Cui, Cui; Wang, Ling-Xiao; Li, Qi; Zaslansky, Ruth; Li, Li
To investigate the effect of introducing a standardised pain management nursing protocol in orthopaedic patients undergoing surgery. Postoperative pain is a common phenomenon but is still undertreated in hospitalised patients. Nurses' lack of sufficient knowledge and skills about pain management may be a contributing factor to poor outcomes. An interventional, separate sample pre- and post-test. A pain management nursing protocol was introduced and a handbook and training sessions regarding management of postsurgical pain were provided to the nurses on a Joint Orthopaedic ward at a university-affiliated general hospital in Guangzhou, China. Before and after the intervention, nurses' knowledge about pain management and attitudes were assessed, and perioperative management practices and pain-related patient-reported outcomes were evaluated. Sixteen and 15 registered nurses, and 77 and 71 patients participated in the study before and after the intervention, respectively. Nurses' scores related to knowledge and skills increased significantly after the protocol was introduced but were still insufficient with regard to pharmacological-related items. The proportion of patients receiving a combined opioid and nonopioid increased after the intervention. Clinically significant changes were observed in some patient-reported outcomes, such as worst pain since surgery, percentage of time experiencing severe pain, and pain interference with activities out of bed. There were significant changes in nonpharmacological methods administered by nurses to patients or used by patients to relieve pain. Implementation of a pain management nursing protocol combined with education in one surgical ward was associated with nurses' increased knowledge and attitudes regarding pain, a change in some management practices, and improvement in a number of pain-related patient-reported outcomes. It was feasible to develop and implement a standardised pain management nursing protocol and use it in the
Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary
In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile.
... Detection- Goggins Lab Sol Goldman Center Discussion Board Pain Management Pain is a very common symptom in patients ... of pain. Pain Assessment The first step in pain management is a thorough assessment. Your healthcare provider will ...
Bayuo, Jonathan; Munn, Zachary; Campbell, Jared
Pain management is a significant issue in health facilities in Ghana. For burn patients, this is even more challenging as burn pain has varied facets. Despite the existence of pharmacological agents for pain management, complaints of pain still persist. The aim of this project was to identify pain management practices in the burns units of Komfo Anokye Teaching Hospital, compare these approaches to best practice, and implement strategies to enhance compliance to standards. Ten evidence-based audit criteria were developed from evidence summaries. Using the Joanna Briggs Institute Practical Application of Clinical Evidence Software (PACES), a baseline audit was undertaken on a convenience sample of ten patients from the day of admission to the seventh day. Thereafter, the Getting Research into Practice (GRiP) component of PACES was used to identify barriers, strategies, resources and outcomes. After implementation of the strategies, a follow-up audit was undertaken using the same sample size and audit criteria. The baseline results showed poor adherence to best practice. However, following implementation of strategies, including ongoing professional education and provision of assessment tools and protocols, compliance rates improved significantly. Atlhough the success of this project was almost disrupted by an industrial action, collaboration with external bodies enabled the successful completion of the project. Pain management practices in the burns unit improved at the end of the project which reflects the importance of an audit process, education, providing feedback, group efforts and effective collaboration.
... Funding Funding Opportunities (NIH Guide) Forms and Deadlines Electronic Research Admin (eRA) Grants Policy OER News About ... remains the most commonly used pain reliever. The French physician, Dr. Albert Schweitzer, proclaimed in 1931 that, “ ...
Full Text Available Treatment of chronic pain is challenging. The Arkys project was initiated in Italy to assist general practitioners (GPs in the management of chronic pain. The main objective of this study was to determine the usefulness of Arkys for selecting new therapeutic strategies. An online interactive questionnaire for assessing pain and guiding therapeutic decisions was made available to GPs participating to Arkys. The GPs were invited to complete the questionnaire for each patient who presented moderate-severe chronic pain, and to decide on a new analgesic treatment based on the information provided by the questionnaire. Two hundred and forty four GPs participated with a total of 3035 patients. Patients (mean age 68.9 years had mostly chronic non-cancer pain (87.7%. In 42.3%, pain had neuropathic components. Only 53.6% of patients were in treatment with analgesics (strong opioids, 38.9%; NSAIDs, 32.6%; weak opioids, 25.6%; anti-epileptics, 17.3%; paracetamol, 14.9%. Use of the questionnaire resulted in the prescription of analgesics to all patients and in increased prescription of strong opioids (69.7%. NSAID prescription decreased (12.8%, while anti-epileptics use remained stable. These findings show that current management of chronic pain in primary care is far from optimal and that efforts are needed to educate GPs and improve guideline implementation.
Project Management Theory Meets Practice contains the proceedings from the 1st Danish Project Management Research Conference (DAPMARC 2015), held in Copenhagen, Denmark, on May 21st, 2015.......Project Management Theory Meets Practice contains the proceedings from the 1st Danish Project Management Research Conference (DAPMARC 2015), held in Copenhagen, Denmark, on May 21st, 2015....
Pilkington, Alan; Chai, Kah-Hin; Le, Yang
This paper identifies the true coverage of PM theory through a bibliometric analysis of the International Journal of Project Management from 1996-2012. We identify six persistent research themes: project time management, project risk management, programme management, large-scale project management......, project success/failure and practitioner development. These differ from those presented in review and editorial articles in the literature. In addition, topics missing from the PM BOK: knowledge management project-based organization and project portfolio management have become more popular topics...
Kaiser, Ulrike; Arnold, Bernhard; Pfingsten, Michael; Nagel, Bernd; Lutz, Johannes; Sabatowski, Rainer
Ulrike Kaiser,1 Bernhard Arnold,2 Michael Pfingsten,3 Bernd Nagel,4 Johannes Lutz,5 Rainer Sabatowski1,61Comprehensive Pain Center, University Hospital “Carl Gustav Carus”, Dresden, 2Department of Pain Management, Klinikum Dachau, Dachau, 3Pain Clinic, University Medicine, University of Göttingen, 4Day Care Unit, DRK Pain Center, Mainz, 5Interdisciplinary Pain Center, Zentralklinik Bad Berka, Bad Berka, 6Department of Anesthesiology and Intensive Care, University ...
Full Text Available Ulrike Kaiser,1 Bernhard Arnold,2 Michael Pfingsten,3 Bernd Nagel,4 Johannes Lutz,5 Rainer Sabatowski1,61Comprehensive Pain Center, University Hospital “Carl Gustav Carus”, Dresden, 2Department of Pain Management, Klinikum Dachau, Dachau, 3Pain Clinic, University Medicine, University of Göttingen, 4Day Care Unit, DRK Pain Center, Mainz, 5Interdisciplinary Pain Center, Zentralklinik Bad Berka, Bad Berka, 6Department of Anesthesiology and Intensive Care, University Hospital “Carl Gustav Carus”, Dresden, Germany
If these therapies fail, and with a thorough multidisciplinary approach involving carefully ... Generally, surgical pain management is divided into neuro- modulative .... 9 suggested. It is important to be sure that the underlying instability or.
Full Text Available The past 2-3 decades have seen dramatic changes in the approach to pain management in the neonate. These practices started with refuting previously held misconceptions regarding nociception in preterm infants. Although neonates were initially thought to have limited response to painful stimuli, it was demonstrated that the developmental immaturity of the central nervous system makes the neonate more likely to feel pain. It was further demonstrated that untreated pain can have long-lasting physiologic and neurodevelopmental consequences. These concerns have resulted in a significant emphasis on improving and optimizing the techniques of analgesia for neonates and infants. The following article will review techniques for pain assessment, prevention, and treatment in this population with a specific focus on acute pain related to medical and surgical conditions.
In this video Associate Professor Constance Kampf talks about the importance project management. Not only as a tool in implementation, but also as a way of thinking, and as something that needs to be considered from idea conception......In this video Associate Professor Constance Kampf talks about the importance project management. Not only as a tool in implementation, but also as a way of thinking, and as something that needs to be considered from idea conception...
Maria Frödin; Margareta Warrén Stomberg
Pain management is an integral challenge in nursing and includes the responsibility of managing patients’ pain, evaluating pain therapy and ensuring the quality of care. The aims of this study were to explore patients’ experiences of pain after lung surgery and evaluate their satisfaction with the postoperative pain management. A descriptive design was used which studied 51 participants undergoing lung surgery. The incidence of moderate postoperative pain varied from 36- 58% among the partici...
James, Dominika Lipowska; Jowza, Maryam
This article describes pathophysiology of burn injury-related pain and the basic principles of burn pain management. The focus is on concepts of perioperative and periprocedural pain management with extensive discussion of opioid-based analgesia, including patient-controlled analgesia, challenges of effective opioid therapy in opioid-tolerant patients, and opioid-induced hyperalgesia. The principles of multimodal pain management are discussed, including the importance of psychological counseling, perioperative interventional pain procedures, and alternative pain management options. A brief synopsis of the principles of outpatient pain management is provided. Copyright © 2017 Elsevier Inc. All rights reserved.
Osterbrink, Jürgen; Bauer, Zsuzsa; Mitterlehner, Barbara; Gnass, Irmela; Kutschar, Patrick
BACKGROUND: Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, ‘Action Alliance Pain-Free City Muenster’, the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic/acute pain-affected persons and highly recommen...
Full Text Available BACKGROUND: Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, ‘Action Alliance Pain-Free City Muenster’, the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic/acute pain-affected persons and highly recommended for practice.
of multimodal and multi-agent approach to acute pain management for better patient care. Data Source:The material ..... in the management of pain and stiffness arising ..... include immediate, direct psychologic feedback to the motivated ...
Tracy, Bridget; Sean Morrison, R
Chronic pain is prevalent among older adults but is underrecognized and undertreated. The approach to pain assessment and management in older adults requires an understanding of the physiology of aging, validated assessment tools, and common pain presentations among older adults. To identify the overall principles of pain management in older adults with a specific focus on common painful conditions and approaches to pharmacologic treatment. We searched PubMed for common pain presentations in older adults with heart failure, end-stage renal disease, dementia, frailty, and cancer. We also reviewed guidelines for pain management. Our review encompassed 2 guidelines, 10 original studies, and 22 review articles published from 2000 to the present. This review does not discuss nonpharmacologic treatments of pain. Clinical guidelines support the use of opioids in persistent nonmalignant pain. Opioids should be used in patients with moderate or severe pain or pain not otherwise controlled but with careful attention to potential toxic effects and half-life. In addition, clinical practice guidelines recommend use of oral nonsteroidal anti-inflammatory drugs with extreme caution and for defined, limited periods. An understanding of the basics of pain pathophysiology, assessment, pharmacologic management, and a familiarity with common pain presentations will allow clinicians to effectively manage pain for older adults. © 2013 Elsevier HS Journals, Inc. All rights reserved.
Elkins, Gary; Johnson, Aimee; Fisher, William
Pain is a serious health care problem and there is growing evidence to support the use of hypnosis and cognitive-behavioral interventions for pain management. This article reviews clinical techniques and methods of cognitive hypnotherapy for pain management. Current research with emphasis given to randomized, controlled trials is presented and the efficacy of hypnotherapy for pain management is discussed. Evidence for cognitive hypnotherapy in the treatment in chronic pain, cancer, osteoarthritis, sickle cell disease, temporomandibular disorder, fibromyalgia, non-cardiac chest pain, and disability related chronic pains are identified. Implications for clinical practice and research are discussed in light of the accumulating evidence in support of the efficacy and effectiveness of cognitive hypnotherapy for pain management.
patients is musculoskeletal pain, headache or abdominal pain.2. The pain ... Children older than four years of age can usually talk about their pain; at the age of six to eight years they can use the ... Pain presentation in children normally falls into one of the ... expression, body posture and movement.10 This scale is often.
Price, Patricia; Fogh, Karsten; Glynn, Chris
of the pain experience: location, duration, intensity, quality, onset and impact on activities of daily living. Holistic management must be based on a safe and effective mix of psychosocial approaches together with local and systemic pain management. It is no longer acceptable to ignore or inadequately...... to the wound should be handled as one of the main priorities in chronic wound management together with addressing the cause. Management of pain in chronic wounds depends on proper assessment, reporting and documenting patient experiences of pain. Assessment should be based on six critical dimensions...... document persistent wound pain and not to develop a treatment and monitoring strategy to improve the lives of persons with chronic wounds. Unless wound pain is optimally managed, patient suffering and costs to health care systems will increase. Udgivelsesdato: 2007-Apr...
Montoro-Lorite, Mercedes; Canalias-Reverter, Montserrat
Pain management in advanced dementia is complex because of neurological deficits present in these patients, and nurses are directly responsible for providing interventions for the evaluation, management and relief of pain for people suffering from this health problem. In order to facilitate and help decision-makers, pain experts recommend the use of standardized protocols to guide pain management, but in Spain, comprehensive pain management protocols have not yet been developed for advanced dementia. This article reflects the need for an integrated management of pain in advanced dementia. From the review and analysis of the most current and relevant studies in the literature, we performed an approximation of the scales for the determination of pain in these patients, with the observational scale PAINAD being the most recommended for the hospital setting. In addition, we provide an overview for comprehensive management of pain in advanced dementia through the conceptual framework «a hierarchy of pain assessment techniques by McCaffery and Pasero» for the development and implementation of standardized protocols, including a four-phase cyclical process (evaluation, planning/performance, revaluation and recording), which can facilitate the correct management of pain in these patients. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
REVIEW. Introduction. Pain is defined by the International Association for the Study of. Pain (IASP) as ... lasts for a short time, whilst chronic pain normally persists for a much longer ..... on a regular time schedule, i.e. 'by the clock', whereby the medicine is .... combination with a non-opioid (from the first step) for severe pain.
Calixte, Nahomy; Brahmbhatt, Jamin; Parekattil, Sijo
Chronic testicular pain although becoming very common in our patient population poses a challenge to the physician, the patient and his family. The pathogenesis of chronic orchialgia (CO) is not well understood. The objective of this paper is to review the current literature on chronic testicular pain and its management and to propose an algorithm for its treatment. Abstracts, original papers and review articles were reviewed during a literature search using words such as testicular pain, CO,...
Petrini, Marcia, A
Pain management by nurses internationally has increased with the awareness of the importance of relief from pain in the healing process. Studies of the physiological mechanisms of pain and the impact on healing havepromoted the recognition for pain relief
Despite the availability of high-quality guidelines and advanced pain management techniques acute postoperative pain management is still far from being satisfactory. The QUIPS (Quality Improvement in Postoperative Pain Management) project aims to improve treatment quality by means of standardised data acquisition, analysis of quality and process indicators, and feedback and benchmarking. During a pilot phase funded by the German Ministry of Health (BMG), a total of 12,389 data sets were collected from six participating hospitals. Outcome improved in four of the six hospitals. Process indicators, such as routine pain documentation, were only poorly correlated with outcomes. To date, more than 130 German hospitals use QUIPS as a routine quality management tool. An EC-funded parallel project disseminates the concept internationally. QUIPS demonstrates that patient-reported outcomes in postoperative pain management can be benchmarked in routine clinical practice. Quality improvement initiatives should use outcome instead of structural and process parameters. The concept is transferable to other fields of medicine. Copyright © 2011. Published by Elsevier GmbH.
Nurwidya, Fariz; Syahruddin, Elisna; Yunus, Faisal
Lung cancer is the leading cause of cancer-related mortality worldwide. Not only burdened by the limited overall survival, lung cancer patient also suffer from various symptoms, such as pain, that implicated in the quality of life. Cancer pain is a complicated and transiently dynamic symptom that results from multiple mechanisms. This review will describe the pathophysiology of cancer pain and general approach in managing a patient with lung cancer pain. The use of opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and adjuvant analgesia, as part of the pharmacology therapy along with interventional strategy, will also be discussed.
or managing the side-effects of pain medication. This will only be possible .... structure of tapentadol is unlike other opioids such as morphine, but resembles .... together with psychological and rehabilitative modalities.36 This multidimensional ...
Topolski, Francielle; Moro, Alexandre; Correr, Gisele Maria; Schimim, Sasha Cristina
Pain is an undesirable side effect of orthodontic tooth movement, which causes many patients to give up orthodontic treatment or avoid it altogether. The aim of this study was to investigate, through an analysis of the scientific literature, the best method for managing orthodontic pain. The methodological aspects involved careful definition of keywords and diligent search in databases of scientific articles published in the English language, without any restriction of publication date. We recovered 1281 articles. After the filtering and classification of these articles, 56 randomized clinical trials were selected. Of these, 19 evaluated the effects of different types of drugs for the control of orthodontic pain, 16 evaluated the effects of low-level laser therapy on orthodontic pain, and 21 evaluated other methods of pain control. Drugs reported as effective in orthodontic pain control included ibuprofen, paracetamol, naproxen sodium, aspirin, etoricoxib, meloxicam, piroxicam, and tenoxicam. Most studies report favorable outcomes in terms of alleviation of orthodontic pain with the use of low-level laser therapy. Nevertheless, we noticed that there is no consensus, both for the drug and for laser therapy, on the doses and clinical protocols most appropriate for orthodontic pain management. Alternative methods for orthodontic pain control can also broaden the clinician's range of options in the search for better patient care.
... Pain: Entire Lesson Viral Hepatitis Menu Menu Viral Hepatitis Viral Hepatitis Home For Veterans and the Public Veterans and the Public Home Hepatitis A Hepatitis B Hepatitis C Hepatitis C Home Getting ...
... health. It is not always easy to reduce stress, but it's easier if you are able to ask your friends ... worse. Then try to make changes in your home and work to decrease the causes of your pain. For ...
Full Text Available Cancer of the cervix uteri is a common cause of pain among women. On the physical realm, the cancer may cause somatic [soft tissue and bone], visceral and neuropathic pain [lumbosacral plexopathy]. Radiotherapy and chemotherapy may cause neuropathy too. Psychological, social and cultural factors modify the pain. Evaluation of the individual type of pain and a patient-centred approach are fundamental requirements for rational management. Disease modifying treatment like radiotherapy and chemotherapy must be considered when applicable. Pain control is usually achieved by the use of WHO three-step ladder, remembering that possible association of renal dysfunction would necessitate caution in the use of NSAIDs and opioids. Side effects must be anticipated, prevented when possible, and aggressively treated; nausea and vomiting may already be present, and constipation can worsen pain when there is a pelvic mass. Pain emergencies can be treated by quick titration with intravenous morphine bolus doses. Neuropathic pain may warrant the use of usual adjuvants, with particular reference to cortico-steroids and the NMDA antagonist, ketamine. In intractable pain, many neurolytic procedures are tried, but a solid evidence base to justify their use is lacking. Continuous epidural analgesia with local anaesthetic and opioid may be needed when drug therapy fails, and desperate situations may warrant interventions such as neurolysis. Such physical measures for pain relief must be combined with psychosocial support and adequate explanations to the patient and the family.
Full Text Available Marcela Romero-Reyes, James M Uyanik Orofacial and Head Pain Service, Department of Oral and Maxillofacial Pathology Radiology and Medicine, New York University College of Dentistry, New York, NY, USA Abstract: Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures. Orofacial pain (OFP can arise from different regions and etiologies. Temporomandibular disorders (TMD are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. Keywords: pain, orofacial, neuropathic, TMD, trigeminal, headache
Marko D. Andrejić
Full Text Available Modern management theory treats all complex tasks and duties like projects and make these projects possible to be managed by a particular organizational-management concept in order to achieve a goal effectively. A large number of jobs and tasks performed in the system of defense or for defense purposes have the characteristics of projects. Project management is both a skill and a science of monitoring human, material, financial, energy and other resources to achieve required objectives within the given limits: deadlines, time, budget, possibility of realization and the satisfaction of the interests of all project participants. Project management is a traditional area of applied (or functional management focused on managing complex and uncertain situations with defined goals. Introduction In conditions of rapid change and high uncertainty, only adaptive organizations survive, i. e. those that are able not only to react quickly to changes but also to proactively take advantage of changes. Development of project management The biggest influence on the development of the area had complex jobs within the engineering profession. In parallel with the traditional approach new approaches began to develop, while the traditional one still remained in use. Contrary to the traditional engineering approach, a dynamic model first developed in order to respond to demands for greater control of costs. Project management Project management is a skill and knowledge of human and material resources to achieve set objectives within prescribed limits: deadlines, time, budget, possibility of realization, and the satisfaction of all participants in the project. In order to realize a project effectively, it is necessary to manage it rationally. Planning and project management A project plan is a document that allows all team members insight on where to go, when to start and when to arrive, what is necessary to be done in order to achieve the project objectives and what
There are difficulties in assessing, managing, and evaluating neuropathic pain in dying children, particularly those with neurological impairment. Neuropathic pain in children often presents differently to how it presents in the adult population. Comprehensive assessment as well as pharmacological and non-pharmacological interventions are crucial to its successful management and frequently require input from an interdisciplinary team. Notwithstanding the need for further research, this paper brings together research papers, reviews, and clinical guidelines to present an exploration of existing evidence regarding care for children with neuropathic pain and their families.
Olesen, Anne E; Farmer, Adam D; Olesen, Søren S
Despite marked differences in underlying pathophysiology, the current management of visceral pain largely follows the guidelines derived from the somatic pain literature. The effective management of patients with chronic visceral pain should be multifaceted, including both pharmacological...... and psychological interventions, thereby providing a mechanism-orientated approach to treatment. Patients can frequently become disenfranchised, and subsequently disengaged, with healthcare providers leading to repeated consultations. Thus, a key aspect of management is to break this cycle by validating patients......' symptoms, adopting an empathic approach and taking time to educate patients. To optimize treatment and outcomes in chronic visceral pain we need to move away from approaches exclusively based on dealing with peripheral nociceptive input toward more holistic strategies, taking into account alterations...
Full Text Available For over 30 years, the International Association for the Study of Pain has defined pain as «an unpleasant sensorial and emotional experience associated to real or potential tissue damage». Today, evident shortcomings still exist in the use of adequate analgesia, especially in the emergency medicine context: pain is the most common symptom amongst the Emergency Department patients (reaching a prevalence of over 60%, however, statistics reported in literature show that only 45% of patients receive analgesic prescriptions on discharge. In recent years, the influence of changes connected to accreditation standards has generated new expectations of healthcare professionals; although this aspect connected to the evolution of public health provides a stimulus to the evolution of the practical aspect of everyday clinical work, we must not forget that doctors take the Hippocratic oath, the ethical obligation to treat suffering and pain, which is especially pertinent to doctors working in Emergency conditions. The quality of the service provided with regard to pain-relief in ED cannot exclude an analysis of the local situation, the definition of roles, the extrinsication of potential with the ultimate aim of providing a service as close as possible to user hopes. Organisational efforts must be directed at reaching excellent quality levels, in which the monitoring of the activities performed takes place through the registration and periodic re-evaluation of the deriving data. Through this observational, prospective study, we intend to evaluate the effective prevalence of the pain symptom in the Emergency Department and the impact of the use of different classes of analgesia, also estimating the latency between the onset of the symptom and triage in order to quantify the efficacy of the analgesia practiced.
Full Text Available This paper presents comparison of three most popular project management standardsbelonging to a wider group of models (for example, PMBOK, Prince 2, CMMI, ISO 10006,BS 6079, IPMA Competence Baseline, European Commission Project Cycle ManagementGuidelines. The author discusses methods of project management according to PMBoK,Prince 2 and ISO 10006, some chosen criteria and fields of knowledge, such as generalregulations of standards, project range management, resources management, and processesconnected with risk, systems of project quality management.
A 23-year-old hemophilia patient with severe pain from bleeding into his joints who developed problematic opioid use is described. The potential value of methadone in such a patient is described, as are the risks of drug interactions leading to toxicity and cardiac arrhythmias.
Full Text Available Francielle Topolski,1 Alexandre Moro,1,2 Gisele Maria Correr,3 Sasha Cristina Schimim1 1Department of Orthodontics, Positivo University, Curitiba, Paraná, Brazil; 2Department of Orthodontics, Federal University of Paraná, Curitiba, Paraná, Brazil; 3Department of Restorative Dentistry, Positivo University, Curitiba, Paraná, Brazil Abstract: Pain is an undesirable side effect of orthodontic tooth movement, which causes many patients to give up orthodontic treatment or avoid it altogether. The aim of this study was to investigate, through an analysis of the scientific literature, the best method for managing orthodontic pain. The methodological aspects involved careful definition of keywords and diligent search in databases of scientific articles published in the English language, without any restriction of publication date. We recovered 1281 articles. After the filtering and classification of these articles, 56 randomized clinical trials were selected. Of these, 19 evaluated the effects of different types of drugs for the control of orthodontic pain, 16 evaluated the effects of low-level laser therapy on orthodontic pain, and 21 evaluated other methods of pain control. Drugs reported as effective in orthodontic pain control included ibuprofen, paracetamol, naproxen sodium, aspirin, etoricoxib, meloxicam, piroxicam, and tenoxicam. Most studies report favorable outcomes in terms of alleviation of orthodontic pain with the use of low-level laser therapy. Nevertheless, we noticed that there is no consensus, both for the drug and for laser therapy, on the doses and clinical protocols most appropriate for orthodontic pain management. Alternative methods for orthodontic pain control can also broaden the clinician’s range of options in the search for better patient care. Keywords: tooth movement, pain control, drug therapy, laser therapy
Romero-Reyes, Marcela; Uyanik, James M
Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities.
Nagpal, Ameet S; Moody, Erika L
Interventional procedures can be applied for diagnostic evaluation and treatment of the patient with pelvic pain, often once more conservative measures have failed to provide relief. This article reviews interventional management strategies for pelvic pain. We review superior and inferior hypogastric plexus blocks, ganglion impar blocks, transversus abdominis plane blocks, ilioinguinal, iliohypogastric and genitofemoral blocks, pudendal nerve blocks, and selective nerve root blocks. Additionally, we discuss trigger point injections, sacroiliac joint injections, and neuromodulation approaches. Copyright © 2017 Elsevier Inc. All rights reserved.
Edwards, R B
In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern.
Lozeron, P; Kubis, N
Neuropathic pain is often underestimated and not adequately treated. The DN4 scale is very useful for its identification since it will benefit from pharmacological and non-pharmacological specific alternative care. The pathophysiological mechanisms involve the hyperexcitability of nociceptive pathways or decreased inhibitory descending controls that will be the target of pharmacological treatments. Frontline molecules are antidepressants (tricyclics and mixed serotonin and norepinephrine reuptake inhibitors) and antiepileptics (α2δ calcium channel inhibitors). However, these drugs will only have a partial efficacy on pain. The therapeutic strategy is based on reasonable goals, starting with a monotherapy adapted to the patient's symptoms and comorbidities and increased step by step. Patient compliance to contract is essential and requires clear and complete information. The impact on profession, social and family integration should rapidly be taken into account. In case of inefficiency, a change of the first-line treatment or an association could be considered. Some indications justify a specific therapy. Patients with resistant chronic pain should be sent to a specialized centre. New drugs are being studied and non-pharmacological support must be evaluated. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.
Full Text Available Cancer pain is multifactorial and complex. The impact of cancer pain is devastating, with increased morbidity and poor quality of life, if not treated adequately. Cancer pain management is a challenging task both due to disease process as well as a consequence of treatment-related side-effects. Optimization of analgesia with oral opioids, adjuvant analgesics, and advanced pain management techniques is the key to success for cancer pain. Early access of oral opioid and interventional pain management techniques can overcome the barriers of cancer pain, with improved quality of life. With timely and proper anticancer therapy, opioids, nerve blocks, and other non-invasive techniques like psychosocial care, satisfactory pain relief can be achieved in most of the patients. Although the WHO Analgesic Ladder is effective for more than 80% cancer pain, addition of appropriate adjuvant drugs along with early intervention is needed for improved Quality of Life. Effective cancer pain treatment requires a holistic approach with timely assessment, measurement of pain, pathophysiology involved in causing particular type of pain, and understanding of drugs to relieve pain with timely inclusion of intervention. Careful evaluation of psychosocial and mental components with good communication is necessary. Barriers to cancer pain management should be overcome with an interdisciplinary approach aiming to provide adequate analgesia with minimal side-effects. Management of cancer pain should comprise not only a physical component but also psychosocial and mental components and social need of the patient. With risk-benefit analysis, interventional techniques should be included in an early stage of pain treatment. This article summarizes the need for early and effective pain management strategies, awareness regarding pain control, and barriers of cancer pain.
Background: Pain management in neonates remains sub-optimal in sub-Saharan countries like Kenya due to lack of resources to procure pharmacological analgesics. There, however, exist low-cost, mother-driven pain management strategies such as breastfeeding and kangaroo care that can be used for pain relief in ...
Yang, Hyeong Tae; Hur, Giyeun; Kwak, In-Suk; Yim, Haejun; Cho, Yong Suk; Kim, Dohern; Hur, Jun; Kim, Jong Hyun; Lee, Boung Chul; Seo, Cheong Hoon; Chun, Wook
Pain management is an important aspect of burn management. We developed a routine pain monitoring system and pain management protocol for burn patients. The purpose of this study is to evaluate the effectiveness of our new pain management system. From May 2011 to November 2011, the prospective study was performed with 107 burn patients. We performed control group (n=58) data analysis and then developed the pain management protocol and monitoring system. Next, we applied our protocol to patients and performed protocol group (n=49) data analysis, and compared this to control group data. Data analysis was performed using the Numeric Rating Scale (NRS) of background pain and procedural pain, Clinician-Administered PTSD Scale (CAPS), Hamilton Depression Rating Scale (HDRS), State-Trait Anxiety Inventory Scale (STAIS), and Holmes and Rahe Stress Scale (HRSS). The NRS of background pain for the protocol group was significantly decreased compared to the control group (2.8±2.0 versus 3.9±1.9), and the NRS of procedural pain of the protocol group was significantly decreased compared to the control group (4.8±2.8 versus 3.7±2.5). CAPS and HDRS were decreased in the protocol group, but did not have statistical significance. STAIS and HRSS were decreased in the protocol group, but only the STAIS had statistical significance. Our new pain management system was effective in burn pain management. However, adequate pain management can only be accomplished by a continuous and thorough effort. Therefore, pain control protocol and pain monitoring systems need to be under constant revision and improvement using creative ideas and approaches. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.
Kurita, Geana Paula; Sjøgren, Per
BACKGROUND: The number of patients surviving cancer disease has increased in last decades. Consequently, an emerging population with different needs due to long-term or late effects of cancer disease and/or treatment, e.g. chronic pain, is of major concern. EPIDEMIOLOGY: Chronic pain is one of th...... survivors. Pain management strategies are discussed according to the biopsychosocial model and with the rapidly growing number of cancer survivors the establishment of multidisciplinary clinics as a part of comprehensive cancer centers are proposed.......BACKGROUND: The number of patients surviving cancer disease has increased in last decades. Consequently, an emerging population with different needs due to long-term or late effects of cancer disease and/or treatment, e.g. chronic pain, is of major concern. EPIDEMIOLOGY: Chronic pain is one...... of the main problems in this population and prevalence varies between 16% and 50%. Most information derives from breast cancer patients assessed by surveys from national or local institutional databases. A Danish population-based survey estimated that 41.5% of all cancer survivors reported chronic pain. PAIN...
Tynan, Belinda; Adlington, Rachael; Stewart, Cherry; Vale, Deborah; Sims, Rod; Shanahan, Peter
This paper will detail three projects which focussed on enhancing online learning at a large Australian distance education University within a School of Business, School of Health and School of Education. Each project had special funding and took quite distinctive project management approaches, which reflect the desire to embed innovation and…
José C. Santiago-Guevara; Mauricio Rojas-Contreras; Luis A. Esteban-Villamizar
This article presents a review in relation to the object of study: Communications Management as an important factor in the management of projects. The review includes the most relevant and most renowned authors in the field of project management, focusing on telecommunications projects, which lets you define a communications management model.
Phillips, Joanna; Simmonds, Lorraine
This paper, the second of a three-part series looking at change management tools, provides a practical guide on how to use common project management principles in practice. Much of the literature on project management focuses on the business arena, with little reference to clinical settings. Identifying this literature and understanding its relevance to managing projects in healthcare can be difficult. This article provides a practical guide to identifying the key principles of good project management and applying these in health settings.
This lecture will focus on the following issues: - The current state of the art in Project Management, especially the integration of Project Management with general management activities, and the integrated view of resources allocation. - Overview of the project life cycle, the phases and the deliverables - Necessity and limits of planning in a research environment - Organizational aspects of the projects the roles of the stakeholders - How to get the resources when they are needed - Risk Management in Projects - Earned value - How to keep a project on track (schedule and budget) - Management of the suppliers - Closing of the project
Dumas, Linda G; Ramadurai, Murali
This article is about pain management and some of the best practices to address the problem of pain in nursing home patients who have a serious illness and multiple comorbid conditions. Management of the emotional distress that accompanies chronic or acute pain is of foremost concern. In this article, the topics discussed include general pain management in a nursing home for a long-term care resident who has chronic pain, the relief of symptoms and suffering in a patient who is on palliative care and hospice, and the pain management of a postoperative patient with acute pain for a short transitional period (post-acute illness or surgery).
Helde-Frankling, Maria; Björkhem-Bergman, Linda
Vitamin D is a hormone synthesized in the skin in the presence of sunlight. Like other hormones, vitamin D plays a role in a wide range of processes in the body. Here we review the possible role of vitamin D in nociceptive and inflammatory pain. In observational studies, low vitamin D levels have been associated with increased pain and higher opioid doses. Recent interventional studies have shown promising effects of vitamin D supplementation on cancer pain and muscular pain-but only in patients with insufficient levels of vitamin D when starting intervention. Possible mechanisms for vitamin D in pain management are the anti-inflammatory effects mediated by reduced cytokine and prostaglandin release and effects on T-cell responses. The recent finding of vitamin D-mediated inhibition of Prostaglandin E2 (PGE2) is especially interesting and exhibits a credible mechanistic explanation. Having reviewed current literature, we suggest that patients with deficient levels defined as 25-hydroxyvitamin D (25-OHD) levels 50 nmol/L probably have little benefit from supplementation. Our conclusion is that vitamin D may constitute a safe, simple and potentially beneficial way to reduce pain among patients with vitamin D deficiency, but that more randomized and placebo-controlled studies are needed before any firm conclusions can be drawn.
Rosser, Benjamin A; Eccleston, Christopher
Smartphone applications (or apps) are becoming increasingly popular. The lack of regulation or guidance for health-related apps means that the validity and reliability of their content is unknown. We have conducted a review of available apps relating to the generic condition of pain. The official application stores for five major smartphone platforms were searched: iPhone, Android, Blackberry, Nokia/Symbian and Windows Mobile. Apps were included if they reported a focus on pain education, management or relief, and were not solely aimed at health-care professionals (HCPs). A total of 111 apps met the inclusion criteria. The majority of apps reviewed claimed some information provision or electronic manual component. Diary tracking of pain variables was also a common feature. There was a low level of stated HCP involvement in app development and content. Despite an increasing number of apps being released, the frequency of HCP involvement is not increasing. Pain apps appear to be able to promise pain relief without any concern for the effectiveness of the product, or for possible adverse effects of product use. In a population often desperate for a solution to distressing and debilitating pain conditions, there is considerable risk of individuals being misled.
This course provides INDOT staff with foundational knowledge and skills in project management principles and methodologies. INDOTs project management processes provide the tools for interdisciplinary teams to efficiently and effectively deliver pr...
Kerzner, Harold R
A new edition of the most popular book of project management case studies, expanded to include more than 100 cases plus a ""super case"" on the Iridium Project Case studies are an important part of project management education and training. This Fourth Edition of Harold Kerzner''s Project Management Case Studies features a number of new cases covering value measurement in project management. Also included is the well-received ""super case,"" which covers all aspects of project management and may be used as a capstone for a course. This new edition:Contains 100-plus case studies drawn from re
Heintz, John Linke; Lousberg, L.; Wamelink, J.W.F.; Saari, A.; Huovinen, P.
In this paper we introduce the concept of Designing Project Management. On the basis of our earlier work, we suggest that there is still a gap between what is known from recent project management literature and what project managers can structurally help in the effectiveness of their work. Assuming
Doman, J.W.; Vlahakis, J.
Management of projects under the control of the Office of Civilian Radioactive Waste Management within the Department of Energy is subject to overview by a variety of internal and external entities. This paper reports that effective project management often requires balancing of conflicting directions and conflicting agendas of the different entities in order to proceed with implementation of the Monitored Retrievable Storage project
Cheville, Andrea L; Smith, Sean R; Basford, Jeffrey R
Rehabilitation medicine offers strategies that reduce musculoskeletal pain, targeted approaches to alleviate movement-related pain, and interventions to optimize patients' function despite the persistence of pain. These approaches fall into four categories: modulating nociception, stabilizing and unloading painful structures, influencing pain perception, and alleviating soft tissue musculotendinous pain. Incorporating these interventions into individualized, comprehensive pain management programs offers the potential to empower patients and limit pain associated with mobility and required daily activities. Rehabilitative approach may be particularly helpful for patients with refractory movement-associated pain and functional vulnerability, and for those who do not wish for, or cannot, tolerate pharmacoanalgesia. Copyright © 2018 Elsevier Inc. All rights reserved.
Suralkar, Sunita; Joshi, Nilambari; Meshram, B B
This paper describes about the need for Web project management, fundamentals of project management for web projects: what it is, why projects go wrong, and what's different about web projects. We also discuss Cost Estimation Techniques based on Size Metrics. Though Web project development is similar to traditional software development applications, the special characteristics of Web Application development requires adaption of many software engineering approaches or even development of comple...
Full Text Available The purpose of the article is to define the essence of project scope management process, its components, as well as to develop an algorithm of project scope management in terms of pharmaceutical production. Methodology. To carry out the study, available information sources on standards of project management in whole and elements of project scope management in particular are analysed. Methods of system and structural analysis, logical generalization are used to study the totality of subprocesses of project scope management, input and output documents, and to provide each of them. Methods of network planning are used to construct a precedence diagram of project scope management process. Results of the research showed that components of the project scope management are managing the scope of the project product and managing the content of project work. It is the second component is investigated in the presented work as a subject of research. Accordingly, it is defined that project scope management process is to substantiate and bring to the realization the necessary amount of work that ensures the successful implementation of the project (achievement of its goal and objectives of individual project participants. It is also determined that the process of managing the project scope takes into account the planning, definition of the project scope, creation of the structure of project work, confirmation of the scope and management of the project scope. Participants of these subprocesses are: customer, investor, and other project participants – external organizations (contractors of the project; project review committee; project manager and project team. It is revealed that the key element of planning the project scope is the formation of the structure of design work, the justification of the number of works, and the sequence of their implementation. It is recommended to use the following sequence of stages for creating the structure of project work
Jr., R. F. Miles
Project risk management is primarily concerned with performance, reliability, cost, and schedule. Environmental risk management is primarily concerned with human health and ecological hazards and likelihoods. This paper discusses project risk management and compares it to environmental risk management, both with respect to goals and implementation. The approach of the Jet Propulsion Laboratory to risk management is presented as an example of a project risk management approach that is an extension to NASA NHB 7120.5: Management of Major System Programs and Projects.
Carrying out a project as planned is not a guarantee for success. Projects may fail because project management does not take the requirements, wishes and concerns of stakeholders sufficiently into account. Projects can only be successful though contributions from stakeholders. And in the end, it is the stakeholders that evaluate whether they find that the project is a success. To manage stakeholders effectively, you need to know your stakeholders, their behaviours and attitudes towards the project. In Project Stakeholder Management, the authors give guidance on how to adopt an analytical and s
Fahey, Jenifer O
Pain has been documented as a major concern for women in the postpartum period. Management of postpartum pain, however, is a relatively neglected area of clinical research. As a result, evidence to support interventions to alleviate the discomforts associated with childbirth is sparse. This paucity of research on postpartum pain management is particularly surprising given that in the United States alone nearly 4 million women give birth each year. Inadequate pain relief in the hours to months following childbirth can interfere with maternal-newborn bonding and feeding and, by impeding mobility, can increase the risk of postpartum complications. In addition, pain that is not adequately managed may increase the risk of chronic pain that lasts beyond the postpartum period. In this article, the more common causes of pain following childbirth are reviewed and recommendations for pain management based on available evidence are outlined. Considerations for pain management in lactating women and for hospital discharge are discussed.
Full Text Available Many software and IT projects fail in completing theirs objectives because different causes of which the management of the projects has a high weight. In order to have successfully projects, lessons learned have to be used, historical data to be collected and metrics and indicators have to be computed and used to compare them with past projects and avoid failure to happen. This paper presents some metrics that can be used for the IT project management.
Under-treated pain can result in a number of potentially serious sequelae (Australian and New Zealand College of Anaesthetists, 2006), including delayed mobilization and recovery, cardiac complications, thromboses, pulmonary complications, delayed healing, psychosocial problems and chronic pain syndromes. This article considers pain management in the context of painful wounds. An international comparative survey on wound pain (European Wound Management Association, 2002) found that practitioners in the wound care community tend to focus on healing processes rather than the patient's total pain experience involving an accurate pain assessment and selection of an appropriate pain management strategy. Procedural pain with dressing removal and cleansing caused the greatest concerns. An overview of simple, evidence-based drug and non-drug techniques is offered as potential strategies to help minimize the experience of pain.
Full Text Available The present article is aimed at developing a set of recommendations for achieving a higher level of organizational project maturity at a given enterprise. Methodology. For the purposes of the current research, the available information sources on the components of project management system are analysed; the essence of “organizational maturity” and the existing models of organizational maturity are studied. The method of systemic and structural analysis, as well as the method of logical generalization, are employed in order to study the existing models of organizational maturity, to describe levels of organizational maturity, and finally to develop a set of methodological recommendations for achieving a higher level of organizational project maturity at a given enterprise. The results of the research showed that the core elements of project management system are methodological, organizational, programtechnical, and motivational components. Project management encompasses a wide range of issues connected with organizational structure, project team, communication management, project participants, etc. However, the fundamental basis for developing project management concept within a given enterprise starts with defining its level of organizational maturity. The present paper describes various models of organizational maturity (staged, continuous, petal-shaped and their common types (H. Кеrzner Organizational Maturity Model, Berkeley PM Maturity Model, Organizational Project Management Maturity Model, Portfolio, Program & Project Management Maturity Model. The analysis of available theoretic works showed that the notion “organizational project maturity” refers to the capability of an enterprise to select projects and manage them with the intention of achieving its strategic goals in the most effective way. Importantly, the level of maturity can be improved by means of formalizing the acquired knowledge, regulating project-related activities
Brennan, Frank; Carr, Daniel B; Cousins, Michael
This article surveys worldwide medical, ethical, and legal trends and initiatives related to the concept of pain management as a human right. This concept recently gained momentum with the 2004 European Federation of International Association for the Study of Pain (IASP) Chapters-, International Association for the Study of Pain- and World Health Organization-sponsored "Global Day Against Pain," where it was adopted as a central theme. We survey the scope of the problem of unrelieved pain in three areas, acute pain, chronic noncancer pain, and cancer pain, and outline the adverse physical and psychological effects and social and economic costs of untreated pain. Reasons for deficiencies in pain management include cultural, societal, religious, and political attitudes, including acceptance of torture. The biomedical model of disease, focused on pathophysiology rather than quality of life, reinforces entrenched attitudes that marginalize pain management as a priority. Strategies currently applied for improvement include framing pain management as an ethical issue; promoting pain management as a legal right, providing constitutional guarantees and statutory regulations that span negligence law, criminal law, and elder abuse; defining pain management as a fundamental human right, categorizing failure to provide pain management as professional misconduct, and issuing guidelines and standards of practice by professional bodies. The role of the World Health Organization is discussed, particularly with respect to opioid availability for pain management. We conclude that, because pain management is the subject of many initiatives within the disciplines of medicine, ethics and law, we are at an "inflection point" in which unreasonable failure to treat pain is viewed worldwide as poor medicine, unethical practice, and an abrogation of a fundamental human right.
Young, Trevor L
Successful Project Management, 5th edition, is an essential guide for anyone who wants to improve the success rate of their projects. It will help managers to maintain a balance between the demands of the customer, the project, the team and the organization. Covering the more technical aspects of a project from start to completion it contains practised and tested techniques, covering project conception and start-up, how to manage stake holders, effective risk management, project planning and launch and execution. Also including a brand new glossary of key terms, it provides help with evaluating your project as well as practical checklists and templates to ensure success for any ambitious project manager. With over one million copies sold, the hugely popular Creating Success series covers a wide variety of topic, with the latest editions including new chapters such as Tough Conversations and Treating People Right. This indispensable business skills collection is suited to a variety of roles, from someone look...
Fleming, Quentin W
Organizations that follow the principles of good Earned Value Management (EVM) create an environment that allows teams to successfully operate and thrive ? even in the face of challenges that could negatively impact their projects. Earned Value Project Management (EVPM) is a methodology used to measure and communicate the real physical progress of a project taking into account the work completed, the time taken and the costs incurred to complete that work. As a result, EVPM allows more educated and effective management decision-making, which helps evaluate and control project risk by measuring project progress in monetary terms. In the first two editions of Earned Value Project Management, Quentin W. Fleming and Joel M. Koppelman provided guidance for project management practitioners already familiar with EVPM, was well as those who were new to the use of this technique. The third edition expanded the information available on of EVPM for medium and smaller projects while still being relevant for larger projec...
With sales of more than 160,000 copies, Fundamentals of Project Management has helped generations of project managers navigate the ins and outs of every aspect of this complex discipline. Using a simple step-by-step approach, the book is the perfect introduction to project management tools, techniques, and concepts. Readers will learn how to: ò Develop a mission statement, vision, goals, and objectives ò Plan the project ò Create the work breakdown structure ò Produce a workable schedule ò Understand earned value analysis ò Manage a project team ò Control and evaluate progress at every stage.
The Hanford Spent Nuclear Fuel Project has been established to safely store spent nuclear fuel at the Hanford Site. This Project Management Plan sets forth the management basis for the Spent Nuclear Fuel Project. The plan applies to all fabrication and construction projects, operation of the Spent Nuclear Fuel Project facilities, and necessary engineering and management functions within the scope of the project
Persson, John Stouby
Increasingly, software projects are becoming geographically distributed, with limited face-toface interaction between participants. These projects face particular challenges that need careful managerial attention. This PhD study reports on how we can understand and support the management...... of distributed software projects, based on a literature study and a case study. The main emphasis of the literature study was on how to support the management of distributed software projects, but also contributed to an understanding of these projects. The main emphasis of the case study was on how to understand...... the management of distributed software projects, but also contributed to supporting the management of these projects. The literature study integrates what we know about risks and risk-resolution techniques, into a framework for managing risks in distributed contexts. This framework was developed iteratively...
The purpose of the FTA Construction Project Management Handbook is to provide guidelines for use by public transit agencies (Agen-cies) undertaking substantial construction projects, either for the first time or with little prior experience with cons...
Miller, D B
Chronic Pain extracts a "penalty" on society now estimated to be well in excess of $100 million per year. The "penalty" that Chronic Pain extracts from its victims is incalculable. Chronic Pain is a major component of Temporomandibular Disorders. The current neurological theory of the mechanism of chronic TMD pain is explored along with the current modes of treatment. Pharmacological management of Chronic Pain in a clinical setting is outlined. Dentists are involved in pain management on a daily basis. Dentists treat pain both prophylacticly and in response to specific patient symptoms. Most dental treatment involves some type of pain management. We, dentists, have become very adept at managing acute pain. We have much greater difficulty managing chronic pain. The word "pain" derives from the Greek word for penalty, and appeared to them to be a "penalty" inflicted by the gods. In 1984, Bonica estimated that one-third of all Americans suffered from some kind of chronic pain at a "penalty" to society of $65 Billion annually in medical expenses and lost wages and productivity. This figure is certainly much greater now. Chronic pain can be a very complex problem that can require a multidisciplinary approach to treatment. Chronic pain in the dental setting is most frequetly caused by prolonged Temporomandibular Disorders.
Bennett, Michael J
Project Management for Engineers, as the title suggests, is a direct attempt at addressing the ever-increasing and specific needs for better project management of engineering students, practicing engineers and managers in the industry. It aims not only to present the principles and techniques of Project Management, but also to discuss project management standards, processes and requirements, such as PMBOK, IEEE and PRINCE. Each chapter begins with the basics of the theme being developed at a level understandable to an undergraduate, before more complex topics are introduced at the end of each section that are suitable for graduate students. For the practicing professionals or managers in the industry, the book also provides many real illustrations of practical application of the principles of Project Management. Through a realistic blend of theory and practical examples, as well as an integration of the engineering technical issues with business issues, this book seeks to remove the veil of mystery that has...
Full Text Available Cancer pain is still one of the most feared entities in cancer and about 75% of these patients require treatment with opioids for severe pain. The cancer pain relief is difficult to manage in patients with episodic or incidental pain, neuropathic pain, substance abuse and with impaired cognitive or communication skills. This non-systematic review article aims to discuss reasons for under treatment, tools of pain assessment, cancer pain and anxiety and possibly carve new approaches for cancer pain management in future. The current status of World Health Organization analgesic ladder has also been reviewed. A thorough literature search was carried out from 1998 to 2010 for current status in cancer pain management in MEDLINE, WHO guidelines and published literature and relevant articles have been included.
Mihalache Anita; Salagean Liana
Project management is a technique that can aid in the planning, scheduling, and monitoring of complex projects characterized by numerous, non repetitive jobs called activities. Examples of projects that would use project management include: - developing a mass rapid – transit system for a metropolitan area; - organizing the relocation of a corporate headquarters; - planning the production of a concert, film, or play; - developing and marketing a new automobile; - constructing a high – rise of...
Project management consists of two very important aspects – managing the right project and managing the project right. To know that you are managing the right project you need to ensure that your project is based on an actual requirement and that your project goal is relevant and beneficial. And professional project planning assists in managing project the right way. The project planning process is very time consuming and is one of the most important parts of the project management process. T...
The basic principles of project management as practiced by NASA management personnel are presented. These principles are given as ground rules and guidelines to be used in the performance of research, development, construction or operational assignments.
Peisker, Andre; Meissner, Winfried; Raschke, Gregor F; Fahmy, Mina D; Guentsch, Arndt; Schiller, Juliane; Schultze-Mosgau, Stefan
Effective pain management is an essential component in the perioperative care of surgical patients. However, postoperative pain after maxillofacial fracture repair and its optimal therapy has not been described in detail. In a prospective cohort study, 95 adults rated their pain on the first postoperative day after maxillofacial fracture repair using the questionnaire of the Quality Improvement in Postoperative Pain Management (QUIPS) project. Quality Improvement in Postoperative Pain Management allowed for a standardized assessment of patients' characteristics and pain-related parameters. Overall, the mean maximal pain and pain on activity (numeric rating scales) were significantly higher in patients with mandibular fractures than in patients with midface fractures (P = 0.002 and P = 0.045, respectively). In patients with mandibular fractures, a longer duration of surgery was significantly associated with higher satisfaction with pain intensity (P = 0.015), but was more frequently associated with postoperative vomiting (P = 0.023). A shorter duration of surgery and an absence of preoperative pain counseling in these patients were significantly correlated to desire for more pain medication (P = 0.049 and P = 0.004, respectively). Patients with mandibular fractures that received opioids in the recovery room had significantly higher strain-related pain (P = 0.017). In patients with midface fractures, a longer duration of surgery showed significantly higher levels of decreased mobility (P = 0.003). Patients receiving midazolam for premedication had significantly less minimal pain (P = 0.021). Patients with mandibular fractures seem to have more postoperative pain than patients with midface fractures. Monitoring of postsurgical pain and a procedure-specific pain-treatment protocol should be performed in clinical routine.
Full Text Available The article is based on literature review and authors’ own recent experience in managing multicultural project teams, in international environment. This comparative study considers two groups of projects: technical assistance (TA projects versus information technology (IT projects. The aim is to explore the size and structure of the project teams – according to the team formation and its lifecycle, and to identify some distinctive attributes of the project teams – both similarities and differences between the above mentioned types of projects. Distinct focus of the research is on the multiculturalism of the project teams: how the cultural background of the team members influences the team performance and team management. Besides the results of the study are the managerial implications: how the team managers could soften the cultural clash, and avoid inter-cultural misunderstandings and even conflicts – in order to get a better performance. Some practical examples are provided as well.
Brown, Carolyn; Constance, Kristel; Bédard, Denise; Purden, Margaret
This study describes surgical colorectal cancer patients' pain levels, recovery activities, beliefs and expectations about pain, and satisfaction with pain management. A convenience sample of 50 adult inpatients who underwent colorectal surgery for cancer participated. Patients were administered the modified American Pain Society Patient Outcome Questionnaire on postoperative day 2 and asked to report on their status in the preceding 24 hours. Patients reported low current (mean 1.70) and average (mean 2.96) pain scores but had higher scores and greater variation for worst pain (mean 5.48). Worst pain occurred mainly while turning in bed or mobilizing, and 25% of patients experienced their worst pain at rest. Overall, patients expected to have pain after surgery and were very satisfied with pain management. Patients with worst pain scores >7 reported interference with recovery activities, mainly general activity (mean 5.67) and walking ability (mean 5.15). These patients were likely to believe that "people can get addicted to pain medication easily" (mean 3.39 out of 5) and that "pain medication should be saved for cases where pain gets worse" (mean 3.20 out of 5). These beliefs could deter patients from seeking pain relief and may need to be identified and addressed along with expectations about pain in the preoperative nursing assessment. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Muto, Donna; Wilk, Jan
One of eight papers from Project Seed, this paper describes a stress management project undertaken with high school sophomores. Managing Stress is described as an interactive workshop that offers young people an opportunity to examine specific areas of stress in their lives and to learn effective ways to deal with them. The program described…
Rao-Gupta, Suma; Kruger, David; Leak, Lonna D; Tieman, Lisa A; Manworren, Renee C B
Most children experience pain in hospitals; and their parents report dissatisfaction with how well pain was managed. Engaging patients and families in the development and evaluation of pain treatment plans may improve perceptions of pain management and hospital experiences. The aim of this performance improvement project was to engage patients and families to address hospitalized pediatric patients' pain using interactive patient care technology. The goal was to stimulate conversations about pain management expectations and perceptions of treatment plan effectiveness among patients, parents, and health care teams. Plan-Do-Study-Act was used to design, develop, test, and pilot new workflows to integrate the interactive patient care technology system with the automated medication dispensing system and document actions from both systems into the electronic health record. The pediatric surgical unit and hematology/oncology unit of a free-standing, university-affiliated, urban children's hospital were selected to pilot this performance improvement project because of the high prevalence of pain from surgeries and hematologic and oncologic diseases, treatments, and invasive procedures. Documentation of pain assessments, nonpharmacologic interventions, and evaluation of treatment effectiveness increased. The proportion of positive family satisfaction responses for pain management significantly increased from fiscal year 2014 to fiscal year 2016 (p = .006). By leveraging interactive patient care technologies, patients and families were engaged to take an active role in pain treatment plans and evaluation of treatment outcomes. Improved active communication and partnership with patients and families can effectively change organizational culture to be more sensitive to patients' pain and patients' and families' hospital experiences. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Braden, Barry M.
How does a Project Management Office provide: Consistent, familiar, easily used scheduling tools to Project Managers and project team members? Provide a complete list of organization resources available for use on the project? Facilitate resource tracking and visibility? Provide the myriad reports that the organization requires? Facilitate consistent budget planning and cost performance information? Provide all of this to the entire organization? Provide for the unique requirement of the organization? and get people to use it? Answer: Implementation of the Kennedy space Center Projects and Resources Online (KPRO), a modified COTS solution.
Osterbrink, Jürgen; Bauer, Zsuzsa; Mitterlehner, Barbara; Gnass, Irmela; Kutschar, Patrick
Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, 'Action Alliance Pain-Free City Muenster', the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic⁄acute pain-affected persons and highly recommended for practice. To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city. In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011. Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent. Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain.
Ra’ad, Mohammed A.; Najdawi, Mohammad K.
The practice of project management has gained enormous importance over the past several years in various business industries. “In industries as diverse as pharmaceuticals, software, and aerospace, projects drive business” (Wheatley). This gain of importance can be attributed to the magnitude of the impact project performance results in terms of time, cost, and scope have over the project performing entity. “On the basis of data released by the Bureau of Economic Analysis, part of the US De...
Bonkowski, Sara L; De Gagne, Jennie C; Cade, Makia B; Bulla, Sally A
Nurses lack adequate pain management knowledge, which can result in poorly managed postsurgical pain. This study aimed to develop, implement, and evaluate pain management education and operational guidelines to improve nursing knowledge and pain management. This quality improvement project employed convenience samples of surgical oncology nurses and postoperative patients. The intervention involved an online module, live education, and operational guideline for pain management. Nurses completed pre- and postintervention practice and attitudes surveys. Random chart reviews of intravenous narcotic administrations the day before discharge were completed to evaluate whether narcotic administration changed after intervention. Readmissions and Hospital Consumer Assessment of Healthcare Providers and Systems data were collected to determine whether the intervention influenced patient satisfaction. A statistically significant improvement in nursing practice and intravenous narcotic administrations demonstrated changes to pain management practices employed by the nursing staff. Although not statistically significant, fewer pain-related readmissions occurred postintervention. Findings demonstrate that targeted pain management continuing education, paired with operational guidelines, improves nursing practice and decreases intravenous narcotic administrations prior to discharge. J Contin Educ Nurs. 2018;49(4):178-185. Copyright 2018, SLACK Incorporated.
International Journal of Development and Management Review ... collapse, project failure, project abandonment, project cost and time overruns, etc. ... component parts that constitute project management in the building construction industry.
Tamara Gvozdenovic; Mirjana Miljanovic; Aleksandar Jegdic; Zeljko Crnogorcic
One of the main trends is standardization of project management. Some of the most important bodies of knowledge in project management, which were created by professional associations for project management are given in this paper. The main of the project management, apart from minimization of time, resources and costs, is to finish the project in the required quality, i.e. it is very important during the whole process of project management to provide realizing the project without any deviatio...
Patients frequently experience moderate to severe pain inthe postoperative period. Although the pain managementis an integral and important part of the nursing care, studiessuggest that, nursing management of postoperativepain remains inadequate.Postoperative care nurses are responsible to assess thepatient’s pain, teach the patient strategies to deal with thepain, apply the analgesic treatment plan, monitor the resultsof treatment, educate the patient and the family onpain management and doc...
When speaking about interfaces within a project and their management, one has to understand and define what an interface is. In general, each component facing another one and each person working on a project with another person represents an interface. Therefore a project will consist practically in its entirety of interfaces with components and people sandwiched between them. This paper is limited to the most important interfaces with a focus on the problems occuring at them and their resolution. (orig.) [de
Full Text Available The management of pain in palliative care of children is somewhat different from that in adults.The use of opioids in pediatric palliative care presents some unique challenges. Confident and rational use of opioids, illustrated by WHO Guidelines is essential for adequate management of pain in children with life limiting conditions.
Collados-Gómez, L; Camacho-Vicente, V; González-Villalba, M; Sanz-Prades, G; Bellón-Vaquerizo, B
To describe the perceptions of nurses in neonatal units on pain management, meet the educational profile and describe the use of pain assessment tools and non-pharmacological management for treatment. Cross-sectional descriptive multicentre study, developed during the months of February to September 2015, in the neonatology services of three hospitals at the Community of Madrid, Spain. Data collection was performed through an ad hoc questionnaire on paper or electronically using Survey Monkey platform. The sample consisted of 142 professionals, with a response rate of 55%: 47.9% (68) confirmed they had received specific training in pain management; 39.5% (56) stated that pain is regularly assessed in the unit; only 43.6% reported using validated scales, the most used being the Premature Infant Pain Profile (PIPP). As for the non-pharmacological management, swaddling and non-nutritive sucking it is the most used, followed by sucrose. Intravenous cannulation was identified as the most painful procedure. Pain management is in the process of improvement, because of training and because there is little pain assessment using validated scales. The improvement in the use of non-pharmacological management for the relief of pain in minor procedures is noteworthy. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.
Full Text Available Patients frequently experience moderate to severe pain inthe postoperative period. Although the pain managementis an integral and important part of the nursing care, studiessuggest that, nursing management of postoperativepain remains inadequate.Postoperative care nurses are responsible to assess thepatient’s pain, teach the patient strategies to deal with thepain, apply the analgesic treatment plan, monitor the resultsof treatment, educate the patient and the family onpain management and document the pain managementoutcomes. The nurses’ holistic approach to pain managementminimizes the patients’ discomfort caused by pain inthe postoperative period after the surgery. In this article,nurses’ approaches to postoperative pain managementare discussed. J Clin Exp Invest 2011; 2 (4: 474-478
Chen, Kelly Yan; Chen, Lucy; Mao, Jianren
Buprenorphine-naloxone (bup/nal in 4:1 ratio; Suboxone; Reckitt Benckiser Pharmaceuticals Incorporation, Richmond, VA) is approved by the Food and Drug Administration for outpatient office-based addiction treatment. In the past few years, bup/nal has been increasingly prescribed off-label for chronic pain management. The current data suggest that bup/nal may provide pain relief in patients with chronic pain with opioid dependence or addiction. However, the unique pharmacological profile of bup/nal confers it to be a weak analgesic that is unlikely to provide adequate pain relief for patients without opioid dependence or addiction. Possible mechanisms of pain relief by bup/nal therapy in opioid-dependent patients with chronic pain may include reversal of opioid-induced hyperalgesia and improvement in opioid tolerance and addiction. Additional studies are needed to assess the implication of bup/nal therapy in clinical anesthesia and perioperative pain management.
Full Text Available Pain is a common feature in functional gastrointestinal disorders (FGID. An abnormally low visceral sensory threshold, as well as a number of central, spinal and peripheral pain-modulating abnormalities, have been proposed for this syndrome. Clinical aspects of pain associated with irritable esophagus, functional dyspepsia, biliary dysmotility, inflammatory bowel syndrome and proctalgia fugax are reviewed. Because of its unclear pathophysiology, pain expression is the main target for the successful assessment and management of symptomatic FGID. The sensory, cognitive and affective components of pain intensity expression need to be addressed in the context of a good physician-patient rapport. A multidisciplinary team approach is ideal for the smaller subset of patients with severe and disabling symptoms. Although pharmacotherapy may target specific functional disorders, the role of behavioural techniques and psychotherapy appears much more important for pain management in FGID. Functional performance and quality of life improvement, rather than pain intensity, are the main therapeutic goals in these patients.
Nielsen, Rikke Vibeke; Fomsgaard, Jonna Storm; Dahl, Jørgen Berg
INTRODUCTION: A prospective observational quality assurance study was performed at Glostrup Hospital, Denmark, to describe patients undergoing spine surgery with regard to perioperative analgesic management, post-operative pain, opioid consumption and side effects. MATERIAL AND METHODS: Patients...... experienced acceptable pain levels, but instrumented lumbar fusion leads to moderate to severe pain levels and a relatively high opioid consumption. The scheduled standard pain management protocols were sparsely followed. Challenges exist in post-operative pain management as observed in previous surveys...... eligible for the study were identified consecutively from the operation chart. The following data were registered: post-operative visual analogue (VAS) pain score at rest and during mobilisation, opioid consumption for the first 24 h, other analgesics administered and side effects. RESULTS: A total of 87...
Cline, Melinda; Guynes, Carl S.; Simard, Karine
The primary challenge of project management is to achieve the project goals and objectives while adhering to project constraints--usually scope, quality, time and budget. The secondary challenge is to optimize the allocation and integration of resources necessary to meet pre-defined objectives. Project management software provides an active…
A two-hours course on the HERMES Project Management Methodology to the attention of Project Leaders and Project Participants. The methodology is quickly presented; the focus is put on the roles and responsibilities and on the project initiation phase. The course is given in French with slides in English. On April 22nd 2013, a new version of the HERMES methodology was made public. For practical reasons, this course is still given based on the 2009 version of HERMES (a.k.a. HERMES 4).
Pries, Kim H
Scrum, which was originally invented solely for software development, can now be applied to all types of projects. This book shows project managers how to implement Scrum by explaining the artifacts, rituals, and roles used. The text provides Scrum planning methods to control project scope and schedule as well as Scrum tracking methods to focus teams on improving throughput and streamlining communications. The authors show how to combine traditional project methods with Scrum and how to adapt the familiar work breakdown structure to create Scrum backlogs and sprints. They also demonstrate how
Pierik, Jorien; IJzerman, Maarten Joost; Gaakeer, Menno I.; Berben, Sivera A.; Eenennaam, Fred L.; van Vugt, Arie B.; Doggen, Catharina Jacoba Maria
Objective While acute musculoskeletal pain is a frequent complaint in emergency care, its management is often neglected, placing patients at risk for insufficient pain relief. Our aim is to investigate how often pain management is provided in the prehospital phase and emergency department (ED) and
This chapter gives an educational overview of: * the concept of project management and its role in modern management * the generic project lifecycle process * processes used in developing a plan for the management of resources - time, cost, physical resources and people * the concept of managing risk in projects * communication processes and practices that are important to the management of projects.
DuPree, Erin; Martin, Lisa; Anderson, Rebecca; Kathuria, Navneet; Reich, David; Porter, Carol; Chassin, Mark R
Patient satisfaction as a direct and public measure of quality of care is changing the way hospitals address quality improvement. The feasibility of using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) methodology to improve patient satisfaction as it relates to pain management was evaluated. This project used the DMAIC methodology to improve patients' overall satisfaction with pain management on two inpatient units in an urban academic medical center. Pre- and postintervention patient surveys were conducted. The DMAIC methodology provided a data-driven structure to determine the optimal improvement strategies, as well as a long-term plan for maintaining any improvements. In addition, the Change Acceleration Process (CAP) was used throughout the project's various DMAIC stages to further the work of the team by creating a shared need to meet the objectives of the project. Overall satisfaction with pain management "excellent" ratings increased from 37% to 54%. Both units surpassed the goal of at least 50% of responses in the "excellent" category. Several key drivers of satisfaction with pain management were uncovered in the Analyze phase of the project, and each saw rating increases from the pre-intervention to postintervention surveys. Ongoing monitoring by the hospital inpatient satisfaction survey showed that the pain satisfaction score improved in subsequent quarters as compared with the pre-intervention period. The Six Sigma DMAIC methodology can be used successfully to improve patient satisfaction. The project led to measurable improvements in patient satisfaction with pain management, which have endured past the duration of the Six Sigma project. The Control phase of DMAIC allows the improvements to be incorporated into daily operations.
Reynolds, Janice; Drew, Debra; Dunwoody, Colleen
Pain at the end of life continues to be of great concern as it may be unrecognized or untreated. While nurses have an ethical obligation to reduce suffering at the end of life, barriers remain regarding appropriate and adequate pain management at the end of life. This position statement from the American Society for Pain Management Nursing contains recommendations for nurses, prescribers, and institutions that would improve pain management for this vulnerable population. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Tse, Mimi Mun Yee; Ho, Suki S K
The aim of the study was to examine the effectiveness of a pain management program (PMP) in enhancing the knowledge and attitudes of health care workers in pain management. Many nursing home residents suffer from pain, and treatment of pain is often inadequate. Failure of health care workers to assess pain and their insufficient knowledge of pain management are barriers to adequate treatment. It was a quasiexperimental pretest and posttest study. Four nursing homes were approached, and 88 staff joined the 8-week PMP. Demographics and the knowledge and attitudes regarding pain were collected with the use of the Nurse's Knowledge and Attitudes Survey Regarding Pain-Chinese version (NKASRP-C) before and after the PMP. A deficit in knowledge and attitudes related to pain management was prominent before the PMP, and there was a significant increase in pain knowledge and attitudes from 7.9 ± SD 3.52 to 19.2 ± SD4.4 (p nursing staff and enable them to provide adequate and appropriate care to older persons in pain. PMPs for nurses and all health care professionals are important in enhancing care for older adults and to inform policy on the provision of pain management. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Romero-Reyes, Marcela; Uyanik, James M
Marcela Romero-Reyes, James M Uyanik Orofacial and Head Pain Service, Department of Oral and Maxillofacial Pathology Radiology and Medicine, New York University College of Dentistry, New York, NY, USA Abstract: Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Tem...
Sarah A Moore
Full Text Available Disorders of the somatosensory system such as neuropathic pain are common in people with chronic neurologic and musculoskeletal diseases, yet these conditions remain an underappreciated morbidity in our veterinary patients. This is likely because assessment of neuropathic pain in people relies heavily on self-reporting, something our veterinary patients are not able to do. The development of neuropathic pain is a complex phenomenon, and concepts related to it are frequently not addressed in the standard veterinary medical curriculum such that veterinarians may not recognize this as a potential problem in patients. The goals of this review are to discuss basic concepts in the pathophysiology of neuropathic pain, provide definitions for common clinical terms used in association with the condition, and discuss available medical treatment options for dogs with neuropathic pain. The development of neuropathic pain involves key mechanisms such as ectopic afferent nerve activity, peripheral sensitization, central sensitization, impaired inhibitory modulation, and activation of microglia. Treatments aimed at reducing neuropathic pain are targeted at one or more of these mechanisms. Several drugs are commonly used in the veterinary clinical setting to treat neuropathic pain. These include gabapentin, pregabalin, amantadine, and amitriptyline. Proposed mechanisms of action for each drug, and known pharmacokinetic profiles in dogs are discussed. Strong evidence exists in the human literature for the utility of most of these treatments, but clinical veterinary-specific literature is currently limited. Future studies should focus on objective methods to document neuropathic pain and monitor response to therapy in our veterinary patients.
Hutton, Natalie; McGee, Anne; Dunbar, Catherine
Most, if not all, cancer patients require care from community teams at some stage during their disease trajectory. For many of these patients, community nurses and General Practitioners are the main point of contact. Pain is reported by between 55-95% of patients with advanced or terminal disease. Optimal pain control positively impacts on the physical, emotional and functional well-being of the patient. Despite the existence of guidelines (WHO, 1996) (SIGN, 2000) and a wealth of literature on cancer pain management, half of all patients in Western countries still do not receive adequate pain relief. This article looks at the reasons behind this and provides community nurses with an overview of up-to-date information on pain pathophysiology and management, so that the control of cancer pain can be optimized in the community.
Administering pain medication to terminal patients can cause legal problems when it has a life-shortening effect, because according to some authors it equates with manslaughter. The legal basis of the acceptance of pain alleviation with life-shortening effect can be found on the grounds of necessity. In different countries physicians have been prosecuted because of their pain management, which to the public prosecutor was in fact a sort of euthanasia. On the other hand, it is not unknown that physicians administer opioids to mask euthanasia. Pain management needs some rules, which can reassure the physician who alleviates pain. The physician who alleviates pain with life-shortening effect will have to act with due care to avoid a liability risk. This implies at least an informed consent, to observe the proportionality rule, and to keep a medical record.
Mu, Alex; Weinberg, Erica; Moulin, Dwight E.; Clarke, Hance
Abstract Objective To provide family physicians with a practical clinical summary of the Canadian Pain Society (CPS) revised consensus statement on the pharmacologic management of neuropathic pain. Quality of evidence A multidisciplinary interest group within the CPS conducted a systematic review of the literature on the current treatments of neuropathic pain in drafting the revised consensus statement. Main message Gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors are the first-line agents for treating neuropathic pain. Tramadol and other opioids are recommended as second-line agents, while cannabinoids are newly recommended as third-line agents. Other anticonvulsants, methadone, tapentadol, topical lidocaine, and botulinum toxin are recommended as fourth-line agents. Conclusion Many pharmacologic analgesics exist for the treatment of neuropathic pain. Through evidence-based recommendations, the CPS revised consensus statement helps guide family physicians in the management of patients with neuropathic pain. PMID:29138154
Ruan, Xiulu; Kaye, Alan David
Chronic pain is pervasive and costly. In 2011, the Institute of Medicine (IOM) released a landmark report on chronic pain, which estimated that more than 100 million Americans suffer from chronic pain, making pain a major and significant public health problem. The benefits of interdisciplinary pain management programs are undeniable and have been demonstrated for over a half century. Until health care leaders and other stakeholders such as insurers work together to ensure best practices in pain management, we will certainly end up in a lose-lose situation for both the health care teams and patients. In order to impact health care policy more effectively, we need to better understand the politics of health policy decision making. J Orthop Sports Phys Ther 2016;46(12):1021-1023. doi:10.2519/jospt.2016.0611.
Pries-Heje, Jan; Pries-Heje, Lene
Scrum has gained surprising momentum as an agile IS project management approach. An obvious question is why Scrum is so useful? To answer that question we carried out a longitudinal study of a distributed project using Scrum. We analyzed the data using coding and categorisation and three carefully...... selected theoretical frameworks. Our conclusion in this paper is that Scrum is so useful because it provides effective communication in the form of boundary objects and boundary spanners, it provides effective social integration by building up social team capital, and it provides much needed control...... and coordination mechanisms by allowing both local and global articulation of work in the project. That is why Scrum is especially useful for distributed IS project management and teamwork....
Full Text Available One of the main trends is standardization of project management. Some of the most important bodies of knowledge in project management, which were created by professional associations for project management are given in this paper. The main of the project management, apart from minimization of time, resources and costs, is to finish the project in the required quality, i.e. it is very important during the whole process of project management to provide realizing the project without any deviations from the previously set quality standards. Basic processes of project quality management are: quality planning, quality assurance and quality control.
Andersen, Jesper Rank; Riis, Jens Ove; Mikkelsen, Hans
This paper will provide a preliminary introduction to the application of Agile Thinking in management of project portfolio and company development. At any point in time, companies have a crowd of development initiatives spread around the organisation and managed at different levels...... in the managerial hierarchy. They compete for resources and managerial attention, and they often take too long time - and some do not survive in the rapid changing context. Top man¬agers ask for speed, flexibility and effectiveness in the portfolio of development activities (projects). But which competencies...
Tsang, Corey C; Giudice, Mirella G
Nabilone, a synthetic cannabinoid, is approved in many countries including, but not limited to, Canada, the United States, Mexico, and the United Kingdom for the treatment of severe nausea and vomiting associated with chemotherapy. Clinical evidence is emerging for its use in managing pain conditions with different etiologies. We review the efficacy and safety of nabilone for various types of pain as well as its abuse potential, precautions and contraindications, and drug interactions; summarize pertinent clinical practice guidelines; and provide recommendations for dosing, monitoring, and patient education. Citations involving nabilone were identified through systematic reviews evaluating cannabinoids for pain. A systematic search (updated July 23, 2015) of the Ovid MEDLINE, EMBASE, PubMed, and Cochrane Library databases was performed. Eight randomized controlled trials, two prospective cohort trials, and one retrospective chart review were retrieved. Cancer pain, chronic noncancer pain, neuropathic pain, fibromyalgia, and pain associated with spasticity were the pain conditions evaluated. Nabilone was most commonly used as adjunctive therapy and led to small but significant reductions in pain. The most common adverse drug reactions included euphoria, drowsiness, and dizziness. Nabilone was rarely associated with severe adverse drug reactions requiring drug discontinuation, and the likelihood of abuse was thought to be low. Although the optimal role of nabilone in the management of pain is yet to be determined, certain clinical practice guidelines consider nabilone as a third-line agent. © 2016 Pharmacotherapy Publications, Inc.
Pain is a symptom associated with prolonged recovery from illness and procedures, decreased quality of life, and increased health-care costs. While there have been advances in the management of cancer pain, there is a need for therapeutic strategies that complement pharmaceutical management without significantly contributing to the side-effect profile of these agents. Hypnosis provides a safe and efficacious supplement to pharmaceutical management of cancer pain. One barrier to the regular use of hypnosis is health-care providers’ lack of current knowledge of the efficacy and safety of hypnosis. Advanced practitioners who are well-informed about hypnosis have an opportunity to increase the treatment options for patients who are suffering with cancer pain by suggesting to the health-care team that hypnosis be incorporated into the plan of care. Integration of hypnosis into the standard of care will benefit patients, caregivers, and survivors by reducing pain and the suffering associated with it. PMID:25031986
Maluf, David A. (Inventor); Bell, David G. (Inventor); Gurram, Mohana M. (Inventor); Gawdiak, Yuri O. (Inventor)
A system for managing a project that includes multiple tasks and a plurality of workers. Input information includes characterizations based upon a human model, a team model and a product model. Periodic reports, such as a monthly report, a task plan report, a budget report and a risk management report, are generated and made available for display or further analysis. An extensible database allows searching for information based upon context and upon content.
Hochberg, Uri; Elgueta, Maria Francisca; Perez, Jordi
Lung cancer is one of the four most prevalent cancers worldwide. Comprehensive patient care includes not only adherence to clinical guidelines to control and when possible cure the disease but also appropriate symptom control. Pain is one of the most prevalent symptoms in patients diagnosed with lung cancer; it can arise from local invasion of chest structures or metastatic disease invading bones, nerves, or other anatomical structures potentially painful. Pain can also be a consequence of therapeutic approaches like surgery, chemotherapy, or radiotherapy. Conventional medical management of cancer pain includes prescription of opioids and coadjuvants at doses sufficient to control the symptoms without causing severe drug effects. When an adequate pharmacological medical management fails to provide satisfactory analgesia or when it causes limiting side effects, interventional cancer pain techniques may be considered. Interventional pain management is devoted to the use of invasive techniques such as joint injections, nerve blocks and/or neurolysis, neuromodulation, and cement augmentation techniques to provide diagnosis and treatment of pain syndromes resistant to conventional medical management. Advantages of interventional approaches include better analgesic outcomes without experiencing drug-related side effects and potential for opioid reduction thus avoiding central side effects. This review will describe various pain syndromes frequently described in lung cancer patients and those interventional techniques potentially indicated for those cases.
Multimodal Pain Management after Arthroscopic Surgery By Sten Rasmussen, M.D. The thesis is based on four randomized controlled trials. The main hypothesis was that multimodal pain treatment provides faster recovery after arthroscopic surgery. NSAID was tested against placebo after knee arthroscopy...
Achterberg, Wilco P; Pieper, Marjoleine J C; van Dalen-Kok, Annelore H; de Waal, Margot W M; Husebo, Bettina S; Lautenbacher, Stefan; Kunz, Miriam; Scherder, Erik J A; Corbett, Anne
There are an estimated 35 million people with dementia across the world, of whom 50% experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause of behavioral symptoms, which can lead to inappropriate treatment with antipsychotic medications. Pain also contributes to further complications in treatment and care. This review explores four key perspectives of pain management in dementia and makes recommendations for practice and research. The first perspective discussed is the considerable uncertainty within the literature on the impact of dementia neuropathology on pain perception and processing in Alzheimer's disease and other dementias, where white matter lesions and brain atrophy appear to influence the neurobiology of pain. The second perspective considers the assessment of pain in dementia. This is challenging, particularly because of the limited capacity of self-report by these individuals, which means that assessment relies in large part on observational methods. A number of tools are available but the psychometric quality and clinical utility of these are uncertain. The evidence for efficient treatment (the third perspective) with analgesics is also limited, with few statistically well-powered trials. The most promising evidence supports the use of stepped treatment approaches, and indicates the benefit of pain and behavioral interventions on both these important symptoms. The fourth perspective debates further difficulties in pain management due to the lack of sufficient training and education for health care professionals at all levels, where evidence-based guidance is urgently needed. To address the current inadequate management of pain in dementia, a comprehensive approach is needed. This would include an accurate, validated assessment tool that is sensitive to different types of pain and therapeutic
Braun, F.; Avital, M.
It is virtually a truism that good leadership practices can help project managers with attaining the desired project outcome. However, a better understanding of which leadership practices enable project managers to be more effective warrants further investigation. Subsequently, in this study, we
Frank, Ronald L.
Information Systems curricula should provide project management (PM) theory, current practice, and hands-on experience. The schedule usually does not allow time in Analysis and Design courses for development oriented project management instruction other than a short introduction. Similarly, networking courses usually don't put project management…
Francke, AL; Dingemans, WA; Borg, PAJ; Luiken, JB; Grypdonck, M; Abu-Saad, HH
Surgical nurses from five Dutch general hospitals participated in a continuing education program on pain assessment and management. Effects of the program were measured in a pretest-post-test control group design, in which nursing wards were randomly allocated to the experimental condition (program)
Management issues of introducing SAT Project include main objectives and expectations; SAT goal and management; major phases of SAT implementation; project quality assurance; SAT based training system and procedures; role of the project team qualifications
A brief description is given of the organisation methods employed by the Bechtel Power Corporation, in their contract with Mississippi Power and Light Company for the design, construction and procurement activities for the Grand Gulf Nuclear Station. The aim is to ensure effective management, and good communications at all stages of construction, between the project team and the client. (U.K.)
From the article: "The object of this paper is to explore the actual practice in project management education in the Netherlands and compare it to reference institutions and recent literature. A little over 40% of the Higher Education institutions in the Netherlands mentions PM education in
Lehmkuhl, D; Meissner, W; Neugebauer, E A M
Demonstration of improved postoperative pain management by implementation of the S3 guidelines on treatment of acute perioperative and posttraumatic pain, by the integrated quality management concept "quality management acute pain" of the TÜV Rheinland or by participation in the benchmark project "Quality improvement in postoperative pain management" (QUIPS). A prospective controlled study (pre-post design) was carried out in hospitals with various levels of care comparing three hospital groups (n = 17/7/3, respectively). Group 1: participation in the QUIPS project (intraclinic and interclinic comparison of outcome data of postoperative pain treatment), group 2: participation in the quality management acute pain program (certified by TÜV Rheinland), group 3: control group with no involvement in either of the two concepts. In all three groups, an anonymous data collection was performed consisting of patient-reported pain intensity, side effects, pain disability and patient satisfaction. Pain therapy intervention was carried out only in group 2 by an integrated quality management concept (certification project: Quality management acute pain) with a package of measures to improve structure, process and outcome quality. The TÜV Rheinland certified clinics (group 2) showed a significant improvement in the pre-post comparison (before versus after certification) in the areas maximum pain (from visual analogue scale VAS 4.6 to 3.7), stress pain (5.3 to 3.9), pain-related impairment (proportion of patients with pain-linked decreased mobility and movement 26% to 16.1%, coughing and breathing 23.1% to 14.3%) and patient satisfaction (from 13.2 to 13.7; scale 0 completely unsatisfied, 15 very satisfied). The clinics with participation in QUIPS for 2 years also showed a significant improvement in stress pain (numeric rating scale NRS for pain 4.5 to 4.2), pain-linked-limitation of coughing and breathing (28% to 23.6%), and patient satisfaction (from 11.9 to 12.4). There were
Gamst-Jensen, Hejdi; Vedel, Pernille Nygaard; Lindberg-Larsen, Viktoria Oline
OBJECTIVE: Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain...... patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn...
Tanabe, P; Buschmann, M
The purpose of this study was to determine areas of emergency nurses' knowledge deficit regarding pain management, and to identify barriers to pain management as perceived by emergency nurses. Data were collected anonymously in a mail survey using a 52-item knowledge questionnaire addressing pain management principles and asking emergency nurses (Illinois Emergency Nurses Association members) to rate various barriers as to how often they affect their practice. Questionnaires were mailed to all Illinois ENA members (n = 1000). Three hundred five emergency nurses' questionnaires were returned. A significant deficit existed on 2 domains of knowledge: understanding of the terms "addiction," "tolerance," and "dependence"; and knowledge of various pharmacologic analgesic principles. Nurses with a master's degree or higher, or those who attended a 1-day seminar on pain management, achieved statistically significantly higher scores. The 2 barriers identified by emergency nurses as the most common were the inability to administer medication until a diagnosis is made (53%), and inadequate assessment of pain and pain relief (48%) (the percentage indicates how often the emergency nurses believed the barrier was present in their practice). The data indicate that emergency nurses may not have a good understanding of the management of pain with drugs, or of such issues as risk of addiction.
Hsu, Chen-Jung (Inventor); Patel, Hemil N. (Inventor); Maluf, David A. (Inventor); Moh Hashim, Jairon C. (Inventor); Tran, Khai Peter B. (Inventor)
A system for managing a project that includes multiple tasks and a plurality of workers. Input information includes characterizations based upon a human model, a team model and a product model. Periodic reports, such as one or more of a monthly report, a task plan report, a schedule report, a budget report and a risk management report, are generated and made available for display or further analysis or collection into a customized report template. An extensible database allows searching for information based upon context and upon content. Seven different types of project risks are addressed, including non-availability of required skill mix of workers. The system can be configured to exchange data and results with corresponding portions of similar project analyses, and to provide user-specific access to specified information.
Carlo Valerio Bellieni
Full Text Available Neonatal pain treatment requires personalization, and pain assessment should be contextualized to be effective. Here we summarize the available tools in neonatal analgesia, paying a special attention to highlight the personalization of antalgic behavior, both in assessment and in treatment of neonatal pain. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the Netherlands, Gavino Faa (Cagliari, Italy, Antonio Giordano (Philadelphia, USA
A 'sensitive' project needs to be managed differently from a 'normal' project. This statement might seem simple enough. However, it does not seem to be a simple task to prove it in twenty minutes. This paper is an attempt to share with the audience some of the experiences the company had dealing with sensitive projects. It describes what a sensitive project is, though of all people, the 'nuclear' should know. Then the common mistakes are described, that are made in the hoping that some personal experiences are recognised. Finally the company's strategy is shown, how we foster third party support and the main tools to be used. Ultimately, success is ensured by having a sufficient quantity of allies. A sensitive project does not die because it has too many opponents, but because it has too few allies. Finding and helping allies to act is the thrust of our activity. It enables sensitive projects which deserve to succeed to do so, where traditional management fails miserably
Siddiqui, Farhan Ahmed
The rate of failed and challenged Information Technology (IT) projects is too high according to the CHAOS Studies by the Standish Group and the literature on project management (Standish Group, 2008). The CHAOS Studies define project success as meeting the triple constraints of scope, time, and cost. The criteria for project success need to be agreed by all parties before the start of the project and constantly reviewed as the project progresses. Assessing critical success factors is another ...
Coluzzi, F; Valensise, H; Sacco, M; Allegri, M
During pregnancy most of women will experience some kind of pain, either as a result of a pre-existing condition (low back pain, headache, fibromyalgia, and rheumatoid arthritis) or as a direct consequence of pregnancy (weight gain, postural changes, pelvic floor dysfunction, hormonal factors). However, chronic pain management during pregnancy and lactation remains a challenge for clinicians and pregnant women are at risk of undertreatment for painful conditions, because of fear about use of drugs during pregnancy. Few analgesic drugs have been demonstrated to be absolutely contraindicated during pregnancy and breastfeeding, but studies in pregnant women are not available for most of pain medications. The aim of this paper is to review the safety profile in pregnancy or lactation of the commonly prescribed pain medications and non-pharmacological treatments. In addition to the conventional classifications from the Food and Drug Administration and the American Academy of Paediatrics, authors analyzed the currently available clinical data from literature.
Queries from European physicians about analgesic pharmacotherapy and responses from the author are presented. Topics addressed in this issue pertain to epidural injection for painful central lumbar stenosis and epicondolysis.
Full Text Available Dental pain is a common symptom that most often causes patient to seek dentist. A survey conducted by the American Association of Endodontics revealed that more than half patients who come to dentist have experienced pain, which originate from the teeth or of the surrounding tissue, can causes difficulties in handling, also the anxiety of the patient. Understanding the pain experienced by patient will help dentist to determine when to make an action. Most patient being fear with pain, so they delay to getting treatment from dentist, and led to the development of further infection and inflammation. Aim of this paper is to improve the understanding of pharmacology and procedures for pain and anxiety management in endodontic treatment. So, it was importance of determining accurate diagnosis, management and drug administration.
Gordon, Debra B; Love, Georgette
The mechanisms underlying the pathogenesis of neuropathic pain are complex but are gradually coming to light. Agents that have been found effective in a variety of neuropathic pain conditions include drugs that act to modulate (a) sodium or calcium channels, (b) N-methyl-D-aspartate receptors, (c) norepinephrine or serotonin reuptake, (d) opioid receptors, and (e) other cellular processes. Clinical trials have primarily evaluated these treatments for postherpetic neuralgia and painful diabetic neuropathy, the two most common types of neuropathic pain. Nonetheless, the identification of effective treatment regimens remains challenging, often because multiple mechanisms may be operating in a given patient giving rise to the same symptom. Alternatively, a single mechanism may be responsible for multiple symptoms. Currently available diagnostic tools are inadequate to determine the best treatment using a mechanism-based model. Clinically, drug treatment of neuropathic pain is often a matter of treatment trials. This article presents a summary of available clinical information on first-line and lesser-known treatments for neuropathic pain.
Rothaug, Judith; Zaslansky, Ruth; Schwenkglenks, Matthias; Komann, Marcus; Allvin, Renée; Backström, Ragnar; Brill, Silviu; Buchholz, Ingo; Engel, Christoph; Fletcher, Dominique; Fodor, Lucian; Funk, Peter; Gerbershagen, Hans J; Gordon, Debra B; Konrad, Christoph; Kopf, Andreas; Leykin, Yigal; Pogatzki-Zahn, Esther; Puig, Margarita; Rawal, Narinder; Taylor, Rod S; Ullrich, Kristin; Volk, Thomas; Yahiaoui-Doktor, Maryam; Meissner, Winfried
PAIN OUT is a European Commission-funded project aiming at improving postoperative pain management. It combines a registry that can be useful for quality improvement and research using treatment and patient-reported outcome measures. The core of the project is a patient questionnaire-the International Pain Outcomes questionnaire-that comprises key patient-level outcomes of postoperative pain management, including pain intensity, physical and emotional functional interference, side effects, and perceptions of care. Its psychometric quality after translation and adaptation to European patients is the subject of this validation study. The questionnaire was administered to 9,727 patients in 10 languages in 8 European countries and Israel. Construct validity was assessed using factor analysis. Discriminant validity assessment used Mann-Whitney U tests to detect mean group differences between 2 surgical disciplines. Internal consistency reliability was calculated as Cronbach's alpha. Factor analysis resulted in a 3-factor structure explaining 53.6% of variance. Cronbach's alpha at overall scale level was high (.86), and for the 3 subscales was low, moderate, or high (range, .53-.89). Significant mean group differences between general and orthopedic surgery patients confirmed discriminant validity. The psychometric quality of the International Pain Outcomes questionnaire can be regarded as satisfactory. The International Pain Outcomes questionnaire provides an instrument for postoperative pain assessment and improvement of quality of care, which demonstrated good psychometric quality when translated into a variety of languages in a large European and Israeli patient population. This measure provides the basis for the first comprehensive postoperative pain registry in Europe and other countries. Copyright © 2013. Published by Elsevier Inc.
Chronic Pain Syndrome; Chronic Pain; Chronic Pain Due to Injury; Chronic Pain Due to Trauma; Chronic Pain Due to Malignancy (Finding); Chronic Pain Post-Procedural; Chronic Pain Hip; Chronic Pain, Widespread
ABSTRACT A case of a 35-year-old woman scheduled for removal of a painful breast tumor is discussed. Ways to reduce risk of chronic pain developing postoperatively are described. Preoperative medications, nerve blocks, local anesthetics, and postoperative epidural pharmacotherapy are described. This report is adapted from paineurope 2014; Issue 1, Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com, at which European health professionals can register online to receive copies of the quarterly publication.
To increase an efficiency of a product, nowadays many web development companies are using different project management systems. A company may run a number of projects at a time, and requires input from a number of individuals, or teams for a multi level development plan, whereby a good project management system is needed. Project management systems represent a rapidly growing technology in IT industry. As the number of users, who utilize project management applications continues to grow, w...
We are pleased to announce the recent launch of a new workshop on Project Management. This is designed for People with budgetary, scheduling and/or organizational responsibilities in a project or a sub-project. The objectives through a management case study specially suited to CERN are: to become familiar with modern management techniques in use for structuring, planning, scheduling, costing and progress monitoring of a project or a sub-project. to understand in-depth issues associated with Deliverable-oriented Project Management, Earned Value Management, Advanced Project Cost Engineering and Project Risk Management. The full description of this workshop can be found here. The next session will be held on 8 October 2004. If you are interested in this workshop, please contact Nathalie Dumeaux, email or 78144. Programme of Seminars October to December 2004 Situation : 21.09.2004 Séminaires bilingues Dates Jours Places disponibles Project Management Case study 8 October 1 oui Intr...
Pain is one common reason for clinical encounters in primary care. The complex nature of chronic pain syndromes can make assessment and management daunting at times. This article presents an easy scheme to help general practitioners efficiently assess, manage and review/follow up patients with chronic pain. The mnemonic presented for assessment is the '4Ps' (pain, other pathology/past medical history, performance/function and psychological/psychiatric status). For management, we can also use '4Ps' (physical, psychological, pharmacological and procedural) and for review there are the '6As' (activities, analgesia, adverse effects, aberrance behaviours, affects and adequate documentation).
O'Conner-Von, Susan; Turner, Helen N
The ASPMN strongly recommends that infants who are being circumcised must receive optimal pain management. ‘‘If a decision for circumcision is made, procedural analgesia should be provided’’ (AAP, 1999, p. 691). Therefore, it is the position of the ASPMN that optimal pain management must be provided throughout the circumcision process. Furthermore, parents must be prepared for the procedure and educated about infant pain assessment. They must also be informed of pharmacologic and integrative pain management therapies that are appropriate before, during, and after the procedure.
Colón, Yvette; Avnet, Mark S
Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. Hypnotherapy, its uses and process, and certification and training of hypnotherapy professionals are addressed.
Muller, Julia; Karl, Anke; Denke, Claudia; Mathier, Fabienne; Dittmann, Jennifer; Rohleder, Nicolas; Knaevelsrud, Christine
Chronic pain (CP) and posttraumatic stress disorder (PTSD) are both frequent and often comorbid in refugees. To date, few controlled trials have studied the efficacy of treatments targeting this comorbidity; no treatment guidelines yet exist. The authors examined the feasibility and efficacy of short-term cognitive behavioural biofeedback (BF) addressing CP in traumatised refugees. The sample comprised 11 severely traumatised refugees with CP and PTSD (mean age = 36 years, SD = 6), who underwent assessment with the Mini International Neuropsychiatric Interview, Posttraumatic Diagnostic Scale, Pain Disability Index, and Visual Rating Scale. Additionally, coping with pain and psychotherapy tolerance were assessed. Acceptance of BF was high. Pre-post effects were small to medium for increased pain management and associated heart rate reactivity but large for coping with pain. The results encourage further research to confirm whether BF is indicated as a treatment component, but not a stand-alone treatment, for traumatised refugees with comorbid CP and PTSD.
Electrical engineering and estates personnel at Sodexo--which manages a wide range of soft and hard facilities management services for five hospitals under a PFI contract at the Manchester Royal Infirmary--have successfully planned, managed, and co-ordinated, a complex electrical engineering project which saw high voltage (HV) switchgear in the site's main intake sub-station dismantled by the supplier to repair a potential earthing mechanism fault which would have prevented individual switchgear panels being shut down, to, for example, cater for renovation of electrical cabling or components cross the site's high voltage network. With detailed planning, including provision for bringing onto site temporary bulk generators, and the formulation of a 600-step switching programme, the replacement of potential faulty driver components in the disconnect mechanism for 20 HV switchgear panels was completed in just four weeks, with minimal interruption to the vast complex's power supply.
Oliver, June; Coggins, Candace; Compton, Peggy; Hagan, Susan; Matteliano, Deborah; Stanton, Marsha; St. Marie, Barbara; Strobbe, Stephen; Turner, Helen N.
The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high qu...
Josler, Cheryl; Burger, James
When charged with overseeing a project, how can one ensure that the project will be completed on time, within budget, and to the satisfaction of everyone involved? In this article, the authors examine project management methodology as a means of ensuring that projects are conducted in a disciplined, well-managed and consistent manner that serves…
Debarle, Michel; Aigron, Rémi; Depernet, Laure
BACKGROUND: Little is known about the level of consensus within the French chiropractic profession regarding management of clinical issues. A previous Swedish study showed that chiropractors agreed relatively well on the management strategy for nine low back pain scenarios. We wished to investiga...
Batten, Meghann; Stevenson, Eleanor; Zimmermann, Deb; Isaacs, Christine
A growing number of women are seeking alternatives to traditional pharmacologic pain management during birth. While there has been an extensive array of nonpharmacologic options developed for labor, there are limited offerings in the postpartum period. The purpose of this quality improvement project was to implement a hydrotherapy protocol in the early postpartum period to improve pain management for women choosing a nonmedicated birth. The postpartum hydrotherapy protocol was initiated in a certified nurse-midwife (CNM) practice in an urban academic medical center. All women who met criteria were offered a 30-minute warm water immersion bath at one hour postpartum. Pain scores were assessed prior to the bath, at 15 minutes after onset, and again at the conclusion (30 minutes). Women who completed the bath were also asked to complete a brief survey on their experience with postpartum hydrotherapy. In women who used the bath (N = 45), there was a significant reduction in pain scores (P hydrotherapy protocol as an alternative or adjunct to medication for early postpartum pain management that significantly reduced pain and improved the birth experience for those who used it. It offers a nonpharmacologic alternative where there have traditionally been limited options. © 2017 by the American College of Nurse-Midwives.
Full Text Available Wilco P Achterberg,1 Marjoleine JC Pieper,2 Annelore H van Dalen-Kok,1 Margot WM de Waal,1 Bettina S Husebo,3 Stefan Lautenbacher,4 Miriam Kunz,4 Erik JA Scherder,5 Anne Corbett6 1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, 2Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands; 3Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; 4Physiological Psychology, Otto Friedrich University Bamberg, Bamberg, Germany; 5Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands; 6Wolfson Centre for Age-Related Diseases, King's College London, London, UK Abstract: There are an estimated 35 million people with dementia across the world, of whom 50% experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause of behavioral symptoms, which can lead to inappropriate treatment with antipsychotic medications. Pain also contributes to further complications in treatment and care. This review explores four key perspectives of pain management in dementia and makes recommendations for practice and research. The first perspective discussed is the considerable uncertainty within the literature on the impact of dementia neuropathology on pain perception and processing in Alzheimer's disease and other dementias, where white matter lesions and brain atrophy appear to influence the neurobiology of pain. The second perspective considers the assessment of pain in dementia. This is challenging, particularly because of the limited capacity of self-report by these individuals, which means that assessment relies in large part on observational methods. A number of tools are available but the psychometric quality and clinical utility of these are
Khanasuk, Yutthana; Ngarmukos, Srihatach
Pain management has become a very important part of postoperative care for total knee arthroplasty patients. Contemporary pain control has evolved from high-dose opioid in the past to state-of-the-art multimodal regimens. These include multiple non-opioid medication such as NSAIDs, COX-2 inhibitors, and gabapentinoid, and novel anesthetic techniques such as preemptive analgesia and ultrasound-guided peripheral nerve blocks. Another method which is gaining popularity is intraarticular injection of anesthetic cocktail during surgery. Pre-op education can also help patients cope with their pain better.
Koch, Christian; Buhl, Henrik
Implementing and Operating integrated Enterprise Systems are a multidimensional effort. It seriously challenges the IT supplier as well as the professional service provider client. The paper discuss these issues in a project management perspective. A framework for supporting project management...
Layton, Mark C
Be flexible and faster with Agile project management As mobile and web technologies continue to evolve rapidly, there is added pressure to develop and implement software projects in weeks instead of months. Agile Project Management For Dummies can make that happen. This is the first book to provide a simple, step-by-step guide to Agile Project Management approaches, tools, and techniques. With the fast pace of mobile and web technology development, software project development must keep pace; Agile Project Management enables developers to complete and implement projects more quickly and this b
Rezende Junior, Ismar de; Mattos, Marcos Duarte de; Nakamura, Ricardo; Lemes Junior, Joaquim; Vanzelli, Talita Lozano, E-mail: email@example.com [Radioterapia do Hospital de Cancer de Barretos, SP (Brazil)
Purpose: This is the first Brazilian study intended to evaluate the response of pain relief with radiotherapy in three different fractionation and the clinical differences in managing pain in patients with painful bone metastases. Methods: Prospective study of patients with painful bone metastases referred to the Radiotherapy Sector of the Hospital de Cancer de Barretos for pain-relieving radiotherapy between March and December 2010. It is known that radiotherapy seems to alter the activation of osteoclast-mediated bone resorption, relieving pain in cases of painful bone metastases. Patients were assessed in relation to the status of pain intensity before and after the initiation of radiotherapy. Either a single fraction of 8Gy, five fractions of 4Gy or ten fractions of 3Gy were given. A visual analog scale (VAS) was applied by doctors, nurses and nursing technicians to assess pain intensity at each session of radiotherapy, and follow-up at 8, 30 and 90 days from the end of treatment. Results: We evaluated 92 consecutive patients, 48 male and 44 female, with a median age of 58 years. We found that 14% of patients referred from the Palliative Care or Clinical Oncology sectors need better pharmacological analgesia due to severe pain, compared with 40.5% of patients from the other sectors (p = 0.004). We also found that the onset of pain relief to patients receiving 10 fractions of 300cGy analgesia without changing the pre-radiotherapy analgesia occurred with significance after the fifth fraction. Improvement in pain experienced within 90 days of follow-up was found in eighty percent of patients, independent of fractionated radiotherapy, site of metastases and the clinical condition of the patient. Discussion/Conclusion: The Palliative Care and Clinical Oncology sectors expressed greater concern in regards to analgesia for the patient with painful bone metastases. Radiotherapy is an effective pain-relieving treatment in different fractionation studied, even though the
Rezende Junior, Ismar de; Mattos, Marcos Duarte de; Nakamura, Ricardo; Lemes Junior, Joaquim; Vanzelli, Talita Lozano
Purpose: This is the first Brazilian study intended to evaluate the response of pain relief with radiotherapy in three different fractionation and the clinical differences in managing pain in patients with painful bone metastases. Methods: Prospective study of patients with painful bone metastases referred to the Radiotherapy Sector of the Hospital de Cancer de Barretos for pain-relieving radiotherapy between March and December 2010. It is known that radiotherapy seems to alter the activation of osteoclast-mediated bone resorption, relieving pain in cases of painful bone metastases. Patients were assessed in relation to the status of pain intensity before and after the initiation of radiotherapy. Either a single fraction of 8Gy, five fractions of 4Gy or ten fractions of 3Gy were given. A visual analog scale (VAS) was applied by doctors, nurses and nursing technicians to assess pain intensity at each session of radiotherapy, and follow-up at 8, 30 and 90 days from the end of treatment. Results: We evaluated 92 consecutive patients, 48 male and 44 female, with a median age of 58 years. We found that 14% of patients referred from the Palliative Care or Clinical Oncology sectors need better pharmacological analgesia due to severe pain, compared with 40.5% of patients from the other sectors (p = 0.004). We also found that the onset of pain relief to patients receiving 10 fractions of 300cGy analgesia without changing the pre-radiotherapy analgesia occurred with significance after the fifth fraction. Improvement in pain experienced within 90 days of follow-up was found in eighty percent of patients, independent of fractionated radiotherapy, site of metastases and the clinical condition of the patient. Discussion/Conclusion: The Palliative Care and Clinical Oncology sectors expressed greater concern in regards to analgesia for the patient with painful bone metastases. Radiotherapy is an effective pain-relieving treatment in different fractionation studied, even though the
Full Text Available The modern information society in ever increasing business projects and time limits to achieve the objectives at minimum cost leads to a search for ways to manage them. Today, more and more managers use IT tools for project management, and the term itself is associated with software solutions for the optimization and management of projects in different fields of human activity. The paper examines the main characteristics of project management by means of information technology. Key tasks and processes in the project implementation and management are discussed.
George, Steven Z
Lindblom Young Investigator Award for Clinical Sciences from the International Association for the Study of Pain, the Florida Physical Therapy Association's Award for Scholarly Impact on Practice, and APTA's Jules M. Rothstein Golden Pen Award and Eugene Michels New Investigator Award. In 2014, George's innovative knowledge contributed to being identified by Expertscape as the 10th-ranked world expert for scholarly contributions to the understanding and treatment of back pain. Expertscape's ranking, based on the quantity and quality of peer-reviewed clinical research publications in the National Library of Medicine's MEDLINE database, highlights George's status as a visionary in the profession. For his advocacy toward conducting meaningful research, expertise on pain management, and profound impact beyond published works, APTA is pleased to honor Steven Z. George as the 2016 John H.P. Maley Lecturer. © 2017 American Physical Therapy Association
Egan, M; Seeger, D; Schöps, P
Patients attend physiotherapy and physical therapy (PT) due to pain problems and/or functional impairments. Although the main focus for therapists has traditionally been physical examination and treatment of tissue structures and biomechanics, over the last few decades a growing body of research has highlighted the importance of central nervous system processing and psychosocial contributors to pain perception. Treatment with PT aims to reduce disability and suffering by reducing pain and increasing tolerance to movement. In Germany, pain management conducted by physiotherapists is currently undergoing major changes. Firstly, PT education is transitioning from a vocational to a degree level and additionally new concepts for improved multidisciplinary treatment approaches are being developed. However, there still remain substantial differences between therapists working in multidisciplinary pain clinics and those following medical referral in private practices. This article provides information on how national and international impulses have contributed to the development of different concepts of passive therapies and active/functional pain rehabilitation in Germany. In the future PT will need to provide more evidence about efficiency and modes of actions for different treatment options to selectively reason the application to patients with acute, subacute and chronic pain.
Farmer, Adam D; Aziz, Qasim
Functional abdominal pain syndrome is characterised by frequent or continuous abdominal pain associated with a degree of loss of daily activity. It has a reported population prevalence of between 0.5% and 1.7%, with a female preponderance. The pathophysiology of functional abdominal pain is incompletely understood although it has been postulated that peripheral sensitisation of visceral afferents, central sensitisation of the spinal dorsal horn and aberrancies within descending modulatory systems may have an important role. The management of patients with functional abdominal pain requires a tailored multidisciplinary approach in a supportive and empathetic environment in order to develop an effective therapeutic relationship. Patient education directed towards an explanation of the pathophysiology of functional abdominal pain is in our opinion a prerequisite step and provides the rationale for the introduction of interventions. Interventions can usefully be categorised into general measures, pharmacotherapy, psychological interventions and 'step-up' treatments. Pharmacotherapeutic/step-up options include tricyclic antidepressants, serotonin noradrenergic reuptake inhibitors and the gabapentinoids. Psychological treatments include cognitive behavioural therapy and hypnotherapy. However, the objective evidence base for these interventions is largely derived from other chronic pain syndrome, and further research is warranted in adult patients with functional abdominal pain. © The Royal Society of Medicine.
Full Text Available Kristoffer Andresen, Jacob Rosenberg Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark Abstract: Chronic pain following inguinal hernia repair is a common problem and feared complication. Up to 16% of people experience chronic pain following the repair of a groin hernia. The aim of this review was to provide an overview of treatment strategies for patients with chronic pain following inguinal hernia repair based on best practice guidelines and current clinical routines. The optimal management of chronic pain following inguinal hernia surgery should begin with a thorough clinical examination to rule out other causes of chronic pain and to rule out a recurrence. A scaled approach to treatment is recommended. Initially, watchful waiting can be tried if it can be tolerated by the patient and then systemic painkillers, escalating to blocks, and surgery as the final option. Surgery should include mesh removal and triple neurectomy following anterior approaches or mesh and tack removal following a posterior approach. The diagnosis and treatment strategies should be performed by or discussed with experts in the field. Keywords: inguinal hernia, chronic pain, management, surgery, pharmacology, radio frequency
The mission of the Uranium Mill Tailings Remedial Action (UMTRA) Project is explicitly stated and directed in the Uranium Mill Tailings Radiation Control Act of 1978, Public Law 95-604, 42 USC 7901 (hereinafter referred to as the ''Act''). Title I of the Act authorizes the Department of Energy (DOE) to undertake remedial actions at 24 designated inactive uranium processing sites and associated vicinity properties containing uranium mill tailings and other residual radioactive materials derived from the processing sites. The Act, amended in January 1983, by Public Law 97-415, also authorizes DOE to perform remedial actions at vicinity properties in Edgemont, South Dakota. Cleanup of the Edgemont processing site is the responsibility of the Tennessee Valley Authority. This document describes the plan, organization, system, and methodologies used to manage the design, construction, and other activities required to clean up the designated sites and associated vicinity properties in accordance with the Act. The plan describes the objectives of the UMTRA Project, defines participants' roles and responsibilities, outlines the technical approach for accomplishing the objectives, and describes the planning and managerial controls to be used in integrating and performing the Project mission. 21 figs., 21 tabs
Boyer, Stéphanie C; Goldfinger, Corrie; Thibault-Gagnon, Stéphanie; Pukall, Caroline F
Our understanding of the sexual pain disorders vaginismus and dyspareunia has been fundamentally altered over the past two decades due to increased attention and empirically sound research in this domain. This increased knowledge base has included a shift from a dualistic view of the etiology of painful and/or difficult vaginal penetration being due to either psychological or physiological causes, to a multifactorial perspective. The present chapter reviews current classification and prevalence rates, including ongoing definitional debates. Research regarding the etiology, assessment and management of sexual pain disorders is discussed from a biopsychosocial perspective. Cyclical theories of the development and maintenance of sexual pain disorders, which highlight the complex interplay among physiological, psychological and social factors, are described. Medical/surgical treatment options, pelvic floor rehabilitation and psychological approaches are reviewed, as well as future directions in treatment research. Copyright © 2011 S. Karger AG, Basel.
Smith, Matthew J
The health care landscape has changed with new legislation addressing the unsustainable rise in costs in the US system. Low-value service lines caring for expensive chronic conditions have been targeted for reform; for better or worse, the treatment of spine pain has been recognized as a representative example. Examining the Patient Protection and Affordable Care Act and existing pilot studies can offer a preview of how chronic care of spine pain will be sustained. Accountable care in an organization capable of collecting, analyzing, and reporting clinical data and operational compliance is forthcoming. Interdisciplinary spine pain centers integrating surgical and medical management, behavioral medicine, physical reconditioning, and societal reintegration represent the model of high-value care for patients with chronic spine pain. Copyright © 2011 Elsevier Inc. All rights reserved.
Suhonen, Marjo; Paasivaara, Leena
To analyse the challenges that nurse managers meet in project management. Project management done by nurse managers has a significant role in the success of projects conducted in work units. The data were collected by open interviews (n = 14). The participants were nurse managers, nurses and public health nurses. Data analysis was carried out using qualitative content analysis. The three main challenges nurse managers faced in project management in health-care work units were: (1) apathetic organization and management, (2) paralysed work community and (3) cooperation between individuals being discouraged. Nurse managers' challenges in project management can be viewed from the perspective of the following paradoxes: (1) keeping up projects-ensuring patient care, (2) enthusiastic management-effective management of daily work and (3) supporting the work of a multiprofessional team-leadership of individual employees. It is important for nurse managers to learn to relate these paradoxes to one another in a positive way. Further research is needed, focusing on nurse managers' ability to promote workplace spirituality, nurse managers' emotional intelligence and their enthusiasm in small projects. © 2011 Blackwell Publishing Ltd.
Rakel, Barbara; Barr, John O
The following conclusions can be made based on review of the evidence: There is limited but positive evidence that select physical modalities are effective in managing chronic pain associated with specific conditions experienced by adults and older individuals. Overall, studies have provided the most support for the modality of therapeutic exercise. Different physical modalities have similar magnitudes of effects on chronic pain. Therefore, selection of the most appropriate physical modality may depend on the desired functional outcome for the patient, the underlying impairment, and the patient's preference or prior experience with the modality. Certain patient characteristics may decrease the effectiveness of physical modalities, as has been seen with TENS. These characteristics include depression, high trait anxiety, a powerful others locus of control, obesity, narcotic use, and neuroticism. The effect on pain by various modalities is generally strongest in the short-term period immediately after the intervention series, but effects can last as long as 1 year after treatment (e.g., with massage). Most research has tested the effect of physical modalities on chronic low back pain and knee OA. The effectiveness of physical modalities for other chronic pain conditions needs to be evaluated more completely. Older and younger adults often experience similar effects on their perception of pain from treatment with physical modalities. Therefore, use of these modalities for chronic pain in older adults is appropriate, but special precautions need to be taken. Practitioners applying physical modalities need formal training that includes the risks and precautions for these modalities. If practitioners lack formal training in the use of physical modalities, or if modality use is not within their scope of practice, it is important to consult with and refer patients to members of the team who have this specialized training. Use of a multidisciplinary approach to chronic pain
Evans, Subhadra; Tsao, Jennie C.I; Zeltzer, Lonnie K.
Children undergo acute painful procedures and many also experience chronic pain.Due to their developing systems, infants and children may be at greater risk than adults for protracted pain sensitivity.There is a need to manage acute and chronic paediatric pain to reduce children's suffering and to prevent future pain problems.Consistent with a biopsychosocial perspective, complementary and alternative medicine (CAM) should be considered in management of acute and chronic paediatric pain.Altho...
Krebs, Erin E; Bair, Matthew J; Carey, Timothy S; Weinberger, Morris
Researchers and quality improvement advocates sometimes use review of chart-documented pain care processes to assess the quality of pain management. Studies have found that primary care providers frequently fail to document pain assessment and management. To assess documentation of pain care processes in an academic primary care clinic and evaluate the validity of this documentation as a measure of pain care delivered. Prospective observational study. 237 adult patients at a university-affiliated internal medicine clinic who reported any pain in the last week. Immediately after a visit, we asked patients to report the pain treatment they received. Patients completed the Brief Pain Inventory (BPI) to assess pain severity at baseline and 1 month later. We extracted documentation of pain care processes from the medical record and used kappa statistics to assess agreement between documentation and patient report of pain treatment. Using multivariable linear regression, we modeled whether documented or patient-reported pain care predicted change in pain at 1 month. Participants' mean age was 53.7 years, 66% were female, and 74% had chronic pain. Physicians documented pain assessment for 83% of visits. Patients reported receiving pain treatment more often (67%) than was documented by physicians (54%). Agreement between documentation and patient report was moderate for receiving a new pain medication (k = 0.50) and slight for receiving pain management advice (k = 0.13). In multivariable models, documentation of new pain treatment was not associated with change in pain (p = 0.134). In contrast, patient-reported receipt of new pain treatment predicted pain improvement (p = 0.005). Chart documentation underestimated pain care delivered, compared with patient report. Documented pain care processes had no relationship with pain outcomes at 1 month, but patient report of receiving care predicted clinically significant improvement. Chart review measures may not accurately
Sebastian Madalin MUNTEANU
This paper tries to capture the importance it holds the project management in socio-cultural sector which stands out when we refer to the sport. So when we talk about project management in sport, to consider a much larger vision, a new project management perspective, they involve a responsibility for the implementation of an event with global impact on very long term. Sports projects, as history shows us, played a significant role in developing societies. Also, all major sports industry proje...
Many IT companies are running project simultaneously. In order to achieve the best results, they have to group to the project in portfolios, and to use specific software that helps to manage them. Project portfolio management applications have a high degree of complexity and they are very important for the companies that are using it. This paper focuses on some characteristics of the testing process for project portfolio management applications
Full Text Available Many IT companies are running project simultaneously. In order to achieve the best results, they have to group to the project in portfolios, and to use specific software that helps to manage them. Project portfolio management applications have a high degree of complexity and they are very important for the companies that are using it. This paper focuses on some characteristics of the testing process for project portfolio management applications
Oliver, June; Coggins, Candace; Compton, Peggy; Hagan, Susan; Matteliano, Deborah; Stanton, Marsha; St Marie, Barbara; Strobbe, Stephen; Turner, Helen N
The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations.
Postoperative Pain Management: Clinicians' Knowledge and Practices on Assessment and Measurement at Moi Teaching and Referral Hospital. ... A standardized questionnaire was administered to 236 hospital – based clinicians including medical doctors, nurses and clinical officers. The questionnaire consisted of ...
May 14, 2003 ... Pain management in the outpatient surgical setting. Robert S. Wolf MD. American Sports Medicine Institute. Birmingham, AL USA emptive and post-operative setting. These medications inhibit prostaglandin synthesis, promote analgesia, and consequently decrease the post-operative demand for opioids.
. The chapter argues for a rethinking process due to pervasiveness and complexity in the contemporary project environment where rethinking is needed in order to stay competitive. The suggested approach for the rethinking project management is a framing process where body of ideas is established......Projects are everywhere across different sectors, industries and countries. Project management is no longer a sub-discipline of engineering and other rather technical disciplines but is also used for many other purposes. Even though practice has changed dramatically over the years, the models...... and methodologies for project management has been fairly static and has therefore received substantial criticism for a lack of relevance to practice. Several scholars have therefore started to think more widely about projects and project management conceptualized as rethinking project management. However this theme...
Go, Seok Hwa; Hong Jeong Yu; Hyun, Byeong Hwan
This book introduces summary on management of research and development project, prepare of research and development with investigation and analysis of paper, patent and trend of technology, structure of project, management model, management of project, management of project range, management of project time, management of project cost, management of project goods, management of project manpower, management of communication, management of project risk, management of project supply, management of outcome of R and D, management of apply and enroll of patent and management of technology transfer.
Alpert, Shannon Atkinson
This study identified factors that influenced the use of project management in higher education research projects. Using a qualitative grounded theory approach that included in-depth interviews with assistant professors, the researcher examined how these individuals were using project management processes and tools and factors that enabled,…
Full Text Available The goal of this research was to examine how project changes can be prevented, and how to reduce their negative impact. Theoretical research examined risk management, project control and change management. Based on the study a “Comprehensive Change Management Model” was developed and verified after conducting empirical research in Slovenian enterprises. The research confirmed that risk management identifies possible changes and reduces their impact; project control ensures the timely detection of changes and an efficient response, while formal change management ensures the effective implementation of changes. The combined functioning of all three areas ensures effective project execution.
Salles, Claudio J.R.
The risk management will be defined by different aspects: danger or loss possibility, or responsibility for damage. The risk management is one stage of project management. The risk management is a continuous process of planning, identification, quantification, answer and risk control to maximize the success potential of activity. The reduction of risk is part of priority establishment. This work will indicate how introduce this important instrument in the management of nuclear projects. (author)
Full Text Available The article deals with contents of the project management on general level first. It mentions the most widespread project management standards, which have historically developed in global scale, their parts and objectives. Further, it describes position of the building industry in national economy, its specific features distinguishing it from the other industrial production, contents of the building industry management and project management of structures. The importance of the role of project manager is documented by characteristics of construction projects, their course, contents of sub-phases, and individual types of managing activities. Attention is devoted to project planning – determination of realization costs, necessary resources, sequence and time course of individual works. The most frequently used graphic methods of schedule presentation – Gantt chart, network chart and frequency bar chart are applied on examples of constructions. These charts can be focused in time sequence on individual types of resources – workforce, finance, materials, energies, and machinery. In conclusion, necessity to manage the project management procedures is emphasized as a part of skills of a construction engineer in the role of preparation manager or construction project realization manager.
Manias, Elizabeth; Bucknall, Tracey; Botti, Mari
Acute pain is a significant problem in the postoperative setting. Patients report a lack of information about pain-control measures and ineffective pain control. Nurses continue to rely on pharmacologic measures and tend to under-administer analgesics. The purpose of this study was to determine the strategies nurses used to manage patients' pain in the postoperative setting. It also sought to examine the effect of context, including organization of care, nurses' prioritization of work activities, and pressures during a working shift, on their pain-management strategies. An observational design was used in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were identified as key periods for pain activities, each comprising a 2-hour duration. An observation period was examined at least 12 times, resulting in the completion of 74 observations and the identification of 316 pain cases. Fifty-two nurses were observed during their normal day's work with postoperative patients. Six themes were identified: managing pain effectively; prioritizing pain experiences for pain management; missing pain cues for pain management; regulators and enforcers of pain management; preventing pain; and reactive management of pain. The findings highlighted the critical nature of communication between clinicians and patients and among clinicians. It also demonstrated the influence of time on management strategies and the relative importance that nurses place on nonpharmacologic measures in actual practice. This research, which portrays what happens in actual clinical practice, has facilitated the identification of new data that were not evident from other research studies.
Beranek, Thomas R
..., A. James Clark School of Engineering - Project Management Program. The course slides and suggested readings provide a general exploration of the nuances of doing projects globally as compared to domestically...
Full Text Available The purpose of the article is to investigate different authorities and responsibilities of a project manager and of a project leader. Considering the fact that nowadays the project management is becoming the important factor in performing and leading the investments which are modified by modern leadership theories, we can say that the key element is the sovereign leadership of a manager and a project leader. The current multi-project environments and modern techniques at the project management area need the interdisciplinary leadership approach and at the same time they enable the strengthening of company’s competitive features so they are consistently satisfying high project expectations of the project investor or a client.
Design. A prospective observational study, using the Numerical Rating Scale for pain (NRS pain), Numerical Rating Scale for anxiety (NRS anxiety), the Alder Hey Triage Pain Score (AHTPS), the COMFORT behaviour scale and the Touch Visual Pain Scale (TVPS). All patients were assessed at admission; those who were ...
Zech, D; Radbruch, L; Grond, S; Heise, W
The number of AIDS patients is steadily increasing. According to the literature these patients are often in severe pain. We evaluated pain diagnoses and treatments with two almost identical questionnaires for AIDS treatment units (ATU) and pain management units (PMU). Questions dealt with unit type and size, number of patients treated per year and the proportion of intravenous drug users. The units were also asked to give an estimate of pain aetiologies, pain types and localizations and treatment modalities offered. Completed questionnaires were returned by 38 of 235 ATU and 85 of 127 PMU. In the ATU, 16% of the patients (estimated at 580 patients per year) had pain requiring treatment. In 26 of the PMU approximately 120 AIDS patients per year were treated, while 59 PMU had not yet seen any AIDS patients. Pain was caused mainly by opportunistic infections and by neurological syndromes connected with AIDS. Pain aetiologies could not be differentiated in the ATU in 22% of patients (PMU 9%), and pain types in 33% (PMU 9%). Neuropathic pain (ATU 38%, PMU 89%) was more frequent than nociceptive pain (ATU 29%, PMU 36%). The treatment modalities were systemic pharmacotherapy in 76% of ATU and 73% of PMU and nerve blocks in 37% of ATU and 42% of PMU. In 82% of ATU the staff thought their analgesic therapy was adequate, and in 92% staff were interested in closer cooperation with PMU such as was currently practised in only 6 of the 38 units (16%) that responded. The high incidence of complicated neuropathic pain syndromes in AIDS patients requires a sophisticated therapeutic approach. Closer cooperation between AIDS specialists and pain specialists, comparable to that already existing for other patient groups, is therefore desirable.
Anderson, Daren; Zlateva, Ianita; Davis, Bennet; Bifulco, Lauren; Giannotti, Tierney; Coman, Emil; Spegman, Douglas
Pain is an extremely common complaint in primary care, and patient outcomes are often suboptimal. This project evaluated the impact of Project ECHO Pain videoconference case-based learning sessions on knowledge and quality of pain care in two Federally Qualified Health Centers. Quasi-experimental, pre-post intervention, with comparison group. Two large, multisite federally qualified health centers in Connecticut and Arizona. Intervention (N = 10) and comparison (N = 10) primary care providers. Primary care providers attended 48 weekly Project ECHO Pain sessions between January and December 2013, led by a multidisciplinary pain specialty team. Surveys and focus groups assessed providers' pain-related knowledge and self-efficacy. Electronic health record data were analyzed to evaluate opioid prescribing and specialty referrals. Compared with control, primary care providers in the intervention had a significantly greater increase in pain-related knowledge and self-efficacy. Providers who attended ECHO were more likely to use formal assessment tools and opioid agreements and refer to behavioral health and physical therapy compared with control providers. Opioid prescribing decreased significantly more among providers in the intervention compared with those in the control group. Pain is an extremely common and challenging problem, particularly among vulnerable patients such as those cared for at the more than 1,200 Federally Qualified Health Centers in the United States. In this study, attendance at weekly Project ECHO Pain sessions not only improved knowledge and self-efficacy, but also altered prescribing and referral patterns, suggesting that knowledge acquired during ECHO sessions translated into practice changes. © 2017 American Academy of Pain Medicine.
K.M. Allegaert (Karel); J.N. van den Anker (John)
textabstractInadequate pain management but also inappropriate use of analgesics in early infancy has negative effects on neuro-developmental outcome. As a consequence, neonatal pain management is still in search for the Holy Grail. At best, effective pain management is based on prevention,
The key to optimal pain management is the ability to effectively monitor the patient to ensure pain relief, whilst minimising or managing the side-effects of pain medication. This will only be possible though the collaborative work of all healthcare professionals managing the patient. This article provides an overview of the ...
In transdisciplinary projects, the roles of researchers change. In addition to being a source of knowledge, they are required to engage in knowledge exchange processes. This results in an alteration at project level: researchers need to creatively manage projects as group processes.
The United States Department of Energy (DOE) is committed to providing high quality products that satisfy customer needs and are the associated with this goal, DOE personnel must possess the knowledge, skills, and abilities to ensure successful job performance. In addition, there must be recognition that the greatest obstacle to proper project performance is inadequate project definition. Without strong project definition, DOE environmental management efforts are vulnerable to fragmented solutions, duplication of effort, and wastes resources. The primary means of ensuring environmental management projects meet cost and schedule milestones is through a structured and graded approach to project definition, which is the focus of this handbook
The Uranium Mill Tailings Remedial Action (UMTRA) Project is a Department of Energy (DOE) designated Major System Acquisition (MSA). To execute and manage the Project mission successfully and to comply with the MSA requirements, the UMTRA Project Office (''Project Office'') has implemented and operates an Integrated Project Management System (IPMS). The Project Office is assisted by the Technical Assistance Contractor's (TAC) Project Integration and Control (PIC) Group in system operation. Each participant, in turn, provides critical input to system operation and reporting requirements. The IPMS provides a uniform structured approach for integrating the work of Project participants. It serves as a tool for planning and control, workload management, performance measurement, and specialized reporting within a standardized format. This system description presents the guidance for its operation. Appendices 1 and 2 contain definitions of commonly used terms and abbreviations and acronyms, respectively. 17 figs., 5 tabs
Full Text Available Based on the development of new communication and data transfer technologies, the mobile solutions for the management process have been able to provide new ways to conduct management actions. This environment describes methods and tools available only here, which will bring information, speed and efficiency to any stage and component of the management process. The paper takes into discussion the impact of the technological development on the management process paradigm. The paper presents the main aspects regarding the business and management models used in mobile management. The role of mobile multimedia informatics applications in mobile management is highlighted.
Voshall, Barbara; Dunn, Karen S; Shelestak, Debra
A descriptive correlational design was used in this study to examine nursing faculty knowledge and attitudes in pain management. Relationships between age, education level, pain management preparation, length of time practicing as a nurse, length of time teaching nursing, time teaching pain management in the classroom, taught pain guidelines in the classroom, and additional continuing education about pain management were explored. Ninety-six nursing faculty participated from 16 schools of nursing in one Midwestern U.S. region. Findings identified that most of the nursing faculty recalled being taught about pain management in their basic education, but less than one-half felt adequately prepared. Most respondents said that they taught pain management, yet fewer than one-half identified that they used specific pain management guidelines. Faculty demonstrated adequate knowledge of pain assessment, spiritual/cultural issues, and pathophysiology. Areas of weakness were found in medications, interventions, and addiction. Faculty that reported teaching pain management in the classroom and reported more continuing education missed fewer items. Older nursing faculty reported more years of practice, more years of teaching, and more continuing education in pain management than younger faculty. Younger nursing faculty remembered being taught pain management in nursing school and felt more adequately prepared than older nursing faculty. Faculty that reported practicing for longer periods of time felt less prepared in pain management than faculty who practiced for shorter periods of time. More continuing education in pain management may be needed for older nurses to meet the recommendations of the Institute of Medicines' report on relieving pain in the U.S. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Kjærgaard, Annemette; Kautz, Karl; Nielsen, Peter Axel
How can a software company make sense of project management when it becomes involved in software process improvement? In software development most research has an instrumental view of knowledge management thus neglecting what is probably the most important part of knowledge management namely making...... sense of practice by developers and project managers. Through an action case, we study the knowledge management processes in a Danish software company. We analyse the case through the lens of a theoretical framework. The theoretical framework focuses in particular on sensemaking, collective construed...... substantial insight which could not have been achieved through an instrumental perspective on knowledge management....
Full Text Available An important factor for the success management of IT projects is the human resource. People involved in the project management process have to be evaluated. In order to do that, same criteria has to be specified. This paper describes some aspects regarding the personnel evaluation.
developing countries however, the prevalence of post-operative pain is relatively very high and pain control strategies ... Keywords: post-operative pain, prevalence, predictors, pain management, satisfaction, Tanzania. Introduction ..... perception and patterns of cerebral activation during noxious heat stimulation in humans.
The main goal of the chapter is the presentation of the application project portfolio management approach to support development of e-Municipality and public administration information systems. The models of how people publish and utilize information on the web have been transformed continually. Instead of simply viewing on static web pages, users publish their own content through blogs and photo- and video-sharing slides. Analysed in this chapter, ICT (Information Communication Technology) projects for municipalities cover the mixture of the static web pages, e-Government information systems, and Wikis. So, for the management of the ICT projects' mixtures the portfolio project management approach is proposed.
Schuller, Y.; Linthorst, G. E.; Hollak, C. E. M.; van Schaik, I. N.; Biegstraaten, M.
Neuropathic pain is one of the key features of (classical) Fabry disease (FD). No randomized clinical trials comparing effectiveness of different pain management strategies have been performed. This review aims to give an overview of existing pain management strategies. PubMed and Embase were
When it comes to project management, the IT department is typically its own worst enemy. When project requests are pushed through the budgeting process by different departments, it's up to IT to make them all work. The staff is required to be "heroic" to get the project load done. People get to work over weekends and postpone their vacations. The…
Project Manager Boston Biomedical Innovation Center 215 First Street, Suite 500; Cambridge, MA 02142 857-307-2441 | firstname.lastname@example.org | b...AWARD NUMBER: W81XWH-15-1-0480 TITLE: Development of Novel Local Analgesics for Management of Acute Tissue Injury Pain PRINCIPAL...31/2017 4. TITLE AND SUBTITLE Development of Novel Local Analgesics for Management of Acute Tissue Injury Pain 5a. CONTRACT NUMBER Tissue Injury
Smith, Caroline A; Collins, Carmel T; Crowther, Caroline A
Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined currently available evidence supporting the use of aromatherapy for pain management in labour. To examine the effects of aromatherapy for pain management in labour on maternal and perinatal morbidity. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2010), The Cochrane Complementary Medicine Field's Trials Register (October 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 4), MEDLINE (1966 to 31 October 2010), CINAHL (1980 to 31 October 2010), the Australian and New Zealand Trials Registry (31 October 2010), Chinese Clinical Trial Register (31 October 2010), Current Controlled Trials (31 October 2010), ClinicalTrials.gov (31 October 2010), ISRCTN Register (31 October 2010), National Center for Complementary and Alternative Medicine (NCCAM) (31 October 2010) and the WHO International Clinical Trials Registry Platform (31 October 2010). Randomised controlled trials comparing aromatherapy with placebo, no treatment or other non-pharmacological forms of pain management in labour. Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We included two trials (535 women) in the review. The trials found no difference between groups for the primary outcomes of pain intensity, assisted vaginal birth (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.48 to 2.28, one trial, 513 women; RR 0.83, 95% CI 0.06 to 11.70, one trial, 22 women), and caesarean section (RR 0.98, 95% CI 0.49 to 1.94, one trial, 513 women; RR 2.54, 95% CI 0.11 to 56.25, one trial, 22 women); there were more babies admitted to neonatal intensive care in the control group of one trial (RR 0.08, 95% CI 0.00 to 1.42, one trial, 513 women) but this
Saini, Shalini; Bhatnagar, Sushma
The World Health Organization estimated that more than 60% of the 14 million new cancer cases worldwide in 2012 were reported in the developing part of the world, including Asia, Africa, Central and South America. Cancer survival rate is poorer in developing countries due to diagnosis at late stage and limited access to timely treatment. Since the disease per se cannot be treated even with the best available treatment modalities, what remains important is symptom management and providing comfort care to these patients. The incidence of pain in advanced stages of cancer approaches 70-80%. Lack of preventive strategies, poverty, illiteracy, and social stigma are the biggest cause of pain suffering and patient presenting in advance stage of their disease. The need for palliative care is expanding due to aging of world's population and increase in the rate of cancer in developed and developing countries. A huge gap remains between demand and current palliative care services. Overcoming barriers to palliative care is a major global health agenda that need immediate attention. Main causes of inadequate pain relief remain lack of knowledge among physician and patients, lack of adequate supply of opioids and other drugs for pain relief, strong bureaucracy involved in terms of procurement, and dispensing of opioids. Beside this, poverty and illiteracy remain the most important factors of increased suffering.
Smith, Caroline A; Levett, Kate M; Collins, Carmel T; Armour, Mike; Dahlen, Hannah G; Suganuma, Machiko
Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute to the popularity of complementary methods of pain management. This review examined currently available evidence on the use of relaxation therapies for pain management in labour. This is an update of a review first published in 2011. To examine the effects of mind-body relaxation techniques for pain management in labour on maternal and neonatal well-being during and after labour. We searched Cochrane Pregnancy and Childbirth's Trials Register (9 May 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 5 2017), MEDLINE (1966 to 24 May 2017), CINAHL (1980 to 24 May 2017), the Australian New Zealand Clinical Trials Registry (18 May 2017), ClinicalTrials.gov (18 May 2017), the ISRCTN Register (18 May 2017), the WHO International Clinical Trials Registry Platform (ICTRP) (18 May 2017), and reference lists of retrieved studies. Randomised controlled trials (including quasi randomised and cluster trials) comparing relaxation methods with standard care, no treatment, other non-pharmacological forms of pain management in labour or placebo. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We attempted to contact study authors for additional information. We assessed evidence quality with GRADE methodology. This review update includes 19 studies (2519 women), 15 of which (1731 women) contribute data. Interventions examined included relaxation, yoga, music and mindfulness. Approximately half of the studies had a low risk of bias for random sequence generation and attrition bias. The majority of studies had a high risk of bias for performance and detection bias, and unclear risk of bias for, allocation concealment, reporting bias and other bias. We assessed the evidence from these studies as ranging from low to very low quality, and
Wolf, Patricia; Hanisch, Christoph
This paper presents a qualitative interview study with 28 RIS project managers that aimed at understanding whether or not this is true in the context of regional innovation and what the specifics of managing regional innovation projects are. In taking up a recent claim for policy intervention studies which allow to “derive precise suggestions for their design and management”. The study investigated the interrelation between the agility of the management approach and the achievements of RIS p...
UNGUREANU, Adrian; UNGUREANU, Anca
Undoubtedly, a methodology properly defined and strictly followed for project management provides a firm guarantee that the work will be done on time, in budget and according to specifications. A project management methodology in simple terms is a “must-have” to avoid failure and reduce risks, because is one of the critical success factors, such basic skills of the management team. This is the simple way to guide the team through the design and execution phases, processes and tasks throughout...
Юлія Юріївна ГУСЄВА
Full Text Available An approach based on an integration of requirements breakdown structure and work breakdown structure of the project is proposed. It can complement existing methods of project stakeholders classification with the indicator of resource input, which can be defined in monetary terms. A method of requirements monitoring is proposed, which allows you to track the requirements of project stakeholders over time according to the actual amount of resources spent by analogy with the earned value method. Proposed indexes are the basis not only for monitoring but for the forecast of the project. The need of creating of a mechanism for getting baseline data taking into account the existence of different types of requirements of project stakeholders is grounded.
On July 13, 1998, the U.S. Department of Energy, Richland Operations Office (DOE-RL) Manager transmitted a letter to Fluor Daniel Hanford, Inc. (FDH) describing several DOE-RL identified failed opportunities for FDH to improve the Quality Assurance (QA) Program and its implementation. In addition, DOE-RL identified specific Quality Program performance deficiencies. FDH was requested to establish a periodic reporting mechanism for the corrective action program. In a July 17, 1998 response to DOE-RL, FDH agreed with the DOE concerns and committed to perform a comprehensive review of the Project Hanford Management Contract (PHMC) QA Program during July and August, 1998. As a result, the Project Hanford Management Contract Quality Improvement Plan (QIP) (FDH-3508) was issued on October 21, 1998. The plan identified corrective actions based upon the results of an in-depth Quality Program Assessment. Immediately following the scheduled October 22, 1998, DOE Office of Enforcement and Investigation (EH-10) Enforcement Conference, FDH initiated efforts to effectively implement the QIP corrective actions. A Quality Improvement Project (QI Project) leadership team was assembled to prepare a Project Management Plan for this project. The management plan was specifically designed to engage a core team and the support of representatives from FDH and the major subcontractors (MSCs) to implement the QIP initiatives; identify, correct, and provide feedback as to the root cause for deficiency; and close out the corrective actions. The QI Project will manage and communicate progress of the process
Atwood, J.; Borden, G.; Rangel, G. R.
The Bechtel Hanford-led Environmental Restoration Contractor team's Waste Management Process Improvement Project is working diligently with the U.S. Department of Energy's (DOE) Richland Operations Office to improve the waste management process to meet DOE's need for an efficient, cost-effective program for the management of dangerous, low-level and mixed-low-level waste. Additionally the program must meet all applicable regulatory requirements. The need for improvement was highlighted when a change in the Groundwater/Vadose Zone Integration Project's waste management practices resulted in a larger amount of waste being generated than the waste management organization had been set up to handle
LeClair, A.N.; Lemire, D.S.
This paper explores the importance of records and information management for decommissioning projects. Key decommissioning information and elements of a sound information management strategy are identified. Various knowledge management strategies and tools are discussed as opportunities for leveraging decommissioning information. The paper also examines the implementation of Atomic Energy of Canada Limited's (AECL) strategy for the long term preservation of decommissioning information, and its initiatives in leveraging of information with the application of several knowledge management strategies and tools. The implementation of AECL's strategy illustrates common as well as unique information and knowledge management challenges and opportunities for decommissioning projects. (author)
In order to improve the management of postoperative pain many publications insist on progressive changes in care organization. The following list outlines steps to be taken for implementation of these changes: 1) an initial analysis of management of post-operative pain allows awareness of reforms to be proposed; 2) participation of health teams in special training in order to use evaluation tools and collect data (use of analgesics, adverse effects); 3) establishing policies and procedures: recovery room, guidelines for analgesic use and adverse effects; 4) notifying patient about the various procedures to be used in postoperative period--discussion with the patient during the preoperative interview; 5) current use of standard patient-controlled analgesia (PCA) and locoregional analgesia; 6) use of combined techniques in order to achieve a balanced analgesia; 7) implementing a quality assurance programme which should include analgesic effectiveness, patient satisfaction and prevention of complications; and 8) planning of an Acute Pain Service based on a clinical nurse co-ordinator which offers highly effective forms of postsurgical analgesia.
Full Text Available Purpose: To provide nursing students knowledge of pain prior, during, and post- surgery, recovery and rehabilitation. Methods: Review articles published during 2005 until 2012 that focused on pain assessment and pain management. The databases used in this study were Medline and CINAHL.Results: Postoperative pains need special approach and care. It needs teach patient how to adapt pain, control pain, monitor result of treatment. Conclusion: Nursing students need to learn how to assess pain using appropriate tools for each age level and in patients with special needs. The students also need to learn about pain management including pharmacology and non-pharmacology means and consider pain as the fifth vital sign. As student nurses learn pain assessment, they should be considerate about culture, and different languages that might happen during practical rotations.
Full Text Available Most children in hospital have pain. Seeing your child in pain or discomfort is incredibly difficult. Pain in children is a public health concern of major significance in most parts of the world. We have learned that unrelieved pain causes the body to release certain chemicals that may actually delay healing, so it's important to work with child's nurses and doctors to help children for control the pain. On the other side, medication is not the only way to relieve pain. Pain in children should always be managed and pain expression is dependent on the child’s age, cognitive development, and socio cultural context and it is important to pay particular attention to developmental variations in any behavioural manifestations of pain. In this study to explain some ways for parents and healthcare team to manage pain in children.
This plan presents the overall objectives, description, justification and planning for the Plutonium Finishing Plant (PFP) Solutions Stabilization subproject. The intent of this plan is to describe how this project will be managed and integrated with other facility stabilization and deactivation activities. This plan supplements the overall integrated plan presented in the Integrated Project Management Plan (IPMP) for the Plutonium Finishing Plant Stabilization and Deactivation Project, HNF-3617. This project plan is the top-level definitive project management document for the PFP Solution Stabilization subproject. It specifies the technical, schedule, requirements and the cost baselines to manage the execution of the Solution Stabilization subproject. Any deviations to the document must be authorized through the appropriate change control process.
This plan presents the overall objectives, description, justification and planning for the Plutonium Finishing Plant (PFP) Solutions Stabilization subproject. The intent of this plan is to describe how this project will be managed and integrated with other facility stabilization and deactivation activities. This plan supplements the overall integrated plan presented in the Integrated Project Management Plan (IPMP) for the Plutonium Finishing Plant Stabilization and Deactivation Project, HNF-3617. This project plan is the top-level definitive project management document for the PFP Solution Stabilization subproject. It specifies the technical, schedule, requirements and the cost baselines to manage the execution of the Solution Stabilization subproject. Any deviations to the document must be authorized through the appropriate change control process
Harvard Business Review
MEET YOUR GOALS—ON TIME AND ON BUDGET. How do you rein in the scope of your project when you’ve got a group of demanding stakeholders breathing down your neck? And map out a schedule everyone can stick to? And motivate team members who have competing demands on their time and attention? Whether you’re managing your first project or just tired of improvising, this guide will give you the tools and confidence you need to define smart goals, meet them, and capture lessons learned so future projects go even more smoothly. The HBR Guide to Project Management will help you: • Build a strong, focused team • Break major objectives into manageable tasks • Create a schedule that keeps all the moving parts under control • Monitor progress toward your goals • Manage stakeholders’ expectations • Wrap up your project and gauge its success
Cooper, Lynne P.; Hecht, Michael H.; Majchrzak, Ann
Organizations that rely on projects to implement their products must find effective mechanisms for propagating lessons learned on one project throughout the organization. A broad view of what constitutes a project's 'legacy' is presented that includes not just the design products and leftover parts, but new processes, relationships, technology, skills, planning data, and performance metrics. Based on research evaluating knowledge reuse in innovative contexts, this paper presents an approach to project legacy management that focuses on collecting and using legacy knowledge to promote organizational learning and effective reuse, while addressing factors of post-project responsibility, information obsolescence, and the importance of ancillary contextual information. .
Інга Борисівна СЕМКО
Full Text Available Project management is widely used around the world as a tool to improve business performance. Correct implementation of the program of implementation of energy efficiency is accompanied by the adoption of an appropriate legislative framework, support programs, the approval of market-based instruments. Currently, it is paying enough attention to the effective application of market-based instruments, although most of the activities in the field of energy efficiency from the economic side are quite profitable. The authors suggested the use of the methodology of project management to the management of energy-saving measures, new approaches to the place and role of project management in the hierarchy of guidance. As a result, this innovation can improve the competitiveness of enterprises. The conclusions that the energy-saving project management allows you to get the best results for their implementation by reducing the time, resources, risk reduction.
Nolli, M; Nicosia, F
The Health Services, not only the Italian one, is under pressure because of request for improving treatment quality and the financial need for reorganization and cost-saving. It's required a rationalization of intervention, together with a careful choice of the best and cheapest techniques and the demonstration of their efficacy. The anaesthesia service activity, in a period of cost rationalization and funds restriction should be aimed to appropriate outcome measures corrected by both patient's risk factors and surgical-anaesthesiological case-mix. The development of a complete strategy for surgical pain management might run into two phases. The first phase, internal and mono-specialistic, should develop like the creation of an Acute Pain Team. The main processes are: focusing the problem (charge of the care), training, information, teaching methodology (timing, methods, drugs, techniques, etc.) and the audit (before and after changes). The main aims are the evaluation of the level of analgesia and pain relief or patient's satisfaction which are partial endpoints useful to demonstrate the improvement and the efficacy of the new pain management strategies. The second phase, multidisciplinary, is directed toward the creation of a Postoperative Evaluation Team. The main objective is to set up a collaborative clinical group able to identify the criteria for quality, efficacy and safety. The major purpose is the evaluation of major outcome measures: surgical outcome, morbidity, mortality and length of hospitalization. The improvement in the quality of postoperative pain treatment goes through a better organization and a progressive increase of the already available therapy. The achievement of the result and the quality projects depend on the interaction among staff members with different behaviours and settings. Internal teaching and training, continuous education for doctors and nurses, and external information, marketing and improvement of attractive capability of
The rules and practices for Scrum-a simple process for managing complex projects-are few, straightforward, and easy to learn. But Scrum's simplicity itself-its lack of prescription-can be disarming, and new practitioners often find themselves reverting to old project management habits and tools and yielding lesser results. In this illuminating series of case studies, Scrum co-creator and evangelist Ken Schwaber identifies the real-world lessons-the successes and failures-culled from his years of experience coaching companies in agile project management. Through them, you'll understand how to
Full Text Available Although the projects are different from each other there are many common things that contribute to their success. Looked overall, the success of a project is the result of a multitude of factors. This person is considered the "engine" of the project. The man who makes the action set for the achievement of project objectives to be brought to an end. The project manager must have the technical knowledge and economic diverse. He should be able to choose a team and lead. You must be tenacious, combative, to know how to communicate both within the team and beyond. In a word, the project manager must have an impressive stock of knowledge, skills and abilities and appreciate as Peter Drucker, to "exist for the organization. To be its servant. Any management who forget this will only cause damage to the organization. "This study will focus on highlighting the skills of the project manager and their role in managing difficult situations or risk.
According to a 1998 World Health Organization Survey of 26 000 primary care ... in pain medicine and continue to follow the biomedical approach, which ... The modern paradigm of pain management has moved from this biomedical to the ...
inpatient system for debilitating events such as crises or acute pain. ... and pharmacological treatments documented in the patients' case files. ... this study. Therefore, our objective was to evaluate acute pain management in SCA children on ...
Al Khalaileh, Murad; Al Qadire, Mohammad
Pain management requires knowledgeable and trained nurses. Because nursing students are the nurses of the future, it is important to ensure that students receive adequate education about pain management in nursing schools. The purpose of this study is to evaluate nursing students' knowledge and attitudes regarding pain management. A cross-sectional survey was used. The sample comprised 144 students from three nursing colleges in Jordan. Sixty-one percent were female and the average age was 21.6 years (SD 1.7). The students' Knowledge and Attitudes Survey Regarding Pain was used. The rate of correct answers ranged from 11.1% to 64%. Students showed a low level of knowledge regarding pain management-the average score was just 16 (SD 5.11) out of 40. Students were weak in their knowledge of pain medications pharmacology (actions and side effects). Less than half of students (47.9%) recognised that pain may be present, even when vital signs are normal and facial expressions relaxed. Finally, students showed negative attitudes towards pain management, believing that patients should tolerate pain as much as they can before receiving opioids; almost half (48%) of students agreed that patients' pain could be managed with placebo rather than medication. In conclusion, Jordanian nursing students showed lower levels of pain knowledge compared with other nursing students around the world. This study underlines the need to include pain-management courses throughout undergraduate nursing curricula in Jordan.
The Waste Isolation Pilot Plant (WIPP) Records Management Handbook provides the WIPP Project Records Management personnel with a tool to use to fulfill the requirements of the WIPP Records Program and direct their actions in the important area of records management. The handbook describes the various project areas involved in records management, and how they function. The handbook provides the requirements for Record Coordinators and Master Record Center (MRC) personnel to follow in the normal course of file management, records scheduling, records turnover, records disposition, and records retrieval. More importantly, the handbook provides a single reference which encompasses the procedures set fourth in DOE Order 1324.2A, ''Records Disposition'' ASME NQA-1, ''Quality Assurance Program Requirements for Nuclear Facilities'' and DOE-AL 5700.6B, ''General Operations Quality Assurance.'' These documents dictate how an efficient system of records management will be achieved on the WIPP Project
Wilson, Bridget H; Nelson, Jessica
Sickle cell disease (SCD) pain continues to emerge in adolescents. More than 98,000 individuals are believed to have SCD in the United States. In fact, 1 in 500 Black infants will be affected by SCD. Identifying standards of care for this unique population can improve pain management and treatment. A significant effect of vaso-occlusive crisis is a decrease in the quality of life in children. Therefore, pain management is multidimensional and includes pharmacologic, physical, and psychological strategies. A review of the literature was conducted to identify best practices regarding pain management in adolescents with sickle cell anemia. Key words such as pain, pain management, adolescent sickle cell anemia, and acute sickle cell pain were entered into databases to reveal qualitative and quantitative studies from 2009 to the present. Many of the research articles identified poor SCD pain management. Studies showed that acute SCD pain management is essential and should be evaluated and robustly managed to achieve optimum pain relief for patients. Acute SCD pain usually occurs as a result of vaso-occlusive crisis. Untreated acute SCD pain can result in morbidity and mortality in adolescents. Nursing knowledge is critical to reducing the stigma and improving management of SCD pain. Nurses play a vital role in the introduction of evidence-based practice within the clinical setting. In an effort to educate nurses and other health care professionals about SCD, this article is a literature review of studies concerning SCD and pain management in emergency rooms. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Diane M. Flynn
Full Text Available Chronic pain is a significant problem among military personnel and a priority of the military health system. The U.S. Army Surgeon General's Pain Management Task Force recommends using telehealth capabilities to enhance pain management. This article describes the development and evaluation of a telehealth intervention (TelePain designed to improve access to pain specialist consultation in the military health system. The study uses a wait-list cluster controlled clinical trial to test: 1 effectiveness of the intervention, and 2 interviews to assess barriers and facilitators of the intervention implementation. The intervention involves a didactic presentation based on the Joint Pain Education Curriculum followed by patient case presentations and multi-disciplinary discussion via videoconference by clinicians working in the military health system. A panel of pain specialists representing pain medicine, internal medicine, anesthesiology, rehabilitation medicine, psychiatry, addiction medicine, health psychology, pharmacology, nursing, and complementary and integrative pain management provide pain management recommendations for each patient case. We use the Pain Assessment Screening Tool and Outcomes Registry (PASTOR to measure patient outcomes, including pain, sleep, fatigue, anxiety, and depression. This article reports some of the challenges and lessons learned during early implementation of the TelePain intervention. Weekly telephone meetings among the multisite research team were instrumental in problem solving, identifying problem areas, and developing solutions. Solutions for recruitment challenges included additional outreach and networking to military health providers, both building on existing relationships and new relationships.
Flynn, Diane M; Eaton, Linda H; McQuinn, Honor; Alden, Ashley; Meins, Alexa R; Rue, Tessa; Tauben, David J; Doorenbos, Ardith Z
Chronic pain is a significant problem among military personnel and a priority of the military health system. The U.S. Army Surgeon General's Pain Management Task Force recommends using telehealth capabilities to enhance pain management. This article describes the development and evaluation of a telehealth intervention (TelePain) designed to improve access to pain specialist consultation in the military health system. The study uses a wait-list controlled clinical trial to test: 1) effectiveness of the intervention, and 2) interviews to assess barriers and facilitators of the intervention implementation. The intervention involves a didactic presentation based on the Joint Pain Education Curriculum followed by patient case presentations and multi-disciplinary discussion via videoconference by clinicians working in the military health system. A panel of pain specialists representing pain medicine, internal medicine, anesthesiology, rehabilitation medicine, psychiatry, addiction medicine, health psychology, pharmacology, nursing, and complementary and integrative pain management provide pain management recommendations for each patient case. We use the Pain Assessment Screening Tool and Outcomes Registry (PASTOR) to measure patient outcomes, including pain, sleep, fatigue, anxiety, and depression. This article reports some of the challenges and lessons learned during early implementation of the TelePain intervention. Weekly telephone meetings among the multisite research team were instrumental in problem solving, identifying problem areas, and developing solutions. Solutions for recruitment challenges included additional outreach and networking to military health providers, both building on.
Manchikanti, Laxmaiah; Hirsch, Joshua A; Falco, Frank JE; Boswell, Mark V
AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain. METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including PubMed from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources including previous systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level I to level V
Vincent, Catherine Van Hulle; Wilkie, Diana J.; Wang, Edward
We evaluated feasibility of the Internet-based Relieve Children's Pain (RCP) protocol to improve nurses’ management of children's pain. RCP is an interactive, content-focused, and Kolb's Experiential Learning Theory-based intervention. Using a one-group, pre/posttest design, we evaluated feasibility of RCP and pre/post difference in scores for nurses’ beliefs, and simulated and actual pain management practices. Twenty-four RNs completed an Internet-based Pain Beliefs and Practices Questionnai...
Wilder-Smith, O.H.G.; Mohrle, J.J.; Dolin, P.J.; Martin, N.C.
Chronic pain management by Swiss specialist physicians with the primary hypothesis that pain clinic practitioners conform better to good practice (interdisciplinarity, diagnostic/therapeutic routines, quality control, education) than other specialists treating chronic pain was surveyed. Management
Connelly, Mark; Wallace, Dustin P; Williams, Kristi; Parker, JoLynn; Schurman, Jennifer V
Evidence-based pain-limiting strategies for pediatric immunizations remain underutilized, with barriers identified to date mostly pertaining to health care providers and systems of care. The present study sought to quantify and investigate parent attitudes toward pain management as another potential barrier to the routine use of pain-mitigating strategies during immunizations. Questionnaires measuring parent attitudes, willingness to pay, and perceived barriers for using pain management for immunizations were completed by 259 parent/guardians of children ages 0 to 5 years attending appointments at an urban primary care clinic in the Midwestern United States. Parent attitudes toward pain management for immunization were relatively normally distributed and varied from strongly positive to negative, with 33% of parents disagreeing that they were concerned about the pain their child may experience and 50% agreeing that there are no lasting negative effects from immunization pain. Negative parent attitudes were associated with willingness to spend less in money or time for pain management and with greater perceived significance of cost, time, and other barriers for using pain-mitigating strategies. Some parents perceive limited value in trying to reduce pain during immunizations such that they may be hesitant to invest much time or effort in interventions. Greater success of translating evidence-based pain management into practice therefore may require accounting for differences in parent attitudes by tailoring educational efforts and pain management options accordingly.
Crowder, James A
Management and enables them to deal with the demands and complexities of modern, agile systems/software/hardware development teams. The book examines the project/program manager beyond the concepts of leadership and aims to connect to employees' sense of identity. The text examines human psychological concepts such as "locus of control," which will help the manager understand their team members' view and how best to manage their "world" contributions. The authors cover new management tools and philosophies for agile systems/software/hardware development teams, with a specific focus on how this
Damsgård, Elin; Solgård, Hege; Johannessen, Karin; Wennevold, Katrine; Kvarstein, Gunnvald; Pettersen, Gunn; Garcia, Beate
Pain is common among elderly patients in nursing homes. However, pain assessment and treatment are inadequate. Interprofessional treatment is recommended, and consequently interprofessional education in pain management is necessary. This pilot project aimed to describe how two interprofessional groups of students approached pain management in two nursing home patients. We formed two teams comprising one student from the nursing, physical therapy, pharmacy, and medical educations. Each team spent one day examining a patient with chronic pain at a nursing home and they developed pain management plans. We collected data through video recordings during teamwork before and after examining the patients and field notes during the patient examination. We analysed the video-recordings applying the seven-step model including 1) viewing the video data, 2) describing the video data, 3) identifying critical events, 4) transcribing, 5) coding, 6) constructing storyline and 7) composing a narrative. Field notes supplied the transcripts. Both teams succeeded in making a pain management plan for their patient. The common examination of the patient was crucial for the students' approaches to pain management and changed their pre-assumptions about the patients' pain. By sharing knowledge and reflecting together, the students reached a common consensus on suggestions for management of the patients' problems. Interprofessional collaboration fostered enthusiasm and a more holistic pain management approach. However,students' lack of knowledge limited their understanding of pain. Knowledge of pain management in nursing home patients and the practice of interprofessional cooperation should be included in pain curricula for health care professionals. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Harris, Dylan G
Pain is common in advanced malignancy but also prevalent in other non-malignant life-limiting diseases such as advanced heart disease; end stage renal failure and multiple sclerosis. Patients with renal or liver impairment need specific consideration, as most analgesics rely on either or both for their metabolism and excretion. Recent evidence-based guidelines and the systematic reviews that have informed their recommendations. The principles of the WHO (World Health Organisation) analgesic ladder are commonly endorsed as a structured approach to the management of pain. For neuropathic pain, the efficacy of different agents is similar and choice of drug more guided by side effects, drug interactions and cost. Evidence supporting the WHO analgesic ladder is disputed and alternatives suggested, but no overwhelming evidence for an alternative approach exists to date. Alternative approaches to the WHO analgesic ladder, new analgesic agents, e.g. rapid onset oral/intranasal fentanyl. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: email@example.com.
Durao, Frederico; Dolog, Peter; Grolin, Daniel
The Knowledge model for project management serves several goals:Introducing relevant concepts of project management area for software development (Section 1). Reviewing and understanding the real case requirements from the industrial perspective. (Section 2). Giving some preliminary suggestions...... for usage in KIWI system (Sections 3). This document is intended for technological partners to understand how for example the software development concepts can be applied to a semantic wiki framework....
Hansen, Lars Kristian; Svejvig, Per
the last five years. Utilizing the theoretical lens proposed by Svejvig and Andersen (2015), we apply two complementary analytical perspectives to classify and analyze the stocks. One perspective, denoted as classical project management (CPM), highlights key characteristics of conventional research....... A second perspective, denoted as rethinking project management (RPM), highlights characteristics of progressive research. Not surprisingly, characteristics from CPM are very dominant in the stock of most cited publications of all years — instrumentality and controllability in particular. In the newest...
Joyce, B A; Keck, J F; Gerkensmeyer, J
The purpose of the study was to determine the efficacy of music and eutectic mixture of local anesthetics (EMLA) on pain responses of neonates undergoing circumcision. A randomized, double-blind experimental design was used with 23 neonates. Pain response was measured using an observational pain intensity rating scale and the physiologic parameters of heart rate, respiratory rate, oxygen saturation levels, salivary cortisol levels, and length of cry. Each infant's state was examined for a potential contribution to the pain response. Infant state, salivary cortisol levels, and respiratory rates were not significant. Pain ratings had considerable variability for all treatment conditions, but both single treatment groups had less pain by the end of the procedure. The heart rate was significantly lower for the EMLA group and remained stable for the music group. Oxygen saturation differences were statistically significant for the music group (P =.02) and approached significance for the EMLA group. Preliminary support was provided for the efficacy of EMLA and music to contribute to the pain relief of neonates undergoing circumcision. Further study is warranted. Neonates deserve interventions that will provide them with a less painful start in life.
Booker, Staja Q
The purpose of this systematic review is to explore the perceptions of acute, persistent, and disease-specific pain and treatment options held by adult African Americans. Underassessment and undermanagement of pain in African Americans has been well documented; however, the cultural continuum of pain perceptions and their influence on pain assessment and management has not been synthesized. Electronic database searches of the Cumulative Index for Nursing and Allied Health Literature and PubMed, Web-based searches of the pain-specific journals plus a manual search of reference lists identified 41 relevant articles addressing perceptions of pain and/or pain management. Analysis of the literature revealed six themes: (a) meaning of pain, (b) description of pain, (c) coping with pain, (d) impact of pain, (e) patient-provider relationship, and (f) treatment approaches. These findings warrant further research and indicate the need for more precise evaluation of pain in African Americans, highlighting an imperative to incorporate cultural patterns into pain management practice and education. © The Author(s) 2014.
centralized database . • Project Recon (formerly Risk Recon) is designed to be used by all Program Management Offices, Integrated Project Teams and any...Create growth plans to proactively capture benefits • Customize reports to group opportunities by programmatic, technical, business, contracting, and
pain syndrome (MFPS) was attributed to an inflammation of fibrous tissue ... Afferent nerve fibres to muscle are classified as groups I, II,. III and IV. .... tion of pain. There is evidence that pain caused by peripheral .... C. Occupational therapy.
Niko Majdandzic; Tadija Lovric; Vido Peric
In this work we have shown the concept of logistic support in management in building production and in building of objects, which is realised in Enterprise resource Planning – ERP system ERPINSG, developed in Informatic firm Informatic engineering – ININ in Slavonski Brod, and in cooperation with scientists of catedra for informatics of Faculty of Mechanical Engineering and users from building firms.
WangYingluo; LiuYi; LiYuan
The strategic management of large projects is both theoretically and practically important. Some scholars have advanced flexible strategy theory in China. The difference of strategic flexibility and flexible strategy is pointed out. The supporting system and characteristics of flexible strategy are analyzed. The changes of flexible strategy and integration of strategic management are discussed.
Full Text Available In today’s methodologies of project management attention is increasingly paid to the crises-related issues. Modern economy and the turbulent environment cause that an emergingcrisis can pose a serious threat to the implementation of any undertaking. This article focuses on the presentation of the conditions and causes of crisis situations, the essence of projects, and their effective management. The major objective of the paper, however, is to demonstrate how companies implementing projects cope with the occurrence of a crisis situation.
Wild, L R; Mitchell, P H
This study explores how an organization, as the context of care, influences nursing practice and a nursing-sensitive, quality health outcome-pain management. The results provide important insights into organizational patterns associated with favorable pain management-related outcomes as well as the congruence between and among subunits within the organization. Outcomes were most favorable on units where nurses had attitudes supportive of aggressive pain management and higher levels of coordination and discretion.
Beatriz Bagoin Guimarães
Records Management System implementation is a complex process that needs to be executed by a multidisciplinary team and involves components of apparently non-related areas such as archival science, computer engineering, law, project management and human resource management. All of them are crucial and complementary to guarantee a full and functional implementation of a system and a perfect fusion with the connected processes and procedures. The purpose of this work is to provide organizations...
Full Text Available Purpose: The objective of this cross-sectional, noninterventional, 6-month observational study was to assess the adequacy of pain management in patients with cancer admitted to the Oncology Department of Guru Gobind Singh Medical College in Faridkot, India. Methods and Materials: A total of 348 patients with cancer were recruited for evaluation of the prevalence of inadequate cancer pain management using the Brief Pain Inventory Pain Management Index. Results: The current study included 127 males (36.5% and 221 females (63.5%. The most prevalent cancer type was genitourinary; 268 patients (77% had inadequately managed pain. A significant correlation was observed between poorly managed pain and age groups, analgesic used, and body mass index. Conclusion: Our observation of inadequate pain management among 77% of patients indicates that pain management was insufficient in three quarters of the patients in this study. Accumulating data regarding the inadequacy of cancer pain management is crucial to improve symptom management. Better management of pain not only alleviates pain symptoms but also increases the quality of life for patients with cancer.
Edward L. Parsons, Jr.
The purpose of this report is to provide the office of Waste Management (WM) with recommended contingency calculation procedures for typical WM projects. Typical projects were defined as conventional construction-type activities that use innovative elements when necessary to meet the project objectives. Projects involve treatment, storage, and disposal of low level, mixed low level, hazardous, transuranic, and high level waste. Cost contingencies are an essential part of Total Cost Management. A contingency is an amount added to a cost estimate to compensate for unexpected expenses resulting from incomplete design, unforeseen and unpredictable conditions, or uncertainties in the project scope (DOE 1994, AACE 1998). Contingency allowances are expressed as percentages of estimated cost and improve cost estimates by accounting for uncertainties. The contingency allowance is large at the beginning of a project because there are more uncertainties, but as a project develops, the allowance shrinks to adjust for costs already incurred. Ideally, the total estimated cost remains the same throughout a project. Project contingency reflects the degree of uncertainty caused by lack of project definition, and process contingency reflects the degree of uncertainty caused by use of new technology. Different cost estimation methods were reviewed and compared with respect to terminology, accuracy, and Cost Guide standards. The Association for the Advancement of Cost Engineering (AACE) methods for cost estimation were selected to represent best industry practice. AACE methodology for contingency analysis can be readily applied to WM Projects, accounts for uncertainties associated with different stages of a project, and considers both project and process contingencies and the stage of technical readiness. As recommended, AACE contingency allowances taper off linearly as a project nears completion
Beatriz Bagoin Guimarães
Full Text Available Records Management System implementation is a complex process that needs to be executed by a multidisciplinary team and involves components of apparently non-related areas such as archival science, computer engineering, law, project management and human resource management. All of them are crucial and complementary to guarantee a full and functional implementation of a system and a perfect fusion with the connected processes and procedures. The purpose of this work is to provide organizations with a basic guide to Records Management Project implementation beginning with the steps prior to acquiring the system, following with the main project activities and concluding with the post implementation procedures of continuous improvement and system maintenance.
The concept of integrated project management represents a single source to which the owner can turn for all project management functions excepting for those relating to outside parties such as site purchase, personnel selection etc. Other functions such as design, procurement, construction management, schedule and cost control, quality assurance/quality control are usually handled by the integrated project manager as the agent of the owner. The arrangement is flexible and the responsibilities can be varied to suit the size and experience of the owner. Past experience in the United States indicates an increase in the trend toward IPM work and it appears that overseas this trend is developing also. (orig./RW) [de
If you're a solo website designer or part of a small team itching to build interesting projects with Drupal, this concise guide will get you started. Drupal's learning curve has thrown off many experienced designers, particularly the way it handles design challenges. This book shows you the lifecycle of a typical Drupal project, with emphasis on the early stages of site planning. Learn how to efficiently estimate and set up your own project, so you can focus on ways to make your vision a reality, rather than let project management details constantly distract you. Plan and estimate your projec
Koh, Su-Jin; Keam, Bhumsuk; Hyun, Min Kyung; Ju Seo, Jeong; Uk Park, Keon; Oh, Sung Yong; Ahn, Jinseok; Lee, Ja Youn; Kim, JinShil
More than half of the patients have reported improper management of breakthrough cancer pain. Empirical evidence is lacking concerning the effectiveness of cancer pain education on breakthrough pain control. This study aimed to examine the effects of individual pain education on pain control, use of short-acting analgesics for breakthrough pain, quality of life outcomes, and rectification of patients' misconceptions regarding cancer pain. A quasi-experimental design was used. In total, 176 (102 inpatients and 74 outpatients) and 163 (93 inpatients and 70 outpatients) cancer patients completed questionnaires on pain intensity, quality of life, use of short-acting medication for breakthrough pain, and misconceptions about cancer pain and opioid use before and immediately and/or seven days after individual pain education. The mean age of the participants was 60.9 years (±11.2), and 56.3% were male. The most common cancers were lung cancer (17.0%), colon cancer (15.9%), and breast cancer (12.5%). The subjects' reasons for attrition were conditional deterioration, death, or voluntary withdrawal (N = 13, 7.4%). Following the education, there was a significant reduction in overall pain intensity over 24 hours (P < 0.001). The outpatients showed more use of short-acting analgesics for breakthrough pain. Sleep quality change was most significantly associated with intervention; other quality of life aspects (e.g., general feelings and life enjoyment) also improved. Pain education also significantly reduced misconceptions regarding cancer pain management. The present educational intervention was effective in encouraging short-acting analgesic use for breakthrough pain, improving quality of life outcomes, and rectifying patients' misconceptions about analgesic use.
Kampf, Constance Elizabeth
In the field of project management, the search for better ways to manage projects is ongoing. One of the more recent trends in the literature focuses on the integration of knowledge management in project management environments. Advantages of integrating knowledge management into projects can be ...... knowledge for project management, this paper focuses on extending Knowledge Management to include concepts related to communicating knowledge from the fields of rhetoric, knowledge communication, and corporate communication....
Full Text Available This article considers threats to a project slipping on budget, schedule and fit-for-purpose. Threat is used here as the collective for risks (quantifiable bad things that can happen and uncertainties (poorly or not quantifiable bad possible events. Based on experience with projects in developing countries this review considers that (a project slippage is due to uncertainties rather than risks, (b while eventuation of some bad things is beyond control, managed execution and oversight are still the primary means to keeping within budget, on time and fit-for-purpose, (c improving project delivery is less about bigger and more complex and more about coordinated focus, effectiveness and developing thought-out heuristics, and (d projects take longer and cost more partly because threat identification is inaccurate, the scope of identified threats is too narrow, and the threat assessment product is not integrated into overall project decision-making and execution. Almost by definition, what is poorly known is likely to cause problems. Yet it is not just the unquantifiability and intangibility of uncertainties causing project slippage, but that they are insufficiently taken into account in project planning and execution that cause budget and time overruns. Improving project performance requires purpose-driven and managed deployment of scarce seasoned professionals. This can be aided with independent oversight by deeply experienced panelists who contribute technical insights and can potentially show that diligence is seen to be done.
Full Text Available Journal of Engineering, Project, and Production Management (EPPM-Journal reflect the journal’s multidisciplinary approach to management research and can be categorized as belonging to three general topics: Project Management, Engineering and Project Management, and Project and Production Management.
... 7 Agriculture 15 2010-01-01 2010-01-01 false Project management. 3565.351 Section 3565.351... AGRICULTURE GUARANTEED RURAL RENTAL HOUSING PROGRAM Project Management § 3565.351 Project management. As a... Agency and complies with an approved management plan for the project. (b) Management plan. The lender...
Journal of Engineering, Project, and Production Management (EPPM-Journal) reflect the journal’s multidisciplinary approach to management research and can be categorized as belonging to three general topics: Project Management, Engineering and Project Management, and Project and Production Management.
Song, Wenjia; Eaton, Linda H; Gordon, Debra B; Hoyle, Christine; Doorenbos, Ardith Z
It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. The aim of this study was to modify and test an evaluation tool for nursing cancer pain documentation, and describe the frequency and quality of nursing pain documentation in one oncology unit via the electronic medical system. A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Medical records were examined for 37 adults hospitalized during April and May 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score ranging from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Full Text Available Currently, the concept of project management is considered to be the best concept for efficient management of a project, so it is used all over the world, and most recently in our country. This concept is designed with all the general characteristics of project management, but adapted to the large investment projects. This paper presents the project management concept and project management organization for capital projects. This concept is conceived with all general characteristics of project management, but adopted to the condition of large investment projects. The concept also includes the project team and the project manager, the person authorized and responsible for achieving the objectives planned in the project. For efficient managing by project, it is necessary to insure a good compozition of project team, as a team of people who, in collaboration with project manager, work directly on managing the project. To effectively manage the project, it is necessary to ensure a proper composition of the project team, a team of people who, in collaboration with the project manager to work directly for project management. It is a particularly good method of achieving the objectives planned projects, which means a project with a certain level of performance required in a planned time, with planned costs.
Pickering, Gis?le; Marcoux, Margaux; Chapiro, Sylvie; David, Laurence; Rat, Patrice; Michel, Micheline; Bertrand, Isabelle; Voute, Marion; Wary, Bernard
Neuropathic pain frequently affects older people, who generally also have several comorbidities. Elderly patients are often poly-medicated, which increases the risk of drug?drug interactions. These patients, especially those with cognitive problems, may also have restricted communication skills, making pain evaluation difficult and pain treatment challenging. Clinicians and other healthcare providers need a decisional algorithm to optimize the recognition and management of neuropathic pain. W...
Abdel Razeq, Nadin M; Akuma, Akuma O; Jordan, Sue
Current pain assessment and management in neonates need to be fully described before neonatal pain care can be optimized. This study's purpose was to report neonatal nurses' knowledge, existing pain assessment practice, and pharmacological pain management of neonates in Jordan. A cross-sectional descriptive study was conducted. Eighteen neonatal intensive care units in Jordan were included in the study. One hundred eighty-four neonatal nurses participated. Questionnaires were distributed by and returned to the neonatal intensive care units' managers between June and August 2014. Descriptive and inferential statistics were used to present study results. Of 240 questionnaires distributed, 184 useable responses were returned. Nurses' knowledge regarding neonates' neurological development, nociception, and need for neonatal pain management was suboptimal. The analgesics most commonly used to treat neonatal pain were acetaminophen (52%) and lidocaine (45%). Benzodiazepines, phenobarbitone, and muscles relaxants were also used. Most nurses (54%-97%) reported that pain emanating from most painful procedures was never or rarely treated. Circumcision, lumbar punctures, and chest tube insertion were assigned the highest pain scores (≥9), but were rarely accompanied by analgesia. Pain assessment scales were more likely to be used, and procedural pain was more likely to be treated, in private hospitals than public hospitals. Neonates who require special care still suffer unnecessary pain that could be avoided and managed by following best practice recommendations. Disparities between developed and developing countries in quality of neonatal pain care appear to exist. Resources for education and routine care are needed to address these discrepancies. Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Loeser, John D; Cahana, Alex
The world of health care and the world of business have fundamentally different ethical standards. In the past decades, business principles have progressively invaded medical territories, leading to often unanticipated consequences for both patients and providers. Multidisciplinary pain management has been shown to be more effective than all other forms of health care for chronic pain patients; yet, fewer and fewer multidisciplinary pain management facilities are available in the United States. The amazing increase in interventional procedures and opioid prescriptions has not led to a lessening of the burden of chronic pain patients. Ethical dilemmas abound in the treatment of chronic pain patients: many are not even thought about by providers, administrators, insurance companies, or patients. We call for increased pain educational experiences for all types of health care providers and the separation of business concepts from pain-related health care.
Stinson, Jennifer; Naser, Basem
Sickle cell disease (SCD) is one of the most common inherited diseases worldwide. The disease is characterized by chronic hemolytic anemia, as well as acute and chronic complications. One of the most intractable problems encountered by children with SCD is the painful episode that results from tissue ischemia due to vaso-occlusion. Pain related to SCD is unique among pain syndromes due to the unpredictable, recurrent, and often persistent nature of the disease, as well as the recurring and essential need for the use of opioids. Painful vaso-occlusive episodes (VOE) are a principal cause of morbidity and account for a significant number of emergency department and hospital admissions. When untreated or inadequately managed, the pain of VOE may cause both short- and long-term consequences. Despite the fact that pain is an almost universal feature of the disease, children with SCD may form one of the most undertreated and understudied populations. One of the factors contributing to poor pain management is conflicting perceptions between patients, their families, and healthcare professionals about pain that is reported and analgesia that is required. Pain management guidelines have recently been published in an effort to overcome barriers in the assessment and management of pain related to SCD. Although there is considerable variability in the way SCD pain is managed, the standard treatment protocol for painful episodes has been rest, rehydration, and analgesia. However, pain control for children with SCD is often a difficult and complex process, and one that requires frequent systematic pain assessments and continuous adjustment of comfort measures, especially analgesics. There are a variety of analgesic agents to choose from, such as acetaminophen (paracetamol), oral or parenteral nonsteroidal anti-inflammatory drugs, and oral or parenteral opioids. Each of these options has advantages and disadvantages to their use. Continuous infusions of analgesics and patient
Full Text Available Teresa Paolucci,* Vincenzo Maria Saraceni, Giulia Piccinini* Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy *These authors contributed equally to this work Abstract: Osteoporosis (OP is a pathological condition that manifests clinically as pain, fractures, and physical disability, resulting in the loss of independence and the need for long-term care. Chronic pain is a multidimensional experience with sensory, affective, and cognitive aspects. Age can affect each of these dimensions and the pain that is experienced. In OP, chronic pain appears to have sensory characteristics and properties of nociceptive and neuropathic pain. Its evaluation and treatment thus require a holistic approach that focuses on the specific characteristics of this population. Pain management must therefore include pharmacological approaches, physiotherapy interventions, educational measures, and, in rare cases, surgical treatment. Most rehabilitative treatments in the management of patients with OP do not evaluate pain or physical function, and there is no consensus on the effects of rehabilitation therapy on back pain or quality of life in women with OP. Pharmacological treatment of pain in patients with OP is usually insufficient. The management of chronic pain in patients with OP is complicated with regard to its diagnosis, the search for reversible secondary causes, the efficacy and duration of oral bisphosphonates, and the function of calcium and vitamin D. The aim of this review is to discuss the most appropriate solutions in the management of chronic pain in OP. Keywords: physical therapy, exercise, pharmacological treatment, posture and balance
Eaton, Joel A.
Managing instrumentation projects, large or small, involves a number of common challenges-defining what is needed, desiging a system to provide it, producing it in an economical way, and putting it into service expeditiously. Doing these things in a university environoment provides unique challenges and opportunities not obtaining in the environment of large projects at NASA or national labs. I address this topic from the viewpoint of knowledge of two such projects, the development of OAO-2 at the University of Wisconsin and the relocation of Fairborn Observatory to the Patagonia Mountains in Arizona, as well as my own developemnt of the Tennessee State 2-m Automatic Spectroscopic Telescope. For the university environment, I argue for a more traditional management style that relies on more informal techniques than those used in large-scale projects conducted by big bureaucratic institutions. This style identifies what tasks are really necessary and eliminates as much wasteful overhead as possible. I discuss many of the formalities used in project management, such as formal reviews (PDR, CDR, etc.) and Gantt charts, and propose other ways of acheving the same results more effectively. The university environment acutely requires getting the right people to do the project, both in terms of their individual personalities, motivation, and technical skills but also in terms of their ability to get on with one another. Two critical challenges confronting those doing such projects in universities are 1) keeping the contractors on task (the major challenge to anyone doing project management) and 2) dealing with the purchasing systems in such institutions.
Full Text Available Any major software development starts with the Initiating process group. Once the charter document is approved, the Planning and then to the Executing stages will follow. Monitoring and Controlling is measuring the potential performance deviation of the project in terms of schedule and costs and performs the related Integrated Change Control activities. At the end, during the Closing, the program/project manager will check the entire work is completed and the objectives are met.
The Dallas Integrated Corridor Management System Demonstration Project is a multi-agency, de-centralized operation which will utilize a set of regional systems to integrate the operations of the corridor. The purpose of the Dallas ICM System is to im...
Drs. A.J.G. Silvius
This paper describes a study into the expected development of the competences op the project manager in the year 2027. The study was performed amongst the members of IPMA-Netherlands during the summer of 2007. In the study the 46 competences of the International Competence Baseline 3 (ICB 3) were
Yassin, Khadra; Rankin, Janet; Al-Tawafsheh, Atef
The purpose of this study was to explore the social organization of nurses' pain management work in Qatar. The research data drew our attention to unacceptable delays in intervening with patients in pain. We describe and analyze delays in opioid administration. Institutional ethnography was the method of inquiry used to guide the study. The main findings of the study reveal that there is a socially organized system of delays built into nurses' work to manage pain. Nurses are subject to time-consuming processes of securing, handling, and administering opioids. This study's innovative approach introduces a promising "alternate" analysis to prior work investigating hospital nurses' pain management practices. Both the method of inquiry and the findings have international relevance for researchers interested in undertreated pain. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
The Integrated Program Management System (IPMS) Description is a ''working'' document that describes the work processes of the Uranium Mill Tailings Remedial Action Project Office (UMTRA) and IPMS Group. This document has undergone many revisions since the UMTRA Project began; this revision not only updates the work processes but more clearly explains the relationships between the Project Office, contractors, and other participants. The work process flow style has been revised to better describe Project work and the relationships of participants. For each work process, more background and guidance on ''why'' and ''what is expected'' is given. For example, a description of activity data sheets has been added in the work organization and the Project performance and reporting processes, as well as additional detail about the federal budget process and funding management and improved flow charts and explanations of cost and schedule management. A chapter has been added describing the Cost Reduction/Productivity Improvement Program. The Change Control Board (CCB) procedures (Appendix A) have been updated. Project critical issues meeting (PCIM) procedures have been added as Appendix B. Budget risk assessment meeting procedures have been added as Appendix C. These appendices are written to act as stand-alone documentation for each process. As the procedures are improved and updated, the documentation can be updated separately
There is a global crisis in access to pain management in the world. WHO estimates that 4.65 billion people live in countries where medical opioid consumption is near to zero. For 2010, WHO considered a per capita consumption of 216.7 mg morphine equivalents adequate, while Taiwan had a per capita consumption of 0.05 mg morphine equivalents in 2007. In Asia, the use of opioids is sensitive because of the Opium Wars in the 19th century and for this reason, the focus of controlled substances policies has been on the prevention of diversion and dependence. However, an optimal public health outcome requires that also the beneficial aspects of these substances are acknowledged. Therefore, WHO recommends a policy based on the Principle of Balance: ensuring access for medical and scientific purposes while preventing diversion, harmful use and dependence. Furthermore, international law requires that countries ensure access to opioid analgesics for medical and scientific purposes. There is evidence that opioid analgesics for chronic pain are not associated with a major risk for developing dependence. Barriers for access can be classified in the categories of overly restrictive laws and regulations; insufficient medical training on pain management and problems related to assessment of medical needs; attitudes like an excessive fear for dependence or diversion; and economic and logistical problems. The GOPI project found many examples of such barriers in Asia. Access to opioid medicines in Taiwan can be improved by analysing the national situation and drafting a plan. The WHO policy guidelines Ensuring Balance in National Policies on Controlled Substances can be helpful for achieving this purpose, as well as international guidelines for pain treatment. Copyright © 2015. Published by Elsevier B.V.
Project management is critical for successful project development. A crucial responsibility of the project manager is ensuring that the client is certified and the scope of work is of high quality, within the agreed budget and time frame. In some way, project financing is completed from the time of project conception. Indeed ...
Pickering, Gisèle; Marcoux, Margaux; Chapiro, Sylvie; David, Laurence; Rat, Patrice; Michel, Micheline; Bertrand, Isabelle; Voute, Marion; Wary, Bernard
Neuropathic pain frequently affects older people, who generally also have several comorbidities. Elderly patients are often poly-medicated, which increases the risk of drug-drug interactions. These patients, especially those with cognitive problems, may also have restricted communication skills, making pain evaluation difficult and pain treatment challenging. Clinicians and other healthcare providers need a decisional algorithm to optimize the recognition and management of neuropathic pain. We present a decisional algorithm developed by a multidisciplinary group of experts, which focuses on pain assessment and therapeutic options for the management of neuropathic pain, particularly in the elderly. The algorithm involves four main steps: (1) detection, (2) evaluation, (3) treatment, and (4) re-evaluation. The detection of neuropathic pain is an essential step in ensuring successful management. The extent of the impact of the neuropathic pain is then assessed, generally with self-report scales, except in patients with communication difficulties who can be assessed using behavioral scales. The management of neuropathic pain frequently requires combination treatments, and recommended treatments should be prescribed with caution in these elderly patients, taking into consideration their comorbidities and potential drug-drug interactions and adverse events. This algorithm can be used in the management of neuropathic pain in the elderly to ensure timely and adequate treatment by a multidisciplinary team.
Felician Alecu; Paul Pocatilu; Sergiu Capisizu
The paper focus on the main key points related to the IT security project management. The most important lifecycle stages are identified: IT security project proposal definition, project organization, project planning, quality planning, project team organization, IT security project activities management and project closing. The most important success factors for IT security projects are the support of top-management, customer satisfaction, prevention over remediation and continuous progress....
Benditz, Achim; Greimel, Felix; Auer, Patrick; Zeman, Florian; Göttermann, Antje; Grifka, Joachim; Meissner, Winfried; von Kunow, Frederik
The number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking. All patients included in the study had undergone total hip arthroplasty (THA). Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project "Quality Improvement in Postoperative Pain Management" (QUIPS). A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward. From 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0) on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2). Over time, the maximum pain score decreased (mean 3.0, ±2.0), whereas patient satisfaction significantly increased (mean 9.8, ±0.4; p benchmarking a standardized pain management concept. But regular benchmarking, implementation of feedback mechanisms, and staff education made the pain management concept even more successful. Multidisciplinary teamwork and flexibility in adapting processes seem to be highly important for successful pain management.
Brown, Karen A
Students today are likely to be assigned to project teams or to be project managers almost immediately in their first job. Managing Projects: A Team-Based Approach was written for a wide range of stakeholders, including project managers, project team members, support personnel, functional mangers who provide resources for projects, project customers (and customer representatives), project sponsors, project subcontractors, and anyone who plays a role in the project delivery process. The need for project management is on the rise as product life cycles compress, demand for IT systems increases, and business takes on an increasingly global character. This book adds to the project management knowledge base in a way that fills an unmet need—it shows how teams can apply many of the standard project management tools, as well as several tools that are relatively new to the field. Managing Projects: A Team-Based Approach offers the academic rigor found in most textbooks along with the practical attributes often foun...
Mulenburg, Gerald M.; Impaeilla, Cliff (Technical Monitor)
This paper reports on a research study by the author that examined ten contemporary National Aeronautics and Space Administration (NASA) complex projects. In-depth interviews with the project managers of these projects provided qualitative data about the inner workings of the project and the methodologies used in establishing and managing the projects. The inclusion of a variety of space, aeronautics, and ground based projects from several different NASA research centers helped to reduce potential bias in the findings toward any one type of project, or technical discipline. The findings address the participants and their individual approaches. The discussion includes possible implications for project managers of other large, complex, projects.
Larsen, Anne Konring; Falkenstrøm, Signe; Jørgensen, Marie Birk
Purpose This study investigates management awareness of employee musculoskeletal pain and conditions that shape managers’ handling of employees with pain. Methods We used a mixed methods design including data from a questionnaire survey and focus group sessions. All employees and managers from...
Three innovative software inventions from Ames Research Center (NETMARK, Program Management Tool, and Query-Based Document Management) are finding their way into NASA missions as well as industry applications. The first, NETMARK, is a program that enables integrated searching of data stored in a variety of databases and documents, meaning that users no longer have to look in several places for related information. NETMARK allows users to search and query information across all of these sources in one step. This cross-cutting capability in information analysis has exponentially reduced the amount of time needed to mine data from days or weeks to mere seconds. NETMARK has been used widely throughout NASA, enabling this automatic integration of information across many documents and databases. NASA projects that use NETMARK include the internal reporting system and project performance dashboard, Erasmus, NASA s enterprise management tool, which enhances organizational collaboration and information sharing through document routing and review; the Integrated Financial Management Program; International Space Station Knowledge Management; Mishap and Anomaly Information Reporting System; and management of the Mars Exploration Rovers. Approximately $1 billion worth of NASA s projects are currently managed using Program Management Tool (PMT), which is based on NETMARK. PMT is a comprehensive, Web-enabled application tool used to assist program and project managers within NASA enterprises in monitoring, disseminating, and tracking the progress of program and project milestones and other relevant resources. The PMT consists of an integrated knowledge repository built upon advanced enterprise-wide database integration techniques and the latest Web-enabled technologies. The current system is in a pilot operational mode allowing users to automatically manage, track, define, update, and view customizable milestone objectives and goals. The third software invention, Query
Fishman, Scott M; Young, Heather M; Lucas Arwood, Ellyn; Chou, Roger; Herr, Keela; Murinson, Beth B; Watt-Watson, Judy; Carr, Daniel B; Gordon, Debra B; Stevens, Bonnie J; Bakerjian, Debra; Ballantyne, Jane C; Courtenay, Molly; Djukic, Maja; Koebner, Ian J; Mongoven, Jennifer M; Paice, Judith A; Prasad, Ravi; Singh, Naileshni; Sluka, Kathleen A; St Marie, Barbara; Strassels, Scott A
The objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported. An interprofessional executive committee led a consensus-building process to develop the core competencies. An in-depth literature review was conducted followed by engagement of an interprofessional Competency Advisory Committee to critique competencies through an iterative process. A 2-day summit was held so that consensus could be reached. The consensus-derived competencies were categorized within four domains: multidimensional nature of pain, pain assessment and measurement, management of pain, and context of pain management. These domains address the fundamental concepts and complexity of pain; how pain is observed and assessed; collaborative approaches to treatment options; and application of competencies across the life span in the context of various settings, populations, and care team models. A set of values and guiding principles are embedded within each domain. These competencies can serve as a foundation for developing, defining, and revising curricula and as a resource for the creation of learning activities across health professions designed to advance care that effectively responds to pain. Wiley Periodicals, Inc.
Fishman, Scott M; Young, Heather M; Lucas Arwood, Ellyn; Chou, Roger; Herr, Keela; Murinson, Beth B; Watt-Watson, Judy; Carr, Daniel B; Gordon, Debra B; Stevens, Bonnie J; Bakerjian, Debra; Ballantyne, Jane C; Courtenay, Molly; Djukic, Maja; Koebner, Ian J; Mongoven, Jennifer M; Paice, Judith A; Prasad, Ravi; Singh, Naileshni; Sluka, Kathleen A; St Marie, Barbara; Strassels, Scott A
Objective The objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported. Methods An interprofessional executive committee led a consensus-building process to develop the core competencies. An in-depth literature review was conducted followed by engagement of an interprofessional Competency Advisory Committee to critique competencies through an iterative process. A 2-day summit was held so that consensus could be reached. Results The consensus-derived competencies were categorized within four domains: multidimensional nature of pain, pain assessment and measurement, management of pain, and context of pain management. These domains address the fundamental concepts and complexity of pain; how pain is observed and assessed; collaborative approaches to treatment options; and application of competencies across the life span in the context of various settings, populations, and care team models. A set of values and guiding principles are embedded within each domain. Conclusions These competencies can serve as a foundation for developing, defining, and revising curricula and as a resource for the creation of learning activities across health professions designed to advance care that effectively responds to pain. PMID:23577878
Evans, Subhadra; Tsao, Jennie C I; Zeltzer, Lonnie K
Children undergo acute painful procedures and many also experience chronic pain.Due to their developing systems, infants and children may be at greater risk than adults for protracted pain sensitivity.There is a need to manage acute and chronic paediatric pain to reduce children's suffering and to prevent future pain problems.Consistent with a biopsychosocial perspective, complementary and alternative medicine (CAM) should be considered in management of acute and chronic paediatric pain.Although research is limited for paediatric pain, CAM interventions receiving the most empirical attention include hypnotherapy, acupuncture and music therapy. Evidence also exists for the therapeutic benefits of yoga, massage, humor therapy and the use of certain biological based therapies.
Manjiani, Deepak; Paul, D Baby; Kunnumpurath, Sreekumar; Kaye, Alan David; Vadivelu, Nalini
Pain can significantly influence an individual's health status and can have serious negative consequences: poor nutrition, decreased appetite, abnormal sleep patterns, fatigue, and impairment of daily living activities. Pain can cause psychological impairment and decrease healing and recovery from injuries and illness. A hallmark of many chronic conditions, pain affects more patients' lives than diabetes mellitus, heart disease, and cancer combined. However, many chronic sufferers do not have access to effective pain management for a variety of reasons, including limited access, restrictions, and personal and cultural biases. This review summarizes issues of access, distribution, and cultural bias with regard to opioid agents and seeks to clarify the challenges related to opioid delivery. The considerable negative physical and mental consequences of chronic pain are discussed for the general and palliative care population. Opioids are an effective treatment for various intractable painful conditions, but problems in global opioid access for safe and rational use in pain management contribute to unnecessary suffering. These problems persist despite increased understanding in recent years of the pathophysiology of pain. Comprehensive guidelines for goal-directed and patient-friendly chronic opiate therapy will potentially enhance the outlook for future chronic pain management. The improvement of pain education in undergraduate and postgraduate training will benefit patients and clinicians. The promise of new medications, along with the utilization of multimodal approaches, has the potential to provide effective pain relief to future generations of sufferers.
Achterberg, W.P.; Pieper, M.J.C.; van Dalen-Kok, A.H.; de Waal, M.W.M.; Husebo, B.S.; Lautenbacher, S.; Kunz, M.; Scherder, E.J.A.; Corbett, A.
There are an estimated 35 million people with dementia across the world, of whom 50% experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause
Horvath, Barbara; Janse, Ineke C.; Sibbald, Gary R.
Hidradenitis suppurativa (HS) is a chronic, relapsing, and painful inflammatory disease. HS patients' quality of life is severely impaired, and this impairment correlates strongly with their pain. Pain in HS can be acute or chronic and has both inflammatory and noninflammatory origins. The purpose
Tse, Mimi Mun Yee; Tang, Angel; Budnick, Andrea; Ng, Shamay Sheung Mei; Yeung, Suey Shuk Yu
Pain is common among university students. Unrelieved pain has adverse impacts on their quality of life. In this study, a pain management Web site was developed to distribute an online survey and provide Web-based pain education to university students. Participants were recruited from eight universities in Hong Kong using snowball sampling. The online survey included 37 items examining pain situations, pain management strategies, knowledge about self-medication, and demographic data of the participants. A total of 387 students participated and over 90 percent of them reported pain in the past 6 months. Around one-third of participants did not take any action to manage their pain. Pharmacological method was the most common strategy for students to relieve pain (37.2 percent). The use of over-the-counter (OTC) drug for pain relief was high (n = 214). However, OTC drug knowledge score was significantly higher among health-related group than nonhealth-related group (p education and completed the evaluation on its usefulness. Nonhealth-related students reported significantly higher scores of self-perceived usefulness for the online education than the health-related students (p online education program in the future.
Safley, Rebecca R; Swietlikowski, Jamie
Opioid dependence is an epidemic in the United States, and the percentage of pregnant women who are opioid dependent has increased dramatically in the last decade. Pain management, already a concern for intrapartum and postpartum care, is complicated in the context of opioid dependence. This clinical review surveys the literature on pain management in opioid-dependent pregnant women to summarize current consensus and evidence to guide clinical practice. Points of consensus for pain management in opioid-dependent pregnant women include continual opioid maintenance therapy throughout the pregnancy and the postpartum period; adequate management of acute pain; the contraindication of opioid agonist-antagonists for pain management; and the need for interdisciplinary teams using a multimodal approach to provide optimal care to opioid-dependent pregnant women.
Andreeva, T.; Petrovska, T.; Tytar, T.
Actual problems of project management in enterprises in order to achieve their goals. The basic members of the organization and implementation of project and the methodology for their implementation. The basic principles of project management are included.
Full Text Available Project Management has come of age, yet multiple surveys and reports confirm the fact that the majority of projects are challenged. Given the more demanding and strict financial constraints associated with the current fiscal climate, project management is regarded as a tool that can deliver more with less. The literature on Project Management shows that, in spite of advancement in Project Management processes, tools and systems, project success has not significantly improved. This problem raises questions about the value and effectiveness of Project Management and Project Management systems. Programs and projects are considered as strategic assets for the majority of businesses, therefore, the trend of these organizations is to embrace a management by projects culture. The main objective of Project Management nowadays is to ensure programs and projects aligned to a certain strategy and also to provide for every member of an organization the ability to take proactive actions creating additional benefits.
Bhakta, Hemangini C; Marco, Catherine A
Patient satisfaction with emergency care is associated with timeliness of care, empathy, technical competence, and information delivery. Previous studies have demonstrated inconsistent findings regarding the association between pain management and patient satisfaction. This study was undertaken to determine the association between pain management and patient satisfaction among Emergency Department (ED) patients presenting with acute painful conditions. In this survey study, a standardized interview was conducted at the Emergency Department at the University of Toledo Medical Center in May-July 2011. Participants were asked to answer 18 questions pertaining to patient satisfaction. Additional data collected included demographic information, pain scores, and clinical management. Among 328 eligible participants, 289 (88%) participated. The mean triage pain score on the verbal numeric rating scale was 8.2 and the mean discharge score was 6.0. The majority of patients (52%) experienced a reduction in pain of 2 or more points. Participants received one pain medication dose (44%), two medication doses (14%), three medication doses (5%), or four medication doses (2%). Reduction in pain scores of 2 or more points was associated with a higher number of medications administered. Reduction in pain scores was associated with higher satisfaction as scored on questions of patient perceptions of adequate assessment and response to pain, and treatment of pain. There was a significant association between patient satisfaction and a reduction in pain of 2 or more points and number of medications administered. Effective pain management is associated with improved patient satisfaction among ED patients with painful conditions. Copyright © 2014 Elsevier Inc. All rights reserved.
Full Text Available The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents, their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients’ pain symptoms during the 24 h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28% answered the questionnaire and for the other 72% (unable to communicate, the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49% had observed their child’s pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals.
Tawfic, Qutaiba A
Ketamine is a noncompetitive antagonist of N-methyl-d-aspartate receptor. It has been widely used in anesthesia and pain management. Ketamine has been administered via the intravenous, intramuscular, subcutaneous, oral, rectal, topical, intranasal, sublingual, epidural, and caudal routes. Ketamine improves postoperative and posttrauma pain scores and reduces opioid consumption. It has special indication for patients with opioid tolerance, acute hyperalgesia, and neuropathic pain. It also has a role in the management of chronic pain including both cancer and noncancer pain. Recreational use of ketamine is increasing as well through different routes of administration like inhalation, smoking, or intravenous injection. Long-time exposure to ketamine, especially in the abusers, may lead to serious side effects. This review is trying to define the role of ketamine in pain management.
... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Project management. 206.438 Section 206.438 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF... Project management. (a) General. The State serving as grantee has primary responsibility for project...
GRAPA ADELINA-ROXANA; SOARE ALICE-MAGDALENA
Project Management has come of age, yet multiple surveys and reports confirm the fact that the majority of projects are challenged. Given the more demanding and strict financial constraints associated with the current fiscal climate, project management is regarded as a tool that can deliver more with less. The literature on Project Management shows that, in spite of advancement in Project Management processes, tools and systems, project success has not significantly improved. T...
Various NASA Langley Research Center and other center projects were attempted for analysis to obtain historical data comparing pre-phase A study and the final outcome for each project. This attempt, however, was abandoned once it became clear that very little documentation was available. Next, extensive literature search was conducted on the role of risk and reliability concepts in project management. Probabilistic risk assessment (PRA) techniques are being used with increasing regularity both in and outside of NASA. The value and the usage of PRA techniques were reviewed for large projects. It was found that both civilian and military branches of the space industry have traditionally refrained from using PRA, which was developed and expanded by nuclear industry. Although much has changed with the end of the cold war and the Challenger disaster, it was found that ingrained anti-PRA culture is hard to stop. Examples of skepticism against the use of risk management and assessment techniques were found both in the literature and in conversations with some technical staff. Program and project managers need to be convinced that the applicability and use of risk management and risk assessment techniques is much broader than just in the traditional safety-related areas of application. The time has come to begin to uniformly apply these techniques. The whole idea of risk-based system can maximize the 'return on investment' that the public demands. Also, it would be very useful if all project documents of NASA Langley Research Center, pre-phase A through final report, are carefully stored in a central repository preferably in electronic format.
Full Text Available Background: Arthroscopy of the great toe MTP joint has been practiced with favourable outcomes. A range of indications have been described ranging from synovitis to osteochondral defects. The purpose of the present study was to describe our technique and to assess the functional outcome following arthroscopic management of Hallux MTP disorders using AOFAS scoring system. Methods: We describe the technique of Hallux MTP joint arthroscopy in twenty patients. Indications included hallux rigidus with osteophytes, chondromalacia, OCDs, loose bodies, arthrofibrosis, synovitis, tophaceous gout arthritis and intra-articular fractures of MTP joint. All patients had been evaluated clinically and radiologically with record of their AOFAS scores pre-operatively. At a minimum follow-up of two years the clinical assessment was carried out with AOFAS scores. Results: The mean pre-operative and post-operative AOFAS score were 47 (range 10-78 and 97 (87 -100 respectively. The patient with intra-articular fracture had an excellent outcome following arthroscopic reduction of the fracture. Conclusion: Arthroscopic management of painful hallucial MTP joint is a specialized technique, which if performed for the right indications, gives a favourable outcome with minimal complications.
Demir, Kadir Alpaslan
Approved for public release; distribution is unlimited. Evaluating, monitoring, and improving the effectiveness of project management can contribute to successful acquisition of software systems. In this dissertation, we introduce a quantitative metric for gauging the effectiveness of managing a software-development project. The metric may be used to evaluate and monitor project management effectiveness in software projects by project managers, technical managers, executive man...
Greg Stewart Usher
Full Text Available Our research applies paradox theory to a project management construct to help project management researchers and practitioners understand the tensions that can exist between project success and client satisfaction. Our research highlights that although project success and client satisfaction are both present within a project management construct, they also belong to different functional systems. Project success and client satisfaction have different systemic-discourses and use different language games to convey information. These distinctions can create latent and sometimes salient tensions within the project management construct that project managers must understand, embrace, and work with. We have used a Grounded Theory (GT methodology to explore the lived experience of project managers, and from this have identified a phenomenon which we have termed project management yinyang. Project management yinyang is the state that exists when both project success and Client satisfaction are tightly coupled within the project management construct. Project management yinyang highlights that these two phenomena cannot be viewed as separate elements because the ‘seed’ of each exists within the other. And to truly achieve one, you must also achieve the other. Our findings indicate that in order to create project management yinyang the project manager must embrace a paradoxical yet holistic philosophy. They must understand the complementarity, interdependency, and structural coupling that exists between the positivist and interpretivist paradigms within the project management construct. They must understand how satisfaction (Yin and success (Yang are created through focus. Furthermore, they must understand how project management yinyang is separate from, but borne from, the convergence of the other two elements.
success criteria for building projects in Ghana and concluded that the “current and ... qualifications, profession, leadership style and project team ... and expectations of project management competence between ... 1.d. Sense of teamwork ...
Czarnecki, Michelle L; Simon, Katherine; Thompson, Jamie J; Armus, Cheryl L; Hanson, Tom C; Berg, Kristin A; Petrie, Jodie L; Xiang, Qun; Malin, Shelly
This study describes strategies used by the Joint Clinical Practice Council of Children's Hospital of Wisconsin to identify barriers perceived as interfering with nurses' (RNs) ability to provide optimal pain management. A survey was used to ascertain how nurses described optimal pain management and how much nurses perceived potential barriers as interfering with their ability to provide that level of care. The survey, "Barriers to Optimal Pain management" (adapted from Van Hulle Vincent & Denyes, 2004), was distributed to all RNs working in all patient care settings. Two hundred seventy-two surveys were returned. The five most significant barriers identified were insufficient physician (MD) orders, insufficient MD orders before procedures, insufficient time to premedicate patients before procedures, the perception of a low priority given to pain management by medical staff, and parents' reluctance to have patients receive pain medication. Additional barriers were identified through narrative comments. Information regarding the impact of the Acute Pain Service on patient care, RNs' ability to overcome barriers, and RNs' perception of current pain management practices is included, as are several specific interventions aimed at improving or ultimately eliminating identified barriers. Copyright © 2011 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Peña, L; Moreno, C B; Gutierrez-Alvarez, A M
Pain is a common symptom in patients with Guillain-Barre syndrome. Intensity is moderate to severe in most cases and pain may persist after resolution of the disease. Identify the most appropriate analgesic therapy for pain management in patients with Guillain-Barre syndrome. Systematic review and selection of scientific articles on treatment of pain in Guillain-Barre syndrome patients, published between January 1985 and December 2012. We included only randomised, double-blind, controlled trials assessing the effectiveness of drugs for pain management in these patients. Four articles met the inclusion criteria. One evaluated the use of gabapentin, another evaluated carbamazepine, a third compared gabapentin to carbamazepine, and the last evaluated use of methylprednisolone. Both carbamazepine and gabapentin were useful for pain management. Patients experienced lower-intensity pain with gabapentin treatment in the study comparing that drug to carbamazepine. Methylprednisolone was not shown to be effective for reducing pain. The published data did not permit completion of a meta-analysis. There is no robust evidence at present that would point to a single treatment option for this disorder. Further clinical studies of larger patient samples and with a longer duration are needed to characterise types of pain for each patient and measure pain intensity in an objective way. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.
Crockett, Matthew; Aherne, Emily; O'Reilly, Michael; Sugrue, Gavin; Cashman, James; Kavanagh, Eoin
Groin pain is a common symptom in athletes, particularly in sports requiring sudden changes in speed and direction and those involving kicking. Despite a high prevalence of groin pain in this patient cohort, the diagnosis and management of the underlying pathological processes remains a challenge for surgeons and radiologists alike. The aim of this paper is to review the imaging findings and management of the common pathological processes which produce groin pain in athletes. The anatomy of the groin region will be defined as a basis for further discussion. The common pathological processes underlying groin pain such as adductor dysfunction, rectus abdominus injury, osteitis pubis, and femuro-acetabular impingement will then be reviewed and correlating radiological imaging findings presented. Current management options will also be considered. This paper will aid surgeons and radiologists in navigating the challenging diagnostic and management dilemma of groin pain in athletes.
Godwalt, C. [Alberta WaterSMART, Calgary, AB (Canada); Kotecha, P. [Suncor Energy Inc, Calgary, AB (Canada); Aumann, C. [Alberta Innovates - Technology Futures, Alberta Governement, AB (Canada)
The Oil sands leadership initiative (OSLI) works with the Government of Alberta on the development of the oil sands industry, considering environmental, economical and social aspects. Water management was identified as one of most important areas to focus on. Alberta WaterSMART was requested to support the development and the management of projects resulting from the work done or underway in this field. The development of a regional water management solution stood out as the most interesting solution to obtain significant results. In the Athabasca Region, oil sands producers work independently on their water sourcing and disposal with particular attention to fresh water conservation and economics. The Athabasca River represents a source for mines and distant saline aquifers are the target of steam assisted gravity drainage (SAGD) operators. As part of a four-phase project aiming to study the environmental and economic footprint (EEF) benefit of alternatives for Athabasca oil sands production water supply and disposal, the purpose of the tailings water management project was to identify tailings treatment technologies that are ready to be implemented, and to design and evaluate solutions in order to improve regional oil sands production water sourcing and disposal. Alternatives were evaluated based on their total EEF, applying a lifecycle assessment methodology with a particular attention on the quantification of important performance indicators. 25 refs., 8 tabs., 40 figs.
Godwalt, C.; Kotecha, P.; Aumann, C.
The Oil sands leadership initiative (OSLI) works with the Government of Alberta on the development of the oil sands industry, considering environmental, economical and social aspects. Water management was identified as one of most important areas to focus on. Alberta WaterSMART was requested to support the development and the management of projects resulting from the work done or underway in this field. The development of a regional water management solution stood out as the most interesting solution to obtain significant results. In the Athabasca Region, oil sands producers work independently on their water sourcing and disposal with particular attention to fresh water conservation and economics. The Athabasca River represents a source for mines and distant saline aquifers are the target of steam assisted gravity drainage (SAGD) operators. As part of a four-phase project aiming to study the environmental and economic footprint (EEF) benefit of alternatives for Athabasca oil sands production water supply and disposal, the purpose of the tailings water management project was to identify tailings treatment technologies that are ready to be implemented, and to design and evaluate solutions in order to improve regional oil sands production water sourcing and disposal. Alternatives were evaluated based on their total EEF, applying a lifecycle assessment methodology with a particular attention on the quantification of important performance indicators. 25 refs., 8 tabs., 40 figs.
Avallin, Therese; Muntlin Athlin, Åsa; Sorensen, Erik Elgaard
AIMS: To explore and describe the impact of the organizational culture on and the patient-practitioner patterns of actions that contribute to or detract from successful pain management for the patient with acute abdominal pain across the acute care pathway. BACKGROUND: Although pain management...... is a recognised human right, unmanaged pain continues to cause suffering and prolong hospital care. Unanswered questions about how to successfully manage pain relate to both organizational culture and individual practitioners' performance. DESIGN: Focused ethnography, applying the Developmental Research Sequence...... and the Fundamentals of Care framework. METHODS: Participant observation and informal interviews (92 hours) were performed at one emergency department and two surgical wards at a University Hospital during April - November 2015. Data includes 261 interactions between patients, aged ≥18 years seeking care for acute...
O'Brien, T; Christrup, L L; Drewes, A M
burdened by an unacceptable level of adverse effects, the overall management strategy must be reviewed and revised. No responsible clinician will wish to pursue a failed treatment strategy or persist with an ineffective and burdensome treatment. In a considered attempt to empower and inform non......Poorly controlled pain is a global public health issue. The personal, familial and societal costs are immeasurable. Only a minority of European patients have access to a comprehensive specialist pain clinic. More commonly the responsibility for chronic pain management and initiating opioid therapy...... years of clinical practice to produce these series of recommendations. Its success will be judged on the extent to which it contributes to an improved pain management experience for chronic pain patients across Europe. SIGNIFICANCE: This position paper provides expert recommendations for primary care...
Hunnicutt, Jacob N; Ulbricht, Christine M; Tjia, Jennifer; Lapane, Kate L
Previous studies estimate that >40% of long-stay nursing home (NH) residents experience persistent pain, with 20% of residents in pain receiving no analgesics. Strengthened NH surveyor guidance and improved pain measures on the Minimum Data Set 3.0 were introduced in March 2009 and October 2010, respectively. This study aimed to provide estimates after the important initiatives of (1) prevalence and correlates of persistent pain; and (2) prevalence and correlates of untreated or undertreated persistent pain. We identified 1,387,405 long-stay residents in U.S. NHs between 2011 and 2012 with 2 Minimum Data Set assessments 90 days apart. Pain was categorized as persistent (pain on both assessments), intermittent (pain on either assessment), or none. Pharmacologic pain management was classified as untreated pain (no scheduled or as needed medications received) or potentially undertreated (no scheduled received). Modified Poisson models adjusting for resident clustering within NHs provided adjusted prevalence ratios (APRs) estimates and 95% confidence intervals (CIs). The prevalence of persistent and intermittent pain was 19.5% and 19.2%, respectively, but varied substantially by age, sex, race and ethnicity, cognitive impairment, and cancer. Of residents in persistent pain, 6.4% and 32.0% were untreated and undertreated, respectively. Racial and ethnic minorities (non-Hispanic blacks vs whites, APR = 1.19, 95% CI: 1.13-1.25) and severely cognitively impaired residents (severe vs no/mild APR = 1.51, 95% CI: 1.44-1.57) had an increased prevalence of untreated and undertreated pain. One in 5 NH residents has persistent pain. Although this estimate is greatly improved, many residents may be undertreated. The disturbing disparities in untreated and undertreated pain need to be addressed.
Millis, Marc G.
To leap past the limitations of existing propulsion, the NASA Breakthrough Propulsion Physics (BPP) Project seeks further advancements in physics from which new propulsion methods can eventually be derived. Three visionary breakthroughs are sought: (1) propulsion that requires no propellant, (2) propulsion that circumvents existing speed limits, and (3) breakthrough methods of energy production to power such devices. Because these propulsion goals are presumably far from fruition, a special emphasis is to identify credible research that will make measurable progress toward these goals in the near-term. The management techniques to address this challenge are presented, with a special emphasis on the process used to review, prioritize, and select research tasks. This selection process includes these key features: (a) research tasks are constrained to only address the immediate unknowns, curious effects or critical issues, (b) reliability of assertions is more important than the implications of the assertions, which includes the practice where the reviewers judge credibility rather than feasibility, and (c) total scores are obtained by multiplying the criteria scores rather than by adding. Lessons learned and revisions planned are discussed.
Farmer, Adam D; Aziz, Qasim
Functional abdominal pain syndrome is characterised by frequent or continuous abdominal pain associated with a degree of loss of daily activity. It has a reported population prevalence of between 0.5% and 1.7%, with a female preponderance. The pathophysiology of functional abdominal pain is incompletely understood although it has been postulated that peripheral sensitisation of visceral afferents, central sensitisation of the spinal dorsal horn and aberrancies within descending modulatory sys...
von Baeyer, Carl L.; Tupper, Susan M.
Purpose: This article provides an overview of literature relevant to the prevention and relief of pain and distress during physiotherapy procedures, with guidance for physiotherapists treating children.
Physical and emotional pain are an inevitable part of human existence and are without natural antidotes. In view of this, and in the light of increasing professional reluctance to depend on analgesics, this paper proposes the widespread application of autogenic training, a relaxation technique which has been seen to confront pain very effectively, and also to reduce substantially drugs dependency. It analyses autogenic training in respect of some of the more common pain-allied disorders such as childbirth, headaches and migraines, back pain, cancer and palliative care, and cardiology.
Brink-Huis, Anita; van Achterberg, Theo; Schoonhoven, Lisette
This paper reports a review of the literature conducted to identify organisation models in cancer pain management that contain integrated care processes and describe their effectiveness. Pain is experienced by 30-50% of cancer patients receiving treatment and by 70-90% of those with advanced disease. Efforts to improve pain management have been made through the development and dissemination of clinical guidelines. Early improvements in pain management were focussed on just one or two single processes such as pain assessment and patient education. Little is known about organisational models with multiple integrated processes throughout the course of the disease trajectory and concerning all stages of the care process. Systematic review. The review involved a systematic search of the literature, published between 1986-2006. Subject-specific keywords used to describe patients, disease, pain management interventions and integrated care processes, relevant for this review were selected using the thesaurus of the databases. Institutional models, clinical pathways and consultation services are three alternative models for the integration of care processes in cancer pain management. A clinical pathway is a comprehensive institutionalisation model, whereas a pain consultation service is a 'stand-alone' model that can be integrated in a clinical pathway. Positive patient and process outcomes have been described for all three models, although the level of evidence is generally low. Evaluation of the quality of pain management must involve standardised measurements of both patient and process outcomes. We recommend the development of policies for referrals to a pain consultation service. These policies can be integrated within a clinical pathway. To evaluate the effectiveness of pain management models standardised outcome measures are needed.
Kozman, T.A.; Chargin, A.K.
The details of the project planning and project management work done on the Baseball II-T experiment are reviewed. The LLL Baseball program is a plasma confinement experiment accomplished with a superconducting magnet in the shape of a baseball seam. Both project planning and project management made use of the Critical Path Management (CPM) computer code. The computer code, input, and results from the project planning and project management runs, and the cost and effectiveness of this method of systems planning are discussed
Schena, F P
Basic and clinical research is accomplished by projects. The design of a project is not only based on the scientific content but also on its financing and management. This article wants to illustrate the correct modalities for project financing and project management in a scientific project.
Project management approaches are commonly used to write and implement business plans. In this thesis standard project management tools and methods are applied to a real project, which aims to improve the properties of the product it offers (an online educational game). This project is unique in that it is based on a voluntary basis, has limited resources and is very responsive to market demands. Project management is broken down into four stages according to the project life cycle: initiatio...
Townsend, J. C.; Salas, A. O.
Over the past decade, the NASA Langley Research Center developed a series of 'grand challenge' applications demonstrating the use of parallel and distributed computation and multidisciplinary design optimization. All but the last of these applications were focused on the high-speed civil transport vehicle; the final application focused on reusable launch vehicles. Teams of discipline experts developed these multidisciplinary applications by integrating legacy engineering analysis codes. As teams became larger and the application development became more complex with increasing levels of fidelity and numbers of disciplines, the need for applying software engineering practices became evident. This paper briefly introduces the application projects and then describes the approaches taken in project management and software engineering for each project; lessons learned are highlighted.
Jørgensen, Michael Søgaard; Mikkelsen, Bent Egberg
A collection of the project planning and the experiences with project management from the Catering 2000 project.As appendieces articles etc. from journals, newspapers etc. about the project.......A collection of the project planning and the experiences with project management from the Catering 2000 project.As appendieces articles etc. from journals, newspapers etc. about the project....
Eisner, Howard S
The Third Edition of Essentials of Project and Systems Engineering Management enables readers to manage the design, development, and engineering of systems effectively and efficiently. The book both defines and describes the essentials of project and systems engineering management and, moreover, shows the critical relationship and interconnection between project management and systems engineering. The author's comprehensive presentation has proven successful in enabling both engineers and project managers to understand their roles, collaborate, and quickly grasp and apply all the basic princip
The Project Management Plan (PMP) assists the San Diego ICM Team by defining a procedural framework for : management and control of the I-15 Integrated Corridor Management Demonstration Project, and development and : deployment of the ICM System. The...
Full Text Available Background: Patients often suffer from inadequate treatment of postoperative pain. The aim of this study was to investigate effect of PCA on postoperative pain management and patients’ satisfaction from use of PCA. Materials and Methods: In this prospective study, between 2010 to 2011, patients presented by orthopedic specialists to acute and chronic pain service of Akhtar Hospital. A satisfaction questionnaire was given on discharge to this patients, were asked to fill out it . Then collected by ward nurse. Results: patients’ satisfaction from pain relief with use of PCA was high ( 94.9% . In this patient pain relief at third day after surgery and require analgesic was low, significantly (p=0.0001. Significant patients’ satisfaction from effect of PCA in pain control and products support was high (p=0.0001. Conclusion: Patient controlled analgesia is a safe, effective and noninvasive method for post operative pain management and in this study patients’ satisfaction for pain management was high for use of PCA and pain service.
This book contains 26 chapters. Some of the titles are: Magnetic resonance imaging of the lumbar spine; Diagnostic techniques; The site and nature of the lesion; The anatomy of the lumbosacral spine; The perception of pain; Differential diagnosis of low back pain; and A comprehensive outline of treatment
Pain is defined by the International Association for the Study of Pain (IASP) as an “unpleasant sensory and emotional experience, associated with actual or potential tissue damage or described in terms of such damage”. It can be steady, throbbing, stabbing, aching, pinching or described in many other ways as being either ...
The Global Opioid Policy Initiative (GOPI) project to evaluate the availability and accessibility of opioids for the management of cancer pain in Africa, Asia, Latin America and the Caribbean, and the Middle East: introduction and methodology.
Cherny, N I; Cleary, J; Scholten, W; Radbruch, L; Torode, J
Opioid analgesics are critical to the effective relief of cancer pain. Effective treatment is predicated on sound assessments, individually tailored analgesic therapy, and the availability and accessibility of the required medications. In some countries, pain relief is hampered by the lack of availability or barriers to the accessibility of opioid analgesics. As the follow-up to a successful project to evaluate the availability and accessibility of opioids and regulatory barriers in Europe, the European Society for Medical Oncology (ESMO) and the European Association for Palliative Care (EAPC) undertook to expand their research to those parts of the world where data were lacking regarding these aspects of care, in particular Africa, Asia, the Middle East, Latin America and the Caribbean, and the states of India. This project has been undertaken in collaboration with the Union for International Cancer Control (UICC), the Pain and Policy Studies Group (PPSG) of the University of Wisconsin, and the World Health Organization (WHO), together with a consortium of 17 international oncology and palliative care societies. This article describes the study methodology.
Full Text Available Orjan Skogar,1,2 Johan Lokk2 1Academy for Health and Care (FUTURUM, Region Jönköping County, Jönköping, 2Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden Abstract: This review focuses on the diagnosis and management of Parkinson-related pain which is one of the more frequently reported nonmotor symptoms in Parkinson’s disease (PD, which is the second most common neurodegenerative disease after Alzheimer’s disease. Pain is ranked high by patients as a troublesome symptom in all stages of the disease. In early-stage PD, pain is rated as the most bothersome symptom. Knowledge of the correct diagnosis of pain origin and possible methods of treatments for pain relief in PD is of great importance. The symptoms have a great negative impact on health-related quality of life. Separating PD-related pain from pain of other origins is an important challenge and can be characterized as “many syndromes under the same umbrella”. Among the different forms of PD-related pain, musculoskeletal pain is the most common form, accounting for 40%–90% of reported pain in PD patients. Augmentation by pathophysiological pathways other than those secondary to rigidity, tremor, or any of the other motor manifestations of the disease seems most probable. In PD, the basal ganglia process somatosensory information differently, and increased subjective pain sensitivity with lower electrical and heat-pain thresholds has been reported in PD patients. The mechanism is assumed to be diminished activity of the descending inhibitory control system of the basal ganglia. PD pain, like many of the nonmotor symptoms, remains underdiagnosed and, thus, poorly managed. A systematic collection of patient descriptions of type, quality, and duration of pain is, therefore, of utmost importance. Recent studies have validated new and more specific and dedicated pain scales for PD-related symptoms. Symptomatic treatments based
Elkins, Gary; Jensen, Mark P.; Patterson, David R.
This article reviews controlled prospective trials of hypnosis for the treatment of chronic pain. Thirteen studies, excluding studies of headaches, were identified that compared outcomes from hypnosis for the treatment of chronic pain to either baseline data or a control condition. The findings indicate that hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic-pain problems. Also, hypnosis was generally found to be more effective than nonhypnotic interventions such as attention, physical therapy, and education. Most of the hypnosis interventions for chronic pain include instructions in self-hypnosis. However, there is a lack of standardization of the hypnotic interventions examined in clinical trials, and the number of patients enrolled in the studies has tended to be low and lacking long-term follow-up. Implications of the findings for future clinical research and applications are discussed. PMID:17558718
Lorentzen, Vibeke; Hermansen, I.L.; Botti, M
Abstract: ABSTRACT Background: Adequacy of pain management is a process indicator of health care quality with consequences for patient outcomes and satisfaction. The reported incidence of moderate to severe postoperative pain worldwide is between 20 to 80%. Objectives: The purpose was to assess...... the quality of pain management in a cohort of Danish postoperative patients by examining their pain experience, beliefs about pain and pain treatment, and relationships between pain intensity, its effect on function, and pharmacological pain management. Methods: The American Pain Society's Patient Outcome...... Questionnaire was used in a consecutive cohort of Danish patients who had undergone gastrointestinal, gynaecological, orthopaedic or urological surgery in the previous 48 hours. Results: Findings indicated uncontrolled pain in 45.5% of patients, who experienced moderate to severe intensity average pain...
Jain, Anuj; Agarwal, Anil; Jain, Suruchi; Shamshery, Chetna
Bertolotti's syndrome (BS), a form of lumbago in lumbosacral transitional vertebrae, is an important cause of low back pain in young patients. The purpose of this study was to assess the etiology of low back pain and the efficacy of treatment offered to patients with BS. All patients of BS Castellvi type1a during a period of 6 months were enrolled in the study. The patients underwent interventional pain procedures for diagnosis and pain relief. Response to the therapy was assessed based on VAS and ODI scores. A 50% decrease in VAS score or a VAS score less than 3 would be considered adequate pain relief. All 20 patients diagnosed with BS during the 6-month observation period had scoliosis. Common causes of back pain were the ipsilateral L5-S1 facet joint, neoarticulation, the SI joint, and disc degeneration. Responses to various interventions for pain relief were different and inconsistent from patient to patient. In particular, responses to interventions for neoarticular pain were generally poor. Pain in patients with BS does not usually respond to interventional pain treatment. A very dynamic treatment approach must be pursued while managing BS patients, and the treatment plan must be individualized at various stages in order to obtain satisfactory pain relief.
Toorenvliet, Boudewijn Ronald
In this thesis several aspects on the diagnosing and management of patients with acute abdominal pain are investigated. 1; The efficacy and safety of standard outpatient re-evaluation for patients not admitted to the hospital after emergency department evaluation for acute abdominal pain. 2; The use
Personal stories of illness give depth to otherwise clinical descriptions of diagnoses. This article offers an autobiographical narrative of complications after total knee replacement surgery. Diagnosis and nursing management of acute compartment syndrome, nociceptive and neuropathic origins of pain, pharmacologic and nursing interventions for pain, the use of prayer in illness, and compassionate caring from a Christian perspective are discussed.
Syrjala, Karen L; Jensen, Mark P; Mendoza, M Elena; Yi, Jean C; Fisher, Hannah M; Keefe, Francis J
This review examines evidence for psychological factors that affect pain across the cancer continuum from diagnosis through treatment and long-term survivorship or end of life. Evidence is convincing that emotional distress, depression, anxiety, uncertainty, and hopelessness interact with pain. Unrelieved pain can increase a desire for hastened death. Patients with cancer use many strategies to manage pain, with catastrophizing associated with increased pain and self-efficacy associated with lower pain reports. A variety of psychological and cognitive behavioral treatments can reduce pain severity and interference with function, as indicated in multiple meta-analyses and high-quality randomized controlled trials. Effective methods include education (with coping skills training), hypnosis, cognitive behavioral approaches, and relaxation with imagery. Exercise has been tested extensively in patients with cancer and long-term survivors, but few exercise studies have evaluated pain outcomes. In survivors post-treatment, yoga and hypnosis as well as exercise show promise for controlling pain. Although some of these treatments effectively reduce pain for patients with advanced disease, few have been tested in patients at the end of life. Given the clear indicators that psychological factors affect cancer pain and that psychological and behavioral treatments are effective in reducing varying types of pain for patients with active disease, these methods need further testing in cancer survivors post-treatment and in patients with end-stage disease. Multidisciplinary teams are essential in oncology settings to integrate analgesic care and expertise in psychological and behavioral interventions in standard care for symptom management, including pain. © 2014 by American Society of Clinical Oncology.
Tank, C; Lefering, R; Althaus, A; Simanski, C; Neugebauer, E
The significance of postoperative pain management for patients in the hospital is well known and has been a focus of research for several years. The ambulatory care after hospital discharge, however, is not well investigated. A prospective observational study was therefore conducted to study the transfer management from in-hospital patients to ambulatory care. A patient questionnaire was developed and patients were asked to fill it out at different time points after the operation: during the time in the hospital, then at 2 weeks and 6 months after hospital discharge. In addition, the responsible family doctor was approached and interviewed. The main focus of the questionnaire was the measurement of post-surgical pain (numeric rating scale NRS), patient satisfaction (Cologne patient questionnaire), and quality of life (SF 12). Of a total of 128 patients 72.9% described moderate to severe pain after the orthopaedic operations in the hospital. 90.8% of the patients had pain directly after discharge from the hospital; in 67.4% of the cases pain was ≥3 and in 23.4% of the cases pain was ≥6. Six months after discharge pain was significant in 29.4% of the patients, 60.8% of the patients were satisfied with the transfer to the home setting. 16% were not satisfied at all and 23.2% were neutral. Important factors for dissatisfaction with the transfer management were, according to stepwise logistic regeression analysis, sex (female patients), young age, a poor bodily constitution at the hospital and thereafter, and the pain management in the hospital and after discharge. The study shows the significance of the acute pain therapy not only during the hospital stay but also after discharge. There are very few data on pain therapy after discharge from the hospital. Based on the significance of the chronification of acute pain it is of the utmost importance to close this gap. © Georg Thieme Verlag KG Stuttgart · New York.
Yamasaki, Takahisa; Fass, Ronnie
Noncardiac chest pain (NCCP) has been defined as recurrent chest pain that is indistinguishable from ischemic heart pain after excluding a cardiac cause. NCCP is a common and highly challenging clinical problem in Gastrointestinal practice that requires targeted diagnostic assessment to identify the underlying cause of the symptoms. Treatment is tailored according to the cause of NCCP: gastroesophageal reflux disease (GERD), esophageal dysmotility or functional chest pain. The purpose of this review is to discuss the current diagnosis and treatment of NCCP. Utilization of new diagnostic techniques such as pH-impedance and high-resolution esophageal manometry, and the introduction of a new definition for functional chest pain have helped to better diagnose the underlying mechanisms of NCCP. A better therapeutic approach toward GERD-related NCCP, the introduction of new interventions for symptoms due to esophageal spastic motor disorders and the expansion of the neuromodulator armamentarium for functional chest pain have changed the treatment landscape of NCCP. GERD is the most common esophageal cause of NCCP, followed by functional chest pain and esophageal dysmotility. The proton pump inhibitor test, upper endoscopy, wireless pH capsule and pH-impedance are used to identify GERD-induced NCCP. High-resolution esophageal manometry is the main tool to identify esophageal motor disorder in non-GERD-related NCCP. Negative diagnostic assessment suggests functional chest pain. Potent antireflux treatment is offered to patients with GERD-related NCCP; medical, endoscopic or surgical interventions are considered in esophageal dysmotility; and neuromodulators are prescribed for functional chest pain. Assessment and treatment of psychological comorbidity should be considered in all NCCP patients.
Skogar, Orjan; Lokk, Johan
This review focuses on the diagnosis and management of Parkinson-related pain which is one of the more frequently reported nonmotor symptoms in Parkinson's disease (PD), which is the second most common neurodegenerative disease after Alzheimer's disease. Pain is ranked high by patients as a troublesome symptom in all stages of the disease. In early-stage PD, pain is rated as the most bothersome symptom. Knowledge of the correct diagnosis of pain origin and possible methods of treatments for pain relief in PD is of great importance. The symptoms have a great negative impact on health-related quality of life. Separating PD-related pain from pain of other origins is an important challenge and can be characterized as "many syndromes under the same umbrella". Among the different forms of PD-related pain, musculoskeletal pain is the most common form, accounting for 40%-90% of reported pain in PD patients. Augmentation by pathophysiological pathways other than those secondary to rigidity, tremor, or any of the other motor manifestations of the disease seems most probable. In PD, the basal ganglia process somatosensory information differently, and increased subjective pain sensitivity with lower electrical and heat-pain thresholds has been reported in PD patients. The mechanism is assumed to be diminished activity of the descending inhibitory control system of the basal ganglia. PD pain, like many of the nonmotor symptoms, remains underdiagnosed and, thus, poorly managed. A systematic collection of patient descriptions of type, quality, and duration of pain is, therefore, of utmost importance. Recent studies have validated new and more specific and dedicated pain scales for PD-related symptoms. Symptomatic treatments based on clinical pain classification include not only pharmacological but also nonpharmacological methods and, to some degree, invasive approaches. In the clinic, pharmacological and nonpharmacological interventions can be effective to varying degrees - as
Rodríguez, Maria Claudia; Villamor, Perla; Castillo, Tatiana
Pain is a disease by itself and it's a public health concern of major implication in children, not just because of the emotional component of the child and his family, but also due to the potential morbidity and mortality involving it. A proper assessment of pain it's a challenge in the pediatric population, due to their lack of understanding and verbalization of hurt. Additionally, a satisfactory treatment of pediatric pain can be arduous due to a lack of clinical knowledge, insufficient pediatric research, and the fear to opioid side effects and addiction. The aim of this review is to address the current definitions of pain, its physiological mechanisms and the consequences of its inadequate management, as well as, to guide the clinicians in the assessment and management of pain in the pediatric population at otolaryngology services. Narrative review by selective MeSH search terms: Children, Pediatrics, Otolaryngology, Pain measurement, Pain Management, Analgesics and Analgesia, from databases: MEDLINE/PubMed, Cochrane, ISI, Current Contents, Scielo and LILACS, between January 2000 and May 2016. 129 articles were reviewed according to the requirements of the objectives. Pain measurement is a challenge in children as there are no physical signs that constitute an absolute or specific indicator of pain, and its diagnosis must rely on physiological, behavioral and self-report methods. Regarding treatment, a suitable alternative are the non-pharmacological cognitive/behavioral therapies helped by pharmacological therapies tailored to the severity of pain and the child's age. We provide evidence-based recommendations on pain treatment, including non-opioid analgesics, opioid analgesics and adjuvant medicines to improve the management of pain in children in otolaryngology services. We present a global review about assessment and management of pain in pediatric otolaryngology, which leads to future specific reviews on each topic. Research gaps on pain assessment and
Full Text Available Background: Most common complaint of an individual is pain, which can be with or without injury. It is the key that enables human being to figure out disease ordisorders that is interfering normal life. Pain can be because of numerous reasons but known pathways for pain can be physiological, nociceptive, neuropathic or mixed, which may be experienced as aching pain, burning pain, stabbing pain, etc. Although there are various clinical methods to reduce pain but the main objective of present study was to find if taping can reduce pain be it musculoskeletal or neurological pain. Also to summarise all evaluated work done in various studies. Methods: various studies have been taken from pub med, Google scholar that includes relief of pain with application of taping irrespective to technique used. Study selection, data extraction, and assessment of methodological quality and clinical relevance were performed independently by two reviewers. All the data extracted from randomised controlled trials included in the review has been used to synthesise the results. Therefore the results are based on facts laid down by the articles included. Results: Pedro scoring has been used to asses various studies which show the use of taping for relief of pain on various musculoskeletal disorders and neurological disorders. Conclusions: Although there are various modalities which can help in reducing pain but present review shows that taping can be used as very useful tool for reducing pain. Further it is cheap, less time consuming and easy to manage with excellent results. taping can be used as an adjunct to modalities present to reduce pain.
Carnes, W.S.; Gros-Gean, P.; Demireva, E.
The Project Management Unit (PMU) has been established in support to the Kozloduy NPP decommissioning department. It is comprised of a Consortium of the British Nuclear Group, EDF and subcontractor ENPRO Consult. It is responsible for the management of seven projects (a facility for dry storage of spent fuel; equipment to treat low activity liquid radioactive waste; provision of physical separation of the plant systems and areas to be decommissioned from the ones in operation; equipment to decontaminate and clean pools and large tanks; a facility to provide high volume reduction of solid radioactive wastes and retrieval and conditioning of ion exchange resins and other sorbents; equipment to provide measurement for the free-release of materials and components; a facility for personnel monitoring, decontamination and clothes changing for work outside of the normal radiological control areas) that will be used in support of the KNPP decommissioning process. The projects will be tendered in compliance with the European Bank for Reconstruction and Development requirements
Berggreen, Line; Kampf, Constance Elizabeth
How can we understand project management communication practices for developing effective practices in professional and technical communication? In this article we explore an approach to project management that focuses on projects as having a technical documentation structure with content...... that is developed through social or interpersonal communication practices. Looking at the broader picture of project management which besides the implementation phase also includes conception, planning and closure, we see a project management framework that brings together both technical and social aspects...... of project communication. To understand how this works, we interviewed project managers about their understanding and strategy in communicating about the projects they lead. Findings demonstrate that more experienced project managers have a more nuanced understanding of project communication as both...
Arthritis is one of the most common chronic conditions in the United States. Unfortunately, as the population ages, it's only expected to increase. In this podcast, Dr. Jennifer Hootman discusses ways to manage the pain of arthritis.
”Project Management – Multi-perspective Leadership” af Hans Mikkelsen og Jens Ove Riis - anmeldelse......”Project Management – Multi-perspective Leadership” af Hans Mikkelsen og Jens Ove Riis - anmeldelse...
This volume of Advances in Library Administration and Organization attempts to put project management into the toolboxes of library administrators through overviews of concepts, analyses of experiences, and forecasts for the use of project management within the profession.
Halman, J.I.M.; Keizer, J.A.
In product innovation projects risk management has become increasingly important. Technological and commercial developments ask for effective and efficient product innovation. Systematic diagnosing and management of risks can help to make product innovation projects successful. In this paper a
Keywords: Communication skills and leadership model, construction project ..... help a manager handle stress and break tension (Gido & Clements,. 2012: 331; Harrin .... production and management of projects, the higher the demand for.
The purpose of this thesis was to evaluate a case project and to study whether it was carried out in a correct manner; meaning that did the case project follow the project management models. In addition, part of the study was to determine what could have been improved in the management of the case project. The case project was about creating and launching a communication channel based on a social media service, on a blog platform called Tumblr, for Team Finland in Spain network. The network p...
The presentation covers the following topics: description of the Project - a contract was signed between KNPP and European Consortium Kozloduy (ECK) consisting of Framatome ANP GmbH as Leader (63%), Framatome ANP S.A.S. (17%), Atomenergoexport (20%) ; Project management in the modernization of NPP Kozloduy units 5 and 6; Project management process within AREVA NP GmbH; current status
Thomsett, Michael C
For nearly twenty years, The Little Black Book of Project Management has provided businesspeople everywhere with a quick and effective introduction to project management tools and methodology. The revised and updated third edition reflects the newest techniques, the latest project management software, as well as the most recent changes to the Project Management Body of Knowledge (PMBOK™). Readers will find invaluable strategies for: • Organizing any project • Choosing the project team • Preparing a budget and sticking to it • Scheduling, flowcharting, and controlling a project • Preparing proj
Geroin, Christian; Gandolfi, Marialuisa; Bruno, Veronica; Smania, Nicola; Tinazzi, Michele
Pain, one of the most frequent nonmotor symptoms of Parkinson disease (PD), is recognized as an important component of the illness that adversely affects patient quality of life. The aims of this review are to summarize the current knowledge on the clinical assessment and to provide a detailed overview of the evidence-based pharmacologic and nonpharmacologic approaches to treating pain. Results of a literature search include studies investigating pain/sensory abnormalities in PD. The effects of levodopa administration, deep brain stimulation (DBS), pallidotomy, spinal cord stimulation, rehabilitation, and complementary/alternative medicine are reviewed critically. PD patients have altered pain and sensory thresholds; levodopa and DBS improve pain and change sensory abnormalities toward normal levels through antinociceptive and/or modulatory effects that remain unknown. A wide range of nonpharmacologic approaches require further investigation. A multidisciplinary approach is fundamental in managing pain syndromes in PD.
Joshi, Grish P; Jaschinski, Thomas; Bonnet, Francis
BACKGROUND: Increase in the diagnosis of prostate cancer has increased the incidence of radical prostatectomy. However, the literature assessing pain therapy for this procedure has not been systematically evaluated. Thus, optimal pain therapy for patients undergoing radical prostatectomy remains...... controversial. METHODS: Medline, Embase, and Cochrane Central Register of Controlled Trials were searched for studies assessing the effects of analgesic and anesthetic interventions on pain after radical prostatectomy. All searches were conducted in October 2012 and updated in June 2015. RESULTS: Most...... treatments studied improved pain relief and/or reduced opioid requirements. However, there were significant differences in the study designs and the variables evaluated, precluding quantitative analysis and consensus recommendations. CONCLUSIONS: This systematic review reveals that there is a lack...
Gagnon, Christine M; Scholten, Paul; Atchison, James
To assess patient impression of change following interdisciplinary pain management utilizing a newly developed Multidimensional Patient Impression of Change (MPIC) questionnaire. A heterogeneous group of chronic pain patients (N = 601) participated in an interdisciplinary treatment program. Programs included individual and group therapies (pain psychology, physical therapy, occupational therapy, relaxation training/biofeedback, aerobic conditioning, patient education and medical management). Patients completed measures of pain, mood, coping, physical functioning and pain acceptance both prior to and at completion of their treatment programs. The newly developed MPIC is an expansion to the Patient Global Impression of Change (PGIC) including seven additional domains (Pain, Mood, Sleep, Physical Functioning, Cope with Pain, Manage Pain Flare-ups, and Medication Effectiveness). The MPIC was administered to the patients post-treatment. There were statistically significant pre- to post-treatment improvements found on all outcome measures. The majority of these improvements were significantly correlated with all domains of the MPIC. The original PGIC item was significantly associated with all of the new MPIC domains and the domains were significantly associated with each other; but there were variations in the distribution of responses highlighting variation of perceived improvements among the domains. Our results support the use of the MPIC as a quick and easy post-treatment assessment screening tool. Future research is needed to examine relevant correlates to Medication Effectiveness. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Full Text Available Achim Benditz,1 Felix Greimel,1 Patrick Auer,2 Florian Zeman,3 Antje Göttermann,4 Joachim Grifka,1 Winfried Meissner,4 Frederik von Kunow1 1Department of Orthopedics, University Medical Center Regensburg, 2Clinic for anesthesia, Asklepios Klinikum Bad Abbach, Bad Abbach, 3Centre for Clinical Studies, University Medical Center Regensburg, Regensburg, 4Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany Background: The number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking.Methods: All patients included in the study had undergone total hip arthroplasty (THA. Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project “Quality Improvement in Postoperative Pain Management” (QUIPS. A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward.Results: From 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0 on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2. Over time, the maximum pain score decreased (mean 3.0, ±2.0, whereas patient satisfaction
Ollus, Martin; Jansson, Kim; Karvonen, Iris; Uoti, Mikko; Riikonen, Heli
This paper presents an approach for collaborative project management. The focus is on the support of collaboration, communication and trust. Several project management tools exist for monitoring and control the performance of project tasks. However, support of important intangible assets is more difficult to find. In the paper a leadership approach is identified as a management means and the use of new IT technology, especially social media for support of leadership in project management is discussed.
When managers want to change their organisation they often set up a project to do it, in the belief that doing so simplifies and focuses the change initiative and brings greater assurance of success. Case studies of three organisational change projects undertaken by Arts Council England during 2006-2007 are used to examine the notion of project management and change management as a duality. It is argued that the structured, systematic approach associated with project management needs to be ba...
Jemec, Gregor Be
perceived as unclean and stigmatizing by the patients, but also cause pain and scarring making this inflammatory skin disorder unique. It is obvious that the disease has a significant negative impact on the patients' quality of life (QOL). The impact is influenced not only by the pain which is a significant...... independent contributor to the patients' life quality, but by the clinically significant comorbidity associated with HS. In particular, the psychological comorbidities of depression and anxiety both further compound QOL impairment and pain. It is strongly recommended that these factors be taken into account...... when planning a treatment strategy for patients with HS, and that specific steps are taken to manage pain and comorbidities associated with the reduced QOL generally experienced by this group of patients. Basic pain management includes anti-inflammatory treatments as well as local- and central...
The Spent Nuclear Fuel Project Safety Management Plan describes the new nuclear facility regulatory requirements basis for the Spemt Nuclear Fuel (SNF) Project and establishes the plan to achieve compliance with this basis at the new SNF Project facilities
Funding project risk management is a process for identifying, assessing, and prioritizing project funding risks. To plan to : minimize or eliminate the impact of negative events, one must identify what projects have higher risk to respond to potentia...
Full Text Available We all are aware of the organizational omnipresence. Projects within the organizations are ubiquitous too. Projects achieve their goals successfully if they are planned, scheduled, controlled and implemented well. The project lifecycle of initiating, planning, scheduling, controlling and implementing are very well-planned by project managers and the organizations. Successful projects have well-developed risk management plans to deal with situations impacting projects. Like any other organisation, a university does try to access funds for different purposes too. For such organisations, running a project is not the issue, rather getting a project proposal approved to fund a project is the key. Project proposal processing is done by the nodal office in every organisation. Usually, these nodal offices help in administration and submission of a project proposal for accessing funds. Seldom are these nodal project offices within the organizations facilitate a project proposal approval by proactively reaching out to the project managers. And as project managers prepare project proposals, little or no attention is made to prepare a project proposal risk plan so as to maximise project acquisition. Risk plans are submitted while preparing proposals but these risk plans cater to a requirement to address actual projects upon approval. Hence, a risk management plan for project proposal is either missing or very little effort is made to treat the risks inherent in project acquisition. This paper is an integral attempt to highlight the importance of risk treatment for project proposal stage as an extremely important step to preparing the risk management plan made for projects corresponding to their lifecycle phases. Several tools and techniques have been proposed in the paper to help and guide either the project owner (proposer or the main organisational unit responsible for project management. Development of tools and techniques to further enhance project
Aziato, Lydia; Adejumo, Oluyinka
There are concerns about adequacy of nurses' knowledge and skill in effective pain management since effective pain management promotes early recovery after surgery. This study explores factors that accounted for Ghanaian nurses' inadequate knowledge of postoperative pain management using a focused ethnographic design for data collection at a tertiary teaching hospital in Ghana. Fourteen nurses designated as key informants with different backgrounds as nurse educators and leaders were purposively sampled to participate. Data were collected through in-depth individual interviews; all interviews were conducted in English, audio-taped and transcribed verbatim. The study revealed that nurses' inadequate pain management knowledge might have resulted from curriculum gaps during training; inadequate clinical supervision, study days, and workshops for practising nurses; lack of funding for organising regular workshops; and, negative attitudes of nurses whereby new information learned at workshops was not readily applied in clinical practice. It was concluded that nursing curricula at all levels of training in Ghana should incorporate credit-bearing courses on pain management, and appropriate pain management education programmes should be instituted for practising nurses. Regular monitoring and evaluation of the impact of such education programs is required. Copyright © 2013 Elsevier Ltd. All rights reserved.
...-0030] RIN 2132-AA92 Capital Project Management AGENCY: Federal Transit Administration (FTA), DOT... extending the comment period on its proposed rule for Capital Project Management to December 2, 2011, to...) proposing to transform the current FTA rule for project management oversight into a discrete set of...
...-0030] RIN 2132-AA92 Capital Project Management AGENCY: Federal Transit Administration (FTA), DOT... current FTA rule for project management oversight into a discrete set of managerial principles for sponsors of major capital projects; enable FTA to more clearly identify the necessary management capacity...
...-0030] RIN 2132-AA92 Capital Project Management AGENCY: Federal Transit Administration (FTA), DOT... withdrawing its September 13, 2011, Notice of Proposed Rulemaking to revise the agency's project management... will reinitiate a rulemaking for project management oversight in the near future. Additionally, FTA may...
As a subproject of the HANDI 2000 project, the Finance and Supply Management system is intended to serve FDH and Project Hanford major subcontractor with financial processes including general ledger, project costing, budgeting, and accounts payable, and supply management process including purchasing, inventory and contracts management. Currently these functions are performed with numerous legacy information systems and suboptimized processes.
Full Text Available Project management has appeared and developed based on scientific management theory during the '50s-'60s of the last century. After the 1990s of the last century, we can say that project management has truly become an independent discipline, which has a huge impact on the success or failure of companies which are engaged in major projects.
Bice, April A
Pediatric nurses have often reported that pain management is a vital part of patient care. Evidence, however, suggests pediatric procedural pain treatments are often underused. Cognitive dissonance, the mental conflict leading to unpleasant thoughts and or feelings, may be related to this evidence-based gap found between what pediatric nurses claim about procedural pain management (that it is important) and what they actually do (underutilize pain treatments). The purpose of this manuscript is to clarify and further develop the concept of cognitive dissonance in terms of its relationship to nurses' mental struggles with underutilization of pediatric procedural pain treatments. A more relevant and extended definition of cognitive dissonance is presented. The concept of cognitive dissonance was examined using Rodgers' evolutionary concept analysis approach/framework. Analysis Methods: Through a six-step process of concept identification, setting and sample identification, data collection, data analysis, and future implication discussion, a more accurate and representative definition of cognitive dissonance is described. Databases used included CINAHL, Google Scholar, PsycINFO, ERIC, and PubMed. Seminal, recent, and relevant works were included in the review to adequately develop and clarify the concept. Procedural pain management breech among pediatric nurses is proposed to occur before the mental conflict produced. The unpleasant mental conflict created after the breech is followed by the nurse's determination to reduce mental conflict through attitude change followed by cognition change, which more closely reflects his or her behavior. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
This report presents plans for resolving saving and disposal concerns for ion exchange modules, cartridge filters and columns. This plan also documents the project baselines for schedules, cost, and technical information
Jalali Sohi, A.; Hertogh, M.J.C.M.; Bosch-Rekveldt, M.G.C.; Blom, R.; Serpell, A.; Ferrada, X.
Still, projects in the construction sector are delivered with time delays and cost overruns. One of the reasons for poor performance was assigned to project complexity. A combination of lean construction and agile project management are hypothesized as a possible solution to cope with project
Duong, Thuong Thi; Skitmore, Martin
This article examines the extent to which challenges in the workplace may cause female project managers to be in a significantly small minority. A survey of members of the Australian Institute of Project Management in Queensland is described. This compares the experiences and observations of both men and women on various issues related to technical and gender aspects in project management workplaces. The results show that although female project managers experience many problems, male project managers also experience most of the same problems. Likewise, there are also few differences between more and less experience, the level of management, and types of industries. The differences that do occur involve discrimination against women in general, differences in project management styles, and support from other project managers.
Panek, Paul E; Skowronski, John J; Wagner, Edwin E
This study examined personality differences among individuals experiencing 3 different types of pain. The projective Hand Test was administered to 90 individuals who were seeking treatment at a pain clinic in an urban area of the southeast United States. These people were seeking treatment for either arthritis (n = 31), fibromyalgia (n = 29), or migraine headaches (n = 30). A 2 (gender) x 3 (pain group) x Age Group multivariate analysis of variance was conducted using the quantitative Hand Test scoring variables as dependent measures. Results indicated that individuals who were seeking treatment for migraine headaches had a higher production rate of responses involving exhibitionistic displays (EXH) than individuals in the other 2 groups. Individuals who were seeking treatment for fibromyalgia had a higher production rate of responses indicating fear and phobic concerns (FEAR) than individuals in the other 2 groups. Individuals who were seeking treatment for arthritis had a higher production rate of Active (ACT) responses than individuals in the other 2 groups. Possible causes and consequences of these effects are discussed.
Fallon, M; Walker, J; Colvin, L; Rodriguez, A; Murray, G; Sharpe, M
Purpose Pain is suboptimally managed in patients with cancer. We aimed to compare the effect of a policy of adding a clinician-delivered bedside pain assessment and management tool (Edinburgh Pain Assessment and management Tool [EPAT]) to usual care (UC) versus UC alone on pain outcomes. Patients and Methods In a two-arm, parallel group, cluster randomized (1:1) trial, we observed pain outcomes in 19 cancer centers in the United Kingdom and then randomly assigned the centers to eithe...
Wang Xiaohui; Xu Yuanhui
The concept and the features of risks in nuclear power projects are introduced, and in terms of nuclear power projects' own features, the Nuclear Power Project Integrated Risk Management Model is presented. The identification, estimation, evaluation, response plan development, control of risks and the theoretical basis of risk management are discussed. The model has feedback and control functions in order to control and manage the risks dynamically
If the projects you manage don't go as smoothly as you'd like, 97 Things Every Project Manager Should Know offers knowledge that's priceless, gained through years of trial and error. This illuminating book contains 97 short and extremely practical tips -- whether you're dealing with software or non-IT projects -- from some of the world's most experienced project managers and software developers. You'll learn how these professionals have dealt with everything from managing teams to handling project stakeholders to runaway meetings and more. While this book highlights software projects, its w
If you were to analyze your team's performance on a typical project, you'd be surprised how much time is wasted on non-productive tasks. This hands-on guide shows you how to work more efficiently by organizing and managing projects with SharePoint 2010. You'll learn how to build a Project Management Information System (PMIS), customized to your project, that can effectively coordinate communication and collaboration among team members. Written by a certified Project Management Professional (PMP) and Microsoft SharePoint MVP with 15 years of IT project management experience, each chapter incl
Олена Борисівна ДАНЧЕНКО
Full Text Available The article reviews new approaches to managing projects deviations (risks, changes, problems. By offering integrated control these parameters of the project and by analogy with medical terminological systems building a new system for managing terminological variations in the projects. With an improved method of triads system definitions are analyzed medical terms that make up terminological basis. Using the method of analogy proposed new definitions for managing deviations in projects. By using triad integrity built a new system triad in project management, which will subsequently also analogous to develop a new methodology of deviations in projects.
Böhmer, A B; Poels, M; Simanski, C; Trojan, S; Messer, K; Wirtz, M D; Neugebauer, E A M; Wappler, F; Joppich, R
Systems for and methods of quality management are increasingly being implemented in public health services. The aim of our study was to analyze the current state of the integrated quality management concept "quality management acute pain therapy" of the TÜV Rheinland® (TÜV) after a 5-year project period. General characteristics of the participating hospitals, number of departments certified by the TÜV and implementation of structures and processes according to the TÜV guidelines were evaluated by a mail questionnaire. Furthermore, positive and negative aspects concerning the effects of certification were evaluated by the hospitals' representatives of certification. A total of 36 questionnaires were returned. Since 2006 the number of certified hospitals (2011: n = 48) and surgical departments (2011: n = 202) has increased continuously. The number of certified medical departments is low (2011: n = 39); however, in the last 3 years, it has increased by about 200-300% annually. Standard operative procedures for pain therapy and measurement of pain intensity at regular intervals were implemented in all certified clinics (100%). Although 41% take part in the benchmarking project QUIPS (Quality Improvement in Postoperative Pain Therapy), 24% do not systematically check the quality of the outcome of pain management. Acceptance of the new pain therapy concepts among nursing staff was rated positively (ratio positive:negative 16:1); however, acceptance among physicians was rated negatively (1:15). Certification by the TÜV leads to sustainable implementation of quality management principles. Future efforts should focus on better integration of physicians in acute pain therapy and the development of an integrated tool to measure patients' outcome.
Utah Department of Transportation (UDOT) project managers (PMs) have identified inefficiencies in the legacy : system electronic Program Management (ePM) used to manage consultant contracts and invoices. To help UDOT : prepare for potential system im...
Johansson, C; Dahl, J; Jannert, M; Melin, L; Andersson, G
A cognitive behavioral multidisciplinary pain management program was evaluated in two separate outcome studies; one controlled study (study I) and one study conducted on a consecutive sample with a long-term follow-up (study II). The 4-week inpatient treatment program included education sessions, goal setting, graded activity training, pacing, applied relaxation, cognitive techniques, social skills training, drug reduction methods, contingency management of pain behaviors, and planning of work return. The outcome of study I showed significant between-group differences in favor of the treatment group on measures of occupational training at 1-month follow-up, activity level in the sparetime at post-treatment and at follow-up, and decreased catastrophizing and pain behaviors at post-treatment. In study II significant improvements over time were found on measures of sick leave, pain intensity, pain interference, life control, affective distress, activity level in the sparetime, physical fitness and use of analgetics at 2-month follow-up and at 1-year follow-up. The results of the two outcome studies reported show that cognitive behavioral multidisciplinary pain management programs can successfully be applied to Swedish musculoskeletal pain patients.
Wright, Josh; Ahmedzai, Sam H
Until recently management of sickle pain was the province of haematologists. However, a recent National Confidential Enquiry into Patient Outcome and Death report highlighted problems with the management of pain and opioid analgesia in this group and suggested a multiagency approach similar to that used in palliative care. Pain is the most frequent complication of this haemoglobin disorder. Sickle cell disease is very variable with many patients leading full lives with long periods with little or no pain. At the other end of the spectrum there are those who exist in a sea of pain. The mechanisms of sickle pain are poorly understood and evidence for the best treatment modalities sparse. Historically there has been a dearth of clinical trials in sickle cell; however, this is starting to be addressed. In this review we will give a brief overview of the disease and its pathogenesis before examining the epidemiology, management of pain in sickle cell disease. We will also review recent evidence regarding quality of life and discuss the role of opioid hyperalgesia in sickle cell disease.
Gannon, Brenda; Finn, David P; O'Gorman, David; Ruane, Nancy; McGuire, Brian E
The objective of the study was to collect data on the direct and indirect economic cost of chronic pain among patients attending a pain management clinic in Ireland. A tertiary pain management clinic serving a mixed urban and rural area in the West of Ireland. Data were collected from 100 patients using the Client Services Receipt Inventory and focused on direct and indirect costs of chronic pain. Patients were questioned about health service utilization, payment methods, and relevant sociodemographics. Unit costs were multiplied by resource use data to obtain full costs. Cost drivers were then estimated. Our study showed a cost per patient of US$24,043 over a 12-month period. Over half of this was attributable to wage replacement costs and lost productivity in those unable to work because of pain. Hospital stays and outpatient hospital services were the main drivers for health care utilization costs, together accounting for 63% of the direct medical costs per study participant attending the pain clinic. The cost of chronic pain among intensive service users is significant, and when extrapolated to a population level, these costs represent a very substantial economic burden. Wiley Periodicals, Inc.
Stein Kaasa, MD, speaks to Dominic Chamberlain, Assistant Commissioning Editor: Stein Kaasa specializes in oncology and palliative medicine. In 1993 he was appointed as the first professor in palliative medicine in Scandinavia and he was one of the founders of the palliative care unit in Trondheim (Norway). He also was the founder of the European Palliative Care Research Centre. He has been president of the European Association for Palliative Care, coordinator for one EU-funded project and is Work Package Leader of several EU-funded research collaboratives and international partnerships on research and policy development. Kaasa has been an important advocate for evidence-based practice and has worked extensively to get palliative care research on the agenda, both nationally and internationally. Through his role as Cancer Director in Norway he coordinated and led the development of guidelines for different cancer diseases. Important areas of work were the development of regional cancer treatment guidelines and integration of patient disease trajectories into the existing guidelines. Currently he is Vice Managing Director at St Olavs Hospital, Trondheim University Hospital (Norway), Professor of palliative medicine at the Faculty of Medicine, Norwegian University of Science and Technology and leads the European Palliative Care Research Centre and chairs the European Association for Palliative Care Research Network. Professor Kaasa has published more than 450 articles and book chapters. He has authored the Nordic Textbook of Palliative Care and is coauthor and editor of the Oxford Textbook of Palliative Medicine. Professor Kaasa advises many international journals - either as an advisory board member or as a reviewer (Journal of Pain and Symptom Management, Palliative Medicine, Journal of Palliative Medicine, Oncology, Journal of Clinical Oncology, Pain and The Lancet Oncology).
The purpose of this document is to provide a project plan for Work Management Implementation by the River Protection Project (RPP). Work Management is an information initiative to implement industry best practices by replacing some Tank Farm legacy system
Cindy A. McGeary
Full Text Available Chronic musculoskeletal pain, such as low back pain, often appears in the presence of psychiatric comorbidities (e.g., depression, posttraumatic stress disorder (PTSD, especially among U.S. military service members serving in the post-9/11 combat era. Although there has been much speculation about how to best address pain/trauma psychiatric symptom comorbidities, there are little available data to guide practice. The present study sought to examine how pre-treatment depression and PTSD influence outcomes in a functional restoration pain management program using secondary analysis of data from the Department of Defense-funded Functional and Orthopedic Rehabilitation Treatment (FORT trial. Twenty-eight FORT completers were analyzed using a general linear model exploring how well depression and PTSD symptoms predict post-treatment pain (Visual Analog Scale (VAS pain rating, disability (Oswestry Disability Index; Million Visual Analog Scale, and functional capacity (Floor-to-Waist and Waist-to-Eye Level progressive isoinertial lifting evaluation scores in a sample of active duty military members with chronic musculoskeletal pain and comorbid depression or PTSD symptoms. Analysis revealed that pre-treatment depression and PTSD symptoms did not significantly predict rehabilitation outcomes from program completers. Implications of these findings for future research on trauma-related pain comorbidities are discussed.
Full Text Available Background: Majority of the patients presenting to emergency department (ED have pain. ED oligoanalgesia remains a challenge. Aims: This study aims to study the effect of implementing a protocol-based pain management in the ED on (1 time to analgesia and (2 adequacy of analgesia obtained. Settings and Design: Cross-sectional study in the ED. Methods: Patients aged 18–65 years of age with pain of numeric rating scale (NRS ≥4 were included. A series of 100 patients presenting before introduction of the protocol-based pain management were grouped “pre-protocol,” and managed as per existing practice. Following this, a protocol for management of all patients presenting to ED with pain was implemented. Another series of 100 were grouped as “post-protocol” and managed as per the new pain management protocol. The data of patients from both the groups were collected and analyzed. Statistical Analysis Used: Descriptive statistical tests such as percentage, mean and standard deviation and inferential statistical tests such as Pearson coefficient, Student's t-test were applied. Differences were interpreted as significant when P < 0.05. Results: Mean time to administer analgesic was significantly lesser in the postprotocol group (preprotocol 20.30 min vs. postprotocol 13.05 min; P < 0.001. There was significant difference in the pain relief achieved (change in NRS between the two groups, with greater pain relief achieved in the postprotocol group (preprotocol group 4.6800 vs. postprotocol group 5.3600; P < 0.001. Patients' rating of pain relief (assessed on E5 scale was significantly higher in the postprotocol group (preprotocol 3.91 vs. postprotocol 4.27; P = 0.001. Patients' satisfaction (North American Spine Society scale with the overall treatment was also compared and found to be significantly higher in postprotocol group (mean: preprotocol 1.59 vs. postprotocol 1.39; P = 0.008. Conclusion: Protocol-based pain management provided timely and
Pham Ngoc, Lan
The purpose of this thesis was to study the effects of Lean Thinking in Project Management and how applying Lean Project Management could enhance the productivity of project work. The study was carried using theoretical research and collecting empirical data from three interviews and one case study at a local company. At the end of the study, the major project management problems at the company were identified and analyzed following Lean Principles. It was also pointed out where there...
The scholars increasingly pay at ention to the internal rules in knowledge development and innovation of construction engineering management,as wel as the framework for engineering management body of knowledge. Considering the one-of-a-kind characteristic of construction project s and highly dependence from projects on management knowledge and its innovation,this paper analyzed the knowledge body of engineering management and its development dimension ,such as thinking and knowledge structure dimensions. The engineering management knowledge innovation model and structural model were put forward. The paper reviewed and proposed the engineering management knowledge system framework under engineering thinking mode,including the basic knowledge system framework which is used in engineering management research ,and a framework for body of knowledge which is applicable for engineering management practice. Based on a brief analysis of engineering management practice,this paper analyzed the development progres of engineering management from engineering thinking to ethical thinking and philosophical thinking. A dynamic model formed from the modern engineering management theory was put forward. The construction of projects are divided into two stages:an investment decision-making stage, and project implementation stage. According to the fact that project owners obtain the project products by transaction,the management during project implementation stage are divided into two aspects:project transaction management for the owner, and construction project management for the contractor. Thus, the three theoretical modules of modern engineering management were established:project investment decision-making management theory,engineering transaction management theory, and engineering project management theory. This paper further analyzed the content and basic theoretical issues of each theoretical module.
Dewey, Stephen L.; Brodie, Jonathan D.; Ashby, Jr., Charles R.
The present invention provides a composition for treating pain. The composition includes a pharmaceutically acceptable analgesic and a GABAergic agent, such as gamma vinyl GABA, effective in reducing or eliminating the addictive liability of the analgesic. The invention also includes a method for reducing or eliminating the addictive
Koncicki, Holly M; Unruh, Mark; Schell, Jane O
Although pain is one of the most commonly experienced symptoms by patients with chronic kidney disease, it is under-recognized, the severity is underestimated, and the treatment is inadequate. Pain management is one of the general primary palliative care competencies for medical providers. This review provides nephrology providers with basic skills for pain management. These skills include recognition of types of pain (nociceptive and neuropathic) syndromes and appropriate history-taking skills. Through this history, providers can identify clinical circumstances in which specialist referral is beneficial, including those who are at high risk for addiction, at risk for adverse effects to medications, and those with complicated care needs such as patients with a limited prognosis. Management of pain begins with the development of a shared treatment plan, identification of appropriate medications, and continual follow-up and assessment of efficacy and adverse effects. Through adequate pain management, providers can positively affect the health of individual patients and the performance of health care systems. Copyright © 2016 National Kidney Foundation, Inc. All rights reserved.
Burnham, Robert; Day, Jeremiah; Dudley, Wallace
Chronic pain is prevalent, complex and most effectively treated by a multidisciplinary team, particularly if psychosocial issues are dominant. The limited access to and high costs of such services are often prohibitive for the rural patient. We describe the development and 18-month outcomes of a small multidisciplinary chronic pain management program run out of a physician's office in rural Alberta. The multidisciplinary team consisted of a family physician, physiatrist, psychologist, physical therapist, kinesiologist, nurse and dietician. The allied health professionals were involved on a part-time basis. The team triaged referral information and patients underwent either a spine or medical care assessment. Based on the findings of the assessment, the team managed the care of patients using 1 of 4 methods: consultation only, interventional spine care, supervised medication management or full multidisciplinary management. We prospectively and serially recorded self-reported measures of pain and disability for the supervised medication management and full multidisciplinary components of the program. Patients achieved clinically and statistically significant improvements in pain and disability. Successful multidisciplinary chronic pain management services can be provided in a rural setting.
Mohammed, U. K.; Prabhakar, G. P.; White, G.
The management of culture has become increasingly important to many organisations and business disciplines, particularly multicultural and international project management. Cultural differences often result in varying degrees of conflict and require careful consideration. This study surveys 116 Project Managers using the Thomas-Kilmann Conflict Mode Instrument to determine their approach toward managing conflict. Indian, French and UK Project Managers’ conflict management style are correlated...
Full Text Available Interstitial cystitis or bladder pain syndrome (BPS is often a chronic debilitating condition characterised by predominantly storage symptoms and associated frequently with pelvic pain that varies with bladder filling. The aetiology is uncertain as the condition occurs in the absence of a urinary tract infection or other obvious pathology. Resulting discomfort may vary and ranges from abdominal tenderness to intense bladder spasms. Diagnosis and management of this syndrome may be difficult and is often made by its typical cystoscopic features. This review discusses the diagnosis and management of interstitial cystitis according to the current available best evidence and advises a multimodal approach in its management.
Harrop, Emily Jane; Brombley, Karen; Boyce, Katherine
Pain and distress in the paediatric palliative care population can be very difficult to manage. Clinical scenarios range from the acute management of cancer-related pain at the end of life to the ongoing long-term support of children with complex multimodal pain related to progressive neurological conditions. Understanding the child's underlying condition, possible causes of pain and their preferred mode of communication are important to the delivery of holistic care. Modification of environmental factors, basic care consideration and non-pharmacological measures have a large role to play, alongside conventional analgesics. Medication may also need to be delivered by novel routes such as transdermal patches, continuous subcutaneous infusion of multiple drugs or transmucosal breakthrough analgesic doses. Two cases are used to illustrate approaches to these clinical problems. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Full Text Available Managing large projects involving different groups of people and complex tasks can be challenging. The solution is to use Project management software, which allows a more efficient management of projects. However, famous project management systems can be costly and may require expensive custom servers. Even if free software is not as complex as Microsoft Project, is noteworthy to think that not all projects need all the features, amenities and power of such systems. There are free and open source software alternatives that meet the needs of most projects, and that allow Web access based on different platforms and locations. A starting stage in adopting an OSS in-house is finding and identifying existing open source solution. In this paper we present an overview of Open Source Project Management Software (OSPMS based on articles, reviews, books and developers’ web sites, about those that seem to be the most popular software in this category.
Luciana Hazin Alencar
Full Text Available The field of project management has historically focused on the administration of one project at a time, a focus that is insufficient given the growing need for organizations to manage multiple projects simultaneously. The requirements of Multiple Project Management (MPM involves demands and practices that are different from those of single projects. MPM poses a special need for coordination of shared resources across multiple projects in a way that can maintain the firm’s strategic focus and facilitate effective decision making. The construction industry is noteworthy for its frequent need for the management of multiple projects. This paper offers a review of the last five years of indexed literature related to multiple project management in the construction industry, identifies gaps and suggests promising new avenues of inquiry.
Full Text Available A significant part of innovation projects management is the distribution logistics. From the point of view of time and material content, the properly chosen way of distribution is one of many factors for success of the project and innovation creation itself. The paper points out the fundamental basis of innovation management in the stage of its realization referring to the importance of distribution logistics in this part of innovation project management. Distribution logistics in the project management provides comprehensive solutions to efficiency of tangible relocating processes in all connections and mutual relations of project in order to maintain compliance between economy and business when implementing innovations.
Maximizing reader insights into project management and handling complexity-driven risks, this book explores propagation effects, non-linear consequences, loops, and the emergence of positive properties that may occur over the course of a project. This book presents an introduction to project management and analysis of traditional project management approaches and their limits regarding complexity. It also includes overviews of recent research works about project complexity modelling and management as well as project complexity-driven issues. Moreover, the authors propose their own new approaches, new methodologies and new tools which may be used by project managers and/or researchers and/or students in the management of their projects. These new elements include project complexity definitions and frameworks, multi-criteria approaches for project complexity measurement, advanced methodologies for project management (propagation studies to anticipate potential behaviour of the project, and clustering approaches...
Zoëga, Sigridur; Gunnarsdottir, Sigridur; Wilson, Margaret E; Gordon, Debra B
To explore the concept of quality pain management (QPM) in adult hospitalized patients. Pain is common in hospitalized patients, and pain management remains suboptimal in some settings. A concept evaluation based on Morse et al.'s method. Of more than 5,000 articles found, data were restricted to 37 selected key articles published in peer-reviewed journals. Data were extracted from the selected articles and then synthesized according to the following: definition, characteristics, boundaries, preconditions, and outcomes. QPM relates to the Structure: organizationally supported evidence-based policies, competent staff, interprofessional and specialized care, and staff accountability; screening, assessment/reassessment and communication of pain and its treatment, patient/family education, individualized evidence-based treatment, embedded in safe, effective, patient-centered, timely, efficient, and equitable services; and reduced pain severity and functional interference, decreased prevalence/severity of adverse consequences from pain or pain treatment, and increase in patient satisfaction. QPM is a multifaceted concept that remains poorly defined in the literature. Studies should aim to develop valid, reliable, and operational measures of the pillars of QPM and to look at the relationship among these factors. Authors need to state how they define and what aspects of QPM they are measuring. © 2014 Wiley Periodicals, Inc.
Larson, Erik; Drexler, John A., Jr.
This article describes a service-learning assignment for a project management course. It is designed to facilitate hands-on student learning of both the technical and the interpersonal aspects of project management, and it involves student engagement with real customers and real stakeholders in the creation of real events with real outcomes. As…
This Project Management Plan describes the planning, systems, and organization that shall be used to manage the Uranium Mill Tailings Remedial Action Project (UMTRA). US DOE is authorized to stabilize and control surface tailings and ground water contamination at 24 inactive uranium processing sites and associated vicinity properties containing uranium mill tailings and related residual radioactive materials
Granlien, Maren Sander; Pries-Heje, Jan; Baskerville, Richard
, managing the explorative and iterative aspects of prototyping projects is not a trivial task. We examine the managerial challenges in a small scale prototyping project in the Danish healthcare sector where a prototype breakdown and project escalation occurs. From this study we derive a framework...... of strategies for coping with escalation in troubled prototyping projects; the framework is based on project management triangle theory and is useful when considering how to manage prototype breakdown and escalation. All strategies were applied in the project case at different points in time. The strategies led...
Del Sorbo, Francesca; Albanese, Alberto
Pain and fatigue are part of the phenomenological spectrum of Parkinson's disease (PD). These non-motor symptoms can be as troublesome as motor symptoms, impact activities of daily living, and are often underdiagnosed. The recognition of pain and fatigue requires a high degree of clinical suspicion and is facilitated by the use of specific questionnaires and ancillary tests. This workup is highly valuable particularly considering that pain and fatigue in PD may be treatable. We review here the clinical manifestations and management of these non-motor symptoms. Their resolution can be challenging, as there is insufficient evidence concerning effective treatment options. Copyright © 2011 Elsevier Ltd. All rights reserved.
Quinn, S.F.; Murtagh, F.R.; Chatfield, R.; Kori, S.; Kavanagh, J.; Clark, R.A.
Radiologists are taking an expanding role in the management of pain. The procedures most commonly used at our institution are facet blocks, peripheral nerve blocks, peripheral nerve ablations, ganglion ablations, chemoinfusions, chemoembolizations, and embolizations alone. CT is used for the facet, ganglion, and peripheral nerve procedures. The techniques for these procedures will be stressed, as meticulous technique is imperative. The radiologist must work closely with the attending clinician to determine both the neurologic level and to monitor therapy. The University of South Florida pain team flow sheet and pain evaluation method is presented
Full Text Available Any company willing to maintain its market position has to search and implement innovative products and services. Integrated development ofenterprise’s innovative activity requests a constant search for new technologies and new organizational forms. Ability of effectivemanagement of innovative projects becomes a crucial issue. The paper presents a characteristic of innovative projects accordingly toOECD standards. Project management concepts based on Project Management Institute (PMI and International Project ManagementAssociation (IPMA procedures have been discussed. Key success factors have been defined, i.e.: obtaining assumed project outcome (range, project implementation conform to planned schedule (deadline, maintaining project costs under a certain limit (budget, quality (are the customers satisfied?, resources (team losses and interpersonal relations. Tables comparing product innovativeness with fields of requested know – how for particular product innovativeness levels have been elaborated. Finally, SCRUM method of adaptive project management aiming at providing possibly optimal outcome has been described.
Priscilla G. Wittkopf
Full Text Available Summary The consequences of chronic pain and associated disabilities to the patient and to the health care system are well known. Medication is often the first treatment of choice for chronic pain, although side effects and high costs restrict long-term use. Inexpensive, safe and easy to self-administer non-pharmacological therapies, such as mirror therapy, are recommended as adjuncts to pain treatment. The purpose of this review is to describe the principles of use of mirror therapy so it can be incorporated into a health care delivery. The physiological rationale of mirror therapy for the management of pain and the evidence of clinical efficacy based on recent systematic reviews are also discussed. Mirror therapy, whereby a mirror is placed in a position so that the patient can view a reflection of a body part, has been used to treat phantom limb pain, complex regional pain syndrome, neuropathy and low back pain. Research evidence suggests that a course of treatment (four weeks of mirror therapy may reduce chronic pain. Contraindications and side effects are few. The mechanism of action of mirror therapy remains uncertain, with reintegration of motor and sensory systems, restored body image and control over fear-avoidance likely to influence outcome. The evidence for clinical efficacy of mirror therapy is encouraging, but not yet definitive. Nevertheless, mirror therapy is inexpensive, safe and easy for the patient to self-administer.
... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Project management. 418.29 Section 418.29... INTERIOR OPERATING CRITERIA AND PROCEDURES FOR THE NEWLANDS RECLAMATION PROJECT, NEVADA Enforcement § 418.29 Project management. In addition to the provisions of § 418.28, if the District is found to be...
An operations management product project is an effective instructional technique that fills a void in current operations management literature in product planning. More than 94.1% of 286 graduates favored the project as a learning tool, and results demonstrate the significant impact the project had in predicting student performance. The author…
Beach, Robert H.
To be effective, project management requires a heavy dependence on the document, list, and computational capability of a computerized environment. Now that microcomputers are readily available, only the rediscovery of classic project management methodology is required for improved resource allocation in small research projects. This paper provides…
Денис Антонович ХАРИТОНОВ
Full Text Available The article examined the fractal model of organizational diagnosis of pathologies in project management development. The proposed fractal model based on the competency approach to project management and allows evaluating the pathology of the project-oriented organizations.
Full Text Available Background: Disasters cause almost 100 thousand deaths and affect 200 million people every year. Operators working in disaster zones reported problems in importing medications, in particular pain killers and narcotics, in areas of disasters. The importance of ensuring access to painkillers, including major analgesics, is pinpointed by the World Health Organization which through its “Access to Controlled Medications Programme” provides normative guidance, policy analysis and training of healthcare workers on this issue. Nevertheless the little evidence available on the assessment and treatment of pain in disasters suggests that the management of pain in disaster zones may be affected by several factors mainly due to the availability of drugs, the skills of health personnel and cultural issues. Aim:The main aims of this project are: evaluating whether pain is correctly assessed and treated in disaster zones, assessing which are the main limitations to its treatment and producing suggestions and reccomandations to improve its treatment. Materials & Methods: In order to achieve our aims we will adopt a combined approach made by: A systematic review of the evidence will be conducted in the scientific databases Medline and Scopus. A review of grey literature concerning the issue on the Web pages of international organizations and NGOs working in the field of humanitarian aid. A survey among healthcare workers who took part to the international humanitarian actions. A survey among expert of the humanitarian field not necessary involved in projects on the field e.g. lawyer expert in international law, international organizations representatives working in the headquarters etc. A technical table with European experts in the field of pain treatment and/or disaster reaponse.
Full Text Available A project management methodology that defines basic processes, tools, techniques, methods, resources and procedures used to manage a project is necessary for effective and successful IT project management. Each company needs to define its own methodology or adapt some of the existing ones. The purpose of the research is to evaluate the possibilities of adapting IT project development methodology according to the company, company employee characteristics and their mutual relations. The adaptation process will be illustrated with a case study at an IT company in Latvia where the developed methodology is based on Agile Scrum, one of the most widespread Agile methods.
Croxatto, A; Greub, G
The need for diagnostic laboratories to improve both quality and productivity alongside personnel shortages incite laboratory managers to constantly optimize laboratory workflows, organization, and technology. These continuous modifications of the laboratories should be conducted using efficient project and change management approaches to maximize the opportunities for successful completion of the project. This review aims at presenting a general overview of project management with an emphasis on selected critical aspects. Conventional project management tools and models, such as HERMES, described in the literature, associated personal experience, and educational courses on management have been used to illustrate this review. This review presents general guidelines of project management and highlights their importance for microbiology diagnostic laboratories. As an example, some critical aspects of project management will be illustrated with a project of automation, as experienced at the laboratories of bacteriology and hygiene of the University Hospital of Lausanne. It is important to define clearly beforehand the objective of a project, its perimeter, its costs, and its time frame including precise duration estimates of each step. Then, a project management plan including explanations and descriptions on how to manage, execute, and control the project is necessary to continuously monitor the progression of a project to achieve its defined goals. Moreover, a thorough risk analysis with contingency and mitigation measures should be performed at each phase of a project to minimize the impact of project failures. The increasing complexities of modern laboratories mean clinical microbiologists must use several management tools including project and change management to improve the outcome of major projects and activities. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.
By bringing together various current directions, Software Project Management in a Changing World focuses on how people and organizations can make their processes more change-adaptive. The selected chapters closely correspond to the project management knowledge areas introduced by the Project Management Body of Knowledge, including its extension for managing software projects. The contributions are grouped into four parts, preceded by a general introduction. Part I "Fundamentals" provides in-depth insights into fundamental topics including resource allocation, cost estimation and risk manage
Walsch, Mary; Curley, Su
The International Space Station (ISS) has been designed as a laboratory for demonstrating technologies in a microgravity environment, benefitting exploration programs by reducing the overall risk of implementing such technologies in new spacecraft. At the beginning of fiscal year 2010, the ISS program manager requested that the amine-based, pressure-swing carbon dioxide and humidity absorption technology (designed by Hamilton Sundstrand, baselined for the Orion Multi-Purpose Crew Vehicle, and tested at the Johnson Space Center in relevant environments, including with humans, since 2005) be developed into a payload for ISS Utilization. In addition to evaluating the amine technology in a flight environment before the first launch of the Orion vehicle, the ISS program wanted to determine the capability of the amine technology to remove carbon dioxide from the ISS cabin environment at the metabolic rate of the full 6 ]person crew. Because the amine technology vents the absorbed carbon dioxide and water vapor to space vacuum (open loop), additional hardware needed to be developed to minimize the amount of air and water resources lost overboard. Additionally, the payload system would be launched on two separate Space Shuttle flights, with the heart of the payload-the swingbed unit itself-launching a full year before the remainder of the payload. This paper discusses the project management and challenges of developing the amine swingbed payload in order to accomplish the technology objectives of both the open -loop Orion application as well as the closed-loop ISS application.
Pries-Heje, Jan; Jakobsen, Peter M.; Korsaa, Morten
Project Portfolio Management (PPM) focus on the integration and alignment of projects with the business operation in order to achieve most value and cost-efficiency for the investment in projects. PPM is often a challenge and especially so for improvement projects where PPM is considerably...... of evaluating a portfolio of improvement projects and combine this evaluation with the effect they have on the CMMI maturity level. Further, the paper demonstrates how the combination of a strong senior management requirement for improved maturity and the focus on getting the most value out of PPM made...
Van Hulle Vincent, Catherine; Wilkie, Diana J; Wang, Edward
We evaluated feasibility of the Internet-based Relieve Children's Pain (RCP) protocol to improve nurses' management of children's pain. RCP is an interactive, content-focused, and Kolb's experiential learning theory-based intervention. Using a one-group, pretest-posttest design, we evaluated feasibility of RCP and pretest-posttest difference in scores for nurses' beliefs, and simulated and actual pain management practices. Twenty-four RNs completed an Internet-based Pain Beliefs and Practices Questionnaire (PBPQ, alpha=.83) before and after they completed the RCP and an Acceptability Scale afterward. Mean total PBPQ scores significantly improved from pretest to posttest as did simulated practice scores. After RCP in actual hospital practice, nurses administered significantly more ibuprofen and ketorolac and children's pain intensity significantly decreased. Findings showed strong evidence for the feasibility of RCP and study procedures and significant improvement in nurses' beliefs and pain management practices. The 2-hr RCP program is promising and warrants replication with an attention control group and a larger sample.
Lewis, James P
In this Third Edition of The Project Manager's Desk Reference, top project management consultant James Lewis arms you with today's most comprehensive and understandable project management resources...
Arain, Faisal Manzoor; Tipu, Syed Awais Ahmad
Emerging contractual delivery systems, collaborative partnerships, new management initiatives, and global product markets require professionals and students to have a broader awareness of construction methods and project management issues. This paper presents the state of the project management education in Pakistan. The analysis is based on…
This issue presents five papers selected from the 2013 (4th) International Conference on Engineering, Project, and Production Management (EPPM2013) held in Bangkok, Thailand. Three of the papers deal with scheduling problems faced in project and production management, while the remaining two focus on engineering management issues.
MacDonald, Neil; Ayoub, Joseph; Farley, Justine; Foucault, Claudette; Lesage, Pauline; Mayo, Nancy
We report the results of a cancer pain survey mailed to Quebec hematologist-oncologists and palliative care physicians in 1999. The survey was designed to sample views on the current status of pain management and on obstacles to the provision of adequate pain relief for patients. The survey, formulated by an ethics network centered at the Clinical Research Institute of Montreal, was distributed to all members of the Association of Hematologist-Oncologists of Quebec and to all physician members of the Quebec Palliative Care Association. Responses were obtained from 138 Palliative Care Association members (response rate 61%) and 76 hematologist-oncologists (response rate 45%). Major obstacles reported included inadequate assessment of both contributory psychosocial issues and severity of pain, patient reluctance to take opioids, and inadequate access to non-drug techniques for pain relief. Access to opioids was not regarded as a problem. Both groups felt generally competent in their ability to manage various aspects of cancer pain therapy. They gave little credit to their formal medical school or residency training. Fifty-six percent of the palliative care group and 57% of the hemato-oncologists rated their medical school experience as only "poor" or "fair" on a 4-point scale. Residency ratings were modestly better. We conclude that medical faculties should assign a high priority to teaching health professionals patient assessment techniques. Simple symptom assessment scales should be routinely used in oncology/palliative care practice. Medical school training in pain management is not highly regarded and should be enhanced. We also note that, based on response to the scenario of a patient presenting with severe pain, many physicians, while feeling competent in the use of opioids, may be overly conservative in their initial use.
Harris, Janet; Williams, Tim; Hart, Ollie; Hanson, Chris; Johnstone, Gareth; Muthana, Aziz; Nield, Chris
In 2011, the Sheffield Primary Care Trust piloted a Health Trainer (HT) programme targeted specifically to people with chronic pain. The programme aimed to determine whether patients presenting to primary care with chronic pain would benefit from self-management support, thereby reducing the burden on primary care and secondary care services. We conducted a formative mixed-methods evaluation of the pilot programme, focusing on four aspects of implementation: general practitioner (GP) referral to the programme, HT's ability to use cognitive behavioural (CB) approaches, short-term outcomes for clients and adequacy of resources. Qualitative data were collected via interviews with GPs, HTs and the chronic pain team; supervision sessions with HTs; and client case studies. Quantitative data were collected on satisfaction with training, HT's self-reported confidence to implement CB and clients' self-rated well-being before and after participation. A total of 143 clients with pain for 1 year or more were referred, exceeding the projected 90 referrals by over 50%. A total of 70% of the clients came from the most deprived areas of Sheffield, 40% were listed as permanently sick/disabled and only 20% were working. Qualitative analysis indicated that the CB training was delivered as intended. Clients reported that 75% of their goals were either achieved or partly achieved, and at follow-up 43% of them reported maintaining strategies for self-management. Financial resources were supplemented by indirect resources, including GP 'champions' with a special interest in pain, and a multidisciplinary chronic pain team. The prior history of working with community organizations was critical in ensuring credibility in client communities and addressing client needs. A HT programme promoting self-management of chronic pain can be successfully implemented when supported by community organisations. Preliminary data indicate that the programme can be instrumental in helping clients to
The purpose of this Handbook is to provide guidelines for use by public transit agencies (Agencies) undertaking substantial construction : projects, either for the first time or with little prior experience with construction project management. It pr...
Ramli, Rindra M.
This presentation describes the electronic resources management project undertaken by the KAUST library. The objectives of this project is to migrate information from MS Sharepoint to Millennium ERM module. One of the advantages of this migration
This research focuses on how to manage the risks of project costs and revenue uncertainties over the long-term, and identifies significant : process improvements to ensure projects are delivered on time and as intended, thus maximizing the miles pave...
factors as a significant system that constrains project management success of public and ... finance for the project and prompt payment for work executed; clients .... consideration of the loading patterns of these variables, the major factor is ...
Idvall, Ewa; Holm, Charlotta; Runeson, Ingrid
Tonsillectomy is one of the most common paediatric surgical procedures. This study aimed to investigate children's experience of pain and the nonpharmacological strategies that they used to manage pain after tonsillectomy. A further aim was to investigate parental views on these same phenomena. Six children (aged seven to 18 years) and their parents (four mothers and two fathers) were interviewed separately on the day after tonsillectomy. The data were analysed using a qualitative approach. Pain experiences were divided into the categories of physiological pain and psychological pain. Children rated their 'worst pain' during the past 24 hours between 6 and 10 (visual analogue scale, 0-10). The non-pharmacological strategies used most frequently to manage pain were thermal regulation (physical method) and distraction (cognitive-behavioural method) according to the framework used. Specific non-pharmacological strategies for pain management relative to different surgical procedures need to be considered.
Mack, Deborah S; Hunnicutt, Jacob N; Jesdale, Bill M; Lapane, Kate L
Racial disparities in pain management persist across health care settings and likely extend into nursing homes. No recent studies have evaluated racial disparities in pain management among residents with cancer in nursing homes at time of admission. Using a cross-sectional study design, we compared reported pain and pain management between non-Hispanic White and non-Hispanic Black newly admitted nursing home residents with cancer (n=342,920) using the de-identified Minimum Data Set version 3.0. Pain management strategies included the use of scheduled analgesics, pro re nata analgesics, and non-pharmacological methods. Presence of pain was based on self-report when residents were able, and staff report when unable. Robust Poisson models provided estimates of adjusted prevalence ratios (aPR) and 95% CIs for reported pain and pain management strategies. Among nursing home residents with cancer, ~60% reported pain with non-Hispanic Blacks less likely to have both self-reported pain (aPR [Black versus White]: 0.98, 95% CI: 0.97-0.99) and staff-reported pain (aPR: 0.89, 95% CI: 0.86-0.93) documentation compared with Non-Hispanic Whites. While most residents received some pharmacologic pain management, Blacks were less likely to receive any compared with Whites (Blacks: 66.6%, Whites: 71.1%; aPR: 0.98, 95% CI: 0.97-0.99), consistent with differences in receipt of non-pharmacologic treatments (Blacks: 25.8%, Whites: 34.0%; aPR: 0.98, 95 CI%: 0.96-0.99). Less pain was reported for Black compared with White nursing home residents and White residents subsequently received more frequent pain management at admission. The extent to which unequal reporting and management of pain persists in nursing homes should be further explored.
Offiah, I; McMahon, S B; O'Reilly, B A
The bladder pain syndrome (BPS) is a spectrum of urological symptoms characterised by bladder pain with typical cystoscopic features. Diagnosis and management of this syndrome may be difficult. There is no evidence-based management approach for the diagnosis or treatment of BPS. The objective of this study was to critically review and summarise the evidence relating to the diagnosis and treatment of the bladder pain syndrome. A review of published data on the diagnosis and treatment of the BPS was performed. Our search was limited to English-language articles, on the "diagnosis", and "management" or "treatment" of "interstitial cystitis" and the "bladder pain syndrome" in "humans." Frequency, urgency and pain on bladder filling are the most common symptoms of BPS. All urodynamic volumes are reduced in patients with BPS. Associated conditions include psychological distress, depression, history of sexual assault, irritable bowel syndrome and fibromyalgia. Cystoscopy remains the test for definitive diagnosis, with visualisation of haemorrhage on cystoreduction. A multidisciplinary treatment approach is essential in the management of this condition. Orally administered amitriptyline is an efficacious medical treatment for BPS. Intravesical hyaluronic acid and local anaesthetic, with/without hydrodistension are among new treatment strategies. Sacral or pudendal neuromodulation is effective, minimally invasive and safe. Surgery is reserved for refractory cases. There remains a paucity of evidence for the diagnosis and treatment of BPS. We encountered significant heterogeneity in the assessment of symptoms, duration of treatment and follow up of patients in our literature review.
Davies, Andrew; Zeppetella, Giovambattista; Andersen, Steen
This study involved 320 cancer patients from four Northern European countries. Patients with breakthrough pain were questioned about the characteristics of their pain, the current management of their pain, and the acceptability/utility of alternative routes of administration. The median number...... of episodes was 3/day. Forty-four percent patients reported incident-type pain, 39% spontaneous-type pain, and 17% a combination of these pains. The median duration was 60 min, and the median time to peak intensity was 15 min. Three percent patients reported "mild" pain, 37% "moderate" pain, and 60% "severe......" pain. Ninety percent patients stated that the pain interfered with their daily activities. All patients were using opioids as rescue medication (mainly oral morphine/oxycodone), whilst 28% patients were using non-opioids, and 50% patients were using non-pharmacological interventions. Only 55% patients...
This pocket guide is designed to help IT project managers to succeed, and is based on the author's years of experience in IT project management. The guide's step-by-step approach will enable those new to IT project management, or intending to make a career in this field, to master the essential skills. For seasoned professionals, the pocket guide offers an invaluable concise reference guide.
Nikander, Ilmari O.
The emergence of Concurrent Engineering has caused growing demands on project management. The classic project management methods are often slow: problems may already exist when those methods are applied. The objective of the present study is to improve the opportunities of those responsible for a project's operational management to receive advance information about potential problems and final results through early warnings typical of the theory of weak signals by Igor Ansoff. The researc...
Harty, Chris; Neerup Themsen, Tim; Tryggestad, Kjell
The assumption that large complex projects should be managed in order to reduce uncertainty and increase predictability is not new. What is relatively new, however, is that uncertainty reduction can and should be obtained through formal risk management approaches. We question both assumptions...... by addressing a more fundamental question about the role of knowledge in current risk management practices. Inquiries into the predominant approaches to risk management in large infrastructure and construction projects reveal their assumptions about knowledge and we discuss the ramifications these have...... for project and construction management. Our argument and claim is that predominant risk management approaches tends to reinforce conventional ideas of project control whilst undermining other notions of value and relevance of built assets and project management process. These approaches fail to consider...
Presentation of two parts in a new concept for changing education in a university course in project management. First part concern running the couse as a project. Second part concern integrated use of Internet.......Presentation of two parts in a new concept for changing education in a university course in project management. First part concern running the couse as a project. Second part concern integrated use of Internet....
Perotti , Clément; Minel , Stéphanie; Benoit , Roussel; Jean , Renaud
International audience; This paper proposes some elements showing that project is an appropriate way to manage organizational change, and that an individual change occurs during these phases. We suggest that project team should manage individual change in the framework of project for three main reasons. First, being at the crossroad of strategic and operational levels, project team is in the right position in organisation to "translate" organizational change to individuals, and vice-versa. Se...
Full Text Available The contribution aims to describe project as a system, to define project control goal and strategy, control variables and their relationships. Three common control variables represented by the project triangle, are extended by two other important variables – project risk and quality. The control system consists of two components: social one – project manager and project team – and technical one – project dynamic simulation model as a decision making support of project manager in project milestones. In the project planning phase, the project baseline with planned controlled variables is created. In milestones after project launch, the actual values of these variables are measured. If the actual values deviate from planned ones, corrective actions are proposed and new baseline for the following control interval is created. Project plan takes into account the actual project progress and optimum corrective actions are determined by simulation, respecting control strategy and availability of resources. The contribution presents list of references to articles dealing with project as a system and its simulation. In most cases, they refer to the project control using the Earned Value Management method and its derivatives. Using of the dynamic simulation model for project monitoring and control, suggested in this contribution, presents a novel approach. The proposed model can serve as departure point to future research of authors and for development of appropriate and applicable tool.
Mercadante, Sebastiano; Klepstad, Pal; Kurita, Geana Paula
was generally poor due to several limitations, including sample size calculation, allocation concealment, no intention to treat analysis. However, at least two CPB studies were of good quality. Data regarding the comparison of techniques or other issues were sparse and of poor quality, and evidence could...... effects in comparison with a conventional analgesic treatment. In one study patients treated with superior hypogastric plexus block (SHPB) had a decrease in pain intensity and a less morphine consumption, while no statistical differences in adverse effects were found. The quality of these studies...
Zhang Li; Zhang Ming; Zhang Ling
The nuclear engineering project documents with great quantity and various types of data, in which the relationships of each document are complex, the edition of document update frequently, are managed difficultly. While the safety of project even the nuclear safety is threatened seriously by the false documents and mistakes. In order to ensure the integrality, veracity and validity of project documents, the lifecycle theory of document is applied to build documents center, record center, structure and database of document lifecycle management system. And the lifecycle management is used to the documents of nuclear engineering projects from the production to pigeonhole, to satisfy the quality requirement of nuclear engineering projects. (authors)
Svejvig, Per; Grex, Sara
Purpose – The purpose of this paper is to analyze the similarities and differences between the Danish Re-thinking Project Management initiative named Project Half Double (PHD) and the rethinking project man-agement (RPM) research stream. The paper furthermore discusses how PHD and RPM can inspire...... ideas and local implementations. Findings – RPM and PHD share a focus on value creation, social processes, learning and complexity while PHD also focuses on lean thinking, agile thinking, front-end loading and leadership, which are largely topics beyond the RPM research stream. Originality...... a foundation for further development of both rethinking project management and Project Half Double....
Svejvig, Per; Grex, Sara
Purpose – The purpose of this paper is to analyze the similarities and differences between the Danish Re-thinking Project Management initiative named Project Half Double (PHD) and the rethinking project man-agement (RPM) research stream. The paper furthermore discusses how PHD and RPM can inspire...... a foundation for further development of both rethinking project management and Project Half Double....... each other in research and practice. Design/methodology/approach – This is an empirical paper based on collaborative research between in-dustry and researchers. PHD has developed principles and practices driven by industry consisting of 10 leading stars and the impact, leadership and flow (ILF) method...
A pragmatic approach to project management Many projects fail to deliver on time or on budget, or even to deliver a workable product that satisfies the customer. While good project management goes a long way towards ensuring success, managers often fail to follow the plans they implement. This unique guide helps you understand and successfully handle project management, once and for all. Covering practical ways to solve problems you'll typically face when managing actual projects, this pragmatic book takes you through a full project management lifecycle. You'll find ample tips, tricks, and bes
Goodman, F Alan
Not connecting software project management (SPM) to actual, real-world development processes can lead to a complete divorcing of SPM to software engineering that can undermine any successful software project. By explaining how a layered process architectural model improves operational efficiency, Process-Based Software Project Management outlines a new method that is more effective than the traditional method when dealing with SPM. With a clear and easy-to-read approach, the book discusses the benefits of an integrated project management-process management connection. The described tight coup
Galina Aleksandrovna Ignat’eva
Full Text Available The purpose of the research was to denote a way to solve the problem of education mana-gement ΄s insufficient efficiency considered from the point of view of education opportunities to influence on the formation of mechanisms for sustainable development of society as a whole and its educational component. The concept «project-resource management of innovation in education» regarded on the basis of the anthropological project-transforming paradigm. Conceptually-categorical context presented by conceptual cluster composed of coordinated concepts «project», «resource», «educational reality», «organizational-resource potential», «project commonality». In the theoretical part of the study on the basis of analysis of the normative and exploratory approaches to educational innovations organization and management it was established the search approach ΄s leading role in the methodological substantiation of project-resource management. The study have indicated that in the presence of variable models of innovation management in education, corresponding to various predictive models of continuing education post-industrial society, project-resource management is an universal mechanism for the transition from separate innovation΄s precedents to the an authentic reality of innovative education. In the technological part of the study the main concern was to submit the project-resource management by the management goal’s system, each of which includes the specific management actions, projected results and the organizational forms. The project-resource management ΄s professional – activity context of the study showed evolution of managerial positions: an effective performer – an effective leader – strategist, implemented during the transition from directly directive management to the project management and further to the project-resource management. Based on the findings identified the key factors of initiatively-problem projects
Ireland, Luu Doan; Allen, Rebecca H
Satisfactory pain control for women undergoing office gynecologic procedures is critical for both patient comfort and procedure success. Therefore, it is important for clinicians to be aware of the safety and efficacy of different pain control regimens. This article aimed to review the literature regarding pain control regimens for procedures such as endometrial biopsy, intrauterine device insertion, colposcopy and loop electrosurgical excisional procedure, uterine aspiration, and hysteroscopy. A search of published literature using PubMed was conducted using the following keywords: "pain" or "anesthesia." These terms were paired with the following keywords: "intrauterine device" or "IUD," "endometrial biopsy," "uterine aspiration" or "abortion," "colposcopy" or "loop electrosurgical excisional procedure" or "LEEP," "hysteroscopy" or "hysteroscopic sterilization." The search was conducted through July 2015. Articles were hand reviewed and selected by the authors for study quality. Meta-analyses and randomized controlled trials were prioritized. Although local anesthesia is commonly used for gynecologic procedures, a multimodal approach may be more effective including oral medication, a dedicated emotional support person, and visual or auditory distraction. Women who are nulliparous, are postmenopausal, have a history of dysmenorrhea, or suffer from anxiety are more likely to experience greater pain with gynecologic procedures. Evidence for some interventions exists; however, the interpretation of intervention comparisons is limited by the use of different regimens, pain measurement scales, patient populations, and procedure techniques. There are many options for pain management for office gynecologic procedures, and depending on the procedure, different modalities may work best. The importance of patient counseling and selection cannot be overstated.
Dworkin, Robert H.; O’Connor, Alec B.; Kent, Joel; Mackey, Sean C.; Raja, Srinivasa N.; Stacey, Brett R.; Levy, Robert M.; Backonja, Miroslav; Baron, Ralf; Harke, Henning; Loeser, John D.; Treede, Rolf-Detlef; Turk, Dennis C.; Wells, Christopher D.
Neuropathic pain (NP) is often refractory to pharmacologic and non-interventional treatment. On behalf of the International Association for the Study of Pain Neuropathic Pain Special Interest Group (NeuPSIG), the authors evaluated systematic reviews, clinical trials, and existing guidelines for the interventional management of NP. Evidence is summarized and presented for neural blockade, spinal cord stimulation (SCS), intrathecal medication, and neurosurgical interventions in patients with the following peripheral and central NP conditions: herpes zoster and postherpetic neuralgia (PHN); painful diabetic and other peripheral neuropathies; spinal cord injury NP; central post-stroke pain; radiculopathy and failed back surgery syndrome (FBSS); complex regional pain syndrome (CRPS); and trigeminal neuralgia and neuropathy. Due to the paucity of high-quality clinical trials, no strong recommendations can be made. Four weak recommendations based on the amount and consistency of evidence, including degree of efficacy and safety, are: (1) epidural injections for herpes zoster; (2) steroid injections for radiculopathy; (3) SCS for FBSS; and (4) SCS for CRPS type 1. Based on the available data, we recommend not to use sympathetic blocks for PHN nor RF lesions for radiculopathy. No other conclusive recommendations can be made due to the poor quality of available of data. Whenever possible, these interventions should either be part of randomized clinical trials or documented in pain registries. Priorities for future research include randomized clinical trials; long-term studies; and head-to-head comparisons among different interventional and non-interventional treatments. PMID:23748119
Chrubasik, Sigrun; Pollak, S
Herbal antirheumatics are indicated in painful inflammatory and degenerative rheumatic diseases. Their mechanism of action is broader than that of synthetic antirheumatics. Particular preparations from Devils's Claw with 50 to 100 mg of harpagoside in the daily dosage as well as a particular willow bark extract with 120 to 240 mg salicin in the daily dosage proved efficacy in a number of clinical studies including confirmatory ones. Exploratory studies indicate that these herbal antirheumatics were not inferior to the selective COX-2 inhibitor rofecoxib when treating acute exacerbations of chronic low back pain. For the proprietary nettle root extract IDS23 promising in vitro/in vivo results indicate an anti-inflammatory effect, however there are only 2 open uncontrolled clinical studies available and the proof of efficacy is still missing. Safety data in order to recommend use during pregnancy and lactation are only available for the herbal combination product Phytodolor prepared from aspen, ash and goldenrod. In principle, blackcurrent leaf with not less than 1.5% flavonoids may be an appropriate antirheumatic. Likewise, the seed oils of blackcurrent, evening primrose and borage offering at least 1 to 3 g gammalinolenic acid/day are recommendable. In case superiority versus placebo has been established, proprietary herbal antirheumatics should be administered before the conventional analgesics due to the lower incidence of adverse events.
Bahr, P.; Baker, T.; Corbin, B.; Keith, L.; Loerch, L.; Mullenax, C.; Myers, R.; Rhodes, B.; Skytland, N.
From dealing with the inherent uncertainties in outcomes of scientific research to the lack of applicability of current NASA Procedural Requirements guidance documentation, research-based projects present challenges that require unique application of classical project management techniques. If additionally challenged by the creation of a new program transitioning from basic to applied research in a technical environment often unfamiliar with the cost and schedule constraints addressed by project management practices, such projects can find themselves struggling throughout their life cycles. Finally, supplying deliverables to a prime vehicle customer, also in the formative stage, adds further complexity to the development and management of research-based projects. The Biomedical Research and Countermeasures Projects Branch at NASA Johnson Space Center encompasses several diverse applied research-based or research-enabling projects within the newly-formed Human Research Program. This presentation will provide a brief overview of the organizational structure and environment in which these projects operate and how the projects coordinate to address and manage technical requirements. We will identify several of the challenges (cost, technical, schedule, and personnel) encountered by projects across the Branch, present case reports of actions taken and techniques implemented to deal with these challenges, and then close the session with an open forum discussion of remaining challenges and potential mitigations.
This configuration management plan describes the organization, policies, and procedures that will be used on the Salt Repository Project (SRP) to implement the configuration management disciplines and controls. Configuration management is a part of baseline management. Baseline management is defined in the SRP Baseline Procedures Notebook and also includes cost and schedule baselines. Configuration management is a discipline applying technical and administrative direction and surveillance to identify and document the functional and physical characteristics of an item, to control changes to those characteristics, to record and report change processing and implementation status, and to audit the results. Configuration management is designed as a project management tool to determine and control baselines, and ensure and document all components of a project interface both physically and functionally. The purpose is to ensure that the product acquired satisfies the project's technical and operational requirements, and that the technical requirements are clearly defined and controlled throughout the development and acquisition process. 5 figs
This document was developed under the auspices of the Laboratory IRM (LIRM) Management Working Group in response to AFSC Program Directive 0008-81-1, Management Information Requirement Project (23 February 1981...
Levine, Harvey A
... Elements of Resource Management 4.2 Role-based Needs for Managing Resources in a Project-driven Organization 4.3 Resource Leveling and Games of Chance 4.4 Practical Resource Scheduling 117 119 12...
S.J.G.M. Ahlers (Sabine)
textabstractIntensive care patients are subject to many factors that may influence the patients’ state of comfort or distress. Pain is the main cause of distress experienced by many adult intensive care patients, which can be caused by different factors like underlying disease, prolonged immobility
Kindinger, J. P. (John P.)
This paper describes the need for better performance in the planning and execution of projects and examines the capabilities of two different project risk analysis methods for improving project performance. A quantitative approach based on concepts and tools adopted from the disciplines of systems analysis, probabilistic risk analysis, and other fields is advocated for managing risk in large and complex research & development projects. This paper also provides an overview of how this system analysis approach for project risk management is being used at Los Alamos National Laboratory along with examples of quantitative risk analysis results and their application to improve project performance.
Vjacheslav A. Kozlov
Full Text Available In the article it is proved that use of information technology today is not only something innovative distinctive feature and competitive advantage for organizations, but it is a necessary condition for effective business. The article discusses the main functionality of financial-analytical system Project Expert as an effective tool of investment project management and instrument of business planning. The main advantages which organizations get from Project Expert program use are in detail considered. Thus in the article Project Expert is considered as the effective tool of investment project management which allows to receive a number of advantages and to carry out the qualitative analysis of projects.
Site quality management of an engineering project of NPIC was introduced in this paper. Requirements on organization and management, interfaces, and management of interior and exterior communication were put forward, by description of quality planning, process management, process monitoring and summarizing for the engineering projects. By the management of personnel, specifications and procedures, and the control of equipment, material and work surroundings, not only the safety is ensured, but also the quality and schedule of the engineering project were guaranteed, and so the expected quality goals were achieved. (author)
This dose management plan facilitates meeting the dose management and ALARA requirements applicable to the design activities of the Spent Nuclear Fuel Project, and establishes consistency of information used by multiple subprojects in ALARA evaluations. The method for meeting the ALARA requirements applicable to facility designs involves two components. The first is each Spent Nuclear Fuel Project subproject incorporating ALARA principles, ALARA design optimizations, and ALARA design reviews throughout the design of facilities and equipment. The second component is the Spent Nuclear Fuel Project management providing overall dose management guidance to the subprojects and oversight of the subproject dose management efforts
This article consider nuclear power plant's current design schedule management mode as the introduction, analysis of current management in-depth, summed up the advantage and disadvantage of the existing management mode. It makes use of mature closed loop cycle project management, and submits progress tracking model assumptions. It also introduces the purpose and background of the progress automation model, the theoretical assumptions of the model, the design criteria and evaluation system of indicators of progress. Based on the achievement process model, this article mainly discusses the specific processes and key points of the project closed loop cycle, and the improvement of the process of project management. (author)
Lorenzen, Mark; Frederiksen, Lars
The paper analyses management of product innovation in project-based industries, offering a view on management not only of firms, but also of markets. It first argues that projects are prominent in industries where the nature of consumer demand means that product innovation takes place...... as experimentation. Then, the paper argues that if skills needed for projects are very diverse and projects are complex, there are few internal managerial economies of projects, and the scope for management then transcends the boundaries of firms. In these cases, markets become organized in combinations of people......, contracts, and other institutions, in order to facilitate the coordination of market-based projects. While contracts play a role, a continuous, active role of knowledgeable managers (leaders and boundary spanners) is also often necessary. Such managers --- and thus (core parts of) whole industries...
Vaismoradi, Mojtaba; Skär, Lisa; Söderberg, Siv; Bondas, Terese E
Older people who live in nursing homes commonly suffer from pain. Therefore, relieving suffering among older people that stems from pain demands knowledge improvement through an integration of international knowledge. This study aimed to integrate current international findings and strengthen the understanding of older people's experiences of and perspectives on pain and pain management in nursing homes. A meta-synthesis study using Noblit and Hare's interpretative meta-ethnography approach was conducted. Empirical research papers from journals were collected from various databases. The search process and appraisal determined six articles for inclusion. Two studies were conducted in the US and one each in Iceland, Norway, the UK, and Australia. The older people's experiences of pain as well as perspectives on pain management from all involved (older people, their family members, and healthcare staff) were integrated into a theoretical model using three themes of "identity of pain," "recognition of pain," and "response to pain." The metaphor of "normalizing suffering" was devised to illustrate the meaning of pain experiences and pain management in nursing homes. Society's common attitude that pain is unavoidable and therefore acceptable in old age in society-among older people themselves as well as those who are responsible for reporting, acknowledging, and relieving pain-must change. The article emphasizes that pain as a primary source of suffering can be relieved, provided that older people are encouraged to report their pain. In addition, healthcare staff require sufficient training to take a person-centered approach towards assessment and management of pain that considers all elements of pain.
Lynch, Margaret M.
This study explores the meaning project managers (PMs) make of their project environment, how they lead their teams and have incorporate complexity into their project management approach. The exploration of the PM's developmental level and meaning making offers a different angle on the project management and leadership literature. The study…
Full Text Available Theresa Mallick-Searle,1 Brett Snodgrass,2 Jeannine M Brant,3 1Pain Management Center, Stanford Health Care, Redwood City, CA, 2LifeLinc Pain Centers, Cordova, TN, 3Billings Clinic, Billings, MT, USA Abstract: Herpes zoster, also known as shingles, is a distinctive clinical condition caused by the reactivation of latent varicella zoster (chickenpox virus following an initial infection. Approximately 1 million cases of herpes zoster occur annually in the US, and one in every three people develops herpes zoster during their lifetime. Postherpetic neuralgia is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster rash. It stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response accompanying varicella zoster virus reactivation. Patients with postherpetic neuralgia report decreased quality of life and interference with activities of daily living. Approaches to management of postherpetic neuralgia include preventing herpes zoster through vaccination and/or antiviral treatment, and administering specific medications to treat pain. Current guidelines recommend treatment of postherpetic neuralgia in a hierarchical manner, with calcium channel α2-δ ligands (gabapentin and pregabalin, tricyclic antidepressants (amitriptyline, nortriptyline, or desipramine, or topical lidocaine patches as first-line drugs. The safety and tolerability of pharmacologic therapies for pain are important issues to consider as postherpetic neuralgia affects primarily an older population. Patients should be educated on appropriate dosing, titration if applicable, the importance of adherence to treatment for optimal effectiveness, and possible side effects. Health-care professionals play a key role in helping to ameliorate the pain caused by postherpetic neuralgia through early recognition and diligent assessment of the problem; recommending evidence
Clark, Lauren; Fink, Regina; Pennington, Karen; Jones, Katherine
Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.
Jacobsen, Ramune; Samsanaviciene, Jurgita; Liubarskiene, Zita
-related barriers to cancer pain management in patient samples from Denmark and Lithuania. Thirty-three Danish and 30 Lithuanian patients responded to, respectively, Danish and Lithuanian versions of the Brief Pain Inventory pain scale, the Barriers Questionnaire II, the Hospital Anxiety and Depression Scale...
Lively, William R.
This paper reviews a management decision of an Information Technology Outsource (ITO) provider to backshore the management oversight of its Project Management Office (PMO) after only one year of offshore operations. Governance is a term used in project management to refer to management oversight. The review is a quantitative analysis of existing…
V. S. Kruglyk
Full Text Available During the work performance students should get the maximal approach to the process of real project execution, so the project should include the need to use the latest technology, integration of data or services with different developments, architecture design, interaction of the team members and others. Implementation of graduation projects is the useful activity for the acquisition and consolidation of key IT competencies. Since the task of educational projects is maximal close to real one, students participate almost in all typical stages of commercial product’s development, and do so successfully. This is also confirmed practically: students, who were actively engaged in some projects at the university, have key positions in IT companies of the city and country after that. The main objective of the paper is to describe the organization of a common group students’ work on a degree project, implementation peculiarity of such projects, recommendations for improving the quality of projects. Thus, the paper is devoted to the peculiarities of the joint students’ work on a project during diploma execution in IT specialties, as the final part of the acquisition and consolidation process of key IT competencies of future programmers. The problem of choosing work topic, project concept, work organization in a group, implementation process organization has been considered. Also the specific stages of software development have been considered: development of interface, choice of technology, product quality, project disposal to the next developers, project completion.
Focusing on correct application of ability level principle in setting organizational structure, the effective management system has been established, and 8 practical management regimes have been developed. Personnel training and management work shall be well done and enhanced. Experience feedback in construction management shall be well done for all systems. Exchange of construction and management techniques shall be actively carried out. All staff shall participate in safety management. KPI system is adopted for assessing stakeholders' project management method, and PDCA cycle is adopted for continued improved. Management level upgrading measures are proposed to ensure the smooth construction of nuclear power project. Setting forth and popularizing management theory can provide reference for and promote the smooth progress of various nuclear power projects. (author)
Werner, Mads U
. Local anesthetic blocks, pharmacological management, and treatment with sensory stimulation methods were presented in seven studies. In spite of shortcomings, the data on surgical management demonstrate that neurectomy with or without mesh removal may provide long-lasting analgesic effects in most...... patients with severe PPP following inguinal hernia repair. The evidence base for other management methods is still fragile, although promising results appear in the neuromodulation studies. CONCLUSIONS: There is a need for improved study designs and, launching of large multicenter collaborative studies...
Pandian, C Ravindranath
Few software projects are completed on time, on budget, and to their original specifications. Focusing on what practitioners need to know about risk in the pursuit of delivering software projects, Applied Software Risk Management: A Guide for Software Project Managers covers key components of the risk management process and the software development process, as well as best practices for software risk identification, risk planning, and risk analysis. Written in a clear and concise manner, this resource presents concepts and practical insight into managing risk. It first covers risk-driven project management, risk management processes, risk attributes, risk identification, and risk analysis. The book continues by examining responses to risk, the tracking and modeling of risks, intelligence gathering, and integrated risk management. It concludes with details on drafting and implementing procedures. A diary of a risk manager provides insight in implementing risk management processes.Bringing together concepts ...
Department of Veterans Affairs — The PMAS Dashboard provides a wide range of helpful data and information to assist you in project management and assessment. The drop down menu can be used to search...
Andrade, Regiane S.; Proctor, Julian W.; Slack, Robert; Marlowe, Ursula; Ashby, Karlotta R.; Schenken, Larry L.
Purpose: The incidence of painful bone metastases increases with longer survival times. Although external beam radiation therapy (EBRT) is an effective palliative treatment, it often requires several days from the start of treatment to produce a measurable reduction in pain scores and a qualitative amelioration of patient pain levels. Meanwhile, the use of analgesics remains the best approach early on in the treatment course. We investigated the role of radiation therapists as key personnel for collecting daily pain scores to supplement assessments by physician and oncology nursing staff and manage pain more effectively during radiation treatment. Methods and Materials: Daily pain scores were obtained by the radiation therapists for 89 patients undertaking a total of 124 courses of EBRT for bone metastases and compared with pretreatment pain scores. The majority of patients (71%) were treated to 30 Gy (range, 20-37.5) in 10 fractions (range, 8-15 fractions). Results: One hundred nineteen treatment courses (96%) were completed. Pain scores declined rapidly to 37.5%, 50%, and 75% of the pretreatment levels by Days 2, 4, and 10, respectively. Pain was improved in 91% of patients with only 4% of worse pain at the end of treatment. Improved pain scores were maintained in 83% of patients at 1-month follow-up, but in 35% of them, the pain was worse than at the end of treatment. Conclusions: Collection of daily pain scores by radiation therapists was associated with an effective reduction in pain scores early on during EBRT of painful osseous metastases.
Wang, Hsiang-Ling; Tsai, Yun-Fang
To explore nurses' knowledge and barriers regarding pain management in intensive care units. Pain is a common and treatable condition among intensive care patients. Quality care of these patients depends on the pain knowledge and pain management skills of critical care nurses. However, no single study has explored these nurses' knowledge of and perceived barriers to pain management in Taiwan. A cross-sectional study. Intensive care unit nurses (n = 370) were recruited from 16 hospitals chosen by stratified sampling across Taipei County in Taiwan. Data were collected on nurses' knowledge of pain management using the Nurses' Knowledge and Attitudes Survey-Taiwanese version, on perceived barriers to pain management using a researcher-developed scale and on background information. The overall average correct response rate for the knowledge scale was 53.4%, indicating poor knowledge of pain management. The top barrier to managing pain identified by these nurses was 'giving proper pain prescription needs doctor's approval; can't depend on me'. Knowledge of pain management was significantly and negatively related to perceived barriers to pain management. In addition, scores for knowledge and perceived barriers differed significantly by specific intensive care unit. Knowledge also differed significantly by nurses' education level, clinical competence level (nursing ladder) and hospital accreditation category. Our results indicate an urgent need to strengthen pain education by including case analysis for intensive care nurses in Taiwan. Pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese nurses in intensive care units. © 2010 Blackwell Publishing Ltd.
BILOKON A. I.
Full Text Available The success or failure of the project often depends on factors which related to the environment, surrounded by the project and which are outside of the direct control of the project manager. The concept of the project environment, the processes of environmental analysis of the project and the ways in which managers can identify potential problems and develop a plan of action to ensure the success of the project. The management strategy the main factors of the environment includes both organizational forms and measures which aimed at the development process. For alignment of the organizational forms of communication manager must have a clear idea: what kind of interested persons and their actions (functions need to monitor, and in what form to maintain communication (bilateral relations of interdependence. This information is key to the further construction of the formal organization that supports interaction, the definition of its functions, competencies, allocation of roles, areas of responsibility, instructions, forms and methods of work. Purpose. Summarize, analyze and form an idea of the potential of existing approaches to the management of the project environment. Object of study. Management processes of the persons, who interested in the project environment. Subject of study. Methods and tools for the project management environment.
Patton, Nanette; Shechet, Allan
.... This article discusses conventional roles and responsibilities of the project sponsor and then discusses strategies a project manager can employ to define boundaries to reduce role confusion and promote partnership to facilitate project success.
This document is a rewrite of the draft ''C'' that was agreed to ''in principle'' by SNF Project level 2 managers on EDT 609835, dated March 1995 (not released). The implementation process philosphy was changed in keeping with the ongoing reengineering of the WHC Controlled Manuals to achieve configuration management within the SNF Project
Comparison of community managed projects and conventional approaches in rural water supply of Ethiopia. ... African Journal of Environmental Science and Technology ... This study aimed to compare Community Managed Projects (CMP) approach with the conventional approaches (Non-CMP) in the case of Ethiopia.
Gilbert Gilbert Silvius; Ron Schipper; Snezana Nedeski
The relationship between project management and sustainable development is rapidly gaining interest from both practitioners and academics. Studies on the integration of the concepts of sustainability into project management, approach this topic mostly from a conceptual, logical or moral point of
Zou Lailong; Zhang Peng; Xiao Ziyan; Chun Zengjun; Huang Futong
Project Management Information System is an important infrastructure facility for the construction and operation of Nuclear Power Station. Based on the practice of Lingao nuclear power project management information system (NPMIS), the author describes the NPMIS design goals, system architecture and software functionality, points out the outline issues during the development and deployment of NPMIS
Full Text Available Project management has been generally known and increasingly used by many organizations to gain competitive advantage. In this context, many studies have proposed maturity models to evaluate how project management knowledge has been deployed effectively and efficiently in or- ganization. As a developing country, Indonesia needs many development projects managed by government and private companies in different industries. Here, a study to assess project manage- ment maturity level in Indonesian businesses may bring insight about current business practices, which is important to speed up country development and business sustainability. Adapting the Project Management Maturity Model (ProMMM, a survey instrument has been developed and ap- plied to professionals from Jakarta and surrounding area. The result of analysis shows that con- struction and primary industry have a higher maturity level compare to manufacturing and servic- es. It is to be noted, however, that the level of project management understanding is low across in- dustries. This indicates that more quality project management training or certification is required to improve overall project management knowledge in Indonesia.
The lack of availability of opioids in many countries has created a pain management crisis. Because the Single Convention on Narcotic Drugs requires governments to report annual opioid statistics, there is a need for methods to calculate individual nations' opioid needs. Ways to address this need are discussed.
Wacker, Margaret S.; Pawasauskas, Joyce
Nine brief onsite educational sessions of 10-20 minutes each trained nurses in pain management techniques. Participants recognized the value of brief presentations, but wanted more time to learn the material. The content was made available on disk for further study. (SK)
Nearly 54 million adults have arthritis, and that number could grow to 78 million by the year 2040. This podcast discusses ways to manage the pain of arthritis. Created: 6/8/2017 by MMWR. Date Released: 6/8/2017.
Arthritis is one of the most common chronic conditions in the United States. Unfortunately, as the population ages, itâs only expected to increase. In this podcast, Dr. Jennifer Hootman discusses ways to manage the pain of arthritis. Created: 6/8/2017 by MMWR. Date Released: 6/8/2017.
Purpose: To compare the effectiveness of post-operative pain management and associated adverse effects of ketamine and nefopam. Methods: In total, 78 American Society of Anesthesiologists (ASA) grade 1 and 2 patients who had undergone abdominal surgery were given 3 mg of intravenous (IV) morphine as ...
Meissner, Winfried; Huygen, Frank Jpm; Neugebauer, Edmund A M
/unsuccessful. In the hospital sector the development and implementation of QIs is complex. The nature of POPM requires a highly-trained, multidisciplinary team and it is at this level where major improvements can be made. Greater involvement of patients regarding pain management is also seen as a priority area for improving...
Meissner, Winfried; Huygen, Frank Jpm; Neugebauer, Edmund A M
/unsuccessful. In the hospital sector the development and implementation of QIs is complex. The nature of POPM requires a highly-trained, multidisciplinary team and it is at this level where major improvements can be made. Greater involvement of patients regarding pain management is also seen as a priority area for improving...
The results showed that the cases of SP involved patients between the ages of 13-89 years with a mean age of. 53.42±15.08 years. .... centred outcome measuring instruments in the management .... study that more older patients reported with spinal pain suggests that .... Sitting spinal posture in adolescents differs between ...
Salehi, Alireza; Alembizar, Faranak; Hosseinkhani, Ayda
Studying the history of science could help develop an understanding of the contributions made by ancient nations towards scientific advances. Although Iranians had an important impact on the improvement of science, the history of Iranian medicine seems not to have been given enough attention by historians. The present study focused on the history of anesthesia and pain management in Iranian medical history. In this regard, related books such as Avesta and Shahnameh were studied in order to obtain the history of anesthesiology in Iranian pre Islamic era. This subject was also studied in the famous books of Rhazes, Haly Abbas, Avicenna, Jorjani, MomenTunekaboni and Aghili from different times of the Islamic era. Scientific data bases such as PubMed, Scopus and Google Scholar were searched using key words "Iranian", "Persian", "pain management" and "anesthesia". It was discovered that pain management and anesthesiology were well known to the Iranians. Rhazes and Avicenna had innovations in this regard. Fourteen Mokhader (anesthetic) herbs, which were included in the collection of the previous knowledge of the 18th century entitled Makhzan al-Advieyh and used as the Persian Materia Medica, were identified and listed. This study introduces the history of anesthesiology and pain management at different periods in the history of Iran.
Background: The aim of this study was to evaluate pain management in paediatric surgery at Sylvanus Olympio University Teaching Hospital, Lome. Patients and Methods: A prospective descriptive study was conducted in the Department of Anaesthesiology and Intensive Care at Sylvanus Olympio teaching hospital from 1 ...
Intravenous analgesics for pain management in post- operative patients: a comparative study of their efficacy and adverse ... patient anxiety, stress, and dissatisfaction. Adequate ... genders who were scheduled to undergo abdominal surgery (hemicolectomy, exploratory ... analysis (n = 48) and separated into three groups.
Full Text Available The common denominator of the five papers published in the current edition of the Journal of Engineering, Project, and Production Management is the improvement of construction project management processes for effective use of resources. Execution of proper project management processes is widely recognized as a key success factor influencing likelihood of project success (Alleman, 2014. It is noticeable that four out of five papers in this issue of the Journal are authored or co-authored by Iranian researchers from the same Institute but their conclusions bear importance that cannot be limited to the authors’ region.
This Environmental Restoration (ER) Project Systems Engineering Management Plan (SEMP) describes relevant Environmental Restoration Contractor (ERC) management processes and shows how they implement systems engineering. The objective of this SEMP is to explain and demonstrate how systems engineering is being approached and implemented in the ER Project. The application of systems engineering appropriate to the general nature and scope of the project is summarized in Section 2.0. The basic ER Project management approach is described in Section 3.0. The interrelation and integration of project practices and systems engineering are outlined in Section 4.0. Integration with sitewide systems engineering under the Project Hanford Management Contract is described in Section 5.0
Nappi, Rossella E; Ferdeghini, Francesea; Abbiati, Ileana; Vercesi, Claudia; Farina, Claudio; Polatti, Franco
We performed an open study to investigate the use of electrical stimulation (ES) on the vestibular area and vaginal introitus in women with sexual pain disorders. We recruited 29 women (age range 20-45 years) from among the patients at our Reproductive Psychobiology Unit to participate in the present study. They each experienced vestibular pain, inducing dyspareunia and vaginism. We performed ES with an ECL43400 apparatus (Elite, EssediEsse srl, Milan, Italy) once a week for 10 weeks. To evaluate the muscular activity of the perineal floor and sexual function, we employed the same apparatus with a vaginal probe for recording myoelectrical activity (muV), we employed a VAS scale for evaluating pain, and we administered the Female Sexual Function Index (FSFI; Rosen et al., 2000) before and after the study protocol. We analyzed data by parametric and nonparametric comparisons and correlations, as appropriate. Our major findings were as follows: (a) the contractile ability of pelvic floor muscles (p vaginism went back to coital activity; (d) FSFI pain score and the current intensity tolerated, both before (R = .59; p < 0.006) and at the end (R = .53; p < 0.02) of the stimulation protocol, positively correlated. ES may be effective in the management of sexual pain disorders. Further controlled studies are necessary to standardize stimulation protocols according to the severity of pain and to better clarify the long-term clinical effects of ES.
Loeber, Anne; Vermeulen, T.
The Aristotelian notion of phronèsis inspired innovative work in the realm of project management as well as in literature on sustainability and societal transformations. We argue that both literatures may benefit from a dialogue between the two, especially in view of outlining project
This study analyzed client's related factors that constrain project management success of public and private sector construction in Nigeria. Issues that concern clients in any project can not be undermined as they are the owners and the initiators of project proposals. It is assumed that success, failure or abandonment of ...
Дмитрий Георгиевич БЕЗУГЛЫЙ
The methods and tools of the developed project promotion, the planning system of promotion strategy are suggested; the main approaches used in the project promotion have been identified. The conclusions about the importance, necessity and role in the promotion of a holistic project management system have been made.
Sasaki, Shigeru; Arai, Masayuki; Takai, Kumiko; Ogawa, Mitsuhiro; Watanabe, Hiroyoshi
In this study, the role-playing situation and the system requirement list are adopted into project-based learning classes to develop web applications. In the classes, the third-year undergraduate project managers communicate with the client of the project rolled by teachers on the Web bulletin board. These are expected to act as scaffolds to…
Carcillo, Anthony Joseph, Jr.
Although it is assumed that increasing the institutionalization (or maturity) of project management in an organization leads to greater project success, the literature has diverse views. The purpose of this mixed methods study was to examine the correlation between project management maturity and IT/IS project outcomes. The sample consisted of two…
The intention of this paper is to provide helpful information and tips for the purchaser with regard to the project management of a DCS upgrade for an existing nuclear power station operator-training simulator. This paper was written shortly after STS Powergen completed two nuclear power station simulator DCS projects in the USA. Areas covered by this paper are: - Contractual documents and arrangements; - Licence and Escrow agreements; - Liquidated damages; - Project management; - Project schedules and resources; - Monitoring progress; - Defect reporting; - DCS automation code; - Access to proprietary information; - Tips for project meetings; - Testing; - Cultural issues; - Training
The term project is a widely used phrase in today’s working life. This thesis explains what project management theory is, how it has evolved through history and how it is applied in managing modern business projects in the contexts of the Finnish music business sector. The literature review contains a description of the key phases a project is typically organised in as well as the terms and tools used to plan and run a successful project. Through qualitative research means the thesis inves...
An updated and revised edition of the bestselling guide to managing projects For any professional responsible for coordinating projects among different departments, across executive levels, or with technical complexity, The Fast Forward MBA in Project Management offers comprehensive instruction on how to deliver on time and on budget. Get the step-by-step advice you need to find the right sponsor, clarify objectives, and set realistic schedules and budget projections. This Fourth Edition of the 200,000-copy bestseller now covers critical new topics including: software and IT projects, agile te
Cuellar, Norma G
Pain is a physical, emotional and psychologic phenomenon that is often ignored in older adults causing depression and poor quality of life. Older adults report the use of complementary and alternative medicine in some form with 80% of these users reporting improvement in their health conditions. Although physical pain in the older adult is usually managed with pharmacologic interventions, methods that may reduce the use of prescription drugs may decrease adverse effects that can compromise the physiologic state of the older adult. Hypnosis has continued to gain acceptance within mainstream medicine as an appropriate treatment and can be integrated safely with conventional medicine as an effective treatment for a variety of conditions in the older adult. It is an intervention that can be used for relaxation and pain control, especially when conventional pharmacologic regimens have failed. The purpose of this article is to review the concepts related to pain in older adults; the use of complementary and alternative medicine in the older adult; hypnosis and the older adult (i.e., background, definition, benefits, research, mechanism of action, hypnotizability, and the process); and the implications of using hypnosis for pain management in the older adult.
Schug, Stephan A; Ting, Sonya
Fentanyl is a synthetic, highly selective opioid with many desirable physicochemical properties, including a high lipophilicity and predictable pharmacokinetics. These properties have an established record in the management of pain in a variety of settings, particularly acute pain and breakthrough cancer pain. Fentanyl was initially developed for parenteral use; however, this is invasive and impractical in the outpatient setting. Unfortunately, the high first-pass metabolism of fentanyl makes oral formulations unfeasible. However, its high lipophilicity allows fentanyl to be absorbed via a number of other routes. Thus new formulations were designed to allow non-invasive methods of administration. Transmucosal and transdermal fentanyl formulations are well established, and have proven useful in the settings of breakthrough cancer pain, emergencies and in the paediatric population. The iontophoretic transdermal system was developed to provide a needle-free system of delivering bolus doses of fentanyl on demand, a novel way of delivering patient-controlled opioid analgesia. Transpulmonary administration of fentanyl remains experimental. The aim of this review is to provide an update on current non-parenteral fentanyl formulations, with attention to their particular pharmacokinetics and features relevant to clinical use in pain management.