impact of stormwater runoff and offers detailed current information on alternative deicing fluid application methods and materials, collection and treatment practices.

Aircraft↗
PubMed2003

Smoking intervention within alcohol and other drug treatment services: a selective review with suggestions for practical management.

This selective review was undertaken in order to highlight the need for alcohol and other drug treatment services to provide intervention for tobacco smoking to their clients. The reasons for the failure of treatment services to date to deal with nicotine addiction within their programmes are discussed and positive suggestions for change are proferred. In addition to the transformation of institutional culture which will be required, managers and staff of alcohol and other drug agencies need to know how best to implement smoking intervention within the treatment setting. The paper concludes with some practical suggestions for the management of intervention for tobacco smoking within treatment settings. These suggestions include: making decisions and formulating policies and procedures with regard to how tobacco smoking will be addressed; considering the particular physical, psychological and social/environmental factors that apply to substance abuse clients; building intervention around a simple structure such as the '5 A's'; encouraging and facilitating the use of nicotine replacement therapies; and allowing flexibility to tailor intervention to the individual. A great deal of further research is required to inform us as to how to intervene most effectively for tobacco smoking among this population group.

Alcoholism↗
PubMed1998

Minor head injury in children: current management practices of pediatricians, emergency physicians, and family physicians.

OBJECTIVE: To describe variation in the clinical management of minor head trauma in children among primary care and emergency physicians. DESIGN: A survey of pediatricians, family physicians, and emergency physicians drawn from a random sample of members of the American Academy of Pediatrics, the American Academy of Family Physicians, and the appropriate American Medical Association specialty listings, respectively. Physicians were given clinical vignettes describing children presenting with normal physical examination results after minor head trauma. Different clinical scenarios (brief loss of consciousness or seizures) were also presented. Information was gathered on initial and subsequent management steps most commonly used by the physician. RESULTS: Surveys were returned by 765 (51%) of 1500 physicians. Of these, 303 (40%) were pediatricians, 269 (35%) family practitioners, and 193 (25%) emergency physicians. For minor head trauma without complications, observation at home was the most common initial physician management choice (n = 547, 72%). Observation in office or hospital was chosen by 81 physicians (11%). Head computed tomographic (CT) scan was chosen by 7 physicians (1%) and skull x-ray by 24 physicians (3%) as the first management option. Most physicians (n = 445, 80%) who initially chose observation at home would obtain a CT scan if the patient showed clinical deterioration. In the original scenario, if the patient had also sustained a loss of consciousness, 383 physicians (58%) altered management. Of these, 120 (18%) chose CT, 13 (2%) chose skull x-ray, 1 (1%) chose magnetic resonance imaging, 141 (21%) chose inpatient observation, and 125 (19%) chose a combination of CT scanning and observation. With seizures, 595 (90%) altered management, with 176 physicians (27%) choosing CT scan, 5 (1%) skull x-ray, 60 (9%) inpatient observation, and 299 (45%) a combination of radiological evaluation and observation. CONCLUSIONS: Most physicians surveyed chose clinic or home observation for initial management of minor pediatric head trauma. Clinical management was more varied when patients had sustained either loss of consciousness or seizures. Further study of the appropriate management of minor head trauma in children is needed to guide physicians in their care.

Adolescent↗
PubMedDate not supplied

Assessment of management practices for colonic cancer in the Paris metropolitan area in 2002.

OBJECTIVE: To assess the management of patients aged 18 years or older with colonic adenocarcinoma (including the rectosigmoid junction), compared with French guidelines (ANAES and SOR). METHODS: This retrospective study carried out in 2003 by the Ile-de-France regional union of health insurance funds from hospital discharge and operative and pathology reports of patients exempted from copayment between April 2001 and March 2002. RESULTS: In all, 1 842 patients were included; mean age was 68.7 +/- 12.7 years and the M/F ratio was 1.09. 17.3% of patients were diagnosed after complications (obstruction, perforation); 25.1% had synchronous metastases, 79.7% with at least one liver metastasis. Serum CEA assay was performed in 50.0% of patients, in combination with CA 19-9 in 31.1% of patients. In 24.9%, less than 8 lymph nodes were analyzed. 37.7% of stage II patients had chemotherapy while 10.8% of stage III and 9.8% of stage IV patients did not. Age was a determining factor in the decision of chemotherapy (P<0.0001). CONCLUSION: Implementation of guidelines for the management of colon cancer can be improved, notably regarding pathologic analysis and indications of chemotherapy.

Adenocarcinoma↗
PubMed2005

Eczema--practical management issues.

BACKGROUND: Eczema is a common, and at times challenging, condition to manage. It often involves an irritable child, concerned parents and numerous return visits. A variety of mainstream and alternative treatments can confuse both the clinician and patient. OBJECTIVE: This article aims to refresh readers by reviewing evidenced based treatment protocols, and exploring some of the new and evolving treatments in eczema. DISCUSSION: Managing eczema is a multifocal task involving a variety of medicinal and practical approaches. Education of parents and carers is critical. Having a clear plan that can be adapted to each patient's needs is helpful for all involved, with management focussing on control rather than cure. Simple emollients and preventive measures are used to reduce heat, dryness and prickling of the skin. Topical corticosteroids remain the gold standard in the treatment of the inflammation of eczema. However, combining topical steroids with the new calcineurin inhibitors, wet dressings and behavioural modification should increase the time interval between exacerbations.

Administration, Topical↗
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↗