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Ongoing Management (ongoing + management)
Selected AbstractsAchieving Integrative, Collaborative Ecosystem ManagementCONSERVATION BIOLOGY, Issue 5 2006HEATHER L. KEOUGH beneficios sociales y ecológicos; gestión; participación pública; toma de decisiones cooperativa Abstract:,Although numerous principles have been identified as being important for successfully integrating social and ecological factors in collaborative management, few authors have illustrated how these principles are used and why they are effective. On the basis of a review of the ecosystem management and collaboration literature, we identified eight factors important for integrative, collaborative ecosystem management,integrated and balanced goals, inclusive public involvement, stakeholder influence, consensus group approach, collaborative stewardship, monitoring and adaptive management, multidisciplinary data, and economic incentives. We examined four cases of successful ecosystem management to illustrate how the factors were incorporated and discuss the role they played in each case's success. The cases illustrate that balancing social and ecosystem sustainability goals is possible. Collaborative efforts resulted in part from factors aimed at making plans economically feasible and from meaningful stakeholder participation in ongoing management. It also required participation in monitoring programs to ensure stakeholder interests were protected and management efforts were focused on agreed-upon goals. Data collection efforts were not all-inclusive and systematic; rather, they addressed the ecological, economic, and social aspects of key issues as they emerged over time. Economic considerations appear to be broader than simply providing economic incentives; stakeholders seem willing to trade some economic value for recreational or environmental benefits. The cases demonstrate that it is not idealistic to believe integrative, collaborative ecosystem management is possible in field applications. Resumen:,Aunque numerosos principios han sido identificados como importantes para la integración exitosa de factores sociales y ecológicos en la gestión cooperativa, pocos autores han ilustrado como son utilizados estos principios y porque son efectivos. Con base en una revisión de la literatura sobre gestión de ecosistemas y colaboración, identificamos cinco factores,metas integradas y balanceadas, inclusive participación pública, influencia de grupos de interés, estrategia de consenso en el grupo, gestión cooperativa, gestión adaptativa y monitoreo, datos multidisciplinarios e incentivos económicos,que son importantes para la gestión integradora y cooperativa de ecosistemas. Examinamos cuatro casos de gestión exitosa de ecosistemas para ilustrar como fueron incorporados los factores y discutimos el papel que jugaron en el éxito de cada caso. Los casos ilustran que el balance de metas de sustentabilidad social y ecológica es posible. En parte, los esfuerzos cooperativos resultaron de factores orientados a hacer que los planes fueran económicamente viables y de la participación significativa de grupos de interés en la gestión en curso. También se requirió la participación en programas de monitoreo para asegurar que los intereses de los grupos fueran protegidos y los esfuerzos de gestión se enfocaran en las metas acordadas. No todos los esfuerzos de recolecta de datos fueron incluyentes y sistemáticos, más bien, eran dirigidos a los aspectos ecológicos, económicos y sociales de temas clave a medida que emergían. Las consideraciones económicas parecen ser más amplias que simplemente proporcionar incentivos económicos, los grupos de interés parecen dispuestos a cambiar algo de valor económico por beneficios recreativos o ambientales. Los casos demuestran que no es idealista pensar que es posible aplicar la gestión integradora y cooperativa de ecosistemas en el campo. [source] Prevalence and correlates of comorbidity 8 years after a first psychotic episodeACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2007S. Farrelly Objective:, While rates and correlates of comorbidity have been investigated in the early course of psychosis, little is known about comorbidity in the medium-to-longer term or its relationship with outcome. Method:, A total of 182 first-episode psychosis (FEP) patients who met DSM-IV criteria for a current psychotic disorder 8 years after index presentation were grouped according to concurrent comorbidity [no concurrent axis I disorder; concurrent substance use disorder (SUD); other concurrent axis I disorder; concurrent SUD and other axis I disorder]. Outcomes were compared between groups controlling for relevant covariates. Results:, As much as 39% met criteria for one or more concurrent axis 1 diagnoses. Comorbidity was associated with greater severity of general psychopathology, but not with measures of functioning, treatment or negative symptoms. Conclusion:, Specific combinations of comorbid disorders may influence patterns of psychotic symptomatology. Routine examination of axis I disorders is warranted in the ongoing management of psychosis. [source] Primary Care Quality and Addiction Severity: A Prospective Cohort StudyHEALTH SERVICES RESEARCH, Issue 2 2007Theresa W. Kim Background. Alcohol and drug use disorders are chronic diseases that require ongoing management of physical, psychiatric, and social consequences. While specific addiction-focused interventions in primary care are efficacious, the influence of overall primary care quality (PCQ) on addiction outcomes has not been studied. The aim of this study was to prospectively examine if higher PCQ is associated with lower addiction severity among patients with substance use disorders. Study Population. Subjects with alcohol, cocaine, and/or heroin use disorders who initiated primary care after being discharged from an urban residential detoxification program. Measurements. We used the Primary Care Assessment Survey (PCAS), a well-validated, patient-completed survey that measures defining attributes of primary care named by the Institute of Medicine. Nine summary scales cover two broad areas of PCQ: the patient,physician relationship (communication, interpersonal treatment, thoroughness of the physical exam, whole-person knowledge, preventive counseling, and trust) and structural/organizational features of care (organizational access, financial access, and visit-based continuity). Each of the three addiction outcomes (alcohol addiction severity (ASI-alc), drug addiction severity (ASI-drug), and any drug or heavy alcohol use) were derived from the Addiction Severity Index and assessed 6,18 months after PCAS administration. Separate longitudinal regression models included a single PCAS scale as the main predictor variable as well as variables known to be associated with addiction outcomes. Main Results. Eight of the nine PCAS scales were associated with lower alcohol addiction severity at follow-up (p,.05). Two measures of relationship quality (communication and whole- person knowledge of the patient) were associated with the largest decreases in ASI-alc (,0.06). More whole-person knowledge, organizational access, and visit-based continuity predicted lower drug addiction severity (ASI-drug: ,0.02). Two PCAS scales (trust and whole-person knowledge of the patient) were associated with lower likelihood of subsequent substance use (adjusted odds ratio, [AOR]=0.76, 95 percent confidence interval [95% CI]=0.60, 0.96 and AOR=0.66, 95 percent CI=0.52, 0.85, respectively). Conclusion. Core features of PCQ, particularly those reflecting the quality of the physician,patient relationship, were associated with positive addiction outcomes. Our findings suggest that the provision of patient-centered, comprehensive care from a primary care clinician may be an important treatment component for substance use disorders. [source] Food allergy in adolescents and adultsINTERNAL MEDICINE JOURNAL, Issue 7 2009J. Yun Abstract There has been an increase in the prevalence of food allergy in the last few decades. Adult food allergy may represent persistence of reactions that commenced in infancy and early childhood or it may be initiated in adulthood through new sensitizations. Persistence of peanut allergy is an example of the former situation. Approximately 20% of children will develop tolerance to peanuts, so there will be an increasing number of individuals reaching adulthood where this problem will need ongoing management. In addition to peanut, tree nuts, fruits, vegetables and seafood are implicated as common causes of food allergy in adulthood. Sensitization may occur directly to a food allergen or indirectly through cross-reactivity with an aeroallergen. Adults may present with a spectrum of clinical manifestations from oral allergy syndrome to fatal anaphylaxis. The management of food allergy consists of appropriate education regarding avoidance of implicated foods, modifying potential risk factors for anaphylaxis, such as asthma and prompt recognition and treatment of acute reactions. [source] Adefovir dipivoxil: review of a novel acyclic nucleoside analogueINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2004M. Danta Summary Adefovir dipivoxil (ADF) is a novel acyclic nucleoside analogue that has recently been approved for the treatment of chronic hepatitis B virus (HBV). Adefovir was initially assessed at higher doses for the treatment of human immunodeficiency virus (HIV) infection. However, in these studies, nephrotoxicity proved a dose-limiting side effect. Large randomised controlled studies have recently shown that ADF results in histological, virological and biochemical improvement in both hepatitis B e antigen (HBeAg)-positive and HBeAg-negative chronic HBV. While the rate of HBeAg seroconversion at 1 year (12%) was lower than both lamivudine and interferon, this increases with prolonged treatment. The clinical improvements occurred without serious side effects or the development of resistance at the dose of 10 mg daily, in treatment trials of up to 2 years, although resistance has now been observed. In addition, the drug is efficacious in HBV/HIV co-infection and hepatitis B-infected liver transplant recipients, particularly in those who have developed lamivudine resistance. ADF can be added as a treatment option to existing treatment options (interferon-alpha and lamivudine) and assumes a role in the ongoing management of chronic HBV. The optimal use of ADF as either a monotherapy or as part of combination therapy requires further assessment. [source] Missed opportunities for a diagnosis of acute otitis media in Aboriginal childrenJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2003KB Gibney Objective: Severe otitis media and its sequelae are common in rural and remote Aboriginal children. Identification of acute otitis media (AOM) is likely to reduce the number of children who go on to develop chronic suppurative otitis media and associated complications. The aim of this study was to compare the diagnoses made by researchers with that documented in the medical records of children admitted to the paediatric isolation ward of the Royal Darwin Hospital, Darwin, Northern Territory. Methods: Children aged <8 years admitted to Royal Darwin Hospital were eligible for assessment by pneumatic otoscopy, video-otoscopy and tympanometry. A diagnosis was made for each child according to the state of their worst ear. Comparisons were made between the researcher diagnoses of ear disease and those documented in the hospital notes by medical staff. Results: Thirty-one children were enrolled during 32 admissions. Most were aged <2 years, Aboriginal, and resided in remote communities. Sixty-one video-otoscopic assessments were attempted and sufficiently good images to allow diagnosis were obtained in 105 of 122 ears. Acute otitis media was diagnosed by the research team in 20 of 32 child admissions. Of 29 children who had ear examinations documented by hospital staff, only seven had a diagnosis of AOM recorded. Overall, the research team were almost three times more likely to make this diagnosis (relative risk 2.9, 95% confidence interval 1.6, 5.2). This difference was unlikely to have occurred by chance (P = 0.0002, McNemar's Chi-squared test). Conclusions: In this small study, young Aboriginal children with clear bulging of their tympanic membrane were not diagnosed with AOM by medical staff. Further training in diagnosis, including cleaning of the ear canal, may lead to more accurate assessment and appropriate recommendations for ongoing management. [source] Genital herpes in older women: A silent epidemicJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 6 2008*Article first published online: 28 JUN 200, Adjunct Faculty2), GNP (Nurse Practitioner, Janice Hoff MSN Abstract Purpose: To present an overview of the prevalence of genital herpes in older women and to present case studies of older women diagnosed with genital herpes in a geriatric practice in the southeastern United States. Data sources: Review of current scientific literature and treatment/practice guidelines. Specific descriptive cases are reviewed to illustrate the clinical problem. Conclusions: Genital herpes is an important differential diagnosis to include when assessing and treating older women for recurrent genital symptoms. Implications for practice: Given the large numbers of older individuals potentially infected with genital herpes, the nurse practitioner (NP) is well positioned to accurately diagnose and initiate treatment that can improve quality of life. The NP's skill in education and counseling is essential to the ongoing management of genital herpes infections. [source] | ||||||||||