Sample records for aggressive medical management

  1. Medical Management (United States)

    ... email share facebook twitter google plus linkedin Medical Management Although there’s no cure for CMT, there are ... individualized physical therapy program. For more on medical management of CMT, see Surgery Sometimes, Bracing Often, Caution ...

  2. Orthodontic Management in Aggressive Periodontitis (United States)

    Bhattarai, Bhagabat


    Aggressive periodontitis is a type of periodontitis with early onset and rapid progression and mostly affecting young adults who occupy a large percentage of orthodontic patients. The role of the orthodontist is important in screening the disease, making a provisional diagnosis, and referring it to a periodontist for immediate treatment. The orthodontist should be aware of the disease not only before starting the appliance therapy, but also during and after the active mechanotherapy. The orthodontic treatment plan, biomechanics, and appliance system may need to be modified to deal with the teeth having reduced periodontal support. With proper force application and oral hygiene maintenance, orthodontic tooth movement is possible without any deleterious effect in the tooth with reduced bone support. With proper motivation and interdisciplinary approach, orthodontic treatment is possible in patients with controlled aggressive periodontitis. PMID:28299350

  3. Antibiotics in the management of aggressive periodontitis

    Directory of Open Access Journals (Sweden)

    Abinaya Prakasam


    Full Text Available Aggressive periodontitis, although not rare, is a fairly unknown condition. Little is known about its optimal management. While majority of patients with common forms of periodontal disease respond predictably well to conventional therapy (oral hygiene instructions (OHI, non-surgical debridement, surgery, and Supportive Periodontal therapy (SPT, patients diagnosed with aggressive form of periodontal disease often do not respond predictably/favorably to conventional therapy owing to its complex multi-factorial etiology. Protocols for treating aggressive periodontitis are largely empirical. There is compelling evidence that adjunctive antibiotic treatment frequently results in more favorable clinical response than conventional therapy alone. This article mainly focuses on the role of adjunct use of pharmacological agents in improving the prognosis and treatment outcome of aggressive periodontitis patients.


    Directory of Open Access Journals (Sweden)



    Full Text Available The offer of medical services depends on medical personnel and more than this, on the management in the medical field since any resource not managed well or not managed at all is only a lost one, regardless its value. Management is therefore the key, the

  5. Polymyositis: Medical Management (United States)

    ... email share facebook twitter google plus linkedin Medical Management Polymyositis (PM) is a highly treatable disease. Some ... PM) Signs and Symptoms Diagnosis Causes/Inheritance Medical Management Research Find your MDA Care Center Current Clinical ...

  6. Aggressiveness


    Stepišnik, Urška


    There are a lot of aspects of aggressiveness and everybody understands and defines it differently. Professionals define aggressiveness as actually inflicting damage to other organism or object6, the reaction which aims in damaging living organism or object. The objectives of aggressive behaviour are physical and mental damage. The difference between aggressiveness and aggression is that the term aggression relates to a momentary reaction, aggressiveness, however, means permanent characteristi...

  7. Medical equipment management

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    Willson, Keith; Tabakov, Slavik


    Know What to Expect When Managing Medical Equipment and Healthcare Technology in Your Organization As medical technology in clinical care becomes more complex, clinical professionals and support staff must know how to keep patients safe and equipment working in the clinical environment. Accessible to all healthcare professionals and managers, Medical Equipment Management presents an integrated approach to managing medical equipment in healthcare organizations. The book explains the underlying principles and requirements and raises awareness of what needs to be done and what questions to ask. I

  8. A multimedia program helps parents manage childhood aggression. (United States)

    Scholer, Seth J; Cherry, Rebecca; Garrard, Henry G; Gupta, Anita O; Mace, Rachel; Greeley, Nicci


    Participants were 65 parents of 6- to 18-month-old children presenting for a well child checkup between September 2002 and February 2003 to one of two private pediatric offices. The intervention was a 30-minute multimedia program, Play Nicely, viewed at home, which teaches the basics in childhood aggression management. One year after intervention, parents were asked, "Do you feel that the CD program was helpful in managing aggressive behavior in your child?" Most (65%) parents who watched the program agreed that it helped them manage aggression with their own child (strongly agree, 31%; agree, 34%; uncertain, 28%; disagree, 7%; and strongly disagree, 0%). An inexpensive, brief, independently viewed, multimedia program helps parents manage aggression in their young children as long as 1 year after receiving it from their pediatrician. An easily implemented intervention may contribute to violence prevention efforts.

  9. Management Strategies for Aggressive Cushing's Syndrome: From Macroadenomas to Ectopics

    Directory of Open Access Journals (Sweden)

    Carlotta Pozza


    Full Text Available Cushing’s syndrome (CS is a rare but severe clinical condition represented by an excessive endogenous cortisol secretion and hence excess circulating free cortisol, characterized by loss of the normal feedback regulation and circadian rhythm of the hypothalamic-pituitary axis due to inappropriate secretion of ACTH from a pituitary tumor (Cushing’s disease, CD or an ectopic source (ectopic ACTH secretion, EAS. The remaining causes (20% are ACTH independent. As soon as the diagnosis is established, the therapeutic goal is the removal of the tumor. Whenever surgery is not curative, management of patients with CS requires a major effort to control hypercortisolemia and associated symptoms. A multidisciplinary approach that includes endocrinologists, neurosurgeons, oncologists, and radiotherapists should be adopted. This paper will focus on traditional and novel medical therapy for aggressive ACTH-dependent CS. Several drugs are able to reduce cortisol levels. Their mechanism of action involves blocking adrenal steroidogenesis (ketoconazole, metyrapone, aminoglutethimide, mitotane, etomidate or inhibiting the peripheral action of cortisol through blocking its receptors (mifepristone “RU-486”. Other drugs include centrally acting agents (dopamine agonists, somatostatin receptor agonists, retinoic acid, peroxisome proliferator-activated receptor γ “PPAR-γ” ligands and novel chemotherapeutic agents (temozolomide and tyrosine kinase inhibitors which have a significant activity against aggressive pituitary or ectopic tumors.

  10. Medical pedagogical resources management. (United States)

    Pouliquen, Bruno; Le Duff, Franck; Delamarre, Denis; Cuggia, Marc; Mougin, Fleur; Le Beux, Pierre


    The main objective of this work is to help the management of training resources for students using a pedagogical network available at the Medical School of Rennes. With the increase of the number of connections and the number of medical documents available on this network, the management of new contents requires a lot of efforts for the webmaster. In order to improve the management of the resources, we implemented an automatic web engine for teachers, able to manage the links for the most interesting resources for their practice.

  11. Medical waste management plan.

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    Lane, Todd W.; VanderNoot, Victoria A.


    This plan describes the process for managing research generated medical waste at Sandia National Laboratories/California. It applies to operations at the Chemical and Radiation Detection Laboratory (CRDL), Building 968, and other biosafety level 1 or 2 activities at the site. It addresses the accumulation, storage, treatment and disposal of medical waste and sharps waste. It also describes the procedures to comply with regulatory requirements and SNL policies applicable to medical waste.

  12. Successful surgical drainage and aggressive medical therapy in a preterm neonate with Bacillus cereus meningitis. (United States)

    Drazin, Doniel; Lehman, Deborah; Danielpour, Moise


    Bacillus cereus meningitis is a rare disease with a very high mortality rate in neonates. The authors present the rare case of a premature infant with B. cereus bacteremia and subsequent intracranial abscesses. In addition to aggressive medical therapy, surgical drainage was performed via a left frontal mini-craniotomy. At 15 months of age, the patient had mild developmental delay, cortical blindness, and sensorineural hearing loss. The clinical case is described and difficulties in the management of B. cereus meningoencephalitis in infants are discussed.

  13. Collaborative management of a young patient with generalized aggressive periodontitis. (United States)

    Sivakumar, Arunachalam; Raju, M A K V; Sunny, James; Cyriac, Rajesh; Bhat, Subraya; Mohandas, Ashil A; Divya, Beemavarapu


    What are the orthodontic treatment possibilities, limitations and risks inherent in patients with periodontal disorders, particularly active periodontal disease? This case report describes the interface between orthodontics, periodontics and restorative dentistry in the management of a 25-year-old young man with generalized aggressive periodontitis.

  14. Managing High Blood Pressure Medications (United States)

    ... can make to work with your medication. Medicine Management Tools For Patients Keeping Track / Developing a System ... while you're out. Some pharmacists will prepare blister packs for daily or weekly medications. Ask your ...

  15. [Discussion on logistics management of medical consumables]. (United States)

    Deng, Sutong; Wang, Miao; Jiang, Xiali


    Management of medical consumables is an important part of modern hospital management. In modern medical behavior, drugs and medical devices act directly on the patient, and are important factors affecting the quality of medical practice. With the increasing use of medical materials, based on practical application, this article proposes the management model of medical consumables, and discusses the essence of medical materials logistics management.

  16. Medical management of obesity. (United States)

    Klein, S


    Obesity has become a major health problem in many countries because of its high prevalence and causal relationship with serious medical complications. Many of the medical complications associated with obesity improve with intentional weight in a dose-dependent fashion, and even a modest weight loss of 50% of initial weight has beneficial effects. This article reviews the nonsurgical approaches for achieving weight loss in obese persons.

  17. Managing Costs and Medical Information (United States)

    People with cancer may face major financial challenges and need help dealing with the high costs of care. Cancer treatment can be very expensive, even when you have insurance. Learn ways to manage medical information, paperwork, bills, and other records.

  18. Medical Information Management System (United States)

    Alterescu, S.; Hipkins, K. R.; Friedman, C. A.


    On-line interactive information processing system easily and rapidly handles all aspects of data management related to patient care. General purpose system is flexible enough to be applied to other data management situations found in areas such as occupational safety data, judicial information, or personnel records.

  19. Medical-Information-Management System (United States)

    Alterescu, Sidney; Friedman, Carl A.; Frankowski, James W.


    Medical Information Management System (MIMS) computer program interactive, general-purpose software system for storage and retrieval of information. Offers immediate assistance where manipulation of large data bases required. User quickly and efficiently extracts, displays, and analyzes data. Used in management of medical data and handling all aspects of data related to care of patients. Other applications include management of data on occupational safety in public and private sectors, handling judicial information, systemizing purchasing and procurement systems, and analyses of cost structures of organizations. Written in Microsoft FORTRAN 77.

  20. Medical management of pyometra in three red wolves (Canis rufus). (United States)

    Anderson, Kadie; Wolf, Karen N


    Pyometra is a serious, life-threatening disease of both domestic and non-domestic species often requiring ovariohysterectomy to preserve the life of the animal. Medical management of pyometra has been successful in domestic and non-domestic species, and the consideration of such treatment is of marked importance in a critically endangered species. Of the canids, the red wolf (Canis rufus) is second only to African hunting dogs (Lycaon pictus) in terms of the prevalence of both cystic endometrial hyperplasia and pyometra. In this report, three red wolves were medically managed for pyometra. Aside from vaginal discharge, none of the wolves exhibited clinical signs, nor were there reflective inflammatory changes in the laboratory findings. All wolves received standard treatment for pyometra, including prostaglandin F2alpha and antibiotic therapy, while one wolf was more aggressively managed with uterine lavage. Pyometra recurred in two of the treated wolves, while the most aggressively managed wolf continues to show ultrasonographic resolution 2 yr posttreatment. Aggressive medical management of pyometra should be considered a treatment option in certain red wolf females, as it may preserve the animal's reproductive potential.

  1. Providing Basic Needs and Encouragement as Strategies in Managing Aggression in Dementia Clients

    Directory of Open Access Journals (Sweden)

    Retno Lestari


    Full Text Available Purpose: The experiences of caregivers in managing dementia clients with aggressive behaviour have been an issue in nursing homes. This study utilized the fact that there is no significant strategy for managing aggression effectively. The aim of the study is to explore the experiences of caregivers in managing dementia clients with aggressive behaviour in nursing home in Jakarta, Indonesia.Method: This study employed a hermeneutic phenomenological approach so that caregivers were able to explore the phenomenon of aggression by dementia residents in the nursing home. Six experienced caregivers were interviewed in this study to uncover caregivers’ strategies they use in managing aggression in dementia residents.Result: The findings in this study were several strategies that have been used by caregivers to manage aggressive behaviour among dementia residents in the nursing home: providing basic needs and encouragement.Conclusion: The findings suggested caregivers to implement the strategies for managing aggression in dementia residents. Due to a limited number of related studies in Indonesia, this study recommended for further research to other nursing homes in Indonesia to determine if other strategies to manage aggression exist.

  2. Medication management in the making

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    Andersen, Tariq Osman


    this by the case of how the concept of 'medication management' has been performed differently on a combined CSCW and participatory design project in healthcare. It is suggested that through design interventions with working prototypes; prospective analysis and participatory design can be fruitfully assembled...

  3. Mindfulness-based program for management of aggression among youth: A follow-up study

    Directory of Open Access Journals (Sweden)

    Manoj Kumar Sharma


    Full Text Available Background: Youth have shown indulgence in various high-risk behaviors and violent activities. Yoga-based approaches have been used for the management of psychological problems. The present work explores the role of mindfulness-based program in the management of aggression among youth. Materials and Methods: Sociodemographic information schedule, Buss-Perry Aggression Questionnaire, and World Health Organization quality of life were administered on 50 subjects in the age range of 18-25 years at pre- and post-mindfulness-based program level. Results: It revealed the presence of feeling of well-being and ability to relax themselves; changes in score of anger, hostility, physical, and verbal aggression; and enhancement of quality of life in the physical and environment domains at 1 month follow-up. Conclusions: Mindfulness-based program has shown changes in aggression expression/control and implies integration of it in available program for the management of aggression among youth.

  4. Accounting for Medication Particularities: Designing for Everyday Medication Management

    DEFF Research Database (Denmark)

    Dalgaard, Lea Gulstav; Grönvall, Erik; Verdezoto, Nervo


    Several projects have shown that self-management of medication in private homes can be challenging. Many projects focused on specific illness-related approaches (e.g. diabetes) or practical issues such as how to handle medication while travelling. However, designing for everyday medication...... management involves more than just specific illness-related strategies and should take into account the broad set of activities conforming people’s everyday life. This study investigates how older adults manage their medication in everyday life. To inform the design of pervasive healthcare medication...... management systems (PHMMS), the study calls for attention to medication-specific particularities that account for: according to need medication, the heterogeneous care network, the substitute medication, the medication informational order, the shared responsibility and the adjustment of medication intake...

  5. Effectiveness of an Afterschool-Based Aggression Management Program for Elementary Students (United States)

    Staecker, Emma; Puett, Eli; Afrassiab, Shayda; Ketcherside, Miranda; Azim, Sabiya; Rhodes, Darson; Wang, Anna


    A school-community partnership team implemented an aggression management curriculum in an afterschool program as an early-intervention strategy at the upper elementary level. Although statistically significant differences in physical or psychological aggression were not found, the partnership team gained a better understanding of evidence-based…

  6. Concordance in cancer medication management. (United States)

    Chewning, Betty; Wiederholt, Joseph B


    This article explores how the concept of concordance can help to identify gaps and opportunities for research on consumer-provider communication related to cancer medication management. The relationship of concordance, patient-centered care and shared decision making is examined. Research on unmet patient agendas, quality of life issues related to symptom management and tools to assist communication about patient somatic experience are discussed. The need for research on patient communication with pharmacists, nurses and other health team members beyond physicians is noted. Research implications for longitudinal, descriptive and intervention studies are offered.

  7. Carotid Disease Management: Surgery, Stenting, or Medication. (United States)

    Khandelwal, Priyank; Chaturvedi, Seemant


    Internal carotid artery stenosis accounts for about 7-10 % of ischemic strokes. Conventional risk factors such as aging, hypertension, diabetes mellitus, and smoking increase the risk for carotid atherosclerosis. All patients with carotid stenosis should receive aggressive medical therapy. Carotid revascularization with either endarterectomy or stenting can benefit select patients with severe stenosis. New clinical trials will examine the contemporary role of carotid revascularization relative to optimal medical therapy.

  8. Medical knowledge discovery and management. (United States)

    Prior, Fred


    Although the volume of medical information is growing rapidly, the ability to rapidly convert this data into "actionable insights" and new medical knowledge is lagging far behind. The first step in the knowledge discovery process is data management and integration, which logically can be accomplished through the application of data warehouse technologies. A key insight that arises from efforts in biosurveillance and the global scope of military medicine is that information must be integrated over both time (longitudinal health records) and space (spatial localization of health-related events). Once data are compiled and integrated it is essential to encode the semantics and relationships among data elements through the use of ontologies and semantic web technologies to convert data into knowledge. Medical images form a special class of health-related information. Traditionally knowledge has been extracted from images by human observation and encoded via controlled terminologies. This approach is rapidly being replaced by quantitative analyses that more reliably support knowledge extraction. The goals of knowledge discovery are the improvement of both the timeliness and accuracy of medical decision making and the identification of new procedures and therapies.


    Frankowski, J. W.


    MIMS, Medical Information Management System is an interactive, general purpose information storage and retrieval system. It was first designed to be used in medical data management, and can be used to handle all aspects of data related to patient care. Other areas of application for MIMS include: managing occupational safety data in the public and private sectors; handling judicial information where speed and accuracy are high priorities; systemizing purchasing and procurement systems; and analyzing organizational cost structures. Because of its free format design, MIMS can offer immediate assistance where manipulation of large data bases is required. File structures, data categories, field lengths and formats, including alphabetic and/or numeric, are all user defined. The user can quickly and efficiently extract, display, and analyze the data. Three means of extracting data are provided: certain short items of information, such as social security numbers, can be used to uniquely identify each record for quick access; records can be selected which match conditions defined by the user; and specific categories of data can be selected. Data may be displayed and analyzed in several ways which include: generating tabular information assembled from comparison of all the records on the system; generating statistical information on numeric data such as means, standard deviations and standard errors; and displaying formatted listings of output data. The MIMS program is written in Microsoft FORTRAN-77. It was designed to operate on IBM Personal Computers and compatibles running under PC or MS DOS 2.00 or higher. MIMS was developed in 1987.

  10. Medical management of contact dermatitis. (United States)

    Alexandroff, A B; Johnston, G A


    Allergic and irritant contact dermatitis are important dermatological problems. Although the frequencies of positive reactions to a number of allergens have decreased during last 30 years because of better avoidance (and at least in part due to improved legislation), contact allergy to other agents is rising. The medical treatment starts from a correct identification of triggers of contact dermatitis which could allow patients to reduce or avoid exposure to these agents in future. A good clinical history, examination and immunological tests including patch testing are of crucial importance at this stage. Further management includes emollients, topical and oral corticosteroids, topical calcineurin inhibitors, azathioprine and ciclosporin. Methotrexate and alitretinoin are recent additions to the armamentarium of dermatologists who manage contact dermatitis.

  11. Disease management and medication compliance. (United States)

    Cohen, Joshua; Christensen, Kathyrn; Feldman, Lanna


    Lack of medication compliance is harmful to health care systems from both a clinical and economic perspective. This study examines the methods that disease management organizations employ to identify nonadherent patients and to measure effectiveness of compliance programs for patients with diabetes, hyperlipidemia, and cystic fibrosis. In addition, this study investigates the degree to which disease managers assume risk in their contracts, and whether compliance strategies are being coordinated with payers' use of value-based insurance design, in which patient cost sharing is a function of the relative value of pharmaceuticals. This study's findings suggest that disease management may be falling short in terms of: (a) comprehensive commitment to expert-recommended at-home devices used to self-diagnose and measure health indicators; (b) early adoption of expert-recommended new technologies to measure and improve compliance; (c) intensity of use of standard tests in outpatient clinics; (d) coordination of compliance strategies with payers' use of value-based insurance design; and (e) the proportion of risk assumed in disease management contracts.

  12. Medical management of venous ulcers. (United States)

    Pascarella, Luigi; Shortell, Cynthia K


    Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration.

  13. Accounting for Medication Particularities: Designing for Everyday Medication Management


    Dalgaard, Lea Gulstav; Grönvall, Erik; Verdezoto, Nervo


    Several projects have shown that self-management of medication in private homes can be challenging. Many projects focused on specific illness-related approaches (e.g. diabetes) or practical issues such as how to handle medication while travelling. However, designing for everyday medication management involves more than just specific illness-related strategies and should take into account the broad set of activities conforming people’s everyday life. This study investigates how older adults ma...

  14. Aggression in Tephritidae Flies: Where, When, Why? Future Directions for Research in Integrated Pest Management. (United States)

    Benelli, Giovanni


    True fruit flies (Diptera: Tephritidae) include over 4000 species, many of which constitute enormous threats to fruit and vegetable production worldwide. A number of Tephritidae are lekking species, forming aggregations in which males fight to defend a small territory where they court females and mate. Male-male contests also occur in non-lekking species, characterized by resource defense polygyny. Tephritidae females display agonistic behavior to maintain single oviposition sites and reduce larval competition for food. Here, how, where, when and why aggressive interactions occur in Tephritidae flies is reviewed. A number of neglected issues deserving further research are highlighted, with a special focus on diel periodicity of aggression, cues evoking aggressive behavior, the role of previous experience on fighting success and the evolution of behavioral lateralization of aggressive displays. In the final section, future directions to exploit this knowledge in Integrated Pest Management, with particular emphasis on enhancement of Sterile Insect Technique and interspecific competitive displacement in the field are suggested.

  15. Aggression on inpatient units: Clinical characteristics and consequences. (United States)

    Renwick, Laoise; Stewart, Duncan; Richardson, Michelle; Lavelle, Mary; James, Karen; Hardy, Claire; Price, Owen; Bowers, Len


    Aggression and violence are widespread in UK Mental Health Trusts, and are accompanied by negative psychological and physiological consequences for both staff and other patients. Patients who are younger, male, and have a history of substance use and psychosis diagnoses are more likely to display aggression; however, patient factors are not solely responsible for violence, and there are complex circumstances that lead to aggression. Indeed, patient-staff interactions lead to a sizeable portion of aggression and violence on inpatient units, thus they cannot be viewed without considering other forms of conflict and containment that occur before, during, and after the aggressive incident. For this reason, we examined sequences of aggressive incidents in conjunction with other conflict and containment methods used to explore whether there were particular profiles to aggressive incidents. In the present study, 522 adult psychiatric inpatients from 84 acute wards were recruited, and there were 1422 incidents of aggression (verbal, physical against objects, and physical). Cluster analysis revealed that aggressive incident sequences could be classified into four separate groups: solo aggression, aggression-rule breaking, aggression-medication, and aggression-containment. Contrary to our expectations, we did not find physical aggression dominant in the aggression-containment cluster, and while verbal aggression occurred primarily in solo aggression, physical aggression also occurred here. This indicates that the management of aggression is variable, and although some patient factors are linked with different clusters, these do not entirely explain the variation.

  16. Should I fight or should I flight? How studying insect aggression can help integrated pest management. (United States)

    Benelli, Giovanni


    Aggression plays a key role all across the animal kingdom, as it allows the acquisition and/or defence of limited resources (food, mates and territories) in a huge number of species. A large part of our knowledge on aggressive behaviour has been developed on insects of economic importance. How can this knowledge be exploited to enhance integrated pest management? Here, I highlight how knowledge on intraspecific aggression can help IPM both in terms of insect pests (with a focus on the enhancement of the sterile insect technique) and in terms of biological control agents (with a focus on mass-rearing optimisation). Then, I examine what implications for IPM can be outlined from knowledge about interspecific aggressive behaviour. Besides predator-pest aggressive interactions predicted by classic biological control, I focus on what IPM can learn from (i) interspecific aggression among pest species (with special reference to competitive displacement), (ii) defensive behaviour exhibited by prey against predaceous insects and (iii) conflicts among predaceous arthropods sharing the same trophic niche (with special reference to learning/sensitisation practices and artificial manipulation of chemically mediated interactions).

  17. Management of inpatient aggression in forensic mental health nursing : the application of the Early Recognition Method

    NARCIS (Netherlands)

    Fluttert, F.A.J.


    Management of Inpatient Aggression in Forensic Mental Health Nursing. The application of the Early Recognition Method. Forensic mental health nurses take care of forensic patients convicted for an offense for which they were assessed not to be fully accountable due to their psychiatric disorder. For

  18. Reasons for Aggressive Classroom Management and Directions for Change through Teachers' Professional Development Programmes (United States)

    Romi, Shlomo; Salkovsky, Merav; Lewis, Ramon


    This investigation was designed to determine whether there are significant relationships between the reasons teachers provide for aggressive classroom management techniques and the type of professional education created to help them reduce their reliance on such techniques. The study reports data from a survey of 192 Australian teachers showing…

  19. Medication development for agitation and aggression in Alzheimer disease: review and discussion of recent randomized clinical trial design. (United States)

    Soto, Maria; Andrieu, Sandrine; Nourhashemi, Fati; Ousset, Pierre Jean; Ballard, Clive; Robert, Philippe; Vellas, Bruno; Lyketsos, Constantine G; Rosenberg, Paul B


    ABSTRACT Background: The management of disruptive neuropsychiatric symptom (NPS) such as agitation and aggression (A/A) is a major priority in caring for people with Alzheimer's disease (AD). Few effective pharmacological or non-pharmacological options are available. Results of randomized clinical trials (RCTs) of drugs for A/A have been disappointing. This may result from the absence of biological efficacy for medications tested in treating A/A. It may also be related to methodological issues such as the choice of outcomes. The aim of this review was to highlight key methodological issues pertaining to RCTs of current and emerging medications for the treatment of A/A in AD. Methods: We searched PubMed/Medline, Cochrane Central Register of Controlled Trials, and for RCTs comparing medications with either placebo or other drugs in the treatment of A/A in AD, between January 2008 and December 2013. Results: We identified a total of 18 RCTs; of these, 11 were completed and 7 ongoing. Of the ongoing RCTs, only one is in Phase III. Seven of 10 completed RCTs with reported results did not report greater benefit from drug than placebo. Each of the completed RCTs used a different definition of "clinically significant A/A." There was considerable heterogeneity in study design. The primary endpoints were largely proxy-based but a variety of scales were used. The definition of caregiver and scales used to assess caregiver outcomes were similarly heterogeneous. Placebo response was notable in all trials. Conclusions: This review highlights a great heterogeneity in RCTs design of drugs for A/A in AD and some key methodological issues such as definition of A/A, choice of outcome measures and caregiver participation that could be addressed by an expert consensus to optimize future trials design.

  20. Structuring medication related activities for information management. (United States)

    Luukkonen, Irmeli; Mykkänen, Juha; Kivekäs, Eija; Saranto, Kaija


    Medication treatment and the related information management are central parts of a patient's health care. As a cross-organizational and cooperative process, medication information management is a complex domain for development activities. We studied medication activities and related information management in a regional project in order to produce a shared broad picture of its processes and to understand the main issues and the needs for improvement. In this paper we provide a summary of the findings in a structured form, based on a six-dimensioned framework for design and analysis of activities and processes.

  1. Medical management of acute severe anorexia nervosa. (United States)

    Norrington, Amy; Stanley, Ruth; Tremlett, Michael; Birrell, Ginny


    Anorexia nervosa (AN) is a common condition affecting young people. The medical management of AN on a general paediatric ward is challenging. It is important to identify young people who are at risk of medical complications, so early intervention can be instigated. This article aims to review the clinical practice and evidence supporting the current medical management of young people with AN. It provides a system-based approach to potential complications of the disease, guidance on feeding and the management of re-feeding syndrome. Approaches to legal and ethical challenges are also considered. While the importance of psychiatric treatment is recognised, the same is not discussed within this article.

  2. Medication management during electroconvulsant therapy

    Directory of Open Access Journals (Sweden)

    Zolezzi M


    Full Text Available Monica Zolezzi Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, Qatar Abstract: Electroconvulsive therapy (ECT has demonstrated to be highly effective and safe, even life saving for many psychiatric disorders such as major depression, bipolar disorder and schizophrenia. Most patients who require ECT are also on concurrent pharmacotherapy. As such, the objective of this article is to provide a review of the most recent literature focusing on the medications used during an ECT procedure and on the effects of concurrent psychiatric and non-psychiatric medications on the effectiveness and safety of ECT. The review also attempts to summarize the recommendations derived from existing documents to guide pharmacotherapy decisions for patients undergoing ECT. For this purpose, using electronic databases, an extensive search of the current literature was made using ECT and medications or drug classes as keywords. Keywords: ECT, medications, drug interactions

  3. [Design and application of implantable medical device information management system]. (United States)

    Cao, Shaoping; Yin, Chunguang; Zhao, Zhenying


    Through the establishment of implantable medical device information management system, with the aid of the regional joint sharing of resources, we further enhance the implantable medical device traceability management level, strengthen quality management, control of medical risk.

  4. [Medical management of cervical arterial dissections]. (United States)

    Vuillier, F; Tatu, L; Moulin, T


    Medical management of cervical arterial dissections is not standardized and has not been the subject of randomized trials. Management is mainly based on the presumed pathophysiology of secondary cerebral infarcts associated with dissections and the individual experience of each treating team. First, a review of the literature regarding medical management of acute and chronic dissections is presented. Then, results from a national study sponsored by the Société Française Neuro-Vasculaire and the Société Française de Neuro-Radiologie evaluating the medical management of this pathology in French neuro-vascular centers will be presented. These data will be useful to generate practical management recommendations and establish guidelines for further studies.

  5. Medical equipment maintenance management and oversight

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    Wang, Binseng


    In addition to being essential for safe and effective patient care, medical equipment also has significant impact on the income and, thus, vitality of healthcare organizations. For this reason, its maintenance and management requires careful supervision by healthcare administrators, many of whom may not have the technical background to understand all of the relevant factors. This book presents the basic elements of medical equipment maintenance and management required of healthcare leaders responsible for managing or overseeing this function. It will enable these individuals to understand thei

  6. Medical management of nuclear disaster

    Energy Technology Data Exchange (ETDEWEB)

    Kinugasa, Tatsuya [Mitsubishi Heavy Industries Ltd., Tokyo (Japan)


    This report briefly describes the measures to be taken other than ordinary duties when an accident happens in nuclear facilities such as atomic power plant, reprocessing plant, etc. Such nuclear disasters are assigned into four groups; (1) accidents in industrial levels, (2) accidents in which the workers are implicated, (3) accidents of which influence to environments should be taken into consideration and (4) accidents to which measures for inhabitants should be taken. Therefore, the measures to be taken at an emergency were also grouped in the following four; (1) treatments for the accident, itself, (2) measures to minimize the effects on the environment, (3) rescues of the victims and emergency cares for them and (4) measures and medical cares to protect the inhabitants from radiation exposure. Presently, medical professionals, especially doctors, nurses etc. are not accustomed to control nuclear contaminations. Therefore, it is needed for radiological professionals to actively provide appropriate advises about the control and measurement of contamination. (M.N.)

  7. Aggression in Tephritidae Flies: Where, When, Why? Future Directions for Research in Integrated Pest Management

    Directory of Open Access Journals (Sweden)

    Giovanni Benelli


    Full Text Available True fruit flies (Diptera: Tephritidae include over 4000 species, many of which constitute enormous threats to fruit and vegetable production worldwide. A number of Tephritidae are lekking species, forming aggregations in which males fight to defend a small territory where they court females and mate. Male-male contests also occur in non-lekking species, characterized by resource defense polygyny. Tephritidae females display agonistic behavior to maintain single oviposition sites and reduce larval competition for food. Here, how, where, when and why aggressive interactions occur in Tephritidae flies is reviewed. A number of neglected issues deserving further research are highlighted, with a special focus on diel periodicity of aggression, cues evoking aggressive behavior, the role of previous experience on fighting success and the evolution of behavioral lateralization of aggressive displays. In the final section, future directions to exploit this knowledge in Integrated Pest Management, with particular emphasis on enhancement of Sterile Insect Technique and interspecific competitive displacement in the field are suggested.

  8. Medical leadership and management: An international revolution

    Directory of Open Access Journals (Sweden)

    Alex Till


    Full Text Available Medical leadership and management are increasingly receiving widespread attention internationally. Significant focus has been paid as to the style of leadership within healthcare and how to develop both leadership and management skills and competencies (the two are inseparable yet distinct throughout the careers of all healthcare professionals. This article discusses how leadership and management development is being considered internationally, both at an organisational and personal level, helpful models and frameworks and challenges and opportunities.

  9. Communicating Medical Needs to Non-Medical Managers (United States)

    Bacal, Kira; Miller, Robert; Doerr, Harold


    Differences in communication styles and languages between groups often lead to miscommunication, confusion, and/or frustration. Engineers, computer specialists, clinicians, and managers often utilize the English language in very different ways, with different groups using the same words to represent different concepts ("complaint" is a typical example). In addition, medical issues are often perceived as "off-nominal" and not "primary mission tasks" by managers, which can cause them to assign lower priorities to medical training time and resources. Knowledge bases differ due to variations in training and skill sets, and the goals (both immediate and long-term) of the communicators may also vary, with managers being primarily concerned with overall mission objectives, while clinicians focus on individual or group health issues. Furthermore, true communication is only possible when clinicians possess a deep understanding of mission requirements as well as the ability to communicate medical requirements on a priority basis using risk assessment, added value, and cost benefit analysis. These understandable differences may contribute to difficulties in expressing concerns and ideas in an efficient manner, particularly in projects, such as the space program or many military operations, where these varied groups must collaborate, and where the final decisions must be made by fully informed mission commanders. Methods: Three scenario-based approaches were developed utilizing decision trees and problem based learning, to help define and integrate these concepts. Results: Use of these techniques by NASA and military personnel will be presented. Discussion: To enhance communication, particularly of medical needs, one must identify the concerns and motivating factors for the other groups; for example, members of management may focus on financial concerns, a desire for risk mitigation, public perceptions, mission objectives, etc. Training clinicians to frame issues in these

  10. Correlation Research of Medical Security Management System Network Platform in Medical Practice (United States)

    Jie, Wang; Fan, Zhang; Jian, Hao; Li-nong, Yu; Jun, Fei; Ping, Hao; Ya-wei, Shen; Yue-jin, Chang

    Objective-The related research of medical security management system network in medical practice. Methods-Establishing network platform of medical safety management system, medical security network host station, medical security management system(C/S), medical security management system of departments and sections, comprehensive query, medical security disposal and examination system. Results-In medical safety management, medical security management system can reflect the hospital medical security problem, and can achieve real-time detection and improve the medical security incident detection rate. Conclusion-The application of the research in the hospital management implementation, can find hospital medical security hidden danger and the problems of medical disputes, and can help in resolving medical disputes in time and achieve good work efficiency, which is worth applying in the hospital practice.

  11. 78 FR 57159 - Scientific Information Request on Medication Therapy Management (United States)


    ... HUMAN SERVICES Agency for Healthcare Research and Quality Scientific Information Request on Medication... scientific information submissions from the public on medication therapy management Scientific information is being solicited to inform our review of Medication Therapy Management, which is currently...

  12. Healthcare Managers' Perceptions of Patient Perpetrated Aggression and Prevention Strategies: A Cross Sectional Survey. (United States)

    Baby, Maria; Swain, Nicola; Gale, Christopher


    Patient or client aggression towards staff is a risk in healthcare. Healthcare takes place in a variety of settings, including hospitals, community, and Aged Care facilities. A minimal amount is known regarding the existence of safety and training measures available throughout the broad range of hospital and community healthcare services. A web-based survey of the type and frequency of violence experienced by healthcare staff was sent to unit managers working in mental health and older peoples' services of District Health Boards, Non-Governmental Organisations, and Aged Care facilities across New Zealand. One hundred and forty-one managers responded to the survey with a response rate of 79.21%. Managers reported high rates of verbal aggression and assaults against staff within their services. A total of 60% of respondents stated that an increase in assaults against staff was due to an increase in violent events and 43.1% related this to increased staff awareness and reporting of violent events to management. Communication skills and de-escalation training were provided across approximately 95% of organisations. The availability of safety measures including panic buttons, personal alarms, use of security personnel, and police assistance were more widely available and accessible within hospital settings and the community sector was found to mostly rely on police for assistance when violence occurs. The perception of violence is high in healthcare. Prevention and management training is provided in public hospital and aged care setting but not so much in NGOs. All areas of healthcare provision could benefit from increased evidence based aggression prevention programmes.

  13. Knowledge Management within the Medical University. (United States)

    Rauzina, Svetlana Ye; Tikhonova, Tatiana A; Karpenko, Dmitriy S; Bogopolskiy, Gennady A; Zarubina, Tatiana V


    The aim of the work is studying the possibilities of ontological engineering in managing of medical knowledge. And also practical implementation of knowledge management system (KMS) in medical university. The educational process model is established that allows analyzing learning results within time scale. Glossary sub-system has been developed; ontologies of educational disciplines are constructed; environment for setup and solution of situational cases is established; ontological approach to assess competencies is developed. The possibilities of the system for solving situation tasks have been described. The approach to the evaluation of competence has been developed.

  14. Medical management of genitourinary tuberculosis

    Directory of Open Access Journals (Sweden)

    Tamilarasu Kadhiravan


    Full Text Available Antimycobacterial chemotherapy is the mainstay of treatment for the majority of patients with genitourinary tuberculosis (GUTB. A large body of evidence from clinical trials suggests that short-course chemotherapy regimens, employing four drugs including rifampicin and pyrazinamide, achieve cure in most of the patients with tuberculosis (TB and are associated with the lowest rates of relapse. Standard six-month regimens are adequate for the treatment of GUTB. Directly observed treatment, short-course (DOTS is the internationally recommended comprehensive strategy to control TB, and directly observed treatment is just one of its five elements. DOTS cures not only the individual with TB but also reduces the incidence of TB as well as the prevalence of primary drug-resistance in the community. Corticosteroids have no proven role in the management of patients with GUTB. Errors in prescribing anti-TB drugs are common in clinical practice. Standardized treatment regimens at correct doses and assured completion of treatment have made DOTS the present-day standard of care for the management of all forms of TB including GUTB.

  15. Medical management of overactive bladder

    Directory of Open Access Journals (Sweden)

    Sarvpreet S Ubee


    Full Text Available Overactive bladder (OAB, as defined by the International Continence Society, is characterized by a symptom complex including urinary urgency with or without urge incontinence, usually associated with frequency and nocturia. OAB syndrome has an incidence reported from six European countries ranging between 12-17%, while in the United States; a study conducted by the National Overactive Bladder Evaluation program found the incidence at 17%. In Asia, the prevalence of OAB is reported at 53.1%. In about 75%, OAB symptoms are due to idiopathic detrusor activity; neurological disease, bladder outflow obstruction (BOO intrinsic bladder pathology and other chronic pelvic floor disorders are implicated in the others. OAB can be diagnosed easily and managed effectively with both non-pharmacological and pharmacological therapies. The first-line treatments are lifestyle interventions, bladder training, pelvic floor muscle exercises and anticholinergic drugs. Antimuscarinics are the drug class of choice for OAB symptoms; with proven efficacy, and adverse event profiles that differ somewhat.

  16. Medical management of chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Dhiraj Yadav; Jonathan E. Clain


    慢性胰腺炎的临床表现包括疼痛、脂肪泻和糖尿病.在西方国家,慢性胰腺炎最常见的病因是酗酒.70%以上的病人在就诊时有疼痛的临床表现,而且,这些患者中又有75%以上会在几年之后出现疼痛减轻或完全消失.对于所有的慢性胰腺炎的病人来说,均应排除非胰源性疼痛和胆道梗阻、胰腺假性囊肿等胰腺局部并发症.应建议所有慢性胰腺炎病人戒烟、戒酒.阿片类镇痛剂仅应用于治疗疼痛严重的病人.尽管有报道认为胰酶替代治疗有助于止痛,但是,对于已经确诊的慢性胰腺炎病人来说,该疗法无效.激素类药物进行腹腔神经丛阻滞术可能有助于病人度过剧烈疼痛期.顽固性疼痛是进行胰液引流或胰腺切除的适应证.建议应用适量胰酶替代联合(或不联合)制酸剂治疗营养不良.慢性胰腺炎导致的糖尿病与原发性糖尿病的治疗原则相似.%The clinical presentation of chronic pancreatitis includes pain, steatorrhea and diabetes. The most common etiology in the western world is excess alcohol use. Pain is present in >70% patients at presentation and decreases in intensity or resolves over several years in up to 75% of patients. Non-pancreatic causes of pain and local complications, chiefly pseudocysts and biliary obstruction should be excluded in all patients. All patients should be advised to abstain from alcohol and smoking and opiates should be used only to control severe exacerbations of pain. Although pancreatic enzyme replacement is reported to be useful in the management of pancreatic pain, it is of little or no benefit in patients with established chronic pancreatitis. Celiac plexus block using steroids may be helpful to tide patients over an episode of severe pain. Intractable pain is an indication for surgery that includes pancreatic drainage procedure or pancreatic resection. For control of malabsorption, adequate pancreatic enzyme replacement with or

  17. Management accounting versus medical profession discourse

    DEFF Research Database (Denmark)

    Malmmose, Margit


    of this domination; the absence of physicians in the general public debate, the creation of a phantom phenomenon meaning that the negative consequences of the reform are blamed on a third person, typically the system, and finally a changing meaning of the health care service quality provided from a medical......This study uses discourse, ideology and hegemony as a theoretical foundation to investigate the development of the polarised discourses of management accounting and the medical profession during the introduction of a NPM reform in the public health care debate, using Denmark as a case study. 194...... newspaper articles and 73 medical profession articles from 2002 to 2008 are analysed, using critical discourse analysis. The analysis shows that the management accounting discourse becomes the dominating ideology which is embedded in the public rhetorical debate. There are three peculiar outcomes...

  18. 21 CFR 880.6315 - Remote Medication Management System. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Remote Medication Management System. 880.6315... Miscellaneous Devices § 880.6315 Remote Medication Management System. (a) Identification. A remote medication management system is a device composed of clinical and communications software, a medication delivery...

  19. Management of Children's Aggressiveness when Playing Competitive Games in the English Class

    Directory of Open Access Journals (Sweden)

    Castellanos Andrea


    Full Text Available Human behaviour has been a changing aspect during the history of mankind. Humanity has learned to get along with others; but the behavioural stage has been very difficult to control across the time, because everyone has his/her own interests. In this article, I will describe some factors that affect children’s aggressive behaviour when playing competitive games and some strategies that may be considered when guiding those types of games with young learners in the English class. These can lead, as I found in my study, to deeper understandings of children’s conducts as well as to improvement in classroom management.

  20. Self-efficacy in Anger Management and Dating Aggression in Italian Young Adults

    Directory of Open Access Journals (Sweden)

    Annalaura Nocentini


    Full Text Available An examination of the influence of self-efficacy regarding anger management on psychological and physical dating aggression using an agentic perspective of individual functioning. The investigation applied both the individual perspective (Study 1 and the interactional perspective (Study 2. The sample comprised 470 Italian young adults (223 females (mean age across genders = 19.10; ds = 1.30 in study 1, and 62 couples in study 2 (mean age for males = 22.34; ds = 2.59; mean age for females = 19.58; ds = 1.50. The first study found that individuals’ efficacy regarding anger management affect dysfunctional behaviors toward the partner via couple conflict. The second study found that one partner’s efficacy regarding anger management affected couple conflict, which in turn affected the other partner’s psychological aggression. Results are discussed within an agentic framework of human development, where young adult partners are proactive agents of their own and their partners' behaviors, contributing actively to their intimate relationship adjustment rather than just re-acting to their partners’ behaviors.

  1. Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report. (United States)

    Gollapalli, Rajesh Babu; Naiman, Ana Nusa; Merry, David


    Cervical necrotizing fasciitis secondary to epiglottitis is rare. The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy. We report the case of an immunocompetent 59-year-old man who developed cervical necrotizing fasciitis as a complication of acute epiglottitis. We were able to successfully manage this patient with conservative surgical treatment (incision and drainage, in addition to antibiotic therapy) that did not involve aggressive debridement.

  2. In-Flight Personalized Medication Management (United States)

    Peletskaya, E.; Griko, Y. V.


    , technologies capable of predicting and managing medication side effects, interactions, and toxicity of drugs during spaceflight are needed. We propose to develop and customize for NASAs applications available on the market Personalized Prescribing System (PPS) that would provide a comprehensive, non-invasive solution for safer, targeted medication management for every crew member resulting in safer and more effective treatment and, consequently, better performance. PPS will function as both decision support and record-keeping tool for flight surgeons and astronauts in applying the recommended medications for situations arising in flight. The information on individual drug sensitivity will translate into personalized risk assessment for adverse drug reactions and treatment failures for each drug from the medication kit as well as predefined outcome of any combination of them. Dosage recommendations will also be made individually. The mobile app will facilitate ease of use by crew and medical professionals during training and flight missions.

  3. Assessment of obesity management in medical examination

    Directory of Open Access Journals (Sweden)

    Treyzon Leo


    Full Text Available Abstract Obesity is a growing international health problem that has already reached epidemic proportions, particularly within the United States where a majority of the population is overweight or obese. Effective methods of treatment are needed, and should be taught to physicians by efficient means. There exists a disconnect between the rising obesity prevalence with its high toll on medical resources, and the lack of obesity education provided to practitioners in the course of their training. One particular shortfall is the lack of representation of obesity on standardized medical examinations. Physician attitudes toward obesity are influenced by their lack of familiarity with the management of the disease. This may include dietary restriction, increasing physical activity, behavior modification, pharmacotherapy, and surgical interventions. Thus, curricular changes in the medical education of obesity could help reduce morbidity and mortality associated with this disease.

  4. Anger as a Train and State, Anger Management Methods, and People\\\\\\'s Tendency towards Collective Aggression

    Directory of Open Access Journals (Sweden)

    Fariborz Nikdel


    significant relationship between anger-out control with tendency to collective aggression . Also, there is a negative and significant relationship between anger-in control and tendency to collective aggression . Indeed, the more people control anger–in and anger-out, the less the tendency to collective aggression . Also, the results showed that 3 variables of state anger, anger–in control and trait anger, are the best predictors of tendency to collective aggression, respectively. In addition, the results of path analysis showed that there is a direct and significant relationship between state anger, trait anger and anger-in control and independent variables and tendency to collective aggression and dependent variable. The relationship between anger-out control and none of the dependent variables was significant so it was excluded from the model.   Therefore, based on the results of the study, state-trait anger variable and anger control and personality specifications can be turning points of many collective aggressions in the Kohgiluye and Buyerahmad province. Therefore, it is recommended to the authorities that states anger factors should controlled and reduced. It is also recommended to train good anger control methods which help people who are under critical condition. By improving these psychological variables among people and families we can be hopeful to reduce tendency of people towards collective aggression .     Keywords: Anger as a Train and State, Anger Management Methods, and People's Tendency towards Collective Aggression

  5. Medical management of non-obstructive azoospermia

    Directory of Open Access Journals (Sweden)

    Rajeev Kumar


    Full Text Available Non-obstructive azoospermia is diagnosed in approximately 10% of infertile men. It represents a failure of spermatogenesis within the testis and, from a management standpoint, is due to either a lack of appropriate stimulation by gonadotropins or an intrinsic testicular impairment. The former category of patients has hypogonadotropic hypogonadism and benefits from specific hormonal therapy. These men show a remarkable recovery of spermatogenic function with exogenously administered gonadotropins or gonadotropin-releasing hormone. This category of patients also includes some individuals whose spermatogenic potential has been suppressed by excess androgens or steroids, and they also benefit from medical management. The other, larger category of non-obstructive azoospermia consists of men with an intrinsic testicular impairment where empirical medical therapy yields little benefit. The primary role of medical management in these men is to improve the quantity and quality of sperm retrieved from their testis for in vitro fertilization. Gonadotropins and aromatase inhibitors show promise in achieving this end point.

  6. [Application of information management system about medical equipment]. (United States)

    Hang, Jianjin; Zhang, Chaoqun; Wu, Xiang-Yang


    Based on the practice of workflow, information management system about medical equipment was developed and its functions such as gathering, browsing, inquiring and counting were introduced. With dynamic and complete case management of medical equipment, the system improved the management of medical equipment.

  7. Medical management of toxicological mass casualty events. (United States)

    Markel, Gal; Krivoy, Amir; Rotman, Eran; Schein, Ophir; Shrot, Shai; Brosh-Nissimov, Tal; Dushnitsky, Tsvika; Eisenkraft, Arik


    The relative accessibility to various chemical agents, including chemical warfare agents and toxic industrial compounds, places a toxicological mass casualty event, including chemical terrorism, among the major threats to homeland security. TMCE represents a medical and logistic challenge with potential hazardous exposure of first-response teams. In addition, TMCE poses substantial psychological and economic impact. We have created a simple response algorithm that provides practical guidelines for participating forces in TMCE. Emphasis is placed on the role of first responders, highlighting the importance of early recognition of the event as a TMCE, informing the command and control centers, and application of appropriate self-protection. The medical identification of the toxidrome is of utmost importance as it may dictate radically different approaches and life-saving modalities. Our proposed emergency management of TMCE values the "Scoop & Run" approach orchestrated by an organized evacuation plan rather than on-site decontamination. Finally, continuous preparedness of health systems - exemplified by periodic CBRN (Chemical, Biological, Radio-Nuclear) medical training of both first responders and hospital staff, mandatory placement of antidotal auto-injectors in all ambulances and CBRN emergency kits in the emergency departments - would considerably improve the emergency medical response to TMCE.

  8. Smart financial management of medical office space. (United States)

    Shactman, D


    In a healthcare environment of strained resources and scarce profits, hospital administrators must seek revenue from all available sources. Some potential revenue sources are capital intensive, however, requiring large initial investments for new construction and modern equipment. Other potential revenue sources may require starting new programs and recruiting additional staff. Few potentially income-producing alternatives can be funded from existing assets, require little additional investment, and yield significant revenue. But hospitals that own and lease medical office buildings, will find that with proper management these existing assets can become sources of additional revenue.

  9. Management by objectives in medical group practice. (United States)

    Bozis, D E


    When the concept of management by objectives first emerged, it was heralded by many as the long-sought secret to employee motivation. The MBO technique, involving the three primary functions of objective setting, objective using, and employee involvement, is described here in terms of both theory and practice. Although it does have its pitfalls and is certainly not the "ultimate answer," MBO in medical group practice does have its merits when properly introduced. It is much more than a purely academic concept, and its major strength lies in its recognition of the importance of human resources in getting the job done.

  10. An evaluation of an aggression management training program to cope with workplace violence in the healthcare sector

    NARCIS (Netherlands)

    J.K. Oostrom (Janneke); H. van Mierlo (Heleen)


    textabstractAbstract Workplace violence is a major occupational hazard for healthcare workers, generating a need for effective intervention programs. The purpose of this study was to evaluate the effectiveness of an aggression management training program. The evaluation design was based on the inter

  11. Psychotropic Medication Management in a Residential Group Care Program (United States)

    Spellman, Douglas F.; Griffith, Annette K.; Huefner, Jonathan C.; Wise, Neil, III; McElderry, Ellen; Leslie, Laurel K.


    This article presents a psychotropic medication management approach that is used within a residential care program. The approach is used to assess medications at youths' times of entry and to facilitate decision making during care. Data from a typical case study have indicated that by making medication management decisions slowly, systematically,…

  12. A model for the facilitation of effective management of aggression experienced by Psychiatric Nurses from patients in a psychiatric institution

    Directory of Open Access Journals (Sweden)

    Emmanuel Bimenyimana


    Full Text Available Background: ‘The time I was hit nobody helped me. They (psychiatric nurses just said: “you do not have to worry, you are not bleeding … in time you will see more”’. The core of the nursing profession is caring for those in need. However, when the psychiatric nurse (PN is overwhelmed by aggression from the person cared for, the ideal of rendering quality patient care is compromised. There has to be a way to assist the PNs to manage aggression effectively in order to render quality patient care and improve PNs mental health.Objectives: The purpose of this article is to describe the process that was followed in developing, describing and evaluating a model that could be used as a framework of reference to facilitate the effective management of aggression as an integral part of the mental health of PNs.Methods: A theory-generative, qualitative, exploratory, descriptive and contextual study design was used to develop the model. The central concept was derived from the Masters’ research ‘The lived experience of aggression and violence by PNs in a Gauteng psychiatric institution’. The process entailed the identification of the central concept, the definition of the central concept and other essential criteria and the classification of the central and related concepts. The conceptual framework was then described and evaluated.Results: The central concept was identified and the ‘facilitation of effective self-management of aggression’ was described and evaluated.Conclusion: The conceptual framework may be able to assist PNs in managing aggression effectively, taking control of workplace environment.

  13. Medical image information system 2001. Development of the medical image information system to risk management- Medical exposure management

    Energy Technology Data Exchange (ETDEWEB)

    Kuranishi, Makoto; Kumagai, Michitomo; Shintani, Mitsuo [Toyama Medical and Pharmaceutical Univ. (Japan). Hospital


    This paper discusses the methods and systems for optimizing the following supplements 10 and 17 for national health and medical care. The supplements 10 and 17 of DICOM (digital imaging and communications in medicine) system, which is now under progress for the purpose to keep compatibility within medical image information system as an international standard, are important for making the cooperation between HIS (hospital information system)/RIS (radiation information system) and modality (imaging instruments). Supplement 10 concerns the system to send the information of patients and their orders through HIS/RIS to modality and 17, the information of modality performed procedure step (MPPS) to HIS/RIS. The latter defines to document patients' exposure, a part of which has not been recognized in Japan. Thus the medical information system can be useful for risk-management of medical exposure in future. (K.H.)

  14. A Mindfulness-Based Strategy for Self-Management of Aggressive Behavior in Adolescents with Autism (United States)

    Singh, Nirbhay N.; Lancioni, Giulio E.; Manikam, Ramasamy; Winton, Alan S. W.; Singh, Ashvind N. A.; Singh, Judy; Singh, Angela D. A.


    Some individuals with autism engage in physical aggression to an extent that interferes with not only their quality of life, but also that of their parents and siblings. Behavioral and psychopharmacological treatments have been the mainstay of treatments for aggression in children and adolescents with autism. We evaluated the effectiveness of a…

  15. Sodium Valproate Withdrawal Correlates with Reduced Aggression (United States)

    Pritchard, Duncan; Hoerger, Marguerite; Dyer, Tim; Graham, Nicola; Penney, Heather; Mace, F. Charles


    People with learning disabilities are sometimes prescribed psychotropic medication to help manage their challenging behaviour. This case study describes how a multicomponent behavioural intervention in conjunction with the systematic withdrawal of sodium valproate was strongly correlated with reduced aggression. No symptoms of bipolar disorder or…

  16. A Smartwatch-Driven Medication Management System Compliant to the German Medication Plan. (United States)

    Keil, Andreas; Gegier, Konstantin; Pobiruchin, Monika; Wiesner, Martin


    Medication adherence is an important factor for the outcome of medical therapies. To support high adherence levels, smartwatches can be used to assist the patient. However, a successful integration of such devices into clinicians' or general practitioners' information systems requires the use of standards. In this paper, a medication management system supplied with smartwatch generated feedback events is presented. It allows physicians to manage their patients' medications and track their adherence in real time. Moreover, it fosters interoperability via a ISO/IEC 16022 data matrix which encodes related medication data in compliance with the German Medication Plan specification.

  17. Medical management of gastrinoma in a cat

    Directory of Open Access Journals (Sweden)

    Michael Lane


    Full Text Available Case summary A 7-year-old male castrated domestic short-haired cat was evaluated for a 4 week history of intermittent vomiting, ptyalism, lethargy and weight loss. Serum biochemistry revealed mild mixed hepatopathy. Abdominal ultrasonography identified multiple heterogeneous hepatic masses and a linear, hyperechoic focus with associated reverberation artifact in the wall of the stomach consistent with a gastric ulcer. Serum gastrin concentrations were markedly increased. Cytologic interpretation of a fine-needle aspirate of the hepatic masses was consistent with neuroendocrine neoplasia, and a diagnosis of gastrinoma was established. Deterioration of the cat’s condition, despite at-home acid-suppressant therapy, led to hospitalization. The cat was initially stabilized with intravenous crystalloid fluid therapy, maropitant, pantoprazole and octreotide. A continuous radiotelemetric intragastric pH monitoring system was used to monitor the response of intragastric pH to therapy. Long-term therapy was continued with omeprazole (orally q12h, octreotide (subcutaneously q8h and thrice-weekly toceranib administered orally. Toceranib therapy led to gastrointestinal upset and was discontinued. Gastric ulceration resolved within 8 weeks, and palliation of clinical signs was achieved for approximately 5 months. Relevance and novel information Including this report, only six cases of feline gastrinoma have been reported in the veterinary literature. Little is known regarding non-surgical therapy, and octreotide has not been previously reported for medical management of feline gastrinoma. Results of intragastric pH monitoring and clinical improvement suggest that medical therapy using octreotide and proton pump inhibitors represents a novel therapeutic option for cats with gastrinoma where surgical excision is not feasible.

  18. Surgical management of Gorham-Stout disease of the pelvis refractory to medical and radiation therapy. (United States)

    Karim, S Mohammed; Colman, Matthew C; Cipriani, Nicole A; Nielsen, G Petur; Schwab, Joseph H; Hornicek, Francis J


    Gorham-Stout disease (GSD) is a rare condition characterized by spontaneous idiopathic bone resorption that can affect any part of the skeleton. Treatment is aimed at halting osteolysis and alleviating complications associated with bone loss. Often this can be achieved via observation and supportive management, medical treatment, and/or radiation therapy. We report a case of GSD of the pelvis that was refractory to medical and radiation therapy and was managed successfully with surgery. A 30-year-old man presented to our clinic 3 years after being diagnosed at an outside institution with GSD of the pelvis that was managed with medical treatments and radiation therapy. Despite aggressive, multimodality treatment, he was unable to ambulate without crutches and was in significant pain. The patient opted for intralesional surgery and spinopelvic fusion. Sixteen months after surgery, the patient had only mild pain and was able to ambulate with a cane. Very few cases have been reported of GSD involving the pelvis that necessitated surgical management. Significant functional impairment can occur as a result of pelvic osteolysis, and traditional management strategies focused on halting resorption may not be adequate. Surgical stabilization of the affected areas is an important treatment strategy for patients who have exhausted other options.

  19. An Integrated Software System for Medical Equipment Management (United States)


    1 of 4 AN INTEGRATED SOFTWARE SYSTEM FOR MEDICAL EQUIPMENT MANAGEMENT Z. Bliznakov, N. Pallikarakis Department of Medical Physics , School of...Project Number Task Number Work Unit Number Performing Organization Name(s) and Address(es) Department of Medical Physics School of Medicine

  20. [Appliancation of logistics in resources management of medical asset]. (United States)

    Miroshnichenko, Iu V; Goriachev, A B; Bunin, S A


    The usage of basic regulations of logistics in practical activity for providing joints and military units with medical asset is theoretically justified. The role of logistics in organizing, building and functioning of military (armed forces) medical supply system is found out. The methods of solving urgent problems of improvement the resources management of medical asset on the basis of logistics are presented.

  1. 28 CFR 549.63 - Initial medical evaluation and management. (United States)


    ... MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.63 Initial medical evaluation and management. (a... hunger strike: (1) Measure and record height and weight; (2) Take and record vital signs; (3) Urinalysis... weight and vital signs at least once every 24 hours while the inmate is on a hunger strike....

  2. Discussion on Management Model of Medical Equipment Maintenance in Hospital

    Institute of Scientific and Technical Information of China (English)

    ZHOU Qiang; DENG Wen-yan; CAI Kui


    With the development of technology, medical equipment plays a more important role in the modern hospital. Medical equipment provides images, physiological results or other schematics of the patients to help doctors deal with the routines. It is also the major tool to the lab assistant in the clinical teaching and studies. It becomes one of a symbol of the technological level in modern hospital. The director of the hospital should establish an efficacious management pattern to manage the medical equipment, so that it will be operated in good condition to insure the safety of the patients. Since the maintenance is an important part of medical equipment management, it is significant that the hospital should establish a system to fit for itself. The study reviews the issues in hospital medical equipment maintenance management, the development of the maintenance management model and the characteristics, as well as the status at home and abroad. The research has been finished by using literature research method, questionnaire survey method and data analysis method. Then we analyze the current status of hospital medical equipment maintenance management model to find the problems. Based on the authentic and effective data from the survey, we can deduce the overview about the maintenance model in Beijing. The paper discusses the advantages and the disadvantages between the different model, and it makes suggestions on the follow aspects, such as system management, quality management, personnel management, cost management, information management perspective.

  3. Manual ventilation therapy and aggressive potassium supplementation in the management of respiratory failure secondary to severe hypokalaemia in a cat with exocrine pancreatic insufficiency. (United States)

    Daste, Thomas; Dossin, Olivier; Reynolds, Brice S; Aumann, Marcel


    A domestic shorthair cat was referred for progressive muscle weakness and dyspnoea. The cat had a 2-month history of severe weight loss, small intestinal diarrhoea, polyphagia and polyuria/polydipsia. Biochemical analysis and venous blood gas evaluation revealed severe hypokalaemia [1.7 mmol/l; reference interval (RI): 3.5-5.1 mmol/l] and hypoventilation (partial pressure of carbon dioxide = 68 mmHg; RI: 34-38 mmHg). Aggressive potassium supplementation was initiated. The cat was manually ventilated until serum potassium increased to 3 mmol/l. A diagnosis of exocrine pancreatic insufficiency (EPI) was made based on clinical signs and serum feline trypsin-like immunoreactivity (0.1 μg/l; RI: 12-82 μg/l). Medical management of the EPI resulted in clinical recovery.

  4. The power of management in medical services. Can we manage better for higher quality and more productive medical services?

    Directory of Open Access Journals (Sweden)

    Magdalena BARBU


    Full Text Available Medical services are the most important services of all since we all depend on them. Their quality and productivity can assure a wealthy nation and therefore good economical results. The offer of medical services depends on medical personnel and more than this, on the management in the medical field since any resource not managed well or not managed at all is only a lost one, regardless its value. Management is therefore the key, the “how to” method of obtaining the desired result. The same approach can be applied into our study in order to reach more productive medical services which to prove high quality to all patients. We need to use and to squeeze the entire force of management tools in order to reach our goal: accessible medical services full of quality. The current worldwide crisis situation makes us think that after job and food, even medical services (also a basic thing after all can become a “luxury” although this should never happen. Therefore we must do whatever needed to improve the way medical organizations are driven so that the quality of their medical services will be better and better and the productivity will be at a higher level. Medical management should have as a goal making it possible for patients to be able to solve their health problems as soon as possible and as good as possible.

  5. [Marketing as a tool in the medical institution management]. (United States)

    Petrova, N G; Balokhina, S A


    The contemporary social economic conditions dictate the necessity to change tactics and strategy of functioning of medical institutions of different property forms. Marketing, alongside with management is to become a leading concept of administration of medical institutions. It should be a framework for systematic collection, registration and analysis of data relevant to the medical services market. The issues of the implementation of marketing concept in the practical everyday activities of commercial medical organization providing cosmetology services to population of metropolis.

  6. The impact of managed care on graduate medical education and academic medical centers. (United States)

    Bolognia, J L; Wintroub, B U


    The goal of this article is to examine the present and future impact of managed care on graduate medical education (GME) and academic medical centers. Obviously, the later 2 entities are closely intertwined and will share in the consequences of changes in our medical care systems. However, there are differences in the funding of medical schools as compared with GME provided by teaching hospitals, and an appreciation of the vital issues and concerns requires that each be discussed separately.

  7. [Evidence-based management of medical disposable materials]. (United States)

    Yang, Hai


    Evidence-based management of medical disposable materials pays attention to collect evidence comprehensively and systematically, accumulate and create evidence through its own work and also evaluate evidence strictly. This can be used as a function to guide out job. Medical disposable materials evidence system contains product register qualification, product quality certification, supplier's behavior, internal and external communication evidence. Managers can find different ways in creating and using evidence referring to specific inside and outside condition. Evidence-based management can help accelerating the development of management of medical disposable materials from traditional experience pattern to a systematic and scientific pattern. It also has the very important meaning to improve medical quality, control the unreasonable growth of medical expense and make purchase and supply chain be more efficient.

  8. Intralesional cidofovir as adjuvant for the successful management of aggressive respiratory papillomatosis in an infant. (United States)

    Durvasula, Venkata S P B; Richter, Gresham T


    Recurrent respiratory papillomatosis (RRP) in young children is frequently characterized by a recalcitrant course and need for multiple surgeries. Periodic surgical debulking and ablation is the mainstay of therapy as a cure for RRP rarely occurs. Benefits of adjuvant treatment with local injection of cidofovir in aggressive cases of RRP have been reported in both children and adults. However, a consensus on initiation, dosage, or scheduling of this drug has not been established in the very young patient. Literature on successful remission in children less than 1 year of age is not available. One such case of an infant with aggressive RRP treated with local adjuvant cidofovir is described herein.

  9. Evaluation of Bio-Medical Waste Management Practices in a Government Medical College and Hospital

    Directory of Open Access Journals (Sweden)

    Srivastav Shalini, Mahajan Harsh, Mathur B P


    Full Text Available Background: Biomedical waste (BMW collection and proper disposal has become a significant concern for both the medical and the general community as improper management poses risks to the health care workers, waste handlers, patients, community in general and largely the environment. Objectives: (i Assessment of current Bio-medical waste management practices including collection, segregation, transportation, storage, treatment and disposal technologies in tertiary health care center. (ii Assessment of health and safety practices for the health care personnel involved in Bio-Medical Waste Management. Materials and Methods: Waste management practices in the Government Hospital was studied during March 2009 – May 2009.The information / data regarding Bio-Medical Waste Management practices and safety was collected by way of semi- structured interview. Results: M.L.B Medical College generates 0.52Kgs waste per bed per day and maximum waste is generated in wards. The institute has got separate color coded bins in wards for collection of waste but segregation practices needs to be more refined. The safety measures taken by health care workers was not satisfactory, it was basically due to un-awareness of health hazards which may occur because of improper waste management practices. Conclusion: Thus it is concluded that there should be strict implementation of a waste management policy set up in the institute; training and motivation must be given paramount importance to meet the current needs and standards of bio-medical waste management.

  10. Strategic management of Public Hospitals' medical services. (United States)

    Hao, Aimin; Yi, Tao; Li, Xia; Wei, Lei; Huang, Pei; Xu, Xinzhou; Yi, Lihua


    Purpose: The quality of medical services provided by competing public hospitals is the primary consideration of the public in determining the selection of a specific hospital for treatment. The main objective of strategic planning is to improve the quality of public hospital medical services. This paper provides an introduction to the history, significance, principles and practices of public hospital medical service strategy, as well as advancing the opinion that public hospital service strategy must not merely aim to produce but actually result in the highest possible level of quality, convenience, efficiency and patient satisfaction.

  11. [Structured medication management in primary care - a tool to promote medication safety]. (United States)

    Mahler, Cornelia; Freund, Tobias; Baldauf, Annika; Jank, Susanne; Ludt, Sabine; Peters-Klimm, Frank; Haefeli, Walter Emil; Szecsenyi, Joachim


    Patients with chronic disease usually need to take multiple medications. Drug-related interactions, adverse events, suboptimal adherence, and self-medication are components that can affect medication safety and lead to serious consequences for the patient. At present, regular medication reviews to check what medicines have been prescribed and what medicines are actually taken by the patient or the structured evaluation of drug-related problems rarely take place in Germany. The process of "medication reconciliation" or "medication review" as developed in the USA and the UK aim at increasing medication safety and therefore represent an instrument of quality assurance. Within the HeiCare(®) project a structured medication management was developed for general practice, with medical assistants playing a major role in the implementation of the process. Both the structured medication management and the tools developed for the medication check and medication counselling will be outlined in this article; also, findings on feasibility and acceptance in various projects and experiences from a total of 200 general practices (56 HeiCare(®), 29 HiCMan,115 PraCMan) will be described. The results were obtained from questionnaires and focus group discussions. The implementation of a structured medication management intervention into daily routine was seen as a challenge. Due to the high relevance of medication reconciliation for daily clinical practice, however, the checklists - once implemented successfully - have been applied even after the end of the project. They have led to the regular review and reconciliation of the physicians' documentation of the medicines prescribed (medication chart) with the medicines actually taken by the patient.

  12. Risperidone in the management of agitation and aggression associated with psychiatric disorders.

    NARCIS (Netherlands)

    Deyn, P.P. de; Buitelaar, J.K.


    OBJECTIVE: This review provides an overview of the prevalence and treatment of agitation and aggression, and focuses on the use of risperidone to treat these symptoms in patients from different age groups. METHODS: MEDLINE and EMBASE databases were used to identify controlled studies of risperidone

  13. Management factors affecting aggression in dynamic group housing systems with electronic sow feeding - a field trial

    DEFF Research Database (Denmark)

    Sørensen, L S; Bertelsen, D; Jensen, K H;


    days after the last introduction) were collected from each herd and analysed according to activity and aggressive interactions. In two of the four herds recordings were collected in two separate periods with different starting times for the feeding cycle. In all herds peaks of activity in the morning...

  14. Reliability and validity of the Management of Aggression and Violence Attitude Scale (MAVAS-BR for use in Brazil

    Directory of Open Access Journals (Sweden)

    Divane de Vargas


    Full Text Available Abstract Background Aggression and violent behavior against health care professionals is a serious problem today and has aroused the interest of researchers and authorities. Objective: The purpose of this study was to examine the reliability and validity of the Management of Aggression and Violence Attitude Scale – Brazil (MAVAS-BR for use with Brazilian nurses. Method The MAVAS-BR was applied in a convenience sample of 262 nurses, the data were submitted to an exploratory factor analysis, and reliability was estimated using Cronbach’s alpha. Results The MAVAS-BR is composed of 23 items distributed among four factors, and the Cronbach’s alpha was σ = 0.75. Discussion The MAVAS-BR is a reliable instrument for measuring the attitudes of Brazilian nurses facing aggression and violent behavior. The scale has shown to possess validity and the recommended reliability criteria; however, additional studies using this scale should be performed to offer further evidence of its validity in the context of Brazilian nursing.

  15. Implementing best practice in medication management in a nursing home



    Medication management is one of the major roles of a nurse leader in any health care setting particularly in the nursing homes. Evidence suggests that errors do occur at any stage of the medication use process (prescribing, documenting/transcribing, dispensing, administering and monitoring) and these might pose significant risks to older people in nursing homes. Thus, this change project was carried out to reduce the incidence of medication errors, ensure resident’s safety and promote complia...

  16. Aggressive Fibromatosis in Neck.

    Directory of Open Access Journals (Sweden)

    Namita Kabdwal


    Full Text Available Aggressive fibromatosis (AF is a locally aggressive infiltrative low-grade benign tumor that accounts for approximately less than 3% of all soft tissue tumors. In the head and neck region this tumor tends to be more aggressive and associated with significant morbidity. Aggressive surgery is a viable management option and may be successfully used as a single modality treatment, or in combination with radiotherapy. We report a rare case of AF in a 38 year old female, who presented with a painless mass over the left supraclavicular fossa, extending inferiorly into the thoracic inlet, which was excised successfully in toto with the help of cardiothoracic vascular surgeon (CTVS.

  17. Medication Management Assessment for Older Adults in the Community (United States)

    Orwig, Denise; Brandt, Nicole; Gruber-Baldini, Ann L.


    Purpose: The purpose of this study was to describe the Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) and to provide results of reliability and validity testing. Design and Methods: Participants were 50 older adults, aged 65 and older, who lived in the community, took at least one prescription medication, and were then…

  18. Retrospective Analysis of Medication Adherence and Cost Following Medication Therapy Management

    Directory of Open Access Journals (Sweden)

    Ashley Branham, PharmD


    Full Text Available Objective: To determine if pharmacist-provided medication therapy management (MTM improves medication adherence in Medicare patients. A secondary objective is to compare the total monthly cost of a patient’s prescription medication regimen 6 months before and 6 months following a comprehensive medication review (CMR. Design: Retrospective analysis of medication adherence, pre-post comparison. Setting: Three independent pharmacies in North Carolina. Patients: 97 Medicare Part D beneficiaries with one or more chronic disease states who participated in a comprehensive medication review (CMR. Intervention: MTM services provided by community pharmacists. Main outcome measure: Change in adherence as measured by the proportion of days covered (PDC and change in medication costs for patients and third party payers. Results: Patients were adherent to chronic disease-state medications before and after MTM (PDC≥ 0.8. Overall, change in mean adherence before and after MTM did not change significantly (0.87 and 0.88, respectively; p = 0.43. However, patients taking medications for cholesterol management, GERD, thyroid and BPH demonstrated improved adherence following a CMR. No change in adherence was noted for patients using antihypertensives and antidiabetic agents. Average total chronic disease-state medication costs for participants were reduced from $210.74 to $193.63 (p=0.08 following the comprehensive medication review. Total costs for patient and third party payers decreased from patients prescribed antilipemics, antihypertensives, GERD and thyroid disorders following a CMR. Conclusions: Pharmacist-provided MTM services were effective at improving medication adherence for some patients managed with chronic medications. Pharmacist-provided MTM services also were effective in decreasing total medication costs.

  19. Site investigation on medical waste management practices in northern Jordan. (United States)

    Abdulla, Fayez; Abu Qdais, Hani; Rabi, Atallah


    This study investigated the medical waste management practices used by hospitals in northern Jordan. A comprehensive inspection survey was conducted for all 21 hospitals located in the study area. Field visits were conducted to provide information on the different medical waste management aspects. The results reported here focus on the level of medical waste segregation, treatment and disposal options practiced in the study area hospitals. The total number of beds in the hospitals was 2296, and the anticipated quantity of medical waste generated by these hospitals was about 1400 kg/day. The most frequently used treatment practice for solid medical waste was incineration. Of these hospitals, only 48% had incinerators, and none of these incinerators met the Ministry of Health (MoH) regulations. As for the liquid medical waste, the survey results indicated that 57% of surveyed hospitals were discharging it into the municipal sewer system, while the remaining hospitals were collecting their liquid waste in septic tanks. The results indicated that the medical waste generation rate ranges from approximately 0.5 to 2.2 kg/bed day, which is comprised of 90% of infectious waste and 10% sharps. The results also showed that segregation of various medical waste types in the hospitals has not been conducted properly. The study revealed the need for training and capacity building programs of all employees involved in the medical waste management.

  20. Flexible medical image management using service-oriented architecture. (United States)

    Shaham, Oded; Melament, Alex; Barak-Corren, Yuval; Kostirev, Igor; Shmueli, Noam; Peres, Yardena


    Management of medical images increasingly involves the need for integration with a variety of information systems. To address this need, we developed Content Management Offering (CMO), a platform for medical image management supporting interoperability through compliance with standards. CMO is based on the principles of service-oriented architecture, implemented with emphasis on three areas: clarity of business process definition, consolidation of service configuration management, and system scalability. Owing to the flexibility of this platform, a small team is able to accommodate requirements of customers varying in scale and in business needs. We describe two deployments of CMO, highlighting the platform's value to customers. CMO represents a flexible approach to medical image management, which can be applied to a variety of information technology challenges in healthcare and life sciences organizations.

  1. Medical group management: a marketing orientation. (United States)

    Bopp, K D; Allcorn, S


    This article considers the pragmatic aspects of conducting a situation/marketing audit for group medical practices. This audit is a key component in the formulation of a competitive strategy and the development of a marketing program. Given are a series of questions that may be used by medical groups to guide assessment of the opportunities and threats present in the environment as well as the strengths and weaknesses of the organization in meeting the environmental challenges. Furthermore, the article provides a framework for thinking about strategy and the variables that should be considered and aligned to achieve effective implementation of strategy. Finally, the parameters are outlined for deciding on a marketing program: the mix of marketing tools (service design, distribution channels, pricing and promotion) that should be employed to offensively and/or defensively position the medical group in the competitive marketplace.

  2. Delinquent Medical Service Accounts at Naval Medical Center Portsmouth Need Additional Management Oversight (United States)


    H 4 , 2 0 1 5 Delinquent Medical Service Accounts at Naval Medical Center Portsmouth Need Additional Management Oversight Report No. DODIG-2015...04 MAR 2015 2. REPORT TYPE 3. DATES COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Delinquent Medical Service Accounts at Naval...of Defense that supports the warfighter; promotes accountability , integrity, and efficiency; advises the Secretary of Defense and Congress; and

  3. Medical and surgical management of priapism (United States)

    Cherian, J; Rao, A R; Thwaini, A; Kapasi, F; Shergill, I S; Samman, R


    Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Pathologically and clinically, two subtypes are seen—the high flow (non‐ischaemic) variety and the low flow (ischaemic) priapism. The low flow type is more dangerous, as these patients are susceptible to greater complications and the long term recovery of erectile function is dependent on prompt and urgent intervention. Many of the causes of priapism are medical, including pharmacological agents, and as such, priapism should be considered as a medical and surgical emergency. PMID:16461470


    Directory of Open Access Journals (Sweden)

    M. H. Dehghani, K. Azam, F. Changani, E. Dehghani Fard


    Full Text Available The management of medical waste is of great importance due to its potential environmental hazards and public health risks. In the past, medical waste was often mixed with municipal solid waste and disposed in residential waste landfills or improper treatment facilities in Iran. In recent years, many efforts have been made by environmental regulatory agencies and waste generators to better managing the wastes from healthcare facilities. This study was carried in 12 educational hospitals of Tehran University of Medical Sciences. The goals of this study were to characterize solid wastes generated in healthcare hospitals, to report the current status of medical waste management and to provide a framework for the safe management of these wastes at the considered hospitals. The methodology was descriptive, cross-sectional and consisted of the use of surveys and interviews with the authorities of the healthcare facilities and with personnel involved in the management of the wastes. The results showed that medical wastes generated in hospitals were extremely heterogeneous in composition. 42% of wastes were collected in containers and plastic bags. In 75% of hospitals, the stay-time in storage sites was about 12-24h. 92% of medical wastes of hospitals were collected by covered-trucks. In 46% of hospitals, transferring of medical wastes to temporary stations was done manually. The average of waste generation rates in the hospitals was estimated to be 4.42kg/bed/day.

  5. Implications of translating research into practice: a medication management intervention. (United States)

    Alkema, Gretchen E; Frey, Dennee


    Through programs such as the Administration on Aging's Evidence-Based Prevention Initiative, researchers and practitioners are developing translational research studies seeking to implement rigorously tested, evidence-based interventions in new practice settings and evaluate the continuing effectiveness of these interventions. One such translational study is the Community-Based Medications Management Intervention (CBM Intervention), a collaborative effort to implement a medication management screening and intervention protocol in community-based waiver care management programs. The overall goals of the CBM Intervention are to implement an evidence-based medication management intervention in a California Medicaid waiver care management program, and to evaluate the effect of client-, intervention-, and organizational-level characteristics on resolving identified medication problems. This article presents the need for improved medication management in a frail, community-dwelling, older adult population and describes the CBM Intervention as an example of translating an evidence-based practice beyond its original efficacy trial in a home healthcare program into a care management program. It discusses critical factors involved in translating research into practice using a translational research framework, Promoting Action on Research Implementation in Health Services (PARIHS). Our experience suggests that although implementing research into practice can positively impact client care, professional skill enhancement and organizational effectiveness, this is very challenging work requiring signification facilitation for successful outcomes.

  6. Making Management Skills a Core Component of Medical Education. (United States)

    Myers, Christopher G; Pronovost, Peter J


    Physicians are being called upon to engage in greater leadership and management in increasingly complex and dynamic health care organizations. Yet, management skills are largely undeveloped in medical education. Without formal management training in the medical curriculum, physicians are left to cultivate their leadership and management abilities through a haphazard array of training programs or simply through trial and error, with consequences that may range from frustration among staff to reduced quality of care and increased risk of patient harm. To address this issue, the authors posit that medical education needs a more systematic focus on topics related to management and organization, such as individual decision making, interpersonal communication, team knowledge sharing, and organizational culture. They encourage medical schools to partner with business school faculty or other organizational scholars to offer a "Management 101" course in the medical curriculum to provide physicians-in-training with an understanding of these topics and raise the quality of physician leadership and management in modern health care organizations.

  7. Medical Management of Chemical Toxicity in Pediatrics (United States)


    1995; Guyton and Hall, 2005). Poiseuille’s law provides a relationship between flow rate and radius of the tube (F=Prcr4/Snl), where n is the...of Turkey: a study of 106 cases. Environ. Res. 88: 89-93. Guyton , A.C., Hall, lE. (2005). Textbook of Medical Physiology, 11th edition. W.B

  8. Quantitative techniques for medical equipment maintenance management

    NARCIS (Netherlands)

    Ben Houria, Zeineb; Masmoudi, Malek; Al Hanbali, Ahmad; Khatrouch, Ikram; Masmoudi, Faouzi


    The maintenance department in a hospital is responsible for ensuring the safety of medical equipment and their availability while keeping the operation costs minimal. The selection of the best maintenance strategy is a key decision to reduce the equipment downtime, increase the availability, and bri

  9. Movement Disorders: A Brief Guide in Medication Management. (United States)

    Julius, Anthony; Longfellow, Katelan


    Movement disorders can be challenging to manage and often use a specific set of medications. Because it is a complex and broad field within neurology, many providers are unfamiliar with the classes of medications. This paper details medications used for specific conditions, explains why these medications are helpful, and shares pearls and pitfalls related to each agent, focusing on parameters such as dose titration, side effect profiles, and specific drug-drug interactions and challenges. We focus on the most commonly encountered movement disorders, including essential tremor, Parkinson's disease, rapid eye movement sleep behavior disorder, and restless leg syndrome.

  10. Multiple 3D medical data watermarking for healthcare data management. (United States)

    Lee, Suk-Hwan; Kwon, Ki-Ryong


    The rapid development of healthcare information management for 3D digital medical libraries, 3D PACS, and 3D medical diagnosis has addressed the security issues pertaining to medical IT technology. This paper presents multiple watermarking schemes for a healthcare information management system for 3D medical image data for the protection, authentication, indexing, and hiding of diagnosis information. The proposed scheme, which is based on POCS watermarking, embeds a robust watermark for a doctor's digital signature and an information retrieval indexing key to the distribution of vertex curvedness; the scheme also embeds a fragile watermark for diagnosis information and an authentication reference message to the vertex distance difference. The multiple embedding process creates three convex sets for robustness, fragileness, and invisibility and projects the 3D medical image data onto these three convex sets alternately and iteratively. Experimental results confirmed that the proposed scheme has the robustness and fragileness to handle various 3D geometric and mesh modifiers simultaneously.

  11. Medical Professionals Designing Hospital Management Models

    DEFF Research Database (Denmark)

    Byg, Vibeke

    Health care administration in many OECD countries has undergone substantial changes in recent years as a consequence of NPM reforms, rising costs, the pace of technological innovation, heightened competition for patients and resources, quality of managed care and demographic shifts. Hospitals...... especially have been reformed due to the high proportion of resources they absorb and the apparent difficulty of prioritizing and coordinating health care within hospitals. There is abundant research literature on the topic of reforming hospital management models. Lacking from the literature, however...... adapt, interpret and negotiate hospital management over time in relation to changing hospital management models in hospital organizations in the Nordic health system context, illustrated by the Danish health system....

  12. 某医学院大学生攻击行为现状分析%Status analysis of aggressive behavior among college students in a medical college

    Institute of Scientific and Technical Information of China (English)

    谭兴秀; 程欢; 陈兰; 黄苹; 庞佳; 罗秀


    Objective To explore the current situation of aggressive behavior among undergraduates ,in order to provide reference for college students′psychological health intervention. A total of 1 105 questionnaires were issued ,and 983 effective questionnaires were returnet. Methods Aggressive behavior questionnaire (AQ) was adopted among students from 13 classes in three years of freshmen,sophomore and junior in a medical college to investigate the current status of aggressive behavior by strat-ified sampling. Results All the students in this survey had a certain degree of aggression,and 83.93%(825/983) of the students showed aggressive behavior of medium level and above;among college students with different attack dimension or midium-level a-gression and above,the students chose verbal aggression accounted for 88.61%(871/983),and the students with physical aggres-sion account for 59.61%(589/983);there were gender differences and grade differences of college students′aggressive behavior on the total average and dimensionality with statistical significance (P<0.05),and it still had to make further study of whether there were major differences. Conclusion Gender and grade are predictive variables of aggressive behavior ,so the intervention of ag-gressive behavior should combine gender and grade systematically.%目的:探讨大学生攻击行为的现状,为大学生心理卫生干预提供参考。方法采用攻击行为问卷(AQ),按照分层抽样的方法,在某医学院校大一、大二、大三3个年级分别随机抽取13个班级的学生进行攻击行为现状调查,共发放调查问卷1105份,回收有效问卷983份。结果被调查的所有大学生均呈现出一定程度的攻击倾向,且83.93%(825/983)的大学生表现出中度及以上的攻击行为;在不同攻击维度、中度及以上攻击倾向的大学生中,选择言语攻击的大学生88.61%(871/983),选择身体攻击的大学生59.61%(586/983);大

  13. Self-management of medical abortion: a qualitative evidence synthesis. (United States)

    Wainwright, Megan; Colvin, Christopher J; Swartz, Alison; Leon, Natalie


    Medical abortion is a method of pregnancy termination that by its nature enables more active involvement of women in the process of managing, and sometimes even administering the medications for, their abortions. This qualitative evidence synthesis reviewed the global evidence on experiences with, preferences for, and concerns about greater self-management of medical abortion with lesser health professional involvement. We focused on qualitative research from multiple perspectives on women's experiences of self-management of first trimester medical abortion (data from these studies, and synthesized review findings. Review findings were organized under the following themes: general perceptions of self-management, preparation for self-management, logistical considerations, issues of choice and control, and meaning and experience. The synthesis highlights that the qualitative evidence base is still small, but that the available evidence points to the overall acceptability of self-administration of medical abortion. We highlight particular considerations when offering self-management options, and identify key areas for future research. Further qualitative research is needed to strengthen this important evidence base.

  14. [The medical management of Cushing's syndrome]. (United States)

    Leal-Cerro, Alfonso; Soto Moreno, Alfonso; Mangas, Miguel Angel; León Justel, Antonio; Webb, Susan


    Cushing's syndrome results from prolonged exposure to excessive circulating glucocorticosteroids and is associated with significant morbidity and mortality. While the treatment of choice in most patients is surgical, the metabolic consequences of this syndrome, including hypertension and diabetes mellitus, increase the risks of such surgery. Hypercortisolemia and its sequelae can be efficiently reversed or controlled using medical therapy, either as a temporary measure prior to definitive treatment or as a longer-term treatment in some particularly difficult cases. Drug treatment has been targeted at the hypothalamic/pituitary level, the adrenal glands and at glucocorticoid receptors. The present review discusses the pharmacotherapeutic agents that have been used in Cushing's syndrome and the criteria for their use, as well as recent drugs that may improve the medical treatment of this complex endocrinological disorder in the future. Finally, the short-and long-term follow-up of patients with Cushing's syndrome after surgery is also discussed.

  15. Understanding and managing medication in elderly people. (United States)

    Lonsdale, Dagan O; Baker, Emma H


    Ageing alters drug handling by the body (pharmacokinetics) and response to medications (pharmacodynamics). Multiple comorbidities increase the risk of adverse drug reactions and medication burden, with increased potential for drug interactions. Elderly people are seldom included in clinical trials, so underestimation of benefits and overestimation of risk may lead to under-treatment. Cognitive and functional changes associated with ageing may make it difficult for elderly people to adhere to treatment regimens. In this review, we consider these issues, with particular reference to drugs prescribed for gynaecology patients (the 'gynaecology formulary'). It will focus on key areas of gynaecological practice, including prescribing anticholinergic drugs, hormone treatments and anticancer drugs, and perioperative issues relating to anaesthesia, analgesia and anticoagulation. Implications of common comorbidities, including osteoporosis, diabetes mellitus and cardiovascular disease, for prescribing in gynaecological patients will also be considered.

  16. Attitudes of medical students to medical leadership and management: a systematic review to inform curriculum development

    Directory of Open Access Journals (Sweden)

    Abbas Mark R


    Full Text Available Abstract Background There is a growing acknowledgement that doctors need to develop leadership and management competences to become more actively involved in the planning, delivery and transformation of patient services. We undertook a systematic review of what is known concerning the knowledge, skills and attitudes of medical students regarding leadership and management. Here we report the results pertaining to the attitudes of students to provide evidence to inform curriculum development in this developing field of medical education. Methods We searched major electronic databases and citation indexes within the disciplines of medicine, education, social science and management. We undertook hand searching of major journals, and reference and citation tracking. We accessed websites of UK medical institutions and contacted individuals working within the field. Results 26 studies were included. Most were conducted in the USA, using mainly quantitative methods. We used inductive analysis of the topics addressed by each study to identity five main content areas: Quality Improvement; Managed Care, Use of Resources and Costs; General Leadership and Management; Role of the Doctor, and Patient Safety. Students have positive attitudes to clinical practice guidelines, quality improvement techniques and multidisciplinary teamwork, but mixed attitudes to managed care, cost containment and medical error. Education interventions had variable effects on students' attitudes. Medical students perceive a need for leadership and management education but identified lack of curriculum time and disinterest in some activities as potential barriers to implementation. Conclusions The findings from our review may reflect the relatively little emphasis given to leadership and management in medical curricula. However, students recognise a need to develop leadership and management competences. Although further work needs to be undertaken, using rigorous methods, to identify

  17. Occurrence of lactational mastitis and medical management

    DEFF Research Database (Denmark)

    Scott, Jane A.; Robertson, Michele; Fitzpatrick, Julie


    BACKGROUND: Lactational mastitis is a painful, debilitating condition that if inappropriately managed, may lead women to discontinue breastfeeding prematurely. The aim of this paper is to report the incidence of mastitis in the first six months postpartum in a Scottish population, its impact on b...

  18. Analysis of Medical Equipment Management in Relation to the Mandatory Medical Equipment Safety Manager (MESM in Japan

    Directory of Open Access Journals (Sweden)

    Kai Ishida


    Full Text Available Half a decade has passed since the fifth revision of the medical law and mandatory appointment of a medical equipment safety manager (MESM in hospitals in Japan. During this period, circumstances have changed regarding maintenance of medical equipment (ME. We conducted a survey to examine these changes and the current situation in ME management. Maintenance of ME and related work were found to have increased in many hospitals, but the number of clinical engineering technologists (CETs has only slightly increased. The appointed MESM was a CET or physician in most hospitals. In hospitals where physicians were appointed as the MESM, 81% had operation managers. Many respondents commented that it was difficult for one person to cover all the tasks required by the MESM, due to a lack of knowledge, too much work, or other reasons. This suggests the importance of an operation manager for ME to work under the MESM.

  19. Evaluation of Medical Faculty Students's Time Management Skills

    Directory of Open Access Journals (Sweden)

    Umit Yavas


    Full Text Available SUMMARY AIM: This study was carried out in order to determine medical faculty students� time management skills. METHOD: This is a cross sectional study and was carried out between 13 -31 May 2010. The universe of the study comprised 513 medical faculty students and data collection was performed by using the Time Management Inventory (TMI from 420 students (%81,9 of the universe. For statistical analyses of data percentage, Kruskal-Wallis, One-way Anova, Mann-Whitney U, Student-t test and Pearson correlation analysis were used. RESULTS: Students� total time management points were minimum 44 and maximum 122. Total points� mean was 79,06±14,07 and also the median was 78 of Time Management Inventory. Total time management points of the fifth class students were higher than the others. There was no correlation between total time management points and ages of the students. Also there is no statistically significant difference between the males and females at the TMI points. CONCLUSION: According to the other studies the medical faculty students� total TMI mean points are low. The reason of this situation may be the pension school that someone else is planning most of students� time and inadequacy of awareness, knowledge and skills about time management. Enhancing awareness with useful knowledge and being full of resource about time management is essential. [TAF Prev Med Bull 2012; 11(1.000: 5-10

  20. MIRMAID: A Content Management System for Medical Image Analysis Research. (United States)

    Korfiatis, Panagiotis D; Kline, Timothy L; Blezek, Daniel J; Langer, Steve G; Ryan, William J; Erickson, Bradley J


    Today, a typical clinical study can involve thousands of participants, with imaging data acquired over several time points across multiple institutions. The additional associated information (metadata) accompanying these data can cause data management to be a study-hindering bottleneck. Consistent data management is crucial for large-scale modern clinical imaging research studies. If the study is to be used for regulatory submissions, such systems must be able to meet regulatory compliance requirements for systems that manage clinical image trials, including protecting patient privacy. Our aim was to develop a system to address these needs by leveraging the capabilities of an open-source content management system (CMS) that has a highly configurable workflow; has a single interface that can store, manage, and retrieve imaging-based studies; and can handle the requirement for data auditing and project management. We developed a Web-accessible CMS for medical images called Medical Imaging Research Management and Associated Information Database (MIRMAID). From its inception, MIRMAID was developed to be highly flexible and to meet the needs of diverse studies. It fulfills the need for a complete system for medical imaging research management.

  1. Quality management for the processing of medical devices. (United States)

    Klosz, Kerstin


    Rules on the reprocessing of medical devices were put into place in Germany in 2001. The present article explains the background situation and the provisions that are currently in force.The implementation of these statutory requirements is described using the example of the quality management system of Germany's market leader, Vanguard AG. This quality management system was successfully certified pursuant to DIN EN ISO 13485:2003 for the scope "reprocessing of medical devices", including class "critical C", in accordance with the recommendation of the Commission for Hospital Hygiene and the Prevention of Infection at the Robert-Koch-Institute (RKI) and the German Federal Institute for Drugs and Medical Devices (BfArM) on the "Hygiene requirements for reprocessing of medical devices".

  2. Quality assurance in military medical research and medical radiation accident management. (United States)

    Hotz, Mark E; Meineke, Viktor


    The provision of quality radiation-related medical diagnostic and therapeutic treatments cannot occur without the presence of robust quality assurance and standardization programs. Medical laboratory services are essential in patient treatment and must be able to meet the needs of all patients and the clinical personnel responsible for the medical care of these patients. Clinical personnel involved in patient care must embody the quality assurance process in daily work to ensure program sustainability. In conformance with the German Federal Government's concept for modern departmental research, the international standard ISO 9001, one of the relevant standards of the International Organization for Standardization (ISO), is applied in quality assurance in military medical research. By its holistic approach, this internationally accepted standard provides an excellent basis for establishing a modern quality management system in line with international standards. Furthermore, this standard can serve as a sound basis for the further development of an already established quality management system when additional standards shall apply, as for instance in reference laboratories or medical laboratories. Besides quality assurance, a military medical facility must manage additional risk events in the context of early recognition/detection of health risks of military personnel on deployment in order to be able to take appropriate preventive and protective measures; for instance, with medical radiation accident management. The international standard ISO 31000:2009 can serve as a guideline for establishing risk management. Clear organizational structures and defined work processes are required when individual laboratory units seek accreditation according to specific laboratory standards. Furthermore, international efforts to develop health laboratory standards must be reinforced that support sustainable quality assurance, as in the exchange and comparison of test results within

  3. Occurrence of lactational mastitis and medical management

    DEFF Research Database (Denmark)

    Scott, Jane A.; Robertson, Michele; Fitzpatrick, Julie;


    BACKGROUND: Lactational mastitis is a painful, debilitating condition that if inappropriately managed, may lead women to discontinue breastfeeding prematurely. The aim of this paper is to report the incidence of mastitis in the first six months postpartum in a Scottish population, its impact...... questionnaire before discharge from hospital. Cases of mastitis were reported either directly to the researchers or were detected during regular follow-up telephone interviews at weeks 3, 8, 18 and 26. Women experiencing mastitis provided further information of their symptoms and the management and advice...... they received from health professionals. RESULTS: In total, 74 women (18%) experienced at least one episode of mastitis. More than one half of initial episodes (53%) occurred within the first four weeks postpartum. One in ten women (6/57) were inappropriately advised to either stop breastfeeding from...

  4. Monitors Enable Medication Management in Patients' Homes (United States)


    Glenn Research Center awarded SBIR funding to ZIN Technologies to develop a platform that could incorporate sensors quantifying an astronaut’s health status and then communicate with the ground. ZIN created a device, developed the system further, and then formed Cleveland-based FlexLife Health to commercialize the technology. Today it is part of an anti-coagulation management system for people with cardiovascular disease.

  5. Medical management of youth baseball and softball tournaments. (United States)

    Kanaan, Matthew; Ray, Tracy R


    The medical management of youth baseball and softball tournaments requires both proper planning and a basic awareness of commonly seen sport-specific injuries. While youth sporting events are designed to be a fun experience for all, injuries and emergencies will occur. With proper planning, and supplies, the impact of these issues can be minimized. This article will outline some basic principles for the medical personnel that may be involved in youth baseball and softball events.

  6. Evaluating an interprofessional disease state and medication management review model. (United States)

    Hoti, Kreshnik; Forman, Dawn; Hughes, Jeffery


    There is lack of literature data reporting an incorporation of medication management reviews in students' interprofessional education (IPE) and practice programs in aged care settings. This pilot study reports how an interprofessional disease state and medication management review program (DSMMR) was established in a residential aged care facility in Perth, Western Australia. Students from the professions of nursing, pharmacy and physiotherapy focused on a wellness check in the areas of cognition, falls and continence while integrating a medication management review. Students' attitudes were explored using a pre- and post-placement questionnaire. Students indicated positive experience with the IPE DSMMR program which also resulted in their positive attitudinal shift towards IPE and practice. These findings indicated that aged care can be a suitable setting for student interprofessional programs focusing on DSMMR.

  7. The problem mastoid cavity: medical and surgical management. (United States)

    Kinney, S E


    The patient with persistent foul drainage from a previously operated-on mastoid cavity has a serious problem that requires aggressive attention from the otologic surgeon. The ear must be carefully evaluated in the office. Careful cleaning of the cavity and effective application of medication will dry up many of these cavities. Revision surgery of the ear requires a systematic approach using all the techniques of modern otologic surgery. This means the use of a post-auricular incision and wide bone removal combined with bone removal combined with obliteration techniques and grafting of the middle ear. This approach was used in 29 ears in 27 patients. Rapid healing and a trouble-free, dry ear was obtained in 26 patients or 90% of the operated-on cases.

  8. Kaposi sarcoma: review and medical management update. (United States)

    Fatahzadeh, Mahnaz


    Despite recent advances in our understanding of pathogenic mechanisms involved, the true nature of Kaposi sarcoma remains an enigma. Four clinical variants have been described for the disease, differing in natural history, site of predilection, and prognosis. All forms of Kaposi sarcoma may manifest in the oral cavity and Kaposi sarcoma-associated virus appears essential to development of all clinical variants. The spectrum of therapeutic strategies is broad and selection of appropriate intervention mandates a thorough understanding of disease spread and the patient's symptomatology, as well as risks and benefits of therapy. This article provides an overview of epidemiology, subtypes, clinical course, pathogenesis, and management strategies for Kaposi sarcoma.

  9. Performance appraisal: helpful hints for the busy medical practice manager. (United States)

    Bolon, Douglas S


    This article describes the performance appraisal process in terms of its three fundamental steps. defining job performance, measuring actual job performance, and providing job performance feedback. Given that most practice managers wear many hats and do not have extensive experience or staff support in human resources, the purpose of this article is to provide these busy individuals with useful, practical suggestions that should enhance the effectiveness of the performance appraisal process for nonphysician employees within the medical practice setting. Performance appraisal should be a priority for all practice managers, as the performance of individual employees represents the key to long-term success for any medical practice.

  10. Medical management of ischemic heart disease. (United States)

    Timmis, G C


    Medical therapy primarily affects myocardial oxygen demands. Nitrates and other vasodilators decrease filling pressure, ventricular diastolic volume and to some extent, impedance to ventricular emptying. Beta blockers decrease myocardial contractility and heart rate through a reduction of sympathetic neural traffic. Afterload reduction by the control of hypertension and preload reduction via the LaPlace relationship through reversal of congestive failure are critical for successful therapy. Modification of smoking habits and personality traits with renunciation of a sedentary life-style are also therapeutically useful. While increases in myocardial blood flow have depended primarily on surgical revascularization procedures, calcium antagonists such as nifedipine have been shown to affect flow by reversing vasospasm, which has been recognized with increasing frequency as a concomitant of even fixed coronary arterial disease. The first therapy, however, is diet since it affects both the supply and demand sides of myocardial oxygen balance. Reduction of body bulk decreases myocardial oxygen demand since both vary in obligate parallel. Religious abstention from saturated fats and cholesterol-containing foods, especially by those with pre-existing coronary heart disease, may arrest the otherwise inexorable deterioration.

  11. The Simpson grading revisited: aggressive surgery and its place in modern meningioma management. (United States)

    Gousias, Konstantinos; Schramm, Johannes; Simon, Matthias


    OBJECTIVE Recent advances in radiotherapy and neuroimaging have called into question the traditional role of aggressive resections in patients with meningiomas. In the present study the authors reviewed their institutional experience with a policy based on maximal safe resections for meningiomas, and they analyzed the impact of the degree of resection on functional outcome and progression-free survival (PFS). METHODS The authors retrospectively analyzed 901 consecutive patients with primary meningiomas (716 WHO Grade I, 174 Grade II, and 11 Grade III) who underwent resections at the University Hospital of Bonn between 1996 and 2008. Clinical and treatment parameters as well as tumor characteristics were analyzed using standard statistical methods. RESULTS The median follow-up was 62 months. PFS rates at 5 and 10 years were 92.6% and 86.0%, respectively. Younger age, higher preoperative Karnofsky Performance Scale (KPS) score, and convexity tumor location, but not the degree of resection, were identified as independent predictors of a good functional outcome (defined as KPS Score 90-100). Independent predictors of PFS were degree of resection (Simpson Grade I vs II vs III vs IV), MIB-1 index (10%), histological grade (WHO I vs II vs III), tumor size (≤ 6 vs > 6 cm), tumor multiplicity, and location. A Simpson Grade II rather than Grade I resection more than doubled the risk of recurrence at 10 years in the overall series (18.8% vs 8.5%). The impact of aggressive resections was much stronger in higher grade meningiomas. CONCLUSIONS A policy of maximal safe resections for meningiomas prolongs PFS and is not associated with increased morbidity.

  12. Medical management of obesity in Scandinavia 2016

    DEFF Research Database (Denmark)

    Tonstad, Serena; Rössner, Stephan; Rissanen, Aila


    ), with a long-term reduction in risk of type 2 diabetes (T2D). The GLP-agonist liraglutide enhances satiety and produces weight loss of 5e7% over 6 months to 2 years, reducing comorbidities. A naltrexone/bupropion combination produces 3e5% weight loss, and reduces risk of T2D. A class of sodium-glucose co......-transporter type 2 (SGLT2) inhibitor approved for the management of T2D also produces a weight loss (2e4% over 3e6 months) by increased excretion of urinary glucose. Conclusion: The available non-pharmacological agents produce clinically relevant weight loss, but studies are small and adverse effects are not well...

  13. Management of expatriate medical assistance in Mozambique

    Directory of Open Access Journals (Sweden)

    Vio Ferruccio


    Full Text Available Abstract This paper discusses how Mozambique coped with the health system needs in terms of specialized doctors since independence, in a troubled context of war, lack of financial resources and modifying settings of foreign aid. The Ministry of Health (MOH managed to make up for its severe scarcity of specialist MDs especially through contracting expatriate technical assistance. Different scenarios, partnerships and contract schemes that have evolved since independence are briefly described, as well as self-reliance option possibility and implications. Lessons learned about donor initiatives aimed at contracting specialists from other developing countries are singled out. The issue of obtaining expertise and knowledge in the global market as cheap as possible is stressed, and realistic figures of cost planning are highlighted, as determined by the overall health system necessities and budget limitations.

  14. Medical management of human immunodeficiency virus infection

    Directory of Open Access Journals (Sweden)

    Kempen John


    Full Text Available The human immunodeficiency virus (HIV/ acquired immune deficiency syndrome (AIDS pandemic has pervasive effects on culture, economics, policy, and human development. All organs can be affected by complications of HIV/AIDS, including the eye. When sufficient resources are available and widespread antiretroviral resistance does not exist, the four available classes of antiretroviral agents - nucleoside/nucleotide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and fusion inhibitors - can be combined to provide highly active antiretroviral therapy (HAART. For many (not all patients, HAART converts an inexorably fatal disease into a chronic disease with a fairly good prognosis. Use of HAART often induces partial immune recovery, which has predominantly beneficial effects on ocular complications of AIDS. However, HAART-induced immune recovery sometimes results in immune recovery inflammatory syndromes, such as immune recovery uveitis. Use of HAART is the single most useful intervention for most patients with ocular complications of AIDS. However, specific ocular therapy is also critical to avoid blindness in the early months before immune recovery can occur, or if HAART is unavailable. Increasing availability of HAART worldwide shows great promise to alleviate one of the world′s greatest plagues. However, predictable secular trends in the AIDS epidemic make it likely that the number of cases of ocular complications of AIDS will increase substantially before they decrease. Ophthalmologists worldwide should be familiar with the diagnosis and management of cytomegalovirus retinitis - the most common ocular complication of AIDS - and should establish partnerships with physicians who are able to provide HAART. Research is needed to determine the optimal approach for managing cytomegalovirus retinitis in resource-constrained settings.

  15. Revolutionary advances in medical waste management. The Sanitec system. (United States)

    Edlich, Richard F; Borel, Lise; Jensen, H Gordon; Winters, Kathryne L; Long, William B; Gubler, K Dean; Buschbacher, Ralph M; Becker, Daniel G; Chang, Dillon E; Korngold, Jonathan; Chitwood, W Randolph; Lin, Kant Y; Nichter, Larry S; Berenson, Susan; Britt, L D; Tafel, John A


    It is the purpose of this collective review to provide a detailed outline of a revolutionary medical waste disposal system that should be used in all medical centers in the world to prevent pollution of our planet from medical waste. The Sanitec medical waste disposal system consists of the following seven components: (1) an all-weather steel enclosure of the waste management system, allowing it to be used inside or outside of the hospital center; (2) an automatic mechanical lift-and-load system that protects the workers from devastating back injuries; (3) a sophisticated shredding system designed for medical waste; (4) a series of air filters including the High Efficiency Particulate Air (HEPA) filter; (5) microwave disinfection of the medical waste material; (6) a waste compactor or dumpster; and (7) an onboard microprocessor. It must be emphasized that this waste management system can be used either inside or outside the hospital. From start to finish, the Sanitec Microwave Disinfection system is designed to provide process and engineering controls that assure complete disinfection and destruction, while minimizing the operator's exposure to risk. There are numerous technologic benefits to the Sanitec systems, including environmental, operational, physical, and disinfection efficiency as well as waste residue disinfection. Wastes treated through the Sanitec system are thoroughly disinfected, unrecognizable, and reduced in volume by approximately 80% (saving valuable landfill space and reducing hauling requirements and costs). They are acceptable in any municipal solid waste program. Sanitec's Zero Pollution Advantage is augmented by a complete range of services, including installation, startup, testing, training, maintenance, and repair, over the life of this system. The Sanitec waste management system has essentially been designed to provide the best overall solution to the customer, when that customer actually looks at the total cost of dealing with the

  16. Healthcare managers' construction of the manager role in relation to the medical profession. (United States)

    von Knorring, Mia; Alexanderson, Kristina; Eliasson, Miriam A


    Purpose - The purpose of this paper is to explore how healthcare managers construct the manager role in relation to the medical profession in their organisations. Design/methodology/approach - In total, 18 of Sweden's 20 healthcare chief executive officers (CEOs) and 20 clinical department managers (CDMs) were interviewed about their views on management of physicians. Interviews were performed in the context of one aspect of healthcare management; i.e., management of physicians' sickness certification practice. A discourse analysis approach was used for data analysis. Findings - Few managers used a management-based discourse to construct the manager role. Instead, a profession-based discourse dominated and managers frequently used the attributes "physician" or "non-physician" to categorise themselves or other managers in their managerial roles. Some managers, both CEOs and CDMs, shifted between the management- and profession-based discourses, resulting in a kind of "yes, but […]" approach to management in the organisations. The dominating profession-based discourse served to reproduce the power and status of physicians within the organisation, thereby rendering the manager role weaker than the medical profession for both physician and non-physician managers. Research limitations/implications - Further studies are needed to explore the impact of gender, managerial level, and basic profession on how managers construct the manager role in relation to physicians. Practical implications - The results suggest that there is a need to address the organisational conditions for managers' role taking in healthcare organisations. Originality/value - Despite the general strengthening of the manager position in healthcare through political reforms during the last decades, this study shows that a profession-based discourse clearly dominated in how the managers constructed the manager role in relation to the medical profession on the workplace level in their organisations.

  17. Medical management of the patient with cardiovascular disease. (United States)

    Mask, A G


    Cigarette smoking, hypertension, hypercholesterolemia, and periodontal disease have been established as major risk factors for cardiovascular disease. Dentists and physicians should work aggressively to educate periodontitis patients about this relationship in an effort to improve the quality of health and contribute to their long-term survival. Blood pressure should be checked at the initial dental visit and at each subsequent visit in patients whose blood pressure is found to be high and/or has a history of hypertension. Dental and medical assistants should receive in-service training to assure competency in measuring blood pressures. All staff should be certified in basic cardiopulmonary resuscitation. Emergency protocol procedures should be in writing and rehearsed regularly. Patients should take their blood pressure medication as usual on the day of the dental procedure. It is helpful for the patients to bring all medications to the office for review at the time of the dental procedure. Good communication should be established between the dentist and physician to maximize good dental and physical health. Because the patient with periodontal disease is at an increased risk for cardiovascular disease, a standardized form should be developed for the convenient exchange of vital information, including but not limited to: blood pressure, medications, allergies, medical conditions and pertinent highlights of dental procedures. Minimize stress in patients with coronary artery disease. This includes providing solid local anesthesia, avoidance of intravascular medication injections, and encouraging relaxation techniques. Antibiotic prophylaxis is indicated in patients with valvular heart disease but does not guarantee the prevention of endocarditis. These patients should be alerted to monitor any symptoms such as fever, chills or shortness of breath. It has also been documented that toothbrushing, flossing and home plaque removers can cause transient bacteremia in

  18. Stress Management in Medical Education: A Review of the Literature. (United States)

    Shapiro, Shauna L.; Shapiro, Daniel E.; Schwartz, Gary E. R.


    Review of clinical studies providing empirical data on stress management programs in medical education found that student participants in such programs demonstrated improved immunologic functioning, decreased depression and anxiety, increased spirituality and empathy, enhanced knowledge of alternative therapies, improved knowledge of stress…

  19. Ohio Medical Office Management. Technical Competency Profile (TCP). (United States)

    Ray, Gayl M.; Wilson, Nick; Mangini, Rick

    This document provides a framework for a broad-based secondary and postsecondary curriculum to prepare students for employment in medical office management. The first part of the technical competency profile (TCP) contains the following items: an explanation of the purpose and scope of Ohio's TCPs; college tech prep program standards; an overview…

  20. Medical School Education in Hypertension Management: A National Survey. (United States)

    Moser, Marvin; And Others


    The management of patients with primary hypertension remains a significant problem for the medical profession. In spite of this, specific programs for education in hypertensive vascular disease have been poorly organized. A survey to determine the level of training in this discipline is discussed. (MLW)

  1. Management of the Patient with Aggressive and Resistant Papillary Thyroid Carcinoma (United States)

    Miftari, Rame; Topçiu, Valdete; Nura, Adem; Haxhibeqiri, Valdete


    Purpose: Papillary carcinoma is the most frequent type of thyroid cancer and was considered the most benign of all thyroid carcinomas, with a low risk of distant metastases. However, there are some variants of papillary thyroid carcinoma that have affinity to spread in many organs, such as: lymph nodes, lungs and bones. Aim: The aim of this study was presentation of a case with papillary carcinoma of the thyroid gland, very persistent and resistant in treatment with I 131. Material and results: A man 56 years old were diagnosed with papillary carcinoma of thyroid gland. He underwent a surgical removal of the tumor and right lobe of thyroid gland. With histopathology examination, were confirmed follicular variant of papillary carcinoma pT4. Two weeks later he underwent total thyroidectomy and was treated with 100 mCi of J 131. Six months later, the value of thyroglobulin was found elevated above upper measured limits (more than 500 ng/ml). Patient underwent surgical removal of 10 metastatic lymph nodes in the left side of the neck and has been treated with 145 mCi of radioiodine I 131. The examination after 5 months shows elevation of thyroglobulin, more than 20000 ng/ml and focally uptake of J 131 in the left lung. Patient was treated once again with 150 mCi radioiodine J 131. Whole body scintigraphy was registered focal uptake of radioiodine in the middle of the left collarbone. After a month, patient refers the enlargement of the lymph node in the right side of the neck. Currently patient is being treated with kinase inhibitor drug sorafenib and ibandronate. We have identified first positive response in treatment. Enlarged lymph node in the neck was reduced and the patient began feeling better. Conclusion: This study suggests that some subtypes of papillary thyroid carcinoma appear to have more aggressive biological course. Subtypes of papillary thyroid carcinoma such as diffuse sclerosing carcinoma, tall cell or columnar cell and insular variants, appears to

  2. Medical Emergency Team syndromes and an approach to their management (United States)

    Jones, Daryl; Duke, Graeme; Green, John; Briedis, Juris; Bellomo, Rinaldo; Casamento, Andrew; Kattula, Andrea; Way, Margaret


    Introduction Most literature on the medical emergency team (MET) relates to its effects on patient outcome. Less information exists on the most common causes of MET calls or on possible approaches to their management. Methods We reviewed the calling criteria and clinical causes of 400 MET calls in a teaching hospital. We propose a set of minimum standards for managing a MET review and developed an approach for managing common problems encountered during MET calls. Results The underlying reasons for initiating MET calls were hypoxia (41%), hypotension (28%), altered conscious state (23%), tachycardia (19%), increased respiratory rate (14%) and oliguria (8%). Infection, pulmonary oedema, and arrhythmias featured as prominent causes of all triggers for MET calls. The proposed minimum requirements for managing a MET review included determining the cause of the deterioration, documenting the events surrounding the MET, establishing a medical plan and ongoing medical follow-up, and discussing the case with the intensivist if certain criteria were fulfilled. A systematic approach to managing episodes of MET review was developed based on the acronym 'A to G': ask and assess; begin basic investigations and resuscitation, call for help if needed, discuss, decide, and document, explain aetiology and management, follow-up, and graciously thank staff. This approach was then adapted to provide a management plan for episodes of tachycardia, hypotension, hypoxia and dyspnoea, reduced urinary output, and altered conscious state. Conclusion A suggested approach permits audit and standardization of the management of MET calls and provides an educational framework for the management of acutely unwell ward patients. Further evaluation and validation of the approach are required. PMID:16507153

  3. Teacher Classroom Management Practices: Effects on Disruptive or Aggressive Student Behavior (United States)

    Oliver, Regina M.; Wehby, Joseph H.; Reschly, Daniel J.


    Despite the large research base grounded in behavioral theory for strategies to increase appropriate behavior and prevent or decrease inappropriate behavior in the classroom, a systematic review of multi-component universal classroom management research is necessary to establish the effects of teachers' universal classroom management approaches.…

  4. Medical ethics and new public management in Sweden. (United States)

    Hansson, Sven Ove


    In order to shorten queues to healthcare, the Swedish government has introduced a yearly "queue billion" that is paid out to the county councils in proportion to how successful they are in reducing queues. However, only the queues for first visits are covered. Evidence has accumulated that queues for return visits have become longer. This affects the chronically and severely ill. Swedish physicians, and the Swedish Medical Association, have strongly criticized the queue billion and have claimed that it conflicts with medical ethics. Instead they demand that their professional judgments on priority setting and medical urgency be respected. This discussion provides an interesting illustration of some of the limitations of new public management and also more generally of the complicated relationships between medical ethics and public policy.

  5. Medical Data Manager an Interface between PACS and the gLite Data Management System

    CERN Document Server

    Montagnat, Johan; Texier, Romain; Nienartowicz, Krzysztof; Baud, Jean-Philippe


    The medical imaging community uses the DICOM image format and protocol to store and exchange data. The Medical Data Manager (MDM) is an interface between DICOM compliant systems such as PACS and the EGEE Data Management System. It opens hospital imaging networks to the world scale Grid while protecting sensitive medical data. It can be accessed transparently from any gLite service. It is an important milestone towards adoption of Grid technologies in the medical imaging community. Hospitals continuously produce tremendous amounts of image data that is managed by local PACS (Picture Archiving and Communication Systems). These systems are often limited to a local network access although the community experiences a growing interest for data sharing and remote processing. Indeed, patient data is often spread out different medical data acquisition centers. Furthermore, researchers in the area often need to analyze large populations whose data can be gathered through federations of PACS. Opening PACS to the outer I...

  6. Medication therapy management clinic: perception of healthcare professionals in a University medical center setting

    Directory of Open Access Journals (Sweden)

    Shah M


    Full Text Available Objective: To determine the overall perception and utilization of the pharmacist managed medication therapy management (MTM clinic services, by healthcare professionals in a large, urban, university medical care setting.Methods: This was a cross-sectional, anonymous survey sent to 195 healthcare professionals, including physicians, nurses, and pharmacists at The University of Illinois Outpatient Care Center to determine their perception and utilization of the MTM clinic. The survey consisted of 12 questions and was delivered through a secure online application. Results: Sixty-two healthcare professionals (32% completed the survey. 82% were familiar with the MTM clinic, and 63% had referred patients to the clinic. Medication adherence and disease state management was the most common reason for referral. Lack of knowledge on the appropriate referral procedure was the prominent reason for not referring patients to the MTM clinic. Of the providers that were aware of MTM services, 44% rated care as ‘excellent’, 44% as ‘good’, 5% as ‘fair’, and 0% stated ‘poor’. Strengths of MTM clinic identified by healthcare providers included in-depth education to patients, close follow-up, and detailed medication reconciliation provided by MTM clinic pharmacists. Of those familiar with MTM clinic, recommendations included; increase marketing efforts to raise awareness of the MTM clinic service, create collaborative practice agreements between MTM pharmacists and physicians, and ensure that progress notes are more concise.Conclusion: In a large, urban, academic institution MTM clinic is perceived as a valuable resource to optimize patient care by providing patients with in-depth education as it relates to their prescribed medications and disease states. These identified benefits of MTM clinic lead to frequent patient referrals specifically for aid with medication adherence and disease state management.

  7. Medication Management in Schools: A Systems Approach to Reducing Risk and Strengthening Quality in School Medication Management (United States)

    Center for Health and Health Care in Schools, 2004


    This paper and the invitational meeting for which it has been prepared make certain assumptions about the challenge of strengthening the quality of medication management in school. The participants believe that recent research on improving the safety and quality of patient care has relevance for health services in school, particularly the safety…

  8. Aggressive behavior

    NARCIS (Netherlands)

    Didden, H.C.M.; Lindsay, W.R.; Lang, R.; Sigafoos, J.; Deb, S.; Wiersma, J.; Peters-Scheffer, N.C.; Marschik, P.B.; O’Reilly, M.F.; Lancioni, G.E.


    Aggressive behavior is common in individuals with intellectual and developmental disabilities (IDDs), and it is most often targeted for intervention. Psychological, contextual, and biological risk factors may contribute to the risk of aggressive behavior. Risk factors are gender (males), level of ID

  9. Risk management for medical devices in research projects

    Directory of Open Access Journals (Sweden)

    Sauter Christian


    Full Text Available In applied research for medical devices exists a conflict between effective research and regulations. While researchers need sufficient freedom the regulations require a complex technical documentation for a medical device. One relevant aspect of the regulations is risk management which takes time and therefore is ignored in many research projects. With adoptions to the standard the effort can be reduced: Identifying of risks can be focused on critical risks, measures can be categorised and only some categories need to be implemented. Research teams using this method can provide results which can be transferred into commercial products easier, cheaper and faster.

  10. Signaling aggression. (United States)

    van Staaden, Moira J; Searcy, William A; Hanlon, Roger T


    From psychological and sociological standpoints, aggression is regarded as intentional behavior aimed at inflicting pain and manifested by hostility and attacking behaviors. In contrast, biologists define aggression as behavior associated with attack or escalation toward attack, omitting any stipulation about intentions and goals. Certain animal signals are strongly associated with escalation toward attack and have the same function as physical attack in intimidating opponents and winning contests, and ethologists therefore consider them an integral part of aggressive behavior. Aggressive signals have been molded by evolution to make them ever more effective in mediating interactions between the contestants. Early theoretical analyses of aggressive signaling suggested that signals could never be honest about fighting ability or aggressive intentions because weak individuals would exaggerate such signals whenever they were effective in influencing the behavior of opponents. More recent game theory models, however, demonstrate that given the right costs and constraints, aggressive signals are both reliable about strength and intentions and effective in influencing contest outcomes. Here, we review the role of signaling in lieu of physical violence, considering threat displays from an ethological perspective as an adaptive outcome of evolutionary selection pressures. Fighting prowess is conveyed by performance signals whose production is constrained by physical ability and thus limited to just some individuals, whereas aggressive intent is encoded in strategic signals that all signalers are able to produce. We illustrate recent advances in the study of aggressive signaling with case studies of charismatic taxa that employ a range of sensory modalities, viz. visual and chemical signaling in cephalopod behavior, and indicators of aggressive intent in the territorial calls of songbirds.

  11. Iatrogenic disease management: moderating medication errors and risks in a pharmacy benefit management environment. (United States)

    Nair, Vinit; Salmon, J Warren; Kaul, Alan F


    Disease Management (DM) programs have advanced to address costly chronic disease patterns in populations. This is in part due to the programs' significant clinical and economical value, coupled with interest by pharmaceutical manufacturers, managed care organizations, and pharmacy benefit management firms. While cost containment realizations for many such interventions have been less than anticipated, this article explores potentials in marrying Medication Error Risk Reduction into DM programs within managed care environments. Medication errors are an emergent serious problem now gaining attention in US health policy. They represent a failure within population-based health programs because they remain significant cost drivers. Therefore, medication errors should be addressed in an organized fashion, with DM being a worthy candidate for piggybacking such programs to achieve the best synergistic effects.


    Directory of Open Access Journals (Sweden)

    Amit Malhotra


    Full Text Available Dental caries is an infectious, communicable disease, which causes destruction of teeth by acid-forming bacteria found in dental plaque. Caries progression or reversal is determined by the balance between protective and pathological factors in the mouth. There have been revolutions in every field and dentistry is no exception to it, these changes have led to a change in concept from the conventional surgical approach of removing dental decay and cutting of tooth structure to the medical model which deals with interception of disease at different stages and possible reversal of the disease process. The key to medical paradigm is determination of caries risk in an individual and effective early detection of initial carious lesions. There are various equipments available in market which uses different principles for diagnosing caries susceptibility in an individual. In the years of thorough research different agents have been investigated for their role in caries prevention and reversal. There is a separate treatment plan for managing patients falling in different risk category. This article outlines the need for the medical management of dental caries and how it can be a viable option in dental decay management.

  13. Delinquent Medical Service Accounts at David Grant Air Force Medical Center Need Additional Management Oversight (United States)


    17 counties. DGMC Uniform Business Office (UBO) uses MSAs to record billing and fee collection for medical and dental services from Uniformed...personnel processed new accounts, the process used by DGMC did not manage or prioritize the aging MSAs or alert clerks of delinquent accounts...have been applied to other valid requirements such as administrative, operating, and equipment costs; readiness training; or trauma consortium

  14. Improving acute medical management: Junior Doctor Emergency Prescription Cards. (United States)

    Hutton, Joe; Gingell, Megan; Hutchinson, Lisa


    Doctors commencing Foundation Year (FY) training face many stresses and challenges. FY doctors are often the first point of contact for acutely unwell and deteriorating patients. Trust guidelines are used to aid acute medical management. Accessing guidelines is often fraught with barriers. Evidence suggests aide-memoire cards can provide easier access to guidelines and management pathways. We aimed to improve prescribing accuracy and efficiency of FY doctors for acute medical conditions within Gloucestershire trust by improving access to and usability of trust guidelines. Questionnaires were distributed to FY doctors to identify acute medical conditions to include on the emergency prescription cards (EPCs). Two small double-sided cards were created containing bullet pointed trust guidelines for: hyper/hypokalaemia, status epilepticus, diabetic emergencies, arrhythmias, myocardial infarction, acute asthma, pulmonary oedema, anaphylaxis and a ward-round checklist. Feedback was used to improve EPCs prior to distribution. Pre (N=53) and post-intervention (N=46) written questionnaires were completed by FY doctors. These assessed acute clinical management including use of guidance, confidence in management, speed of prescribing and EPC "usability". To assess prescribing accuracy, prescriptions for acute medical conditions were reviewed pre (N=8) and post-intervention (N=12). The EPCs were well received (80% quite/very useful) and found "easy to use" (83%). The introduction of EPCs increased guidance use (pre-intervention 58.8%, post-intervention 71.7%), increased confidence (pre-intervention 79%, post-intervention 89%) and significantly improved prescribing speed (p=0.05). There was a significant correlation with confidence and prescribing speed (p = 0.023). The accuracy of prescribed doses improved (pre-intervention 62.5%, post-intervention 87.5% accurate) as did details regarding route / additional required information (pre-intervention 75%, post-intervention 97

  15. Publication ethics and the ghost management of medical publication. (United States)

    Sismondo, Sergio; Doucet, Mathieu


    It is by now no secret that some scientific articles are ghost authored - that is, written by someone other than the person whose name appears at the top of the article. Ghost authorship, however, is only one sort of ghosting. In this article, we present evidence that pharmaceutical companies engage in the ghost management of the scientific literature, by controlling or shaping several crucial steps in the research, writing, and publication of scientific articles. Ghost management allows the pharmaceutical industry to shape the literature in ways that serve its interests. This article aims to reinforce and expand publication ethics as an important area of concern for bioethics. Since ghost-managed research is primarily undertaken in the interests of marketing, large quantities of medical research violate not just publication norms but also research ethics. Much of this research involves human subjects, and yet is performed not primarily to increase knowledge for broad human benefit, but to disseminate results in the service of profits. Those who sponsor, manage, conduct, and publish such research therefore behave unethically, since they put patients at risk without justification. This leads us to a strong conclusion: if medical journals want to ensure that the research they publish is ethically sound, they should not publish articles that are commercially sponsored.

  16. Stimulant Medication Management of Students with Attention Deficit Hyperactivity Disorder: What Educators Need To Know. (United States)

    Schulz, Eldon G.; Edwards, Mark C.


    Addresses the critical issues in the medication management of students with attention deficit hyperactivity disorder in the classroom. Discusses the issues of considering, trying, and optimizing stimulant medication effects. Highlights medication side effects and their management, along with long-term management issues. (Author/CR)

  17. Integrated software system for improving medical equipment management. (United States)

    Bliznakov, Z; Pappous, G; Bliznakova, K; Pallikarakis, N


    The evolution of biomedical technology has led to an extraordinary use of medical devices in health care delivery. During the last decade, clinical engineering departments (CEDs) turned toward computerization and application of specific software systems for medical equipment management in order to improve their services and monitor outcomes. Recently, much emphasis has been given to patient safety. Through its Medical Device Directives, the European Union has required all member nations to use a vigilance system to prevent the reoccurrence of adverse events that could lead to injuries or death of patients or personnel as a result of equipment malfunction or improper use. The World Health Organization also has made this issue a high priority and has prepared a number of actions and recommendations. In the present workplace, a new integrated, Windows-oriented system is proposed, addressing all tasks of CEDs but also offering a global approach to their management needs, including vigilance. The system architecture is based on a star model, consisting of a central core module and peripheral units. Its development has been based on the integration of 3 software modules, each one addressing specific predefined tasks. The main features of this system include equipment acquisition and replacement management, inventory archiving and monitoring, follow up on scheduled maintenance, corrective maintenance, user training, data analysis, and reports. It also incorporates vigilance monitoring and information exchange for adverse events, together with a specific application for quality-control procedures. The system offers clinical engineers the ability to monitor and evaluate the quality and cost-effectiveness of the service provided by means of quality and cost indicators. Particular emphasis has been placed on the use of harmonized standards with regard to medical device nomenclature and classification. The system's practical applications have been demonstrated through a pilot

  18. CHD risk equivalents and the metabolic syndrome. Trial evidence supports aggressive management. (United States)

    Thompson, Paul D


    Updated guidelines issued by the National Cholesterol Education Program's 2001 Adult Treatment Panel III (ATP III) reaffirm the importance of intensive management of low density lipoprotein cholesterol (LDL-C) in patients with established coronary heart disease (CHD). Clinical studies also show that diabetes, peripheral arterial disease, abdominal aortic aneurysm, and symptomatic carotid artery disease are CHD risk equivalents that require intensive therapeutic lifestyle changes and drug therapy to prevent associated morbidity and mortality. Likewise, the metabolic syndrome is a secondary target of treatment. Drug therapy usually starts with an LDL-C-lowering agent, such as a statin. If LDL-C and non-high-density lipoprotein cholesterol goals are not achieved, statin therapy should be intensified or a fibrate or niacin should be added.

  19. Medical management of patients after bariatric surgery: Principles and guidelines

    Institute of Scientific and Technical Information of China (English)

    Abd; Elrazek; Mohammad; Ali; Abd; Elrazek; Abduh; Elsayed; Mohamed; Elbanna; Shymaa; E; Bilasy


    Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index(BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients(BMI ≥ 30 kg/m2) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m2 and those with BMI > 35 kg/m2 with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

  20. Medical management of patients after bariatric surgery: Principles and guidelines. (United States)

    Elrazek, Abd Elrazek Mohammad Ali Abd; Elbanna, Abduh Elsayed Mohamed; Bilasy, Shymaa E


    Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index (BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients (BMI ≥ 30 kg/m(2)) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m(2) and those with BMI > 35 kg/m(2) with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

  1. Incorporating medical leadership and management into the UK undergraduate medical curriculum

    Directory of Open Access Journals (Sweden)

    Ah-kee EY


    Full Text Available Elliott Yann Ah-kee,1 Aamir Asif Khan21Monklands Hospital, Airdrie, 2Glasgow Royal Infirmary, Glasgow, UKWe read with high interest the letter by Singh et al1 which advocates a mandatory year studying for a BSc in management, within the UK undergraduate medical curriculum. The authors have supported their proposition with compelling figures from a recent National Health Service (NHS report, which is expecting a £30 billion funding gap by 2020/2021.We strongly believe that nowadays, leadership and management skills are crucial within the NHS and have been shown to positively impact the overall performance of doctors appointed to hospital boards of directors and clinical outcomes.2 Furthermore, we agree with the authors that a lack of knowledge of the NHS structure can be efficiently addressed by incorporating medical leadership and management (MLM early during undergraduate training.However, we believe that a mandatory year studying management within an already overcrowded undergraduate curriculum is not realistic and feasible. Moreover, several identified barriers to the implementation of such education, including negative attitudes held by both doctors and students toward MLM still need to be addressed.2Previous letter has been published 

  2. Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies. (United States)

    Haddad, Peter M; Brain, Cecilia; Scott, Jan


    Nonadherence with medication occurs in all chronic medical disorders. It is a particular challenge in schizophrenia due to the illness's association with social isolation, stigma, and comorbid substance misuse, plus the effect of symptom domains on adherence, including positive and negative symptoms, lack of insight, depression, and cognitive impairment. Nonadherence lies on a spectrum, is often covert, and is underestimated by clinicians, but affects more than one third of patients with schizophrenia per annum. It increases the risk of relapse, rehospitalization, and self-harm, increases inpatient costs, and lowers quality of life. It results from multiple patient, clinician, illness, medication, and service factors, but a useful distinction is between intentional and unintentional nonadherence. There is no gold standard approach to the measurement of adherence as all methods have pros and cons. Interventions to improve adherence include psychoeducation and other psychosocial interventions, antipsychotic long-acting injections, electronic reminders, service-based interventions, and financial incentives. These overlap, all have some evidence of effectiveness, and the intervention adopted should be tailored to the individual. Psychosocial interventions that utilize combined approaches seem more effective than unidimensional approaches. There is increasing interest in electronic reminders and monitoring systems to enhance adherence, eg, Short Message Service text messaging and real-time medication monitoring linked to smart pill containers or an electronic ingestible event marker. Financial incentives to enhance antipsychotic adherence raise ethical issues, and their place in practice remains unclear. Simple pragmatic strategies to improve medication adherence include shared decision-making, regular assessment of adherence, simplification of the medication regimen, ensuring that treatment is effective and that side effects are managed, and promoting a positive

  3. [The realization way and lean management about medical consumable material in clinical use]. (United States)

    Shang, Changhao; Cheng, Junpei; Xu, Hailin; Wang, Xiaoguang


    The medical consumable material management is an important part of logistic support in the management of hospital, but the hospital has many weak links in the management of supplies. This paper aims to explore the common problems (especially in clinical use) existing in the management of medical consumables and years of management experience in Changhai hospital's practice, then discusses lean management from the perspective of lean management

  4. Considerations in the medical management of pregnancy in transplant recipients. (United States)

    Josephson, Michelle A; McKay, Dianne B


    Pregnancy, although rare in the patient with end-stage renal disease, is not uncommon in the transplant recipient. Physicians taking care of transplant recipients must be able to inform patients about the potential risks of pregnancy in this setting. The patient and her partner must know that the risks associated with pregnancy increase with worsening kidney function and hypertension. Current consensus opinion is that pregnancy can be relatively safely undertaken by 1 year after transplant if the patient has had no rejections during the year, allograft function is adequate, there are no infections that could affect the fetus, the patient is not taking teratogenic medications, and immunosuppressive medication dosing is stable. Consideration must be given to immunosuppression during pregnancy both with respect to the specific agents as well as the level of dosing. None of the medications are FDA category A; all are B or higher. Part of planning for pregnancy should include an evaluation of immunosuppression medication and a plan to modify the regimen prior to conception if its use may be risky for the developing fetus. Rejection can occur during a kidney transplant, so maintaining adequate immunosuppression is important. Other issues that need to be managed when caring for a pregnant transplant patient include: potential for infection (urinary tract infections are very common), hypertension, and anemia. The type of delivery, posttransplant contraception, and breast-feeding also need to be addressed.

  5. Crisis resource management, simulation training and the medical emergency team. (United States)

    Gillon, Stuart; Radford, Sam; Chalwin, Richard; Devita, Michael; Endacott, Ruth; Jones, Daryl


    Recently there has been increased focus on improved detection and management of deteriorating patients in Australian hospitals. Since the introduction of the medical emergency team (MET) model there has been an increased role for intensive care unit staff in responding to deterioration of patients in hospital wards. Review and management of MET patients differs from the traditional model of ward patient review, as ICU staff may not know the patient. Furthermore, assessment and intervention is often time-critical and must occur simultaneously. Finally, about 10% of MET patients require intensive care-level interventions to be commenced on the ward, and this requires participation of non-ICU-trained ward staff. • To date, the interventions performed by MET staff and approaches to training responders have been relatively under investigated, particularly in the Australian and New Zealand context. In this article we briefly review the principles of the MET and contend that activation of the MET by ward staff represents a response to a medical crisis. We then outline why MET intervention differs from traditional ward-based doctor-patient encounters, and emphasise the importance of non-technical skills during the MET response. Finally, we suggest ways in which the skills required for crisis resource management within the MET can be taught to ICU staff, and the potential benefits, barriers and difficulties associated with the delivery of such training in New Zealand and Australia.

  6. Successful pregnancy following medical management of heterotopic pregnancy

    Directory of Open Access Journals (Sweden)

    R Lavanya


    Full Text Available We present a case of sonographic demonstration of quadruplet heterotopic pregnancy consisting of twin intrauterine (IU pregnancy and a twin adnexal pregnancy after ovulation induction (OI with clomiphene citrate (CC and timed intercourse (TI. Both heterotopic pregnancy and spontaneous twinning are frequent after OI, this combination although extremely rare must be kept in mind. The role of early transvaginal sonography and serum beta human chorionic gonadotrophin after missed periods helps in early diagnosis. It gives us an opportunity for medical management, saving the patient the agony of surgery along with loss of pregnancy. The management of heterotopic pregnancy is controversial. This patient did not have a viable IU pregnancy and both the sacs in the adnexa were small. Thus, we treated her successfully by medical management with systemic methotrexate, with regular follow-up. This patient successfully conceived after 6 months with OI and TI, with ovulation occurring from the same side of the previous ectopic. She had a viable IU gestation corresponding to 12 weeks.

  7. [Management and organization of ambulatory medical care in a district]. (United States)

    Schneider, K; Keune, H G; Miethe, D; Ringel, M; Szkibik, B


    An analysis is given of the management and organization of out-patient medical care in 15 districts and of the District Physician's responsibilities as well as the profile of a District Health Department. Compared to the situation of a decade ago, substantial changes in the territorial health organization have occurred (decentralization, formation of care areas, affiliation of small health facilities to bigger ones). The District Physician's scope of responsibility is increasingly determined by activities within the framework of the District Council, the proportion of organizational work has increased. In order to be able to fulfill his tasks the District Physician needs the support of a special Health Department. Skeleton regulations for out-patient medical care are necessary.

  8. Medical management of urinary calculi: up to date 2016. (United States)

    Marangella, Martino


    Nephrolithiasis (NL) is one of the most prevalent nontransmissible diseases in western countries. It is being associated with other frequent diseases, including osteoporosis, cardiovascular disease, hypertension, diabetes mellitus, through a putative common link with metabolic syndrome and insulin resistance or altered mineral metabolism. This review will focus on classification, physicochemical basis, risk factors, laboratory and imaging investigations, medical management.Classification as to stone composition includes calcium, uric acid (UA), cystine (Cys), infected, 2-8 dihydroxyadenine and rare NL. According to pathophysiology, NL is classified as primary, secondary to systemic diseases or drugs, caused by renal or metabolic hereditary disorders.A stone can only form in supersaturated environment, and this is sufficient in UA, Cys and infected NL, but not in Ca-NL, which results from the imbalance between supersaturation and inhibition. All types are characterized by derangements of peculiar risk factors. Laboratory investigations aim at identifying type of NL, underlying risk factors and state of saturation, and pathophysiology. This justifies a rationale therapy able to dissolve some types of stones and/or produce reduction in recurrence rate in others.Medical management includes alkali and allopurinol for UA nephrolithiasis (UA-NL), thiols and alkali in Cys-NL, dietary and pharmacological intervention for Ca-NL. Thiazides and alkaline citrate salts are the most widely used drugs in Ca-NL, where they proved efficient to prevent new stones. Other drugs have only been used in particular subsets.Proper medical management and modern urological approaches have already notably improved clinical outcomes. Future studies will further clarify mechanisms of NL with expected new and targeted therapeutic options.

  9. Non-Medical Management of Raynaud’s Disease, (United States)


    I AD-AIll 032 ARMY RESEARCH INST OF ENVIRONMENTAL MEDICINE NATICK MA F/B &/ S I NON-MEDICAL MANAGEMENT OF RAYNAUD’S OISEASE,(U) I JUN 81 J B JOBE. J B...collagen disease, they are referred to as Rana d’s phenomenon or syndrome . Minimal criteria for diagnosis of Raynaud’s disease have long been established...JAMA. l945; 129:1-- s . 2. blain, A 1l1, Coiler, FA, Carver, 6i. Raynaud’s disease: A study ot criteria for prognosis. Surgery. 19)1; 2V:387-31)7. 3

  10. [Hygiene and security management in medical biology laboratory]. (United States)

    Vinner, E; Odou, M F; Fovet, B; Ghnassia, J C


    Risk management in Medical Biology Laboratory (MBL) which includes hygiene and waste management, is an integrated process to the whole MBL organisation. It is composed of three stages: risks factors identification, grading and prioritization, and their evaluation in the system. From the legislation and NF EN ISO 15189 standard's requirements viewpoint, prevention and protection actions to implement are described, at premises level, but also at work station environment's one (human resources and equipments) towards biological, chemical, linked to gas, to ionizing or non ionizing radiations and fire riks, in order not to compromise patients safety, employees safety, and quality results. Then, although NF EN 15189 standard only enacts requirements in terms of prevention, curative actions after established blood or chemical exposure accident are defined.

  11. The Balanced Scorecard: A Management System for Wilford Hall Medical Center - The Premier Air Force Medical Enterprise (United States)


    The Balanced Scorecard Management System (BSMS) at Wilford Hall Medical Center (WHMC) is a strategic management and measurement system that...prompted the study to a look at the statement of the problem, the author explores the history and use of the balanced scorecard concept in civilian...was an Intranet-based, database automated, Balanced Scorecard Management System.

  12. Implementation of Quality Management System in Iranian Medical Laboratories

    Directory of Open Access Journals (Sweden)

    P Dahim


    Full Text Available "nReference health Laboratory of Iran (RHL has been established under the Secretary of Health in 2007. This organization has been developed from integration of Reference laboratories of Iran, Directorate of General Affairs and Laboratory de­partment of CDC. In accordance with policies of Ministry of Health and Medical Education, also Millennium Development Goals and requirements of IHR the RHL has highlighted his main goal as "Quality Improvement of Medical Laboratory Net­work". In order to achieve this goal as soon and efficient as possible, RHL has tried to launch Quality Management sys­tem in medical laboratories. After studying and analyzing the situation in the country RHL has tried by using ISO 15189 which is an successful international standard to draw national standards and write necessary manuals, guidelines and check­lists. For a successful implementation and detailed managerial observance, three phases were designed: Training, Stepwise imple­mentation of standard requirements in the laboratories, accreditation of laboratories. After one year of training and send­ing out national standards and guidelines, the RHL is in the middle of the second phase "implementation".

  13. Introducing managed care to the medical school curriculum: effect on student attitudes. (United States)

    Field, T S; Baldor, R A; Casey, L M; Chuman, A; Lasser, D; Ehrlich, A; Gurwitz, J H


    In order to assess the effect of clinical training and didactic instruction on medical student attitudes toward managed care, we conducted a survey of all medical students at the midpoint of their third year clerkships at the University of Massachusetts Medical School. The students were exposed to clinical training in managed care settings and a 2-day required course on the principles underlying managed care. The main outcome measures were student attitudes toward the concepts of managed care, managed care organizations, and future careers in managed care. Students also assessed the attitudes of medical faculty toward managed care. Attitudes of students with previous clinical training in managed care settings did not differ from those of students without such exposure toward the concepts underlying managed care or managed care organizations and were less positive about careers in managed care. Student responses before and after the 2-day course on managed care demonstrated that attitudes moved in a significantly positive direction. Seventy-one percent of students reported that the opinions they had heard from medical faculty about managed care were negative. Preparing medical students to practice medicine effectively in managed care settings will require focused attention on managed care issues in the medical school curriculum and the combined efforts of academic health centers and managed care organizations.

  14. Personalized Medication Management: Towards a Design of Individualized Support for Elderly Citizens at Home

    DEFF Research Database (Denmark)

    Verdezoto, Nervo; Olsen, Jesper Wolff


    Several technologies have been developed to support people's medication management, including pillboxes, specialized software applications, reminders and paper-based medication lists. Several of these technologies were discovered in older adults' homes during user studies carried out with the main...... purpose to help them to manage their medications and recall challenges. We confirm that a considerable number of older adults integrate their medication treatments into their daily life routines, and that the lack of knowledge, caregiver's support, medicine outside the home, forgetting medication intake...... towards the design of a personalized medication management system. We further describe our initial stage in a participatory design process as part of the ongoing Lev Vel Consortium....

  15. Educational Implications of Nurse Practitioner Students and Medical Residents' Attitudes toward Managed Care. (United States)

    Breer, M. Lynn; Pohl, Joanne M.; Stommel, Manfred; Barkauskas, Violet H.; Schillo, Barbara; Oakley, Deborah


    Attitudes toward managed care of 431 medical residents and 153 advanced practice nursing students were compared. Medical students were more likely to agree that managed care emphasizes cost over quality and threatens autonomy. Nursing students were more likely to agree that it encourages preventive care. Medical students were less enthusiastic…

  16. Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies

    Directory of Open Access Journals (Sweden)

    Haddad PM


    and monitoring systems to enhance adherence, eg, Short Message Service text messaging and real-time medication monitoring linked to smart pill containers or an electronic ingestible event marker. Financial incentives to enhance antipsychotic adherence raise ethical issues, and their place in practice remains unclear. Simple pragmatic strategies to improve medication adherence include shared decision-making, regular assessment of adherence, simplification of the medication regimen, ensuring that treatment is effective and that side effects are managed, and promoting a positive therapeutic alliance and good communication between the clinician and patient. These elements remain essential for all patients, not least for the small minority where vulnerability and risk issue dictate that compulsory treatment is necessary to ensure adherence.Keywords: adherence, nonadherence, antipsychotics, schizophrenia, long-acting injections, relapse, risk factors

  17. Radio nuclear aggression. Psychological impact and management; L'agression radio-nucleaire. Impact psychologique et prise en charge

    Energy Technology Data Exchange (ETDEWEB)

    Boisseaux, H. [Hopital d' Instruction des Armees du Val-de-Grace, Service de Psychiatrie, 75 - Paris (France); Laroche, P.; Carbonnieres, H. de [Hopital des Armees Percy, Service de Protection Radiologique, 92 - Clamart (France); Foehrenbach, H. [Hopital d' Instruction des Armees du Val-de-Grace, Service de Medecine Nucleaire, 75 - Paris (France)


    Long before possible organic effects, exposure to ionizing radiations can provoke anxiety. In front of invisibility, the imagination quickly ignites. The terrorists have perfectly understood it. They are ready to use ionizing radiations as a weapon to remind traumatic images deeply rooted in people's memory. These images induce anxiety with all the clinical expressions connected to it. These symptoms require to be treated because of a possible anarchic development. For that purpose, plans have been elaborated to coordinate the different professional's actions. The coherence of medical management and communication aims to allow the most implicated people to find the way to face the events. When it is not possible, medico-psychological cells permit a specialized care. (author)

  18. Children with medically unexplained pain symptoms: Categorization and effective management

    Directory of Open Access Journals (Sweden)

    Sharmishtha S Deshpande


    Full Text Available Context: Medically unexplained pain symptoms are common in children, and their incidence is on the rise. There is often a lack of clearly articulated pathophysiology in these patients. There is need to improve understanding about varied causes and presentations of these patients which would generate further insight in management of these patients. Documentation and detailed assessment of such children in Indian setting is not seen in literature. Materials and Methods: A series of 17 cases, 10 boys and 7 girls referred from pediatrics department is discussed, so as to categorize them in three different subgroups for management. Result and Discussion: Although there were often no overt anxiety or depressive features, some psychosocial stress which was mostly unnoticed by the child, the parents and the doctor, preceded such a pain. It was often an academic stress, familial separation or parental psychiatric illness. They were at times not able to verbalize their distress, which was revealed with the help of Children′s Apperception Test (C.A.T.. They mainly had anxieties about loss of love or disapproval by parents and also fear of harm or injury. They used defence mechanisms like denial, reaction formation and repression, which were ineffective in handling the overwhelming anxiety. Most of these children had either above average or borderline intelligence. Somatic expression of emotional needs and fears in these children was managed effectively by supportive therapy and antidepressant drugs.

  19. Improvised explosive devices: pathophysiology, injury profiles and current medical management. (United States)

    Ramasamy, A; Hill, A M; Clasper, J C


    The improvised explosive device (IED), in all its forms, has become the most significant threat to troops operating in Afghanistan and Iraq. These devices range from rudimentary home made explosives to sophisticated weapon systems containing high-grade explosives. Within this broad definition they may be classified as roadside explosives and blast mines, explosive formed pojectile (EFP) devices and suicide bombings. Each of these groups causeinjury through a number of different mechanisms and can result in vastly different injury profiles. The "Global War on Terror" has meant that incidents which were previously exclusively seen in conflict areas, can occur anywhere, and clinicians who are involved in emergency trauma care may be required to manage casualties from similar terrorist attacks. An understanding of the types of devices and their pathophysiological effects is necessary to allow proper planning of mass casualty events and to allow appropriate management of the complex poly-trauma casualties they invariably cause. The aim of this review article is to firstly describe the physics and injury profile from these different devices and secondly to present the current clinical evidence that underpins their medical management.

  20. [The management of implantable medical device and the application of the internet of things in hospitals]. (United States)

    Zhou, Li; Xu, Liang


    Implantable medical device is a special product which belongs to medical devices. It not only possesses product characteristics in common, but also has specificity for safety and effectiveness. Implantable medical device must be managed by the relevant laws and regulations of the State Food and Drug Administration. In this paper, we have used cardiac pacemakers as an example to describe the significance of the management of implantable medical device products and the application of the internet of things in hospitals.

  1. Integrating Medication Therapy Management Education into a Core Pharmacy Curriculum. (United States)

    Poole, Traci M; Kodali, Leela; Pace, Adam C


    Objective. To describe the design of a core course directed at improving confidence and competence of students to perform medication therapy management (MTM) services. Design. Using the American Pharmacists Association (APhA) certificate training program framework, a core course was developed to teach MTM concepts to third-year student pharmacists. Using deep learning and authentic assignments, course instructors attempted to improve student confidence and readiness to provide MTM services. Assessment. Student ability to meet course objectives was evaluated by examinations and the APhA MTM program self-assessment. Students had an overall success rate of 93% on all three assessments. Student perceptions of confidence, competence, and importance of performing MTM services were measured using a survey instrument with 56 Likert-type items. Students completing both surveys reported significantly increased confidence and competence. Conclusion. Integrating MTM-specific education into the core curriculum increased student pharmacists' perceived competence and confidence to perform MTM services.

  2. Electronic Aggression

    Centers for Disease Control (CDC) Podcasts


    Aggression is no longer limited to the school yard. New forms of electronic media, such as blogs, instant messaging, chat rooms, email, text messaging, and the internet are providing new arenas for youth violence to occur.  Created: 11/20/2007 by National Center for Injury Prevention and Control, Division of Violence Prevention.   Date Released: 11/28/2007.

  3. Towards a paperless medical physics residency management system. (United States)

    Schubert, Leah K; Miften, Moyed


    Documentation is a required component of a residency program, but can be difficult to collect and disseminate, resulting in minimal utilization by residents and faculty. The purpose of this work is to adapt a commercially-available Web-based medical residency management system to improve the learning experience by efficiently distributing program information, documenting resident activities, and providing frequent monitoring and timely feedback of resident progress. To distribute pro- gram information, program requirements and rotation readings were uploaded. An educational conference calendar was created with associated files and attendance records added. To document resident progress, requirements for over 37 different clinical procedures were added, for which the resident logged the total number of procedures performed. Progress reports were created and automatically distributed. To provide feedback to the resident, an extensive electronic evaluation system was created. Results are shown for the initial 21 months of program existence, consisting of a single resident for the first 12 months and two residents for the subsequent 9 months. The system recorded that 130 documents were uploaded and 100% of required documents were downloaded by the resident. In total, 385 educational conferences and meetings were offered, of which the residents attended 95%. The second-year and first-year residents logged 1030 and 522 clinical proce- dures, respectively. The residents submitted a total of 116 status reports detailing weekly activities, 100% of which were reviewed by faculty within an average of 11.3 days. A total of 65 evaluations of the residents were submitted. The residents reviewed 100% of respective evaluations within an average of 1.5 days. We have successfully incorporated a paperless, Web-based management system in a medical physics residency program. A robust electronic documentation system has been implemented, which has played a central role in enhancing the

  4. Can we widen the scope of medical management in ectopic pregnancy?

    Directory of Open Access Journals (Sweden)

    Usha Kiran TS


    Full Text Available The objective of the study was to Safe Medical management of ectopic pregnancy in those where surgical management was indicated. Patients with one or more criteria not suitable for medical treatment but refusing surgical management were included. Exclusion criteria were those who were not haemodynamically stable. They were managed with close monitoring as inpatient to assess resolution of ectopic with Methotrexate. All five cases have been managed successfully by medical method. There is a possible role for medical management in patients who might not satisfy the criteria fully, however further research is needed. Ectopic pregnancy is life threatening disorder. With advances in diagnostic approaches such as ultrasound coupled with hormone markers diagnosis of ectopic has become easier in cases having first trimester bleeding per vaginum. Ectopic can be managed expectantly, medically and surgically. Medical management includes Inj. Methotrexate (MTX. In this case series we have studied five cases which are managed successfully with hundred percent successful results by medical management despite not satisfying criteria. It is a retrospective study. So from this study we can conclude that we can manage ectopic pregnancies medically based upon clinical judgment. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 1257-1259

  5. Keeping Up with Healthcare Trends: IcHeart as a Medication Management Application (United States)

    Kasinathan, Vinothini; Mustapha, Aida; Azah Samsudin, Noor


    According to the US governments, more than 125,000 people die each year due to failure to manage their medications, leading to approximately USD100 billion in preventable costs to healthcare systems. The core failure in medication management is attributed by patients failing to adhere their medication regimens, whether by accident, negligence, or intentional. Recognizing the importants of vigilant monitoring in medication management, this paper is set to review the latest android-based healthcare trends and propose a new mobile medication reminder application called IcHeart.


    NARCIS (Netherlands)

    Sino, C. G. M.; Sietzema, M.; Egberts, T. C. G.; Schuurmans, M. J.


    Objective: to determine the medication management capacity of independently living older people (>= 75 years) on polypharmacy (>= 5 medications) in relation to their cognitive- and self-management skills. Design: Cross-sectional study. Setting: two homecare organizations in the Netherlands. Particip

  7. Trans fat consumption and aggression.

    Directory of Open Access Journals (Sweden)

    Beatrice A Golomb

    Full Text Available BACKGROUND: Dietary trans fatty acids (dTFA are primarily synthetic compounds that have been introduced only recently; little is known about their behavioral effects. dTFA inhibit production of omega-3 fatty acids, which experimentally have been shown to reduce aggression. Potential behavioral effects of dTFA merit investigation. We sought to determine whether dTFA are associated with aggression/irritability. METHODOLGY/PRINICPAL FINDINGS: We capitalized on baseline dietary and behavioral assessments in an existing clinical trial to analyze the relationship of dTFA to aggression. Of 1,018 broadly sampled baseline subjects, the 945 adult men and women who brought a completed dietary survey to their baseline visit are the target of this analysis. Subjects (seen 1999-2004 were not on lipid medications, and were without LDL-cholesterol extremes, diabetes, HIV, cancer or heart disease. Outcomes assessed adverse behaviors with impact on others: Overt Aggression Scale Modified-aggression subscale (primary behavioral endpoint; Life History of Aggression; Conflict Tactics Scale; and self-rated impatience and irritability. The association of dTFA to aggression was analyzed via regression and ordinal logit, unadjusted and adjusted for potential confounders (sex, age, education, alcohol, and smoking. Additional analyses stratified on sex, age, and ethnicity, and examined the prospective association. Greater dTFA were strongly significantly associated with greater aggression, with dTFA more consistently predictive than other assessed aggression predictors. The relationship was upheld with adjustment for confounders, was preserved across sex, age, and ethnicity strata, and held cross-sectionally and prospectively. CONCLUSIONS/SIGNIFICANCE: This study provides the first evidence linking dTFA with behavioral irritability and aggression. While confounding is always a concern in observational studies, factors including strength and consistency of association

  8. Ensuring safe and quality medication use in nuclear medicine: a collaborative team achieves compliance with medication management standards. (United States)

    Beach, Trent A; Griffith, Karen; Dam, Hung Q; Manzone, Timothy A


    As hospital nuclear medicine departments were established in the 1960s and 1970s, each department developed detailed policies and procedures to meet the specialized and specific handling requirements of radiopharmaceuticals. In many health systems, radiopharmaceuticals are still unique as the only drugs not under the control of the health system pharmacy; however, the clear trend--and now an accreditation requirement--is to merge radiopharmaceutical management with the overall health system medication management system. Accomplishing this can be a challenge for both nuclear medicine and pharmacy because each lacks knowledge of the specifics and needs of the other field. In this paper we will first describe medication management standards, what they cover, and how they are enforced. We will describe how we created a nuclear medicine and pharmacy team to achieve compliance, and we will present the results of their work. We will examine several specific issues raised by incorporating radiopharmaceuticals in the medication management process and describe how our team addressed those issues. Finally, we will look at how the medication management process helps ensure ongoing quality and safety to patients through multiple periodic reviews. The reader will gain an understanding of medication management standards and how they apply to nuclear medicine, learn how a nuclear medicine and pharmacy team can effectively merge nuclear medicine and pharmacy processes, and gain the ability to achieve compliance at the reader's own institution.

  9. [Aggressive fibromatoses]. (United States)

    Döhler, J R; Hamelmann, H; Lasson, U


    Benign by nature, aggressive fibromatoses (desmoid fibromas) may represent as difficult therapeutic problems as malignant tumours. When subtotally resected they tend to recur. But spontaneous regression is possible. Expense and limits of their surgical treatment are discussed with reference to seven patients. In five cases primary affliction of bone was evident. There are three reports given in detail: In the first, malignant transformation may be due to radiation therapy and hemipelvectomy could not prevent recurrence. In the second, spontaneous regression of untreated pelvic affection may have occurred. In the third, several resections and amputation of the leg failed to cure congenital infantile fibromatosis.

  10. [Research and development of medical case database: a novel medical case information system integrating with biospecimen management]. (United States)

    Pan, Shiyang; Mu, Yuan; Wang, Hong; Wang, Tong; Huang, Peijun; Ma, Jianfeng; Jiang, Li; Zhang, Jie; Gu, Bing; Yi, Lujiang


    To meet the needs of management of medical case information and biospecimen simultaneously, we developed a novel medical case information system integrating with biospecimen management. The database established by MS SQL Server 2000 covered, basic information, clinical diagnosis, imaging diagnosis, pathological diagnosis and clinical treatment of patient; physicochemical property, inventory management and laboratory analysis of biospecimen; users log and data maintenance. The client application developed by Visual C++ 6.0 was used to implement medical case and biospecimen management, which was based on Client/Server model. This system can perform input, browse, inquest, summary of case and related biospecimen information, and can automatically synthesize case-records based on the database. Management of not only a long-term follow-up on individual, but also of grouped cases organized according to the aim of research can be achieved by the system. This system can improve the efficiency and quality of clinical researches while biospecimens are used coordinately. It realizes synthesized and dynamic management of medical case and biospecimen, which may be considered as a new management platform.

  11. [Structured medication management in primary care - a tool to promote medication safety

    NARCIS (Netherlands)

    Mahler, C.; Freund, T.; Baldauf, A.; Jank, S.; Ludt, S.; Peters-Klimm, F.; Haefeli, W.E.; Szecsenyi, J.


    Patients with chronic disease usually need to take multiple medications. Drug-related interactions, adverse events, suboptimal adherence, and self-medication are components that can affect medication safety and lead to serious consequences for the patient. At present, regular medication reviews to c

  12. Experiences of Emotion Management in Medical Care (Case Study: Toronto

    Directory of Open Access Journals (Sweden)

    Masoud Kianpour


    Full Text Available Introduction   This study lies at the intersection of the sociology of emotions and medical sociology, investigating emotion management among a rather unknown category of medical personnel –Hospital Chaplains. Sociologists of emotions seek to understand how emotions can be socially influenced in terms of both experience and expression. They believe emotions can be influenced by such institutions as culture and religion. As a result, not only do societies and subcultures have different patterns of expressing emotions according to their own norms and characteristics, but there are also different ways of managing emotions in social institutions. For example, in North American healthcare system, hospital chaplaincy is institutionalized, like other members of the medical team, to provide spiritual and religious care, which is often accompanied with emotional support, requiring therefore emotion management. In order to explore emotional experiences that chaplains undergo as a result of working in hospital and dealing with people who are emotionally overwhelmed, the author utilized insights from interactional and symbolic interactionist, phenomenological, and ethnomethodological approaches within the sociology of emotions and spoke with different chaplains from five faith traditions. The aim was to understand how chaplains perform interpersonal emotion management, what techniques, strategies and skills are involved in dealing with people’s emotions, and how performing emotion management in healthcare institutions brings religion and spirituality at the forefront of a secular society.       Material and Methods   This is a qualitative study based on in-depth interviewing with hospital chaplains working in different hospitals in the Toronto area. Toronto has a large number of hospitals and medical/healthcare institutions, most of which have a spiritual care department in which a number of full-time and part-time chaplains work to provide

  13. [Perspectives on the development of quality management system for medical devices in China from the GMP aspects]. (United States)

    Jiang, Haihong


    The full implementation of GMP for medical devices, which is an important step to improve quality management system of medical devices production, will have a positive impact on the quality management system of medical device. It will improve and promote the development of quality management system for medical device, by updating the idea and rebuilding the frame and optimizing the contents.

  14. Perspectives on management education: an exploratory study of UK and Portuguese medical students. (United States)

    Martins, Henrique M G; Detmer, Don E; Rubery, Eileen


    Healthcare management is becoming extremely important and large health organizations face increasing demands for leadership and system change. The role of doctors is pivotal but their relationship with management issues and practice has been a matter of long-lasting debate. The aim of this research was to establish opinions of medical students and other medical educational stakeholders on the value and structure of a management and leadership course in medical school. A survey of undergraduate medical students from two medical schools (n = 268) was carried out, and quantitative and qualitative data were analysed and compared with opinions collected from interviews with hospital managers and clinical professors. Portuguese medical students attributed higher relevance to leadership/management education than their UK counterparts. For both groups, such a course would be best: (1) situated in the clinical years, (2) optional and (3) one term/semester long. Main topics desired were 'Managing people/team management'; 'National Health Service'; 'Doctors and Leadership', 'Costs/prices and resource management'. In conclusion, leadership/management education is perceived as relevant but its inclusion in the medical curriculum as well as its content needs careful consideration. Education in informatics and knowledge management would also provide a positive contribution to professional development but is scarcely appreciated at present.

  15. Aggressive and acute periodontal diseases. (United States)

    Albandar, Jasim M


    genetic profile, currently do not exist. Genetic markers have the potential to be implemented as screening tools to identify subjects at risk. This approach may significantly enhance treatment outcome through the early detection and treatment of affected subjects, as well as using future approaches based on gene therapy. At present, the treatment of this disease is directed toward elimination of the subgingival bacterial load and other local risk factors. Adjunctive use of appropriate systemic antibiotics is recommended and may contribute to a longer suppression of the microbial infection. Other aggressive forms of periodontal diseases occur in patients who are affected with certain systemic diseases, including the leukocyte adhesion deficiency syndrome, Papillon-Lefèvre syndrome, Chediak-Higashi syndrome and Down syndrome. Management of the periodontal component of these diseases is very challenging. Acute gingival and periodontal lesions include a group of disorders that range from nondestructive to destructive forms, and these lesions are usually associated with pain and are a common reason for emergency dental consultations. Some of these lesions may cause a rapid and severe destruction of the periodontal tissues and loss of teeth. Oral infections, particularly acute infections, can spread to extra-oral sites and cause serious medical complications, and even death. Hence, prompt diagnosis and treatment are paramount.

  16. Present situation and development trend of the management specialty of high-risk medication - Discussion on the physician's responsibility in high-risk medication management

    Directory of Open Access Journals (Sweden)

    Hui YAN


    Full Text Available Objective To comprehend the development status quo of the management specialty of high-risk medications, to elucidate the trend on relational research field, and to provide a theoretical basis for rational clinical medication. Methods The literature published domestically and abroad was reviewed, the development status on the management specialty of highrisk medications was reviewed, an idea of future development on the research field of high-risk medications was formed, and responsibility of clinicians on high-risk medication management was elucidated. Results The research work of high-risk medication management is still in its infancy in China. Its studies were dispersed in certain areas, with remarkable repetition, and large gaps were found in the research field as compared with that in developed countries. Development of the said discipline and its related research should be strengthened at the present and henceforth. The corresponding society should play a leading role in the development of the discipline. Systemic analysis and comprehensive evaluation should be implemented by applying pharmaceutical epidemiology and evidence-based pharmacology methodology. The catalogue of high-risk medications and the evidencebased guideline of injury prevention against high-risk medications should be established, and the control regulation of high-risk medications should be formulated. The research achievements should be assessed and improved, and then disseminated and applied. An integrated and scientific theoretical system of high-risk medications management should be established, which should contain institutional framework, education, research, and management regulation. Conclusions A joint participation of several disciplines and professions is needed in the research work of high-risk medications management in order to guide the safe and rational use of the drugs. The responsibilities of different professionals, including physicians

  17. A Systematic Review of Stress-Management Programs for Medical Students (United States)

    Shiralkar, Malan T.; Harris, Toi B.; Eddins-Folensbee, Florence F.; Coverdale, John H.


    Objective: Because medical students experience a considerable amount of stress during training, academic leaders have recognized the importance of developing stress-management programs for medical students. The authors set out to identify all controlled trials of stress-management interventions and determine the efficacy of those interventions.…

  18. An Exploration of Healthcare Inventory and Lean Management in Minimizing Medical Supply Waste in Healthcare Organizations (United States)

    Hicks, Rodney


    The purpose of this study was to understand how lean thinking and inventory management technology minimize expired medical supply waste in healthcare organizations. This study was guided by Toyota's theory of lean and Mintzberg's theory of management development to explain why the problem of medical supply waste exists. Government…

  19. Medication management strategy for older people with polypharmacy: the GP's perspective.

    NARCIS (Netherlands)

    Sinnige, J.; Korevaar, J.C.; Lieshout, J. van; Westert, G.P.; Schellevis, F.G.; Braspenning, J.C.C.


    Background & Aim: for older patients with polypharmacy medication management is a process of careful deliberation that needs periodic adjustment based on treatment effects and changing conditions. The aim of this study is to gain insight into the GP's medication management strategy for patients with

  20. Task analysis of IT-mediated medication management in outpatient care

    NARCIS (Netherlands)

    Stiphout, van F.; Zwart-van Rijkom, J.E.F.; Maggio, L.A.; Aarts, J.E.C.M.; Bates, D.W.; Gelder, van T.; Jansen, P.A.F.; Schraagen, J.M.C.; Egberts, A.C.G.; Braak, ter E.W.M.T.


    Aim Educating physicians in the procedural as well as cognitive skills of IT-mediated medication management could be one of the missing links for improvement of patient safety. We aimed to compose a framework of tasks that need to be addressed to optimize medication management in outpatient care. M

  1. 试论病案档案管理%On medical case archives management

    Institute of Scientific and Technical Information of China (English)



    该文从病案档案管理现状出发,对病案档案如何管理,从七个方面提出了具体措施与方法。%From the current situation of medical case archives management, it advanced measures and methods on how to manage medical case archives from seven aspects.

  2. 75 FR 391 - Medical Device Quality System Regulation Educational Forum on Risk Management Through the Product... (United States)


    ... No. FDA-2009-N-0664] Medical Device Quality System Regulation Educational Forum on Risk Management... System Regulation Educational Forum on Risk Management through the Product Life Cycle.'' This public workshop is intended to provide information about FDA's Medical Device Quality Systems Regulation (QSR)...

  3. The medical device industry developments in software risk management

    CERN Document Server

    Burton, John; McCaffery, Fergal; hAodha, Micheal O


    The Medical Device industry is one of the fastest growing industries in the world. Device manufacturers are producing increasingly sophisticated and complex medical device software to differentiate themselves in the battle for dominance in this sector.

  4. How to teach medication management: a review of novel educational materials in geriatrics. (United States)

    Ramaswamy, Ravishankar


    Medication management is an important component of medical education, particularly in the field of geriatrics. The Association of American Medical Colleges has put forth 26 minimum geriatrics competencies under eight domains for graduating medical students; medication management is one of these domains. The Portal of Geriatric Online education ( is an online public repository of geriatrics educational materials and modules developed by geriatrics educators and academicians in the United States, freely available for use by educators and learners in the field. The three POGOe materials presented in this review showcase pearls of medication management for medical and other professional students in novel learning formats that can be administered without major prior preparation. The review compares and contrasts the three materials in descriptive and tabular formats to enable its appropriate use by educators in promoting self-learning or group learning among their learners.

  5. Aggression in children with behavioural/emotional difficulties: seeing aggression on television and video games


    Mitrofan, Oana; Paul, Moli; Weich, Scott; Spencer, Nicholas


    Background Mental health professionals are often asked to give advice about managing children’s aggression. Good quality evidence on contributory environmental factors such as seeing aggression on television and in video games is relatively lacking, although societal and professional concerns are high. This study investigated possible associations between seeing aggression in such media and the aggressive behaviour of children attending specialist outpatient child and adolescent mental health...

  6. Aggression in children with behavioural/emotional difficulties : seeing aggression on television and video games


    Mitrofan, Oana; Paul, Moli; Weich, Scott; Spencer, Nick


    Background:\\ud Mental health professionals are often asked to give advice about managing children’s aggression. Good quality evidence on contributory environmental factors such as seeing aggression on television and in video games is relatively lacking, although societal and professional concerns are high. This study investigated possible associations between seeing aggression in such media and the aggressive behaviour of children attending specialist outpatient child and adolescent mental he...

  7. Time management tips, tricks, and exercises for busy medical practice employees. (United States)

    Hills, Laura


    Working in a busy medical practice requires excellent time management skills and an ability to handle those unanticipated emergencies, urgencies, and monkey-wrenches that can and often do throw a well-planned day out of whack. This article offers busy medical practice employees 50 time management tips to help them manage their time well. It focuses specifically on eliminating time wasters, working more efficiently, and developing personal goals and habits that can increase productivity, reduce stress, and make working in the practice more enjoyable. This article also offers several hands-on time management exercises, including a time management self-assessment quiz, a multitasking exercise, and a time drain exercise. These can be completed individually or collaboratively with other members of the medical practice team. Finally, this article explores 12 popular time management myths and how a medical practice employee can increase his or her productivity by identifying and harnessing his or her productivity "happy hour(s)".

  8. A principal components analysis of Rorschach aggression and hostility variables. (United States)

    Katko, Nicholas J; Meyer, Gregory J; Mihura, Joni L; Bombel, George


    We examined the structure of 9 Rorschach variables related to hostility and aggression (Aggressive Movement, Morbid, Primary Process Aggression, Secondary Process Aggression, Aggressive Content, Aggressive Past, Strong Hostility, Lesser Hostility) in a sample of medical students (N= 225) from the Johns Hopkins Precursors Study (The Johns Hopkins University, 1999). Principal components analysis revealed 2 dimensions accounting for 58% of the total variance. These dimensions extended previous findings for a 2-component model of Rorschach aggressive imagery that had been identified using just 5 or 6 marker variables (Baity & Hilsenroth, 1999; Liebman, Porcerelli, & Abell, 2005). In light of this evidence, we draw an empirical link between the historical research literature and current studies of Rorschach aggression and hostility that helps organize their findings. We also offer suggestions for condensing the array of aggression-related measures to simplify Rorschach aggression scoring.

  9. Effective management of medical information through ROI-lossless fragile image watermarking technique. (United States)

    Das, Sudeb; Kundu, Malay Kumar


    In this article, we have proposed a blind, fragile and Region of Interest (ROI) lossless medical image watermarking (MIW) technique, providing an all-in-one solution tool to various medical data distribution and management issues like security, content authentication, safe archiving, controlled access retrieval, and captioning. The proposed scheme combines lossless data compression and encryption technique to embed electronic health record (EHR)/DICOM metadata, image hash, indexing keyword, doctor identification code and tamper localization information in the medical images. Extensive experiments (both subjective and objective) were carried out to evaluate performance of the proposed MIW technique. The findings offer suggestive evidence that the proposed MIW scheme is an effective all-in-one solution tool to various issues of medical information management domain. Moreover, given its relative simplicity, the proposed scheme can be applied to the medical images to serve in many medical applications concerned with privacy protection, safety, and management.

  10. European guidelines on managing adverse effects of medication for ADHD


    Graham, J.; Banaschewski, Tobias; Buitelaar, J; Coghill, D.; Danckaerts, M.; Dittmann, R. W.; Döpfner, M.; Hamilton, R; Hollis, C.; Holtmann, M.; Hulpke-Wette, M.; Lecendreux, M.; Rosenthal, E; Rothenberger, A; Santosh, P.


    Abstract The safety of ADHD medications is not fully known. Concerns have arisen about both a lack of contemporary-standard information about medications first licensed several decades ago, and signals of possible harm arising from more recently developed medications. These relate to both relatively minor adverse effects and extremely serious issues such as sudden cardiac death and suicidality. A guidelines group of the European Network for Hyperkinetic Disorders (EUNETHYDIS) has t...

  11. Challenges and solutions in medically managed ACS in the Asia-Pacific region: expert recommendations from the Asia-Pacific ACS Medical Management Working Group. (United States)

    Huo, Yong; Thompson, Peter; Buddhari, Wacin; Ge, Junbo; Harding, Scott; Ramanathan, Letchuman; Reyes, Eugenio; Santoso, Anwar; Tam, Li-Wah; Vijayaraghavan, Govindan; Yeh, Hung-I


    Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations.

  12. Medication error management around the globe: An overview

    Directory of Open Access Journals (Sweden)

    Patel Isha


    Full Text Available Medical mistakes that include medication errors have raised concerns about medication safety. Due to high consumption of medicines and self-treatment by all, especially the aging population, the issue of proper medication use and safety is at the forefront of public health concerns globally. Each country has a different approach towards medication event monitoring that is compliant with its own health care system. This paper focuses on the efforts and endeavors of some of the countries around the world to create an efficient error reporting systems to ensure public safety. Our analysis indicates that there are established and effective medication vigilance systems in many developed countries. The different countries undertake activities which range from collecting information about prescriptions, surveying physicians about adverse drug events, and conducting sophisticated post-marketing surveillance studies. There is still need for such sophisticated system in India; however recent promising developments are occurring towards building a medication vigilance system. Development of these systems may eventually contribute to a global medication vigilance system, which could reduce concern with medication errors and safety.

  13. Managing medical groups: 21st century challenges and the impact of physician leadership styles. (United States)

    Martin, William E; Keogh, Timothy J


    Physician group managers and administrators charged with leading medical groups in the 21st century face a set of old and new challenges and opportunities. Leadership is assumed to make the difference between a successful and not-so-successful medical group. Yet, there is little research about how physician manager leadership styles contribute to the success of medical group practices. This article is a study of physician leadership styles using the DiSC, based upon a sample of 232 physician managers. Dominance (D) and conscientiousness (C) were the two dominant styles found in this study. Moreover, the two dominant combination leadership styles fall under the categories of the "creative" and the 'perfectionist." The article formulates practical recommendations for both physician managers and administrators for leading medical groups to respond more effectively to the challenges and opportunities facing medical groups in the 21st century.

  14. [Application of supply chain integration management of medical consumables]. (United States)

    Zhang, Jian


    This paper introduces the background, the content, the information management system of material supply chain integration management and the consumables management process. The system helps to expand the selection of hospital supplies varieties, to reduce consumables management costs, to improve the efficiency of supplies, to ensure supplies safety, reliability and traceability.

  15. Physical aggressive resident behavior during hygienic care. (United States)

    Farrell Miller, M


    Management of aggressive behavior has been identified as a concern for nursing staff who provide institutional care for cognitively impaired elderly. The Omnibus Reconciliation Act (OBRA '87) mandates a trial reduction in the use of chemical and physical restraints, and the development of nursing interventions for the management of behavioral disorders of institutionalized cognitively impaired elderly. Most skilled nursing facilities, however, are limited in their ability to provide environmental and behavioral programs to manage aggressive patient behavior. For the purposes of this study, physically aggressive behavior was identified as threatened or actual aggressive patient contact which has taken place between a patient and a member of the nursing staff. This study explored the nursing staff's responses to patient physical aggression and the effects that physical aggression had on them and on nursing practice from the perspective of the nursing staff. Nursing staff employed on one Dementia Special Care Unit (DSCU) were invited to participate. Interviews with nursing staff were analyzed using qualitative descriptive methods described by Miles and Huberman (1994). Nursing staff reported that they were subjected to aggressive patient behaviors ranging from verbal threats to actual physical violence. Nursing staff reported that showering a resident was the activity of daily living most likely to provoke patient to staff physical aggression. The findings revealed geropsychiatric nursing practices for the management of physically aggressive residents, and offered recommendations for improving the safety of nursing staff and residents on a secured DSCU.

  16. Tissue Engineered Medical Products (TEMPs): A prelude to risk management

    NARCIS (Netherlands)

    Wassenaar C; Geertsma RE; Kallewaard M; LGM


    In medical practice products containing cultured cells have emerged. These products could be labelled Tissue Engineered Medical Products (TEMPs). A literature review covering the past ten years was carried out to collect information useful for the assessment of risks associated with these products

  17. The potential of electronic medical records for health service management.

    NARCIS (Netherlands)

    Zee, J. van der; Fleming, D.M.


    The medical record held in primary care provides the most comprehensive summary of all medical events. Diagnostic, laboratory, and prescribing data are all linked in individual patient records. Networks of GPs in some European countries are routinely recording data electronically in a way which allo

  18. Loneliness at the Top: Ten Ways Medical Practice Administrators Can Manage the Isolation of Leadership. (United States)

    Hills, Laura


    Medical practice.managers spend their days surrounded by people, so the last thing they may expect to feel is lonely. Yet for many, being the manager of a medical practice can lead to feelings of isolation from the rest of the staff, and loneliness. This article explores the many reasons that managing a medical practice can be a lonely business. It considers the risks when a practice manager's loneliness goes unchecked, both to the individual and to the practice. It suggests 10 effective and healthy strategies for preventing and managing the leadership loneliness that medical practice managers sometimes experience. Next, this article argues that acceptance is the first step in overcoming loneliness in the workplace. It offers guidance for medical practice managers who wish to help lonely members of their teams. It describes the benefits of having a confidant to help support the medical practice manager, and the characteristics of an ideal confidant. Finally, this article suggests a strategy for combatting loneliness by interacting with the staff more frequently.

  19. Effects of a "Brief Stress Management Training Program" from Medical Students’ Viewpoints: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Sepideh Herizchi


    Full Text Available Introduction: Medical students undergo many stressors during various stages of medical education and must learn to cope with their new situation. Some studies have reported that stress management training methods have significant effects on decreasing stress in medical students. The aim of this study was to evaluate the efficacy of a "Stress Management Training Session" from medical students’ viewpoints. Methods: This study design employed a qualitative phenomenological research method. Using a goal-directed sampling method, medical students in the psychiatry ward during 3 months, participated in a "Stress Management Training Session". In this section, the nature of stress and some simple techniques for stress management were taught practically. After 1 month, participants cooperated in 3 focus group discussions. In the FGDs students explained their experiences in the stress management session and its effectiveness. After recording and writing discussions, subjects’ content was analyzed. Results: In total, 6 themes and 2:10 subthemes materialized from data analysis. In the students’ opinions, learning and using stress management techniques had good effects on their stress, sleep and headaches. Although some students didn’t notice to the efficacy on concentration, others believed stress management techniques were useful for learning and concentration. Conclusion: Based on the medical students’ opinions, learning and using stress management techniques had good effects on their stress, sleep and headaches and may improve concentration and learning quality.

  20. Medical Equipment Procurement Management%医疗设备采购管理

    Institute of Scientific and Technical Information of China (English)



    This paper starts from the importance of medical equipment procurement management, elaborated four elements of medical equipment procurement management principles that should be followed, and made useful practice and exploration on the actual work of medical equipment procurement management .%文章从医疗设备采购管理的重要性出发,阐述了医疗设备采购管理应遵循的四要素原则,并结合工作实际,对医疗设备采购管理进行了有益的实践与探索.

  1. Construction of a Smart Medication Dispenser with High Degree of Scalability and Remote Manageability

    Directory of Open Access Journals (Sweden)

    JuGeon Pak


    Full Text Available We propose a smart medication dispenser having a high degree of scalability and remote manageability. We construct the dispenser to have extensible hardware architecture for achieving scalability, and we install an agent program in it for achieving remote manageability. The dispenser operates as follows: when the real-time clock reaches the predetermined medication time and the user presses the dispense button at that time, the predetermined medication is dispensed from the medication dispensing tray (MDT. In the proposed dispenser, the medication for each patient is stored in an MDT. One smart medication dispenser contains mainly one MDT; however, the dispenser can be extended to include more MDTs in order to support multiple users using one dispenser. For remote management, the proposed dispenser transmits the medication status and the system configurations to the monitoring server. In the case of a specific event such as a shortage of medication, memory overload, software error, or non-adherence, the event is transmitted immediately. All these operations are performed automatically without the intervention of patients, through the agent program installed in the dispenser. Results of implementation and verification show that the proposed dispenser operates normally and performs the management operations from the medication monitoring server suitably.

  2. Introduction of a learning management system for medical education at the University Medical Center Hamburg-Eppendorf

    Directory of Open Access Journals (Sweden)

    Handels, Heinz


    Full Text Available Connected with the introduction of a learning management system at the University Medical Center Hamburg-Eppendorf three different learning management systems were evaluated. Based on the purposes and demands of modern medical education the systems WebCT CE 4.0, ILIAS 3.6 and Moodle 1.5.3 were testet and evaluated.This comparison led to an installation of the learning management system Moodle, which is now used by pilot projects and is getting prepared for normal student access in autumn 2006. First experiences under practical conditions are denoted. Finally prospective subjects like the concept of support and further options of use, even in the research domain, are discussed.

  3. Medication therapy management: why it no longer should be considered optional. (United States)

    Molokwu, Ogochukwu Chidozie; Nkansah, Nancy Twum


    Medications are the primary therapeutic intervention in many health care settings. As prescription drug use continues to grow, and medication therapies become more complex, our health care systems have become more prone to medication errors and adverse drug events. Medication Therapy Management services provided by pharmacists have been shown to help reduce medication errors, adverse drug events, and costs. Such services need to be integrated into the health care system and not be regarded as optional. This article is intended to provide pharmacists, pharmacy leaders, and health care policymakers the information needed to broach this topic at the health care policy level.

  4. Locally advanced adenocarcinoma of the rectum presenting with necrotising fasciitis of the perineum: successful management with early aggressive surgery and multimodal therapy. (United States)

    Ferreira, Luís; Alexandrino, Henrique; Soares Leite, Júlio; Castro Sousa, Francisco


    Colorectal cancer is a common malignant neoplasm and its treatment usually involves surgery associated, in some cases, depending on the staging, with chemoradiotherapy. Necrotising fasciitis of the perineum is a highly lethal infection of the perineum, perirectal tissues and genitals, requiring emergency surgical debridement, broad-spectrum antibiotics and control of sepsis. We present the case of a 59-year-old man with necrotising fasciitis of the perineum as the first clinical manifestation of locally advanced adenocarcinoma of the rectum, in which successful management consisted of early and aggressive surgical debridement, followed by multimodal therapy with curative intent. 2 years and 6 months after surgery the patient is well, with no evidence of local or systemic relapse.

  5. Co-occurrence of Calcifying Odontogenic Cyst, Aggressive Central Giant Cell Granuloma and Central Odontogenic Fibroma: Report of a Very Rare Entity and Its Surgical Management

    Directory of Open Access Journals (Sweden)

    Touraj Vaezi


    Full Text Available Calcifying odontogenic cyst (COC, Central odontogenic fibroma (COF and aggressive central giant cell granuloma (CGCG are rare pathologic diseases affecting the jaws. While the Co-existence of two of them is reported in the literature, existence of all three conditions in one patient is an extremely rare entity. In the present report, initial biopsy revealed fibrosarcoma, therefore mandibular resection was performed for the subject. Sectional Histopathologic evaluation revealed the co-existence of three conditions through histopathologic evaluation. This report emphasizes the importance of precise microscopical evaluation of jaw lesions and thorough sectional examination of the lesions to reach the precise diagnosis. Treatment modalities and follow-up radiographs are also provided to help clinicians manage these entities.

  6. Management of medical records: facts and figures for surgeons. (United States)

    Bali, Amit; Bali, Deepika; Iyer, Nageshwar; Iyer, Meenakshi


    Medical records are the document that explains all detail about the patient's history, clinical findings, diagnostic test results, pre and postoperative care, patient's progress and medication. If written correctly, notes will support the doctor about the correctness of treatment. Inspite of knowing the importance of proper record keeping in India, it is still in the initial stages. Medical records are the one of the most important aspect on which practically almost every medico-legal battle is won or lost. This article discusses the various aspect of record maintenance.

  7. Clinical metric and medication persistency effects: evidence from a Medicaid care management program. (United States)

    Berg, Gregory D; Leary, Fredric; Medina, Wendie; Donnelly, Shawn; Warnick, Kathleen


    The objective was to estimate clinical metric and medication persistency impacts of a care management program. The data sources were Medicaid administrative claims for a sample population of 32,334 noninstitutionalized Medicaid-only aged, blind, or disabled patients with diagnosed conditions of asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, or heart failure between 2005 and 2009. Multivariate regression analysis was used to test the hypothesis that exposure to a care management intervention increased the likelihood of having the appropriate medication or procedures performed, as well as increased medication persistency. Statistically significant clinical metric improvements occurred in each of the 5 conditions studied. Increased medication persistency was found for beta-blocker medication for members with coronary artery disease, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and diuretic medications for members with heart failure, bronchodilator and corticosteroid medications for members with chronic obstructive pulmonary disease, and aspirin/antiplatelet medications for members with diabetes. This study demonstrates that a care management program increases the likelihood of having an appropriate medication dispensed and/or an appropriate clinical test performed, as well as increased likelihood of medication persistency, in people with chronic conditions.

  8. Treatment of Aggressive Prolactin-Secreting Pituitary Adenomas with Adjuvant Temozolomide Chemotherapy: A Review. (United States)

    Moisi, Marc; Cruz, Aurora S; Benkers, Tara; Rostad, Steven; Broyles, Frances Broyles; Yuen, Kevin; Mayberg, Marc


    Most prolactin-secreting pituitary adenomas demonstrate slow growth and are effectively managed with medical/surgical therapy. Rarely, these tumors can behave aggressively with rapid growth and invasion of local tissues, and are refractory to medical, surgical, or radio-surgical therapies. We report a case of a prolactin-secreting adenoma in a young woman, which became progressively aggressive and refractory to usual treatment modalities, but responded to treatment with the chemotherapeutic agent temozolomide. In addition, we review the literature for treatment of refractory adenomas with temozolomide. The clinical and pathologic characteristics of aggressive prolactin-secreting adenomas are reviewed, as well as their response to dopamine agonists, surgery, radiotherapy, and chemotherapy.

  9. Should an iBSc in Management be compulsory for all UK medical students?

    Directory of Open Access Journals (Sweden)

    Singh B


    Full Text Available Bharpoor Singh,1 Natalie Ramjeeawon,2 Neil Shah,1 Shawmian Singagireson1 1Imperial College London, London, UK; 2University of Sheffield, Sheffield, UKThe UK medical school system has traditionally offered an intercalated science degree (iBSc to supplement their regular medical degree. However, in recent times with an increasing focus on leadership in the National Health Service (NHS, there has been a shift. More medical schools now offer the option to study an iBSc in Management.I have just spent a year completing an iBSc in Management at Imperial College Business School. Throughout the year I became more and more immersed in our intricate health care system, which is only really apparent to health care professionals whilst on the job. My question to the General Medical Council is – should an iBSc in Management be compulsory for all UK medical students?

  10. Medication supply chain management through implementation of a hospital pharmacy computerized inventory program in Haiti

    Directory of Open Access Journals (Sweden)

    Michelle R. Holm


    Full Text Available Background: In the aftermath of the 2010 earthquake in Haiti, St. Luke Hospital was built to help manage the mass casualties and subsequent cholera epidemic. A major problem faced by the hospital system was the lack of an available and sustainable supply of medications. Long-term viability of the hospital system depended largely on developing an uninterrupted medication supply chain. Objective: We hypothesized that the implementation of a new Pharmacy Computerized Inventory Program (PCIP would optimize medication availability and decrease medication shortages. Design: We conducted the research by examining how medications were being utilized and distributed before and after the implementation of PCIP. We measured the number of documented medication transactions in both Phase 1 and Phase 2 as well as user logins to determine if a computerized inventory system would be beneficial in providing a sustainable, long-term solution to their medication management needs. Results: The PCIP incorporated drug ordering, filling the drug requests, distribution, and dispensing of the medications in multiple settings; inventory of currently shelved medications; and graphic reporting of ‘real-time’ medication usage. During the PCIP initiation and establishment periods, the number of medication transactions increased from 219.6 to 359.5 (p=0.055, respectively, and the mean logins per day increased from 24.3 to 31.5, p<0.0001, respectively. The PCIP allows the hospital staff to identify and order medications with a critically low supply as well as track usage for future medication needs. The pharmacy and nursing staff found the PCIP to be efficient and a significant improvement in their medication utilization. Conclusions: An efficient, customizable, and cost-sensitive PCIP can improve drug inventory management in a simplified and sustainable manner within a resource-constrained hospital.

  11. Guidelines for Managing the Implementation of Automated Medical Systems


    Brown, Bob; Harbort, Bob; Kaplan, Bonnie; Maxwell, Joseph


    The nontechnical aspects of medical computing systems are as important as the technical. We offer some reasons why. We discuss the social context of systems, the human engineering necessary for medical systems to work, and the specifics of the man machine interface. We offer some suggestions for planning for the change which comes with any new method. Finally, we take a step that has often been neglected in such “how to do it” approaches and describe a theoretical framework for understanding ...

  12. Normative influences on aggression in urban elementary school classrooms. (United States)

    Henry, D; Guerra, N; Huesmann, R; Tolan, P; VanAcker, R; Eron, L


    We report a study aimed at understanding the effects of classroom normative influences on individual aggressive behavior, using samples of 614 and 427 urban elementary school children. Participants were assessed with measures of aggressive behavior and normative beliefs about aggression. We tested hypotheses related to the effects of personal normative beliefs, descriptive classroom norms (the central tendency of classmates' aggressive behavior), injunctive classroom normative beliefs (classmates' beliefs about the acceptability of aggression), and norm salience (student and teacher sanctions against aggression) on longitudinal changes in aggressive behavior and beliefs. injunctive norms affected individual normative beliefs and aggression, but descriptive norms had no effect on either. In classrooms where students and teachers made norms against aggression salient, aggressive behavior diminished over time. Implications for classroom behavior management and further research are discussed.

  13. [Depression and stress management in medical students. A comparative study between freshman and advanced medical students]. (United States)

    Jurkat, H B; Richter, L; Cramer, M; Vetter, A; Bedau, S; Leweke, F; Milch, W


    International studies have indicated a high prevalence of depression and a lack of coping with stress in medical students. Freshman and advanced medical students were investigated using a specific questionnaire and the Beck Depression Inventory (BDI) with a response rate of 100%. Of the subjects studied 81.1% did not have any depression, 13.1% slight and 5.8% clinically relevant symptoms of depression. The severity of symptoms was highly associated with subjective appraisal of stressors. Coping skills of first year students significantly influenced the depression symptoms calling for preventative measures even in freshman medical students.

  14. Stockless Medical Materials Management: Applications for the United States Air Force Medical Service (United States)


    percent would agree with the following stockless materials management definition . This research effort will adopt the following stockless materials... management definition : In a stockless program, the distributor takes over the hospitals central distribution function (i.e., the "pick-and-pack" developed a generally accepted stockless materials management definition . It defines stockless materials management as an inventory system where

  15. Medical waste management in Trachea region of Turkey: suggested remedial action. (United States)

    Uysal, Füsun; Tinmaz, Esra


    The main objective of this paper was to analyse the present status of medical waste management in the Trachea region of Turkey and subsequently to draw up a policy regarded with generation, collection, on-site handling, storage, processing, recycling, transportation and safe disposal of medical wastes. This paper also presents the results of study about awareness on how to handle expired drugs. Initially all health-care establishments in Tekirdağ, Edirne and Kýrklareli provinces in Trachea region were identified and the amounts of hospital wastes generated by each of them were determined. Current medical waste-management practices, including storage, collection, transportation and disposal, in surveyed establishments were identified. Finally, according to results, remedial measurements for medical waste management in these establishments were suggested. Unfortunately, medical wastes are not given proper attention and these wastes are disposed of together with municipal and industrial solid wastes. The current disposal method is both a public health and environmental hazard. When landfill sites are visited, many scavengers can be seen sorting for recyclable materials, a practice which is dangerous for the scavengers. In addition, it was found that some staff in health-care establishments are unaware of the hazard of medical wastes. It is concluded that a new management system, which consists of segregation, material substitution, minimization, sanitary landfilling and alternative medical waste treatment methods should be carried out. For the best appropriate medical waste management system, health-care establishment employers, managers and especially the members of house- keeping divisions should be involved in medical waste management practice.

  16. Front office staff as medical educators, risk creators, and risk managers. (United States)

    Kapp, Marshall B


    The author describes his own negative series of encounters with the front office staff of a large specialty medical practice during a recent lengthy episode of significant medical distress. The author suggests several reasons, including legal risk management, that medical students should be exposed as part of their education to the interactions of patients with front office staffs (not just physicians) to get a fuller picture of patients' actual experiences with the health care system.

  17. Task analysis of information technology-mediated medication management in outpatient care

    NARCIS (Netherlands)

    Stiphout, F. van; Zwart-van Rijkom, J.E.F.; Maggio, L.A.; Aarts, J.E.C.M.; Bates, D.W.; Gelder, T. van; Jansen, P.A.F.; Schraagen, J.M.C.; Egberts, A.C.G.; Braak, E.W.M.T. ter


    Aims Educating physicians in the procedural as well as cognitive skills of information technology (IT)-mediated medication management could be one of the missing links for the improvement of patient safety. We aimed to compose a framework of tasks that need to be addressed to optimize medication man

  18. Applying quality management tools to medical photography services: a pilot project. (United States)

    Murray, Peter


    The Medical Photography Department at Peterborough Hospitals NHS Trust set up a pilot project to reduce the turnaround time of fundus fluorescein angiograms to the Ophthalmology Department. Quality management tools were used to analyse current photographic practices and develop more efficient methods of service delivery. The improved service to the Ophthalmology Department demonstrates the value of quality management in developing medical photography services at Peterborough Hospitals.

  19. Gaining Autonomy & [corrected] Medication Management (GAM): new perspectives on well-being, quality of life and psychiatric medication. (United States)

    del Barrio, Lourdes Rodriguez; Cyr, Céline; Benisty, Lisa; Richard, Pierrette


    Autonomous Medication Management (GAM) is an innovative approach developed in partnership with medication users. It takes their subjective experience into account and strives to place the individual at the center of pharmacological treatment in psychiatry with a view to improving well-being and quality of life. It creates spaces of open dialogue on the issue of medication amongst users, physicians and their family and friends. This article is derived from a research study and presents the principles, practices and main impacts of GAM on how people relate to their medications and the physicians who prescribe them. The major positive effects were the users' clearer understanding of their experience of taking psychiatric medication and their rights, the reduction or elimination of sudden and unsupervised treatment interruptions and the users' sense of having more control over their treatment. It includes inner experience and life, an improved relationship with professionals and space for negotiation with the physician and, lastly, changes to prescriptions that significantly improved well-being and recovery. The distinguishing features of GAM are described and compared with other approaches, giving a voice to people who take medication.

  20. Medication supply chain management through implementation of a hospital pharmacy computerized inventory program in Haiti. (United States)

    Holm, Michelle R; Rudis, Maria I; Wilson, John W


    Background In the aftermath of the 2010 earthquake in Haiti, St. Luke Hospital was built to help manage the mass casualties and subsequent cholera epidemic. A major problem faced by the hospital system was the lack of an available and sustainable supply of medications. Long-term viability of the hospital system depended largely on developing an uninterrupted medication supply chain. Objective We hypothesized that the implementation of a new Pharmacy Computerized Inventory Program (PCIP) would optimize medication availability and decrease medication shortages. Design We conducted the research by examining how medications were being utilized and distributed before and after the implementation of PCIP. We measured the number of documented medication transactions in both Phase 1 and Phase 2 as well as user logins to determine if a computerized inventory system would be beneficial in providing a sustainable, long-term solution to their medication management needs. Results The PCIP incorporated drug ordering, filling the drug requests, distribution, and dispensing of the medications in multiple settings; inventory of currently shelved medications; and graphic reporting of 'real-time' medication usage. During the PCIP initiation and establishment periods, the number of medication transactions increased from 219.6 to 359.5 (p=0.055), respectively, and the mean logins per day increased from 24.3 to 31.5, psupply as well as track usage for future medication needs. The pharmacy and nursing staff found the PCIP to be efficient and a significant improvement in their medication utilization. Conclusions An efficient, customizable, and cost-sensitive PCIP can improve drug inventory management in a simplified and sustainable manner within a resource-constrained hospital.

  1. Baseline Antihypertensive Drug Count and Patient Response to Hypertension Medication Management. (United States)

    Crowley, Matthew J; Olsen, Maren K; Woolson, Sandra L; King, Heather A; Oddone, Eugene Z; Bosworth, Hayden B


    Telemedicine-based medication management improves hypertension control, but has been evaluated primarily in patients with low antihypertensive drug counts. Its impact on patients taking three or more antihypertensive agents is not well-established. To address this evidence gap, the authors conducted an exploratory analysis of an 18-month, 591-patient trial of telemedicine-based hypertension medication management. Using general linear models, the effect of medication management on blood pressure for patients taking two or fewer antihypertensive agents at study baseline vs those taking three or more was compared. While patients taking two or fewer antihypertensive agents had a significant reduction in systolic blood pressure with medication management, those taking three or more had no such response. The between-subgroup effect difference was statistically significant at 6 months (-6.4 mm Hg [95% confidence interval, -12.2 to -0.6]) and near significant at 18 months (-6.0 mm Hg [95% confidence interval, -12.2 to 0.2]). These findings suggest that baseline antihypertensive drug count may impact how patients respond to hypertension medication management and emphasize the need to study management strategies specifically in patients taking three or more antihypertensive medications.

  2. An intervention to maximize medication management by caregivers of persons with memory loss: Intervention overview and two-month outcomes. (United States)

    Lingler, Jennifer H; Sereika, Susan M; Amspaugh, Carolyn M; Arida, Janet A; Happ, Mary E; Houze, Martin P; Kaufman, Robert R; Knox, Melissa L; Tamres, Lisa K; Tang, Fengyan; Erlen, Judith A


    Overseeing medication-taking is a critical aspect of dementia caregiving. This trial examined a tailored, problem-solving intervention designed to maximize medication management practices among caregivers of persons with memory loss. Eighty-three community-dwelling dyads (patient + informal caregiver) with a baseline average of 3 medication deficiencies participated. Home- and telephone-based sessions were delivered by nurse or social worker interventionists and addressed basics of managing medications, plus tailored problem solving for specific challenges. The outcome of medication management practices was assessed using the Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) and an investigator-developed Medication Deficiency Checklist (MDC). Linear mixed modeling showed both the intervention and usual care groups had fewer medication management problems as measured by the MedMaIDE (F = 6.91, p importance of medication adherence, there may be benefit.

  3. Challenges of managing medications for older people at transition points of care. (United States)

    Manias, Elizabeth; Hughes, Carmel


    In clinical practice, pharmacists play a very important role in identifying and correcting medication discrepancies as older patients move across transition points of care. With increasing complexity of health care needs of older people, these discrepancies are likely to increase. The major concern with identifying and correcting medication discrepancies is that medication reconciliation is considered a retrospective problem--that is, dealing with medication discrepancies after they have occurred. It is argued here that a more proactive stance should be taken where doctors, nurses and pharmacists collectively work together to prevent medication discrepancies from happening in the first place. Improved involvement of patients and family members will help to facilitate better management of medications across transition points of care. Efficient use of information technology aids, such as electronic medication reconciliation tools, should also assist with organizational systems problems associated with the working culture, heavy workloads, and staff and skill mix of health professionals.

  4. [Medical theories and urban management: Fortaleza's 1877-79 drought]. (United States)

    Costa, Maria Clélia Lustosa


    Down through the nineteenth century, new medical theories on the origin of disease influenced the norms and regulations that controlled the population's behavior and the urban space. The present study discusses the ideas, medical practices , and administrative initiatives adopted during the 1877-79 drought in Fortaleza, capital of Ceará province. The drought was accompanied by a smallpox epidemic, along with the increased migration of sertão dwellers to the capitol. The city lacked a public service network capable of meeting the needs of this new population, which took up lodgings on the city and periphery. The municipal administration endeavored to implement the recommendations of physicians based on modern principles of hygienization. Through an analysis of reports by the provincial presidents and by public health inspectors, the study intends to show how these medical theories influenced the practices of urban reorganization at a moment of public emergency.

  5. [Promoting research in a medical center--the management narrative]. (United States)

    Halevy, Jonathan; Turner, Dan


    Promoting research within a medical institute is a delicate balance between the importance of facilitating academia and maximizing resources towards the primary goal of a hospital--healing sick people. Shaare Zedek Medical Center have successfully adopted a "niche" approach to research in which the hospital invests in selected talented clinicians-scientists rather than futile expectation that all clinicians would be engaged in high impact research. Moreover, these research excellence centers are developing into a driving force to also foster research endeavors of other clinicians and residents in the hospital. In this special issue of Harefuah honoring Shaare Zedek investigators, 18 manuscripts included reflect the diversity of research projects performed in the medical center. We believe that this project will assist and encourage clinicians to be engaged in research, at all levels and disciplines.

  6. SPD-based Logistics Management Model of Medical Consumables in Hospitals

    Directory of Open Access Journals (Sweden)

    Tongzhu LIU


    Full Text Available Background: With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. Methods: We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China.Results: We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. Conclusion: The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China.  

  7. Improving medication adherence with a targeted, technology-driven disease management intervention. (United States)

    Lawrence, David B; Allison, Wanda; Chen, Joyce C; Demand, Michael


    Treatment adherence is critical in managing chronic disease, but achieving it remains an elusive goal across many prevalent conditions. As part of its care management strategy, BlueCross BlueShield of South Carolina (BCBSSC) implemented the Longitudinal Adherence Treatment Evaluation program, a behavioral intervention to improve medication adherence among members with cardiovascular disease and/or diabetes. The objectives of this study were to 1) assess the effectiveness of telephonic intervention in influencing reinitiation of medication therapy, and 2) evaluate the rate and timing of medication reinitiation. BCBSSC applied algorithms against pharmacy claims data to identify patients prescribed targeted medications who were 60 or more days overdue for refills. This information was provided to care managers to address during their next patient contact. Care managers received focused training on techniques for medication behavior change, readiness to change, motivational interviewing, and active listening. Training also addressed common barriers to adherence and available resources, including side effect management, mail order benefits, drug assistance programs, medication organizers, and reminder systems. Overdue refills were tracked for 12 months, with medication reinitiation followed for an additional 3 months. In the intervention group, 94 patients were identified with 123 instances of late medication refills. In the age- and gender-matched comparison group, 61 patients were identified with 76 late refills. The intervention group had a significantly higher rate of medication reinitiation (59.3%) than the control group (42.1%; P management intervention promoting patient behavior change increased the number of patients who reinitiated therapy after a period of nonadherence and decreased the time from nonadherence to adherence.

  8. Financing and cash flow management for the medical group practice. (United States)

    Bert, Andrew J


    The expansion of a medical group practice and the addition of ancillary services require a substantial cash outlay. Obtaining proper financing to complete a successful expansion is a process that takes time, and there are critical steps that must be followed. The group's business objectives must be presented properly by developing a business plan detailing the practice and goals associated with the desired expansion. This article discusses some of the key elements that are essential in creating an overall effective business plan for the group medical practice.

  9. Integrated absence management and the Family and Medical Leave Act. (United States)

    Morris, Judy A


    Intermittent unscheduled absenteeism often challenges employers to meet the needs of their employees, control direct absenteeism costs, and maintain the staff needed to serve customers. Occupational health nurses have opportunities to play an important role in addressing this challenge. Measurable financial impacts have been demonstrated from integrating the management of intermittent FMLA leave with an employer's existing absence management program.

  10. Standardised assessment of patients' capacity to manage medications: a systematic review of published instruments

    Directory of Open Access Journals (Sweden)

    Elliott Rohan A


    Full Text Available Abstract Background Older people are commonly prescribed complex multi-drug regimens while also experiencing declines in the cognitive and physical abilities required for medication management, leading to increased risk of medication errors and need for assisted living. The purpose of this study was to review published instruments designed to assess patients' capacity to self-administer medications. Methods Searches of Medline, EMBASE, CINAHL, PsycINFO, International Pharmaceutical Abstracts, Health and Psychosocial Instruments, Google, and reference lists of identified publications were conducted to identify English-language articles describing development and validation of instruments designed to assess patients' capacity to self-administer medications. Methodological quality of validation studies was rated independently against published criteria by two reviewers and reliability and validity data were reviewed. Results Thirty-two instruments were identified, of which 14 met pre-defined inclusion criteria. Instruments fell into two categories: those that used patients' own medications as the basis for assessment and those that used a simulated medication regimen. The quality of validation studies was generally low to moderate and few instruments were subjected to reliability testing. Most instruments had some evidence of construct validity, through associations with tests of cognitive function, health literacy, activities of daily living or measures of medication management or adherence. Only one instrument had sensitivity and specificity data with respect to prediction of medication-related outcomes such as adherence to therapy. Only three instruments had validity data from more than one independent research group. Conclusion A number of performance-based instruments exist to assess patients' capacity to manage their own medications. These may be useful for identifying physical and cognitive barriers to successful medication management, but

  11. Treating asthma by the guidelines: developing a medication management information system for use in primary care. (United States)

    Twiggs, Joan E; Fifield, J; Jackson, E; Cushman, R; Apter, A


    The aim of this study was to develop, implement, and assess an automated asthma medication management information system (MMIS) that provides patient-specific evaluative guidance based on 1997 NAEPP clinical consensus guidelines. MMIS was developed and implemented in primary care settings within a pediatric asthma disease management program. MMIS infrastructure featured a centralized database with Internet access. MMIS collects detailed patient asthma medication data, evaluates pharmacotherapy relative to practitioner-reported disease severity, symptom control and model of guideline-recommended severity-appropriate medications and produces a patient-specific "curbside consult" feedback report. A system algorithm translates actual detailed medication data into actual severity-specific medication-class combinations. A table-driven computer program compares actual medication-class combinations to a guideline-based medication-class combinations model. Methodology determines whether the patient was prescribed a "severity-appropriate" amount or an amount "more" or "less" medication than indicated for patient's reported severity. Feedback messages comment on comparison. Missing data, unrecognized amounts of controller medication or unrecognized medication combinations create error cases. Post hoc review analyzed error cases to determine prevalence of non-guideline medicating practices among these practitioners. Proportion of valid and error cases across two clinical visits before and after post hoc clinical review were measured, as well as proportion of severity-appropriate, out-of-severity and non-guideline medications. MMIS produced a valid feedback report for 83% of patient visits. Missing data accounted for 60% of error cases. Practitioners used severity-appropriate medications for 60% of cases. When non-severity-appropriate medications were used they tended to be "too much" rather than "too little" (22%, 5%), suggesting appropriate use of guideline-recommended "step

  12. Retrieval and management of medical information from heterogeneous sources, for its integration in a medical record visualisation tool. (United States)

    Cabarcos, Alba; Sanchez, Tamara; Seoane, Jose A; Aguiar-Pulido, Vanessa; Freire, Ana; Dorado, Julian; Pazos, Alejandro


    Nowadays, medical practice needs, at the patient Point-of-Care (POC), personalised knowledge adjustable in each moment to the clinical needs of each patient, in order to provide support to decision-making processes, taking into account personalised information. To achieve this, adapting the hospital information systems is necessary. Thus, there is a need of computational developments capable of retrieving and integrating the large amount of biomedical information available today, managing the complexity and diversity of these systems. Hence, this paper describes a prototype which retrieves biomedical information from different sources, manages it to improve the results obtained and to reduce response time and, finally, integrates it so that it is useful for the clinician, providing all the information available about the patient at the POC. Moreover, it also uses tools which allow medical staff to communicate and share knowledge.

  13. Impact of information technology on the role of medical libraries in information managment: normative background

    Directory of Open Access Journals (Sweden)

    Anamarija Rožić-Hristovski


    Full Text Available Exponential growth of biomedical knowledge and information technology development is changing the infrastructure of health care systems, education and research. So medical libraries roles have shifted from managing containers of information toward influencing biomedical information resource content and education. These new tasks are formalised in modem American standards for medical libraries, stressing information management role in evolving environment.In Slovenia medical libraries also are aware of development imperative of information activities for advances in medicine. At one side they are faced with lack of specific guidelines for proactive action and on the other with inadequate assessment in legal documents and insufficient funding.

  14. The practice and effect of combined duty of administrative management, medical treatment and nursing

    Directory of Open Access Journals (Sweden)

    Min HU


    Full Text Available Objective: To explore the effect of combined duty mode on discovery and control of medical nursing hidden trouble. Method: In order to make sure that patients are in the first place, we should take the mode of combined duty of administrative management, medical treatment and nursing. Results:The incidence of nursing errors and defects reduced, and patients’ satisfaction improved. the differences were statistically significant (P<0.01 or P<0.05.Results: Combined duty can the reduce medical nursing defects, improve the efficiency of quality health care services and the management efficiency.

  15. Medical Information Management System (MIMS): A generalized interactive information system (United States)

    Alterescu, S.; Friedman, C. A.; Hipkins, K. R.


    An interactive information system is described. It is a general purpose, free format system which offers immediate assistance where manipulation of large data bases is required. The medical area is a prime area of application. Examples of the system's operation, commentary on the examples, and a complete listing of the system program are included.

  16. Trusted data management for Grid-based medical applications

    NARCIS (Netherlands)

    van 't Noordende, G.J.; Olabarriaga, S.D.; Koot, M.R.; de Laat, C.T.A.M.; Udoh, E.


    Existing Grid technology has been foremost designed with performance and scalability in mind. When using Grid infrastructure for medical applications, privacy and security considerations become paramount. Privacy aspects require a re-thinking of the design and implementation of common Grid middlewar

  17. Medical management of first trimester miscarriage according to ultrasonographic findings

    DEFF Research Database (Denmark)

    Vejborg, Thomas; Nilas, Lisbeth; Rørbye, Christina


    BACKGROUND: The efficacy of medical treatment of first trimester miscarriages may depend on the regimen used, the definition of success, clinical symptoms, and, possibly, on the ultrasonographic findings. Our primary aim was to assess if a single dose of misoprostol could reduce the number of sur...

  18. A preliminary study of medical waste management in Lagos metropolis, Nigeria

    Directory of Open Access Journals (Sweden)

    E. O. Longe, A. Williams


    Full Text Available A survey of medical waste management (MWM practices and their implications to health and environment was carried out in metropolitan Lagos. Lagos is currently the most populous and urbanized city in the country with an estimated population of over 13 million people. The study assessed management practices in four (2 privates and 2 publics hospitals ranging in capacity from 40 to 600 beds. Empirical data was obtained on medical waste generation, segregation, storage, collection, transportation and disposal. The observed MWM practices in all hospitals indicate absence of full compliance with the protocol for handling medical waste as stipulated in the relevant sections of the guidelines and standards for environmental pollution control in Nigeria. Three hospitals demonstrated high priority for segregation of infectious medical waste. Average generation rate of medical waste in the investigated hospitals ranged from 0.562 kg/ to 0.670 kg/ Infectious waste accounts for between 26 to 37% of this volume. Only two of the hospitals investigated carry out treatment of their infectious and sharp waste types by incineration before final disposal. Burning and burial of medical waste is an unusual but common practice among the hospitals. All the hospitals employ the services of the state owned solid waste management company, the Lagos State Waste Management Authority (LAWMA for final collection, and disposal of their medical waste at government approved sites.

  19. Bio-medical waste management in the U.T., Chandigarh. (United States)

    Singh, Kamaljit; Arora, Shakti Kumar; Dhadwal, P J S; Singla, Ashwani; John, Siby


    Investigations were carried out to assess the generation and disposal of biomedical waste in the various medical establishments in the urban and rural areas of the U.T. Chandigarh. It was found that there were 474 medical establishments in the U.T., Chandigarh including Nursing Homes, Clinics, Dispensaries, Pathological labs., Hospitals, Veterinary Institutions and Animal houses. The total quantity of bio-medical waste generated in Chandigarh is 811.35 kg/day and the rate of generation of bio-medical waste varies from 0.06 kg/day/bed to 0.25 kg/day/bed. Though the major hospitals are equipped with incinerators, proper bio-medical waste management system is yet to be implemented. The medical establishments in the rural area and smaller ones in the urban area dispose off their bio-medical waste along with municipal solid waste and no waste management system exists. It is recommended that an integrated waste management plan using the three incinerators installed at the major hospitals can safely dispose off the total bio-medical waste generated in the city.

  20. [Quality management system in the medical laboratory--ISO15189 and laboratory accreditation]. (United States)

    Kubono, Katsuo


    Medical laboratory services are essential to patient care and therefore should meet the needs of all patients and clinical personnel responsible for human health care. Recently, ISO15189, the first quality management ISO system for medical laboratories, has attracted the attention of all medical laboratories. ISO 15189:2003, Medical laboratories--Particular requirements for quality and competence, provides a framework for the design and improvement of process-based quality management systems by medical laboratories. It is based on ISO17025:1999, General requirements for the competence of testing and calibration laboratories, but provides specific requirements for implementation in medical laboratories. This will help medical laboratories to comply with regulatory requirements, to meet the expectations of their clients and, most importantly, to improve and maintain their service to patients. ISO15189 will be an important template for assessing and recognizing the competence of medical laboratories in their technical capacity and the effective quality management of a professional service and its staff--with or without the aim of accreditation.

  1. Impact of managed care on the development of new medical technology: ethical concerns (United States)

    Saha, Pamela; Saha, Subrata


    During the last three decades, development of new medical technology has been largely responsible for the spectacular advances in the diagnosis and treatment of many human diseases. This has contributed to improved medical care of our population. However, concerns have been raised that in today's managed care environment of health care, introduction of new medical technology will be difficult. Cost-sensitive health care providers should consider various ethical issues involved before demanding that only those technologies that save money and show highly positive cost benefit ratio will be reimbursed. The impact of such considerations on the innovations of new medical devices and their developments is discussed.

  2. Impact of decreasing copayments on medication adherence within a disease management environment. (United States)

    Chernew, Michael E; Shah, Mayur R; Wegh, Arnold; Rosenberg, Stephen N; Juster, Iver A; Rosen, Allison B; Sokol, Michael C; Yu-Isenberg, Kristina; Fendrick, A Mark


    This paper estimates the effects of a large employer's value-based insurance initiative designed to improve adherence to recommended treatment regimens. The intervention reduced copayments for five chronic medication classes in the context of a disease management (DM) program. Compared to a control employer that used the same DM program, adherence to medications in the value-based intervention increased for four of five medication classes, reducing nonadherence by 7-14 percent. The results demonstrate the potential for copayment reductions for highly valued services to increase medication adherence above the effects of existing DM programs.

  3. Management of Medical Disposable Materials%浅谈医用材料管理

    Institute of Scientific and Technical Information of China (English)

    曲培玲; 童美英; 朱江华


    With the increasing demand of medical disposable materials, how to further improve the management of medical disposable materials has become an outstanding problem. By upgrading the database management software,we have proposed that suppliers' deliveries and clinical materials requisition should be distributed at different time for the reason of improving the conventional management of medical disposable materials.[Chinese Medical Equipment Jouran1,2011 , 32 (3) :116-117]%阐述了在医用材料使用量不断上升以及数据库管理软件升级的情况下,如何进一步提升医用材料的管理水平,探讨了关于错时分配供应商送货与临床领用材料的方法.

  4. Effectiveness of an interprofessional workshop on pain management for medical and nursing students. (United States)

    Erickson, Jeanne M; Brashers, Valentina; Owen, John; Marks, Jennifer R; Thomas, Shannon M


    Interprofessional (IP) care is critical for effective pain management, but evidence is lacking about the best way to teach pain management skills to medical and nursing students using IP strategies. In 2013 and 2014, 307 medical and 169 nursing students participated in an IP case-based pain management workshop. The aims of this study were to determine (1) if students who participate in IP case-based learning groups will have improved pain management skills compared to students who participate in uniprofessional case-based learning groups, and (2) if students mentored by faculty with IP training will have improved pain management skills compared to students who are not mentored by IP-trained faculty. Student learning was assessed and compared using scored checklists for each group's pain management plans. Findings show that IP mentorship and IP group participation improved medical students' pain management skills but did not have the same effect on nursing student performance. Continued work is needed to develop, refine, and integrate innovative and tailored IP strategies into the curricula of medical and nursing schools to advance the pain management competencies of students before they enter clinical practice.

  5. Major incident medical management and support the practical approach at the scene

    CERN Document Server

    Advanced Life Support Group


    Major Incident Medical Management and Support (MIMMS) is the coursebook for the Advanced Life Support Group's internationally taught training for health care professionals responding to major incidents. The practical approach employed in MIMMS has proved an invaluable aid to both civilian and military doctors, nurses and paramedics working in disaster management worldwide.

  6. Effects of Crew Resource Management Training on Medical Errors in a Simulated Prehospital Setting (United States)

    Carhart, Elliot D.


    This applied dissertation investigated the effect of crew resource management (CRM) training on medical errors in a simulated prehospital setting. Specific areas addressed by this program included situational awareness, decision making, task management, teamwork, and communication. This study is believed to be the first investigation of CRM…

  7. Medication and finance management among HIV-infected adults: the impact of age and cognition. (United States)

    Thames, April D; Kim, Michelle S; Becker, Brian W; Foley, Jessica M; Hines, Lindsay J; Singer, Elyse J; Heaton, Robert K; Castellon, Steven A; Hinkin, Charles H


    This study examined the effects of aging and cognitive impairment on medication and finance management in an HIV sample. We observed main effects of age (older finance management. The interaction of advancing age and cognitive impairment may confer significant functional limitations for HIV individuals that may be better detected by performance-based measures of functional abilities rather than patient self-report.

  8. The Importance of Preparing Medical Students to Manage Different Types of Uncertainty. (United States)

    Fargason, Crayton A., Jr.; Evans, H. Hughes; Ashworth, Carolyn S.; Capper, Stuart A.


    To design effective academic health centers for the future, medical leaders must define the competencies needed by tomorrow's physicians, including the ability to manage the uncertainty associated with creating clinical models and the uncertainty associated with managing care delivery. Currently, focus is on the former, but there is increasing…

  9. How do hospital doctors manage patients with medically unexplained symptoms: a qualitative study of physicians. (United States)

    Warner, Alex; Walters, Kate; Lamahewa, Kethakie; Buszewicz, Marta


    Objective Medically unexplained symptoms are a common presentation in medical practice and are associated with significant morbidity and high levels of service use. Most research exploring the attitudes and training of doctors in treating patients with unexplained symptoms has been conducted in primary care. This study aims to explore the ways in which doctors working in secondary care approach and manage patients with medically unexplained symptoms. Design A qualitative study using in-depth interviews and thematic analysis. Setting Three hospitals in the North Thames area. Participants Twenty consultant and training-grade physicians working in cardiology, gastroenterology, rheumatology and neurology. Main outcome measure Physicians' approach to patients with medically unexplained symptoms and their views on managing these patients. Results There was considerable variation in how the physicians approached patients who presented with medically unexplained symptoms. Investigations were often ordered without a clear rationale and the explanations given to patients when results of investigations were normal were highly variable, both within and across specialties. The doctor's level of experience appeared to be a more important factor in their investigation and management strategies than their medical specialty. Physicians reported little or no formal training in how to manage such presentations, with no apparent consistency in how they had developed their approach. Doctors described learning from their own experience and from senior role models. Organisational barriers were identified to the effective management of these patients, particularly in terms of continuity of care. Conclusions Given the importance of this topic, there is a need for serious consideration as to how the management of patients with medically unexplained symptoms is included in medical training and in the planning and delivery of services.

  10. 从医保管理角度谈医院医疗设备管理%Discussion on Hospital Medical Equipment Management from View of Medical Insurance

    Institute of Scientific and Technical Information of China (English)

    王方; 郑小溪


    阐述了医疗设备管理过程中出现的新问题,简要说明了医保工作的基本现状,分析了医保管理对医疗设备管理提出的新要求,探讨了医疗设备管理工作的新思路并提出相关建议,以期完善医疗设备管理工作,适应目前医疗改革的步伐.%New problems of medical equipment management are discussed. The status of medical insurance is illuminated.and new request of medical equipment management which puts forward by medical insurance ia analyzed. The new thinking of medical equipment management and suggestions are put forward, so as to perfect medical equipments management, and adapt to the step of health care reform.

  11. Transmitting patient and device data via GSM--central management for decentral mobile medical devices. (United States)

    Bachmor, T; Schöchlin, J; Bolz, A


    Equipping medical devices with long range telemetry opens completely new possibilities for emergency response, home care and remote diagnosis. Mobile communications nowadays seem to be a generally accepted part of our modern world, but bridging the gap between new (consumer-) technologies and medical devices still is a challenge today. Providing a telemetry link (GSM) is just the trivial part--ensuring security, reliability and service management are the more critical tasks that need to be addressed. Therefore, a complete system concept consists of an automatic fleet management (e.g. periodic device-initiated service calls) as well as customer relationship management (CRM), including technical service and a trouble-ticket system.

  12. Diabetic foot infections: a team-oriented review of medical and surgical management

    Directory of Open Access Journals (Sweden)

    Claire M Capobianco


    Full Text Available As the domestic and international incidence of diabetes and metabolic syndrome continues to rise, health care providers need to continue improving management of the long-term complications of the disease. Emergency department visits and hospital admissions for diabetic foot infections are increasingly commonplace, and a like-minded multidisciplinary team approach is needed to optimize patient care. Early recognition of severe infections, medical stabilization, appropriate antibiotic selection, early surgical intervention, and strategic plans for delayed reconstruction are crucial components of managing diabetic foot infections. The authors review initial medical and surgical management and staged surgical reconstruction of diabetic foot infections in the inpatient setting.

  13. Medication management during pregnancy: role of the pharmacist. (United States)

    Samuel, Nardin; Einarson, Adrienne


    A community pharmacist is frequently the first healthcare professional who is asked to give advice regarding medication use during pregnancy. As 50% of pregnancies are unplanned, a woman often discovers she is pregnant while already taking a medication and visits a pharmacy which is easily accessible, to enquire if she has harmed her baby by this action. Following a review of the literature, of which there is a paucity on this topic, we found that pharmacists often do not feel equipped to dispense teratology information and frequently refer the woman to her attending physician, without giving any information. In addition, it was clear that even when they did give information, it was not necessarily evidence-based and at times, inaccurate and based on their own opinions. In this article, we have attempted to make pharmacists aware of all the sources that are available, to enable them to perform this important role as a member of the health care team. These include websites, texts, evidence-based literature, teratogen information services and more. With the knowledge extracted from various resources, following critical appraisal of the data, they should be more comfortable and feel better equipped to transfer this information to a pregnant woman. In conclusion, while there may be a lack of adequate information regarding use of certain medications during pregnancy, pharmacists should be able to integrate available information with their medication expertise, to make appropriate individual risk/benefit decisions. This requires active engagement with pregnant women, rather than automatically referring them to their physician, thus establishing the pharmacist role as an essential member of the health care team.


    Directory of Open Access Journals (Sweden)

    Adina BĂLAN


    Full Text Available The unprecedented incertitude existing in the health system in Romaniaimplies menaces for the system managers. The improvement of theperformance of the medical system has never been more adequate, so thatthe health system needs specific managerial strategies. Romania needs acomplete solution which could assure a performant management of themedical information in the system, and in their plans, the managers of thehealthcare organizations must include investments for the application of theinformational technologies, like the administration of medical information, ofthe health electronic file, the medical information exchange, so that themedical service be continuous and permanent from the birth until the death ofany individual. But the piece of information is only valuable to the one whoknows how to use it, where to search for it, how to choose it and finally howto use it, so that we can say the main instrument to which the manager fromthe health system may resort rapidly in order to find new solutions isinformation.

  15. The cost-effectiveness of managed care regarding chronic medicine prescriptions in a selected medical scheme

    Directory of Open Access Journals (Sweden)

    K. Day


    Full Text Available The purpose of the study was to examine the cost-effectiveness of managed care interventions with respect to prescriptions for chronic illness sufferers enrolled with a specific medical scheme. The illnesses included, were epilepsy, hypertension, diabetes and asthma. The managed care interventions applied were a primary discount; the use of preferred provider pharmacies, and drug utilization review. It was concluded that the managed care interventions resulted in some real cost savings.

  16. Medical residents' perceptions of their competencies and training needs in health care management

    DEFF Research Database (Denmark)

    Berkenbosch, Lizanne; Schoenmaker, Suzanne Gerdien; Ahern, Susannah


    Previous research has shown that Dutch medical residents feel inadequate in certain management areas: 85% had a need for management training and reported preferences on the format of such training. Our objective was to explore if the perceived deficiencies and needs among Dutch residents were...... similar to those of their peers in other countries, and if a longer duration of the incorporation of the CanMEDS competency framework into curricula as well as management training had an influence on these perceptions....

  17. The Role of Knowledge Creation and Its Dimensions in Management Skills of Managers of Tabriz University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Mohammad-Ali Hemmati


    Full Text Available ​Background and Objectives : The purpose of this study was to study the role of knowledge creation and management skills of managers in Tabriz University of Medical Sciences. Material and Methods : This was a descriptive correlational study. The statistical population consisted of all managers (140 managers in Tabriz University of Medical Sciences. Census sampling method was used due to limited statistical population. The data were collected through management skills and knowledge creation questionnaire developed by Goudarzi (2002. The reliability was 0.933 and 0.792 respectively using Cronbach's alpha. The validity of the questionnaire was verified by management faculty members. Pearson correlation and multiple regression analysis were used to analyze the data. Results : Results showed that there was a positive relationship between knowledge creation and management skills of the managers. In addition, there was a positive and significant relationship between the management skills indicators (human, conceptual and technical and the knowledge creation variables. Multiple regression results indicated that the knowledge creation dimensions had a predictive role in human, perceptual and technical skills. A significant relationship between knowledge creation and management skills of managers indicated that managers should have access to the up-to-date knowledge to promote it in order to execute it at all levels within the organization to improvement staff and organization creativity. Conclusion : The results demonstrated that the enhancement of organizational knowledge creation and its dimensions lead to improvement of management skills.  Managers need to have dynamic capabilities to move towards knowledge creation and make the best use of available and potential resources of the organization to achieve these capabilities and identify, acquire, apply, integrate and combine the information, knowledge and skills.

  18. Medical management of paediatric burn injuries: best practice. (United States)

    Kim, Leo K P; Martin, Hugh C O; Holland, Andrew J A


    Burns commonly occur in children and their first aid remains inadequate despite burn prevention programmes. While scald injuries predominate, contact and flame burns remain common. Although typically less severe injuries overall than those in adults, hypertrophic scarring complicating both the burn wound and even donor sites occur more frequently in children. The heterogeneous nature of burn wounds, coupled with the difficulties associated with the early clinical assessment of burn depth, has stimulated the application of novel technologies to predict burn wound outcome. This review explores current best practice in the management of paediatric burns, with a focus on prevention, optimal first aid, resuscitation, burn wound prediction and wound management strategies.

  19. [Motives and interpersonal functions of aggression]. (United States)

    Ohbuchi, K


    In this review, the author theoretically and empirically examined motives and interpersonal functions of aggression. A factor-analysis of Averill's questionnaire items on anger revealed that motives involved in aggressive responses were clustered into two groups: the hostile and the instrumental. It was also clarified that an individual is likely to engage in aggression particularly when some hostile motives are evoked. Concerning the interpersonal functions, the author proposed that aggression might serve four principal goals. (1) Aggression can be generated as an avoidance response to an aversive stimulus, such as frustration, annoyance, or pain, and so on. It depends on the severity of the stimulus. It was however emphasized that aggression is also mediated by social cognition, such as an attribution of intent to a harm-doer. (2) Aggression can be used as a means of coercing the other person into doing something. An individual is likely to use such a power strategy if he/she is lacking in self-confidence or a perspective for influencing the target person by more peaceful strategies. (3) Aggression can be interpreted as a punishment when it is directed toward a transgressor. In this case, aggression is motivated by restoration of a social justice, and thus its intensity is determined by the perceived moral responsibility of the transgressor. Further, it was indicated that aggression is intensified if it is justified as a sanctional conduct against the immoral. (4) Aggression can be also evoked when an individual's social identity is threatened. It was suggested that impression management motives are involved in aggression by an unexpected finding that the presence of audience or the identifiability rather facilitated retaliative aggression. The aggression-inhibition effect of apology was also explained in terms of impression management. In conclusion, it was presented that aggression is a behavioral strategy as an attempt to resolve interpersonal conflicts

  20. Organization and Management of the International Space Station (ISS) Multilateral Medical Operations (United States)

    Duncan, J. M.; Bogomolov, V. V.; Castrucci, F.; Koike, Y.; Comtois, J. M.; Sargsyan, A. E.


    The goal of this work is to review the principles, design, and function of the ISS multilateral medical authority and the medical support system of the ISS Program. Multilateral boards and panels provide operational framework, direct, and supervise the ISS joint medical operational activities. The Integrated Medical Group (IMG) provides front-line medical support of the crews. Results of ongoing activities are reviewed weekly by physician managers. A broader status review is conducted monthly to project the state of crew health and medical support for the following month. All boards, panels, and groups function effectively and without interruptions. Consensus prevails as the primary nature of decisions made by all ISS medical groups, including the ISS medical certification board. The sustained efforts of all partners have resulted in favorable medical outcomes of the initial fourteen long-duration expeditions. The medical support system appears to be mature and ready for further expansion of the roles of all Partners, and for the anticipated increase in the size of ISS crews.

  1. Contemporary and optimal medical management of peripheral arterial disease. (United States)

    Tattersall, Matthew C; Johnson, Heather M; Mason, Peter J


    Atherosclerotic lower extremity peripheral arterial disease (PAD) is a highly prevalent condition associated with a significant increase in risk of all-cause mortality and cardiovascular morbidity and mortality. PAD is underdiagnosed and undertreated. Treatment is focused on (1) lowering cardiovascular risk and cardiovascular disease event rates and (2) improvement in symptoms and quality of life. Multidisciplinary and intersociety guidelines guide optimal medical therapy. Substantial evidence supports implementation of tobacco cessation counseling and pharmacotherapy to help achieve tobacco abstinence, antiplatelet therapy, HMG-CoA reductase inhibitors (statins) therapy, and antihypertensive therapy for the purpose of lowering cardiovascular event rates and improving survival.

  2. Application of Medical Internet of Things in the Medical Waste Management%医疗物联网在医疗垃圾管理中的应用

    Institute of Scientific and Technical Information of China (English)



    随着近年来不断出现新的大型突发性公共卫生事件,医疗废物处理问题备受到了社会的广泛关注。医疗废物管理不仅是医院管理的难题,而且也是一个重要的公共卫生问题。随着信息技术尤其是医疗物联网的发展,基于RFID的物联网医疗垃圾处理管理系统采用射频识别技术、网络技术,对医疗垃圾产生、回收、运输、处理等全过程进行监控追踪。我院通过实施医疗物联网在医疗垃圾管理中的应用,实现了垃圾的电子标签化管理、电子监控和在线监测等,对医疗垃圾处理进行全程监管。%In recent years, the continuous emergence of new large public health emergencies, medical waste disposal problem preparation has been widespread concern in society. Medical waste management is not only the problem of hospital management, but also an important public health problem. Along with the information technology, especial y the development of medical Internet of things, RFID Internet of things based on medical waste management system uses a network of radio frequency identification technology, technology, the whole process of medical waste generation, recycling, transportation, processing, monitoring and tracking. Our hospital through the implementation of medical Internet of things applications in medical waste management, realize the electronic label management, waste electronic monitoring and online monitoring, process monitoring of medical waste disposal.In recent years, the continuous emergence of new large public health emergencies, medical waste disposal problem preparation has been widespread concern in society. Medical waste management is not only the problem of hospital management, but also an important public health problem. Along with the information technology, especially the development of medical Internet of things, RFID Internet of things based on medical waste management system uses a network of radio

  3. Managing Information Technology in Academic Medical Centers: A "Multicultural" Experience. (United States)

    Friedman, Charles P.; Corn, Milton; Krumrey, Arthur; Perry, David R.; Stevens, Ronald H.


    Examines how beliefs and concerns of academic medicine's diverse professional cultures affect management of information technology. Two scenarios, one dealing with standardization of desktop personal computers and the other with publication of syllabi on an institutional intranet, form the basis for an exercise in which four prototypical members…

  4. Resolution of cor pulmonale after medical management in a patient with cblC-type methylmalonic aciduria and homocystinuria: a case report. (United States)

    Profitlich, Laurie; Kirmse, Brian; Wasserstein, Melissa P; Diaz, George; Srivastava, Shubhika


    We describe a 3-year-old Hispanic male with cblC-type methylmalonic aciduria and homocystinuria who presented to the emergency department with progressive tachypnea, vomiting, and edema secondary to pulmonary embolism and cor pulmonale. With aggressive medical management, there was complete resolution of right heart failure and pulmonary hypertension after 3 months. Pulmonary embolism is rare in the pediatric population. Children with cblC-type methylmalonic aciduria and homocystinuria may be at increased risk for thrombus formation and pulmonary embolism due to chronic hyperhomocystinemia, a risk factor for thrombus formation in the adult population. Aspirin therapy may be indicated in children with inborn errors of metabolism that predispose to hyperhomocystinemia.

  5. Survey of animal shelter managers regarding shelter veterinary medical services. (United States)

    Laderman-Jones, B E; Hurley, K F; Kass, P H


    Veterinary services are increasingly used in animal shelters, and shelter medicine is an emerging veterinary specialty. However, little is known about working relationships between animal shelters and veterinarians. The aims of this survey were to characterize working relationships that shelter personnel have and want with veterinarians, identify opinions that shelter managers have regarding the veterinarians they work with, and determine areas for relationship growth between veterinarians and shelter managers. An electronic survey was distributed to 1373 managers of North American animal shelters; 536 (39.0%) responded. Almost all shelters had some veterinary relationship, and most had regular relationships with veterinarians. The proportion of shelters that used local clinics (73.9%) was significantly higher than the proportion that retained on-site paid veterinarians (48.5%). The proportion of respondents who did not have but wanted a paid on-site veterinarian (42%) was significantly higher than the proportion of respondents who did not use local clinics but wanted to (7.9%). These data suggest shelter managers valued veterinary relationships, and wished to expand on-site veterinary services. Almost all shelters in this study provided some veterinary care, and all respondents identified at least one common infectious disease, which, for most, had a substantial negative impact on shelter successes. Respondents indicated that the most important roles and greatest expertise of veterinarians were related to surgery, diagnosis and treatment of individual animals. Education of both veterinarians and shelter managers may help ensure that shelters benefit from the full range of services veterinarians can provide, including expertise in disease prevention and animal behavior.

  6. Workplace aggression: beginning a dialogue. (United States)

    McLemore, Monica R


    The June 2005 Clinical Journal of Oncology Nursing editorial titled "Communication: Whose Problem Is It?" (Griffin-Sobel, 2005) was written to begin a dialogue about a phenomenon frequently experienced yet rarely discussed: workplace aggression, also known as disruptive behavior. Prompted by a groundbreaking study published in the American Journal of Nursing by Rosenstein and O'Daniel (2005), the editorial challenged oncology nurses to begin to fix problems of communication. After reflecting on both of the articles and considering my own experience as a nurse manager, clinician, and scholar, I decided to explore the topic as it relates to nurse-to-nurse workplace aggression. The following is a summary of interviews with nurse managers, nurse practitioners, and nurse scientists about root causes and effective strategies to manage these sometimes complicated situations. This article is meant to continue the dialogue about the very sensitive issue. Confidentiality has been maintained, and I welcome your comments.

  7. Psychotherapy and medication management strategies for obsessive-compulsive disorder

    Directory of Open Access Journals (Sweden)

    McDougle CJ


    Full Text Available Kelda H Walsh, Christopher J McDougleDepartment of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USAAbstract: Obsessive-compulsive disorder (OCD is a chronic anxiety disorder. While medication and psychotherapy advances have been very helpful to patients, many patients do not respond adequately to initial trials of serotonergic medication or cognitive-behavioral therapy (CBT and require multiple treatment trials or combination therapies. Comorbidity may also influence treatment response. The role of streptococcal infections in pediatric OCD has become an area of intense scrutiny and controversy. In this article, current treatment methods for OCD will be reviewed, with special attention to strategies for treating OCD in children and in patients with comorbid tic disorders. Alternative psychotherapy strategies for patients who are highly anxious about starting CBT, such as cognitive therapy or augmentation with D-cycloserine, will be reviewed. Newer issues regarding use of antibiotics, neuroleptics, and glutamate modulators in OCD treatment will also be explored.Keywords: OCD, exposure/response prevention therapy, PANDAS, tic disorder

  8. Update on medical management of dyslipidemia and atherosclerosis. (United States)

    Ginter, E; Simko, V


    Scientific achievements revealing the pathogenesis of atherosclerosis resulted in the second half of the 20th century in major improvement in prevention and therapy of cardiovascular disorders (CVD). Essential became the understanding of a critical pathogenetic role of the low-density lipoproteins (LDL), mainly their oxidized form (oxLDL) and also the protective potential of the high-density lipoproteins (HDL). CVD is now regarded to be an inflammatory disease in which a systemic inflammatory reaction is combined with an accumulation of immune cells in atherosclerotic plaques. Higher intake of antioxidants in fruit and vegetable, life style modifications, cessation of smoking, physical exercise and introduction of medications that lower LDL and promote HDL (statins, niacin and fibrates) resulted in a substantial decline of the killer effect of unmanaged CVD. In the United Kingdom the male CVD mortality declined between 1970 and 2009 from 700 to 200 deaths per 100,000. In France, CVD mortality in the middle age population (25-64 years) is now responsible for death in only 15 % men and in 11 % women. Unfortunately, in many parts of the world CVD mortality remains a prominent population scourge. Recent discoveries, especially on the role of peroxisome proliferator-activated receptors (PPAR) and antisense compounds used in addition to established anti-atherogenic medications, promise further gains in the fight against atherosclerosis (Fig. 4, Ref. 54).

  9. Managing the culturally diverse medical practice team: twenty-five strategies. (United States)

    Hills, Laura


    A common misconception is that the phrase workplace diversity means meeting certain quotas in employee race or gender categories. In fact, diversity is much more than that. This article explores the unique benefits and challenges of managing a culturally diverse medical practice team and offers practice managers 25 practical strategies. It describes the two types of diversity training that are beneficial to practice managers and the kinds of policies, practices, and procedures that foster and promote diversity. This article also explores ethnocentrism, racism, ageism, sexism, stereotyping, and other potentially divisive issues among a diverse medical practice team. It provides an assessment instrument practice managers can use to evaluate their own diversity management skills. Finally, this article defines specifically what is meant by the term diversity and explores the top 10 diversity issues in workplaces today.

  10. Inhaled medication for asthma management: evaluation of how asthma patients, medical students, and doctors use the different devices

    Directory of Open Access Journals (Sweden)

    Muniz Janaína Barbosa


    Full Text Available Asthma results from a combination of three essential features: airflow obstruction, hyperresponsiveness of airways to endogenous or exogenous stimuli and inflammation. Inadequacy of the techniques to use different inhalation devices is one of the causes of therapeutic failure. The main purpose of this study was to evaluate how 20 medical students, 36 resident physicians of Internal Medicine/Pediatrics, and 40 asthma patients used three devices for inhalation therapy containing placebo. All patients were followed at the Pulmonary Outpatient Service of Botucatu Medical School and had been using inhaled medication for at least six months. The following devices were evaluated: metered dose inhalers (MDI, dry powder inhalers (DPI, and MDI attached to a spacer device. A single observer applied a protocol containing the main steps necessary to obtain a good inhaler technique to follow and grade the use of different devices. Health care professionals tested all three devices and patients tested only the device being used on their management. MDI was the device best known by doctors and patients. MDI use was associated with errors related to the coordination between inspiration and device activation. Failure to exhale completely before inhalation of the powder was the most frequent error observed with DPI use. In summary, patients did not receive precise instruction on how to use inhaled medication and health care professionals were not well prepared to adequately teach their patients.

  11. Aggression in Psychiatric Wards

    DEFF Research Database (Denmark)

    Hvidhjelm, Jacob; Sestoft, Dorte; Skovgaard, Lene Theil


    Health care workers are often exposed to violence and aggression in psychiatric settings. Short-term risk assessments, such as the Brøset Violence Checklist (BVC), are strong predictors of such aggression and may enable staff to take preventive measures against aggression. This study evaluated...

  12. Medical management of tinnitus: role of the physician. (United States)

    Shi, Yongbing; Robb, Michael J A; Michaelides, Elias M


    Tinnitus is a common auditory complaint that can be caused by many auditory as well as nonauditory systems diseases. Comorbidities including insomnia, anxiety, and depression are common in severe tinnitus. Other factors such as personality characteristics and socioeconomic difficulties can also contribute to tinnitus distress. Management of tinnitus therefore requires diagnosis and treatment expertise by physicians to adequately address existing etiologies and comorbidities, as well as relevant expertise by nonphysician specialists such as audiologists and psychologists. In assessing the efficacy of tinnitus treatments, nonspecific effects such as placebo effects must be taken into consideration. Management of complex tinnitus cases often requires a multidisciplinary team approach. Physicians and nonphysician specialists need to promptly refer patients to relevant specialist colleagues for adequate evaluation and treatment when such needs are present.

  13. Evaluation of knowledge of cancer pain management among medical practitioners in a low-resource setting

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    Ogboli-Nwasor EO


    Full Text Available EO Ogboli-Nwasor,1 JG Makama,2 LMD Yusufu21Department of Anesthesia, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria; 2Department of Surgery, Ahmadu Bello University Teaching Hospital, Shika, Zaria, NigeriaBackground: Several factors considered to be barriers to cancer pain management have been reported in the past. The knowledge of cancer pain management may be a hindrance to the proper assessment and treatment of pain in cancer patients.Objective: This report presents an evaluation of the knowledge and practice of cancer pain management among medical practitioners in Ahmadu Bello University Teaching Hospital Shika, Zaria.Methods: This report involves medical practitioners at the Ahmadu Bello University Teaching Hospital who are directly involved in the management of cancer patients. Information was obtained using a structured questionnaire, and the data were analyzed using SPSS (version 11.5.Results: The response rate to the questionnaire was 82%, with an age range of 23 to 50 years (mean age, 34.9, and the majority of actual respondents, 55 (67%, were male. Thirty-six (44% strongly agreed that cancer patients require pain relief. Yet only 40% of the respondents routinely conducted pain assessments among cancer patients, while 51% only treated when patients complained of pain. Concerning the type of analgesic commonly used for cancer patients, 43% used weak opioids, 32% used NSAIDs, and only 20% used strong opioids. Seventy-five respondents (91.5% had no formal training on pain management.Conclusion: The knowledge of pain management for cancer patients among medical personnel at the Ahmadu Bello University Teaching Hospital appears to be elementary. We recommend that formal training in the form of lectures, seminars, and workshops on cancer pain management should be part of continuing medical education in low-resource settings like the Ahmadu Bello University Teaching Hospital.Keywords: cancer pain, management, evaluation

  14. Acute bilateral emphysematous pyelonephritis successfully managed by medical therapy alone: A case report and review of the literature

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    Calleja Juan


    Full Text Available Abstract Background Bilateral emphysematous pyelonephritis is a life threatening condition usually occurring in diabetics. Management of this condition has traditionally been aggressive and surgery is considered mandatory. However, this is itself a hazardous intervention in a septic, unstable patient with circulatory or liver failure. When bilateral disease is present, the need for long-term dialysis is obviously unavoidable. Case presentation We herein report one of the few cases of bilateral emphysematous pyelonephritis successfully managed by non-surgical treatment.

  15. Marketing and the medical specialist in the managed care environment. (United States)

    Treister, N W


    Marketing means more than just communicating or advertising to potential patients; marketing means identifying your customers and working to meet or exceed their expectations. There are five key areas of a marketing plan: (1) Establish the foundation, beginning with your mission statement; (2) Assess your marketing environment by internal and external research; (3) Target your efforts, looking at image and perception; (4) Develop your particular mix of product, price, place of distribution, and promotion; and (5) implement and evaluate your marketing process. This article discusses the importance of a marketing plan for the medical specialist and highlights the features unique to a practice working in a system of capitated reimbursement. Applying these principles will help to demonstrate added value, protect the fundamental role of the patient-physician relationship, ensure that our efforts are aligned with professional missions and goals, and ultimately increase profitability and professional success.

  16. [Initial medical management in radiological accidents and nuclear disaster]. (United States)

    Tanigawa, Koichi


    Major radiological emergencies include criticality in nuclear power plants or terrorist attacks using dirty bombs or nuclear device detonation. Because irradiation itself does not cause any immediate death of the victims, and there is a minimum risk of secondary irradiation to medical personnel during decontamination procedures, lifesaving treatments should be prioritized. When a major radiological accident occurs, information is scarce and/or becomes intricate. We might face with significant difficulties in determining the exact culprits of the event, i.e., radiological or chemical or others. Therefore, it is strongly recommended for the national and local governments, related organizations and hospitals to develop comprehensive systems to cope with all hazards(chemical, biological, radiation, nuclear, and explosion) under the common incident command system.

  17. CORTIM Project: Medical Regulation Concept Designed for Forward Field Casualty Management Based on an Information System (United States)


    CORTIM, and the quality of casualty handling by the SAMU (the French Mobile Emergency Medical Service) for the RMT concept. We consider that...of crisis situations in the case of CORTIM, and the quality of casualty handling by the SAMU (the French Mobile Emergency Medical Service) for the... SAMU for the RMT concept. We consider that operational casualty management can be enhanced in at least three areas. The first concerns improvements in

  18. Implementing a Pharmacist-Led Medication Management Pilot to Improve Care Transitions

    Directory of Open Access Journals (Sweden)

    Rachel Root, PharmD, MS


    Full Text Available Purpose: The purpose of this project was to design and pilot a pharmacist-led process to address medication management across the continuum of care within a large integrated health-system.Summary: A care transitions pilot took place within a health-system which included a 150-bed community hospital. The pilot process expanded the pharmacist’s medication management responsibilities to include providing discharge medication reconciliation, a patient-friendly discharge medication list, discharge medication education, and medication therapy management (MTM follow-up.Adult patients with a predicted diagnosis-related group (DRG of congestive heart failure or chronic obstructive pulmonary disease admitted to the medical-surgical and intensive care units who utilized a primary care provider within the health-system were included in the pilot. Forty patients met the inclusion criteria and thirty-four (85% received an intervention from an inpatient or MTM pharmacist. Within this group of patients, 88 drug therapy problems (2.6 per patient were identified and 75% of the drug therapy recommendations made by the pharmacist were accepted by the care provider. The 30-day all-cause readmission rates for the intervention and comparison groups were 30.5% and 35.9%, respectively. The number of patients receiving follow-up care varied with 10 (25% receiving MTM follow-up, 26 (65% completing a primary care visit after their first hospital discharge, and 23 (58% receiving a home care visit.Conclusion: Implementation of a pharmacist-led medication management pilot across the continuum of care resulted in an improvement in the quality of care transitions within the health-system through increased identification and resolution of drug therapy problems and MTM follow-up. The lessons learned from the implementation of this pilot will be used to further refine pharmacy care transitions programs across the health-system.

  19. Alternate Care Sites for the Management of Medical Surge in Disasters (United States)


    FMS contains beds and medical and pharmaceutical resources. Outside of the main mission, to mass vaccinate or supply antidotes from the Strategic... antidotes and the more metropolitan areas of Florida have MMRS, response teams, trauma centers and caches of medical supplies and equipment. Florida...on their individual facility. Hospitals have also become a partner with the CDC to store caches of antidotes to manage the effects on patients from

  20. Diabetic foot infections: stepwise medical and surgical management. (United States)

    Armstrong, David G; Lipsky, Benjamin A


    Foot complications are common among diabetic patients; foot ulcers are among the more serious consequences. These ulcers frequently become infected, with potentially disastrous progression to deeper spaces and tissues. If not treated promptly and appropriately, diabetic foot infections can become incurable or even lead to septic gangrene, which may require foot amputation. Diagnosing infection in a diabetic foot ulcer is based on clinical signs and symptoms of inflammation. Properly culturing an infected lesion can disclose the pathogens and provide their antibiotic susceptibilities. Specimens for culture should be obtained after wound debridement to avoid contamination and optimise identification of pathogens. Staphylococcus aureus is the most common isolate in these infections; the increasing incidence of methicillin-resistant S. aureus over the past two decades has further complicated antibiotic treatment. While chronic infections are often polymicrobial, many acute infections in patients not previously treated with antibiotics are caused by a single pathogen, usually a gram-positive coccus. We offer a stepwise approach to treating diabetic foot infections. Most patients must first be medically stabilised and any metabolic aberrations should be addressed. Antibiotic therapy is not required for uninfected wounds but should be carefully selected for all infected lesions. Initial therapy is usually empirical but may be modified according to the culture and sensitivity results and the patient's clinical response. Surgical intervention is usually required in cases of retained purulence or advancing infection despite optimal medical therapy. Possible additional indications for surgical procedures include incision and drainage of an abscess, debridement of necrotic material, removal of any foreign bodies, arterial revascularisation and, when needed, amputation. Most foot ulcers occur on the plantar surface of the foot, thus requiring a plantar incision for any drainage

  1. Medication management policy, practice and research in Australian residential aged care: Current and future directions. (United States)

    Sluggett, Janet K; Ilomäki, Jenni; Seaman, Karla L; Corlis, Megan; Bell, J Simon


    Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting.

  2. Model medication management process in Australian nursing homes using business process modeling. (United States)

    Qian, Siyu; Yu, Ping


    One of the reasons for end user avoidance or rejection to use health information systems is poor alignment of the system with healthcare workflow, likely causing by system designers' lack of thorough understanding about healthcare process. Therefore, understanding the healthcare workflow is the essential first step for the design of optimal technologies that will enable care staff to complete the intended tasks faster and better. The often use of multiple or "high risk" medicines by older people in nursing homes has the potential to increase medication error rate. To facilitate the design of information systems with most potential to improve patient safety, this study aims to understand medication management process in nursing homes using business process modeling method. The paper presents study design and preliminary findings from interviewing two registered nurses, who were team leaders in two nursing homes. Although there were subtle differences in medication management between the two homes, major medication management activities were similar. Further field observation will be conducted. Based on the data collected from observations, an as-is process model for medication management will be developed.

  3. ISO 13485 a complete guide to quality management in the medical device industry

    CERN Document Server

    Abuhav, Itay


    Although complex and lengthy, the process of certification for the ISO 13485 can be easily mastered using the simple method outlined in ISO 13485: A Complete Guide to Quality Management in the Medical Device Industry. Written by an experienced industry professional, this practical book provides a complete guide to the ISO 13485 Standard certification for medical device manufacturing. Filled with examples drawn from the author's experience and spanning different sectors and fields of the medical device industry, the book translates the extra ordinary requirements and objectives of the standard


    Ogawa, Tomohiro


    Endovenous ablation of saphenous veins using laser energy was approved by the Japanese Ministry of Health, Labor and Welfare in 2011 as a more effective, less-invasive method than classical treatment for varicose veins. New medical laser and radiofrequency devices for this purpose were also approved in 2014. A requirement for the treatment of varicose veins with health insurance reimbursement using these devices is a physician with sufficient knowledge of endovenous ablation. The management standards for endovenous ablation set by varicose vein specialist medical societies are used to accredit qualified physicians who have basic clinical experience in the treatment of varicose veins, qualified instructors, and safe, effective medical facilities.

  5. [Dyslipidemia management with medical nutrition therapy: current status and perspectives]. (United States)

    Sucato, Vincenzo; Triolo, Oreste Fabio; Bronte, Enrico; Trovato, Rosaria Linda; Tona, Giuseppe Riccardo; Novo, Salvatore


    In Italy, patients with dyslipidemia account for 15-20% of the adult population with major healthcare and socio-economic impact. According to the ESC/EAS guidelines for the management of dyslipidemias, desirable cholesterol and triglyceride levels can be achieved with a synergy between drug treatment and adequate diet therapy. However, what diets should be adopted? In this review article, different types of dietary treatments are compared, with a special focus on diet education. The new scientific frontier of nutrigenetics is also discussed.

  6. Medical management of epileptic seizures: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Sarma AK


    Full Text Available Anand K Sarma,1 Nabil Khandker,1 Lisa Kurczewski,2 Gretchen M Brophy2 1Department of Neurology, 2Departments of Pharmacotherapy & Outcomes Science and Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA Abstract: Epilepsy is one of the most common neurologic illnesses. This condition afflicts 2.9 million adults and children in the US, leading to an economic impact amounting to $15.5 billion. Despite the significant burden epilepsy places on the population, it is not very well understood. As this understanding continues to evolve, it is important for clinicians to stay up to date with the latest advances to provide the best care for patients. In the last 20 years, the US Food and Drug Administration has approved 15 new antiepileptic drugs (AEDs, with many more currently in development. Other advances have been achieved in terms of diagnostic modalities like electroencephalography technology, treatment devices like vagal nerve and deep-brain stimulators, novel alternate routes of drug administration, and improvement in surgical techniques. Specific patient populations, such as the pregnant, elderly, those with HIV/AIDS, and those with psychiatric illness, present their own unique challenges, with AED side effects, drug interactions, and medical–psychiatric comorbidities adding to the conundrum. The purpose of this article is to review the latest literature guiding the management of acute epileptic seizures, focusing on the current challenges across different practice settings, and it discusses studies in various patient populations, including the pregnant, geriatric, those with HIV/AIDS, comatose, psychiatric, and “pseudoseizure” patients, and offers possible evidence-based solutions or the expert opinion of the authors. Also included is information on newer AEDs, routes of administration, and significant AED-related drug-interaction tables. This review has tried to address only some of these issues that any practitioner who

  7. Delinquent Medical Service Accounts at Brooke Army Medical Center Need Additional Management Oversight (United States)


    project focused on capture of the DD Form 2569 within BAMC to assist the working group. Also, according to the Chief of Staff, a Lean Six Sigma ... six claims were valued at $3.1 million. BAMC UBO management noted that SAMMC is not a registered TMHP provider, and these patients had to receive... six denied claims, only two account files contained evidence that BAMC personnel sent a letter to TMHP officials disputing the denial; however, each

  8. Radiological and Nuclear Emergencies: Medical Management of Radiation Injuries

    Directory of Open Access Journals (Sweden)

    L. Ravi Shankar


    Full Text Available Nuclear radiation which could be in the form of alpha, beta, gamma rays, etc, could cause radioactive contamination, radiation burns, acute radiation syndrome or a combination of any of these above-mentioned disasters. Effects of radiation and the subsequent treatment depend on the severity of exposure and the organs directly involved. Radiation levels up to 200 rads lead to nausea and vomiting whilst radiation levels between 200 rads and 400 rads lead to diarrhea, vomiting and pneumonitis. Whilst 450 rads is lethal in 50 per cent population, doses above this cause increased fatality and organ involvement with the Central Nervous System being affected with 2000 rads radiation. Nuclear disaster management lies most importantly in identifying that patient who would recover if treated immediately. Whereas decontamination of skin and wounds is done first, immediate first aid may take priority in a seriously injured patient. In the event of internal contamination, effective decorporation maybe required. This is followed by prevention and treatment of infections in sterile conditions. Radiation burn injuries will require effective long-term management. Finally, what would be most important is the necessity to have suitable hospital care where bone marrow, stem cell transfusion and restitution of the immune system would take place.Defence Science Journal, 2011, 61(2, pp.113-117, DOI:

  9. The Patient with Turner Syndrome: Puberty and Medical Management Concerns (United States)

    Gonzalez, Luisa; Witchel, Selma Feldman


    Turner Syndrome (TS) affects approximately 1 in 2500 liveborn females and is characterized by loss or structural anomalies of an X chromosome. Clinical features vary among patients; multiple organ systems can be affected. Endocrinologists are involved in the management of short stature, delayed puberty, and infertility. Endocrine therapies can include growth hormone, estrogen, and progestagen to promote linear growth and pubertal development. The duration of estrogen and progestagen treatment (HRT) is generally more than 40 years. There is not one standard HRT protocol that is suitable for all women. Thus, general guidelines are provided for HRT to induce pubertal development. Additional considerations regarding choice of HRT include thrombotic risk and disorders associated with thrombophila. Involvement of cardiologists is important because approximately 50% of patients with TS have congenital structural cardiac anomalies linked to an increased risk for aortic dissection and rupture. Although oocyte donation offers the chance to carry a pregnancy, accumulating information has highlighted the potential dangers associated with pregnancy. Advances in the care of infants, girls, and women with TS have been achieved. Management of infants, girls, and women with TS involves coordinated care from a multi-disciplinary team including endocrinologists, cardiologists, geneticists, otolaryngologists, behavioral health experts, nurse educators, and social workers. PMID:22884020

  10. The treatment of severe child aggression (TOSCA study: Design challenges

    Directory of Open Access Journals (Sweden)

    Farmer Cristan A


    Full Text Available Abstract Background Polypharmacy (the concurrent use of more than one psychoactive drug and other combination interventions are increasingly common for treatment of severe psychiatric problems only partly responsive to monotherapy. This practice and research on it raise scientific, clinical, and ethical issues such as additive side effects, interactions, threshold for adding second drug, appropriate target measures, and (for studies timing of randomization. One challenging area for treatment is severe child aggression. Commonly-used medications, often in combination, include psychostimulants, antipsychotics, mood stabilizers, and alpha-2 agonists, which vary considerably in terms of perceived safety and efficacy. Results In designing our NIMH-funded trial of polypharmacy, we focused attention on the added benefit of a second drug (risperidone to the effect of the first (stimulant. We selected these two drugs because their associated adverse events might neutralize each other (e.g., sleep delay and appetite decrease from stimulant versus sedation and appetite increase from antipsychotic. Moreover, there was considerable evidence of efficacy for each drug individually for the management of ADHD and child aggression. The study sample comprised children (ages 6-12 years with both diagnosed ADHD and disruptive behavior disorder (oppositional-defiant or conduct disorder accompanied by severe physical aggression. In a staged sequence, the medication with the least problematic adverse effects (stimulant was openly titrated in 3 weeks to optimal effect. Participants whose behavioral symptoms were not normalized received additional double-blind medication, either risperidone or placebo, by random assignment. Thus children whose behavioral symptoms were normalized with stimulant medication were not exposed to an antipsychotic. All families participated in an empirically-supported parent training program for disruptive behavior, so that the actual

  11. Information Risk Management: Qualitative or Quantitative? Cross industry lessons from medical and financial fields

    Directory of Open Access Journals (Sweden)

    Upasna Saluja


    Full Text Available Enterprises across the world are taking a hard look at their risk management practices. A number of qualitative and quantitative models and approaches are employed by risk practitioners to keep risk under check. As a norm most organizations end up choosing the more flexible, easier to deploy and customize qualitative models of risk assessment. In practice one sees that such models often call upon the practitioners to make qualitative judgments on a relative rating scale which brings in considerable room for errors, biases and subjectivity. On the other hand under the quantitative risk analysis approach, estimation of risk is connected with application of numerical measures of some kind. Medical risk management models lend themselves as ideal candidates for deriving lessons for Information Security Risk Management. We can use this considerably developed understanding of risk management from the medical field especially Survival Analysis towards handling risks that information infrastructures face. Similarly, financial risk management discipline prides itself on perhaps the most quantifiable of models in risk management. Market Risk and Credit Risk Information Security Risk Management can make risk measurement more objective and quantitative by referring to the approach of Credit Risk. During the recent financial crisis many investors and financial institutions lost money or went bankrupt respectively, because they did not apply the basic principles of risk management. Learning from the financial crisis provides some valuable lessons for information risk management.

  12. Medical management of acid-peptic disorders of the stomach. (United States)

    Eswaran, Sheila; Roy, Michael A


    In the past 30 years, medicine has witnessed an unprecedented evolution in acid-peptic disorder management, fueled by major advances in our understanding of the physiology of acid secretion and the gastric mucosal barrier. The other pivotal development in understanding these disorders has been the recognition of Helicobacter pylori's role in the pathophysiology of peptic ulcer disease,chronic gastritis, and even gastric malignancy. This evolution continues as H pylori wanes in significance, and medicine is challenged by treating iatrogenic conditions brought on by ulcerogenic anti-inflammatory drugs. Following a description of the relevant physiology and biochemistry of gastric acid secretion and the gastric mucosal barrier, this article describes the current medicinal arsenal available to treat acid-peptic disorders of the stomach.

  13. Autonomous, In-Flight Crew Health Risk Management for Exploration-Class Missions: Leveraging the Integrated Medical Model for the Exploration Medical System Demonstration Project (United States)

    Butler, D. J.; Kerstman, E.; Saile, L.; Myers, J.; Walton, M.; Lopez, V.; McGrath, T.


    The Integrated Medical Model (IMM) captures organizational knowledge across the space medicine, training, operations, engineering, and research domains. IMM uses this knowledge in the context of a mission and crew profile to forecast risks to crew health and mission success. The IMM establishes a quantified, statistical relationship among medical conditions, risk factors, available medical resources, and crew health and mission outcomes. These relationships may provide an appropriate foundation for developing an in-flight medical decision support tool that helps optimize the use of medical resources and assists in overall crew health management by an autonomous crew with extremely limited interactions with ground support personnel and no chance of resupply.

  14. The Modern Criteria for Medical Management of Acromegaly. (United States)

    Frara, Stefano; Maffezzoni, Filippo; Mazziotti, Gherardo; Giustina, Andrea


    Acromegaly is an insidious disorder characterized by excess secretion of growth hormone (GH) and elevated circulating levels of insulin-like growth factor-I (IGF-I), generally caused by a pituitary adenoma. It is a rare disease associated with an average 10-year reduction in life expectancy due to metabolic, cardiovascular, and cerebrovascular comorbidities and reduced quality of life caused by paresthesias, fatigue, osteoarthralgia, or bone fractures. In 2000, Cortina Consensus Conference established general criteria for diagnosis and biochemical control of acromegaly, which have been revised in recent years, adapting them to emerging clinical evidences as well as the evolving assay techniques. Authors have proposed a binary definition of cure for acromegaly, where both GH and IGF-I are important determinants: the former is more linked to the presence of residual adenomatous tissue, while the latter to the peripheral activity of the disease. Control of tumor growth and complications is also an essential goal of treatment. Surgical, medical, and radiotherapy approaches are all valid alternatives. The surgical option is, however, unsuccessful in about 50% of patients. Somatostatin analogs (SRLs), octreotide LAR, and lanreotide ATG can inhibit cell growth, besides their beneficial effects on GH hypersecretion and on most comorbidities. Pasireotide is a new multireceptor-targeted SRL with reported superior biochemical efficacy to octreotide, due to higher affinity for SSTR-5, but potentially causing detrimental effects on glucose homeostasis. Pegvisomant could be a valid choice in all patients resistant to SRLs. It is a competitive GH antagonist, which efficaciously blocks IGF-I production, inhibiting the dimerization of GH receptor. Normal IGF-I levels represent, therefore, its only relevant efficacy endpoint, while only few cases of tumor growth on pegvisomant have been reported, so far.

  15. A pilot study of a practice management training module for medical residents


    Berkenbosch,Lizanne; Arno M. M. Muijtjens; Zimmermann, Luc J. I.; Heyligers, Ide C.; Scherpbier, Albert J. J. A.; Busari, Jamiu O


    Background In 2005 a competency based curriculum was introduced in the Dutch postgraduate medical training programs. While the manager’s role is one of the seven key competencies, there is still no formal management course in most postgraduate curricula. Based on a needs assessment we conducted, several themes were identified as important for a possible management training program. We present the results of the pilot training we performed to investigate two of these themes. Methods The topics...

  16. Sunway Medical Laboratory Quality Control Plans Based on Six Sigma, Risk Management and Uncertainty. (United States)

    Jairaman, Jamuna; Sakiman, Zarinah; Li, Lee Suan


    Sunway Medical Centre (SunMed) implemented Six Sigma, measurement uncertainty, and risk management after the CLSI EP23 Individualized Quality Control Plan approach. Despite the differences in all three approaches, each implementation was beneficial to the laboratory, and none was in conflict with another approach. A synthesis of these approaches, built on a solid foundation of quality control planning, can help build a strong quality management system for the entire laboratory.

  17. The Impact of Medical Tourism on Thai Private Hospital Management: Informing Hospital Policy


    James, Paul TJ


    Background: The purpose of this paper is to help consolidate and understand management perceptions and experiences of a targeted group (n=7) of Vice-Presidents of international Private Thai hospitals in Bangkok regarding medical tourism impacts. Methods: The method adopted uses a small-scale qualitative inquiry. Examines the on-going development and service management factors which contribute to the establishment and strengthening of relationships between international patients and hospital m...

  18. Evaluating condom catheter balloon tamponade in non-traumatic postpartum haemorrhage resistant to medical management


    Syed Nawaz Ahmad; Sunita Seth; Shefali Agarwal; Swati Choudhary


    Background: Obstetric haemorrhage remains the most important cause of maternal mortality worldwide accounting for 25% of maternal deaths annually. The aim of the study was to evaluate efficacy of a condom catheter assembly for uterine tamponade in the management of non-traumatic postpartum haemorrhage (PPH). Methods: It was a prospective interventional study done in a tertiary care hospital in New Delhi, India. Thirty three women with intractable PPH unresponsive to medical management were...

  19. Periocular necrotizing fasciitis associated with kerato-conjunctivitis and treated with medical management: A case report

    Directory of Open Access Journals (Sweden)

    Shome Debraj


    Full Text Available We report a 25-year-old systemically healthy male who presented with periocular necrotizing fasciitis (NF in the left eyelid. This was associated with the presence of immunologically mediated marginal kerato-conjunctivitis, in the same eye. This potentially dangerous lid infection and the associated ocular surface infection resolved successfully, with medical management. We report this case to highlight the successful conservative management of periocular NF and the hitherto unreported anterior segment involvement.

  20. Management of Postoperative Pain in Medical Institutions in Shandong Province in China. (United States)

    Liu, Donghua; Ma, Jianzhong; Zhang, Zongwang; Yu, Ailan; Chen, Xueli; Feng, Cuicui; Lei, Weifu


    The aim of the study was to investigate current situation of postoperative pain management in medical institutions in Shandong Province.A questionnaire was developed on the basis of guidelines of acute pain and pain quality assessment scale. The questionnaire was used to obtain information regarding the nature and scale of the medical institution, structure of pain management organization, implementation of pain assessment, and analgesic techniques and processes used in clinical practice. A multistage stratified and cluster sampling method was employed to investigate the current situation of postoperative pain management in 168 medical institutions in Shandong Province.For acute pain service (APS), 32% of the hospitals established postoperative pain management organizations similar to APS. For pain evaluation, 57.1% of the hospitals evaluated pain as the fifth vital sign, and 47.0% of the hospitals evaluated pain at rest and during activity. Furthermore, 43.0% of the surveyed hospitals employed patient-controlled analgesia mode, of which hospitals employing brachial plexus block, lumbar plexus block, and femoral nerve block analgesia accounted for 5.0%, 1.0%, and 4.0%, respectively. The survey revealed that 51.0% of the hospitals educated patients about pain and pain management, of which patients were postoperatively educated by ward nurses in 5.0% and patients were educated by APS during ward rounds in 2.0%.There is a lack of standardized postoperative pain management, the involvement of nurses in pain management is scarce, and the pain assessment and education and application of advanced analgesic management techniques were found to be inadequate in medical institutions in Shandong Province.

  1. Evaluating condom catheter balloon tamponade in non-traumatic postpartum haemorrhage resistant to medical management

    Directory of Open Access Journals (Sweden)

    Syed Nawaz Ahmad


    Conclusions: Placement of a condom catheter balloon can successfully treat non-traumatic PPH refractory to medical management. It is simple, inexpensive, easily, available and in those with successful placement no procedure related morbidity was observed. The potential for it to be used by inexperienced operators in areas with limited resources makes it a useful tool in management of PPH. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1874-1878


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    Full Text Available BACKGROUND: Uterine leiomyoma is the most common benign tumour of uterus affecting women of reproductive age group and accounting for most common indication of hysterectomy in India. Effective medical treatment option can prevent hysterectomy related morbidity. MATERIALS AND METHODS: A total of 50 women with symptomatic leiomyoma and asymptomatic with uterine volume >160cc and fibroid size >2.5cm were included in the study. 20mg/day mifepristone was given to them over period of 3 months. Follow up was done at 1, 3 and 6 months of starting treatment. At each visit patients were evaluated for symptomatic improvement of menorrhagia, dysmenorrhoea and ultrasound for myoma volume, haemogram was done. Endometrial biopsy was done at the beginning of therapy, 3rd month and at end of treatment. RESULTS: At the beginning of study, all patients had menorrhagia. At 3 months, 80% developed amenorrhea and 20% scanty menses. At 6 months, 56% had scanty menses and 38% had normal menses but none had menorrhagia. 50% of patients had dysmenorrhoea at the beginning of study with severe dysmenorrhoea in 36% of cases. Only 10% of patients at 3 months and 14% at 6 months had dysmenorrhoea. Improvement in haemoglobin percentage from 9.6 gram% to 10.8 gram% at 3 months of therapy. The reduction in mean uterine volume was 12.28%after 1 month, 26.95% after 3 months and 11.13% at end of 6 months, as compared to pre-treatment level. Fibroid volume decreased by 14.34% after 1 month ,29.8% after 3 months and 24.98% at end of 6 months, as compared to pre-treatment level. At the end of 3 months, 50% of patients experienced no side effect. Rest 50% experienced minor side effects like nausea (8%, hot flushes (4%, liver dysfunction as evidenced by mild increase in transaminase (8% and simple endometrial hyperplasia in 30%. Follow up of these patients at 6 month i.e., 3 months after stopping the drug does not show any evidence of persistence of these effects. CONCLUSION: 20mg

  3. Approach to the medical management of surgically resectable gastric cancer. (United States)

    Tesfaye, Anteneh; Marshall, John L; Smaglo, Brandon G


    The optimal adjuvant management of patients with resectable gastric cancer remains a therapeutic challenge. Although the benefit of adjuvant therapy for these patients is clearly established, recurrence and mortality rates remain high despite such treatment. Moreover, surgical comorbidities and treatment toxicities result in high rates of failure to complete treatment after surgery. Two divergent approaches to adjuvant treatment have emerged as standard: postoperative chemoradiotherapy and perioperative chemotherapy. Because these approaches have never been compared directly, recommendations for adjuvant treatment require multidisciplinary discussion. During this discussion, the characteristics of the symptoms, the histology, location, and stage of the tumor, and the feasibility of the patient's completing all recommended therapy may be considered. In our own practice, we favor perioperative chemotherapy for patients with asymptomatic, proximal, higher-stage disease and adjuvant chemoradiotherapy for patients with symptomatic, distal, lower-stage disease. Herein, we summarize the available data for approaches to the adjuvant treatment of gastric cancer, with special consideration of the characteristics of the patients enrolled in the various studies. We also describe how we developed our paradigm for recommending a particular approach to adjuvant treatment for each patient.

  4. Marketing aspects of development of medical waste management in health care institutions in Ukraine

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    Inesa Gurinа


    Full Text Available The concept of marketing approach to medical waste management in health care is suggested.The goal of research was to study the state of marketing activities of health care institutions on medical waste management and development trends of   resolution of outstanding issues.Methods. The methods, which were used in the research, are the methods of mathematical statistics, social studies and scientific knowledge.Results. Environmental marketing institutions of healthcare means perfectly safe for the environment provision of health services. The main directions of environmental marketing concept in health care institutions is the acceptance generally binding legal standards of Use Resources, strict control the formation and licensing of medical waste; economic incentives for workers, aimed at minimizing their interest in the volumes of medical waste; financing of R & D relative to the development of new waste and sound technologies; develop a system of taxes and penalties for polluting the environment and so on.Conclusions. As a result of the implementation of marketing strategies for managing medical waste of healthcare institutions are obtained strategic, social, environmental and economic benefits.

  5. Relationship between Emotional Intelligence and the Success of Educational Managers at Golestan University of Medical Sciences

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    Einollah Mollaei


    Full Text Available Introduction: Emotional intelligence is a new evolution in the field of thought – excitement relationship, which has a major effect on the success of managers. Therefore, the aim of this study was to assess the relationship between emotional intelligence and the success of educational managers at Golestan University of medical sciences. Methods: This study was conducted with all (n=96 educational managers (45 females and 51 males at Golestan University of Medical Sciences who were selected through census method in 2009. Data collection tools included a demographic data questionnaire, Shring Emotional Intelligence Scale and a success questionnaire. Relationship between emotional intelligence of the educational managers and their success rate was analyzed by spearman correlation coefficient. Results: The findings showed that mean emotional intelligence of successful and unsuccessful managers were 98.74 and 76.74 respectively. The spearman correlation coefficient between emotional intelligence and success of managers was 0.71 which indicates a direct relationship between emotional intelligence and success (P<0.001. Conclusion: With regard to the direct relationship between emotional intelligence of managers and their success demonstrated in this study, organizing some workshops on emotional intelligence are suggested to improve the capabilities of organizational managers.

  6. New Bottles for Vintage Wines: The Changing Management of the Medical School Faculty. (United States)

    Griner, Paul F.; Blumenthal, David


    Case studies of 10 medical schools identified innovative mechanisms of faculty governance and management to enlist faculty in meeting demands of a competitive marketplace, including appointment letters explicitly specifying roles and responsibilities; annual, objective, performance reviews; salary tied to performance; lengthened pretenure period;…

  7. T2QM (Teaching and Total Quality Management) for Medical Teachers. (United States)

    Bing-You, R. G.


    Explores the potential relationship of teaching and total quality management (TQM) and the subsequent benefits for individual medical teachers. Addresses issues such as defining teaching processes and quality teaching, responding to customers' needs, assessing current teaching practices, and improving one's own teaching. Contains 18 references.…


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    Ketinlly Yasmyne Nascimento Martins


    Full Text Available Based on a case study, this paper presents a methodology to adopt ISO 9001 standards for organizations which make use of additive manufacturing to build products for medical use. Starting with a conceptual model, guidelines were identified to guide planning and operation of the management system, as well as its maintenance and improvement.

  9. Management recommendations for invasive dental treatment in patients using oral antithrombotic medication, including novel oral anticoagulants

    NARCIS (Netherlands)

    van Diermen, D.E.; van der Waal, I.; Hoogstraten, J.


    Objective The aims were (1) to search the scientific literature from 2007 to 2012 for guidelines and new studies on the dental management of patients using oral antithrombotic medication; (2) to summarize the articles' evidence and recommendations; and (3) to propose an updated clinical practice gui

  10. Early Detection and Outpatient Management of Alcoholism: A Curriculum for Medical Residents. (United States)

    Barnes, Henrietta N.; And Others


    A course in the early detection and outpatient management of alcoholism for medical residents is discussed. Unlike other courses on alcoholism that have emphasized changes in physicians' attitudes, this course was designed to promote changes in residents' practice behavior and to foster the development of necessary clinical skills. (MLW)

  11. Management of Hypertension in Private Practice: A Randomized Controlled Trial in Continuing Medical Education. (United States)

    Gullion, David S.; And Others


    A randomized control trial was used to evaluate a physician education program designed to improve physician management of patients' hypertension, hypertension-related behaviors, and diastolic blood pressure. It was suggested that more intensive continuing medical education programs are needed to improve physician performance and patient outcome.…

  12. Psychiatric Services for Individuals with Intellectual and Developmental Disabilities: Medication Management (United States)

    Russell, Andrew T.; Hahn, Joan Earle; Hayward, Katharine


    The purpose of this study was to describe the medication management and treatment provided in a specialty outpatient psychiatry clinic for 198 community-residing children and adults with intellectual disability and other developmental disabilities (IDD) referred to the clinic and discharged between 1999 and 2008. Using a descriptive design, data…

  13. 78 FR 61363 - Correction-Scientific Information Request on Medication Therapy Management (United States)


    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Correction--Scientific Information Request on Medication Therapy Management The original date of publication for this Federal Register notice was...

  14. Prevalence and psychosocial factors of aggression among youth

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    Manoj Kumar Sharma


    Full Text Available Background: Youth indulgence themselves in various aggressive behaviors leading to significant psychosocial dysfunctions. The present study assesses the prevalence of aggression among youth and to assess the risk factors of aggression among youth. Materials and Methods: Anger Data sheet, Resilience Scale and Buss-Perry Aggression Scale, were administered on 5476 participants using survey design. Data was collected from different communities (college, residential, apartments and workplace of Bangalore, Jammu, Indore, Kerala, Rajasthan, Sikkim and Delhi. 47% were female and 53% were male. The mean age of the sample was 20.2 years. Comparative analysis was carried out by Pearson correlation coefficient and Chi-square was also carried out. Results: About 17.7% of the youth has high mean aggression score on Buss-Perry Aggression Scale. Males have high mean score on aggression than females. Males experienced more verbal aggression, physical aggression and anger than females. Younger age group (16-19 years experienced more aggression than older age group (20-26 years. The risk factors of the youth aggressions were identified as physical abuse in childhood, substance abuse such as alcohol and tobacco, negative peer influence, family violence, academic disturbance, psychological problems attention deficit-hyperactivity disorder, suspicious, loneliness, mood disturbance, negative childhood experience and TV and media. Conclusion: The study document, the presence of correlates of risk factors of aggression among youth and implies usages of management strategies to help them to handle aggression.

  15. Safety in home care: A research protocol for studying medication management

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    Easty Anthony


    Full Text Available Abstract Background Patient safety is an ongoing global priority, with medication safety considered a prevalent, high-risk area of concern. Yet, we have little understanding of the supports and barriers to safe medication management in the Canadian home care environment. There is a clear need to engage the providers and recipients of care in studying and improving medication safety with collaborative approaches to exploring the nature and safety of medication management in home care. Methods A socio-ecological perspective on health and health systems drives our iterative qualitative study on medication safety with elderly home care clients, family members and other informal caregivers, and home care providers. As we purposively sample across four Canadian provinces: Alberta (AB, Ontario (ON, Quebec (QC and Nova Scotia (NS, we will collect textual and visual data through home-based interviews, participant-led photo walkabouts of the home, and photo elicitation sessions at clients' kitchen tables. Using successive rounds of interpretive description and human factors engineering analyses, we will generate robust descriptions of managing medication at home within each provincial sample and across the four-province group. We will validate our initial interpretations through photo elicitation focus groups with home care providers in each province to develop a refined description of the phenomenon that can inform future decision-making, quality improvement efforts, and research. Discussion The application of interpretive and human factors lenses to the visual and textual data is expected to yield findings that advance our understanding of the issues, challenges, and risk-mitigating strategies related to medication safety in home care. The images are powerful knowledge translation tools for sharing what we learn with participants, decision makers, other healthcare audiences, and the public. In addition, participants engage in knowledge exchange

  16. A fundamental, national, medical disaster management plan: an education-based model. (United States)

    Djalali, Ahmadreza; Hosseinijenab, Vahid; Hasani, Azadeh; Shirmardi, Kianoush; Castrén, Maaret; Ohlén, Gunnar; Panahi, Farzad


    During disasters, especially following earthquakes, health systems are expected to play an essential role in reducing mortality and morbidity. The most significant naturally occurring disaster in Iran is earthquakes; they have killed >180,000 people in the last 90 years. According to the current plan in 2007, the disaster management system of Iran is composed of three main work groups: (1) Prevention and risk management, (2) Education, and (3) Operation. This organizational separation has resulted in lack of necessary training programs for experts of specialized organizations, e.g., the Ministry of Health and Medical Education (MOHME).The National Board of MOHME arranged a training program in the field of medical disaster management. A qualified training team was chosen to conduct this program in each collaborating center, based on a predefined schedule. All collaborating centers were asked to recall 5-7 experts from each member university. Working in medical disaster management field for greater than or equal to 2 years was an inclusion criterion. The training programs lasted three days, consisted of all relevant aspects of medical disaster management, and were conducted over a six-month period (November 2007-April 2008). Pre-test and post-tests were used to examine the participants' knowledge regarding disaster management; the mean score on the pretest was 67.1 +/-11.6 and 88.1 +/-6.2, respectively. All participants were asked to hold the same training course for their organizations in order to enhance knowledge of related managers, stakeholders, and workers, and build capacity at the local and provincial levels. The next step was supposed to be developing a comprehensive medical disaster management plan for the entire country. Establishing nine disaster management regional collaborating centers in the health system of Iran has provided an appropriate base for related programs to be rapidly and easily accomplished throughout the country. This tree-shaped model is

  17. Medical management of the kidney transplant recipient: a practical approach for the primary care provider. (United States)

    Pedraza, Fernando; Roth, David


    Kidney transplant recipients (KTRs) commonly present with complex medical issues that are best managed jointly by both their primary care physician and the kidney transplant center. Hypertension, diabetes, dyslipidemias, and obesity are frequently present in the KTR population and the successful management of these comorbidities is essential in achieving excellent posttransplant outcomes. Cardiovascular disease is the leading cause of mortality in KTRs, and interventions that mitigate the risk factors that contribute to these adverse outcomes are an important part of the long-term management of a KTR.

  18. A Stress Management Program for Higher Risk Medical Students: Preliminary Findings. (United States)

    Brennan, Julie; McGrady, Angele; Lynch, Denis J; Schaefer, Paul; Whearty, Kary


    Approximately 10 % of first year medical students have clinically relevant anxiety or depression which may affect academic success and quality of life. This study tested the effects of a stress management intervention on indicators of anxiety, depression and self-efficacy in self-selected first year medical students. Forty two medical students volunteered to participate and provided informed consent. An eight session intervention was offered and focused on building relaxation skills, adaptive coping, and basic nutrition. Anxiety, depression, and self-efficacy were assessed pre and post intervention. This group of students had significantly higher baseline values of depression and anxiety but lower self-efficacy compared to a previous study of medical students at the same institution (p students were at risk for later clinical syndromes. Intervention directed to decreasing the effects of stress was associated with improvement in indicators of distress and may modify the longer term risk.

  19. [Design and Implementation of a Mobile Operating Room Information Management System Based on Electronic Medical Record]. (United States)

    Liu, Baozhen; Liu, Zhiguo; Wang, Xianwen


    A mobile operating room information management system with electronic medical record (EMR) is designed to improve work efficiency and to enhance the patient information sharing. In the operating room, this system acquires the information from various medical devices through the Client/Server (C/S) pattern, and automatically generates XML-based EMR. Outside the operating room, this system provides information access service by using the Browser/Server (B/S) pattern. Software test shows that this system can correctly collect medical information from equipment and clearly display the real-time waveform. By achieving surgery records with higher quality and sharing the information among mobile medical units, this system can effectively reduce doctors' workload and promote the information construction of the field hospital.

  20. An automatic medication self-management and monitoring system for independently living patients. (United States)

    McCall, Corey; Maynes, Branden; Zou, Cliff C; Zhang, Ning J


    This paper describes the development, prototyping, and evaluation of RMAIS (RFID-based Medication Adherence Intelligence System). Previous work in this field has resulted in devices that are either costly or too complicated for general (especially elderly) patients to operate. RMAIS provides a practical and economical means for ordinary patients to easily manage their own medications, taking the right dosage of medicine at the prescribed time in a fully automatic way. The system design has the following features: (1) fully automatic operation for easy medication by using the built-in scale for dosage measurement and a motorized rotation plate to deliver the right medicine container in front of a patient, (2) various medication reminder messages for patients, and noncompliance alerts for caregivers (such as doctors, relatives or social workers who take care of the patients), and (3) incremental and economical adoption by pharmacies, patients, and insurance companies.

  1. Strategic management of medical tourism in Iran based on SWOT model

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    Majid Daeichini


    Full Text Available Medicine and related services worldwide, branches of tourism as medical tourism, have created. Every year, thousands of tourists have access to modern medical services, and of course reasonably priced way to Iran, the more they attract and develop medical tourism, a comprehensive review is necessary. This study, based on an analytical method - a description, and utilization of available resources in the field of tourism management, tourism, and its role in the development of medical tourism in the country, as well as a comprehensive analysis SWOT, and enjoying open questionnaire was used to determine the basic strategies for the management and development of medical tourism in the country. The results of the analysis of the potential and limitations, it suggests that the benefit of proper infrastructure and the fields of health and medicine, and medical and hospital environments, and human capital of the country, benefiting from a weighted score of 0.64, in the first place strengths inappropriate accommodation and welfare facilities, with a weighted score of 0.48 in the first position of weakness, the incentive to travel to Iran for treatment among tourists, with a weighted score of 0.56, the highest rating have weight, and at the first available opportunity, and the continued Weakness adequate facilities to attract medical tourists, with a weighted score of 0.52, in the first place is under threat. The most important strategies that can be employed in this field, namely, infrastructure services, recreational facilities, health care centers and tourist sites, optimum use of the potential therapeutic, medical and human resources of the country, and efforts to strengthen absorption for the treatment of Iran stated

  2. Early childhood aggression


    Alink, Lenneke Rosalie Agnes


    In this thesis the development, stability, and correlates of early childhood aggression were investigated. The normative development was examined in a general population sample using questionnaires completed by the parents of 12-, 24-, and 36-month-old children and again one year later. Results showed an early childhood aggression curve, with increasing rates of aggression in the second year of life and decreasing rates in the fourth year. One-year stabilities were moderate for 12-month-olds ...

  3. Effects of Medicaid disease management programs on medical expenditures: Evidence from a natural experiment in Georgia. (United States)

    Kranker, Keith


    In recent decades, most states' Medicaid programs have introduced disease management programs for chronically ill beneficiaries. Interventions assist beneficiaries and their health care providers to appropriately manage chronic health condition(s) according to established clinical guidelines. Cost containment has been a key justification for the creation of these programs despite mixed evidence they actually save money. This study evaluates the effects of a disease management program in Georgia by exploiting a natural experiment that delayed the introduction of high-intensity services for several thousand beneficiaries. Expenditures for medical claims decreased an average of $89 per person per month for the high- and moderate-risk groups, but those savings were not large enough to offset the total costs of the program. Impacts varied by the intensity of interventions, over time, and across disease groups. Heterogeneous treatment effect analysis indicates that decreases in medical expenditures were largest at the most expensive tail of the distribution.

  4. 医疗设备档案管理的探讨%Discussion On Management of Medical Equipment Archives

    Institute of Scientific and Technical Information of China (English)



    To explore the composition, classiifcation and management of medical equipment archives, and to understand the ifle management of medical equipment.%探讨医疗设备档案的组成、分类、管理的难点,了解医疗设备档案管理工作。

  5. Knowledge Management Components from the Viewpoint of Departments’ Chairmen Ahvaz Jundishapur University of Medical Sciences

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    Faraji Khiavi F


    Full Text Available Aims: Knowledge management is one of the most important success instruments for organizations in the competitive conditions and information era. Setting knowledge management in the organizational system of Medical Sciences’ Universities is required in order to achieve and use the latest research and scientific achievements. So this study aimed to determine the knowledge management components from the viewpoint of the departments’ chairmen of Ahvaz Jundishapur University of Medical Sciences. Instrument & Methods: This descriptive cross-sectional research was performed in the society of department chairmen of Ahvaz Jundishapur University of Medical Sciences (60 persons in 2012 and all of them were studied by census method. Data gathering instrument was a standard questionnaire with 2 parts demographic data and knowledge management. Data were analyzed by SPSS 17 software using descriptive statistics and non-parametric tests like Mann-Whitney and Kruskal-Wallis tests. Findings: The situation of knowledge creation dimension (2.84±0.70 was estimated relatively not appropriate, while knowledge sharing (3.00±0.74, knowledge transfer (3.11±0.61, knowledge application (3.11±0.64, knowledge assessment (3.10±0.77 and general knowledge management (3.01±0.58 were estimated relatively appropriate. There was a significant relationship between samples’ age and the application of knowledge dimension (p=0.009. Conclusion: Knowledge management status seems relatively appropriate from the viewpoint of the departments’ chairmen of Ahvaz Jundishapur University of Medical Sciences.

  6. 精细化管理在医院医疗设备管理中的运用%Application of fine Management in Hospital Medical Equipment Management

    Institute of Scientific and Technical Information of China (English)



    This article briefly outlines the importance of medical equipment archives management, analyzes the application of fine management in medical equipment archives management, in order to improve the management level of medical equipment archives.%简要概述了医疗设备档案管理的重要性,详细分析了精细化管理在医疗设备档案管理工作中的应用,以期提高医疗设备档案的管理水平.

  7. The Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight (United States)


    E M B E R 1 8 , 2 0 1 3 The Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More...Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight 5a. CONTRACT NUMBER...Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight Objective Our audit objective was to determine whether the

  8. Incidence and risk factors for failed medical management of spinal epidural abscess: a systematic review and meta-analysis. (United States)

    Stratton, Alexandra; Gustafson, Karla; Thomas, Kenneth; James, Matthew T


    OBJECTIVE Spinal epidural abscess (SEA) is a life-threatening infection. It is uncertain whether medical versus surgical treatment is the ideal initial approach for neurologically intact patients with SEA. Recent evidence demonstrates that initial medical management is increasingly common; however, patients who ultimately require surgery after failed medical management may have a worse prognosis than those whose treatment was initially surgical. The primary objective of this study was to establish the current incidence of failed medical management for SEA. The secondary aim was to identify risk factors associated with the failure of medical management. METHODS The authors conducted a systematic review and meta-analysis by searching electronic databases (MEDLINE, Embase, CINAHL, and PubMed), recent conference proceedings, and reference lists of relevant articles. Studies that reported original data on consecutive adult patients with SEA treated medically were eligible for inclusion. RESULTS Twelve studies met the inclusion criteria, which included a total of 489 medically treated patients with SEA. Agreement on articles for study inclusion was very high between the reviewers (kappa 0.86). In a meta-analysis, the overall pooled risk of failed medical management was 29.3% (95% CI 21.4%-37.2%) and when medical to surgical crossover was used to define failure the rate was 26.3% (95% CI 13.0%-39.7%). Only 6 studies provided data for analysis by intended treatment, with a pooled estimate of 35.1% (95% CI 15.7%-54.4%) of failed medical management. Two studies reported predictors of the failure of medical management. CONCLUSIONS Although the incidence of failed medical management of SEA was relatively common in published reports, estimates were highly heterogeneous between studies, thus introducing uncertainty about the frequency of this risk. A consensus definition of failure is required to facilitate comparison of failure rates across studies.

  9. Integrating Six Sigma into a Quality Management System in the Medical Device Industry

    Directory of Open Access Journals (Sweden)

    Nadica Hrgarek


    Full Text Available Normal 0 21 false false false MicrosoftInternetExplorer4 Six Sigma is a valuable management strategy to improve business processes, reduce development and production costs, increase profit margin and improve customer satisfaction. The purpose of this paper is to describe how applicable Six Sigma concepts may complement and support formal quality management systems (QMS in the medical device industry.A significant number of issues, which increase the development costs and times, is often found during different phases of a medical device life cycle. Some defects with high patient safety risk may result in dangerous and very costly product recalls.The basic idea of this paper is to explore the possibilities of integrating Six Sigma techniques with an existing QMS throughout the entire life cycle of a medical device. This paper addresses how Six Sigma techniques, when appropriately integrated into the QMS at medical device companies, can eliminate defects earlier in the medical device life cycle, identify major opportunities for cost savings, focus on customer needs and expectations, and improve the overall business processes.

  10. Quality management of medical education at the Carl Gustav Carus Faculty of Medicine, University of Technology Dresden, Germany. (United States)

    Dieter, Peter Erich


    The Carl Gustav Carus Faculty of Medicine, University of Technology Dresden, Germany, was founded in 1993 after the reunification of Germany. In 1999, a reform process of medical education was started together with Harvard Medical International. The traditional teacher and discipline-centred curriculum was replaced by a student-centred, interdisciplinary and integrative curriculum which has been named DIPOL (Dresden Integrative Patient/Problem- Oriented Learning). The reform process was accompanied and supported by a parallel-ongoing Faculty Development Program. In 2004, a Quality Management Program in medical education was implemented, and in 2005 medical education received DIN EN ISO 9001:2000 certification. Quality Management Program and DIN EN ISO 9001:2000 certification were/are unique for the 34 medical schools in Germany. The students played a very important strategic role in all processes. They were/are members in all committees like the Faculty Board, the Board of Study Affairs (with equal representation) and the ongoing audits in the Quality Management Program. Students are the only ones who experience all years of the curriculum and are capable of detecting, for example gaps, overlaps, inconsistencies of the curriculum and assessments. Therefore, the in-depth knowledge of students about the medical school's curriculum is a very helpful and essential tool in curriculum reform processes and Quality Management Programs of medical education. The reform in medical education, the establishment of the Quality Management program and the certification resulted in an improvement of quality and output of medical education and medical research.

  11. Successful medical management of a neonate with spontaneous splenic rupture and severe hemophilia A. (United States)

    Badawy, Sherif M; Rossoff, Jenna; Yallapragada, Sushmita; Liem, Robert I; Sharathkumar, Anjali A


    Splenic rupture in neonates is a rare event, usually occurring in the setting of underlying predisposing conditions. Here, we present the case of a term neonate who presented with worsening anemia in the setting of known hemolytic disease during the newborn period and was later found to have a spontaneous splenic rupture. He was subsequently diagnosed with severe hemophilia A, and was managed medically with recombinant factor VIII replacement therapy without any surgical intervention. This is the first reported case of a neonate who had spontaneous splenic rupture and severe hemophilia A, and underwent successful medical treatment without any surgical intervention.

  12. [The development of strategic management of high-tech surgical medical care]. (United States)

    Nechaev, V S; Krasnov, A V


    The high-tech surgical medical care is one of the most effective types of medical care in Russia. However high-tech surgical treatment very often is inaccessible for patients. The development of basics of strategic management of high-tech surgical care makes it possible to enhance availability of this type of care and to shorten the gap between volumes of rendered care and population needs. This approach can be resulted in decrease of disability and mortality of the most prevalent diseases of cardio-vascular diseases, malignant neoplasms, etc. The prerequisites can be developed to enhance life quality and increase longevity of population.

  13. The challenge of medical waste management: a case study in northwest Iran-Tabriz. (United States)

    Taghipour, Hassan; Mosaferi, Mohammad


    This article presents the results of a descriptive cross-sectional study on medical waste management in Tabriz (Iran's fourth largest city). The study was conducted in 10 of 25 active hospitals of the city in the summer of 2007. The methodology of the present study was based on data collected from hospitals through a checklist, site visits (observation), and quantity analysis by weight. The results indicated that more than 13.59 tonnes day(-1) of total medical waste and 4.06 tonnes day(-1) of hazardous-infectious medical waste are generated by the active hospitals of the city. Currently, there are no practical instructions, or suitable supervision on different levels of waste management. The health authorities and hospital managers do not accept sufficient responsibility for the medical waste due to financial problems and the lack of awareness regarding the hazards of medical waste. Segregation and minimization of waste are not carried out correctly in any of the hospitals. The use of protective measures by staff and temporary storage areas was not in agreement with standards in 70 and 60% of the hospitals in the present study, respectively. About 50% of the hospitals had been equipped with an incinerator, but all but one (10%) of them had been phased out due to operation and maintenance problems, air pollution, etc. Almost all of the hospitals have a waste management officer, but there is not an effective training programme for the staff. Infectious-hazardous medical waste is mixed with general waste, and it is disposed of in a municipal waste landfill, which is an unsanitary dumpsite. Illegal segregation and recycling of medical waste is carried out at the final disposal site; therefore, there are concerns about environmental pollution and the transmission of infectious diseases. It is proposed that, through the allocation of increased budgets, implementation of integrated segregation, minimization of waste, and creation of a training programme in the hospitals

  14. Budgetary participation and performance: The mediating effects of medical managers' job engagement and self-efficacy. (United States)

    Macinati, Manuela S; Bozzi, Stefano; Rizzo, Marco Giovanni


    Professional hybrids in healthcare have attracted a great deal of policy, managerial, and research interest. However, the current literature offers little guidance on (i) how hybrid roles can be supported by the hospital organization they work for as well as (ii) the cognitive and behavioral driving forces underpinning medical managers' managerial work that determine how they inhabit their roles and consequently meet the standards of performance that contribute to organizational effectiveness. Building on engagement theory and social cognitive theory and using data collected from clinical managers working in a large Italian public hospital, the current study focuses on the mediating role of psychological variables associated with the managerial role of medical managers, namely managerial job engagement and managerial self-efficacy, in the budgetary participation-job performance link. The results suggest that the information gained by participating in budgeting impact medical managers' thoughts and feelings about their managerial role and these, in turn, motivate different aspects of their performance. The findings are discussed in relation to theory and their managerial and policy implications.

  15. Barriers to adult hemodialysis patients' self-management of oral medications. (United States)

    Browne, Teri; Merighi, Joseph R


    Hemodialysis patients use a variety of oral medications on a daily basis to control their kidney disease and comorbid illnesses. Under the new paradigm of kidney disease care for dialysis units outlined in the 2008 US Centers for Medicare & Medicaid Services Conditions for Coverage, there has been a formal shift in the role of the hemodialysis patient from a passive participant in care planning to a fully collaborative member of the interdisciplinary team. In the chronic disease care field, the focus from patient compliance or patient adherence to patient self-management complements this paradigm shift in dialysis care. In this narrative review, we discuss key barriers to adult hemodialysis patient self-management of oral medications that include pill burden, demographic and socioeconomic variables, psychosocial factors, health literacy, patient satisfaction, and health beliefs. We further examine these barriers in the context of the 2008 Medicare Conditions for Coverage. To promote hemodialysis patients' self-management of oral medication regimens, additional research and behavioral interventions are needed to help hemodialysis patients overcome obstacles that impede their ability to effectively manage chronic illness and improve health outcomes.

  16. Effective management of medical information through a novel blind watermarking technique. (United States)

    Das, Sudeb; Kundu, Malay Kumar


    Medical Data Management (MDM) domain consists of various issues of medical information like authentication, security, privacy, retrieval and storage etc. Medical Image Watermarking (MIW) techniques have recently emerged as a leading technology to solve the problems associated with MDM. This paper proposes a blind, Contourlet Transform (CNT) based MIW scheme, robust to high JPEG and JPEG2000 compression and simultaneously capable of addressing a range of MDM issues like medical information security, content authentication, safe archiving and controlled access retrieval etc. It also provides a way for effective data communication along with automated medical personnel teaching. The original medical image is first decomposed by CNT. The Low pass subband is used to embed the watermark in such a way that enables the proposed method to extract the embedded watermark in a blind manner. Inverse CNT is then applied to get the watermarked image. Extensive experiments were carried out and the performance of the proposed scheme is evaluated through both subjective and quantitative measures. The experimental results and comparisons, confirm the effectiveness and efficiency of the proposed technique in the MDM paradigm.

  17. Diagnostic Value and Safety of Medical Thoracoscopy in the Management of Exudative Pleural Effusion

    Directory of Open Access Journals (Sweden)

    Mehmet Akif Özgül


    Full Text Available Objective: Medical thoracoscopy is a minimally invasive procedure that is performed by experienced pulmonologists under local anesthesia and conscious intravenous sedation. It allows direct observation and evaluation of the pleural space. Our aim is to evaluate the diagnostic efficacy and safety of this procedure while presenting our results of medical thoracoscopy performed by rigid thoracoscopy in our clinic. Methods: Thirty-seven patients who had gone thorough medical thoracoscopy between March 2011 and August 2014 were evaluated retrospectively. Results: Of these 37 patients, 26 were male and the average age was 50.94±15.38 years. Fourteen patients had right-sided pleural effusion, whereas 23 had left-sided pleural effusion. Closed pleural biopsy was performed previously in 16 patients with no diagnostic results. In 36 patients (97.3%, a specific diagnosis was achieved. One patient, diagnosed as lymphocytic pleuritis by medical thoracoscopy, underwent decortication and the pathology was consistent with biphasic malignant pleural mesothelioma. Another patient, diagnosed as chronic nonspecific pleuritis with medical thoracoscopy, underwent decortication and the diagnosis was fibrinous pleuritis characterized by extensive fibrosis. Three patients had expansion defects during the post-operative period. Hemothorax occurred in one patient that died of respiratory failure on day 34 of hospitalization. The median length of stay in the hospital after the procedure was 5 days (1–34. Conclusion: Medical thoracoscopy is a secure procedure with high diagnostic value in the management of exudative pleural effusion.

  18. The relationship between the social management of emotional intelligence and academic performance among medical students. (United States)

    Chew, Boon-How; Md Zain, Azhar; Hassan, Faezah


    Positive social interaction with peers was said to facilitate cognitive and intellectual development leading to good academic performance. There was paucity of published data on the effect of social management (SM) emotional intelligence (EI) on academic performance. We conducted this study to examine their relationship in the undergraduate medical students in a public medical school in Malaysia. This was a cross-sectional study using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) to measure the SM. The first and final year medical students were invited to participate. Students answered a paper-based demography questionnaire and completed the online MSCEIT in privacy. Independent predictors were identified using multivariate analyses. A total of 163 (84 first year and 79 final year) medical students completed the study (at a response rate of 66.0%). SM score (B = -.10 95% CI -.175 to -.015, p = .021) was significantly related to the continuous assessment (CA) marks (adjusted R(2) = .45, F13,137 = 10.26, p < .0001), and was a predictor of poor result in the overall CA (adjusted OR 1.06 95% CI 1.011-1.105). Negative relationships might exist between emotional social intelligence and academic success in undergraduate medical students. A different collection of social skills and SM EI could be constructive towards academic achievement in medical schools.

  19. Humor, Aggression, and Aging. (United States)

    Barrick, Ann Louise; And Others

    Although humor is an important phenomenon in human interactions, it has rarely been studied in the elderly. An understanding of responses to humor in aggressive cartoons as a function of advancing age would provide information regarding both the development of humor and the negative (aggressive) emotional experiences of the elderly. This study was…

  20. Serotonin and Aggression. (United States)

    Brown, Serena-Lynn; And Others


    Decreased serotonin function has consistently been shown to be highly correlated with impulsive aggression across a number of different experimental paradigms. Such lowered serotonergic indices appear to correlate with the dimension of aggression dyscontrol and/or impulsivity rather than with psychiatric diagnostic categories per se. Implications…

  1. Inpatient verbal aggression: content, targets and patient characteristics. (United States)

    Stewart, D; Bowers, L


    Verbally aggressive behaviour on psychiatric wards is more common than physical violence and can have distressing consequences for the staff and patients who are subjected to it. Previous research has tended to examine incidents of verbal aggression in little detail, instead combining different types of aggressive behaviour into a single measure. This study recruited 522 adult psychiatric inpatients from 84 acute wards. Data were collected from nursing and medical records for the first 2 weeks of admission. Incidents of verbal aggression were categorized and associations with patient characteristics examined. There were 1398 incidents of verbal aggression in total, reported for half the sample. Types of verbal aggression were, in order of prevalence: abusive language, shouting, threats, expressions of anger and racist comments. There were also a large number of entries in the notes which did not specify the form of verbal aggression. Staff members were the most frequent target of aggression. A history of violence and previous drug use were consistently associated with verbal aggression. However, there were also some notable differences in patient variables associated with specific types of verbal aggression. Future studies should consider using multidimensional measures of verbal aggression.

  2. Parents’ Aggressive Influences and Children's Aggressive Problem Solutions with Peers


    Duman, Sarah; Margolin, Gayla


    This study examined children's aggressive and assertive solutions to hypothetical peer scenarios in relation to parents’ responses to similar hypothetical social scenarios and parents’ actual marital aggression. The study included 118 9−10 year old children, and their mothers and fathers. Children's aggressive solutions correlated with same-sex parents’ actual marital aggression. For children with mothers who exhibit low actual marital aggression, mothers’ aggressive solutions to hypothetical...

  3. Brief Report: Comparative Effects of Antecedent Exercise and Lorazepam on the Aggressive Behavior of an Autistic Man. (United States)

    Allison, David B.; And Others


    This case study of a 24-year-old man with autistic disorder and mental retardation who exhibited aggression found that antecedent exercise significantly decreased aggression; drug therapy with an anxiolytic (lorazepam) alone had no significant effect on aggression; and exercise plus medication decreased aggression to a somewhat lesser degree than…

  4. Foreign bodies in otorhinolaryngology: a study of 860 cases managed in medical college hospital.

    Directory of Open Access Journals (Sweden)

    Sudhir M Naik


    Full Text Available Background: Foreign bodies (FB are the commonest emergencies in otorhino-laryngology. The most common incidences are in the nasal cavity, ears and oropharynx. FB in the nose, ears and oropharynx have characteristic symptoms and their removal does not represent a great difficulty to the otorhino-laryngologist unless 2 the FB is in the tracheo-bronchial tree. The FB inoculation may be voluntary or accidental.Design: A retrospective study of 860 cases managed in 57 months period between January 2007 to July 2011.Setting: Department of ENT, Head and Neck Surgery, KVG Medical College, Sullia.Materials and method: 860 cases of foreign bodies were managed successfully in the OPD under topical anaesthesia and also under general anaesthesia. There were 471 males & 389 females in the study, the youngest was 4 year old girl and the oldest was 69 year old female.Result: In our study we managed 860 cases of FBs which included 505 ear cases, 118 nasal cases, 118 pharyngeal cases, 100 esophageal cases and 19 FBs in the trachea, bronchus. 429 cases were managed in the OPD under topical anaesthesia and 431 cases were managed under general anaesthesia.Conclusion: Most of the foreign bodies in the nose and ear can be managed in the outpatients itself. All the foreign bodies of the esophagus and trachea bronchus were managed under general anaesthesia after admission. Complication rates are very low when managed prudently by a trained otorhino-laryngologist.

  5. The Management of a Patient with Elevated Intraocular Pressure Resistant to Medical Treatment: Anterior Chamber Irrigation

    Directory of Open Access Journals (Sweden)

    Abdullah Beyoğlu


    Full Text Available A 7-year-old male patient was medically treated in another center for hyphema which occurred after blunt trauma to his right eye. He was admitted to our clinic when his visual acuity decreased after being discharged. Biomicroscopic examination revealed total hyphema. Intraocular pressure (IOP was 48 mm Hg in the right eye with Goldmann applanation tonometry. Since IOP could not be managed by medical therapy and there was no regression in hyphema, anterior chamber was irrigated. As in our case, it should not be forgotten that re-hemorrhage may occur in the first week of hyphema during childhood. Moreover, surgical treatment should be considered when hemorrhage does not regress with medical treatment, increased IOP persists, and when there is a risk of corneal endothelial staining (corneal blood staining. (Turk J Ophthalmol 2014; 44: 400-2

  6. Application of Lean Management in archives Management of Medical Equipment%精益管理在医疗设备档案管理中的应用

    Institute of Scientific and Technical Information of China (English)

    曾冬梅; 张正军


    Through introducing importance of medical equipment archives management and content of lean management, this paper expounds effective application of lean management in medical equipment archives management, finally summarizes the achievement of using lean management.%本文通过对医疗设备档案管理重要性及精益管理内容的介绍,阐述了如何将精益管理有效应用于医疗设备档案管理中,最后总结了运用精益管理所取得的成效.

  7. The political economy of a public health case management program's transition into medical homes. (United States)

    Wells, Rebecca; Cilenti, Dorothy; Issel, L Michele


    Throughout the United States, public health leaders are experimenting with how best to integrate services for individuals with complex needs. To that end, North Carolina implemented a policy incorporating both local public health departments and other providers into medical homes for low income pregnant women and young children at risk of developmental delays. To understand how this transition occurred within local communities, a pre-post comparative case study was conducted. A total of 42 people in four local health departments across the state were interviewed immediately before the 2011 policy change and six months later: 32 professionals (24 twice) and 10 pregnant women receiving case management at the time of the policy implementation. We used constant comparative analysis of interview and supplemental data to identify three key consequences of the policy implementation. One, having medical homes increased the centrality of other providers relative to local health departments. Two, a shift from focusing on personal relationships toward medical efficiency diverged in some respects from both case managers' and mothers' goals. Three, health department staff re-interpreted state policies to fit their public health values. Using a political economy perspective, these changes are interpreted as reflecting shifts in public health's broader ideological environment. To a large extent, the state successfully induced more connection between health department-based case managers and external providers. However, limited provider engagement may constrain the implementation of the envisioned medical homes. The increased focus on medical risk may also undermine health departments' role in supporting health over time by attenuating staff relationships with mothers. This study helps clarify how state public health policy innovations unfold at local levels, and why front line practice may in some respects diverge from policy intent.

  8. Medical Assistant-based care management for high risk patients in small primary care practices

    DEFF Research Database (Denmark)

    Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.


    Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective.......77) and general health scores (EQ-5D +0.03, CI 0.00 to 0.05) improved significantly at 24 months of intervention. Intervention costs summed up to 10 United States dollars per patient per month. Limitations: Limitations included a small number of primary care practices and a low intensity of intervention......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients with type 2...

  9. Value-based insurance plus disease management increased medication use and produced savings. (United States)

    Gibson, Teresa B; Mahoney, John; Ranghell, Karlene; Cherney, Becky J; McElwee, Newell


    We evaluated the effects of implementing a value-based insurance design program for patients with diabetes in two groups within a single firm. One group participated in disease management; the other did not. We matched members of the two groups to similar enrollees within the company that did not offer the value-based program. We found that participation in both value-based insurance design and disease management resulted in sustained improvement over time. Use of diabetes medications increased 6.5 percent over three years. Adherence to diabetes medical guidelines also increased, producing a return on investment of $1.33 saved for every dollar spent during a three-year follow-up period.

  10. Q-Pro: a quality control management system for medical equipment. (United States)

    Kolitsi, Z; Bliznakov, J; Gueorguieva-Bliznakova, K; Theodorakos, Y; Pallikarakis, N


    Q-Pro is an application for quality control (QC) and inspection of medical equipment. The system has been designed on the basis of a broad requirements analysis, contributed by clinical engineers from several European countries and with a focus on current and forthcoming regulatory requirements concerning the quality control and risk management for medical equipment. Q-Pro comprises a generalized application, providing the necessary flexibility to accommodate the different degrees of difficulty and specialization in creating or customizing QC protocols, carrying out inspections and managing collected data. The system incorporates a tool library for QC protocol design, widely used multimedia as well as a local database for protocol and inventory data archiving. The paper presents a detailed account of the system context of use, design and functionality.

  11. Psychiatric and Medical Management of Marijuana Intoxication in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Bui, Quan M.


    Full Text Available We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation. Psychiatric management of cannabis psychosis involves symptomatic treatment and maintenance of safety during detoxification. Acute medical complications of marijuana use are primarily cardiovascular and respiratory in nature; electrolyte and electrocardiogram monitoring is indicated. This patient’s psychosis, hypokalemia and prolonged QTc interval resolved over two days with supportive treatment and minimal intervention in the emergency department. Patients with cannabis psychosis are at risk for further psychotic sequelae. Emergency providers may reduce this risk through appropriate diagnosis, acute treatment, and referral for outpatient care. [West J Emerg Med. 2015;16(3:414–417.

  12. Medical management of cerebellar abscess: a case report and review of the literature. (United States)

    Turner, Ryan C; Dodson, Sean C; Rosen, Charles L


    A large abscess of the posterior fossa often warrants surgical intervention. We report a case of a 50-year-old male presenting with a cerebellar abscess measuring 2.8 cm x 1.6 cm located in the left cerebellar hemisphere at the level of the middle cerebellar peduncle that was treated conservatively and successfully with antibiotics. Therapeutic management options are discussed in regards to this case specifically as well as a review of the literature. This case illustrates the successful medical management of a cerebellar abscess of otogenic origin in an adult, a unique result in terms of abscess size and age of the patient.

  13. Evaluating medical residents as managers of care: a critical appraisal of assessment methods

    Directory of Open Access Journals (Sweden)

    Busari JO


    Full Text Available Jamiu O Busari,1,2 Lorette A Stammen,2 Lokke M Gennissen,2 Rob M Moonen1 1Department of Pediatrics, Atrium Medical Center, Henri Dunantstraat 5, 6401 CX Heerlen, the Netherlands; 2Faculty of Health, Medicine and Life Sciences, University of Maastricht, the Netherlands Introduction: The increasing demands for effective and efficient health care delivery systems worldwide have resulted in an expansion of the desired competencies that physicians need to possess upon graduation. Presently, medical residents require additional professional competencies that can prepare them to practice adequately in a continuously changing health care environment. Recent studies show that despite the importance of competency-based training, the development and evaluation of management competencies in residents during residency training is inadequate. The aim of this literature review was to find out which assessment methods are currently being used to evaluate trainees' management competencies and which, if any, of these methods make use of valid and reliable instruments. Methods: In September 2012, a thorough search of the literature was performed using the PubMed, Cochrane, Embase®, MEDLINE®, and ERIC databases. Additional searches included scanning the references of relevant articles and sifting through the “related topics” displayed by the databases. Results: A total of 25 out of 178 articles were selected for final review. Four broad categories emerged after analysis that best reflected their content: 1 measurement tools used to evaluate the effect of implemented curricular interventions; 2 measurement tools based on recommendations from consensus surveys or conventions; 3 measurement tools for assessing general competencies, which included care-management; and 4 measurement tools focusing exclusively on care-management competencies. Conclusion: Little information was found about (validated assessment tools being used to measure care-management competence

  14. Medical residents’ perceptions of their competencies and training needs in health care management: an international comparison

    Directory of Open Access Journals (Sweden)

    Berkenbosch Lizanne


    Full Text Available Abstract Background Previous research has shown that Dutch medical residents feel inadequate in certain management areas: 85% had a need for management training and reported preferences on the format of such training. Our objective was to explore if the perceived deficiencies and needs among Dutch residents were similar to those of their peers in other countries, and if a longer duration of the incorporation of the CanMEDS competency framework into curricula as well as management training had an influence on these perceptions. Methods Medical residents from Denmark, Canada and Australia were approached for participation. The questionnaire used to survey the perceptions of Dutch residents was slightly modified, translated into English and sent by email to all international participants. Results Response rates were; Denmark 719/2105 (34%, Canada 177/500 (35% and Australia 194/1213 (16% respectively. The Danish as well as the Canadian residents rated their negotiating skills poorly. In Australia the residents found their knowledge on how their specialist department was organized to be insufficient, while residents in the Netherlands rated their knowledge on how the healthcare system was organized as inadequate. In all of the countries, more than 70% of the residents reported a perceived need for management training. Conclusions A majority of the residents in all countries felt the need for specific training in developing their management competencies. The adoption of the CanMEDS framework alone seems to be insufficient in meeting residents’ perceived educational needs in this area.

  15. The medical management of lower urinary tract symptoms and benign prostatic hyperplasia. (United States)

    Holtgrewe, H L


    Prostatism is a widely used term assigned to the symptom complex of older men with voiding dysfunction. The cause of the syndrome has routinely been ascribed to an enlarged prostate. More recent thinking recognizes that many men with such symptoms do not, in fact, have prostate enlargement or benign prostatic hyperplasia (BPH) and that such symptoms are not a surrogate for BPH. Such recognition is essential if cost effective medical management of lower urinary tract symptoms (LUTS) is to be achieved. Prostate volume has emerged as a key factor in the selection of medical therapy of LUTS and BPH not only regarding symptom relief but also to the newer concept of the prevention of disease progression and the avoidance of future adverse events in those men with true BPH. In the United States, medical management is now first line therapy for LUTS. The proper selection of therapy based on the patient's individual pathophysiologic characteristics is now made possible by many new recent studies within the medical literature.

  16. Leadership, management and teamwork learning through an extra-curricular project for medical students: descriptive study

    Directory of Open Access Journals (Sweden)

    Maria Lucia da Silva Germano Jorge

    Full Text Available CONTEXT AND OBJECTIVE: Professionalism in medicine requires preparation for the globalized world. Our objective was to describe a project that introduces medical students to the community, hospital and laboratory activities, thereby allowing them to gain experience in people management, leadership and teamwork.DESIGN AND SETTING: Descriptive study of the process applied at a philanthropic medical school in Curitiba, Paraná.METHOD: Inclusion of management and leadership practices as part of the medical degree program.RESULTS: The study groups consisted of fifteen students. After six months, any of the participants could be elected as a subcoordinator, with responsibility for managing tasks and representing the team in hospital departments and the community. The activities required increasing levels of responsibility. In medical schools, students' involvement in practical activities is often limited to observation. They are not required to take responsibilities or to interact with other students and stakeholders. However, they will become accountable, which thus has an adverse effect on all involved. The learning space described here aims to fill this gap by bringing students closer to the daily lives and experiences of healthcare professionals.CONCLUSION: Being a physician requires not only management and leadership, but also transferrable competencies, communication and critical thinking. These attributes can be acquired through experience of teamwork, under qualified supervision from teaching staff. Students are thus expected to develop skills to deal with and resolve conflicts, learn to share leadership, prepare others to help and replace them, adopt an approach based on mutual responsibility and discuss their performance.

  17. Investigation of Management Status on MedicalWastes in Public Hospitals of Arak City

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    R Nabizadeh


    Full Text Available "nBackground and Objectives: Not paying attention to management and control of medical wastes in different stages of production, keeping, gathering, transporting and finally eliminating them all have been creating various setbacks such that the environment and human's health are in danger with the relevant consequences. This descriptive cross-sectional study was performed in Vali-e Asr, Amir Kabir, Taleghani, Amir Al-Momenin and Imam Khomeini hospitals of Arak city in 2009. In this research the current condition of gathering, maintaining, transportation and final elimination of hospital wastes of Arak city was investigated .Eventually an appropriate model was introduced."nMaterial and Methods: Solid wastes were separated, weighed and registered in two sequential intervals. In order to get acquaintance with the management procedure of medical solid wastes in the hospitals studied, a questionnaire approved byW.H.O was used. The questions were then replied by the Managers and Hygiene Experts worked at hospitals and their responses were recorded."nResults: The investigations conducted in 5 hospitals reveal that the average per annual was2.9 Kg in 24 hours per active bed and 4.6 Kg for each patient. This volume consists of 60% for semi-home solid wastes, 39% for infectious solid wastes, 0.34% for sharp wastes, 0.28% for the pathologic and 0.38% for medicinal and chemical solid wastes."nConclusion: According to the results obtained in this study, in order to reduce pollution create in the hospitals, action should be taken to deal with pollutants at their source of generation. The staff members involved in waste collection and transportation should practice all the personal protection measures.finaly it also should be considered that,success in medical waste management wouldn't be achievable unless all groups of medical staff involved cooperate and participle.

  18. Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety


    Cichero, Julie AY


    Dysphagia is the medical term for difficulty swallowing. Thickened liquids are often used in the management of dysphagia to improve bolus control and to help prevent aspiration. A range of starches and gums has historically been used to thicken liquids. Although thickened liquids improve swallow safety, they appear to have a great potential for unintended physiological consequences. Initial concerns were raised about the impact of thickeners on water binding due to the high prevalence of dehy...

  19. Levels of Aggression among Turkish Adolescents and Factors Leading to Aggression. (United States)

    Avci, Dilek; Kilic, Mahmut; Tari Selcuk, Kevser; Uzuncakmak, Tugba


    Aggression, an increasing problem among adolescents, is a potential threat to public health as it can lead to violence. Determining the factors causing aggression plays an important role in taking measures to reduce violence. This study aimed at determining the level of aggression among adolescents and at identifying the factors associated with high levels of aggression. This cross-sectional study was conducted with 2,409 Turkish adolescents. Data were collected with the Socio-demographic Questionnaire, Aggression Scale, Perceived Social Support Scale, and Communication Skills Attitude Scale. Data were analyzed using descriptive statistics, the chi-square test, t-test, and logistic regression. The participants' mean aggression score was 91.83 ± 24.05, and 24.0% of the adolescents' aggression levels rated high. According to the logistic regression model, aggression was 1.26 times higher among males, 1.92 times higher among those who perceived their mental health as poor, 1.58 times higher among those with suicidal ideation, 1.29 times higher among those who did not get prepared for university entrance exams, and 1.62 times higher among those who perceived their school performance as poor. Perceived family social support was a protective factor against high aggression. Approximately one out of every four adolescents in the two Turkish high schools where the study was conducted was determined to display high levels of aggression. Therefore, in order to reduce aggression among adolescents, programs such as coping management and coping with anger should be applied by nurses. Programs should include not only students but also families.

  20. The Application of Medical Record Management in Quality Management System%质量管理体系在病案管理中的应用

    Institute of Scientific and Technical Information of China (English)



    Objective The IS09001 quality management system in the application of medical record management is discussed.Methods The existing main problems of situation of medical record management in our hospital are analyzed according to the requirem ent of ISO 9001 quality management system to medical record management.Results The paper puts forward effective counterm easures about medical record safety management strengthening, quality control of medical record, data statistical analysis, basic facility construction of department and construction of professional staffs.Conclusions The level of medical record management is improved by implementing quality management system.%目的 探讨ISO9001质量管理体系在病案管理中的应用.方法 根据ISO9001质量管理体系对病案管理的要求,对我院病案管理现状存在的主要问题进行分析.结果 提出加强病案安全管理、病案质量控制、数据统计分析、科室基础设施建设及专业队伍建设的有效措施.结论 通过实施ISO9001质量管理体系,使病案管理水平得到提高.



    Anatoly A. Kozlov


    The article justifies the introduced proposals for a management accounting of theFederal Compulsory Medical InsuranceFund formation and the characteristics and principles of management accounting forms for the analysis of the territorialcompulsory medical insurance programs.

  2. Medical management of male and female cats with nonobstructive lower urinary tract disease. (United States)

    Osborne, C A; Polzin, D J; Klausner, J S; Kruger, J M


    This case is typical of recurrent urolithiasis managed by repeated surgery. Retrospective assessment of the disorder indicates the need for quantitative analyses of uroliths removed by cystotomy. Compliance of the owners with recommendations to minimize recurrent urolithiasis might have been beneficial. Results of medical therapy designed to induce dissolution of uroliths in this case are representative of preliminary findings of medical dissolution of naturally occurring struvite uroliths in ten other cats. It is of interest that the uroliths dissolved even though no effort was made to induce diuresis. The underlying cause of UTI in this patient may have been damage to the lower urinary tract induced by previous diagnostic and therapeutic procedures and/or sterile struvite uroliths that compromised local host defense mechanisms. Lack of urease production by the uropathogens suggests that they did not play a causative role in formation of uroliths. The need for preventative therapy of recurrent formation of uroliths after their medical dissolution is worthy of further comment. In this patient, specific measures to prevent urolith recurrence were not initiated because it is a part of a prospective clinical study. In the event uroliths recur, medical therapy designed to induce dissolution of uroliths would be repeated. Need for long-term preventative therapy would be dependent on the time interval between recurrent episodes (weeks, months, or years), and the effectiveness of medical therapy for urolith dissolution. Long-term prophylactic therapy would include urine acidifiers and diets low in magnesium.

  3. Application of RFID Technology in Medical Management%RFID技术在医疗管理中的应用

    Institute of Scientific and Technical Information of China (English)

    史今驰; 于敏; 王彦


    从实用的角度分析了RFID技术在医疗管理中的可行性,简要阐述了RFID的控制、存储以及通信电路,在此基础上分别介绍了医疗设备管理和患者信息管理的RFID技术具体应用,最后通过对上位机通信终端和医疗管理信息平台的设计,构成了以RFID技术为核心的医疗管理系统,提高了医护人员的工作效率,降低了医疗事故和医疗成本,保证了医疗系统运行的安全性.%The feasibility of RFID technology in medical management is analyzed from a practical point. The control, storage and communication circuit of RFID is described briefly. On this basis, the application of RFID technology in medical equipment management and patient's information management is introduced respectively. At last, through the design of the upper machine communication terminal and medical management information platform, the medical management system using RFID technology as the core is constructed, which improves the working efficiency of the medical staff, reduces the medical malpractice and medical costs, and ensures the running security of the health care system. [Chinese Medical Equipment Journal, 2012,33(6):120-122

  4. Useful measures and models for analytical quality management in medical laboratories. (United States)

    Westgard, James O


    The 2014 Milan Conference "Defining analytical performance goals 15 years after the Stockholm Conference" initiated a new discussion of issues concerning goals for precision, trueness or bias, total analytical error (TAE), and measurement uncertainty (MU). Goal-setting models are critical for analytical quality management, along with error models, quality-assessment models, quality-planning models, as well as comprehensive models for quality management systems. There are also critical underlying issues, such as an emphasis on MU to the possible exclusion of TAE and a corresponding preference for separate precision and bias goals instead of a combined total error goal. This opinion recommends careful consideration of the differences in the concepts of accuracy and traceability and the appropriateness of different measures, particularly TAE as a measure of accuracy and MU as a measure of traceability. TAE is essential to manage quality within a medical laboratory and MU and trueness are essential to achieve comparability of results across laboratories. With this perspective, laboratory scientists can better understand the many measures and models needed for analytical quality management and assess their usefulness for practical applications in medical laboratories.

  5. Anger Management among Medical Undergraduate Students and Its Impact on Their Mental Health and Curricular Activities

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    Gayathri S. Prabhu


    Full Text Available Background. This study was intended to determine the practice of students in good anger management skills and to what extent their anger can affect their studies, work, and social interactions. In this study the relationship between anger management and the effects on the mental health of medical students was evaluated. A survey was also done to determine duration of the feeling of anger which lasts among medical students and its consequences. Materials and Methods. A newly developed questionnaire was utilized which included a simplified version of the Novaco Anger Scale and Provocation Inventory and the modified Patient Health Questionnaire 9 (to measure the mental health. Results. The data suggests that although students with high anger tendencies display poor mental health, there is no lowering of the mental health/PHQ-9 score as the anger management technique’s effectiveness rises. “Friends” was cited as the major triggering factor for anger, whereby the feelings can last for up to a day and somewhat affect their concentration on normal activities. Conclusion. When anger is suppressed and not let out, it can be an underlying factor for anxiety and depression. Therefore, more emphasis needs to be placed on educating students on how to manage their anger especially in a stressful environment away from home.

  6. Patient aggression in clinical psychiatry: perceptions of mental health nurses. (United States)

    Jonker, E J; Goossens, P J J; Steenhuis, I H M; Oud, N E


    Mental health nurses are faced with an increasing number of aggressive incidents during their daily practice. The coercive intervention of seclusion is often used to manage patient aggression in the Netherlands. However, GGZ Nederland, the Dutch association of service providers for mental health and addition care, has initiated a project to decrease the number of seclusions in clinical psychiatry. A first step in this project is to gain insight into the current situation: the perceived prevalence of patient aggression, the attitudes of mental health nurses towards patient aggression and those socio-demographic and psychosocial factors that contribute to the use of coercive interventions. A survey was undertaken among 113 nurses from six closed and semi-closed wards. In this survey, two questionnaires were used: (1) the Attitude Toward Aggression Scale; and (2) the Perceptions of the Prevalence of Aggression Scale. Variables derived from the Theory of Planned Behaviour were also measured. Nurses reported being regularly confronted with aggression in general and mostly with non-threatening verbal aggression. They perceived patient aggression as being destructive or offensive and not serving a protective or communicative function. The nurses generally perceived themselves as having control over patient behaviour (i.e. considerable self-efficacy) and reported considerable social support from colleagues. Although the nurses in this study were frequently confronted with aggression, they did not experience the aggression as a major problem.

  7. Physicians’ use of computerized clinical decision supports to improve medication management in the elderly – the Seniors Medication Alert and Review Technology intervention (United States)

    Alagiakrishnan, Kannayiram; Wilson, Patricia; Sadowski, Cheryl A; Rolfson, Darryl; Ballermann, Mark; Ausford, Allen; Vermeer, Karla; Mohindra, Kunal; Romney, Jacques; Hayward, Robert S


    Background Elderly people (aged 65 years or more) are at increased risk of polypharmacy (five or more medications), inappropriate medication use, and associated increased health care costs. The use of clinical decision support (CDS) within an electronic medical record (EMR) could improve medication safety. Methods Participatory action research methods were applied to preproduction design and development and postproduction optimization of an EMR-embedded CDS implementation of the Beers’ Criteria for medication management and the Cockcroft–Gault formula for estimating glomerular filtration rates (GFR). The “Seniors Medication Alert and Review Technologies” (SMART) intervention was used in primary care and geriatrics specialty clinics. Passive (chart messages) and active (order-entry alerts) prompts exposed potentially inappropriate medications, decreased GFR, and the possible need for medication adjustments. Physician reactions were assessed using surveys, EMR simulations, focus groups, and semi-structured interviews. EMR audit data were used to identify eligible patient encounters, the frequency of CDS events, how alerts were managed, and when evidence links were followed. Results Analysis of subjective data revealed that most clinicians agreed that CDS appeared at appropriate times during patient care. Although managing alerts incurred a modest time burden, most also agreed that workflow was not disrupted. Prevalent concerns related to clinician accountability and potential liability. Approximately 36% of eligible encounters triggered at least one SMART alert, with GFR alert, and most frequent medication warnings were with hypnotics and anticholinergics. Approximately 25% of alerts were overridden and ~15% elicited an evidence check. Conclusion While most SMART alerts validated clinician choices, they were received as valuable reminders for evidence-informed care and education. Data from this study may aid other attempts to implement Beers’ Criteria in

  8. Canine aggression toward people: a guide for practitioners. (United States)

    Sueda, Karen Lynn C; Malamed, Rachel


    This article reviews the various causes of human-directed aggression in dogs and provides a step-by-step plan guiding the general practitioner through history taking, behavior observations, diagnosis, consultation, treatment, and follow-up care. Charts summarizing how to obtain behavioral information, the client's management options, treatment recommendations, diagnosis and treatment of human-directed aggression, and the clinician's role in preventing human-directed aggression are included. A graphic illustration of canine body language is also provided.

  9. Detection and management of medication errors in internal wards of a teaching hospital by clinical pharmacists.

    Directory of Open Access Journals (Sweden)

    Mohammad Abbasinazari


    Full Text Available Any suboptimum treatment in the management of patients can lead to medication errors (MEs that may increase morbidity and mortality in hospitalized individuals. By establishing well-designed patient care activities within the managed care setting, clinical pharmacists can cooperate with other health care professionals to provide quality care and maximize safety. The aim of this study was to evaluate the frequency and prevention of MEs by clinical pharmacists. This was a cross-sectional interventional study conducted in internal wards of a teaching hospital during a two-month period. During this period, patient records, and physician orders were reviewed by clinical pharmacists. Any prescription error identified was documented. Incorrect drug selection, dose, dosage form, frequency, or route of administration all were considered as medication errors. Then, the clinical pharmacist discuss about findings with the clinical fellows to change faulty orders. The frequency and types of MEs in different wards that were detected and prevented by clinical pharmacists was documented. During the study period, in 132 patients, 262 errors were detected (1.98 per each. Wrong frequency 71 (27%, forget to order 37 (14.1%, wrong selection 33 (12.5%, drug interactions 26 (9.9%, forget to discontinue 25 (9.5% and inappropriate dose adjustment in renal impairment 25 (9.5% were the most types of errors. Cardiovascular medications were the class with the highest detected errors (31.6% followed by gastrointestinal agents (15.6%. Medication errors are common problems in medical wards that their frequency can be restricted by the intervention of clinical pharmacists.

  10. E-book for Knowledge Management in Scientific Research Conducted in the Medical Sciences Graduate Program

    Directory of Open Access Journals (Sweden)

    Oramis Sosa Palacios


    Full Text Available The training of students enrolled in the Medical Sciences graduate program (residents includes research activities such as research projects, the final paper of the specialty, scientific events and scientific publications. Knowledge gaps in residents lead to problems seen in both the poor quality of the research project and the final paper of the specialty and in the lack of autonomy to make decisions, affecting their overall training. An electronic book aimed at residents was created for knowledge management in scientific research. The first version was designed using the Crheasoft 2.0 program. It consists of: presentation, start modules, list of topics and complementary information. It comprises condensed knowledge on: research management, research methodology, statistics, information management, computer science, linguistics and language. This e-book contributes to the execution of research activities and promotes learning independence.

  11. Management of radioactive material safety programs at medical facilities. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Camper, L.W.; Schlueter, J.; Woods, S. [and others


    A Task Force, comprising eight US Nuclear Regulatory Commission and two Agreement State program staff members, developed the guidance contained in this report. This report describes a systematic approach for effectively managing radiation safety programs at medical facilities. This is accomplished by defining and emphasizing the roles of an institution`s executive management, radiation safety committee, and radiation safety officer. Various aspects of program management are discussed and guidance is offered on selecting the radiation safety officer, determining adequate resources for the program, using such contractual services as consultants and service companies, conducting audits, and establishing the roles of authorized users and supervised individuals; NRC`s reporting and notification requirements are discussed, and a general description is given of how NRC`s licensing, inspection and enforcement programs work.

  12. Design of a Medical Triage Evidence-Based Clinical Management Protocol and Implementation of Medical Triage On-Line Training for Use by Mission of Mercy Volunteers. (United States)

    Allen, Kimberly D; DiBartolo, Mary C; Welsh, Debra L; Brown, Voncelia


    Evidence-based protocols in safety net settings can help standardize care practices, increase organizational workflow, and enhance quality outcomes for those receiving services. The purpose of this quality improvement project is two-fold: to design an evidence-based medical triage clinical management protocol, and, to influence adherence to that protocol by safety net medical triage volunteers through an on-line volunteer orientation. Leadership skills were required to help translate evidence-based practice recommendations into useful tools to assist in directing practice. Project outcomes included successful multidisciplinary practice change, significantly improved volunteer knowledge surrounding medical triage protocol parameters, increased organizational workflow, and enhanced quality client outcomes.

  13. Aggression in Pretend Play and Aggressive Behavior in the Classroom (United States)

    Fehr, Karla K.; Russ, Sandra W.


    Research Findings: Pretend play is an essential part of child development and adjustment. However, parents, teachers, and researchers debate the function of aggression in pretend play. Different models of aggression predict that the expression of aggression in play could either increase or decrease actual aggressive behavior. The current study…

  14. Aggressive periodontitis: A review

    Directory of Open Access Journals (Sweden)

    Vaibhavi Joshipura


    Full Text Available The purpose of this review is to highlight the current etiological and therapeutic concepts of aggressive periodontitis which is rapidly progressing and aggressive in nature. It leads to destruction of periodontal tissues and loss of teeth. We need advanced diagnostic techniques to learn about current disease activity and rate of progression. We also require strategies to keep the disease under control with proper maintenance regime and prevent tooth loss, because it can result into complicated prosthetic rehabilitation in a very young patient. The evidence suggests that aggressive periodontitis is influenced by microbiological, genetic, and host factors. This paper reviews clinical, microbiological, immunological, and genetic aspects of pathogenesis of aggressive periodontitis, as well as diagnostic criteria of the disease and appropriate nonsurgical and surgical treatment options.

  15. Aggression And Attachment Security

    Directory of Open Access Journals (Sweden)

    Prem Verma


    Full Text Available Objective:The aim of the present study is to examine the factors related aggression in Iranian and Indian school children. Method: Attachment security (dependency, availability, and total considered as the variable. The KSS questionnaire was administrated students in the 5th grade; 300 were Iranian and 300 were Indian consisted of 150 boys and 150 girls. Results: Attachment security demonstrated significant negative correlations with aggression in the boys, girls and the total Iranian sample. The dependency on mothers was the only case with insignificant correlation.In the Indian sample, attachment security was also found to be significantly negatively correlated with aggression. The only exception was the correlation between mother's availability and aggression in girls, which was not significant Conclusion: It is important that parents treat their children in a tender, manner so that a secure attachment develop between them.

  16. In-hospital delirium risk assessment, diagnosis and management; medications to avoid

    Directory of Open Access Journals (Sweden)

    Andrew Clegg


    Full Text Available Background: Delirium is a common, but potentially preventable complication of acute illness that is associated with important adverse outcomes including increased length of hospital admission, risk of dementia and admission to long-term care. In-hospital risk assessment and diagnosis: Age over 65, severe illness, current hip fracture and presence of cognitive impairment or dementia are important risk factors for delirium. Assess people with any of these risk factors for recent changes or fluctuations in behaviour that might indicate delirium. If any indicators are present, complete a full cognitive assessment to confirm the diagnosis of delirium. In-hospital risk management: Multicomponent delirium prevention interventions can reduce the incidence of delirium in hospital by around one third and should be provided to people with any of the important risk factors that do not have delirium at admission. A medication review that considers both the number and type of prescribed medications is an important part of the multicomponent delirium prevention intervention. Which medications to avoid in people at risk of delirium: For people at risk of delirium, avoid new prescriptions of benzodiazepines or consider reducing or stopping these medications where possible. Opioids should be prescribed with caution in people at risk of delirium but this should be tempered by the observation that untreated severe pain can itself trigger delirium. Caution is also required when prescribing dihydropyridines and antihistamine H1 antagonists for people at risk of delirium and considered individual patient assessment is advocated. Conclusion: Delirium is common, distressing to patients, relatives and carers and is associated with important adverse outcomes. Multicomponent delirium prevention interventions can reduce the incidence of delirium by approximately one third and usually incorporate a medication review. Identification of which medications to avoid in people at

  17. Use of failure mode effect analysis (FMEA) to improve medication management process. (United States)

    Jain, Khushboo


    Purpose Medication management is a complex process, at high risk of error with life threatening consequences. The focus should be on devising strategies to avoid errors and make the process self-reliable by ensuring prevention of errors and/or error detection at subsequent stages. The purpose of this paper is to use failure mode effect analysis (FMEA), a systematic proactive tool, to identify the likelihood and the causes for the process to fail at various steps and prioritise them to devise risk reduction strategies to improve patient safety. Design/methodology/approach The study was designed as an observational analytical study of medication management process in the inpatient area of a multi-speciality hospital in Gurgaon, Haryana, India. A team was made to study the complex process of medication management in the hospital. FMEA tool was used. Corrective actions were developed based on the prioritised failure modes which were implemented and monitored. Findings The percentage distribution of medication errors as per the observation made by the team was found to be maximum of transcription errors (37 per cent) followed by administration errors (29 per cent) indicating the need to identify the causes and effects of their occurrence. In all, 11 failure modes were identified out of which major five were prioritised based on the risk priority number (RPN). The process was repeated after corrective actions were taken which resulted in about 40 per cent (average) and around 60 per cent reduction in the RPN of prioritised failure modes. Research limitations/implications FMEA is a time consuming process and requires a multidisciplinary team which has good understanding of the process being analysed. FMEA only helps in identifying the possibilities of a process to fail, it does not eliminate them, additional efforts are required to develop action plans and implement them. Frank discussion and agreement among the team members is required not only for successfully conducing

  18. Medical Management of Glaucoma in the 21st Century from a Canadian Perspective

    Directory of Open Access Journals (Sweden)

    Paul Harasymowycz


    Full Text Available Glaucoma is a medical term describing a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and retinal nerve fibre layer and resulting in changes in the optic nerve head. Glaucoma is a leading cause of irreversible vision loss worldwide. With the aging population it is expected that the prevalence of glaucoma will continue to increase. Despite recent advances in imaging and visual field testing techniques that allow establishment of earlier diagnosis and treatment initiation, significant numbers of glaucoma patients are undiagnosed and present late in the course of their disease. This can lead to irreversible vision loss, reduced quality of life, and a higher socioeconomic burden. Selection of therapeutic approaches for glaucoma should be based on careful ocular examination, patient medical history, presence of comorbidities, and awareness of concomitant systemic therapies. Therapy should also be individualized to patients’ needs and preferences. Recent developments in this therapeutic field require revisiting treatment algorithms and integration of traditional and novel approaches in order to ensure optimal visual outcomes. This article provides an overview of recent developments and practice trends in the medical management of glaucoma in Canada. A discussion of the surgical management is beyond the scope of this paper.

  19. Diagnosis and management of familial Mediterranean fever: integrating medical genetics in a dedicated interdisciplinary clinic. (United States)

    Zadeh, Neda; Getzug, Terri; Grody, Wayne W


    Familial Mediterranean fever is an autosomal recessive genetic disorder characterized by recurrent febrile polyserositis, especially prevalent in individuals of Mediterranean descent. Familial Mediterranean fever can have nonspecific manifestations that mimic many common acquired disorders such as infections, acute appendicitis, cholecystitis, and arthritis, which can delay diagnosis for many years and subject patients to extensive evaluations and even unnecessary surgery. Untreated familial Mediterranean fever can result in serious complications such as end-stage renal disease and malabsorption secondary to amyloid deposition in the kidneys and digestive tract, male and female infertility, and growth retardation in children. These significant sequelae, along with the episodic acute attacks, are readily preventable by treatment with oral colchicine and underscore the necessity of early detection and treatment from a medical, psychosocial, and economic standpoint. We describe our comprehensive approach to the accurate diagnosis and effective management of this disorder by means of a dedicated familial Mediterranean fever clinic that incorporates medical genetics on equal footing with general medicine. In addition to providing the clinician with the presenting features of familial Mediterranean fever, methods of diagnosis including molecular testing, and current management based on our extensive experience with hundreds of affected individuals, we also advance this approach as a model for the incorporation of medical genetics practice into the more traditional domains of general medicine.

  20. Medical Management of Glaucoma in the 21st Century from a Canadian Perspective (United States)

    Birt, Catherine; Gooi, Patrick; Heckler, Lisa; Hutnik, Cindy; Jinapriya, Delan; Shuba, Lesya; Yan, David; Day, Radmila


    Glaucoma is a medical term describing a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and retinal nerve fibre layer and resulting in changes in the optic nerve head. Glaucoma is a leading cause of irreversible vision loss worldwide. With the aging population it is expected that the prevalence of glaucoma will continue to increase. Despite recent advances in imaging and visual field testing techniques that allow establishment of earlier diagnosis and treatment initiation, significant numbers of glaucoma patients are undiagnosed and present late in the course of their disease. This can lead to irreversible vision loss, reduced quality of life, and a higher socioeconomic burden. Selection of therapeutic approaches for glaucoma should be based on careful ocular examination, patient medical history, presence of comorbidities, and awareness of concomitant systemic therapies. Therapy should also be individualized to patients' needs and preferences. Recent developments in this therapeutic field require revisiting treatment algorithms and integration of traditional and novel approaches in order to ensure optimal visual outcomes. This article provides an overview of recent developments and practice trends in the medical management of glaucoma in Canada. A discussion of the surgical management is beyond the scope of this paper. PMID:27895937

  1. The pattern of time management in college students of Kerman University of Medical Sciences in the year 2006


    Ali Ravari; Fatemeh Alhani; Monireh Anoosheh; Tayebeh Mirzaie-Khalilabadi


    Background: One potential coping strategy frequently offered by university counseling services is time management for studying. Besides stress relief, time management skills will positively influence key outcomes such as academic performance, problem-solving ability, and health. Thus, it is necessary to investigate how college students manage their timing for studying. The aim of the present study was to assess the pattern of college students' time management in Kerman University of Medical S...

  2. Managing bundled payments. (United States)

    Draper, Andrew


    Results of Medicare's ACE demonstration project and Geisinger Health System's ProvenCare initiative provide insight into the challenges hospitals will face as bundled payment proliferates. An early analysis of these results suggests that hospitals would benefit from bringing full automation using clinical IT tools to bear in their efforts to meet these challenges. Other important factors contributing to success include board and physician leadership, organizational structure, pricing methodology for bidding, evidence-based medical practice guidelines, supply cost management, process efficiency management, proactive and aggressive case management, business development and marketing strategy, and the financial management system.

  3. The medical management of abnormal uterine bleeding in reproductive-aged women. (United States)

    Bradley, Linda D; Gueye, Ndeye-Aicha


    In the treatment of women with abnormal uterine bleeding, once a thorough history, physical examination, and indicated imaging studies are performed and all significant structural causes are excluded, medical management is the first-line approach. Determining the acuity of the bleeding, the patient's medical history, assessing risk factors, and establishing a diagnosis will individualize their medical regimen. In acute abnormal uterine bleeding with a normal uterus, parenteral estrogen, a multidose combined oral contraceptive regimen, a multidose progestin-only regimen, and tranexamic acid are all viable options, given the appropriate clinical scenario. Heavy menstrual bleeding can be treated with a levonorgestrel-releasing intrauterine system, combined oral contraceptives, continuous oral progestins, and tranexamic acid with high efficacy. Nonsteroidal antiinflammatory drugs may be utilized with hormonal methods and tranexamic acid to decrease menstrual bleeding. Gonadotropin-releasing hormone agonists are indicated in patients with leiomyoma and abnormal uterine bleeding in preparation for surgical interventions. In women with inherited bleeding disorders all hormonal methods as well as tranexamic acid can be used to treat abnormal uterine bleeding. Women on anticoagulation therapy should consider using progestin-only methods as well as a gonadotropin-releasing hormone agonist to treat their heavy menstrual bleeding. Given these myriad options for medical treatment of abnormal uterine bleeding, many patients may avoid surgical intervention.

  4. Physicians’ use of computerized clinical decision supports to improve medication management in the elderly – the Seniors Medication Alert and Review Technology intervention

    Directory of Open Access Journals (Sweden)

    Alagiakrishnan K


    Full Text Available Kannayiram Alagiakrishnan,1 Patricia Wilson,2 Cheryl A Sadowski,3 Darryl Rolfson,1 Mark Ballermann,4,5 Allen Ausford,6,7 Karla Vermeer,7 Kunal Mohindra,8 Jacques Romney,9 Robert S Hayward10 1Department of Medicine, Division of Geriatric Medicine, 2Department of Medicine, 3Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 4Chief Medical Information Office, Alberta Health Services, 5Division of Critical Care, Department of Medicine, University of Alberta, 6Department of Family Medicine, University of Alberta, 7Lynwood Family Physician, 8eClinician EMR, Alberta Health Services-Information Systems, 9Department of Medicine, Division of Endocrinology, 10Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada Background: Elderly people (aged 65 years or more are at increased risk of polypharmacy (five or more medications, inappropriate medication use, and associated increased health care costs. The use of clinical decision support (CDS within an electronic medical record (EMR could improve medication safety.Methods: Participatory action research methods were applied to preproduction design and development and postproduction optimization of an EMR-embedded CDS implementation of the Beers’ Criteria for medication management and the Cockcroft–Gault formula for estimating glomerular filtration rates (GFR. The “Seniors Medication Alert and Review Technologies” (SMART intervention was used in primary care and geriatrics specialty clinics. Passive (chart messages and active (order-entry alerts prompts exposed potentially inappropriate medications, decreased GFR, and the possible need for medication adjustments. Physician reactions were assessed using surveys, EMR simulations, focus groups, and semi-structured interviews. EMR audit data were used to identify eligible patient encounters, the frequency of CDS events, how alerts were managed, and when evidence links were followed.Results: Analysis of

  5. Caregivers experiences of managing medications for palliative care patients at the end of life: a qualitative study. (United States)

    Sheehy-Skeffington, Barbara; McLean, Sarah; Bramwell, Michael; O'Leary, Norma; O'Gorman, Aisling


    Informal caregivers are important in enabling palliative care patients to die at home, including their role in managing medications. Often these patients are taking multiple medications, imposing an unnecessary burden on those who are already struggling with oral intake. A literature review revealed that, while there are a number of qualitative studies published examining the experience of caregivers looking after patients at the end of life, there is a dearth of published studies specifically examining the impact of managing medications on caregivers. This study explores the experience of caregivers managing medications for patients dying at home, focusing on the impact of polypharmacy, the use of syringe drivers and the use of "as needed" medications for symptom control. Three focus groups were performed, involving bereaved caregivers of patients that had died at home, and were analysed using content thematic analysis. Themes that emerged include: the significant burden of polypharmacy; the positive impact of subcutaneous infusions; the value of being able to give medications as needed for symptom control; the importance of clear guidance to assist with medication management. Strategies are suggested that might ease the burden of medications at the end of life.

  6. Application of visual management in medication management in the ward%目视管理在病区备用药物管理中的应用

    Institute of Scientific and Technical Information of China (English)

    苏琴; 何桂娟; 金瑛


    Objective:To investigate the effects of visual management in standby medication management in the ward. Methods:Using visual management method including color, logo, regional lines, and signboard to perform the standardized management of standby medication in the ward. Results:After implementation of visual management, the adverse events of ward standby medication reduced signiifcantly (P<0.05). Conclusion:Using visual management model in standby medication management in the ward is beneifcial for nurses to be familiar with the environment, enhance the safety awareness on standby medication management, reduce medication errors, ensure patient safety, and promote the standardized management of the ward standby medication.%目的:探讨目视管理在病区备用药物管理中的应用效果。方法:采用颜色、标识、区域线、看板等目视管理方法对病区备用药物进行规范化管理。结果:实施目视管理后,病区备用药物相关的不良事件发生率较前明显降低,差异有统计学意义(P<0.05)。结论:目视管理应用于病区备用药物管理,可方便护士熟悉环境,增强护士对药物管理的安全意识,降低病区备用药物不良事件发生率,保证患者用药安全,实现病区备用药物的规范化管理。

  7. Towards Building High Performance Medical Image Management System for Clinical Trials. (United States)

    Wang, Fusheng; Lee, Rubao; Zhang, Xiaodong; Saltz, Joel


    Medical image based biomarkers are being established for therapeutic cancer clinical trials, where image assessment is among the essential tasks. Large scale image assessment is often performed by a large group of experts by retrieving images from a centralized image repository to workstations to markup and annotate images. In such environment, it is critical to provide a high performance image management system that supports efficient concurrent image retrievals in a distributed environment. There are several major challenges: high throughput of large scale image data over the Internet from the server for multiple concurrent client users, efficient communication protocols for transporting data, and effective management of versioning of data for audit trails. We study the major bottlenecks for such a system, propose and evaluate a solution by using a hybrid image storage with solid state drives and hard disk drives, RESTful Web Services based protocols for exchanging image data, and a database based versioning scheme for efficient archive of image revision history. Our experiments show promising results of our methods, and our work provides a guideline for building enterprise level high performance medical image management systems.

  8. Managing Medical Vocabulary Updates in a Clinical Data Warehouse: An RxNorm Case Study. (United States)

    Podchiyska, Tanya; Hernandez, Penni; Ferris, Todd; Weber, Susan; Lowe, Henry J


    Use of terminology standards facilitates aggregating data from multiple sources for information retrieval, exchange and analysis. However, medical vocabularies are continuously updated and incorporating those changes consistently into clinical data warehouses requires rigorous methodology. To integrate pharmacy data from two hospital pharmacy information systems the Stanford Translational Research Integrated Database Environment (STRIDE) project mapped medication orders to RxNorm content using the RxNorm drug model. In order to keep the data relevant and up-to-date, we developed a strategy for updating to RxNorm, while preserving the original meaning and mapping of the legacy data. This case study discusses managing the vocabulary update by following the RxNorm content maintenance strategy and supplementing it with operations to retain access to its drug model information.

  9. Relevance of immobility and importance of risk assessment management for medically ill patients. (United States)

    Hull, Russell D


    Recent or continued immobility is a significant risk factor for venous thromboembolism (VTE) in acutely ill medical patients. Patients may benefit from thromboprophylaxis; however, its optimal duration remains unclear. The Extended Clinical Prophylaxis in Acutely Ill Medical Patients (EXCLAIM) study was the first trial to systematically investigate how the degree of immobilization relates to the risk of developing VTE. EXCLAIM offers insights into the duration of VTE risk associated with reduced mobility and helps identify which patients would benefit most from extended-duration thromboprophylaxis. Further recent studies suggest that extended-duration thromboprophylaxis may be in order in certain high-risk patients to protect the patients from the risk of VTE events occurring, particularly in the posthospitalization period. Baseline d-dimer data and level of mobility could be included in risk assessment. Physicians are recommended to consider the use of extended-duration thromboprophylaxis based on individual risk assessment management (RAM) and balance of benefit and harm.

  10. Quality management of eLearning for medical education: current situation and outlook (United States)

    Abrusch, Jasmin; Marienhagen, Jörg; Böckers, Anja; Gerhardt-Szép, Susanne


    Introduction: In 2008, the German Council of Science had advised universities to establish a quality management system (QMS) that conforms to international standards. The system was to be implemented within 5 years, i.e., until 2014 at the latest. The aim of the present study was to determine whether a QMS suitable for electronic learning (eLearning) domain of medical education to be used across Germany has meanwhile been identified. Methods: We approached all medical universities in Germany (n=35), using an anonymous questionnaire (8 domains, 50 items). Results: Our results (response rate 46.3%) indicated very reluctant application of QMS in eLearning and a major information deficit at the various institutions. Conclusions: Authors conclude that under the limitations of this study there seems to be a considerable need to improve the current knowledge on QMS for eLearning, and that clear guidelines and standards for their implementation should be further defined. PMID:26038685

  11. The Function Analysis of Informationization in New Rural Cooperatives Medical Service Management (United States)

    Zhou, Yuefeng; Liu, Min

    The establishment of new rural cooperative medical system is an important action for comprehensive affluent society. It is an important measure for Central Party Committee and State Council to solve "three rural" issue effectively and to overall urban and rural, regional, coordinated economic and social development, building a well-off society in the new situation. It has important role to alleviate farmers to see a doctor expensively, see a doctor difficultly, reduce the burden on farmers and improve their level of health protection and quality of life, solve the problem of poor because of illness and the problem of returning poor due to illness, promote the production and rural economic development and stability in the rural areas. This article will analyze the function of informationization in new rural cooperative medical service management selectively.

  12. Implemention of Medical Care Quality Score Management to Continuing Improve medical qualitu%实施积分管理提高医疗质量

    Institute of Scientific and Technical Information of China (English)

    邹升帆; 刘华坤; 林新华; 彭广福


    Recently, hospitals across the country have been searching for efficient management methods to improve hospital quality. Performance point management system of hospital quality and medical safety is a A management method that is set Accroding to the essence of several health laws and regulations. By establishing and improving this management method in my hospital, we supervise individual service behavior using Performance point management system. In this way, the service behavior of the medical workers is specified so that the function of medical care quality - benefit management is strengthened.%制定并完善《医疗质量和医疗安全积分管理办法(试行)》,加强对个人医疗服务行为的监管与考核.实行院科两级质量控制,以科室自查、质控办月查、职能部门联合检查等方法促进办法落实,每月将检查结果交质控办汇总,经积分管理考核小组讨论通过后全院通报.实践表明,办法的实施,有效提升了医疗质量持续提高.

  13. “Unwell while Aboriginal”: iatrogenesis in Australian medical education and clinical case management (United States)

    Ewen, Shaun C; Hollinsworth, David


    Introduction Attention to Aboriginal health has become mandatory in Australian medical education. In parallel, clinical management has increasingly used Aboriginality as an identifier in both decision making and reporting of morbidity and mortality. This focus is applauded in light of the gross inequalities in health outcomes between indigenous people and other Australians. Methods A purposive survey of relevant Australian and international literature was conducted to map the current state of play and identify concerns with efforts to teach cultural competence with Aboriginal people in medical schools and to provide “culturally appropriate” clinical care. The authors critically analyzed this literature in light of their experiences in teaching Aboriginal studies over six decades in many universities to generate examples of iatrogenic effects and possible responses. Results and discussion Understanding how to most effectively embed Aboriginal content and perspectives in curriculum and how to best teach and assess these remains contested. This review canvasses these debates, arguing that well-intentioned efforts in medical education and clinical management can have iatrogenic impacts. Given the long history of racialization of Aboriginal people in Australian medicine and the relatively low levels of routine contact with Aboriginal people among students and clinicians, the review urges caution in compounding these iatrogenic effects and proposes strategies to combat or reduce them. Conclusion Long overdue efforts to recognize gaps and inadequacies in medical education about Aboriginal people and their health and to provide equitable health services and improved health outcomes are needed and welcome. Such efforts need to be critically examined and rigorously evaluated to avoid the reproduction of pathologizing stereotypes and reductionist explanations for persistent poor outcomes for Aboriginal people. PMID:27313485

  14. Impact of standardized patients on the training of medical students to manage emergencies (United States)

    Herbstreit, Frank; Merse, Stefanie; Schnell, Rainer; Noack, Marcel; Dirkmann, Daniel; Besuch, Anna; Peters, Jürgen


    Abstract Background: Teaching emergency management should educate medical students not only for facts and treatment algorithms but also for time effective physical examination, technical skills, and team interaction. We tested the hypothesis, that using standardized emergency patients would be more effective in transmitting knowledge and skills compared with a more traditional teaching approach. Methods: Medical students (n = 242) in their fourth (second clinical) year were randomized to receive either training on standardized patients simulating 3 emergency settings (“acute chest pain,” “stroke,” and “acute dyspnea/asthma”) or traditional small group seminars. Before and after the respective training pathways, the students’ knowledge base (multiple-choice examination) and practical performance (objective structured clinical examination using 3 different emergency scenarios) were assessed. Results: Teaching using standardized patients resulted in a significant albeit small improvement in objective structured clinical examination scores (61.2 ± 3 for the standardized patient trained group vs 60.3 ± 3.5 for the traditional seminar group; P = 0.017, maximum achievable score: 66), but no difference in the written examination scores (27.4 ± 2.4 vs 27.0 ± 4.4; P = 0.341; maximum achievable score: 30). Conclusion: Teaching management of emergencies using standardized patients can improve medical students’ performance in clinical tests, and a change from traditional seminars in favor of practice sessions with standardized patients does not compromise the learning of medical facts. PMID:28151877

  15. "Unwell while Aboriginal": iatrogenesis in Australian medical education and clinical case management

    Directory of Open Access Journals (Sweden)

    Ewen SC


    Full Text Available Shaun C Ewen,1 David Hollinsworth2 1Melbourne Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, 2Indigenous Studies, Faculty of Arts, Business and Law, University of the Sunshine Coast, Sippy Downs, QLD, Australia Introduction: Attention to Aboriginal health has become mandatory in Australian medical education. In parallel, clinical management has increasingly used Aboriginality as an identifier in both decision making and reporting of morbidity and mortality. This focus is applauded in light of the gross inequalities in health outcomes between indigenous people and other Australians. Methods: A purposive survey of relevant Australian and international literature was conducted to map the current state of play and identify concerns with efforts to teach cultural competence with Aboriginal people in medical schools and to provide “culturally appropriate” clinical care. The authors critically analyzed this literature in light of their experiences in teaching Aboriginal studies over six decades in many universities to generate examples of iatrogenic effects and possible responses. Results and discussion: Understanding how to most effectively embed Aboriginal content and perspectives in curriculum and how to best teach and assess these remains contested. This review canvasses these debates, arguing that well-intentioned efforts in medical education and clinical management can have iatrogenic impacts. Given the long history of racialization of Aboriginal people in Australian medicine and the relatively low levels of routine contact with Aboriginal people among students and clinicians, the review urges caution in compounding these iatrogenic effects and proposes strategies to combat or reduce them. Conclusion: Long overdue efforts to recognize gaps and inadequacies in medical education about Aboriginal people and their health and to provide equitable health services

  16. Strength and Weakness of Crisis Management in Hormozgan Medical University’s Hospitals

    Directory of Open Access Journals (Sweden)

    Zahra Mastane


    Full Text Available Background & Objective: Various communities continuously try to manage the unexpected events. In this regard, hospitals with providing timely health care services has transformed to the most pragmatic unit of health system. Planning and preparation of them should be strategic policy of health system. This paper aimed to investigate the strength and weakness of crisis management in training hospitals of Hormozgan University of Medical Sciences. Materials & Methods: This is descriptive-analytic research. Research statistical population includes managers, nursing directors, financial directors and masters of crises committee of hospitals, totally 34 persons. Data collected with questionnaire in 8 domains and demographic information. Questionnaire was validated and reliabled. Collected data entered to SPSS and analyzed by descriptive & inferential statistics. Results: Preparedness Rate of Hospitals encounters Unexpected Events was average (50%. Preparedness rate in managerial policies (44.1%, structural and non-structural stability (41.2% and register & informed (47% domains were in average level. In this regard HEICS (32.3%, maneuvers (55.9% and use of relative technologies were in very low grade. Between preparedness rate with crises committee function, training and maneuvers there were meaningful relations (P<0.05. Conclusion: Suitable crises management will be feasible by documented planning, preparing intra and extra organizational relations, reinforcing human resources with organizing, delivering of training and durational maneuvers to them. Keywords: Strength, Weakness, Crisis, Crisis Management Type of Article: Original Article

  17. Agitation, aggression, and disinhibition syndromes after traumatic brain injury. (United States)

    Kim, Edward


    Traumatic brain injury (TBI) is frequently complicated by disinhibition and aggression. These often profound changes in personality, present obstacles to rehabilitative treatments and community reentry. Syndromal presentations may involve a loss of impulse control, spontaneous aggression, and dysphoric bipolar states. Common neuropathological findings of inferior frontal lobe dysfunction support both disinhibition and kindling models of TBI-induced aggression. Assessment of these highly disruptive symptoms requires detailed historical, clinical, and neuropsychological information to formulate appropriate strategies. Management of TBI-related aggression may involve pharmacological, environmental, and psychotherapeutic strategies that incorporate caregiver training and support.

  18. 医学科研管理中的创新分析%Medical Research Management Innovation Analysis

    Institute of Scientific and Technical Information of China (English)



    OBJECTIVE:To investigate the management of innovation in medical research. Methods:We analyzed the medical research management innovation analysis and management innovation to promote medical research and effective strategies. Results:The medical research management innovations include Innovative consciousness and motivation, innovation goals, innovation, and promote innovative medical research management measures include a guide 2 through innovative medical research management policies and regulations, to create a good atmosphere for innovation. Conclusion:medical research management can effectively integrate scientific and technological achievements in medical research, enabling dynamic creative activities responsibilities and objectives for the research and development of the medicine has a very important significance.%目的:探讨医学科研管理中的创新。方法:分析了医学科研管理中的创新分析和推动医学科研管理创新的有效策略。结果:医学科研管理中的创新包括创新意识、创新动机、创新目标、创新能力,推动医学科研管理创新的措施包括1、通过政策法规引导医学科研管理创新2、营造良好的创新氛围。结论:医学科研管理能够有效整合医学科研的科技成果,从而实现责任和目标的创造性动态活动,对于我国医学科研发展有着非常重要的意义。

  19. The Design and Management of Medical Device Clinical Trials Strategies and Challenges

    CERN Document Server

    Abdel-aleem, Salah M


    Clinical trials tasks and activities are widely diverse and require certain skill sets to both plan and execute. This book provides professionals in the field of clinical research with valuable information on the challenging issues of the design, execution, and management of clinical trials, and how to resolve these issues effectively. It discusses key obstacles such as challenges to patient recruitment, investigator and study site selection, and dealing with compliance issues. Through practical examples, professionals working with medical device clinical trials will discover the appropriate s

  20. Update on Medical Management of Clinical Manifestations of Chronic Kidney Disease. (United States)

    Quimby, Jessica M


    Dysregulation of normal kidney functions in chronic kidney disease (CKD) leads to several pathophysiologic abnormalities that have the potential to significantly clinically affect the CKD patient. This article discusses the clinical impact of hypertension, hypokalemia, anemia, dysrexia, nausea/vomiting, and constipation in the CKD patient and therapies for these conditions. These clinical manifestations of disease may not occur in every patient and may also develop later during the progression of disease. Therefore, monitoring for, identifying, and addressing these factors is considered an important part of the medical management of CKD.

  1. Regression of inflammatory pseudotumor of the bladder in a child with medical management. (United States)

    Fletcher, Sophie G; Galgano, Mary T; Michalsky, Marc P; Roth, Jonathan A


    Inflammatory pseudotumor of the bladder is a benign proliferative lesion of the submucosal stroma that cannot be distinguished from malignant tumors of the bladder either endoscopically or radiographically. Although benign, the proliferative nature of the inflammatory pseudotumor histopathology has led others to recommend open surgical removal or complete transurethral resection for definitive treatment. A limited number of case reports have described inflammatory pseudotumor of the bladder in either adults or children. This is a case of biopsy-proven inflammatory pseudotumor in the bladder of a child that regressed after medical management alone.

  2. Performance of online drug information databases as clinical decision support tools in infectious disease medication management. (United States)

    Polen, Hyla H; Zapantis, Antonia; Clauson, Kevin A; Clauson, Kevin Alan; Jebrock, Jennifer; Paris, Mark


    Infectious disease (ID) medication management is complex and clinical decision support tools (CDSTs) can provide valuable assistance. This study evaluated scope and completeness of ID drug information found in online databases by evaluating their ability to answer 147 question/answer pairs. Scope scores produced highest rankings (%) for: Micromedex (82.3), Lexi-Comp/American Hospital Formulary Service (81.0), and Medscape Drug Reference (81.0); lowest includes: Epocrates Online Premium (47.0), Johns Hopkins ABX Guide (45.6), and PEPID PDC (40.8).

  3. Managing data quality in an existing medical data warehouse using business intelligence technologies. (United States)

    Eaton, Scott; Ostrander, Michael; Santangelo, Jennifer; Kamal, Jyoti


    The Ohio State University Medical Center (OSUMC) Information Warehouse (IW) is a comprehensive data warehousing facility that provides providing data integration, management, mining, training, and development services to a diversity of customers across the clinical, education, and research sectors of the OSUMC. Providing accurate and complete data is a must for these purposes. In order to monitor the data quality of targeted data sets, an online scorecard has been developed to allow visualization of the critical measures of data quality in the Information Warehouse.

  4. 精益管理在手术医疗耗材管理中的应用%Application of Lean Management in Surgical Management of Medical Consumables

    Institute of Scientific and Technical Information of China (English)



    Objective Use of lean management, improve the level of hospital medical consumables management.Methods Using the method of lean logistics management, establish a complete medical consumables management system, the implementation of lean management in surgical management of medical consumable materials, detailed record the implementation of this law after the hospital operating room medical consumables procurement and usage, record the data.Results After using lean management, operation of medical consumables purchase time, amount, material quality and inventory before taking lean management on the indicators are better than not to have obvious difference.Conclusion In the surgical management of medical consumable materials using lean management method, can reduce the medical consumables purchase time, improve efficiency, to reduce procurement value at the same time, improve the quality of procurement, the purpose of the use of lean management in the surgical management of medical consumable materials contributes to the standardization of the management.%目的利用精益管理,提高医院的医疗耗材管理水平.方法 利用物流管理方法之精益管理法,建立起完整的医疗耗材管理体系,在手术医疗耗材管理上实施精益管理法,详细记录下实施此法后医院手术室的医疗耗材采购和使用情况,记录相关数据.结果 采用精益管理后,手术医疗耗材的采购时间、金额,耗材质量以及库存量等各项指标均优于未采取精益管理之前,产生明显差异.结论 在手术医疗耗材管理中采用精益管理方法,可以减少医疗耗材采购时间,提高效率,同时达到降低采购金额,提高采购质量的目的,在手术医疗耗材管理中利用精益管理有助于管理的规范化.

  5. A prediction model for the radiation safety management behavior of medical cyclotrons

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Ji Hye; Han, Eun Ok [Daegu Health College, Daegu (Korea, Republic of); Kim, Ssang Tae [CareCamp Inc., Seoul (Korea, Republic of)


    This study attempted to provide reference materials for improving the behavior level in radiation safety managements by drawing a prediction model that affects the radiation safety management behavior because the radiation safety management of medical Cyclotrons, which can be used to produce radioisotopes, is an important factor that protects radiation caused diseases not only for radiological operators but average users. In addition, this study obtained follows results through the investigation applied from January 2 to January 30, 2008 for the radiation safety managers employed in 24 authorized organizations, which have already installed Cyclotrons, through applying a specific form of questionnaire in which the validity was guaranteed by reference study, site investigation, and focus discussion by related experts. The radiation safety management were configured as seven steps: step 1 is a production preparation step, step 2 is an RI production step, step 3 is a synthesis step, step 4 is a distribution step, step 5 is a quality control step, step 6 is a carriage container packing step, and step 7 is a transportation step. It was recognized that the distribution step was the most exposed as 15 subjects (62.5%), the items of 'the sanction and permission related works' and 'the guarantee of installation facilities and production equipment' were the most difficult as 9 subjects (37.5%), and in the trouble steps in such exposure, the item of 'the synthesis and distribution' steps were 4 times, respectively (30.8%). In the score of the behavior level in radiation safety managements, the minimum and maximum scores were 2.42 and 4.00, respectively, and the average score was 3.46 {+-} 0.47 out of 4. Prosperity and well-being programs in the behavior and job in radiation safety managements (r=0.529) represented a significant correlation statistically. In the drawing of a prediction model based on the factors that affected the behavior in

  6. Evidence-based medical quality management in dialysis--Part I: Routine implementation of QiN, a German quality management system. (United States)

    Stoffel, M P; Barth, C; Lauterbach, K W; Baldamus, C A


    Increasing medical complexity, centrifugal forces of medical subspecialization and growing economic constraints are the key reasons for the introduction of quality management into routine care processes such as dialysis. Adequate quality assurance and improvement must be implemented in order to supply medical staff, care providers, and patients with the necessary information on critical issues of clinical management of dialysis patients. QiN (Quality in Nephrology), the quality management program of the largest German dialysis provider, is outlined here as a practicable example. The first of 2 parts provides information on the structure, implementation of QiN and achieved clinical improvement in routine care. The second part (quotation) analyzes longitudinal data in order to differentiate whether observed improvements during more than 5 years of QiN can be ascribed to the intervention (application of QiN) or whether they are due to other factors such as generally improved medical knowledge.

  7. Aggression patterns and speciation. (United States)

    Nevo, E; Naftali, G; Guttman, R


    The evolutionary significance of interspecific aggression as a factor in speciation was tested among three chromosome forms of the actively speciating fossorial rodent Spalax ehrenbergi in Israel. Laboratory experiments testing intra- and interspecific aggression were conducted on 48 adult animals from 10 populations comprising three chromosome forms with 2n = 52, 58, and 60. Twelve agonistic, motivational-conflict, and territorial behavioral variables were recorded during 72 combats involving homo- and heter-ogametic encounters between opponents. Analysis of the data matrix was carried out by the nonmetric multivariate Smallest Space Analysis (SSA-II). The results indicate that (a) aggression patterns, involving agonistic conflict and territorial variables, are higher in heterogametic encounters than in homogametic ones; and (b) aggression is higher between contiguous chromosome forms (2n = 58-60, and 2n = 52-58) than between noncontiguous ones (2n = 52-60). Both a and b suggest that high interspecific aggression appears to be adaptively selected at final stages of speciation in mole rats as a premating isolating mechanism which reinforces species identification and establishes parapatric distributions between the evolving species. PMID:1059109

  8. Proposal for the conclusion of a partnership agreement, without competitive tendering, for the management of medical emergencies on the CERN site and the training of CERN's medical staff and firefighters in emergency situations

    CERN Document Server


    Proposal for the conclusion of a partnership agreement, without competitive tendering, for the management of medical emergencies on the CERN site and the training of CERN's medical staff and firefighters in emergency situations

  9. ABC分类法与耗材库存管理%ABC Classiifcation & Medical Consumables Management

    Institute of Scientific and Technical Information of China (English)

    汪永莲; 张凤勤; 张超群


    目的:必要的医疗耗材储备是为了满足临床需求,保证医疗活动的正常进行。在减少库存耗材短缺发生的同时尽可能降低库存、减少资金占用、降低运营成本,构建合理库存。方法参照ABC分析法指导原则,将耗材按照销量金额计算累计比率,数据分析汇总后,将所有耗材按照重要程度分为重要耗材(A类)、次要耗材(B类)和一般耗材(C类)3个等级。结果经过4年的实践,应用ABC分类法管理耗材,在出库金额不断增长的情况下,库存周转率有了明显的提高。结论根据耗材不同类型进行分类管理和控制管理,优化库存结构,使其趋于合理,降低管理成本,准确、迅捷、安全、有效地为临床提供服务,提高医院的核心竞争力。%Objective The necessary medical consumable reserves can meet the clinical requirements in multiple departments and serve as a good guarantee for regular operation of medical services. While the medical consumable shortage is diminished, its inventory, capital infusion and operating costs shall be reduced as low as possible so as to maintain a proper inventory of medical consumables. Methods Accumulative ratios between medical consumables are calculated on the basis of the total sales under the guidance of ABC (Activity Based Classiifcation). Through analysis of the data acquired, the consumables are classified into three categories (A-level: Important Consumables; B-level: Secondarily Important Consumables;C-level:Least Important Consumables) according to the degree of importance. Results Four-year practices manifested that deployment of ABC in medical consumables management had made the velocity of the inventory a distinct improvement in spite of the increasing ex-warehouse volume. Conclusion The categories-based classiifcation and management of medical consumables optimize the structure of the inventory and reduce the management costs, which

  10. Medical-dental findings and management of a child with infantile Refsum disease: a case report. (United States)

    Acharya, Bhavini S; Ritwik, Priyanshi; Velasquez, Gisela M; Fenton, Sanford J


    Infantile Refsum disease (IRD) is a peroxisome biogenesis disorder (PBD), and is part of a larger group of diseases called leukodystrophies, which are inherited conditions that damage the white matter of the brain and affect motor movements. Multiple signs and symptoms of IRD begin in infancy and progress through early childhood, including hearing and visual impairment, intellectual and growth impairment, seizures, liver involvement, and orofacial and dental abnormalities. This paper presents a case history of a 12-year-old female patient with IRD who underwent dental rehabilitation in the operating room under general anesthesia and includes a 2-year follow-up. Medical, dental, and management considerations in the care of this child's condition are presented. This paper also discusses the importance of a multidisciplinary approach in the management of children with special needs.

  11. Medical and Surgical Management of Postpartum Hemorrhage in a Woman with Factor XIII Deficiency

    Directory of Open Access Journals (Sweden)

    Michael Cheng


    Full Text Available Factor XIII deficiency is a rare inherited coagulopathy. Factor XIII is the last clotting factor in the coagulation cascade to insure strength and stability to fibrin clots. Without this enzyme, the fibrous clot is unstable and nonresistant to fibrinolysis. Gravid women with this congenital disease are especially at risk for complications including miscarriages and hemorrhage without appropriate interventions. We present a case of a woman in her 20s with Factor XIII deficiency who was treated with cryoprecipitate and had a successful normal spontaneous vaginal delivery; subsequently, patient suffered from postpartum hemorrhage and consumptive coagulopathy due to consumption of Factor XIII, requiring emergency surgical intervention. Intraoperative management was challenged by an ethical dilemma involving the patient’s religious beliefs about not receiving blood. This paper will discuss the mechanism of Factor XIII and the medical and surgical management involved with this patient.

  12. Factors which affect the occurrence of nursing errors in medication administration and the errors' management

    Directory of Open Access Journals (Sweden)

    Theodore Kapadohos


    Full Text Available Nursing, as a humanitarian science, offers its services, on the comprehensive care of patients. Each nurse handling, involves the possibility of error. Meurier appointed nursing error as "any act, any decision or omission by a nurse, assessed as incorrect, by more experienced colleagues, and have adverse consequences for patients". Medication errors are the most common category of nursing errors. They affect health, patient safety and also have a high economic impact to health systems of each country. Aim: The present study investigated the causative factors of nursing errors, the frequency of medication errors and the ways of reporting, recording and managing these errors in the hospitals of Greece. Method: For the purpose of this study, a descriptive cross-sectional design was used. The sample consisted of 176 registered nurses, from eight public and three private hospitals, working in the ICU and their duties included the administration of drugs. Data collection was performed using an anonymous structured questionnaire that included demographic characteristics of the sample and closed questions about the factors implicated in the occurrence of errors and their management. To investigate the existence of correlation between demographics and various questions referred to the management of errors by nurses, the criterion of heterogeneity X2 of Pearson was used and to check for correlation between questions that reflect the participants' views on working conditions and management of errors, the non-parametric correlation coefficient of Spearman (Spearman rho was applied. The statistical analysis was performed using SPSS 17 software. Results: After statistical analysis of data, the most important causative factors for the occurrence of errors are the nursing workload (78.9%, the distraction of nurses (75.8% and the burnout (56.8%. More than 9 out of 10 nurses have made errors in drug administration (91.5%, especially with the wrong dose (34.7% and

  13. Medical-device risk management and public safety: using cost-benefit as a measurement of effectiveness (United States)

    Hughes, Allen A.


    Public safety can be enhanced through the development of a comprehensive medical device risk management. This can be accomplished through case studies using a framework that incorporates cost-benefit analysis in the evaluation of risk management attributes. This paper presents a framework for evaluating the risk management system for regulatory Class III medical devices. The framework consists of the following sixteen attributes of a comprehensive medical device risk management system: fault/failure analysis, premarket testing/clinical trials, post-approval studies, manufacturer sponsored hospital studies, product labeling, establishment inspections, problem reporting program, mandatory hospital reporting, medical literature surveillance, device/patient registries, device performance monitoring, returned product analysis, autopsy program, emergency treatment funds/interim compensation, product liability, and alternative compensation mechanisms. Review of performance histories for several medical devices can reveal the value of information for many attributes, and also the inter-dependencies of the attributes in generating risk information flow. Such an information flow network is presented as a starting point for enhancing medical device risk management by focusing on attributes with high net benefit values and potential to spur information dissemination.

  14. Design and evaluation of a multimodal mHealth based medication management system for patient self administration. (United States)

    Schreier, Gunter; Schwarz, Mark; Modre-Osprian, Robert; Kastner, Peter; Scherr, Daniel; Fruhwald, Friedrich


    The intake of prescribed medication presents a challenge, in particular for elderly people and in cases where a variety of medications have to be taken in accordance to a complex schedule. To support patients with this task, an mHealth-concept was developed and evaluated in the course of a clinical trial. The system used a multimodal user interface concept, i.e. both RFID tags and barcodes to identify and document the intake of medications. Results of the clinical study with 20 patients indicate that the multimodal mHealth concept utilizing barcode and RFID tags enabled easy-to-use medication management. Although further clinical evaluation is needed to assess whether such a tool can also enhance adherence, the system shows the potential for targeting the problem of medication management with mHealth methods.

  15. Special aspects of quality management system functioning in Saratov State Medical University n.a. V.I. Razumovsky

    Directory of Open Access Journals (Sweden)

    Bugaeva I.0.


    Full Text Available The article considers specificity of quality management system functioning in educational institutions and presents an overview of the historical and contemporary aspects of the quality management system's development in Saratov State Medical University n.a. V. I. Razumovsky.

  16. The Impact of a Telephone-Based Chronic Disease Management Program on Medical Expenditures. (United States)

    Avery, George; Cook, David; Talens, Sheila


    The impact of a payer-provided telephone-based chronic disease management program on medical expenditures was evaluated using claims data from 126,245 members in employer self-ensured health plans (16,224 with a chronic disease in a group enrolled in the self-management program, 13,509 with a chronic disease in a group not participating in the program). A random effects regression model controlling for retrospective risk, age, sex, and diagnosis with a chronic disease was used to determine the impact of program participation on market-adjusted health care expenditures. Further confirmation of results was obtained by an ordinary least squares model comparing market- and risk-adjusted costs to the length of participation in the program. Participation in the program is associated with an average annual savings of $1157.91 per enrolled member in health care expenditures. Savings increase with the length of participation in the program. The results support the use of telephone-based patient self-management of chronic disease as a cost-effective means to reduce health care expenditures in the working-age population. (Population Health Management 2016;19:156-162).

  17. Microbiology of aggressive periodontitis. (United States)

    Könönen, Eija; Müller, Hans-Peter


    For decades, Aggregatibacter actinomycetemcomitans has been considered the most likely etiologic agent in aggressive periodontitis. Implementation of DNA-based microbiologic methodologies has considerably improved our understanding of the composition of subgingival biofilms, and advanced open-ended molecular techniques even allow for genome mapping of the whole bacterial spectrum in a sample and characterization of both the cultivable and not-yet-cultivable microbiota associated with periodontal health and disease. Currently, A. actinomycetemcomitans is regarded as a minor component of the resident oral microbiota and as an opportunistic pathogen in some individuals. Its specific JP2 clone, however, shows properties of a true exogenous pathogen and has an important role in the development of aggressive periodontitis in certain populations. Still, limited data exist on the impact of other microbes specifically in aggressive periodontitis. Despite a wide heterogeneity of bacteria, especially in subgingival samples collected from patients, bacteria of the red complex in particular, and those of the orange complex, are considered as potential pathogens in generalized aggressive periodontitis. These types of bacterial findings closely resemble those found for chronic periodontitis, representing a mixed polymicrobial infection without a clear association with any specific microorganism. In aggressive periodontitis, the role of novel and not-yet-cultivable bacteria has not yet been elucidated. There are geographic and ethnic differences in the carriage of periodontitis-associated microorganisms, and they need to be taken into account when comparing study reports on periodontal microbiology in different study populations. In the present review, we provide an overview on the colonization of potential periodontal pathogens in childhood and adolescence, and on specific microorganisms that have been suspected for their role in the initiation and progression of aggressive

  18. Leadership and management in the undergraduate medical curriculum: a qualitative study of students’ attitudes and opinions at one UK medical school (United States)

    Quince, Thelma; Abbas, Mark; Murugesu, Sughashini; Crawley, Francesca; Hyde, Sarah; Wood, Diana; Benson, John


    Objective To explore undergraduate medical students’ attitudes towards and opinions about leadership and management education. Design Between 2009 and 2012 we conducted a qualitative study comprising five focus group discussions, each devoted to one of the five domains in the Medical Leadership Competency Framework, (Personal Qualities, Working with Others, Managing Services, Improving Services and Setting Direction). Each discussion examined what should be learnt, when should learning occur, what methods should be used, how should learning be assessed, what are the barriers to such education. Participants 28 students from all three clinical years (4–6) of whom 10 were women. Results 2 inter-related themes emerged: understanding the broad perspective of patients and other stakeholders involved in healthcare provision and the need to make leadership and management education relevant in the clinical context. Topics suggested by students included structure of the National Health Service (NHS), team working skills, decision-making and negotiating skills. Patient safety was seen as particularly important. Students preferred experiential learning, with placements seen as providing teaching opportunities. Structured observation, reflection, critical appraisal and analysis of mistakes at all levels were mentioned as existing opportunities for integrating leadership and management education. Students’ views about assessment and timing of such education were mixed. Student feedback figured prominently as a method of delivery and a means of assessment, while attitudes of medical professionals, students and of society in general were seen as barriers. Conclusions Medical students may be more open to leadership and management education than thought hitherto. These findings offer insights into how students view possible developments in leadership and management education and stress the importance of developing broad perspectives and clinical relevance in this context. PMID

  19. Effect of Advanced Trauma Life Support program on medical interns' performance in simulated trauma patient management

    Institute of Scientific and Technical Information of China (English)

    Koorosh Ahmadi; Mohammad Sedaghat; Mahdi Safdarian; Amir Masoud Hashemian; Zahra Nezamdoust; Mohammad Vaseie; Vafa Rahimi-Movaghar


    Since appropriate and timetable methods in trauma care have an important impact on patients' outcome,we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns'performance in simulated trauma patient management.Methods:A descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad,Iran.On the first day,we assessed interns' clinical knowledge and their practical skill performance in confronting simulated trauma patients.After 2 days of ATLS training,we performed the same study and evaluated their score again on the fourth day.The two findings,preand post-ATLS periods,were compared through SPSS version 15.0 software.P values less than 0.05 were considered statistically significant.Results:Our findings showed that interns' ability in all the three tasks improved after the training course.On the fourth day after training,there was a statistically significant increase in interns' clinical knowledge of ATLS procedures,the sequence of procedures and skill performance in trauma situations (P<0.001,P=0.016 and P=0.01 respectively).Conclusion:ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

  20. Ozone (O3: an excellent adjunctive tool in medical and surgical management of patient

    Directory of Open Access Journals (Sweden)

    Vipin Thakkar


    Full Text Available In the condition like increasing susceptibility to allergic reaction and weaken response to antibiotics, along with constantly growing prices for medical treatment, new non-medicinal methods are to be appreciated. The history of medical ozone starts in the XX century. The pioneers to apply ozone in clinical practice were E. Payer, A. Fish and H. Wolf. Ozone as an antiseptic means had been known and used from the beginning of the XX century, however, extensive and systemic research in the field of ozone therapy started in Germany in mid 70s, when ozone-resistant polymer materials and convenient ozone generating equipment came into every day clinical practice. Ozone (O3 therapy due to its disinfection effect and its capacity to transport and release oxygen into tissues is gaining a justified recognizing in many countries of the world. O3 therapy can produce its immune modulators, anti-inflammatory, bactericidal, virucidal, fungicidal, analgesics and other effects. Considering this the purpose of this literature is to highlight the significance of Ozone as an excellent adjunctive tool in the management of various medical and surgical conditions. [Int J Res Med Sci 2014; 2(4.000: 1257-1261

  1. Management of Sigmoid Volvulus in Three General Community Hospitals of the Cuban Medical Mission in Bolivia

    Directory of Open Access Journals (Sweden)

    Jorge Luís Estepa Pérez


    Full Text Available Background: Sigmoid volvulus is an emergency that occurs very frequently in the South American Andean area hospitals. It accounts for over 50% of all intestinal obstructions and still retains high mortality rates. Objective: To characterize the management of sigmoid volvulus. Methods: A prospective and descriptive study was conducted including all patients with sigmoid volvulus who attended three general community hospitals of the Cuban medical mission in Bolivia from June 2006 to June 2007 and were treated trough general surgery. We analyzed the following variables: age, sex, medical history, surgical diagnosis, classification and type of surgery, surgery performed, evolution, complications, use of antibiotic-prophylaxis and admission to intensive care units. The information was obtained from medical records, operative reports and a data collector model. Results: Sigmoid volvulus occurred more frequently in the Yapacaní hospital, department of Santa Cruz; the predominant age group was that from 55 to 64 years old as well as the predominant sex was that of males. Chagas disease was detected in most of the patients studied. Among symptoms those that predominated were distension, abdominal pain and stool detention. Decompression, devolvulation and surgical treatment were the processes followed in all cases, being the Rankin-Mikulicz colostomy the most widely used. No patients underwent a second surgery, and there were no mortality rates. Conclusions: Decompression, devolvulation and surgical treatment were the processes followed in all cases, being the Rankin-Mikulicz colostomy the most widely used. Most patients had a satisfactory evolution.

  2. In emergency departments, radiologists' access to EHRs may influence interpretations and medical management. (United States)

    Franczak, Michael J; Klein, Madeline; Raslau, Flavius; Bergholte, Jo; Mark, Leighton P; Ulmer, John L


    The adoption of electronic health records (EHRs) that meet federal meaningful-use standards is a major US national policy priority. Policy makers recognize the potential of electronic communication in delivering high-quality health care, particularly in an environment of expanding remote access to medical care and the ever-increasing need to transmit health care records across institutions. To demonstrate this principle, we sought to estimate the significance of EHR access in emergent neuroradiologic interpretations. Three neuroradiologists conducted a prospective expert-rater analysis of 2,000 consecutive head computed tomography (CT) exams ordered by emergency department (ED) physicians. For each head CT exam, the neuroradiologists compared medical information generated by ED physicians to information generated by the interpreting radiologists who had access to additional EHR-derived patient data. In 6.1 percent of the head CT exams, the neuroradiologists reached consensus--meaning two out of three agreed--that the additional clinical data derived from the EHR was "very likely" to influence radiological interpretations and that the lack of that data would have adversely affected medical management in those patients. Health care providers must recognize the value of implementing EHRs and foster their widespread adoption.

  3. Effect of Advanced Trauma Life Support program on medical interns' performance in simulated trauma patient management

    Directory of Open Access Journals (Sweden)

    Ahmadi Koorosh


    Full Text Available 【Abstract】Objective: Since appropriate and time-table methods in trauma care have an important impact on patients’ outcome, we evaluated the effect of Advanced Trauma Life Support (ATLS program on medical interns' performance in simulated trauma patient management. Methods: A descriptive and analytical study before and after the training was conducted on 24 randomly se-lected undergraduate medical interns from Imam Reza Hos-pital in Mashhad, Iran. On the first day, we assessed in-terns' clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre-and post- ATLS periods, were compared through SPSS ver-sion 15.0 software. P values less than 0.05 were considered statistically significant. Results: Our findings showed that interns’ ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns' clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P<0.001, P=0.016 and P=0.01 respectively. Conclusion: ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns. Key words: Advanced Trauma Life Support Care; Knowledge; Inservice training; Wounds and injuries

  4. Contribution of Electronic Medical Records to the Management of Rare Diseases

    Directory of Open Access Journals (Sweden)

    Dominique Bremond-Gignac


    Full Text Available Purpose. Electronic health record systems provide great opportunity to study most diseases. Objective of this study was to determine whether electronic medical records (EMR in ophthalmology contribute to management of rare eye diseases, isolated or in syndromes. Study was designed to identify and collect patients’ data with ophthalmology-specific EMR. Methods. Ophthalmology-specific EMR software (Softalmo software Corilus was used to acquire ophthalmological ocular consultation data from patients with five rare eye diseases. The rare eye diseases and data were selected and collected regarding expertise of eye center. Results. A total of 135,206 outpatient consultations were performed between 2011 and 2014 in our medical center specialized in rare eye diseases. The search software identified 29 congenital aniridia, 6 Axenfeld/Rieger syndrome, 11 BEPS, 3 Nanophthalmos, and 3 Rubinstein-Taybi syndrome. Discussion. EMR provides advantages for medical care. The use of ophthalmology-specific EMR is reliable and can contribute to a comprehensive ocular visual phenotype useful for clinical research. Conclusion. Routinely EMR acquired with specific software dedicated to ophthalmology provides sufficient detail for rare diseases. These software-collected data appear useful for creating patient cohorts and recording ocular examination, avoiding the time-consuming analysis of paper records and investigation, in a University Hospital linked to a National Reference Rare Center Disease.

  5. The medical antigravity suit for management of surgically uncontrollable bleeding associated with abdominal pregnancy. (United States)

    Sandberg, E C; Pelligra, R


    Three patients with abdominal pregnancy have been treated at Stanford University Hospital in recent years. Common to each was surgically uncontrolled hemorrhage for which circumferential pneumatic compression (supplied by a medical antigravity suit) was used to stop the bleeding. In each patient, the hemostatic effect of treatment was dramatic. In published accounts of the use of the garment in other severely hemorrhaging patients, the effects have been similarly dramatic and equally successful. These observations lead to a compelling consideration in regard to optimum management of patients with abdominal pregnancy. If our experience is confirmed by others, optimum management in abdominal pregnancy hereafter should regularly and routinely include removal of the placenta at the primary operation. This approach would anticipate use of the medical antigravity suit to provide hemostasis if surgically uncontrollable bleeding is encountered. Theoretically, the complications and long-term morbidity associated with retention of the placenta would be eliminated by this means while the previous disadvantage of placental removal, the potential for exsanguinating hemorrhage, would be circumvented.

  6. Medical management of ischemic stuttering priapism: a contemporary review of the literature

    Institute of Scientific and Technical Information of China (English)

    Helen R Levey; Omer Kutlu; Trinity J Bivalacqua


    Priapism is defined as a prolonged and persistent erection of the penis without sexual stimulation.This is a poorly understood disease process with little information on the pathophysiology of this erectile disorder.Complications from this disorder are devastating due to the irreversible erectile damage and resultant erectile dysfunction (ED).Stuttering priapism,though relatively rare,affects a high prevalence of men with sickle-cell disease (SCD) and presents a challenging problem with guidelines for treatment lacking or resulting in permanent ED.The mechanisms involved in the development of priapism in this cohort are poorly characterized; therefore,medical management of priapism represents a therapeutic challenge to urologists.Additional research is warranted,so we can effectively target treatments for these patients with prevention as the goal.This review gives an introduction to stuttering priapism and its clinical significance,specifically with regards to the patient with SCD.Additionally,the proposed mechanisms behind its pathophysiology and a summary of the current and future targets for medical management are discussed.

  7. Medical management of ischemic stuttering priapism: a contemporary review of the literature. (United States)

    Levey, Helen R; Kutlu, Omer; Bivalacqua, Trinity J


    Priapism is defined as a prolonged and persistent erection of the penis without sexual stimulation. This is a poorly understood disease process with little information on the pathophysiology of this erectile disorder. Complications from this disorder are devastating due to the irreversible erectile damage and resultant erectile dysfunction (ED). Stuttering priapism, though relatively rare, affects a high prevalence of men with sickle-cell disease (SCD) and presents a challenging problem with guidelines for treatment lacking or resulting in permanent ED. The mechanisms involved in the development of priapism in this cohort are poorly characterized; therefore, medical management of priapism represents a therapeutic challenge to urologists. Additional research is warranted, so we can effectively target treatments for these patients with prevention as the goal. This review gives an introduction to stuttering priapism and its clinical significance, specifically with regards to the patient with SCD. Additionally, the proposed mechanisms behind its pathophysiology and a summary of the current and future targets for medical management are discussed.

  8. How to Enhance Quality Management on Medical Records%如何加强病案质量管理

    Institute of Scientific and Technical Information of China (English)

    王冠英; 郑新瑞; 王宏斌; 张珊红


    The quality of the medical records management is an important constituent of overall hospital quality management. This article introduces methods and experience of the medical records quality management from how to construct medical records quality management system, perfect regulations and implement it, strengthen training, promote the process quality control, constantly update and perfect the system of rewards and penalties.%病案质量管理是医院质量管理的重要组成部分.从建立健全三级病案质控体系、完善规章制度、强化培训、加强环节控制、优化反馈流程、落实奖惩等6方面,介绍了病案质量管理的主要做法.

  9. Radiation event medical management (REMM): website guidance for health care providers. (United States)

    Bader, Judith L; Nemhauser, Jeffrey; Chang, Florence; Mashayekhi, Bijan; Sczcur, Marti; Knebel, Ann; Hrdina, Chad; Coleman, Norman


    Planning for and exercising the medical response to potential chemical, biological, radiological, nuclear, and explosive (CBRNE) terrorist events are new responsibilities for most health care providers. Among potential CBRNE events, radiological and/or nuclear (rad/nuc) events are thought to have received the least attention from health care providers and planners. To assist clinicians, the U.S. Department of Health and Human Services (HHS) has created a new, innovative tool kit, the Radiation Event Medical Management (REMM) web portal ( Goals of REMM include providing (1) algorithm-style, evidence-based, guidance about clinical diagnosis and treatment during mass casualty rad/nuc events; (2) just-in-time, peer-reviewed, usable information supported by sufficient background material and context to make complex diagnosis and management issues understandable to those without formal radiation medicine expertise; (3) a zip-file of complete web portal files downloadable in advance so the site would be available offline without an Internet connection; (4) a concise collection of the printable, key documents that can be taken into the field during an event; (5) a framework for medical teams and individuals to initiate rad/nuc planning and training; and (6) an extensive bibliography of key, peer-reviewed, and official guidance documents relevant to rad/nuc responses. Since its launch, REMM has been well received by individual responders and teams across the country and internationally. It has been accessed extensively, particularly during training exercises. Regular content updates and addition of new features are ongoing. The article reviews the development of REMM and some of its key content areas, features, and plans for future development.

  10. Voluntary medical male circumcision: logistics, commodities, and waste management requirements for scale-up of services.

    Directory of Open Access Journals (Sweden)

    Dianna Edgil


    Full Text Available BACKGROUND: The global HIV prevention community is implementing voluntary medical male circumcision (VMMC programs across eastern and southern Africa, with a goal of reaching 80% coverage in adult males by 2015. Successful implementation will depend on the accessibility of commodities essential for VMMC programming and the appropriate allocation of resources to support the VMMC supply chain. For this, the United States President's Emergency Plan for AIDS Relief, in collaboration with the World Health Organization and the Joint United Nations Programme on HIV/AIDS, has developed a standard list of commodities for VMMC programs. METHODS AND FINDINGS: This list of commodities was used to inform program planning for a 1-y program to circumcise 152,000 adult men in Swaziland. During this process, additional key commodities were identified, expanding the standard list to include commodities for waste management, HIV counseling and testing, and the treatment of sexually transmitted infections. The approximate costs for the procurement of commodities, management of a supply chain, and waste disposal, were determined for the VMMC program in Swaziland using current market prices of goods and services. Previous costing studies of VMMC programs did not capture supply chain costs, nor the full range of commodities needed for VMMC program implementation or waste management. Our calculations indicate that depending upon the volume of services provided, supply chain and waste management, including commodities and associated labor, contribute between US$58.92 and US$73.57 to the cost of performing one adult male circumcision in Swaziland. CONCLUSIONS: Experience with the VMMC program in Swaziland indicates that supply chain and waste management add approximately US$60 per circumcision, nearly doubling the total per procedure cost estimated previously; these additional costs are used to inform the estimate of per procedure costs modeled by Njeuhmeli et al. in

  11. EndNote and Reference Manager Citation formats compared to "instructions to authors" in top medical journals. (United States)

    Brahmi, Frances A; Gall, Carole


    The study compared citation format in EndNote version 7 and Reference Manager version 11 with the citation format for references found in the instructions to authors from the most significant medical literature. The resulting information should be very useful to those who depend on citation management software to format and organize their references for publication in medicine, and librarians and others who teach the use of citation management software.

  12. The Development of a Total Quality Management Plan for David Grant USAF Medical Center Travis Air Force Base, California (United States)


    Ralston, F. (Summer, 1984). Total quality management: A revolutionary management philosophy. S.A.M. Advanced Management Journal , 24-33. Ryan, M. 3...Care" that appeared in the 5 January 1989 edition of The New England Journal of Medicine. In this article he lists six steps that lead to continuous...pathology, endodontics, pediatrics, periodontics, and prosthodontics . In addition to the basic allied specialties, David Grant USAF Medical Center

  13. New Idea about Hospital Medical Equipment Management%医院医疗仪器管理新思路

    Institute of Scientific and Technical Information of China (English)

    常骁毅; 李万周; 吴智泉


    This paper discusses the new management system of medical equipment of public hospital. It is based on professional management software and the skillful operation of engineers and management personnel who are with concept of modern management and excellent management skill.%本文探讨了公立医院医疗仪器管理的一种新模式.以专业管理软件为主体,辅以具有现代化维修理念的院内工程师和管理能力的科室设备管理人员的全新医疗仪器管理方式.

  14. Ulipristal acetate: a novel option for the medical management of symptomatic uterine fibroids. (United States)

    Talaulikar, Vikram S; Manyonda, Isaac T


    Fibroids, the most common tumor in women of reproductive age, impact negatively on women's health and quality of life, and have significant cost implications for their management. The current mainstay treatments are surgical (myomectomy and hysterectomy) and more recently radiological (UAE and focused ultrasound surgery). Hysterectomy is curative but precludes future fertility, whereas the impact of the other treatments on reproduction is uncertain. With women in Western societies deferring childbearing to their 30s and 40s, when fibroids are most symptomatic, there is a pressing need for a uterus-sparing medical therapy that is cheap, effective, and enhances reproductive potential. Serendipity and meticulous translational research has shown that progesterone augments fibroid proliferation, raising the possibility that progesterone receptor modulators could inhibit fibroid growth; this research has culminated in the emergence of ulipristal acetate (UA), a first-in-class, oral selective progesterone receptor modulator (SPRM) that has successfully completed phase III clinical trials. It has been licensed in Western Europe for short-term clinical use prior to surgery, and has shown efficacy with a significant reduction in uterine bleeding, fibroid volume, and improved quality of life, without the side effects associated with other medications such as gonadotropin-releasing hormone (GnRH) agonists. As with all new medicines, there are concerns surrounding UA, not least its effect on the endometrium and the long-term impact on general health and reproduction. Research to date has tended to be industry led, and therefore, there is a need for researcher/clinician-led studies to address the wider issues concerning SPRMs. UA may not turn out to be the "Holy Grail" of medical therapy in the treatment of symptomatic uterine fibroids, but it has rightly given cause for a huge optimism. Further laboratory and clinical research into PRMs and related compounds will no doubt lead

  15. Researchers' experience with project management in health and medical research: Results from a post-project review

    Directory of Open Access Journals (Sweden)

    Elliott Elizabeth J


    Full Text Available Abstract Background Project management is widely used to deliver projects on time, within budget and of defined quality. However, there is little published information describing its use in managing health and medical research projects. We used project management in the Alcohol and Pregnancy Project (2006-2008 and in this paper report researchers' opinions on project management and whether it made a difference to the project. Methods A national interdisciplinary group of 20 researchers, one of whom was the project manager, formed the Steering Committee for the project. We used project management to ensure project outputs and outcomes were achieved and all aspects of the project were planned, implemented, monitored and controlled. Sixteen of the researchers were asked to complete a self administered questionnaire for a post-project review. Results The project was delivered according to the project protocol within the allocated budget and time frame. Fifteen researchers (93.8% completed a questionnaire. They reported that project management increased the effectiveness of the project, communication, teamwork, and application of the interdisciplinary group of researchers' expertise. They would recommend this type of project management for future projects. Conclusions Our post-project review showed that researchers comprehensively endorsed project management in the Alcohol and Pregnancy Project and agreed that project management had contributed substantially to the research. In future, we will project manage new projects and conduct post-project reviews. The results will be used to encourage continuous learning and continuous improvement of project management, and provide greater transparency and accountability of health and medical research. The use of project management can benefit both management and scientific outcomes of health and medical research projects.

  16. Survey of medical waste characterization and management in Iran: a case study of Sistan and Baluchestan Province. (United States)

    Bazrafshan, E; Mostafapoor, F Kord


    Medical waste management has not received enough attention in recent decades in Iran, as is the case in most economically developing countries. This study investigated the quantities, generation rate, quality and composition of medial waste generated by hospitals in Sistan and Baluchestan province in Iran. A comprehensive inspection survey was performed for 14 hospitals located in the study area. Field visits were conducted to provide information on the different medical waste management aspects. The total number of beds in the hospitals was 2139, and the anticipated quantity of medical waste generated by these hospitals was about 6100 kg day(-1). The results indicated that the medical waste generation rate for total waste, infectious waste, general waste and sharp waste were 2.76, 1.36, 1.37 and 0.042 kg bed(-1) day(-1), respectively, which was comprised of 51.6% of infectious waste, 47.2% general waste and 1.2% sharps waste. The most frequently used treatment practice for solid medical waste was disposal in an unsanitary dumpsite after open burning. The results also showed that segregation of various medical waste types in the hospitals had not been conducted properly. The study revealed the need for training and capacity building programmes for all employees involved in management of the medical waste.

  17. Digital management and regulatory submission of medical images from clinical trials: role and benefits of the core laboratory (United States)

    Robbins, William L.; Conklin, James J.


    Medical images (angiography, CT, MRI, nuclear medicine, ultrasound, x ray) play an increasingly important role in the clinical development and regulatory review process for pharmaceuticals and medical devices. Since medical images are increasingly acquired and archived digitally, or are readily digitized from film, they can be visualized, processed and analyzed in a variety of ways using digital image processing and display technology. Moreover, with image-based data management and data visualization tools, medical images can be electronically organized and submitted to the U.S. Food and Drug Administration (FDA) for review. The collection, processing, analysis, archival, and submission of medical images in a digital format versus an analog (film-based) format presents both challenges and opportunities for the clinical and regulatory information management specialist. The medical imaging 'core laboratory' is an important resource for clinical trials and regulatory submissions involving medical imaging data. Use of digital imaging technology within a core laboratory can increase efficiency and decrease overall costs in the image data management and regulatory review process.

  18. Are female CFOs less tax aggressive? Evidence from tax aggressiveness


    Francis , Bill B; Hasan, Iftekhar; Wu,Qiang; YAN Meng


    This paper investigates the effect of CFO gender on corporate tax aggressiveness. Focusing on firms that experience a male-to-female CFO transition, the paper compares those firms’ degree of tax aggressiveness during the pre- and post-transition periods. Using the probability of tax sheltering, the predicted unrecognized tax benefits, and the discretionary permanent book-tax differences to measure tax aggressiveness, we find that female CFOs are associated with less tax aggressiveness as comp...

  19. Witz, Lust und Aggression

    DEFF Research Database (Denmark)

    Rösing, Lilian Munk


    Artiklen beskæftiger sig med forholdet mellem vits, lyst og aggression med udgangspunkt i lysten ved aggressiv litterær humor, eksemplificeret ved tekststeder fra Shakespeares Hamlet. Der argumenteres for, at aggressionen eller angrebet er et fælles centralt aspekt ved Sigmund Freuds og Friedrich...

  20. Early childhood aggression

    NARCIS (Netherlands)

    Alink, Lenneke Rosalie Agnes


    In this thesis the development, stability, and correlates of early childhood aggression were investigated. The normative development was examined in a general population sample using questionnaires completed by the parents of 12-, 24-, and 36-month-old children and again one year later. Results show

  1. Relational Aggression among Students (United States)

    Young, Ellie L.; Nelson, David A.; Hottle, America B.; Warburton, Brittney; Young, Bryan K.


    "Relational aggression" refers to harm within relationships caused by covert bullying or manipulative behavior. Examples include isolating a youth from his or her group of friends (social exclusion), threatening to stop talking to a friend (the silent treatment), or spreading gossip and rumors by email. This type of bullying tends to be…

  2. Aggressive malignant phyllodes tumor

    Directory of Open Access Journals (Sweden)

    Nathan Roberts


    Conclusion: Despite biopsy proven malignant phyllodes tumor, it was near impossible to predict such a rapid course of disease progression in our patient. Our case illustrates the unpredictable nature of this disease in general and it possibly sheds light on a variant of the disease which had undergone an aggressive transformation.

  3. Aggressiveness and Disobedience (United States)

    Vaaland, Grete Sorensen; Idsoe, Thormod; Roland, Erling


    This study aims to conceptualize disobedient pupil behavior within the more general framework of antisocial behavior and to reveal how two forms of aggressiveness are related to disobedience. Disobedience, in the context of this article, covers disruptive pupil behavior or discipline problems when the pupil is aware of breaking a standard set by…

  4. A stewardship intervention program for safe medication management and use of antidiabetic drugs

    Directory of Open Access Journals (Sweden)

    Zhao RY


    Full Text Available Rui-yi Zhao,1 Xiao-wen He,1 Yan-min Shan,1 Ling-ling Zhu,2 Quan Zhou3 1Clinical Nurse Specialist Section, Division of Nursing, 2Geriatric VIP Care Ward, Division of Nursing, 3Department of Pharmacy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China Background: Diabetes patients are complex due to considerations of polypharmacy, multimorbidities, medication adherence, dietary habits, health literacy, socioeconomic status, and cultural factors. Meanwhile, insulin and oral hypoglycemic agents are high-alert medications. Therefore it is necessary to require a multidisciplinary team’s integrated endeavors to enhance safe medication management and use of antidiabetic drugs.Methods: A 5-year stewardship intervention program, including organizational measures and quality improvement activities in storage, prescription, dispensing, administration, and monitoring, was performed in the Second Affiliated Hospital of Zhejiang University, People’s Republic of China, a 3,200-bed hospital with 3.5 million outpatient visits annually.Results: The Second Affiliated Hospital of Zhejiang University has obtained a 100% implementation rate of standard storage of antidiabetic drugs in the Pharmacy and wards since August 2012. A zero occurrence of dispensing errors related to highly “look-alike” and “sound-alike” NovoMix 30® (biphasic insulin aspart and NovoRapid® (insulin aspart has been achieved since October 2011. Insulin injection accuracy among ward nurses significantly increased from 82% (first quarter 2011 to 96% (fourth quarter 2011 (P<0.05. The number of medication administration errors related to insulin continuously decreased from 20 (2011 to six (2014. The occurrence rate of hypoglycemia in non–endocrinology ward diabetes inpatients during 2011–2013 was significantly less than that in 2010 (5.03%–5.53% versus 8.27% (P<0.01. Percentage of correct management of

  5. Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia

    Directory of Open Access Journals (Sweden)

    Nasir T Wabe


    Full Text Available Background : Type-2 diabetes mellitus and its complication are becoming more prevalent in Ethiopia. Evidence abound that the most important predictor of reduction of morbidity and mortality due to diabetes complication is the level of glycemic control achieved. Aims : The aim is to assess adherence to anti diabetic drug therapy and self management practice among type-2 diabetic patient in Ethiopia. Patients and Method : The study consists of two phases. A cross-sectional review of randomly selected 384 case notes of type-2 diabetic patient that attend diabetes mellitus clinic over 3 month and cross-sectional interview, with pre tested adherence and self management and monitoring tool questioner of 347 consecutive patients that attend in Jimma university specialized hospital diabetic clinic. Result: Oral hypoglycemic agent were prescribed for 351(91.4 of the patient while insulin and oral hypoglycemic agent was prescribed in 33(8.6%. About 312 (88.9% patients on oral hypoglycemic agent were on mono therapy, the most frequently prescribed oral hypoglycemic agent was glibenclamide 232(74.3% and metformine 80(25.7%. Only 41.8% of the patient had adequate glycemic control. The main external factors for non adherence were lack of finance (37.1% followed by perceived side effect of drug 29.2%. Only 6.5% patient who missed their medications disclosed to physician during consultation. The knowledge and practice of critical component of diabetes self management behavior were generally low among the patient studied. Conclusion: Majority of the patient with type 2 diabetes in Ethiopia are managed by OHA monotherapy mainly glybenclamide and metformine. While the current prescribing strategy do not achieve glycemic control on majority of the patient. This is due to poor adherence with the prescribed drug regimen and poor knowledge and practice of successful self management.

  6. An international comparative study on the reliability and validity of the attitudes towards aggression scale

    NARCIS (Netherlands)

    Jansen, GJ; Middel, B; Dassen, TWN


    One of the factors known to be associated with the management of patient aggression is the attitude of staff members towards the aggressive behaviour of patients. The construct validity of an instrument measuring the attitudes of staff towards inpatient aggression in psychiatry was evaluated in this

  7. Primary Care Providers’ experiences with Pharmaceutical Care-based Medication Therapy Management Services

    Directory of Open Access Journals (Sweden)

    Heather L. Maracle, Pharm.D.


    Full Text Available This study explored primary care providers’ (PCPs experiences with the practice of pharmaceutical care-based medication therapy management (MTM. Qualitative, semi-structured interviews were conducted with six PCPs who have experiences working with MTM pharmacists for at least three years. The first author conducted the interviews that were audio-taped, transcribed, and coded independently. The codes were then harmonized via discussion and consensus with the other authors. Data were analyzed for themes using the hermeneutic-phenomenological method as proposed by Max van Manen. Three men and three women were interviewed. On average, the interviewees have worked with MTM pharmacists for seven years. The six (6 themes uncovered from the interviews included: (1 “MTM is just part of our team approach to the practice of medicine”: MTM as an integral part of PCPs’ practices; (2 “Frankly it’s education for the patient but it’s also education for me”: MTM services as a source of education; (3 “It’s not exactly just the pharmacist that passes out the medicines at the pharmacy”: The MTM practitioner is different from the dispensing pharmacist; (4 “So, less reactive, cleaning up the mess, and more proactive and catching things before they become so involved”: MTM services as preventative health care efforts; (5“I think that time is the big thing”: MTM pharmacists spend more time with patients; (6 “There’s an access piece, there’s an availability piece, there’s a finance piece”: MTM services are underutilized at the clinics. In conclusion, PCPs value having MTM pharmacists as part of their team in ambulatory clinics. MTM pharmacists are considered an important source of education to patients as well as to providers as they are seen as having a unique body of knowledge –medication expertise. All PCPs highly treasure the time and education provided by the MTM pharmacists, their ability to manage and adjust patients

  8. Helicopter emergency medical services in major incident management: A national Norwegian cross-sectional survey (United States)

    Johnsen, Anne Siri; Sollid, Stephen J. M.; Vigerust, Trond; Jystad, Morten; Rehn, Marius


    Objective Helicopter Emergency Medical Services (HEMS) aim to bring a highly specialised crew to the scene of major incidents for triage, treatment and transport. We aim to describe experiences made by HEMS in Norway in the management of major incidents. Design Doctors, rescue paramedics and pilots working in Norwegian HEMS and Search and Rescue Helicopters (SAR) January 1st 2015 were invited to a cross-sectional study on experiences, preparedness and training in major incident management. Results We identified a total of 329 Norwegian crewmembers of which 229 (70%) responded; doctors 101/150, (67%), rescue paramedics 64/78 (82%), pilots 64/101, (63%). HEMS and SAR crewmembers had experience from a median of 2 (interquartile range 0–6) major incidents. Road traffic incidents were the most frequent mechanism and blunt trauma the dominating injury. HEMS mainly contributed with triage, treatment and transport. Communication with other emergency services prior to arrival was described as bad, but good to excellent when cooperating on scene. The respondents called for more interdisciplinary exercises. Conclusion HEMS and SAR crewmembers have limited exposure to major incident management. Interdisciplinary training on frequent scenarios with focus on cooperation and communication is called for. PMID:28192440

  9. Knowledge of Childhood Autism and Challenges of Management among Medical Doctors in Kaduna State, Northwest Nigeria. (United States)

    Eseigbe, E E; Nuhu, F T; Sheikh, T L; Eseigbe, P; Sanni, K A; Olisah, V O


    Autism is a neurodevelopmental disorder with serious implications in childhood. There is a significant gap in the identification and provision of health and social services for autism in Africa. The knowledge of autism among health care providers and identifying challenges associated with its management could facilitate bridging the gap and ensuring better outcomes. A self-administered tool, the Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire, was used in assessing knowledge of autism among 175 medical doctors (participants) attending an annual scientific meeting in northwest Nigeria. Other parameters assessed were sociodemographic and professional characteristics of the participants and challenges encountered in the management of autism. Out of 175 questionnaires distributed, 167 (95.4%) were returned. Good knowledge (KCAHW score ≥15) was significantly associated with being a paediatrician or psychiatrist and practicing in a tertiary health facility (P knowledge (KCAHW score knowledge gap was associated with onset of autism and its comorbidities (KCAHW Domain 4) while the least was concerning communication impairments (KCAHW Domain 2). Major challenges encountered in autism management were dearth of specialist services, cost of evaluation, and poor caregiver perspectives of autism.

  10. The pattern of time management in college students of Kerman University of Medical Sciences in the year 2006

    Directory of Open Access Journals (Sweden)

    Ali Ravari


    Full Text Available Background: One potential coping strategy frequently offered by university counseling services is time management for studying. Besides stress relief, time management skills will positively influence key outcomes such as academic performance, problem-solving ability, and health. Thus, it is necessary to investigate how college students manage their timing for studying. The aim of the present study was to assess the pattern of college students' time management in Kerman University of Medical Sciences. Methods: This cross-sectional study was conducted on 300 students who were selected by stratified random sampling method among students of Kerman University of Medical Sciences. Information about how students managed their study time during their educational course was collected using a questionnaire which consisted time management stages such as planning, prioritizing, time allocation, listing all study-related tasks and goal setting. Study time management was measured according to Likert scale in range of “never” to “always”. Results: There was a significant difference between the course of study and the mean of study duration (p<0.004. Mean scores of the study time management showed that the medical students (mean=67.5 ±12.87 had the highest scores and the bachelor students (mean= 61.1±15.1 had the lowest scores, but the ANOVA test did not show any significant difference between the mean scores of study time management and the course of study (p=0.07. The majority of students (186 persons=62% “occasionally” and only 48 persons (16% “always” were managing their study time. A total of 26.2% of medical students always managed their study time, and in this criterion they had the highest scores in comparison with others. There was no significant difference between the course of study and the pattern of study management (p<0.05. Conclusion: Most of the students of medical sciences have no scheduled programming for their study time

  11. Assurance of medical device quality with quality management system: an analysis of good manufacturing practice implementation in Taiwan. (United States)

    Li, Tzu-Wei; Tu, Pei-Weng; Liu, Li-Ling; Wu, Shiow-Ing


    The implementation of an effective quality management system has always been considered a principal method for a manufacturer to maintain and improve its product and service quality. Globally many regulatory authorities incorporate quality management system as one of the mandatory requirements for the regulatory control of high-risk medical devices. The present study aims to analyze the GMP enforcement experience in Taiwan between 1998 and 2013. It describes the regulatory implementation of medical device GMP requirement and initiatives taken to assist small and medium-sized enterprises in compliance with the regulatory requirement. Based on statistical data collected by the competent authority and industry research institutes, the present paper reports the growth of Taiwan local medical device industry after the enforcement of GMP regulation. Transition in the production, technologies, and number of employees of Taiwan medical device industry between 1998 and 2013 provides the competent authorities around the world with an empirical foundation for further policy development.

  12. Assurance of Medical Device Quality with Quality Management System: An Analysis of Good Manufacturing Practice Implementation in Taiwan

    Directory of Open Access Journals (Sweden)

    Tzu-Wei Li


    Full Text Available The implementation of an effective quality management system has always been considered a principal method for a manufacturer to maintain and improve its product and service quality. Globally many regulatory authorities incorporate quality management system as one of the mandatory requirements for the regulatory control of high-risk medical devices. The present study aims to analyze the GMP enforcement experience in Taiwan between 1998 and 2013. It describes the regulatory implementation of medical device GMP requirement and initiatives taken to assist small and medium-sized enterprises in compliance with the regulatory requirement. Based on statistical data collected by the competent authority and industry research institutes, the present paper reports the growth of Taiwan local medical device industry after the enforcement of GMP regulation. Transition in the production, technologies, and number of employees of Taiwan medical device industry between 1998 and 2013 provides the competent authorities around the world with an empirical foundation for further policy development.

  13. Ionizing radiations management in university, medical and industrial media; La gestion des sources ionisantes en milieux universitaire, medical et industriel

    Energy Technology Data Exchange (ETDEWEB)

    Klein, D. [Universite Technologique de Belfort Montbeliard - LERMPS, 90 - Belfort (France)]|[Universite de Franche Comte, CREST-IRMA, 25 - Montbeliard (France)


    The radioactive sources are useful in several areas: medicine, research, measurement laboratories. Severe accidents in the past (Forbach in France 1991, Arequipa, Peru 1999, Goiania, Brazil 1987) remind us of the dangerous character of ionizing radiations. That is why the the management of radioactive sources are so regulated. Radiation protection and legal aspects of sealed and unsealed sources management are evoked, as well as the different official organisms that take a part in their management. (N.C.)

  14. Safe medication management and use of narcotics in a Joint Commission International-accredited academic medical center hospital in the People's Republic of China. (United States)

    Fang, Xu; Zhu, Ling-Ling; Pan, Sheng-Dong; Xia, Ping; Chen, Meng; Zhou, Quan


    Safe medication management and use of high-alert narcotics should arouse concern. Risk management experiences in this respect in a large-scale Joint Commission International (JCI)-accredited academic medical center hospital in the People's Republic of China during 2011-2015, focusing on organizational, educational, motivational, and information technological measures in storage, prescribing, preparing, dispensing, administration, and monitoring of medication are summarized. The intensity of use of meperidine in hospitalized patients in 2015 was one-fourth that in 2011. A 100% implementation rate of standard storage of narcotics has been achieved in the hospital since December 2012. A "Plan, Do, Check, Act" cycle was efficient because the ratio of number of inappropriate narcotics prescriptions to total number of narcotics prescriptions for inpatients decreased from August 2014 to December 2014 (28.22% versus 2.96%, P=0.0000), and it was controlled below 6% from then on. During the journey to good pain management ward accreditation by the Ministry of Health, People's Republic of China, (April 2012-October 2012), the medical oncology ward successfully demonstrated an increase in the pain screening rate at admission from 43.5% to 100%, cancer pain control rate from 85% to 96%, and degree of satisfaction toward pain nursing from 95.4% to 100% (all P-values <0.05). Oral morphine equivalent dosage in the good pain management ward increased from 2.3 mg/patient before June 2012 to 54.74 mg/patient in 2014. From 2011 to 2015, the oral morphine equivalent dose per discharged patient increased from 8.52 mg/person to 20.36 mg/person. A 100% implementation rate of independent double-check prior to narcotics dosing has been achieved since January 2013. From 2014 to 2015, the ratio of number of narcotics-related medication errors to number of discharged patients significantly decreased (6.95% versus 0.99%, P=0.0000). Taken together, continuous quality improvements have been

  15. How to manage secure direct access of European patients to their computerized medical record and personal medical record. (United States)

    Quantin, Catherine; Allaert, François André; Fassa, Maniane; Riandey, Benoît; Avillach, Paul; Cohen, Olivier


    The multiplication of the requests of the patients for a direct access to their Medical Record (MR), the development of Personal Medical Record (PMR) supervised by the patients themselves, the increasing development of the patients' electronic medical records (EMRs) and the world wide internet utilization will lead to envisage an access by using technical automatic and scientific way. It will require the addition of different conditions: a unique patient identifier which could base on a familial component in order to get access to the right record anywhere in Europe, very strict identity checks using cryptographic techniques such as those for the electronic signature, which will ensure the authentication of the requests sender and the integrity of the file but also the protection of the confidentiality and the access follow up. The electronic medical record must also be electronically signed by the practitioner in order to get evidence that he has given his agreement and taken the liability for that. This electronic signature also avoids any kind of post-transmission falsification. This will become extremely important, especially in France where patients will have the possibility to mask information that, they do not want to appear in their personal medical record. Currently, the idea of every citizen having electronic signatures available appears positively Utopian. But this is yet the case in eGovernment, eHealth and eShopping, world-wide. The same was thought about smart cards before they became generally available and useful when banks issued them.

  16. Serotonin and Aggressiveness in Chickens (United States)

    Serotonin (5-HT) regulates aggressive behavior in animals. This study examined if 5-HT regulation of aggressiveness is gene-dependent. Chickens from two divergently selected lines KGB and MBB (Kind Gentle Birds and Mean Bad Birds displaying low and high aggressiveness, respectively) and DXL (Dekalb ...

  17. Multi-agent system as a platform for management of medical documentation. (United States)

    Lhotska, Lenka


    The paper is focused on description of an ongoing project of a pilot study and implementation of a multi-agent system for management of medical documentation in a hospital. First we analyzed the problem and divided it into four groups of tasks: storing and retrieving stored data, user interaction, data archiving, and system security. All these tasks are performed by corresponding agents, namely user interface agent, database agent, archive agent, and security agent. Communication between the agents is a crucial point of the system operation. The system has been designed as an open system and we assume that it will be extended by additional agents with new functions, e.g. decision support, biomedical signal evaluation, laboratory test evaluation.

  18. [Nutritional management in amyotrophic lateral sclerosis: A medical and ethical stake]. (United States)

    Lehéricey, Guillaume; Le Forestier, Nadine; Dupuis, Luc; Gonzalez-Bermejo, Jésus; Meininger, Vincent; Pradat, Pierre-François


    Malnutrition and dehydration are common and result from swallowing disorders secondary to degeneration of brainstem motor neurons. Recent knowledge argues in favor of the associated primary metabolism abnormalities. Though muscle atrophy, a paradoxical hypermetabolism at rest has often been observed. Hyperlipidemia and glucose intolerance are more frequent than in general population. The heterogeneity of the nutritional assessment of patients in published series is due, partially at least, to the use of disparate criteria and evaluating procedures. Weight lost is an independent negative survival prognostic factor. Overweight may be beneficial for the survival of ALS patients. A specific nutritional management for ALS is an essential point in the multidisciplinary support. The criteria leading to artificial nutrition indication are medical, mainly based on percentage of weight loss, but also psychological and ethical.

  19. Medical management of urethral and colonic perforation associated with urinary catheterization in a kitten. (United States)

    Whittemore, Jacqueline C; Zucca, Lynda


    A 6-week-old male kitten was evaluated because of stranguria and possible urethral blockage; a urinary catheter placed during general anesthesia penetrated the urethral and colonic walls and entered the colon. Treatment was conservative, with fluids administered i.v., administration of piperacillin, and supportive care. The kitten never became febrile or clinically ill and continued to thrive. There was no development of clinical signs consistent with stricture, diverticulum, or fistula formation. Complications from urethral perforation include infection and urethral stricture. Reconstructive surgery is considered the treatment of choice for traumatic urethral-colonic perforation. However, surgery may not be feasible or may be cost-prohibitive in certain situations. In such instances, medical management may provide a reasonable alternative to euthanasia.

  20. Role of Medical Nutrition Therapy in the Management of Gestational Diabetes Mellitus. (United States)

    Moreno-Castilla, Cristina; Mauricio, Didac; Hernandez, Marta


    Medical nutrition therapy (MNT) plays an important role in the management of gestational diabetes mellitus (GDM), and accordingly, it has a significant impact on women and newborns. The primary objective of MNT is to ensure adequate pregnancy weight gain and fetus growth while maintaining euglycemia and avoiding ketones. However, the optimal diet (energy content, macronutrient distribution, its quality and amount, among others) remains an outstanding question. Overall, the nutritional requirements of GDM are similar for all pregnancies, but special attention is paid to carbohydrates. Despite the classical intervention of restricting carbohydrates, the latest evidence, although limited, seems to favor a low-glycemic index diet. There is general agreement in the literature about caloric restrictions in the case of being overweight or obese. Randomized controlled trials are necessary to investigate the optimal MNT for GDM; this knowledge could yield health benefits and cost savings.

  1. Management of a multinational mass fatality incident in Kaprun, Austria: a forensic medical perspective. (United States)

    Labovich, Marc H; Duke, Jim B; Ingwersen, Kathleen M; Roath, David B


    The Armed Forces Regional Medical Examiner in Europe is responsible for medico-legal death investigations for the U.S. military in 89 countries in Europe, Southwest Asia, and Africa. The Disaster Mortuary Affairs Response Team (DMART) is a rapidly deployable, experienced, multidisciplinary team patterned after the regional U.S. civilian Disaster Mortuary Response Teams. One of the first major challenges since the DMART's inception occurred on November 11, 2000. A fire in a funicular servicing a ski resort claimed 155 victims in a mountain tunnel in Kaprun, Austria. The DMART deployed to assist the Austrian authorities in the rapid recovery, examination, identification, and return of the remains. The DMART's considerable forensic expertise and inherent spirit of cooperation were instrumental in the successful management of the disaster, resulting in the positive identification and release of all 155 remains within 2 weeks of the incident.

  2. Employer-based coverage and medical travel options: lessons for healthcare managers. (United States)

    Karuppan, Corinne Marie


    Outbound medical travel (MT) involves U.S. patients going abroad to seek medical care. Over the past decade, there has been much discussion about MT's broadening appeal to several segments of U.S. healthcare consumers, but little is known about its penetration in the employer-based coverage (EBC) marketplace. The objectives of this article are to fill this gap and identify (1) the current status of MT options in EBC, (2) the differences between adopters and nonadopters of MT options, and (3) the factors that impede adoption. The results were obtained from a nationwide survey of human resources (HR) professionals making decisions regarding medical benefits. In this sample (n = 608), 16.8% of the respondents offered outbound MT options to their employees, often bypassing their insurance providers. Besides benefiting from a strong HR function, these organizations tended to be more involved in global business transactions, more open to change, more sensitive to cost savings, and more flexible in implementing administrative innovations than nonadopters were. An organizational climate conducive to innovation may explain their propensity to downplay the importance of well-known obstacles to implementation, such as the effort required to make changes, an emphasis on short-term goals, and the fear of liability. The lessons to be learned by U.S. healthcare managers are clear. To attract a value-conscious market, they must offer an attractive package of outstanding quality (clinical outcomes and patient experience) at competitive costs. Operational excellence may thus be the key to slowing the inevitable diffusion of MT options in EBC and maintaining or even expanding the U.S. market share of elective surgeries.

  3. Management of Adult Growth Hormone Deficiency at Peking Union Medical College Hospital:A Survey among Physicians

    Institute of Scientific and Technical Information of China (English)

    Hong-bo Yang; Meng-qi Zhang; Hui Pan; Hui-juan Zhu


    Objective To evaluate physicians’ attitude and knowledge about the management of adult growth hormone deficiency (AGHD) at Peking Union Medical College Hospital and impact factors associated with better decision-making. Methods A 21-question anonymous survey was distributed and collected at Peking Union Medical College Hospital, a major teaching hospital in Chinese Academy of Medical Sciences. Data of physicians’ educational background, clinical training, patient workload per year and continuing medical education in AGHD were collected. Factors associated with appropriate answers were further analyzed by multivariate regression models. Results One hundred and eighteen internal medicine residents, endocrine fellows, attending physicians and visiting physicians responded to the survey. Among them, 44.9% thought that AGHD patients should accept recombinant human growth hormone replacement therapy. Moreover, 56.8% selected insulin tolerance test and growth hormone-releasing hormone-arginine test for the diagnosis of AGHD. Logistic regression analysis of physician demographic data, educational background, and work experience found no consistent independent factors associated with better decision-making, other than continued medical education, that were associated with treatment choice. Conclusions The physicians’ reported management of AGHD in this major academic healthcare center in Beijing was inconsistent with current evidence. High quality continued medical education is required to improve Chinese physician management of AGHD.

  4. Interconnection of electronic medical record with clinical data management system by CDISC ODM. (United States)

    Matsumura, Yasushi; Hattori, Atsushi; Manabe, Shiro; Takeda, Toshihiro; Takahashi, Daiyo; Yamamoto, Yuichiro; Murata, Taizo; Mihara, Naoki


    EDC system has been used in the field of clinical research. The current EDC system does not connect with electronic medical record system (EMR), thus a medical staff has to transcribe the data in EMR to EDC system manually. This redundant process causes not only inefficiency but also human error. We developed an EDC system cooperating with EMR, in which the data required for a clinical research form (CRF) is transcribed automatically from EMR to electronic CRF (eCRF) and is sent via network. We call this system as "eCRF reporter". The interface module of eCRF reporter can retrieves the data in EMR database including patient biography data, laboratory test data, prescription data and data entered by template in progress notes. The eCRF reporter also enables users to enter data directly to eCRF. The eCRF reporter generates CDISC ODM file and PDF which is a translated form of Clinical data in ODM. After storing eCRF in EMR, it is transferred via VPN to a clinical data management system (CDMS) which can receive the eCRF files and parse ODM. We started some clinical research by using this system. This system is expected to promote clinical research efficiency and strictness.

  5. Managing complex processing of medical image sequences by program supervision techniques (United States)

    Crubezy, Monica; Aubry, Florent; Moisan, Sabine; Chameroy, Virginie; Thonnat, Monique; Di Paola, Robert


    Our objective is to offer clinicians wider access to evolving medical image processing (MIP) techniques, crucial to improve assessment and quantification of physiological processes, but difficult to handle for non-specialists in MIP. Based on artificial intelligence techniques, our approach consists in the development of a knowledge-based program supervision system, automating the management of MIP libraries. It comprises a library of programs, a knowledge base capturing the expertise about programs and data and a supervision engine. It selects, organizes and executes the appropriate MIP programs given a goal to achieve and a data set, with dynamic feedback based on the results obtained. It also advises users in the development of new procedures chaining MIP programs.. We have experimented the approach for an application of factor analysis of medical image sequences as a means of predicting the response of osteosarcoma to chemotherapy, with both MRI and NM dynamic image sequences. As a result our program supervision system frees clinical end-users from performing tasks outside their competence, permitting them to concentrate on clinical issues. Therefore our approach enables a better exploitation of possibilities offered by MIP and higher quality results, both in terms of robustness and reliability.

  6. 47,XXY Klinefelter syndrome: clinical characteristics and age-specific recommendations for medical management. (United States)

    Aksglaede, Lise; Link, Katarina; Giwercman, Aleksander; Jørgensen, Niels; Skakkebaek, Niels E; Juul, Anders


    47,XXY (Klinefelter syndrome) is the most frequent sex chromosomal disorder and affects approximately one in 660 newborn boys. The syndrome is characterized by varying degrees of cognitive, social, behavioral, and learning difficulties and in adulthood additionally primary testicular failure with small testes, hypergonadotropic hypogonadism, tall stature, and eunuchoid body proportions. The phenotype is variable ranging from "near-normal" to a significantly affected individual. In addition, newborns with Klinefelter syndrome generally present with a normal male phenotype and the only consistent clinical finding in KS is small testes, that are most often not identified until after puberty. Decreased awareness of this syndrome among health professionals and a general perception that all patients with 47,XXY exhibit the classic textbook phenotype results in a highly under-diagnosed condition with up to 75% of the patients left undetected. Typically, diagnosis is delayed with the majority of patients identified during fertility workup in adulthood, and only 10% of patients diagnosed prior to puberty. Early detection of this syndrome is recommended in order to offer treatment and intervention at the appropriate ages and stages of development for the purpose of preventing osteopenia/osteoporosis, metabolic syndrome, and other medical conditions related to hypogonadism and to the XXY as well as minimizing potential learning and psychosocial problems. The aim of this review is to present the clinical aspects of XXY and the age-specific recommendations for medical management. © 2013 Wiley Periodicals, Inc.

  7. Managing the quality of health information using electronic medical records: an exploratory study among clinical physicians. (United States)

    Smith, Alan D


    As technology is advancing in the healthcare field, ways of reducing costs and improving quality are key initiatives in the tedious processes of operations planning. There are several ways of reducing costs and improving quality management. One such way is the implementation of Electronic Health Records (HERs). A personally interviewed sample from a relatively large healthcare facility located in Pittsburgh, Pennsylvania, which is associated with the University of Pittsburgh Medical Center, netted a total of 44 physicians. There were no statistically significant relationships found based on 'clinicians' willingness to accept Electronic Medical Record (EMR)-embedded systems with gender', 'benefits outweigh risks for EMR-embedded implementation', 'EMR-embedded systems should be mandated', 'EMR-embedded systems should be administered by the federal government', 'EMR-embedded systems should be administered by regional systems', 'EMR applications are an invasion of privacy' and 'IT-related technologies pose an added threat to the healthcare environment'. It was only for the independent variable 'improves quality of care by EMR-embedded implementation' that most physicians felt that such a technology does positively impact patient care.

  8. Metyrapone for Long-Term Medical Management of Cushing’s Syndrome

    Directory of Open Access Journals (Sweden)

    Andrea N. Traina


    Full Text Available Cushing’s syndrome is characterized by any cause of excess cortisol in the blood and produces many physiologic consequences. Left untreated, Cushing’s is associated with significant morbidity and mortality. Seventy percent of endogenous cases of Cushing’s syndrome are secondary to a pituitary tumor; because of this, the primary mode of management is surgical resection of the tumor. Should hypercortisolism persist following surgical resection, further treatment options are limited. Metyrapone is an orphan medication that is often used in the diagnosis of the disease and occasionally for short-term treatment prior to surgery. Long-term treatment with metyrapone is usually discouraged due to the contradictory increase in ACTH production, acne, hirsutism, hyperkalemia, edema, and other mineralocorticoid effects. We present a patient with refractory Cushing’s syndrome successfully treated for nearly 6 years with metyrapone with minimal adverse effects. This orphan medication may be a viable long-term treatment option for this difficult disease.

  9. Update on the Medical Management of Gastrointestinal Behçet's Disease (United States)

    Venerito, Vincenzo; Franceschini, Rossella; Lapadula, Giovanni; Galeazzi, Mauro; Frediani, Bruno; Iannone, Florenzo


    Behçet's disease (BD) is a multisystemic disorder of unknown etiology mainly defined by recurrent oral aphthosis, genital ulcers, and chronic relapsing bilateral uveitis, all of which represent the “stigmata” of disease. However, many other organs including the vascular, neurological, musculoskeletal, and gastrointestinal systems can be affected. The gastrointestinal involvement in Behçet's disease (GIBD), along with the neurological and vascular ones, represents the most feared clinical manifestation of BD and shares many symptoms with inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. Consequently, the differential diagnosis is often a daunting task, albeit the presence of typical endoscopic and pathologic findings may be a valuable aid to the exact diagnosis. To date, there are no standardized medical treatments for GIBD; therefore therapy should be tailored to the single patient and based on the severity of the clinical features and their complications. This work provides a digest of all current experience and evidence about pharmacological agents suggested by the medical literature as having a potential role for managing the dreadful features of GIBD. PMID:28210071

  10. Achieving the HIV prevention impact of voluntary medical male circumcision: lessons and challenges for managing programs. (United States)

    Sgaier, Sema K; Reed, Jason B; Thomas, Anne; Njeuhmeli, Emmanuel


    Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009-2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection "Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up." The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform.

  11. Safe medication management and use of narcotics in a Joint Commission International-accredited academic medical center hospital in the People’s Republic of China

    Directory of Open Access Journals (Sweden)

    Fang X


    Full Text Available Xu Fang,1,2 Ling-ling Zhu,3 Sheng-dong Pan,4 Ping Xia,4 Meng Chen,5 Quan Zhou51Office of Hospital Administration, 2Office of Party and Administration Council, 3Geriatric VIP Care Ward, Division of Nursing, 4Division of Medical Administration, 5Department of Pharmacy, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of ChinaAbstract: Safe medication management and use of high-alert narcotics should arouse concern. Risk management experiences in this respect in a large-scale Joint Commission International (JCI-accredited academic medical center hospital in the People’s Republic of China during 2011–2015, focusing on organizational, educational, motivational, and information technological measures in storage, prescribing, preparing, dispensing, administration, and monitoring of medication are summarized. The intensity of use of meperidine in hospitalized patients in 2015 was one-fourth that in 2011. A 100% implementation rate of standard storage of narcotics has been achieved in the hospital since December 2012. A “Plan, Do, Check, Act” cycle was efficient because the ratio of number of inappropriate narcotics prescriptions to total number of narcotics prescriptions for inpatients decreased from August 2014 to December 2014 (28.22% versus 2.96%, P=0.0000, and it was controlled below 6% from then on. During the journey to good pain management ward accreditation by the Ministry of Health, People’s Republic of China, (April 2012–October 2012, the medical oncology ward successfully demonstrated an increase in the pain screening rate at admission from 43.5% to 100%, cancer pain control rate from 85% to 96%, and degree of satisfaction toward pain nursing from 95.4% to 100% (all P-values <0.05. Oral morphine equivalent dosage in the good pain management ward increased from 2.3 mg/patient before June 2012 to 54.74 mg/patient in 2014. From 2011 to 2015, the oral morphine

  12. A virtual reality apartment as a measure of medication management skills in patients with schizophrenia: a pilot study. (United States)

    Kurtz, Matthew M; Baker, Elizabeth; Pearlson, Godfrey D; Astur, Robert S


    Performance on a novel, virtual reality (VR) assessment of medication management skills, the Virtual Reality Apartment Medication Management Assessment (VRAMMA), was investigated in 25 patients with schizophrenia and 18 matched healthy controls. The VRAMMA is a virtual 4-room apartment consisting of a living room with an interactive clock and TV, a bedroom, a kitchen, and a bathroom with an interactive medicine cabinet. After an exploratory phase, participants were given a mock prescription regimen to be taken 15 minutes later from pill bottles located in the medicine cabinet in the bathroom of the virtual environment. The VRAMMA was administered with a validated measure of medication management skills, several neurocognitive tests, and a symptom scale. Results revealed that (1) schizophrenic patients made significantly more quantitative errors in the number of pills taken, were less accurate at taking the prescribed medications at the designated time, and checked the interactive clock less frequently than healthy controls; (2) in patients with schizophrenia, there was significant agreement in classification of adherence vs nonadherence between a validated measure of medication management skills and the VRAMMA; and (3) in patients with schizophrenia, years of education and a measure of verbal learning and memory were linked to quantitative errors on the VRAMMA, while positive symptoms, specifically delusional symptoms, were inversely linked to distance traveled within the VRAMMA. This is the first study, to our knowledge, to provide evidence for the utility of VR technology in the assessment of instrumental role functioning in patients with schizophrenia.

  13. 内控制度下医学装备管理%Medical Equipment Management under Internal Control System

    Institute of Scientific and Technical Information of China (English)

    张徐婧; 沈懿明


    医学装备管理作为医院内控的一个重要内容,是摆在众多医院面前的难题。该文通过对内控的背景、医学装备管理现状的探讨和分析,提出现阶段内控机制渗入医学装备管理工作的具体措施,将内控制度应用于医疗机构的医学装备管理。%Medical equipment management, as an important content of hospital internal control, is a major problem for many hospitals. Through the discussion and analysis on the background of the internal control and the present situation of medical equipment management, we proposed concrete measures for the permeation of internal control mechanism into the management of medical equipment at the present stage, in order to apply internal control system to medical equipment management of medical institutions.

  14. Critical elements and lessons learnt from the implementation of an RFID-enabled healthcare management system in a medical organization. (United States)

    Ting, S L; Kwok, S K; Tsang, Albert H C; Lee, W B


    Healthcare services are complex and life-critical. One mistake in any procedure may lead to irremediable consequences; numerous researchers, thus, introduce information and communication technology to improve quality of services and enhance patient safety by reducing the medical errors. Radio frequency identification (RFID) is considered as one of the emerging tool assist in meeting the challenges of the present situation. In recent years, RFID has been applied in medical organizations for the purpose of managing and tracking medical equipment, monitoring and identifying patients, ensuring that the right medication is given to the right patient, and preventing the use of counterfeit medicine. However, most of the existing literature focuses on demonstrating how RFID can benefit the healthcare industry, whereas little attention has been given to the management issues involved in constructing an RFID project in medical organizations. In this paper, an exploratory case study is conducted in a medical organization to illustrate the development framework and critical issues that should be taken into consideration in the preparation, implementation and maintenance stage of constructing such a project. All the experiences and results discussed in this paper offer valuable and useful insights to steer those who would like to start their journey using RFID in medical organizations.

  15. [Health care waste management of potentially infectious medical waste by healthcare professionals in a private medical practice: a study of practices]. (United States)

    Brunot, Alain; Thompson, Céline


    A cross-sectional study was conducted with a sample of 278 health professionals (GPs and specialists, dentists, physical therapists and nurses) in a private medical practice in Paris to study the medical waste management practices related to the production and disposal of potentially hazardous health care waste. With the exception of physical therapists, most professionals produced medical waste (72% to 96,2% according to occupation), with a monthly median of 3 liters (inter-quartile range 1-15 liters). All sharp objects and needles were separated and 91% of them eliminated via a specific process for that sector. These percentages were respectively 84% and 69% concerning contaminated waste that was neither needles or used for cutting. 48% of the professionals reported the existence of documents that could track the disposal of their medical waste. To improve practice, professionals cited collection on-site at the office (74%) and reliability of the contracted service provider to collect the waste (59%). The study showed that health professionals need information on the regulations regarding potentially infectious medical waste, in particular on the traceability of its elimination. They also noted the lack of clarity and precision with regard to the definition of risk of infection: 31,7% of professionals only declare the production of sharp or cutting waste without having specified criteria for risk of infection.

  16. Has increased clinical experience with methotrexate reduced the direct costs of medical management of ectopic pregnancy compared to surgery?

    Directory of Open Access Journals (Sweden)

    Westaby Daniel T


    Full Text Available Abstract Background There is a debate about the cost-efficiency of methotrexate for the management of ectopic pregnancy (EP, especially for patients presenting with serum human chorionic gonadotrophin levels of >1500 IU/L. We hypothesised that further experience with methotrexate, and increased use of guideline-based protocols, has reduced the direct costs of management with methotrexate. Methods We conducted a retrospective cost analysis on women treated for EP in a large UK teaching hospital to (1 investigate whether the cost of medical management is less expensive than surgical management for those patients eligible for both treatments and (2 to compare the cost of medical management for women with hCG concentrations 1500–3000 IU/L against those with similar hCG concentrations that elected for surgery. Three distinct treatment groups were identified: (1 those who had initial medical management with methotrexate, (2 those who were eligible for initial medical management but chose surgery (‘elected’ surgery and (3 those who initially ‘required’ surgery and did not meet the eligibility criteria for methotrexate. We calculated the costs from the point of view of the National Health Service (NHS in the UK. We summarised the cost per study group using the mean, standard deviation, median and range and, to account for the skewed nature of the data, we calculated 95% confidence intervals for differential costs using the nonparametric bootstrap method. Results Methotrexate was £1179 (CI 819–1550 per patient cheaper than surgery but there were no significant savings with methotrexate in women with hCG >1500 IU/L due to treatment failures. Conclusions Our data support an ongoing unmet economic need for better medical treatments for EP with hCG >1500 IU/L.

  17. Information Seeking in Uncertainty Management Theory: Exposure to Information About Medical Uncertainty and Information-Processing Orientation as Predictors of Uncertainty Management Success. (United States)

    Rains, Stephen A; Tukachinsky, Riva


    Uncertainty management theory outlines the processes through which individuals cope with health-related uncertainty. Information seeking has been frequently documented as an important uncertainty management strategy. The reported study investigates exposure to specific types of medical information during a search, and one's information-processing orientation as predictors of successful uncertainty management (i.e., a reduction in the discrepancy between the level of uncertainty one feels and the level one desires). A lab study was conducted in which participants were primed to feel more or less certain about skin cancer and then were allowed to search the World Wide Web for skin cancer information. Participants' search behavior was recorded and content analyzed. The results indicate that exposure to two health communication constructs that pervade medical forms of uncertainty (i.e., severity and susceptibility) and information-processing orientation predicted uncertainty management success.

  18. The impact of critical event checklists on medical management and teamwork during simulated crises in a surgical daycare facility. (United States)

    Everett, T C; Morgan, P J; Brydges, R; Kurrek, M; Tregunno, D; Cunningham, L; Chan, A; Forde, D; Tarshis, J


    Although the incidence of major adverse events in surgical daycare centres is low, these critical events may not be managed optimally due to the absence of resources that exist in larger hospitals. We aimed to study the impact of operating theatre critical event checklists on medical management and teamwork during whole-team operating theatre crisis simulations staged in a surgical daycare facility. We studied 56 simulation encounters (without and with a checklist available) divided between an initial session and then a retention session several months later. Medical management and teamwork were quantified via percentage adherence to key processes and the Team Emergency Assessment Measure, respectively. In the initial session, medical management was not improved by the presence of a checklist (56% without checklist vs. 62% with checklist; p = 0.50). In the retention session, teams performed significantly worse without the checklists (36% without checklist vs. 60% with checklist; p = 0.04). We did not observe a change in non-technical skills in the presence of a checklist in either the initial or retention sessions (68% without checklist vs. 69% with checklist (p = 0.94) and 69% without checklist vs. 65% with checklist (p = 0.36), respectively). Critical events checklists do not improve medical management or teamwork during simulated operating theatre crises in an ambulatory surgical daycare setting.

  19. [Aggressive fibromatoses in orthopedics]. (United States)

    Adler, C P; Stock, D


    Aggressive fibromatoses which may develop either in soft tissue or in the bone present considerable problems for the pathologist trying to establish a diagnosis as well as for the radiologist and surgeon. In radiographs, a destruction of the soft and osseous tissue is seen which suggests a malignant tumor. Histologically a monomorphic connective tissue prevails in the biopsy showing no essential signs of malignancy. Under pathoanatomical aspects often a benign proliferation of the connective tissue is assumed. Surgically the tumor may either be removed in a too radical and mutilating way, or the excision may remain incomplete. Two cases of desmoplastic bone fibroma (aggressive fibromatosis in the ulna and in the sacrum) are described in which the complete tumor removal led to healing, whereas the incomplete excision of the tumor resulted in recurrences. Aggressive fibromatosis represents a semimalignant tumor which has a locally destructive and invasive growth tendency but does not metastasize. The various fibromatoses are defined with regard to their biological growth tendency and the therapeutic consequences are discussed.

  20. Chronic Disease Management Strategies of Early Childhood Caries: Support from the Medical and Dental Literature. (United States)

    Edelstein, Burton L; Ng, Man Wai


    An Institute of Medicine report places chronic disease management (CDM) as an intervention on a treatment spectrum between prevention and acute care. CDM commonly focuses on conditions in which patient self-care efforts are significant. Framing early childhood caries (ECC) as such a chronic condition invites dentistry to reconsider its approach to caries management and shift gears from a strictly surgical approach to one that also incorporates a medical approach. This paper's purpose was to explore the definition of and concepts inherent in CDM. An explanatory model is introduced to describe the multiple factors that influence ECC-CDM strategies. Reviewed literature suggests that early evidence from ECC-CDM interventions, along with results of pediatric asthma and diabetes CDM, supports CDM of ECC as a valid approach that is independent of both prevention and repair. Early results of ECC-CDM endeavors have demonstrated a reduction in rates of new cavitation, dental pain, and referral to the operating room compared to baseline rates. ECC-CDM strategies hold strong promise to curtail caries activity while complementing dental repair when needed, thereby reducing disease progression and cavity recurrence. Institutionalizing ECC-CDM will both require and benefit from evolving health care delivery and financing systems that reward positive health outcomes.