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What becomes an icon most?

Some brands become icons. Think of Nike, Apple, Harley-Davidson: They're the brands every marketer regards with awe. But they are not built according to the principles of conventional marketing, says Harvard Business School marketing professor Douglas Holt. Iconic brands beat the competition not just by delivering innovative benefits, services, or technologies but by forging a deep connection with the culture. A brand becomes an icon when it offers a compelling myth, a story that can help people resolve tensions in their lives. The deepest source of tension in modern society is the disparity between national ideology and the average citizen's reality. When ideologies shift, myths become even more important, and in America, the most potent myths are depictions of rebels. Mountain Dew has long offered a rebel myth in ads showing exciting, vital men who are far from the ideological model of success. Loyal customers drink the beverage to consume the myth. But Mountain Dew's greatest achievement is that it has retained its iconic power by creating fresh rebel myths to suit the tensions of each era: first the hillbilly, who stood in stark contrast to the organization man of the 1950s and 1960s; then the redneck, who rebelled against the investment bankers and consultants of the 1970s and 1980s; and most recently the slacker, who rejects the values and behaviors that, for the past decade, have marked the successful executive. Holt says marketers can learn from Mountain Dew and other iconic brands if they are willing to move beyond conventional brand management and acquire knowledge and skills they may not have. They must learn to target national contradictions instead of just consumer segments, create myths that make sense of confusing societal changes, and speak with a rebel's voice.

Advertising↗

[Concepts of health personnel in relation to the management of acute diarrhea].

With the objective of gaining more knowledge on the concepts of management of acute diarrhea in children from health personnel, a study was designed and carried out in two Central American countries. The sample was composed of pediatric residents, general practitioners, registered nurses and assistant nurses. A special form was designed and field workers were trained for this purpose. A total of 389 health personnel was interviewed. The results showed that there is a good knowledge on morbidity and mortality from diarrheal disease in children, less knowledge on the etiology of the disease and very little knowledge on the composition of oral rehydration solutions. Also there is no standard criterion on the use of drugs, being the general practitioners and nurses who have more wrong concepts. The factors most mentioned for non-acceptance of oral rehydration therapy (ORT) are little promotion of ORT, that the rehydration salts are not available in every place, that mothers do not accept ORT and that ORT seems a non-scientific therapy.

Acute Disease↗

Summer camps and quality of life in children and adolescents with type 1 diabetes.

Topics concerning quality of life in children and adolescents with Type 1 Diabetes Mellitus (T1DM) and summer camps, have only recently appeared in the scientific literature. Interest in quality of life in diabetic patients has lately increased. The Hvidore study group has recruited 2000 patients from several countries and has published an important paper whose conclusions suggest that T1DM patients have a better quality of life if they have a good metabolic control. The aim of this paper is to evaluate if summer camps, seen as an educational and therapeutic tool, can improve quality of life by increasing knowledge and self-management capacities. Certainly summer camps help T1DM children and adolescents to understand that they can be on vacations, practice sports, have fun with other children away from home and parents, just like every other child and adolescent. At summer camps T1DM patients become aware of not being the only ones to deal with the problem of diabetes; in addition parents become aware of their child's skills in the disease management and lastly improve the relationship with the medical staff who will have the opportunity of living an extremely important training experience. The more ambitious aim of summer camps, i.e. the gaining of knowledge and self-management skills and improvement in metabolic control, seems difficult to achieve. The limited literature available suggests that it is unlikely that one or more summer camps will contribute to the improvement of metabolic control; nevertheless, it is not easy to make such evaluations with scientific criteria. We think that Italian guidelines for summer camps should help in standardizing the organization and management; in this way it will be probably easier to evaluate the impact of summer camps on the quality of life.

Adolescent↗

Nursing management of second stage labor.

Despite considerable research into nursing management of second stage labor, traditional approaches continue to predominate. Women are still encouraged to deliver in a recumbent position using sustained, closed-glottis pushing. Current research suggests that utilizing an upright position with pushing that is open glottis and complementary with the involuntary bearing-down reflex produces good maternal/fetal outcomes. Issues such as position, second stage phases, and bearing-down techniques are discussed in view of recent research findings. Gaps in knowledge are identified and practice implications are clearly defined. Now is the time to apply research-based knowledge to nursing management of second stage labor.

Journal Article↗

Hereditary nonpolyposis colorectal carcinoma (HNPCC) and HNPCC-like families: Problems in diagnosis, surveillance, and management.

BACKGROUND: To the authors' knowledge, hereditary nonpolyposis colorectal carcinoma (HNPCC) is the most commonly occurring hereditary disorder that predisposes to colorectal carcinoma (CRC), accounting for approximately 2-7% of all CRC cases diagnosed in the U.S each year. Its diagnosis is wholly dependent on a meticulously obtained family history of cancer of all anatomic sites, with particular attention to the pattern of cancer distribution within the family. METHODS: The objective of the current study was to illustrate various vexing problems that can deter the diagnosis of HNPCC and, ultimately, its management. This was an observational cohort study. Sixteen HNPCC and HNPCC-like families were selected from a large resource of highly extended HNPCC families. High-risk patients were selected from these HNPCC families. An ascertainment bias was imposed by the lack of a population-based data set. Personal interviews and questionnaires were used for data collection. RESULTS: There was an array of difficulties highlighted by limitations in compliance, lack of a clinical or molecular basis for an HNPCC diagnosis, ambiguous DNA findings, problems in genetic counseling, failure to meet Amsterdam or Bethesda criteria, small families, lack of medical and pathologic documentation, poor cooperation of family members and/or their physicians, cultural barriers, economic stress, frequent patient fear and anxiety, perception of insurance discrimination, and limited patient and/or physician knowledge regarding hereditary cancer. CONCLUSIONS: The diagnosis and management of HNPCC is predicated on physician knowledge of its phenotypic and genotypic heterogeneity, in concert with the multifaceted problems that impact on patient compliance.

Adult↗

Percutaneous management of pyogenic hepatic abscesses.

Twelve patients (9 men, 3 women) with a mean age of 65 (54-78) years, with pyogenic hepatic abscesses were managed by percutaneous drainage between 1979 and 1987. Biliary origin was most common (4 patients), followed by hepatic abscesses as a late postoperative complication (seen in 3 patients) and hepatic abscesses occurring in association with acute appendicitis (2 patients). The origin was unknown in 3 patients. Diagnosis was reached by computed tomography or ultrasonography with a diagnostic delay of in mean 11 days. Seventeen abscesses were found among the 12 patients. The median abscess size (maximal diameter) was 7 (1-12) cm. Nine patients were treated with percutaneous drainage with an indwelling catheter within the abscess cavity for up to 3 weeks, while 3 patients were managed with percutaneous puncture and aspiration alone. The most commonly isolated organism from the drained hepatic abscess was E. coli. The course following percutaneous treatment was uneventful, without mortality and recurrence of the hepatic abscess during follow-up. One patient required surgical drainage of an additional hepatic abscess. Percutaneous drainage of hepatic abscesses, independent of origin, thus seems as a safe and reliable method, which should be considered as the treatment of choice if facilities and knowledge of percutaneous management are provided.

Aged↗

A randomized controlled trial of a decision aid for women at increased risk of ovarian cancer.

PURPOSE: To carry out a randomized controlled trial of a decision aid for women at increased risk of developing ovarian cancer to facilitate decision making regarding risk management options. METHODS: This randomized trial, conducted through 6 familial cancer centers, compared the efficacy of tailored decision aid to that of a general educational pamphlet in preparing women for decision making. PARTICIPANTS: 131 women with a family history of breast and/or ovarian cancer or of hereditary nonpolyposis colorectal cancer. OUTCOME MEASURES: Decisional conflict, knowledge about ovarian cancer risk management options, and psychological adjustment were reassessed at 3 time points. RESULTS: Compared to those who received the pamphlet (control), women who received the decision aid (intervention) were significantly more likely to report a high degree of acceptability of the educational material at both follow-up assessment time points. Findings indicate neither group experienced significant increases in psychological distress at either follow-up assessment time points relative to baseline. Two weeks postintervention, the intervention group demonstrated a significant decrease in decisional conflict compared to the control group (t = 2.4, P < 0.025) and a trend for a greater increase in knowledge about risk management options (t = 2.1, P = 0.037). No significant differences were found 6 months postintervention. CONCLUSION: This form of educational material is successful in increasing knowledge about risk management options and in reducing decisional conflict in the shorter term. The decision aid is an effective and acceptable strategy for patient education to facilitate an inclusive and informed decision-making process about managing ovarian cancer risk.

Anxiety↗

Strategic management simulations is a novel way to measure resident competencies.

BACKGROUND: The Strategic Management Simulation (SMS) has been used extensively to test and train higher cognitive functions in persons who occupy professional and leadership positions (i.e., skills like those needed by a surgeon). METHODS: The SMS was used to predict surgical residents' competency in decision making. Skills required for integrative surgical decision making including critical thinking, crisis management, flexibility, factual knowledge, and team building were assessed. Surgical residents with at least 2 years of experience participated. In additional, attending faculty familiar with the residents' work evaluated each resident with a standard comprehensive rating scale. Simulation performance on multiple measures was compared with faculty ratings. RESULTS: A number of measures obtained on simulation performance (eg, activity level, response speed, initiative, adequate usage of and appropriate search for relevant information) generated high correlations with comprehensive faculty assessment (eg, measures of crisis management, team interactions, flexibility of approach). CONCLUSION: The simulation technique is able to accurately assess performance of surgical residents (on a number of parameters) in a relatively brief time period. Simulation data were highly similar to faculty ratings that were based on at least 2 years of experience with the resident.

Clinical Competence↗

Is experience with human immunodeficiency virus disease related to clinical practice? A survey of rural primary care physicians.

BACKGROUND: Human immunodeficiency virus (HIV) disease is spreading to the rural United States, and medical care is increasingly provided by local primary care physicians. A volume-outcome relationship might exist in HIV care. However, little is known about the HIV experience and practices of rural primary care physicians. OBJECTIVES: To estimate the HIV experience of rural primary care physicians, and to determine whether experience is associated with use of newer management strategies, confidence in care, and consultation needs. DESIGN: Telephone survey of a random sample of primary care physicians. SETTING: Primary care sites in nonmetropolitan California. PARTICIPANTS: One hundred twenty eligible primary care physicians in nonmetropolitan California, with 102 respondents (85.0%). MAIN OUTCOME MEASURES: Physicians' HIV experience, use of protease inhibitors and viral load tests, familiarity with vertical HIV transmission prophylaxis, confidence in HIV care, and consultation needs. RESULTS: Most physicians were low-volume providers of HIV care and had limited knowledge of newer management strategies. Experience with protease inhibitors and viral load tests was significantly related to number of recent patients with HIV; 25.0% of those with 1 to 3 patients but 75.0% of those with 4 or more patients had prescribed protease inhibitors (P = .01), whereas 20.8% of those with 1 to 3 patients but 83.3% of those with 4 or more patients had used a viral load test (P = .001). Only 59.8% of all respondents, but 100.0% of those with 4 or more patients, were familiar with vertical HIV transmission prophylaxis (P = .001). After adjustment for other characteristics, HIV experience remained significantly associated with use of newer management strategies (P = .01) and familiarity with vertical HIV transmission prophylaxis (P = .007). Physicians' confidence in HIV care increased with experience (P = .006), and consultation needs decreased (P = .006). CONCLUSIONS: Primary care physicians in rural California lacked in-depth experience with HIV disease. Experience was significantly associated with use of newer HIV management strategies, confidence, and consultation needs. Treating 4 or more patients with HIV or acquired immunodeficiency syndrome may be the threshold above which primary care physicians rapidly adopt new strategies and have confidence in their care.

Adult↗

A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus.

OBJECTIVES: The objective of the study was to study the short-term impact of a brief lifestyle intervention based on yoga on some of the biochemical indicators of risk for cardiovascular disease and diabetes mellitus. DESIGN: The variables of interest were measured at the beginning (day 1) and end (day 10) of the intervention using a pre-post design. SETTING: The study is the result of operational research carried out in our Integral Health Clinic (IHC). The IHC is an outpatient facility which conducts 8-day lifestyle modification programs based on yoga for prevention and management of chronic disease. A new course begins every alternate week of the year. SUBJECTS: The study is based on data collected on 98 subjects (67 male, 31 female), ages 20-74 years, who attended one of our programs. The subjects were a heterogeneous group of patients with hypertension, coronary artery disease, diabetes mellitus, and a variety of other illnesses. INTERVENTION: The intervention consisted of asanas (postures), pranayama (breathing exercises), relaxation techniques, group support, individualized advice, lectures and films on the philosophy of yoga and the place of yoga in daily life, meditation, stress management, nutrition, and knowledge about the illness. OUTCOME MEASURES: The outcome measures were fasting plasma glucose and serum lipoprotein profile. These variables were determined in fasting blood samples, taken on the first and last day of the course. RESULTS: Fasting plasma glucose, serum total cholesterol, low-density lipoprotein (LDL) cholesterol, very- LDL cholesterol, the ratio of total cholesterol to high density lipoprotein (HDL) cholesterol, and total triglycerides were significantly lower, and HDL cholesterol significantly higher, on the last day of the course compared to the first day of the course. The changes were more marked in subjects with hyperglycemia or hypercholesterolemia. CONCLUSIONS: The observations suggest that a short lifestyle modification and stress management education program leads to favorable metabolic effects within a period of 9 days.

Adult↗

Elderly hospice patients' perspective on pain management.

The literature reports that 70% of cancer patients with advanced disease experience pain. Even with increased emphasis on research and education, problems with effective pain management are still evident. Hospice patients' knowledge and attitudes about pain may contribute to this complex problem. To gain an understanding of hospice patients' perspective on the management of pain, 57 hospice patients were asked to describe their knowledge of pain management and their attitudes toward controlling pain. Results showed non-facilitative attitudes and gaps in knowledge that may contribute to ineffective pain management among hospice patients.

Aged↗

Management of arterial hypertension in patients with acute stroke.

Management of arterial hypertension in the hyperacute period immediately after stroke ictus remains controversial. Extremes of blood pressure (BP) are associated with poor outcomes in all stroke subtypes. Severely hypertensive patients likely benefit from modest BP reductions, but aggressive BP reduction may worsen outcome. Although little evidence is currently available to definitively establish guideline recommendations for optimal BP goals at stroke presentation, recently published research is shedding some light on how to approach management of BP after stroke. Antihypertensive treatment should probably be deferred in ischemic stroke patients except in cases of severe hypertension or when thrombolytic therapy is warranted and the patient's BP is above acceptable levels. Hypertensive hemorrhagic stroke patients may benefit from modest BP reductions. Relative hypotension causing regional hypoperfusion is an increasingly understood concept immediately following ischemic or hemorrhagic stroke, emphasizing the need for careful titration of appropriate medications to minimize fluctuations in BP for treated patients. Ongoing trials will improve our current knowledge regarding BP management after ischemic and hemorrhagic stroke.

Journal Article↗

Food selection and eating patterns: themes found among people with type 2 diabetes mellitus.

OBJECTIVE: The objective of this study was to examine the beliefs and perspectives among people with type 2 diabetes mellitus about dietary requirements, food selection and eating patterns, and attitudes about self-management practices. DESIGN: Semistructured, in-depth interviews explored participants' experiences with diabetes prior to their diagnosis, participants' understanding of the guidelines for the nutritional management of diabetes, how participants applied their understanding of dietary guidelines to daily food selection and eating patterns, and the social and personal themes influencing participants' food selection and eating patterns. SUBJECTS: Interviews were conducted with members of a convenience sample of 45 men and women diagnosed with type 2 diabetes for at least 1 year. ANALYSES PERFORMED: Interviews were coded using a conceptual matrix derived from participants' statements. Common characteristics were grouped, and broad themes were identified. RESULTS: Eating patterns were influenced by participants' knowledge of diabetes management. Challenges that participants encountered when applying nutrition recommendations were linked to their prior eating practices. Dietary self-efficacy, social support, and time management were identified as mediating variables that can influence dietary behaviors. IMPLICATIONS: Diabetes nutrition education programs should increase awareness of eating history, spousal support, and time management practices. Future research should include the refinement and validation of a nutritional management model of diabetes.

Adult↗

Campus and education: an experience with PD patients.

Every day patients on peritoneal dialysis (PD) must focus on their dialysis schedules and on nutritional and therapeutic prescriptions. Unfortunately, over time all these actions may not follow the initial protocol. In order to evaluate patient's knowledge and approach to dialysis, an alternative educational tool to hospital or home was investigated. The campus was utilised as a place for re-training and detecting and correcting discrepancies in knowledge and the management of techniques. A continuous educational programme involves some re-training of PD patients and this approach helps us to identify whether the treatment management at home is in accordance with the information given at the start of the dialysis, but there was a need to improve on this and to improve patient understanding and compliance. The campus was chosen as an alternative educational process with the aim of involving the patients themselves and their families to achieve additional benefits and long-term success of the therapy. This initiative, outside the hospital and in collaboration with professional figures not affiliated with the dialysis unit, hoped to offer patients new knowledge about: dialysis technique and procedures, prevention of infectious complications, nutrition and physical activity.

Family↗

Organising primary health care for people with asthma: the patient's perspective.

BACKGROUND: The 1993 chronic disease management contract encourages United Kingdom general practices to implement a standardised package of care with an emphasis on regular visits to an asthma clinic. AIM: To explore the views of people with asthma about the organisation of asthma care in general practice. METHOD: Semi-structured interviews with 20 patients registered with one practice with a nurse-run asthma clinic. The sample was selected to provide people with a wide range of ages and disease severity, and included parents of children. RESULTS: The age range of the interviewees was five to 87 years (parents of children were interviewed) and half of the interviewees had attended the asthma clinic at some time. In describing how they managed their asthma, people identified their medical care alongside other important factors, such as avoiding smoking and pollution, and a decision to seek medical help was made in the context of all of life's other priorities. People expressed diverse views about the organisation of care, describing how their needs changed over time and how they balanced up several factors in deciding what was best for them. These factors were encompassed by four themes: the accessibility of care, severity of asthma and dealing with uncertainty, self-knowledge and self-management, and expert knowledge and therapeutic relationships. Interviewees were evenly split between wishing to be seen regularly in the clinic and wishing only to attend when needing help. CONCLUSION: Patients required asthma services that allow individual choice and flexibility, and eight service objectives were identified that would cover most people's needs.

Adolescent↗

Treatment of non-Hodgkin's lymphomas in elderly patients.

The roles of evolving treatment strategies for non-Hodgkin's lymphomas (NHL) in elderly patients are still not well defined and their effects on the overall epidemiology of the disease are still not clear. Three questions arise when discussing the management of NHL in elderly patients. First, should older patients be treated with the same regimens usually administered to younger patients? Second, are health outcomes of elderly patients similar to those usually observed in young patients, particularly response rate and overall survival? Third, which strategies should be adopted to improve overall health outcomes? Periodic review of the literature and updated data on the management of NHL in elderly patients may provide an answer to all these queries. In essence, older patients must be treated with the same intensive approaches that are usually reserved for younger patients. The results reported in randomized controlled clinical trials are consistent with the capability of older patients to exhibit overall response rate, event-free survival, and overall survival similar to those observed in their younger counterparts. Combining chemotherapy and monoclonal antibodies seems to be the main optional strategy for better outcomes in elderly patients. In contrast, knowledge concerning the management of indolent lymphomas in elderly patients is still lacking, and available clinical data are limited in this setting, especially in patients with poor prognostic factors who may need an immediate therapeutic intervention.

Aged↗

Knowledge, attitudes and practices of trained traditional birth attendants in the Gambia in the prevention, recognition and management of postpartum haemorrhage.

OBJECTIVES: to assess the knowledge, attitudes, practices and the potential role of trained Gambian traditional birth attendants (TBAs) in the prevention, recognition and management of postpartum haemorrhage (PPH). DESIGN: a qualitative, reflective approach using semi-structured interviews followed by group discussions. SETTING: poorly-resourced rural villages in The Gambia, West Africa. PARTICIPANTS: 22 trained TBAs and their supervisors from 12 villages. FINDINGS: the TBAs recognised complications such as retained placenta and excessive blood loss and were well aware of the need to refer these women to a health facility quickly. Delay in referral was often due to late call-out of the TBA or lack of transport. Although the TBAs did not know the causes of excessive blood loss, they knew that anaemia was a risk factor for dying from PPH. The TBAs were keen to improve their knowledge and to participate in further training. KEY CONCLUSIONS: although all the TBAs were illiterate, information from training programmes had usually been incorporated into their knowledge and practice. While the local infrastructure remains poor, home deliveries and delayed referrals will continue and interventions for PPH need to be effective at the site of delivery i.e. in the woman's home. These Gambian TBAs have the potential to contribute to the management of PPH in these situations. IMPLICATIONS FOR PRACTICE: these Gambian TBAs could be trained to implement other practices relevant to prevention of PPH in the primary care setting. Linking together and maximising the skills of all health workers is important to reduce PPH mortality in home births in this setting.

Adolescent↗

Case managers' roles and functions: Commission for Case Manager Certification's 2004 research, part II.

The Commission for Case Manager Certification (CCMC) conducted its third case managers' role and functions study in 2004 for the purpose of validating the currency and relevancy of the certified case manager examination. The results of this study are shared in an article of 2 parts. Part I, which was published in the previous issue of this journal, discussed the process the CCMC used for the development of the Case Managers' Role and Functions Survey Instrument and the identification of new 6 essential functions and 6 knowledge areas that describe case management practice. These findings were based on the survey of a large national sample of practicing case managers. Part II continues the analysis of the results and focuses on identifying the empirical (statistically derived) activity and knowledge domains of case management practice, using exploratory factor analysis. It discusses the similarities and differences found among various subgroups of case managers who were compared on the basis of certain demographic variables. In addition, Part II summarizes future changes in the field of case management as perceived by those who participated in the study.

Adult↗