Browsing by Subject "management"

Now showing 1 - 13 of 13
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    ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle
    (2016) Bousquet, J; Hellings, P W; Agache, I; Bedbrook, A; Bachert, C; Bergmann, K C; Bewick, M; Bindslev-Jensen, C; Bosnic-Anticevitch, S; Bucca, C; Caimmi, D P; Camargos, P A M; Canonica, G W; Casale, T; Chavannes, N H; Cruz, A A; De Carlo, G; Dahl, R; Demoly, P; Devillier, P; Fonseca, J; Fokkens, W J; Guldemond, N A; Haahtela, T; Illario, M; Just, J; Keil, T; Klimek, L; Kuna, P; Larenas-Linnemann, D; Morais-Almeida, M; Mullol, J
    Abstract The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.
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    A critical look at the potential of Ecopath with ecosim to assist in practical fisheries management
    (National Inquiry Services Centre, 2004) Plagányi, Éva E; Butterworth, Doug S
    Ecosystem-orientated thinking is increasingly incorporated into fishery management. Given the complexity of ecosystem processes, there is a need to evaluate the tools used to steer this thinking critically. ECOPATH with ECOSIM (EwE), an aggregate system-modelling package, is currently the most widely employed approach to assess the ecosystem effects of fishing. The basic equations and assumptions, strengths and weaknesses, and the potential of this approach to contribute to practical fisheries management advice are reviewed. Strengths include the structured parameterization framework, the inclusion of a well-balanced level of conceptual realism, a novel representation of predator-prey interaction terms, and the inclusion of a Bayes-like approach (ECORANGER) to take account of the uncertainty associated with values for model inputs. Weaknesses in model structure include the constraining nature of the mass-balance assumption (of ECOPATH) for initiating projections, the questionable handling of life history responses such as compensatory changes in the natural mortality rates of marine mammals, overcompensatory stock-recruit relationships that result from default parameter settings, possible problems in extrapolating from the microscale to the macroscale, as well as some (not too far-reaching) mathematical inconsistencies in the underlying equations. There is a paucity of systematic and stepwise investigations into model behaviour and properties, and users are cautioned against non-critical use of the default settings. An important limitation related to the predominant use of EwE as a "black-box" modelling tool is that some users fail to consider a range of alternative interaction representations. As with all multispecies approaches, the major limitation in applying the EwE approach lies in the quality and quantity of available data. Current EwE applications generally do not adequately address uncertainty in data inputs and model structure. Prudent EwE applications that utilize good data and are based upon rigorous statistical analyses can complement the quantitative predictions of traditional single-species models. They could be particularly useful in some contexts if output in the form of probability distributions encompassing a range of likely ecosystem responses were to be coupled with attempts to extend Operational Management Procedure (OMP) approaches to fisheries management beyond the singlespecies level. In particular, such applications could serve as the operating models of the underlying dynamics that are used for computer simulation testing of OMPs.
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    Historical background to the South African horse mackerel fishery and its management
    (2004) Johnston, Susan J; Butterworth, Doug S; Leslie, R W
    The commercial fishery for the South African horse mackerel Trachurus capensis began in 1950. Horse mackerel are exploited by four fleets: purse-seine, offshore demersal, inshore demersal, and midwater trawl. Characterisation of the catches by these sectors is complex. A brief summary will be given here, and will be described in more detail later.
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    A history of recent bases for management and the development of a species-combined Operational Management Procedure for the South African hake resource
    (National Inquiry Services Centre, 2010) Rademeyer, Rebecca A; Plagányi, Éva E; Butterworth, Doug S
    The bases for historical catch limits placed on the hake fishery are reviewed in brief for earlier years and then in some depth over the period from 1991 when the Operational Management Procedure (OMP) approach was introduced for this fishery. The new OMP implemented from 2007 was the first to be based on the use of rigorous species-disaggregated assessments of the resource as Operating Models. The paper describes the Reference Set and range of robustness trials, together with the associated Operating Models, which were used for the simulation testing of the new OMP. Performance statistics for a number of candidate OMPs are compared, and the two key trade-off decisions in the selection process discussed (substantial Merluccius paradoxus and catch per unit effort [CPUE] recovery, and total allowable catch [TAC] stability constraints). Details of the OMP adopted and how its formulae depend on recent trends in CPUE and survey estimates of abundance are provided. OMP-2007, which is tuned to a median 20-year recovery target of 20% of pristine spawning biomass for M. paradoxus and a 50% increase in CPUE over the next 10 years, has been adopted for recommending hake TACs over the 2007–2010 period until the next scheduled major review. A set of general guidelines adopted for the process of possible overruling of recommendations from OMPs or bringing forward their reviews within an otherwise intended four-year cycle is detailed.
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    Implementing a structured triage system at a community health centre using Kaizen
    (2009) Isaacs, A A; Hellenberg, D A
    Background: More than 100 unbooked patients present daily to the Mitchell’s Plain Community Health Centre (MPCHC), and are triaged by a doctor, with the assistance of a staff nurse. The quality of the triage assessments has been found to be variable, with patients often being deferred without their vital signs being recorded. This leads to frustration, and a resultant increased workload for doctors; management is concerned with the medicolegal risk of deferring patients who have not been triaged in accordance with the guidelines; and patients are unhappy with the quality of service they receive. Aim: We set out to standardise the triage process and to manage unbooked patients presenting to the community health centre (CHC) in a manner that is medico-legally safe, cost efficient and patient friendly, using the Kaizen method. Methods: The principles of Kaizen were used to observe and identify inefficiencies in the existing triage process at the MPCHC. Findings were analysed and interventions introduced to improve outcomes. The new processes were, in turn, validated and standardised. Results: The majority of patients presenting to Triage were those needing reissuing of prescriptions for their chronic medication, and this prevented practitioners from timeously attending to other patients waiting to be seen. Reorganising of the process was needed; it was necessary to separate the patients needing triage from those requiring only prescriptions to be reissued. After the intervention, triage was performed by a staff nurse only, using the Cape Triage Score (CTS) method. Subsequent to the implementation of interventions, no patients have been deferred, and all patients are now assessed according to a standardised protocol. The reasons for patients requiring reissuing of prescriptions were numerous, and implementing countermeasures to the main causes thereof decreased the number of reissues by 50%. Conclusion: The Kaizen method can be used to improve the triage process for unbooked patients at the MPCHC, thereby improving the quality of services delivered to these patients. As the needs of the various CHCs differ quite widely across the service platform, the model needs to be adapted to suit local conditions.
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    Improve your online presence (2010)
    (2010) Noakes, Travis
    What online search shows about you, can be an important aid to your CV. For my first tutoring session in the "Online Media Production" course, I prepared a presentation on the importance of students using their practical internet work to improve their online reputation. This is highly relevant in Film and Media, where examples of a student's practical work are critical when searching for employment in industry.
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    Interventions used by health care professionals to transition preterm infants and neonates from enteral feeds to full-oral feeds: A Scoping review
    (2021) Rabbipal, Yajna; Norman, Vivienne; Pascoe, Michelle
    Background: Preterm infants and neonates may present with dysphagia due to immaturity or the presence of medical conditions. Enteral feeds are used to ensure optimal nutrition is achieved while the neonates are developing appropriate oral feeding skills. Varied interventions may be used to transition neonates to full oral feeds as oral feeding is often a prerequisite for discharge from hospital. Aims: The main aim of this study was to summarize, interpret and analyse the literature on the different interventions used for the transition to full oral feeds in preterm infants and neonates to identify research gaps and to inform clinical practice on the best intervention options. A secondary aim was to validate the findings of the scoping review for the South African context. Methods: A scoping review was conducted. Relevant studies were identified by searching six databases, Google and Google scholar. Inclusion criteria included studies written in English, peer reviewed and published between 1998–2018, that described the interventions used to transition preterm infants and neonates to full oral feeds. Data were extracted from the articles using a data charting form and analysed descriptively and thematically. The findings were shared with health care professionals who work with premature infants and neonates who then participated in a semi-structured interview to provide feedback relevant to the South African context. Results: Forty-seven articles were included. Six broad intervention categories were identified: oral-motor, oral-sensory, other senses, timing, cue-based and utensils. Non-nutritive sucking (NNS) interventions were reported most frequently across single and combined interventions. Outcome measures reported included: time taken to full oral feeds, earlier hospital discharge, long-term feeding outcomes, weight and sucking proficiency. Improved outcomes were associated with NNS and NNS with oral stimulation. Nine health care professionals were interviewed. They confirmed using a number of the interventions, with NNS reported the most. Health care professionals also provided insight into the challenges of implementing some interventions due to limited resources and staffing in the South African context. Conclusions: There are a range of interventions reported in the literature and many of them are used in South Africa. Positive outcomes such as earlier transition to full oral feeds; earlier hospital discharge; improved weight gain and improved sucking proficiency have been reported with NNS and combined NNS and Oral Stimulation interventions, however further studies are needed.
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    Is the golden hour optimally used in South Africa for children presenting with polytrauma?
    (2013) Zuidgeest, J; Jonkheijm, A; Van Dijk, M; Van As, A
    BACKGROUND: The major paediatric public health problem worldwide is injury or trauma. In 2004, 950 000 children died as a result of injury. OBJECTIVE: The aim of this study was to evaluate the logistics of medical care after paediatric polytrauma within the first hours after arrival into a trauma unit - the so-called Golden Hour. METHODS: Children presenting with polytrauma to the Trauma Unit at the Red Cross War Memorial Children's Hospital between May 2011 and August 2011 were considered for inclusion in the study. RESULTS: Fifty-five children were included in the final analysis. The median duration of stay in the Trauma Unit was 205 minutes (interquartile range 135 - 274). CONCLUSION: Several factors were identified that unnecessarily prolonged the time that patients stayed in the trauma unit following arrival in hospital for polytrauma management.
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    Modern management of colorectal cancer
    (South African Academy of Family Physicians, 2013) Baigrie, R J
    Colorectal cancer affects approximately 1:20 of the population and in South Africa is largely managed by general surgeons. Management of this disease has undergone very significant changes over the last two decades. Until very recently, only two academic general surgery departments included a specialist colorectal unit, and this remains so in the majority of our universities. This has resulted in a generation of surgical graduates who are unfamiliar with, and unskilled in current best management practices for this disease. Rectal cancer is particular challenging and attracts extremely high morbidity and mortality, with poor oncological outcomes. Repeatedly, outcome has been shown to be worse in the hands of generalists, rather than specialist colorectal surgeons, of whom there are very few in the country. This review presents the most important advances of the last 20 years and highlights current controversies and frontiers.
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    Pain assessment and management: An audit of practice at a tertiary hospital
    (2019) Prempeh, Nana Agya Boakye Atonsah; Parker, Romy; Duys, Rowan; De Vaal, Alma
    Background: Despite advances in techniques and analgesics for pain management, pain remains a major health problem. Regular assessment and reassessment of pain using guidelines with measurable goals is essential for effective pain management in acute hospital settings. Unfortunately, no such guidelines exist in South Africa. To implement appropriate precepts for the South African context, current practice must be understood. Aim: To evaluate pain assessment and management of patients in two surgical wards at Groote Schuur Hospital. Setting: Groote Schuur Hospital is a government-funded tertiary academic institution within the Western Cape Province of South Africa. The patients at this hospital are generally from the low-income strata and live in resource-poor communities. Methods: A cross-sectional, retrospective medical record audit was conducted. The folders of all 215 patients admitted to a specific orthopaedic trauma and urogynaecological ward at Groote Schuur Hospital in June 2015 were targeted for review. Medical folders not available or with missing notes were excluded. Variables evaluated included the number of pain assessments recorded, pain assessor, assessment tool and management plan. Results: 168 folders were available for review. Nearly half of the patients had no documented pain assessment. When pain assessment was conducted, the verbal rating scale was the predominant tool used, and assessments were mostly conducted by the ward doctor. Pain interventions appeared to be primarily based on the professional knowledge and experience of the practitioner and were not evidence-based. Conclusion: Pain assessment and management was a problem in the two wards reviewed, which is similar to the findings of studies referenced in this text. Health professionals need to be empowered to manage pain adequately. An assessment tool, which integrates the biopsychosocial factors that influence the pain experience, should be routinely employed by a multidisciplinary team to facilitate goal-directed therapy.
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    Protected areas as social-ecological systems: perspectives from resilience and social-ecological systems theory
    (2017) Cumming, Graeme S; Allen, Craig R
    Conservation biology and applied ecology increasingly recognize that natural resource management is both an outcome and a driver of social, economic, and ecological dynamics. Protected areas offer a fundamental approach to conserving ecosystems, but they are also social-ecological systems whose ecological management and sustainability are heavily influenced by people. This editorial, and the papers in the invited feature that it introduces, discuss three emerging themes in social-ecological systems approaches to understanding protected areas: (1) the resilience and sustainability of protected areas, including analyses of their internal dynamics, their effectiveness, and the resilience of the landscapes within which they occur; (2) the relevance of spatial context and scale for protected areas, including such factors as geographic connectivity, context, exchanges between protected areas and their surrounding landscapes, and scale dependency in the provision of ecosystem services; and (3) efforts to reframe what protected areas are and how they both define and are defined by the relationships of people and nature. These emerging themes have the potential to transform management and policy approaches for protected areas and have important implications for conservation, in both theory and practice.
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    A summary of the assessment and management approach applied to South African abalone (Haliotis midae) in Zones?A-D
    (2007) Plagányi, Éva E
    The management of abalone stocks worldwide is complicated by factors such as poaching combined with the difficulties of assessing a sedentary (but not immobile) resource that is often patchily distributed. The South African abalone Haliotis midae fishery is faced with an additional problem in the form of a movement of rock lobsters Jasus lalandii into much of the range of the abalone. The lobsters have dramatically reduced sea urchin Parechinus angulosus populations, thereby indirectly negatively impacting juvenile abalone, which rely on the urchins for shelter. The model developed for abalone is an extension of more standard age-structured assessment models because it explicitly takes spatial effects into account, incorporates the ecosystem change effect described above and formally estimates illegal catches using a novel index, the Confiscations Per Unit Policing Effort (CPUPE). The model is simultaneously fitted to CPUE and Fishery-Independent Abalone Survey (FIAS) abundance data as well as several years of catch-at-age (cohort-sliced from catch-at-length) data for the various components of the fishery as well as for different strata. A basic tenet of fisheries modelling is to not go beyond the information content of the data. The model developed involves the efficient use of data to allow a model of greater complexity (as was essential in this instance) than usual. It has provided the basis for management advice over recent years by projecting abundance trends under alternative future catch levels.
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    The pharmacological management of palliative care symptoms in haematology and oncology patients at Parirenyatwa Group of Hospitals (PGH) in Harare Zimbabwe
    (2020) Tererai, Agnes Chipo; Barnard, Alan; Tsikai, Nomsa
    Introduction: Palliative care is the approach to the care of patients with life-threatening illnesses. An important part of this is the rational use of a pharmacological approach to relieve suffering by addressing the symptom burden of the patient. Palliative care symptoms contribute a great deal to the suffering of the patient and affects quality of life. Different studies across several countries on the palliative care symptoms have identified common symptoms with pain being the most frequent. The WHO Public Health Strategy for palliative care outlines four components: policy, education, implementation and drug availability. These components interlink and each one affects the others. The drugs used for palliative care symptoms should be classified as essential medicines and be available to all patients who need this treatment. Factors influencing the effective pharmacological management of palliative care symptoms include drug availability, policy and the approach of the prescribers. Studies have shown that developing countries rank low in the use of the essential palliative care drugs especially morphine. Aim: The aim of this study was to describe the prevalence of palliative care symptoms and the prescribing and administration patterns in oncology and haematology patients at PGH, as well as exploring the health workers' opinions on the pharmacological approach to these symptoms. Methods: A mixed method approach was used to qualitatively look at the health workers' responses using inductive thematic analysis and quantitatively obtain information on palliative care symptom management from the health workers and patient records. Results: Pain was the commonest palliative care symptom identified by health workers, and evident in the patient records. A list of other palliative care symptoms, and the frequency at which they occurred was compiled in this study. The health workers highlighted drug availability, palliative care education and need to engage some nurses in prescribing some of the palliative care drugs. Fewer than half of the patient records assessed as being in need of palliative care (N = 247) were given medications from the recognized palliative care drug list (N = 101). Conclusion: This study showed that essential medicines for palliative care symptoms are not easily available in Zimbabwe for various reasons that include cost, policy, education and training. Pain and other palliative care symptoms are not adequately managed. Therefore, palliative care is not yet integrated into the health care system in Zimbabwe as mandated by the WHO. Recommendations to improve palliative care symptom treatment are suggested.