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Sample records for csu manager generally

  1. Liquid and Ice Cloud Microphysics in the CSU General Circulation Model. Part III: Sensitivity to Modeling Assumptions.

    Science.gov (United States)

    Fowler, Laura D.; Randall, David A.

    1996-03-01

    The inclusion of cloud microphysical processes in general circulation models makes it possible to study the multiple interactions among clouds, the hydrological cycle, and radiation. The gaps between the temporal and spatial scales at which such cloud microphysical processes work and those at which general circulation models presently function force climate modelers to crudely parameterize and simplify the various interactions among the different water species (namely, water vapor, cloud water, cloud ice, rain, and snow) and to use adjustable parameters to which large-scale models can be highly sensitive. Accordingly, the authors have investigated the sensitivity of the climate, simulated with the Colorado State University general circulation model, to various aspects of the parameterization of cloud microphysical processes and its interactions with the cumulus convection and radiative transfer parameterizations.The results of 120-day sensitivity experiments corresponding to perpetual January conditions have been compared with those of a control simulation in order to 1 ) determine the importance of advecting cloud water, cloud ice, rain, and snow at the temporal and spatial scale resolutions presently used in the model; 2) study the importance of the formation of extended stratiform anvils at the tops of cumulus towers, 3) analyze the role of mixed-phase clouds in determining the partitioning among cloud water, cloud ice, rain, and snow and, hence, their impacts on the simulated cloud optical properties; 4) evaluate the sensitivity of the atmospheric moisture budget and precipitation rates to a change in the fall velocities of rain and snow; 5) determine the model's sensitivity to the prescribed thresholds of autoconversion of cloud water to rain and cloud ice to snow; and 6) study the impact of the collection of supercooled cloud water by snow, as well as accounting for the cloud optical properties of snow.Results are presented in terms of 30-day mean differences

  2. Itch Management: General Principles.

    Science.gov (United States)

    Misery, Laurent

    2016-01-01

    Like pain, itch is a challenging condition that needs to be managed. Within this setting, the first principle of itch management is to get an appropriate diagnosis to perform an etiology-oriented therapy. In several cases it is not possible to treat the cause, the etiology is undetermined, there are several causes, or the etiological treatment is not effective enough to alleviate itch completely. This is also why there is need for symptomatic treatment. In all patients, psychological support and associated pragmatic measures might be helpful. General principles and guidelines are required, yet patient-centered individual care remains fundamental.

  3. Strategic Management: General Concepts

    Directory of Open Access Journals (Sweden)

    Shahram Tofighi

    2010-05-01

    Full Text Available In the era after substitution of long term planning by strategic planning, it was wished that the managers could act more successful in implementing their plans. The outcomes were far from the expected, there were minor improvements. In the organizations, a plenty of namely strategic plans has been developed during strategic planning processes, but most of these plans have been kept in the shelves, a few of them played their roles as guiding documents for the entire organization. What are the factors inducing such outcomes? Different scientists have offered a variety of justifications, according to their expe-riences."nThe first examined issue was misunderstanding stra-tegic planning by the managers and staff; it means the strategic planning process may be executed erroneously, and what they had expected from this process was not accurate. Substantially, strategic planning looks at the future and coming situations, and is designed to answer the questions which emerge in the future. Unfortunately, this critical and fundamental characteristic of strategic planning is obscured."nStrategic planning conveys the concept of drawing the future and developing a set of different probable scenarios along with defining a set of solutions in order to combat undesirable coming conditions for positioning the system or business. It helps organizations save themselves safe and maintain them successful. In other words, in strategic planning efforts we are seeking solutions fit for problems which will appear in the future for the conditions that will emerge in the future. Unfortunately, most of strategic plans which have been developed in the organizations lack this important and critical characteristic; I mean in most of them the developers had offered solutions in order to solve today's problems in the future! "nThe second issue which was considered by the scientists, was the task of ensuring the continuity of effectiveness of the planning, there was a

  4. Beam Position Monitoring in the CSU Accelerator Facility

    Science.gov (United States)

    Einstein, Joshua; Vankeuren, Max; Watras, Stephen

    2014-03-01

    A Beam Position Monitoring (BPM) system is an integral part of an accelerator beamline, and modern accelerators can take advantage of newer technologies and designs when creating a BPM system. The Colorado State University (CSU) Accelerator Facility will include four stripline detectors mounted around the beamline, a low-noise analog front-end, and digitization and interface circuitry. The design will support a sampling rate greater than 10 Hz and sub-100 μm accuracy.

  5. Sustainability in Higher Education through the Perspective of CSU Campus Presidents

    Science.gov (United States)

    Christov, Ellie

    2016-01-01

    Institutions of Higher Education (IHEs) play a central role in global efforts toward environmental sustainability. With 23 campuses, the California State University (CSU) is the largest higher education system in the world. The CSU graduates over 100,000 students annually and significantly contributes to developing the workforce of the state and…

  6. Implementing an Open Source Learning Management System: A Critical Analysis of Change Strategies

    Science.gov (United States)

    Uys, Philip M.

    2010-01-01

    This paper analyses the change and innovation strategies that Charles Sturt University (CSU) used from 2007 to 2009 during the implementation and mainstreaming of an open source learning management system (LMS), Sakai, named locally as "CSU Interact". CSU was in January 2008 the first Australian University to implement an open source…

  7. Implementing an Open Source Learning Management System: A Critical Analysis of Change Strategies

    Science.gov (United States)

    Uys, Philip M.

    2010-01-01

    This paper analyses the change and innovation strategies that Charles Sturt University (CSU) used from 2007 to 2009 during the implementation and mainstreaming of an open source learning management system (LMS), Sakai, named locally as "CSU Interact". CSU was in January 2008 the first Australian University to implement an open source…

  8. Management of rhinosinusitis in Dutch general practice

    NARCIS (Netherlands)

    Hoffmans, R.; Schermer, T.R.J.; Weel, C. van; Fokkens, W.

    2011-01-01

    AIMS: To determine whether general practitioners (GPs) distinguish between the management of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS), especially with regard to prescription of antibiotics and nasal steroids. METHODS: A questionnaire on the management of rhinosinusitis was sent to

  9. BASE Temperature Data Record (TDR) from the SSM/I and SSMIS Sensors, CSU Version 1

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The BASE Temperature Data Record (TDR) dataset from Colorado State University (CSU) is a collection of the raw unprocessed antenna temperature data that has been...

  10. Hotel Nikko Tianjin General Manager Interview

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Before the grand opening of Hotel Nikko Tianjin on April 11,Beijing Review conducted an interview with Mr.Hiroshi O’ishi,General Manager of the new hotel,in order to share the operational and management expertise of Nikko Hotels International with our readers.

  11. LOGISTICS MANAGEMENT IN THE GENERAL STRUCTURE OF COMPANY MANAGEMENT

    OpenAIRE

    SERGIU PETROVICI; ALA GUDIMA

    2011-01-01

    The paper is dedicated to the place of logistics management in the general structure of an enterprise. It states some rules to improve the logistic system through development of logistic management as integral system and through a complex approach, development of a market-orientated logistic management with clear short-term and long-term purposes, development of information system in logistics. The course of Logistics Management is taught at the Cooperative-Commercial University of Moldova at...

  12. Management of upper dyspepsia in general practice

    DEFF Research Database (Denmark)

    Kjeldsen, Hans Christian; Kier, Svend; Husum, Gitte

     Aim: To compare the effect of two strategies for management of dyspepsia. Evaluation based on GP's assessment after two weeks and patients assessment after three months.   Design: Prospective randomised controlled trial in general practice   Methods: 357 patients with dyspepsia where the general......) for two weeks. If symptoms were unchanged after to weeks => referral to endoscopy. Later recurrence of symptoms => endoscopy (> 45 year) or management strategy according to helicobacter pylori status and/or clinical reflux (measures......)   Conclusion In management of dyspepsia therapy does have a better short term effect than endoscopy concerning symptom relief, but after 3 months the endoscopy strategy had a better effect than PPI concerning symptom relief  ...

  13. Management of psychosis in Australian general practice.

    Science.gov (United States)

    Charles, Janice; Miller, Graeme; Ng, Anthea

    2006-03-01

    The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of consultations involving the management of psychoses. In this analysis we have included schizophrenia, affective disorders/bipolar, organic psychoses, and senile psychoses, with undefined psychosis and chronic brain syndrome grouped as 'other'. This synopsis provides a backdrop against which the theme articles in this issue of Australian Family Physician can be further considered.

  14. Management of upper dyspepsia in general practice

    DEFF Research Database (Denmark)

    Kjeldsen, Hans Christian; Kier, Svend; Husum, Gitte

    of dyspepsia, dyspeptic episodes, main symptom, previous contact to general practice, previous gastroscopia, use of antacids or NSAID's, Helicobacter Pylori status and mental/physical well being (SF-36 measurement scale) (Table 1). After two weeks the GPs assessed 46 % of the patients to be free of symptoms...... Aim: To compare the effect of two strategies for management of dyspepsia. Evaluation based on GP's assessment after two weeks and patients assessment after three months.   Design: Prospective randomised controlled trial in general practice   Methods: 357 patients with dyspepsia where the general...... after 3 months.   Results: Response rate GPs after two weeks were 92% (330/357). Response rate patients after three months were 71% (252/357). There were no significant difference between the groups randomised to strategy 1(PPI group) and strategy 2 (endoscopy group) concerning, age, gender, duration...

  15. Identifying management competencies of hotel owner-managers & general managers in the Republic of Ireland

    OpenAIRE

    O’Reilly, C

    2015-01-01

    The objective of this research was to investigate the concept of competencies, explore and identify the management competencies of hotel owner-managers and general managers in the hospitality industry in the Republic of Ireland. In other words, this research explored how hotel owner-managers and general managers identified, interpreted and made sense of their notion of managerial competencies in a complex work environment. The research was set within the context of the Irish hospitality and t...

  16. NOAA Climate Data Record (CDR) of SSM/I and SSMIS Microwave Brightness Temperatures, CSU Version 1

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This NOAA Climate Data Record (CDR) from Colorado State University (CSU) contains brightness temperatures that have been improved and quality-controlled over the...

  17. Transportation and General Traffic Management, Change 2

    Science.gov (United States)

    1979-01-01

    This Handbook sets forth those transportation and general traffic management responsibilities, guidelines, and procedures governing the use of commercial and Government transportation for NASA. Transportation is an integral function of the logistic process, involving all activities incident to the movement of persons and things. The fundamental and continuous objectives of transportation are to control and diminish the time-distance of lines of communication by the most suitable means. The function of transportation is accomplished through, and encompasses all, the planning, direction, supervision, and execution of the technical, operational, and administrative tasks required to procure or furnish efficient and economical conveyance of cargo and personnel by all modes of commercial and Government transportation. This Handbook is applicable to NASA Headquarters and Field Installations.

  18. General Framework of Hearing Aid Fitting Management.

    Science.gov (United States)

    Oh, Soo Hee; Lee, Junghak

    2016-04-01

    Hearing aids are one of the most widely used treatment options for the hearing impaired and optimal outcomes of hearing aids are supported by comprehensive hearing aid fitting protocols. Currently, the term 'hearing aid fitting' is prevalently used among service and industry sectors with its comprehensive procedures not systematically explicated. In addition, a variety of non-normalized guidelines for hearing aid fitting has led to non-uniform care, outcome variability, and dissatisfaction of the use of hearing aids. The main purpose of the present study is to suggest a general framework of standardized practice for hearing aid fitting management including its pre- and post-fitting stages. The management framework centers on its fitting process with its prior steps of assessment as well as its posterior steps of follow-up, thereby eliminating diverging interpretations and non-uniform practices. Outcomes of this study are also expected to improve potential benefits such as quality of hearing aid fitting, user satisfaction, and cost effectiveness across relevant stakeholders.

  19. The undergraduate physics tutorial program at CSU Los Angeles assessment of utility and areas of interest

    Science.gov (United States)

    Avetyan, Smbat

    The Physics Education Research (PER) group at the University of Washington have researched traditional teaching methods and found that students in introductory physics are lacking a conceptual understanding of the physics material. The solution they put forth is an interactive tutorial program designed to meet the lack of conceptual understanding. Since the tutorial programs inception at CSU Los Angeles in Fall 2006 no evaluation has been successfully undertaken therefore the effect of the tutorial program in the physics 200 series is deeply obscure to the department. The research has shed light on the tutorial program and brought into context its effectiveness on the overall physics 200 series courses at CSU Los Angeles. The researcher has addressed the following research questions, what overall effect does the tutorial program have on the Physics 200 series curriculum? What is the size and significance of gains attributable to the undergraduate calculus based Physics 200 series tutorial program at CSU Los Angeles? What can we learn from gains about individual weekly lessons from the Physics 200 series tutorial courses? What is the correlation of tutorial gains with student final course grades? Are the gains from the tutorial program different for genders? Is there a difference in gains based on the different students' colleges?

  20. Office of General Counsel Total Quality Management Plan

    Science.gov (United States)

    1989-07-01

    Total Quality Management Plan 6. AUTHOR(S) 7...of General Counsel. - r DTIC 65 LE- E CTEn’" SEP291 989 14. SUBJECT TERMS 15. NUMBER OF PAGES TQM ( Total Quality Management ), Office of General...89) Pra-ifcr~bed ANSI Sid 139-1S ""-"’- ", ~ mmmmmu10n S S OFFICE OF GENERAL COUNSEL TOTAL QUALITY MANAGEMENT PLAN Acc’, ’ 7or. .?:" t ’_7 Codes K

  1. Multiple sclerosis: management in Dutch general practice.

    NARCIS (Netherlands)

    Donker, G.A.; Foets, M.; Spreeuwenberg, P.

    1996-01-01

    BACKGROUND AND OBJECTIVES: A descriptive study on 118 MS patients in general practice, to describe the family physician's role in diagnosis, treatment and follow-up of patients. METHOD: Random sample of 103 general practices (161 family physicians) throughout The Netherlands with a total list of 335

  2. Tetralogy of Fallot: General Principles of Management.

    Science.gov (United States)

    Downing, Tacy E; Kim, Yuli Y

    2015-11-01

    Repaired tetralogy of Fallot (TOF) is one of the most common diagnoses encountered when caring for adults with congenital heart disease. Although long-term survival after childhood TOF repair is excellent, morbidity is common and most patients require reintervention in adulthood. This review provides an overview of key surveillance and management issues for adults with TOF, including residual right ventricular outflow tract disease and timing of pulmonary valve replacement, arrhythmias and risk stratification, left-sided heart disease and heart failure, and pregnancy management. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. General survey of solid-waste management

    Science.gov (United States)

    Reese, T. G.; Wadle, R. C.

    1974-01-01

    Potential ways of providing solid-waste management for a building complex serviced by a modular integrated utility system (MIUS) were explored. Literature surveys were conducted to investigate both conventional and unusual systems to serve this purpose. The advantages and disadvantages of the systems most compatible with MIUS are discussed.

  4. Role of Management Accounting in Accounting in General

    OpenAIRE

    Oleksandr Panadiy

    2015-01-01

    The article elucidates main scientific approaches to understanding of essence of management accounting. From scientific studies of domestic scientists it is concluded that most of them classify management accounting under competence of accounting in general. It is shown that the first institutional factors concomitant with division of general theory of accounting into financial and management components were development of forms of business and implementation of accounting standards and manua...

  5. Doctors as managers: moving towards general management? The case of unitary management reform in Norwegian hospitals.

    Science.gov (United States)

    Mo, Tone Opdahl

    2008-01-01

    The paper seeks to explore whether the development in department management in Norwegian hospitals after the unitary management reform in 2001 constitutes a development in the direction of general management. Interviews were conducted with ten managers from different levels in a large Norwegian university hospital in 2001-2002, as a unitary management model was implemented. There is an emerging change of practice among the physician managers according to this study. The manager function is more explicit and takes a more general responsibility for the department and the professions. However, the managerial function is substantiated by conditions related to the professional field of knowledge, which gives legitimacy within a medical logic. Contact with the clinic is stressed as important, but it is possible to adjust both amount and content of a clinical engagement to the demands of the new manager position. This has both a symbolic and a practical significance, as it involves both legitimacy and identity issues. The paper shows that the institutionalised medical understanding of management has a bearing on managerial reforms. Managerial changes need to relate to this if they are to have consequences for the managerial roles and structures on department level in hospitals. The paper suggests that the future development of this role will depend on the way the collectivist and individualist aspects of responsibility are handled, as well as on the further development of managerial knowledge of physicians.

  6. Interpretive Management: What General Managers Can Learn from Design.

    Science.gov (United States)

    Lester, Richard K.; Piore, Michael J.; Malek, Kamal M.

    1998-01-01

    An analytical management approach reflects a traditional perspective and an interpretive approach involves a perspective suited to rapidly changing, unpredictable markets. Both approaches are valid, but each serves different purposes and calls for different strategies and skills. (JOW)

  7. Interpretive Management: What General Managers Can Learn from Design.

    Science.gov (United States)

    Lester, Richard K.; Piore, Michael J.; Malek, Kamal M.

    1998-01-01

    An analytical management approach reflects a traditional perspective and an interpretive approach involves a perspective suited to rapidly changing, unpredictable markets. Both approaches are valid, but each serves different purposes and calls for different strategies and skills. (JOW)

  8. The transition to general management in South Africa

    Directory of Open Access Journals (Sweden)

    Stephen J. Mallaby

    2017-01-01

    Full Text Available Orientation: Understanding the nature and challenges of making the transition from a functional role to a general management role in South African organisations.Research purpose: The objective of this study was to gain insight into the obstacles that affect the transition from functional to general management and identify steps that may be taken to overcome these challenges.Motivation for the study: One of the most difficult crossroads for a manager is making the shift from being a functional specialist to becoming a general manager. New competencies and behaviours are required, as well as a more strategic mind set. If the transition is not made successfully, the manager and the organisation suffer.Research design, approach and method: A qualitative design was used consisting of in-depth, semi-structured interviews, with 19 senior business leaders who had successfully made the transition. The interviews were used to gather insights into the challenges they faced during their transitions, and how these were overcome.Main findings: To make the transition successfully, functional managers need to gain relevant experience to prepare them for the broader scope of a general management role. They need to develop appropriate skills, attitudes and personal characteristics. Mentoring is an effective development process. Newly appointed general managers need to learn to let go of control while maintaining ownership, build relationships and strike the right balance between strategic thinking and execution. There are unique aspects of being a general manager in South Africa, such as dealing with Black Economic Empowerment and challenges of race and identity, given the country’s history.Practical and managerial implications: Specific interventions are suggested which are directed at both aspiring general managers and organisations seeking to assist middle managers to make the transition to general managers.Contribution: This study contributes to knowledge

  9. Head injury management guidelines for general practitioners

    Directory of Open Access Journals (Sweden)

    Jeremy C Ganz

    2011-01-01

    Full Text Available A complete examination of a head injured patient in the hospital requires a number of instruments. These include a stethoscope, sphygmomanometer, ophthalmoscope, otoscope, cotton wool, safety pin, tuning fork, reflex hammer and a small key to test the plantar response. Few of these are required at the accident scene. This is because, in the hospital, the aim is optimal definitive treatment. At the accident scene, the aim is prevention of secondary injury, rapid recording of the most important findings and safe efficient transport to the hospital. This short paper reviews how the local doctor should undertake a neurosurgical assessment of traumatic brain injury patients. Moreover, the primary management at accident scenes is described and the rationale behind the approach is outlined

  10. Head injury management guidelines for general practitioners.

    Science.gov (United States)

    Ganz, Jeremy C

    2011-07-01

    A complete examination of a head injured patient in the hospital requires a number of instruments. These include a stethoscope, sphygmomanometer, ophthalmoscope, otoscope, cotton wool, safety pin, tuning fork, reflex hammer and a small key to test the plantar response. Few of these are required at the accident scene. This is because, in the hospital, the aim is optimal definitive treatment. At the accident scene, the aim is prevention of secondary injury, rapid recording of the most important findings and safe efficient transport to the hospital. This short paper reviews how the local doctor should undertake a neurosurgical assessment of traumatic brain injury patients. Moreover, the primary management at accident scenes is described and the rationale behind the approach is outlined.

  11. ASSURE-CSU : A real-world study of burden of disease in patients with symptomatic chronic spontaneous urticaria

    NARCIS (Netherlands)

    Weller, Karsten; Maurer, Marcus; Grattan, Clive; Nakonechna, Alla; Abuzakouk, Mohamed; Bérard, Frédéric; Sussman, Gordon; Giménez-Arnau, Ana M.; Ortiz De Frutos, Javier; Knulst, André; Canonica, G. Walter; Hollis, Kelly; McBride, Doreen; Balp, Maria Magdalena

    2015-01-01

    BACKGROUND: Chronic spontaneous urticaria (CSU) formerly known as chronic idiopathic urticaria (CIU) is a severe and distressing skin condition that remains uncontrolled in approximately one half of patients, despite the use of licensed, recommended doses of modern, second-generation H1-antihistamin

  12. Bureau of Land Management, General Land Office Records System

    Data.gov (United States)

    Bureau of Land Management, Department of the Interior — The General Land Office Records System (GLO) encompasses the automation and retrieval of eastern and western land title information images which includes patent...

  13. Generalized Nets for the Diagnosis and Management of Diabetic Nephropathy

    Directory of Open Access Journals (Sweden)

    Anthony Shannon

    2009-10-01

    Full Text Available This paper develops Generalized Nets for the diagnosis and management of diabetic nephropathy. The first net accounts for the development of nephropathy from an initial increase in glomerular filtration rates through mciroalbuminuria to end stage renal disease. The second net referes to the management of diabetes mellitus to increase the probability of preventing diabetic nephropathyor minimising its effects.

  14. Child health and general practitioners' management, 1987 - 2001.

    NARCIS (Netherlands)

    Otters, H.; Schellevis, F.

    2006-01-01

    This contribution compares the presentation and management of childhood morbidity (0-17 years) in general practice in 2001 with that in 1987. In the Netherlands, childhood morbidity presented to the general practitioner (GP) has changed: (infectious) skin problems have become more important. In 2001

  15. Smart management in effective schools : effective management configurations in general and vocational education in the Netherlands

    NARCIS (Netherlands)

    Hofman, W.H.A.; Hofman, R.H.

    2011-01-01

    Purpose: In this study the authors focus on different (configurations of) leadership or management styles in schools for general and vocational education. Findings: Using multilevel (students and schools) analyses, strong differences in effective management styles between schools with different stud

  16. Smart management in effective schools : effective management configurations in general and vocational education in the Netherlands

    NARCIS (Netherlands)

    Hofman, W.H.A.; Hofman, R.H.

    2011-01-01

    Purpose: In this study the authors focus on different (configurations of) leadership or management styles in schools for general and vocational education. Findings: Using multilevel (students and schools) analyses, strong differences in effective management styles between schools with different

  17. Managing high-risk patients: the Mass General care management programme

    OpenAIRE

    Dennis L. Kodner

    2015-01-01

    The Massachusetts General Care Management Program (Mass General CMP or CMP) was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS) beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each). It started during the first phase at Massachusett...

  18. Dental management of hemophiliac child under general anesthesia

    Directory of Open Access Journals (Sweden)

    R Rayen

    2011-01-01

    Full Text Available Hemophilia is the most common inherited bleeding disorder. Hemophilic patients should be cosidered as special patients. There is no contraindication to general dental treatment for hemophiliacs, as they generally do not involve bleeding. But caution must be used with any surgical procedures that involve the local and general anesthesia. Such patients should always be managed in the setting of specialized units with appropriate clinical expertise and laboratory support. Recent advances in the management of hemophilia have enabled many hemophiliac patients to receive surgical dental procedures in an outpatient dental care on a routine basis. The purpose of this case report is to provide a few management strategies when providing full mouth rehabilitation under anesthesia and replacement therapies that are available. In addition, overviews of possible complication that may be encountered when providing such treatment are discussed here.

  19. Airway management for cesarean delivery performed under general anesthesia.

    Science.gov (United States)

    Rajagopalan, S; Suresh, M; Clark, S L; Serratos, B; Chandrasekhar, S

    2017-02-01

    With the increasing popularity of neuraxial anesthesia, there has been a decline in the use of general anesthesia for cesarean delivery. We sought to examine the incidence, outcome and characteristics associated with a failed airway in patients undergoing cesarean delivery under general anesthesia. A retrospective review of airway management in women undergoing cesarean delivery under general anesthesia over an eight-year period from 2006-2013 at an academic medical center was conducted. During the study period, 10 077 cesarean deliveries were performed. Neuraxial anesthesia was used in 9382 (93%) women while general anesthesia was used in 695 (7%). Emergent cesarean delivery was the most common indication for general anesthesia. Failed intubation was encountered in only three (0.4%) women, who were successfully managed with a laryngeal mask airway. The overall incidence of failed intubation was 1 in 232 (95% CI 1:83 to 1:666) and general anesthesia was continued in all cases. There were no adverse maternal or fetal outcomes directly related to failed intubation. Advances in adjunct airway equipment, availability of an experienced anesthesiologist and simulation-based teaching of failed airway management in obstetrics may have contributed to our improved maternal outcomes in patients undergoing cesarean delivery under general anesthesia. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. The California State University Louis Stokes Alliance for Minority Participation (CSU-LSAMP): A Collaborative, Comprehensive Approach to Broadening Participation in STEM.

    Science.gov (United States)

    Hammersley, L. C.

    2016-12-01

    The National Science Foundation's Louis Stokes Alliances for Minority Participation (LSAMP) program supports alliances of institutions in their efforts to broaden participation in STEM and diversify the STEM workforce. There are currently 42 LSAMP alliances across the nation. Formed in 1993, the California State University LSAMP program (CSU-LSAMP) is an alliance of all 23 campuses of the CSU system and serves over 3,000 students per year. The primary goals of CSU-LSAMP are to increase persistence and graduation rates for URM participants, increase the number of STEM degrees awarded by the CSU to URM students, and increase the number of CSU-LSAMP students who advance to STEM graduate study. CSU-LSAMP activities are focused on four objectives - academic support (e.g. supplemental instruction & peer mentoring), support at transition points (e.g. first time freshmen & transfer students), research experiences (including international research experiences), and professional development (e.g. conference presentations & graduate school preparation activities). Financial support is offered in the form of textbook assistance, research stipends, and travel awards. We maintain a structure that allows campuses to tailor their programs to meet the needs of their own student populations but that also ties the Alliance together with a set of common activities, goals and policies. External evaluation of the program shows that our approach has been highly successful and can provide useful lessons for other programs focused on broadening participation. Since 1994, the number of URM students enrolled in STEM disciplines at CSU campuses has more than doubled and the number of STEM degrees to URM students has almost tripled. Persistence and graduation rates for URM students who participate in CSU-LSAMP are almost twice those of URM non-participants and equal to those of non-URM students. Of the students who participated in the past 15 years, 42 percent either earned a post

  1. 75 FR 38832 - Record of Decision for the General Management Plan for the Chattahoochee River National...

    Science.gov (United States)

    2010-07-06

    ... General Management Plan Environmental Impact Statement for the Chattahoochee River National Recreation...-- Continue Current Management; Alternative B, Focus on Solitude--implements management programs to minimize... General Management Plan for the Chattahoochee River National Recreation Area, GA AGENCY: National Park...

  2. General practitioners' management of the long-term sick role.

    Science.gov (United States)

    Higgins, Angela; Porter, Sam; O'Halloran, Peter

    2014-04-01

    In this paper, we use qualitative research techniques to examine the role of general practitioners in the management of the long-term sickness absence. In order to uncover the perspectives of all the main agents affected by the actions of general practitioners, a case study approach focussing on one particular employment sector, the public health service, is adopted. The role of family physicians is viewed from the perspectives of health service managers, occupational health physicians, employees/patients, and general practitioners. Our argument is theoretically framed by Talcott Parsons's model of the medical contribution to the sick role, along with subsequent conceptualisations of the social role and position of physicians. Sixty one semi-structured interviews and three focus group interviews were conducted in three Health and Social Care Trusts in Northern Ireland between 2010 and 2012. There was a consensus among respondents that general practitioners put far more weight on the preferences and needs of their patients than they did on the requirements of employing organisations. This was explained by respondents in terms of the propinquity and longevity of relationships between doctors and their patients, and by the ideology of holistic care and patient advocacy that general practitioners viewed as providing the foundations of their approach to patients. The approach of general practitioners was viewed negatively by managers and occupational health physicians, and more positively by general practitioners and patients. However, there is some evidence that general practitioners would be prepared to forfeit their role as validators of sick leave. Given the imperatives of both state and capital to reduce the financial burden of long-term sickness, this preparedness puts into doubt the continued role of general practitioners as gatekeepers to legitimate long-term sickness absence. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Municipal solid waste management problems: an applied general equilibrium analysis

    NARCIS (Netherlands)

    Bartelings, H.

    2003-01-01

    Keywords: Environmental policy; General equilibrium modeling; Negishi format; Waste management policies; Market distortions.

    About 40% of the entire budget spent on environmental problems in theNetherlan

  4. Municipal solid waste management problems: an applied general equilibrium analysis

    NARCIS (Netherlands)

    Bartelings, H.

    2003-01-01

    Keywords: Environmental policy; General equilibrium modeling; Negishi format; Waste management policies; Market distortions.

    About 40% of the entire budget spent on environmental problems in the

  5. Collaborative management of a young patient with generalized aggressive periodontitis.

    Science.gov (United States)

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

    2014-01-01

    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.

  6. General Review of Tinnitus Prevalence, Mechanisms, Effects, and Management

    Science.gov (United States)

    Henry, James A.; Dennis, Kyle C.; Schechter, Martin A.

    2005-01-01

    Tinnitus is an increasing health concern across all strata of the general population. Although an abundant amount of literature has addressed the many facets of tinnitus, wide-ranging differences in professional beliefs and attitudes persist concerning its clinical management. These differences are detrimental to tinnitus patients because the…

  7. The management of otitis externa in UK general practice.

    Science.gov (United States)

    Pabla, L; Jindal, M; Latif, K

    2012-03-01

    Acute otitis externa is common and provides a heavy workload for general practitioners. We aim to determine the first-line treatment used by general practitioners in the management of otitis externa and subsequent second-line treatment in a hospital ENT clinic. In addition, this study aims to ascertain whether local and national guidelines are being followed appropriately. A prospective observational study on the management of otitis externa in consecutive patients referred to an ENT emergency clinic was undertaken. Data were collected and analysed on symptoms, initial management by general practitioners, findings and treatment in the ENT clinic. A total of 106 patients were studied. The mean duration of symptoms before presentation to clinic was 13 days; 42% of patients received no treatment by their GP prior to referral to the ENT emergency clinic. Only 14% of patients received topical antibiotics alone, whilst 44% received oral antibiotics, either alone or in conjunction with topical antibiotics by their GP. Of the 106 patients, 86% received topical antibiotics in the ENT emergency clinic and oral antibiotics were reserved for those presenting with complicated acute otitis externa. Topical antibiotics are associated with a decrease in disease persistence, whilst oral antibiotics are associated with an increase. However, general practitioners are prescribing oral antibiotics more often than required. There are few regional guidelines and no explicit national guidelines on the management of acute otitis externa for GPs to refer to. We suggest the implementation of national guidelines to aid clinical practice.

  8. Managing high-risk patients: the Mass General care management programme

    Directory of Open Access Journals (Sweden)

    Dennis L Kodner

    2015-09-01

    Full Text Available The Massachusetts General Care Management Program (Mass General CMP or CMP was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each. It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO. The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a “whole systems” approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program

  9. Managing high-risk patients: the Mass General care management programme

    Directory of Open Access Journals (Sweden)

    Dennis L Kodner

    2015-09-01

    Full Text Available The Massachusetts General Care Management Program (Mass General CMP or CMP was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each. It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO. The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a “whole systems” approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program

  10. The new General Motors diesel engine management system; Die neue Dieselmotor-Steuerung von General Motors

    Energy Technology Data Exchange (ETDEWEB)

    Graglia, Riccardo; Catanese, Alessandro; Parisi, Filippo; Barbero, Simone [General Motors Powertrain Europe S.r.L., Turin (Italy)

    2011-02-15

    For more than ten years, General Motors has been developing ECUs for spark-ignition engines in-house. The company has now also developed an engine management system for diesel engines that offers such features as closed-loop injector control and integrated glow plug electronics. (orig.)

  11. Place of Budget Management in the General System of Trade Enterprise Management

    Directory of Open Access Journals (Sweden)

    Kravchenko Olena S.

    2014-01-01

    Full Text Available The article grounds urgency of identification of the place of budget management in the general system of trade enterprise management. It analyses points of view of economists with respect to definitions of the “budgeting” and “budget management” terms. It considers main functions of budget management. It identifies the place of budget management in the general system of enterprise management. Pursuant to definition of the budget management as a managerial technology, which should meet a number of requirements, which would be determined by specific features of enterprise practical activity, the article identifies its main principles. It groups principles of budget management in accordance with the functions it performs.

  12. Weight management in general practice: what do patients want?

    Science.gov (United States)

    Tan, Daisy; Zwar, Nicholas A; Dennis, Sarah M; Vagholkar, Sanjyot

    2006-07-17

    To explore patients' views of the role of general practitioners in weight management. Waiting-room questionnaire survey, including measurement of height, weight and waist circumference, May-August 2005. 227 patients from five general practices located in metropolitan and rural New South Wales. Patients' views on: the role of GPs in weight management; the usefulness of weight-loss strategies; and the likelihood of following the GP's advice about weight loss. Most patients (78%) felt that GPs had a role in weight management, but only 46% thought that GPs would be able to spend enough time to provide effective weight loss advice. Over 80% of patients perceived advice on healthy eating and physical activity to be useful or very useful, and were likely to follow weight-loss recommendations; 78% were in favour of regular review. Patients indicated they would be less likely to see a dietitian or to attend information sessions, and unlikely to take weight-loss medication. Views of overweight and obese patients were generally similar to those of normal weight patients, but there were significant differences in perceptions of the usefulness of information on weight and weight-related medical conditions, as well as willingness to change lifestyle, possibly reflecting resistance to change among obese or overweight patients. These findings have implications for the design of primary care interventions for managing obesity.

  13. Stakeholders Involvement in Performance Management in Public General Schools

    Directory of Open Access Journals (Sweden)

    Kristi Ploom

    2013-01-01

    Full Text Available In response to increasing concerns with the legitimacy and efficiency of public spending, performance management as a part of world-wide public sector reform, called New Public Management (NPM has taken place. This is also the case of educational sector. In Estonian education system, legislation formally enables to design an integrated performance management system. But there is few research done to investigate how these policies and regulations ought to be put into force in order to gain the benefits considering the schools' and pupils' better performance. This study investigates how different stakeholders are involved into the performance management in Estonian general schools. The study is based on empirical survey data gathered from 303 schools providing secondary education in Estonia. The research findings have three main implications. Firstly, the paper contributes to the scarce knowledge about implementation of performance management issues in public schools. Our analysis revealed that compilation of school development plans in Estonian schools is rather a formal obligation. Therefore we propose that the analysis and discussion of the school development plans is needed to organize on regional level, involving all main stakeholders of a school. Secondly, we suggest that in the circumstances of a decentralised education system, like in Estonia, it is needed to implement, central practical performance assessment principles and guidance for the schools. Thirdly, it is highly necessary to improve schools’ cooperation with different stakeholder groups. Also the framework involving different stakeholder groups in the decentralized schools management system should be built up.

  14. Leadership and management curriculum planning for Iranian general practitioners

    Directory of Open Access Journals (Sweden)

    SHAHLA KHOSRAVAN

    2015-10-01

    Full Text Available Introduction: Leadership and management are two expected features and competencies for general practitioners (GPs. The purpose of this study was leadership and management curriculum planning for GPs which was performed based on Kern’s curriculum planning cycle. Methods: This study was conducted in 2011-2012 in Iran using an explanatory mixed-methods approach. It was conducted through an initial qualitative phase using two focus group discussions and 28 semi-structured interviews with key informants to capture their experiences and viewpoints about the necessity of management courses for undergraduate medical students, goals, objectives, and educational strategies according to Kern’s curriculum planning cycle. The data was used to develop a questionnaire to be used in a quantitative written survey. Results of these two phases and that of the review of medical curriculum in other countries and management curriculum of other medical disciplines in Iran were used in management and leadership curriculum planning. In the qualitative phase, purposeful sampling and content analysis with constant comparison based on Strauss and Corbin’s method were used; descriptive and analytic tests were used for quantitative data by SPSS version 14. Results: In the qualitatively stage of this research, 6 main categories including the necessity of management course, features and objectives of management curriculum, proper educational setting, educational methods and strategies, evolutionary method and feedback result were determined. In the quantitatively stage of the research, from the viewpoints of 51.6% of 126 units of research who filled out the questionnaire, ranked high necessary of management courses. The coordination of care and clinical leadership was determined as the most important role for GPs with a mean of 6.2 from sample viewpoint. Also, team working and group dynamics had the first priority related to the principles and basics of management with a

  15. Chinese hotel general managers' perspectives on energy-saving practices

    Science.gov (United States)

    Zhu, Yidan

    As hotels' concern about sustainability and budget-control is growing steadily, energy-saving issues have become one of the important management concerns hospitality industry face. By executing proper energy-saving practices, previous scholars believed that hotel operation costs can decrease dramatically. Moreover, they believed that conducting energy-saving practices may eventually help the hotel to gain other benefits such as an improved reputation and stronger competitive advantage. The energy-saving issue also has become a critical management problem for the hotel industry in China. Previous research has not investigated energy-saving in China's hotel segment. To achieve a better understanding of the importance of energy-saving, this document attempts to present some insights into China's energy-saving practices in the tourist accommodations sector. Results of the study show the Chinese general managers' attitudes toward energy-saving issues and the differences among the diverse hotel managers who responded to the study. Study results indicate that in China, most of the hotels' energy bills decrease due to the implementation of energy-saving equipments. General managers of hotels in operation for a shorter period of time are typically responsible for making decisions about energy-saving issues; older hotels are used to choosing corporate level concerning to this issue. Larger Chinese hotels generally have official energy-saving usage training sessions for employees, but smaller Chinese hotels sometimes overlook the importance of employee training. The study also found that for the Chinese hospitality industry, energy-saving practices related to electricity are the most efficient and common way to save energy, but older hotels also should pay attention to other ways of saving energy such as water conservation or heating/cooling system.

  16. Smart Management in Effective Schools: Effective Management Configurations in General and Vocational Education in the Netherlands

    Science.gov (United States)

    Hofman, W. H. Adriaan; Hofman, Roelande H.

    2011-01-01

    Purpose: In this study the authors focus on different (configurations of) leadership or management styles in schools for general and vocational education. Findings: Using multilevel (students and schools) analyses, strong differences in effective management styles between schools with different student populations were observed. Conclusions: The…

  17. 77 FR 14568 - Environmental Impact Statement for Proposed General Management Plan, Pinnacles National Monument...

    Science.gov (United States)

    2012-03-12

    ... analysis for this general management planning effort. SUPPLEMENTARY INFORMATION: This new GMP will update... planning process to date, the NPS planning team developed four preliminary alternatives for the management... National Park Service Environmental Impact Statement for Proposed General Management Plan,...

  18. Controversies and challenges in the management of chronic urticaria.

    Science.gov (United States)

    Staubach, P; Zuberbier, T; Vestergaard, C; Siebenhaar, F; Toubi, E; Sussman, G

    2016-07-01

    This supplement reports proceedings of the second international Global Urticaria Forum, which was held in Berlin, Germany in November 2015. Despite the clear international guideline, there remain a number of controversies and challenges in the management of patients with chronic urticaria (CU). As a result of major advancements in urticaria over the past 4 years, the current EAACI/GA(2) LEN/EDF/WAO urticaria guideline treatment algorithm requires updating. Case studies from patients with chronic spontaneous urticaria (CSU) [also called chronic idiopathic urticaria (CIU)], chronic inducible urticaria (CIndU) or diseases and syndromes related to CU are useful in describing and exploring challenges in disease management. Case studies of specific CSU patient populations such as children with CU or patients with angio-edema but no hives also require consideration as potentially challenging groups with unmet needs. The current EAACI/GA(2) LEN/EDF/WAO urticaria guideline provides a general framework for the management of patients with CU but, as these cases highlight, a personalized approach based on the expert knowledge of the physician may be required. © 2016 European Academy of Dermatology and Venereology.

  19. Management of erectile dysfunction: barriers faced by general practitioners

    Institute of Scientific and Technical Information of China (English)

    Wah-YunLow; Chirk-JennNg; Ngiap-ChuanTan; Wan-YuenChoo; Hui-MengTan

    2004-01-01

    Aim: To explore the barriers faced by general practitioners (GPs) in the management of patients with erectile dysfunction (ED). Methods: This was a qualitative analysis of focus group discussions and in-depth interviews involving 28 Malaysian GPs. Results: GPs' perception of ED being not a serious condition was a major determinant of their prescribing practice. Doctor's age (younger), gender (female), short consultation time and lack of experience were cited as barriers. The GPs' prescribing habits were heavily influenced by the feedback from the first few patients under treatment, the uncertainty of etiology of ED without proper assessment and the profit margin with bulk purchase. Other barriers include Patients' coexisting medical conditions, older age, lower socio-economic status, unrealistic expectations and inappropriate use of the anti-impoteneet drugs. Cardiovascular side effects and cost were two most important drug barriers. Conclusion: The factors influencing the management of ED among the general practitioners were multiple and complex. An adequate understanding of how these factors (doctors, patientsand drugs) interact can assist in the formulation and implementation of strategies that encourage GPs to identify and manage ED patients.

  20. DRUG MANAGEMENT REVIEWS IN DISTRICT DRUG MANAGEMENT UNIT AND GENERAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Max Joseph Herman

    2009-12-01

    Full Text Available Drug is one of the essential elements in healthcare that should be effectively and efficiently managed. Following thedecentralization in 2001 in Indonesia, drug management has changed in district drug management units and also in District General Hospitals. Certainly this condition influences the sustainability of drug access in primary health care such as in Community Health Center and District General Hospital, especially in drug financing policy. A cross sectional descriptive study to obtain information on drug management in public healthcare in district had been carried out between July and December 2006 in 10 District Public Drug Management Units from 10 district health offices and 9 district general hospitals as samples. Data were collected by interviewing heads of Drug Section in District Health Offices and heads of Hospital Pharmacies using structured questionnaires and observing drug storage in District Drug Management Units, Community Health Centers, and Hospital Pharmacies. Results of the study show that drug planning in District Health Offices and General Hospitals did not meet the basic real need in some districts nor District Hospitals. The minimum health service standards had no been achieved yet. Furthermore, drug procurement, storage and recording as well as reporting was not good enough either, such as shown by the existence of expired drugs. Lead time for drug delivery to community health centers in some districts was longer than the average of lead time in the past 3 years.

  1. General review of tinnitus: prevalence, mechanisms, effects, and management.

    Science.gov (United States)

    Henry, James A; Dennis, Kyle C; Schechter, Martin A

    2005-10-01

    Tinnitus is an increasing health concern across all strata of the general population. Although an abundant amount of literature has addressed the many facets of tinnitus, wide-ranging differences in professional beliefs and attitudes persist concerning its clinical management. These differences are detrimental to tinnitus patients because the management they receive is based primarily on individual opinion (which can be biased) rather than on medical consensus. It is thus vitally important for the tinnitus professional community to work together to achieve consensus. To that end, this article provides a broad-based review of what is presently known about tinnitus, including prevalence, associated factors, theories of pathophysiology, psychological effects, effects on disability and handicap, workers' compensation issues, clinical assessment, and various forms of treatment. This summary of fundamental information has relevance to both clinical and research arenas.

  2. Informatics application for a general file management; Aplicacion informatica para la gestion de un registro general

    Energy Technology Data Exchange (ETDEWEB)

    Botija, L.

    1988-07-01

    It makes easier the mechanization of a General Fill for a great Center as it allows the management, storage, maintenance and retrieval of all the circulating documents, involving any unit or section, to be considered officially or not. Shortly, it is a system which makes possible the inclusion, within the same Data Base, of references to official and unofficial documents of different classes, as well as document associated with them, under a number of registration correlative for each document and originated by the application. (Author)

  3. General business model patterns for Local Energy Management concepts

    Directory of Open Access Journals (Sweden)

    Emanuele eFacchinetti

    2016-03-01

    Full Text Available The transition towards a more sustainable global energy system, significantly relying on renewable energies and decentralized energy systems, requires a deep reorganization of the energy sector. The way how energy services are generated, delivered and traded is expected to be very different in the coming years. Business model innovation is recognized as a key driver for the successful implementation of the energy turnaround. This work contributes to this topic by introducing a heuristic methodology easing the identification of general business model patterns best suited for Local Energy Management concepts such as Energy Hubs. A conceptual framework characterizing the Local Energy Management business model solution space is developed. Three reference business model patterns providing orientation across the defined solution space are identified, analyzed and compared. Through a market review a number of successfully implemented innovative business models have been analyzed and allocated within the defined solution space. The outcomes of this work offer to potential stakeholders a starting point and guidelines for the business model innovation process, as well as insights for policy makers on challenges and opportunities related to Local Energy Management concepts.

  4. Management of acute rhinosinusitis in Danish general practice: a survey

    Directory of Open Access Journals (Sweden)

    Hansen JG

    2011-07-01

    Full Text Available Jens Georg HansenDepartment of Clinical Epidemiology, Aarhus University Hospital and Aalborg Hospital, Aalborg, DenmarkPurpose: To evaluate whether the ongoing debate over diagnostic problems and treatment choices for acute rhinosinusitis has had any influence on the management of the disease.Methods: We randomly selected 300 Danish general practitioners (GPs from the files of the Research Unit for General Practice at Aarhus University. Invitations to participate and a questionnaire were sent to the GPs by mail.Results: A total of 149 (49% GPs answered the questionnaire. When asked about symptoms, the highest priority was given to sinus pain and signs of tenderness. The most frequent examinations were objective examination of the ear-nose-throat (ENT, palpation of the maxillofacial area, and C-reactive protein point-of-care testing (or CRP rapid test. Nearly all GPs prescribed local vasoconstrictors, and in 70% of cases, antibiotics were prescribed. Phenoxymethylpenicillin was the preferred antibiotic. Use of the CRP rapid test, years in practice, or employment in an ENT department did not have a significant impact on the diagnostic certainty and antibiotic prescribing rate.Conclusion: The clinical diagnoses are based on a few symptoms, signs, and the CRP rapid test. Other examinations, including imaging techniques, are seldom used. Phenoxymethylpenicillin is the preferred antibiotic, and the GPs' diagnostic certainty was 70%.Keywords: general practice, acute rhinosinusitis, diagnosis, treatment, antibiotic

  5. The compatibility of general managers' activities and intentions in managing change in the NHS.

    Science.gov (United States)

    Spurgeon, P; Barwell, F

    1990-03-01

    As Hales (1986) has observed, the problem of much of the managerial research to date has been the reluctance to ask why managers behave in the way they do. The behaviour of general managers in tackling organisational change in the NHS needs to be viewed not only with respect to what is done but also with respect to how personal and organisational objectives are construed. In other words, the implementation of organisational change ultimately rests on how general managers perceive the nature of this change and their role in structuring their own personal and organisational objectives into appropriate activities. Examining the compatibility of managerial activities and the underlying values and intentions which support them is of critical importance in any cognitively-based approach. These intentions provide an important link between perceptions (i.e. how the organisation is construed) and behaviour (i.e. what activities managers choose to perform). Understanding the conceptual frameworks which underpin managerial activities could have profound implications for assessing the performance of general managers.

  6. 75 FR 27812 - Final Environmental Impact Statement for the General Management Plan; Harpers Ferry National...

    Science.gov (United States)

    2010-05-18

    ... Statement for the General Management Plan; Harpers Ferry National Historical Park AGENCY: National Park... Statement for the General Management Plan for Harpers Ferry National Historical Park. SUMMARY: Pursuant to... Harpers Ferry [[Page 27813

  7. Nurses in Australian general practice: implications for chronic disease management.

    Science.gov (United States)

    Halcomb, Elizabeth J; Davidson, Patricia M; Salamonson, Yenna; Ollerton, Richard; Griffiths, Rhonda

    2008-03-01

    The purpose of this study was to describe the demographic and employment characteristics of Australian practice nurses and explore the relationship between these characteristics and the nurses' role. Nursing in general practice is an integral component of primary care and chronic disease management in the United Kingdom and New Zealand, but in Australia it is an emerging specialty and there is limited data on the workforce and role. National postal survey embedded in a sequential mixed method design. 284 practice nurses completed a postal survey during 2003-2004. Descriptive statistics and factor analysis were utilized to analyse the data. Most participants were female (99%), Registered Nurses (86%), employed part-time in a group practice, with a mean age of 45.8 years, and had a hospital nursing certificate as their highest qualification (63%). The tasks currently undertaken by participants and those requiring further education were inversely related (R2 = -0.779). Conversely, tasks perceived to be appropriate for a practice nurse and those currently undertaken by participants were positively related (R2 = 0.8996). There was a mismatch between the number of participants who perceived that a particular task was appropriate and those who undertook the task. This disparity was not completely explained by demographic or employment characteristics. Extrinsic factors such as legal and funding issues, lack of space and general practitioner attitudes were identified as barriers to role expansion. Practice nurses are a clinically experienced workforce whose skills are not optimally harnessed to improve the care of the growing number of people with chronic and complex conditions. Relevance to clinical practice. Study data reveal a need to overcome the funding, regulatory and interprofessional barriers that currently constrain the practice nurse role. Expansion of the practice nurse role is clearly a useful adjunct to specialist management of chronic and complex disease

  8. Promising synergies of simulation model management, software engineering, artificial intelligence, and general system theories

    Energy Technology Data Exchange (ETDEWEB)

    Oren, T.I.

    1982-01-01

    Simulation is viewed within the model management paradigm. Major components of simulation systems as well as elements of model management are outlined. Possible synergies of simulation model management, software engineering, artificial intelligence, and general system theories are systematized. 21 references.

  9. Toward generalized decision support systems for flood risk management

    Directory of Open Access Journals (Sweden)

    Muste Marian V.

    2016-01-01

    Full Text Available Despite the emergence of a large number of specialized decision-support systems (DSS in the last decades, currently there are fewer efforts made for integrating the flood risk management relevant sciences with information and communication technologies into generalized DSS. Such systems are expected to formulate decision options for prevention, mitigation, preparation, response, and recovery from flood impacts with consideration of climate change, socio-economic evolution, and stakeholders’ input. Currently, there is no unified vision on the architecture, components, and the needed computer and communications technologies for attaining generic DSS for flood mitigation and resilience. Moreover, there is no guidance of what components should be developed first and in what order and how to efficiently include human-computer interfaces for efficient stakeholder engagement and consensus. This paper calls for the formation of a strategic global partnership for framing and subsequently assisting in the development of a generalized flood DSS (FLOODSS that can overcome the current flood DSS limitations. The call is preceded by a review of the flood decision-support terminology and context. Subsequently, an initial vision on the FLOODSS is outlined and the steps for transitioning such a system from vision to practice are proposed.

  10. A Report Card on Latina/o Leadership in California's Public Universities: A Trend Analysis of Faculty, Students, and Executives in the CSU and UC Systems

    Science.gov (United States)

    Santos, Jose L.; Acevedo-Gil, Nancy

    2013-01-01

    The article examines the status of leadership in two California public higher education systems: California State University (CSU) and the University of California (UC) from 2001 to 2009. Findings reveal that the representation of Latina/o faculty and administrators does not reflect the density in the Latina/o undergraduate student and general…

  11. General overview of the disaster management framework in Cameroon.

    Science.gov (United States)

    Bang, Henry Ngenyam

    2014-07-01

    Efficient and effective disaster management will prevent many hazardous events from becoming disasters. This paper constitutes the most comprehensive document on the natural disaster management framework of Cameroon. It reviews critically disaster management in Cameroon, examining the various legislative, institutional, and administrative frameworks that help to facilitate the process. Furthermore, it illuminates the vital role that disaster managers at the national, regional, and local level play to ease the process. Using empirical data, the study analyses the efficiency and effectiveness of the actions of disaster managers. Its findings reveal inadequate disaster management policies, poor coordination between disaster management institutions at the national level, the lack of trained disaster managers, a skewed disaster management system, and a top-down hierarchical structure within Cameroon's disaster management framework. By scrutinising the disaster management framework of the country, policy recommendations based on the research findings are made on the institutional and administrative frameworks.

  12. Assessment, design and control strategy development of a fuel cell hybrid electric vehicle for CSU's EcoCAR

    Science.gov (United States)

    Fox, Matthew D.

    Advanced automotive technology assessment and powertrain design are increasingly performed through modeling, simulation, and optimization. But technology assessments usually target many competing criteria making any individual optimization challenging and arbitrary. Further, independent design simulations and optimizations take considerable time to execute, and design constraints and objectives change throughout the design process. Changes in design considerations usually require re-processing of simulations and more time. In this thesis, these challenges are confronted through CSU's participation in the EcoCAR2 hybrid vehicle design competition. The complexity of the competition's design objectives leveraged development of a decision support system tool to aid in multi-criteria decision making across technologies and to perform powertrain optimization. To make the decision support system interactive, and bypass the problem of long simulation times, a new approach was taken. The result of this research is CSU's architecture selection and component sizing, which optimizes a composite objective function representing the competition score. The selected architecture is an electric vehicle with an onboard range extending hydrogen fuel cell system. The vehicle has a 145kW traction motor, 18.9kWh of lithium ion battery, a 15kW fuel cell system, and 5kg of hydrogen storage capacity. Finally, a control strategy was developed that improves the vehicles performance throughout the driving range under variable driving conditions. In conclusion, the design process used in this research is reviewed and evaluated against other common design methodologies. I conclude, through the highlighted case studies, that the approach is more comprehensive than other popular design methodologies and is likely to lead to a higher quality product. The upfront modeling work and decision support system formulation will pay off in superior and timely knowledge transfer and more informed design

  13. Management of general surgical problems after cardiac transplantation.

    Science.gov (United States)

    Jones, M T; Menkis, A H; Kostuk, W J; McKenzie, F N

    1988-07-01

    Over a 6-year period at the University Hospital in London, Ont., 101 patients underwent heart transplantation and 5 heart-lung transplantation. The authors review the general surgical problems identified from the charts of 13 of these patients. In the early postoperative period (within 30 days), laparotomy was required for pancreatitis (one), perforated peptic ulcer (two), cholecystectomy (one), pancreatic cyst (one) and appendicitis (one). In addition, a spontaneous colocutaneous fistula and spontaneous pneumoperitoneum occurred; both were managed conservatively. Later, three patients required cholecystectomy; one underwent a below-knee and a Symes amputation for dry gangrene and one surgical correction of a lymphocele. The incidence of surgical problems (13%) indicates an increased susceptibility in this group of patients. Four of the 13 patients died. Pancreatitis is a well-recognized complication of cardiac surgery; it is frequently associated with a normal or only slightly elevated serum amylase level, making a definitive diagnosis without laparotomy almost impossible. Persistence of abdominal signs should signal the need for exploratory surgery. During the early postoperative period and in the absence of multiorgan failure, immediate operation for an acute abdomen is usually successful. Despite the additional risk, cardiac transplantation does not preclude later surgery, but immunosuppression must be continued and carefully monitored.

  14. A generalization information management system applied to electrical distribution

    Energy Technology Data Exchange (ETDEWEB)

    Geisler, K.I.; Neumann, S.A.; Nielsen, T.D.; Bower, P.K. (Empros Systems International (US)); Hughes, B.A.

    1990-07-01

    This article presents a system solution approach that meets the requirements being imposed by industry trends and the electric utility customer. Specifically, the solution addresses electric distribution management systems. Electrical distribution management is a particularly well suited area of application because it involves a high diversity of tasks, which are currently supported by a proliferation of automated islands. Islands of automation which currently exist include (among others) distribution operations, load management, automated mapping, facility management, work order processing, and planning.

  15. 77 FR 12877 - Record of Decision for the General Management Plan/Abbreviated Final Environmental Impact...

    Science.gov (United States)

    2012-03-02

    ... National Park Service Record of Decision for the General Management Plan/Abbreviated Final Environmental... Management Plan for New River Gorge National River, West Virginia. The Record of Decision selects the... the Record of Decision selecting Alternative 5 as the approved General Management Plan for New River...

  16. 24 CFR 990.310 - Purpose-General policy on financial management, monitoring and reporting.

    Science.gov (United States)

    2010-04-01

    ... Management Systems, Monitoring, and Reporting § 990.310 Purpose—General policy on financial management, monitoring and reporting. All PHA financial management systems, reporting, and monitoring of program... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Purpose-General policy on...

  17. 76 FR 51395 - Draft Environmental Impact Statement for the General Management Plan (DEIS/GMP), Canaveral...

    Science.gov (United States)

    2011-08-18

    ... National Park Service Draft Environmental Impact Statement for the General Management Plan (DEIS/GMP... Draft Environmental Impact Statement for the General Management Plan (DEIS/GMP), Canaveral National...-Action Alternative that continues current management policies and the NPS's preferred alternative. The...

  18. 77 FR 12323 - Draft Environmental Impact Statement for the General Management Plan, Buck Island Reef National...

    Science.gov (United States)

    2012-02-29

    ... National Park Service Draft Environmental Impact Statement for the General Management Plan, Buck Island... Availability of a Draft Environmental Impact Statement for the General Management Plan (DEIS/GMP), Buck Island... alternatives for consideration, including a No-Action Alternative that continues current management policies...

  19. 78 FR 68469 - Draft General Management Plan/Wilderness Study/Environmental Impact Statement, Channel Islands...

    Science.gov (United States)

    2013-11-14

    ... National Park Service Draft General Management Plan/Wilderness Study/Environmental Impact Statement... availability of a Draft General Management Plan (GMP)/Wilderness Study/Environmental Impact Statement (EIS) for... action alternative) reflects current management direction and serves as a baseline for comparison with...

  20. Dutch general practitioners’ weight management policy for overweight and obese patients.

    NARCIS (Netherlands)

    Kloek, C.J.J.; Tol, J.; Veenhof, C.; Wulp, I. van der; Swinkels, I.C.S.

    2014-01-01

    Background: General practitioners (GPs) can play an important role in both the prevention and management of overweight and obesity. Current general practice guidelines in the Netherlands allow room for GPs to execute their own weight management policy. Objective: To examine GPs’ current weight manag

  1. 41 CFR 105-1.101 - General Services Administration Property Management Regulations.

    Science.gov (United States)

    2010-07-01

    ...-INTRODUCTION 1.1-Regulations System § 105-1.101 General Services Administration Property Management Regulations... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false General Services Administration Property Management Regulations. 105-1.101 Section 105-1.101 Public Contracts and Property...

  2. 75 FR 1802 - Termination of the Environmental Impact Statement for the General Management Plan, Gila Cliff...

    Science.gov (United States)

    2010-01-13

    ... heritage by providing a more unified management approach to the two units of the monument. --Alternative 4... National Park Service Termination of the Environmental Impact Statement for the General Management Plan.... ACTION: Notice of termination of the Environmental Impact Statement for the General Management Plan,...

  3. Public Governance Principles in General Education School Management of Latvia

    OpenAIRE

    Rečs, Normunds

    2015-01-01

    In contemporary world the effect of globalisation and information technologies cause transformational processes of states` public management that promote the application of new managament approaches and principles in public institution management.The changes in the public managament have effected and still effects processes of management also in education. The increase of school autonomy, a stronger focus on the process of education and its results created the need to expand the application o...

  4. 78 FR 29245 - U.S. General Services Administration Federal Property Management Regulations; Administrative Wage...

    Science.gov (United States)

    2013-05-20

    ... Administration Federal Property Management Regulations; Administrative Wage Garnishment AGENCY: Office of the... amending the U.S. General Services Administration Property Management Regulation (GSPMR) to remove... telephone number. The Administrative Wage Garnishment Code of Federal Regulations (CFR) Parts affected...

  5. Adsorption Mechanism of Collector CSU-Y on Surface of Calcium Molybdate%捕收剂CSU-Y在钼酸钙表面的吸附机理研究

    Institute of Scientific and Technical Information of China (English)

    刘建东; 王振; 刘润清; 孙伟; 胡岳华

    2015-01-01

    To avoid problems such as low recovery, resource loss and environmental pollution generated during the flotation of calcium molybdate in Ni-Mo ore, open-circuit and closed-circuit tests were carried out to treat flotation tailings of sulfide minerals based on the mineralogical analysis, and a flotation process for oxidized molybdenum ore was proposed while the method of molecular dynamics simulation was introduced to study the absorption behavior of the collector on calcium molybdate and pyrite. The results show that, the primary molybdenum mineral in sulfide mineral flotation tailings is calcium molybdate, while the main gangues are fluorapatite and pyrite. The closed-circuit flotation test resulted in a concentrate grading 3.24% Mo and 3.37% Ni with corresponding recoveries of 69.15% and 62.44%. Collector CSU-Y can be easily absorbed on (111) surface of calcium molybdate, while hardly on (010) plane of apatite and (110) plane of pyrite, through which an efficient flotation separation of calcium molybdate and gangues in tailings can be attained.%针对镍钼矿中钼酸钙浮选回收率低、丢弃造成资源浪费和环境污染等问题,在工艺矿物学研究基础上,对镍钼矿中硫化矿物浮选尾矿进行了开路实验和闭路实验,设计了氧化钼浮选流程,并利用分子动力学模拟研究了捕收剂分子在矿物解离面的吸附过程,结果表明:镍钼矿中硫化矿物浮选尾矿主要含钼矿物为钼酸钙,脉石矿物主要为氟磷灰石和黄铁矿;通过闭路浮选试验得到了Mo品位3.24%、Ni品位3.37%、Mo回收率69.15%、Ni回收率62.44%的精矿;捕收剂油酸分子在钼酸钙(111)面吸附强于氟磷灰石(010)面和黄铁矿( 110)面,从而实现了浮选过程中钼酸钙和脉石矿物的分离,说明捕收剂CSU-Y可浮选分离钼酸钙和脉石矿物.

  6. General principles for integrating geoheritage conservation in protected area management

    Science.gov (United States)

    Gordon, John E.; Crofts, Roger

    2015-04-01

    Development of more integrated approaches to the management of protected areas requires not only the protection of geosites, but also the effective application of geoconservation principles that apply more widely to the sustainable management of natural systems. Key guiding principles include: working with natural processes; managing natural systems and processes in a spatially integrated manner; accepting the inevitability of natural change; considering the responses of geomorphological processes to the effects of global climate change; recognising the sensitivity of natural systems and managing them within the limits of their capacity to absorb change; basing conservation management of active systems on a sound understanding of the underlying physical processes; making provision for managing visitors at sensitive sites; and acknowledging the interdependency of geodiversity and biodiversity management. As well as recognising the value of geoheritage in its own right, a more integrated approach to conservation across the full range of IUCN Protected Area Management Categories would benefit both biodiversity and geodiversity, through application of the concept of 'conserving nature's stage' and adopting an ecosystem approach.

  7. CLOUDCLOUD : general-purpose instrument monitoring and data managing software

    Science.gov (United States)

    Dias, António; Amorim, António; Tomé, António

    2016-04-01

    An effective experiment is dependent on the ability to store and deliver data and information to all participant parties regardless of their degree of involvement in the specific parts that make the experiment a whole. Having fast, efficient and ubiquitous access to data will increase visibility and discussion, such that the outcome will have already been reviewed several times, strengthening the conclusions. The CLOUD project aims at providing users with a general purpose data acquisition, management and instrument monitoring platform that is fast, easy to use, lightweight and accessible to all participants of an experiment. This work is now implemented in the CLOUD experiment at CERN and will be fully integrated with the experiment as of 2016. Despite being used in an experiment of the scale of CLOUD, this software can also be used in any size of experiment or monitoring station, from single computers to large networks of computers to monitor any sort of instrument output without influencing the individual instrument's DAQ. Instrument data and meta data is stored and accessed via a specially designed database architecture and any type of instrument output is accepted using our continuously growing parsing application. Multiple databases can be used to separate different data taking periods or a single database can be used if for instance an experiment is continuous. A simple web-based application gives the user total control over the monitored instruments and their data, allowing data visualization and download, upload of processed data and the ability to edit existing instruments or add new instruments to the experiment. When in a network, new computers are immediately recognized and added to the system and are able to monitor instruments connected to them. Automatic computer integration is achieved by a locally running python-based parsing agent that communicates with a main server application guaranteeing that all instruments assigned to that computer are

  8. Scheduled asthma management in general practice generally improve asthma control in those who attend

    DEFF Research Database (Denmark)

    Backer, Vibeke; Bornemann, Maja; Knudsen, Anja Dorte Brandt;

    2012-01-01

    Successful asthma management involves guideline-based treatment and regular follow-up. We aimed to study the level of disease control in asthmatic individuals managed by their GP and a dedicated nurse when using a systematic asthma consultation guide based on Global Initiative of Asthma guideline...

  9. General Aspects Regarding the Management Activity in International Business

    OpenAIRE

    Mihaela Loredana LĂPĂDUŞI; CARUNTU CONSTANTIN

    2010-01-01

    The strategy of penetrating and developing the external markets is an important objective of the international enterprises management. This involves a specific analysis of the business environment for illustrating the opportunities of business and risks and the business potential of a particular enterprise in order to establish the internalisation objectives and types. The international management is individualised by the environment where the enterprises develop their...

  10. Waste management in Germany: general overview; Gestion de residuos en Alemania: perspectiva general

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt-Tegge, J.; Joachim Wuttke

    1997-04-01

    The Federal Republic of Germany is a highly industrialized country in which almost all technologies and processes know are being operated. Therefore, many kinds of wastes are generated and have to be handled in the waste management system. (Author)

  11. Dutch general practitioners’ weight management policy for overweight and obese patients.

    NARCIS (Netherlands)

    Kloek, C.J.J.; Tol, J.; Veenhof, C.; Wulp, I. van der; Swinkels, I.C.S.

    2014-01-01

    Background: General practitioners (GPs) can play an important role in both the prevention and management of overweight and obesity. Current general practice guidelines in the Netherlands allow room for GPs to execute their own weight management policy. Objective: To examine GPs’ current weight

  12. 77 FR 30320 - General Management Plan/Environmental Impact Statement, Ross Lake National Recreation Area, North...

    Science.gov (United States)

    2012-05-22

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service General Management Plan/Environmental Impact Statement, Ross Lake National Recreation... the Final Environmental Impact Statement for the new General Management Plan (GMP) for Ross...

  13. Management and marketing for the general practice dental office.

    Science.gov (United States)

    Clarkson, Earl; Bhatia, Sanjeev

    2008-07-01

    This article reviews trends in the dental marketplace. Marketing is an essential element of dentistry. Communicating treatment options with patients is one aspect of marketing. Treatment planning helps patients understand the relationships between oral health, occlusion, temporomandibular joint function, and systemic health. Through marketing, dental practice owners inform patients of ever-changing treatment modalities. Understanding treatment options allows patients to make better, informed choices. More options leads to a higher level of care and more comprehensive dental treatment. Managing a practice requires tracking its financial health. Economic statistics measure the effect of management decisions that mark the direction of a dental practice.

  14. How Agile Methods Conquers General Project Management - The Project Half Double Initiative

    DEFF Research Database (Denmark)

    Tordrup Heeager, Lise; Svejvig, Per; Schlichter, Bjarne Rerup

    2016-01-01

    Increased complexity in projects has forced new project management initiatives. In software development several agile methods have emerged and methods such as Scrum are today highly implemented in practice. General project management practice has been inspired by agile software development....... But in order to fully understand and to provide suggestions for future practice on how agility can be incorporated in general project management, this paper addresses how agile methods have inspired general project management practices. To answer the research question, the paper provides an analysis which...... compares ten characteristics of agile software development (identified in theory) and the general project management method developed by the Danish Project Half Double (PHD) initiative. The method consists of 10 leading stars for rethinking project management the impact, flow and leadership (ILF) method...

  15. Leadership and management skills of general practice nurses: experience or education?

    Science.gov (United States)

    Lau, Rosalind; Cross, Wendy; Moss, Cheryle; Campbell, Annie; De Castro, Magali; Oxley, Victoria

    2014-12-01

    A key finding of this qualitative exploratory descriptive study into advanced nursing for general practice nurses (Australian setting) revealed that participants viewed leadership and management as best learnt 'apprenticeship' style on the job by years of experience. Participants (48) comprised of general practice nurses, practice managers and general practitioners from metropolitan Melbourne were interviewed. Other findings demonstrated that the participants generally had limited awareness that postgraduate education can assist in the development of leadership and management in advanced nursing practice. The participants lacked clarity about professional competencies and generally did not connect these to leadership and management. Professional bodies need to take the opportunity to promote awareness of the national competency standards. All three groups of participants expressed hopes about the future provision of professional development opportunities and support by the Medicare Local for leadership and management aspirations within advanced practice nursing.

  16. General RMP Guidance - Chapter 9: Risk Management Plan

    Science.gov (United States)

    You must submit one risk management plan (RMP) to EPA for all of your covered processes. The internet-based RMP*eSubmit allows you to submit your RMP in EPA's Central Data Exchange (CDX), where you can access and change/correct existing RMPs.

  17. 12 CFR 615.5180 - Interest rate risk management by banks-general.

    Science.gov (United States)

    2010-01-01

    ... § 615.5135 of this part. The program shall establish a risk management process that effectively... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Interest rate risk management by banks-general... FISCAL AFFAIRS, LOAN POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Risk Assessment and Management § 615...

  18. Project management under uncertainty beyond beta: The generalized bicubic distribution

    Directory of Open Access Journals (Sweden)

    José García Pérez

    2016-01-01

    Full Text Available The beta distribution has traditionally been employed in the PERT methodology and generally used for modeling bounded continuous random variables based on expert’s judgment. The impossibility of estimating four parameters from the three values provided by the expert when the beta distribution is assumed to be the underlying distribution has been widely debated. This paper presents the generalized bicubic distribution as a good alternative to the beta distribution since, when the variance depends on the mode, the generalized bicubic distribution approximates the kurtosis of the Gaussian distribution better than the beta distribution. In addition, this distribution presents good properties in the PERT methodology in relation to moderation and conservatism criteria. Two empirical applications are presented to demonstrate the adequateness of this new distribution.

  19. Managing RFID Sensors Networks with a General Purpose RFID Middleware

    Science.gov (United States)

    Abad, Ismael; Cerrada, Carlos; Cerrada, Jose A.; Heradio, Rubén; Valero, Enrique

    2012-01-01

    RFID middleware is anticipated to one of the main research areas in the field of RFID applications in the near future. The Data EPC Acquisition System (DEPCAS) is an original proposal designed by our group to transfer and apply fundamental ideas from System and Data Acquisition (SCADA) systems into the areas of RFID acquisition, processing and distribution systems. In this paper we focus on how to organize and manage generic RFID sensors (edge readers, readers, PLCs, etc…) inside the DEPCAS middleware. We denote by RFID Sensors Networks Management (RSNM) this part of DEPCAS, which is built on top of two new concepts introduced and developed in this work: MARC (Minimum Access Reader Command) and RRTL (RFID Reader Topology Language). MARC is an abstraction layer used to hide heterogeneous devices inside a homogeneous acquisition network. RRTL is a language to define RFID Reader networks and to describe the relationship between them (concentrator, peer to peer, master/submaster). PMID:22969370

  20. Management of bibliographic information by Dutch researchers in general practice

    NARCIS (Netherlands)

    Verhoeven, AAH; Jong, BMD

    1997-01-01

    Background. As a result of changes in information technology and the rapid growth of publications methods of searching the literature have changed. Systematic searching of the growing literature has become very important. It is not known whether researchers in general practice search systematically,

  1. Management of bibliographic information by Dutch researchers in general practice

    NARCIS (Netherlands)

    Verhoeven, AAH; Jong, BMD

    Background. As a result of changes in information technology and the rapid growth of publications methods of searching the literature have changed. Systematic searching of the growing literature has become very important. It is not known whether researchers in general practice search systematically,

  2. Medical Information Management System (MIMS): A Generalized Interactive Information System.

    Science.gov (United States)

    Alterescu,Sidney; And Others

    This report describes an interactive information system. It is a general purpose, free format system which can offer immediate assistance where manipulation of large data bases is required. The medical area is a prime area of application. The report is designed to serve as a manual for potential users--nontechnical personnel who will use the…

  3. Medical Information Management System (MIMS): A generalized interactive information system

    Science.gov (United States)

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

    1975-01-01

    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.

  4. Management of gout in a South Auckland general practice

    Directory of Open Access Journals (Sweden)

    Reaves E

    2014-03-01

    Full Text Available BACKGROUND AND CONTEXT: In New Zealand, the highest prevalence of gout is in Maori and Pacific people. Counties Manukau District Health Board (CMDHB has the highest Maori and Pacific population of any New Zealand District Health Board. A CMDHB study found that a high proportion of patients with gout were also at increased risk of cardiovascular disease. ASSESSMENT OF PROBLEMS: The primary objective was to examine whether the control of gout had changed over time at one clinic. The secondary objective was to assess the management of cardiovascular risk factors in patients with gout at that clinic. RESULTS: The mean serum uric acid level of patients with gout in the practice had risen in comparison with a similar audit carried out in March 2009. This indicates that the control of gout for patients at the practice has worsened over time. Many patients had not had an annual serum uric acid test. STRATEGIES FOR IMPROVEMENT: A repeat uric acid level was scheduled for all patients with gout in the practice, with follow-up appointments to be arranged if the result was abnormal. LESSONS: Gout is often suboptimally managed. Serum uric acid levels may only be tested when a patient presents with an acute attack of gout. Consideration should be given to a minimum of annual serum uric acid levels. Appropriate management of modifiable cardiovascular risk factors in this particular cohort is important and should be a particular focus of care.

  5. Impact on diabetes management of General Practice Management Plans, Team Care Arrangements and reviews.

    Science.gov (United States)

    Wickramasinghe, Leelani K; Schattner, Peter; Hibbert, Marienne E; Enticott, Joanne C; Georgeff, Michael P; Russell, Grant M

    2013-08-19

    To investigate whether General Practice Management Plans (GPMPs), Team Care Arrangements (TCAs) and reviews of these improve the management and outcomes of patients with diabetes when supported by cdmNet, a web-based chronic disease management system; and to investigate adherence to the annual cycle of care (ACOC), as recommended in diabetes guidelines. A before-and-after study to analyse prospectively collected data on 577 patients with type 1 or 2 diabetes mellitus who were managed with a GPMP created using cdmNet between June 2008 and November 2012. Completion of the clinical tests in the ACOC (process outcome) and values of six of these clinical measurements (clinical outcomes). Significant improvements were seen after creation of a GPMP in the proportion of ACOC clinical tests completed (57.9% v 74.8%, P < 0.001), total cholesterol level (P < 0.01), low-density lipoprotein (LDL) cholesterol level (P < 0.001) and body mass index (BMI) (P < 0.01). Patients using GPMPs and TCAs also improved their glycated haemoglobin (HbA1c) level (P < 0.05). Patients followed up with irregular reviews had significant improvements in the proportion of ACOC clinical tests completed (59.2% v 77.6%, P < 0.001), total cholesterol level (P < 0.05), and BMI (P < 0.01), but patients with regular reviews had greater improvements in the proportion of ACOC clinical tests completed (58.9% v 85.0%, P < 0.001), HbA(1c) level (57.7 v 53.0 mmol/mol, P < 0.05), total cholesterol level (4.8 v 4.5 mmol/L, P < 0.05), LDL cholesterol level (2.8 v 2.4 mmol/L, P < 0.01) and diastolic blood pressure (76.0 v 74.0 mmHg, P < 0.05). There were significant improvements in process and clinical outcomes for patients on a GPMP or a GPMP and TCA, particularly when these were followed up by regular reviews. Patients using cdmNet were four times more likely to have their GPMP or TCA followed up through regular reviews than the national average.

  6. GENERAL REQUIREMENTS FOR SIMULATION MODELS IN WASTE MANAGEMENT

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Ian; Kossik, Rick; Voss, Charlie

    2003-02-27

    Most waste management activities are decided upon and carried out in a public or semi-public arena, typically involving the waste management organization, one or more regulators, and often other stakeholders and members of the public. In these environments, simulation modeling can be a powerful tool in reaching a consensus on the best path forward, but only if the models that are developed are understood and accepted by all of the parties involved. These requirements for understanding and acceptance of the models constrain the appropriate software and model development procedures that are employed. This paper discusses requirements for both simulation software and for the models that are developed using the software. Requirements for the software include transparency, accessibility, flexibility, extensibility, quality assurance, ability to do discrete and/or continuous simulation, and efficiency. Requirements for the models that are developed include traceability, transparency, credibility/validity, and quality control. The paper discusses these requirements with specific reference to the requirements for performance assessment models that are used for predicting the long-term safety of waste disposal facilities, such as the proposed Yucca Mountain repository.

  7. Managing RFID Sensors Networks with a General Purpose RFID Middleware

    Directory of Open Access Journals (Sweden)

    Enrique Valero

    2012-06-01

    Full Text Available RFID middleware is anticipated to one of the main research areas in the field of RFID applications in the near future. The Data EPC Acquisition System (DEPCAS is an original proposal designed by our group to transfer and apply fundamental ideas from System and Data Acquisition (SCADA systems into the areas of RFID acquisition, processing and distribution systems. In this paper we focus on how to organize and manage generic RFID sensors (edge readers, readers, PLCs, etc… inside the DEPCAS middleware. We denote by RFID Sensors Networks Management (RSNM this part of DEPCAS, which is built on top of two new concepts introduced and developed in this work: MARC (Minimum Access Reader Command and RRTL (RFID Reader Topology Language. MARC is an abstraction layer used to hide heterogeneous devices inside a homogeneous acquisition network. RRTL is a language to define RFID Reader networks and to describe the relationship between them (concentrator, peer to peer, master/submaster.

  8. General Motors' R&D: Managing Innovation Globally

    Science.gov (United States)

    Taub, Alan

    2006-03-01

    The rapid pace of technology development and the globalization of the automobile industry are major forces driving General Motors to devise new ways to innovate faster and more efficiently. In response, GM has developed a global R&D network that has transformed GM's research and development organization from a U.S.-based enterprise to one that is over 30 percent leveraged with collaboration in 16 countries. This talk will focus on the challenges faced as well as the lessons learned and best practices developed in building this network.

  9. Role of general practitioner in the management of acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Beeleonie Beeleonie

    2005-12-01

    Full Text Available Acute myocardial infarction (AMI has been the leading cause of death in Western countries, as well as in Indonesia. Delay in diagnosis and incorrect early management often result in failure of thrombolytic reperfusion. General practitioner (GP as the primary care, needs to be equipped with the ability to diagnose and moreover to manage AMI. A case of fail thrombolytic management in a 47 years old man after seven hours of angina typical chest pain, after previously managed by GP, is being reported. (Med J Indones 2005; 14:249-52Keywords: acute myocardial infarction, reperfusion, general practitioner

  10. Producing guidance for the management of patients with chronic periodontal disease in general dental practice.

    Science.gov (United States)

    Allen, G

    2015-04-24

    The vast majority of patients will experience gingival-related disease at some point in their life, and up to a quarter of those are susceptible to advanced periodontal disease. This makes its effective management an important part of general dental practice. This paper provides guidance on management which incorporates periodontal assessment, management and recall according to patient's oral hygiene and modifiable risk factors. This has been produced in flow diagram format to aid non-surgical management of chronic gingival and periodontal disease in general dental practice.

  11. GM energy management: organization and results. [General Motors

    Energy Technology Data Exchange (ETDEWEB)

    DeKoker, N.

    1975-01-01

    Energy conservation is not new to industry. The effective and efficient use of labor and materials including energy has been an important tool in cost control for many years. Today, an even greater emphasis must be placed on conserving energy while at the same time stimulating the longer term development of existing as well as new energy resources. Energy conservation in manufacturing can involve product material and/or finish specification changes, process changes or elimination, improved control of equipment, the installation of heat recovery devices and the consolidation of operations. GM's organization to meet these energy management challenges and some of the specific measures taken to improve the efficiency of manufacturing operations are presented.

  12. Nanoparticle risk management and cost evaluation: a general framework

    Energy Technology Data Exchange (ETDEWEB)

    Fleury, Dominique; Metz, Sebastien; Bouillard, Jacques X; Brignon, Jean-Marc [INERIS, Parc Technologique Alata BP2 - 60550 Verneuil-en-Halatte (France); Bomfim, Joao A S, E-mail: dominique.fleury@ineris.fr [Centro Ricerche Plast-optica (CRP), Via Jacopo Linussio 1 - 33020 Amaro (Italy)

    2011-07-06

    Industrial production of nano-objects has been growing fast during the last decade and a wide range of products containing nanoparticles (NPs) is proposed to the public in various markets (automotive, electronics, textiles...). The issues encountered in monitoring the presence of nano-objects in any media cause a major difficulty for controlling the risk associated to the production stage. It is therefore very difficult to assess the efficiency of prevention and mitigation solutions, which potentially leads to overestimate the level of the protection barriers that are recommended. The extra costs in adding nano-objects to the process, especially that of nanosafety, must be estimated and optimized to ensure the competitiveness of the future production lines and associated products. The risk management and cost evaluation methods presented herein have been designed for application in a pilot production line of injection-moulded nanocomposites.

  13. Nanoparticle risk management and cost evaluation: a general framework

    Science.gov (United States)

    Fleury, Dominique; Bomfim, João A. S.; Metz, Sébastien; Bouillard, Jacques X.; Brignon, Jean-Marc

    2011-07-01

    Industrial production of nano-objects has been growing fast during the last decade and a wide range of products containing nanoparticles (NPs) is proposed to the public in various markets (automotive, electronics, textiles...). The issues encountered in monitoring the presence of nano-objects in any media cause a major difficulty for controlling the risk associated to the production stage. It is therefore very difficult to assess the efficiency of prevention and mitigation solutions, which potentially leads to overestimate the level of the protection barriers that are recommended. The extra costs in adding nano-objects to the process, especially that of nanosafety, must be estimated and optimized to ensure the competitiveness of the future production lines and associated products. The risk management and cost evaluation methods presented herein have been designed for application in a pilot production line of injection-moulded nanocomposites.

  14. Obesity, periodontal and general health: Relationship and management

    Directory of Open Access Journals (Sweden)

    Parveen Dahiya

    2012-01-01

    Full Text Available Obesity is a multifaceted subject. It has increased at an alarming rate in recent years. Being overweight increases the likelihood of a patient having associated health and social problems which may affect dental services and dental management. A review of the literature on obesity and periodontal disease suggested that they both confound each other and obesity itself has been recognized as a major risk factor for periodontal disease. It has been found that adverse effects of obesity on the periodontium may be mediated through pro-inflammatory cytokines and various other bioactive substances. This article tries to focus on the possible role of obesity and obesity-related diseases like diabetes and coronary heart diseases (CHD, as a potential contributor to periodontal disease and vice versa. The meanings of these associations can be useful for various diagnostic and treatment planning purposes.

  15. The management of depressive symptoms in patients with COPD: a postal survey of general practitioners.

    NARCIS (Netherlands)

    Yohannes, A.M.; Hann, M.; Sibbald, B.S.

    2011-01-01

    AIMS: We examined the management of depression by general practitioners (GPs), through the use of case vignettes, in patients with chronic obstructive pulmonary disease (COPD), severe osteoarthritis and depressive symptoms alone. BACKGROUND: Depression is common in patients with COPD. Untreated

  16. Life Insurance Makes Great Contributions to the Country-- An exclusive interview with AIA Beijing General Manager

    Institute of Scientific and Technical Information of China (English)

    Sun Yongjian

    2005-01-01

    @@ "It is my belief that life insurance industry makes great contributions to a country. I have come to Beijing to fight for this belief instead of making a lot of money" said Mr. Simpson Hsu, General Manager of AIA Beijing.

  17. A nurse-led model of chronic disease management in general practice: Patients' perspectives.

    Science.gov (United States)

    Young, Jacqueline; Eley, Diann; Patterson, Elizabeth; Turner, Catherine

    2016-12-01

    Evidence suggests that current models of chronic disease management within general practice are not effective in meeting the needs of the community. The objective of this article is to examine patients' perceptions of a nurse-led collaborative model of care trialled in three general practices in Australia. This article reports on the second phase of a mixed-methods study in which semi-structured interviews with purposively selected patients were conducted to elicit information about their perceptions of nurse-led care. Three themes emerged from the data - time, ambiance and dimensions of the nurse role. The results suggest that general practice nurses had a positive impact on patients' ability to manage their chronic disease. This infers that there is scope for general practice nurses to expand their role in chronic disease management to assist patients to better self-manage their chronic diseases.

  18. Practical and effective management of libraries integrating case studies, general management theory and self-understanding

    CERN Document Server

    Moniz, Jr, Richard

    2010-01-01

    Aimed at library science students and librarians with newly assigned administrative duties the book is about improving one's thinking and decision making in a role as a library manager. Most librarians get very little exposure to management issues prior to finding themselves in a management role. Furthermore, most library science students do not expect that they will need to understand management yet they quickly find that there is a need to understand this perspective to be effective at almost any library job. Effective library management is about having some tools to make decisions (such as

  19. Upper urinary tract stone disease: the changing management in a district general hospital.

    OpenAIRE

    Goble, N M; Hammonds, J C; Wells, I P

    1987-01-01

    The advent of percutaneous nephrolithotomy (PCN) and ureteroscopy, in combination with stone disruption techniques, has dramatically altered the management of upper urinary tract stone disease. These advances are not necessarily confined to the teaching centres. The problems encountered introducing these techniques in a District General Hospital and their impact on the surgical management of upper urinary tract stones is presented.

  20. Using Self-Management Interventions to Address General Education Behavioral Needs: Assessment of Effectiveness and Feasibility

    Science.gov (United States)

    Briesch, Amy M.; Daniels, Brian

    2013-01-01

    A comprehensive self-management intervention was utilized to increase the on-task behavior of three African American students within an urban middle-school setting. The intervention was designed to necessitate minimal management on the part of the general education classroom teacher by utilizing an electronic prompting device, as well as a…

  1. Outpatient Management of Hypertension By General Medicine and Traditional Track Residents.

    Science.gov (United States)

    Robie, Peter W.; Andrus, Peter L.

    1982-01-01

    A study to determine whether general internal medicine and traditional track medicine residents differed in their outpatient management of essential hypertension is discussed. General internal medicine residents seem to do better in the areas of assessment of drug side effects and patient education. (MLW)

  2. Apple-CORE: harnessing general-purpose many-cores with hardware concurrency management

    NARCIS (Netherlands)

    Poss, R.; Lankamp, M.; Yang, Q.; Fu, J.; van Tol, M.W.; Uddin, I.; Jesshope, C.

    2013-01-01

    To harness the potential of CMPs for scalable, energy-efficient performance in general-purpose computers, the Apple-CORE project has co-designed a general machine model and concurrency control interface with dedicated hardware support for concurrency management across multiple cores. Its SVP interfa

  3. Monitoring Based Commissioning: Benchmarking Analysis of 24 UC/CSU/IOU Projects

    Energy Technology Data Exchange (ETDEWEB)

    Mills, Evan; Mathew, Paul

    2009-04-01

    Buildings rarely perform as intended, resulting in energy use that is higher than anticipated. Building commissioning has emerged as a strategy for remedying this problem in non-residential buildings. Complementing traditional hardware-based energy savings strategies, commissioning is a 'soft' process of verifying performance and design intent and correcting deficiencies. Through an evaluation of a series of field projects, this report explores the efficacy of an emerging refinement of this practice, known as monitoring-based commissioning (MBCx). MBCx can also be thought of as monitoring-enhanced building operation that incorporates three components: (1) Permanent energy information systems (EIS) and diagnostic tools at the whole-building and sub-system level; (2) Retro-commissioning based on the information from these tools and savings accounting emphasizing measurement as opposed to estimation or assumptions; and (3) On-going commissioning to ensure efficient building operations and measurement-based savings accounting. MBCx is thus a measurement-based paradigm which affords improved risk-management by identifying problems and opportunities that are missed with periodic commissioning. The analysis presented in this report is based on in-depth benchmarking of a portfolio of MBCx energy savings for 24 buildings located throughout the University of California and California State University systems. In the course of the analysis, we developed a quality-control/quality-assurance process for gathering and evaluating raw data from project sites and then selected a number of metrics to use for project benchmarking and evaluation, including appropriate normalizations for weather and climate, accounting for variations in central plant performance, and consideration of differences in building types. We performed a cost-benefit analysis of the resulting dataset, and provided comparisons to projects from a larger commissioning 'Meta-analysis' database. A

  4. 78 FR 76855 - Record of Decision for the General Management Plan/Wilderness Study, Fort Pulaski National...

    Science.gov (United States)

    2013-12-19

    ... National Park Service Record of Decision for the General Management Plan/Wilderness Study, Fort Pulaski... (NPS) announces the availability of the Record of Decision (ROD) for the General Management Plan... general management plan process, the National Park Service conducted a wilderness eligibility assessment...

  5. 78 FR 32442 - Record of Decision for the General Management Plan, Blue Ridge Parkway, Virginia and North Carolina

    Science.gov (United States)

    2013-05-30

    ... National Park Service Record of Decision for the General Management Plan, Blue Ridge Parkway, Virginia and... (NPS) announces the availability of the Record of Decision (ROD) for the General Management Plan (GMP... modern-day management realities. Under Alternative C, parkway management would be more integrated with...

  6. 25 CFR 900.43 - What are the general financial management system standards that apply to a tribal organization...

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false What are the general financial management system... ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems Standards for Financial Management Systems § 900.43 What are the general financial management system standards that apply to a...

  7. 25 CFR 900.42 - What are the general financial management system standards that apply to an Indian tribe carrying...

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false What are the general financial management system... Standards for Tribal or Tribal Organization Management Systems Standards for Financial Management Systems § 900.42 What are the general financial management system standards that apply to an Indian...

  8. Accurate Characterization of Winter Precipitation Using In-Situ Instrumentation, CSU-CHILL Radar, and Advanced Scattering Methods

    Science.gov (United States)

    Newman, A. J.; Notaros, B. M.; Bringi, V. N.; Kleinkort, C.; Huang, G. J.; Kennedy, P.; Thurai, M.

    2015-12-01

    We present a novel approach to remote sensing and characterization of winter precipitation and modeling of radar observables through a synergistic use of advanced in-situ instrumentation for microphysical and geometrical measurements of ice and snow particles, image processing methodology to reconstruct complex particle three-dimensional (3D) shapes, computational electromagnetics to analyze realistic precipitation scattering, and state-of-the-art polarimetric radar. Our in-situ measurement site at the Easton Valley View Airport, La Salle, Colorado, shown in the figure, consists of two advanced optical imaging disdrometers within a 2/3-scaled double fence intercomparison reference wind shield, and also includes PLUVIO snow measuring gauge, VAISALA weather station, and collocated NCAR GPS advanced upper-air system sounding system. Our primary radar is the CSU-CHILL radar, with a dual-offset Gregorian antenna featuring very high polarization purity and excellent side-lobe performance in any plane, and the in-situ instrumentation site being very conveniently located at a range of 12.92 km from the radar. A multi-angle snowflake camera (MASC) is used to capture multiple different high-resolution views of an ice particle in free-fall, along with its fall speed. We apply a visual hull geometrical method for reconstruction of 3D shapes of particles based on the images collected by the MASC, and convert these shapes into models for computational electromagnetic scattering analysis, using a higher order method of moments. A two-dimensional video disdrometer (2DVD), collocated with the MASC, provides 2D contours of a hydrometeor, along with the fall speed and other important parameters. We use the fall speed from the MASC and the 2DVD, along with state parameters measured at the Easton site, to estimate the particle mass (Böhm's method), and then the dielectric constant of particles, based on a Maxwell-Garnet formula. By calculation of the "particle-by-particle" scattering

  9. Management of Overweight during Childhood: A Focus Group Study on Health Professionals’ Experiences in General Practice

    Directory of Open Access Journals (Sweden)

    Lone Marie Larsen

    2015-01-01

    Full Text Available Background. Because of the increasing prevalence of overweight and obesity in childhood in the Western world, focus on the management in general practice has also increased. Objective. To explore the experiences of general practitioners (GPs and practice nurses participating in a randomised controlled trial (RCT comparing two management programmes in general practice for children who are overweight or obese. Methods. Three focus groups with GPs and nurses participating in the RCT. Transcribed data were analysed using systematic text condensation followed by thematic analysis. Results. Health professionals considered it their responsibility to offer a management programme to overweight children. They recognised that management of overweight during childhood was a complex task that required an evidence-based strategy with the possibility of supervision. Health professionals experienced a barrier to addressing overweight in children. However, increasing awareness of obesity in childhood and its consequences in society was considered helpful to reach an understanding of the articulations concerning how best to address the issue. Conclusions. Health professionals in general practice recognised that they have a special obligation, capacity, and role in the management of obesity in childhood. Implementation of future management programmes must address existing barriers beyond an evidence-based standardised strategy.

  10. Increasing general practitioners' confidence and self-efficacy in managing obesity: a mixed methods study

    Science.gov (United States)

    Haesler, Emily; Elmitt, Nicholas; van Weel, Chris; Douglas, Kirsty

    2017-01-01

    Objectives Internationally, general practitioners (GPs) are being encouraged to take an active role in the care of their patients with obesity, but as yet there are few tools for them to implement within their clinics. This study assessed the self-efficacy and confidence of GPs before and after implementing a weight management programme in their practice. Design Nested mixed methods study within a 6-month feasibility trial. Setting 4 urban general practices and 1 rural general practice in Australia. Participants All vocationally registered GPs in the local region were eligible and invited to participate; 12 GPs were recruited and 11 completed the study. Interventions The Change Programme is a structured GP-delivered weight management programme that uses the therapeutic relationship between the patient and their GP to provide holistic and person-centred care. It is an evidence-based programme founded on Australian guidelines for the management of obesity in primary care. Primary outcome measures Self-efficacy and confidence of the GPs when managing obesity was measured using a quantitative survey consisting of Likert scales in conjunction with pro forma interviews. Results In line with social cognitive theory, GPs who experienced performance mastery during the pilot intervention had an increase in their confidence and self-efficacy. In particular, confidence in assisting and arranging care for patients was improved as demonstrated in the survey and supported by the qualitative data. Most importantly from the qualitative data, GPs described changing their usual practice and felt more confident to discuss obesity with all of their patients. Conclusions A structured management tool for obesity care in general practice can improve GP confidence and self-efficacy in managing obesity. Enhancing GP ‘professional self-efficacy’ is the first step to improving obesity management within general practice. Trial registration number ACTRN12614001192673; Results. PMID:28132016

  11. Management decision-making process at General Viejo Technical High School

    OpenAIRE

    2013-01-01

    The purpose of this research is essential to analyze the management decision making process at General Viejo Technical High School, located in Perez Zeledon, San Jose Province, Costa Rica. This is a descriptive study with qualitative technical support for analyzing the information with the purpose of understanding the data in terms of the educational reality to which it responds. .Among the findings, it is evident that in the management process that is conducted the educational community does...

  12. Emergent management of postpartum hemorrhage for the general and acute care surgeon

    Directory of Open Access Journals (Sweden)

    Blankenship Charles L

    2009-11-01

    Full Text Available Abstract Background Postpartum hemorrhage is one of the rare occasions when a general or acute care surgeon may be emergently called to labor and delivery, a situation in which time is limited and the stakes high. Unfortunately, there is generally a paucity of exposure and information available to surgeons regarding this topic: obstetric training is rarely found in contemporary surgical residency curricula and is omitted nearly completely from general and acute care surgery literature and continuing medical education. Methods The purpose of this manuscript is to serve as a topic specific review for surgeons and to present a surgeon oriented management algorithm. Medline and Ovid databases were utilized in a comprehensive literature review regarding the management of postpartum hemorrhage and a management algorithm for surgeons developed based upon a collaborative panel of general, acute care, trauma and obstetrical surgeons' review of the literature and expert opinion. Results A stepwise approach for surgeons of the medical and surgical interventions utilized to manage and treat postpartum hemorrhage is presented and organized into a basic algorithm. Conclusion The manuscript should promote and facilitate a more educated, systematic and effective surgeon response and participation in the management of postpartum hemorrhage.

  13. A preliminary study for the implementation of general accident management strategies

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Soo Hyung; Kim, Soo Hyung; Jeong, Young Hoon; Chang, Soon Heung [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

    1997-12-31

    To enhance the safety of nuclear power plants, implementation of accident management has been suggested as one of most important programs. Specially, accident management strategies are suggested as one of key elements considered in development of the accident management program. In this study, generally applicable accident management strategies to domestic nuclear power plants are identified through reviewing several accident management programs for the other countries and considering domestic conditions. Identified strategies are as follows; 1) Injection into the Reactor Coolant System, 2) Depressurize the Reactor Coolant System, 3) Depressurize the Steam Generator, 4) Injection into the Steam Generator, 5) Injection into the Containment, 6) Spray into the Containment, 7) Control Hydrogen in the Containment. In addition, the systems and instrumentation necessary for the implementation of each strategy are also investigated. 11 refs., 3 figs., 3 tabs. (Author)

  14. Knowledge of managing avulsed tooth among general dental practitioners in Malaysia.

    Science.gov (United States)

    Abdullah, Dalia; Soo, Suet Yeo; Kanagasingam, Shalini

    2016-12-01

    Dental and maxillofacial injuries are one of the areas of concern highlighted in the Malaysian National Oral Health Plan 2011-2020. General dental practitioners (GDPs) have the responsibility of diagnosing and assessing dental trauma and determining the prognosis and outcomes of trauma along with its management. The purpose of this study was to evaluate the knowledge base and preferred methods of general dental practitioners regarding the management of avulsed tooth. A random convenient sampling methodology was employed for sample selection. A pre-tested 11-item questionnaire was validated on the dental officers. The survey was distributed to 182 GDPs attending the annual Malaysian Dental Association conference in January 2010. The data obtained was statistically analyzed using descriptive analysis and logistic regression was employed to predict the probability of achieving high scores. A total of 182 general dental practitioners participated in the study, with the majority being female (n=153, 75%). The place of practice significantly affected the knowledge score. In the group that scored more than 80 points (n=84, 46%), 76% of them worked with government hospitals. Age, work duration and number of traumatised teeth previously treated had no significant effect. The odds ratio for place of practice indicates that respondents who work in government hospitals are 3.6 times more likely to score more than 80 points compared to those who worked in private clinics (OR=3.615, P=0.001). The knowledge level on the management of avulsed tooth among general dental practitioners in Malaysia needs to be improved. Strategies in improvement of the Malaysian dental educational system, continuous dental educational activities and utilisation of guidelines on trauma management should be recommended to increase the knowledge level of avulsed tooth management to ensure good treatment outcomes. Trauma prevention and further education regarding the management of avulsed tooth is an

  15. 78 FR 46604 - Notice of Availability of the Record of Decision for the General Management Plan/Environmental...

    Science.gov (United States)

    2013-08-01

    ... National Park Service Notice of Availability of the Record of Decision for the General Management Plan...) announces the availability of the Record of Decision (ROD) for the General Management Plan/ Environmental... continuation of existing management at the Trail and provides a baseline for evaluating the changes and impacts...

  16. 75 FR 19422 - Availability of a Final Environmental Impact Statement for the General Management Plan (FEIS/GMP...

    Science.gov (United States)

    2010-04-14

    ... National Park Service Availability of a Final Environmental Impact Statement for the General Management... of availability of a Final Environmental Impact Statement for the General Management Plan (FEIS/GMP... Alternative, which would continue current management practices and trends, with no major changes in direction...

  17. 75 FR 1806 - Draft General Management Plan and Environmental Impact Statement, New River Gorge National River, WV

    Science.gov (United States)

    2010-01-13

    ... National Park Service Draft General Management Plan and Environmental Impact Statement, New River Gorge... availability of the Draft General Management Plan and Environmental Impact Statement for New River Gorge.... Alternative 1 is the no action alternative, which would continue current management and trends, with no major...

  18. 75 FR 79389 - Notice of Availability of the Record of Decision for the General Management Plan/Environmental...

    Science.gov (United States)

    2010-12-20

    ... rehabilitating existing features, but will follow contemporary best practices for land management within select... National Park Service Notice of Availability of the Record of Decision for the General Management Plan... of Decision for the General Management Plan/Environmental Impact Statement (GMP/ EIS) for...

  19. How General Practitioners and Their Patients Adhere to Osteoporosis Management: A Follow-Up Survey among Czech General Practitioners.

    Science.gov (United States)

    Vytrisalova, Magda; Touskova, Tereza; Fuksa, Leos; Karascak, Roman; Palicka, Vladimir; Byma, Svatopluk; Stepan, Jan

    2017-01-01

    Introduction: General practitioners (GPs) are key participants in osteoporosis (OP) management. The aim was to evaluate their adherence to lege artis management of the disease, potential barriers, and to discuss differences observed in comparison with the baseline survey carried out in 2007; the focus was on secondary prevention. Methods: On behalf of two professional associations, 2-round postal survey among randomly selected GPs (>1/4 of all Czech GPs) was performed in 2014. The questionnaire covered areas concerning GP's role in the fight against OP, knowledge about OP, management of OP-related fractures, barriers to the management of OP, system- and patient-related in particular, and availability and use of information sources. Results: The overall questionnaire return rate was 37% (551 respondents); mean age of the respondents was 53 year (37% men). The GP's role in the treatment of OP was rated as essential in 28 and 37% of men and women, respectively (P = 0.012). The guideline for diagnosis and treatment of OP for GPs was considered accessible by 92% of respondents. As much as 60% of the respondents were adherent to the guideline, i.e., used it repeatedly. The knowledge of several risk factors was very good, however, recommended daily intake of calcium was stated correctly by only 41% of respondents, and daily intake of vitamin D by only 40%. Three quarters reported active steps after a fracture: referral to a specialist, life-style recommendations, prescription of calcium/vitamin D supplements. Half of the respondents focus on fall prevention. System-related barriers, such as lack of possibility to prescribe selected drugs (61%) and financial limits set by health insurance company (44%) were most frequently reported. Patient-related barriers were also common, patient's non-adherence (reported by 29%) and patient's reluctance to go to a specialist (18%). Conclusion: GPs adhered to OP management more than in 2007. Knowledge of risk factors and involvement in

  20. Personnel Management in Access Services: A General Overview of the Literature, 1990-2002

    Science.gov (United States)

    Lee, Leslie A.; Wu, Michelle M.

    2003-01-01

    Access services is not unique in its need for effective personnel management. A review of the literature indicates that there are many publications on or relating to library personnel administration; however, relatively few of them are dedicated to the narrow topic of access services. As such, this review encompasses literature that is general to…

  1. Life Insurance Makes Great Contributions to the Country-- An exclusive interview with AIA Beijing General Manager

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

      "It is my belief that life insurance industry makes great contributions to a country. I have come to Beijing to fight for this belief instead of making a lot of money" said Mr. Simpson Hsu, General Manager of AIA Beijing.……

  2. 76 FR 81962 - Final Environmental Impact Statement for General Management Plan, Ross Lake National Recreation...

    Science.gov (United States)

    2011-12-29

    ... planning process and soliciting feedback on issues to be addressed in park planning. The Notice of Intent..., public workshops and informal meetings, the NPS Planning, Environment, and Public Comment (PEPC) Web site... opportunity to learn about the general management planning project and to offer comments. During the scoping...

  3. Achieving Competitive Advantage in Human Resource Management in General School District of Riyadh in Saudi Arabia

    Science.gov (United States)

    Al dakeel, Taghreed M.; Almannie, Mohamed A.

    2015-01-01

    The general school district of Riyadh is one of largest in the country of (45) school districts in Saudi Arabia. The school districts play an important roles in the development of education, therefore the objective of the study is to examine the roles of the management in the school districts to see if it is achieving competitive advantage. After…

  4. School-Based Management: An Approach to Decision-Making Quality in Egyptian General Secondary Schools

    Science.gov (United States)

    Elmelegy, Reda Ibrahim

    2015-01-01

    The current research aims at clarifying how school-based management (SBM) can contribute to achieve the decision-making quality in Egyptian general secondary schools and determine the requirements of quality decision-making. It depends on the descriptive method in order to acknowledge the basics of the SBM and its relationship with the quality of…

  5. 78 FR 38072 - General Management Plan, Final Environmental Impact Statement, Guadalupe Mountains National Park...

    Science.gov (United States)

    2013-06-25

    ... National Park Service General Management Plan, Final Environmental Impact Statement, Guadalupe Mountains... Plan, Guadalupe Mountains National Park, Texas. DATES: The NPS will execute a Record of Decision no... CONTACT: Dennis A. V squez, Superintendent, Guadalupe Mountains National Park, HC 60, Box 400, Salt...

  6. 78 FR 47410 - General Management Plan, Draft Environmental Impact Statement, Gateway National Recreation Area...

    Science.gov (United States)

    2013-08-05

    ... National Park Service General Management Plan, Draft Environmental Impact Statement, Gateway National Recreation Area, New Jersey and New York AGENCY: National Park Service, Interior. ACTION: Notice of... National Park Service (NPS) is releasing a Draft Environmental Impact Statement (DEIS) for the...

  7. Scaling the Fractal Plain: Towards a General View of Knowledge Management

    Science.gov (United States)

    Griffiths, David; Evans, Peter

    2011-01-01

    Purpose: The purpose of the paper is to explore coherence across key disciplines of knowledge management (KM) for a general model as a way to address performance dissatisfaction in the field. Design/methodology/approach: Research employed an evidence-based meta-analysis (287 aspects of literature), triangulated through an exploratory survey (91…

  8. Self-Management of Social Initiations by Kindergarten Students with Disabilities in the General Education Classroom

    Science.gov (United States)

    Reynolds, Brooke M.; Gast, David L.; Luscre, Deanna

    2014-01-01

    The effectiveness of a self-management intervention on social interaction behaviors was evaluated for students with disabilities and social deficits. Four students enrolled in a general education kindergarten classroom were taught to self-monitor social initiations during nonstructured social time via a digital wrist counter. The number of social…

  9. Management of asthma and COPD patients: feasibility of the application of guidelines in general practice.

    NARCIS (Netherlands)

    Jans, M.P.; Schellevis, F.G.; Hensbergen, W. van; Dukkers van Emden, T.; Eijk, J.T.M. van

    1998-01-01

    Objective: To examine the feasibility of the application of guidelines to the management of asthma and chronic obstructive pulmonary disease (COPD) by assessing compliance with the guidelines and listing the barriers general practitioners (GPs) encountered during implementation. Insight into the fea

  10. Process evaluation of a tailored intervention programme of cardiovascular risk management in general practices

    NARCIS (Netherlands)

    Huntink, E.; Wensing, M.; Timmers, I.M.; Lieshout, J. van

    2016-01-01

    BACKGROUND: A tailored implementation programme to improve cardiovascular risk management (CVRM) in general practice had little impact on outcomes. The questions in this process evaluation concerned (1) impact on counselling skills and CVRM knowledge of practice nurses, (2) their use of the various

  11. Generalized File Management Systems: Their Implication for a California Junior College Data Base System.

    Science.gov (United States)

    Fedrick, Robert John

    Criteria to use in evaluating data processing efficiency, factors of file and record definitions, convenience of use for non-programmers, report generating capabilities, and customer support for generalized file management systems for use by the California junior colleges are indicated by the author. The purchase of such a system at the state…

  12. 78 FR 42149 - Privacy Act; System of Records: State-53, Office of Inspector General Investigation Management...

    Science.gov (United States)

    2013-07-15

    ..., affidavits, banking and other financial records, medical records, and personnel and other employment-related... statutes, Executive Orders and the Code of Federal Regulations. These records may be disclosed as follows... Office of Inspector General Investigation Management System, State-53. POLICIES AND PRACTICES FOR STORING...

  13. School-Based Management: An Approach to Decision-Making Quality in Egyptian General Secondary Schools

    Science.gov (United States)

    Elmelegy, Reda Ibrahim

    2015-01-01

    The current research aims at clarifying how school-based management (SBM) can contribute to achieve the decision-making quality in Egyptian general secondary schools and determine the requirements of quality decision-making. It depends on the descriptive method in order to acknowledge the basics of the SBM and its relationship with the quality of…

  14. 76 FR 70483 - Environmental Impact Statement and General Management Plan, Paterson Great Falls National...

    Science.gov (United States)

    2011-11-14

    ... National Park Service Environmental Impact Statement and General Management Plan, Paterson Great Falls... Environmental Impact Statement (GMP/EIS) for Paterson Great Falls National Historical Park (NHP), New Jersey. In the park's enabling legislation, Congress established the Paterson Great Falls NHP Advisory...

  15. Army Financial Improvement Plans Generally Managed Effectively, but Better Contract Management Needed

    Science.gov (United States)

    2014-04-08

    stating that except for reporting deficiencies associated with missiles held at the contractor’s facilities and material in transit, the assertion...Optically-tracked, Wire-command link; Javelin; and Hellfire missiles ). From February 2011 through January 2012, ASA(FM&C) personnel and audit...vehicles $92 General Equipment Equipment for material handling, training, and special tooling and testing 11 OM&S Missiles , ammunition, and munitions

  16. Pleth variability index-directed fluid management in abdominal surgery under combined general and epidural anesthesia.

    Science.gov (United States)

    Yu, Yinan; Dong, Jing; Xu, Zifeng; Shen, Hao; Zheng, Jijian

    2015-02-01

    Pleth variability index (PVI), a noninvasive dynamic indicator of fluid responsiveness has been demonstrated to be useful in the management of the patients with goal directed fluid therapy under general anesthesia, but whether PVI can be used to optimize fluid management under combined general and epidural anesthesia (GEN-EPI) remains to be elucidated. The aim of our study was to explore the impact of PVI as a goal-directed fluid therapy parameter on the tissue perfusion for patients with GEN-EPI. Thirty ASA I-II patients scheduled for major abdominal surgeries under GEN-EPI were randomized into PVI-directed fluid management group (PVI group) and non PVI-directed fluid management group (control group). 2 mL/kg/h crystalloid fluid infusion was maintained in PVI group, once PVI>13%, a 250 mL colloid or crystalloid was rapidly infused. 4-8 mL/kg/h crystalloid fluid infusion was maintained in control group, and quick fluid infusion was initiated if mean arterial blood pressure (BP)PVI than control group, PPVI-based goal-directed fluid management can reduce the intraoperative fluid amount and blood lactate levels in patients under GEN-EPI, especially the crystalloid. Furthermore, the first hour following GEN-EPI might be the critical period for anesthesiologist to optimize the fluid management.

  17. Tracking the evolution of the disaster management cycle: A general system theory approach

    Directory of Open Access Journals (Sweden)

    Christo Coetzee

    2012-06-01

    Full Text Available Officials and scholars have used the disaster management cycle for the past 30 years to explain and manage impacts. Although very little understanding and agreement exist in terms of where the concept originated it is the purpose of this article to address the origins of the disaster management cycle. To achieve this, general system theory concepts of isomorphisms, equifinality, open systems and feedback arrangements were applied to linear disaster phase research (which emerged in the 1920s and disaster management cycles. This was done in order to determine whether they are related concepts with procedures such as emergency, relief, recovery and rehabilitation.

  18. General practitioners' knowledge, practices, and obstacles in the diagnosis and management of dementia.

    Science.gov (United States)

    Pathak, Krishna P; Montgomery, Anthony

    2015-01-01

    To identify general practitioners' (GPs) knowledge, practices, and obstacles with regard to the diagnosis and management of dementia. Standardized questionnaires covering knowledge, practices, and obstacles were distributed among a purposive sample of GPs in Kathmandu, Nepal. Three hundred and eighty GPs responded (response rate = 89%). Knowledge of practitioners' with regard to the diagnosis and management of dementia was unsatisfactory (management barriers are presented with regard to GP, patient, and carer factors. Specifically, the results address the following issues: communicating the diagnosis, negative views of dementia, difficulty diagnosing early-stage dementia, acceptability of specialists, responsibility for extra issues, knowledge of dementia and aging, less awareness of declining abilities, diminished resources to handle care, lack of specific guidelines, and poor awareness of epidemiology. Demographic changes mean that dementia will represent a significant problem in the future. The following paper outlines the problems and solutions that the Nepalese medical community needs to adopt to deal effectively with diagnosis, care, and management of dementia.

  19. [Difficult airway management for general anesthesia in two patients with Kartagener syndrome].

    Science.gov (United States)

    Andoh, Taiki; Momota, Yoshihiro; Murata, Kenji; Kotani, Junichiro

    2010-05-01

    Two patients with Kartagener syndrome were managed under general anesthesia by nasal intubation for sagital split ramus osteotomy. Many episodes of expectoration were encountered in the former patient's perioperative period and the expectoration discharge was inadequate by postoperative nausea, leading to trouble in airway management. In the second patient, tube collapse was caused after intubation by serious nasal cavity strangulation, and re-intubation was necessary. Expectoration is seen resulting from decreased ciliary function with bronchiectasis during anesthetic management of patients with Kartagener syndrome. It is important to prevent lung complications by nausea prevention and pain killing in the postoperative period, in addition to proper suctioning in the perioperative period. Furthermore, there is nasal cavity narrowing by chronic sinusitis. When performing nasal intubation, the difficult airway management is required.

  20. A Generalized Decision Framework Using Multi-objective Optimization for Water Resources Planning

    Science.gov (United States)

    Basdekas, L.; Stewart, N.; Triana, E.

    2013-12-01

    Colorado Springs Utilities (CSU) is currently engaged in an Integrated Water Resource Plan (IWRP) to address the complex planning scenarios, across multiple time scales, currently faced by CSU. The modeling framework developed for the IWRP uses a flexible data-centered Decision Support System (DSS) with a MODSIM-based modeling system to represent the operation of the current CSU raw water system coupled with a state-of-the-art multi-objective optimization algorithm. Three basic components are required for the framework, which can be implemented for planning horizons ranging from seasonal to interdecadal. First, a water resources system model is required that is capable of reasonable system simulation to resolve performance metrics at the appropriate temporal and spatial scales of interest. The system model should be an existing simulation model, or one developed during the planning process with stakeholders, so that 'buy-in' has already been achieved. Second, a hydrologic scenario tool(s) capable of generating a range of plausible inflows for the planning period of interest is required. This may include paleo informed or climate change informed sequences. Third, a multi-objective optimization model that can be wrapped around the system simulation model is required. The new generation of multi-objective optimization models do not require parameterization which greatly reduces problem complexity. Bridging the gap between research and practice will be evident as we use a case study from CSU's planning process to demonstrate this framework with specific competing water management objectives. Careful formulation of objective functions, choice of decision variables, and system constraints will be discussed. Rather than treating results as theoretically Pareto optimal in a planning process, we use the powerful multi-objective optimization models as tools to more efficiently and effectively move out of the inferior decision space. The use of this framework will help CSU

  1. Management of urticaria: not too complicated, not too simple

    Science.gov (United States)

    Ferrer, M; Bartra, J; Giménez-Arnau, A; Jauregui, I; Labrador-Horrillo, M; Ortiz de Frutos, J; Silvestre, J F; Sastre, J; Velasco, M; Valero, A

    2015-01-01

    In spite of being an old disease and apparently easy to diagnose, chronic spontaneous urticaria (CSU) is still perceived as an uncontrollable and difficult to manage disease. The perception of the patient is that his/her condition is not well understood and that is suffering from a disorder with hidden causes that doctors are not able to tackle. Sometimes patients go through a number of clinicians until they found some CSU expert who is familiar with the disease. It is surprising that myths and believes with no scientific support still persist. Guidelines are not widely implemented, and recent tools to assess severity are infrequently used. European and American recent guidelines do not agree in several key points related to diagnosis and treatment, which further contributes to confusion. With the aim to clarify some aspects of the CSU picture, a group of allergists and dermatologists from the Spanish Dermatology and Allergy societies developed a Frequent Asked Questions leaflet that could facilitate physicians work in daily practice and contribute to a better knowledge of common clinical scenarios related to patients with CSU. PMID:25429900

  2. Disaster Management and General Dental Practitioners in India: An Overlooked Resource.

    Science.gov (United States)

    Chhabra, Kumar Gaurav; Rajesh, Gururaghavendran; Chhabra, Chaya; Binnal, Almas; Sharma, Ashish; Pachori, Yashpal

    2015-12-01

    To assess General Dental Practitioners' (GDPs) in India willingness to participate in disaster management and their previous training pertaining to disaster management, and to assess GDP objective knowledge, attitude, and behavior regarding disaster management. This study was a cross-sectional survey conducted on all GDPs of Jodhpur, Rajasthan, India. Willingness to participate, perceived knowledge, perceived effectiveness, objective knowledge, attitude, and behavior regarding disaster management were assessed through questionnaire method. Information also was collected regarding age, gender, religion, and residence. A total of 142 out of 180 GDPs participated in the study, representing a response rate of 79%. A majority (85%) of respondents were willing to participate in disaster management. Mean score for knowledge was 12.21%, for attitude was 33.56%, for behavior was 14.50%, and for perceived effectiveness was 9.08%. Significant correlations were observed between qualification and perceived effectiveness (P=.003), and between attitude and years of practice (P=.04). Willingness to participate in disaster management and age showed significant association (P=.000). High willingness and attitude to participate in disaster management was observed among respondents. Low knowledge and behavior scores were observed among GDPs.

  3. Promoting leadership and management in Australian general practice nursing: what will it take?

    Science.gov (United States)

    Halcomb, Elizabeth J; Davidson, Patricia M; Patterson, Elizabeth

    2008-10-01

    This paper outlines the current state of Australian practice nursing, describes the context of general practice and establishes the importance of promoting leadership and management in this setting. Australian general practice nurses have emerged as key stakeholders in primary health care. However, their role in leadership and management has been largely invisible. The reasons for this are multifactorial, including the delay to establish a strong professional organization, their negative power relationships with general medical practitioners, limited nursing leadership and poorly defined roles. To date, the impetus for practice nurse growth has been largely external to the nursing profession. Growth has been driven by the increasing burden of chronic disease and workforce shortages. This has further weakened the control of nurse leaders over the development of the specialty. The Australian practice nurse role is at a crossroads. While the practice nurse role is a viable force to improve health outcomes, the growing strength of the practice nurse challenges traditional professional roles and practice patterns. There is an urgent need to develop practice nurse leaders and managers to not only embrace the challenges of Australian general practice from an operational perspective, but also undertake a clinical leadership role. As clinical leaders, these nurses will need to develop a culture that not only optimizes health outcomes but also advances the status of the nursing profession.

  4. Why the general dentist needs to know how to manage oral lichen planus.

    Science.gov (United States)

    Price, Stephanie M; Murrah, Valerie A

    2015-01-01

    Oral lichen planus (OLP) is a frequently mismanaged chronic disease that requires care throughout a patient's life, and therefore a condition the general dentist must know how to manage. Patients with OLP often suffer considerable physical discomfort and an inability to perform proper oral hygiene, eventually resulting in poor periodontal health. In addition, these patients are confronted with the psychological stress of knowing that OLP is not curable. This is accompanied by a fear of other negative health developments, particularly oral cancer. The objective of this study was to identify major issues surrounding the management of OLP by the general dentist. A literature review of over 1100 articles was performed. An eclectic compilation of the issues revealed 12 major areas of concern. This article reviews those concerns and presents strategies for coping with the myriad signs, symptoms, and complications associated with this disease, as well as educational approaches and legal considerations. A rationale is provided to place the responsibility for the management of these patients under the person best positioned to coordinate care for this condition--the general dentist. A general dentist can contribute to the overall oral health of an OLP patient with timely diagnosis, effective treatment, thorough patient education, and the orchestration of efforts by a team of health care providers.

  5. Comparing stream-specific to generalized temperature models to guide salmonid management in a changing climate

    Science.gov (United States)

    Andrew K. Carlson,; William W. Taylor,; Hartikainen, Kelsey M.; Dana M. Infante,; Beard, Douglas; Lynch, Abigail

    2017-01-01

    Global climate change is predicted to increase air and stream temperatures and alter thermal habitat suitability for growth and survival of coldwater fishes, including brook charr (Salvelinus fontinalis), brown trout (Salmo trutta), and rainbow trout (Oncorhynchus mykiss). In a changing climate, accurate stream temperature modeling is increasingly important for sustainable salmonid management throughout the world. However, finite resource availability (e.g. funding, personnel) drives a tradeoff between thermal model accuracy and efficiency (i.e. cost-effective applicability at management-relevant spatial extents). Using different projected climate change scenarios, we compared the accuracy and efficiency of stream-specific and generalized (i.e. region-specific) temperature models for coldwater salmonids within and outside the State of Michigan, USA, a region with long-term stream temperature data and productive coldwater fisheries. Projected stream temperature warming between 2016 and 2056 ranged from 0.1 to 3.8 °C in groundwater-dominated streams and 0.2–6.8 °C in surface-runoff dominated systems in the State of Michigan. Despite their generally lower accuracy in predicting exact stream temperatures, generalized models accurately projected salmonid thermal habitat suitability in 82% of groundwater-dominated streams, including those with brook charr (80% accuracy), brown trout (89% accuracy), and rainbow trout (75% accuracy). In contrast, generalized models predicted thermal habitat suitability in runoff-dominated streams with much lower accuracy (54%). These results suggest that, amidst climate change and constraints in resource availability, generalized models are appropriate to forecast thermal conditions in groundwater-dominated streams within and outside Michigan and inform regional-level salmonid management strategies that are practical for coldwater fisheries managers, policy makers, and the public. We recommend fisheries professionals reserve resource

  6. Patients with urinary tract infection: proposed management strategies of general practitioners, microbiologists and urologists.

    Science.gov (United States)

    Olesen, F; Oestergaard, I

    1995-01-01

    BACKGROUND. It is difficult to implement change in general practice. It is not known how best to conduct effective continuing medical education in general practice. General practitioners' criteria for good clinical practice vary and it is unknown whether systematic education by hospital specialists could be expected to reduce variation between general practitioners. AIM. A study was undertaken to describe general practitioners', microbiologists' and urologists' strategies for diagnosis, treatment, and follow up of female patients with symptoms of urinary tract infection, a common reason for consultation in general practice. The findings of the study were to be used as a base upon which to discuss the advantages and disadvantages of using hospital specialists as a resource in general practitioners' peer group based continuing medical education. METHOD. Three vignettes together with several proposals for diagnosis, treatment and follow up were presented in a questionnaire to general practitioners, microbiologists and urologists in Denmark. The case histories concerned three female patients (aged 10, 30 and 60 years) who consulted their general practitioner for advice. The female patients were otherwise healthy and well known to the practice. General practitioners', microbiologists' and urologists' recommendations for good clinical practice were compared. RESULTS. A total of 154 general practitioners (77%), 45 microbiologists (51%) and 54 urologists (61%) who were eligible for the study responded to the questionnaire. There was considerable variation in the management strategies proposed by doctors within each specialty and between the specialties. Microbiologists and urologists were more likely to suggest treating the 30-year-old woman by giving advice and a prescription by telephone compared with their general practitioner colleagues. Conversely, the microbiologists and urologists were more likely to suggest asking the 10- and 60-year-old patients to attend the

  7. General Electric Company proposed management plan, commercial buildings, National Solar Demonstration Program

    Energy Technology Data Exchange (ETDEWEB)

    None

    1976-04-01

    The National Solar Demonstration Plan (NSDP) for the solar heating and cooling of non-residential buildings is designed to meet the goals and objectives of ERDA 23A. The plan has been formulated for a matrix of two hundred (200) commercial demonstration projects. This report contains the General Electric recommendations for the NSDP pertaining to the management structure, demonstration implementation, schedules, data dissemination, and resource requirements. Closely associated with these major planning elements are the related elements in the other recent General Electric reports submitted under the SHACOB Phase I contract. (WDM)

  8. Australian general practitioners' preferences for managing the care of people diagnosed with cancer.

    Science.gov (United States)

    Johnson, Claire E; Lizama, Natalia; Garg, Neeraj; Ghosh, Manonita; Emery, Jonathan; Saunders, Christobel

    2014-06-01

    To investigate general practitioners' (GPs) preferences for involvement in the management of people diagnosed with the seven most frequent cancers and any barriers to or concerns about an expanded role for GPs. A self-report survey was mailed to a random sample of 1969 Australian GPs. In all, 33% (648) of GPs participated. Participants were a median of 50 years and worked 38 h per week; 53% were male and 68% practiced in metropolitan areas. Most participants preferred to be involved in cancer prevention (86%) and initial diagnosis (85%). Fewer were interested in monitoring for recurrence (70%), follow up after treatment (68%), coordinating psychological support (70%) and palliative care (68%). Only 52% of GPs had a preference for providing supportive care to manage the symptoms of cancer treatment, 45% for managing postoperative care and 40% for coordinating treatment. On multivariate analysis, preference for involvement in more aspects of cancer management increased with age (P = 0.030), if the GP practiced in rural compared to metropolitan areas (P = 0.005), was a partner in a practice compared to a sole practitioner (P = 0.003), had previously received cancer-specific training (P management. While many GPs are currently involved in some aspects of cancer management, with training, good communication and support from specialists this role may be successfully expanded. © 2012 Wiley Publishing Asia Pty Ltd.

  9. Anesthetic and airway management of general anesthesia in a patient with Meckel-Gruber syndrome.

    Science.gov (United States)

    Miyazu, Mitsunori; Sobue, Kazuya; Ito, Hiroaki; Azami, Takafumi; Ito, Shoji; Takeuchi, Akinori; Sasano, Hiroshi; Tsuda, Takako; Katsuya, Hirotada

    2005-01-01

    Meckel-Gruber syndrome, characterized by occipital encephalocele, microcephaly, polydactyly, cleft lip or palate, mandibular micrognathism, and anatomical abnormality of the larynx and tongue, along with other associated malformations, is in the list of diseases associated with difficult airway. However, there has been no report on the management of general anesthesia and airway management for such patients. A 2-year-old girl with Meckel-Gruber syndrome was scheduled for cardioplasty and gastrostomy for gastroesophageal reflux under general anesthesia. Preoperative examination revealed obesity, microgenia, dysspondylism, proteinuria, hypoplastic kidneys, and stenosis of the anal canal. Although we anticipated some difficulty with the intubation and prepared several alternative methods for intubation, such as a bronchofiberscope and a laryngeal mask airway, tracheal intubation was completed without difficulty using conventional laryngoscopy after inhalational induction with sevoflurane. Because most patients with this syndrome die before and shortly after delivery, those who survive to some age might have less severe deformities.

  10. Management of asthma in pregnant women by general practitioners: A cross sectional survey

    Directory of Open Access Journals (Sweden)

    Abramson Michael J

    2011-11-01

    Full Text Available Abstract Background Poorly controlled asthma can lead to maternal and fetal complications. Despite the known risks of poorly controlled asthma during pregnancy and the need for stepping up therapy when appropriate, there are concerns that management is suboptimal in primary care. Our objective was to investigate the management of asthma during pregnancy by general practitioners providing shared maternity care. Methods A pre-piloted, anonymous mail survey was sent to all general practitioners (n = 842 involved in shared maternity care at six maternity hospitals in Victoria, Australia. Respondents were asked about their perceived safety of individual asthma medications during pregnancy. Approach to asthma management during pregnancy was further explored using scenarios of pregnant women with stable and deteriorating asthma and poor medication adherence. Results Inhaled corticosteroids (ICS were perceived to be the safest and were the preferred preventive medication in first trimester (74.1%, whilst leukotriene receptor antagonists were the least preferred (2.9%. A quarter (25.8% of respondents would stop or decrease patients' ICS doses during pregnancy, even when their asthma was well controlled by current therapy. In addition, 12.1% of respondents were not sure how to manage deteriorating asthma during pregnancy and opted to refer to another health professional. Almost half the respondents (48.9% reported encountering medication nonadherence during pregnancy. Conclusion A lack of confidence and/or knowledge among general practitioners in managing deteriorating asthma in pregnancy was observed despite a good understanding of the safety of asthma medications during pregnancy, compliance with evidence-based guidelines in the selection of preventive medications, and self reported good asthma knowledge.

  11. Approaches in highly parameterized inversion - GENIE, a general model-independent TCP/IP run manager

    Science.gov (United States)

    Muffels, Christopher T.; Schreuder, Willem A.; Doherty, John E.; Karanovic, Marinko; Tonkin, Matthew J.; Hunt, Randall J.; Welter, David E.

    2012-01-01

    GENIE is a model-independent suite of programs that can be used to generally distribute, manage, and execute multiple model runs via the TCP/IP infrastructure. The suite consists of a file distribution interface, a run manage, a run executer, and a routine that can be compiled as part of a program and used to exchange model runs with the run manager. Because communication is via a standard protocol (TCP/IP), any computer connected to the Internet can serve in any of the capacities offered by this suite. Model independence is consistent with the existing template and instruction file protocols of the widely used PEST parameter estimation program. This report describes (1) the problem addressed; (2) the approach used by GENIE to queue, distribute, and retrieve model runs; and (3) user instructions, classes, and functions developed. It also includes (4) an example to illustrate the linking of GENIE with Parallel PEST using the interface routine.

  12. [Standardized management of acupuncture-moxibustion clinic in Singapore General Hospital].

    Science.gov (United States)

    Cui, Shu-Li; Tan, Kian Hian; Ong, Biauw Chi; Lim, Shih hui; Yong, Yang; Seah, Cheng Ngee; Huang, Youyi; Han, Seong Ng

    2014-02-01

    The standardized management of acupuncture-moxibustion in Singapore General Hospital is introduced. With gradual improvement of outpatient infrastructure, re-training of medical staff, strict disinfection of manipulation, periodical inspection of medical instruments, unified management of writing, saving and processing in medical records and public education of TCM knowledge, a standardized management system in accordance with modernized hospital is gradually established. As a result, efficiency and quality of clinical treatment is continuously increasing. From April of 1998 to December of 2012, a total of 74 654 times of treatment were performed, and treatment amount per day is gradually increased. The unusual condition of acupuncture is avoided. Periodical strict inspection of joint committee authenticated by domestic and overseas medical health organization is repeatedly passed and accepted. Additionally, three clinical researches funded by Singapore Health-care Company are still in progress in acupuncture-moxibustion department.

  13. Strategic directions for developing the Australian general practice nurse role in cardiovascular disease management.

    Science.gov (United States)

    Halcomb, Elizabeth J; Davidson, Patricia M; Yallop, Julie; Griffiths, Rhonda; Daly, John

    2007-08-01

    Practice nursing is an integral component of British and New Zealand primary care, but in Australia it remains an emerging specialty. Despite an increased focus on the Australian practice nurse role, there has been limited strategic role development, particularly relating to national health priority areas. This paper reports the third stage of a Project exploring the Australian practice nurse role in the management of cardiovascular disease (CVD). This stage involved a consensus development conference, undertaken to identify strategic, priority recommendations for practice nurse role development. 1. Practice nurses have an important role in developing systems and processes for CVD management; 2. A change in the culture of general practice is necessary to promote acceptance of nurse-led CVD management; 3. Future research needs to evaluate specific models of care, incorporating outcome measures sensitive to nursing interventions; 4. Considerable challenges exist in conducting research in general practice; and 5. Changes in funding models are necessary for widespread practice nurse role development. The shifting of funding models provides evidence to support interdisciplinary practice in Australian general practice. The time is ripe, therefore, to engage in prospective and strategic planning to inform development of the practice nurse role.

  14. General Managers' and building managers' different evaluation of building value and quality - as built and over time

    DEFF Research Database (Denmark)

    Jensen, Per Anker

    2007-01-01

    This paper is one of the results of a research project on real estate strategies and building values based on a case study of the corporate buildings of DR (Danish Broadcasting Corporation). The paper presents some of the results from a questionnaire survey among select groups of managers in DR...... concerning their evaluation of 5 buildings. The overall purpose of the survey was to evaluate the different buildings’ values and quality, both as built and over time. A second purpose was to develop and test a methodology to describe the values and quality of buildings at a general but still differentiated...... building. Furthermore, the respondents were asked to prioritize the quality factors. In the analysis the quality factors were grouped into cultural value and use value and into quality as built and over time. The paper presents the general results of the survey with focus on the differences between...

  15. General practitioners' clinical expertise in managing suicidal young people: implications for continued education.

    Science.gov (United States)

    Michail, Maria; Tait, Lynda; Churchill, Dick

    2017-09-01

    Aim To examine general practitioners' (GPs) clinical expertise in assessing, communicating with, and managing suicidal young people aged 14-25 to inform the development of an educational intervention for GPs on youth suicide prevention. Suicide is the second leading cause of death for young people worldwide. GPs are ideally suited to facilitate early identification and assessment of suicide risk. However, GPs' levels of competence, knowledge, and attitudes towards suicidal young people have not yet been explored. A cross-sectional survey on GPs' levels of confidence in assessing and managing young people at risk of suicide; knowledge of risk factors and warning signs of suicide in young people; attitudes towards young suicidal people; and training preferences on managing suicide risk. Findings Seventy GPs completed the survey (30 males). The majority of GPs reported high levels of confidence in assessing and managing suicidality in young people. Experienced GPs demonstrated high levels of knowledge of suicide risk factors in young people but low levels of knowledge of warning signs that might indicate heightened risk. Although 48% of GPs disagreed that maintaining compassionate care is difficult with those who deliberately self-harm, GPs perceived communication with young people to be difficult, with one-third reporting frustration in managing those at risk of suicide. A total of 75% of GPs said they would be interested in receiving further training on assessing and managing young people at risk of suicide. The study has important implications for providing specialist training to support GPs in assessing and managing youth suicide risk and facilitating attitudinal change. GP education on youth suicide risk assessment and management should promote a holistic understanding and assessment of risk and its individual, social and contextual influences in line with clinical recommendations to facilitate therapeutic engagement and communication with young people.

  16. 77 FR 54922 - Record of Decision for the General Management Plan/Final Environmental Impact Statement, Hampton...

    Science.gov (United States)

    2012-09-06

    ... National Park Service Record of Decision for the General Management Plan/Final Environmental Impact... Region signed the Record of Decision selecting Alternative 3 as the approved General Management Plan (GMP... (NEPA), the National Park Service (NPS) announces the availability of the Record of Decision for the...

  17. 76 FR 5820 - Record of Decision for the General Management Plan for the Cumberland Gap National Historical...

    Science.gov (United States)

    2011-02-02

    ... National Park Service Record of Decision for the General Management Plan for the Cumberland Gap National... the Record of Decision for the General Management Plan Environmental Impact Statement for the..., the National Park Service (NPS) announces the availability of the Record of Decision (ROD) for the...

  18. A Reinforcement Model of the Relationships of Supervisors' General Communication Styles and Conflict Management Styles to Task Attraction.

    Science.gov (United States)

    Wheeless, Lawrence R.; Reichel, Lisa S.

    1990-01-01

    Investigates the relationship between general styles of communicating and more situation-specific conflict management styles. Finds substantial relationships between general communication styles and conflict management styles, as well as very substantial relationships between the style constructs and task attraction of supervisors. (SR)

  19. 78 FR 67187 - Notice of Availability of the Draft General Management Plan/Wilderness Study/Environmental Impact...

    Science.gov (United States)

    2013-11-08

    ... National Park Service Notice of Availability of the Draft General Management Plan/ Wilderness Study... availability of the Draft General Management Plan/Wilderness Study/Environmental Impact Statement (GMP/WS/EIS... for evaluating the action alternatives. The NPS would maintain the Big Spring Wilderness Study...

  20. 78 FR 63974 - Student Assistance General Provisions-Subpart K-Cash Management; Extension of Public Comment...

    Science.gov (United States)

    2013-10-25

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF EDUCATION Student Assistance General Provisions--Subpart K--Cash Management; Extension of Public Comment Period..., ``Student Assistance General Provisions--Subpart K--Cash Management''. ED is extending the comment period...

  1. [Halitosis management by the general dental practitioner- results of an International Consensus Workshop*].

    Science.gov (United States)

    Seemann, Rainer; Duarte da Conceicao, Mauricio; Filippi, Andreas; Greenman, John; Lenton, Patricia; Nachnani, Sushma; Quirynen, Marc; Roldán, Silvia; Schulze, Hendrik; Sterer, Nir; Tangerman, Albert; Winkel, Edwin G; Yaegaki, Ken; Rosenberg, Mel

    2014-01-01

    Clinical investigations on patients suffering from halitosis clearly reveal that in the vast majority of cases the source for an offensive breath odor can be found within the oral cavity (90%). Based on these studies, the main sources for intra-oral halitosis where tongue coating, gingivitis/periodontitis and a combination of the two. Thus, it is perfectly logical that general dental practitioners (GDPs) should be able to manage intra-oral halitosis under the conditions found in a normal dental practice. However, GDPs who are interested in diagnosing and treating halitosis are challenged to incorporate scientifically based strategies for use in their clinics. Therefore, the present paper summarizes the results of a consensus workshop of international authorities held with the aim to reach a consensus on general guidelines on how to assess and diagnose patients’ breath odor concerns and general guidelines on regimens for the treatment of halitosis.

  2. Halitosis management by the general dental practitioner--results of an international consensus workshop.

    Science.gov (United States)

    Seemann, R; Conceicao, M D; Filippi, A; Greenman, J; Lenton, P; Nachnani, S; Quirynen, M; Roldan, S; Schulze, H; Sterer, N; Tangerman, A; Winkel, E G; Yaegaki, K; Rosenberg, M

    2014-03-01

    Clinical investigations on patients suffering from halitosis clearly reveal that in the vast majority of cases the source for an offensive breath odor can be found within the oral cavity (90%). Based on these studies, the main sources for intra-oral halitosis where tongue coating, gingivitis/periodontitis or a combination of the two. Thus, it is perfectly logical that general dental practitioners (GDPs) should be able to manage intra-oral halitosis under the conditions found in a normal dental practice. However, GDPs who are interested in diagnosing and treating halitosis are challenged to incorporate scientifically based strategies for use in their clinics. Therefore, the present paper summarizes the results of a consensus workshop of international authorities held with the aim to reach a consensus on general guidelines on how to assess and diagnose patients' breath odor concerns and general guidelines on regimens for the treatment of halitosis.

  3. Instructional and behavior management practices implemented by elementary general education teachers.

    Science.gov (United States)

    Reddy, Linda A; Fabiano, Gregory A; Dudek, Christopher M; Hsu, Louis

    2013-12-01

    This investigation examined 317 general education kindergarten through fifth-grade teachers' use of instructional and behavioral management strategies as measured by the Classroom Strategy Scale (CSS)-Observer Form, a multidimensional tool for assessing classroom practices. The CSS generates frequency of strategy use and discrepancy scores reflecting the difference between recommended and actual frequencies of strategy use. Hierarchical linear models (HLMs) suggested that teachers' grade-level assignment was related to their frequency of using instructional and behavioral management strategies: Lower grade teachers utilized more clear 1 to 2 step commands, praise statements, and behavioral corrective feedback strategies than upper grade teachers, whereas upper grade teachers utilized more academic monitoring and feedback strategies, content/concept summaries, student focused learning and engagement, and student thinking strategies than lower grade teachers. Except for the use of praise statements, teachers' usage of instructional and behavioral management strategies was not found to be related to years of teaching experience or to the interaction of years of teaching experience and grade-level assignment. HLMs suggested that teachers' grade level was related to their discrepancy scores of some instructional and behavioral management strategies: Upper grade teachers had higher discrepancy scores in academic performance feedback, behavioral feedback, and praise than lower grade teachers. Teachers' discrepancy scores of instructional and behavioral management strategies were not found to be related to years of teaching experience or to the interaction of years of teaching experience and grade-level assignment. Implications of results for school psychology practice are outlined.

  4. General practitioners' management of mental disorders: A rewarding practice with considerable obstacles

    Directory of Open Access Journals (Sweden)

    Fleury Marie-Josée

    2012-03-01

    Full Text Available Abstract Background Primary care improvement is the cornerstone of current reforms. Mental disorders (MDs are a leading cause of morbidity worldwide and widespread in industrialised countries. MDs are treated mainly in primary care by general practitioners (GPs, even though the latter ability to detect, diagnose, and treat patients with MDs is often considered unsatisfactory. This article examines GPs' management of MDs in an effort to acquire more information regarding means by which GPs deal with MD cases, impact of such cases on their practices, factors that enable or hinder MD management, and patient-management strategies. Methods This study employs a mixed-method approach with emphasis on qualitative investigation. Based on a previous survey of 398 GPs in Quebec, Canada, 60 GPs representing a variety of practice settings were selected for further study. A 10-minute-long questionnaire comprising 27 items was administered, and 70-minute-long interviews were conducted. Quantitative (SPSS and qualitative (NVivo analyses were performed. Results At least 20% of GP visits were MD-related. GPs were comfortable managing common MDs, but not serious MDs. GPs' based their treatment of MDs on pharmacotherapy, support therapy, and psycho-education. They used clinical intuition with few clinical tools, and closely followed their patients with MDs. Practice features (salary or hourly fees payment; psycho-social teams on-site; strong informal networks, and GPs' individual characteristics (continuing medical education; exposure and interest in MDs; traits like empathy favoured MD management. Collaboration with psychologists and psychiatrists was considered key to good MD management. Limited access to specialists, system fragmentation, and underdeveloped group practice and shared-care models were impediments. MD management was seen as burdensome because it required more time, flexibility, and emotional investment. Strategies exist to reduce the burden (one

  5. Understanding the process of patient satisfaction with nurse-led chronic disease management in general practice.

    Science.gov (United States)

    Mahomed, Rosemary; St John, Winsome; Patterson, Elizabeth

    2012-11-01

      To investigate the process of patient satisfaction with nurse-led chronic disease management in Australian general practice.   Nurses working in the primary care context of general practice, referred to as practice nurses, are expanding their role in chronic disease management; this is relatively new to Australia. Therefore, determining patient satisfaction with this trend is pragmatically and ethically important. However, the concept of patient satisfaction is not well understood particularly in relation to care provided by practice nurses.   A grounded theory study underpinned by a relativist ontological position and a relativist epistemology.   Grounded theory was used to develop a theory from data collected through in-depth interviews with 38 participants between November 2007-April 2009. Participants were drawn from a larger project that trialled a practice nurse-led, collaborative model of chronic disease management in three Australian general practices. Theoretical sampling, data collection, and analysis were conducted concurrently consistent with grounded theory methods.   Patients undergo a cyclical process of Navigating Care involving three stages, Determining Care Needs, Forming Relationship, and Having Confidence. The latter two processes are inter-related and a feedback loop from them informs subsequent cycles of Determining Care Needs. If any of these steps fails to develop adequately, patients are likely to opt out of nurse-led care.   Navigating Care explains how and why time, communication, continuity, and trust in general practitioners and nurses are important to patient satisfaction. It can be used in identifying suitable patients for practice nurse-led care and to inform the practice and organization of practice nurse-led care to enhance patient satisfaction. © 2012 Blackwell Publishing Ltd.

  6. Generalized Information Architecture for Managing Requirements in IBM?s Rational DOORS(r) Application.

    Energy Technology Data Exchange (ETDEWEB)

    Aragon, Kathryn M.; Eaton, Shelley M.; McCornack, Marjorie Turner; Shannon, Sharon A.

    2014-12-01

    When a requirements engineering effort fails to meet expectations, often times the requirements management tool is blamed. Working with numerous project teams at Sandia National Laboratories over the last fifteen years has shown us that the tool is rarely the culprit; usually it is the lack of a viable information architecture with well- designed processes to support requirements engineering. This document illustrates design concepts with rationale, as well as a proven information architecture to structure and manage information in support of requirements engineering activities for any size or type of project. This generalized information architecture is specific to IBM's Rational DOORS (Dynamic Object Oriented Requirements System) software application, which is the requirements management tool in Sandia's CEE (Common Engineering Environment). This generalized information architecture can be used as presented or as a foundation for designing a tailored information architecture for project-specific needs. It may also be tailored for another software tool. Version 1.0 4 November 201

  7. Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice.

    Science.gov (United States)

    Eley, Diann S; Patterson, Elizabeth; Young, Jacqui; Fahey, Paul P; Del Mar, Chris B; Hegney, Desley G; Synnott, Robyn L; Mahomed, Rosemary; Baker, Peter G; Scuffham, Paul A

    2013-01-01

    The Australian government's commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model's feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients' stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded.

  8. Physiological Signal Processing for Individualized Anti-nociception Management During General Anesthesia: a Review.

    Science.gov (United States)

    De Jonckheere, J; Bonhomme, V; Jeanne, M; Boselli, E; Gruenewald, M; Logier, R; Richebé, P

    2015-08-13

    The aim of this paper is to review existing technologies for the nociception / anti-nociception balance evaluation during surgery under general anesthesia. General anesthesia combines the use of analgesic, hypnotic and muscle-relaxant drugs in order to obtain a correct level of patient non-responsiveness during surgery. During the last decade, great efforts have been deployed in order to find adequate ways to measure how anesthetic drugs affect a patient's response to surgical nociception. Nowadays, though some monitoring devices allow obtaining information about hypnosis and muscle relaxation, no gold standard exists for the nociception / anti-nociception balance evaluation. Articles from the PubMed literature search engine were reviewed. As this paper focused on surgery under general anesthesia, articles about nociception monitoring on conscious patients, in post-anesthesia care unit or in intensive care unit were not considered. In this article, we present a review of existing technologies for the nociception / anti-nociception balance evaluation, which is based in all cases on the analysis of the autonomous nervous system activity. Presented systems, based on sensors and physiological signals processing algorithms, allow studying the patients' reaction regarding anesthesia and surgery. Some technological solutions for nociception / antinociception balance monitoring were described. Though presented devices could constitute efficient solutions for individualized anti-nociception management during general anesthesia, this review of current literature emphasizes the fact that the choice to use one or the other mainly relies on the clinical context and the general purpose of the monitoring.

  9. The opinion of the general practitioner toward clinical management of patients with psychogenic nonepileptic seizures.

    LENUS (Irish Health Repository)

    O'Sullivan, S S

    2012-02-03

    OBJECTIVE: The purpose of this work was to assess the opinion of general practitioners (GPs) regarding the diagnosis of psychogenic nonepileptic seizures (PNES) and the role they feel they should play in the management of the disorder. METHODS: Patients with PNES were identified from hospital records. Seizure and patient characteristics were recorded. Their GPs were surveyed regarding their understanding of the diagnosis and ongoing management of PNES. RESULTS: Twenty-three patients were identified over a 3-year period as having been diagnosed with PNES. Sixty-five percent of GPs agreed with the diagnosis, and when asked to grade their understanding of the diagnosis (poor = 1, excellent = 10), the mean score was 5.7 (+\\/-SD 2.3). Thirty-five percent of GPs felt psychological input was of benefit to their patients. Fifty-two percent of GPs felt comfortable following up these patients, either with or without neurology outpatient services. CONCLUSIONS: PNES remains a difficult disease to manage. There is a high level of uncertainty regarding the optimum management of PNES among primary care physicians, for which further education is needed.

  10. A Business Process Management System based on a General Optimium Criterion

    Directory of Open Access Journals (Sweden)

    Vasile MAZILESCU

    2009-01-01

    Full Text Available Business Process Management Systems (BPMS provide a broadrange of facilities to manage operational business processes. These systemsshould provide support for the complete Business Process Management (BPMlife-cycle [16]: (redesign, configuration, execution, control, and diagnosis ofprocesses. BPMS can be seen as successors of Workflow Management (WFMsystems. However, already in the seventies people were working on officeautomation systems which are comparable with today’s WFM systems.Recently, WFM vendors started to position their systems as BPMS. Our paper’sgoal is a proposal for a Tasks-to-Workstations Assignment Algorithm (TWAAfor assembly lines which is a special implementation of a stochastic descenttechnique, in the context of BPMS, especially at the control level. Both cases,single and mixed-model, are treated. For a family of product models having thesame generic structure, the mixed-model assignment problem can be formulatedthrough an equivalent single-model problem. A general optimum criterion isconsidered. As the assembly line balancing, this kind of optimisation problemleads to a graph partitioning problem meeting precedence and feasibilityconstraints. The proposed definition for the "neighbourhood" function involvesan efficient way for treating the partition and precedence constraints. Moreover,the Stochastic Descent Technique (SDT allows an implicit treatment of thefeasibility constraint. The proposed algorithm converges with probability 1 toan optimal solution.

  11. Management of orthodontic emergencies in primary care - self-reported confidence of general dental practitioners.

    Science.gov (United States)

    Popat, H; Thomas, K; Farnell, D J J

    2016-07-08

    Objective To determine general dental practitioners' (GDPs) confidence in managing orthodontic emergencies.Design Cross-sectional study.Setting Primary dental care.Subjects and methods An online survey was distributed to dentists practicing in Wales. The survey collected basic demographic information and included descriptions of ten common orthodontic emergency scenarios.Main outcome measure Respondents' self-reported confidence in managing the orthodontic emergency scenarios on a 5-point Likert scale. Differences between the Likert responses and the demographic variables were investigated using chi-squared tests.Results The median number of orthodontic emergencies encountered by respondents over the previous six months was 1. Overall, the self-reported confidence of respondents was high with 7 of the 10 scenarios presented scoring a median of 4 indicating that GDPs were 'confident' in their management. Statistical analysis revealed that GDPs who saw more orthodontic emergencies in the previous six months were more confident when managing the presented scenarios. Other variables such as age, gender, geographic location of practice and number of years practising dentistry were not associated with self-reported confidence.Conclusions Despite GDPs encountering very few orthodontic emergencies in primary care, they appear to be confident in dealing with commonly arising orthodontic emergency situations.

  12. Recovery schemes for different distributed connection management in generalized multi-protocol label switching networks

    Institute of Scientific and Technical Information of China (English)

    Can Wang; Yuefeng Ji

    2007-01-01

    As the wavelength division multiplexing (WDM) technology matures and the demands for bandwidth increase, survivability becomes more and more important in generalized multi-protocol label switching (GMPLS) controlled intelligent optical networks (IONs). There are great interests to study the performance of restorability under one certain connection management strategy. And studies in the problem of providing recovery from link failures under two different resource reservation schemes, forward reservation protocols (FRPs) and backward reservation protocols (BRPs), are presented. They are examined from the point of view of connection blocking probability, restorability and average recovery time. The two different connection management schemes and the survey of different recovery schemes are first presented. The performance of these recovery strategies is analyzed and compared both through theoretical analysis and simulation results. The main stressed idea is that using BRPs gives the best performance in terms of restorability and blocking probability in restorable GMPLS networks.

  13. Surveillance Monitoring Management for General Care Units: Strategy, Design, and Implementation.

    Science.gov (United States)

    McGrath, Susan P; Taenzer, Andreas H; Karon, Nancy; Blike, George

    2016-07-01

    The growing number of monitoring devices, combined with suboptimal patient monitoring and alarm management strategies, has increased "alarm fatigue," which have led to serious consequences. Most reported alarm man- agement approaches have focused on the critical care setting. Since 2007 Dartmouth-Hitchcock (Lebanon, New Hamp- shire) has developed a generalizable and effective design, implementation, and performance evaluation approach to alarm systems for continuous monitoring in general care settings (that is, patient surveillance monitoring). In late 2007, a patient surveillance monitoring system was piloted on the basis of a structured design and implementation approach in a 36-bed orthopedics unit. Beginning in early 2009, it was expanded to cover more than 200 inpatient beds in all medicine and surgical units, except for psychiatry and labor and delivery. Improvements in clinical outcomes (reduction of unplanned transfers by 50% and reduction of rescue events by more than 60% in 2008) and approximately two alarms per patient per 12-hour nursing shift in the original pilot unit have been sustained across most D-H general care units in spite of increasing patient acuity and unit occupancy. Sample analysis of pager notifications indicates that more than 85% of all alarm conditions are resolved within 30 seconds and that more than 99% are resolved before escalation is triggered. The D-H surveillance monitoring system employs several important, generalizable features to manage alarms in a general care setting: alarm delays, static thresholds set appropriately for the prevalence of events in this setting, directed alarm annunciation, and policy-driven customization of thresholds to allow clinicians to respond to needs of individual patients. The systematic approach to design, implementation, and performance management has been key to the success of the system.

  14. Perioperative management of patients for osteo-odonto-kreatoprosthesis under general anaesthesia: A retrospective study

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2011-01-01

    Full Text Available An osteo-odonto-keratoprosthesis (OOKP procedure is indicated in patients with failed corneal transplant but having intact retina for visual improvement. We studied perioperative concerns of patients who underwent the staged OOKP procedure. This was a retrospective analysis of patients who underwent OOKP. The information regarding symptoms, associated comorbidities, perioperative events including anaesthetic management were collected. Eight patients (five females and three males underwent the staged OOKP procedure. The median age was 18 years. The median weight was 45 kg. The median duration of loss of vision was 4 years. The aetiology of blindness included Stevens-Johnson′s syndrome (SJS (7 and chemical burn (1. Four patients had generalized skin problem due to SJS. All cases were managed under general anaesthesia, and airway management included nasotracheal intubation for stage I and orotracheal intubation for stage II. The median mallampati classification was I prior to OOKP stage I procedure while it changed to II at stage II procedure. Two patients required fibreoptic nasotracheal intubation. One patient had excessive oozing from the mucosal harvest site and was managed conservatively. In one patient, tooth harvesting was done twice as the first tooth was damaged during creating a hole in it. We conclude that OOKP requires multidisciplinary care. Anaesthesiologist should evaluate the airway carefully and disease-associated systemic involvements. The use of various drugs requires caution and steroid supplementation should be done. Airway difficulty should be anticipated, mandating thorough evaluation. Re-evaluation of airway is prudent as it may become difficult during the staged OOKP procedure.

  15. Dynamic Analysis of General Integrated Pest Management Model with Double Impulsive Control

    Directory of Open Access Journals (Sweden)

    Yingke Li

    2015-01-01

    Full Text Available A general predator-prey model with disease in the prey and double impulsive control is proposed and investigated for the purpose of integrated pest management. By using the Floquet theory, the comparison theorem of impulsive differential equations, and the persistence theory of dynamical systems, we obtain that if threshold value R01, then the model is permanent. The numerical examples not only illustrate the theoretical results, but also show that when the model is permanent, then it may possess a unique globally attractive T-periodic solution.

  16. Generalized data management systems and scientific information. Report of a specialist study

    Energy Technology Data Exchange (ETDEWEB)

    1978-06-01

    Separate abstracts were prepared for 19 of the papers in this volume. Four additional papers have already been cited in ERA; these can be found by referring to CONF-771062-- in the Report Number Index. Five other papers were not in the scope of coverage of ERA; these dealt with an introduction to generalized data management systems and capabilities required of them in handling data, a programming language for data bases, and specialized applications of data bases to laboratory animals (environmental husbandry, hematology, clinical chemistry) and environmental chemicals. (RWR)

  17. Minimal intervention dentistry II: part 2. Management of caries and periodontal risks in general dental practice.

    Science.gov (United States)

    Lallam, C; Decup, F

    2014-02-01

    The long-term clinical management of caries and periodontal diseases requires a double approach, one that is concerned with both treatment and prevention. Dentists should recognise the risk factors and their likely triggers to be able to implement the right strategy as early as the diagnostic phase. This comprehensive assessment can easily be done in general practice. All it takes is to combine the patient's general information with the systemic and behavioural factors, and the clinical observations with the local factors. The resulting patient profile can thus effectively support treatment by providing the necessary explanations, advice or prescriptions in relation with the clinical procedures. The modifiable risk factors need to be monitored and the behaviours changed to stabilise or limit disease progression. The practitioner's active approach is meant to meet the patient's demand for preventive counselling.

  18. The management of alcohol-related problems in general practice in north India.

    Science.gov (United States)

    Varma, V K; Malhotra, A K

    1988-07-01

    Twenty-seven general medical practitioners (GPs) were administered WHO semi-structured schedule enquiring "The Management of Alcohol-Related Problems in General Practice". Majority of the GPs had some involvement in each one of the specified alcohol-related problems. The involvement in alcohol and health education had been modest. Involvement in the control and regulatory activities was minimal. None of them felt that they had any role in the development of health and alcohol policy. Treatment response lo three typical situations appeared to be quite appropriate. To regulate production, to market less potent drinks at cheaper rates, to organize public health education programme through mass media were the suggestions made by them. It is suggested that GPs can and should be encouraged in leadership roles in policy decisions regarding the delivery of services, control and regulation of alcohol and research.

  19. Management of intra-operative acute pulmonary embolism during general anesthesia: a case report.

    Science.gov (United States)

    Mao, Yuanyuan; Wen, Shuai; Chen, Gezi; Zhang, Wei; Ai, Yanqiu; Yuan, Jingjing

    2017-05-26

    Acute pulmonary embolism (APE) can be life-threatening. Early detection is even more difficult for patients under general anesthesia as common symptoms are not available and the pathophysiological course of intra-operative APE is influenced by procedures of surgery and anesthesia, which makes patients under general anesthesia a distinctive group. We report a case of APE during orthopedic surgery under general anesthesia. A 64-year-old female with atrial fibrillation and surgical history of varicosity underwent total right hip replacement surgery under general anesthesia. No arterial or deep vein thrombosis (DVT) was found prior to the surgery, but APE still occurred intraoperatively. The sudden decrease in PETCO2 and increase in PaCO2 combined other clues raised the suspect of APE, which is further evidenced by transesophageal echocardiogram (TEE). Multidisciplinary consultation was started immediately. After discussion with the consultation team and communication with patient's family members, anticoagulation therapy was started and IVC filter was placed to prevent PE recurrence. The patient went through the operation and discharged uneventfully 30 days later. Pulmonary embolism is a rare and potentially high-risk perioperative situation, with a difficult diagnosis when occurs under anesthesia. The separation phenomenon of decrease in PETCO2 and increase in PaCO2 might be a useful and suggestive sign, enabling prompt management and therefore improving the prognosis.

  20. BOUNDED RATIONALITY: AN ANALYSIS OF TEACHING MANUALS OF MANAGEMENT GENERAL THEORY

    Directory of Open Access Journals (Sweden)

    Daniela Teixeira Dias

    2016-08-01

    Full Text Available The objective of this article was to analyze how the concept of bounded rationality has been treated in the educational manuals of General Theory of Management, with the objective to analyze its quality, in terms of quality and complexity. Therefore, three educational manuals provided by the Central Library of the Alfa Federal University were used: “General Theory of Administration” authored by Motta and Vasconcelos (Manual A; “Introduction to Management” by Chiavenato (Manual B, and “Management: Theory and Processes” by Caravantes, Caravantes, and Kloeckener (Manual C. These were observed from the content analysis in four dimensions defined a priori: delimitation of the approach and quality of the references; historical-concrete dimension; relationship dimension; and theoretical dimension. The results showed that all manuals presented considerations about the bounded rationality assumption and made reference to Simon and Barnard, although they have not discussed their work and their contribution more widely. Manual A was the most complete in the axes analysis herein. Manual B turned to a summarized and synthetic theoretical discussion. Whereas C Manual defined and conceptualized bounded rationality and was the only one to describe the types of rationality presented by Simon.

  1. Knowledge Management Systems as an Interdisciplinary Communication and Personalized General-Purpose Technology

    Directory of Open Access Journals (Sweden)

    Ulrich Schmitt

    2015-10-01

    Full Text Available As drivers of human civilization, Knowledge Management (KM processes have co-evolved in line with General-Purpose-Technologies (GPT, such as writing, printing, and information and communication systems. As evidenced by the recent shift from information scarcity to abundance, GPTs are capable of drastically altering societies due to their game-changing impact on our spheres of work and personal development. This paper looks at the prospect of whether a novel Personal Knowledge Management (PKM concept supported by a prototype system has got what it takes to grow into a transformative General-Purpose-Technology. Following up on a series of papers, the KM scenario of a decentralizing revolution where individuals and self-organized groups yield more power and autonomy is examined according to a GPT's essential characteristics, including a wide scope for improvement and elaboration (in people's private, professional and societal life, applicability across a broad range of uses in a wide variety of products and processes (in multi-disciplinary educational and work contexts, and strong complementarities with existing or potential new technologies (like organizational KM Systems and a proposed World Heritage of Memes Repository. The result portrays the PKM concept as a strong candidate due to its personal, autonomous, bottom-up, collaborative, interdisciplinary, and creativity-supporting approach destined to advance the availability, quantity, and quality of the world extelligence and to allow for a wider sharing and faster diffusion of ideas across current disciplinary and opportunity divides.

  2. Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency Departments

    Directory of Open Access Journals (Sweden)

    Baumann, Brigitte M

    2011-05-01

    Full Text Available Objectives: To compare the evaluation and management of pediatric cutaneous abscess patients at three different emergency department (ED settings.Method: We conducted a retrospective cohort study at two academic pediatric hospital EDs, a general academic ED and a community ED in 2007, with random sampling of 100 patients at the three academic EDs and inclusion of 92 patients from the community ED. Eligible patients were ≤18 years who had a cutaneous abscess. We recorded demographics, predisposing conditions, physical exam findings, incision and drainage procedures, therapeutics and final disposition. Laboratory data were reviewed for culture results and antimicrobial sensitivities. For subjects managed as outpatients from the ED, we determined where patients were instructed to follow up and, using electronic medical records, ascertained the proportion of patients who returned to the ED for further management.Result: Of 392 subjects, 59% were female and the median age was 7.7 years. Children at academic sites had larger abscesses compared to community patients, (3.5 versus 2.5 cm, p=0.02. Abscess incision and drainage occurred in 225 (57% children, with the lowest rate at the academic pediatric hospital EDs (51% despite the relatively larger abscess size. Procedural sedation and the collection of wound cultures were more frequent at the academic pediatric hospital and the general academic EDs. Methicillin-resistant Staphylococcus aureus (MRSA prevalence did not differ among sites; however, practitioners at the academic pediatric hospital EDs (92% and the general academic ED (86% were more likely to initiate empiric MRSA antibiotic therapy than the community site (71%, (p<0.0001. At discharge, children who received care at the community ED were more likely to be given a prescription for a narcotic (23% and told to return to the ED for ongoing wound care (65%. Of all sites, the community ED also had the highest percentage of follow-up visits (37

  3. INTRA-ABDOMINAL INFECTION AND ACUTE ABDOMEN-EPIDEMIOLOGY, DIAGNOSIS AND GENERAL PRINCIPLES OF SURGICAL MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Jovanović Dušan

    2015-03-01

    Full Text Available Intra-abdominal infections are multifactorial and present an complex inflammatory response of the peritoneum to microorganisms followed by exudation in the abdominal cavity and systemic response Despite advances in management and critical care of patients with acute generalized peritonitis due to hollow viscus perforation, prognosis is still very poor, with high mortality rate. Early detection and adequate treatment is essential to minimize complications in the patient with acute abdomen. Prognostic evaluation of complicated IAI by modern scoring systems is important to assess the severity and the prognosis of the disease. Control of the septic source can be achieved either by nonoperative or operative means. Nonoperative interventional procedures include percutaneous drainages of abscesses. The management of primary peritonitis is non-surgical and antibiotic- treatment. The management of secondary peritonitis include surgery to control the source of infection, removal of toxins, bacteria, and necrotic tissue, antibiotic therapy, supportive therapy and nutrition. "Source control" is sine qua non of success and adequate surgical procedure involves closure or resection of any openings into the gastrointestinal tract, resection of inflamed tissue and drainage of all abdominal and pelivic collections.

  4. How French general practitioners manage and prevent recurrent respiratory tract infections in children: the SOURIRRE survey

    Science.gov (United States)

    Chicoulaa, Bruno; Haas, Hervé; Viala, Jérôme; Salvetat, Maryline; Olives, Jean-Pierre

    2017-01-01

    Background Recurrent respiratory tract infections (RRTIs) are the most common reason for children’s visits to primary care physicians in France; however, little is known about general practitioners’ (GPs) opinions and expectations concerning the management and prevention of these common and recurrent pathologies. Purpose To describe French GPs’ daily practice in the management of respiratory infections and the prevention of their recurrence in children. Methods A sample group of French GPs answered a structured questionnaire on risk factors, RRTI management, antibiotic use and prevention measures. Results A total of 358 GPs participated in the survey. Rhinopharyngitis, the most frequent respiratory infection, was considered to be recurrent if six or more episodes occurred in a year. Four risk factors were acknowledged as substantial: living in communities, passive smoking, pollution and allergies. Around 63% of GPs said that RRTIs are too often treated with antibiotics. More than 85% thought that prevention of RRTIs is possible. Smoking cessation, vaccination, allergen avoidance and hygiene were identified as the main preventive measures. A large majority of GPs (84%) prescribed products for prevention and ~90% would prescribe a product stimulating immunity if the efficacy and tolerability of these agents was proven and confirmed in their daily practice. Conclusions French GPs are well aware of the health and socioeconomic burdens resulting from RRTIs, as well as the risk of antibiotic overuse. They have a prevention-oriented approach, implement preventive measures when possible and prescribe products for prevention. PMID:28293116

  5. The management of depressive symptoms in patients with COPD: a postal survey of general practitioners.

    Science.gov (United States)

    Yohannes, Abebaw Mengistu; Hann, Mark; Sibbald, Bonnie

    2011-07-01

    We examined the management of depression by general practitioners (GPs), through the use of case vignettes, in patients with chronic obstructive pulmonary disease (COPD), severe osteoarthritis and depressive symptoms alone. Depression is common in patients with COPD. Untreated depression leads to poor compliance with medical treatment and increases health-care utilisation. We surveyed a random sample of GPs (n = 3956) in England using a postal questionnaire. The questionnaire explored how GPs would approach the management of emotional distress in patients with and without a chronic condition and gauged their views of and experiences with depression in patients with COPD. A total of 864 completed responses were received (22%). In the vignettes, a significantly greater percentage of GPs reported that they would explore or offer the diagnosis of depression in a patient with COPD (95.4%) compared with patients with either severe osteoarthritis (88.3%) or depressive symptoms alone (86.3%). In each case, the vast majority of GPs reported that they would explore a diagnosis of depression using a clinical diagnostic tool. The preferred method of treatment, if offered, in all three cases was a combination of anti-depressant drugs and psychological therapy. GPs endorsed the importance of routinely screening for depression in patients who have COPD and acknowledged that depression impairs patient self-management of COPD.In conclusion, GPs in England were able to diagnose depression from the vignettes and plan appropriate treatment strategies in patients with chronic diseases. This should be complemented with thorough physical examination by GPs to rule out other factors such as the impact of physical illness. GPs believe depression interferes with patient self-management of COPD.

  6. Australian general practitioners’ current practice for chronic kidney disease (CKD detection and management

    Directory of Open Access Journals (Sweden)

    Marie Ludlow

    2017-06-01

    Full Text Available Background Guidelines for early detection of chronic kidney disease (CKD emphasise regular testing of kidney health in high-risk individuals. However, evidence suggests that CKD is not being adequately detected or appropriately managed in primary care. Aims Assess Australian general practitioners’ (GP current practice in relation to CKD detection and management. Methods This was a cross-sectional study utilising a random sample of GPs identified by interrogation of the national online telephone directory, and stratified by geographical location. Data collection occurred between October 2014 and January 2015. Of 2,815 eligible contacts, the final response rate was 23 per cent. Results Of the 656 respondents, over 90 per cent assessed kidney health at least annually in people with diabetes or high blood pressure, and 71 per cent correctly assessed kidney health every 3–6 months in a patient with Stage 3b CKD. The tests most commonly used to assess kidney health were serum creatinine (with eGFR, blood pressure and urine albumin creatinine ratio. The most commonly reported CKD management strategies were ‘blood pressure reduction using pharmacological agents’ (81 per cent and ‘glycaemic control if diabetes present’ (64 per cent. Knowledge testing highlighted that 32 per cent of respondents were not able to correctly identify how to properly assess absolute cardiovascular risk, and this was significantly more common in more experienced GPs (p=0.003. Conclusion The results indicate that Australian GPs are mainly practising in accordance with current guidelines for detection and management of patients with CKD, but with room for improvement in some areas

  7. Current Status of Management in Type 2 Diabetes Mellitus at General Hospitals in South Korea

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    Jin-Hee Jung

    2015-08-01

    Full Text Available BackgroundIn Korea, the prevalence, complications, and mortality rate of diabetes are rapidly increasing. However, investigations on the actual condition of diabetes management are very limited due to lack of nation-wide research or multicenter study. Hence, we have minutely inquired the current status of diabetes management and achievement of glucose target goal in general hospital offering education program. That way, we are able to furnish data for policy making of diabetes education and draw up guideline which may allow us to reduce the morbidity and mortality of diabetes.MethodsThe subjects consisted of 2,610 patients with type 2 diabetes who visited the 13 general hospital in Seoul or Gyeonggi region from March 19 to May 29, 2013. General characteristics, associated diseases, complications, and management status were investigated.ResultsThe mean age was 61.0±11.6 years, body mass index was 25.0±3.3 kg/m2, and family history of diabetes was 50.5%. The mean duration of diabetes was 10.7±7.9 years and 53% received education about diabetes. The prevalence of hypertension and dyslipidemia were 59.2% and 65.5%, respectively, and 18.3% of the subjects were accompanied by liver disease. Diabetic retinopathy appeared in 31.6%, nephropathy in 28.1%, and neuropathy in 19.9% of the subjects. The mean glycosylated hemoglobin (HbA1c level was 7.3%±1.3% and the achieving rate based on Korean Diabetes Association guideline (HbA1c <6.5% was 24.8%, blood pressure (130/80 mm Hg or less was 49.4%, and low density lipoprotein cholesterol (<100 mg/dL was 63.6%. The reaching rate to the target level in four parameters (blood glucose, blood pressure, lipids, and body weight was 7.8%.ConclusionThe blood glucose control rate was lower than other parameters, and the implementation rate of diabetes education was only 53%. Thus more appropriate glucose control and systematic diabetes education are imperative.

  8. Attitudes, norms and controls influencing lifestyle risk factor management in general practice.

    Science.gov (United States)

    Ampt, Amanda J; Amoroso, Cheryl; Harris, Mark F; McKenzie, Suzanne H; Rose, Vanessa K; Taggart, Jane R

    2009-08-26

    With increasing rates of chronic disease associated with lifestyle behavioural risk factors, there is urgent need for intervention strategies in primary health care. Currently there is a gap in the knowledge of factors that influence the delivery of preventive strategies by General Practitioners (GPs) around interventions for smoking, nutrition, alcohol consumption and physical activity (SNAP). This qualitative study explores the delivery of lifestyle behavioural risk factor screening and management by GPs within a 45-49 year old health check consultation. The aims of this research are to identify the influences affecting GPs' choosing to screen and choosing to manage SNAP lifestyle risk factors, as well as identify influences on screening and management when multiple SNAP factors exist. A total of 29 audio-taped interviews were conducted with 15 GPs and one practice nurse over two stages. Transcripts from the interviews were thematically analysed, and a model of influencing factors on preventive care behaviour was developed using the Theory of Planned Behaviour as a structural framework. GPs felt that assessing smoking status was straightforward, however some found assessing alcohol intake only possible during a formal health check. Diet and physical activity were often inferred from appearance, only being assessed if the patient was overweight. The frequency and thoroughness of assessment were influenced by the GPs' personal interests and perceived congruence with their role, the level of risk to the patient, the capacity of the practice and availability of time. All GPs considered advising and educating patients part of their professional responsibility. However their attempts to motivate patients were influenced by perceptions of their own effectiveness, with smoking causing the most frustration. Active follow-up and referral of patients appeared to depend on the GPs' orientation to preventive care, the patient's motivation, and cost and accessibility of

  9. Attitudes, norms and controls influencing lifestyle risk factor management in general practice

    Directory of Open Access Journals (Sweden)

    McKenzie Suzanne H

    2009-08-01

    Full Text Available Abstract Background With increasing rates of chronic disease associated with lifestyle behavioural risk factors, there is urgent need for intervention strategies in primary health care. Currently there is a gap in the knowledge of factors that influence the delivery of preventive strategies by General Practitioners (GPs around interventions for smoking, nutrition, alcohol consumption and physical activity (SNAP. This qualitative study explores the delivery of lifestyle behavioural risk factor screening and management by GPs within a 45–49 year old health check consultation. The aims of this research are to identify the influences affecting GPs' choosing to screen and choosing to manage SNAP lifestyle risk factors, as well as identify influences on screening and management when multiple SNAP factors exist. Methods A total of 29 audio-taped interviews were conducted with 15 GPs and one practice nurse over two stages. Transcripts from the interviews were thematically analysed, and a model of influencing factors on preventive care behaviour was developed using the Theory of Planned Behaviour as a structural framework. Results GPs felt that assessing smoking status was straightforward, however some found assessing alcohol intake only possible during a formal health check. Diet and physical activity were often inferred from appearance, only being assessed if the patient was overweight. The frequency and thoroughness of assessment were influenced by the GPs' personal interests and perceived congruence with their role, the level of risk to the patient, the capacity of the practice and availability of time. All GPs considered advising and educating patients part of their professional responsibility. However their attempts to motivate patients were influenced by perceptions of their own effectiveness, with smoking causing the most frustration. Active follow-up and referral of patients appeared to depend on the GPs' orientation to preventive care, the

  10. MANAGEMENT OF DIABETES IN ACUTE MYOCARDIAL INFARCTION IN CELJE GENERAL HOSPITAL IN 1999

    Directory of Open Access Journals (Sweden)

    Gregor Veninšek

    2001-12-01

    Full Text Available Background. DIGAMI study showed that intrahospital mortality and mortality at one year after myocardial infarction can be significantly reduced in diabetics treated in acute phase of myocardial infarction by GI infusion and afterwards for at least three months with intensive insulin treatment. Mortality can be reduced for more than 50% in a subgroup of patients younger than 70 years, without congestive heart failure, with first myocardial infarction, not treated with insulin or digitalis. In this perspective we reviewed treatment of diabetics with acute myocardial infarction in 1999 in Celje General Hospital.Methods. We reviewed documentation of treatment of all diabetics with acute myocardial infarction treated in Celje General Hospital in 1999. We collected data on number of newly discovered diabetes, on previous treatment of diabetes, on treatment of diabetes during hospitalization and at discharge, on drugs used for treatment of diabetes and on mortality during hospitalization.Results. Diabetics presented 20% of all patients with acute myocardial infarction treated in Celje General Hospital in 1999. None of patients received GI infusion, none had intensively managed blood sugar. 24% of patients were treated with sulfonylureas in acute phase of myocardial infarction. 33% of patients were discharged from hospital with insulin therapy. Intrahospital mortality was 9%, comparable with patients without diabetes.Conclusions. In 1999 was intrahospital treatment of diabetics with acute myocardial infarction in Celje General Hospital successful as their intrahospital mortality equaled non-diabetics. Treatment of diabetes itself, during hospitalization and after discharge, on the other hand, in 1999 had not been up to date according to results of recent studies. In our opinion, it is mandatory for diabetologist to make part of the team that treats diabetic with acute myocardial infarction

  11. Chronic disease management in general practice: results from a national study.

    LENUS (Irish Health Repository)

    Darker, C

    2012-04-01

    The aim of this study was to provide baseline data on chronic disease management (CDM) provision in Irish general practice (GP). The survey instrument was previously used in a study of primary care physicians in 11 countries, thus allowing international comparisons. The response rate was 72% (380\\/527).The majority of GPs (240\\/380; 63%) reported significant changes are needed in our health care system to make CDM work better. Small numbers of routine clinical audits are being performed (95\\/380; 25%). Irish GPs use evidence based guidelines for treatment of diabetes (267\\/380; 71%), asthma \\/ COPD (279\\/380; 74%) and hypertension (297\\/380; 79%), to the same extent as international counterparts. Barriers to delivering chronic care include increased workload (379\\/380; 99%), lack of appropriate funding (286\\/380; 76%), with GPs interested in targeted payments (244\\/380; 68%). This study provides baseline data to assess future changes in CDM.

  12. Troponin T: role in altering patient management and enabling earlier discharge from a district general hospital.

    Science.gov (United States)

    Owen, A; Khan, W; Griffiths, K D

    2001-03-01

    The use of troponin T to facilitate early patient discharge was investigated in a prospective study in a district general hospital. Troponin T was measured in 91 patients admitted over a period of 6 months with chest pain but without evidence of myocardial infarction. The main outcome measure was length of hospital stay. A negative troponin T was found in 70 patients. Fifty of these were discharged within 24 h of the troponin result being available and they had a significantly shorter hospital stay than a case control group and a historical control group from the previous 6 months. Troponin T measurement has a role in altering patient management by enabling early discharge, resulting in significant cost savings and increasing bed availability.

  13. Generic functional requirements for a NASA general-purpose data base management system

    Science.gov (United States)

    Lohman, G. M.

    1981-01-01

    Generic functional requirements for a general-purpose, multi-mission data base management system (DBMS) for application to remotely sensed scientific data bases are detailed. The motivation for utilizing DBMS technology in this environment is explained. The major requirements include: (1) a DBMS for scientific observational data; (2) a multi-mission capability; (3) user-friendly; (4) extensive and integrated information about data; (5) robust languages for defining data structures and formats; (6) scientific data types and structures; (7) flexible physical access mechanisms; (8) ways of representing spatial relationships; (9) a high level nonprocedural interactive query and data manipulation language; (10) data base maintenance utilities; (11) high rate input/output and large data volume storage; and adaptability to a distributed data base and/or data base machine configuration. Detailed functions are specified in a top-down hierarchic fashion. Implementation, performance, and support requirements are also given.

  14. The effectiveness of a semi-tailored facilitator-based intervention to optimise chronic care management in general practice

    DEFF Research Database (Denmark)

    Due, Tina Drud; Thorsen, Thorkil; Kousgaard, Marius Brostrøm

    2014-01-01

    BACKGROUND: The Danish health care sector is reorganising based on disease management programmes designed to secure integrated and high quality chronic care across hospitals, general practitioners and municipalities. The disease management programmes assign a central role to general practice...... indicate that a semi-tailored facilitator-based intervention of relatively low intensity is unlikely to add substantially to the implementation of disease management programmes for DM2 and COPD in a context marked by important concurrent initiatives (including financial incentives and mandatory registry...

  15. Management of shoulder pain by UK general practitioners (GPs): a national survey.

    Science.gov (United States)

    Artus, Majid; van der Windt, Danielle A; Afolabi, Ebenezer K; Buchbinder, Rachelle; Chesterton, Linda S; Hall, Alison; Roddy, Edward; Foster, Nadine E

    2017-06-21

    Studies in Canada, the USA and Australia suggested low confidence among general practitioners (GPs) in diagnosing and managing shoulder pain, with frequent use of investigations. There are no comparable studies in the UK; our objective was to describe the diagnosis and management of shoulder pain by GPs in the UK. A national survey of a random sample of 5000 UK GPs collected data on shoulder pain diagnosis and management using two clinical vignettes that described primary care presentations with rotator cuff tendinopathy (RCT) and adhesive capsulitis (AdhC). Seven hundred and fourteen (14.7%) responses were received. 56% and 83% of GPs were confident in their diagnosis of RCT and AdhC, respectively, and a wide range of investigations and management options were reported. For the RCT presentation, plain radiographs of the shoulder were most common (60%), followed by blood tests (42%) and ultrasound scans (USS) (38%). 19% of those who recommended a radiograph and 76% of those who recommended a USS did so 'to confirm the diagnosis'. For the AdhC presentation, the most common investigations were blood tests (60%), plain shoulder radiographs (58%) and USS (31%). More than two-thirds of those recommending a USS did so 'to confirm the diagnosis'. The most commonly recommended treatment for both presentations was physiotherapy (RCT 77%, AdhC 71%) followed by non-steroidal anti-inflammatory drugs (RCT 58%, AdhC 74%). 17% opted to refer the RCT to secondary care (most often musculoskeletal interface service), compared with 31% for the AdhC. This survey of GPs in the UK highlights reliance on radiographs and blood tests in the management of common shoulder pain presentations. GPs report referring more than 7 out of 10 patients with RCT and AdhC to physiotherapists. These findings need to be viewed in the context of low response to the survey and, therefore, potential non-response bias. © Article author(s) (or their employer(s) unless otherwise stated in the text of the

  16. Participation of private general practitioners in disease man-agement of malaria in Myanmar

    Institute of Scientific and Technical Information of China (English)

    Thein Tun; Zaw Win Tun; Hla Soe Tint; Khin Lin; Thar Tun Kyaw; Moe Kyaw Myint

    2009-01-01

    Objective:Myanmar has been trying to improve the disease management of malaria through public health serv-ices.The involvement of private general practitioners (GPs)is recognized as one of the key contributory issues in malaria control,but no one has yet made an attempt to study the efficiency of their role.This study aimed to assess the participation of GPs in improvement of disease management.Methods:The study was conducted with all 32 GPs practicing at three randomly selected townships with high malaria load situated in Upper Myanmar from June 2006 to March 2007 using a pretest-posttest design to assess their knowledge of the disease manage-ment prior to and after intervention.The intervention package consisted of a one-day workshop on diagnosis and treatment of malaria and the supply of facilities for microscopy.Questionnaires filled in before and after tests were compared to assess the change of knowledge after the intervention.Diagnosis and treatment practice dur-ing the study period was analysed by review of registers kept by GPs,together with a follow-up survey of their patients for the reliability of data.Results:An overall improvement of knowledge was observed and significant changes were apparent for three variables:the criteria for referral of severe malaria,the effect of incomplete treatment and recommended treatment of Plasmodium vivax.Pre-test results showed that only 65.6 % of GPs perceived microscopy or Rapid Diagnostic Test kits (RDTs)for confirmation of malaria necessary,while only 15.6 % and 40.6 % of the GPs knew the recommended treatments of falciparum and vivax malaria,respec-tively.However,after intervention 92 % of the patients were diagnosed as malaria by RDTs and 3 % by mi-croscopy throughout the study.The GPs prescribed artemisinin-based combination therapy (ACTs)to 95 % of confirmed falciparum cases and treated 82.4 % of RDT confirmed falciparum negatives with chloroquine and primaquine.Concurrent with our study,an international NGO

  17. A Generalized Fuzzy Integer Programming Approach for Environmental Management under Uncertainty

    Directory of Open Access Journals (Sweden)

    Y. R. Fan

    2014-01-01

    Full Text Available In this study, a generalized fuzzy integer programming (GFIP method is developed for planning waste allocation and facility expansion under uncertainty. The developed method can (i deal with uncertainties expressed as fuzzy sets with known membership functions regardless of the shapes (linear or nonlinear of these membership functions, (ii allow uncertainties to be directly communicated into the optimization process and the resulting solutions, and (iii reflect dynamics in terms of waste-flow allocation and facility-capacity expansion. A stepwise interactive algorithm (SIA is proposed to solve the GFIP problem and generate solutions expressed as fuzzy sets. The procedures of the SIA method include (i discretizing the membership function grade of fuzzy parameters into a set of α-cut levels; (ii converting the GFIP problem into an inexact mixed-integer linear programming (IMILP problem under each α-cut level; (iii solving the IMILP problem through an interactive algorithm; and (iv approximating the membership function for decision variables through statistical regression methods. The developed GFIP method is applied to a municipal solid waste (MSW management problem to facilitate decision making on waste flow allocation and waste-treatment facilities expansion. The results, which are expressed as discrete or continuous fuzzy sets, can help identify desired alternatives for managing MSW under uncertainty.

  18. Knowledge of Brazilian general dentists and endodontists about the emergency management of dento-alveolar trauma.

    Science.gov (United States)

    Hu, Li Wen; Prisco, Cleide Rosana Duarte; Bombana, Antonio Carlos

    2006-06-01

    The purpose of this study was to determine Brazilian dentists' knowledge of emergency management of dento-alveolar trauma. A two-part questionnaire containing questions on demographic data and knowledge were mailed to 230 general dental practitioners (GDPs) and 70 endodontists. Questionnaires were returned by 42.6% of the GDPs and 62.8% of the endodontists. The survey data were statistically analyzed using Mann-Whitney U-test for practitioners' knowledge and Pearson's correlation coefficient for association between knowledge scores and practitioner age or years since graduation. The mean knowledge score of endodontists was significantly greater than for GDPs (Ptrauma experience in their practices and those who had attended postgraduate courses on dental trauma had a significant higher mean knowledge score. In contrast, there was a poor correlation between the knowledge score and the ages of the respondents (r=0.086) or the years since graduation (r=0.108). In conclusion, this survey showed a poor knowledge of dental trauma management among the surveyed dentists and highlights the need to develop strategies to improve the knowledge base in this area of dentistry for the benefit of the dental trauma patient.

  19. Mobile task management tool that improves workflow of an acute general surgical service.

    Science.gov (United States)

    Foo, Elizabeth; McDonald, Rod; Savage, Earle; Floyd, Richard; Butler, Anthony; Rumball-Smith, Alistair; Connor, Saxon

    2015-10-01

    Understanding and being able to measure constraints within a health system is crucial if outcomes are to be improved. Current systems lack the ability to capture decision making with regard to tasks performed within a patient journey. The aim of this study was to assess the impact of a mobile task management tool on clinical workflow within an acute general surgical service by analysing data capture and usability of the application tool. The Cortex iOS application was developed to digitize patient flow and provide real-time visibility over clinical decision making and task performance. Study outcomes measured were workflow data capture for patient and staff events. Usability was assessed using an electronic survey. There were 449 unique patient journeys tracked with a total of 3072 patient events recorded. The results repository was accessed 7792 times. The participants reported that the application sped up decision making, reduced redundancy of work and improved team communication. The mode of the estimated time the application saved participants was 5-9 min/h of work. Of the 14 respondents, nine discarded their analogue methods of tracking tasks by the end of the study period. The introduction of a mobile task management system improved the working efficiency of junior clinical staff. The application allowed capture of data not previously available to hospital systems. In the future, such data will contribute to the accurate mapping of patient journeys through the health system. © 2015 Royal Australasian College of Surgeons.

  20. What do we call Adaptive Management? A general characterization from a global sample

    Directory of Open Access Journals (Sweden)

    T. Espigares

    2008-03-01

    Full Text Available This study presents a characterisation of the implementation of Adaptive Management (AM from the analysis of 35 projects around the world. Our results reveal that AM projects are usually aimed at ecosystem management, conservation and restoration. Also, they mainly act upon forest or epicontinental water ecosystems and their goal is generally species exploitation and in most cases these projects act at a local scale. From a methodological point of view, most AM cases use an active approach and monitoring programs and were at the phase of problem identification. We found differences in the implementation of AM between developed and developing countries that were present in our samples in the following way: AM projects in developed countries were typically carried out by state agencies, and focused on solving problems concerning epicontinental waters and the public use of ecosystems. They had the support of national funds and used modelling techniques. In contrast, the AM projects from developing countries were mainly aimed at the conservation of natural protected areas and at the mitigation of environmental impacts derived from mining activities. The financial support of these projects was frequently provided by international organizations, and the use of modelling techniques was uncommon. For a better exploitation of all the possibilities of AM, we suggest the use of criteria to be customized to the specific needs of the socio-economic reality of every country and to monitor the results at a global scale to continuously improve this practice.

  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

    2013-02-01

    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. Corrosion science general-purpose data model and interface (Ⅲ):Data integration and management environment

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    A brand new Corrosion Data Integration and Management Environment(CDIME) is developed in Java programming language based on general-purpose corrosion data model(GPCDM) and corrosion data markup language(CDML) proposed in the previous works.In general,the functionalities and features of CDIME meet most of design requirements including composition,inheritance,self-contained,relatively independence and so on.An insight tutorial is introduced on the life circle of corrosion data islands from its creation,maintenance,and application like publishing.The template feature makes the building of comprehensive data island as simple as a few mouse clicks.Read-only publishing of data as e-Book and PDF hold their own places.Achieved document can be imported and exported freely on any running CDIME.The achieving feature is addressed in detail because it is critical to data sharing and integration in GPCDM.At the end,a real example is presented to help the understanding of data islands assembling and the advanced features offered by CDIME.

  3. Corrosion science general-purpose data model and interface (Ⅲ): Data integration and management environment

    Institute of Scientific and Technical Information of China (English)

    TANG ZiLong

    2008-01-01

    A brand new Corrosion Data Integration and Management Environment (CDIME) is developed in Java programming language based on general-purpose corrosion data model (GPCDM) and corrosion data markup language (CDML) proposed in the previous works. In general, the functionalities and features of CDIME meet most of design requirements including composition, inheritance, self-contained, relatively independence and so on. An insight tutorial is introduced on the life circle of cor-rosion data islands from its creation, maintenance, and application like publishing. The template feature makes the building of comprehensive data island as simple as a few mouse clicks. Read-only publishing of data as e-Book and PDF hold their own places. Achieved document can be imported and exported freely on any running CDIME. The achieving feature is addressed in detail because it is critical to data sharing and integration in GPCDM. At the end, a real example is presented to help the understanding of data islands assembling and the advanced features offered by CDIME.

  4. [Moderate asthma in adults: diagnosis and management in general medical practice].

    Science.gov (United States)

    Vernejoux, J M; Tunon De Lara, J M; Guizard, A V; Villanueva, P; Taytard, A

    1996-10-01

    Moderate asthma is a frequent disorder in general medicine. In 1990, the British Thoracic Society published their first guidelines on the management of asthma. Three years later, we have studied, using a questionnaire, the diagnosis and therapeutic criteria of moderate asthma used by general physicians, and comparing these to the guideline recommendations. Out of 46 physicians questioned in Bordeaux, 40 (87 per cent) agreed to participate in the study. Thirty two physicians (80 per cent) described as moderate an asthma which was mild according to the guidelines; eight physicians (20 per cent) described a moderate asthma according to the guidelines; twenty five (63 per cent) considered as severe a moderate asthma according to the recommendations, although eleven (28 per cent) considered it as moderate and four (10 per cent) did not give an opinion. In total, four (10 per cent) judged asthma severity according to the guidelines (Group R), twenty one (52 per cent) over-estimated the severity of moderate asthma (Group S), and fifteen (37 per cent) gave an inconsistent assessment (Group 1). Twenty six (65 per cent) prescribed an association of beta-2-agonists and inhaled corticosteroids for moderate asthma. Although most of the questioned physicians gave an appropriate treatment for moderate asthma treatment adapted to the severity of the situation, their therapeutic approach did not seem to be based upon the same criteria than that recommended in the guidelines.

  5. Economic evaluation of an implementation strategy for the management of low back pain in general practice.

    Science.gov (United States)

    Jensen, Cathrine Elgaard; Riis, Allan; Petersen, Karin Dam; Jensen, Martin Bach; Pedersen, Kjeld Møller

    2017-05-01

    In connection with the publication of a clinical practice guideline on the management of low back pain (LBP) in general practice in Denmark, a cluster randomised controlled trial was conducted. In this trial, a multifaceted guideline implementation strategy to improve general practitioners' treatment of patients with LBP was compared with a usual implementation strategy. The aim was to determine whether the multifaceted strategy was cost effective, as compared with the usual implementation strategy. The economic evaluation was conducted as a cost-utility analysis where cost collected from a societal perspective and quality-adjusted life years were used as outcome measures. The analysis was conducted as a within-trial analysis with a 12-month time horizon consistent with the follow-up period of the clinical trial. To adjust for a priori selected covariates, generalised linear models with a gamma family were used to estimate incremental costs and quality-adjusted life years. Furthermore, both deterministic and probabilistic sensitivity analyses were conducted. Results showed that costs associated with primary health care were higher, whereas secondary health care costs were lower for the intervention group when compared with the control group. When adjusting for covariates, the intervention was less costly, and there was no significant difference in effect between the 2 groups. Sensitivity analyses showed that results were sensitive to uncertainty. In conclusion, the multifaceted implementation strategy was cost saving when compared with the usual strategy for implementing LBP clinical practice guidelines in general practice. Furthermore, there was no significant difference in effect, and the estimate was sensitive to uncertainty.

  6. Severe exacerbations of chronic obstructive pulmonary disease: management with noninvasive ventilation on a general medicine ward

    Directory of Open Access Journals (Sweden)

    Sirio Fiorino

    2013-04-01

    Full Text Available Introduction: Recent evidence suggests that, with a well-trained staff, severe exacerbations of chronic obstructive pulmonary disease (COPD with moderate respiratory acidosis (pH > 7.3 can be successfully treated with noninvasive mechanical ventilation (NIMV on a general respiratory care ward. We conducted an open prospective study to evaluate the efficacy of this approach on a general medicine ward. Material and methods: This study population consisted in 27 patients admitted to a general medicine ward (median nurse:patient ratio 1:12 December 1, 2004 May 31, 2006 for acute COPD exacerbation with hypercapnic respiratory failure and acidosis (arterial pH < 7.34, PaC02 > 45 mmHg. All received assist-mode NIMV (average 12 h / day via oronasal masks (inspiratory pressure 10-25 cm H2O, expiratory pressure 4-6 cm H2O to maintain O2 saturation at 90-95%. Treatment was supervised by an experienced pulmonologist, who had also provided specific training in NIMV for medical and nursing staffs (90-day course followed by periodic refresher sessions. Arterial blood pressure, O2 saturation, and respiratory rate were continuously monitored during NIMV. Based on baseline arterial pH, the COPD was classified as moderate (7.25-7.34 or severe (< 7.25. Results: In patients with moderate and severe COPD, significant improvements were seen in arterial pH after 2 (p < 0.05 and 24 h (p< 0.05 of NIMV and in the PaC02 after 24 hours (p < 0.05. Four (15% of the 27 patients died during the study hospitalization (in-hospital mortality 15%, in 2 cases due to NIMV failure. For the other 23, mean long-term survival was 14.5 months (95% CI 10.2 to 18.8, and no significant differences were found between the moderate and severe groups. Over half (61% the patients were alive 1 year after admission. Conclusions: NIMV can be a cost-effective option for management of moderate or severe COPD on a general medicine ward. Its proper use requires: close monitoring of ventilated subjects

  7. Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia - case report

    Directory of Open Access Journals (Sweden)

    Márcio Luiz Benevides

    Full Text Available Abstract Background and objectives: The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index >50 kg/m2, who underwent cesarean section under general anesthesia. Case report: Pregnant woman in labor, 35 years of age, body mass index 59.8 kg/m2. Cesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21 min, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850 g, with Apgar scores of 2 in the 1st minute (received positive pressure ventilation by mask for about 2 min and 8 in the 5th minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4th postoperative day.

  8. Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia - case report.

    Science.gov (United States)

    Benevides, Márcio Luiz; Brandão, Verônica Cristina Moraes; Lovera, Jacqueline Ivonne Arenas

    2016-01-01

    The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index >50kg/m(2), who underwent cesarean section under general anesthesia. Pregnant woman in labor, 35 years of age, body mass index 59.8kg/m(2). Cesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21min, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850g, with Apgar scores of 2 in the 1st minute (received positive pressure ventilation by mask for about 2min) and 8 in the 5th minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4th postoperative day. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  9. [Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia - case report].

    Science.gov (United States)

    Benevides, Márcio Luiz; Brandão, Verônica Cristina Moraes; Lovera, Jacqueline Ivonne Arenas

    2016-01-01

    The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index > 50 kg/m(2), who underwent cesarean section under general anesthesia. Pregnant woman in labor, 35 years of age, body mass index 59.8 kg/m(2). Caesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21 minutes, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850 g, with Apgar scores of 2 in the 1(st) minute (received positive pressure ventilation by mask for about 2 minutes) and 8 in the 5(th) minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4(th) postoperative day. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  10. Recognition and management of overweight and obese children: A questionnaire survey of general practitioners and parents in England

    OpenAIRE

    Gage, H; Erdal, E.; Saigal, P; Raats, MM; Williams, P.; Qiao, Y.

    2012-01-01

    Aims: To (i) compare the views of general practitioners (GPs) and parents about the causes, consequences and management of childhood overweight/obesity; and (ii) explore the extent to which they can identify overweight/obesity in children. Methods: A questionnaire was mailed to all GPs in one Primary Care Trust and all parents in one primary school in southern England, 2008. Information was gathered on socio-demographic background, views about causes, consequences and management of childhood ...

  11. Management of Overweight during Childhood: A Focus Group Study on Health Professionals’ Experiences in General Practice,”

    DEFF Research Database (Denmark)

    Larsen, Lone Marie; Ledderer, Loni; Jarbol, Dorte E

    2015-01-01

    professionals considered it their responsibility to offer a management programme to overweight children. They recognised that management of overweight during childhood was a complex task that required an evidence-based strategy with the possibility of supervision. Health professionals experienced a barrier...... to addressing overweight in children. However, increasing awareness of obesity in childhood and its consequences in society was considered helpful to reach an understanding of the articulations concerning how best to address the issue. Conclusions. Health professionals in general practice recognised...

  12. Antimicrobial management and appropriateness of treatment of urinary tract infection in general practice in Ireland

    Directory of Open Access Journals (Sweden)

    Hanahoe Belinda

    2011-10-01

    Full Text Available Abstract Background Urinary tract infections (UTIs are the second most common bacterial infections in general practice and a frequent indication for prescription of antimicrobials. Increasing concern about the association between the use of antimicrobials and acquired antimicrobial resistance has highlighted the need for rational pharmacotherapy of common infections in general practice. Methods Management of urinary tract infections in general practice was studied prospectively over 8 weeks. Patients presenting with suspected UTI submitted a urine sample and were enrolled with an opt-out methodology. Data were collected on demographic variables, previous antimicrobial use and urine samples. Appropriateness of different treatment scenarios was assessed by comparing treatment with the laboratory report of the urine sample. Results A total of 22 practices participated in the study and included 866 patients. Bacteriuria was established for 21% of the patients, pyuria without bacteriuria for 9% and 70% showed no laboratory evidence of UTI. An antimicrobial agent was prescribed to 56% (481 of the patients, of whom 33% had an isolate, 11% with pyuria only and 56% without laboratory evidence of UTI. When taking all patients into account, 14% patients had an isolate identified and were prescribed an antimicrobial to which the isolate was susceptible. The agents most commonly prescribed for UTI were co-amoxyclav (33%, trimethoprim (26% and fluoroquinolones (17%. Variation between practices in antimicrobial prescribing as well as in their preference for certain antimicrobials, was observed. Treatment as prescribed by the GP was interpreted as appropriate for 55% of the patients. Three different treatment scenarios were simulated, i.e. if all patients who received an antimicrobial were treated with nitrofurantoin, trimethoprim or ciprofloxacin only. Treatment as prescribed by the GP was no more effective than treatment with nitrofurantoin for all patients

  13. Crew Factors in Flight Operations XV: Alertness Management in General Aviation Education Module

    Science.gov (United States)

    Rosekind, Mark R.; Co, Elizabeth L.; Neri, David F.; Oyung, Raymond L.; Mallis, Melissa M.; Cannon, Mary M. (Technical Monitor)

    2002-01-01

    Regional operations encompass a broad range of pilots and equipment. This module is intended to help all those involved in regional aviation, including pilots, schedulers, dispatchers, maintenance technicians, policy makers, and others, to understand the physiological factors underlying fatigue, how flight operations affect fatigue, and what can be done to counteract fatigue and maximize alertness and performance in their operations. The overall purpose of this module is to promote aviation safety, performance, and productivity. It is intended to meet three specific objectives: (1) to explain the current state of knowledge about the physiological mechanisms underlying fatigue; (2) to demonstrate how this knowledge can be applied to improving flight crew sleep, performance, and alertness; and (3) to offer strategies for alertness management. Aviation Safety Reporting System (ASRS) and National Transportation Safety Board (NISH) reports are used throughout this module to demonstrate that fatigue is a safety issue in the regional operations community. The appendices at the end of this module include the ASRS reports used for the examples contained in this publication, brief introductions to sleep disorders and relaxation techniques, summaries of relevant NASA publications, and a list of general readings on sleep, sleep disorders, and circadian rhythms.

  14. The experience and management of neck pain in general practice: the patients' perspective.

    Science.gov (United States)

    Scherer, Martin; Schaefer, Helene; Blozik, Eva; Chenot, Jean-François; Himmel, Wolfgang

    2010-06-01

    The objective of this study is to investigate the perspective and expectation of patients presenting with neck pain in general practice. The study design is a qualitative analysis of patient interviews and was conducted in a primary care setting in Germany. Twenty patients aged 20-78, according to theoretical sampling were included in the study. Patients tried to cope autonomously with the situation and consulted GPs only if their self-help had failed. When patients asked for external help, they usually focused on somatic treatment options such as massage, physiotherapy or injections. Most patients reported to have experiences with somatic therapies; however, they felt that some or all of these treatments were inefficient or led only to short-time improvements. Patients often avoided psychosocial themes when talking to doctors for fear of being branded as 'neurotic'. Although neck pain is difficult to manage and a burden for patients, they have obviously found a way of both living with their pain and a pragmatic approach of talking about their symptoms with their doctor. According to the patients' statements, the interaction between doctor and patient seems to be rather distant, ensuring that both sides avoid any issues that might touch upon psychological aspects of neck pain.

  15. The levels of forming at students of general school operating mobility as executive component of arbitrary management of moving activity.

    Directory of Open Access Journals (Sweden)

    Artyushenko A.A.

    2011-03-01

    Full Text Available The aim of researches is to determine concept «Personality mobility» in the light of pictures of arbitrary management conduct and activity of man In the article is considered question of diagnostics of forming operating mobility for the students of general school as activity of constituent of arbitrary management. It is certain four levels of formed operating mobility for lower boys, for teenagers and for senior pupils. It is well-proven that for period of studies at general school the indexes of operating mobility of students are not change substantially.

  16. Focused cardiac ultrasound is feasible in the general practice setting and alters diagnosis and management of cardiac disease

    Directory of Open Access Journals (Sweden)

    James Yates

    2016-08-01

    Full Text Available Background: Ultrasound-assisted examination of the cardiovascular system with focused cardiac ultrasound by the treating physician is non-invasive and changes diagnosis and management of patient’s with suspected cardiac disease. This has not been reported in a general practice setting. Aim: To determine whether focused cardiac ultrasound performed on patients aged over 50 years changes the diagnosis and management of cardiac disease by a general practitioner. Design and setting: A prospective observational study of 80 patients aged over 50 years and who had not received echocardiography or chest CT within 12 months presenting to a general practice. Method: Clinical assessment and management of significant cardiac disorders in patients presenting to general practitioners were recorded before and after focused cardiac ultrasound. Echocardiography was performed by a medical student with sufficient training, which was verified by an expert. Differences in diagnosis and management between conventional and ultrasound-assisted assessment were recorded. Results and conclusion: Echocardiography and interpretation were acceptable in all patients. Significant cardiac disease was detected in 16 (20% patients, including aortic stenosis in 9 (11% and cardiac failure in 7 (9%, which were missed by clinical examination in 10 (62.5% of these patients. Changes in management occurred in 12 patients (15% overall and 75% of those found to have significant cardiac disease including referral for diagnostic echocardiography in 8 (10%, commencement of heart failure treatment in 3 (4% and referral to a cardiologist in 1 patient (1%. Routine focused cardiac ultrasound is feasible and frequently alters the diagnosis and management of cardiac disease in patients aged over 50 years presenting to a general practice.

  17. Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry.

    Science.gov (United States)

    Boriani, Giuseppe; Laroche, Cecile; Diemberger, Igor; Fantecchi, Elisa; Popescu, Mircea Ioachim; Rasmussen, Lars Hvilsted; Sinagra, Gianfranco; Petrescu, Lucian; Tavazzi, Luigi; Maggioni, Aldo P; Lip, Gregory Y H

    2015-05-01

    Atrial fibrillation is often asymptomatic, but outcomes require further characterization. The study objective was to investigate the clinical presentation, management, and outcomes in asymptomatic and symptomatic patients with atrial fibrillation who were prospectively enrolled in the EurObservational Research Programme - Atrial Fibrillation (EORP-AF) Pilot General Registry. A total of 3119 patients were enrolled, and 1237 (39.7%) were asymptomatic (European Heart Rhythm Association [EHRA] score I). Among symptomatic patients, 963 (51.2%) had mild symptoms (EHRA score II) and 919 (48.8%) had severe or disabling symptoms (EHRA III-IV). Permanent atrial fibrillation was 3-fold more common in asymptomatic patients than in symptomatic patients. On multivariate analysis, male gender (odds ratio [OR], 1.630; 95% confidence interval [CI], 1.384-1.921), older age (OR, 1.019; 95% CI, 1.012-1.026), previous myocardial infarction (OR, 1.681; 95% CI, 1.350-2.093), and limited physical activity (OR, 1.757; 95% CI, 1.495-2.064) were associated significantly with asymptomatic (EHRA I) atrial fibrillation. Fully asymptomatic atrial fibrillation (absence of current and previous symptoms) was present in 520 patients (16.7%) and was associated independently with male gender, age, and previous myocardial infarction. Appropriate guideline-based prescription of oral anticoagulants was lower in these patients, and aspirin was prescribed more frequently. Mortality at 1 year was more than 2-fold higher in asymptomatic patients compared with symptomatic patients (9.4% vs 4.2%, P < .0001) and was associated independently with older age and comorbidities, including chronic kidney disease and chronic heart failure. Asymptomatic atrial fibrillation is common in daily cardiology practice and is associated with elderly age, more comorbidities, and high thromboembolic risks. A higher 1-year mortality was found in asymptomatic patients compared with symptomatic patients. Copyright © 2015 Elsevier

  18. The usefulness of a clinical 'scorecard' in managing patients with sore throat in general practice

    Directory of Open Access Journals (Sweden)

    Bakare Tony MO

    2010-07-01

    Full Text Available Abstract Background Objective: To evaluate the usefulness of a clinical scorecard in managing sore throat in general practice. Design: Validation study of scorecard for sore throat with a throat swab culture used as the 'gold standard'. Setting: A solo family practice in rural New South Wales, Australia Participants: Patients attending with sore throat. Methods Patients from the age of 5 years and above presenting with the main symptom of a sore throat, and who have not had any antibiotic treatment in the previous two weeks, were invited to participate in the study. The doctor completed a scorecard for each patient participating and took a throat swab for culture. Adult patients (> 16 yrs were asked to complete a patient satisfaction questionnaire, while guardians accompanying children (5 yr to Main outcome measures: 1. Ability of a new scorecard to differentiate between bacterial and non-bacterial sore throat. 2. Patients' trust in the scorecard. Results The scorecard has a sensitivity of 93.33%, a specificity of 63.16%, a positive predictive value of 50% and a negative predictive value of 96%. The sensitivity is better than other sore throat scorecards that have been published but with a slightly lower specificity. There was a high level of patient trust in the scorecard was (85.8% agreement. Patients also trusted their doctor's judgement based on the scorecard (90.6% agreement. Conclusions As the scorecard has a high sensitivity but only a moderate specificity, this means that it is more reliable for negative results, i.e. when the result suggests a viral infection. When the result favours a bacterial sore throat, then a high sensitivity can mean that there are a number of false positives. GPs can be confident in withholding antibiotics when the scorecard indicates a viral infection.

  19. Routine general practice care for panic disorder within the lifestyle approach to managing panic study

    Directory of Open Access Journals (Sweden)

    Rodney A. Lambert

    2012-07-01

    Full Text Available Routine general practice (GP care is rarely comprehensively described in clinical trials. This paper examines routine GP care within the lifestyle approach to managing panic (LAMP study. The aim of this paper is to describe/discuss routine GP care for panic disorder (PD patients within both study arms in the LAMP study. An unblinded pragmatic randomised controlled trial in 15 East of England GP practices (2 primary care trusts. Participants met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for PD with/without agoraphobia. Follow-up measures recorded at 20 weeks/10 months following randomisation. Control arm, unrestricted routine GP care (practice appointments, referrals and prescriptions. Trial arm, occupational therapyled lifestyle treatment comprising lifestyle review of fluid intake, diet pattern, exercise, caffeine, alcohol and nicotine. Primary outcome measure: beck anxiety inventory. At baseline, participants attended 2-3 times more GP appointments than population average, reducing at 10 months to 1.6 times population average for routine GP care and 0.97 population average for lifestyle arm. At 10 months, 33% fewer referrals (6 referrals; 0 mental health than at baseline (9 referrals; 2 mental health were made for lifestyle arm patients compared with 42% increase (from 12 referrals; 8 mental health at baseline to 17 referrals; 7 mental health in GP care arm. Selective serotonin reuptake inhibitors were prescribed most often. Benzodiazepines and beta-blockers were prescribed more often than tricyclic against current clinical guidelines. In conclusion, we found that PD patients at baseline were high healthcare resource users. Treatment in both study arms reduced resource use. Routine GP care requires further review for this patient group.

  20. 75 FR 21341 - Millerton Lake Resource Management Plan/General Plan (RMP/GP), Madera and Fresno Counties, CA

    Science.gov (United States)

    2010-04-23

    ... Bureau of Reclamation Millerton Lake Resource Management Plan/General Plan (RMP/GP), Madera and Fresno... Fresno and Madera Counties, CA. The Dam, which regulates the normal flow of the San Joaquin River and stores floodwaters for irrigation diversion into the Friant-Kern and Madera Canals, was completed in 1947...

  1. "337" Lawsuit Is Our Motivation Forward——An Interview with An Lijun, General Manager of JK Sucralose Inc

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    @@ "Right now our biggest problem is that the demand has outstripped supply; expanding production capacity is urgently needed. Now there are quite a number of venture capital companies contacting us." JK's general manager An Lijun said confidently. Comparing with his high spirits six months ago, An looked a bit tired. He said, "Now 1 feel greater pressure, but pressure is also my motivation."

  2. Examining the Perceptions of Secondary School General Education Administrators Regarding the Supervision and Management of Special Education Programs

    Science.gov (United States)

    Flores, Christine M.

    2012-01-01

    This dissertation includes a report of the results of a quantitative and qualitative research project that examined the perceptions of 58 secondary general education administrators regarding the supervision and management of special education programs in their buildings. Data were gathered through an online survey that requested participants to…

  3. Anxiety Management Training and Relaxation as Self-Control in the Treatment of Generalized Anxiety in Medical Outpatients.

    Science.gov (United States)

    Cragan, Mary K.; Deffenbacher, Jerry L.

    1984-01-01

    Compared Anxiety Management Training (AMT) and Relaxation as Self-Control (RSC) in reducing stress in 55 anxious medical outpatients. At posttreatment and follow-up assessments, both AMT and RSC groups reported significantly less anxiety, stress reactivity, general physiological arousal, depression, and anger than controls. (JAC)

  4. 77 FR 68140 - Privacy Act of 1974; New System of Records, Office of General Counsel E-Discovery Management...

    Science.gov (United States)

    2012-11-15

    ... new system of records for the Office of General Counsel (OGC) E- Discovery Management System (EDMS). EDMS was first announced and described in a July 17, 2012, Federal Register notice, in which HUD solicited comment. Based on comment received, this notice makes certain revisions to the description of...

  5. Do General Practices of Management Play Role as Drivers for Employee Job Satisfaction in Pakistani Entrepreneurial Companies?

    Directory of Open Access Journals (Sweden)

    Sergey Nikolaevich Polbitsyn

    2017-03-01

    Full Text Available Using general practices of management is management philosophy; many organizations practice these tools that endeavor to improve their efficiency and competitiveness in the business markets. It is an integrated approach to reaching and maintaining high-quality production and services focusing on the maintenance and continuous improvement of operations in order to satisfy or exceed the customer satisfaction. Many researchers have done a lot of work on other management practices; total quality management is an important one of them in this competitive era, which has rarely studied especially in small and medium size entrepreneurial companies in Pakistan. This quantitative research study tried to determine the impact of Total Quality Management practices on job satisfaction level of the employees of those small and medium size companies based on new and creative ideas in the capital city. The conducted survey among 550 employees of small and medium size entrepreneurial companies in the capital of Pakistan got 200 employees response properly in filling out the questionnaire. The collected data was analyzed after applying software (version 20 Statistical Package for Social Sciences. Multiple regression was applied to test the proposed model, which was found satisfied. Leadership and top management support were founded the most dominant practice among the selected Total Quality Management practices which has a significant effect on employee job satisfaction. The findings of this study prove that the implementation of Total Quality Management practices can help in increasing employees’ job satisfaction which intern would increase Productivity of small and medium size entrepreneurial companies.

  6. 29 CFR 541.201 - Directly related to management or general business operations.

    Science.gov (United States)

    2010-07-01

    ...; budgeting; auditing; insurance; quality control; purchasing; procurement; advertising; marketing; research; safety and health; personnel management; human resources; employee benefits; labor relations; public...

  7. Teacher Professional Knowledge and Classroom Management: On the Relation of General Pedagogical Knowledge (GPK) and Classroom Management Expertise (CME)

    Science.gov (United States)

    König, Johannes; Kramer, Charlotte

    2016-01-01

    Due to the need for measurement instruments that allow an investigation of teachers' situational cognition and thus go beyond the limited scope of classical paper-and-pencil-tests, we ask how a specific video-based measurement of teachers' classroom management expertise can provide additional information when compared with an established…

  8. Teacher Professional Knowledge and Classroom Management: On the Relation of General Pedagogical Knowledge (GPK) and Classroom Management Expertise (CME)

    Science.gov (United States)

    König, Johannes; Kramer, Charlotte

    2016-01-01

    Due to the need for measurement instruments that allow an investigation of teachers' situational cognition and thus go beyond the limited scope of classical paper-and-pencil-tests, we ask how a specific video-based measurement of teachers' classroom management expertise can provide additional information when compared with an established…

  9. 76 FR 75557 - Draft Environmental Impact Statement for General Management Plan/Wilderness Study, Hawaii...

    Science.gov (United States)

    2011-12-02

    .... As part of this conservation planning and environmental impact analysis effort, the Draft EIS will... managing the area over the next 15 to 20 years. The GMP will prescribe desired resource conditions and... alternatives for managing the park, including ``no-action'' and ``agency preferred'' alternatives will be...

  10. Participation of general practitioners in disease management: experiences from the Netherlands

    Directory of Open Access Journals (Sweden)

    L.M.G. Steuten

    2002-03-01

    Full Text Available Objective: To investigate the extent to which GPs in the Netherlands participate in disease management and how personal opinions, impeding and promoting incentives as well as physician characteristics influence their attitude towards disease management. Methods: The attitude-model of Fishbein and Ajzen was used to describe the attitude of GPs towards disease management and main influencing factors. After interviewing seventeen representatives of the GPs and testing a questionnaire, the final questionnaire was sent to all GPs in the Netherlands (7680 GPs barring those involved in the testing of the questionnaire. Results: At least 10.4% of all Dutch GPs are active in disease management. The main factors predicting a positive attitude towards disease management are the following: GPs' opinion that they are improving quality and efficiency of care when executing disease management, presence of a good quality network between actors involved prior to the start of disease management, working in a health centre, and performing sideline activities besides their daily activities as GPs. The main factors predicting a negative attitude are: GPs' opinion that the investment-time is too high, lack of reimbursement for disease management activities, working in a solo practice, and not performing any sideline activities beside their daily activities as GP. Conclusions: The factors predicting a negative attitude of Dutch GPs towards disease management dominate the factors predicting a positive attitude. The arguments in favour of disease management are matters of belief, for example concerning improvements in the quality of care, while arguments against are more concrete barriers e.g. high workload and financial reimbursement. Placed on the innovation timeline, the 10.4% participation might be taken to represent the start of a trend.

  11. Participation of general practitioners in disease management: experiences from the Netherlands

    Directory of Open Access Journals (Sweden)

    L.M.G. Steuten

    2002-03-01

    Full Text Available Objective: To investigate the extent to which GPs in the Netherlands participate in disease management and how personal opinions, impeding and promoting incentives as well as physician characteristics influence their attitude towards disease management. Methods: The attitude-model of Fishbein and Ajzen was used to describe the attitude of GPs towards disease management and main influencing factors. After interviewing seventeen representatives of the GPs and testing a questionnaire, the final questionnaire was sent to all GPs in the Netherlands (7680 GPs barring those involved in the testing of the questionnaire. Results: At least 10.4% of all Dutch GPs are active in disease management. The main factors predicting a positive attitude towards disease management are the following: GPs' opinion that they are improving quality and efficiency of care when executing disease management, presence of a good quality network between actors involved prior to the start of disease management, working in a health centre, and performing sideline activities besides their daily activities as GPs. The main factors predicting a negative attitude are: GPs' opinion that the investment-time is too high, lack of reimbursement for disease management activities, working in a solo practice, and not performing any sideline activities beside their daily activities as GP. Conclusions: The factors predicting a negative attitude of Dutch GPs towards disease management dominate the factors predicting a positive attitude. The arguments in favour of disease management are matters of belief, for example concerning improvements in the quality of care, while arguments against are more concrete barriers e.g. high workload and financial reimbursement. Placed on the innovation timeline, the 10.4% participation might be taken to represent the start of a trend.

  12. 综合性医院的医院感染管理%Nosocomial infection managements in general hospital

    Institute of Scientific and Technical Information of China (English)

    杨梅

    2011-01-01

    OBJECTIVE To explore the effective measures of management of nosocomial infection in general hospital, so as to control nosocomial infection. METHODS The training and promotion of the knowledge about nosocomial infection were reinforced, the inspecting management was strengthened. Its emphasis was put on the key departments and links. RESULTS The awareness of the medical staff to nosocomial infection management was improved, and each management system and measure were implemented and the nosocomial infection was well controlled. CONCLUSIONS The management of nosocomial infection in general hospital should be emphasized, the strict supervision and checking can effectively control the nosocomial infection.%目的 探讨综合性医院感染管理的有效方法,以控制医院感染.方法 加强医院感染宣传和培训,加强重点环节和重点科室的督查管理.结果 提高了医护人员对医院感染管理的认识,使各项医院感染管理制度与措施得以落实,有效控制了医院感染.结论 重视综合性医院感染管理工作,加强督查、严格把关,可有效预防控制医院感染.

  13. Modelo de dirección estratégica para el departamento de Medicina General Integral Model of strategical management for the Department of General Comprehensive Medicine

    Directory of Open Access Journals (Sweden)

    Alcides Abad Ochoa Alonso

    2005-12-01

    Full Text Available La creciente complejidad del proceso organizacional del Departamento de Medicina General Integral, de la Facultad de Ciencias Médicas “Mariana Grajales Coello” de Holguín, evidenció la necesidad de una intervención de carácter estratégico, capaz de guiar la gestión del cambio y de facilitar la sostenibilidad de las estrategias en curso en el departamento. Valiéndose de métodos de investigación científica, como son, el dialéctico, la modelación y la triangulación, y otros propios de las ciencias de la administración, se construyó un modelo de dirección estratégica específico para este departamento. El proyecto de intervención concebido es producto del análisis crítico de los modelos de dirección estratégica estudiados, y de la introducción de momentos, procedimientos y técnicas adecuados a las condiciones del departamento. Los enfoques rectores del proceso, aplicados en el modelo construido, permiten una mayor integración entre los niveles estratégico, táctico y operativo, con el consiguiente impacto esperado sobre la eficacia y la eficiencia en el alcance de los objetivos.The increasing complexity of the organizational process of the Department of General Comprehensive Medicine of “Mariana Grajales Coello” Faculty of Medical Sciences, in Holguin , evidenced the need of an intervention of strategical character capable of guiding the change management and of facilitating the sustainability of the strategies under way in the department. By using methods of scientific research, such as the dialectic methods, modeling, triangulation and others characteristic of the management science, it was constructed a specific model of strategical management for this department.The intervention project created is the result of the critical analysis of studied strategic management models, and of the introduction of moments, procedures and techniques adjusted to the conditions of the department. The ruling approaches of the

  14. 76 FR 55107 - Draft Environmental Impact Statement for General Management Plan, Gulf Islands National Seashore...

    Science.gov (United States)

    2011-09-06

    ... opportunities. The seashore would be managed as an outdoor classroom for exploring the natural and human history of the Gulf of Mexico's barrier islands and coastal environments. Interpretive programs would...

  15. Managing Intraoral Lesions in Oral Cancer Patients in a General Dental Practice: An Overview.

    Science.gov (United States)

    Kim, Reuben Han-Kyu; Yang, Paul; Sung, Eric C

    2016-02-01

    As medical technology advances in the area of cancer therapeutics, dental practitioners will encounter patients with active cancer or a history of cancer. Typically, these patients may have had or are undergoing therapies such as surgery, radiation, chemotherapy or a combination of therapies. These patients may present with multiple side effects that dental practitioners can manage or prevent. We discuss some of these concerns and provide management strategies.

  16. NELS 2.0 - A general system for enterprise wide information management

    Science.gov (United States)

    Smith, Stephanie L.

    1993-01-01

    NELS, the NASA Electronic Library System, is an information management tool for creating distributed repositories of documents, drawings, and code for use and reuse by the aerospace community. The NELS retrieval engine can load metadata and source files of full text objects, perform natural language queries to retrieve ranked objects, and create links to connect user interfaces. For flexibility, the NELS architecture has layered interfaces between the application program and the stored library information. The session manager provides the interface functions for development of NELS applications. The data manager is an interface between session manager and the structured data system. The center of the structured data system is the Wide Area Information Server. This system architecture provides access to information across heterogeneous platforms in a distributed environment. There are presently three user interfaces that connect to the NELS engine; an X-Windows interface, and ASCII interface and the Spatial Data Management System. This paper describes the design and operation of NELS as an information management tool and repository.

  17. Are managers' and the general public's perceptions of risk communication needs in line? A French alpine valley case study

    Science.gov (United States)

    Charrière, Marie; Sprague, Teresa; Bogaard, Thom; Greiving, Stefan; Malet, Jean-Philippe; Mostert, Erik

    2013-04-01

    Risk communication is a crucial element of risk management. It contributes to social capacity building by influencing the knowledge, attitude, behavior, psychology, as well as social and organizational aspects1,2. It is globally recognized that effective risk communication should address needs and requirements of targeted audiences, especially those of the public. This study compares needs and requirements related to risk communication as seen by the risk managers, with the needs and requirements as expressed by the general public. Two surveys were conducted in a mountainous region facing multi-hazards, the Ubaye valley (France). The first survey, conducted within the context of the Marie Curie Research and Training Network 'Mountain Risk', was addressed to the local community. It aimed at gathering perceptions, needs and requirements of the general public (344 respondents) on risk communication3. The second survey, conducted in the context of the Marie Curie Initial Training Network 'CHANGES', targeted risk managers (16 stakeholders of the authorities, technical services and emergency units) at both the local and the regional scale to evaluate their perceptions regarding risk communication with the general public. The needs and requirements were analyzed with respect to several dimensions: 1) the information provided to the public, 2) the legal requirements for communication, 3) the level of trust the population has in risk managers, 4) insights on awareness and preparedness, and 5) information on the media used in past communication efforts. Results of the analysis concerning the last dimension reveal that, while the general public mentioned press, official reports and technical reports as the top three media by which they received information, the risk managers cited the press but in contrast also selected radio and television. Other results indicate that a potential mismatch exists as more than 80% of the respondents of the population find all listed topics

  18. A Study of the Geographic Origin, Education, and Experience of Hotel General Managers. RHI 590 Individual Project

    Science.gov (United States)

    1993-04-01

    Hospitality Degrees, and Professional Food & Beverage Experience, by Hotel Rating 5 ACKNOWLEDGMENTS I would like to thank Dr. Eddystone Nebel for the...have been accomplished without him. Special thanks are also extended to Dr. Howard Adler and Professor Carl Braunlich for their advice and comments...witnessed many studies about general managers (GMs) of hotels within the hospitality industry (Arnaldo, 1981; Koureas, 1985; Nebel , 1991; Shortt, 1989

  19. A Novel Clinical Pharmacy Management System in Improving the Rational Drug Use in Department of General Surgery

    Directory of Open Access Journals (Sweden)

    L Bao

    2013-01-01

    Full Text Available Hospital information system is widely used to improve work efficiency of hospitals in China. However, it is lack of the function providing pharmaceutical information service for clinical pharmacists. A novel clinical pharmacy management system developed by our hospital was introduced to improve the work efficiency of clinical pharmacists in our hospital and to carry out large sample statistical analyzes by providing pharmacy information services and promoting rational drug use. Clinical pharmacy management system was developed according to the actual situation. Taking prescription review in the department of general surgery as the example, work efficiency of clinical pharmacists, quality and qualified rates of prescriptions before and after utilizing clinical pharmacy management system were compared. Statistics of 48,562 outpatient and 5776 inpatient prescriptions of the general surgical department were analyzed. Qualified rates of both the inpatient and outpatient prescriptions of the general surgery department increased, and the use of antibiotics decreased. This system apparently improved work efficiency, standardized the level and accuracy of drug use, which will improve the rational drug use and pharmacy information service in our hospital. Meanwhile, utilization of prophylactic antibiotics for the aseptic operations also reduced.

  20. Study to evaluate the effectiveness of stress management workshops on response to general and occupational measures of stress.

    Science.gov (United States)

    Heron, R J; McKeown, S; Tomenson, J A; Teasdale, E L

    1999-09-01

    This study was designed to evaluate the effectiveness of stress management training workshops within Zeneca Pharmaceuticals. The study was of cross-sectional design, comparing groups of workshop attendees and non-attendees. In addition, self-rated well-being scores of attendees were compared with results obtained pre-workshop and 2-3 months after the workshop. Employees participating in the study were drawn from the Manufacturing, Research and Development, Sales and Marketing sites of Zeneca Pharmaceuticals located in Cheshire, United Kingdom. Three hundred and ninety persons who had participated in stress management workshops since 1988 were matched for age, gender and department with an equal number of employees who had not attended stress management workshops. Outcome measures included self-rated well-being (as measured by the 30-question General Health Questionnaire), knowledge of company guidance on the management of stress in staff, and an assessment of coping strategies. Subjects who had not attended a stress management workshop were much more likely to have a poor understanding of the principles of management of stress in staff [odds ratio (OR) = 8.3; 95% confidence interval (CI) = 3.3-21.3] and more likely to have poor coping skills (OR = 2.8; CI = 1.3-6.1). However, mean scores for the two measures were similar in attendees and non-attendees. Self-rating of current well-being was strongly associated with the life-events score, but not related to workshop attendance. The study indicates that stress management training workshops reduce the prevalence of employees with a poor understanding of the principles of the management of stress in staff and with poor coping strategies. An improvement in the self-rated well-being observed shortly after the workshop was not sustained.

  1. 76 FR 70166 - Electrical Standards for Construction and General Industry; Extension of the Office of Management...

    Science.gov (United States)

    2011-11-10

    ... installation and maintenance of electric utilization equipment that prevent death and serious injuries among... Occupational Safety and Health Administration Electrical Standards for Construction and General Industry... collection requirements contained in the Electrical Standards for Construction (29 CFR part 1926, Subpart...

  2. Numerical expression of general relationships in hierarchical data base management systems

    Energy Technology Data Exchange (ETDEWEB)

    Hall, R. C.

    1980-01-01

    The need for a means to express general relationships among entity occurrences in hierarchical data bases is addressed. Integer expression of general path segments is described as a means to meet this need. Operations on the expressions are also described. Two possible implementations are discussed. Both implementations are compatible with the hierarchical data model, and provide a logical extension that permits representation of many-to-many relationships. 4 figures.

  3. Management of a pediatric patient with epidermolysis bullosa receiving comprehensive dental treatment under general anesthesia.

    Science.gov (United States)

    Yoon, Richard K; Ohkawa, Susumu

    2012-01-01

    The purpose of this report was to detail clinical considerations and a general anesthetic approach for a 3-year-old pediatric dental patient with epidermolysis bullosa, a group of rare genetic disorders characterized by blister development following minor trauma or traction to the skin or mucosal surfaces. Challenges in providing comprehensive dental treatment and care under general anesthesia are discussed. Early evaluation is vital to preventing the consequences of severe early childhood caries.

  4. General description and operation of the agro-environmental system: Crop management modeling. [Virginia

    Science.gov (United States)

    Gross, E.; Scott, J. H., Jr.

    1981-01-01

    Input for a data management system to provide farmers with information to improve crop management practices in Virginia requires monitoring of control crops at field stations, crop surveys derived from remotely sensed aircraft data, meteorological data from synchronous satellites, and details of local agricultural conditions. Presently models are under development for determining pest problems, water balance in the soil, stages of plant maturity, and optimum planting date. The status of the Cerospora leafspot model for peanut crop management is considered. Other models under development planned relate to Cylindtocladium Blackrot and Sclerotinia blight of peanuts, cyst nematode (Globerdena solanacearum) of tobacco, and red crown rot of soybeans. A software for program for estimating precipitation and solar radiation on a statewise basis is also being developed.

  5. A General Approach of Quality Cost Management Suitable for Effective Implementation in Software Systems

    Directory of Open Access Journals (Sweden)

    Stelian BRAD

    2010-01-01

    Full Text Available Investments in quality are best quantified by implementing and managing quality cost systems. A review of various opinions coming from practitioners and researchers about the existent quality cost models reveals a set of drawbacks (e.g. too theoretical and too close to ideal cases; too academic, with less practical impact; too much personalized to particular business processes, with difficulties in extrapolating to other cases; not comprising all dimensions of a business system. Using concepts and tools in quality management theory and practice and algorithms of innovative problem solving, this paper formulates a novel approach to improve practical usability, comprehensiveness, flexibility and customizability of a quality cost management system (QCMS when implementing it in a specific software application. Conclusions arising from the implementation in real industrial cases are also highlighted.

  6. Implementation of Supply Chain Management (SCM in pharmaceutical company, general principles and case study

    Directory of Open Access Journals (Sweden)

    Zoran Nakov

    2014-12-01

    Full Text Available Supply Chain Management (SCM in pharmaceutical industry is defined as a “responsible SCM” and its implementation is according to the principles of: business ethics, rights of labor and principles of healthy and safe working environment. Pharmaceutical companies with implemented “responsible SCM” have to use management systems to facilitate continuous improvement in accordance with their working principles. The main purpose of this management system is to ensure the consistency, reliability and continuous improvement of all workflows within an organization.The analyzed case describes the project of European generic pharmaceutical company, which intends to implement best practice SCM operations for five European manufacturing sites and European logistics organizations (active ingredients supply, distribution centers, affiliate customers and third party manufacturers. The main objectives of the project were the creation of the future improved To-Be situation through implementation of new SCM models to the existing To-Day situation.

  7. Environment: General; Grammar & Usage; Money Management; Music History; Web Page Creation & Design.

    Science.gov (United States)

    Web Feet, 2001

    2001-01-01

    Describes Web site resources for elementary and secondary education in the topics of: environment, grammar, money management, music history, and Web page creation and design. Each entry includes an illustration of a sample page on the site and an indication of the grade levels for which it is appropriate. (AEF)

  8. Environment: General; Grammar & Usage; Money Management; Music History; Web Page Creation & Design.

    Science.gov (United States)

    Web Feet, 2001

    2001-01-01

    Describes Web site resources for elementary and secondary education in the topics of: environment, grammar, money management, music history, and Web page creation and design. Each entry includes an illustration of a sample page on the site and an indication of the grade levels for which it is appropriate. (AEF)

  9. Prevalence, characteristics, and management of childhood functional abdominal pain in general practice

    NARCIS (Netherlands)

    Spee, Leo A. A.; Lisman-Van Leeuwen, Yvonne; Benninga, Marc A.; Bierma-Zeinstra, Sita M. A.; Berger, Marjolein Y.

    2013-01-01

    Objective. To (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children presenting wi

  10. 78 FR 13081 - Draft Environmental Impact Statement for General Management Plan, Everglades National Park, Florida

    Science.gov (United States)

    2013-02-26

    ... next 20+ years. The last comprehensive planning effort for the Park was completed in 1979. Patterns and... of public meetings will be announced through the NPS Planning, Environment, and Public Comment (PEPC... informed and involved throughout the planning process. The GMP EEWS will provide a framework for management...

  11. Quality management in general surgery:a review of the literature

    Institute of Scientific and Technical Information of China (English)

    Mircea Beuran; Ionut Negoi; Sorin Paun; Mihaela Vartic; Bogdan Stoica; Ioan Tnase; Ruxandra Irina Negoi; Sorin Hostiuc

    2014-01-01

    Introduction:Total quality management is a systematic approach focused on satisfying customers’ expectations, identifying problems, analytically solving patient’s problems and to implement continuous quality improvement.Method:Systematic review of theEnglish language medical literature, using electronic search of thePubmed,ProQuest andScienceDirect databases with different combinations of the keywords: totalquality management, healthcare, trauma, and minimally invasive surgery.Results:The assessment of outcomes in surgery represents a part of the quality assurance of patients’ care.Usually, the surgeons have their own set of mental variables that can predict good and bad outcomesSurveys of complication rates and outcome are a poor substitute for quality control.For the reported complications it is impossible to know which complications are real(inherent to surgery and unavoidable) and which are a consequence of a mistake or an error in judgment.For polytrauma patients, optimal outcome requires an initial management fulfilling a high standard of quality assurance.A prerequisite is the availability of adequate resources at all times, including personnel, technical equipment, and special designed emergency room.Conclusions:Romanian hospitals need a more aggressive implementation of total quality management policy, in order to maintain their competitiveness on nowadays EuropeanUnion competitive market.

  12. 76 FR 56220 - Draft Environmental Impact Statement for General Management Plan for Golden Gate National...

    Science.gov (United States)

    2011-09-12

    ... resources and values. Park management would focus on ways to attract and welcome people, connect people with... place an emphasis on the park's nationally important natural and cultural resources. The fundamental..., or other personal identifying information in your comment, you should be aware that your...

  13. Prevalence, characteristics, and management of childhood functional abdominal pain in general practice

    NARCIS (Netherlands)

    L.A.A. Spee (Leo); Y. Lisman-van Leeuwen (Yvonne); M.A. Benninga (Marc); S.M. Bierma-Zeinstra (Sita); M.Y. Berger (Marjolein)

    2013-01-01

    textabstractObjective. To (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children p

  14. Prevalence, characteristics, and management of childhood functional abdominal pain in general practice

    NARCIS (Netherlands)

    L.A.A. Spee (Leo); Y. Lisman-van Leeuwen (Yvonne); M.A. Benninga (Marc); S.M. Bierma-Zeinstra (Sita); M.Y. Berger (Marjolein)

    2013-01-01

    textabstractObjective. To (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children

  15. Prevalence, characteristics, and management of childhood functional abdominal pain in general practice

    NARCIS (Netherlands)

    Spee, Leo A. A.; Lisman-Van Leeuwen, Yvonne; Benninga, Marc A.; Bierma-Zeinstra, Sita M. A.; Berger, Marjolein Y.

    2013-01-01

    Objective. To (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children presenting

  16. Public management, context, and performance: in quest of a more general theory

    NARCIS (Netherlands)

    O'Toole, Laurence J.; Meier, Kenneth J.

    2015-01-01

    Recent years have seen a substantial growth in the large-N quantitative study of public management and performance. Much of the progress can be attributed to a small number of data sets on local governments in a few countries. The range of data sets suggests the validity of the overall hypothesis of

  17. Conditions, factors and criteria for successful project implementation: generalization of experience of project management

    Directory of Open Access Journals (Sweden)

    Feraru Galina Sergeevna

    2014-11-01

    Full Text Available The article addresses issues characterizing features of project management contributing to their competitive advantage; shows the factors and criteria of success of projects and the main reasons for their failures, making the failed efforts of developers to create projects.

  18. Dynamic probabilistic modelling of reproduction and replacement management in sow herds. General aspects and model description.

    NARCIS (Netherlands)

    Jalvingh, A.W.; Dijkhuizen, A.A.; Arendonk, van J.A.M.

    1992-01-01

    A dynamic probabilistic model has been designed for the personal computer to determine the technical and economic consequences of various biological variables and management strategies concerning reproduction and replacement in swine. In it, the Markov chain approach is used to simulate herd

  19. [Perioperative management of patients during general endoprosthethic operations on the knee joint (a review of literature)].

    Science.gov (United States)

    Iudin, A M

    2006-01-01

    Arthrosis deformans of the knee joint (gonarthrosis) is a common disease accompanied by pain syndrome and disability. Medical treatment of the disease ensures only a temporary analgesic effect and fails to restore the range of motion in the legs. General endoprosthetic operations on the knee joint can significantly improve the results of treatment, alleviate pain, and restore the patients' working capacity. Most patients undergoing endoprosthetic repair of the knee joint are elderly and senile, who have concomitant multiple organ somatic pathology. Comorbidity, old age, the specific features and traumaticity of a surgical intervention make high requirements for anesthesic maintenance at surgery and for stability of hemodynamic parameters in the perioperative period, and adequate analgesia in the postoperative period. Different approaches to adequate anesthesia are considered in both intra- and postoperative period. Numerous references lead to the conclusion that many widely used anesthetic procedures (general inhalational and intravenous anesthesia, high-conduction anesthesia, etc.) are incompletely adequate during a general endoprosthetic repair of the knee joint. A number of authors state that spinal or combined spinal epidural anesthesia is the most adequate methods of intra- and postoperative anesthesia at general endoprosthetic repair of the knee joint.

  20. Retinoblastoma in Mexico: part I. A review of general knowledge of the disease, diagnosis, and management

    Directory of Open Access Journals (Sweden)

    Van C. Lansingh

    2015-09-01

    Advances in Rb therapy are generally limited to developed countries. The implications in Mexico, of the findings from this review will be discussed in Part 2, which will be a comprehensive situational analysis of the state of Rb programming in Mexico, including a review of current demographic data available from hospitals that have Rb programs or treat Rb.

  1. Adding Hierarchical Objects to Relational Database General-Purpose XML-Based Information Managements

    Science.gov (United States)

    Lin, Shu-Chun; Knight, Chris; La, Tracy; Maluf, David; Bell, David; Tran, Khai Peter; Gawdiak, Yuri

    2006-01-01

    NETMARK is a flexible, high-throughput software system for managing, storing, and rapid searching of unstructured and semi-structured documents. NETMARK transforms such documents from their original highly complex, constantly changing, heterogeneous data formats into well-structured, common data formats in using Hypertext Markup Language (HTML) and/or Extensible Markup Language (XML). The software implements an object-relational database system that combines the best practices of the relational model utilizing Structured Query Language (SQL) with those of the object-oriented, semantic database model for creating complex data. In particular, NETMARK takes advantage of the Oracle 8i object-relational database model using physical-address data types for very efficient keyword searches of records across both context and content. NETMARK also supports multiple international standards such as WEBDAV for drag-and-drop file management and SOAP for integrated information management using Web services. The document-organization and -searching capabilities afforded by NETMARK are likely to make this software attractive for use in disciplines as diverse as science, auditing, and law enforcement.

  2. [Management of bronchiolitis in general practice and determinants of treatment being discordant with guidelines of the HAS].

    Science.gov (United States)

    Branchereau, E; Branger, B; Launay, E; Verstraete, M; Vrignaud, B; Levieux, K; Senand, R; Gras-Le Guen, C

    2013-12-01

    The Haute autorité de santé released clinical practice guidelines in 2000 to assist in the management of bronchiolitis. These guidelines emphasized supportive care with nasal suctioning and encouraged chest physiotherapy. The aim of this study was to examine the adherence to the french guidelines for the management of bronchiolitis by general practitioners. The study included infants less than 24 months of age with bronchiolitis, consulting a general practitioner in Vendée or in Loire-Atlantique, from November 2011 to April 2012 and whose parents accepted to participate to the study. The primary endpoint was the concordance of therapeutic practice with the french guidelines (administrated treatments, refer to pediatric emergencies). Data were collected through questionaires completed by general practitioners. Of the 1236 questionnaires distributed, 134 were completed and 118 therapeutic practice were analyzed. A total of 52.5% of therapeutic practice were concordant with guidelines and 57.5% in case of first bronchiolitis. 50% of infants with a hospitalization criteria according to the guidelines, have not been, which probably shows the interest of new guidelines, with highlighting of hospitalization criteria. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  3. Interference Calculus A General Framework for Interference Management and Network Utility Optimization

    CERN Document Server

    Schubert, Martin

    2012-01-01

    This book develops a mathematical framework for modeling and optimizing interference-coupled multiuser systems. At the core of this framework is the concept of general interference functions, which provides a simple means of characterizing interdependencies between users. The entire analysis builds on the two core axioms scale-invariance and monotonicity. The proposed network calculus has its roots in power control theory and wireless communications. It adds theoretical tools for analyzing the typical behavior of interference-coupled networks. In this way it complements existing game-theoretic approaches. The framework should also be viewed in conjunction with optimization theory. There is a fruitful interplay between the theory of interference functions and convex optimization theory. By jointly exploiting the properties of interference functions, it is possible to design algorithms that outperform general-purpose techniques that only exploit convexity. The title “network calculus” refers to the fact tha...

  4. Ocular risk management in patients undergoing general anesthesia: an analysis of 39,431 surgeries

    Directory of Open Access Journals (Sweden)

    Newton Kara-Junior

    2015-08-01

    Full Text Available OBJECTIVE:This study sought to describe and analyze ocular findings associated with nonocular surgery in patients who underwent general anesthesia.METHODS:The authors retrospectively collected a series of 39,431 surgeries using standardized data forms.RESULTS:Ocular findings were reported in 9 cases (2.3:10,000, which involved patients with a mean age of 58.9±19.5 years. These cases involved patients classified as ASA I (33%, ASA II (55% or ASA III (11%. General anesthesia with propofol and remifentanil was used in 4 cases, balanced general anesthesia was used in 4 cases, and regional block was used in combination with balanced general anesthesia in one case. Five patients (55% underwent surgery in the supine position, one patient (11% underwent surgery in the lithotomy position, two patients (22% underwent surgery in the prone position, and one patient (11% underwent surgery in the lateral position. Ocular hyperemia was detected in most (77% of the 9 cases with ocular findings; pain/burning of the eyes, visual impairment, eye discharge and photophobia were observed in 55%, 11%, 11% and 11%, respectively, of these 9 cases. No cases involved permanent ocular injury or vision loss.CONCLUSION:Ophthalmological findings after surgeries were uncommon, and most of the included patients were relatively healthy. Minor complications, such as dehydration or superficial ocular trauma, should be prevented by following systematic protocols that provide appropriate ocular occlusion with a lubricating ointment and protect the eye with an acrylic occluder. These procedures will refine the quality of anesthesia services and avoid discomfort among patients, surgeons and anesthesia staff.

  5. Management of adult attention deficit hyperactivity disorder in UK primary care: a survey of general practitioners

    OpenAIRE

    McCarthy, Suzanne; Wilton, Lynda; Murray, Macey; Hodgkins, Paul; Asherson, Philip; Wong, Ian CK

    2013-01-01

    Background: Compared to existing literature on childhood attention deficit hyperactivity disorder (ADHD), little published adult data are available, particularly outside of the United States. Using General Practitioner (GP) questionnaires from the United Kingdom, this study aimed to examine a number of issues related to ADHD in adults, across three cohorts of patients, adults who received ADHD drug treatment in childhood/adolescence but stopped prior to adulthood; adults who received ADHD dru...

  6. Intensive care and pregnancy: Epidemiology and general principles of management of obstetrics ICU patients during pregnancy.

    Science.gov (United States)

    Zieleskiewicz, Laurent; Chantry, Anne; Duclos, Gary; Bourgoin, Aurelie; Mignon, Alexandre; Deneux-Tharaux, Catherine; Leone, Marc

    2016-10-01

    In developed countries, the rate of obstetric ICU admissions (admission during pregnancy or the postpartum period) is between 0.5 and 4 per 1000 deliveries and the overall case-fatality rate is about 2%. The most two common causes of obstetric ICU admissions concerned direct obstetric pathologies: obstetric hemorrhage and hypertensive disorders of pregnancy. This review summarized the principles of management of critically ill pregnant patient. Its imply taking care of two patients in the same time. A coordinated multidisciplinary team including intensivists, anesthesiologists, obstetricians, pediatricians and pharmacists is therefore necessary. This team must work effectively together with regular staff aiming to evaluate daily the need to maintain the patient in intensive care unit or to prompt delivery. Keeping mother and baby together and fetal well-being must be balanced with the need of specialized advanced life support for the mother. The maternal physiological changes imply various consequences on management. The uterus aorto-caval compression implies tilting left the parturient. In case of cardiac arrest, uterus displacement and urgent cesarean delivery are needed. The high risk of aspiration and difficult tracheal intubation must be anticipated. Even during acute respiratory distress syndrome, hypoxemia and permissive hypercapnia must be avoided due to their negative impact on the fetus. Careful analysis of the benefit-risk ratio is needed before all drug administration. Streptococcal toxic shock syndrome and perineal fasciitis must be feared and a high level of suspicion of sepsis must be maintained. Finally the potential benefits of an ultrasound-based management are detailed.

  7. Laser-Assisted Periodontal Management of Drug-Induced Gingival Overgrowth under General Anesthesia: A Viable Option

    Directory of Open Access Journals (Sweden)

    Tupili Muralikrishna

    2013-01-01

    Full Text Available Gingival overgrowth/hyperplasia can be attributed to several causes, but drug-induced gingival overgrowth/hyperplasia arises secondarily to prolonged use of antihypertensive drugs, anticonvulsants and immunosuppressants. The management is complex in nature considering the multitude of factors involved such as substitution of drug strict plaque control along with excision of the tissue to be performed under local anesthesia as outpatient. In the recent times, the patient’s psychological fear of the treatment with the use of surgical blade and multiple visits has developed the concept of single visit treatment under general anesthesia incorporating a laser as viable option. The present case highlights the new method of management of gingival overgrowth.

  8. Evaluation of a policy to strengthen case management and quality of diabetes care in general practice in Denmark

    DEFF Research Database (Denmark)

    Rudkjøbing, Andreas; Vrangbaek, Karsten; Birk, Hans Okkels;

    2015-01-01

    OBJECTIVES: To evaluate the utilization of a policy for strengthening general practitioner's case management and quality of care of diabetes patients in Denmark incentivized by a novel payment mode. We also want to elucidate any geographical variation or variation on the basis of practice features...... of the GP were are able to determine differences in use of the policy in relation to the practice-specific information. RESULTS: At the end of the study period (2007-2012) approximately 30% of practices have enrolled extending services to approximately 10% of the diabetes population. There is regional...

  9. Management of COPD in general practice in Denmark--participating in an educational program substantially improves adherence to guidelines

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Hansen, Ejvind Frausing; Jensen, Michael Skov;

    2010-01-01

    BACKGROUND AND AIM: The general practitioner (GP) is the first contact with the health care system for most patients with COPD in Denmark. We studied, if participating in an educational program could improve adherence to guidelines, not least for diagnosis, staging, and treatment of the disease....... DESIGN AND SETTING: Two cross-sectional surveys were performed precisely one year apart before and after an educational program for the participating GPs. A total of 124 GPs completed the study; 1716 and 1342 patients with GP-diagnosed COPD and no concomitant asthma, respectively, were included...... activity, and referral for rehabilitation; use of inhaled corticosteroids in patients with mild COPD (FEV(1) > 80%pred) declined from 76% to 45%. CONCLUSION: Diagnosis and management of COPD in general practice in Denmark is not according to guidelines, but substantial improvements can be achieved...

  10. Peripheral vasodilators and the management of peripheral vascular disease and Raynaud's syndrome in general practice.

    Science.gov (United States)

    Connolly, J P; McGavock, H; Wilson-Davis, K

    1998-05-01

    There is no convincing evidence that peripheral vasodilators produce any significant improvement in exercise tolerance in patients with peripheral vascular disease, and these drugs may do more harm than good. In the treatment of severe Raynaud's syndrome, however, thymoxamine, prazosin or nifedipine is recommended. A descriptive study was carried out, firstly, to determine why these drugs are prescribed in general practice, and secondly, to describe the drug choices in the treatment of both Raynaud's syndrome and peripheral vascular disease in a representative sample of 22 practices in Northern Ireland. Of those patients prescribed peripheral vasodilators 69.6% were diagnosed as peripheral vascular disease, claudication or atherosclerosis. Over three-quarters of peripheral vasodilators prescribed were repeat prescriptions. Of those with Raynaud's syndrome only half were treated appropriately, and certainty of diagnosis did not guarantee appropriate treatment. Peripheral vasodilators accounted for the majority (51.5%) of items prescribed for peripheral vascular disease. A minority of patients with peripheral vascular disease (20.3%) were prescribed aspirin, and a smaller minority (4.4%) had undergone amputation. Peripheral vasodilators were prescribed unnecessarily and inappropriately. Measures to promote evidence-based treatment of both Raynaud's syndrome and peripheral vascular disease in general practice need to be taken. Copyright 1998 John Wiley & Sons, Ltd.

  11. HEMODYNAMIC STATUS IN AIRWAY MANAGEMENT DURING GENERAL ANESTHESIA: COMPARISON OF THREE METHODS

    Directory of Open Access Journals (Sweden)

    K MONTAZERI

    2000-03-01

    Full Text Available Introduction. The laryngeal mask airway (LMA was recently introduced in general anesthesia as an alternative to the face mask or tracheal intubation for airway maintenance. Methods. The effects of LMA insertion, face mask or tracheal intubation on homodynamic status were studied in 195 normotensive patients who underwent elective transurethral lithotripsy (TUL. The patients were monitored with blood pressure measurement and pulse oximetry. Anesthesia was induced with sodium thiopental, succynilcholine and fentanyl and maintained with halothane, nitrous oxide and oxygen. Findings. The heart rate (HR and mean arterial pressure increased after LMA insertion. face mask or tracheal intubation, compared with baseline (P<0.05. The hemodynamic changes were significantly greater after tracheal intubation and face mask than after LMA insertion (P<0.05. Conclusion. We conclude that insertion of LMA is associated with less hemodynamic disturbances than face mask or tracheal intubation in normotensive patients undergoing elective operations.

  12. Decreased management of genital warts in young women in Australian general practice post introduction of national HPV vaccination program: results from a nationally representative cross-sectional general practice study.

    Directory of Open Access Journals (Sweden)

    Christopher Harrison

    Full Text Available OBJECTIVES: Since the introduction of Australia's human papillomavirus vaccination program, the management rate of genital warts in sexual health clinics and private hospitals has decreased in women of vaccine-eligible age. However, most genital warts in Australia are managed in general practice. This study examines whether a similar decrease occurred in Australian general practice after the introduction of the program. METHODS: Analysis of a nationally representative cross-sectional database of Australian general practice activity (1,175,879 patient encounters with 11,780 general practitioners. Genital warts management rates were estimated for the periods before and after introduction of the program (Pre-program, July 2002-June 2006; Post-program, July 2008-June 2012. Control conditions included genital herpes and gardnerella/bacterial vaginosis in female patients and genital herpes and urethritis in male patients. Trends in management rates by year, pre-vaccine (July 2000-June 2007 and post-vaccine (July 2007-June 2012 were also calculated. RESULTS: Management rate of genital warts among women potentially covered by program (aged 15-27 years decreased by 61% from 4.33 per 1,000 encounters in the Pre-program period to 1.67 in the Post-program period. Trend analysis of the post-vaccine period showed, among women of vaccine eligible age, a significant year-on-year reduction in the rate of genital warts management (p<0.0001 and a significant increase in the management rate of control conditions per year (p<0.0001. For all other age-sex groups there was no significant change in the management rate of genital warts between the Pre- and Post-program periods. CONCLUSION: The large decrease in general practice management of genital warts in women of vaccine-eligible age highlights the success of the program in the wider community.

  13. Knowledge management for systems biology a general and visually driven framework applied to translational medicine.

    Science.gov (United States)

    Maier, Dieter; Kalus, Wenzel; Wolff, Martin; Kalko, Susana G; Roca, Josep; Marin de Mas, Igor; Turan, Nil; Cascante, Marta; Falciani, Francesco; Hernandez, Miguel; Villà-Freixa, Jordi; Losko, Sascha

    2011-03-05

    To enhance our understanding of complex biological systems like diseases we need to put all of the available data into context and use this to detect relations, pattern and rules which allow predictive hypotheses to be defined. Life science has become a data rich science with information about the behaviour of millions of entities like genes, chemical compounds, diseases, cell types and organs, which are organised in many different databases and/or spread throughout the literature. Existing knowledge such as genotype-phenotype relations or signal transduction pathways must be semantically integrated and dynamically organised into structured networks that are connected with clinical and experimental data. Different approaches to this challenge exist but so far none has proven entirely satisfactory. To address this challenge we previously developed a generic knowledge management framework, BioXM™, which allows the dynamic, graphic generation of domain specific knowledge representation models based on specific objects and their relations supporting annotations and ontologies. Here we demonstrate the utility of BioXM for knowledge management in systems biology as part of the EU FP6 BioBridge project on translational approaches to chronic diseases. From clinical and experimental data, text-mining results and public databases we generate a chronic obstructive pulmonary disease (COPD) knowledge base and demonstrate its use by mining specific molecular networks together with integrated clinical and experimental data. We generate the first semantically integrated COPD specific public knowledge base and find that for the integration of clinical and experimental data with pre-existing knowledge the configuration based set-up enabled by BioXM reduced implementation time and effort for the knowledge base compared to similar systems implemented as classical software development projects. The knowledgebase enables the retrieval of sub-networks including protein

  14. Knowledge management for systems biology a general and visually driven framework applied to translational medicine

    Directory of Open Access Journals (Sweden)

    Falciani Francesco

    2011-03-01

    Full Text Available Abstract Background To enhance our understanding of complex biological systems like diseases we need to put all of the available data into context and use this to detect relations, pattern and rules which allow predictive hypotheses to be defined. Life science has become a data rich science with information about the behaviour of millions of entities like genes, chemical compounds, diseases, cell types and organs, which are organised in many different databases and/or spread throughout the literature. Existing knowledge such as genotype - phenotype relations or signal transduction pathways must be semantically integrated and dynamically organised into structured networks that are connected with clinical and experimental data. Different approaches to this challenge exist but so far none has proven entirely satisfactory. Results To address this challenge we previously developed a generic knowledge management framework, BioXM™, which allows the dynamic, graphic generation of domain specific knowledge representation models based on specific objects and their relations supporting annotations and ontologies. Here we demonstrate the utility of BioXM for knowledge management in systems biology as part of the EU FP6 BioBridge project on translational approaches to chronic diseases. From clinical and experimental data, text-mining results and public databases we generate a chronic obstructive pulmonary disease (COPD knowledge base and demonstrate its use by mining specific molecular networks together with integrated clinical and experimental data. Conclusions We generate the first semantically integrated COPD specific public knowledge base and find that for the integration of clinical and experimental data with pre-existing knowledge the configuration based set-up enabled by BioXM reduced implementation time and effort for the knowledge base compared to similar systems implemented as classical software development projects. The knowledgebase enables the

  15. Laparoscopic management of pancreatic pseudocysts: experience at a general hospital in Mexico City.

    Science.gov (United States)

    Crisanto-Campos, B A; Arce-Liévano, E; Cárdenas-Lailson, L E; Romero-Loera, L S; Rojano-Rodríguez, M E; Gallardo-Ramírez, M A; Cabral-Oliver, J; Moreno-Portillo, M

    2015-01-01

    Invasive management of pancreatic pseudocysts (PP) is currently indicated in those patients with symptoms or complications. Treatment options are classified as surgical (open and laparoscopic) and non-surgical (endoscopic and radiologic). To describe the morbidity, mortality, and efficacy in terms of technical and clinical success of the laparoscopic surgical approach in the treatment of patients with PP in the last 3 years at our hospital center. We included patients with PP treated with laparoscopic surgery within the time frame of January 2012 and December 2014. The morbidity and mortality associated with the procedure were determined, together with the postoperative results in terms of effectiveness and recurrence. A total of 38 patients were diagnosed with PP within the last 3 years, but only 20 of them had invasive treatment. Laparoscopic surgery was performed on 17 of those patients (mean pseudocyst diameter of 15.3, primary drainage success rate of 94.1%, complication rate of 5.9%, and a 40-month follow-up). The results obtained with the laparoscopic technique used at our hospital center showed that this approach is feasible, efficacious, and safe. Thus, performed by skilled surgeons, it should be considered a treatment option for patients with PP. Copyright © 2015 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  16. Management of the acute scrotum in a district general hospital: 10-year experience.

    LENUS (Irish Health Repository)

    Tajchner, Lukas

    2012-01-31

    The acutely painful scrotum is a common urologic emergency. The primary objective of management is to avoid testicular loss. This requires a high index of clinical suspicion and prompt surgical intervention. In our series conducted between January 1996 and December 2005, 119 patients (age range: 4-62 years) underwent emergency operative exploration for acute scrotal pain. The most common finding was torted cyst of Morgagni (63\\/119, 52.9%), followed by testicular torsion (41\\/119, 34.4%). The majority of testicular torsions occurred in the pubertal group (22\\/41, 53.6%). Only one patient in this group had an unsalvageable testis necessitating orchidectomy, a testicular loss rate in torsion of 2.4%. There were no postoperative wound infections or scrotal haematomas. Testicular salvage depends critically on early surgical intervention, so the delay incurred in diagnostic imaging may extend the period of ischaemia. Furthermore, all radiological investigations have a certain false-negative rate. We advocate immediate surgical exploration of the acute scrotum. We report a low orchidectomy rate (2.4%) in testicular torsion.

  17. Averting a Disaster with Groundwater Depletion in India: The General Case of Water Management Principles and Development (Invited)

    Science.gov (United States)

    Lall, U.

    2013-12-01

    Many countries, including the USA, China, and India are experiencing chronic groundwater depletion. In part this unsustainable water use results from climatic factors that reduce surface water availability and also the recharge to the aquifer system. However, a more critical factor is uncontrolled use for agriculture and energy and mineral processing. Interestingly in places such as India endowments have been politically created that lead to ever increasing use, through the provision of free energy for pumping. Reversing the situation is considered politically challenging, and the concept of metering and payment for what is essentially economic use of water is also considered difficult to apply. In this talk I use the Indian situation as a general example and discuss the role central planning strategies for demand and resource management can play recognizing the private action by millions of users as an inevitable tool that needs to be leveraged without necessarily the high transaction costs that come with monitoring and fee collection for monitored use. Specifically, targeting and stimulating potential cropping strategies and on farm water and energy management emerge as a choice in a difficult management environment. In a broader development context, I argue that the role of private sector aggregators in developing farm to market procurement strategies can play a role in both improving rural economies and providing a trajectory for more efficient water use through technology and crop choice.

  18. A tool to measure whether business management capacity in general practice impacts on the quality of chronic illness care.

    Science.gov (United States)

    Holton, Christine H; Proudfoot, Judith G; Jayasinghe, Upali W; Grimm, Jane; Bubner, Tanya K; Winstanley, Julie; Harris, Mark F; Beilby, Justin J

    2010-11-01

    Our aim was to develop a tool to identify specific features of the business and financial management of practices that facilitate better quality care for chronic illness in primary care. Domains of management were identified, resulting in the development of a structured interview tool that was administered in 97 primary care practices in Australia. Interview items were screened and subjected to factor analysis, subscales identified and the overall model fit determined. The instrument's validity was assessed against another measure of quality of care. Analysis provided a four-factor solution containing 21 items, which explained 42.5% of the variance in the total scores. The factors related to administrative processes, human resources, marketing analysis and business development. All scores increased significantly with practice size. The business development subscale and total score were higher for rural practices. There was a significant correlation between the business development subscale and quality of care. The indicators of business and financial management in the final tool appear to be useful predictors of the quality of care. The instrument may help inform policy regarding the structure of general practice and implementation of a systems approach to chronic illness care. It can provide information to practices about areas for further development.

  19. Recommendations by the EACD for examination, diagnosis, and management of patients with temporomandibular disorders and orofacial pain by the general dental practitioner.

    NARCIS (Netherlands)

    Boever, JA De; Nilner, M.; Orthlieb, J.D.; Steenks, M.H.

    2008-01-01

    The Council of the European Academy of Craniomandibular Disorders charged the Educational Committee with the task of establishing Guidelines and Recommendations for the examination, diagnosis, and management of patients with temporomandibular disorders and orofacial pain by the general dental practi

  20. Diagnostic accuracy on the management of acute paediatric urinary tract infection in a general paediatric unit

    Institute of Scientific and Technical Information of China (English)

    Fahisham Taib; Bakht Jamal

    2015-01-01

    Objective: To ascertain diagnostic accuracy of paediatric urinary tract infection (UTI) in a general paediatric unit of a district hospital. Methods: Retrospective case note review and comparing to the final computerised database of Human in-Patient Enquiry (HIPE) at Portiuncula Hospital, Galway, Ireland. All children from 0-16 years of age with the diagnosis of UTI were enrolled within the 3 year study period. The information was first retrieved from HIPE system to capture list of patients. Case notes revision was followed to extract data under standardized pro-forma for demography, accuracy of diagnosis, treatment instituted and investigation ordered. Patients’ data was reviewed according to updated definition. Results: There were 85 cases treated for UTI during the 3 year period, and only 45 cases were considered as genuine UTI according to diagnostic criteria. Out of 45 cases, 16 cases were considered as suspected UTI cases. Escherichia coli was noted to be the commonest organism. Cephradine has been used as the first line treatment as per local guideline;however, different antibiotic regimes were based on physician’s preferences. The sensitivity of the current method of UTI diagnosis remained at 64%when comparing final diagnosis in the HIPE system. Conclusions: UTI can be difficult to accurately diagnosis in certain clinical cases. Decisions made should be individualized and tailored according to clinical suspicion and presentation of the patients. Improvement to ensure accurate diagnosis is vital to ensure correct data capture in the HIPE system thus giving valuable information and resource for future care.

  1. Diagnosis and management of generalized anxiety disorder and panic disorder in adults.

    Science.gov (United States)

    Locke, Amy B; Kirst, Nell; Shultz, Cameron G

    2015-05-01

    Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States, and they can negatively impact a patient's quality of life and disrupt important activities of daily living. Evidence suggests that the rates of missed diagnoses and misdiagnosis of GAD and PD are high, with symptoms often ascribed to physical causes. Diagnosing GAD and PD requires a broad differential and caution to identify confounding variables and comorbid conditions. Screening and monitoring tools can be used to help make the diagnosis and monitor response to therapy. The GAD-7 and the Severity Measure for Panic Disorder are free diagnostic tools. Successful outcomes may require a combination of treatment modalities tailored to the individual patient. Treatment often includes medications such as selective serotonin reuptake inhibitors and/or psychotherapy, both of which are highly effective. Among psychotherapeutic treatments, cognitive behavior therapy has been studied widely and has an extensive evidence base. Benzodiazepines are effective in reducing anxiety symptoms, but their use is limited by risk of abuse and adverse effect profiles. Physical activity can reduce symptoms of GAD and PD. A number of complementary and alternative treatments are often used; however, evidence is limited for most. Several common botanicals and supplements can potentiate serotonin syndrome when used in combination with antidepressants. Medication should be continued for 12 months before tapering to prevent relapse.

  2. Success of Dental Treatments under Behavior Management, Sedation and General Anesthesia.

    Science.gov (United States)

    Blumer, Sigalit; Costa, Liora; Peretz, Benjamin

    To present comparative study aims to assist the practitioner to choose between behavior modification (BM) techniques, pharmacologic sedation (N2O-O2 alone or combined with midazolam 0.5 mg/ kg) or routine general anesthesia (GA) for the most successful approach in enabling pediatric dental care. Dental records of 56 children treated in a university dental clinic between 2006-2016 were reviewed, and data on age, gender, required treatment (amalgam restorations, composite restorations, pulpotomy, and stainless steel crowns [SSC]), treatment approaches and therapeutic success at final follow-up were retrieved. Treatment under GA had the best success rates compared to both BM and pharmacologic sedation. N2O-O2 alone had a 6.1-fold greater risk of failure compared to N2O-O2+midazolam (p- <0.008). Amalgam restorations had a 2.61-fold greater risk of failure than SSC (p- <0.008). The GA mode yielded significantly greater success than the N2O-O2 mode alone. There were no significant differences in success rates between GA and combined midazolam 0.5 mg/kg+N2O-O2. When choosing restoration material, it is important to remember the high success rate of SSC compared to amalgam restoration.

  3. A generalized fuzzy linear programming approach for environmental management problem under uncertainty.

    Science.gov (United States)

    Fan, Yurui; Huang, Guohe; Veawab, Amornvadee

    2012-01-01

    In this study, a generalized fuzzy linear programming (GFLP) method was developed to deal with uncertainties expressed as fuzzy sets that exist in the constraints and objective function. A stepwise interactive algorithm (SIA) was advanced to solve GFLP model and generate solutions expressed as fuzzy sets. To demonstrate its application, the developed GFLP method was applied to a regional sulfur dioxide (SO2) control planning model to identify effective SO2 mitigation polices with a minimized system performance cost under uncertainty. The results were obtained to represent the amount of SO2 allocated to different control measures from different sources. Compared with the conventional interval-parameter linear programming (ILP) approach, the solutions obtained through GFLP were expressed as fuzzy sets, which can provide intervals for the decision variables and objective function, as well as related possibilities. Therefore, the decision makers can make a tradeoff between model stability and the plausibility based on solutions obtained through GFLP and then identify desired policies for SO2-emission control under uncertainty.

  4. Hypokalaemia: Improving the investigation, management and therapeutic monitoring of hypokalaemic medical inpatients at a district general hospital.

    Science.gov (United States)

    Jordan, Mark; Caesar, Jenny

    2015-01-01

    Hypokalaemia is prevalent in 20% of hospitalised patients. Furthermore, inadequate management of hypokalemia was identified in 24% of these patients. Associated with significant patient morbidity and mortality, the identification, investigation, and treatment of hypokalaemia was identified as an area for improvement in the management of medical inpatients. The project aims to measure the assessment, management, and therapeutic monitoring of medical inpatients with hypokalaemia in a district general hospital. All medical inpatients over a one week period who met the criteria for hypokalaemia (serum potassium <3.5 mmol/L on standard biochemical sample) were included in the audit. Patient's notes were located and evaluated to identify if they had mild, moderate, or severe hypokalaemia. Further data on ECG requests, repeat U&Es, serum magnesium analysis, treatment prescribed, and medication review dates was collated. A re-audit was completed after the introduction of a set of interventions which included a hypokalaemia treatment algorithm. Pre-intervention analysis of all medical inpatients, who met our inclusion criteria for hypokalaemia, identified 32 patients. 25 of these patients met the criteria for mild hypokalaemia (3.1-3.4 mmol/L) and 7 met the criteria for moderate hypokalaemia (2.5-3.0 mmol/L). Only 7/32 (22 %) patients were receiving adequate treatment based on trust guidelines. Post intervention results showed marked improvement in the management of patients with hypokalaemia. A total of 30 patients were identified in this post-intervention group. There were 16/30 patients who qualified as mild hypokalaemia (3.1-3.4 mmol/L) and 14/30 with moderate hypokalaemia (2.5-3.0 mmol/L). 19/30 (63%) patients in the post-intervention group were correctly prescribed appropriate medication doses consistent with the treatment algorithm. Following the initial success of the project, analysis at 3 months showed a positive trend for sustained improvement when compared to

  5. General consumer communication tools for improved image management and communication in medicine.

    Science.gov (United States)

    Rosset, Chantal; Rosset, Antoine; Ratib, Osman

    2005-12-01

    We elected to explore new technologies emerging on the general consumer market that can improve and facilitate image and data communication in medical and clinical environment. These new technologies developed for communication and storage of data can improve the user convenience and facilitate the communication and transport of images and related data beyond the usual limits and restrictions of a traditional picture archiving and communication systems (PACS) network. We specifically tested and implemented three new technologies provided on Apple computer platforms. (1) We adopted the iPod, a MP3 portable player with a hard disk storage, to easily and quickly move large number of DICOM images. (2) We adopted iChat, a videoconference and instant-messaging software, to transmit DICOM images in real time to a distant computer for conferencing teleradiology. (3) Finally, we developed a direct secure interface to use the iDisk service, a file-sharing service based on the WebDAV technology, to send and share DICOM files between distant computers. These three technologies were integrated in a new open-source image navigation and display software called OsiriX allowing for manipulation and communication of multimodality and multidimensional DICOM image data sets. This software is freely available as an open-source project at http://homepage.mac.com/rossetantoine/OsiriX. Our experience showed that the implementation of these technologies allowed us to significantly enhance the existing PACS with valuable new features without any additional investment or the need for complex extensions of our infrastructure. The added features such as teleradiology, secure and convenient image and data communication, and the use of external data storage services open the gate to a much broader extension of our imaging infrastructure to the outside world.

  6. Roles and practices of general practitioners and psychiatrists in management of depression in the community

    Directory of Open Access Journals (Sweden)

    Blin Patrick

    2006-01-01

    Full Text Available Abstract Background Little is known about depressed patients' profiles and how they are managed. The aim of the study is to compare GPs and psychiatrists for 1° sociodemographic and clinical profile of their patients considered as depressed 2° patterns of care provision. Methods The study design is an observational cross-sectional study on a random sample of GPs and psychiatrists working in France. Consecutive inclusion of patients seen in consultation considered as depressed by the physician. GPs enrolled 6,104 and psychiatrists 1,433 patients. Data collected: sociodemographics, psychiatric profile, environmental risk factors of depression and treatment. All clinical data were collected by participating physicians; there was no direct independent clinical assessment of patients to check the diagnosis of depressive disorder. Results Compared to patients identified as depressed by GPs, those identified by psychiatrists were younger, more often urban (10.5% v 5.4% – OR = 2.4, educated (42.4% v 25.4% – OR = 3.9, met DSM-IV criteria for depression (94.6% v 85.6% – OR = 2.9, had been hospitalized for depression (26.1% v 15.6% – OR = 2.0 and were younger at onset of depressive problems (all adjusted p Compared to GPs, psychiatrists more often prescribed tricyclics and very novel antidepressants (7.8% v 2.3% OR = 5.0 and 6.8% v 3.0% OR = 3.8 with longer duration of antidepressant treatment. GPs' patients received more "non-conventional" treatment (8.8% v 2.4% OR = 0.3 and less psychotherapy (72.2% v 89.1% OR = 3.1 (all adjusted p Conclusion Differences between patients mainly concerned educational level and area of residence with few differences regarding clinical profile. Differences between practices of GPs and psychiatrists appear to reflect more the organization of the French care system than the competence of providers.

  7. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    NARCIS (Netherlands)

    Plas, A.G.M. van der; Onwuteaka-Philipsen, B.D.; Vissers, K.C.; Deliens, L.; Jansen, W.J.J.; Francke, A.L.

    2016-01-01

    Aims: To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case managemen

  8. STRATEGIC KNOWLEDGE MANAGEMENT IN THE ARMED FORCES ACADEMY OF GENERAL M. R. ŠTEFÁNIK IN LIPTOVSKÝ MIKULÁŠ, THE SLOVAK REPUBLIC

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    Mária PETRUFOVÁ

    2015-10-01

    Full Text Available The article stresses the importance of strategic knowledge management in the era of global competition. Strategic knowledge management raises the demand for permanent learning stressing the visions and personal aspirations of everyone within the modern effi cient organisation. Within the AFA of General M.R. Štefánik and, inherently, in the Armed Forces of the Slovak Republic, strategic knowledge management employs and implements knowledge as the ultimate step in the knowledge pyramid.

  9. Role of general practitioner, specialist and insurance practitioner in managing knee impairment

    Directory of Open Access Journals (Sweden)

    Olivera Masten-Cuznar

    2006-02-01

    Full Text Available Background: Proper treatment of the pacient with knee injury or disease, early diagnosis, therapy, rehabilitation which may include use of knee orthoses are most important for the best outcome. Communication between general practitioner, the specialists involved and even insurance practitioner on ZZZS (Health Insurance Institute of Slovenia and especially motivation of the patient are essential for the best cure in every case. World-wide studies showed opposite, positive and negative effects of active support of knee orthoses. The aim of the study was to find out if any differences could be detected in deciding about confirmation of knee orthoses and health resort rehabilitation between insurance practitioners in Slovenia.Methods: Retrospective review of number of confirmed orthoses and especially knee orthoses in connection with registrated active population of ten ZZZS areas on the ZZZS division for orthoses in 2001, 2002 in 2003 has been done. Retrospective review of number of all confirmed health resort rehabilitation and comparison for selected ten diagnosis of knee injuries and diseases in connection with registered active population of ten ZZZS areas from ZZZS computer basis data in 2001, 2002, 2003 in 2004 has been done.Results: Analysed data indicated a decrease in number of confirmed knee orthoses and number of health resort rehabilitation but moderate increase in number of health resort rehabilitation for selected ten diagnosis. Top number of confirmed orthoses in connection with registered active population was detected in Novo mesto and Maribor ZZZS area and the smallest number in Koper and Nova Gorica ZZZS area. Top number of health resort rehabilitation for selected ten diagnosis of knee dysfunction was confirmed in Krško and Ravne na Koroškem ZZZS area and the smallest number in Maribor and Koper ZZZS area.Conclusions: The research showed differences between decisions of insurance practitioners about knee orthoses and health

  10. Understanding diagnosis and management of dementia and guideline implementation in general practice: a qualitative study using the theoretical domains framework.

    Science.gov (United States)

    Murphy, Kerry; O'Connor, Denise A; Browning, Colette J; French, Simon D; Michie, Susan; Francis, Jill J; Russell, Grant M; Workman, Barbara; Flicker, Leon; Eccles, Martin P; Green, Sally E

    2014-03-03

    Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important role in diagnosing and managing dementia; however, there are gaps between recommended and current practice. The aim of this study was to explore GPs' reported practice in diagnosing and managing dementia and to describe, in theoretical terms, the proposed explanations for practice that was and was not consistent with evidence-based guidelines. Semi-structured interviews were conducted with GPs in Victoria, Australia. The Theoretical Domains Framework (TDF) guided data collection and analysis. Interviews explored the factors hindering and enabling achievement of 13 recommended behaviours. Data were analysed using content and thematic analysis. This paper presents an in-depth description of the factors influencing two behaviours, assessing co-morbid depression using a validated tool, and conducting a formal cognitive assessment using a validated scale. A total of 30 GPs were interviewed. Most GPs reported that they did not assess for co-morbid depression using a validated tool as per recommended guidance. Barriers included the belief that depression can be adequately assessed using general clinical indicators and that validated tools provide little additional information (theoretical domain of 'Beliefs about consequences'); discomfort in using validated tools ('Emotion'), possibly due to limited training and confidence ('Skills'; 'Beliefs about capabilities'); limited awareness of the need for, and forgetting to conduct, a depression assessment ('Knowledge'; 'Memory, attention and decision processes'). Most reported practising in a manner consistent with the recommendation that a formal cognitive assessment using a validated scale be undertaken. Key factors enabling this were having an awareness of the need to conduct a cognitive assessment ('Knowledge'); possessing the necessary skills and confidence ('Skills'; 'Beliefs

  11. Decreased Management of Genital Warts in Young Women in Australian General Practice Post Introduction of National HPV Vaccination Program: Results from a Nationally Representative Cross-Sectional General Practice Study

    Science.gov (United States)

    Harrison, Christopher; Britt, Helena; Garland, Suzanne; Conway, Lynne; Stein, Alicia; Pirotta, Marie; Fairley, Christopher

    2014-01-01

    Objectives Since the introduction of Australia's human papillomavirus vaccination program, the management rate of genital warts in sexual health clinics and private hospitals has decreased in women of vaccine-eligible age. However, most genital warts in Australia are managed in general practice. This study examines whether a similar decrease occurred in Australian general practice after the introduction of the program. Methods Analysis of a nationally representative cross-sectional database of Australian general practice activity (1,175,879 patient encounters with 11,780 general practitioners). Genital warts management rates were estimated for the periods before and after introduction of the program (Pre-program, July 2002-June 2006; Post-program, July 2008-June 2012). Control conditions included genital herpes and gardnerella/bacterial vaginosis in female patients and genital herpes and urethritis in male patients. Trends in management rates by year, pre-vaccine (July 2000-June 2007) and post-vaccine (July 2007-June 2012) were also calculated. Results Management rate of genital warts among women potentially covered by program (aged 15–27 years) decreased by 61% from 4.33 per 1,000 encounters in the Pre-program period to 1.67 in the Post-program period. Trend analysis of the post-vaccine period showed, among women of vaccine eligible age, a significant year-on-year reduction in the rate of genital warts management (pwarts between the Pre- and Post-program periods. Conclusion The large decrease in general practice management of genital warts in women of vaccine-eligible age highlights the success of the program in the wider community. PMID:25180698

  12. Science, the public, and social elites: how the general public, scientists, top politicians and managers perceive science.

    Science.gov (United States)

    Prpić, Katarina

    2011-11-01

    This paper finds that the Croatian public's and the social elites' perceptions of science are a mixture of scientific and technological optimism, of the tendency to absolve science of social responsibility, of skepticism about the social effects of science, and of cognitive optimism and skepticism. However, perceptions differ significantly according to the different social roles and the wider value system of the observed groups. The survey data show some key similarities, as well as certain specificities in the configuration of the types of views of the four groups--the public, scientists, politicians and managers. The results suggest that the well-known typology of the four cultures reveals some of the ideologies of the key actors of scientific and technological policy. The greatest social, primarily educational and socio-spatial, differentiation of the perceptions of science was found in the general public.

  13. Contributing factors to influenza vaccine uptake in general hospitals: an explorative management questionnaire study from the Netherlands

    Directory of Open Access Journals (Sweden)

    Riphagen-Dalhuisen Josien

    2012-12-01

    Full Text Available Abstract Background The influenza vaccination rate in hospitals among health care workers in Europe remains low. As there is a lack of research about management factors we assessed factors reported by administrators of general hospitals that are associated with the influenza vaccine uptake among health care workers. Methods All 81 general hospitals in the Netherlands were approached to participate in a self-administered questionnaire study. The questionnaire was directed at the hospital administrators. The following factors were addressed: beliefs about the effectiveness of the influenza vaccine, whether the hospital had a written policy on influenza vaccination and how the hospital informed their staff about influenza vaccination. The questionnaire also included questions about mandatory vaccination, whether it was free of charge and how delivered as well as the vaccination campaign costs. The outcome of this one-season survey is the self-reported overall influenza vaccination rate of health care workers. Results In all, 79 of 81 hospitals that were approached were willing to participate and therefore received a questionnaire. Of these, 42 were returned (response rate 52%. Overall influenza vaccination rate among health care workers in our sample was 17.7% (95% confidence interval: 14.6% to 20.8%. Hospitals in which the administrators agreed with positive statements concerning the influenza vaccination had a slightly higher, but non-significant, vaccine uptake. There was a 9% higher vaccine uptake in hospitals that spent more than €1250,- on the vaccination campaign (24.0% versus 15.0%; 95% confidence interval from 0.7% to 17.3%. Conclusions Agreement with positive statements about management factors with regard to influenza vaccination were not associated with the uptake. More economic investments were related with a higher vaccine uptake; the reasons for this should be explored further.

  14. Use of antimicrobial resistance information and prescribing guidance for management of urinary tract infections: survey of general practitioners in the West Midlands

    OpenAIRE

    2016-01-01

    Background There is a marked variation in both antibiotic prescribing practice and urine sampling rates for diagnostic microbiology across general practices in England. To help understand factors driving this variation, we undertook a survey in 2012/13 to determine sampling protocols and antibiotic formularies used by general practitioners (GPs) for managing urinary tract infections (UTIs) in the West Midlands region of England. Method Cross-sectional survey of all eligible general practices ...

  15. Cow’s Milk Protein Allergy from Diagnosis to Management: A Very Different Journey for General Practitioners and Parents

    Science.gov (United States)

    Lozinsky, Adriana C.; Meyer, Rosan; Anagnostou, Katherine; Dziubak, Robert; Reeve, Kate; Godwin, Heather; Fox, Adam T.; Shah, Neil

    2015-01-01

    Cow’s milk protein allergy (CMPA) is the most common food allergy in infants and can affect a family’s quality of life. The purpose of this paper is to evaluate the knowledge and experience of general practitioners (GPs) in terms of CMPA diagnosis and management and to explore the views of parents on the current diagnostic process. Two surveys were conducted in June 2014, which collected data from GPs and parents of infants diagnosed with CMPA in the United Kingdom. The questionnaires included quantitative and qualitative questions, which measured self-reported knowledge, management and perceived treatment progression, and the educational needs of GPs. We also explored parents’ experiences of local healthcare support in relation to CMPA. A total of 403 GPs and 300 parents completed the surveys. The main symptoms of CMPA and diagnosis period differed between GPs and parents. Other key points include different perceptions on symptom presentation and improvement, lack of awareness from GPs about current guidelines, and the significant burden on both families and GPs. This is the first study attempting to establish GP and parental experience in diagnosing CMPA. It isnotable that the difference can be improved through training, appropriate diagnostic tools and improved communication between physicians and parents. PMID:27417366

  16. Effectiveness of using high-fidelity simulation to teach the management of general anesthesia for Cesarean delivery.

    Science.gov (United States)

    Balki, Mrinalini; Chakravarty, Subrata; Salman, Aliya; Wax, Randy S

    2014-10-01

    The objective of this study was to assess the influence of a teaching plan consisting of didactic teaching and repeated simulations on the performance of anesthesia residents in the management of general anesthesia (GA) for emergency Cesarean delivery (CD). Twenty-one postgraduate year 2 (PGY2) and 3 (PGY3) anesthesia residents from the University of Toronto were recruited in this prospective cohort study. All participants received didactic teaching in the management of GA for emergency CD, which was followed one week later by assessment of performance in the same scenario using a high-fidelity simulator. Another simulation assessment was repeated two months later in the same scenario. All simulation video recordings were assessed by two blinded experts using a validated checklist and an Anaesthetists' Non-Technical Skills (ANTS) scale in order to rate their technical and non-technical skills, respectively. The participants' performance (based on the above scales) in the two simulation sessions were then compared. Nineteen residents completed both simulation sessions. There was an improvement in the mean (SD) weighted checklist score from 64.5% (7.1%) in session 1 to 76.7% (6.7%) in session 2 (P technical skills but also the non-technical skills of residents, most likely due to the feedback received after the first simulation session. Repeated simulation sessions may help prepare residents to deal more effectively with similar critical situations in clinical practice with minimum errors.

  17. Investigating patients' and general practitioners' views of computerised decision support software for the assessment and management of cardiovascular risk.

    Science.gov (United States)

    Wilson, Anne; Duszynski, André; Turnbull, Deborah; Beilby, Justin

    2007-01-01

    This paper reports an evaluation of the usability and acceptability of a computer-based decision support program (EMPOWER) for cardiovascular risk from the perspectives of both general practitioners (GPs) and consumers. A qualitative research design utilised semi-structured telephone interviews to assess the program from participants' perspectives. Qualitative approaches included the use of purposeful sampling, the collection of open-ended data, and the analysis of text and personal interpretation of findings. The theoretical foundations for the methods chosen are explained. Consumers enjoyed being involved in the study and thought the program had benefits for encouraging confidence in seeking health care. Consumers reported feeling reassured about the processes followed during consultation. GPs found the application of the software program increased demands on their time but admired several features of the program, especially its educational advantages. Participants were of the opinion that the program would be of particular benefit to inexperienced GPs and newly diagnosed patients. Computer decision support programs are becoming more prevalent, but little is known about their usability and acceptability to both health professionals and consumers. The complexities of cardiovascular risk assessment and management can be adequately managed with such programs. As a contemporary report this study contributes to the growing knowledge required for developers of medical software and decision support systems to better understand the needs of end-users.

  18. The role of the internal medicine specialist in the management of infective complications in general surgical wards

    Directory of Open Access Journals (Sweden)

    Patrizia Zoboli

    2013-05-01

    Full Text Available BACKGROUND Internal medicine specialists are often asked to evaluate a patient before surgery. Perioperative risk evaluation for elderly patients is important, because complications increase with age. The increasing age of the general population increases the probabilities of surgery in the older patients. The manifestation of a surgical problem, is more likely to be severe and complicated in the elderly patients. In fact, emergency surgery treatment occurs more frequently in the elderly (e.g., it is much more common to see intestinal obstruction complicating colorectal cancer in the elderly compared with a younger population. Old age is an independent factor for long hospital stay after surgery. The role of the preoperative medical consultant is to identify and evaluate a patient’s current medical status and provide a clinical risk profile, in order to decide whether further tests are indicated prior to surgery, and to optimise the patient’s medical condition in the attempt of reducing the risk of complications. The medical consultant must know which medical condition could eventually influence the surgery, achieve a good contact and communication between the medical and surgical team, in order to obtain the best management planning. AIM OF THE STUDY This paper focuses on the rational use of antibiotic prophylaxis and on the treatment of the complications of post-surgery infections (e.g., pulmonary complication, peritonitis, intra-abdominal infection. Specific aspects of pre-operative risk evaluation and peri and post-operative management are discussed. CONCLUSIONS The internal medicin specialist in collaboration with the surgical team is necessary in the peri and post-surgery management.

  19. HOSPITAL PATIENT DATABASE MANAGEMENT SYSTEM ‘A Case Study of General Hospital NORTH-BANK Makurdi- Nigeria’

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    Oye Nathaniel David

    2014-03-01

    Full Text Available Health care in Nigeria as in many other countries is confronted with growing demand for medical treatment and services. The medical records must appropriately have all of the patients’ medical history. Physicians must maintain flawless records, because this document serves a number of purposes. This study on hospital patient datable management system was design to transform the manual way of searching, sorting, keeping and accessing patient medical information (files into electronic medical record (EMR in order to solve the problem associate with manual method. The existing system (manual has been studied and hence a computer based application was provided to replace this manual method. These computer based systems generate the patient report as the patient register in and out of the hospital. This paper generally looks for a more accurate, reliable and efficient method of computer to facilitate patient record’s keeping in General Hospitals to ensure efficient outcome that will lessen time consuming. The study proposed that the design of hospital patient database record will be a solution to the problem being experienced by the current manual method of keeping patient medical record.

  20. [Undesired awareness phenomena during general anesthesia: Evidence-based state of knowledge, current discussions and strategies for prevention and management].

    Science.gov (United States)

    Bischoff, P; Rundshagen, I; Schneider, G

    2015-10-01

    Patient awareness during general anesthesia and the later recall of what happened during surgery can be experienced by patients as horrifying events that leave lasting mental trauma in the form of posttraumatic stress syndrome (PTSS). Awareness is related to a temporary insufficient depth of anesthesia. This phenomenon has been discussed for more than 20 years. According to randomized controlled studies, in the absence of risk factors awareness phenomena occur in 1-2 per 1000 operations involving general anesthesia (0.1-0.2%) and are classified as occasionally occurring critical events. An astonishing twist occurred elicited by the recent data from the 5th National Audit Project from Great Britain (NAP5) published in the British Journal of Anaesthesia and in Anaesthesia. The NAP5 evaluated patient reports of accidental awareness during general anesthesia (AAGA) in a multicenter manner in more than 2.7 million cases and indicated incidences of awareness of only 1:19,600, a frequency 20 times less than previously reported. These results gave rise to some controversy. It seems likely that, due to the absence of structured interviews, the NAP5 data only demonstrated the tip of the iceberg and may have vastly underestimated the real incidence of intraoperative awareness. The present overview summarizes the current knowledge about awareness. Furthermore, it addresses the question whether the awareness problem has been overestimated by evidence-based criteria or underestimated by the results of the NAP5. The responsibility for sufficient anesthesia in the clinical routine requires knowledge of awareness risks and potential sequelae. A formal recommendation from the German Society of Anesthesia and Intensive Care Medicine (DGAI) concerning awareness is not yet available; however, the recognition of evidence-based strategies in the management of anesthesia may minimize the occurrence of awareness and its sequelae.

  1. 76 FR 31359 - Notice of Intent To Prepare an Environmental Impact Statement on a General Management Plan...

    Science.gov (United States)

    2011-05-31

    ... plan. A range of reasonable alternatives for managing the park will be developed through this planning... management goals for managing the area during the next 15 to 20 years. The plan will prescribe desired...

  2. Interface Management between General Practitioners and Rheumatologists-Results of a Survey Defining a Concept for Future Joint Recommendations.

    Directory of Open Access Journals (Sweden)

    Rudolf Puchner

    Full Text Available To measure the views of general practitioners (GPs and rheumatologists in a nationwide evaluation, so as to optimise their cooperation in managing patients with inflammatory rheumatic diseases.A questionnaire covering aspects of collaboration was sent, both by mail and/or by email, to all GPs and rheumatologists in Austria. Topics covered were (i examinations and interventions to be performed before referral, (ii the spectrum of diseases to be referred, and (iii the role of GPs in follow-up and continuous management of patients.1,229 GPs of the 4,016 GPs (31% and 110 of the 180 rheumatologists (61% responded to the questionnaire. In cases of suspected arthritis, 99% of the GPs and 92% of the rheumatologists recommended specific laboratory tests, and 92% and 70%, respectively, recommended X-rays of affected joints before referral. Rheumatoid arthritis and spondyloarthritis, psoriatic arthritis and connective tissue disease were unanimously seen as indications for referral to a rheumatologist. Only 12% of rheumatologists felt responsible for the treatment of hand osteoarthritis and fibromyalgia. 80% of GPs and 85% of rheumatologists were of the opinion that treatment with disease-modifying drugs should be initiated by a specialist. Subsequent drug prescription and administration by GPs was supported by a majority of GPs and rheumatologists, with a concomitant rheumatologist follow-up every three to six months.The considerable consensus between the two professional groups constitutes a solid base for future joint recommendations, with the aim to accelerate the diagnostic process and the initiation of adequate therapy.

  3. General practitioner management of shoulder pain in comparison with rheumatologist expectation of care and best evidence: an Australian national survey.

    Directory of Open Access Journals (Sweden)

    Rachelle Buchbinder

    Full Text Available OBJECTIVES: To determine whether current care for common shoulder problems in Australian general practice is in keeping with rheumatologist expectations and the best available evidence. METHODS: We performed a mailed survey of a random sample of 3500 Australian GPs and an online survey of all 270 rheumatologists in Australia in June 2009. Each survey included four vignettes (first presentation of shoulder pain due to rotator cuff tendinopathy, acute rotator cuff tear in a 45 year-old labourer and early and later presentation of adhesive capsulitis. For each vignette, GPs were asked to indicate their management, rheumatologists were asked to indicate appropriate primary care, and we determined best available evidence from relevant Cochrane and other systematic reviews and published guidelines. RESULTS: Data were available for at least one vignette for 614/3500 (17.5% GPs and 64 (23.8% rheumatologists. For first presentation of rotator cuff tendinopathy, 69% and 82% of GPs and 50% and 56% rheumatologists would order a shoulder X-ray and ultrasound respectively (between group comparisons P = 0.004 and P<0001. Only 66% GPs and 60% rheumatologists would refer to an orthopaedic surgeon for the acute rotator cuff tear. For adhesive capsulitis, significantly more rheumatologists recommended treatments of known benefit (e.g. glucocorticoid injection (56% versus 14%, P<0.0001, short course of oral glucocorticoids (36% versus 6%, p<0.0001 and arthrographic distension of the glenohumeral joint (41% versus 19%, P<0.0001. CONCLUSIONS: There is a mismatch between the stated management of common shoulder problems encountered in primary care by GPs, rheumatologist expectations of GP care and the available evidence.

  4. Workload and management of childhood fever at general practice out-of-hours care: an observational cohort study.

    Science.gov (United States)

    de Bont, Eefje G P M; Lepot, Julie M M; Hendrix, Dagmar A S; Loonen, Nicole; Guldemond-Hecker, Yvonne; Dinant, Geert-Jan; Cals, Jochen W L

    2015-05-19

    Even though childhood fever is mostly self-limiting, children with fever constitute a considerable workload in primary care. Little is known about the number of contacts and management during general practitioners' (GPs) out-of-hours care. We investigated all fever related telephone contacts, consultations, antibiotic prescriptions and paediatric referrals of children during GP out-of-hours care within 1 year. Observational cohort study. We performed an observational cohort study at a large Dutch GP out-of-hours service. Children (parents contacted the GP out-of-hours service for a fever related illness in 2012 were included. Number of contacts and consultations, antibiotic prescription rates and paediatric referral rates. We observed an average of 14.6 fever related contacts for children per day at GP out-of-hours services, with peaks during winter months. Of 17,170 contacts in 2012, 5343 (31.1%) were fever related and 70.0% resulted in a GP consultation. One in four consultations resulted in an antibiotic prescription. Prescriptions increased by age and referrals to secondary care decreased by age (pparents (89.5%) contacted the out-of-hours service only once during a fever episode (89.5%) and 7.6% of children were referred to secondary care. This study shows that childhood fever does account for a large workload at GP out-of-hours services. One in three contacts is fever related and 70% of those febrile children are called in to be assessed by a GP. One in four consultations for childhood fever results in antibiotic prescribing and most consultations are managed in primary care without referral. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. 41 CFR 102-193.15 - What are the records management responsibilities of the Administrator of General Services (the...

    Science.gov (United States)

    2010-07-01

    .... Records management policies and guidance established by the Archivist are contained in 36 CFR chapter XII... ensure economical and effective records management. Records management policies and guidance established... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What are the...

  6. Does brief chronic pain management education change opioid prescribing rates? A pragmatic trial in Australian early-career general practitioners.

    Science.gov (United States)

    Holliday, Simon Mark; Hayes, Chris; Dunlop, Adrian J; Morgan, Simon; Tapley, Amanda; Henderson, Kim M; van Driel, Mieke L; Holliday, Elizabeth G; Ball, Jean I; Davey, Andrew; Spike, Neil Allan; McArthur, Lawrence Andrew; Magin, Parker John

    2017-02-01

    We aimed to evaluate the effect of pain education on opioid prescribing by early-career general practitioners. A brief training workshop was delivered to general practice registrars of a single regional training provider. The workshop significantly reduced "hypothetical" opioid prescribing (in response to paper-based vignettes) in an earlier evaluation. The effect of the training on "actual" prescribing was evaluated using a nonequivalent control group design nested within the Registrar Clinical Encounters in Training (ReCEnT) cohort study: 4 other regional training providers were controls. In ReCEnT, registrars record detailed data (including prescribing) during 60 consecutive consultations, on 3 occasions. Analysis was at the level of individual problem managed, with the primary outcome factor being prescription of an opioid analgesic and the secondary outcome being opioid initiation. Between 2010 and 2015, 168,528 problems were recorded by 849 registrars. Of these, 71% were recorded by registrars in the nontraining group. Eighty-two percentages were before training. Opioid analgesics were prescribed in 4382 (2.5%, 95% confidence interval [CI]: 2.40-2.63) problems, with 1665 of these (0.97%, 95% CI: 0.91-1.04) representing a new prescription. There was no relationship between the training and total prescribing after training (interaction odds ratio: 1.01; 95% CI: 0.75-1.35; P value 0.96). There was some evidence of a reduction in initial opioid prescriptions in the training group (interaction odds ratio: 0.74; 95% CI: 0.48-1.16; P value 0.19). This brief training package failed to increase overall opioid cessation. The inconsistency of these actual prescribing results with "hypothetical" prescribing behavior suggests that reducing opioid prescribing in chronic noncancer pain requires more than changing knowledge and attitudes.

  7. Knowledge, illness perceptions and stated clinical practice behaviour in management of gout: a mixed methods study in general practice.

    Science.gov (United States)

    Spaetgens, Bart; Pustjens, Tobias; Scheepers, Lieke E J M; Janssens, Hein J E M; van der Linden, Sjef; Boonen, Annelies

    2016-08-01

    The objective of the present study is to explore knowledge, illness perceptions and stated practice behaviour in relation to gout in primary care. This is a mixed methods study among 32 general practitioners (GPs). The quantitative assessment included the Gout Knowledge Questionnaire (GKQ; range 0-10; better) and Brief Illness Perceptions Questionnaire (BIPQ; nine items, range 0-10; stronger). Structured individual interviews obtained further qualitative insight into knowledge and perceptions, in the context of daily practice. Among 32 GPs, 18 (56.3 %) were male, mean age 44.4 years (SD 9.6) and mean working experience 17.1 years (SD 9.7). Median score [interquartile ranges (IQR)] on the GKQ was 7.8 [6.7-8.9] and 9.0 [8.0-10.0], when presented as open or multiple-choice questions, respectively. The BIPQ (median; [IQR]) revealed that gout was seen as a chronic disease (8.0; [7.0-9.0]), affecting life and emotions moderately (6.5; [5.0-7.0]), having many severe symptoms (8.0; [7.0-9.0]) and in which treatment could be very helpful (8.0; [7.0-9.0]). Further interviews revealed large variation in specific aspects of knowledge and about gaps concerning indications for uric acid-lowering therapy (UALT), duration of UALT, target serum uric acid (sUA) level or duration of prophylactic treatment. Finally, patients' adherence was not checked systematically. Specific knowledge gaps and discrepancies between perceptions and stated practice behaviour were identified, which might hamper effective management of this well-treatable disease. Improving evidence on the rationale and effectiveness of treatment targets and adherence interventions, tailoring guidelines to general practice and intensification of implementation of guidelines in primary health care seem to be needed.

  8. Delayed Recovery from General Anaesthesia: A Post-operative Diagnostic Dilemma and Implications of ICU Management of Serotonin Toxicity. Case report

    Directory of Open Access Journals (Sweden)

    Naik Asha

    2015-10-01

    Full Text Available We report a case of delayed recovery from general anesthesia following a routine parathyroidectomy. Our objectives are to describe the process of establishing a differential diagnosis and subsequent management of a patient presenting with atypical neurological signs from an unknown etiology and to increase awareness about the potential for serotonin syndrome and neurotoxicity due to known interactions between methylene blue and selective serotoninnoradrenaline re-uptake inhibitors. ICU management of Serotonin Toxicity is briefly described.

  9. Exploring the nature of power distance on general practitioner and community pharmacist relations in a chronic disease management context.

    Science.gov (United States)

    Rieck, Allison Margaret

    2014-09-01

    To improve collaboration in Australian primary health care, there is a need to understand aspects of the general practitioner (GP)/community pharmacist relationship, its influence on collaborative chronic disease management (CDM) and if this influence can be explained by a pre-existing theory or concept. Adopting a grounded theory approach, 22 GP and 22 community pharmacist semi-structured interviews were undertaken. Analysis of the transcripts identified common themes regarding the GP/community pharmacist relationship. Trustworthiness of the themes identified was tested through negative case analysis and member checking. Hofstede's (in 1980) phenomenon of power distance was employed to illuminate the nature of GP/community pharmacist relations. The majority of GPs and community pharmacists described the characteristics of this phenomenon. The power distance was based on knowledge and expertise and was shown to be a barrier to collaboration between GPs and community pharmacists because GPs perceived that community pharmacists did not have the required expertise to improve CDM above what the GP could deliver alone. Power distance exists within the GP/community pharmacist relationship and has a negative influence on GP/community pharmacist collaborative CDM. Understanding and improving GP awareness of community pharmacist expertise has important implications for the future success of collaborative CDM.

  10. The emergency Management Alternative Center (EMAC). Requirements and general considerations; Centro Alternativo de Gestion de la Emergencia (CAGE). Requisitos y consideraciones generales

    Energy Technology Data Exchange (ETDEWEB)

    Turrion, F.; Barrio, M. A. del; Cobos, A.

    2014-10-01

    The Emergency Management Alternative Center (EMAC) will give support to the emergency Organization Response on site, combining the continuity of the accident mitigation actions with the rest and the protection of personnel, adjusting these works to the conditions of the Power Plant and the evolution of the emergency. It must be operational in the Spanish NNPP by December 2015 and the design must be in accordance with the criteria by the Nuclear Safety Council. (Author)

  11. Comparison of Pediatric and General Orthopedic Surgeons? Approaches in Management of Developmental Dysplasia of the Hip and Flexible Flatfoot: the Road to Clinical Consensus

    OpenAIRE

    Ramin Haj Zargarbashi; Hirbod Nasiri Bonaki; Shayan Zadegan; Taghi Baghdadi; Mohammad Hossein Nabian; Mehdi Ramezan Shirazi

    2017-01-01

    Developmental dysplasia of the hip (DDH) and flatfoot are common pediatric orthopedic disorders, being referred to and managed by both general and pediatric orthopedic surgeons, through various modalities. Our study aimed to evaluate their consensus and perspective disagreements in terms of diagnostic and therapeutic approaches of the mentioned deformities. Forty participants in two groups of general orthopedic surgeons (GOS) (n=20) and pediatric orthopedic surgeons (POS) (n=20), were asked t...

  12. Non-face-to-face consultations and communications in primary care: the role and perspective of general practice managers in Scotland.

    Science.gov (United States)

    Hanna, Lisa; May, Carl; Fairhurst, Karen

    2011-01-01

    Practice managers play an important role in the organisation and delivery of primary care, including uptake and implementation of technologies. Little is currently known about practice managers' attitudes to the use of information and communication technologies, such as email or text messaging, to communicate or consult with patients. To investigate practice managers' attitudes to non-face-to-face consultation/communication technologies in the routine delivery of primary care and their role in the introduction and normalisation of these technologies. We carried out a mixed-methods study in Scotland, UK. We invited all practice managers in Scotland to take part in a postal questionnaire survey. A maximum variation sample of 20 survey respondents participated subsequently in in-depth qualitative interviews. Practice managers supported the use of new technologies for routine tasks to manage workload and maximise convenience for patients, but a range of contextual factors such as practice list size, practice deprivation area and geographical location affected whether managers would pursue the introduction of these technologies in the immediate future. The most common objections were medico-legal concerns and lack of perceived patient demand. Practice managers are likely to play a central role in the introduction of new consultation/communication technologies within general practice. They hold varying views on the appropriateness of these technologies, influenced by a complex mix of contextual characteristics. Managers from areas in which the ethos of the practice prioritises personalised care in service delivery are less enthusiastic about the adoption of remote consultation/communication technologies.

  13. 40 CFR 63.7886 - What are the general standards I must meet for my affected remediation material management units?

    Science.gov (United States)

    2010-07-01

    ... meet for my affected remediation material management units? 63.7886 Section 63.7886 Protection of... meet for my affected remediation material management units? (a) For each remediation material... material management units exempted under paragraph (c) or (d) of this section. (b) For each affected...

  14. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMP(2)ART qualitative study.

    Science.gov (United States)

    Morrow, Susan; Daines, Luke; Wiener-Ogilvie, Sharon; Steed, Liz; McKee, Lorna; Caress, Ann-Louise; Taylor, Stephanie J C; Pinnock, Hilary

    2017-07-18

    Despite an overwhelming evidence base, supported self-management of asthma is poorly implemented into routine practice. Strategies for implementation must address organisational routines, as well as provide resources for patients and training to improve professionals' skills. We aimed to explore the priority that primary care practices attach to asthma self-management, to describe their existing asthma management routines, and to generate innovative implementation strategies. We recruited 33 participants (23 general practitioners; seven nurses; three administrative staff) from 14 general practices. The 12 interviews and three focus groups were transcribed, coded and analysed thematically. Supported self-management was largely a nurse-led task within clinic-based annual reviews. Barriers included poor attendance at asthma clinics, lack of time, demarcation of roles, limited access to a range of tailored resources, and competing agendas in consultation, often due to multimorbidity. Suggestions for initiatives to improve the provision of supported self-management included emphasising the evidence for benefit (to influence prioritisation), improving teamwork (including team-based education), organisational strategies (including remote consulting) which need to fit within existing practice routines. Technology offers some potential solutions (e.g., improved templates, 'app'-based plans), but must be integrated with the practice information technology systems. Building on these insights, we will now develop a theoretically-based implementation strategy that will address patient, professional, and organisational buy-in, provide team-based education and offer a range of practical options and tools, which can be adapted and integrated within existing routines of individual practices.OVERCOMING THE ORGANISATIONAL BARRIERS TO IMPLEMENTING ASTHMA SELF-MANAGEMENT: Understanding the routines of primary care practices can suggest strategies to implement supported self-management

  15. Acute diarrhea in adults consulting a general practitioner in France during winter: incidence, clinical characteristics, management and risk factors.

    Science.gov (United States)

    Arena, Christophe; Amoros, Jean Pierre; Vaillant, Véronique; Ambert-Balay, Katia; Chikhi-Brachet, Roxane; Jourdan-Da Silva, Nathalie; Varesi, Laurent; Arrighi, Jean; Souty, Cécile; Blanchon, Thierry; Falchi, Alessandra; Hanslik, Thomas

    2014-10-30

    Data describing the epidemiology and management of viral acute diarrhea (AD) in adults are scant. The objective of this study was to identify the incidence, clinical characteristics, management and risk factors of winter viral AD in adults. The incidence of AD in adults during two consecutive winters (from December 2010 to April 2011 and from December 2011 to April 2012) was estimated from the French Sentinelles network. During these two winters, a subset of Sentinelles general practitioners (GPs) identified and included adult patients who presented with AD and who filled out a questionnaire and returned a stool specimen for virological examination. All stool specimens were tested for astrovirus, group A rotavirus, human enteric adenovirus, and norovirus of genogroup I and genogroup II. Age- and sex-matched controls were included to permit a case-control analysis with the aim of identifying risk factors for viral AD. During the studied winters, the average incidence of AD in adults was estimated to be 3,158 per 100,000 French adults (95% CI [2,321 - 3,997]). The most reported clinical signs were abdominal pain (91.1%), watery diarrhea (88.5%), and nausea (83.3%). GPs prescribed a treatment in 95% of the patients with AD, and 80% of the working patients with AD could not go to work. Stool examinations were positive for at least one enteric virus in 65% (95% CI [57 - 73]) of patients with AD with a predominance of noroviruses (49%). Having been in contact with a person who has suffered from AD in the last 7 days, whether within or outside the household, and having a job (or being a student) were risk factors significantly associated with acquiring viral AD. During the winter, AD of viral origin is a frequent disease in adults, and noroviruses are most often the cause. No preventable risk factor was identified other than contact with a person with AD. Thus, at the present time, reinforcement of education related to hand hygiene remains the only way to reduce the

  16. Non-healing foot ulcers in diabetic patients: general and local interfering conditions and management options with advanced wound dressings.

    Science.gov (United States)

    Uccioli, Luigi; Izzo, Valentina; Meloni, Marco; Vainieri, Erika; Ruotolo, Valeria; Giurato, Laura

    2015-04-01

    Medical knowledge about wound management has improved as recent studies have investigated the healing process and its biochemical background. Despite this, foot ulcers remain an important clinical problem, often resulting in costly, prolonged treatment. A non-healing ulcer is also a strong risk factor for major amputation. Many factors can interfere with wound healing, including the patient's general health status (i.e., nutritional condition indicated by albumin levels) or drugs such as steroids that can interfere with normal healing. Diabetic complications (i.e., renal insufficiency) may delay healing and account for higher amputation rates observed in diabetic patients under dialysis treatment. Wound environment (e.g., presence of neuropathy, ischaemia, and infection) may significantly influence healing by interfering with the physiological healing cascade and adding local release of factors that may worsen the wound. The timely and well-orchestrated release of factors regulating the healing process, observed in acute wounds, is impaired in non-healing wounds that are blocked in a chronic inflammatory phase without progressing to healing. This chronic phase is characterised by elevated protease activity (EPA) of metalloproteinases (MMPs) and serine proteases (e.g., human neutrophil elastase) that interfere with collagen synthesis, as well as growth factor release and action. EPA (mainly MMP 9, MMP-8 and elastase) and inflammatory factors present in the wound bed (such as IL-1, IL-6, and TNFa) account for the catabolic state of non-healing ulcers. The availability of wound dressings that modulate EPA has added new therapeutic options for treating non-healing ulcers. The literature confirms advantages obtained by reducing protease activity in the wound bed, with better outcomes achieved by using these dressings compared with traditional ones. New technologies also allow a physician to know the status of the wound bed environment, particularly EPA, in a clinical

  17. General radiation management situation at the first stage of accident occurrence. Fire and explosion of asphalt solidification processing facility

    Energy Technology Data Exchange (ETDEWEB)

    Noda, Kimio; Shimizu, Takehiko; Ishiguro, Shuji [Health and Safety Division, Power Reactor and Nuclear Fuel Development Corp., Tokai, Ibaraki (Japan)

    1998-03-01

    Fire accident in the cell of Asphalt Solidification Processing Facility (ASP) in PNC took placed at 10:06 a.m., March 11, 1997. Explosion accident occurred subsequently in the ASP at 8:04 p.m. of the day about 10 hours later. The accident which included loss of confinement function of the cell, release of radioactive materials to the working environment, evacuation of many workers, radioactive materials intake of the workers, alarm of many radiation monitoring system, diffusion of radiation materials to off-site, required the radiation management division to take a prompt and wide-ranging protective action. No one was inflicted an external injury by the accident. The workers who inhaled a few radioactive materials, such as Cs-137, were 37 in number. The maximum committed effective dose equivalent or a person was estimated 0.4-1.6 mSv, taking account of the effects of alpha-ray emission nuclides. Radioactive materials were released outside through the raptured windows of the facility. Radioactive nuclides, such as Cs, Sr, Pu, and Am were detected in site by the environmental monitoring. A small quantity of Cs was detected in the aerosols of Oarai area, where is located at about 20 km south-south-west distant from the accidental site. The total amount of effluent throughout the accident was estimated about 1-4 GBq for {beta}-ray emission nuclides, excluding C-14, and about 1x10{sup -4}-4 x 10{sup -3} GBq for {alpha}-ray emission nuclides. The maximum committed effective dose equivalent for the general public was estimated about 1x10{sup -3}-2 x 10{sup -2} mSv. (M. Suetake)

  18. General radiation management situation at the first stage of accident occurrence. Fire and explosion of asphalt solidification processing facility

    Energy Technology Data Exchange (ETDEWEB)

    Noda, Kimio; Shimizu, Takehiko; Ishiguro, Shuji [Health and Safety Division, Power Reactor and Nuclear Fuel Development Corp., Tokai, Ibaraki (Japan)

    1998-03-01

    Fire accident in the cell of Asphalt Solidification Processing Facility (ASP) in PNC took placed at 10:06 a.m., March 11, 1997. Explosion accident occurred subsequently in the ASP at 8:04 p.m. of the day about 10 hours later. The accident which included loss of confinement function of the cell, release of radioactive materials to the working environment, evacuation of many workers, radioactive materials intake of the workers, alarm of many radiation monitoring system, diffusion of radiation materials to off-site, required the radiation management division to take a prompt and wide-ranging protective action. No one was inflicted an external injury by the accident. The workers who inhaled a few radioactive materials, such as Cs-137, were 37 in number. The maximum committed effective dose equivalent or a person was estimated 0.4-1.6 mSv, taking account of the effects of alpha-ray emission nuclides. Radioactive materials were released outside through the raptured windows of the facility. Radioactive nuclides, such as Cs, Sr, Pu, and Am were detected in site by the environmental monitoring. A small quantity of Cs was detected in the aerosols of Oarai area, where is located at about 20 km south-south-west distant from the accidental site. The total amount of effluent throughout the accident was estimated about 1-4 GBq for {beta}-ray emission nuclides, excluding C-14, and about 1x10{sup -4}-4 x 10{sup -3} GBq for {alpha}-ray emission nuclides. The maximum committed effective dose equivalent for the general public was estimated about 1x10{sup -3}-2 x 10{sup -2} mSv. (M. Suetake)

  19. General Management Laws and the 9/11 Commission’s Proposed Office of National Intelligence Director (NID) and National Counterterrorism Center (NCTC)

    Science.gov (United States)

    2004-09-21

    Saturno , 7-2381 CRS-27 General Management Law (location in CRS Report RL30795) If the Office of the National Intelligence Director (NID) and National...entities’ budgets would be covered by the act in the same way as other independent entities in the executive branch.) James V. Saturno , 7-2381 CRS

  20. 75 FR 4413 - Notice of Intent to Prepare an Environmental Impact Statement for a General Management Plan...

    Science.gov (United States)

    2010-01-27

    ... alternatives for managing the park will be developed through this planning process and will include, at a... managing the area during the next 15 to 20 years. The plan will prescribe desired resource conditions and... proposal for additional wilderness designation within the park. As the first phase of the planning process...

  1. 49 CFR 1242.83 - Officers-general superintendence; accounting, auditing and finance; management services and data...

    Science.gov (United States)

    2010-10-01

    ..., auditing and finance; management services and data processing; personnel and labor relations; legal and... on corporate income or payrolls; and other (accounts XX-63-01, XX-63-86, XX-63-87, XX-63-91, XX-63-92..., auditing and finance; management services and data processing; personnel and labor relations; legal and...

  2. The Effectiveness of Group Training of CBT-Based Stress Management on Anxiety, Psychological Hardiness and General Self-Efficacy Among University Students.

    Science.gov (United States)

    Molla Jafar, Hamdam; Salabifard, Seddigheh; Mousavi, Seyedeh Maryam; Sobhani, Zahra

    2015-09-28

    Admission to university is a very sensitive period of life for efficient, active, and young workforces in any country, and it is mostly associated with many changes in social and human relationships. These changes lead to anxiety in students. Moreover, humans need certain functions in order to adaptively deal with different life situations and challenges. By training stress management, these functions can help human acquire the required abilities. The present study was aimed at investigating the effectiveness of stress management training in anxiety, psychological hardiness, and general self-efficacy among university students. The study was a quasi-experimental intervention (pretest-posttest-follow-up) including a control group, it was a fundamental applied study. The statistical population consisted of all students of Islamic Azad University, Karaj, Iran. Convenient sampling was employed to select 30 students who were divided into an experimental group (n=15) and a control group (n=15). Before stress management training, both groups filled out Beck Anxiety Inventory, Long and Goulet scale of psychological hardiness, and General Self-efficacy Scale (GSE-10). Afterwards, the experimental group was provided with stress management training. And after the experiment, the abovementioned questionnaires and scales were responded by the two groups. Finally the collected data were analyzed and compared using one-way MANOVA. The results of MANOVA indicated that there was a significant difference between the two groups in terms of anxiety, hardiness, and general self-efficacy (pstress management among university students cause anxiety to drop; moreover, it enhances their psychological hardiness and self-efficacy. In regard with the role and importance of stress management, training this skill should be included in educational plans of university.

  3. Engaging general practice nurses in chronic disease self-management support in Australia: insights from a controlled trial in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Walters, Julia A E; Courtney-Pratt, Helen; Cameron-Tucker, Helen; Nelson, Mark; Robinson, Andrew; Scott, Jenn; Turner, Paul; Walters, E Haydn; Wood-Baker, Richard

    2012-01-01

    The growing burden of chronic disease will increase the role of primary care in supporting self-management and health behaviour change. This role could be undertaken to some extent by the increased practice nurse workforce that has occurred over recent years. Mixed methods were used to investigate the potential for general practice nurses to adopt this role during a 12-month randomised controlled study of telephone-delivered health mentoring in Tasmanian practices. Nurses (general practice and community health) were trained as health mentors to assist chronic obstructive pulmonary disease patients to identify and achieve personal health related goals through action plans. Of 21% of invited practices that responded, 19 were allocated to health mentoring; however, general practice nurses were unable to train as health mentors in 14 (74%), principally due to lack of financial compensation and/or workload pressure. For five general practice nurses trained as health mentors, their roles had previously included some chronic disease management, but training enhanced their understanding and skills of self-management approaches and increased the focus on patient partnership, prioritising patients' choices and achievability. Difficulties that led to early withdrawal of health mentors were competing demands, insufficient time availability, phone calls having lower priority than face-to-face interactions and changing employment. Skills gained were rated as valuable, applicable to all clinical practice and transferable to other health care settings. Although these results suggest that training can enhance general practice nurses' skills to deliver self-management support in chronic disease, there are significant system barriers that need to be addressed through funding models and organisational change.

  4. The general feeding and nesting ecology of black-necked stilts on the Stillwater Wildlife Management Area

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This pilot project provided baseline information on black-necked stilts located on the Stillwater Wildlife Management Area. The primary objectives of this study...

  5. Apple-CORE: Microgrids of SVP cores: flexible, general-purpose, fine-grained hardware concurrency management

    NARCIS (Netherlands)

    Poss, R.; Lankamp, M.; Yang, Q.; Fu, J.; van Tol, M.W.; Jesshope, C.; Nair, S.

    2012-01-01

    To harness the potential of CMPs for scalable, energy-efficient performance in general-purpose computers, the Apple-CORE project has co-designed a general machine model and concurrency control interface with dedicated hardware support for concurrency control across multiple cores. Its SVP interface

  6. 78 FR 34406 - Asbestos in General Industry; Extension of the Office of Management and Budget's (OMB) Approval...

    Science.gov (United States)

    2013-06-07

    ... Occupational Safety and Health Administration Asbestos in General Industry; Extension of the Office of...) approval of the information collection requirements specified in the Standard on Asbestos in General... providing their workers with protection from exposure to hazardous asbestos. Asbestos exposure results...

  7. 75 FR 17164 - Asbestos in General Industry; Extension of the Office of Management and Budget's (OMB) Approval...

    Science.gov (United States)

    2010-04-05

    ... Occupational Safety and Health Administration Asbestos in General Industry; Extension of the Office of... requirements specified in its Standard on Asbestos in General Industry (29 CFR 1910.1001). DATES: Comments must... workers with protection from hazardous asbestos exposure. Asbestos exposure results in asbestosis,...

  8. Investigating patients' and general practitioners' views of computerised decision support software for the assessment and management of cardiovascular risk

    Directory of Open Access Journals (Sweden)

    Anne Wilson

    2007-01-01

    Conclusion Computer decision support programs are becoming more prevalent, but little is known about their usability and acceptability to both health professionals and consumers. The complexities of cardiovascular risk assessment and management can be adequately managed with such programs. As a contemporary report this study contributes to the growing knowledge required for developers of medical software and decision support systems to better understand the needs of endusers.

  9. Managed aquifer recharge by using spreading basin methods on alluvial fans: a general overview of the situation in Japan

    Energy Technology Data Exchange (ETDEWEB)

    Hida, N.

    2009-07-01

    In this paper, the author reviews the present situation of managed aquifer recharge (MAR) by using basin method as of 2009 in Japan. Most of the MAR basin is carried in the area of alluvial fans. The enhancing groundwater resources in the Rokugo alluvial aquifer has resulted in sustain ability for the groundwater environment, especially in the distal fan. As a recent tendency, the MAR basin contributes to sustainable aquifer management in alluvium and is spreading in Japan. (Author)

  10. Project Cost Management under General Contracting Mode%总承包模式下的工程造价管理

    Institute of Scientific and Technical Information of China (English)

    李晓平

    2014-01-01

    随着我国建筑行业不断发展,工程项目总承包模式也随之发展起来。在现代建筑工程管理中,工程项目总承包是一种新型的管理模式,弥补了传统工程承包模式中的不足,推动了工程管理工作的发展。%Along with the construction industry continues to develop in our country, the general contracting mode of project has also developed. In modern construction project managem- ent, general contracting of project is a kind of new manage- ment mode. It makes up for the deficiencies of the traditional engineering contracting mode and promotes the development of project management work.

  11. Practice Exploration of Point System Appraisal Management in General Practitioner Team%全科团队积分制考核管理的实践探索

    Institute of Scientific and Technical Information of China (English)

    陈建峰; 朱玉琴

    2016-01-01

    Objective To improve the work efficiency of team and provide guidance basis for the management of general practitioner team in community by implementing the point system appraisal management in the general practitioner team in community. Methods The team service number and quality and the satisfactory degree of patients before and after the point system appraisal management were surveyed by the third-party quality control method, and the effect after implementation was analyzed. Results The implementation of point system appraisal management enhanced the team awareness of members in general practitioner team, created a positive team atmosphere, obviously improved the community service work quantity and quality and improved the service satisfactory rate of community residents. Conclusion The point system appraisal man-agement is one of the scientific and effective management methods of the general practitioner team in community, and the rational integral coefficient setting can improve the work efficiency and service quality of the general practitioner team.%目的:通过对社区全科团队内部实施积分制考核管理,提升团队工作效能,为社区全科团队管理提供指导依据。方法采用第三方质控的方法,调查积分制考核管理前后的团队服务数量、质量以及病人满意度情况,分析实施后的效果。结果实施积分制考核管理后,增强了全科团队成员的团队意识,营造了团队积极向上的氛围,社区服务工作量和质量均得到了显著的上升,提高了社区居民的服务满意率。结论积分制考核管理是社区全科团队科学有效的管理方法之一,通过合理的积分系数设置,能提高全科团队的工作效能和服务质量。

  12. Educational interventions for general practitioners to identify and manage depression as a suicide risk factor in young people: a systematic review and meta-analysis protocol.

    Science.gov (United States)

    Tait, Lynda; Michail, Maria

    2014-12-15

    Suicide is a major public health problem and globally is the second leading cause of death in young adults. Globally, there are 164,000 suicides per year in young people under 25 years. Depression is a strong risk factor for suicide. Evidence shows that 45% of those completing suicide, including young adults, contact their general practitioner rather than a mental health professional in the month before their death. Further evidence indicates that risk factors or early warning signs of suicide in young people go undetected and untreated by general practitioners. Healthcare-based suicide prevention interventions targeted at general practitioners are designed to increase identification of at-risk young people. The rationale of this type of intervention is that early identification and improved clinical management of at-risk individuals will reduce morbidity and mortality. This systematic review will synthesise evidence on the effectiveness of education interventions for general practitioners in identifying and managing depression as a suicide risk factor in young people. We shall conduct a systematic review and meta-analysis following the Cochrane Handbook for Systematic Reviews of Interventions guidelines and conform to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Electronic databases will be systematically searched for randomised controlled trials and quasi-experimental studies investigating the effectiveness of interventions for general practitioners in identifying and managing depression as a suicide risk factor in young people in comparison to any other intervention, no intervention, usual care or waiting list. Grey literature will be searched by screening trial registers. Only studies published in English will be included. No date restrictions will be applied. Two authors will independently screen titles and abstracts of potential studies. The primary outcome is

  13. Tongrentang,A Pearl of Chinese Traditional Medicine Interview with Mei Qun, General Manager of China Beijing Tongrentang(Group) Co., Ltd.

    Institute of Scientific and Technical Information of China (English)

    Sun Yongjian; Bai Yifeng

    2006-01-01

    @@ On June 10, China Beijing Tongrentang (Group) Co., Ltd. celebrated its first Day of Cultural Heritage because its brand Tongrentang had been registered in the Directory of Chinese Intangible Cultural Heritages. Tongrentang is welknown in China for its effective Chinese traditional medicine, but what is the core value of the brand? Mei Qun, General Manager of China Beijing Tongrentang(Group) Co., Ltd. let the secret out when interviewed by China's Foreign Trade.

  14. Risk management research of general contractor of EPC mode%总承包商在EPC总承包模式下的风险管理初探

    Institute of Scientific and Technical Information of China (English)

    陈静纯

    2014-01-01

    Engineering project risk management is the most key factor of the success of the project management. Based on the general contractor, combining about the engineering example and the special natural of EPC mode, the paper discusses the identification and the evaluation of engineering risk management applying the answer of the expert and the scoring of the examine .Lastly, some advise is given to control and survey the risk.%工程项目管理风险是项目管理成败的关键因素。本文从项目总承包商的角度,结合具体工程实例和EPC总承包模式特点,采用专家调查法、调查打分法开展项目管理风险识别与评价,提出风险控制和监测的建议。

  15. Guiding Principles for Implementing School-Based Management Programs: An Online Toolkit Providing General Principles That Can Be Applied to the Implementation of School-Based Management Reforms

    Science.gov (United States)

    Patrinos, Harry Anthony; Fasih, Tazeen; Barrera, Felipe; Garcia-Moreno, Vicente A.; Bentaouet-Kattan, Raja; Baksh, Shaista; Wickramasekera, Inosha

    2007-01-01

    School-based management (SBM) has become a very popular movement over the past decade. The World Bank Education Team's SBM work program emerged out of a need to define the concept more clearly, review the evidence, support impact assessments in various countries, and provide some initial feedback to teams preparing education projects. During the…

  16. The effectiveness of isometric exercises as compared to general exercises in the management of chronic non-specific neck pain.

    Science.gov (United States)

    Khan, Muhammad; Soomro, Rabail Rani; Ali, Syed Shahzad

    2014-09-01

    To evaluate the effectiveness of isometric exercises as compared to general exercises in chronic non-specific neck pain. For this randomised controlled trial total 68 patients (34 each group) with chronic non-specific neck pain were recruited from Alain Poly Clinic and Institute of Physical Medicine & Rehabilitation Dow University of Health Sciences, Karachi between May, 2012 and August, 2012. Simple randomisation method was used to assign participants into isometric exercise group and general exercise groups. The isometric exercise group performed exercises for neck muscle groups with a rubber band and general exercises group performed active range of movement exercises for all neck movements. Patients in both groups received 3 supervised treatment sessions per week for 12 weeks. Visual Analogue Scale (VAS), North wick Park Neck Pain Questionnaire and goniometer were used to assess pain, disability and neck range of movements at baseline and after 12 weeks. Both interventions showed statistically significant improvements in pain, function and range of movement p = 0.001f or isometric exercise group, p = 0.04 for general exercises group and p = 0.001 for range of movement. However, mean improvements in post intervention VAS score and North wick Park Neck Pain Questionnaire score was better in isometric exercises group as compared to general exercise group. In conclusion, both interventions are effective in the treatment of chronic non-specific neck pain however; isometric exercises are clinically more effective than general exercises.

  17. Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 2. Results: Primary care management and community orientation.

    Science.gov (United States)

    Hummers-Pradier, Eva; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri Ejh; Topsever, Pinar; Ungan, Mehmet; van Royen, Paul

    2010-03-01

    At the WONCA Europe conference 2009 the recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' was presented. It is a background paper and reference manual, providing advocacy of general practice/family medicine (GP/FM) in Europe. The Research Agenda summarizes the evidence relating to the core competencies and characteristics of the WONCA Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In this second article, the results for the core competencies 'primary care management' and 'community orientation' are presented. Though there is a large body of research on various aspects of 'primary care management', it represents a very scattered rather than a meta view. Many studies focus on care for specific diseases, the primary/secondary care interface, or the implications of electronic patient records. Cost efficiency or process indicators of quality are current outcomes. Current literature on community orientation is mainly descriptive, and focuses on either care for specific diseases, or specific patient populations, or on the uptake of preventive services. Most papers correspond poorly to the WONCA concept. For both core competencies, there is a lack of research with a longitudinal perspective and/or relevant health or quality of life outcomes as well as research on patients' preferences and education for organizational aspects of GP/FM.

  18. Siting of nuclear power plants in accordance with the scenario of a ''fossil nuclear energy mix'' prepared by the CDU/CSU and FDP in the inquiry commission of the Bundestag on ''Sustainable energy supply in times of globalisation and deregulation''. Short study; Standortbestimmung fuer Kernkraftwerke gemaess dem von CDU/CSU und FDP definierten Szenario 'fossil-nuklearer Energiemix' der Enquete-Kommission 'Nachhaltige Energieversorgung unter den Bedingungen der Globalisierung und der Liberalisierung' des Deutschen Bundestages. Kurzstudie

    Energy Technology Data Exchange (ETDEWEB)

    Benik, G.; Gundelach, T.

    2002-08-28

    In effect the present study makes concrete proposals for the installation of a nuclear power plant capacity of 91.8 GW as determined by the CDU/CSU and FDP in the inquiry commission on ''Sustainable development''. Because of the infrastructural requirements and the large number of plants that would have to be planned in Germany alone these siting proposals must be regarded as an outline for the implementation of a nuclear climate protection strategy. Without extensive assessment work a short study such as this cannot of course replace the detailed planning that would be required for authorisation procedures. The primary benefit of the study is that it makes clear the true consequences of a nuclear climate protection policy that is now being discussed as a hypothetical possibility. [German] Die vorliegende Studie macht im Ergebnis entsprechend der Aufgabenstellung konkrete Vorschlaege fuer die Bereitstellung der im von CDU/CSU und FDP in der Enquete-Kommission ''Nachhaltige Entwicklung'' definierten Szenario ''Fossilnuklearer Energiemix'' ermittelten nuklearen Kraftwerksleistung von 91,8 GW Diese Standortvorschlaege muessen angesichts der infrastrukturellen Anforderungen und der grossen Zahl von zu planenden Anlagen allein innerhalb der Grenzen der Bundesrepublik Deutschland als Anhaltspunkte fuer die Umsetzung einer nuklearen Klimaschutzstrategie herangezogen werden. Dabei kann eine Kurzstudie selbstverstaendlich ohne umfaengliche Pruefung keine detaillierten Planungen ersetzen, welche im Rahmen entsprechender Genehmigungsverfahren erforderlich sind. Der Nutzen der Studie besteht in erster Linie darin, deutlich vor Augen zu fuehren, welche realen Konsequenzen eine zur Zeit noch hypothetisch gefuehrte Diskussion ueber den Einsatz der Kernkraft zum Klimaschutz hat. (orig.)

  19. Management of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia by general practitioners in Jakarta

    Directory of Open Access Journals (Sweden)

    Faisal Abdi Matondang

    2014-06-01

    Conclusions: Our study provides evidence that the management of male LUTS suggestive of BPH by GPs in Jakarta suggests referral in part to available guidelines in terms of diagnostic methods and initial therapy. However, several aspects of the guidelines, such as PSA level measurement, renal function assessment, urinalysis, ultrasound examination, and prescription of combination therapies, are still infrequently performed.

  20. 78 FR 760 - Notice of Availability of the Final General Management Plan/Final Environmental Impact Statement...

    Science.gov (United States)

    2013-01-04

    ... opportunities to enjoy appropriate low-impact outdoor recreation. Ecological resources would largely be managed to reveal the glacial landscape. The most sensitive ecological areas would be carefully protected... alternative. The Final GMP/EIS assesses impacts to soil resources, water quality, soundscapes, vegetation...

  1. Iowa's solid-waste stream: Characterization and management strategy. A report to the General Assembly

    Energy Technology Data Exchange (ETDEWEB)

    Craggs, R.W.; Wnuk, M.M.; Smith, L.J.

    1990-07-01

    The report contains a characterization of Iowa's solid waste stream and a strategy for managing each major component of the waste stream. Preparation of the report was mandated in Iowa's 1989 Waste Volume Reduction and Recycling Act which contains the statewide waste reduction and recycling goals of 25% by 1994 and 50% by the year 2000. The report is divided into two parts. The first part outlines Iowa's solid waste program, identifies methods for characterizing solid waste, and develops a solid waste characterization unique to Iowa. The second part of the report identifies a strategy for managing the overall waste stream and strategies for managing the major components (paper, glass, plastics, metals, and compostable materials) of the waste stream. These strategies incorporate considerations on all of the following: waste reduction, management for recyclability, and market development for recycled materials. Essential framework for a waste reduction and recycling program was identified to ensure the state's waste reduction and recycling goals are achievable. Existing barriers to waste reduction and recycling were also identified.

  2. Medication management strategy for older people with polypharmacy in general practice: a qualitative study on prescribing behaviour in primary care.

    NARCIS (Netherlands)

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

    2016-01-01

    Background For older patients with polypharmacy, medication management is a process of careful deliberation that needs periodic adjustment based on treatment effects and changing conditions. Because of the heterogeneity of the patient group, and limited applicability of current guid

  3. [Pain medicine as a cross-sectional subject in German medical schools. An opportunity for general pain management].

    Science.gov (United States)

    Kopf, A; Dusch, M; Alt-Epping, B; Petzke, F; Treede, R-D

    2014-08-01

    Unrelieved pain is a substantial public health concern owing in part to deficits in clinical expertise among physicians. In most medical faculties worldwide, teaching on pain and pain management is either nonexistent or limited to a small number of students attending voluntary courses. In light of the fact that pain is the most frequent reason to seek medical advice, the lack of formal training of pain medicine is considered the leading reason for inadequate pain management. Therefore, the patients' unmet needs for adequate diagnosis and therapy call for action. Pain assessment and effective pain management should be a priority in the health care system. The limited number of pain specialists available in hospitals and primary care and CME (continuous medical education) activities focusing on pain are not sufficient to solve the problem. Every practicing physician should, therefore, have basic knowledge of the most prominent painful conditions and management strategies. To achieve this goal, pain medicine should become an integral part of the undergraduate curriculum for medical students. In Germany, pain medicine became a mandatory subject in undergraduate medical studies in 2012. The introduction of pain medicine into the undergraduate curriculum in Germany is a major challenge regarding the development and implementation processes. This article describes current instruments and implementation strategies for pain medicine as a new cross-sectional subject in Germany.

  4. [Management of adult's renal and ureteral stones. Update of the Lithiasis Committee of the French Association of Urology (CLAFU). General considerations].

    Science.gov (United States)

    Chabannes, É; Bensalah, K; Carpentier, X; Bringer, J-P; Conort, P; Denis, É; Dore, B; Estrade, V; Gautier, J-R; Hadjadj, H; Hubert, J; Hoznek, A; Lechevallier, É; Meria, P; Mozer, P; Saussine, C; Yonneau, L; Traxer, O

    2013-12-01

    The Lithiasis Committee of the French Association of Urology (CLAFU) aimed to update the current knowledge about urolithiasis. This update will be divided into four parts: 1) general considerations; 2) the management of ureteral stones; 3) the management of kidney stones; 4) metabolic assessment and medical treatment of urolithiasis. Recent technicals advances helped the urologists to improve stones management: new extracorporeal shockwave lithotripsy (ESWL) devices, new flexible ureterorenoscopes, development of laser fragmentation. ESWL, semi-rigid and flexible ureteroscopy and the percutaneous nephrolithotomy (PCNL) remain currently the main therapeutic options. The first part of this update deals with the description and classification of stones, preoperative assessment, post-operative management and clinical follow-up. Main criteria of therapeutic choices are stone location, stone composition and stone size. Stone composition is assessed with infrared spectrophotometry analysis and its hardness is correlated with U.H. density on CT scan assessment. Preoperative assessment consists in urinary cytobacteriological examine, urinary PH, blood creatininemia, hemostasis. Low-dose CT scan is recommended before urological treatment. The result of the treatment must be done 1 or 3 months later with plain abdominal film and ultrasonography. Medical management of urolithiasis will be based on stone composition, metabolic and nutritional evaluation. Treatment success is definited by absence of residual fragments. Annual follow-up is recommended and based either on plain abdominal film and ultrasonography or low-dose CT scan.

  5. Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice

    DEFF Research Database (Denmark)

    French, Simon D; McKenzie, Joanne E; O'Connor, Denise A

    2013-01-01

    Introduction: This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP) in general practice. Methods: General practices were randomised to either access to a guideline for acute LBP...... and 45 practices (59 GPs) to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs...

  6. Management of stage III colon cancer in the elderly: Practice patterns and outcomes in the general population.

    Science.gov (United States)

    Merchant, Shaila J; Nanji, Sulaiman; Brennan, Kelly; Karim, Safiya; Patel, Sunil V; Biagi, James J; Booth, Christopher M

    2017-08-01

    Clinical trials have established surgical resection and adjuvant chemotherapy (ACT) as the standard management for stage III colon cancer; however, the extent to which these results apply to elderly patients in routine practice is unclear. This article describes the management and outcomes of elderly patients with stage III colon cancer. All cases of surgically resected colon cancer from 2002 to 2008 were identified with the population-based Ontario Cancer Registry. Pathology reports were obtained for a random sample (25% of all cases); those with stage III disease constituted the study population. The utilization of ACT, cancer-specific survival (CSS), and overall survival (OS) in elderly patients (≥70 years) and nonelderly patients (colon cancer do not receive ACT. Although the effect size is smaller than that in younger patients, ACT is associated with improved long-term survival. Cancer 2017;123:2840-49. © 2017 American Cancer Society. © 2017 American Cancer Society.

  7. Management of COPD in general practice in Denmark--participating in an educational program substantially improves adherence to guidelines

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Hansen, Ejvind Frausing; Jensen, Michael Skov

    2010-01-01

    BACKGROUND AND AIM: The general practitioner (GP) is the first contact with the health care system for most patients with COPD in Denmark. We studied, if participating in an educational program could improve adherence to guidelines, not least for diagnosis, staging, and treatment of the disease. ...

  8. Knowledge, illness perceptions and stated clinical practice behaviour in management of gout: a mixed methods study in general practice

    NARCIS (Netherlands)

    Spaetgens, B.; Pustjens, T.; Scheepers, L.E.; Janssens, H.J.E.M.; Linden, S. van der; Boonen, A.

    2016-01-01

    The objective of the present study is to explore knowledge, illness perceptions and stated practice behaviour in relation to gout in primary care. This is a mixed methods study among 32 general practitioners (GPs). The quantitative assessment included the Gout Knowledge Questionnaire (GKQ; range

  9. Laser-Assisted Periodontal Management of Drug-Induced Gingival Overgrowth under General Anesthesia: A Viable Option

    OpenAIRE

    Tupili Muralikrishna; Butchibabu Kalakonda; Sumanth Gunupati; Pradeep Koppolu

    2013-01-01

    Gingival overgrowth/hyperplasia can be attributed to several causes, but drug-induced gingival overgrowth/hyperplasia arises secondarily to prolonged use of antihypertensive drugs, anticonvulsants and immunosuppressants. The management is complex in nature considering the multitude of factors involved such as substitution of drug strict plaque control along with excision of the tissue to be performed under local anesthesia as outpatient. In the recent times, the patient’s psychological fear o...

  10. The feasibility, acceptability and sustainability of nurse-led chronic disease management in Australian general practice: the perspectives of key stakeholders.

    Science.gov (United States)

    Hegney, Desley G; Patterson, Elizabeth; Eley, Diann S; Mahomed, Rosemary; Young, Jacqui

    2013-02-01

    This was the first Australian study investigating the acceptability, feasibility and sustainability of a nurse-led model of chronic disease management in general practice. A concurrent mixed-methods design was used within a 12-month intervention of nurse-led care in three general practices. Adult patients with type 2 diabetes, hypertension and/or stable ischaemic heart disease were randomized into nurse-led or standard care. Semi-structured interviews explored perceptions of key stakeholders towards this model including patients in the nurse-led arm, and all practice staff pre- and posttrial. The data were thematically analysed and the emergent themes were: importance of time; collaborative relationships; nurse job satisfaction, confidence and competence; patient self-management and choice. Our findings showed that nurses provided chronic disease management that was acceptable, feasible and sustainable. The collaborative involvement of doctors was intrinsic to patient acceptability of nurse-led care that facilitated job satisfaction, and therefore retention and growth within this nursing speciality.

  11. Knowledge, management and perceived barriers to treatment of molar-incisor hypomineralisation in general dental practitioners and dental nurses in Malaysia.

    Science.gov (United States)

    Hussein, A S; Ghanim, A M; Abu-Hassan, M I; Manton, D J

    2014-10-01

    Molar-incisor hypomineralisation (MIH) is a global dental problem, yet little is known about the knowledge of the general dental practitioners (GDPs) and dental nurses (DNs) regarding this defect in South East Asia. To assess and compare the knowledge of the GDPs and DNs in Malaysia regarding the frequency of occurrence of MIH within their practice, its diagnosis, putative aetiological factors and management. A questionnaire was distributed to GDPs and DNs during a nationwide dental conference in Melaka, Malaysia and who were asked to answer questions about demographic variables, knowledge, attitudes and practices in the management of MIH. Descriptive statistics and bivariate analysis were performed. A 5% level of statistical significance was applied for the analyses. A response rate of 58.2% (131/225) was obtained. Most respondents were aware of MIH and encountered it in their practice (GDPs = 82.5%, DNs = 82.4%). The condition was observed by respondents less in primary molars compared to first permanent molars. Full agreement between GDPs and DNs did not exist concerning the aetiological factors and management of MIH. Glass ionomer cements were the most popular material used in treating MIH. Most respondents (GDPs = 93%, DNs = 76.5%) indicated that they had not received sufficient information about MIH and were willing to have clinical training in the diagnosis and therapeutic modalities of MIH. MIH is identified and encountered by most respondents. Agreement did not exist between GDPs and DNs concerning MIH frequency of occurrence within their practice, its diagnosis, aetiological factors and management.

  12. The Efficacy of the Training of Stress Management by Cognitive-Behavior Method on Addicts’ Anxiety of with Generalized Anxiety Disorder

    Directory of Open Access Journals (Sweden)

    Zahra Lak

    2013-01-01

    Full Text Available Aim: The purpose of this study was to investigate the effectiveness of cognitive–behavioral stress management on reduction of anxiety among addicts with GAD. Method: The design of the study is experimental with pretest -posttest and control group. The population of the study was all addicts with GAD in Tehran self-referred centers that scored the most points in GAD-7 test. 24 addicts were allocated into experimental group (N=12 and control group (N=12. The cognitive-behavioral stress management was demonstrated in 10 weekly sessions on the experimental group while there was no psychological treatment for the control group. DASS-21 questionnaire and GAD-7 questionnaire were completed by both groups before and after program. The data was analyzed using covariance. Results: There were no significant differences in anxiety between two groups before intervention. Results of this study demonstrated that cognitive –behavioral stress management led to significant decrease in anxiety in experimental group. Conclusion: Regarding to effectiveness of cognitive-behavioral stress management on anxiety, it may also be used as a supplement method decreasing generalized anxiety disorder among addicts.

  13. Emergencies in orthodontics. Part 1: Management of general orthodontic problems as well as common problems with fixed appliances.

    Science.gov (United States)

    Dowsing, Paul; Murray, Alison; Sandler, Jonathan

    2015-03-01

    Fixed appliance treatment is a popular treatment modality with a burgeoning increase in the numbers of children and adults realizing the benefits that can be gained. Appliance breakage is an unavoidable nuisance which is at best inconvenient, and at worst may result in significant pain or discomfort for the patient. General dental practitioners (GDPs) should have the practical knowledge of how to provide timely and appropriate orthodontic 'emergency treatment'. This will significantly reduce the sometimes considerable inconvenience and discomfort for both the patient and his/her parents, and the inevitable frustration for the clinician providing ongoing care. This first paper will deal with general orthodontic problems that commonly present, as well as some issues specific to fixed appliances. The second paper will deal with the other orthodontic appliances that may be encountered by GDPs in their daily practice. Clinical Relevance: Appropriate handling of an orthodontic 'emergency' by the general practitioner will, on many occasions, provide immediate relief of pain and distress for the patient. This will in turn allow treatment to continue moving in the right direction, thus allowing more efficient and effective use of valuable resources.

  14. Consultation computer use to improve management of chronic disease in general practice: a before and after study.

    Science.gov (United States)

    Mitchell, Elizabeth; McConnahie, Alex; Sullivan, Frank

    2003-01-01

    Computers have become widespread in primary care but their potential to improve clinical effectiveness has not been completely fulfilled. One explanation for this is the difficulty in evaluating their impact on the process of care. To determine the effects of computers in consulting rooms on the management of chronic disease. Before and after study with concurrent control group, matching six practices moving from paper-based recording to a consultation-based computer environment, with six practices using paper-based systems. Data were collected retrospectively via case note review for the year preceding the arrival of the computers and for the subsequent year. All patients with diagnosed diabetes mellitus (n = 1070) or rheumatoid disease (n = 202) were included. The main outcome measure was recording of disease management items. The computer group improved recording for seven of the eight diabetic and four of the seven rheumatoid items studied. Increases were significant for height (5% increase; 95% confidence interval (CI): 1.2% to 8.8%), weight (6.6%; 95% CI: 2.2% to 11.0%), foot pulses (8.7%; 95% CI: 4.1% to 13.4%), foot sensation (8.6%; 95% CI: 5.2% to 11.9%), blood pressure (12.6%; 95% CI: 2.0% to 23.2%) and urinalysis (20.2%; 95% CI: 11.0% to 29.4%). The control group improved for two diabetic and five rheumatoid items, the only significant increase being for urinalysis (1.1%; 95% CI: 0.2% to 22.0%). Computer use was associated with increased recording of each diabetes item except fundoscopy, and with increased blood pressure recording for rheumatoid disease. The larger the practice, the larger the effects observed. Use of computers can improve management of chronic disease in primary care. Impact is most clearly seen in those items easily recorded on computer during consultations. Effects are most evident in practices with larger patient numbers.

  15. Web 2.0 systems supporting childhood chronic disease management: a pattern language representation of a general architecture.

    Science.gov (United States)

    Timpka, Toomas; Eriksson, Henrik; Ludvigsson, Johnny; Ekberg, Joakim; Nordfeldt, Sam; Hanberger, Lena

    2008-11-28

    Chronic disease management is a global health concern. By the time they reach adolescence, 10-15% of all children live with a chronic disease. The role of educational interventions in facilitating adaptation to chronic disease is receiving growing recognition, and current care policies advocate greater involvement of patients in self-care. Web 2.0 is an umbrella term for new collaborative Internet services characterized by user participation in developing and managing content. Key elements include Really Simple Syndication (RSS) to rapidly disseminate awareness of new information; weblogs (blogs) to describe new trends, wikis to share knowledge, and podcasts to make information available on personal media players. This study addresses the potential to develop Web 2.0 services for young persons with a chronic disease. It is acknowledged that the management of childhood chronic disease is based on interplay between initiatives and resources on the part of patients, relatives, and health care professionals, and where the balance shifts over time to the patients and their families. Participatory action research was used to stepwise define a design specification in the form of a pattern language. Support for children diagnosed with diabetes Type 1 was used as the example area. Each individual design pattern was determined graphically using card sorting methods, and textually in the form Title, Context, Problem, Solution, Examples and References. Application references were included at the lowest level in the graphical overview in the pattern language but not specified in detail in the textual descriptions. The design patterns are divided into functional and non-functional design elements, and formulated at the levels of organizational, system, and application design. The design elements specify access to materials for development of the competences needed for chronic disease management in specific community settings, endorsement of self-learning through online peer

  16. Web 2.0 systems supporting childhood chronic disease management: A pattern language representation of a general architecture

    Directory of Open Access Journals (Sweden)

    Ekberg Joakim

    2008-11-01

    Full Text Available Abstract Background Chronic disease management is a global health concern. By the time they reach adolescence, 10–15% of all children live with a chronic disease. The role of educational interventions in facilitating adaptation to chronic disease is receiving growing recognition, and current care policies advocate greater involvement of patients in self-care. Web 2.0 is an umbrella term for new collaborative Internet services characterized by user participation in developing and managing content. Key elements include Really Simple Syndication (RSS to rapidly disseminate awareness of new information; weblogs (blogs to describe new trends, wikis to share knowledge, and podcasts to make information available on personal media players. This study addresses the potential to develop Web 2.0 services for young persons with a chronic disease. It is acknowledged that the management of childhood chronic disease is based on interplay between initiatives and resources on the part of patients, relatives, and health care professionals, and where the balance shifts over time to the patients and their families. Methods Participatory action research was used to stepwise define a design specification in the form of a pattern language. Support for children diagnosed with diabetes Type 1 was used as the example area. Each individual design pattern was determined graphically using card sorting methods, and textually in the form Title, Context, Problem, Solution, Examples and References. Application references were included at the lowest level in the graphical overview in the pattern language but not specified in detail in the textual descriptions. Results The design patterns are divided into functional and non-functional design elements, and formulated at the levels of organizational, system, and application design. The design elements specify access to materials for development of the competences needed for chronic disease management in specific community

  17. 谈电力工程 EPC 总承包项目风险管理%Discussion on EPC general contracting project risk management of power engineering

    Institute of Scientific and Technical Information of China (English)

    李勇

    2015-01-01

    The paper explores the importance of EPC general contracting project risk management of power engineering,analyzes its risk factors identification methods,and puts forward effective risk management measures,with a view to guarantee power engineering construction smooth.%探讨了电力工程EPC总承包项目风险管理的重要性,分析了EPC总承包项目风险因素的识别方法,并且提出了EPC总承包项目风险的有效管理措施,以保证电力工程建设工作的顺利进行。

  18. Changing the Ties That Bind? The Emerging Roles and Identities of General Practitioners and Managers in the New Clinical Commissioning Groups in the English NHS

    Directory of Open Access Journals (Sweden)

    Julia Segar

    2014-10-01

    Full Text Available The English National Health Service (NHS is undergoing significant reorganization following the 2012 Health and Social Care Act. Key to these changes is the shift of responsibility for commissioning services from Primary Care Trusts (PCTs to general practitioners (GPs working together in Clinical Commissioning Groups (CCGs. This article is based on an empirical study that examined the development of emerging CCGs in eight case studies across England between September 2011 and June 2012. The findings are based on interviews with GPs and managers, observations of meetings, and reading of related documents. Scott’s notion that institutions are constituted by three pillars—the regulative, normative, and cognitive–cultural—is explored here. This approach helps to understand the changing roles and identities of doctors and managers implicated by the present reforms. This article notes the far reaching changes in the regulative pillar and questions how these changes will affect the normative and cultural–cognitive pillars.

  19. Use of antimicrobial resistance information and prescribing guidance for management of urinary tract infections: survey of general practitioners in the West Midlands.

    Science.gov (United States)

    Ironmonger, Dean; Edeghere, Obaghe; Gossain, Savita; Hawkey, Peter M

    2016-05-24

    There is a marked variation in both antibiotic prescribing practice and urine sampling rates for diagnostic microbiology across general practices in England. To help understand factors driving this variation, we undertook a survey in 2012/13 to determine sampling protocols and antibiotic formularies used by general practitioners (GPs) for managing urinary tract infections (UTIs) in the West Midlands region of England. Cross-sectional survey of all eligible general practices in the West Midlands region of England undertaken in November 2012. GPs were invited to complete an online survey questionnaire to gather information on policies used within the practice for urine sampling for microbiological examination, and the source of antibiotic formularies used to guide treatment of UTIs. The questionnaire also gathered information on how they would manage five hypothetical clinical scenarios encountered in the community. The response rate was 11.3 % (409/3635 GPs), equivalent to a practice response rate of 26 % (248/950). Only 50 % of GPs reported having a practice policy for urine sampling. Although there was good agreement from GPs regarding collecting specimens in scenarios symbolising treatment failure (98 %), UTI in an adult male (98 %) and asymptomatic UTI in pregnancy (97 %), there was variation in GPs requesting a specimen for the scenarios involving a suspected uncomplicated urinary tract infection (UTI) and an asymptomatic catheterised elderly patient; with 40 and 38 % respectively indicating they would collect a specimen for microbiological examination. Standardised evidence based clinical management policies and antibiotic formularies for GPs should be readily available. This will promote the rational use of diagnostic microbiology services, improve antimicrobial stewardship and aid the interpretation of ongoing antimicrobial resistance surveillance.

  20. Online Canton Fairs Ready for Convenient Trade--An Interview with Ding Qiang, General Manager of MOFCOM China International Electronic Commerce Center

    Institute of Scientific and Technical Information of China (English)

    Li Yinghong; Sun Yongjian

    2006-01-01

    @@ In 2006, the Canton Fairs will greet the 99th and 100th respectively in spring and fall. To meet the need of the development of the convenient trade, the Canton Fairs website, the platform of the online Canton Fairs run by MOFCOM China International Electronic Commerce Center is ready to take several effective measures to offer more convenient services. On March 24, China's Foreign Trade took the occasion to interview with Mr. Ding Qiang, General Manager of MOFCOM China International Electronic Commerce Center.

  1. Early diagnosis of airway closure from pigtail signature capnogram and its management in intubated small infants undergoing general anaesthesia for surgery

    Directory of Open Access Journals (Sweden)

    Sanghamitra Mishra

    2010-01-01

    Full Text Available Spontaneous glottis closure during expiration in infants is a normal protective reflex that helps prevent alveolar and small airway collapse (due to compliant chest wall and thereby maintains functional residual capacity. Endotracheal intubation eliminates this protective mechanism and puts the infant into the risk of hypoxaemia and hypercarbia. This report sums up the early detection of airway closure in a series of three intubated small infants undergoing surgery with general anaesthesia, by the appearance of typical pigtail shaped capnogram, associated with decreased end tidal carbon dioxide and mild hypoxaemia, which was successfully managed by early institution of positive end expiratory pressure.

  2. What factors determine Belgian general practitioners' approaches to detecting and managing substance abuse? A qualitative study based on the I-Change Model.

    Science.gov (United States)

    Ketterer, Frederic; Symons, Linda; Lambrechts, Marie-Claire; Mairiaux, Philippe; Godderis, Lode; Peremans, Lieve; Remmen, Roy; Vanmeerbeek, Marc

    2014-06-14

    General practitioners (GPs) are considered to play a major role in detecting and managing substance abuse. However, little is known about how or why they decide to manage it. This study investigated the factors that influence GP behaviours with regard to the abuse of alcohol, illegal drugs, hypnotics, and tranquilisers among working Belgians. Twenty Belgian GPs were interviewed. De Vries' Integrated Change Model was used to guide the interviews and qualitative data analyses. GPs perceived higher levels of substance abuse in urban locations and among lower socioeconomic groups. Guidelines, if they existed, were primarily used in Flanders. Specific training was unevenly applied but considered useful. GPs who accepted abuse management cited strong interpersonal skills and available multidisciplinary networks as facilitators.GPs relied on their clinical common sense to detect abuse or initiate management. Specific patients' situations and their social, psychological, or professional dysfunctions were cited as cues to action.GPs were strongly influenced by their personal representations of abuse, which included the balance between their professional responsibilities toward their patients and the patients' responsibilities in managing their own health as well the GPs' abilities to cope with unsatisfying patient outcomes without reaching professional exhaustion. GPs perceived substance abuse along a continuum ranging from a chronic disease (whose management was part of their responsibility) to a moral failing of untrustworthy people. Alcohol and cannabis were more socially acceptable than other drugs. Personal experiences of emotional burdens (including those regarding substance abuse) increased feelings of empathy or rejection toward patients.Multidisciplinary practices and professional experiences were cited as important factors with regard to engaging GPs in substance abuse management. Time constraints and personal investments were cited as important barriers

  3. INTELLIGENT MANAGEMENT OF THE QUALITY OF SYSTEMS BY SOLVING A GENERALIZED ASSIGNMENT PROBLEM WITH THE USE OF ASC-ANALYSIS AND "EIDOS-X++" SYSTEM

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    Lutsenko Y. V.

    2015-05-01

    Full Text Available The quality of a system is seen as an emergent property of systems, due to their composition and structure, and it reflects their functionality, reliability and cost. Therefore, when we speak about quality management, the purpose of management is the formation of pre-defined system properties of the object of management. The stronger the object of the control expresses its system properties, the stronger the nonlinearity manifests of the object: both the dependence of the management factors from each other, and the dependence of the results of the action of some factors from the actions of others. Therefore, the problem of quality management is that in the management process the management object itself changes qualitatively, i.e. it changes its level of consistency, the degree of determinism and the transfer function itself. This problem can be viewed as several tasks: First is the system identification of the condition of the object of management, 2nd – making decisions about controlling influence that changes the composition of the control object in a way its quality maximally increases at minimum costs. To solve the 2nd problem we have proposed an application of the component selection of the object by functions based on the resources allocated for the implementation of different functions; costs associated with the choice of the components and the degree of compliance of various components to their functional purpose. In fact, we have proposed a formulation and a solution of the new generalization of a variant of the assignment problem: "multi backpack", which differs from the known with the fact that the selection has been based not only on the resources and costs, but also with taking into account the degree of compliance of the components to their functional purpose. A mathematical model, which provides a solution to the 1st problem, and reflecting the degree of compliance of the components to their functionality, as well as the entire

  4. [Post-operative management for 86 cases of heart valve replacement surgery patients undergoing transcutaneous electrical acupoint stimulation combined with general anesthesia].

    Science.gov (United States)

    Zhou, Wen-Xiong; Xu, Jian-Jun; Wu, Yao-Yao; Chi, Hao; Chen, Tong-Yu; Ge, Wen; Zhou, Jia

    2014-02-01

    To summarize post-operative management strategy for heart valve replacement surgery under transcutaneous electrical acupoint stimulation (TEAS) combined with general anesthesia. From July 2006 to June 2012, a total of 86 cases of open-heart surgery patients experiencing TEAS plus general anesthesia with cardiopulmonary bypass (heart valve replacement surgery without intubation) were recruited in the present summary. Post-operative managements in the Intensive Care Unit (ICU) were administrated with strict hemodynamic monitoring for volume infusion, routine administration of vasoactive drugs (including dopamine and nitroglycerin), oxygen inhalation, and analgesics and monitoring of central nervous system and renal function. All the 86 patients under TEAS + general anesthesia and cardiopulmonary bypass and without intubation experienced successful heart valve replacement surgery. The post-operative pulmonary infection was found in 8 cases (9.30%), the average stay duration in ICU was (28.6 +/- 6.2) hours, and the average draining volume of the interpleural space was (291 +/- 73)mL. The cardia insufficiency was found in 5 cases (5.81%), hypoxia occurred in 8 cases (9.30%), nausea in 8 cases (9.30%), vomiting 5 cases (5.81%) and post-operative gastrointestinal distension 13 cases (15.12%), mild renal insufficiency 3 cases (3.49%), fever (> 38.5 degrees C) 1 case(1. 16%) and severe post-operative pain 7 cases (8.14%). TEAS combined with general anesthesia is safe for patients undergoing heart valve replacement surgery under cardiopulmonary bypass. The key points of treatment in ICU are volume infusion, body temperature maintenance, and pain control.

  5. [Anaesthetic management of patients in the third trimester of pregnancy undergoing urgent laparoscopic surgery. Experience in a general hospital].

    Science.gov (United States)

    López-Collada Estrada, María; Olvera Martínez, Rosalba

    2016-01-01

    Laparoscopic surgery is well accepted as a safe technique when performed on a third trimester pregnant woman. The aim is to describe the anaesthetic management of a group of patients undergoing this type of surgery. An analysis was made of records of 6 patients in their third trimester of pregnancy and who underwent urgent laparoscopic surgery from 2011 to 2013. The study included 6 patients, with a diagnosis of acute cholecystitis in 4 of them. The other 2 patients had acute appendicitis, both of who presented threatened preterm labour. The most frequent indications for laparoscopic surgery during the last trimester of birth were found to be acute cholecystitis and acute appendicitis. Acute appendicitis is related to an elevated risk of presenting threatened preterm labour. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  6. Two Generalized Predator-Prey Models for Integrated Pest Management with Stage Structure and Disease in the Prey Population

    Directory of Open Access Journals (Sweden)

    Ruiqing Shi

    2013-01-01

    Full Text Available Stage-structured predator-prey models with disease in the prey are constructed. For the purpose of integrated pest management, two types of impulsive control strategies (impulsive release of infective prey and impulsive release of predator are used. For Case  1, infective prey applications are more frequent than releases of predator (natural enemies. For Case  2, predator (natural enemies releases are more frequent than infective prey applications. In both cases, we get the sufficient conditions for the global attractivity of the susceptible prey-eradication periodic solution. In addition, the persistence of the systems is also discussed. At last, the results are discussed and some possible future work is put forward.

  7. Speleoclimate dynamics in Santana Cave (PETAR, São Paulo State, Brazil: general characterization and implications for tourist management

    Directory of Open Access Journals (Sweden)

    Heros Augusto Santos Lobo

    2015-01-01

    Full Text Available Show caves provide tourists with the opportunity to have close contact with natural underground spaces. However, visitation to these places also creates a need for management measures, mainly the definition of tourist carrying capacity. The present work describes the results of climate monitoring and atmospheric profiling performed in Santana Cave (Alto Ribeira State and Tourist Park – PETAR, Brazil between 2008 and 2011. Based on the results, distinct preliminary zones with different levels of thermal variation were identified, which classify Santana Cave as a warm trap. Two critical points along the tourist route (Cristo and Encontro Halls were identified where the temperature of the locality increased by 1.3 °C when tourists were present. Air flow from the inner cave to the outside occurs during the austral summer, and the opposite flow occurs when the outside environment is colder than the air inside the cave during the austral winter. The temperature was used to establish thresholds to the tourist carrying capacity by computing the recovery time of the atmospheric conditions after the changes caused by the presence of tourists. This method suggests a maximum limit of approximately 350 visits per day to Santana Cave. The conclusion of the study is that Santana Cave has an atmosphere that is highly connected with the outside; daily variations in temperature and, to a lesser extent, in the relative humidity occur throughout the entire studied area of the cave. Therefore, the tourist carrying capacity in Santana Cave can be flexible and can be implemented based on the climate seasonality, the tourism demand and other management strategies.

  8. FIDIC contracts: analysis of the impact of general and particular conditions on the financial risk management in Romanian infrastructure projects

    Directory of Open Access Journals (Sweden)

    Constanţa-Nicoleta Bodea

    2016-12-01

    Full Text Available Construction projects are characterized by risks and uncertainties mainly due to technical and economic complexity. Risk management is an important tool in making decisions involving the identification and reduction, avoidance or transfer risk and uncertainties consequences of events that occurs during project implementation. For this reason, the objective of the contract between the beneficiary and the contractor is the allocation of risk. The distribution of risk in contracts for the execution of construction works was and is an ongoing challenge faced by parties having a significant impact on the type of contract is used. On the one hand, the beneficiaries tend to transfer to the contractors as many of the project risks and uncertainties, on the other hand, the contractors look to exploit any weakness contract, so as to reduce their impact on the expected profit. One of the most important risks assumed by the contractor by signing the contract which is also increasingly common in the current economic situation is the reduced financial capacity to support the project. A purely legal or purely technical interpretation is not meant to describe the complexity of issues related to implementation of construction projects. For this reason the authors have adopted a multi-disciplinary approach, which includes the legal issues related to the nature of the contract, but also the financial and technical aspects of construction projects. The paper aims to analyze how special contract clauses can influence the implementation of construction projects and in particular the financial management of contractors. The authors propose a model for analyzing the impact of FIDIC contract conditions applied on a case study of five transport infrastructure projects.

  9. HOW WE HAVE USED ITEM RESPONSE THEORY AND CLASSROOM MANAGEMENT TO IMPROVE STUDENT SUCCESS RATES IN LARGE GENERAL CHEMISTRY CLASSES

    Directory of Open Access Journals (Sweden)

    Brock L. Casselman

    Full Text Available Since 2012 we have tracked general chemistry student success rates at the University of Utah. In efforts to improve those rates we have implemented math prerequisites, changed our discussion session format, installed some metacognitive exercises aimed at the lowest quartile of students and instituted a flipped classroom model. Furthermore, using Item Response Theory we have identified what topics each individual student struggles with on practice tests. These steps have increased our success rates to ~76%. As well, student performance on nationally normed American Chemical Society final exams has improved to a median of 86 percentile. Our lowest quartile of students in spring 2016 scored at the 51 st percentile, above the national median.

  10. EPC总承包模式下项目风险管理研究%Study on project risk management under EPC general contracting mode

    Institute of Scientific and Technical Information of China (English)

    曾其威

    2012-01-01

    EPC(设计-采购-施工)合同模式是近年来国内逐渐推行的建设管理模式,该模式下经济风险一般都要求由总承包企业承担,其对风险防范能力的强弱成为项目赢利多少的关键。文章简要介绍EPC项目的风险因素以及可能产生的风险损失,并提出工程总承包项目风险防范的相关措施。%EPC(Design-Procurement-Construction) contract model is the promoting gradually construction management mode at domestic in recent years.General contract enterprises should take all responsibilities under the construction management mode,and the ability of risk prevention is the key to profitability of the project.This paper briefly introduces that the risk factors of EPC project and possible risk losses,and put forward the measures of risk prevention of general contracted project.

  11. Experiences in managing problematic crystal methamphetamine use and associated depression in gay men and HIV positive men: in-depth interviews with general practitioners in Sydney, Australia.

    Science.gov (United States)

    Saltman, Deborah C; Newman, Christy E; Mao, Limin; Kippax, Susan C; Kidd, Michael R

    2008-08-15

    This paper describes the experiences of Australian general practitioners (GPs) in managing problematic crystal methamphetamine (crystal meth) use among two groups of male patients: gay men and HIV positive men. Semi-structured qualitative interviews with GPs with HIV medication prescribing rights were conducted in Sydney, Adelaide and a rural-coastal town in New South Wales between August and October 2006. Participants were recruited from practices with high caseloads of gay and HIV positive men. Sixteen GPs were recruited from seven practices to take part in interviews. Participants included 14 male GPs and two female GPs, and the number of years each had been working in HIV medicine ranged from two to 24. Eleven of the GPs who were based in Sydney raised the issue of problematic crystal meth use in these two patient populations. Five key themes were identified: an increasing problem; associations with depression; treatment challenges; health services and health care; workforce issues. Despite study limitations, key implications can be identified. Health practitioners may benefit from broadening their understandings of how to anticipate and respond to problematic levels of crystal meth use in their patients. Early intervention can mitigate the impact of crystal meth use on co-morbid mental illness and other health issues. Management of the complex relationships between drug use, depression, sexuality and HIV can be addressed following a 'stepped care' approach. General practice guidelines for the management of crystal meth use problems should address specific issues associated with gay men and HIV positive men. GPs and other health practitioners must appreciate drug use as a social practice in order to build trust with gay men to encourage full disclosure of drug use. Education programs should train health practitioners in these issues, and increased resourcing provided to support the often difficult task of caring for people who use crystal meth. Greater

  12. Musculoskeletal (MSK) and Sport and Exercise Medicine (SEM) in General Practice (GP): A Novel GP-based MSK and SEM Clinic for Managing Musculoskeletal symptoms in a GP.

    Science.gov (United States)

    Heron, Neil

    2015-01-01

    Musculoskeletal (MSK) complaints are common within primary care (1) (2) (3) but some General Practitioners (GPs)/family physicians do not feel comfortable managing these symptoms (3), preferring to refer onto hospital specialists or Integrated Clinical Assessment and Treatment Services (ICATs). Long waiting times for hospital outpatient reviews are a major cause of patient inconvenience and complaints (4). We therefore aimed to establish a GP-ran MSK and sport and exercise medicine (SEM) clinic based within a Belfast GP surgery that would contribute to a sustainable improvement in managing these common conditions within primary care as well as reducing waiting times for patients with these conditions to see a specialist. This shift from hospital-based to community-based management is in-keeping with recent policy changes within the UK health-system, including Transforming Your Care within Northern Ireland (NI) (5). The GP-ran MSK and SEM clinic was held monthly within a Belfast GP practice, staffed by one GP with a specialist interest in MSK and SEM conditions and its performance was reviewed over a three month period. Parameters audited included cases seen, orthopaedic and x-ray referral rates and secondary care referrals comparing the GP practice's performance to the same time period in the previous year as well as patient satisfaction questionnaires.

  13. The Knowledge, Awareness, and Practices of Portuguese General Practitioners Regarding Multimorbidity and its Management: Qualitative Perspectives from Open-Ended Questions

    Directory of Open Access Journals (Sweden)

    Filipe Prazeres

    2016-11-01

    Full Text Available Multimorbidity’s high prevalence and negative impact has made it a subject of worldwide interest. The main aim of this study was to access the Portuguese knowledge, awareness, and practices of general practitioners (GPs regarding multimorbidity and its management, in order to aid in the development of interventions for improving outcomes in multimorbid patients in primary care. A web-based qualitative descriptive study was carried out in the first trimester of 2016 with primary care physicians working in two districts of the Centre region of Portugal. Open-ended questions were analysed via inductive thematic content analysis. GPs pointed out several difficulties and challenges while managing multimorbidity. Extrinsic factors were associated with the healthcare system logistics’ management (consultation time, organization of care teams, clinical information and society (media pressure, social/family support. Intrinsic factors related to the GP, patient, and physician-patient relationship were also stated. The most significant conclusion to emerge from this study is that although GPs perceived difficulties and challenges towards multimorbidity, they also have the tools to deal with them: the fundamental characteristics of family medicine. Also, the complex care required by multimorbid patients needs adequate consultation time, multidisciplinary teamwork, and more education/training.

  14. Misconceptions of Spanish general practitioners' attitudes toward the management of urinary tract infections and asymptomatic bacteriuria: an internet-based questionnaire study.

    Science.gov (United States)

    Llor, C; Moragas, A; Hernández, S; Crispi, S; Cots, J M

    2017-07-24

    The diagnosis and management of urinary tract infections (UTI) vary widely across countries and practices. The objective of this study was to gain insight into general practitioners' (GP) perceptions on the current management of UTIs and asymptomatic bacteriuria in Spain. Cross-sectional, internet-based questionnaire study answered from July to September 2013. GPs affiliated with the largest Spanish scientific society in primary care (Sociedad Española de Medicina Familiar y Comunitaria) were invited to participate in the study. They were asked about the tests ordered in both uncomplicated and complicated UTIs and about the management in three clinical scenarios, depicting a 50-year woman with: 1. An uncomplicated UTI, 2. A complicated UTI, and 3. An asymptomatic bacteriuria. The questionnaire was completed by 1,239 GPs (6.7%). Urine cultures were reportedly requested by 26.3% of the GPs in uncomplicated UTIs and by 71.8% of the cases corresponding to the complicated UTIs whereas it was declared that dipsticks were the preferred tests in only uncomplicated UTIs (38.2%). A total of 22% and 13.2% of the GPs stated that they would withhold antibiotic therapy in patients with low-count and high-count asymptomatic bacteriuria, respectively. GPs have important misconceptions as to the indications for ordering urine cultures and in interpreting the definitions of common UTIs and treating UTIs and asymptomatic bacteriuria. The unnecessary use of antibiotics in patients with asymptomatic bacteriuria is considerable in Spain.

  15. TO STUDY THE AWARENESS OF HEALTH CARE PERSONNEL INVOLVED IN BIO-MEDICAL WASTE MANAGEMENT IN NEW GOVERNMENT GENERAL HOSPITAL AT VIJAYAWADA, ANDHRA PRADESH

    Directory of Open Access Journals (Sweden)

    Lalith

    2014-03-01

    Full Text Available BACKGROUND: The recent developments in healthcare units are precisely made for the prevention and protection of community health. Sophisticated instruments have come into existence in various operations for disease treatment. Such improvement and advances in scientific knowledge has resulted in per capita per patient generation of wastes in health care units. Waste generated in the process of health care are composed of variety of wastes including hypodermic needles, scalpels, blades, surgical cotton, gloves, bandages, discarded medicine, body fluids, human tissues and organs, chemicals etc., other wastes generated in healthcare settings include radioactive wastes, mercury containing instruments, PVC plastics etc., so the awareness of personnel involved in the management of biomedical waste is important. AIM: To assess the waste handling and treatment system of hospital bio-medical solid waste and its mandatory compliance with regulatory notifications for bio-medical waste (BMW management rules 1998, under Environment Protection Act (EPA 1986, Ministry of Environment & Forest, Government of India at Government General Hospital (GGH, Vijayawada, Andhra Pradesh. SETTINGS AND DESIGN: This cross sectional study was conducted in GGH at Vijayawada, Andhra Pradesh. MATERIAL AND METHODS: 75 study subjects selected were personnel involved in management of hospital solid waste observed for one month and frequency tables, percentages, and proportions were used as statistical applications. STATISTICAL ANALYSIS: Analysis was done using MS – Excel software. RESULTS AND CONCLUSIONS: Out of gross total quantity of BMW generated in entire GGH, Vijayawada 74% of it is general waste. Knowledge levels regarding storage of BMW was more among class IV employees, were as awareness in differentiation of infectious and non-infectious waste was more among staff nurses.

  16. Acute back pain management in primary care: a qualitative pilot study of the feasibility of a nurse-led service in general practice.

    Science.gov (United States)

    Breen, Alan; Carr, Eloise; Mann, Eileen; Crossen-White, Holly

    2004-05-01

    (1) To determine the acceptability of the Royal College of General Practitioner Guidelines to small samples of nurses, General Practitioners and acute back pain patients, (2) to determine what additional roles for nurses in the management of acute back pain in primary care might be acceptable to these samples, (3) to evaluate the responses of General Practitioners, nurses and patients to a suggested service model based on the RCGP Guidelines, (4) to identify opportunities for and barriers to the further development of such models and to obtain the appraisal of the above by an external group of assessors. Using a qualitative design the pilot study included Primary Care (General Practitioners, Practice Nurses and Patients) with the main outcome measures as: appraisal questionnaires (for RCGP Guideline), qualitative content analysis of focus group narratives, and appraisal of process and outcomes by an external panel. Attitudes towards the RCGP guidelines were positive, but professionals and patients alike did not think their recommendations could be implemented with the current service provision in primary care. There was criticism by professionals of the capacity for a nurse-led service within practices. Access to chiropractors, osteopaths and/or specialist physiotherapists in National Health Service primary care was raised as a need by both groups. All members of the Advisory Panel approved the processes for the recruitment of participants, focus group questions and analysis. Barriers to implementation of the RCGP Guideline and to a nurse-led acute back pain service in general practice, were illustrated. These mainly relate to grossly inadequate capacity to deal with multidimensional patient needs, allowing progression to chronic pain states and much higher health care costs. There was a strong desire to include a different group of professionals in primary care. We recommend a local needs assessment and consideration of a national strategy for the implementation

  17. Hoisting the Sails, Shining the Bright Pearl——Interviewing LiQingPing, Vice Chairman of the Board of International Pearl Jadeite Jewelry Investment Company, General Manager & CEO of Ming Qin Jewelry Group

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Li Qingping was born in Wuning County, Jiangxi Province, in 1954. Now, he is Vice Chairman of the Board of International Pearl, Jadeite and Jewelry Investment Company, General Manager & CEO of Ming Qin Jewelry Group.

  18. Multimodal Generally Recognized as Safe ZnO/Nanocopper Composite: A Novel Antimicrobial Material for the Management of Citrus Phytopathogens.

    Science.gov (United States)

    Young, Mikaeel; Ozcan, Ali; Myers, Monty E; Johnson, Evan G; Graham, James H; Santra, Swadeshmukul

    2017-09-05

    Copper (Cu) bactericides/fungicides are used extensively for crop protection in agriculture. Concerns for Cu accumulation in soil, Cu leaching into the surrounding ecosystem, and development of Cu resistance in phytopathogenic bacteria are evident. While there is no suitable alternative to Cu available to date for agricultural uses, it is possible to reduce Cu per application by supplementing with Zn and improving Cu bioavailability using nanotechnology. We have prepared a non-phytotoxic composite material consisting of generally recognized as safe ZnO 800 particles and nanocopper-loaded silica gel (ZnO-nCuSi). The morphology of the ZnO-nCuSi material was characterized using scanning electron microscopy, showing ZnO particles dispersed in the silica gel matrix. ZnO-nCuSi demonstrated strong in vitro antimicrobial properties against several model plant bacterial species. Two consecutive year field efficacy results showed that agri-grade ZnO-nCuSi was effective in controlling citrus canker disease at less than half the metallic rate of the commercial cuprous oxide/zinc oxide pesticide.

  19. Surgical management of pneumothorax: significance of effective admission or communication strategies between the district general hospitals and specialized unit.

    Science.gov (United States)

    Aslam, Muhammad I; Martin-Ucar, Antonio E; Nakas, Apostolos; Waller, David A

    2011-11-01

    A preoperative delay in emergency surgery for spontaneous pneumothorax is associated with a poor outcome after surgery and a prolonged hospital stay. To reduce preoperative delays, all tertiary referrals from district general hospitals to our thoracic surgery unit were processed through a 'clinical decisions unit' (CDU). Prior to the establishment of the CDU, these patients were added to a waiting list for a surgical bed. This study has reviewed the effect of this change in admission policy on the efficiency of treatment for non-elective spontaneous pneumothorax. An intergroup comparison (pre-CDU group vs. post-CDU group) was made of the following parameters: referral to transfer time, transfer to surgery time and length of inpatient stay in the referring and tertiary hospitals. There were no significant differences in gender, diagnosis, treatment in the referring hospitals, postoperative clinical outcome, or indications for or type of surgery. The total length of inpatient stay in the referring and tertiary hospitals was significantly reduced for the post-CDU group (12 vs. 15 days; P<0.001), which was attributed to the earlier transfer of patients (18 vs. 78 hours; P<0.001) hours. Allowing surgical access to a traditional medical admission unit is therefore, cost-effective and significantly improves the efficiency of non-elective pneumothorax surgery.

  20. The Teamwork Study: enhancing the role of non-GP staff in chronic disease management in general practice.

    Science.gov (United States)

    Black, D A; Taggart, J; Jayasinghe, U W; Proudfoot, J; Crookes, P; Beilby, J; Powell-Davis, G; Wilson, L A; Harris, M F

    2013-01-01

    There is evidence for a team-based approach in the management of chronic disease in primary health care. However, the standard of care is variable, probably reflecting the limited organisational capacity of health services to provide the necessary structured and organised care for this group of patients. This study aimed to evaluate the impact of a structured intervention involving non-GP staff in GP practices on the quality of care for patients with diabetes or cardiovascular disease. A cluster randomised trial was undertaken across 60 GP practices. The intervention was implemented in 30 practices with staff and patients interviewed at baseline and at 12-15 months follow up. The change in team roles was evaluated using a questionnaire completed by practice staff. The quality of care was evaluated using the Patient Assessment of Chronic Illness Care questionnaire. We found that although the team roles of staff improved in the intervention practices and there were significant differences between practices, there was no significant difference between those in the intervention and control groups in patient-assessed quality of care after adjusting for baseline-level score and covariates at the 12-month follow up. Practice team roles were not significantly associated with change in Patient Assessment of Chronic Illness Care scores. Patients with multiple conditions were more likely to assess their quality of care to be better. Thus, although previous research has shown a cross-sectional association between team work and quality of care, we were unable to replicate these findings in the present study. These results may be indicative of insufficient time for organisational change to result in improved patient-assessed quality of care, or because non-GP staff roles were not sufficiently focussed on the aspects of care assessed. The findings provide important information for researchers when designing similar studies.

  1. Comparison of diabetes management status between cancer survivors and the general population: results from a Korean population-based survey.

    Directory of Open Access Journals (Sweden)

    Ji-Yeon Shin

    Full Text Available This study aimed to determine and compare the prevalences of diabetes awareness, treatment, and adequate glycemic control among cancer survivors in a Korean population and two non-cancer control groups, comprising individuals without a history of cancer but with other chronic diseases (non-cancer, chronic disease controls and individuals without a history of cancer or any other chronic disease (non-cancer, non-chronic disease controls.We analyzed data from 2,660 subjects with prevalent diabetes (aged ≥30 years, who had participated in the 2007-2011 Korea National Health and Nutrition Examination Survey. Awareness was defined as a subject having been diagnosed with diabetes by a clinician. Treatment was defined as a subject who was taking anti-diabetic medicine. Adequate glycemic control was defined as a hemoglobin A1c level of <7%. Multivariable logistic regression and predictive margins were used to evaluate whether awareness, treatment, or adequate glycemic control differed among cancer survivors and the two non-cancer control groups.Cancer survivors had greater awareness compared with the non-cancer, chronic disease and non-cancer, non-chronic disease control groups (85.1%, 80.4%, and 60.4%, respectively. Although the prevalences of treatment and adequate glycemic control were higher for survivors compared with the non-cancer, non-chronic disease controls, they were lower compared with the non-cancer, chronic disease controls. The prevalence of diabetes treatment was 67.5% for cancer survivors, 69.5% for non-cancer, chronic disease controls, and 46.7% for non-cancer, non-chronic disease controls; the prevalences of adequate glycemic control in these three groups were 31.7%, 34.6%, and 17.8%, respectively.Cancer survivors were less likely than the non-cancer chronic disease subjects to receive diabetes management and to achieve adequate glycemic targets. Special attention and education are required to ensure that this population receives

  2. 台北荣民总医院护理管理见闻及借鉴%Learning experiences of nursing management from Taipei Veterans General Hospital

    Institute of Scientific and Technical Information of China (English)

    闫雅凤

    2014-01-01

    介绍了台北荣民总医院护理管理见闻,包括完善的护理人员进阶制度、护理教师临床实务指导能力考评、院内护理丰富资源共享性、计算机执行医嘱核对实物图片信息的再校对性以及医院开展各种人性化措施。结合大陆护理管理工作实际,可参考和借鉴台北荣民总医院的护理管理经验,尝试建立院内网络护理信息库,实现资源共享;计算机录入校正,显示各类药品实物图片信息,提高医嘱执行查对的高效性和准确性;允许护理人员“要休”“要班”,实施科学、有效、人性化的护理管理,以便进一步为病人提供身心并护的优质服务,同时有益于提升护理人员的快乐工作指数,最终实现多维度共赢。%The author introduced the information of nursing management in Taipei Veterans General Hospital, included the well-established nurse staff promotion system, sharing abundant nursing resources, double check of medication picture information when executing doctor's orders on computer, and lots of humanistic measures applied in this hospital. Combined with the nursing management status of mainland, we can learn some nursing management experiences from Taipei Veterans General Hospital. We could establish nursing information database to share resources, improve the effect and accuracy of doctor's orders checking through computer input revision and displaying medications pictures. We should implement scientiifc, effective and humanistic nursing management, thinking about nurses' demands of on or off duty when allocating nursing staff. It would be help to improve nurses' happiness and patients holistic care, ultimately realize multidimensional win.

  3. General Assembly

    CERN Multimedia

    Staff Association

    2016-01-01

    5th April, 2016 – Ordinary General Assembly of the Staff Association! In the first semester of each year, the Staff Association (SA) invites its members to attend and participate in the Ordinary General Assembly (OGA). This year the OGA will be held on Tuesday, April 5th 2016 from 11:00 to 12:00 in BE Auditorium, Meyrin (6-2-024). During the Ordinary General Assembly, the activity and financial reports of the SA are presented and submitted for approval to the members. This is the occasion to get a global view on the activities of the SA, its financial management, and an opportunity to express one’s opinion, including taking part in the votes. Other points are listed on the agenda, as proposed by the Staff Council. Who can vote? Only “ordinary” members (MPE) of the SA can vote. Associated members (MPA) of the SA and/or affiliated pensioners have a right to vote on those topics that are of direct interest to them. Who can give his/her opinion? The Ordinary General Asse...

  4. Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care: a qualitative study.

    Science.gov (United States)

    van der Biezen, Mieke; Derckx, Emmy; Wensing, Michel; Laurant, Miranda

    2017-02-07

    Due to the increasing demand on primary care, it is not only debated whether there are enough general practitioners (GPs) to comply with these demands but also whether specific tasks can be performed by other care providers. Although changing the workforce skill mix care by employing Physician Assistants (PAs) and Nurse Practitioners (NPs) has proven to be both effective and safe, the implementation of those professionals differs widely between and within countries. To support policy making regarding PAs/NPs in primary care, the aim of this study is to provide insight into factors influencing the decision of GPs and managers to train and employ a PA/NP within their organisation. A qualitative study was conducted in 2014 in which 7 managers of out-of-hours primary care services and 32 GPs who owned a general practice were interviewed. Three main topic areas were covered in the interviews: the decision-making process in the organisation, considerations and arguments to train and employ a PA/NP, and the tasks and responsibilities of a PA/NP. Employment of PAs/NPs in out-of-hours services was intended to substitute care for minor ailments in order to decrease GPs' caseload or to increase service capacity. Mangers formulated long-term planning and role definitions when changing workforce skill mix. Lastly, out-of-hours services experienced difficulties with creating team support among their members regarding the employment of PAs/NPs. In general practices during office hours, GPs indented both substitution and supplementation for minor ailments and/or target populations through changing the skill mix. Supplementation was aimed at improving quality of care and extending the range of services to patients. The decision-making in general practices was accompanied with little planning and role definition. The willingness to employ PAs/NPs was highly influenced by an employees' motivation to start the master's programme and GPs' prior experience with PAs/NPs. Knowledge about

  5. 电力工程总承包风险管理研究%Risk management on electric power project general contracting

    Institute of Scientific and Technical Information of China (English)

    周玕

    2013-01-01

      The mode of electric power engineering general contracting is a risky business for all kinds of risk throughout the project. Recognizing and controlling risk timely which improves the ability to resist risks dramatically decides the institute and its subordinate whether can remain invincible in the fierce competition. This paper illustrates all kinds of risks and effective measures on risk-controlling during general contracting projects, aiming at building an overall and systematic mechanism on risk management.%  电力工程总承包是一项充满风险的事业,各种风险贯穿于项目的全过程。能否及时识别并控制风险,提高企业抗风险能力,在很大程度上将决定电力工程总承包企业能否在激烈的市场竞争中立于不败之地。文章阐明电力工程总承包项目可能产生的风险,并提出风险控制措施,力求实现风险控制机制建设的全面性及系统性。

  6. An embedded longitudinal multi-faceted qualitative evaluation of a complex cluster randomized controlled trial aiming to reduce clinically important errors in medicines management in general practice

    Directory of Open Access Journals (Sweden)

    Cresswell Kathrin M

    2012-06-01

    Full Text Available Abstract Background There is a need to shed light on the pathways through which complex interventions mediate their effects in order to enable critical reflection on their transferability. We sought to explore and understand key stakeholder accounts of the acceptability, likely impact and strategies for optimizing and rolling-out a successful pharmacist-led information technology-enabled (PINCER intervention, which substantially reduced the risk of clinically important errors in medicines management in primary care. Methods Data were collected at two geographical locations in central England through a combination of one-to-one longitudinal semi-structured telephone interviews (one at the beginning of the trial and another when the trial was well underway, relevant documents, and focus group discussions following delivery of the PINCER intervention. Participants included PINCER pharmacists, general practice staff, researchers involved in the running of the trial, and primary care trust staff. PINCER pharmacists were interviewed at three different time-points during the delivery of the PINCER intervention. Analysis was thematic with diffusion of innovation theory providing a theoretical framework. Results We conducted 52 semi-structured telephone interviews and six focus group discussions with 30 additional participants. In addition, documentary data were collected from six pharmacist diaries, along with notes from four meetings of the PINCER pharmacists and feedback meetings from 34 practices. Key findings that helped to explain the success of the PINCER intervention included the perceived importance of focusing on prescribing errors to all stakeholders, and the credibility and appropriateness of a pharmacist-led intervention to address these shortcomings. Central to this was the face-to-face contact and relationship building between pharmacists and a range of practice staff, and pharmacists’ explicitly designated role as a change agent

  7. An embedded longitudinal multi-faceted qualitative evaluation of a complex cluster randomized controlled trial aiming to reduce clinically important errors in medicines management in general practice.

    Science.gov (United States)

    Cresswell, Kathrin M; Sadler, Stacey; Rodgers, Sarah; Avery, Anthony; Cantrill, Judith; Murray, Scott A; Sheikh, Aziz

    2012-06-08

    There is a need to shed light on the pathways through which complex interventions mediate their effects in order to enable critical reflection on their transferability. We sought to explore and understand key stakeholder accounts of the acceptability, likely impact and strategies for optimizing and rolling-out a successful pharmacist-led information technology-enabled (PINCER) intervention, which substantially reduced the risk of clinically important errors in medicines management in primary care. Data were collected at two geographical locations in central England through a combination of one-to-one longitudinal semi-structured telephone interviews (one at the beginning of the trial and another when the trial was well underway), relevant documents, and focus group discussions following delivery of the PINCER intervention. Participants included PINCER pharmacists, general practice staff, researchers involved in the running of the trial, and primary care trust staff. PINCER pharmacists were interviewed at three different time-points during the delivery of the PINCER intervention. Analysis was thematic with diffusion of innovation theory providing a theoretical framework. We conducted 52 semi-structured telephone interviews and six focus group discussions with 30 additional participants. In addition, documentary data were collected from six pharmacist diaries, along with notes from four meetings of the PINCER pharmacists and feedback meetings from 34 practices. Key findings that helped to explain the success of the PINCER intervention included the perceived importance of focusing on prescribing errors to all stakeholders, and the credibility and appropriateness of a pharmacist-led intervention to address these shortcomings. Central to this was the face-to-face contact and relationship building between pharmacists and a range of practice staff, and pharmacists' explicitly designated role as a change agent. However, important concerns were identified about the likely

  8. Acute variceal bleeding: general management

    Institute of Scientific and Technical Information of China (English)

    David Patch; Lucy Dagher

    2001-01-01

    @@ TREATMENT STRATEGIES FOR ACUTE VARICEAL BLEEDING Backgound Acute variceal bleeding has a significant mortality which ranges form 5% to 50% in patients with cirrhosis[1].Overall survival is probably improving,because of new therapeutic approaches,and improved medical care.However,mortality is still closely related to failure to control hacmorrhage or carly rebleeding,which is a distinct characteristic of portal hypertensive bleeding and occures in as many as 50% of patients in the first days to 6 weeks after admission et al[2].

  9. General physicians and the management of heart failure in an Argentine population Los médicos generales y el tratamiento de la insuficiencia cardíaca en una muestra de la población argentina

    Directory of Open Access Journals (Sweden)

    Mario A Ciruzzi

    2004-06-01

    Full Text Available The aim of this study was to assess how general physicians (GP think that heart failure (HF should be managed and how they implement their knowledge. It was conducted in Buenos Aires City and suburban area, with the collaboration of 5 cardiologists, and 29 GP who were selected randomly, and were asked to keep a log of all patients they saw with HF. The methodology was similar to that employed in an international initiative named"Improvement" already performed in Europe. Data were obtained of 220 note patients. GP knowledge and perceptions about the management of HF were assessed initially with a"perception survey", and later on how a representative sample of patients was managed, with an"actual practice survey". The electrocardiogram and the chest radiograph were recorded in most patients (≅90%, but the echocardiogram only in 67% of cases. Forty percent of the patients had history of myocardial infarction and ischaemic heart disease, but exercise test was not considered as a potential diagnostic test and was recorded only in 16% of the patient records. Likewise coronary angiogram was performed in 7% of patients. Only 23% of the patients had a left ventricular ejection fraction test result documented in their charts. In practice, 43% of GP patients were receiving an ACE inhibitor and one third betablockers. Only 9% received these drugs in combination. At the last interview, 50% had hypertension (blood pressure > 140/90 and 15% had not recorded this data in patients notes. This study identified, in a random sample of GP of Buenos Aires City and suburbs, that management of HF was less than optimal.El objetivo de este estudio fue evaluar cómo los médicos generales (MG piensan que debe tratarse la insuficiencia cardíaca (IC y cómo ponen en práctica su conocimiento. Se realizó en la ciudad de Buenos Aires y su área suburbana, con la colaboración de 5 cardiólogos, y de 29 MG que fueron seleccionados al azar, a los cuales se les solicitó que

  10. Application of Risk Management in Nursing Management of General Surgery Department%普外科护理管理中风险管理的应用体会

    Institute of Scientific and Technical Information of China (English)

    袁倩倩; 谢唯双

    2013-01-01

    目的:探讨风险管理在普外科临床护理管理中的应用。方法:通过对日常护理工作中可能存在的风险进行评估,制定常见风险的应急处理程序,对其工作制度进行完善,改进工作流程,提高护士对风险意识的强化培训,加强护理风险监控等措施。结果:实施风险管理后,提高了护士的护理风险意识,使患者满意度明显高于实施管理前。结论:护理管理中应用风险管理后,有效的提高了护理人员对普外科工作中的危险因素的预见性和干预性,提高了患者对护理工作的满意度,显著降低了护理纠纷的发生。%Objective: study the application of risk management in clinical nursing management of general surgery department. Method:through evaluating the potential risk in daily nursing work, the common risk emergency treatment procedure is developed, the working system is improved and the workflow is improved, the risk awareness training of nurse is enhanced, and the measures on strengthening nursing risk monitor is developed. Result: after implementing risk management, the nursing risk awareness of nurse is improved, and the satisfaction of patients is significantly higher than before. Conclusion: after the application of risk management in nursing management, it effectively improves the foresee and intervention ability of risk elements in nursing, improves the satisfaction of patients and significantly reduces the nursing disputes.

  11. BIM技术在天津117大厦项目工程总承包管理中的应用%BIM Technology in the Application of the Tianjin 117 Building Project Engineering General Contracting Management

    Institute of Scientific and Technical Information of China (English)

    安培; 周晓帆

    2014-01-01

    以天津117大厦项目中BIM技术应用为例,探索BIM技术在项目总承包管理过程中的应用,从BIM实施策划、BIM实施专项应用、BIM综合管理三个方面,阐述了BIM实施内容和管理方式,通过BIM模型作为纽带,将BIM技术与项目总承包管理相结合,实现设计管理和施工管理全过程信息传递及共享,打造设计、施工、资源、商务等一体化BIM总承包管理体系。%117 building project in the BIM technology application in Tianjin as an example,explore the BIM technology application in the project general contracting management process,from the BIM implementation plan,the implementation of special application,plus BIM integrated management three aspects,this paper expounds the BIM implementation content and management mode,through the BIM model as the link,the BIM technology combined with project general contracting management,design management and construction management the whole process of information transfer and sharing,building design,construction,resources,BIM general contracting business,such as integration management system.

  12. [The general practitioner faced with memory problems in the aged patient in Luxembourg: a study of the management employed, the experience of the physicians and the perception of the specific treatment].

    Science.gov (United States)

    Gondoin, C; Lévy, F; Tirmarche, D

    2012-01-01

    Memory impairments are common in elderly. General practitioners are in first line to detect and manage these troubles, for which many countries published recommendations. For Alzheimer disease there are currently four treatments, none of which is healing. Some countries limited the first prescription of those medicines to specialists whereas in Luxembourg, every practitioner is allowed to prescribe them, but has to ask health insurance first. Consequently, it is important that general practitioners know what to do. The aim of our paper is to study the management done by the general practitioners in Luxembourg, the way they feel about it and the way they see the specific medicines for Alzheimer disease. Therefore, we have sent a questionnaire to every general practitioner in Luxembourg. We found that 87% of the practitioners realize at least one cognitive impairment test. More than half of them check for depression and 22.6% also add an autonomy assessment scale, even though all these tests are done by the dependence insurance. The involvement of general practitioners in the diagnosis of dementia is important as more than half of them have a statistically adequate number of demented patients. About two third of the practitioners do systematically start a specific medicine for Alzheimer disease. The management of cognitive impairment is difficult for general practitioners of Luxembourg, particularly the disclosure of diagnosis and management of behavioural and psychological symptoms.

  13. Position statement for the use of omalizumab in the management of chronic spontaneous urticaria in Indian patients

    Directory of Open Access Journals (Sweden)

    Kiran Godse

    2016-01-01

    Full Text Available Chronic spontaneous urticaria (CSU affects 1% of the world population and also their quality of life, and 50% of these patients are refractory to H1-antihistamines. Omalizumab is a humanized monoclonal anti-IgE antibody that binds with free IgE antibodies and reduces the circulating levels of free IgE. This reduction in free IgE prevents mast-cell degranulation. The EAACI/GA2LEN/EDF/WAO guidelines recommend omalizumab as the third-line of therapy as an add-on to antihistamines. The recommended dose of omalizumab is 300 mg, 4 weekly in the management of CSU refractory to standard of care with H1-antihistamines in adults and adolescents ≥12 years of age. In some patients, a dose of 150 mg may be acceptable. Omalizumab has a good safety profile. However, due to the biologic nature of the drug, all patients administered omalizumab must be observed for 2 h after administration for anaphylactoid reactions. There have been no studies on the effect of impaired renal or hepatic function on the pharmacokinetics of omalizumab. While no particular dose adjustment is recommended, omalizumab should be administered with caution in these patients.

  14. Research for Design: Exploring Student and Instructor Attitudes toward Accessing Library Resources and Services from Course Management Systems (CMS

    Directory of Open Access Journals (Sweden)

    Merinda McLure

    2010-10-01

    Full Text Available The authors report a study concerning student and instructor attitudes toward accessing library resources and services from within course management systems (CMS. In spring 2008, the authors conducted semi-structured interviews with a small population of students and instructors at the University of California, Berkeley (UCB and at Colorado State University (CSU. They asked participants to respond to examples of library integrations in course management systems at other institutions and to report their local experiences with both the campus CMS and library services. Participant responses frequently challenged and complicated the authors’ assumptions about best practices in integrating a library presence and library services in CMS. The interview findings are discussed thematically, in relation to higher education and library literature, and can inform librarians’ efforts to integrate an effective library presence in a campus course management system. This study might be readily adapted for implementation at other institutions.

  15. Comparison of Pediatric and General Orthopedic Surgeons’ Approaches in Management of Developmental Dysplasia of the Hip and Flexible Flatfoot: the Road to Clinical Consensus

    Directory of Open Access Journals (Sweden)

    Ramin Haj Zargarbashi

    2017-01-01

    Full Text Available Developmental dysplasia of the hip (DDH and flatfoot are common pediatric orthopedic disorders, being referred to and managed by both general and pediatric orthopedic surgeons, through various modalities. Our study aimed to evaluate their consensus and perspective disagreements in terms of diagnostic and therapeutic approaches of the mentioned deformities. Forty participants in two groups of general orthopedic surgeons (GOS (n=20 and pediatric orthopedic surgeons (POS (n=20, were asked to answer an 8-item questionnaire on DDH and flexible flatfoot. The questions were provided with two- or multiple choices and a single choice was accepted for each one. Chi-square and Fisher’s exact tests was performed to compare the responses. For a neonate with limited hip abduction, hip ultrasonography was the agreed-upon approach in both groups (100% POS vs 71% GOS, and for its interpretation 79% of POS relied on their own whereas 73% of GOS relied on radiologist’s report (P=0.002. In failure of a 3-week application of the Pavlik harness, ending it and closed reduction (57% POS vs. 41% GOS followed by surgery quality assessment with CT scan (64% POS vs. 47% GOS and without the necessity for avascular necrosis evaluation (79% POS vs. 73% GOS were the choice measures. In case of closed reduction failure, open reduction via medial approach was the favorite next step in both groups (62% POS and 80% GOS. For the patient with flexible flat foot, reassurance was the choice plan of 79% of pediatric orthopedists. Our findings demonstrated significant disagreements among the orthopedic surgeons. This proposes insufficiency of high-level evidence.

  16. Comparison of Pediatric and General Orthopedic Surgeons' Approaches in Management of Developmental Dysplasia of the Hip and Flexible Flatfoot: the Road to Clinical Consensus.

    Science.gov (United States)

    Zargarbashi, Ramin Haj; Bonaki, Hirbod Nasiri; Zadegan, Shayan Abdollah; Baghdadi, Taghi; Nabian, Mohammad Hossein; Shirazi, Mehdi Ramezan

    2017-01-01

    Developmental dysplasia of the hip (DDH) and flatfoot are common pediatric orthopedic disorders, being referred to and managed by both general and pediatric orthopedic surgeons, through various modalities. Our study aimed to evaluate their consensus and perspective disagreements in terms of diagnostic and therapeutic approaches of the mentioned deformities. Forty participants in two groups of general orthopedic surgeons (GOS) (n=20) and pediatric orthopedic surgeons (POS) (n=20), were asked to answer an 8-item questionnaire on DDH and flexible flatfoot. The questions were provided with two- or multiple choices and a single choice was accepted for each one. Chi-square and Fisher's exact tests was performed to compare the responses. For a neonate with limited hip abduction, hip ultrasonography was the agreed-upon approach in both groups (100% POS vs 71% GOS), and for its interpretation 79% of POS relied on their own whereas 73% of GOS relied on radiologist's report (P=0.002). In failure of a 3-week application of the Pavlik harness, ending it and closed reduction (57% POS vs. 41% GOS) followed by surgery quality assessment with CT scan (64% POS vs. 47% GOS) and without the necessity for avascular necrosis evaluation (79% POS vs. 73% GOS) were the choice measures. In case of closed reduction failure, open reduction via medial approach was the favorite next step in both groups (62% POS and 80% GOS). For the patient with flexible flat foot, reassurance was the choice plan of 79% of pediatric orthopedists. Our findings demonstrated significant disagreements among the orthopedic surgeons. This proposes insufficiency of high-level evidence.

  17. An evaluation of Birmingham Own Health® telephone care management service among patients with poorly controlled diabetes. a retrospective comparison with the General Practice Research Database

    Directory of Open Access Journals (Sweden)

    Adab Peymané

    2011-09-01

    Full Text Available Abstract Background Telephone-based care management programmes have been shown to improve health outcomes in some chronic diseases. Birmingham Own Health® is a telephone-based care service (nurse-delivered motivational coaching and support for self-management and lifestyle change for patients with poorly controlled diabetes, delivered in Birmingham, UK. We used a novel method to evaluate its effectiveness in a real-life setting. Methods Retrospective cohort study in the UK. 473 patients aged ≥ 18 years with diabetes enrolled onto Birmingham Own Health® (intervention cohort and with > 90 days follow-up, were each matched by age and sex to up to 50 patients with diabetes registered with the General Practice Research Database (GPRD to create a pool of 21,052 controls (control cohort. Controls were further selected from the main control cohort, matching as close as possible to the cases for baseline test levels, followed by as close as possible length of follow-up (within +/-30 days limits and within +/-90 days baseline test date. The aim was to identify a control group with as similar distribution of prognostic factors to the cases as possible. Effect sizes were computed using linear regression analysis adjusting for age, sex, deprivation quintile, length of follow-up and baseline test levels. Results After adjusting for baseline values and other potential confounders, the intervention showed significant mean reductions among people with diabetes of 0.3% (95%CI 0.1, 0.4% in HbA1c; 3.5 mmHg (1.5, 5.5 in systolic blood pressure, 1.6 mmHg (0.4, 2.7 in diastolic blood pressure and 0.7 unit reduction (0.3, 1.0 in BMI, over a mean follow-up of around 10 months. Only small effects were seen on average on serum cholesterol levels (0.1 mmol/l reduction (0.1, 0.2. More marked effects were seen for each clinical outcome among patients with worse baseline levels. Conclusions Despite the limitations of the study design, the results are consistent with the

  18. 浅谈电力工程总承包项目基础工作的管理与控制%Management and Control of Power Engineering General Contracting Project Foundation Work

    Institute of Scientific and Technical Information of China (English)

    陈红军; 高阳

    2012-01-01

    This paper discussed the advantages and development of power system engineering general contracting project management, analyzed the points and content of project management of general contracting, and made the scientific outlook on the engineering general contracting of project management.%文章对电力系统工程总承包项目实施管理的优势和未来市场发展前景进行论述,对工程总承包关于项目管理的要点及内容具体分析,对电力系统工程总承包的科学建设模式展望.

  19. Clinical practice guideline for diagnosis and management of urticaria.

    Science.gov (United States)

    Kulthanan, Kanokvalai; Tuchinda, Papapit; Chularojanamontri, Leena; Chanyachailert, Pattriya; Korkij, Wiwat; Chunharas, Amornsri; Wananukul, Siriwan; Limpongsanurak, Wanida; Benjaponpitak, Suwat; Wisuthsarewong, Wanee; Aunhachoke, Kobkul; Wessagowit, Vesarat; Chatchatee, Pantipa; Wattanakrai, Penpun; Jirapongsananuruk, Orathai; Klaewsongkram, Jettanong; Noppakun, Nopadon; Vichyanond, Pakit; Suthipinittharm, Puan; Ruxrungtham, Kiat; Singalavanija, Srisupalak; Ngamphaiboon, Jarungchit

    2016-09-01

    Urticaria is a common skin condition that can compromise quality of life and may affect individual performance at work or school. Remission is common in majority of patients with acute spontaneous urticaria (ASU); however, in chronic cases, less than 50% had remission. Angioedema either alone or with urticaria is associated with a much lower remission rate. Proper investigation and treatment is thus required. This guideline, a joint development of the Dermatological Society of Thailand, the Allergy, Asthma, and Immunology Association of Thailand and the Pediatric Dermatological Society of Thailand, is graded and recommended based on published evidence and expert opinion. With simple algorithms, it is aimed to help guiding both adult and pediatric physicians to better managing patients who have urticaria with/without angioedema. Like other recent guideline, urticaria is classified into spontaneous versus inducible types. Patients present with angioedema or angioedema alone, drug association should be excluded, acetyl esterase inhibitors (ACEIs) and non-steroidal anti-inflammatory drugs (NSAIDs) in particular. Routine laboratory investigation is not cost-effective in chronic spontaneous urticaria (CSU), unless patients have clinical suggesting autoimmune diseases. Non-sedating H1-antihistamine is the first-line treatment for 2-4 weeks; if urticaria was not controlled, increasing the dose up to 4 times is recommended. Sedating first-generation antihistamines have not been proven more advantage than non-sedating antihistamines. The only strong evidence-based alternative regimen for CSU is an anti-IgE: omalizumab; due to very high cost it however might not be accessible in low-middle income countries. Non-pharmacotherapeutic means to minimize hyper-responsive skin are also important and recommended, such as prevention skin from drying, avoidance of hot shower, scrubbing, and excessive sun exposure.

  20. Managing urticaria in primary care.

    Science.gov (United States)

    Tidman, Michael J

    2015-02-01

    Urticaria is characterised by transient wheals that consist of a swollen palpable centre often surrounded by an erythematous flare, associated with itching or, less commonly, a burning sensation. Individual wheals usually disappear within 1 to 24 hours leaving normal skin. Wheals may be accompanied by angioedema, a more deep-seated flesh-coloured or erythematous swelling of skin or mucous membrane, which may last longer than 24 hours. Urticaria is classified as acute when it resolves within six weeks and chronic when its duration exceeds six weeks. Chronic urticaria is now sub-classified into chronic spontaneous urticaria (CSU) and chronic inducible urticaria. The prognosis for eventual recovery from spontaneous and inducible urticaria is excellent. However, the time course is unpredictable and may extend to years, often following a relapsing and remitting course. Urticaria results from the release of inflammatory mediators from dermal mast cells, resulting in vasodilatation, plasma extravasation, recruitment of immunologically active cells and sensory nerve stimulation. The cause of urticaria cannot usually be precisely identified for most affected individuals. IgE-mediated food allergy is rarely the cause of CSU in patients with the daily appearance of urticarial lesions, although it should be considered in CSU patients with intermittent symptoms. For patients with CSU a differential full blood count and inflammatory markers are all that are routinely recommended. It is also reasonable to test thyroid function and check for circulating thyroid autoantibodies as there is an association between CSU and thyroid autoimmunity.

  1. Exploring the contribution of general self-efficacy to the use of self-care symptom management strategies by people living with HIV infection.

    Science.gov (United States)

    Corless, Inge B; Wantland, Dean; Kirksey, Kenn M; Nicholas, Patrice K; Human, Sarie; Arudo, John; Rosa, Maria; Cuca, Yvette; Willard, Sue; Hamilton, Mary Jane; Portillo, Carmen; Sefcik, Elizabeth; Robinson, Linda; Bain, Cathy; Moezzi, Shanaz; Maryland, Mary; Huang, Emily; Holzemer, William L

    2012-06-01

    General self-efficacy (GSE), the expectation that one is able to perform a behavior successfully, may differentiate those who are able to successfully utilize self-care symptom management strategies (SCSMS). This subanalysis (n=569) of an international 12 site longitudinal randomized controlled trial (RCT) (n=775), investigated GSE as an important factor determining symptom burden, SCSMS, engagement with the provider, and medication adherence over time, and identified differences in those with high and low GSE ratings concerning these variables. Parametric and nonparametric repeated-measures tests were employed to assess GSE and the perceived effectiveness of SCSMS for anxiety, depression, diarrhea, fatigue, nausea, and neuropathy. Symptom burden, engagement with the provider, and antiretroviral adherence were analyzed with regard to GSE. Our data indicated that there were differences in the perceived symptom burden over time of HIV infected individuals by GSE. Those individuals with higher GSE had fewer symptoms and these symptoms were perceived to be less intense than those experienced by the low GSE group. There were few meaningful differences in the SCSMS used by those with high versus low GSE other than the use of illicit substances in the low GSE group. The low GSE group was also significantly (p= < 0.001) less engaged with their healthcare providers. Given the difference in substance use by perceived GSE, and the importance of engagement with the healthcare provider, more attention to the resolution of the concerns of those with low GSE by healthcare providers is warranted.

  2. Sexual history taking in general practice: managing sexually transmitted infections for female sex workers by doctors and assistant doctors in Vietnam.

    Science.gov (United States)

    Do, Khoi; Minichiello, Victor; Hussain, Rafat; Khan, Asaduzzaman

    2015-01-01

    Sexually transmitted infections (STIs) in Vietnam have been increasing. Control of STIs among female sex workers (FSWs) is important in controlling the epidemic. Effective STI control requires that physicians are skilful in taking sexual history for FSW patients. Three hundred and seventy-one physicians responded to a survey conducted in three provinces in Vietnam. The respondents were asked whether they asked FSW patients about their sexual history and information asked during sexual history taking. The respondents were also asked about their barriers for taking sexual history. Over one-fourth (27%) respondents always, over half (54%) respondents sometimes and 19% respondents never obtained a sexual history from FSW patients. Multivariable analysis revealed that factors associated with always taking a sexual history were being doctor, training in STIs and working at provincial level facilities. Physician's discomfort was found to be inversely associated with training on communication with patients, seeing 15 or fewer patients a week, working at provincial level facilities. Issues in sexual history taking among FSW patients in general practice in Vietnam were identified. These issues can help STI control for FSW patients and need due attention in order to improve STI management in Vietnam.

  3. 从经营者角度谈 ERP 实施要点%The Key Points for Successful Implementation of ERP From A General Manager

    Institute of Scientific and Technical Information of China (English)

    王胜

    2013-01-01

    从企业经营者的角度论述了离散制造企业成功实施ERP的经验教训、企业实施ERP的时机选择、成功实施的必要条件、实施过程各阶段的重点工作以及成功实施ERP的要点,着重阐述了成功实施ERP的关键点,即期与量的处理方法。%As the view of perspective of the general manager , it discusses the experience for a typical discrete manufacturing company to implement ERP system , such as the timing of implementation , the necessary condi-tions of implementation , the focused works for various stages , and some key points of successful implementation of ERP.It shows the detail about the treatment of period and amount of the successful implementation of ERP .

  4. Impact on knowledge and behaviour of the general population of two different methods of solid waste management: An explorative cross-sectional study.

    Science.gov (United States)

    Del Cimmuto, Angela; Mannocci, Alice; Ribatti, Domenico; Boccia, Antonio; La Torre, Giuseppe

    2014-06-01

    The objectives of the present study were to evaluate knowledge among general population about the risks factors of waste management, to estimate the feeling of anxiety concerning the waste, and to compare knowledge of two different methods for collecting municipal solid waste (MSW): a street separate collection system and a door-to-door separate collection system. A cross-sectional study was performed, administering an anonymous questionnaire to 180 inhabitants in Aprilia, Latium, Italy. The study sample consisted of 183 citizens: 64 in the intervention group and 119 in the control group. The intervention was represented by a campaign of door-to-door collection. The correct implementation of separate collection of waste was 87.5% in the intervention group and 63% in the control group (pwaste collection was door-to-door (p=0.013); a high difference concerning the quality of information was found (pmanagement of waste and household waste. The door-to-door collection was appreciated and preferred by both groups. The adoption of a door-to-door scheme seems to be a winning option mostly because it is supported by an information and education system for the citizens.

  5. The management of non-valvular atrial fibrillation (NVAF in Australian general practice: bridging the evidence-practice gap. A national, representative postal survey

    Directory of Open Access Journals (Sweden)

    Middleton Sandy

    2008-11-01

    Full Text Available Abstract Background General practitioners (GPs are ideally placed to bridge the widely noted evidence-practice gap between current management of NVAF and the need to increase anticoagulant use to reduce the risk of fatal and disabling stroke in NVAF. We aimed to identify gaps in current care, and asked GPs to identify potentially useful strategies to overcome barriers to best practice. Methods We obtained contact details for a random sample of 1000 GPs from a national commercial data-base. Randomly selected GPs were mailed a questionnaire after an advance letter. Standardised reminders were administered to enhance response rates. As part of a larger survey assessing GP management of NVAF, we included questions to explore GPs' risk assessment, estimates of stroke risk and GPs' perceptions of the risks and benefits of anticoagulation with warfarin. In addition, we explored GPs' perceived barriers to the wider uptake of anticoagulation, quality control of anticoagulation and their assessment of strategies to assist in managing NVAF. Results 596 out of 924 eligible GPs responded (64.4% response rate. The majority of GPs recognised that the benefits of warfarin outweighed the risks for three case scenarios in which warfarin is recommended according to Australian guidelines. In response to a hypothetical case scenario describing a patient with a supratherapeutic INR level of 5, 41.4% of the 596 GPs (n = 247 and 22.0% (n = 131 would be "highly likely" or "likely", respectively, to cease warfarin therapy and resume at a lower dose when INR levels are within therapeutic range. Only 27.9% (n = 166/596 would reassess the patient's INR levels within one day of recording the supratherapeutic INR. Patient contraindications to warfarin was reported to "usually" or "always" apply to the patients of 40.6% (n = 242/596 of GPs when considering whether or not to prescribe warfarin. Patient refusal to take warfarin "usually" or "always" applied to the patients of 22

  6. Professional Vision of Classroom Management and Learning Support in Science Classrooms--Does Professional Vision Differ across General and Content-Specific Classroom Interactions?

    Science.gov (United States)

    Steffensky, Mirjam; Gold, Bernadette; Holdynski, Manfred; Möller, Kornelia

    2015-01-01

    The present study investigates the internal structure of professional vision of in-service teachers and student teachers with respect to classroom management and learning support in primary science lessons. Classroom management (including monitoring, managing momentum, and rules and routines) and learning support (including cognitive activation…

  7. Professional Vision of Classroom Management and Learning Support in Science Classrooms--Does Professional Vision Differ across General and Content-Specific Classroom Interactions?

    Science.gov (United States)

    Steffensky, Mirjam; Gold, Bernadette; Holdynski, Manfred; Möller, Kornelia

    2015-01-01

    The present study investigates the internal structure of professional vision of in-service teachers and student teachers with respect to classroom management and learning support in primary science lessons. Classroom management (including monitoring, managing momentum, and rules and routines) and learning support (including cognitive activation…

  8. Airway management under general anesthesia during operation for oral and maxillofacial injuries%品腔颌面创伤手术麻醉气道管理

    Institute of Scientific and Technical Information of China (English)

    刘可斌; 李向京

    2009-01-01

    Establishment and maintenance of fluent re-spiratory tract is important in management of general anesthe-sia in surgery for oral and maxillofacial injuries. Patients with oral and maxillofaeial injuries are likely to have obstruction of respiratory tract, especially patients with coma, massive hem-orrhage, foreign bodies in respiratory tract and wallowing tongue base. Studies showed that the mortality caused by re-spiratory problems is higher than that caused by injury itself in patients with oral and maxiUofacial injuries. Along with the in-novation of anesthesia, in-depth understanding of difficult re-spiratory tract and development of new anesthetic or instru-ment, more and more methods can be attained for management of the respiratory tract in surgery for oral and maxillofacial in-juries. The pivot of maintenance of fluent respiratory tract is taking effective steps to avoid lack of oxygen in pre-operation period. It is also important to use all kinds of intubation meth-ods and technologies skillfully.%维持气道通畅是口腔颌面创伤麻醉处理的重要课题.观察显示口腔颌面部外伤容易并发呼吸道梗阻,尤其是合并颅脑外伤者、昏迷状态、颌面部大出血、各种异物、舌根后坠等.相关报道合并颅脑外伤昏迷时,呼吸道问题引起的死亡,往往高于创伤本身.随着麻醉学技术的进步和对困难气道的深入认识以及麻醉药品器械的研制,解决问题的手段也日益增多.但每种解决办法都有自身特点,即适应证或禁忌证,尚需深入研究.颌面创伤气道的安全性关键在于围术期如何避免缺氧,有防范策略;其次是如何熟练应用各种插管方法.

  9. Development of Management Metrics for Research and Technology

    Science.gov (United States)

    Sheskin, Theodore J.

    2003-01-01

    Professor Ted Sheskin from CSU will be tasked to research and investigate metrics that can be used to determine the technical progress for advanced development and research tasks. These metrics will be implemented in a software environment that hosts engineering design, analysis and management tools to be used to support power system and component research work at GRC. Professor Sheskin is an Industrial Engineer and has been involved in issues related to management of engineering tasks and will use his knowledge from this area to allow extrapolation into the research and technology management area. Over the course of the summer, Professor Sheskin will develop a bibliography of management papers covering current management methods that may be applicable to research management. At the completion of the summer work we expect to have him recommend a metric system to be reviewed prior to implementation in the software environment. This task has been discussed with Professor Sheskin and some review material has already been given to him.

  10. The contribution of quality to health services. Application of the quality management system ISO 9001:2008 in Intensive Care Unit of the General Hospital of Larissa

    Directory of Open Access Journals (Sweden)

    Dimitrios Patsios

    2014-10-01

    Full Text Available In our country there have been many efforts in recent years to introduce laws that lead to the introduction of the concept of quality in the field of public hospitals. The implementation of health quality systems contributes to health care improvement, while the assessment of quality services is a basic tool in quality management. Purpose: The purpose of the study was to describe the benefits that can be gained by a public institute of health when a quality model is applied. Material and methods: This paper focus on the application of the ISO 9001:2008 standard in the Intensive Care Unit of the General Hospital of Larissa during the years 2010-2012. The results and benefits of its implementation, recorded by measuring satisfaction of the relatives of the patients. The questionnaire Family Satisfaction with Care in the Intensive Care Unit (FS-ICU 24 and quality indicators were applied. The study sample was all the relatives of the patients hospitalized in ICU during 2010-2012. Descriptive statistics was performed. Results: Quality indicators were considerably improved after ISO implementation with SMR falling to 35% in 2012 (from 58% in 2007, thus being one of the lowest in Greece and below European ICU’s SMR mean value. Over 80% of patients’ relatives answered that Nursing and Medical care was “excellent” and over 10% characterized it as “very good”. Family members’ total satisfaction surpassed 90%. Medical and Nursing care were highly appreciated by family members (very positive attitude expressed by over 90% of participants and satisfaction from nursing services approaches 100%. Conclusion: The implementation of quality systems in healthcare organizations is not easy and has many dimensions. However, it offers competitive advantage, improves the efficiency and effectiveness of the health care service providers and substantially contributes to the improvement of the delivered heath care.

  11. A General Procedure to Assess the Internal Structure of a Noncognitive Measure--The Student360 Insight Program (S360) Time Management Scale. Research Report. ETS RR-11-42

    Science.gov (United States)

    Ling, Guangming; Rijmen, Frank

    2011-01-01

    The factorial structure of the Time Management (TM) scale of the Student 360: Insight Program (S360) was evaluated based on a national sample. A general procedure with a variety of methods was introduced and implemented, including the computation of descriptive statistics, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).…

  12. Study on General Pattern and Path of Supply Chain Management Progress and Innovation%供应链管理进步一般规律与创新路径

    Institute of Scientific and Technical Information of China (English)

    黄彦领

    2015-01-01

    In this paper, on the basis of summarizing the general pattern of the development and innovation of the management science concluded in previous researches and from the aspects of object, method, instrument and perspective, we introduced the pattern for the progress of the supply chain management science and then presented the general path for the innovation of the corporate supply chain management practice.%在前人归纳的管理科学发展创新的一般规律基础上,从管理对象、管理方法、管理工具、管理视角四大方面论述了供应链管理进步的规律,从而给出了企业供应链管理创新的一般路径。

  13. General Dentist

    Science.gov (United States)

    ... Some general dentists work in government health services, research programs, higher education, corporations and even the military. ?xml:namespace> What kind of procedures do general dentists provide? ?xml:namespace> Many general dentists are ...

  14. 工业建设项目工程总承包施工管理探讨%Investigation on construction management of general contracting in industrial construction projects

    Institute of Scientific and Technical Information of China (English)

    董达; 金锋

    2013-01-01

    随着EPC工程总承包模式在工程建设领域的应用,工程总承包逐渐成为工程建设企业的一项主营业务.而施工管理作为EPC总承包中重要一环,也越来越多地引起关注和重视.本文从工程总承包商的角度,探讨了工业建设项目工程总承包的施工管理工作;从质量、进度、职业健康安全/环境和费用四个方面对总承包商施工管理的主要问题进行了归纳分析;并对工程总承包商的施工管理给出整合、规划、监控、质量/职业健康安全/环境和组织过程资产五个方面的改进建议,为工程总承包的有效管理提供参考.%General Contracting has gradually become a main business of construction enterprises with the application of the general contracting mode in the field of engineering construction.Construction management,which is an important part of general contracting,has attracted more and more attention.The construction management of industrial construction project general contracting is discussed from the perspective of general contractors.Main problems of construction management are analyzed in the four aspects of quality,schedule,HSE and cost.The five proposals for improvements in construction management,which are given to general contractors,are integration,planning,monitoring,QHSE,and organizational process asset.

  15. General aspects of quality management applicable to R and D and I groups and laboratories; Aspectos generales de sistemas de gestion de la calidad aplicables a laboratorios y grupos de I+D+i

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez Espartero, A.; Gonzalez Leiton, A.; Hernandez Tapia, J. P.

    2013-07-01

    In organizations such as CIEMAT that focus on Research, Development and Innovation, it is increasingly important to establish quality parameters, both in scientific and technological work and in the management activities that support and enable R and D and I activities, in order to increase the organizations own and customer confidence in the results obtained and to optimize the material and human costs by reducing errors. In the particular case of laboratories dedicated to calibration and analysis activities, the implementation of a Quality Management System ensures that the laboratory results will be consistent and reproducible over time and have a known associated uncertainty. (Author)

  16. Discussion on general contracting enterprise in architectural engineering to subcontractors management%谈总承包企业在建筑工程中对分包单位的管理

    Institute of Scientific and Technical Information of China (English)

    李俊伟

    2015-01-01

    From the safety,quality,progress three aspects,this paper researched the management measures of general contracting enterprise in architectural engineering to subcontractors,elaborated in detail the matters needing attention in subcontractors management,in order to strengthen the management to subcontractors in project management,so as to realize the economic efficiency of enterprises.%从安全、质量、进度三方面着手,研究了总承包企业在建筑工程中对分包单位的管理措施,对各分项管理工作中的注意事项进行了详细阐述,以期在项目管理中加强对分包单位的管理,从而实现企业的经济效益。

  17. A general risk-based adaptive management scheme incorporating the Bayesian Network Relative Risk Model with the South River, Virginia, as case study.

    Science.gov (United States)

    Landis, Wayne G; Markiewicz, April J; Ayre, Kim K; Johns, Annie F; Harris, Meagan J; Stinson, Jonah M; Summers, Heather M

    2017-01-01

    Adaptive management has been presented as a method for the remediation, restoration, and protection of ecological systems. Recent reviews have found that the implementation of adaptive management has been unsuccessful in many instances. We present a modification of the model first formulated by Wyant and colleagues that puts ecological risk assessment into a central role in the adaptive management process. This construction has 3 overarching segments. Public engagement and governance determine the goals of society by identifying endpoints and specifying constraints such as costs. The research, engineering, risk assessment, and management section contains the decision loop estimating risk, evaluating options, specifying the monitoring program, and incorporating the data to re-evaluate risk. The 3rd component is the recognition that risk and public engagement can be altered by various externalities such as climate change, economics, technological developments, and population growth. We use the South River, Virginia, USA, study area and our previous research to illustrate each of these components. In our example, we use the Bayesian Network Relative Risk Model to estimate risks, evaluate remediation options, and provide lists of monitoring priorities. The research, engineering, risk assessment, and management loop also provides a structure in which data and the records of what worked and what did not, the learning process, can be stored. The learning process is a central part of adaptive management. We conclude that risk assessment can and should become an integral part of the adaptive management process. Integr Environ Assess Manag 2017;13:115-126. © 2016 SETAC.

  18. Polish and European management strategies in patients with atrial fibrillation. Data from the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot).

    Science.gov (United States)

    Lenarczyk, Radosław; Mitręga, Katarzyna; Mazurek, Michał; Janion, Marianna; Opolski, Grzegorz; Drożdż, Jarosław; Streb, Witold; Fuglewicz, Artur; Sokal, Adam; Laroche, Cécile; Lip, Gregory Y H; Kalarus, Zbigniew

    2016-01-01

    Despite continued efforts of the European Society of Cardiology (ESC) to unify management of patients with atrial fibrillation (AF) across Europe, interregional differences in guideline adherence are likely. The aim of the study was to compare treatment strategies depending on baseline characteristics of AF patients between Poland and other members of the European Union (EU). We analyzed the baseline data and treatment strategies in participants of the ESC registry: the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase. A total of 3119 consecutive patients with AF diagnosed within the last year were included in 67 centers from 9 countries, including 419 patients enrolled in 15 Polish centers. A rhythm control strategy was more frequent in Poland than in other EU countries (20.8% vs 11.9%; P <0.0001). Catheter ablation for AF was also used more frequently in Polish cardiology wards (13.9% vs 8.3%; P = 0.0017), while amiodarone at discharge was used less frequently (12.0% vs 22.7%; P <0.0001). In-hospital use of vitamin K antagonists (VKAs) and non-VKA anticoagulants was less frequent in Polish patients with a CHA2DS2-VASc score of 2 or higher than in patients from other EU countries (61.1% vs 79.0%; P <0.0001), but overall anticoagulation rates at discharge were similar to those in other countries (83.3% vs 82.6%). A rhythm control-oriented strategy in patients with AF with the use of ablation in cardiology wards is more frequent in Poland than in other EU countries. Similar to other EU countries, compliance with the ESC guidelines regarding anticoagulation in AF patients is suboptimal in Poland. Undertreatment was observed in a significant proportion of patients at high risk of stroke, while a large group of low-risk patients are overtreated. Differences between the types of recruiting centers in Poland and other EU countries might have influenced the results.

  19. Comprehensive Risk Management of General Contractor of Hydropower EPC Project%水电工程EPC项目总承包商全面风险管理研究

    Institute of Scientific and Technical Information of China (English)

    张建成; 彭反霸

    2011-01-01

    From the characteristics of EPC, this paper introduces the risk features of EPC mode and describes the connotation of comprehensive risk management. And then the risk of general contractor is analyzed from the perspective of comprehensive risk management. Finally, it sets up scientific, systemic and dynamic flowchart for general contractor controlling risk and integration mode of comprehensive risk management. Thus, it provides reference for general contractor managing the risk.%从EPC总承包模式的特点出发,介绍了EPC项目风险的特点,阐述了全面风险管理的内涵,从总承包商的视角利用全面风险管理理论分类分析了总承包商风险,并建立了科学、系统、动态的总承包商风险控制流程图及全面风险管理集成模式,可为总承包商进行风险管理提供参考.

  20. Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial.

    NARCIS (Netherlands)

    Perry, M.; Draskovic, I.; Achterberg, T. van; Borm, G.F.; Eijken, M.I.J. van; Lucassen, P.; Vernooij-Dassen, M.J.F.J.; Olde Rikkert, M.G.M.

    2008-01-01

    BACKGROUND: Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and

  1. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study.

    NARCIS (Netherlands)

    Kwok, W.Y.; Kwaadsteniet, M.C. de; Harmsen, M.; Suijlekom-Smit, L.W. van; Schellevis, F.G.; Wouden, J.C. van der

    2006-01-01

    BACKGROUND: We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. METHOD: During one calendar year, 195 general prac

  2. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study.

    NARCIS (Netherlands)

    Kwok, W.Y.; Kwaadsteniet, M.C.E. de; Harmsen, M.; Suijlekom-Smit, L.W.A. van; Schellevis, F.G.; Wouden, J.C. van der

    2006-01-01

    Background: We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. Method: During one calendar year, 195 general prac

  3. Practice of the Construction of Hospital Management Ethics in a General Hospital%某综合医院在医院管理伦理的做法

    Institute of Scientific and Technical Information of China (English)

    唐月红; 陈瑛瑛; 石慧; 姚华

    2016-01-01

    Hospital management ethics is a management model that has been developed in recent years . This paper reviews domestic and overseas researches on hospital management ethics , introduces the current situation of ethics establishment in hospital management , and analyzes problems and challenges in hospital management eth-ics.The key finding of this paper is that many scholars have proposed an expanding ethics management model , which covers research ethics , clinic ethics and management ethics .This paper also introduces some practices of the First Affiliated Hospital of Xinjiang Medical University .Finally, the paper puts forward some strategies and meas-ures to improve the establishment and improvement of hospital management ethics .%医院管理伦理是近年来发展起来的管理方式,从国内外学者关于医院管理伦理的研究情况、医院管理在伦理建设方面的基本现状、存在的问题进行分析,并发现有学者提出医院管理“大伦理”的管理模式:即涵盖研究伦理、临床伦理、管理伦理三方面;同时,介绍作者所在医院的几点做法。在文章的最后,作者提出关于提升医院管理伦理建设水平的对策。

  4. Research on dynamics mechanism and mode of general aviation safety management system self-organizing evolvement%通用航空安全体系自组织演化动力学机制与模式研究

    Institute of Scientific and Technical Information of China (English)

    许红军; 田俊改

    2012-01-01

    建立符合通用航空发展规律的通用航空安全管理理论体系,是通用航空发展的前提.本文以通用航空发展特点为基础,应用自组织理论对通用航空发展的组织特性进行了分析,研究了通用航空安全体系自组织生成模式的前提条件和动因,剖析了通用航空安全体系自组织演化的内外部动力因素,以及其相互作用方式和过程,从而解构出通用航空安全体系自组织演化的动力学机制—涨落机制、创新机制、选择机制和学习机制,在此基础上,构建了通用航空安全体系自组织演化动力学模型.最后,结合实际对我国通用航空安全管理体系建设提出了相应的建议.%To establish a comprehensive and effective safety management system is a prerequisite for sustainable development of general aviation. In this paper,based on self-organizing theory, the organization characters of general aviation were analyzed. Then, the prerequisite for general aviation safety management system evolvement was studied and the exterior and interior dynamics factors which drive the self-organizing evolvement of general aviation safety management system were analyzed, as well as their interaction mechanism and process, thereby the dynamics mechanism of the general aviation safety management system evolvement were deconstructed which included fluctuating mechanism, invocation mechanism, choosing mechanism and learning mechanism. Finally, some suggestions were put forward to develop the general aviation safety management system.

  5. Study of General Awareness, Attitude, Behavior, and Practice Study on Dog Bites and its Management in the Context of Prevention of Rabies Among the Victims of Dog Bite Attending the OPD Services of CHC Muradnagar

    OpenAIRE

    Jain, Piyush; Jain, Garima

    2014-01-01

    Objectives: This is a recent study conducted during 15th September 2013 to 15th December 2013 at the community health centre (CHC), Muradnagar, distt Ghaziabad, among the victims of dog/animal bite attending the daily OPD services of CHC. To identify the level of general awareness and knowledge of wound management and rabies among the cases of dog bite and to study the awareness of people about antirabies vaccines and health service utilization. Methods: The study population composed of 250 v...

  6. 关于企业通用行政管理业务流程的探讨%Discussion of general administrative management of enterprise business processes

    Institute of Scientific and Technical Information of China (English)

    陈夏仙; 张小琴; 张海波

    2013-01-01

    本文阐述流程的定义以及流程管理对企业的意义.详细描述行政管理的概念,行政管理中业务流程的分类及其相关的关键流程.对流程建模的主要方法与步骤,如何通过业务流程管理来加强企业的行政管理方面进行了探讨和研究.%The definition of the process and the significance of the process management of the enterprise were described in the paper.It was a detailed description of the concept of administrative management,the classification of business process and the related key process in administrative management.The main methods and steps of the process modeling were also discussed.Finally,the paper studied on how to strengthen the administrative management of enterprise by the management of business process.

  7. INVESTIGATING THE MANAGEMENT OF CARIOUS PRIMARY TEETH IN GENERAL DENTAL PRACTICE: AN OVERVIEW OF THE DEVELOPMENT AND CONDUCT OF THE FICTION TRIAL.

    Science.gov (United States)

    Stewart, Matthew; Keightley, Alexander; Maguire, Anne; Chadwick, Barbara; Vale, Luke; Homer, Tara; Douglas, Gail; Deery, Chris; Marshman, Zoe; Ryan, Vicky; Innes, Nicola

    2015-11-01

    The management of carious primary teeth is a challenge for patients, parents and clinicians. Most evidence supporting different management strategies originates from a specialist setting and therefore its relevance to the primary care setting is questionable. The UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) has commissioned the FiCTION (Filling Children's Teeth: Indicated Or Not?) trial; a multi-centre primary dental care randomised controlled trial (RCT) to determine the most clinically and cost- effective approach to managing caries in the primary dentition in the UK. This large trial began in 2012, is due to be completed in late 2017 and involves 72 practices and 1,124 children initially aged three to seven years with dentine caries, following randomisation to one of three caries management strategies. Clinical, radiographic, quality of life, treatment acceptability and health economics data are collected during the three-year follow up period. This article provides an overview of the development and conduct of FiCTION and discusses some approaches adopted to manage challenges and achieve the patient recruitment target.

  8. Churn management as a general corporate strategy of electric utilities. Preventive action against customers' propensity to change supplier; Churn Management als strategische Gesamtaufgabe. Wechselpraevention und Kundenrueckgewinnung in EVU

    Energy Technology Data Exchange (ETDEWEB)

    Doehrer, A.; Fausten, D. [ConEnergy AG, Essen (Germany). Beratung fuer Energiewirtschaft

    2000-02-01

    Given the current dynamics of the market in electricity, it sometimes happens that an important management strategy in the competitive market, namely that of competitive account management, is pushed into background. The contribution here explains why it is so important to conceive strategic marketing planning as a task equal to operative planning. In handling the day-to-day operations, churn management along with account development are major business management tasks. (orig./CB) [German] Im turbulenten Tagesgeschaeft der EVU geht die strategische Komponente der Beziehung zum Kunden oft etwas unter. Der Geschaeftserfolg wird aber laengerfristig davon abhaengen, ob und wie es gelingt, das eine (operatives Geschaeft) zu tun, ohne das andere (marketingstrategische Ausrichtung) zu lassen. Tagesgeschaeft, d.h. momentan, den harten Weg der Neukundenakquisition gehen und versuchen, das (Preis-)Begehren aktueller Kunden zu erfuellen. Im angloamerikanischen Raum wird der Umgang mit den Anbieterwechslern mit dem Begriff 'Churn Management' umschrieben. (orig./CB)

  9. Managing work-related psychological complaints by general practitioners, in coordination with occupational physicians: A pilot Study - Developing and testing a guideline

    NARCIS (Netherlands)

    Buijs, P.C.; Dijk, F.J.H. van; Evers, M.; Klink, J.J.L. van de; Anema, H.

    2007-01-01

    Increasingly, workers have psychological work-related complaints, endangering their work ability and causing considerable economic losses. Many employees consult their general practitioner (GP). He, however, often pays insufficient attention to work-relatedness or to coordination with occupational p

  10. “大档案”理念下的开发区档案管理模式研究--以苏州工业园区档案管理中心为例%Research on the Management Mode of Archives of Development Districts under the Idea of"General Archive"-Case Study on Suzhou Industrial Park Archives Management Center

    Institute of Scientific and Technical Information of China (English)

    李倢; 项文新

    2014-01-01

    开发区不同于一般的行政区域,因此其档案管理模式需适应开发区行政管理体制与机制。本文探讨在“大档案”理念下既能体现开发区精简、统一、高效的行政管理体制,又有利于发挥开发区档案工作效能的档案管理模式,并以苏州工业园区档案管理中心为例,剖析开发区“大档案”管理模式的实际运作情况,最后介绍“SIP(Suzhou Industrial Park)大档案管理模式”在我国的推广应用。%Development districts are different from normal administrative districts,so their management mode of archives needs to adapt to the system and mechanism of the administrative management of the development districts. This paper discusses the management mode of archives under the idea of"General Archive"that will demonstrate the simplifi-cation,unification and efficiency of the system of the administrative management of the development districts,as well as help to perform their effectiveness of archive work. Using the case study of Suzhou Industrial Park Archives Management Center,this paper analyses the actual situation of operation with the management mode of"General Archive"of the de-velopment districts. Last,this paper introduces the popularization and application of the"SIP General Archive Manage-ment Mode"in China.

  11. Discussion on safety management of nuclear power engineering in general contracting mode%总承包模式下核电工程安全管理相关问题探讨

    Institute of Scientific and Technical Information of China (English)

    赵显; 刘勃

    2014-01-01

    The characteristics of safety management on nuclear power engineering in general contracting mode, which were different from the common construction projects, were analyzed.Then the main problems in current safety management of nuclear power engineering construction were put forward, such as lagging of relevant laws and regulations, the contradiction between expansion of nuclear power construction project and lack of human resources, the labor subcontracting system and safety problems brought by its working personnel, and passive regulation of safety production costs etc.These problems would directly impact the existing work safety defense line, and bring unprecedented challenge to safety management work of general contractor.So the suggestions and countermeasures were put forward, including that the relevant government departments should publish the relevant laws and regula-tions about general contracting of project as soon as possible, the general contractor should fully integrate on-site safety management resources, strengthen the safety management on subcontractors, strengthen safety training of the labor service personnel, and explore the management mode of work safety costs.%首先分析了总承包模式下核电工程建设不同于一般建设工程安全管理的特点,提出目前工作中存在的主要问题,包括相关法律法规的滞后、核电建设工程扩张与人力资源不足之间的矛盾、劳务分包体制及其作业人员引起的相关问题以及安全生产费用监管被动等,这些都直接冲击现有的安全生产防线,并给总承包单位安全管理工作带来前所未有的挑战。为此,提出以下建议和对策措施:有关部门尽快出台总承包工程相关法律法规;总承包单位应充分整合现场安全管理资源,加大对分包单位安全管理力度,加强劳务作业人员安全培训,探索安全生产费用管理模式等。

  12. The Sophia-Antipolis Conference: General presentation and basic documents. [remote sensing for agriculture, forestry, water resources, and environment management in France

    Science.gov (United States)

    1980-01-01

    The procedures and techniques used in NASA's aerospace technology transfer program are reviewed for consideration in establishing priorities and bases for joint action by technicians and users of remotely sensed data in France. Particular emphasis is given to remote sensing in agriculture, forestry, water resources, environment management, and urban research.

  13. Interest of general tools of functional simulation in the idea of `mecatronic` groups: an application to energy management of hybrid vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Esteve, D.; Jammes, B.; Vinassa, J.M.; Marpinard, J.C.

    1994-04-01

    This report is a first approach of the simulation to validate the structure of the traction chain of a hybrid vehicle. This first step relies on the use of existing models in libraries of simulation programs. The next steps are going to consist in improving these models, in writing others one more performing and to test this simulation about energy management. (N.C.).

  14. Application of General- sub Account Mode in Fund Centralized Management in Enterprise Group%企业集团资金集中管理总分账户模式的应用

    Institute of Scientific and Technical Information of China (English)

    邓群伟

    2012-01-01

    Fund centralized management can improve fund management capacity, heighten fund service eflqciency, which has become the main trend of fund management in enterprise group. Through comparative analysis of fund centralized management mode, we have come to the conclusion that generalsub account mode meets necessary requirement of development of fund centralized management in giant enterprise group. We studied cause, principle, operation mode and special features of fund centralized management in the process of implementation of fund centralized management in giant enterprise group, taking financial corporation as the plat, depending on business bank network system, in terms of innovation mode of general sub account.%资金集中管理,可以增强资金管理能力,提高资金使用效率,目前已经成为企业集团资金管理的主流方式。通过对资金集中管理模式的比较分析,得出总分账户模式是适应特大型企业集团资金集中管理发展必然要求的结论。探讨特大型企业集团在实施资金集中管理过程中,以财务公司为平台,依托商业银行网络系统,借助总分账户这一创新模式进行资金集中管理的成因、原理、运行方式及特点。提出进一步完善总分账户模式的建议。

  15. Generalized product

    OpenAIRE

    Greco,Salvatore; Mesiar, Radko; Rindone, Fabio

    2014-01-01

    Aggregation functions on [0,1] with annihilator 0 can be seen as a generalized product on [0,1]. We study the generalized product on the bipolar scale [–1,1], stressing the axiomatic point of view. Based on newly introduced bipolar properties, such as the bipolar increasingness, bipolar unit element, bipolar idempotent element, several kinds of generalized bipolar product are introduced and studied. A special stress is put on bipolar semicopulas, bipolar quasi-copulas and bipolar copulas.

  16. Generalized product

    OpenAIRE

    Greco, Salvatore; Mesiar, Radko; Rindone, Fabio

    2014-01-01

    Aggregation functions on [0,1] with annihilator 0 can be seen as a generalized product on [0,1]. We study the generalized product on the bipolar scale [–1,1], stressing the axiomatic point of view. Based on newly introduced bipolar properties, such as the bipolar increasingness, bipolar unit element, bipolar idempotent element, several kinds of generalized bipolar product are introduced and studied. A special stress is put on bipolar semicopulas, bipolar quasi-copulas and bipolar copulas.

  17. 41 CFR 101-27.101 - General.

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true General. 101-27.101 Section 101-27.101 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 27-INVENTORY MANAGEMENT 27.1-Stock...

  18. A GIS-based decision support tool for renewable energy management and planning in semi-arid rural environments of northeast of Brazil-general description and methodology

    Energy Technology Data Exchange (ETDEWEB)

    Tiba, Chigueru; Fraidenraich, Naum; Souza Barbosa, Elielza Moura de [Dept. de Energia Nuclear da Univ. Federal de Pernambuco Recife, Pernambuco (Brazil); Bezerra Candeias, Ana Lucia [Dept. de Engenharia Cartografica da Univ. Federal de Pernambuco Recife, Pernambuco (Brazil); Carvalho Neto, Pedro Bezerra de; Melo Filho, Jose Bione de [Companhia Hidro Electrica do Sao Francisco -DTG- CHESF Recife, Pernambuco (Brazil)

    2008-07-01

    This work describes the development of a system of management and planning elaborated on a GIS platform (Geographic Information System) and is directed to decision makers, be they administrators, planners or consultants in renewable energy. It was conceived to deal with the management and planning of photovoltaic solar systems, biomass and aeolic energy in rural regions of the Northeast of Brazil. The prototype of the GIS tool covers an area of 183,500 km{sup 2} (in a second phase it will be extended to 1,561,178 km{sup 2}) and it is made up of two main blocks: management of installed renewable energy systems and planning of insertion of new renewable energy systems. The system was mainly developed for PV systems as a possible tool of support for the management and planning of the Program of Energetic Development of the States and Municipalities (PRODEEM), a program of insertion of large scale photovoltaic solar energy (thousands of systems), in the rural environment, directed by the Ministry of Mines and Energy of Brazil. The tool for the management of the photovoltaic systems permits the execution of the technical analyses that are involved in the different combinations of the following layers of information: PV systems installed for the purpose of application (energetic, water pumping and others), identification of systems components, identification of component failures, maintenance and training posts, map of monthly mean solar irradiation, infrastructure access, electric transmission lines and distance from a given municipality to the nearest maintenance post. All the maps above can be combined in such a way that information at state or municipal level can be obtained. Additionally, in all the circumstances above, resulting thematic maps as well as issue reports can be printed. The tool for planning the insertion of new photovoltaic systems permits the execution of the technical analyses that are involved in the different combinations of the following layers

  19. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study.

    NARCIS (Netherlands)

    W.Y. Kwok (Wing-Yee); M.C. Kwaadsteniet (Marjolein); M. Harmsen (Mirjam); L.W.A. van Suijlekom-Smit (Lisette); F.G. Schellevis (François); J.C. van der Wouden (Hans)

    2006-01-01

    textabstractBACKGROUND: We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. METHOD: During one calendar year, 195

  20. Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care: a qualitative study

    NARCIS (Netherlands)

    Biezen, M.G. van der; Derckx, E.; Wensing, M.; Laurant, M.G.

    2017-01-01

    BACKGROUND: Due to the increasing demand on primary care, it is not only debated whether there are enough general practitioners (GPs) to comply with these demands but also whether specific tasks can be performed by other care providers. Although changing the workforce skill mix care by employing Phy

  1. Exploration on Teaching Management in General Hospital%综合医院教学管理工作的探讨

    Institute of Scientific and Technical Information of China (English)

    白琳茹

    2014-01-01

    临床实习教育是临床医学专业人才培养的重要教学阶段,其水平的高低、质量的好坏直接影响医学教育质量和医学人才的培养质量,而临床教学医院的管理方法是指导临床实习教育的重要部分。本文探讨规范实习生教学管理,提高临床教学质量的措施和途径。从健全教学管理机制、规范教学管理程序和改革教学方法,调动教学双方的积极性两方面,就临床教学医院如何保障和提高实习教学质量进行了初步的探索和实践。%Clinical practicum is an important teaching stage of training professional personnel and its quality will exert direct impact on the quality of medical education as well as medical personnel. The management of clinical teaching in hospital plays a key role in guiding clinical practicum. This article explored how to standardize the practicum teaching management and improve the quality of clinical teaching. The author conducted a preliminary exploration and practice of that how clinical teaching hospitals protect and improve the teaching quality from the perspectives of the teaching management system improvement, standardizing management procedures and teaching methods reform as well as mobilizing enthusiasm of both teachers and students.

  2. Discussion of facilities management as an academic discipline: To what extent are the general requirements met and what does it mean?

    OpenAIRE

    Junghans, Antje; Olsson, Nils

    2014-01-01

    Purpose – The purpose of this paper is to explore what an academic discipline is and to apply and discuss this definition using facilities management as an example. The paper addresses an academic world that is facing the challenge of developing research and education in response to emerging disciplines and dealing with changes in the higher education system. Institutions are also confronted with the aim of the European Commission to “enhance the performance and international ...

  3. Waste Management: DOD Has Generally Addressed Legislative Requirements on the Use of Burn Pits but Needs to Fully Assess Health Effects

    Science.gov (United States)

    2016-09-01

    Health Effects Report to Congressional Committees September 2016 GAO-16-781 United States Government Accountability Office...United States Government Accountability Office Highlights of GAO-16-781, a report to congressional committees September 2016 WASTE MANAGEMENT...on the results of its review in March 2016. Section 313 also includes a provision for GAO to assess DOD’s report and its compliance with

  4. Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial

    OpenAIRE

    Lucassen PL; van Eijken MIJ; Borm GF; van Achterberg T; Drašković I; Perry M; Vernooij-Dassen MJFJ; Olde Rikkert MGM

    2008-01-01

    Abstract Background Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff. However, none of these interventions focussed on collaboration between GPs and nurses in dementia care. We developed an EASYcare-bas...

  5. On General Management of Geological Archives%如何做好地质档案的全面管理工作

    Institute of Scientific and Technical Information of China (English)

    张艳霞

    2012-01-01

    地质勘探单位的地质档案是记录历来地质信息的有效载体,随着社会的发展进步及地质勘探方面的快速发展,地质档案的管理工作任务量、责任也越来越大,对地质档案管理的工作越来越重要.本文就地质档案管理的现状、问题及如何做好现代信息化地质档案全面管理的工作进行分析探讨.%Geological archives of geological exploration are effective carriers recording historical geological information. With the development and progress of the society and the rapid development of geological exploration aspects, geological archives management work task quantity and responsibility also become more and more big, and more and more important to the work pf geological archives management work. This paper discusses the present situation, problems, and how to do well modern and information geological archives management.

  6. "The General Requirement About the Management of Electronic Records"--MoReq%《电子文件管理通用需求》--MoReq

    Institute of Scientific and Technical Information of China (English)

    于丽娟

    2003-01-01

    电子文件管理的各项研究及其成果,大多数都将落实到以软件为核心的解决方案上.国际范围内已出台了一系列电子文件管理系统需求标准和报告.在同类需求标准或报告中,MoReq是最具通用色彩的一个,同时也最先提倡将电子文档管理系统EDMS(Electronic Document Management System)和电子文件管理系统ERMS(Electronic Record Management System)进行集成的需求报告.本文将对欧盟2∞1年5月推出的(Model Requirements for the Management of ElectronicRecords,MoReq)进行介绍,内容涉及:报告的制定过程、主要内容、特点、社会影响等.

  7. Generalized Data Management Model of Smart Grid Based on Ontology Theory%基于本体理论的智能电网广义数据管理模型

    Institute of Scientific and Technical Information of China (English)

    黄彦浩; 周孝信

    2014-01-01

    In order to automatically acquire generalized data,a kind of generalized data management model used for intelligent processing is studied.Confronted with the multiple types and complex structure of generalized data,the management model achieves its purpose by establishing the internal relations between different generalized data,while the storage,analysis and use of generalized data are handed over to the corresponding application systems.As the relationship between the generalized data is complex and varied,the existing power grid knowledge modeling methods are incapable of meeting its requirements.Based on the ontology theory and semantic web technology,the logical basis of the model structure and various components,and the ways of modeling and application are discussed.The effect of using the model is shown through a case study to be applicable to many kinds of heterogeneous power grid data resource management and retrieval and easily expanded.%针对广义数据自动获取问题,研究了可用于智能化处理的广义数据管理模型。广义数据类型多样、结构复杂,管理模型通过建立不同广义数据间的内在联系达到将其纳入管理的目的,而对广义数据的存储、解析和利用则交由相应的应用系统负责。广义数据间的联系复杂多样,现有的电网知识模型不能满足对其建模、应用的要求。因此,以本体和语义网技术为基础,研究了该模型的逻辑基点、结构和各级构件,并讨论了其建模和应用方式,最后通过一个案例说明了该模型的使用效果。研究表明,该模型可用于电网多类型异构数据资源的管理和获取,并具备良好的可扩展性。

  8. How to Strengthen General Management of Foreign Economic Aid Projects%如何加强对国外经济援助项目的综合管理

    Institute of Scientific and Technical Information of China (English)

    弋丹

    2011-01-01

    为加强对国外经济援助项目的综合管理,优质高效地完成经济援助项目,在项目实施前,要择优选定实施企业,选派具有施工管理经验和资质条件的各类主要管理人员;在项目实施过程中,要建立责、权、利相结合的激励机制,以物资供应、工期、安全和质量为管理重点,厉行合同。%To strengthen the general management of foreign economic aid project and finish them efficiently and with high quality,we should chose excellent implement enterprises and appoint main management personnel with construction management experience and qualifications before project execution.In the process of project execution,we should establish incentive mechanism containing responsibility,right and interest,view material supply,construction period,safety and quality as management point and execute the contract strictly.

  9. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study

    Science.gov (United States)

    Kwok, Wing-Yee; de Kwaadsteniet, Marjolein CE; Harmsen, Mirjam; van Suijlekom-Smit, Lisette WA; Schellevis, François G; van der Wouden, Johannes C

    2006-01-01

    Background We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. Method During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their patient contacts. This study was performed by the Netherlands Institute for Health Services Research (NIVEL) in 2001. Of 82,053 children aged 0 to 18 years, the following variables were collected: number of episodes per patient, number of contacts per episode, month of the year in which the diagnosis of urinary tract infection was made, age, gender, urbanisation level, drug prescription and referral. Results The overall incidence rate was 19 episodes per 1000 person years. The incidence rate in girls was 8 times as high as in boys. The incidence rate in smaller cities and rural areas was 2 times as high as in the three largest cities. Throughout the year, incidence rates varied with a decrease in summertime for children at the age of 0 to 12 years. Of the prescriptions, 66% were in accordance with current guidelines, but only 18% of the children who had an indication were actually referred. Conclusion This study shows that incidence rates of urinary tract infections are not only related to gender and season, but also to urbanisation. General practitioners in the Netherlands frequently do not follow the clinical guidelines for urinary tract infections, especially with respect to referral. PMID:16584577

  10. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study

    Directory of Open Access Journals (Sweden)

    Schellevis François G

    2006-04-01

    Full Text Available Abstract Background We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. Method During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their patient contacts. This study was performed by the Netherlands Institute for Health Services Research (NIVEL in 2001. Of 82,053 children aged 0 to 18 years, the following variables were collected: number of episodes per patient, number of contacts per episode, month of the year in which the diagnosis of urinary tract infection was made, age, gender, urbanisation level, drug prescription and referral. Results The overall incidence rate was 19 episodes per 1000 person years. The incidence rate in girls was 8 times as high as in boys. The incidence rate in smaller cities and rural areas was 2 times as high as in the three largest cities. Throughout the year, incidence rates varied with a decrease in summertime for children at the age of 0 to 12 years. Of the prescriptions, 66% were in accordance with current guidelines, but only 18% of the children who had an indication were actually referred. Conclusion This study shows that incidence rates of urinary tract infections are not only related to gender and season, but also to urbanisation. General practitioners in the Netherlands frequently do not follow the clinical guidelines for urinary tract infections, especially with respect to referral.

  11. A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry.

    Science.gov (United States)

    Lip, Gregory Y H; Laroche, Cécile; Dan, Gheorghe-Andrei; Santini, Massimo; Kalarus, Zbigniew; Rasmussen, Lars Hvilsted; Oliveira, Mário Martins; Mairesse, Georges; Crijns, Harry J G M; Simantirakis, Emmanouil; Atar, Dan; Kirchhof, Paulus; Vardas, Panos; Tavazzi, Luigi; Maggioni, Aldo P

    2014-03-01

    Given the advances in atrial fibrillation (AF) management and the availability of new European Society of Cardiology (ESC) guidelines, there is a need for the systematic collection of contemporary data regarding the management and treatment of AF in ESC member countries. We conducted a registry of consecutive in- and outpatients with AF presenting to cardiologists in nine participating ESC countries. All patients with an ECG-documented diagnosis of AF confirmed in the year prior to enrolment were eligible. We enroled a total of 3119 patients from February 2012 to March 2013, with full data on clinical subtype available for 3049 patients (40.4% female; mean age 68.8 years). Common comorbidities were hypertension, coronary disease, and heart failure. Lone AF was present in only 3.9% (122 patients). Asymptomatic AF was common, particularly among those with permanent AF. Amiodarone was the most common antiarrhythmic agent used (∼20%), while beta-blockers and digoxin were the most used rate control drugs. Oral anticoagulants (OACs) were used in 80% overall, most often vitamin K antagonists (71.6%), with novel OACs being used in 8.4%. Other antithrombotics (mostly antiplatelet therapy, especially aspirin) were still used in one-third of the patients, and no antithrombotic treatment in only 4.8%. Oral anticoagulants were used in 56.4% of CHA2DS2-VASc = 0, with 26.3% having no antithrombotic therapy. A high HAS-BLED score was not used to exclude OAC use, but there was a trend towards more aspirin use in the presence of a high HAS-BLED score. The EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot Registry has provided systematic collection of contemporary data regarding the management and treatment of AF by cardiologists in ESC member countries. Oral anticoagulant use has increased, but novel OAC use was still low. Compliance with the treatment guidelines for patients with the lowest and higher stroke risk scores remains suboptimal.

  12. The contribution of quality to health services. Application of the quality management system ISO 9001:2008 in Intensive Care Unit of the General Hospital of Larissa

    OpenAIRE

    Dimitrios Patsios; Apostolos Komnos; Charilaos Apostolidis; Anastasia Mpalasopoulou

    2014-01-01

    In our country there have been many efforts in recent years to introduce laws that lead to the introduction of the concept of quality in the field of public hospitals. The implementation of health quality systems contributes to health care improvement, while the assessment of quality services is a basic tool in quality management. Purpose: The purpose of the study was to describe the benefits that can be gained by a public institute of health when a quality model is applied. Material and meth...

  13. The Research on risk Management of the Design-Build General Contracting Construction Projects%在设计-施工总承包建设项目中风险管理的研究

    Institute of Scientific and Technical Information of China (English)

    董章增

    2009-01-01

    Design-Build general contracting construction project risk management is an international construction project organization and implementation method.Only by understanding the risk can we better manage risk, through risk identification, assessment, prevention and control, we can maximize the capital-output.%设计-施工总承包建设项目风险管理是国际通行的工程建设项目组织实施方式.只有了解风险才能更好的管理风险,通过风险识别、评估、防范扣控制,达到资本产出最大化.

  14. Study on Engineering General Contract Management Mode for Superhigh-rise Steel Structure%超高层钢结构工程总承包项目管理模式研究

    Institute of Scientific and Technical Information of China (English)

    马昕; 卜楠楠; 田伟强

    2011-01-01

    By contrasting and analyzing of theory and engineering practice, the key controlling factors of engineering general contract management for super-high-rise steel structure are analyzed for the aspect of summarizing construction enterprise' s experience, such as setting out of organization structure, analysis of key construction technologies, engineering period, quality and safety.The engineering general contract management mode for super-high-rise steel structure adapting to China is discussed.For the super-highrise steel structure of Tianjin Jin Tower project and International Business Phase Ⅲ contracted by China Construction First Division Group Construction & Development Co., Ltd.as example, the authors introduce in detail the characteristics, integrate organization flew and key controlling factors of EPC general contract management.%通过理论与实际对比与分析,从总结施工企业实践的角度剖析超高层钢结构工程总承包管理的关键控制要素,如超高层钢结构管理组织机构设置、关键施工技术分析、工期、质量、安全等关键控制要素,探讨适合中国国情的超高层钢结构工程总承包管理模式.以中建一局集团建设发展有限公司承包的国贸三期和天津津塔超高层钢结构总承包为例,详细介绍了EPC总承包管理模式的特点、整体组织流程以及关键要素.

  15. Conflict Management.

    Science.gov (United States)

    Fisher, William; Koue, Glen

    1991-01-01

    Discusses general issues involved in conflict management and provides more specific examples of conflict management in libraries. Causes of conflict are considered, including organizational structure, departmentalization, performance appraisal, poor communication, and technological change; and methods of dealing with conflict are described,…

  16. General Conformity

    Science.gov (United States)

    The General Conformity requirements ensure that the actions taken by federal agencies in nonattainment and maintenance areas do not interfere with a state’s plans to meet national standards for air quality.

  17. General Anesthesia

    Science.gov (United States)

    ... unconscious and unable to feel pain during medical procedures. General anesthesia usually uses a combination of intravenous drugs ... 1998-2017 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.

  18. To assess and create awareness among anesthetists regarding prevention and management of injuries to the teeth and their associated structures during general anesthesia

    Directory of Open Access Journals (Sweden)

    Amita M Tiku

    2014-01-01

    Full Text Available Aims: The aim of this study was to assess the awareness among anesthetists regarding prevention and management of injuries to the teeth and their associated structures during anesthesia. Study design, Materials and Methods: Fifty anesthetists practicing in various hospitals in Mumbai participated in this study. A questionnaire was devised and distributed among them. The completion of the questionnaire by the respondents was taken as their consent to participate in the study. Statistical analysis: The data thus collected was analyzed using statistical package Medcalc (Version 12.7.0.0. Results: The results showed that the injury to the oro-dental tissues is a common finding during anesthesia. The maxillary incisors underwent injuries more commonly than the mandibular incisors. Padding of the teeth was the most common precaution taken to prevent injuries to the teeth which, however, is not adequate. The management for such injuries was inadequate and in many cases, the patients′ referral to a dentist was not considered post-operatively. Conclusion: Pediatric dentists can play a major role in creating the awareness among the anesthesia providers regarding prevention of oro-dental injuries during anesthesia.

  19. Analysis and design of a general examination management system%通用试题库管理系统的分析与设计

    Institute of Scientific and Technical Information of China (English)

    冯素梅

    2013-01-01

    Building scientific and reasonable examination database is an important content of an university deepen teaching. Development of examination management system of easy operation becomes the key. The system has reasonable database, high security, practical strong, can be effective on the course, examination, building paper, examination paper, the system, etc management, and improve the quality of teaching.%  建设科学合理的试题库是高校深化教学改革的一项重要内容,开发操作方便的通过试题库管理系统成为关键。本系统数据库设计合理、安全性高、实用性强,可切实有效地对课程、试题、组卷、试卷、系统等进行科学管理,促进教学质量的提高。

  20. The General Framework Design of Carbon Trading Management System in China%中国碳交易管理体制的总体框架设计

    Institute of Scientific and Technical Information of China (English)

    张帆; 李佐军

    2012-01-01

    环境资源的外部性特征决定了政府干预的必要性,当前我国推进碳交易试点、规范碳交易秩序等均需要完善的碳交易管理体制支撑.结合欧盟、澳大利亚、美国等国家建立碳交易管理体制的经验和启示,立足我国碳交易管理体制的现状和面临的主要问题,本文提出构建国务院、国家部委、地方政府、交易所、中介机构、专家组织组成的六位一体的协调分工管理体制.由国务院应对气候变化领导小组统一指导,国家发展改革委负责碳排放权管理,环保部承担注册、登记、核查、监测等职能,其他相关部委积极配合并提供相关支持.在地方层面设立对应的碳排放权交易管理机构,积极推进碳交易试点,进行区域性碳交易市场的探索和实践.中介机构的培育包括四类:独立的第三方认证机构、金融机构、信息服务机构和行业协会.专家组织展面则依托国家气候变化专家委员会等开展各种课题研究为政府决策者提供前瞻性、战略性、预警性的政策建议.考虑到碳交易管理体制的建立是一项长期的系统工程,本文提出了三阶段的推进措施.%The externality of environmental resources determines necessity of government intervention, and currently to promote the trial project of carbon trading and regulate carbon trading market requires an excellent carbon trading management system. Combined with experience and inspiration from developed countries such as European Union, Australia and United States thai have established such a system, based on status quo of and major issues in carbon trading management system in China, this paper proposes to construct a coordinated management system, consisting of State Council, Ministries and Commissions, local governments, trade exchange, intermediaries and experts. The Climate Change Leadership Group should be guided uniformly by the State Cabinet, carbon emission rights managed

  1. Knowledge management: another management fad?

    Directory of Open Access Journals (Sweden)

    Leonard J. Ponzi

    2002-01-01

    Full Text Available Knowledge management is a subject of a growth body of literature. While capturing the interest of practitioners and scholars in the mid-1990s, knowledge management remains a broadly defined concept with faddish characteristics. Based on annual counts of article retrieved from Science Citation Index, Social Science Citation Index, and ABI Inform referring to three previous recognized management fad, this paper introduces empirical evidence that proposes that a typical management movement generally reveals itself as a fad in approximately five years. In applying this approach and assumption to the case of knowledge management, the findings suggest that knowledge management is at least living longer than typical fads and perhaps is in the process of establishing itself as a new aspect of management. To further the understanding of knowledge management's development, its interdisciplinary activity and breadth are reported and briefly discussed.

  2. Public debate on the general options relative to the management of high-medium activity and long-lived radioactive wastes; Debat public sur les options generales en matiere de gestion des dechets radioactifs de haute activite et de moyenne activite a vie longue

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-09-15

    The law from December 30, 1991, precisely defines 3 axes of researches for the management of high level and long-lived radioactive wastes: separation/transmutation, surface storage and underground disposal. A global evaluation report about these researches is to be supplied in 2006 by the French government to the Parliament. A first synthesis of the knowledge gained after 14 years of research has led the national commission of the public debate (CNDP) to organize a national debate about the general options of management of high-level and long-lived radioactive wastes before the 2006 date line. This document presents the organizational aspects of the debate: origin, organization committee (mission, members, commitments), framework (the December 31, 1991 law, technical enlargement, society aspects), topics (summary of the debate in ten questions), organization modalities (4 main steps, schedule, venues), objectives and perspectives (sharing information, decision making processes to be implemented by 2006). (J.S.)

  3. Proceedings of the public debate on the general options of management of high and intermediate activity and long-lived radioactive wastes; Compte-rendu du debat public sur les options generales en matiere de gestion des dechets radioactifs de haute activite et de moyenne activite a vie longue

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-01-15

    The law from December 30, 1991, precisely defines 3 axes of researches for the management of high level and long-lived radioactive wastes: separation/transmutation, surface storage and underground disposal. A global evaluation report about these researches is to be supplied in 2006 by the French government to the Parliament. A first synthesis of the knowledge gained after 14 years of research has led the national commission of the public debate (CNDP) to organize a national debate about the general options of management of high-level and long-lived radioactive wastes before the 2006 date line. The debate comprised 4 public hearings (September 2005: Bar-le-Duc, Saint-Dizier, Pont-du-Gard, Cherbourg), 12 round-tables (October and November 2005: Paris, Joinville, Caen, Nancy, Marseille), a synthesis meeting (December 2005, Dunkerque) and a closing meeting (January 2006, Lyon). This document is a summary of the main questions tackled during this debate from its preparation to its closing meeting and dealing with: the acceptation of the debate, the progress of the debate, the socio-technical problem of gathering the different points to be debated with respect to the different areas in concern, the general questions about the overall nuclear wastes and materials (radioactivity, health, radioprotection, management, reprocessing, control, actors organization, knowledge sharing, perenniality of the financing), the specific questions about long-lived wastes (inventory, separation-transmutation feasibility, nuclear energy and energy policy, management solutions, storage and geologic disposal feasibility, impact of debates on the 2006 law, long-lived waste territories), the conclusions for the 2006 law: mastering the overall nuclear wastes and materials and step-by-step building up of a solution for long-lived wastes (difficulties, lessons learnt from foreign experience, first draft of the 2006 law). Some opinions expressed by some participants about these proposals conclude

  4. Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 1: a status report on the disease state, general measures, and adjunctive skin care.

    Science.gov (United States)

    Del Rosso, James Q; Thiboutot, Diane; Gallo, Richard; Webster, Guy; Tanghetti, Emil; Eichenfield, Larry; Stein-Gold, Linda; Berson, Diane; Zaenglein, Andrea

    2013-11-01

    Rosacea is a common clinical diagnosis that encompasses a variety of presentations, predominantly involving the centrofacial skin. Reported to present most commonly in adults of Northern European heritage with fair skin, rosacea can affect males and females of all ethnicities and skin types. Pathophysiologic mechanisms that appear to correlate with the manifestation of rosacea have been the focus of multiple research studies, with outcomes providing a better understanding of why some individuals are affected and how their visible signs and symptoms develop. A better appreciation of the pathophysiologic mechanisms and inflammatory pathways of rosacea has allowed therapeutic strategies to be optimally incorporated. Part 1 of this 5-part series discusses the rosacea disease state with an emphasis on clinical correlation, reviews adjunctive skin care for cutaneous rosacea, and provides management caveats.

  5. General introduction

    NARCIS (Netherlands)

    Emmelkamp, P.; Ehring, T.; Emmelkamp, P.; Ehring, T.

    2014-01-01

    This introductory chapter of this two-volume handbook commences with an overview of the book, which is aimed to provide a comprehensive overview of the current knowledge on the phenomenology, classification, epidemiology, etiology, and clinical management of anxiety disorders. Whereas Volume 1

  6. Efficacy of an Extract of Ocimum tenuiflorum (OciBest in the Management of General Stress: A Double-Blind, Placebo-Controlled Study

    Directory of Open Access Journals (Sweden)

    Ram Chandra Saxena

    2012-01-01

    Full Text Available A randomized, double-blind, placebo-controlled study was conducted to evaluate the efficacy of OciBest, an extract of Ocimum tenuiflorum Linn. in symptomatic control of general stress. The participants received either placebo (n=79 or OciBest (n=71; 1200 mg of actives per day for six weeks. The severity of stress-related symptoms was self-evaluated by patients at weeks 0, 2, 4 and 6 of the trial period using a symptom rating scale. After six weeks of intervention, scores of symptoms such as forgetfulness, sexual problems of recent origin, frequent feeling of exhaustion, and frequent sleep problems of recent origin decreased significantly (P≤0.05 in OciBest group as compared with placebo group. Also, the total symptom scores of OciBest group revealed significant reduction (P≤0.05 as compared to placebo group. The overall improvement in OciBest group was found to be 1.6 times or 39% more in the control of general stress symptoms with respect to placebo. No adverse events were reported during the study. The findings revealed that OciBest was found to be effective and well tolerated by all the patients over the six weeks of study period.

  7. Expanding the National Drug Abuse Treatment Clinical Trials Network to address the management of substance use disorders in general medical settings

    Directory of Open Access Journals (Sweden)

    Tai B

    2014-07-01

    Full Text Available Betty Tai, Steven Sparenborg, Udi E Ghitza, David Liu Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA Abstract: The Patient Protection and Affordable Care Act (2010 and the Mental Health Parity and Addiction Equity Act (2008 expand substance use disorder (SUD care services in the USA into general medical settings. Care offered in these settings will engage substance-using patients in an integrated and patient-centered environment that addresses physical and mental health comorbidities and follows a chronic care model. This expansion of SUD services presents a great need for evidence-based practices useful in general medical settings, and reveals several research gaps to be addressed. The National Drug Abuse Treatment Clinical Trials Network of the National Institute on Drug Abuse can serve an important role in this endeavor. High-priority research gaps are highlighted in this commentary. A discussion follows on how the National Drug Abuse Treatment Clinical Trials Network can transform to address changing patterns in SUD care to efficiently generate evidence to guide SUD treatment practice within the context of recent US health care legislation. Keywords: Patient Protection and Affordable Care Act, National Drug Abuse Treatment Clinical Trials Network, substance use disorders, practice-based research network, electronic health records

  8. 护理人员分层使用模式在普外科病区应用的效果%Clinical application of graded management of nurses in general surgery department

    Institute of Scientific and Technical Information of China (English)

    乔莉娜; 王璇; 车文芳; 马华; 赵阳

    2010-01-01

    目的 探讨护理岗位分层管理模式在临床运行的方式与优越性.方法 对普外科实施护理人员分层使用,改进护理人员配备、排班、培训考核及绩效分配的方法,并把实施前、后住院病人对护理工作满意率进行比较分析.结果 护理岗位分层管理模式运行后,护士的责任心增加,病人对护理工作满意率达到了99%,护理质量优于运行前,差异有统计学意义(P<0.05).结论 护理人员分层使用模式更加合理地运用了护理人力资源,满足临床护理实际工作的需要,是可行的运行模式.%Objective To investigate the application and advantage of graded management of nurses in clinic work. Methods This subject introduced the method of graded management of nurses in general surgery department, in order to improve methods of nursing personnel, scheduling, training and allocation. Then, the clinical basic nursing of quality and the patients' degree of satisfaction were compared and analyzed after and before application to graded management. Results Nurses' responsibility was strengthened obviously, patients' rate of satisfaction reached 99% and the quality of nursing improved, which was higher than before, and there was statistical difference (P < 0.05 ). Conclusions The mode of graded management makes nursing human resource more reasonably, and meets the need of clinical nursing work, so it is better than common management mode.

  9. Generalized polygons

    CERN Document Server

    Van Maldeghem, Hendrik

    1998-01-01

    Generalized Polygons is the first book to cover, in a coherent manner, the theory of polygons from scratch. In particular, it fills elementary gaps in the literature and gives an up-to-date account of current research in this area, including most proofs, which are often unified and streamlined in comparison to the versions generally known. Generalized Polygons will be welcomed both by the student seeking an introduction to the subject as well as the researcher who will value the work as a reference. In particular, it will be of great value for specialists working in the field of generalized polygons (which are, incidentally, the rank 2 Tits-buildings) or in fields directly related to Tits-buildings, incidence geometry and finite geometry. The approach taken in the book is of geometric nature, but algebraic results are included and proven (in a geometric way!). A noteworthy feature is that the book unifies and generalizes notions, definitions and results that exist for quadrangles, hexagons, octagons - in the ...

  10. Generalized derivations and general relativity

    CERN Document Server

    Heller, M; Pysiak, L; Sasin, W

    2013-01-01

    We construct differential geometry (connection, curvature, etc.) based on generalized derivations of an algebra A. Such a derivation, introduced by Bresar in 1991, is given by a linear mapping u: A -> A such that there exists a usual derivation d of A satisfying the generalized Leibniz rule u(a b) = u(a) b + a d(b) for all a,b in A. The generalized geometry "is tested" in the case of the algebra of smooth functions on a manifold. We then apply this machinery to study the generalized general relativity. We define the Einstein-Hilbert action and deduce from it Einstein's field equations. We show that for a special class of metrics containing, besides the usual metric components, only one non-zero term, the action reduces to O'Hanlon action that is a Brans-Dicke action with potential and with the parameter \\omega equal to zero. We also show that the generalized Einstein equations (with zero energy-stress tensor) are equivalent to those of the Kaluza-Klein theory satisfying a "modified cylinder condition" and hav...

  11. GENERAL EQUILIBRIUM

    Directory of Open Access Journals (Sweden)

    Monique Florenzano

    2008-09-01

    Full Text Available General equilibrium is a central concept of economic theory. Unlike partial equilibrium analysis which study the equilibrium of a particular market under the clause “ceteris paribus” that revenues and prices on the other markets stay approximately unaffected, the ambition of a general equilibrium model is to analyze the simultaneous equilibrium in all markets of a competitive economy. Definition of the abstract model, some of its basic results and insights are presented. The important issues of uniqueness and local uniqueness of equilibrium are sketched; they are the condition for a predictive power of the theory and its ability to allow for statics comparisons. Finally, we review the main extensions of the general equilibrium model. Besides the natural extensions to infinitely many commodities and to a continuum of agents, some examples show how economic theory can accommodate the main ideas in order to study some contexts which were not thought of by the initial model

  12. Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial.

    Science.gov (United States)

    French, Simon D; McKenzie, Joanne E; O'Connor, Denise A; Grimshaw, Jeremy M; Mortimer, Duncan; Francis, Jill J; Michie, Susan; Spike, Neil; Schattner, Peter; Kent, Peter; Buchbinder, Rachelle; Page, Matthew J; Green, Sally E

    2013-01-01

    This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP) in general practice. General practices were randomised to either access to a guideline for acute LBP (control) or facilitated interactive workshops (intervention). We measured behavioural predictors (e.g. knowledge, attitudes and intentions) and fear avoidance beliefs. We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced other outcomes measured at the general practitioner (GP) level: behavioural simulation (clinical decision about vignettes) and rates of x-ray and CT-scan (medical administrative data). All those not involved in the delivery of the intervention were blinded to allocation. 47 practices (53 GPs) were randomised to the control and 45 practices (59 GPs) to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs, although effect estimates were small, the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more likely to adhere to guideline recommendations about x-ray (OR 1.76, 95%CI 1.01, 3.05) and more likely to give advice to stay active (OR 4.49, 95%CI 1.90 to 10.60). Imaging referral was not statistically significantly different between groups and the potential importance of effects was unclear; rate ratio 0.87 (95%CI 0.68, 1.10) for x-ray or CT-scan. The intervention led to small changes in GP intention to practice in a manner that is consistent with an evidence-based guideline, but it did not result in statistically significant changes in actual behaviour. Australian New Zealand

  13. Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial.

    Directory of Open Access Journals (Sweden)

    Simon D French

    Full Text Available INTRODUCTION: This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP in general practice. METHODS: General practices were randomised to either access to a guideline for acute LBP (control or facilitated interactive workshops (intervention. We measured behavioural predictors (e.g. knowledge, attitudes and intentions and fear avoidance beliefs. We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced other outcomes measured at the general practitioner (GP level: behavioural simulation (clinical decision about vignettes and rates of x-ray and CT-scan (medical administrative data. All those not involved in the delivery of the intervention were blinded to allocation. RESULTS: 47 practices (53 GPs were randomised to the control and 45 practices (59 GPs to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs, although effect estimates were small, the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more likely to adhere to guideline recommendations about x-ray (OR 1.76, 95%CI 1.01, 3.05 and more likely to give advice to stay active (OR 4.49, 95%CI 1.90 to 10.60. Imaging referral was not statistically significantly different between groups and the potential importance of effects was unclear; rate ratio 0.87 (95%CI 0.68, 1.10 for x-ray or CT-scan. CONCLUSIONS: The intervention led to small changes in GP intention to practice in a manner that is consistent with an evidence-based guideline, but it did not result in statistically significant

  14. Dementia care initiative in primary practice – study protocol of a cluster randomized trial on dementia management in a general practice setting

    Directory of Open Access Journals (Sweden)

    Holle Rolf

    2009-06-01

    Full Text Available Abstract Background Current guidelines for dementia care recommend the combination of drug therapy with non-pharmaceutical measures like counselling and social support. However, the scientific evidence concerning non-pharmaceutical interventions for dementia patients and their informal caregivers remains inconclusive. Targets of modern comprehensive dementia care are to enable patients to live at home as long and as independent as possible and to reduce the burden of caregivers. The objective of the study is to compare a complex intervention including caregiver support groups and counselling against usual care in terms of time to nursing home placement. In this paper the study protocol is described. Methods/Design The IDA (Initiative Demenzversorgung in der Allgemeinmedizin project is designed as a three armed cluster-randomized trial where dementia patients and their informal caregivers are recruited by general practitioners. Patients in the study region of Middle Franconia, Germany, are included if they have mild or moderate dementia, are at least 65 years old, and are members of the German AOK (Allgemeine Ortskrankenkasse sickness fund. In the control group patients receive regular treatment, whereas in the two intervention groups general practitioners participate in a training course in evidence based dementia treatment, recommend support groups and offer counseling to the family caregivers either beginning at baseline or after the 1-year follow-up. The study recruitment and follow-up took place from July 2005 to January 2009. 303 general practitioners were randomized of which 129 recruited a total of 390 patients. Time to nursing home admission within the two year intervention and follow-up period is the primary endpoint. Secondary endpoints are cognitive status, activities of daily living, burden of care giving as well as healthcare costs. For an economic analysis from the societal perspective, data are collected from caregivers as well as

  15. General Relativity

    CERN Document Server

    Canuto, V

    2015-01-01

    This is an English translation of the Italian version of an encyclopedia chapter that appeared in the Italian Encyclopedia of the Physical Sciences, edited by Bruno Bertotti (1994). Following requests from colleagues we have decided to make it available to a more general readership. We present the motivation for constructing General Relativity, provide a short discussion of tensor algebra, and follow the set up of Einstein equations. We discuss briefly the initial value problem, the linear approximation and how should non gravitational physics be described in curved spacetime.

  16. General Practitioners in Community Management of Chronic Disease%全科医生在社区慢病管理中的作用

    Institute of Scientific and Technical Information of China (English)

    王丽华; 庞栋; 刘霞; 李巧玲

    2015-01-01

    Chronic diseases which threaten people's health, the prevention and control work has been crunch time. GPS can pro-vide timely, convenient and effective health services has become an important implementation of chronic disease prevention and control work. In this paper, based on the concept of general practitioners, and analyzes the role of community chronic disease man-agement.%慢性疾病极大地威胁着人们的健康,其防治工作已刻不容缓。全科医生因能提供及时、方便和有效的医疗服务而成为慢病防治工作的重要实施者。该文结合全科医生的概念,分析了其在社区慢病管理中的作用。

  17. 围绕客户个性化需求提升总承包管理水平%On promotion of general contract management around individualized demands of users

    Institute of Scientific and Technical Information of China (English)

    马生旺

    2012-01-01

    深入研究了围绕客户个性化需求,提升总承包管理水平的方法,通过论述建立以客户为中心的管理理念,积极主动参与和引导项目前期策划,确保客户工期控制需求,满足客户质量控制需求,实现客户投资控制需求等方面内容,将更好地提升国有大型建筑企业总承包、总集成能力,保持可持续和稳定的发展。%The paper studies the individualized demands of users and the methods for promoting the general contract management, and further promotes the general contract and total integration capacity of state-owned large-scale architectural enterprises and maintains the sustainable and stable development by indicating the establishment of the user-centered management idea, taking part in and leading the program planning at the earlier stage actively, guaranteeing the users' demand for the construction period control, meeting the users' demands for the quality control, and realizing users' demands for the investment control.

  18. Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Lucassen PL

    2008-04-01

    Full Text Available Abstract Background Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff. However, none of these interventions focussed on collaboration between GPs and nurses in dementia care. We developed an EASYcare-based Dementia Training Program (DTP aimed at stimulating collaboration in dementia primary care. We expect this program to increase the number of cognitive assessments and dementia diagnoses and to improve attitudes and knowledge of GPs and nurses. Methods The DTP is a complex educational intervention that consists of two workshops, a coaching program, access to an internet forum, and a Computerized Clinical Decision Support System on dementia diagnostics. One hundred duos of GPs and nurses will be recruited, from which 2/3 will be allocated to the intervention group and 1/3 to the control group. The effects of implementation of the DTP will be studied in a cluster-randomised controlled trial. Primary outcomes will be the number of cognitive assessments and dementia diagnoses in a period of 9 months following workshop participation. Secondary outcomes are measured on GP and nurse level: adherence to national guidelines for dementia, attitude, confidence and knowledge regarding dementia diagnosis and management; on patient level: number of emergency calls, visits and consultations and patient satisfaction; and on caregiver level: informal caregiver burden and satisfaction. Data will be collected from GPs' electronic medical records, self-registration forms and questionnaires. Statistical analysis will be performed using the MANOVA-method. Also, exploratory analyses will be performed, in order to gain insight into barriers and facilitators for implementation and

  19. Airway management of infants with cleft lip under general anesthesia during operation%婴幼儿唇裂手术麻醉呼吸道管理

    Institute of Scientific and Technical Information of China (English)

    王淼

    2009-01-01

    Cleft lip is one of the common diseases in Oral and Maxillofacial Surgery, and children with cleft lip should be treated by cleft lip repair, mostly operation in infan-cy. The management of airway plays an important role in safety of surgery. Pay attention to the prevention of preoperative re-spiratory infection, intraoperative hypoxia and airway edema, postoperative respiratory depression and respiratory complica-tions such as laryngeal spasm, We can effectively prevent the occurrence of accidents and complications in anesthesia and improve surgical safety.%唇裂是口腔颌面外科的常见病之一,主要在婴儿期采用唇裂修补术来进行治疗.呼吸道的管理对手术安全具有非常重要的作用.注意术前预防呼吸道感染、术中防止缺氧及气道水肿、术后防止呼吸抑制及喉痉挛等呼吸道并发症,可以有效预防麻醉意外及并发症的发生,提高手术安全性.

  20. Generalized Parabolas

    Science.gov (United States)

    Joseph, Dan; Hartman, Gregory; Gibson, Caleb

    2011-01-01

    In this article we explore the consequences of modifying the common definition of a parabola by considering the locus of all points equidistant from a focus and (not necessarily linear) directrix. The resulting derived curves, which we call "generalized parabolas," are often quite beautiful and possess many interesting properties. We show that…