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PubMed1994

Attributes of effective managers and implications for health care management education in the Asia-Pacific region.

This paper explores the perceptions of managers and students from 11 countries in the Asia-Pacific region regarding the attributes needed for becoming effective managers and the broad implications of these findings for health care management education. The study forms part of a wider international project aimed at exploring the role of national culture in managerial behavior and effectiveness.

Administrative Personnel↗

PubMed2004

Successful obstetrical management of 110-day intertwin delivery interval without cerclage: counseling and conservative management approach to extreme asynchronous twin birth.

BACKGROUND: This report describes a patient counseling approach and non-surgical management of a dichorionic-diamniotic twin pregnancy where delivery of the second twin followed the delivery of the first by 110 days. CASE PRESENTATION: An early transvaginal sonogram at 19 1/2 weeks suggested cervical dilation with protruding amniotic membranes. Tocolytic and antibiotic therapy was initiated; no cerclage was placed. Spontaneous rupture of membranes and cord prolapse occurred 48 h later, resulting in delivery of a stillborn female infant. Conservative management was offered after counseling for possible risks associated with maternal sepsis, need for extended hospitalization, potential for hysterectomy and death. The cervix appeared closed after delivery and the umbilical cord was ligated, with subsequent spontaneous cord retraction in utero. Reassuring fetal status was observed for twin B without evidence of contractions or chorioamnionitis. A viable male infant (2894 g) was delivered vaginally at 35 1/2 weeks. CONCLUSIONS: This report outlines a counseling approach useful for patients with premature delivery of one twin, and presents application of conservative obstetrical management principles for the aftercoming twin even when delivery interval is extreme.

Journal Article↗

PubMed2005

The management of patients with intradural post-traumatic mass lesions: a multicenter survey of current approaches to surgical management in 729 patients coordinated by the European Brain Injury Consortium.

OBJECTIVE: Controversy exists about the indications and timing for surgery in head injured patients with an intradural mass lesion. The aim of this study was to survey contemporary approaches to the treatment of head injured patients with an intradural lesion, placing a particular focus on the utilization of decompressive craniectomy. METHODS: A prospective international survey was conducted over a 3-month period in 67 centers from 24 countries on the neurosurgical management of head injured patients with an intradural mass lesion and/or radiological signs of raised intracranial pressure. Information was obtained about demographic, clinical, and radiological features; surgical management, and mortality at discharge. RESULTS: Over the period of the study, data were collected about 729 patients consecutively admitted to one of the participating centers. The survey included 397 patients with a severe head injury (Glasgow Coma Scale [GCS] 3-8), 155 with a moderate head injury (GCS 9-12) and 143 patients with a mild head injury (GCS 13-15). An operation was performed on 502 patients (69%). Emergency surgery (<24 h) was most frequently performed for patients with an extracerebral mass lesions (subdural hematomas) whereas delayed surgery was most frequently performed for an intracerebral hematoma or contusion. Decompressive craniectomy was performed in a substantial number of patients, either during an emergency procedure (n = 134, 33%) or a delayed procedure (n = 47, 31%). The decompressive procedure was nearly always combined with evacuation of a mass lesion. The size of the decompression was however considered too small in 25% of cases. CONCLUSION: The results provide a contemporary picture of neurosurgical surgical approaches to the management of head injured patients with an intradural mass lesion and/or signs of raised intracranial pressure in some Neurosurgical Units across the world. The relative benefits of early versus delayed surgery in patients with intraparenchymal lesions and on the indications, technique and benefits of decompressive craniectomy could be topics for future head injury research.

Adolescent↗

PubMed2004

Managing or managed? Experience of general practitioners in English Primary Care Groups and Trusts.

This article presents findings from a wider UK Department of Health funded evaluation of English Primary Care Groups (PCGs) and Trusts (PCTs). It presents qualitative research into the experiences of general practitioners (GPs) in these PCG/Ts and explores the extent to which GPs manage, or are managed by, these new organizations. Using the framework of stratification theory, the paper explores whether there is any evidence to suggest PCTs will strengthen collective medical control over resource allocation whilst fending off management control of clinical decision-making. It also examines whether individual GPs not involved at board level feel a loss of control over decisions and their own clinical practice. A stratified random sample of 20 GPs was selected for in-depth interview. The in-depth interviews were designed to capture the full complexity and variety of GPs' experiences that routinely available data could not capture. GPs were anxious that clinical decisions were, or could, be overridden by other concerns such as cost control. The extent to which primary care professionals leading PCGs and PCTs could fend off managerial control was doubted. However, whilst GPs felt under threat, this was more an anticipated threat than a reality. GPs within PCG/Ts seem prepared to accept a degree of standardization if they feel that this is consistent with good clinical care. However, although there was the impression of greater central control, PCGs and PCTs and Government policies did not appear to have made an impression on clinical autonomy.

Decision Making↗

PubMed2006

UK National Audit of Early Syphilis Management. Clinics audit: screening for and management of early syphilis.

Data were provided by 131 clinics, and 56% of cases were managed in clinics in the London regions in 2003. Three clinics (2%) do not routinely screen new patients for syphilis, and 28 clinics (21%) do not routinely screen 'rebook' patients who have had a new partner. More than 80% of clinics routinely conduct cardiovascular and neurological examinations, although chest radiography is only performed by 50% of clinics and lumbar puncture by 13%. Only 19 (14%) clinics indicated not routinely using the recommended procaine penicillin G (PPG) regimen or one- or two-dose benzathine penicillin G (BPG) regimens for early syphilis, with 57% providing two doses of BPG 2.4 g, 40% providing PPG 750 mg for 10 days, and 15% providing one dose of BPG 2.4 g. Only seven clinics (5%) indicated that they provided treatment for early syphilis with PPG that is inferior to that recommended in the national guidelines. Only 18 clinics specified using the recommended dose and duration (or in excess of this) of PPG for neurosyphilis for cases with HIV infection. Provision for management of severe penicillin reaction is good, although few patients are desensitized. All clinics report that contact tracing for early syphilis is provided, and is mainly the responsibility of health advisers. Compared with auditing outcomes, audit of management policies overestimated performance in contact tracing and provision of dark ground microscopy.

Anti-Bacterial Agents↗

PubMed2006

Implementing MOE/MAR: balancing project management with change management.

When Toronto-based University Health Network initiated its Medication Order Entry/Medication Administration Record project in 2001, it was well understood by the organization that this would be one of the largest change management initiatives undertaken, and would require rigorous project management, significant clinical involvement and a well-developed change management program.

Diffusion of Innovation↗

PubMed2006

Planting transgenic insecticidal corn based on economic thresholds: consequences for integrated pest management and insect resistance management.

A simulation model of the western corn rootworm, Diabrotica virgifera virgifera LeConte, was used to investigate whether sampling and economic thresholds can improve integrated pest management (IPM) and insect resistance management (IRM) when transgenic insecticidal crops are used for insect pest management. When transgenic corn killed at least 80% of susceptible larvae, the calculated economic threshold increased linearly as the proportion of susceptible beetles surviving the toxin increased. The use of economic thresholds slightly slowed the evolution of resistance to transgenic insecticidal crops. In areas with or without rotation-resistant western corn rootworm phenotypes, the use of sampling and economic thresholds generated similar returns compared with strategies of planting transgenic corn, Zea mays L., every season. Because transgenic crops are extremely effective, farmers may be inclined to plant transgenic crops every season rather than implementing costly and time-consuming sampling protocols.

Agriculture↗

PubMed2005

HER1/EGFR inhibitor-associated rash: future directions for management and investigation outcomes from the HER1/EGFR inhibitor rash management forum.

Skin rash associated with HER1/epidermal growth factor receptor (EGFR) inhibitors is common. The lack of clinical and patient guidance for this often chronic and sometimes distressing side effect makes rash management and etiology investigation high priorities. To address this, oncologists and dermatologists with experience with HER1/EGFR inhibitors attended the HER1/EGFR Inhibitor Rash Management Forum. Recommendations include continued analysis of the correlation between rash and clinical outcome and improving the accuracy and reproducibility of terminology and grading systems. Because acne vulgaris has a unique pathology, and the pathology and etiology of rash are unclear yet distinct from acne vulgaris, using such terms as acne, acne-like, or acneiform should be avoided. Until there is a specific dermatological definition, rash is best described using phenotypic terms for its appearance and location. It is currently unknown which agents are best for treating rash. Clinical trials of rash treatments are urgently required, and suggestions for agents to consider are made based on current knowledge. The effect of dose reduction or interruption on rash should also be investigated. Secondarily infected rash may be more frequent than has been previously recognized, and some investigators favor empiric use of an oral antibiotic if this appears to be the case. Suggestions for patients include makeup to camouflage the rash and an emollient to prevent and alleviate skin dryness. The increasing use of HER1/EGFR-targeted agents makes managing rash important. We hope the outcomes from this Forum provide background for future studies.

Animals↗

PubMed2003

Specialist nurse management programmes: economic benefits in the management of heart failure.

Chronic heart failure (CHF) is a modern-day epidemic in most developed countries. As such, it is both common and costly. Contrary to the impression given by clinical trial data, CHF mainly affects older individuals with approximately equal numbers of men and women and concurrent disease profiles likely to complicate or even prohibit the application of proven treatments. It is within this context that there has been an increasing interest in specific CHF-management programmes designed to limit costly hospital use in typically older individuals at high risk for poor quality of life, recurrent readmissions and premature death. This paper examines the evidence to suggest that CHF programmes involving individualised multidisciplinary post-discharge healthcare, with a major focus on specialist nurse management to ensure that the patient receives optimal treatment, are clinically and economically effective in reducing the typical burden imposed by CHF. These programmes appear to be most effective in 'high-risk' patients who typically have recurrent readmissions in high-cost units. Overall, the literature suggests that these programmes are able to reduce recurrent hospital stay by 30-50% relative to usual care (even in the presence of gold-standard treatment) in the short to medium term with comparable cost benefits. Recent data from a management programme involving a cohort of typically older and fragile patients with CHF in Australia showed that at 3 years post index admission, hospital utilisation costs were reduced by one-third relative to usual care. The potential for enormous cost benefits (both in terms of absolute cost savings and in terms of facilitating a more efficient healthcare system) if a specialist nurse programme of care was applied in the form of a UK-wide heart failure service was also recently examined. Based on year 2000 activity levels, it was found that for each specialist heart failure nurse appointed in the UK (with a caseload of 200-250 patients per annum), nominal savings of pound 49 000 per annum could be generated in order to make the healthcare system more efficient.

Cost-Benefit Analysis↗

PubMedDate not supplied

Outpatient management of Stevens-Johnson syndrome: a report of four cases and management strategy.

Stevens-Johnson syndrome is a severe form of erythema multiforme with or without bullous lesions. This is a potentially life-threatening condition that has traditionally required hospitalization for optimal management. We report the successful management of four patients who developed this syndrome following administration of antimicrobial agents. In our experience, for individuals with mild to moderate disease, Stevens-Johnson syndrome can be managed with corticosteroids as an outpatient.

Adrenal Cortex Hormones↗

PubMed1989

Management of depressed skull fractures. Selective conservative management of nonmissile injuries.

The management of 319 cases with nonmissible depressed skull fractures is discussed. The majority of these injuries (75%) resulted from assaults and more than 90% were compound fractures. Of these, 35 cases were excluded from the series; these were patients who died before investigation or treatment could be instituted, or whose major injury was an intracranial hematoma or extensive traumatic hemorrhagic necrosis rather than a depressed fracture with underlying localized contusion. In the remaining 284 cases a comparison is made between the outcome in 124 (44%) patients treated by a conventional surgical method and 160 (56%) selected patients whose wound was only inspected, cleaned, and sutured in the emergency room. The nonsurgical group included 21 (9%) patients with simple depressed fractures and also patients without severe wound contamination, established infection, severe comminution of the fracture, or brain or cerebrospinal fluid in the wound. The results of management were assessed in relation to septic complications, the outcome of focal neurological abnormalities, and fatal complications. The group treated conservatively compared favorably with the surgical cases and also with previously reported series. The obvious bias in favor of the conservative group is admitted; however, it is clear that the majority of simple fractures and some compound depressed skull fractures can be managed safely without major surgical intervention. Socioeconomic implications are discussed.

Epilepsy, Post-Traumatic↗

PubMed2004

Evidence-based medical quality management in dialysis--Part I: Routine implementation of QiN, a German quality management system.

Increasing medical complexity, centrifugal forces of medical subspecialization and growing economic constraints are the key reasons for the introduction of quality management into routine care processes such as dialysis. Adequate quality assurance and improvement must be implemented in order to supply medical staff, care providers, and patients with the necessary information on critical issues of clinical management of dialysis patients. QiN (Quality in Nephrology), the quality management program of the largest German dialysis provider, is outlined here as a practicable example. The first of 2 parts provides information on the structure, implementation of QiN and achieved clinical improvement in routine care. The second part (quotation) analyzes longitudinal data in order to differentiate whether observed improvements during more than 5 years of QiN can be ascribed to the intervention (application of QiN) or whether they are due to other factors such as generally improved medical knowledge.

Evidence-Based Medicine↗

PubMed1992

Active management of the dying patient.

OBJECTIVE: To document the process of managing the dying patient in the intensive care unit (ICU) and thus to broaden community debate about an issue that is usually only discussed at a theoretical or philosophical level. SETTING: A six-bed ICU in Liverpool Hospital, a 419-bed teaching institution in the southwestern area of Sydney. PATIENTS: Twenty-seven patients, seen over a nine-month period, who had curative treatment withdrawn or withheld. The mean age of the patients was 68 years and the severity of illness, by the APACHE II scoring system, ranged from 12 to 45. INTERVENTIONS: Twenty-three of the 27 patients were mechanically ventilated and 11 were receiving inotropic support. Medical staff usually initiated discussions and sought staff consensus that the patient should be allowed to die (on 23 of 27 occasions). Most relatives (25 of 27) accepted this decision. Support therapies and routine care were stopped according to policy guidelines. Sedatives and narcotics were used in some patients (18 of 27). Twenty-one patients died in the ICU and six in the general ward areas. CONCLUSION: Introduction of a policy to guide management of dying patients in intensive care has been accepted by staff. Most dying patients are now managed in accordance with these guidelines. Further discussion and debate of this important issue, by health professionals and society as a whole, is required.

Adult↗

PubMed1995

Education review: diversity and opportunity in health management systems and health information management.

Innovative methods for managing health care information are critical to solving the problems posed by our nation's health care system. The Department of Health Information Sciences at the John G. Rangos, Sr. School of Health Sciences at Duquesne University in Pittsburgh has created baccalaureate and master's degree programs in health management systems that respond to a need for the redesign and management of the cultural and technologic infrastructure necessary to create more efficient, highly effective, and better informed health care organizations.

Curriculum↗

PubMedDate not supplied

Proactive management in the managed care era.

Preparing for the future impact of managed care on clinical laboratories remains a complex challenge as the corporate strategies of health maintenance organizations (HMOs) and managed care contracting continue to evolve. Employers often fail to use data or quality measures to select an HMO, preventing a clinical laboratory from competing on patient care issues. Developing analysis skills and knowledge concerning physician ordering data, HMO information, costs, and capitation rate corridors prepares the enterprise and managers for a successful future.

Capitation Fee↗

PubMedDate not supplied

Managing for efficiency, managing for equity.

It is a truism that not all managers do the same things in the same ways. Less often recognized, however, is the fact that the essential tasks and goals of management are not everywhere the same. Indeed, so unlike each other are the two primary systems of management--the "technocratic" and the "political"--that they consistently vary in the implicit contract offered to participants, the career path of members, the use of organizational structure, the choice of purpose, and the allocation of resources, but also provides a conceptual framework for understanding why they happen and what can be done to prevent their happening in the future.

Facility Regulation and Control↗

PubMed1989

Doctors and management. 1. General management and the consultant.

Consultants should expect from the general manager a clear context for their work and the systematic support of the organisation around them. General managers seem to be unable to provide these things at present. There is frustration on both sides. There is avoidable overwork for some doctors and good ideas are not being implemented. This article contains a personal view on what kind of understanding between consultants and general managers might start to make things better.

England↗

PubMed2001

Modern management instruments--control of a water resources management association by means of an agreement on targets (balanced scorecard).

Since the matter of water supply and sewage disposal is safeguarded in Germany, public concern would no longer appear to be directed at questions of disposal reliability, but almost exclusively to economic efficiency. The requirements with respect to sewage disposal are dominated not only by growing environmental regulations and technical challenges, but also to a major extent by a discussion on the costs arising. In order to ensure a viable and at the same time economic water supply and sewage disposal despite this, it is necessary to have a holistic corporate control system. As a counterpart to the river basin management approach adopted at the Wupperverband there is, on the business management side, the agreement on targets (balanced scorecard) as a management and controlling approach. This incorporates purely financial variables as well as non-financial variables in the economic valuation of corporate success. The starting point is the formulation of strategic goals, while including customer-oriented, in-company and forward-looking perspectives, taking into account at the same time the interactions between them. A major perspective of such balanced scorecards is customer satisfaction. By means of an intensive dialogue with members, licensing and supervisory authorities of the Wupperverband within the framework of a holistic corporate control, it has been possible not only to improve corporate success, but also, and more importantly, to achieve an appreciable increase in confidence.

Commerce↗