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Management Program (management + program)
Kinds of Management Program Selected AbstractsMigraine Education Improves Quality of Life in a Primary Care SettingHEADACHE, Issue 4 2010Timothy R. Smith MD (Headache 2010;50:600-612) Objective., The objective of this study was to evaluate the effectiveness of the Mercy Migraine Management Program (MMMP), an educational program for physicians and patients. The primary outcome was change in headache days from baseline at 3, 6, and 12 months. Secondary outcomes were changes in migraine-related disability and quality of life, worry about headaches, self-efficacy for managing migraines, emergency room (ER) visits for headache, and satisfaction with headache care. Background., Despite progress in the understanding of the pathophysiology of migraine and development of effective therapeutic agents, many practitioners and patients continue to lack the knowledge and skills to effectively manage migraine. Educational efforts have been helpful in improving the quality of care and quality of life for migraine sufferers. However, little work has been performed to evaluate these changes over a longer period of time. Also, there is a paucity of published research evaluating the influence of education about migraine management on cognitive and emotional factors (for example, self-efficacy for managing headaches, worry about headaches). Methods., In this open-label, prospective study, 284 individuals with migraine (92% female, mean age = 41.6) participated in the MMMP, an educational and skills-based program. Of the 284 who participated in the program, 228 (80%) provided data about their headache frequency, headache-related disability (as measured by the Headache Impact Test-6 (HIT-6), migraine-specific quality of life (MSQ), worry about headaches, self-efficacy for managing headaches, ER visits for headaches, and satisfaction with care at 4 time points over 12 months (baseline, 3 months, 6 months, 12 months). Results., Overall, 46% (106) of subjects reported a 50% or greater reduction in headache frequency. Over 12 months, patients reported fewer headaches and improvement on the HIT-6 and MSQ (all P < .001). The improvement in headache impact and quality of life was greater among those who had more worry about their headaches at baseline. There were also significant improvements in "worry about headaches,""self-efficacy for managing headaches," and "satisfaction with headache care." Conclusion., The findings demonstrate that patients participating in the MMMP reported improvements in their headache frequency as well as the cognitive and emotional aspects of headache management. This program was especially helpful among those with high amounts of worry about their headaches at the beginning of the program. The findings from this study are impetus for further research that will more clearly evaluate the effects of education and skill development on headache characteristics and the emotional and cognitive factors that influence headache. [source] Low level laser therapy for healing acute and chronic wounds , the extendicare experienceINTERNATIONAL WOUND JOURNAL, Issue 2 2008Anita E Saltmarche Abstract The purpose of the study is to assess the effectiveness of low level laser therapy for wound healing when combined with the Extendicare Wound Prevention and Management Program. Sixteen residents at a Canadian Extendicare nursing home had a total of 27 sites treated consisting of 23 open wounds and 4 ,at risk' areas. Of the 23 open wounds, two wounds in between toes were not able to be ,traced' and deemed ,immeasurable' wounds, resulting in 21 open, measured wounds. The four ,at risk' (closed) areas were treated preventatively. Pressure, venous insufficiency and diabetic wounds were included. The majority (12/21) or 57·1%, of the wounds were chronic (,3 months duration) and 42·9% were acute (<3 months duration). The primary outcome measures included the PUSH Tool score, EZ GraphTM tracings and photographs. Secondary outcome measures were employed to better understand potential barriers to successful integration into clinical practice. Feedback on the effectiveness of low level laser therapy, the education program and determinations of hands-on relevance was sought from staff. At the end of the 9-week trial, the majority (61·9%) of the 21 wounds achieved significant improvement (,50% wound closure). Nine (42·8%) had 100% closure. Some improvement was seen in 14·3% and 23·8% of wounds demonstrated no change. Chronic and acute wounds had similar improvement. None of the wounds in this debilitated, frail population deteriorated during the study and no negative consequences of treatment were encountered. Without staff support, even if new technology has positive clinical outcomes, success would be limited. Staff rated low level laser, easy to learn and use, effective for the majority of their residents worth the additional time. Staff requested a continuation of low level laser even after study completion. [source] Environmental Allergens and Irritants in Schools: A Focus on AsthmaJOURNAL OF SCHOOL HEALTH, Issue 1 2002Susan R. Tortolero ABSTRACT: As part of the Partners in School Asthma Management Program, environmental data were collected from 385 rooms in 60 elementary schools in southeast Texas, using an Environmental Observation Checklist and a Q-TRAK Indoor Air Quality Monitor. Dust samples for allergen analysis were collected from floors, carpets, and area rugs in 80 classrooms in a subset of 20 schools. CO2 levels >1,000 ppm were found in 86% of rooms; 69% had indoor humidity above recommended levels. Der p I dust mite allergen levels >2,000 ng/g were present in 20% of rooms, but only 2.5% of rooms had Der f I mite allergen levels exceeding recommended tolerances. Detectable levels of cockroach allergen (Bla g II) were found in all schools (median 5.5 ng/g), with 10% of rooms over the recommended threshold. Almost two-thirds of classrooms had mold spore counts >10,000 col/g (median, 14,400 col/g; range, 2,000 , 52,000 col/g). [source] A serosurvey of Coxiella burnetii infection in children and young adults in South West QueenslandAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2010Neil Parker Abstract Objective: To describe the seroepidemiology of Coxiella burnetii, the causative agent of Q fever, in those under 25 years of age in South West Queensland. Methods: A convenience sample of residual sera from a diagnostic laboratory was tested for C. burnetii antibodies by immunofluorescence at 1:10 dilution. Prevalence and annual incidence were calculated from the results. Results: Twenty-nine of 447 (6.5%, 95% CI 4.5%-9.2%) samples were positive. Seropositivity increased from 2.5% in those <15 (95% CI 1.0%-5.5%) to 11.0% in those 15-24 years old (95% CI 7.4%-16.0%). The estimated annual incidence for the latter age group was 7.7 per 1,000. Conclusions: Q fever is a relatively common infection in South West Queensland, even in those aged <15 years for whom the vaccine is not recommended. Implications: Vaccination programs, such as the federally funded National Q fever Management Program, are needed in this and similar high risk rural areas. [source] Older and Younger Adults in Pain Management Programs in the United States: Differences and SimilaritiesPAIN MEDICINE, Issue 2 2006Harriët M. Wittink PhD ABSTRACT Objectives., 1) To investigate health status of older (,60 years) and younger adults (<60 years) with chronic pain and to separately compare that with existing normative data; and 2) to examine more fully differences in health status between younger and older adults with chronic pain and explore their geographic variation across three multidisciplinary pain programs in the Pacific, Mountain, and New England regions of the United States. Design., We performed a cross-sectional analysis. Patients., Initial assessments of 6,147 patients dating from January 1998 to January 2003 were used. Outcomes Measures., We used the Treatment Outcomes of Pain Survey (TOPS), a disease-specific instrument that includes the Short Form-36. Results., The health status of the older pain patients in terms of their actual scores was comparable with that of younger pain patients across the three sites. Health status is impaired to a lesser degree in older than in younger adults with chronic pain as compared with normative adults. Statistically significant differences were found in a number of domains of the TOPS. Older adults with chronic pain present with pain intensity similar to that of younger patients with chronic pain, but report better mental health (P < 0.002), less fear-avoidance (P < 0.05), less passive coping (P < 0.0001), more life control (P < 0.05), and more lower body physical limitations (P < 0.005) than younger patients with chronic pain. Conclusions., Older adults with chronic pain differ in a number of important domains from younger adults with chronic pain: overall the former present with greater physical, and less psychosocial impairment. [source] Administrative Characteristics of Comprehensive Prenatal Case Management ProgramsPUBLIC HEALTH NURSING, Issue 5 2003L. Michele Issel Ph.D., R.N. Abstract The purpose of this study was to examine comprehensive prenatal case management programs in terms of organizational, program, and process characteristics. Data from 66 program surveys of government agencies were used. Organizational capacity was measured as extent of organizational change and extent of interagency agreements. Program data included age and size of the program, reasons for having case management, and funding diversity. Process data were eight types of interventions. The most highly rated reason for having case management was to improve client outcomes. The greatest organizational change was in the area of the organizational structure, followed by financial status and types of services provided. Contracts with other agencies were rare. Agencies with more interagency contacts reported higher levels of change in the case management department and turnover among mid-level managers. Older programs had fewer employees. Approximately 49% of client contacts were not billed to Medicaid. Larger programs had significantly less time allocated to emotional support and coaching. Data on organizational characteristics, program, and process variables provide insights into comprehensive case management. Relationships among these variables underscore the importance of studying client outcomes within the context of program and organizational idiosyncrasies. Future studies of comprehensive prenatal case management should focus on cross-level questions. [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] The Effect of Anemia on Mortality in Indigent Patients With Mild-to-Moderate Chronic Heart FailureCONGESTIVE HEART FAILURE, Issue 2 2006Kathy Hebert MD Anemia has been described as an independent predictor of death in patients with chronic heart failure. Little is known, however, about the significance of anemia in heart failure patients with severely depressed socioeconomic backgrounds who receive comprehensive care in a heart failure management program. The impact of anemia on mortality was investigated in 410 indigent chronic heart failure patients, the majority of whom were in New York Heart Association functional class I,III and were treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and , blockers at maximally tolerated doses. Anemia was present in 28% of patients. In an adjusted Cox analysis, anemia was strongly associated with mortality, but only in men: hazard ratio, 2.54; 95% confidence interval, 1.31,4.93; p=0.006. The investigators conclude that anemia in this population is common and that, for men, the relative risk increase associated with anemia is high. [source] Using Buyer,Supplier Performance Frontiers to Manage Relationship Performance,DECISION SCIENCES, Issue 1 2009Anthony D. Ross ABSTRACT This article presents a consensus-building methodology to implement dyadic performance measurement. It focuses on transmuting supplier performance and buyer performance metrics on several important attributes into actionable relationship management plans using Clark's (1996) theory of performance frontiers. Access to the supplier performance management program of a Fortune 100 corporation was granted to the research team. Direct observation of practice and in-depth discussions with several managers provided a roadmap for investigating both the literature on quantitative evaluation methods and the empirically derived theory on buyer,supplier relationships from several perspectives. This study describes a multiphase, iterative framework that uses current methods and theory on dyadic buyer,supplier evaluation to consider: (i) evaluation criteria and their importance; (ii) whether the improvement focus should be on strengths, weaknesses, or both; and (iii) whether the referent role supplier should be the ideal supplier, best supplier, or best-in-strategic-group supplier in the focal supply base. We illustrate a unifying approach by reporting results from a large buyer and 35 of its key suppliers. This research makes the case for managing supplier relationships through the dyadic performance lens. The outputs from this framework provide individual supplier improvement paths which are actionable prescriptions for each buyer,supplier dyad, as well as recommendations for strategic group formation. [source] Comparative seed ecology of the endangered shrub, Pimelea spicata and a threatening weed, Bridal Creeper: Smoke, heat and other fire-related germination cuesECOLOGICAL MANAGEMENT & RESTORATION, Issue 1 2003Anthony J. Willis SummaryPimelea spicata R. Br. is a nationally listed endangered Australian shrub threatened with extinction by habitat fragmentation and environmental weed invasion. Bridal Creeper (Asparagus asparagoides L. W. Wight) is the primary weed threat to the largest remaining populations of P. spicata in the Cumberland Plain. Fire, as part of an integrated pest management program, offers the potential to stimulate P. spicata populations while controlling Bridal Creeper. It is important, therefore, to understand how the components of fire affect the germination and growth of both species. Using laboratory experiments we investigated the effects of smoke, heat, ash and/or light on the germination of P. spicata and Bridal Creeper. We found a significant promotive effect of smoke and indication of an inhibitory heat shock (90°C for 10 min) effect on the germination of P. spicata seeds. The response of Bridal Creeper seeds to the same factors was complex; while the results of one experiment suggested an inhibitory effect of smoke and a promotive effect of heat, subsequent trials were contradictory, implying that Bridal Creeper, like many weeds, is able to germinate under a wide range of environmental conditions. Other experiments investigated the optimal germination temperature and innate dormancy of P. spicata in the absence of fire-related germination cues. Of the incubation temperatures investigated, the optimal diurnally fluctuating regime for P. spicata germinations was 10°C and 20°C in the night and day, respectively. The innate dormancy of freshly produced seeds disappeared after 3 months. In contrast to Bridal Creeper, we found a persistent germinable seed bank of about 97 P. spicata seeds/m2 located in the top 5 cm of the soil profile. While fire alone is unlikely to kill Bridal Creeper plants, fire may help to manage local infestations of the weed by limiting germination and providing opportunity for herbicide treatment of regrowth. [source] Vegetated agricultural drainage ditches for the mitigation of pyrethroid-associated runoffENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 9 2005Erin R. Bennett Abstract Drainage ditches are indispensable components of the agricultural production landscape. A benefit of these ditches is contaminant mitigation of agricultural storm runoff. This study determined bifenthrin and lambda-cyhalothrin (two pyrethroid insecticides) partitioning and retention in ditch water, sediment, and plant material as well as estimated necessary ditch length required for effective mitigation. A controlled-release runoff simulation was conducted on a 650-m vegetated drainage ditch in the Mississippi Delta, USA. Bifenthrin and lambda-cyhalothrin were released into the ditch in a water-sediment slurry. Samples of water, sediment, and plants were collected and analyzed for pyrethroid concentrations. Three hours following runoff initiation, inlet bifenthrin and lambda-cyhalothrin water concentrations ranged from 666 and 374 ,g/L, respectively, to 7.24 and 5.23 ,g/L at 200 m downstream. No chemical residues were detected at the 400-m sampling site. A similar trend was observed throughout the first 7 d of the study where water concentrations were elevated at the front end of the ditch (0,25 m) and greatly reduced by the 400-m sampling site. Regression formulas predicted that bifenthrin and lambda-cyhalothrin concentrations in ditch water were reduced to 0.1% of the initial value within 280 m. Mass balance calculations determined that ditch plants were the major sink and/or sorption site responsible for the rapid aqueous pyrethroid dissipation. By incorporating vegetated drainage ditches into a watershed management program, agriculture can continue to decrease potential non-point source threats to downstream aquatic receiving systems. Overall results of this study illustrate that aquatic macrophytes play an important role in the retention and distribution of pyrethroids in vegetated agricultural drainage ditches. [source] Incident Monitoring in Emergency Departments An Australian ModelACADEMIC EMERGENCY MEDICINE, Issue 11 2000FIFEM, John Vinen FACEM Abstract. The specialty-based study of incidents, adverse events, and errors in medicine has largely occurred in anesthesia and to a lesser extent in intensive care and psychiatry. Few studies have specifically addressed the problem in emergency medicine (EM). Because of the significant risks, the resulting adverse outcome, and the high degree of preventability of errors occurring in the emergency department (ED), it is essential that an incident monitoring system be part of the ED's risk management program. The combination of time pressure, uncertainty, complexity, and workload means the ED is a high-risk environment. The delivery of high-quality emergency care is dependent on having an effective patient processing system in place and, because EM is a "systems-dependent" specialty, the environment lends itself to improvements to the system (re-engineering) to improve the safety of the environment given that the majority of errors in the ED are probably the result of failures of the system. This paper describes an existing incident monitoring system that has recently been adopted by six EDs in Australia. It was developed as a result of a similar successful program in anesthesia, and funded by the Federal Department of Health of Australia. Incorporating incident monitoring and analysis to identify causative factors of incidents and the subsequent implementation of corrective strategies as part of the ED risk management program may result in improvement in the quality of care through a reduction in the frequency of incidents. [source] An expert system for lighting energy management in public school facilitiesEXPERT SYSTEMS, Issue 4 2006Daniel J. Fonseca Abstract: Lighting accounts for a large part of the energy expenses of a facility, ranging from 40% to 60% of the total energy cost. Therefore, it represents a critical factor to consider in any energy management program. Lighting audits involve complex energy calculations, such as the estimation of light intensity per square unit area, quality of illumination, and required number of light sources to obtain an adequate illumination level in the facility. In this paper we discuss the development and implementation of an easy-to-use expert system for lighting energy management in public schools. The prototype computer-based system can evaluate 11 different areas of a school facility, and it can identify suitable lighting solutions from 17 distinct bulb types and 38 ballast types. The system determines a facility's required number of bulbs, and it performs the cost and saving analysis of its final recommendation. The constructed expert system was successfully validated by two human experts through two case studies, involving the evaluation of a conventional classroom and a medium-size office. [source] Effect of five diatomaceous earth formulations against Tribolium castaneum (Coleoptera: Tenebrionidae), Oryzaephilus surinamensis (Coleoptera: Silvanidae) and Rhyzopertha dominica (Coleoptera: Bostrychidae)INSECT SCIENCE, Issue 5 2007MASUMEH ZIAEE Abstract Laboratory bioassays were conducted to determine the effect of food source on the survival of Tribolium castaneum Herbst, Oryzaephilus surinamensis L. and Rhyzopertha dominica F., after exposure to five diatomaceous earth (DE) formulations: Protect-It®, Insecto®, Perma-GuardÔ, Dryacide® and SilicoSec®. Adults of these species were exposed to DEs at the rate of 0.5 mg/cm2 for 1 day on filter paper inside plastic Petri dishes. After exposure, the initial mortality was counted and live individuals of the three species were held for a week in glass vials containing 50 mg wheat flour, rice and whole wheat, respectively. In the second experiment, after 1 day exposure to DEs, beetles were transferred to Petri dishes without food and held for a week to determine if the presence of food source would decrease the mortality of beetles. Experiments were carried out at 27°C and 55% RH in the dark. The initial mortality in both of the experiments reached 100% for the three species exposed to Protect-It® and in the case of R. dominica and O. surinamensis exposed to Dryacide®. In contrast, low level of mortality (< 10%) was observed for T. castaneum exposed to Perma-GuardÔ and Insecto®. The mortality after the post-treatment period on food was decreased for the three species exposed to Perma-GuardÔ and in the case of T. castaneum and R. dominica exposed to Insecto® and SilicoSec®. Adults of O. surinamensis were the most susceptible followed by R. dominica and 100% adult mortality was obtained, whereas T. castaneum were the least susceptible beetles to DEs. Protect-It® and Dryacide® were the most efficient DE formulations and can be used effectively in a stored grain integrated pest management program. [source] Costs of community-based public mental health services for older adults: variations related to age and diagnosisINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2006Todd Gilmer Abstract Background Several studies have examined service use among older adults although, to our knowledge, none has examined costs from a systems perspective. This study examined use and costs of mental health services among older adults in San Diego County in order to determine how expenditures and modes of service varied by age cohort and psychiatric diagnosis. Methods Utilization data from San Diego County Adult and Older Adult Mental Health Services (AOAMHS) were used to identify older adults (age,,,60) receiving services in the community during fiscal year 2003,2004. Cost data were derived from detailed examination of cost reports, and Medicaid fee schedules. Trends in demographic and clinical characteristics by six age cohorts were described. Multivariate models were used to estimate the relationships between costs, age, and clinical diagnosis while controlling for other demographic and clinical characteristics. Components of costs were also examined. Results Total expenditures declined from age cohorts 60,64 through ages 85 and over. Expenditures were similar, and greatest, for clients with schizophrenia and bipolar disorder, while outlays were lower for those with major depression, other psychotic disorder, other depression, anxiety, substance use disorder, and cognitive disorders. Clients diagnosed with cognitive disorder had high use of emergency services and little connection to outpatient services. Conclusions Expenditures were related to age and clinical diagnosis. Future efforts should investigate older adults' pathways to care, and should determine whether older adults presenting in emergency services would benefit from a specialized case management program providing linkages to community based resources. Copyright © 2006 John Wiley & Sons, Ltd. [source] Room for improvement: nurses' and physicians' views of a post-operative pain management programACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2010C. S. HARTOG Background: The practice of post-operative pain therapy continues to be a problem. We conducted a survey among nurses and physicians about their views of an established post-operative pain management program. Methods: A questionnaire was sent to all nurses and physicians of nine surgical wards (general, trauma, cardio-thoracic and oromaxillofacial surgery and gynecology). Questions were developed from qualitative interviews with staff. Patient data were derived from a post-operative pain registry. Results: Seventy-eight physicians and nurses answered; the overall response rate was 23%. Post-operative pain therapy had high personal priority on an 11-point numeric rating scale (mean 9.08±1.27 standard deviation), but the success of pain management on the ward was rated as 7.32±1.37. Staff rating of success tended to correspond with patients' actual pain ratings. Knowledge of pain therapy was assessed as 6.85±1.82; nurses consistently rated levels higher than physicians. Staff over- or underestimated the painfulness of typical procedures and females rated procedures as more painful than men. There was considerable confusion about responsibilities and duties. 10.7% of staff perceived time delays exceeding 6 h between a request for acute pain services (APS) consultation and administration of medication to the patient. Invited comments suggested improvement in personnel education, team coordination, communication with patients and speed of action to increase the quality of pain therapy. Conclusion: Despite staff's high personal priority and well-established APS and pain management program, post-operative pain therapy still leaves room for improvement. Considerable confusion about responsibilities and duties underlines the importance of better organizational approaches. [source] Kaiser Permanente Community Partners Project: Improving Geriatric Care Management PracticesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2003Susan M. Enguidanos MPH This article describes a geriatric care management project that is testing whether geriatric care management plus a brief purchase of service (POS) intervention will lower medical costs, improve satisfaction with care, increase care plan adherence, and improve perceived quality of life. Kaiser Permanente members aged 65 and older who were eligible for geriatric care management and consented to participate in the study were randomized to one of four study groups: information and referral via mail, telephone care management, geriatric care management, or geriatric care management with POS capability. The POS intervention provides up to $2,000 of designated, paid services including in-home supportive services, transportation, respite, or medical equipment within the first 6 months of care management enrollment. Approximately 1,400 senior members were referred to the geriatric care management program, and 451 were randomly assigned to one of the four study groups. Those enrolled in the geriatric care management program were significantly more likely to be ethnic minorities and have lower income than the general Kaiser Permanente senior enrollment. Barriers encountered in implementing the POS intervention included establishing contractual agreements between Kaiser Permanente and private and community agencies, locating adequate and sufficient community agencies to provided needed services, monitoring service contracts, and delaying use of the POS benefit. [source] Enterprise Risk Management: Theory and PracticeJOURNAL OF APPLIED CORPORATE FINANCE, Issue 4 2006Brian W. Nocco The Chief Risk Officer of Nationwide Insurance teams up with a distinguished academic to discuss the benefits and challenges associated with the design and implementation of an enterprise risk management program. The authors begin by arguing that a carefully designed ERM program,one in which all material corporate risks are viewed and managed within a single framework,can be a source of long-run competitive advantage and value through its effects at both a "macro" or company-wide level and a "micro" or business-unit level. At the macro level, ERM enables senior management to identify, measure, and limit to acceptable levels the net exposures faced by the firm. By managing such exposures mainly with the idea of cushioning downside outcomes and protecting the firm's credit rating, ERM helps maintain the firm's access to capital and other resources necessary to implement its strategy and business plan. At the micro level, ERM adds value by ensuring that all material risks are "owned," and risk-return tradeoffs carefully evaluated, by operating managers and employees throughout the firm. To this end, business unit managers at Nationwide are required to provide information about major risks associated with all new capital projects,information that can then used by senior management to evaluate the marginal impact of the projects on the firm's total risk. And to encourage operating managers to focus on the risk-return tradeoffs in their own businesses, Nationwide's periodic performance evaluations of its business units attempt to refl ect their contributions to total risk by assigning risk-adjusted levels of "imputed" capital on which project managers are expected to earn adequate returns. The second, and by far the larger, part of the article provides an extensive guide to the process and major challenges that arise when implementing ERM, along with an account of Nationwide's approach to dealing with them. Among other issues, the authors discuss how a company should assess its risk "appetite," measure how much risk it is bearing, and decide which risks to retain and which to transfer to others. Consistent with the principle of comparative advantage it uses to guide such decisions, Nationwide attempts to limit "non-core" exposures, such as interest rate and equity risk, thereby enlarging the firm's capacity to bear the "information-intensive, insurance- specific" risks at the core of its business and competencies. [source] MyCrystals, a simple visual data management program for laboratory-scale crystallization experimentsJOURNAL OF APPLIED CRYSTALLOGRAPHY, Issue 4 2009Monika Nøhr Løvgreen MyCrystals is designed as a user-friendly program to display crystal images and list crystallization conditions. The crystallization conditions entry fields can be customized to suit the experiments. MyCrystals is also able to sort the images by the entered crystallization conditions, which presents a unique opportunity to easily assess the effect of, for example, changing pH or concentration and thus establish the best conditions to be used for optimization. [source] Perceptions about services and dropout from a substance abuse case management programJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 5 2007Michael R. Sosin This article uses event history analysis to examine certain determinants of dropout from a case management program that serves homeless adults with substance abuse problems. The examined determinants are perceptions of conventional treatment services: (a) client perceptions concerning the value of the conventional services that case managers help them to obtain, (b) the views of use services held by social contacts, and (c) client perceptions of the legitimacy of conventional services. The findings, some of which involve statistical interactions, suggest that clients drop out of case management services more slowly (a) when they favor pursuit of particularly efficacious conventional programs; (b) when they find conventional programs to be of low legitimacy; (c) when, under special conditions, they perceive that conventional services are less caring; or (d) when social contracts do not pressure them. These findings generally imply that clients look to case management services when they are more skeptical about conventional services. The variables predicting dropout from case management poorly predict continuation in conventional substance abuse services, indicating that dropout is linked to perceptions of services in context-specific ways. © 2007 Wiley Periodicals, Inc. J Comm Psychol 35: 583,602, 2007. [source] Bridging the gap between evidence and practice in acute decompensated heart failure managementJOURNAL OF HOSPITAL MEDICINE, Issue S6 2008FACP, Franklin A. Michota Jr MD Abstract Registry data indicate a gap between evidence-based guidelines and current management of patients with acute decompensated heart failure (ADHF). Bridging this gap is crucial given the frequency and cost of hospitalization for this disorder. Patients with ADHF require rapid assessment to determine appropriate treatment location and initial therapy. Patients with impending respiratory failure or cardiogenic shock should be managed in an intensive care setting, patients with congestion that is expected to require prolonged intravenous therapy should be admitted to the hospital, and patients with congestion that is likely to respond within 12,24 hours can be managed in an observation unit. Clinical status should guide selection of initial therapy. Initially, therapeutic response should be assessed every couple of hours. Once effective acute therapy has been established, it is important to implement strategies to improve long-term outcomes. These strategies include ensuring that care complies with established core performance measures, providing patient education in a manner suited to ensure comprehension and retention, and arranging for appropriate outpatient follow-up, ideally in a comprehensive heart failure disease management program. The purpose of this review is (1) to examine evidence-based guidelines for the treatment of ADHF, (2) to present a practical algorithm for patient assessment and treatment derived from these guidelines and personal experience, and (3) to discuss systems to enhance the ultimate transition of patient care from the inpatient to outpatient setting. Journal of Hospital Medicine 2008;3(Suppl 6):S7,S15. ©2008 Society of Hospital Medicine. [source] Setting Up a Multidisciplinary Program for Management of Patent Foramen Ovale-Mediated SyndromesJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2006GIANLUCA RIGATELLI M.D. Background: These days no codified multidisciplinary protocol has been reported to manage all the different patent foramen ovale (PFO)-mediated syndromes. We sought to propose a multidisciplinary program of diagnosis, treatment, and follow-up of all PFO-mediated syndromes based on an in-hospital multidisciplinary task force and to review the activities during the first year. Methods: From September 2004, we organized in our hospital, a 600-bed tertiary hospital, a management program for PFO-mediated syndromes based on a task force composed of cardiologists, neurologists, and internists. Different levels of protocols were created in order to cover diagnosis, treatment, and follow-up of PFO-mediated syndromes. We reviewed the activity of our program in the first year up to September 2005. Results: Thirty-five patients (23 female, mean age 65 ± 24 years) were evaluated for suspected PFO-mediated syndromes: 20 for cryptogenic stroke, 2 for peripheral and coronary embolisms, 3 for platypnea-orthodeoxia, 9 for emicrania with aura, and 1 with hypoxiemia during neurosurgical intervention in the posterior cranial fossa. Diagnosis of PFO was confirmed in 25 patients. According to the multidisciplinary protocols, 15 patients failed to meet the requirements for transcatheter closure and were left in medical therapy whereas 11 patients (7 patients with PFO, 2 with multiperforated ASD, and 2 with a secundum ASD) underwent transcatheter closure. After a mean follow-up of 10.8 ± 4.9 months, no recurrent PFO syndromes were noted in patients treated with devices. Conclusion: The first year of our multidisciplinary program allowed a reasonable and potentially successful approach for correctly identifying patients with PFO-mediated syndromes until randomized studies are completed. [source] Diet of free-ranging cats and dogs in a suburban and rural environment, south-eastern BrazilJOURNAL OF ZOOLOGY, Issue 1 2007C. B. Campos Abstract In spite of the worldwide occurrence of domestic cats and dogs, and their close relationship with humans, the number of published papers on free-ranging cats Felis catus and dogs Canis familiaris, is small. The diet of both species was estimated in a suburban and rural environment in July 2002 and January 2003. Visual observations and scat collection of both species were accomplished along a 10 km transect line in the Campus ,Luiz de Queiroz', University of São Paulo, Piracicaba, south-eastern Brazil. The diet of both species was determined by analysis of sterilized, washed, dried and sorted scats. Estimated abundances of free-ranging cats and dogs in the sampled area were 81 (±4.32) and 42 (±2.96), respectively. Cats and dogs were more abundant in the suburban than in the rural environment (t=3.78, P<0.001, N=55; t=8.38, P<0.001, N=55, respectively) and cats were more abundant than dogs in the suburban environment (t=6.76, P<0.001, N=55), even though there was no significant difference between the abundance of both species in the rural environment (t=0.82, P=0.46, N=55). Invertebrates were the most commonly consumed item by both species, followed by mammals (cats: 63.24 and 20.51%; dogs: 57.05 and 25.15%, respectively). Niche breadth was 0.4892 for cats and 0.4463 for dogs. Niche overlap was almost complete (0.97108). The consumption of mammals was estimated to be between 16.76 and 25.42 kg individual,1year,1 for dogs and between 2.01 and 2.9 kg individual,1year,1 for cats. These data might be useful to establish a management program to minimize the predation pressure of free-ranging cats and dogs on wildlife. [source] The organizational knowledge iceberg: An empirical investigationKNOWLEDGE AND PROCESS MANAGEMENT: THE JOURNAL OF CORPORATE TRANSFORMATION, Issue 2 2009Sajjad HaiderArticle first published online: 11 APR 200 This study explores the critical success factors of implementing and running a knowledge management program. In doing so, the paper proposes and tests a conceptual model of "knowledge iceberg" inside the organization using a case study methodology. In total 89 in-depth semi-structured interviews were conducted over a period of 1 year in the SoftNetCo company to study success factors in the implementation of knowledge initiatives. During the research period 11 knowledge management initiatives were launched in the company which provided an excellent platform to conduct this research. The findings of the study suggest the existence of a knowledge iceberg inside organizations. It is reported that six activities can cause the knowledge iceberg to rise which is critical for the success of knowledge management initiatives. It is further argued that a holistic approach is required to manage knowledge, people, and culture and that managers have to concentrate more on managing people than the knowledge itself. Copyright © 2009 John Wiley & Sons, Ltd. [source] Improved pain management in pediatric postoperative liver transplant patients using parental education and non-pharmacologic interventionsPEDIATRIC TRANSPLANTATION, Issue 2 2006Paul J. Sharek Abstract:, A pain management intervention, consisting of pretransplant parental education and support, pre- and postoperative behavioral pediatrics consultation, postoperative physical and occupational therapy consultation, and implementation of non-pharmacologic pain management strategies, was introduced to all pediatrics patients receiving liver transplants at Lucile Packard Children's Hospital beginning August 2001. Children receiving transplants pre-intervention (May, 2000 to February, 2001) and post-intervention (August, 2001 to March, 2002) were compared using pain scores, parent perception of pain ratings, length of stay, ventilator days, total cost, and opioid use. A total of 27 children were evaluated (13 historical control, 14 intervention). The two populations did not differ on age at transplant (mean age 53.8 vs. 63.6 months), sex (46.1% vs. 50% male), ethnicity (53.8% vs. 57.1% white, non-Hispanic) weight at transplant (17.5 vs. 24.7 kg), percent with biliary atresia as the primary reason for transplant (42.9% vs. 69.2%), percent with status 1 transplant listing score (38.5% vs. 50.0%), or public insurance status (30.8 vs. 57.2% with Medicaid). No differences were found in mean pediatric intensive care unit (PICU) postoperative length of stay (6.7 vs. 5.3 days), total postoperative length of stay (17.5 vs. 17.5 days), total inpatient length of stay (27.0 vs. 24.4 days), time to extubation (30 vs. 24.3 h), total cost ($147 983 vs. $157 882) or opioid use through postoperative day (POD) 6 (0.24 vs. 0.25 mg/kg/day morphine equivalent). A decrease in mean pain score between POD 0 and 6 (2.82 vs. 2.12; p = 0.047), a decrease in mean parental pain perception score (3.1 vs. 2.1; p = 0.001), and an increase in number of pain assessments per 12 h shift (3.43 vs. 6.79; p < 0.005) were seen. A comprehensive non-pharmacologic postoperative pain management program in children receiving a liver transplant was associated with decreased pain scores, improved parent perception of pain, and an increased number of pain assessments per 12 h shift. No increases in lengths of stay (PICU, postoperative, total), time to extubation, or total cost were found. [source] psbA mutation (Asn266 to Thr) in Senecio vulgaris L. confers resistance to several PS II-inhibiting herbicidesPEST MANAGEMENT SCIENCE (FORMERLY: PESTICIDE SCIENCE), Issue 9 2006Kee Woong Park Abstract DNA sequence analysis of the psbA gene encoding the D1 protein of photosystem II (PS II), the target site of PS II-inhibiting herbicides, identified a point mutation (Asn266 to Thr) in a bromoxynil-resistant Senecio vulgaris L. population collected from peppermint fields in Oregon. Although this mutation has been previously reported in Synechocystis, this is the first report of this particular point mutation in a higher plant exhibiting resistance to PS II-inhibiting herbicides. The resistant population displayed high-level resistance to bromoxynil and terbacil (R/S ratio 10.1 and 9.3, respectively) and low-level resistance to metribuzin and hexazinone (R/S ratio 4.2 and 2.6, respectively) when compared with the susceptible population. However, the population was not resistant to the triazine herbicides atrazine and simazine or to the urea herbicide diuron. A chlorophyll fluorescence assay confirmed the resistance levels and patterns of cross-resistance of the whole-plant studies. The resistant S. vulgaris plants produced fewer seeds. Differences in cross-resistance patterns to PS II-inhibiting herbicides and the difference in fitness cost could be exploited in a weed management program. Copyright © 2006 Society of Chemical Industry [source] Impact of intraguild predation and lambda-cyhalothrin on predation efficacy of three acarophagous predatorsPEST MANAGEMENT SCIENCE (FORMERLY: PESTICIDE SCIENCE), Issue 6 2005Caroline Provost Abstract This laboratory study reports the interaction of three predators found in commercial apple orchards in Quebec, Hyaliodes vitripennis (Say) (Hemiptera: Miridae), Harmonia axyridis Pallas (Coleoptera: Coccinellidae) and Amblyseius fallacis (Garman) (Acarina: Phytoseiidae). First, intraguild predation between H vitripennis and the two other predators was characterized in the absence and presence of their extraguild prey, Tetranychus urticae Koch. The results showed an asymmetrical interaction in favour of the larger predator and the levels of intraguild predation were weak for the two predatory combinations. Presence of the phytophagous mite reduced the intensity of intraguild predation in the predatory combination of H axyridis and H vitripennis. Second, the effects of intraguild predation and the application of lambda-cyhalothrin on predation efficacy of the predators were evaluated. The application of the insecticide reduced prey consumption of H vitripennis and H axyridis but did not affect that of A fallacis. Combination of predators and an insecticide application resulted in two different situations depending on the species involved: a reduced predation efficacy for the combination of H vitripennis and H axyridis due to a knockdown effect caused by the insecticide, and no effect on T urticae consumption for H vitripennis and A fallacis. It is suggested that an integrated pest management program based on H vitripennis, A fallacis and lambda-cyhalothrin may be evaluated to repress phytophagous mites in Quebec orchards. Copyright © 2005 Society of Chemical Industry [source] National addictions vigilance intervention and prevention program (NAVIPPROÔ): a real-time, product-specific, public health surveillance system for monitoring prescription drug abuse,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 12 2008Stephen F. Butler PhD Abstract Purpose The National Addictions Vigilance Intervention and Prevention Program (NAVIPPROÔ) is a scientific, comprehensive risk management program for scheduled therapeutics. NAVIPPROÔ provides post-marketing surveillance, signal detection, signal verification and prevention and intervention programs. Here we focus on one component of NAVIPPROÔ surveillance, the Addiction Severity Index-Multimedia Version® (ASI-MV®) Connect, a continuous, real-time, national data stream that assesses pharmaceutical abuse by patients entering substance abuse treatment by collecting product-specific, geographically-detailed information. Methods We evaluate population characteristics for data collected through the ASI-MV® Connect in 2007 and 2008 and assess the representativeness, geographic coverage, and timeliness of report of the data. Analyses based on 41,923 admissions to 265 treatment centers in 29 states were conducted on product-specific opioid abuse rates, source of drug, and route of administration. Results ASI-MV® Connect data revealed that 11.5% of patients reported abuse of at least one opioid analgesic product in the 30 days prior to entering substance abuse treatment; differences were observed among sub-populations of prescription opioid abusers, among products, and also within various geographic locations. Conclusions The ASI-MV® Connect component of NAVIPPROÔ represents a potentially valuable data stream for post-marketing surveillance of prescription drugs. Analyses conducted with data obtained from the ASI-MV® Connect allow for the characterization of product-specific and geospatial differences for drug abuse and can serve as a tool to monitor responses of the abuse population to newly developed "abuse deterrent" drug formulations. Additional data, evaluation, and comparison to other systems are important next steps in establishing NAVIPPROÔ as a comprehensive, post-marketing surveillance system for prescription drugs. Copyright © 2008 John Wiley & Sons, Ltd. [source] Hypersensitivity pneumonitis due to metal working fluids: Sporadic or under reported?AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 6 2006Amit Gupta MD Abstract Background Occupational exposure to metal working fluids (MWF) is common with over 1.2 million workers in the United States involved in machine finishing, machine tooling, and other metalworking operations. MWF is a known cause of hypersensitivity pneumonitis (HP). Recent reports of outbreaks of hypersensitivity HP secondary to exposure to MWF are reported. Design Cases were identified through the Occupational Disease surveillance system in the State of Michigan and from referrals for evaluation to the Division of Occupational and Environmental Medicine at Michigan State University (MSU). Each patient underwent a clinical examination including an occupational history, lung function studies, radiographic imaging, and in some cases lung biopsies. Following the diagnosis of definite HP, an industrial hygiene investigation was carried out, which included a plant walk-through, and review of the "Injury and Illness" log. Air monitoring and microbial sampling results were reviewed. Results As part of Michigan's mandatory surveillance system for occupational illnesses, seven cases of suspected HP were identified in 2003,2004 from three facilities manufacturing automobile parts in Michigan. Each plant used semi-synthetic MWFs, and conducted a MWF management program including biocide additions. Two facilities had recently changed the MWF before the cases arose. Growth of mycobacteria was found in these two MWFs. Breathing zone samples for particulates of two employees in plant A (two cases) ranged from 0.48 to 0.56 mg/m3. In plant B (four cases), two employees' sampling results ranged from 0.10 to 0.14 mg/m3. No air sampling data were available from plant C. Conclusion Hypersensitivity pneumonitis due to exposure to MWFs is under-recognized by health care providers, and current surveillance systems are inadequate to provide a true estimate of its occurrence. HP arose from environments with exposures well below the Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL) for MWF, and in one case from exposures well below the National Institute of Occupational Safety and Health (NIOSH) recommended exposure limit (REL). The sporadic nature of reports of HP in relationship to MWF probably represents a combination of workplace changes that cause the disease and inadequate recognition and reporting of the disease when it does occur. Physician awareness of HP secondary to MWF and an effective medical surveillance program are necessary to better understanding the epidemiology and prevention of this disease. Am. J. Ind. Med. 2006. © 2006 Wiley-Liss, Inc. [source] Coronary Risk Factor Management in the Framework of a Community Hospital-Based Ambulatory Exercise Training ProgramPREVENTIVE CARDIOLOGY, Issue 2 2004Morton Leibowitz MD Ischemic heart disease is a chronic illness that causes major mortality and morbidity. Angiographic studies have shown the effectiveness of exercise programs, in combination with aggressive lipid management, in reversing or slowing the progression of atherosclerotic coronary disease. Despite these studies, participation in supervised programs that combine exercise and risk-factor management is limited. The authors measured the ability of a community hospital-based ambulatory cardiac rehabilitation program to recruit patients and to facilitate reduction of risk factors that have been demonstrated to influence progression of disease. Patients were recruited from a single community hospital for an ambulatory exercise training and cardiac risk-factor management program, and clinical and laboratory data was collected periodically. Recruited patients participated in a minimum 3-month period of training and counseling by a multidisciplinary team with follow-up measurements of weight, lipid profile, blood pressure, and exercise capacity. Thirty-two percent of the eligible hospitalized patients were successfully recruited into the program. Dropout rates over the initial 3 months were low (25%). Improvement in low-density lipoprotein cholesterol level (,4.5%), high-density lipoprotein cholesterol level (+7%), body mass index (,2%), systolic blood pressure (,3%), and maximum metabolic equivalents (+25%) were comparable to levels achieved in studies showing angiographic stabilization and/or regression of disease. Implementation of a community hospital-based risk management exercise program is an effective method for improving the long-term management of patients with chronic ischemic heart disease. [source] | ||||||||||||||||||||||||||||||||||||||||