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Disease Management (disease + management)
Kinds of Disease Management Terms modified by Disease Management Selected AbstractsJOINTLY-DETERMINED ECOLOGICAL THRESHOLDS AND ECONOMIC TRADE-OFFS IN WILDLIFE DISEASE MANAGEMENTNATURAL RESOURCE MODELING, Issue 4 2007ELI P. FENICHEL ABSTRACT. We investigate wildlife disease management, in a bioeconomic framework, when the wildlife host is valuable and disease transmission is density-dependent. Disease prevalence is reduced in density-dependent models whenever the population is harvested below a host-density threshold a threshold population density below which disease prevalence declines and above which a disease becomes epidemic. In conventional models, the threshold is an exogenous function of disease parameters. We consider this case and find a steady state with positive disease prevalence to be optimal. Next, we consider a case in which disease dynamics are affected by both population controls and changes in human-environmental interactions. The host-density threshold is endogenous in this case. That is, the manager does not simply manage the population relative to the threshold, but rather manages both the population and the threshold. The optimal threshold depends on the economic and ecological trade-offs arising from the jointly-determined system. Accounting for this endogene-ity can lead to reduced disease prevalence rates and higher population levels. Additionally, we show that ecological parameters that may be unimportant in conventional models that do not account for the endogeneity of the host-density threshold are potentially important when host density threshold is recognized as endogenous. [source] Heart Failure and Diabetes: Collateral Benefit of Chronic Disease ManagementCONGESTIVE HEART FAILURE, Issue 3 2006Molly G. Ware MD To test the hypothesis that a focus on heart failure (HF) care may be associated with inadequate diabetes care, the authors screened 78 patients (aged 64±11 years; 69% male) with diabetes enrolled in an HF disease management program for diabetes care as recommended by the American Diabetes Association (ADA). Ninety-five percent of patients had hemoglobin A1c levels measured within 12 months, and 71% monitored their glucose at least once daily. Most patients received counseling regarding diabetic diet and exercise, and approximately 80% reported receiving regular eye and foot examinations. Mean hemoglobin A1c level was 7.8±1.9%. There was no relationship between hemoglobin A1c levels and New York Heart Association class or history of HF hospitalizations. Contrary to the authors' hypothesis, patients in an HF disease management program demonstrated levels of diabetic care close to ADA goals. "Collateral benefit" of HF disease management may contribute to improved patient outcomes in diabetic patients with HF. [source] Management of Chronic Hepatitis CJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 10 2001APRN-C, Mary Jo Goolsby EdD One purpose of the Clinical Practice Guideline column is to increase the awareness of the broad availability of existing guidelines and recommendations on various health topics. The hepatitis C virus (HCV) currently accounts for 20% to 40% of acute viral hepatitis, 60% to 80% of chronic hepatitis, and 20% to 30% of cirrhosis, end-stage liver disease, and liver cancer. Nearly four million Americans are currently infected with hepatitis C. Nurse practitioners should be aware of the recommendations regarding the diagnosis, management, and monitoring of the dis ease. This column summarizes the content of two NIH documents regarding the care of patients with hepatitis C: Management of Hepatitis C: NIH Consensus Statement (NIH, 1997) and Chronic Hepatitis C: Current Disease Management (NIDDK, 2000). Readers are encouraged to suggest specific CPGs for future columns or to request that the editor search for and summarize a CPG addressing a common health problem. Readers are also invited to submit a manuscript reviewing CPGs that they find helpful in their area of practice. [source] Recognizing and Reducing the Risks of Helminthic Eosinophilic Meningitis in Travelers: Differential Diagnosis, Disease Management, Prevention, and ControlJOURNAL OF TRAVEL MEDICINE, Issue 4 2009Dr PH, James H. Diaz MD First page of article [source] Anreizkompatibilität als zentrales Element eines neu gestalteten GesundheitsmarktesPERSPEKTIVEN DER WIRTSCHAFTSPOLITIK, Issue 3 2004Thomas Gries Frequently, administrative rules defined by the government or private health (doctor) associations dominate the allocation mechanisms of the health system. These administrative rules along with asymmetric information often cause moral hazard problems leading to vast inefficiencies in the ,Physician-Patient-Market". Therefore, the discussion of efficient health systems should focus on the problem of compatible incentives within the allocation system of the health sector. Even more, without incentive consistency instruments recently suggested to cure the inefficiency of the German system like ,Managed Care", ,Disease Management" or ,Diagnosis Related Groups" will not be able to improve the efficiency of the health system. Introducing these instruments without a full incentive , compatible allocation system covering all segments of the health system will just shift the problem of asymmetric information and moral hazard to another sub-market of the system, the ,Health Insurance,Patient-Market". Therefore, the intention of the paper is to identify the major elements of a suitable incentive , compatible allocation scheme for the health market. Further, we propose an independent evaluation and information institution as a major tool to cure the problem of asymmetric information in the health market. [source] Spray Oils Beyond 2000 , Sustainable Pest and Disease ManagementAUSTRALIAN JOURNAL OF ENTOMOLOGY, Issue 1 2004Roger Broadley No abstract is available for this article. [source] Determining if disease management saves money: an introduction to meta-analysisJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2007Ariel Linden DrPH MS Abstract Disease management (DM) programmes have long been promoted as a major medical cost-saving mechanism, even though the scant research that exists on the topic has provided conflicting results. In a 2004 literature review, the Congressional Budget Office stated that ,there is insufficient evidence to conclude that disease management programs can generally reduce the overall cost of health care services'. To address this question more accurately, a meta-analysis was warranted. Meta-analysis is the quantitative technique used to pool the results of many studies on the same topic and summarize them statistically. This method is also quite suitable for individual DM firms to assess whether their programmes are effective at the aggregate level. This paper describes the elements of a rigorous meta-analytic process and discusses potential biases. A hypothetical DM organization is then evaluated with a specific emphasis on medical cost-savings, simulating a case in which different populations are served, evaluation methodologies are employed, and diseases are managed. [source] Heart Failure and Diabetes: Collateral Benefit of Chronic Disease ManagementCONGESTIVE HEART FAILURE, Issue 3 2006Molly G. Ware MD To test the hypothesis that a focus on heart failure (HF) care may be associated with inadequate diabetes care, the authors screened 78 patients (aged 64±11 years; 69% male) with diabetes enrolled in an HF disease management program for diabetes care as recommended by the American Diabetes Association (ADA). Ninety-five percent of patients had hemoglobin A1c levels measured within 12 months, and 71% monitored their glucose at least once daily. Most patients received counseling regarding diabetic diet and exercise, and approximately 80% reported receiving regular eye and foot examinations. Mean hemoglobin A1c level was 7.8±1.9%. There was no relationship between hemoglobin A1c levels and New York Heart Association class or history of HF hospitalizations. Contrary to the authors' hypothesis, patients in an HF disease management program demonstrated levels of diabetic care close to ADA goals. "Collateral benefit" of HF disease management may contribute to improved patient outcomes in diabetic patients with HF. [source] Management of chronic hand eczemaCONTACT DERMATITIS, Issue 4 2007Thomas L. Diepgen Hand eczema (HE) is one of the most frequent skin diseases and has often a chronically relapsing course with a poor prognosis resulting in a high social and economic impact for the individual and the society. In this article, we highlight the results of an expert workshop on the ,management of severe chronic hand eczema' with the focus on the epidemiology, the burden of severe HE, its classification and diagnostic procedures, and the current status of treatment options according to an evidence-based approach (randomized controlled clinical trials, RCTs). We conclude that despite the abundance of topical and systemic treatment options, disease management in patients with severe chronic HE is frequently inadequate. There is a strong need for RCTs of existing and new treatment options based on clearly diagnosed subtypes of HE and its severity. [source] Are clinical practical guidelines (CPGs) useful for health services and health workforce planning?DIABETIC MEDICINE, Issue 5 2010A critique of diabetes CPGs Diabet. Med. 27, 570,577 (2010) Abstract Aims, Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. Methods, This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. Results, Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. Conclusions, Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely. [source] Psychodrama: helping families to adapt to childhood diabetesEUROPEAN DIABETES NURSING, Issue 3 2006B Bektas RN. Abstract Effective management of diabetes in children requires a holistic approach that takes into account the roles of diabetes education, treatment and disease management, and the integral role of family relationships. Psychodrama is a group-based psychological support technique that aims to improve the acceptance and understanding of diabetes within the families of diagnosed children. Through group improvisation, role plays and feedback sessions, the families of children with diabetes participate in a cathartic process that helps them to share their problems, benefit from others' insight and feedback and to discuss behavioural changes that will avoid similar problems in the future. The families that participated in this study reported an enhanced understanding of the contribution that relationships with their children have on the successful management of their diabetes. Through recognition of the reasons for their anxieties about their children's diabetes, they were able to address fixed behavioural patterns in a supportive, non-judgmental arena, and to work towards positive change. Their children benefited indirectly through changes in their parents' behaviour and improved communication within their families. A reduction in the children's HbA1c levels was observed through the course of the study, although this could not be considered a direct result of psychodrama. Copyright © 2006 FEND. [source] Do cytogenetic abnormalities precede morphologic abnormalities in a developing malignant condition?EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 2 2007Jill K. Northup Abstract Cytogenetic evaluation of bone marrow and neoplastic tissues plays a critical role in determining patient management and prognosis. Here, we highlight two cases in which the cytogenetic studies challenge the common practice of using hematologic and morphologic changes as key factors in malignant disease management. The first case is that of a lymph node sample from a 40-yr-old non-Hodgkin's lymphoma (NHL) patient sent for determination of disease progress. Hematologic studies showed no evidence of transformation to high-grade NHL (>15% blasts with rare mitotic figures). Cytogenetic studies of lymph node showed multiple clonal abnormalities, most notably a der(18) from a t(14;18) which is associated with high-grade NHL. After two cycles of chemotherapy with fludarabine, the patient did not show any clinical response, suggesting possible progression to high-grade lymphoma. The second case is of a patient with a history of human immunodeficiency virus and blastic natural killer leukemia/lymphoma. Hematologic studies of ascitic fluid classified the patient as having pleural effusion lymphoma whereas bone marrow analysis showed no malignancy. Bone marrow cytogenetic studies showed multiple clonal abnormalities including a t(8;14), which is commonly associated with Burkitt's lymphoma (BL). To our knowledge, this is the first case wherein a morphologically normal bone marrow showed presence of clonal abnormalities consistent with BL or Pleural effusion lymphoma. After two cycles of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy, the patient's general condition and ascitis improved and she was discharged. These studies clearly demonstrate that genetic changes often precede morphologic changes in a developing malignant condition. Therefore, the critical information needed for care of patients with malignant disorders may be incomplete or inaccurate if cytogenetic evaluation is overlooked. [source] Resolving Disease Management Problems in European-American and Latino Couples with Type 2 Diabetes: The Effects of Ethnicity and Patient Gender,FAMILY PROCESS, Issue 4 2000Lawrence Fisher Ph.D. The management of type 2 diabetes requires major life style changes. How patients and family members resolve disagreements about disease management affects how well the disease is managed over time. Our goal was to identify differences in how couples resolved disagreements about diabetes management based on ethnicity and patient gender. We recruited 65 Latino and 110 European-American (EA) couples in which one spouse had type 2 diabetes. Couples participated in a 10-minute videotaped, revealed differences interaction task that was evaluated with 7 reliable observer ratings: warm-engagement, hostility, avoidance, amount of conflict resolution, off-task behavior, patient dominance, and dialogue. A series of 2 × 2, Ethnicity × Sex ANOVAs indicated significant effects for Ethnicity and for the Ethnicity × Sex interaction, but not for Sex. Latino couples were rated as significantly more emotionally close, less avoidant, less hostile toward each other, and had less dominant patients than EA couples; however, Latino couples achieved significantly less problem resolution and were more frequently off-task than EA couples. These findings were qualified by patient gender. The findings highlight important differences in how couples manage diabetes based on ethnicity and patient gender, and suggest that effective family-based programs of intervention must take both characteristics into account. [source] Analysis of the distribution of Phytophthora cinnamomi in soil at a disease site in Western Australia using nested PCRFOREST PATHOLOGY, Issue 2 2009N. Williams Summary The oomycete plant pathogen Phytophthora cinnamomi has infected a very large area of native vegetation in the south western corner of Australia. An important aspect of effective disease management depends on being able to accurately map areas of infestation. For this purpose, we have developed a nested polymerase chain reaction (PCR) protocol for the detection of P. cinnamomi in soil. The test uses two sets of primers developed from the rRNA ITS sequences of P. cinnamomi and can detect as little as 1 pg DNA. The degree of sensitivity was reduced with DNA extracted from soil although this depended on the type of soil. Soils with a high organic content, such as eucalypt forest soil and potting mix were more inhibitory than sandy soils. Inhibition by soil DNA could be reduced by the addition of bovine serum albumin and formamide to the reaction. Taq DNA polymerase was very sensitive to inhibitors compared with Tth+ or TaqF1*. In comparison with baiting (0,10% positive samples), nested PCR proved to be a very much more efficient (90,100% positive samples) method for the detection of P. cinnamomi in soil. [source] Spatial patterns and environmental factors affecting the presence of Melampsorella caryophyllacearum infections in an Abies alba forest in NE SpainFOREST PATHOLOGY, Issue 3 2006A. Solla Summary The presence of trunk swellings caused by the rust fungus Melampsorella caryophyllacearum was systematically surveyed in an Abies alba forest (Irati, NE Spain), using 1237 circular plots (diameter = 18 m). The relationship between fungal presence and several abiotic (aspect, elevation, distance to the nearest river and slope) and biotic factors (basal area of A. alba and/or Fagus sylvatica, shrub, fern and herb cover) was assessed through correlation and ordination analyses. Additionally, the spatial pattern of the presence of diseased trees was described using Ripley's K function. Southern-aspect plots had a significantly lower presence of diseased trees than plots-oriented north, east and west. Plots with diseased trees were located at a significantly lower elevation, and at a shorter distance to the river than plots without infections. Plots with diseased trees had almost twice the average A. alba basal area, and less average F. sylvatica basal area than plots without diseased trees. However, similar mean values of slope and shrub, fern and herb cover were found in both types of plots. The disease showed spatial aggregation in patches with a mean radius of ca. 900 m. The implications of the results for disease management are discussed. Résumé La présence de renflements sur les troncs causés par l'agent de la rouille, Melampsorella caryophyllacearum, a étéétudiée de façon systématique dans une forêt d'Abies alba (Irati, NE Espagne), en utilizant 1237 placettes circulaires (diamètre de 18 m). Les relations entre la présence du champignon et divers facteurs abiotiques (orientation, altitude, distance à la rivière la plus proche, pente) et biotiques ( surface terrière de A. alba et/ou Fagus sylvatica, abondance de la couverture herbacée et abondance d'arbustes et fougères) ont étéétudiées par analyses de corrélation et d'ordination. D'autre part, la structure spatiale de la présence d'arbres infectés a été décrite en utilizant la fonction K de Ripley. Les placettes exposées au sud présentent moins fréquemment des arbres malades que celles exposées au nord, à l'est ou à l'ouest. Les placettes avec des arbres malades sont situées à une altitude significativement plus faible et à une distance plus faible d'une rivière que les placettes sans infections, et elles présentent une surface terrière 2 fois plus forte en moyenne pour A. alba, et plus faible pour F. sylvatica, que les placettes non-infectées. Toutefois, des valeurs moyennes équivalentes pour la pente, la couverture herbacée et l'abondance d'arbustes et fougères, sont observées pour les deux types de placettes. La maladie montre une agrégation spatiale en foyers d'un rayon moyen de 900 m. Les résultats sont discutés dans une perspective de gestion de la maladie. Zusammenfassung Das Vorkommen von durch den Rostpilz Melampsorella caryophyllacearum verursachten Stammdeformationen wurde in einem Abies alba - Wald (Irati, NO-Spanien) auf 1237 kreisförmigen Probeflächen (Durchmesser 18 m) systematisch erfasst. Die Beziehung zwischen dem Pilzvorkommen und mehreren abiotischen (Exposition, Meereshöhe, Distanz zum nächsten Fluss, Hangneigung) und biotischen Faktoren (Deckungsgrad von A. alba und/oder Fagus sylvatica, Strauch-, Farn- und Krautschicht) wurden durch Korrelations- und Ordinations-Analysen überprüft. Zudem wurden räumliche Muster der befallenen Bäume mit Hilfe von Ripley's K-Funktion beschrieben. In südexponierten Probeflächen kamen signifikant weniger erkrankte Bäume vor als in nach Norden, Osten und Westen orientierten Standorten. Flächen mit Befall lagen in signifikant geringerer Meereshöhe und kürzerer Distanz zum nächsten Fluss als solche ohne Befall. Zudem hatten sie beinahe die doppelte Basalfläche mit A. alba und eine durchschnittliche geringere Basalfläche mit F. sylvatica. Die durchschnittlichen Werte für die Strauch-, Farn- und Krautschicht sowie die Hangneigung unterschieden sich jedoch nicht in den Flächen mit und ohne Befall. Erkrankte Bäume waren räumlich aggregiert mit einem mittleren Radius von ca. 900 m. Die Bedeutung dieser Befunde für das Krankheitsmanagement wird diskutiert. [source] Saxagliptin: a new option for the management of type 2 diabetesFUTURE PRESCRIBER, Issue 3 2009MD Consultant Diabetologist, Marc Evans MRCP Incretin-based therapies for the treatment of diabetes mellitus (T2DM) present a new approach to disease management. Over recent years, several new drugs have entered the marketplace, and NICE have recently issued guidance on how best to incorporate these new drugs into treatment regimens. In this article, Marc Evans reviews saxagliptin, a dipeptidyl peptidase-IV (DPP-IV) inhibitor, and considers its potential clinical use. Copyright © 2009 John Wiley & Sons, Ltd. [source] What is the perceived nature of parental care and support for young people with cystic fibrosis as they enter adult health services?HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2010Nicola Iles RN MSc Abstract The majority of those diagnosed with cystic fibrosis (CF) now live to adulthood. In response to increased survival age, transition services have been developed to ensure smooth transfer from paediatric to adult specialist healthcare, although the majority of treatment and care continues to be delivered in the home. However, little is known about how young adults and staff conceptualise the nature of the parental role after young people have left paediatric care. The aim of this study is to explore the nature of parental support that is perceived to be available at this time. As part of a larger study of transitional care, semi-structured interviews were conducted with 50 young people with CF aged 13,24 years (32 with experience of transition and/or adult CF services) and 23 specialist healthcare professionals (14 working in adult care) across two CF centres in Southeast England. Interviews took place in young people's homes or within CF services, using a topic guide and were recorded, transcribed and analysed thematically. Four domains of perceived parental support were identified by the young people interviewed, with varying degrees of continuity into adult care: (1) Providing non-clinical practical and emotional support; (2) Acting as ,troubleshooters' in times of health-related crisis; (3) Working in partnership with offspring in ongoing disease management in the home and clinic; (4) Acting as ,protectors' of their children. Young people and service staff expressed tensions in managing parental involvement in post-paediatric consultations and the degree to which parents should be aware of their offspring's deteriorating health and social concerns. Parental anxiety and over-involvement was perceived by many young people and staff as unsupportive. We suggest that although health and social care providers are mindful of the tensions that arise for those leaving paediatric services, the place of parental support in adult care is currently contentious for these ,new' ageing populations. [source] A Comparison of Clinically Important Differences in Health-Related Quality of Life for Patients with Chronic Lung Disease, Asthma, or Heart DiseaseHEALTH SERVICES RESEARCH, Issue 2 2005Kathleen W. Wyrwich Objective. On the eight scales of the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36), Version 2, we compared the clinically important difference (CID) thresholds for change over time developed by three separate expert panels of physicians with experience in quality of life assessment among patients with chronic obstructive pulmonary disease (COPD), asthma, and heart disease. Study Design. We used a modified Delphi technique combined with a face-to-face panel meeting within each disease to organize and conduct the consensus process among the expert panelists, who were familiar with the assessment and evaluations of health-related quality of life (HRQL) measures among patients with the panel-specific disease. Principal Findings. Each of the expert panels first determined the magnitude of the smallest numerically possible change on each SF-36 scale, referred to as a state change, and then built their CIDs from this metric. All three panels attained consensus on the scale changes that constituted small, moderate, and large clinically important SF-36 change scores. The CIDs established by the heart disease panel were generally greater than the CIDs agreed on by the asthma and COPD panels. Conclusions. These panel-derived thresholds reflect possible differences in disease management among the represented panel-specific diseases, and are all greater than the minimal CID thresholds previously developed for the SF-36 scales among patients with arthritis. If confirmed among patients with the relevant diseases and those patients' physicians, these disease-specific CIDs could assist both researchers and practicing clinicians in the use and interpretation of HRQL changes over time. [source] Molecular diagnosis of inherited disorders: lessons from hemoglobinopathies,HUMAN MUTATION, Issue 5 2005George P. Patrinos Abstract Hemoglobinopathies constitute a major health problem worldwide, with a high carrier frequency, particularly in certain regions where malaria has been endemic. These disorders are characterized by a vast clinical and hematological phenotypic heterogeneity. Over 1,200 different genetic alterations that affect the DNA sequence of the human ,-like (HBZ, HBA2, HBA1, and HBQ1) and ,-like (HBE1, HBG2, HBG1, HBD, and HBB) globin genes are mainly responsible for the observed clinical heterogeneity. These mutations, together with detailed information about the resulting phenotype, are documented in the globin locus-specific HbVar database. Family studies and comprehensive hematological analyses provide useful insights for accurately diagnosing thalassemia at the DNA level. For this purpose, numerous techniques can provide accurate, rapid, and cost-effective identification of the underlying genetic defect in affected individuals. The aim of this article is to review the diverse methodological and technical platforms available for the molecular diagnosis of inherited disorders, using thalassemia and hemoglobinopathies as a model. This article also attempts to shed light on issues closely related to thalassemia diagnostics, such as prenatal and preimplantation genetic diagnoses and genetic counseling, for better-quality disease management. Hum Mutat 26(5), 399,412, 2005. © 2005 Wiley-Liss, Inc. [source] Preliminary evidence supporting a framework of psychological adjustment to inflammatory bowel disease,INFLAMMATORY BOWEL DISEASES, Issue 10 2010Jennifer L. Kiebles PhD Abstract Background: Adjustment to chronic disease is a multidimensional construct described as successful adaptation to disease-specific demands, preservation of psychological well-being, functional status, and quality of life. Inflammatory bowel disease (IBD) can be particularly challenging due to the unpredictable, relapsing and remitting course of the disease. Methods: All participants were patients being treated in an outpatient gastroenterology clinic at a university medical center. Participants completed a survey of questionnaires assessing illness perceptions, stress, emotional functioning, disease acceptance, coping, disease impact, and disease-specific and health-related quality of life. Adjustment was measured as a composite of perceived disability, psychological functioning, and disease-specific and health-related quality of life. Results: Participants were 38 adults with a diagnosis of either Crohn's disease (45%) or ulcerative colitis (55%). We observed that our defined adjustment variables were strongly correlated with disease characteristics (r = 0.33,0.80, all P < 0.05), an emotional representation of illness (r = 0.44,0.58, P < 0.01), disease acceptance (r = 0.34,0.74, P < 0.05), coping (r = 0.33,0.60, P < 0.05), and frequency of gastroenterologist visits (r = 0.39,0.70, P < 0.05). Better adjustment was associated with greater bowel and systemic health, increased activities engagement and symptom tolerance, less pain, less perceived stress, and fewer gastroenterologist visits. All adjustment variables were highly correlated (r = 0.40,0.84, P < 0.05) and demonstrated a cohesive composite. Conclusions: The framework presented and results of this study underscore the importance of considering complementary pathways of disease management including cognitive, emotional, and behavioral factors beyond the traditional medical and psychological (depression and anxiety) components. (Inflamm Bowel Dis 2010) [source] Effectiveness of general practice nurse interventions in cardiac risk factor reduction among adultsINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 3 2007Elizabeth Halcomb RN BN(Hons) Grad Cert. Abstract Background, Cardiovascular disease is the leading cause of death for adults in Australia. In recent years there has been a shift in health service delivery from institutional to community-based care for chronic conditions, including cardiovascular disease. The general practice setting is seen to offer greater flexibility, higher levels of efficiency and more client focused healthcare delivery than is possible in the acute care sector. It has been suggested that practice nurses represent a useful adjunct to current models of cardiovascular disease management. To date, significant descriptive research has been conducted exploring the demographics, roles, educational needs and issues facing practice nurses. However, there is a need to evaluate the effectiveness of practice nurse interventions in terms of patient outcomes, clinician satisfaction and cost-effectiveness. Objectives, This review seeks to present the best available evidence regarding the efficacy of general practice nurse interventions for cardiac risk factor reduction in healthy adults, as well as those with established cardiovascular disease or known cardiac risk factors. Search Strategy, A systematic literature search was performed using Medline (1966 , 2005), CINAHL (1982 ,2005), Cochrane Controlled Trials Register (Issue 4, 2005) and the Joanna Briggs Institute Evidence Library. In addition, the reference lists of retrieved papers, conference proceedings and the Internet, were scrutinised for additional trials. Selection Criteria, This review considered any English language randomised trials that investigated interventions conducted by the practice nurse for cardiovascular disease management or reduction of cardiac risk factors. Interventions conducted by specialist cardiac nurses in general practice were excluded. Outcomes measured included blood pressure, smoking cessation, total cholesterol, exercise, body weight/body mass index and cost-effectiveness. Results, Eighteen trials, reported in 33 papers, were included in the review. Ten trials investigated multifaceted interventions, while the remaining eight trials reported targeted interventions. Of the trials that reported multifaceted interventions, three trials investigated risk reduction in those with established cardiovascular disease, four trials focused on those with known cardiovascular disease risk factors and three trials included the general community. The eight trials which examined the efficacy of targeted interventions focused upon dietary intake (two trials), smoking cessation (three trials), weight reduction (one trial) and physical activity (two trials). The effect of both the multifaceted and targeted interventions on patient outcomes was variable. However, both the multifaceted and targeted interventions demonstrated similar outcome trends for specific variables. Improvements were demonstrated by most studies in blood pressure, cholesterol level, dietary intake and physical activity. The variation in outcome measures and contradictory findings between some studies makes it difficult to draw definitive conclusions. Conclusions, While interventions to reduce cardiovascular disease risk factors have produced variable results, they offer significant potential to assist patients in modifying their personal risk profile and should be developed. The public health importance of these changes is dependant upon the sustainability of the change and its effect on the health outcomes of these individuals. Further well-designed research is required to establish the effectiveness of practice nurse interventions for cardiovascular disease management and risk factor reduction in terms of patient outcomes and cost-effectiveness. [source] Systematic review of the effectiveness of primary care nursingINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 1 2009Helen Keleher This paper reports on a systematic review that sought to answer the research question: What is the impact of the primary and community care nurse on patient health outcomes compared with usual doctor-led care in primary care settings? A range of pertinent text-words with medical subject headings were combined and electronic databases were searched. Because of the volume of published articles, the search was restricted to studies with high-level evidence. Overall, 31 relevant studies were identified and included in the review. We found modest international evidence that nurses in primary care settings can provide effective care and achieve positive health outcomes for patients similar to that provided by doctors. Nurses are effective in care management and achieve good patient compliance. Nurses are also effective in a more diverse range of roles including chronic disease management, illness prevention and health promotion. Nevertheless, there is insufficient evidence about primary care nurses' roles and impact on patient health outcomes. [source] Information Therapy: the strategic role of prescribed information in disease self-managementINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2005Molly METTLER Abstract Information Therapy is a new disease management tool that provides cost-effective patient support to a much larger portion of the chronically ill population than is generally reached. Defined as the prescription of specific, evidence-based medical information to a specific patient, caregiver, or consumer at just the right time to help them make a specific health decision or take a self-management action, Information Therapy can be electronically integrated into the process of care. Information prescriptions made available through Information Therapy will support efforts to improve health outcomes and quality in disease management. [source] Activating Seniors to Improve Chronic Disease Care: Results from a Pilot Intervention StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2010Dominick L. Frosch PhD OBJECTIVES: To evaluate the effect of an activation intervention delivered in community senior centers to improve health outcomes for chronic diseases that disproportionately affect older adults. DESIGN: Two-group quasi-experimental study. SETTING: Two Los Angeles community senior centers. PARTICIPANTS: One hundred sixteen senior participants. INTERVENTION: Participants were invited to attend group screenings of video programs intended to inform about and motivate self-management of chronic conditions common in seniors. Moderated discussions reinforcing active patient participation in chronic disease management followed screenings. Screenings were scheduled over the course of 12 weeks. MEASUREMENTS: One center was assigned by coin toss to an encouragement condition in which participants received a $50 gift card if they attended at least three group screenings. Participants in the nonencouraged center received no incentive for attendance. Validated study measures for patient activation, physical activity, and health-related quality of life were completed at baseline and 12 weeks and 6 months after enrollment. RESULTS: Participants attending the encouraged senior center were more likely to attend three or more group screenings (77.8% vs 47.2%, P=.001). At 6-month follow-up, participants from either center who attended three or more group screenings (n=74, 64%) reported significantly greater activation (P<.001), more minutes walking (P<.001) and engaging in vigorous physical activity (P=.006), and better health-related quality of life (Medical Outcomes Study 12-item Short-Form Survey (SF-12) mental component summary, P<.001; SF-12 physical component summary, P=.002). CONCLUSION: Delivering this pilot intervention in community senior centers is a potentially promising approach to activating seniors that warrants further investigation for improving chronic disease outcomes. [source] Quality and Outcomes of Heart Failure Care in Older Adults: Role of Multidisciplinary Disease-Management ProgramsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2002Ali Ahmed MD, FACP PURPOSE: To determine whether the management of heart failure by specialized multidisciplinary heart failure disease-management programs was associated with improved outcomes. BACKGROUND: The advent of angiotensin-converting enzyme inhibitors, beta-blockers, and spironolactone has revolutionized the management of heart failure. Randomized double-blind studies have demonstrated survival benefits of these drugs in heart failure patients. Nevertheless, in spite of these advances, heart failure continues to be a syndrome of poor outcomes.1,4 There is also evidence that a significant portion of heart failure patients does not receive this evidence-based therapy that reduces morbidity and mortality.5,7 Various disease-management programs have been proposed and tested to improve the quality of heart failure care. Most of these programs are specialized multidisciplinary heart failure clinics lead by cardiologists or heart failure specialists and conducted by nurses or nurse practitioners. Similar to the Department of Veterans Affairs (VA) multidisciplinary geriatric assessment clinics, these clinics also use many other services, including pharmacists, dietitians, physical therapists, and social workers. Some of these programs also have an affiliated home health service. Several observation studies, using mostly pre- and postcomparison designs, have demonstrated the effectiveness of these programs in the process of care, resource use, healthcare costs, and clinical outcomes in patients with heart failure.8 Risk of hospitalization was reduced by 50% to 85% in six of the studies.8 Subsequently, several randomized trials were conducted to determine the effectiveness of these programs. The purpose of this systematic review was to determine the effectiveness of these programs on mortality and hospitalization rates of heart failure patients. METHODS: Published articles on human randomized trials involving specialized heart failure disease-management programs in all languages were searched using Medline from 1966 to 1999 and other online databases using the following terms and Medical Subject Headings: case management (exp); comprehensive health care (exp); disease management (exp); health services research (exp); home care services (exp); clinical protocols (exp); patient care planning (exp); quality of health care (exp); nurse led clinics; special clinics; and heart failure, congestive (exp). In addition, a manual search of the bibliographies of searched articles was performed to identify articles otherwise missed in the above search. Personal communications were made with three authors to obtain further data on their studies. Using a data abstraction tool, two of the investigators separately abstracted data from the selected articles. Data from the selected studies were combined using the DerSimonian and Laird random effects model and the Mantel-Haenszel-Peto fixed effects model. Meta-Analyst 0.998 software (J. Lau, New England Medical Center, Boston, MA) was used to determine risk ratios (RRs) with 95% confidence intervals (CIs) of mortality and hospitalization for patients receiving care through these specialized programs compared with those receiving usual care. The Cochran Q test was used to test heterogeneity among the studies, and sensitivity analyses were performed to examine the effect of various covariates, such as duration of intervention, and other characteristics of the disease-management programs. RESULTS: The original search resulted in 416 published articles, of which 35 met preliminary selection criteria. Of these, 11 were randomized trials and were selected for the meta-analysis. Studies that were not randomized trials, did not involve heart failure patients or disease-management programs, or had missing outcomes were excluded. Of the 11 studies selected, nine involved specialized follow-up using multidisciplinary teams and the remaining two involved follow-up by primary care physicians and telephone. These studies involved 1,937 heart failure patients with a mean age of 74. The follow-up period ranged from no follow-up (one study) to 1 year (one study). Patients receiving care from specialized heart failure disease-management programs had a 13% lower risk of hospitalization than those receiving usual care (summary RR = 0.87; 95% CI = 0.79,0.96), but the Cochran Q test demonstrated significant heterogeneity among the studies (P = .003). Subgroup analysis of the nine studies using specialized follow-up by a multidisciplinary team showed similar results (summary RR = 0.77, 95% CI = 0.68,0.86; test of heterogeneity, P> .50). Seven of the nine studies did not show any significant association between intervention and reduced hospitalization, but the two studies that used follow up by primary care physicians and telephone failed to show any significant reduction in hospitalization (summary RR = 0.94, 95% CI = 0.75,1.19). In fact, one of the studies demonstrated a higher risk of hospitalization for patients receiving intervention (RR = 1.26, 95% CI = 1.04,1.52). Of the 11 studies, only six reported mortality as an outcome. None of these studies found any association between intervention and mortality (summary RR = 1.15, 95% CI = 0.96,1.37; test of heterogeneity, P> .15). Five of the studies used quality of life or functional status as outcomes, and, of them, only one demonstrated significant positive association. The results of the sensitivity analyses were negative for any significant association with duration of intervention or follow-up or year of study. Eight studies performed cost analyses and seven demonstrated cost-effectiveness of the intervention. CONCLUSIONS: The authors concluded that specialized disease-management programs were cost-effective, and heart failure patients cared for by these programs were more likely to undergo fewer hospitalizations, but the study did not provide any conclusive association between these programs and quality of care or mortality. The authors recommend that disease-management programs involve patient education and specialized follow-up by a multidisciplinary team including home health care. [source] Host culling as an adaptive management tool for chronic wasting disease in white-tailed deer: a modelling studyJOURNAL OF APPLIED ECOLOGY, Issue 2 2009Gideon Wasserberg Summary 1Emerging wildlife diseases pose a significant threat to natural and human systems. Because of real or perceived risks of delayed actions, disease management strategies such as culling are often implemented before thorough scientific knowledge of disease dynamics is available. Adaptive management is a valuable approach in addressing the uncertainty and complexity associated with wildlife disease problems and can be facilitated by using a formal model. 2We developed a multi-state computer simulation model using age, sex, infection-stage, and seasonality as a tool for scientific learning and managing chronic wasting disease (CWD) in white-tailed deer Odocoileus virginianus. Our matrix model used disease transmission parameters based on data collected through disease management activities. We used this model to evaluate management issues on density- (DD) and frequency-dependent (FD) transmission, time since disease introduction, and deer culling on the demographics, epizootiology, and management of CWD. 3Both DD and FD models fit the Wisconsin data for a harvested white-tailed deer population, but FD was slightly better. Time since disease introduction was estimated as 36 (95% CI, 24,50) and 188 (41,>200) years for DD and FD transmission, respectively. Deer harvest using intermediate to high non-selective rates can be used to reduce uncertainty between DD and FD transmission and improve our prediction of long-term epidemic patterns and host population impacts. A higher harvest rate allows earlier detection of these differences, but substantially reduces deer abundance. 4Results showed that CWD has spread slowly within Wisconsin deer populations, and therefore, epidemics and disease management are expected to last for decades. Non-hunted deer populations can develop and sustain a high level of infection, generating a substantial risk of disease spread. In contrast, CWD prevalence remains lower in hunted deer populations, but at a higher prevalence the disease competes with recreational hunting to reduce deer abundance. 5Synthesis and applications. Uncertainty about density- or frequency-dependent transmission hinders predictions about the long-term impacts of chronic wasting disease on cervid populations and the development of appropriate management strategies. An adaptive management strategy using computer modelling coupled with experimental management and monitoring can be used to test model predictions, identify the likely mode of disease transmission, and evaluate the risks of alternative management responses. [source] The effects of reducing population density on contact rates between brushtail possums: implications for transmission of bovine tuberculosisJOURNAL OF APPLIED ECOLOGY, Issue 5 2002Dave Ramsey Summary 1Interactions during mating are thought to be an important mechanism for transmission of tuberculosis (Tb) Mycobacterium bovis in the brushtail possum Trichosurus vulpecula . However, little information is available on the frequency of contacts between males and females in oestrus during the breeding season, and the relationship between mating contacts and population density. 2We used radio-telemetry to record contacts between male and oestrous and non-oestrous female possums, and determined paternity of offspring using DNA analysis. This was repeated following the removal of c . 70% of the resident possums to determine the effect of reducing density on the contact rate. 3We could not detect any significant differences in the contact rate between oestrous and non-oestrous females and males, either before or after the density reduction, even when paternity was positively identified from DNA analysis. This suggests that actual mating contacts could not be distinguished from other agonistic or affiliative contact behaviours. 4Despite this, the relationships between male,female and male,male contact rates and population density were non-linear convex-up, implying that the contact rate during the breeding season did not decrease in proportion to reductions in density. This appeared to be driven by the enlargement of male ranges and a corresponding increase in male overlap of female ranges following the density reduction. 5The form of the contact rate function will influence predictions of disease spread in epidemiological models for Tb in wildlife. This has major implications for the development of tactical approaches to disease management based on such models. [source] Post-discharge health care needs of patients after lung cancer resectionJOURNAL OF CLINICAL NURSING, Issue 17-18 2010Kwua-Yun Wang Aims and objective., To determine the health care needs of patients after surgical resection of lung cancer at discharge and evaluate the significance of factors associated with such needs. Background., Other studies have found that symptom distress level, social supports and health beliefs are associated with health care needs. Design., Sixty-two participants were recruited from a thoracic surgery clinic at a medical centre in Taipei from July,December 2005. Data related to demographic variables, disease characteristics, functional status, symptom distress and social support were collected. Methods., The patients were administered the Karnofsky Performance Scale, the Symptom Distress Scale,Chinese Modified Form, the Social Support Scale (adapted from the Interpersonal Support Evaluation List), the Health Needs Scale and self-reported rating scales for pain. Data were analysed using Pearson's correlation coefficients and linear regression models. Results., Pulmonary function was found to be correlated with the level of need for health care information and physiological care. Self-perceived symptom distress and degree of distress were also correlated with levels of need for information, physiological care and psychosocial care. The level of pain was found to be correlated with the level of need for health care information and physiological care. After controlling for pain level, multivariate analysis revealed that self-perceived symptom severity (p = 0·032) and degree of distress (p = 0·043) were modestly correlated with the need for health care. Conclusions., Pulmonary function, self-perceived symptom distress, degree of distress and level of pain were correlated with the level of need for health care information and physiological care. Self-perceived symptom severity and degree of distress were independent predictors of health care needs. Relevance to clinical practice., Administration of relevant questionnaires to assess postoperative symptom distress may be necessary for optimal disease management. [source] Review of nursing care for patients undergoing percutaneous coronary intervention: a patient journey approachJOURNAL OF CLINICAL NURSING, Issue 17 2009John X Rolley Aim., To evaluate the existing literature to inform nursing management of people undergoing percutaneous coronary intervention. Background., Percutaneous coronary intervention is an increasingly important revascularisation strategy in coronary heart disease management and can be an emergent, planned or rescue procedure. Nurses play a critical role in delivering care in both the independent and collaborative contexts of percutaneous coronary intervention management. Design., Systematic review. Method., The method of an integrative literature review, using the conceptual framework of the patient journey, was used to describe existing evidence and to determine important areas for future research. The electronic data bases CINAHL, Medline, Cochrane and the Joanna Briggs data bases were searched using terms including: (angioplasty, transulminal, percutaneous coronary), nursing care, postprocedure complications (haemorrhage, ecchymosis, haematoma), rehabilitation, emergency medical services (transportation of patients, triage). Results., Despite the frequency of the procedure, there are limited data to inform nursing care for people undergoing percutaneous coronary intervention. Currently, there are no widely accessible nursing practice guidelines focusing on the nursing management in percutaneous coronary intervention. Findings of the review were summarised under the headings: Symptom recognition; Treatment decision; Peri-percutaneous coronary intervention care, describing the acute management and Postpercutaneous coronary intervention management identifying the discharge planning and secondary prevention phase. Conclusions., Cardiovascular nurses need to engage in developing evidence to support guideline development. Developing consensus on nurse sensitive patient outcome indicators may enable benchmarking strategies and inform clinical trial design. Relevance to clinical practice., To improve the care given to individuals undergoing percutaneous coronary intervention, it is important to base practice on high-level evidence. Where this is lacking, clinicians need to arrive at a consensus as to appropriate standards of practice while also engaging in developing evidence. This must be considered, however, from the central perspective of the patient and their family. [source] An exploration of mothers' and fathers' views of their identities in chronic-kidney-disease management: parents as students?JOURNAL OF CLINICAL NURSING, Issue 23 2008Veronica Swallow Aim., To explore parents' views of their identities as they learn to manage their child's chronic kidney disease. Background., Parents are expected to participate in management and usually learn necessary skills from the multidisciplinary team. Research highlights the importance of professionals defining parents' management roles in chronic disease; but little is known about parents' views on their own identities as the complex and dynamic process of teaching and learning unfolds around their child's condition. According to positioning theory, identity development is a dynamic and fluid process that occurs during interaction, with each person positioning themselves while simultaneously positioning the other person, yet this concept has not been considered in relation to parents' contributions to disease management. Design., A longitudinal, grounded theory study conducted in a UK Children's Kidney Unit. Method., This paper focuses on one aspect of a larger study exploring family learning in disease management. Six mothers and two fathers of six children with a recently diagnosed chronic kidney disease participated in a total of 21 semi-structured interviews during the 18 months after referral to the unit. Interviews included discussion about the parts they played in relation to professionals during the management process. Findings were interpreted within a framework of positioning theory. Results., Parents participated in teaching/learning/assessment that was both planned (involving allocated clinical lessons and tasks) and spontaneous (in response to current situations), to facilitate their participation. They positioned multidisciplinary team members as teachers as well as professionals, simultaneously positioning themselves as students as well as parents. Conclusion., Parents' clinical duties and obligations are not an automatic part of parenting but become part of the broader process of sharing disease management, this can lead to them assuming the additional identity of a ,student'. Relevance to clinical practice., Involving parents in ongoing discussions about their positions in management may help promote their active and informed participation. [source] | |||||||||||||||||||||||||||||||||||||||||||