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Appropriate Use (appropriate + use)
Selected AbstractsInfluence in the Ivory Tower: Examining the Appropriate Use of Social Power in the University ClassroomJOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 11 2007Steven M. Elias A study was conducted to determine how appropriate university students feel it is for professors to use varying bases of social power as a means of influence. Participants (n = 91) completed a modified version of the Interpersonal Power Inventory (Raven, Schwarzwald, & Koslowsky, 1998) and a demographic questionnaire. Students rated the use of soft power as significantly more appropriate than harsh power. Repeated-measures ANOVA indicated that informational and expert power were thought to be the most appropriate bases for professors to use, and a gender effect was observed such that female students rated the use of social power in the classroom as significantly less appropriate than did male students. Implications for university instructors and other power holders are discussed. [source] Appropriate use of non-prescription ibuprofen: a survey of patients' perceptions and understandingINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 1 2010Suong N. T. Ngo Abstract Objectives The aim was to investigate patients' perceptions and understanding on the appropriate use of non-prescription ibuprofen. Methods In this pilot study, a self-administered anonymous survey was completed by 183 patients presenting at one of the eight selected community pharmacy premises in South Australia and the Northern Territory during the study. The questionnaire comprised items on: demographics (age, gender), current medications, frequency of ibuprofen use, medical consultations, reading manufacturer's printed dosage/warning instructions, sources from which drug information was gathered and understanding of common indications for ibuprofen. Key findings Sixty per cent of patients (n= 110/183), predominantly females, were currently on other medications and 64.5% of patients (n= 118/183) did not seek medical advice before using non-prescription ibuprofen. Seventy-one per cent (n= 130) of these patients had used ibuprofen for more than a year. The majority of patients did not provide precise answers for the common indications of ibuprofen. Sixty-six per cent of patients (n= 110) reported rarely or never reading manufacturer's printed warning instructions on the potential drug interactions or adverse effects associated with the use of the product. Conclusions Many patients are unaware that non-presciption analgesics such as ibuprofen can cause potentially serious adverse effects when used in combination with other common medications. [source] Evaluation and economic impact analysis of different treatment options for ankle distortions in occupational accidentsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2010Amaryllis Audenaert Grad Eng PhD Abstract Rationale, aims and objectives, Appropriate use of diagnostic and treatment modalities are essential for rational use of resources. The aim of this study is to evaluate the use of diagnostic modalities and different treatment options and their economic impacts following an acute ankle distortion resulting from an occupational accident. We evaluated the type-of-treatment impact on the victims' course of recovery as well as its impact on the associated accident costs. Research was carried out in Belgium. Methods, An ankle distortion victims' database consisting of 200 cases of (Belgian) occupational accidents during the period 2005,2007 was analysed. Results, Patients who were prescribed immobilization or the use of adjuvant support or physical therapy (118 cases) were not employed during a period of 37 days on average, with a mean total cost of 3140.14 Euros caused by the ankle sprain. Patients without any adjuvant therapy (82 cases) were characterized by an unemployment rate of 15 days on average, and a total cost of 1077.86 Euros. Cast immobilization, although its application is not supported by evidence-based literature, was still applied in 36% of the population studied and resulted in the longest average absence of work of 42 days with an obvious significant increase in medical and total costs. Conclusions, Our results show a high rate of inappropriate use of cast immobilizations for ankle distortions. From an economic point of view and for the same clinical endpoint (being full resumption of the occupational activities), simple conventional treatment, consisting of rest, ice, compression and elevation at diagnosis with allowance of early weight bearing in the further clinical course, leads to the quickest full resumption of activities in combination with the lowest medical costs, if compared with any other kind of treatment. [source] Appropriate use of quality measures: Response to "risk factors for hospital readmission within 30 days: A new quality measure for children with sickle cell disease"PEDIATRIC BLOOD & CANCER, Issue 7 2009Ellen Schwalenstocker PhD No abstract is available for this article. [source] Unlicensed Residential Programs: The Next Challenge in Protecting YouthAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 3 2006Robert M. Friedman Over the past decade in the United States, the number of private residential facilities for youth has grown exponentially, and many are neither licensed as mental health programs by states, nor accredited by respected national accrediting organizations. The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) is a multi,disciplinary group of mental health professionals and advocates that formed in response to rising concerns about reports from youth, families and journalists describing mistreatment in a number of the unregulated programs. This article summarizes the information gathered by A START regarding unregulated facilities. It provides an overview of common program features, marketing strategies and transportation options. It describes the range of mistreatment and abuse experienced by youth and families, including harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions, medical and nutritional neglect, rights violations and death. It reviews the licensing, regulatory and accrediting mechanisms associated with the protection of youth in residential programs, or the lack thereof. Finally, it outlines policy implications and provides recommendations for the protection of youth and families who pursue residential treatment. [source] Translational medicine perspective in development of disease modifying therapies for Alzheimer's disease: biomarkers to buy down the riskDRUG DEVELOPMENT RESEARCH, Issue 2 2009Hong I. Wan Abstract Alzheimer's disease (AD) is a progressive neurodegenerative disease and the most common cause of age-related dementia. Currently available pharmacologic therapies, including acetylcholinesterase (AChE) inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists, only treat symptoms and do not address the underlying neurodegeneration. In addition to potentially improve the accuracy of diagnosis, biomarkers serve important roles for the development of putative disease-modifying drugs for AD. In this article, we review the existing and emerging areas of biomarker research and development for AD. Biochemical biomarkers in cerebrospinal fluid have been used to provide a link to disease pathology and may provide important proof of concept data for several classes of emerging therapeutics. Imaging biomarkers including volumetric magnetic resonance imaging and positron emission tomography assessing either glucose utilization or radioligands binding to amyloid plaque are discussed. Appropriate uses of these biomarkers in the context of the development of disease-modifying therapies are discussed. Drug Dev Res 70, 2009. © 2009 Wiley-Liss, Inc. [source] The Child Health Questionnaire in Australia: reliability, validity and population meansAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2000Elizabeth Waters Objective: To provide reliability, validity and population means for the Australian Authorised Adaptation of the parent-report Child Health Questionnaire (CHQ). Method: We surveyed a representative sample of Australian parents of school-aged children (5,18 years) in Victoria between July and December 1997, using a school-based cluster sample design stratified by educational sector and age. Results: Some 5, 414 parents responded (72%). Good psychometric performance was observed for the CHQ in Australia. Population means demonstrated differences in health on domains of functioning and well-being by age and gender. This population-derived sample demonstrated high ceiling values on Physical Functioning and Social Role scales. Implications: The CHQ appears to be a reliable and valid measure of child and adolescent functional health and well-being for the Australian population. Child health outcomes of children and adolescents with particular conditions or within population subgroups can be compared with these age and gender benchmarks. Appropriate uses for the CHQ may be to discriminate between children who are generally healthy and children with health problems, or in population surveys partnered with measures that extend the range of physical functioning and social functioning. [source] Elusive '68: The Challenge to PedagogyDIE UNTERRICHTSPRAXIS/TEACHING GERMAN, Issue 2 2008William Collins Donahue Teaching ,68 presents pedagogical challenges far greater than assembling a set of workable classroom materials. Divisive controversies that were the hallmark of the time,e.g., the debate over the nature and appropriate use of violence,are with us still, though in a somewhat different form. Further, the instructor,s own politics and positionality can hardly be ignored,as they will certainly not be overlooked by our students. Additionally, this essay argues that fundamental terms (such as who qualifies as a ,68er) remain problematic; that the instrumentalization of the Holocaust by the German New Left continues to affect political decisions down to the present; that our investment as teachers in poststructuralist literary theory may,perhaps inadvertently,affect the way we view and therefore teach ,68; and, finally, that there is a pressing need, despite a recent explosion in Germany of publications celebrating the fortieth anniversary of ,68, for a didacticized reader designed for the North American German Studies classroom. [source] The importance of ecological research for ecosystem management: The case of browsing by swamp wallabies (Wallabia bicolor) in commercially harvested native forestsECOLOGICAL MANAGEMENT & RESTORATION, Issue 1 2004Julian Di Stefano Summary Ecosystem management often proceeds within the context of sub-optimal relationships between ecologists and ecosystem managers, and management outcomes could be improved with greater collaboration between members of these disciplines. This paper identifies an ecosystem management problem resulting from the interaction between timber harvesting and browsing wallabies, and this case study is used to exemplify how ecological data and expertise can contribute to the process of ecosystem management. It is argued that appropriate use of existing ecological data, establishment of strategic new research and the implementation of management actions as experimental hypothesis tests can facilitate achievement of management objectives, but greater collaboration between ecologists and managers is required before this can occur. Reasons for sub-optimal relationships are outlined, and the potential for structural change within large State-run ecosystem management agencies to improve interactions between managers and ecologists is discussed. [source] Optimizing the appropriate use of the emergency call system, and dealing with hoax callersEMERGENCY MEDICINE AUSTRALASIA, Issue 5 2010Stephen Rashford No abstract is available for this article. [source] Electronic Mail in Foreign Language Writing: A Study of Grammatical and Lexical Accuracy, and Quantity of LanguageFOREIGN LANGUAGE ANNALS, Issue 2 2000Manuela Gonzälez-Bueno The authors statistically analyzed the quality and quantity of discourse generated via the electronic and the traditional (i.e., paper-and-pencil) medium. The primary objective was to determine whether the use of electronic mail had any effect on grammatical accuracy, appropriate use of vocabulary, and language productivity. In addition, the participants completed a written survey at the end of the semester that elicited their opinions of the program's effectiveness. It was found that the electronic version of dialogue journals had a significantly positive effect on the amount of language generated by the students, and that it improved students' attitude towards learning and practicing the target language. However, the electronic version of dialogue journals did not seem to pose any significant advantage over the paper-and-pencil version with regard to lexical and grammatical accuracy. [source] Linkage mapping methods applied to the COGA data set: Presentation Group 4 of Genetic Analysis Workshop 14GENETIC EPIDEMIOLOGY, Issue S1 2005E. Warwick Daw Abstract Presentation Group 4 participants analyzed the Collaborative Study on the Genetics of Alcoholism data provided for Genetic Analysis Workshop 14. This group examined various aspects of linkage analysis and related issues. Seven papers included linkage analyses, while the eighth calculated identity-by-descent (IBD) probabilities. Six papers analyzed linkage to an alcoholism phenotype: ALDX1 (four papers), ALDX2 (one paper), or a combination both (one paper). Methods used included Bayesian variable selection coupled with Haseman-Elston regression, recursive partitioning to identify phenotype and covariate groupings that interact with evidence for linkage, nonparametric linkage regression modeling, affected sib-pair linkage analysis with discordant sib-pair controls, simulation-based homozygosity mapping in a single pedigree, and application of a propensity score to collapse covariates in a general conditional logistic model. Alcoholism linkage was found with ,2 of these approaches on chromosomes 2, 4, 6, 7, 9, 14, and 21. The remaining linkage paper compared the utility of several single-nucleotide polymorphism (SNP) and microsatellite marker maps for Monte Carlo Markov chain combined oligogenic segregation and linkage analysis, and analyzed one of the electrophysiological endophenotypes, ttth1, on chromosome 7. Linkage was found with all marker sets. The last paper compared the multipoint IBD information content of several SNP sets and the microsatellite set, and found that while all SNP sets examined contained more information than the microsatellite set, most of the information contained in the SNP sets was captured by a subset of the SNP markers with ,1-cM marker spacing. From these papers, we highlight three points: a 1-cM SNP map seems to capture most of the linkage information, so denser maps do not appear necessary; careful and appropriate use of covariates can aid linkage analysis; and sources of increased gene-sharing between relatives should be accounted for in analyses. Genet. Epidemiol. 29(Suppl. 1):S29,S34, 2005. © 2005 Wiley-Liss, Inc. [source] Religious Involvement and the Use of Mental Health CareHEALTH SERVICES RESEARCH, Issue 2 2006Katherine M. Harris Objectives. To examine the association between religious involvement and mental health care use by adults age 18 or older with mental health problems. Methods. We used data from the 2001,2003 National Surveys on Drug Use and Health. We defined two subgroups with moderate (n=49,902) and serious mental or emotional distress (n=14,548). For each subgroup, we estimated a series of bivariate probit models of past year use of outpatient care and prescription medications using indicators of the frequency of religious service attendance and two measures of the strength and influence of religious beliefs as independent variables. Covariates included common Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, disorders symptoms, substance use and related disorders, self-rated health status, and sociodemographic characteristics. Results. Among those with moderate distress, we found some evidence of a positive relationship between religious service attendance and outpatient mental health care use and of a negative relationship between the importance of religious beliefs and outpatient use. Among those with serious distress, use of outpatient care and medication was more strongly associated with service attendance and with the importance of religious beliefs. By contrast, we found a negative association between outpatient use and the influence of religious beliefs on decisions. Conclusion. The positive relationship between religious service participation and service use for those with serious distress suggests that policy initiatives aimed at increasing the timely and appropriate use of mental health care may be able to build upon structures and referral processes that currently exist in many religious organizations. [source] National review of maternity care for women with HIV infectionHIV MEDICINE, Issue 5 2006C McDonald Objective To assess adherence to the British HIV Association (BHIVA) 2001 guidelines for the management of HIV-infected pregnant women. Methods A survey and a case note review were carried out using structured questionnaires sent to providers of adult HIV care in the UK and Ireland. Participants were women with HIV infection who delivered a live or stillborn infant between October 2002 and September 2003. The main outcome measures were the appropriate use of antiretroviral therapy, the use and timing of elective Caesarean section, and support for the avoidance of breast-feeding. Results Of 186 centres, 100 (54%) responded with data on 501 eligible pregnancies. Conclusions In general, practice was in accordance with the BHIVA 2001 guidelines. However, in a number of cases Caesarean sections were planned later than the recommended 38 weeks. [source] Validity of the indicator ,death in low-mortality diagnosis-related groups' for measuring patient safety and healthcare quality in hospitalsINTERNAL MEDICINE JOURNAL, Issue 4 2010S. Mihrshahi Abstract The indicator ,death in low-mortality diagnosis-related groups (DRG)' is a patient safety indicator (PSI) that can be derived from routinely collected administrative data sources. It is included in a group of PSI that have been proposed to compare and monitor standards of hospital care in Australia. To summarize the attributes of this indicator as a measure of quality and safety in healthcare and examine issues regarding the development process, definitions and use of the indicator in practice. A structured literature search was conducted using the Ovid Medline database to identify peer-reviewed published literature which used ,death in low-mortality DRG' as a quality/safety indicator. Key quality websites were also searched. The studies were critically appraised using a standardized method. A total of 12 articles was identified which met our search criteria. Most were of low methodological quality because of their retrospective study designs. Only three studies provided evidence that the quality of care gap is higher in ,deaths in low-mortality DRG' than in other cases. Most of the studies reviewed show that there are several limitations of the indicator for assessing patient safety and quality of care. The few studies that have assessed associations with other measures of hospital quality have shown only weak and inconsistent associations. Higher quality, prospective, analytic studies are required before ,death in low-mortality DRG' is used as an indicator of quality and safety in healthcare. Based on current evidence, the most appropriate use is as a screening tool for institutions to quickly and easily identify a manageable number of medical records to investigate in more detail. [source] Understanding heterogeneity in meta-analysis: the role of meta-regressionINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2009W. L. Baker Summary Background:, Meta-regression has grown in popularity in recent years, paralleling the increasing numbers of systematic reviews and meta-analysis published in the biomedical literature. However, many clinicians and decision-makers may be unfamiliar with the underlying principles and assumptions made within meta-regression leading to incorrect interpretation of their results. Aims:, This paper reviews the appropriate use and interpretation of meta-regression in the medical literature, including cautions and caveats to its use. Materials & Methods:, A literature search of MEDLINE (OVID) from 1966-February 2009 was conducted to identify literature relevant to the topic of heterogeneity and/or meta-regression in systematic reviews and meta-analysis. Results:, Meta-analysis, a statistical method of pooling data from studies included in a systematic review, is often compromised by heterogeneity of its results. This could include clinical, methodological or statistical heterogeneity. Meta-regression, said to be a merging of meta-analytic and linear regression principles, is a more sophisticated tool for exploring heterogeneity. It aims to discern whether a linear relationship exists between an outcome measure and on or more covariates. The associations found in a meta-regression should be considered hypothesis generating and not regarded as proof of causality. Conclusions:, The current review will enable clinicians and healthcare decision-makers to appropriately interpret the results of meta-regression when used within the constructs of a systematic review, and be able to extend it to their clinical practice. [source] The value of a specialist lipid clinicINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2008S. C. Martin Summary Aims:, To establish the value of the first 3 years of a cardiovascular risk factor clinic in tackling the major risk factors for cardiovascular disease (CVD). Methods:, A database review of all 339 patients referred to the clinic. Results:, Blood pressure levels in the hypertensive patients were significantly reduced and 9% of the smokers managed to quit for 12 months, half of them subsequently relapsing. Ninety-eight oral glucose tolerance tests were performed and 40% were abnormal yielding 10 patients with hitherto unsuspected diabetes and 29 with impaired glucose tolerance. Sixty-four of the 97 referrals of patients in the primary prevention group (no evidence of CVD) were found to have calculated Framingham coronary heart disease risk estimates of < 15% per decade, the lowest being 0.3%. Lipid levels were significantly reduced in both the hypercholesterolaemic (n = 290) and hypertriglyceridaemic (n = 49) patient groups through the use of more potent statins, extensive use of combination therapy and appropriate use of fibrates and omega-3 fish oil supplements. The annual drug cost per patient treated only increased from £310.72 to £398.08, yet there was a 3.5-fold increase in the number of patients achieving the General Medical Services 2 target of a total cholesterol < 5 mmol/l and a 4.5-fold increase in patients achieving the Joint British Societies 2 target of a low-density lipoprotein (LDL) cholesterol < 2 mmol/l. Conclusion:, The need for a specialist clinic was demonstrated by the 66% of primary prevention referrals who did not meet the current NICE treatment threshold. Additionally, the clinic was able to diagnose and treat 39 patients with undiagnosed diabetes mellitus/impaired glucose tolerance and 12 with hypothyroidism. LDL cholesterol was reduced overall by 36% implying a greater than one-third reduction in future cardiovascular events before the improvements in blood pressure control and smoking cessation are included and this was achieved at marginal extra cost to the mean drug bill at referral. [source] Fusion of dispatching centres into one entity: effects on performanceACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2010T. MÄÄTTÄ Background: Dispatching centres were fused into one of the 112 entity, which caused concerns regarding whether the medical calls could be processed effectively also in the new centre. We evaluated the effects of the reform on key performance criteria in medical calls. Methods: This observational study in the Helsinki Dispatching Centre consisted of two periods: Period I 2 years before the reform and Period II 2 years after. The main outcome measures were answering and call processing times, accuracy of risk assessment and appropriate use of ambulances. Results: In Period I (n=574,276), 92.2% of all incoming phone calls were answered within 10 s and in Period II (n=758,022) 82.8% (P<0.0001). Time to dispatch a first responding fire unit increased from 98 to 113 s (P<0.0001) and an advanced life support unit in category A calls increased from 73 to 84 s (P<0.0001). In Period I 47.7%, 34.8% and 17.5% of phone calls were completed in <3, 3,5 and >5 min and in Period II 29.8%, 36.1% and 34.1% (P<0.0001). The number of three studied non-transportation call types and unnecessary lights-and-siren responses increased significantly (P<0.0001 and 0.0001, respectively). Neither the accuracy of risk assessment in the three studied call types nor the rate of telephone-guided cardiopulmonary resuscitation changed. Conclusions: The reform increased the total number of ambulance dispatches, prolonged answering and call processing times and had a negative effect on the appropriate use of ambulances. The accuracy of risk assessment was not affected. Evidence-based data should be the basis for the future as dispatching centre processes are shown to be vulnerable during organisational reforms. [source] Use of antipsychotic medications among elderly residents in long-term institutional care: a three-year follow-upINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2006Hanna-Mari Alanen Abstract Objective To analyse the use of antipsychotic medications, change over time and associated factors in a three-year follow-up among elderly residents in long-term institutional care. Design Retrospective study was designed with three identical cross-sectional samples originating from the same long-term care facilities, and collected 1 July to 31 December in 2001, 2002 and 2003, in Finland. These were extracted from the Resident Assessment Instrument (RAI) database, based on Minimum Data Set (MDS) assessments. Setting Of the data providers 16 were hospital-based institutions and 25 residential homes. Participants Each of the data sets included 3662-3867 resident assessments. Results The prevalence use of one or more antipsychotic decreased from 42% in 2001 to 39% in 2003. The overall confounder-adjusted decrease in antipsychotic use was not statistically significant. However, the use of antipsychotics decreased among residents who had wandering as a behavioural problem (OR 0.79, 95% CI 0.63,0.99) and increased among residents with concomitant use of anxiolytic medications (OR 1.23, 95% CI 1.03,1.48). Conclusions The use of antipsychotic medications among residents in long-term institutional care was common and the caring patterns were quite stable during the observation period. Adequate indications may not have been achieved in all cases. More attention should be paid to the appropriate use of antipsychotics in this frail population. Copyright © 2006 John Wiley & Sons, Ltd. [source] The role of user charges and structural attributes of quality on the use of maternal health services in MoroccoINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2005David R. Hotchkiss Abstract Health care decision makers in settings with low levels of utilization of primary services are faced with the challenge of balancing the sometimes competing goals of increasing coverage and utilization of maternity services, particularly among the poor, with that of ensuring the financial viability of the health system. Morocco is a case in point where this policy dilemma is currently being played out. This study examines the role of household out-of-pocket costs and structural attributes of quality on the use of maternity care in Morocco using empirical data collected from both households and health care facilities. A nested logit model is estimated, and the coefficient estimates are used to carry out policy simulations of the impact of changes in the levels of out-of-pocket fees and structural attributes of quality in order to help guide policy makers responsible for the design of pending social insurance programs. The results of the paper suggest that social insurance strategies that involve increases in out-of-pocket charges in the form of copayments could be implemented without untoward effects on appropriate use of maternity care for non-poor women, but would be contraindicated for poorer and rural households. Copyright © 2005 John Wiley & Sons, Ltd. [source] Appropriate use of non-prescription ibuprofen: a survey of patients' perceptions and understandingINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 1 2010Suong N. T. Ngo Abstract Objectives The aim was to investigate patients' perceptions and understanding on the appropriate use of non-prescription ibuprofen. Methods In this pilot study, a self-administered anonymous survey was completed by 183 patients presenting at one of the eight selected community pharmacy premises in South Australia and the Northern Territory during the study. The questionnaire comprised items on: demographics (age, gender), current medications, frequency of ibuprofen use, medical consultations, reading manufacturer's printed dosage/warning instructions, sources from which drug information was gathered and understanding of common indications for ibuprofen. Key findings Sixty per cent of patients (n= 110/183), predominantly females, were currently on other medications and 64.5% of patients (n= 118/183) did not seek medical advice before using non-prescription ibuprofen. Seventy-one per cent (n= 130) of these patients had used ibuprofen for more than a year. The majority of patients did not provide precise answers for the common indications of ibuprofen. Sixty-six per cent of patients (n= 110) reported rarely or never reading manufacturer's printed warning instructions on the potential drug interactions or adverse effects associated with the use of the product. Conclusions Many patients are unaware that non-presciption analgesics such as ibuprofen can cause potentially serious adverse effects when used in combination with other common medications. [source] Agricultural Biotechnology and Regime Formation: A Constructivist Assessment of the ProspectsINTERNATIONAL STUDIES QUARTERLY, Issue 4 2002William D. Coleman Controversies surrounding the appropriate use and diffusion of agricultural biotechnologies are giving rise to questions about governance at the international level. This article investigates the likelihood that a single, international regime or multiple regimes governing this technology will form by way of negotiation. We show that four normative,institutional arrangements, organized around distinct general principles, have a potential governance role: world food security and safety, liberalized trade, protection of intellectual property, and conservation and sustainable use of biodiversity. We argue that an adequate amount of compatibility between the principles and norms of these arrangements is required to support the type of communicative action or truth,seeking needed to develop the intersubjective understanding for a regime. Using a framework for assessing normative compatibility, we find not one, but two nascent understandings rooted in the trade and biodiversity areas competing to form the foundation for governance. Further analysis of levels of institutional density between the two developing regimes reveals they are presently too low to support a negotiated resolution of normative conflict. Finally, we demonstrate that recent framing attempts at the international level to decrease areas of tension and incompatibility in principles/norms between the regimes have neglected to create the crucial normative background conditions needed to avert a scenario of increased political conflict in the near future. [source] A Clinical Review of Infected Wound Treatment with Vacuum Assisted Closure® (V.A.C.®) Therapy: Experience and Case SeriesINTERNATIONAL WOUND JOURNAL, Issue 2009Allen Gabriel ABSTRACT Over the last decade Vacuum Assisted Closure® (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C.® Therapy and V.A.C. Instill® with either GranuFoamÔ or GranuFoam SilverÔ Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C.® Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C.® Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C.® Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies. [source] V.A.C.® Therapy in the management of paediatric wounds: clinical review and experienceINTERNATIONAL WOUND JOURNAL, Issue 2009Mona Baharestani ABSTRACT Usage of negative pressure wound therapy (NPWT) in the management of acute and chronic wounds has grown exponentially in the past decade. Hundreds of studies have been published regarding outcomes and methods of therapy used for adult wounds. This treatment is increasingly being used to manage difficult-to-treat paediatric wounds arising from congenital defects, trauma, infection, tumour, burns, pressure ulceration and postsurgical complications in children, although relatively few studies have been aimed at this population. Given the anatomical and physiological differences between adults and children, a multidisciplinary expert advisory panel was convened to determine appropriate use of NPWT with reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum Assisted Closure® (V.A.C.® Therapy, KCI Licensing, Inc., San Antonio, TX) for the treatment of paediatric wounds. The primary objectives of the expert advisory panel were to exchange state-of-practice information on paediatric wound care, review the published data regarding the use of NPWT/ROCF in paediatric wounds, evaluate the strength of the existing data and establish guidelines on best practices with NPWT/ROCF for the paediatric population. The proposed paediatrics-specific clinical practice guidelines are meant to provide practitioners an evidence base from which decisions could be made regarding the safe and efficacious selection of pressure settings, foam type, dressing change frequency and use of interposing contact layer selections. The guidelines reflect the state of knowledge on effective and appropriate wound care at the time of publication. They are the result of consensus reached by expert advisory panel members based on their individual clinical and published experiences related to the use of NPWT/ROCF in treating paediatric wounds. Best practices are described herein for novice and advanced users of NPWT/ROCF. Recommendations by the expert panel may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the collaborating medical team, including the surgeon and wound care specialist based on available resources, individual patient circumstances and experience with the V.A.C.® Therapy System. [source] Established ways to keep donor's interest aliveISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue n1 2010J. Ringwald Background, The future demographic changes will be associated with an enhancement of the worldwide shortage of blood. The ageing of the population in developed countries is associated with a decrease in young individuals being potentially eligible to donate blood and an increase in older individuals who might be in the need of blood transfusion. Therefore, the retention of active blood donors (BD) is becoming more important. A substantial increase in blood donations could be achieved by a relatively small increase in BD return. It is the task of blood donation services (BDSs) to elaborate specific and adequate measures to increase the BD's likelihood to return. Successful BD retention programmes are viable to ensure a sufficient supply with blood and blood components at present and the upcoming years. Aims, To give recommendations for BD retention strategies based on a survey of potential and established measures how BD's interest could be kept alive. Methods, With focus on the last decade, literature about internal and external influences on BD's intention to regular blood donation and their actual return behaviour was reviewed. Furthermore, a special aspect was drawn on published articles about established or potential measures to increase BD's return-rate. Based on this information, different ways how BD's interest could be kept alive were suggested. Results, Overall, individuals of younger age (< 30,40 years), women, those with a lower education level are less likely to return to blood donation. External influences of friends, family or co-workers are import for starting a BD career. To become a committed BD, however, a high level of intrinsic motivation is needed. To keep BD's interest alive for a long time, BDSs should focus on the following to increase the satisfaction of the BD: Make blood donation a good experience and as convenient as possible, reduce adverse events and anxiety, and train and motivate your staff. This could be further supported by an intensive and active communication with the BDs right from the start, the application of loyalty builders to establish BD identity, and the appropriate use of incentives. Finally, temporarily deferred BDs should ask to return personally and advertisement programmes for repeat BDs should appeal on personal motivation and moral norms. However, BDS should always try to adapt their measures on their target population considering that people are different all around the world. Moreover, some promotion programmes should be even tailored for distinct subgroups of BDs to have a successful outcome. Conclusions, There is quite a number of ways to keep BDs interest alive and to start a career as a regular and committed BD. In this context, the self-identification as a BD is definitely of major importance. BDSs are challenged to support this developmental process. They have to make sure that blood donation is associated with a good experience for the BD, making him or her feeling good and happy. [source] Incidence of In-Hospital Falls in Geriatric Patients Before and After the Introduction of an Interdisciplinary Team,Based Fall-Prevention InterventionJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2007Wolfgang Von Renteln-Kruse MD Falls are among the most common unwanted events in older hospital inpatients, but evidence of effective prevention is still limited compared with that in the community and in long-term care facilities. This article describes a prevention program and its effects on the incidence of falls in geriatric hospital wards. It was a prospective cohort study with historical control including all 4,272 patients (mean age 80, 69% female) before and 2,982 (mean age 81, 69% female) after introduction of the intervention. The intervention included fall-risk assessment on admission and reassessment after a fall; risk alert; additional supervision and assistance with the patients' transfer and use of the toilet; provision of an information leaflet; individual patient and caregiver counseling; encouragement of appropriate use of eyeglasses, hearing aids, footwear, and mobility devices; and staff education. Measurements included standardized fall-incidence reporting, activity of daily living and mobility status, number of falls and injurious falls, and number of patients who fell. Before the intervention was introduced, 893 falls were recorded. After the intervention was implemented, only 468 falls were recorded (incidence rate ratio (IRR)=0.82, 95% confidence interval (CI)=0.73,0.92), 240 versus 129 total injurious falls (IRR=0.84, 95% CI=0.67,1.04), 10 versus nine falls with fracture (IRR=1.40, 95% CI=0.51,3.85) and 611 versus 330 fallers. The relative risk of falling was significantly reduced (0.77, 95% CI=0.68,0.88). A structured multifactorial intervention reduced the incidence of falls, but not injurious falls, in a hospital ward setting with existing geriatric multidisciplinary care. Improvement of functional competence and mobility may be relevant to fall prevention in older hospital inpatients. [source] Potentially Inappropriate Prescribing in Elderly Veterans: Are We Using the Wrong Drug, Wrong Dose, or Wrong Duration?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2005Mary Jo V. Pugh PhD Objectives: To identify the extent of inappropriate prescribing using criteria for proper use developed by the Agency for Healthcare Research and Quality (AHRQ) and dose-limitation criteria defined by Beers, as well as to describe duration of use and patient characteristics associated with inappropriate prescribing for older people. Design: Retrospective national Veterans Health Administration (VA) administrative database analysis. Setting: VA outpatient facilities during fiscal year 2000 (FY00). Participants: Veterans aged 65 and older having at least one VA outpatient visit in FY00 (N=1,265,434). Measurements: Operational definitions of appropriate use were developed based on recommendations of an expert panel convened by the AHRQ (Zhan criteria). Inappropriate use was identified based on these criteria and inappropriate use of drugs per Beers criteria for dose-limitations in older people. Furthermore, duration of use and patient characteristics associated with inappropriate use were described. Results: After adjusting for diagnoses, dose, and duration, inappropriate prescribing decreased from 33% to 23%. Exposure to inappropriate drugs was prolonged. Pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents constituted 61% of inappropriate prescribing. Whites, patients with psychiatric comorbidities, and patients receiving more medications were most likely to receive inappropriate drugs. Women were more likely to receive Zhan criteria drugs; men were more likely to receive dose-limited drugs Conclusion: For the most part, the Zhan criteria did not explain inappropriate prescribing, which includes problems related to dose and duration of prescriptions. Interventions targeted at prescriptions for pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents may dramatically decrease inappropriate prescribing and improve patient outcomes. [source] Optimizing Coding and Reimbursement to Improve Management of Alzheimer's Disease and Related DementiasJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2002Howard Fillit MD The objectives of this study were to review the diagnostic, International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM), diagnosis related groups (DRGs), and common procedural terminology (CPT) coding and reimbursement issues (including Medicare Part B reimbursement for physicians) encountered in caring for patients with Alzheimer's disease and related dementias (ADRD); to review the implications of these policies for the long-term clinical management of the patient with ADRD; and to provide recommendations for promoting appropriate recognition and reimbursement for clinical services provided to ADRD patients. Relevant English-language articles identified from MEDLINE about ADRD prevalence estimates; disease morbidity and mortality; diagnostic coding practices for ADRD; and Medicare, Medicaid, and managed care organization data on diagnostic coding and reimbursement were reviewed. Alzheimer's disease (AD) is grossly undercoded. Few AD cases are recognized at an early stage. Only 13% of a group of patients receiving the AD therapy donepezil had AD as the primary diagnosis, and AD is rarely included as a primary or secondary DRG diagnosis when the condition precipitating admission to the hospital is caused by AD. In addition, AD is often not mentioned on death certificates, although it may be the proximate cause of death. There is only one ICD-9-CM code for AD,331.0,and no clinical modification codes, despite numerous complications that can be directly attributed to AD. Medicare carriers consider ICD-9 codes for senile dementia (290 series) to be mental health codes and pay them at a lower rate than medical codes. DRG coding is biased against recognition of ADRD as an acute, admitting diagnosis. The CPT code system is an impediment to quality of care for ADRD patients because the complex, time-intensive services ADRD patients require are not adequately, if at all, reimbursed. Also, physicians treating significant numbers of AD patients are at greater risk of audit if they submit a high frequency of complex codes. AD is grossly undercoded in acute hospital and outpatient care settings because of failure to diagnose, limitations of the coding system, and reimbursement issues. Such undercoding leads to a lack of recognition of the effect of AD and its complications on clinical care and impedes the development of better care management. We recommend continuing physician education on the importance of early diagnosis and care management of AD and its documentation through appropriate coding, expansion of the current ICD-9-CM codes for AD, more appropriate use of DRG coding for ADRD, recognition of the need for time-intensive services by ADRD patients that result in a higher frequency of use of complex CPT codes, and reimbursement for CPT codes that cover ADRD care management services. [source] Beyond the Usual Strategies for Blood Pressure Reduction: Therapeutic Considerations and Combination TherapiesJOURNAL OF CLINICAL HYPERTENSION, Issue 6 2001Thomas D. Giles MD Rapidly accumulating clinical data have repeatedly demonstrated not only the critical importance of even small increases in blood pressure as a pathophysiologic factor in the development of cardiovascular disease, particularly in individuals with diabetes mellitus, but also the therapeutic necessity of more aggressive blood pressure reduction and the achievement of progressively lower blood pressure targets in reducing cardiovascular event rates. JNC VI has defined optimal blood pressure as ,120/80 mm Hg, and Stage 1 hypertension as ,140/80 mm Hg. Target blood pressures are now ,130/80 mm Hg in patients with diabetes and <125/75 mm Hg for patients with hypertensive renal disease with proteinuria of>1 gm/24 hours. Achieving such target pressures is increasingly difficult, particularly in diabetic patients with chronic renal disease, who require complex multidrug antihypertensive regimens. This review attempts to provide some suggestions for constructing such antihypertensive regimens, and provides considerations for the appropriate use of diuretics and the most effective drug combinations. Factors potentially contributing to drug resistant hypertension include such problems as failure to maximize drug dosing, suboptimal diuretic use, noncompliance, and possible confounding effects of such concomitant medications as nonsteroidal and anti-inflammatory drugs or decongestants. The issues underlying drug-resistant hypertension are listed, together with strategies for overcoming this problem. [source] Perimenopausal knowledge of mid-life women in northern TaiwanJOURNAL OF CLINICAL NURSING, Issue 5 2004Lee-Ing Tsao DNSc Background., This work has been carried out keeping in view that although knowledge related to perimenopause is an important health issue for women worldwide, little information is known about mid-life Taiwanese women's knowledge of perimenopause. Objective., The aim of this paper was to explore the level of perimenopausal knowledge of mid-life women in northern Taiwan, to describe the relationship between demographic factors and women's knowledge, and to identify what information health providers need to offer them. Design., A cross-sectional descriptive survey was conducted. Method., The Perimenopausal Knowledge Questionnaire was used to collect data. The study was carried out in August 2000 to September 2001. A convenience sample was recruited from traditional Chinese medicine clinics, gynecology clinics and communities in northern Taipei. Results., Our findings indicated that the overall mean correct answer weighted Perimenopausal Knowledge score of these mid-life women was 46.31. The rank of weighted scores from highest to lowest was: (1) self-care during perimenopause, (2) the perception of perimenopause, (3) knowledge related to hormone replacement therapy and (4) body changes associated with the declined oestrogen in perimenopause. Only educational level was significantly associated with Perimenopause Knowledge level (P < 0.01). Less than 20% (n = 353) of the women answered the items that measured self-management of symptoms related to perimenopause correctly. Less than 1.4% of the women knew that taking hormone replacement therapy required a physician's prescription and subsequent regular health check-ups. Conclusion., Participants lacked adequate knowledge about perimenopause. Relevance to clinical practices., Health providers need to provide factual information about the normal body changes of perimenopause, self-management of perimenopausal disturbances and appropriate use of hormone replacement therapy. 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