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Modern Management (modern + management)
Selected AbstractsBT05 MODERN MANAGEMENT OF COLONIC DIVERTICULITIS IN THE OBESEANZ JOURNAL OF SURGERY, Issue 2009S. White Colonic diverticulitis is a dietary disorder of the ageing Western population associated with a low intake of oral fibre. Symptoms develop in only 10% of patients and overall only 1% of patients experience a complication. CT scan is the investigation of choice, although CT fails to predict clinical outcomes in many cases. Uncomplicated diverticulitis is reliably managed by antibiotics in the great majority of cases. So much so that enthusiasm for elective surgical resection after two documented attacks is waning, particularly in the high risk patient i.e. obese. Complicated diverticulitis (abscess, peritonitis, fistulae, stricture or bleeding) that fails conservative management is traditionally treated by open Hartmann's rectosigmoidectomy. Alternatives to laparoscopy are particularly helpful in the obese where large incisions cause significant problems with pain management, patient mobilisation and wound breakdown with hernia. Endoscopic management of acute diverticular bleeding and stricture with obstruction is well described. Radiological management of diverticular abscess is widely available Laparoscopic washout for purulent peritonitis is new whilst laparoscopic resection for faecal peritonitis is proven. Technical aspects of colonic diverticular surgery in the obese will be discussed and our experiences with laparoscopic, colonoscopic and radiological management complicated diverticulitis will be presented. [source] Modern management of salivary calculiBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2005M. McGurk Background: The aim was to investigate the results of a minimally invasive approach to the management of salivary calculi. Methods: Four hundred and fifty-five salivary calculi (323 submandibular and 132 parotid) were treated using extracorporeal shock-wave lithotripsy (ECSWL), fluoroscopically guided basket retrieval or intraoral stone removal under general anaesthesia. The techniques were used either alone or in combination. Results: ECSWL achieved complete success (stone and symptom free) in 87 (39·4 per cent) of 221 patients (84 of 218 primary and all of three secondary procedures; 43 of 131 submandibular, 44 of 90 parotid). Basket retrieval cured 124 (74·7 per cent) of 166 patients (103 of 136 primary and 21 of 30 secondary procedures; 80 of 109 submandibular, 44 of 57 parotid). Intraoral surgical removal was successful in a further 137 (95·8 per cent) of 143 patients with submandibular stones (99 of 101 primary, 36 of 38 secondary and two of four tertiary procedures). The overall success rate for the three techniques was 348 (76·5 per cent) of 455. Conclusion: A minimally invasive approach to the management of salivary calculi is to be encouraged. All three techniques described have low morbidity and afford the possibility of retaining a functional gland. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Building on formal education: employers' approaches to the training and development of new recruits in the People's Republic of ChinaINTERNATIONAL JOURNAL OF TRAINING AND DEVELOPMENT, Issue 3 2003Katharine Venter Conceptions of modern management and of skill in China have developed out of quantitative, production oriented traditions that have tended to downplay the human side of management, training and development. Based on recent survey and case study research this paper argues that some organisations are moving away from such narrow definitions. These tend to be resource rich, larger enterprises, often in modern growth sectors and organisations exposed to foreign practice (either by virtue of foreign ownership or investment, or as a result of exposure to the pressures of global competition through operation in international markets). Skills shortages are faced by organisations throughout China. However, employers do not generally feel that the education system is serving to address these skills needs. The varying conceptions of modern management shape the manner in which organisations recruit from, and build, on formal education provision. Many resource rich employers are using formal education as a selection mechanism, selecting the educational elite and continuing to develop them. Those organisations that have limited access to highly qualified recruits are also least likely to be in a position to provide extensive or high quality training. Consequently the divide between resource rich and resource poor organisations, in terms of both organisational resources and employees' opportunities for skill acquisition, learning and development, seems likely to widen. [source] Stage I seminoma: What should a practicing uro-oncologist do in 2009?INTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2009Julia Skliarenko Abstract Testicular tumors are uncommon, but they continue to represent an important group of malignancies in young men. It is the most common solid malignancy in males between the ages of 20 and 35, and primary germ cell tumors are the most common histological type. In the United States in 2008, approximately 4800 cases of seminoma, approximately 4100 of which were stage I disease were projected after the completion of staging investigations. Remarkable progress has been made in the treatment of testicular seminoma over the past 25 years. Management options of stage I seminoma include radiotherapy, surveillance, or adjuvant chemotherapy. Standard management until recent years has been adjuvant retroperitoneal radiotherapy. Although providing excellent long term results, this approach has been associated with increased risk of gonadal toxicity, development of secondary malignancies and an increased risk of cardiovascular disease. The use of surveillance in management of patients with stage I seminoma is therefore becoming more frequent as it minimizes the burden of treatment and maintains the cure rate at virtually 100%. Adjuvant chemotherapy using Carboplatin has been investigated as an alternative management approach. However, the long term outcomes of patients managed with Carboplatin are not yet clear and this strategy should only be used in a study setting. It has been suggested that more patients with stage I seminoma will die of their treatment than of their cancer; therefore, the thrust of modern management should be to maintain 100% cure while minimizing the burden of treatment. [source] Improving outcomes for operable pancreatic cancer: Is access to safer surgery the problem?JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7pt1 2008David K Chang Abstract Despite advances in the understanding and treatment of pancreatic cancer in the last two decades, there is a persisting nihilistic attitude among clinicians. An alarmingly high rate of under-utilization of surgical management for operable pancreatic cancer was recently reported in the USA, where more than half of patients with stage 1 operable disease and no other contraindications were not offered surgery as therapy, denying this group of patients a 20% chance of long-term survival. These data indicate that a nihilistic attitude among clinicians may be a significant and reversible cause of the persisting high mortality of patients with pancreatic cancer. This article examines the modern management of pancreatic cancer, in particular, the advances in surgical care that have reduced the mortality of pancreatectomy to almost that of colonic resection, and outlines a strategy for improving outcomes for patients with pancreatic cancer now and in the future. [source] The Denial of Slavery in Management StudiesJOURNAL OF MANAGEMENT STUDIES, Issue 8 2003Bill Cooke abstract American slavery has been wrongfully excluded from histories of management. By 1860, when the historical orthodoxy has modern management emerging on the railroads, 38,000 managers were managing the 4 million slaves working in the US economy. Given slaves' worth, slaveholders could literally claim ,our people are our greatest asset.' Yet a review of histories of management shows ante-bellum slavery excluded from managerial modernity as pre-capitalist, unsophisticated in practice, and without non-owner managers identified as such. These grounds for exclusion are challenged. First, it is shown slavery is included within capitalism by many historians, who also see plantations as a site of the emergence of industrial discipline. Second, ante-bellum slavery is demonstrated to have been managed according to classical management and Taylorian principles. Third, those doing the managing are shown to have been employed at the time as ,managers'. In the idea of the manager, and of scientific and classical management slavery has therefore left an ongoing imprint in management practice and thought. A strong argument is made for not just for postcolonialist accounts of management, but for management histories in which anti-African-American racism is a continuing strand. The fundamental significance of the article however is its identification of slavery as of intrinsic, but hitherto denied, relevance to management studies. [source] The Characteristics and Features of SMEs: Favorable or Unfavorable to Logistics Integration?JOURNAL OF SMALL BUSINESS MANAGEMENT, Issue 3 2004René Gélinas For small and medium-sized enterprises (SMEs), logistics integration is one of the most significant challenges of modern management. Growing numbers of SMEs are under pressure from large manufacturing enterprises (LMEs) to change their traditional management styles, both operationally and organizationally, replacing them with integrated systems that help increase the speed and fluidity of physical and information flows, help synchronize demand with supply, and help manage transactions more accurately. The recent literature discusses integrated logistics chain management quite extensively, but most studies address the issue from the standpoint of large firms. Given the importance of SMEs in the economies of industrialized countries, and given, too, that a constantly growing number of such firms will have to replace their management methods by logistically integrated practices, the authors of this study believe that it is important to examine the characteristics and features of SMEs in order to identify those favorable and unfavorable to logistics integration. [source] Topical antifungal drugs for the treatment of onychomycosis: an overview of current strategies for monotherapy and combination therapyJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 1 2005R Baran ABSTRACT Background, Onychomycosis is a relatively common disease accounting for up to 50% of all nail disorders and its prevalence rises with age. As onychomycosis is an important medical disorder affecting both patient's health and quality of life, it requires prompt and effective treatment. Objective, Topical antifungal nail lacquers have been formulated to provide efficient delivery to the nail unit. As both amorolfine and ciclopirox have proved useful as monotherapy for onychomycosis that does not involve the nail matrix area, the purpose of this article is to check if, when combined with oral agents, the effectiveness and scope of treatment can be improved further. Methods, Combining data for mycological cure with clinical success (nail morphology) provides a more exacting efficacy measure. Results, Clinical investigations have shown that the combination of oral therapies with antifungal nail lacquer can confer considerable advantage over monotherapy with either drug type. Conclusion, The improved effectiveness and economic advantages of combined topical/oral therapies benefit both patients and health providers; these treatment regimens therefore have an important role to play in the modern management of onychomycosis. [source] Review article: the modern management of autoimmune hepatitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2010A. D. YEOMAN Aliment Pharmacol Ther,31, 771,787 Summary Background, The management of autoimmune hepatitis (AIH) continues to be refined. However, several issues remain unresolved, primarily as a consequence of the low incidence of the disease. This factor has contributed both to a lack of understanding of and a paucity of large scale clinical trials involving therapeutic agents. Aim, To summarize the latest evidence regarding the pathogenesis, diagnosis, therapy and long-term management of AIH with a focus on clinical aspects of the disease. Method, We searched PUBMED for articles pertaining to AIH, its pathogenesis, treatment and clinical outcomes, combined with the authors' own knowledge of the literature. Results, Standard therapy (corticosteroids and azathioprine) is effective in more than 80% of patients which renders study of novel agents difficult. Budesonide appears to show equivalence to prednisolone. Available, but limited, data suggest that mycophenolate mofetil, tacrolimus and ciclosporin are all variably effective second line agents. Patients with AIH and cirrhosis are at risk of hepatocellular carcinoma (HCC) and require screening. Patients with end stage liver disease represent excellent candidates for liver transplantation. Conclusions, Despite ongoing limitations in the understanding of pathogenesis and difficulties in evaluating novel therapies, the management of AIH continues to evolve slowly. Multi-centre collaboration is necessary to obtain sufficient patient numbers to undertake good quality therapeutic studies. [source] Review article: the modern management of hepatic encephalopathyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2010J. S. BAJAJ Aliment Pharmacol Ther,31, 537,547 Summary Background, Hepatic encephalopathy, both overt and minimal, forms a continuum of cognitive change in cirrhosis. Strategies to diagnose and treat hepatic encephalopathy have evolved considerably. Aim To examine the updated diagnostic and treatment strategies for hepatic encephalopathy. Methods, Techniques for the clinical, psychometric and neurophysiological evaluation of hepatic encephalopathy are reviewed. The methods reviewed include pure clinical scales (West-Haven), psychometric tests (PSE-syndrome test), neurophysiological tests (EEG, Critical flicker frequency, CFF) and computerized tests (Inhibitory control test, ICT). Results, Clinical scales are limited, whereas psychometric tests (specifically PSE-syndrome test), CFF and ICT can be used to diagnose minimal hepatic encephalopathy. However, there is no single test that can capture the entire spectrum of cognitive impairment. Treatment options and goals depend on the acuity of hepatic encephalopathy. In-patient management should concentrate on supportive care, precipitating factor reversal and lactulose and/or rifaximin therapy. Out-patient therapy should aim to prevent recurrences, and both lactulose and rifaximin have evidence to support their use. Conclusions, Diagnostic techniques for hepatic encephalopathy range from simple scales to sophisticated tools. Treatment options depend on the stage of hepatic encephalopathy. The future challenge is to evaluate cognitive function as a continuum with clinically relevant outcomes and to develop well-tolerated and inexpensive treatments for hepatic encephalopathy. [source] Review article: the modern management of portal vein thrombosisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2009Y. CHAWLA Summary Background, Portal vein thrombosis (PVT) is an important cause of portal hypertension. It may occur as such with or without associated cirrhosis and hepatocellular carcinoma. Information on its management is scanty. Aim, To provide an update on the modern management of portal vein thrombosis. Information on portal vein thrombosis in patients with and without cirrhosis and hepatocellular carcinoma is also updated. Methods, A pubmed search was performed to identify the literature using search items portal vein thrombosis-aetiology and treatment and portal vein thrombosis in cirrhosis and hepatocellular carcinoma. Results, Portal vein thrombosis occurs because of local inflammatory conditions in the abdomen and prothrombotic factors. Acute portal vein thrombosis is usually symptomatic when associated with cirrhosis and/or superior mesenteric vein thrombosis. Anticoagulation should be given for 3,6 months if detected early. If prothrombotic factors are identified, anticoagulation should be given lifelong. Chronic portal vein thrombosis usually presents with well tolerated upper gastrointestinal bleed. It is diagnosed by imaging, which demonstrates a portal cavernoma in place of a portal vein. Anticoagulation does not have a definite role, but bleeds can be treated with endotherapy or shunt surgery. Rarely liver transplantation may be considered. Conclusion, Role of anticoagulation in chronic portal vein thrombosis needs to be further studied. [source] Management of red cell alloimmunisation in pregnancy: the non-invasive monitoring of the diseasePRENATAL DIAGNOSIS, Issue 7 2010Sebastian Illanes Abstract Haemolytic disease of the fetus and newborn (HDFN) due to red cell alloimmunization was a significant cause of fetal and neonatal morbidity and mortality until the introduction of anti-D immunoglobulin, which has dramatically changed the incidence of the disease. However, it is still a major problem in affected pregnancies. The emphasis of current clinical management has shifted from an invasive approach to non-invasive monitoring of the disease. The key elements of the modern management are determining which fetuses are at risk of HDFN with the use of cell-free fetal DNA in maternal plasma (fetal RHD genotype) and the follow-up of antigen positive fetuses by Doppler ultrasonography to detect anaemia severe enough to need treatment. When anaemia is suspected, an invasive approach is still required in a timely manner for confirmation of the degree of anaemia and to administer blood transfusions. This non-invasive approach prevents unnecessary administration of human-derived blood products, with the consequent ethical and cost implications and most importantly avoids iatrogenic conversion of mild to severe disease by avoiding need for techniques such as amniocentesis. The potential problem of the non-invasive approach is the reduction in the total number of invasive procedures, with the subsequent difficulty of maintaining the skills required to perform them. Copyright © 2010 John Wiley & Sons, Ltd. [source] Captive and wild orangutan (Pongo sp.) survivorship: a comparison and the influence of managementAMERICAN JOURNAL OF PRIMATOLOGY, Issue 8 2009S.A. Wich Abstract For managers of captive populations it is important to know whether their management provides a species with the physical and social environment that maximizes its survivorship. To determine this, survivorship comparisons with wild populations and long-term evaluations of captive populations are important. Here we provide both for orangutans. We show that survivorship has increased during the past 60 years for captive orangutan populations in zoos. In addition, we show that survivorship of captive orangutans in the past used to be lower than for wild orangutans, but that for recently born (1986,2005) orangutans survivorship is not significantly different from the wild. This indicates that captive management in the past was suboptimal for orangutan survivorship, but that modern management of captive orangutans has increased their survivorship. We discuss the possible factors of modern management that could have influenced this. Am. J. Primatol. 71:680,686, 2009. © 2009 Wiley-Liss, Inc. [source] The ABCS of modern management of chronic stable angina pectorisCLINICAL CARDIOLOGY, Issue 3 2005C. Richard Conti M.D., M.A.C.C. Editor-in-Chief No abstract is available for this article. [source] | ||||||||||||||||||||||||||||