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PubMed2000

Managing one's body using self-management techniques: practicing autonomy.

This paper discusses some of the anthropological and philosophical features of the use of self-management plans by patients with a chronic disease, focusing on patients with asthma. Characteristics of this technologically mediated form of self-care are contrasted with the work of Mauss and Foucault on body techniques and techniques of self. The similarities and differences between self-management of asthma and Foucault's technologies of self highlight some of the ways in which self-management contributes to modifications in the definitions of patients and physicians. Patients, in measuring their lung function, first come to rely on measurements more than on felt disturbances, but next, felt disturbances become modified by previous measurements. Physicians, one the other hand, see their role changed from expert to being a participant in a joint treatment. It is argued that the concept of agency is more appropriate for describing the advantage of self-management for patients than autonomy.

Anti-Asthmatic Agents↗

PubMed1991

Female healthcare managers and the glass ceiling. The obstacles and opportunities for women in management.

Despite the large number of women in the healthcare field, healthcare management resembles other industries in its severe lack of women in upper-management positions and in the "glass ceiling" that contributes to this dearth. Although not enough has been specifically written on women healthcare managers, the author reviews what is available, along with some of the general management literature.

Career Mobility↗

PubMed1999

Influence of nursing management education on management direction and role.

The authors discuss how 13 nurse managers in Sweden experienced management direction and the management role before and 1 year after a professional development course in advanced nursing at the masters-degree level. The nurse managers related theoretical knowledge to an increased awareness of further possibilities inherent in managerial positions. They stressed the importance of networking for future support and growth.

Education, Nursing, Graduate↗

PubMed2003

Is syndromic management better than the current approach for treatment of STDs in China? Evaluation of the cost-effectiveness of syndromic management for male STD patients.

BACKGROUND: The syndromic treatment approach has not been evaluated in sexually transmitted disease (STD) clinics in China. GOAL: The goal was to evaluate and compare the validity and cost-effectiveness of syndromic management with current STD management for men in clinics in Hefei, China. STUDY DESIGN: Diagnostic accuracy, treatment appropriateness, costs, and effectiveness of current clinical procedures and syndromic management were compared for 406 men attending four STD clinics. RESULTS: A modified World Health Organization (WHO) syndromic algorithm for urethral discharge yielded 100% sensitivity and a 69% positive predictive value (PPV). A syndromic algorithm for genital ulcers correctly treated all syphilis patients, with a 25% PPV. The average cost (in US dollars) per correct treatment by the current approach was 323.48 dollars for urethritis and 85.65 dollars for syphilis. For the syndromic approach, the average cost per correct treatment was 3.15 dollars for urethritis and 13.54 dollars for syphilis. CONCLUSION: Syndromic management can provide better treatment for men with STDs at significantly lower cost in resource-poor settings such as China.

Adult↗

PubMed2002

The Management Academy for Public Health: a new paradigm for public health management development.

Research has established a need to develop management skills among public health professionals. The University of North Carolina-Chapel Hill created the Management Academy for Public Health as a pilot program for this specialized training need. This article describes why a management academy for public health managers was formed, its curriculum and instructional methods, and the evaluation findings from its first year. The program sponsors hope to effect individual and organization level change, eventually leading to improved community health. Results suggest that this innovative program gives public health professionals needed skills and improves their job performance.

Curriculum↗

PubMed2005

Management of urinary tract infections: historical perspective and current strategies: Part 2--Modern management.

PURPOSE: An understanding of the microbial origin of infectious diseases and the introduction of antimicrobial therapy stimulated more advances in the management of urinary tract infections (UTIs) in the 20th century than had occurred in the previous 5 centuries. MATERIALS AND METHODS: Numerous resources were used to collect the information described in this review. Medical texts from the 19th and 20th century contain information regarding the traditional contemporary treatment of UTI during those eras. Early volumes of the Journal of Urology from the beginning of the 20th century describe the first attempts at chemotherapy for UTI. MEDLINE searches were used to collect appropriate information after 1969. Modern medical journals and modern medical texts were used to collect information on antimicrobial therapy since the late 1960s through today. RESULTS: Numerous advances in the diagnosis and management of UTI were made during the 20th century. Advances in microbiological and chemical assays have facilitated the development of historical uroscopy into modern day urinalysis and culture techniques, which are the cornerstone of UTI diagnosis. Imaging technologies, including x-ray, ultrasound, nuclear imaging, magnetic resonance and computerized tomography, have been particularly helpful in the diagnosis of complicated or recurrent UTIs. Major innovations in nonpharmacological therapy include noninvasive shock wave lithotripsy and percutaneous drainage of kidney abscesses. The most profound advance in UTI management during the 20th century was the discovery of antimicrobial agents. Nitrofurantoin was the first truly effective and safe antimicrobial therapy for UTI but its spectrum of activity is limited. Broad use of amoxicillin (and other beta-lactams) after its introduction in the 1970s led to the development of resistance to this antimicrobial, prompting a gradual change to trimethoprim/sulfamethoxazole (TMP/SMX) as first line therapy for UTI. However, wide use of TMP/SMX also resulted in the progressive emergence of resistance, limiting the clinical usefulness of this therapy in the modern management of UTI. Fluoroquinolones offer an attractive alternative to TMP/SMX, and American and European guidelines recommend their empirical use in areas where TMP/SMX resistance is 10% or higher. CONCLUSIONS: The development of antimicrobial therapy was the defining moment of 20th century medicine and one of the key innovations in medical history. While the initial promise of antimicrobials has been validated in clinical practice, overuse of certain agents has led to the emergence of resistance, illustrating the importance of using evidence based strategies to select therapy.

Anti-Infective Agents, Urinary↗

PubMed1996

Lower utilization of dermatologists in managed care: despite growth in managed care, visits to dermatologists did not decrease: an analysis of National Ambulatory Medical Care Survey data, 1990-1992.

Growth of managed care and the decline of direct access are two of the major issues confronting dermatology. Previous study has demonstrated that patients in managed care are less likely than patients with indemnity insurance to see a dermatologist for skin problems, and it was predicted that this would result in a slowing in the demand for dermatologist services. To examine whether the changing health-care environment has resulted in fewer visits to dermatologists, we used National Ambulatory Medical Care Survey data from the years 1990-1992 to examine utilization of dermatologist services over a period in which managed care grew by 32%. Patients with HMO/prepaid insurance were less likely to have their skin care provided by dermatologists than patients with commercial insurance (Blue Cross/Blue Shield and other commercial carriers) or Medicare. A reduction in the number of visits to dermatologists was observed among patients with HMO/prepaid insurance despite the growth in HMO/prepaid insurance as a form of payment; when all payors were considered, however, the number of visits to dermatologists increased from the 1989 level, reaching a plateau in 1992. The number of visits for skin disease to all physicians increased from 56.5 million to 63.5 million, whereas the proportion of this care delivered by dermatologists decreased from 39.6% to 37.9%. The overall increase in visits for skin conditions tempered the reduction in demand for dermatology services expected with the growing transition to managed care.

Dermatology↗

PubMed2003

Diagnosis and management of the painful ankle/foot. Part 2: examination, interpretation, and management.

Diagnosis, interpretation, and subsequent management of ankle/foot pathology can be challenging to clinicians. A sensitive and specific physical examination is the strategy of choice for diagnosing selected ankle/foot injuries and additional diagnostic procedures, at considerable cost, may not provide additional information for clinical diagnosis and management. Because of a distal location in the sclerotome and the reduced convergence of afferent signals from this region to the dorsal horn of the spinal cord, pain reference patterns are low and the localization of symptoms is trustworthy. Effective management of the painful ankle/foot is closely linked to a tissue-specific clinical examination. The examination of the ankle/foot should include passive and resistive tests that provide information regarding movement limitations and pain provocation. Special tests can augment the findings from the examination, suggesting compromises in the structural and functional integrity of the ankle/foot complex. The weight bearing function of the ankle/foot compounds the clinician's diagnostic picture, as limits and pain provocation are frequently produced only when the patient attempts to function in weight bearing. As a consequence, clinicians should consider this feature by implementing numerous weightbearing components in the diagnosis and management of ankle/foot afflictions. Limits in passive motion can be classified as either capsular or non-capsular patterns. Conversely, patients can present with ankle/foot pain that demonstrates no limitation of motion. Bursitis, tendopathy, compression neuropathy, and instability can produce ankle/foot pain that is challenging to diagnose, especially when they are the consequence of functional weight bearing. Numerous non-surgical measures can be implemented in treating the painful ankle/foot, reserving surgical interventions for those patients who are resistant to conservative care.

Journal Article↗

PubMed1992

Attitudes of nurse managers and assistant nurse managers toward chemically impaired colleagues.

The purpose of this research was to determine attitudes among nurse managers and assistant nurse managers toward impaired colleagues in a descriptive correlational study method, using the Perceptions of Nursing Impairment Inventory. The study revealed no significant differences in attitudes between groups; assistant nurse managers demonstrated a more disciplinary orientation toward impairment within nursing. Both groups tended to have supportive attitudes toward impaired colleagues. Racial/ethnic origin had the most influence on nurse managers' attitudes toward chemically impaired colleagues. The Philippine/Oriental group demonstrated a stronger need to know when a colleague is impaired or receiving treatment, exhibited less belief in the treatability of impairment and displayed a stronger belief in impairment as a personality weakness.

Adult↗

PubMed2003

Emergency medicine crisis resource management (EMCRM): pilot study of a simulation-based crisis management course for emergency medicine.

OBJECTIVES: To determine participant perceptions of Emergency Medicine Crisis Resource Management (EMCRM), a simulation-based crisis management course for emergency medicine. METHODS: EMCRM was created using Anesthesia Crisis Resource Management (ACRM) as a template. Thirteen residents participated in one of three pilot courses of EMCRM; following a didactic session on principles of human error and crisis management, the residents participated in simulated emergency department crisis scenarios and instructor-facilitated debriefing. The crisis simulations involved a computer-enhanced mannequin simulator and standardized patients. After finishing the course, study subjects completed a horizontal numerical scale survey (1 = worst rating to 5 = best rating) of their perceptions of EMCRM. Descriptive statistics were calculated to evaluate the data. RESULTS: The study subjects found EMCRM to be enjoyable (4.9 +/- 0.3) (mean +/- SD) and reported that the knowledge gained from the course would be helpful in their practices (4.5 +/- 0.6). The subjects believed that the simulation environment prompted realistic responses (4.6 +/- 0.8) and that the scenarios were highly believable (4.8 +/- 0.4). The participants reported that EMCRM was best suited for residents (4.9 +/- 0.3) but could also benefit students and attending physicians. The subjects believed that the course should be repeated every 8.2 +/- 3.3 months. CONCLUSIONS: The EMCRM participants rated the course very favorably and believed that the knowledge gained would be beneficial in their practices. The extremely positive response to EMCRM found in this pilot study suggests that this training modality may be valuable in training emergency medicine residents.

Adult↗

PubMed1993

Management of genital herpes by genitourinary physicians: does experience or doctor's gender influence clinical management?

OBJECTIVE: To determine the variation in management of genital herpes by genitourinary physicians, and whether their duration of experience or gender influence their clinical management. METHODS: A postal questionnaire was sent to UK consultant genitourinary physicians with detailed questions about management of primary and recurrent herpes. The gender and duration of genitourinary medicine experience of the physicians were also recorded. RESULTS: One hundred and eighty two questionnaires were sent, 112 (62%) returned. Eighty-one (72%) physicians treat all patients with primary genital herpes, but physicians with more than 20 years experience were significantly (p < 0.05) more likely to treat only "severe" primary attacks. Most experienced physicians were also most likely (p < 0.05) to prescribe topical acyclovir. Prescription of suppressive acyclovir was also influenced by the experience of the physician, the least experienced physicians being more likely to prescribe to patients who were HIV antibody positive or to those entering new relationships, whereas the more experienced prescribed to those patients who were particularly anxious (p < 0.05 for each of these). Male physicians were significantly more likely to agree with the proposition that men cope better with genital herpes (54%) than female physicians (24%, p < 0.01). CONCLUSION: The response to the questionnaire illustrates that management of genital herpes is influenced by the duration of the physicians clinical experience. Gender of the physician may have an indirect role to play as we have shown that physicians differ in their perception of how the sexes cope with genital herpes.

Acyclovir↗

PubMed2001

MOSHI: a culture-tailored management game for African hospital managers.

The computer-based management game MOSHI (management of small hospitals) was developed in Tanzania and became an integrated component of a training programme for East African hospital managers. Players are in charge of a 120-bed hospital in rural Tanzania and have to make strategic and tactical decisions according to their own traditions and values. Thus, it becomes possible that the cultural gap between western management philosophy and traditional African values is bridged.

Cultural Characteristics↗

PubMed2002

Managing it: a mother's perspective of managing a pre-school child's acute asthma episode.

Over the last decade asthma management strategies have required families to take increased responsibility for the assessment and treatment of their child's asthma. This exploratory descriptive study informed by grounded theory examines the experience of mothers in managing their pre-school child's acute asthma attack at home. The study reveals that mothers perceive that they are responsible for the management of their pre-school child during an acute asthma episode, a process they described as 'managing it'. This process involves mother in 'working on treatment', 'making the call', 'watching' and 'calming', while the husband/partner, family, friends and health professionals are 'supporting treatment'. This study suggests that nurses and doctors need to move away from the current paternalistic view of health care delivery in acute settings and embrace the concepts of support and partnership in the care of the pre-school child with asthma and their family.

Acute Disease↗

PubMed2006

The marketplace for new caries management products: dental caries detection and caries management by risk assessment.

The number of new technologies emerging each year in the realm of dental caries management is growing at an exponential rate. Examining the patent literature, one can see that this growth rate will likely continue, with the outcome that dentistry will see an expanded growth in managing dental caries by risk assessment with medicinal therapeutic interventions. Restorative dentistry solutions, treating the results of dental caries, will continue to grow, while technologies to identify the caries process at its earliest stages will soon invade practices everywhere. The most interesting aspect of these changes will be how industry responds to the inexorable, yet slow change in dental professional demand for these new technologies, while trying to be the "first to market" within the various categories of this business opportunity. This paper will take a close look at how businesses with the core competence to be key players in this emerging growth category will assess the marketplace, and match up their business interests with the changing needs of the dental profession. The paper will also address the strategic planning and business processes that the dental industry will undertake to bring new technologies to market, and how these technologies will be positioned to health care professionals and consumers. The results of the key interactions between industry and the dental profession will determine the extent to which dental caries is managed as a disease, in addition to being managed by surgical restorative interventions.

Journal Article↗

PubMed2006

A randomized clinical trial of group-based cognitive-behavioral stress management in localized prostate cancer: development of stress management skills improves quality of life and benefit finding.

BACKGROUND: Recent literature has indicated that a significant percentage of oncology patients describe finding some benefit (e.g., improved personal growth, sense of meaning, and enhanced interpersonal relationships) in the cancer experience. However, few studies have investigated the role of group-based psychosocial interventions in improving benefit finding (BF), and virtually none have investigated these constructs in men. PURPOSE: This study examined whether a cognitive-behavioral stress management (CBSM) intervention improves BF and quality of life (QoL) in men recovering from treatment for localized prostate cancer. METHODS: Participants in this study were 191 men (M age = 65.1) treated with radiation or radical prostatectomy for clinically localized (i.e., Stage I or II) prostate cancer. Participants were primarily non-Hispanic White (40%) or Hispanic (41%), followed by Black (18%) and other ethnicity (1%), were an average of 65.1 years old (SD = 7.7), and earned an average of 47,800 US dollars annually (SD = 41,000 US dollars). Participants were randomized to either a 10-week group-based cognitive-behavioral stress management intervention or a half-day educational seminar as a control condition. All participants provided demographic information and completed the Positive Contributions Scale-Cancer to assess BF, the Functional Assessment of Cancer Therapy to measure quality of life, and a measure of perceived stress management skills. Structural equation modeling was utilized for all analyses. RESULTS: Results indicated that the CBSM condition led to increases in BF and QoL and that these changes were mediated by the development of stress management skills. CONCLUSIONS: Results support the use of group-based cognitive-behavioral interventions in promoting QoL and BF in this population.

Aged↗

PubMed2004

Proactive management promotes outcome in extremely preterm infants: a population-based comparison of two perinatal management strategies.

OBJECTIVE: There is a need for evidence-based knowledge regarding perinatal management in extreme prematurity. The benefit of a proactive attitude versus a more selective one is controversial. The objective of the present study was to analyze perinatal practices and infant outcome in extreme prematurity in relation to different management policies in the North (proactive) and South of Sweden. METHODS: A population-based, retrospective, cohort study design was used. Data in the Swedish Medical Birth Register (MBR) from 1985 to 1999 were analyzed according to region of birth and gestational age (22 weeks + 0 days to 27 weeks + 6 days). A total of 3 602 live-born infants were included (North = 1040, South = 2562). Survival was defined as being alive at 1 year. Morbidity in survivors, based on discharge diagnoses of major morbidity during the first year of life, was described by linking the MBR to the Hospital Discharge Register. RESULTS: In infants with a gestational age of 22 to 25 weeks, the proactive policy was significantly associated with 1) increased incidence of live births, 2) higher degree of centralized management, 3) higher frequency of caesarean section, 4) fewer infants with low Apgar score (<4) at 1 and 5 minutes, 5) fewer infants dead within 24 hours, and 6) increased number of infants alive at 1 year. There were no indications of increased morbidity in survivors of the proactive management during the first year of life, and the proportion of survivors without denoted morbidity was larger. CONCLUSION: In infants with a gestational age of 22 to 25 weeks, a proactive perinatal strategy increases the number of live births and improves the infant's postnatal condition and survival without evidence of increasing morbidity in survivors up to 1 year of age.

Birth Rate↗

PubMed2001

Management of children with prolonged fever of unknown origin and difficulties in the management of fever of unknown origin in children in developing countries.

This is Part II of a 2-part paper on fever of unknown origin (FUO) in children. It examines the aetiology and management of prolonged FUO in children and the difficulties in the management of FUO in children in developing countries. Part I of this paper discussed acute FUO in children and was published in the March 2001 issue of Paediatric Drugs. Prolonged FUO is documented fever of more than 7 to 10 days which has no apparent source and no apparent diagnosis after 1 week of clinical investigations. About 34% of cases of prolonged FUO are caused by infections, with bacterial meningitis and urinary tract infection accounting for about 6.5 and 11.4%, respectively, of cases attributable to infections. Chronic infections, particularly tuberculosis and 'old' disorders such as Kawasaki disease, cat-scratch disease and Epstein-Barr virus infection presenting with 'new' manifestations, collagen-vascular diseases and neoplastic disorders are the other issues of major concern in prolonged FUO. Overall, however, there is a trend towards an increased number of undiagnosed cases. This is due to advancements in diagnostic techniques, such that illnesses which were previously common among the causes of prolonged FUO are now diagnosed earlier, before the presentation becomes that of prolonged FUO. Clinical examination supplemented with laboratory tests to screen for serious bacterial infections should be the mainstay of initial evaluation of children with prolonged FUO. Use of scanning techniques (such as computerised tomography and ultrasound) as additional supplements to this clinical examination may allow for the earlier diagnosis of causes of prolonged FUO in children such as 'occult' abdominal tumours. A common error in management of children with prolonged FUO is the failure to perform a complete history and physical examination; repeated clinical examination and continued observation are of paramount importance in the diagnosis of difficult cases. Major difficulties in the management of FUO in children in developing countries include constraints in the availability and reliability of laboratory tests, cost, misuse of antibiotics and difficulties encountered in the diagnosis of malaria and typhoid fever. Malaria and typhoid fever are major aetiological considerations in both acute and prolonged FUO in children in developing countries. The newer quinolones may hold great promise for the treatment of serious bacterial infections, including meningitis, which are associated with prolonged FUO in developing countries.

Child↗

PubMedDate not supplied

Management of obese patients with diabetes mellitus: comparison of advice education with group management.

The purpose of our study was to compare the effect on diabetes control of group management with the advice-educational technique traditionally used in managing obese outpatients with poorly controlled non-insulin-dependent diabetes mellitus (NIDDM). Forty-one patients were randomly assigned to these two treatment programs, and 32 patients completed the 6-mo study. Initially, patients were seen for 1-h sessions at 1- and 2-wk intervals and later at 1-mo intervals. Patients were asked to do home blood glucose monitoring, decrease caloric intake, increase exercise, and if they were taking insulin, to adjust the dose to attain approximate euglycemia and to stabilize food and exercise patterns. The combined groups reduced mean +/- SD glycohemoglobin from 10.9 +/- 3.1 to 9.4 +/- 2.4% (P less than .05). Internal Health Locus of Control Scale was negatively and significantly correlated with initial and subsequent glycohemoglobin values (the more internal, the lower the glycohemoglobin). At the end of the study the patients in the group management program had significantly lower blood glucose levels than those given advice and education, but no significant differences in glycohemoglobin values or percentage overweight were observed. One patient had a normal initial glycohemoglobin, and only 4 patients had values in the normal range of 4-6.8% at the end of the study. Better management programs need to be developed for treating obese outpatients with NIDDM.

Blood Glucose↗