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PubMed2002

Institutionalising cost sharing for catchment management: lessons from land and water management planning in Australia.

A recurring theme in recent Australian reports on integrated catchment management (ICM) has been the need to institutionalise more formally the cost-sharing commitments made within this domain. This represents a significant departure from earlier visions of ICM as essentially promoting voluntary uptake of resource-conservation measures. Two important questions raised by this nascent policy shift are addressed in this paper. Firstly, how might cost-sharing arrangements be given greater formality without undermining the efforts of ICM to increase the preparedness of civil stakeholders to voluntarily, or informally, accept responsibility for sharing costs? Secondly, how is it possible to formalise cost-sharing arrangements so that the transaction costs of enforcing compliance with them remain affordable? Answers to these questions are explored through a case study of the Land and Water Management Planning Program now being successfully implemented in the irrigation districts of the central-Murray region of southern inland New South Wales (NSW) surrounding Deniliquin. The sophisticated system of institutional arrangements introduced in the program to facilitate monitoring, enforcement and adaptive management of cost-sharing commitments is discussed, and insights into how informally motivated cooperation can enhance the affordability and political feasibility of formal arrangements are presented.

Australia↗

PubMed2003

Are the components of the Asthma Management Plan important in managing childhood asthma? A survey of general practitioners.

AIM: To gauge the importance and relevance placed by general practitioners on components of the National Asthma Campaign's 'Six step' Asthma Management Plan for childhood asthma. METHOD: A cross sectional postal survey of a national randomised sample of 824 GPs. RESULTS: Each component was considered to be 'quite' or 'very' important by at least 70% of respondents. All 11 components were rated to be either 'quite' or 'very' important by 44%, and 91% of respondents considered eight or more of the components to be 'quite' or 'very' important. Two characteristics were consistently associated with the rating of importance: gender, (women GPs generally showing higher ratings), and reported frequency of use of the Asthma Management Plan (frequent users rate importance more frequently). CONCLUSION: There were high levels of endorsement of the Asthma Management Plan for children with asthma.

Adolescent↗

PubMed2003

Improving institutional performance by better internal hospital management: a framework for assessing management training needs.

In the face of diverse contexts in the world's regions and countries, decentralization and increasing autonomy of hospitals are an important trend in hospital sector development. Substantial gains in institutional performance can be achieved through better internal hospital management. The article examines hospital managers' functions and practices and outlines a framework for assessing their management education needs. We argue that training is most appropriate if targeted at improving managerial competence within a specific health system development context.

Efficiency, Organizational↗

PubMed1992

Clinicians' quick reference guide to postoperative pain management in adults. Pain Management Guideline Panel. Agency for Health Care Policy and Research, US Department of Health and Human Services.

The management of pain is an important part of a health professional's role. The challenge for clinicians is to balance pain control with concern for patient safety and side effects of pain treatments. This is the first of two articles that summarize the highlights of the Agency for Health Care Policy and Research's Panel to develop clinical practice guidelines for the management of pain. This first article includes a summary of the methods used to develop the guidelines and the clinical highlights of pain assessment and management in adults.

Adult↗

PubMed2005

Linking integrated water resources management and integrated coastal zone management.

Some of the world's most valuable aquatic ecosystems such as deltas, lagoons and estuaries are located in the coastal zone. However, the coastal zone and its aquatic ecosystems are in many places under environmental stress from human activities. About 50% of the human population lives within 200 km of the coastline, and the population density is increasing every day. In addition, the majority of urban centres are located in the coastal zone. It is commonly known that there are important linkages between the activities in the upstream river basins and the environment conditions in the downstream coastal zones. Changes in river flows, e.g. caused by irrigation, hydropower and water supply, have changed salinity in estuaries and lagoons. Land use changes, such as intensified agricultural activities and urban and industrial development, cause increasing loads of nutrients and a variety of chemicals resulting in considerable adverse impacts in the coastal zones. It is recognised that the solution to such problems calls for an integrated approach. Therefore, the terms Integrated Water Resources Management (IWRM) and Integrated Coastal Zone Management (ICZM) are increasingly in focus on the international agenda. Unfortunately, the concepts of IWRM and ICZM are mostly being developed independently from each other by separate management bodies using their own individual approaches and tools. The present paper describes how modelling tools can be used to link IWRM and ICZM. It draws a line from the traditional sectoral use of models for the Istanbul Master Planning and assessment of the water quality and ecological impact in the Bosphorus Strait and the Black Sea 10 years ago, to the most recent use of models in a Water Framework Directive (WFD) context for one of the selected Pilot River Basins in Denmark used for testing of the WFD Guidance Documents.

Alismatales↗

PubMed2005

Public participation in water resources management: stakeholder voices on degree, scale, potential, and methods in future water management.

The European Water Framework Directive puts strong emphasis on stakeholder and public participation in water management. Several practical questions regarding who should be involved, why, when, and how still remain unanswered. This paper investigates stakeholders' own experiences and views of increased public participation in water management. The article also explores the potential for increasing levels of participation by forming catchment committees with representation from stakeholder groups and through the use of various practical methods for participation. For both these aspects of participation, the views, expectations, and apprehensions of different stakeholder groups involved in nutrient loss management are investigated. Stakeholder opinions were collected by inviting representatives from five stakeholder groups within the Rönneå catchment in southern Sweden to a catchment dialog process.

Community Participation↗

PubMed2006

[Quality assurance in airway management: education and training for difficult airway management].

Respiratory problem is one of the main causes of death or severe brain damage in perioperative period. Three major factors of respiratory problem are esophageal intubation, inadequate ventilation, and difficult airway. The wide spread of pulse oximeter and capnograph reduced the incidences of esophageal intubation and inadequate ventilation, but the difficult airway still occupies the large portion in the causes of adverse events during anesthesia. "Practice guideline for management of the difficult airway" was proposed by American Society of Anesthesiologists (ASA) in 1992 and 2002. Improvement of knowledge, technical skills, and cognitive skills are necessary for the education and training of the difficult airway management. "The practical seminar of difficult airway management (DAM practical seminar)" has been cosponsored by the Japanese Association of Medical Simulation (JAMS) in the 51 st and 52 nd annual meetings of Japanese Society of Anesthesiologists and the 24th annual meeting of Japanese Society for Clinical Anesthesia. The DAM practical seminar is composed of the lecture session for ASA difficult airway algorithm, the hands-on training session for technical skills, and the scenario-based training session for cognitive skills. Ninty six Japanese anesthesiologists have completed the DAM practical seminar in one year. "The DAM instructor course" should be immediately prepared to organize the seminar more frequently.

Algorithms↗

PubMed2004

Information technology in the interventional pain practice: electronic medical records, practice management software, and document management.

Electronic medical records (EMR) can both replace the paper clinical chart and perform scheduling and billing tasks. EMRs are currently used in only a small proportion of medical practices; however, EMR adoption is expected to soar in a few years. Governmental and industry concerns about safety and quality, along with medical practice needs for increased productivity, are fueling this transition. Medical practices are likely to consider transitioning to EMRs. At this point, the marketplace is fragmented in terms of suppliers, and refinement of the software is continuing. Transitioning to an EMR is a step that offers enormous benefits to interventional pain management physicians, in terms of compliance, the ability to maintain quality, and the ability to manage practices, including larger and more complex practices. Transitioning to an EMR is also a major effort in terms of time and expense: the goal is to settle on a specific EMR and continue to use it. This review focuses on (1) why physicians are or are not transitioning to EMRs; (2) the benefits of a transition; and (3) factors to consider in evaluating the various competing software products. Although EMR technology continues to develop, the review also considers areas in which future development is necessary. The most important areas are seen in document management, data input, and outcomes analysis and decision support capability. The EMR market is evolving rapidly. However, this review should in no way serve as an endorsement of any particular system, vendor, or technology.

Journal Article↗

PubMed2006

Decision support, knowledge representation and management: A broad methodological spectrum. Findings from the Decision Support, Knowledge Representation and Management.

OBJECTIVES: To summarize current excellent research in the field of decision support, knowledge management and representation. METHODS: Synopsis of the articles selected for the IMIA Yearbook 2006. RESULTS: Decision Support, Knowledge Representation and Management covers a broad spectrum of methods applied to a variety of medical problems and domains. Some particularly interesting and current topics were picked for the IMIA Yearbook 2006: the importance of ontologies for systematic system engineering of decision support systems, syndromic surveillance based on natural language processing, the evaluation of large semantic networks, and a comprehensive ontology for a randomised controlled trial database to support evidence-based practise. CONCLUSIONS: The best paper selection shows that methods for decision support, knowledge representation and management can decisively contribute to the solution of many different medical problems, but also that there is still a lot of exiting research to be done.

Awards and Prizes↗

PubMed2006

[Management of blood glucose--target of the management and its practice].

Accumulating evidence supports that management of blood glucose levels is critical for the prevention of diabetic vascular complications including macroangiopathy. Several therapeutic modalities are available in the management of blood glucose levels. In type 2 diabetes with obesity, achievement of body weight control with intensive caloric restriction is essential. Sulfonylurea remains the central drug in the management in insulin-independent patients without obesity. For patients with insulin resistance, biguanide or thiazolidinediones are the drugs of choice. For patients with postprandial hyperglycemia, a-glucosidase inhibitors and meglitinide analogs should be considered. Combination of some of these drugs has additive effect for patients with suboptimal blood glucose control with monotherapy. When the above therapies fail, we should not hesitate to start insulin.

Benzamides↗

PubMed1991

Clinicians: manage your move to manager.

Clinicians seeking to advance in their careers often look to management positions. But making that step from clinician to manager can be a shaky proposition if the clinician doesn't apply management savvy to the move.

Career Mobility↗

PubMed1989

MANAGER: a multi-user computer scheme for management of laboratory staff working hours.

To administer a flexible-working-time system in a busy medical microbiology department, without increased administrative workload, a set of programs was produced for computer monitoring of staff time-keeping records. The programs--initially written to facilitate management and minimise clerical work, and extended to encompass all staff absences--are collectively called MANAGER. They allow efficient management of working hours and staff absences, using a multi-user laboratory computer. The programs were all written in MUMPS and evolved in-house, but could be developed for any multi-user laboratory computer system.

Laboratories↗

PubMed1988

Mosquito production in a rotationally managed impoundment compared to other management techniques.

Mosquito production was monitored by larval dipping for 12 months in a 20.2 ha central east coast Florida salt marsh impoundment which was being managed under a rotational impoundment management (RIM) regime. This regime, implemented to provide mosquito control while retaining natural resource benefits, virtually eliminated salt-marsh Aedes mosquito production from late May through September when the marsh was closed to the estuary and flooded to approximately 1.0 ft NGVD. Anopheles spp. were collected only along the upland marsh edges in relatively low densities. Compared with the management methods of: 1) open to the estuary with culverts and, 2) passive retention of water with flapgate risers, RIM proved to be significantly more effective in reducing mosquito production.

Aedes↗

PubMed1995

Medical management of sinusitis: educational goals and management guidelines. The International Conference on sinus Disease.

The primary goal of sinusitis management is resolution of infection, leading to patency of the ostiomeatal complex. Antibiotics and decongestants are the cornerstones of therapy for acute sinusitis. Diagnosis of acute sinusitis is based on the history and physical findings. Sinusitis is considered to be acute or recurrent acute if infection resolves without residual mucosal damage. Choices for first-line antibiotic therapy include adequate dosages of trimethoprim-sulfamethoxazole, loracarbef, and amoxicillin-clavulanate. Decongestants and mucoevacuants may reduce tissue edema, facilitate drainage, and maintain ostial patency. Topical corticosteroids are useful additional therapy in allergic rhinosinusitis and as an aid in the long-term management of chronic sinusitis. Parenteral corticosteroids have no role in first-line management of acute or recurrent acute sinusitis.

Chronic Disease↗

PubMed1994

Physicians in health care management: 2. Managing performance: who, what, how and when?

Physicians are becoming more involved in performance management as hospitals restructure to increase effectiveness. Although physicians are not hospital employees, they are subject to performance appraisals because the hospitals are accountable to patients and the community for the quality of hospital services. The performance of a health care professional may be appraised by the appropriate departmental manager, by other professionals in a team or program or by peers, based on prior agreement on expectations. Appraisal approaches vary. They include behavioural approaches such as rating scales, peer rating, ranking or nomination and outcome approaches such as management by objectives and goal setting. Professionals should give and receive timely feedback on a flexible schedule. Feedback can be provided one-on-one, by a group assessing quality of care or through an anonymous survey.

Canada↗

PubMed1996

Innovation in nursing management: professional, management and methodological considerations.

There are many changes occurring in the National Health Service (NHS) at this time, not just to economic and funding policies, but also at the very heart of nursing delivery. The introduction of "managerialism" into the senior clinical grades of nursing, midwifery and other professional staff has characterized the past few years. Against this backdrop is the increasing belief that NHS organizations must find improved ways of delivering patient care and other services. This has inexorably led to the consideration of diffusing innovation into practice as a way to improve performance and competitiveness. While there have been a number of clinical attempts at understanding this process, there has been very little written about innovation from the perspective of the nurse (or midwifery) clinical manager. This paper discusses some of the issues surrounding management innovation including the planning of interventions aimed at introducing innovation, and some of the methodological difficulties of studying complex organizations. The wider issues of innovation, nursing management and professional staff are also discussed.

Diffusion of Innovation↗

PubMed1996

Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 2. The use of bone density measurement in the diagnosis and management of osteoporosis.

OBJECTIVE: To determine the best method of diagnosing osteoporosis and determining fracture risk and to promote standards in the use of bone densitometry and the reporting of results. OPTIONS: Methods of bone mineral density measurement: dual-energy x-ray absorptiometry (DXA), radiographic absorptiometry, single-photon absorptiometry, dual-photon absorptiometry, quantitative computed tomography, quantitative ultrasound, neutron activation analysis. The options of using bone densitometry in individual patient management and as a mass screening tool are also considered. OUTCOMES: Appropriate use of densitometry to promote accurate diagnosis and assessment of fracture risk and timely, appropriate treatment. EVIDENCE: Relevant clinical studies and reports were examined. Clinical practice in Canada was also considered. VALUES: Accurate assessment of osteoporotic fracture risk and diagnosis of osteoporosis and assuring low exposure to medical radiation were given a high value. BENEFITS, HARMS AND COSTS: Early diagnosis through bone density measurement allows proper management of osteoporosis to minimize injury and disability, improve quality of life and reduce the personal and social costs associated with the condition. Potential harms include radiation exposure and cost. The harms and costs of appropriate use of DXA are minimal compared with the harms and costs associated with osteoporosis. RECOMMENDATIONS: Bone mineral density should be measured only to assist in making a clinical management choice. DXA is the best method of measuring bone density and, thus, the best available indicator of osteoporotic fracture risk. Plain radiographs may supplement DXA if there is a specific reason for their use. Measurement of the lumbar spine and femoral neck is standard, but a different site or a single measurement is recommended in specific cases. Unless accelerated bone loss is suspected, DXA should be repeated every 2 to 4 years for patients receiving ovarian hormone therapy and 1 to 2 years for patients undergoing bisphosphonate therapy. Measurements and reporting of results must be standardized. Reports should refer to the World Health Organization's recommended definitions of osteopenia and osteoporosis and provide actual measurement and its relation to peak bone mass.

Aged↗

PubMed1998

Diabetes care management: a managed care approach.

A Diabetes Care Management program was developed by PrimeCare, a network model HMO, to improve quality of life health outcomes and reduce the costs of medical care for its members with diabetes. The HMO used a systems-based approach to communicate information about appropriate self-management and standards of care to members and physicians. The focus of the program was to educate and encourage patients to self-manage their illness, and to partner with physicians, other health care providers and community organizations to achieve improved quality of life, clinical and financial results. Clinical process indicators were used to measure results of interventions. Significant increases in the percentage of participants receiving glycosylated hemoglobin (HbA1c) tests, retinal eye exams and lipid panel tests were achieved.

Diabetes Mellitus↗