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Demand management

Hussein Walijee, Alexandria Morgan, Bethan Gibson, Sandeep Berry, Ali Jaffery
Critical Care Unit (CCU) beds are a limited resource and in increasing demand. Studies have shown that complex head and neck patients can be safely managed on a ward setting given the appropriate staffing and support. This retrospective case series aims to quantify the CCU care received by patients following total laryngectomy (TL) at a District General Hospital (DGH) and compare patient outcomes in an attempt to inform current practice. Data relating to TL were collected over a 5-year period from 1st January 2010 to 31st December 2015...
2016: International Journal of Otolaryngology
Naomi A Hartley, Ellen Breen, Susan L Thibeault
Purpose: The purpose of this study was to document typical vocal health characteristics (including voice-related activities, behaviors, and symptomatology) of young adults attending college and to determine lifetime and point prevalence rates of voice disorders. Method: Undergraduates at University of Wisconsin-Madison completed an anonymous online survey detailing vocal use, symptomatology, impact, sociodemographics, and voice-related quality of life. Univariate analyses and multivariate regression models isolated risk factors for lifetime and point prevalence rates of a voice disorder...
October 17, 2016: Journal of Speech, Language, and Hearing Research: JSLHR
Kegong Diao, Chris Sweetapple, Raziyeh Farmani, Guangtao Fu, Sarah Ward, David Butler
Evaluating and enhancing resilience in water infrastructure is a crucial step towards more sustainable urban water management. As a prerequisite to enhancing resilience, a detailed understanding is required of the inherent resilience of the underlying system. Differing from traditional risk analysis, here we propose a global resilience analysis (GRA) approach that shifts the objective from analysing multiple and unknown threats to analysing the more identifiable and measurable system responses to extreme conditions, i...
October 4, 2016: Water Research
Tingting Wu, James D Englehardt
An urban net-zero water treatment system, designed for energy-positive water management, 100% recycle of comingled black/grey water to drinking water standards, and mineralization of hormones and other organics, without production of concentrate, was constructed and operated for two years, serving an occupied four-bedroom, four-bath university residence hall apartment. The system comprised septic tank, denitrifying membrane bioreactor (MBR), iron-mediated aeration (IMA) reactor, vacuum ultrafilter, and peroxone or UV/H2O2 advanced oxidation, with 14% rainwater make-up and concomitant discharge of 14% of treated water (ultimately for reuse in irrigation)...
October 5, 2016: Water Research
Anne P Glass
Social isolation has serious negative public health impacts for older adults. Survey data were collected at three resident-managed elder intentional neighborhoods in the U.S. (n = 59), to determine if these neighborhoods, each based on the cohousing model, promote development of social resources for their residents. Social resources were measured on three dimensions: social networks, neighborly support, and satisfaction with the neighborhood community. Respondents were white, mean age of 73.3 (range = 63-91), primarily female (76...
October 17, 2016: Journal of Gerontological Social Work
Nigel Hardiman, Kristina Charlotte Dietz, Ian Bride, Louis Passfield
Land managers of natural areas are under pressure to balance demands for increased recreation access with protection of the natural resource. Unintended dispersal of seeds by visitors to natural areas has high potential for weedy plant invasions, with initial seed attachment an important step in the dispersal process. Although walking and mountain biking are popular nature-based recreation activities, there are few studies quantifying propensity for seed attachment and transport rate on boot soles and none for bike tires...
October 17, 2016: Environmental Management
Emanuel A Shapera, Vinay K Rai
Proper surgical management of anal fistula demands sound clinical judgment and extraordinary care to prevent incontinence and adequate postoperative pain control and provide satisfactory resolution to optimize quality of life. Fecal incontinence can be a devastating complication of procedures performed for fistula in ano. We report a unique case in which temporary incontinence (for less than 4 days) followed injection of liposomal bupivacaine for postoperative pain control after draining seton placement for fistula in ano...
2016: Case Reports in Surgery
Mark Cropley, Fred R H Zijlstra, Dawn Querstret, Sarah Beck
Work-related rumination, that is, perseverative thinking about work during leisure time, has been associated with a range of negative health and wellbeing issues. The present paper examined the association between work-related rumination and cognitive processes centerd around the theoretical construct of executive functioning. Executive functioning is an umbrella term for high level cognitive processes such as planning, working memory, inhibition, mental flexibility; and it underlies how people manage and regulate their goal directed behavior...
2016: Frontiers in Psychology
Helen A Hamilton, Eva Brod, Ola Hanserud, Daniel B Müller, Helge Brattebø, Trond K Haraldsen
The plant-availability of phosphorus (P) plays a central role in the ability of secondary P resources to replace mineral fertilizer. This is because secondary P plant-availability varies, often with large fractions of residual P that has no immediate fertilization effect. Therefore, if low quality secondary P fertilizers are applied, they will accumulate in soils that, in the long run, may increase the risk of P runoff and eutrophication. Substance flow analyses (SFA), used to identify potentials for improved P management, have not considered this well-known quality barrier...
October 13, 2016: Science of the Total Environment
Manas Panigrahi, Manoranjitha Kumari, Sudhindra Vooturi
BACKGROUND: Keeping the operating field clean and visible is an important technique in neurosurgery. Continuous irrigation-suction (IS) of the surgical field is currently often done using devices available that are expensive and demand technical proficiency. We report a simple method of continuous ISusing widely available central venous catheter and controlled suction cannula. METHODS: We used a controlled suction cannula attached to a central suction system. Single lumen central venous catheter is passed through the key hole of a controlled suction cannula, which is connected to a continuous irrigation system...
October 12, 2016: World Neurosurgery
P Sneha, C George Priya Doss
The pace of anti-diabetic drug discovery is very slow in spite of increasing rate of prevalence of Type 2 Diabetes which remains a major public health concern. Though extensive research steps are taken in the past decade, yet craves for better of new treatment strategies to overcome the current scenario. One such general finding is the evolution of gliptins which discriminately inhibits DPP4 (Dipeptidyl peptidase-4) enzyme. Although the mechanism of action of gliptin is highly target oriented and accurate, still its long-term use stands unknown...
October 12, 2016: Life Sciences
Yohannes Yihdego, Len Drury
The efficient use of water resources in arid region has become highly relevant in the evaluation and mining planning, since the exploration phase to closure. The objective of the numerical groundwater model was to assess the potential for groundwater extraction to meet mine water demand from one of the driest area in the world. Numerical groundwater models were used to assess groundwater resource. Modelling was undertaken using MODFLOW-SURFACT code, an advanced MODFLOW based code, within the framework of Visual MODFLOW version 4...
November 2016: Environmental Monitoring and Assessment
Barbara Stetson, Karl E Minges, Caroline R Richardson
Accelerating diabetes rates have resulted in a global public health epidemic. Lifestyle change is a cornerstone of care, yet regimen demands may result in adherence difficulties. Distress, depression, and other psychosocial concerns are higher in those with diabetes. While interventions, such as the Diabetes Prevention Program appear to be effective, further research is needed to support the translation of interventions to prevent diabetes. Studies assessing optimal approaches to promoting effective decision making, coping and adherence are needed...
October 14, 2016: Journal of Behavioral Medicine
Christopher Eccleston, Abby Tabor, Rhiannon Terri Edwards, Edmund Keogh
A psychological model of coping with the demands of aging is outlined. Chronic pain is conceptualized as a challenge to normal aging, because it threatens identity, risks affective disorder (depression), and interferes with action. The sparse evidence for psychological interventions is reviewed, and a case is made for the types of interventions that should be developed to address the specific presentation of geriatric pain management.
November 2016: Clinics in Geriatric Medicine
Yafit Maza, Efrat Shechter, Neta Pur Eizenberg, Efrat Gortler Segev, Moshe Y Flugelman
BACKGROUND: The physician manager role in the health care system is invaluable as they serve as role models and quality setters. The requirements from physician managers have become more demanding and the role less prestigious; yet burnout and its prevention in this group have received little attention. Physician leadership development programmes have generally dealt directly with skill and knowledge acquisition. The aim of this research was to evaluate an intensive workshop designed to modify attitudes and improve skills of physician-managers of community clinics, through focus on personal well-being and empowerment...
October 14, 2016: BMC Medical Education
Nadine Thompson, Margaret Murphy, John Robinson, Thomas Buckley
INTRODUCTION: Due to increasing demands on hospital Emergency Departments (EDs), the role of registered nurses, with additional training, has been extended to include requesting X-ray examinations. The aim of this study was to evaluate nurse practice guidelines for requesting X-rays in the ED setting and to utilise inter-professional learning and change management theory to promote practice improvements. METHODS: Three hundred and one nurse initiated X-ray (NIX) requests were randomly selected between January and March 2012, and reviewed for observance of local department guidelines and quality of clinical history...
October 12, 2016: Journal of Medical Radiation Sciences
Kristin Mühldorfer, Gudrun Wibbelt, Claudia A Szentiks, Dominik Fischer, Holger C Scholz, Michael Zschöck, Tobias Eisenberg
AIMS: Novel cases of Brucella infections in frogs are discussed together with results of published reports to extend our current knowledge on 'atypical' brucellae isolated from amphibians and discuss challenges we face on this extraordinary emerging group of pathogens. METHODS AND RESULTS: Since our first description, additional 14 isolates from 4 different frog species were collected. Novel isolates and a subset of Brucella isolates previously cultured from African bullfrogs were characterized by MALDI-TOF mass spectrometry, Fourier transform-infrared spectroscopy and broth microdilution susceptibility testing...
October 14, 2016: Journal of Applied Microbiology
C Maiorana, D Andreoni, P P Poli
Particularly in the premaxillary area, the stability of hard and soft tissues plays a pivotal role in the success of the rehabilitation from both a functional and aesthetic aspect. The present case report describes the clinical management of a localized alveolar ridge atrophy in the area of the upper right canine associated with a thin gingival biotype with a lack of keratinized tissue. An autogenous bone block harvested from the chin associated with heterologous bone particles was used to replace the missing bone, allowing for a prosthetic driven implant placement...
2016: Case Reports in Dentistry
Katherine Fitzgerald, Philip Yates, Jonathan Benger, Adrian Harris
OBJECTIVE: To explore the experience of psychological distress and well-being in emergency medicine (EM) consultants. METHODS: A qualitative, interpretative phenomenological analysis (IPA) study based on 1:1 semistructured interviews with EM consultants working full time in EDs across South West England. Eighteen EM consultants were interviewed across five EDs, the mean (SD) age of participants being 43.17 (5.8) years. The personal meanings that participants attached to their experiences were inductively analysed...
October 13, 2016: Emergency Medicine Journal: EMJ
Ismail Jatoi, John R Benson, Masakazu Toi
With the advent of sentinel lymph node biopsy, surgical methods for accurately staging the axilla in patients with early-stage breast cancer have become progressively less extensive, with formal axillary lymph node dissection confined to a dwindling group of patients. Although details of methods for sentinel lymph node biopsy have yet to be standardised, this technique is now widely practised and accepted as standard of care worldwide. In the past 5 years, attention has focused on minimisation of surgical morbidity by restricting further axillary surgery or considering radiotherapy in patients with a small tumour burden in their sentinel nodes...
October 2016: Lancet Oncology
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