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At least 991 records · Page 55Linked to original sources
PubMed1976

Symposium: management of tumors of the parotid gland. IV. Differential diagnosis and management of deep lobe parotid tumors.

The problem of the pathological anatomy, the diagnosis, differential diagnosis and management of tumors of the parapharyngeal space has been discussed. Preoperative biopsy is to be discouraged in all benign lesions of the area. External approach with good adequate exposure is most important. Surgery is the treatment of choice in the benign lesion, by far the most common tumor as reported in the literature. Any tumor or disease of the superficial parotid may also be found in the deep lobe.

Diagnosis, Differential↗
PubMed1979

Nutritional concepts in the management of the head and neck cancer patient. II. Management concepts.

Essential to the management of the head and neck cancer patient is carefully monitored nutritional support. Traditionally, enteral alimentation, using the nasogastric feeding tube, has been the mainstay of treatment. Tube feedings should provide ample amounts of essential nutrients, minerals, vitamins, and adequate calories and protein. Knowledge of the tube feedings available and problems associated with their administration helps to avoid the pitfalls which limit their effectiveness. The inadequacies of enteral alimentation preclude its use in selected circumstances of severe nutritional depletion. Parenteral hyperalimentation, as a primary or adjuvant mode of therapy, may be capable of rapidly reversing deficits, improving postoperative morbidity and increasing tolerance to radiation and chemotherapy. Postoperative deglutition abnormalities may prolong the nutritional problems of head and neck cancer patients as well.

Enteral Nutrition↗
PubMed2000

Clinical and economic impact of ambulatory care clinical pharmacists in management of dyslipidemia in older adults: the IMPROVE study. Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers.

We examined the impact of ambulatory care clinical pharmacist interventions on clinical and economic outcomes of 208 patients with dyslipidemia and 229 controls treated at nine Veterans Affairs medical centers. This was a randomized, controlled trial involving patients at high risk of drug-related problems. Only those with dyslipidemia are reported here. In addition to usual medical care, clinical pharmacists were responsible for providing pharmaceutical care for patients in the intervention group. The control group did not receive pharmaceutical care. Seventy-two percent of the intervention group and 70% of controls required secondary prevention according to the National Cholesterol Education Program guidelines. Significantly more patients in the intervention group had a fasting lipid profile compared with controls (p=0.021). The absolute change in total cholesterol (17.7 vs 7.4 mg/dl, p=0.028) and low-density lipoprotein (23.4 vs 12.8 mg/dl, p=0.042) was greater in the intervention than in the control group. There were no differences in patients achieving goal lipid values or in overall costs despite increased visits to pharmacists. Ambulatory care clinical pharmacists can significantly improve dyslipidemia in a practice setting designed to manage many medical and drug-related problems.

Aged↗
PubMed2006

Comparative study of integrated pest management and baiting for German cockroach management in public housing.

This study assessed the cost and effectiveness of a building-wide cockroach integrated pest management (IPM) program compared with bait alone treatment in public housing. In total, 12 buildings (66 apartments) were treated and monitored for cockroach infestations over 7 mo. The buildings were divided into two groups: bait treatment and IPM. Apartments in the bait alone group were treated with Maxforce FC Select (0.01% fipronil) during the first 12 wk and Maxforce Roach Killer Bait Gel (2.15% hydramethylnon) from 16 wk when necessary. For the IPM group, cockroaches were flushed and vacuumed at the beginning of the study; sticky traps were placed in all apartments to monitor and reduce cockroach numbers; educational materials were delivered to the residents; and Maxforce FC Select and Maxforce Roach Killer Bait Gel were applied to kill cockroaches. Two seminars were presented to the manger, and Community Service Program staff of the Gary Housing Authority to help gain tenant cooperation in the program. Effects of the treatments were monitored using sticky traps (six per apartment) at 2, 4, 8, 12, 16, and 29 wk after treatment. More treatments were applied during each monitoring visit when necessary. Those apartments with high levels of infestations (> or =12 cockroaches in six traps) before treatment were used to compare the IPM and bait only treatments. IPM resulted in significantly greater trap catch reduction than the bait treatment. The IPM (n=12) and bait only treatment (n=11) resulted in 100.0 and 94.6%, respectively, reduction in trap catch after 16 wk. At 29 wk, only one apartment in the IPM group had a high level (>12 cockroaches) of cockroach infestation. In contrast, five apartments in the bait treatment group had high level infestations at 29 wk based on overnight trapping counts; thus, IPM is a more sustainable method of population reduction. Sanitation levels in the IPM group significantly improved at 29 wk (n=11) compared with that at the beginning of the study. The sanitation levels in the bait treatment group remained similar throughout the experiment (n=9). The cumulative cost of IPM was significantly higher than that of the bait treatment. The median costs per apartment during 29 wk were 64.8 dollars and 35.0 dollars for the IPM and bait treatment, respectively. The median amount of bait used per apartment in the IPM and bait treatment was 45.0 and 50.0 g, respectively. The cost of the IPM group for the 29 wk service was similar to that of the bait treatment group. We expect that IPM will provide better control at similar cost compared with bait treatment beyond 29 wk.

Animals↗
PubMed1994

Upper-airway obstruction and perioperative management of the airway in patients managed with posterior operations on the cervical spine for rheumatoid arthritis.

We reviewed the records of 128 patients who had a total of 128 consecutive posterior operations on the cervical spine for problems related to rheumatoid arthritis. Our purpose was to examine perioperative complications related to the airway. The patients were divided into two groups for analysis on the basis of the technique of intubation that had been used. An upper-airway obstruction developed after extubation in eight (14 per cent) of the fifty-eight patients who had been intubated without fiberoptic assistance compared with one (1 per cent) of the seventy patients who had been intubated fiberoptically (p = 0.02). The two groups had similar characteristics with regard to age, sex, severity of the myelopathy, American Rheumatology Association classification, American Society of Anesthesiologists physical status classification, cigarette use, duration of the arthritis, use of preoperative traction, use of steroids (both preoperatively and intraoperatively), size of the endotracheal tube, duration of the operation, total duration of the anesthesia, intraoperative fluid balance, and type of immediate immobilization of the neck. The only significant difference between the groups was the time to extubation, which averaged 17.9 hours in the fiberoptic group and 10.6 hours in the non-fiberoptic group (p = 0.02). Logistic regression analysis showed that non-fiberoptic intubation was the significant risk factor, even when allowance was made for the difference in the lengths of time to extubation. We concluded that this life-threatening complication can be minimized with fiberoptic management of the airway.

Adult↗
PubMed1999

Current use and timing of spinal surgery for management of acute spinal surgery for management of acute spinal cord injury in North America: results of a retrospective multicenter study.

OBJECT: A multicenter retrospective study was performed in 36 North American centers to examine the use and timing of surgery in patients who have sustained acute spinal cord injury (SCI). The study was performed to obtain information required for the planning of a randomized controlled trial in which early and late decompressive surgery are compared. METHODS: The records of all patients aged 16 to 75 years with acute SCI admitted to 36 centers within 24 hours of injury over a 9-month period in 1994 and 1995 were examined to obtain data on admission variables, methods of diagnosis, use of traction, and surgical variables including type and timing of surgery. A total of 585 patients with acute SCI or cauda equina injury were admitted to participating centers, although approximately half were ultimately excluded because they did not meet inclusion criteria. Common causes for exclusion were late admission, age, gunshot wound, and absence of signs of compression on imaging studies. Thus, only approximately 50% of patients with acute SCI would be eligible for inclusion in a study of acute decompressive surgery. Although all patients underwent computerized tomography (CT) scanning, only 54% underwent magnetic resonance imaging, and CT myelography was performed in only 6%. Complete neurological injuries (American Spinal Injury Association Grade A) were present in 57.8%. Traction was applied in only 47% of patients who sustained cervical injury, in whom decompressive traction was successful in only 42% of cases. Neurological deterioration occurred in 8.1% of cases after traction. Surgery was performed in 65.4% of patients. The timing of surgery varied widely: less than 24 hours postinjury in 23.5%, between 25 and 48 hours postinjury in 15.8%, between 48 and 96 hours in 19%, and more than 5 days postinjury in 41.7% of patients. CONCLUSIONS: These data indicate that although surgery is commonly performed in patients with acute SCI, one third of cases are managed nonoperatively, and there is very little agreement on the optimum timing of surgical treatment. The results of this study confirm the need for a randomized controlled trial to assess the optimum timing of decompressive surgery in SCI.

Acute Disease↗
PubMed2002

Effective management of hepatitis C molecular testing improves test use without compromising patient management.

CONTEXT: The availability of effective antiviral therapy for hepatitis C has increased the need for molecular detection and quantification of circulating hepatitis C viral particles. The limits of detection differ for the quantitative and qualitative reverse transcriptase polymerase chain reaction (RT-PCR) assays; furthermore, adequate patient assessment requires both detection of hepatitis C virus when it is present and quantitation of the viral load when possible. The combination of these factors promotes the simultaneous ordering of both tests with the possibility of generating redundant test information. OBJECTIVE: To reduce the number of unnecessary hepatitis C tests performed. METHODS: We established a reflexive testing protocol for quantitative and qualitative RT-PCR testing for hepatitis C. RESULTS: During a 3(1/2)-month interval, 170 qualitative RT-PCR hepatitis C tests were eliminated (a 59.4% reduction in the number of these tests). This reduction was achieved without a clinically significant change in turnaround time or a compromise of patient care. CONCLUSIONS: Establishing the quantitative and qualitative RT-PCR tests in-house and adopting the reflexive testing protocol was cost-effective and did not compromise patient management or care.

Hepacivirus↗
PubMed1999

The Childhood Asthma Management Program (CAMP): design, rationale, and methods. Childhood Asthma Management Program Research Group.

The Childhood Asthma Management Program (CAMP) is a multicenter, randomized, double-masked clinical trial designed to determine the long-term effects of three inhaled treatments for mild to moderate childhood asthma: budesonide (a glucocorticoid used daily) and albuterol (a short-acting beta-agonist bronchodilator used as needed); nedocromil (a nonsteroid anti-inflammatory agent used daily) and albuterol; and placebo and albuterol. One thousand forty-one children (32% from ethnic minority groups), aged 5 to 12 years at screening, are currently participating. The primary outcome measure is lung growth as indicated by postbronchodilator forced expiratory volume in 1 second (FEV1) percent of predicted, observed over 5- to 6-year period. The trial also assesses differences between treatment groups with respect to airway responsiveness, morbidity, physical growth and development, and psychological growth and development. This report describes the design of the trial, the rationale for the design choices made, and the methods used to carry out the trial.

Albuterol↗
PubMedDate not supplied

Management ... working day of a health services manager.

A varied day for one of the NHS's first marketing managers is in store for Christine Miles, Middlesex Hospital. A key message to get across is that marketing is not just promotion or selling: it is matching the strengths of the organisation to the unmet needs of 'customers'.

Appointments and Schedules↗
PubMed1993

Management ... working day of a health services manager.

Bob Nicholls, General Manager of Oxford RHA, shed some light on an RGM's typical day. It's not the orderly, leisurely affair some might imagine but one spent in and out of meetings and briefings and culminating in the regional review

Administrative Personnel↗
PubMed1993

Management ... working day of a health services manager.

The private sector is not immune from financial pressures; some of the effects of these directly affect staff. As manager of a small independent hospital, John Audsley, Director, Benenden Hospital, finds that his proximity to staff--and patients--is always a factor in decision making.

Chief Executive Officers, Hospital↗
PubMed1993

Management ... working day of a health services manager.

As an executive director of King's Healthcare, Heather-Jane Sears combines her responsibilities for the professional leadership of nursing and midwifery and quality improvement with general management. A typical day will combine all three elements, but always there is the need to provide a top-class service to patients - and to spot opportunities to expand the business.

Job Description↗
PubMed1994

American Health Information Management Association. Position statement. Issue: managing health information in facility mergers and acquisitions.

Healthcare facility mergers and acquisitions are becoming more common as the industry consolidates. Many critical issues must be considered in mergers and acquisitions, including the management of patient health information. In addition to operational issues, licensure, regulatory, and accreditation requirements must be addressed. To ensure availability of health information to all legitimate users, patient records should be consolidated or linked in the master patient index. A record retention policy should be developed and implemented to meet user needs and assure compliance with legal, regulatory, and accreditation requirements. If health information from closed facilities will be stored for a period of time, its integrity and confidentiality must be preserved, and it must be readily accessible for patient care. The compatibility and functionality of existing information systems should be assessed, and a plan should be formulated for integration of the systems to the extent possible. Such integration may be essential for the organization to successfully meet the demands of integrated delivery systems. Existing databases should be maintained in an accessible form to meet anticipated future needs.

Health Facility Merger↗
PubMed1994

Health management guide. Managing mergers.

Structural change is everywhere in the health service. Driven by political imperatives, the logic of the market and the frenetic pace of development in medical technology, the impetus on both purchasers and providers is towards merger into fewer, more influential organisations. But as health authorities combine to increase their purchasing power, moving ever closer to family health services authorities, and as trusts rethink patterns of service provision to maintain a competitive edge, are they getting it right? This Health Management Guide surveys the changing health service landscape and puts forward a practical manifesto for successful mergers.

Guidelines as Topic↗
PubMed1996

Can managed care save Medicare? Achieving high quality and low costs through managed care.

The article tackles the broad questions that currently engage policy makers grappling with Medicare managed care: quality, satisfaction, selection bias, disenrollment trends, cost savings, and the full savings potential of HMOs. HMOs have been shown to perform well in both the private sector and the Medicare Risk program on all of these dimensions, although the Risk program's flawed payment methodology limits the overall cost savings to Medicare.

Capitation Fee↗
PubMedDate not supplied

Point-of-care testing: managing people and technology. A win-win approach to successful point-of-care test management.

The objective of this article is to provide a step-by-step approach to evaluating the need for a point-of-care testing program. It also describes a process for writing a proposal for the implementation of the program, getting the program accepted by all stake-holder groups, and managing it after it has been established. More importantly, the actions described will help assure that the program design: 1. fits the information needs of the patient care area where it will be implemented 2. meshes with the resources available in the organization 3. takes advantage of the state-of-the-art in laboratory technology.

Feasibility Studies↗
PubMed1998

Syndromic management of sexually transmitted diseases. Part 4--The management of lower abdominal pain in women.

The symptom of lower abdominal pain in women is extremely common and does not always indicate the presence of serious illness. However, women with certain serious conditions such as pelvic inflammatory disease (PID), acute appendicitis, ectopic pregnancy and other complications of pregnancy may present initially with this symptom. Therefore, in managing women with lower abdominal pain care should be taken to exclude any serious condition before dismissing the patient. PID is a condition in which there is infection of the reproductive tract of women above the internal os of the cervix. This usually occurs as a result of an ascending cervical infection caused by Neisseria gonorrhoeae, Chlamydia trachomatis and anaerobic bacteria. The immediate and long term effects of PID include salpingitis, pelvic abscess, peritonitis, infertility and predisposition to tubal ectopic pregnancy. Women with lower abdominal pain should be assessed carefully and if PID is the cause they should be treated for gonococcal, chlamydial and anaerobic bacterial infection. Other gynaecological and surgical causes of lower abdominal pain and the immediate complications of PID require urgent referral to a specialist. PID is associated with significant morbidity and mortality.

Abdominal Pain↗