Practice management. Sweetening the pill.
Explore the source record for details and available documents.
Appointments and Schedules↗
SEARCH · Search PubMed
Results for “Practice 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.
Patient referral: implications for medical practice management.
Explore the source record for details and available documents.
Communication↗
Practice management. Reimbursement basics.
Explore the source record for details and available documents.
Insurance, Health, Reimbursement↗
Assessment of tuberculosis screening and management practices of large jail systems.
OBJECTIVE: This descriptive study sought to explore the use and timeliness of tuberculosis (TB) screening and management activities in jail facilities. METHODS: Study personnel visited 20 large U.S. jail systems and reviewed the medical records of 56 inmates who had recently been evaluated for TB disease and 376 inmates who were diagnosed with or confirmed to have latent TB infection (LTBI). Data from these records were analyzed to determine completion and timeliness of screening, diagnostic, and treatment activities. RESULTS: In 14% of 56 inmates evaluated for TB disease and 24% of 376 inmates with LTBI, chest radiographs were either not performed or not documented. Of 48 inmates evaluated for TB disease who were not receiving treatment when admitted to jail, 10 had no record of sputum collection being done. A mean delay of 3.1 days occurred from symptom report to respiratory isolation. Time from tuberculin skin test reading to chest radiograph reading was a mean of 5.3 days in inmates evaluated for TB disease and a mean of 7.0 days in inmates with LTBI. Follow-up was arranged for 91% of released inmates who were on treatment for TB disease and only 17% of released inmates who were on treatment for LTBI. CONCLUSIONS: Jail health information systems should be augmented to better document and monitor inmate health care related to TB. Completion rates and timeliness of TB screening, diagnostic, and treatment measures should be evaluated to identify areas needing improvement. Finally, mechanisms for continuity of care upon inmate release should be enhanced to promote therapy completion and prevent TB transmission in the community.
Forms and Records Control↗
Clinical nurse specialist and evidence-based practice: managing anthracycline extravasation.
The clinical nurse specialist (CNS) is a clinical expert and client advocate in a specialized area of nursing practice, who directs efforts toward the improvement of nursing care. The CNS role is essential in closing the therapeutic gap between the development of science knowledge and its implementation in daily patient care situations. An essential step in developing evidence-based interventions is rating the quality of the evidence. An example of the CNS's role in improving care can be found in a response to an anthracycline extravasation. The clinical standard for extravasation was amended to incorporate new evidence-based guidelines that included prevention of extravasation and a new assessment method and intervention. When an extravasation is suspected with an anthracycline agent, a Wood's lamp (ultraviolet lamp) is shined on the area of interest, in a dark room. The anthracycline extravasation area, if present, will illuminate in the lamp's light. In addition to the standard interventions of topical DMSO applications, current literature also suggests an intravenous infusion of dexrazoxane (Zinecard) as an effective antidote to prevent tissue damage.
Adolescent↗
A survey of pain assessment and management practices among critical care nurses.
BACKGROUND: Postoperative pain is one of the major obstacles in the prevention of complications during patient recovery. Pain and its management have gained great interest among researchers, clinicians and policy-makers. PURPOSES: To explore the relationship between two variables in pain assessment (length of time after surgery and ventilator status) and medication decisions made by critical care nurses, and to identify nurses' concerns about opioid use. METHODS: A convenience sample of 71 critical care nurses participated in the survey. RESULTS: Certain patient conditions such as length of time after surgery and ventilator status affected nurses' assessment and management of pain. Nurses' knowledge about pain assessment and management may affect patient care and outcomes.
Adult↗
Management practices among primary care physicians and thyroid specialists in the care of hypothyroid patients.
Prospective studies are not available to address various issues commonly encountered in the management of hypothyroid patients. We have conducted a case-based mail survey of American Thyroid Association (ATA) members and primary care providers (PCP) regarding hypothyroidism management issues. A majority of ATA members and a minority of PCPs used antithyroid antibody testing in the evaluation of hypothyroidism. Approximately 2/3 of all respondents indicated that they would treat patients with mild thyroid failure when antithyroid antibodies are negative; 77% of PCPs and 95% of ATA members recommended treatment when antibodies are positive. For a young patient with mild thyroid failure, 71% of ATA members would initiate a full levothyroxine (LT4) replacement dose of 1.6 microg/kg per day or slightly lower; PCPs were more likely to start with a low dose and titrate upwards. For a young patient with overt hypothyroidism, 42% of PCPs and 51% of ATA respondents recommended an initial full LT4 replacement dose. The majority of all respondents would start with a low LT4 dose and adjust the dose gradually in an elderly patient, regardless of the severity of thyroid hormone deficiency. More than 40% of ATA respondents chose a target thyrotropin (TSH) range of 0.5-2.0 microU/mL for a young patient while 39% favored a goal of 1.0-4.0 microU/mL for an elderly patient. PCPs more often chose a broader TSH goal of 0.5-5.0 microU/mL. In conclusion, the current practice patterns of PCPs and ATA members that were elicited in this survey differ significantly in regard to the evaluation and management of hypothyroidism.
Adult↗
Improving care with nurse case managers: practical aspects of designing lipid clinics.
Compliance with the National Cholesterol Education Program (NCEP II) Adult Treatment Panel II guidelines for lipid management in patients with coronary artery disease has not been widespread. Barriers to effective lipid management occur at numerous levels of interaction between the patient, provider, and healthcare organizations. Nurse care managers (NCMs), recognized in the inpatient and discharge planning settings, are emerging in new roles in the outpatient setting working in subspecialty areas including lipid/risk-reduction, heart failure, and anticoagulation clinics. To improve patient adherence to NCEP II goals, NCMs can help overcome treatment barriers by: (1) bridging inpatient/outpatient care; (2) securing long-term patient compliance and follow-up; (3) developing clinic policy and computerized patient databases; (4) implementing management algorithms; and (5) enhancing financial reimbursement from insurers. Additional graduate nursing programs and novel healthcare delivery models demonstrating the ability to overcome the barriers to improved patient care must be encouraged and supported.
Ambulatory Care↗
Ethical challenges in the managed practice of obstetrics and gynecology.
Obstetrics and gynecology has been transformed from a fee-for-service, unmanaged system to a prepaid managed system. This change poses significant ethical challenges, which we address. We show that obstetrician-gynecologists and medical institutions are moral co-fiduciaries of female and pregnant patients, that the obstetrician-gynecologist should be economically disciplined without capitulating to managed care, and that managed care organizations have an obligation to support the medical education and research from which they benefit.
Ethics, Medical↗
Guidelines for clinical practice. Management of colorectal polyps.
Explore the source record for details and available documents.
Colonic Polyps↗
Management practices in a normal monkey colony.
Explore the source record for details and available documents.
Animals↗
The SCAMP system for patient and practice management.
SCAMP is a comprehensive clinical information system for ambulatory care. Four design goals distinguish this system: ease of use, comprehensiveness, the incorporation of medical knowledge into system functions, and ease of modification of system capabilities by clinicians. Major subsystems are dedicated to billing, administrative reports, entry, retrieval and analysis of the medical record, clinical research, and provision of clinical reminders. Because clinicians differ in their needs and preferences, SCAMP has been designed to let clinicians modify aspects of the content, format, and processing of information available on the system. The SCAMP system has become increasingly accepted by many primary care physicians as a practical and useful tool for managing their information needs in ambulatory care.
Accounts Payable and Receivable↗
Effects of grazing management practices on parasite load and weight gain of beef cattle.
Stocking rate, method of grazing (rotational vs. continuous) and supplementation are three grazing management variables which strongly affect weight gain of beef cattle. However, reports on the interaction between these variables and parasitism in beef cattle are often conflicting or not conclusive. Although several studies have shown increased parasite loads with increased stocking rates, few studies have included animals treated and untreated with anthelmintics at several stocking rates. Those that did have this treatment combination did not show greater response in weight gain to treatment with anthelmintics at high stocking rates than at low stocking rates. Experiments designed to investigate the effect of rotational and continuous grazing on parasitism have provided variable results. However, as the high stock densities associated with rotational grazing will probably cause animals to graze closer to the ground and to dung pats, and to spread dung more with their hooves, it is not likely that rotational grazing will reduce the need for chemotherapy. Some studies have shown reduced parasite loads with supplementation of untreated animals, but none has apparently investigated whether weight gain response to treatment with anthelmintics is greater for non-supplemented animals than for supplemented animals. Published studies on the interaction between management factors and parasitism in grazing animals reveal many weaknesses. Elimination of these weaknesses and cognisance of recent trends in design and conduct of grazing experiments will substantially improve the quality and value of research in this field.
Animal Feed↗
Home intravenous antibiotic therapy. A practical management approach for the 1980s.
The development of antibiotics with extended duration of activity, combined with the social and economic changes in the practice of medicine in recent years, has resulted in use of home intravenous (IV) antibiotic therapy to treat a wide range of infections in selected patients. At Lovelace Medical Center, infections of the musculoskeletal system have accounted for two thirds of the cases for which such therapy is used. First-and third-generation cephalosporins have been used most often and at our institution are almost identical in terms of actual charges to the patient. Although several important medicolegal and ethical problems have yet to be resolved, home IV antibiotic therapy has been shown to be safe, effective, and capable of reducing medical costs to both patients and health care providers.
Ambulatory Care↗
The relative effect of self-management practices on glycaemic control in type 2 diabetic patients in Mexico.
OBJECTIVE: In this study, we examined the relative impact of self-management activities on glycaemic control in a population at high risk for developing complications. METHODS: Patients diagnosed with diabetes mellitus of at least 1 year in duration at 30 years of age or older were sampled from the Instituto de Mexico Seguro Social (IMSS) Family Medicine Clinics in Guadalajara, Mexico (n=800). Demographic, clinical and health behaviour variables were used to predict good/poor glycaemic control, as measured by haemoglobin Alc (A1C). RESULTS: Most (72.24%) patients had poor control (A1C > or = 7.0). Hyperglycaemia was significantly associated with factors not under patient control, such as having diabetes for a longer time [odds ratio (OR) = 2.40, 95% confidence interval (CI) 1.39, 4.14], having a first-degree relative with diabetes (OR= 1.52; 95% CI 1.06, 2.19), and being prescribed anti-diabetic medications, e.g. insulin (OR = 7.88, 95% CI 2.42, 25.63). After controlling for these variables, the only self-management variable that reduced the likelihood of hyperglycaemia was following a special diet (OR=0.49; 95% CI 0.32, 0.76). Furthermore, depression had an important effect on self-management, as those with lower levels of depressive symptoms were more likely to follow a diet and exercise. DISCUSSION: While patients in this population have little control over many factors associated with glycaemic control, an important exception is diet. However, because of the adverse effect of depression on dieting, both depression management and dietary education are important for this population.
Adult↗
Practical management of patients with non-small-cell lung cancer treated with gefitinib.
PURPOSE: The use of gefitinib, the first drug approved to inhibit the epidermal growth factor receptor tyrosine kinase, is indicated in patients with non-small-cell lung cancer with tumors progressive after chemotherapy. The unique mechanism of action of this agent leads to distinctive patterns of response and toxicity in persons with lung cancer. Many of the principles of management relevant to gefitinib are distinct from those with conventional cytotoxic drugs. To meet this need, we present practical guidelines on the use of gefitinib in patients with non-small-cell lung cancer. METHODS: This article reviews gefitinib's indications, dosing, response phenomena, and patterns of relapse in individuals with radiographic response. RESULTS: We present our recommendations for the management of rash and diarrhea caused by this agent. CONCLUSION: This information can guide practitioners and help them inform their patients about what to expect when they receive gefitinib.
Antineoplastic Agents↗
Pencil and paper: the simple solution to getting the numbers you need to effectively manage your practice.
Once you have mastered the basics by going through the monitoring exercise once or twice, you will find it takes little time and effort to start finding out just where your practice stands. You only solve a problem after you have found out that there is one and you might find that this simple monitoring exercise shows you areas of your practice where a little attention from you will pay big dividends. Monitoring is like a fine wine: it improves with age. As you begin to compile more and more months of data, you will be able to start comparing this month's performance with last month's, or this quarter with last quarter, this year with last year. One of the most useful things monitoring will do for you is to allow you to compare your practice's performance with that of other practices. Averages, norms, and performance survey results are to be found in a range of practice management publications. Using your monitoring information in this comparative way helps you to identify those areas in your practice management that are holding you back from achieving your true potential. This lets you focus your management time and effort on the truly important issues, which, when solved, will help you turn your practice into a less stressful, more enjoyable, and more profitable place to work.
Budgets↗
The seroprevalence of maedi-visna in Ontario sheep flocks and its relationship to flock demographics and management practices.
The objectives of this study were to describe the serological prevalence of maedi-visna in a sample of Ontario sheep flocks, and to identify management and demographic variables that were associated with seroprevalence for maedi-visna. A sample of 103 sheep flocks in Ontario was randomly selected from those flocks participating in the Red Meat Plan. The owners of these flocks were surveyed regarding management procedures on their farms, and blood samples were taken from a random sample of ewes in each flock. At least one ewe tested serologically positive, based on the agar gel immuno-diffusion test, in 69.9% of the farms. Positive serological reactions occurred in 20.9% of the 3880 sheep tested. Flock demographics and farm management variables were considered in a multiple regression model, and several factors were positively associated with higher maedi-visna seroprevalence rates. These included the average age of the flock, the number of years the owner had been sheep farming, the practice of using foster ewes, the practice of allowing lambs to have contact with other ewes that are lambing, and the average pasture acreage per ewe.
Animal Husbandry↗