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Yegane, A., and H. Shariatmadari. "Risk managment in LSF structures (identifying, assessment, responding)." Journal of Fundamental and Applied Sciences 8, no. 2 (June 14, 2016): 163. http://dx.doi.org/10.4314/jfas.8vi2s.53.
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Davis, John W. "ROBOT-ASSISTED LAPAROSCOPIC SURGICAL MANAGMENT OF HIGH RISK PROSTATE CANCER." Journal of Urology 181, no. 4S (April 2009): 364–65. http://dx.doi.org/10.1016/s0022-5347(09)61032-6.
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Paul, M. M., M. Young, and B. Wilkinson. "Antpsychotics and CVD risk managment in rehabilitation inpatients - findings of an audit." European Psychiatry 26, S2 (March 2011): 1471. http://dx.doi.org/10.1016/s0924-9338(11)73176-5.
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IntroductionPatients with severe mental illness are at increased risk of cardiovascular disease because of lifestyle, co-morbidity and medication effects.Aim/objectivesThe aim of this audit is to ascertain the regularity of metabolic health checks, CVD risk assessment and adequate lipid modification therapy among patients on antipsychotic medication in 3 rehabilitation wards in county Durham and Darlington.MethodAccording to audit standards (based on NICE guidelines-Schizophrenia, Lipid Modification, Maudsley guidelines), All patients should have Blood Pressure, Body Mass Index (BMI), CVD risk assessment using appropriate calculator, Fasting blood glucose and Fasting Lipid profile done at least once a year. Lipid modification therapy has to be offered to those with 10 year CVD risk of 20% or greater. All 31 patients in 3 rehabilitation wards were included. We searched for these readings between 1/09/2010 to 30/08/2010 in patient records.ResultsOf 31 patients, 26(84%) had blood pressure, 29(94%) had BMI and 11(35%) had either fasting blood sugar or HbA1c recorded. CVD risk assessment using calculator was not done in any patients. 19(61%) lipid profile done. Of the 19 patients 16 (84%) had abnormal lipid profile. 9 (26%) patients were on lipid modifying drugs, 6 (19%) patients were on appropriate dose of lipid modifying drugs.ConclusionOur audit identified a need for systemic assessment of physical health with emphasis on cardiovascular risk management (lifestyle education, lipid modification therapy) which are critical to minimising risks and preventing long term adverse health consequences.
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Khalifa, Gamal, and Elhessien Ali. "Information Technology Risk Managment "ITRM" in Egyptian Hotels : Drives Versus Boundraies." Journal of Association of Arab Universities for Tourism and Hospitality 11, no. 3 (December 20, 2014): 91–114. http://dx.doi.org/10.21608/jaauth.2014.57692.
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Harness, Neil G., Tadeshi Funahashi, Annette L. Adams, Grace Chen, Denise Greene, and Richard Dell. "Distal Radius Fracture Risk Reduction with a Comprehensive Osteoporosis Managment Program." Journal of Hand Surgery 35, no. 10 (October 2010): 26. http://dx.doi.org/10.1016/s0363-5023(10)60104-9.
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Dasek, Tomasz. "Ewolucja audytu wewnętrznego na świecie." Studenckie Prace Prawnicze, Administratywistyczne i Ekonomiczne 22 (July 19, 2018): 35–46. http://dx.doi.org/10.19195/1733-5779.22.3.
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EVOLUTION OF INTERNATIONAL AUDIT IN THE WORLDThe role of internal audit is to provide independent and objective assurance that anorganisation‘s risk managment, governance and internal control processes are operating effectively. The article presents the history of internal audit in the world, which due to environment changes as well as unfavourable occurrences taking place on the global market, play a remarkable role in banking systems.
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Ovechkin, Аlexei M., Mikhail E. Politov, and Sergey V. Sokologorskiy. "Ibuprofen for intravenous administration: new possibilities for the use of NSAIDs in postoperative pain management." Regional Anesthesia and Acute Pain Management 16, no. 2 (October 19, 2022): 91–101. http://dx.doi.org/10.17816/1993-6508-2022-16-1-91-101.
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Non-steroidal anti-inflammatory drugs are an essential component of postoperative multimodal analgesia. Their analgesic efficacy has been confirmed by data from evidence-based medicine. The appearance of an intravenous form of ibuprofen on the Russian pharmaceutical market expands the possibilities of using NSAIDs in postoperative pain managment schemes. Ibuprofen characterized a high analgesic potential and an optimal safety profile in relation to the risk of gastrointestinal and cardiovascular complications.
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Atika, Rulia, Husaini Husaini, and Fitrawati Ilyas. "KONSENTRASI KEPEMILIKAN, STRUKTUR DEWAN KOMISARIS DAN RISIKO KREDIT BANK YANG TERDAFTAR DI BURSA EFEK INDONESIA." JURNAL FAIRNESS 10, no. 2 (March 31, 2021): 115–24. http://dx.doi.org/10.33369/fairness.v10i2.15258.
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This study aims to find empirical evidence regarding the influence of ownership concetration and board structure on credit risk. The sample of this study is the banks listed on the Indonesia Stock Exchange. Board structure proxied by the board size, proportion of independent commissioners, the presence of foreign commissioners, audit committee and risk management committee. The hypothesis was tested using multiple linear regression. This study found that ownership concentration 25%, ownership concentration 50% and audit committee have a positive effect on credit risk, Proportion of independent commissioners and risk managment committee have negatively affect on credit risk. While the. ownership concentration 10%, board size and the presence of foreign commissioners have no affect on credit risk.
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Hauff, K., S. Hill, and J. Zeidler. "Risk managment and patient safety: Assaying for ethylene glycol — A case of mistaken identity?" Clinical Biochemistry 44, no. 13 (September 2011): 1171. http://dx.doi.org/10.1016/j.clinbiochem.2011.06.029.
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Puspa, Dewi, Adhiawan Soegiharto, Achmad Nizar Hidayanto, and Qorib Munajat. "Data Privacy, What Still Need Consideration in Online Application System?" Jurnal Sistem Informasi 16, no. 1 (April 29, 2020): 49–63. http://dx.doi.org/10.21609/jsi.v16i1.941.
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This paper aims to conduct an analysis and exploration of matters that still needs to be considered in relation to data privacy in the online application system. This research is still a preliminary study. We conduct research related to data privacy using systematic literature review approach (SLR). Bt using SLR stages, we made a synthesis of 44 publications from Scopus Database Online that were released in the range 2015 - 2019. Based on this study, we found six things points to consider in data privacy, namely security and data protection, user awareness, risk managment, control setting, ethics, and transparency.
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Sendy, Feras, Eman AlShehri, Amani AlAjmi, Elham Bamanie, Surekha Appani, and Taghreed Shams. "Failure Rate of Single Dose Methotrexate in Managment of Ectopic Pregnancy." Obstetrics and Gynecology International 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/902426.
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Background. One of the treatment modalities for ectopic pregnancy is methotrexate. The purpose of this study is to identify the failure rate of methotrexate in treating patients with ectopic pregnancy as well as the risk factors leading to treatment failure.Methods. A retrospective chart review of 225 patients who received methotrexate as a primary management option for ectopic pregnancy. Failure of single dose of methotrexate was defined as drop of BHCG level less than or equal to 14% in the seventh day after administration of methotrexate.Results. 225 patients had methotrexate. Most of the patients (151 (67%)) received methotrexate based on the following formula: f 50 mg X body surface area. Single dose of methotrexate was successful in 72% (162/225) of the patients. 28% (63/225) were labeled as failure of single dose of methotrexate because of suboptimal drop in BhCG. 63% (40/63) of failure received a second dose of methotrexate, and 37% (23/63) underwent surgical treatment. Among patient who received initial dose of methotrexate, 71% had moderate or severe pain, and 58% had ectopic mass size of more than 4 cm on ultrasound.Conclusion. Liberal use of medical treatment of ectopic pregnancy results in 71% success rate.
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Frunza, S. "Directions of efective system of managment decisions making on the example of agricultural machinery industry enterprise." Galic'kij ekonomičnij visnik 69, no. 2 (2021): 129–36. http://dx.doi.org/10.33108/galicianvisnyk_tntu2021.02.129.
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In Ukraine, taking into account the constant changes in the economy and policy, the enterprises need to improve management decision-making systems for efficient and well-established production process. Thus it is especially important for the state economy to establish a system of management of the machine-building industry in the field of agricultural production as they: provide the main share of revenues to GDP in Ukraine; are the main source for ensuring the food and agricultural products development. The objective of the paper is to investigate more thoroughly the theoretical foundations of the management decision-making system formation, to develop the direction for optimization under the conditions of uncertainty and risk on the example of agricultural machinery industry enterprise. The theoretical foundations of management decisions at the enterprise as a process for developing and selecting the most effective solution to achieve the best results in the enterprise are outlined in this paper. The factors influencing management decisions such as: degree of risk; information; time; personal qualities of the leader are considered. Methods for application contributing to the most optimal decisions such as: traditional, systematic, economic-analytical, systemic and targeted are identified. Analysis of the current state of agricultural machinery industry development in Ukraine, which shows the dynamics in the direction of deteriorating their condition is carried out. Therefore, there is the need to make management decisions concerning the establishment of their system in management. For example, the agricultural machinery company JSC «Elvorti» is considered. The problem of effective management which requires optimization of directions in the process of making managerial decisions in order to improve its activities is determined. The following factors of the influence on crisis phenomena in the given industry: external factors (political, economic) and internal factors (lack of working capital) significantly affecting the activities results are considered. On the basis of JSC «Elvorti» activity analysis, it is proved that it is necessary to take optimization measures and certain directions in the management decision-making process in order to ensure effective operation. The directions for control, simplification of decision-making process due to automation of document circulation on the basis of 1C, motivation of the personnel which will be able to improve organizational structure of the enterprise and production process are proposed.
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Metobo, Evans. "EFFECTS OF SLUM UPGRADING ON SECURITY MANAGMENT IN SOWETO SLUMS, ROYSAMBU SUB-COUNTY IN NAIROBI, KENYA." Advances in Social Sciences Research Journal 8, no. 1 (February 2, 2021): 479–530. http://dx.doi.org/10.14738/assrj.81.9648.
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This paper uses data collected for an MA Thesis to explore the effects of slum upgrading on security management in Soweto slums, Roysambu sub-county in Nairobi, Kenya. The study was guided by three objectives to establish social effect of slum upgrading on security management in Kahawa Soweto slums; to examine the economic effect of slum upgrading on security management in Kahawa Soweto slums; and to establish the challenges of security management in the slum upgrading programme for Kahawa Soweto Slums. The study adopted a descriptive research design and random sampling to select 318 respondents (main respondents) and 10 Key informants (K.I). Questionnaire was the main method of data collection while interview was used to collect data from K.I. Data collected was organized, and systematically interpreted thematically by use of graphs, frequency tables, and percentages.
This study established the relationship between slum setting and rise of crime and insecurity in Kahawa Soweto slums in Roysambu sub-county in Nairobi, Kenya with 69.2% of respondents agreeing to this count. According to this study, poor roads, high poverty levels, low education levels, poor spatial designs/environmental design of slum area and housing, absence of police station and poor lighting predisposed the slum dwellers to crime and insecurity. According to this study slum upgrade will reduce crime and insecurity, given that special aspects such as improvement in spatial designs/environmental design of urban areas and housing with enhanced modern lighting will significantly reduce crime in slums by eliminating criminogenic and insecurity risk factors. Additionally, improved economic effects of slum upgrading on slum dwellers would build resilience to crime and insecurity. This includes; Job creation, provision of educational facilities such as vocational training institutes (polytechnics), basic education institutions (primary and secondary schools) as well as other skills enhancement institutions. Community empowerment aimed at income generating activities, construction of police station to provide security to the slum dwellers (77%), and construction of better roads (55.3%) were recommended to reduce crime and improved security management in Kahawa Soweto slums in Roysambu sub-county in Nairobi, Kenya.
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Zorzi, Simone, Eva Marangone, Fabrizio Giorgeschi, and Laura Berteotti. "Promoting Choice Using Switches in People With Severe Disabilities: A Case Report." SAGE Open 12, no. 1 (January 2022): 215824402210821. http://dx.doi.org/10.1177/21582440221082141.
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People with severe intellectual disabilities have a remarkably high risk of spending most of their lifetime without the possibility of engaging their surroundings. This study aimed to verify if it is possible to teach operant and choice behaviours for autonomus managment of leisure activity throught switches to people with severe intellectual disabilities. A two-switches training program was implemented following three subsequent steps: (1) switch pressure learning; (2) choice behavior learning (Level 1: choices between preferred and non-preferred stimuli; Level 2: choices between preferred and neutral stimuli); (3) subjective satisfaction. A single subject (N=1) multiple probe design, using intermittent probe sessions across behaviors, demonstrated experimental control. Results confirm the effectiveness of training in promoting both repertoires of switch pressure and choice behavior. The response rate and accuracy were statistically significant ( r range: .83–.99). The study shed light on the possibility of autonomous activity management through switches for persons with severe intellectual disabilities.
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Focardi, Silvia, Ilaria Corsi, Stefania Mazzuoli, Leonardo Vignoli, Steven A. Loiselle, and Silvano Focardi. "Integrating Remote Sensing Approach with Pollution Monitoring Tools for Aquatic Ecosystem Risk Assessment and Managment: A Case Study of Lake Victoria(UGANDA)." Environmental Monitoring and Assessment 122, no. 1-3 (June 1, 2006): 275–87. http://dx.doi.org/10.1007/s10661-005-9180-7.
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Kim, Sung Jae, Jae Hoo Lee, and Yong Min Chun. "Treatment of Open Proximal Humerus Fracture by Gunshot." Clinics in Shoulder and Elbow 15, no. 1 (January 1, 2012): 37–42. http://dx.doi.org/10.5397/cise.2012.15.1.37.
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PURPOSE: To consider the proper managment of proximal humerus fracture on gunshot wounds.MATERIALS AND METHODS: A 28-year-old male patient, who sustained a gunshot injury on the left arm 5 days ago, was admitted through the emergency department. Although he underwent an emergency surgery (bullet fragment removal and debridement), there remained bullet fragments around the proximal humerus fracture site. The wound seemed to be infected and a partial dehiscence occurred. No neurologic deficit was noted. Immediate exploration and debridement were performed, and an external fixator was applied to restore the anatomical alignment and manage the wounds. Intravenous antibiotics were administered. On the 9th postoperative day, wound debridement was done again, and cement beads mixed with antibiotics were inserted. After two weeks, the external fixator was removed, and the pin sites were closed after debridement. One week later, the open reduction and internal fixation with locking compression plate and screws were done.RESULTS: At 3 months after the internal fixation, the bone union was obtained with satisfactory alignment of the humerus.CONCLUSION: The severity of the soft tissue injury influences the fracture management plan. Further, the risk on lead toxicity should be considered.
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Bhalla, Shivali, Seema Grover Bhatti, and Shalini Devgan. "Obstetric and perinatal outcome of twin pregnancy: a prospective study in a tertiary care hospital in North India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 6 (May 26, 2018): 2455. http://dx.doi.org/10.18203/2320-1770.ijrcog20182368.
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Background: Multiple pregnancy constitutes an important portion of high risk pregnancies and is a matter of grave concern to obstetricians and paediatricians owing to maternal and perinatal morbidity and mortality associated to it. Objective of present study was to evaluate maternal and perinatal outcome of twin pregnancy.Methods: This observational study included 50 women with twin pregnancy with gestational age of 26 weeks or more. Maternal and perinatal outcomes were studied.Results: The incidence of twin pregnancy was 2.8 % with maximum incidence in age group of 20 -29 years and in multigravida. Mean gestational age was 34.2 weeks. Vertex - vertex fetal presentation was most common presentation. Most frequent mode of delivery was ceserean section (54%). Preterm labour was most common maternal complication (74%), followed by anaemia (62%). Complications in perinatal period were birth hypoxia (58 %), intrauterine growth restriction (15 %), hyper-bilirubinemia (11%) and neonatal sepsis (10 %). 88% of the newborns were LBW. Perinatal mortality in our study was 17%.Conclusions: Twin pregnancies are associated with significant maternal and perinatal morbidity which is more so for second twin. Effective antenatal care planned delivery and good pediatric facilities help decrease the complications. Managment of twin pregnancy requires multidisciplinary approach and involvement of skilled obstetricians and paediatricians.
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Lambert, L. A., T. S. Armstrong, J. J. Lee, M. H. Katz, C. Eng, R. A. Wolff, C. S. Ng, M. L. Smith, S. Gonzalez-Moreno, and P. F. Mansfield. "Female sex and standardized mitomycin-c dose are associated with increased risk of neutropenia after hyperthermic intraperitoneal chemotherapy." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 15091. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.15091.
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15091 Background: Cytoreductive sugery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are being increasingly employed in the managment of peritoneal-based malignancies. Depending on the treatment regimen, neutropenia (NP) is a common and potentially life-threatening early postoperative complication of HIPEC. However, little is known about the incidence or risk factors associated with HIPEC-induced NP. Methods: From January 1993 to October 2006, 120 CRS and HIPEC with mitomycin-c (MMC) were performed in 117 patients with appendiceal neoplasm. NP was defined as an absolute neutrophil count of < 1,000/mm3. Variables assessed as potential risk factors for HIPEC-induced NP included: age, sex, weight, BMI, BSA, splenectomy, dose of MMC (standardized for BSA and nonstandardized), percent of perfusate recovered, length of surgery, estimated blood loss, perioperative blood transfusion, and history of prior chemotherapy. Results: Total perfusate MMC doses ranged between 37.25 and 65 mg. The overall incidence of NP was 39.2%. The NP rates in female and male were 57.6% and 21.3%, respectively. Female sex, BMI, BSA, and the standardized dose of MMC were significantly associated with an increased risk of NP by univariable logistic regression. Female sex and standardized dose of MMC remained statistically significant for an increased risk of NP on multivariable logistic regression. The odds ratio (OR) of NP for females was 3.63 (95% CI: 1.54, 8.52); the OR of NP for a 1 mg/m2 increase in standardized MMC dose was 1.26 (95% CI: 1.11, 1.44). No other variables were identified as independent predictors of increased or decreased risk of NP. Compared to patients without NP, patients with NP had a higher rate of urinary tract infection (42.6% vs. 21.1%, p=0.01) and slightly higher length of stay (median: 24.0 days vs. 18.5 days, p=0.16). Conclusions: NP is a common complication after HIPEC with MMC . Female patients are at significantly increased risk for this complication. Risk of NP also increases with MMC dose standardized for BSA. With increasing interest in the use of CRS and HIPEC, understanding the risk factors for HIPEC-induced NP may facilitate reducing the morbidity associated with this procedure. No significant financial relationships to disclose.
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Bartl, S., S. Schümberg, and M. Deutsch. "Revising time series of the Elbe river discharge for flood frequency determination at gauge Dresden." Natural Hazards and Earth System Sciences 9, no. 6 (November 5, 2009): 1805–14. http://dx.doi.org/10.5194/nhess-9-1805-2009.
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Abstract. The German research programme RIsk MAnagment of eXtreme flood events has accomplished the improvement of regional hazard assessment for the large rivers in Germany. Here we focused on the Elbe river at its gauge Dresden, which belongs to the oldest gauges in Europe with officially available daily discharge time series beginning on 1 January 1890. The project on the one hand aimed to extend and to revise the existing time series, and on the other hand to examine the variability of the Elbe river discharge conditions on a greater time scale. Therefore one major task were the historical searches and the examination of the retrieved documents and the contained information. After analysing this information the development of the river course and the discharge conditions were discussed. Using the provided knowledge, in an other subproject, a historical hydraulic model was established. Its results then again were used here. A further purpose was the determining of flood frequency based on all pre-processed data. The obtained knowledge about historical changes was also used to get an idea about possible future variations under climate change conditions. Especially variations in the runoff characteristic of the Elbe river over the course of the year were analysed. It succeeded to obtain a much longer discharge time series which contain fewer errors and uncertainties. Hence an optimized regional hazard assessment was realised.
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Ennis, Harriet. "Credibility in mindfulness training for young people." Psychology Teaching Review 24, no. 1 (2018): 59–62. http://dx.doi.org/10.53841/bpsptr.2018.24.1.59.
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Providing the evidence-base to establish whether mindfulness for young people is beneficial is undoubtedly more challenging than it has been for adults. First of all there are the practical difficulties in training teachers to deliver mindfulness well. Yet this is what needs to be done; teachers with the class managment and pedagogical expertise are best placed to deliver mindfulness training to students with whom they have built trust. Secondly, it is difficult to measure the outcomes, particularly for teenagers, because unlike the positively predisposed adult participants ofMindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) training, adolescents, particularly if drafted into research at school, are less likely to focus on gaining understanding of the techniques, let alone actually practise them. Thirdly, a Whole-School drive and parental involvement, to promote mindfulness practice, may seem necessary to get students to spend enough time mindfully to see measurable benefits, but may actually have counterproductive effects. Students, parents and even teachers can react badly to such initiatives from leadership, which means any null results from formal studies may not be valid. The upshot of this is that clear evidence may be some time away. In the meantime the low risk of adverse reactions to mindfulness needs to be mitigated through the use of guidelines and training for educators. In search of solutions to the challenges to research validity, randomised controlled trials using teachers (not researchers) who have training and credibility to deliver mindfulness training, will paint a clearer picture of its effectiveness for young people.
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عمري, حسن محمود محمد. "الهندسة المالية و دورها في إدارة المخاطر في المصارف الإسلامية مع إشارة خاصة للمصارف الإسلامية في الأردن = Financial Engineering and Its Role in Risk Managment in Islamic Banks with Special Reference to Islamic Banks in Jordan." Journal of Humanities and Social Studies, no. 35 (February 2015): 75–126. http://dx.doi.org/10.12816/0017998.
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Yasser Abdurabo Obadiel, Mohammed Hamood Alyan, Yasser Abdurabo Obadiel, Mohammed Hamood Alyan. "PREDISOPSING FACTORS; MANAGMENT AND OUTCOMES OF NECROTIZING FASCITIS Among patients who admitted to surgical ward at Al-Thawra hospital; January 2020 to January 2021: العوامل المسببة؛ إدارة ونتائج التفتت الناخر؛ لدى عينة من المرضى في قسم الجراحة بمستشفى الثورة بصنعاء." Journal of medical and pharmaceutical sciences 5, no. 3 (September 30, 2021): 118–99. http://dx.doi.org/10.26389/ajsrp.s310521.
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Background: Necrotizing fasciitis is a serious infection of skin and soft tissues that rapidly progresses along the deep fascia. It’s a fatal infection with high mortality if treatment delayed. Early diagnosis, surgical debridement and broad-spectrum antibiotic therapy are the optimal treatments to reduce the mortality. Objective: The aims were to identify risk factors for Necrotizing fasciitis and to describe the outcome of management. Methods: A prospective descriptive study was conduted at AL-THAWRA HOSIPTAL located in Sana’a, Yemen. All medical records of patients with confirmed NF who admitted to surgical department between January 2020 and January 2021 were reviewed. Results: The study enrolled 54 patients diagnosed with Necrotizing fasciitis. Male patients were 43 patients (79.6%) and female patients were 11 patients (20.3%). The age rang was 9 – 75 years old and the peak age incidence was at 46–60 years (33.3%). The incidence of NF increases with aging, male gander (79.6%), in comorbid patients (64.9%) especially DM (37%). The etiologies of NF were trauma in (16.6%) and perianal abscess in (14.8%), but (27.7%) of NF patients hadn’t specific cause. The defected wound was treated by skin graft in (32.5%) and primary closure in (27.5%). The mortality rate was (27.7% n=15); (60%) of them died on first 5 days. Septic shock was the reason of death in (73.2%). The higher mortality rate was seen at male gander (66.6%), age group > 60 years (46.6%), in patients who presented in shocked state (73.3%) and in comorbid patients (73.3%). Conclusion: Necrotizing fasciitis represents a life threatening condition with challenges in diagnosis. Incidence and mortality of NF are common in male gander, an elderly patient, or in who suffers of comorbidities; especially DM.
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Saunders, J., S. Maroo, E. Brownson, and R. Boulton Jones. "P485 An Assessment Of A Guided Self-Help and Patient Initiated Review Pathway for Ulcerative Proctitis." Journal of Crohn's and Colitis 17, Supplement_1 (January 30, 2023): i616. http://dx.doi.org/10.1093/ecco-jcc/jjac190.0615.
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Abstract Background The COVID-19 pandemic has placed great strain on standard outpatient services including those with IBD. There has been interest in using guided self-management and patient-initiated review to allow patients to manage their condition, while at the same time reserving outpatient capacity for those needing seen urgently. We developed a pathway for patients with stable ulcerative proctitis, which included a leaflet on symptom managment and when to contact the IBD nurses if ongoing symptoms. Methods Patients were identified from clinic lists cancelled during the pandemic who had a diagnosis of ulcerative proctitis. Case notes were reviewed to ensure a correct diagnosis and inclusion criteria met(stable disease,no immunosuppressant treatment). These patients were sent a Guided Self-Management leaflet in the post. A follow on questionnaire was sent 6 months after ensuring patients were happy with the information received. Non-responders were sent a second questionnaire and/or telephone call. Results 37 Patients were identified. We received responses (via post, phone or email) from 28/37 patients (76%). 10/28 (36%) didn’t receive or do not recall receiving the leaflet. 18/28 (64%) received the leaflet. Of those who received the leaflet, 16/18 felt it was easy to understand and contained enough information to confidently manage their symptoms. 2 patients had 1 flare and 3 patients had multiple flares after receiving the leaflet. Of those with flares, 2 patients were able to self-manage their proctitis using the guided self help information. 2 patients had to contact the IBD nurses. These patients were called back within 24 hours and received useful advice. One patient had forgotten to use the leaflet. No one required rescue steroids or admission to hospital. Overall, 17/18 (94%) felt the service was good or excellent compared to previous clinic review systems. Conclusion These results suggest patients are receptive to using guided self-management and patient-initiated review. Although we were not expecting to see many flares, given the low risk selected group, the results suggest patients can successfully manage flares and contact our services for support if required. It is a concern a significant proportion of patients did not recall receiving the leaflet. Although this is a small subgroup, the results show clinic time can be saved which remains a pressurised resource as we recover from the pandemic. The principles of guided self management and patient initiated review could be applied to other patient groups(eg stable UC patients not on immunosuppressants). In future it would be important to ensure patients receive and understand the leaflet. A clinic appointment prior to discharge into such pathways should be considered.
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Fischer, Isabel, Tina Beuchelt, Tom Dufhues, and Gertrud Buchenrieder. "Risk managmement networks of ethnic minorities in Viet Nam." Asia-Pacific Development Journal 17, no. 2 (September 6, 2011): 93–118. http://dx.doi.org/10.18356/6487d1bb-en.
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Mishchenko, Andrei, Saida Gadzhieva, Aleksei Beliaev, Valentina Sokolskaia, and Vsevolod Galkin. "Features of the anti-epidemic measures system in oncosurgery hospital in pandemic period of COVID-19." Problems in oncology 66, no. 6 (December 30, 2020): 645–52. http://dx.doi.org/10.37469/0507-3758-2020-66-6-645-652.
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The special conditions during the pandemic show the problems and raised actuality of questions about the safe organization of planned work of non-infectious hospitals for the managment of oncological patients. The surgical component of treatment, as an integral part of oncological care, should be considered as urgent, since the delay in its realisation inevitably worsens the results of treatment. On the other hand surgical operations in the epidemic condition is associated with the obvious additional risks. The article describes the experience of implementing elements of the system of anti-epidemic measures in a oncological surgical hospital, examines the objective characteristics of the situation that affect its components and analyzes their effectiveness.
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Mukta, Mukta, and Manjula Karlwad. "MANAGMENT OF MULTIPLE SCLEROSIS THROUGH THE RAY OF AYURVEDIC PRINCIPLE: A CASE STUDY." April 2021 9, no. 4 (April 15, 2021): 904–8. http://dx.doi.org/10.46607/iamj3709042021.
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Autoimmune disease occurs when the immune system attacks self-molecules as a result of a breakdown of immu- nological tolerance to auto reactive immune cells. Autoimmune disorders are on the rise globally and affect 8.5% of the population worldwide. In that one among is Multiple Sclerosis (MS)2 is a chronic progressive disease with a variety of cognitive, motor and sensory deficits. In Ayurveda, Multiple Sclerosis can be correlated to Pranaavruta Vyana3, all autoimmune diseases are the result of Amavisha and ama utpatti.4 Modern treatments like immuno- suppressant, corticosteroids, stem cell therapy are highly expensive when compared to Ayurvedic management. The scope of Ayurvedic Management and preventive aspect mainly concentrates on Ama Pachana, Agni Deepana, Doshavashechana, Shesha Dosha Shamana and followed by Rasayana, which in turn improves the quality of life and life expectancy. Keywords: Autoimmune disorders, Multiple Sclerosis, Pranaavruta Vyana, Ama
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Perepu, Usha S., Amy M. Leitch, and Sundara Reddy. "Implementation of a Preoperative Anemia Management Clinic in a Tertiary Academic Medical Center." Blood 128, no. 22 (December 2, 2016): 1004. http://dx.doi.org/10.1182/blood.v128.22.1004.1004.
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Abstract Background: Preoperative anemia is commonly encountered with a reported incidence of 5-75% in elective presurgical populations. Anemia is an independent risk factor for perioperative morbidity and mortality and is a strong predictor of perioperative blood transfusion. Approximately 50% of all blood transfusions occur in the perioperative setting and transfusions are a significant financial burden for healthcare institutions. Although preoperative anemia management has been shown to reduce transfusion requirements and improve perioperative outcomes, the optimal delivery model for this service remains unclear. We describe the implementation of a novel preoperative anemia management clinic (AMC) workflow and report patient volume trends since its implementation in Jan 2015 at the University Of Iowa Hospitals & Clinics. Methods: We identified patients undergoing elective high blood loss (HBL) surgical procedures (defined as predicted blood loss >500 cc) with a preoperative hemoglobin (Hb) <12 g/dl as the target population for preoperative anemia management. We identified HBL procedures by ICD codes using information derived from our institutional maximum surgical blood-ordering schedule (MSBOS), intraoperative estimated blood loss (EBL) data from the electronic medical record (EMR) and surgical provider input. In calendar year 2014, 3262 elective HBL surgical patients were identified, out of which 452 (13.9%) received perioperative red cell transfusions. 232 (51.3%) of these patients had a preoperative Hb <12 g/dl. 61 (26%) of these patients were transfused 1 unit PRBCs, 62 (27%) were transfused 2 units and the remaining 109 (47%) patients were transfused > 2 units. Assuming 1- 2 unit transfusions were preventable by preoperative anemia managment, the calculated cost savings to the institution by avoiding these transfusions was estimated to be $200,000/year, not including potential improvement in length of stay. Using these data as baseline, a business plan for an AMC was presented to and approved by our hospital administration. An outpatient clinic was initiated in a temporaray location in early 2015 and later moved to a permanent location with infusion capabilities in August 2015 with two full time staff including a nurse practitioner and a medical assistant supervised by a nurse manager and a medical director. To streamline workflow, a stepwise algorithm for diagnosis and management of anemia was created by a multidisciplinary team that included Hematology, Anesthesiology, Surgery, Internal Medicine, Nursing and Pharmacy. We established referral mechanisms primarily from surgical clinics via automatic EMR alerts for elective HBL procedures linked to case scheduling through the EMR and secondarily through direct outpatient consultations. Results: We observed an overall trend of reduction in the percentage of patients transfused perioperatively in the two quarters following implementation of the preoperative AMC compared with the preceding quarterly intervals since Jan 2014 (Figure). In the same time period we observed a steady increase in number of patient visits to the AMC and number of iron infusions administered. Patient visits and iron infusions more than doubled in the first two quarters of 2016 compared to same time period in 2015 (594 vs 195 and 366 vs 124 respectively). There was a significant reduction in average length of stay (2.78 days) for patients who received transfusions after an AMC visit compared with patients who were not seen in the AMC. Conclusions: Implementation of a structured preoperative anemia management clinic (AMC) with an automatic referral workflow is feasible at a large academic medical center and appears to result in reductions in blood transfusions and hospital length of stay. The heterogeneity of our surgical population and the short timespan since implementation of the AMC are limitations of this analysis. We have ongoing efforts to minimize system errors in our referral mechanisms (ie appropriate EMR alerts to surgeons) and enhance surgical provider education to maximize preoperative anemia management opportunities. Disclosures No relevant conflicts of interest to declare.
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Vorobyov, S. V., A. A. Ivanova, M. A. Rasskazova, D. A. Slyusarenko, E. Y. Petrovskaya, and N. A. Kuzmenko. "A clinical case of favorable course of non-alcoholic fatty liver disease with type 2 diabetes mellitus." South Russian Journal of Therapeutic Practice 3, no. 2 (June 26, 2022): 107–15. http://dx.doi.org/10.21886/2712-8156-2022-3-2-107-115.
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We want to draw the attention of clinical therapists, endocrinologists and gastroenterologists to the problem of e⁄ective drug therapy for diabetes mellitus type 2 combined with non-alcoholic fatty liver disease, which can improve the life quality and achieve compliance with this category of patients. Type 2 diabetes mellitus is a carbohydrate metabolism disorder caused by insulin resistance, which may be accompanied by relative insulin de‹ciency or not. Type 2 diabetes mellitus is often combined with certain diseases, one of which is non-alcoholic fatty liver disease. This imposes certain limitations in the treatment of type 2 diabetes mellitus, which must be taken into account in order to maintain e⁄ective clinical managment. Understanding the genetically individualized risks allows the doctor to remain wary of these patients and treat them with the appropriate clinical methods. The combination of e⁄ective drug therapy and patient's awareness of the necessity for the lifestyle changes makes it possible to achieve signi‹cant improvements in the treatment of type 2 diabetes mellitus combined with non-alcoholic fatty liver disease. This treatment allows to improve the patient's life quality and prognosis of the disease as well as to avoid various risks and complications that can lead to irreversible consequences such as the need for liver transplantation.
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Bussel, James B., Jenny Zhang, Shande Tang, Joe McIntosh, and David J. Kuter. "Efficacy, Safety and Tolerability of E5501 (AKR501) In a 6-Month Extension Study In Subjects with Chronic Immune Thrombocytopenia (ITP)." Blood 116, no. 21 (November 19, 2010): 3695. http://dx.doi.org/10.1182/blood.v116.21.3695.3695.
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Abstract Abstract 3695 The thrombopoietin (TPO) receptor agonist E5501 (AKR501) is one of a new class of oral TPO agents which increase platelet production. In a recent multicenter, randomized, double-blind, placebo-controlled Phase II study (501-CL-003) in subjects with chronic ITP who were refractory to, or relapsed after, at least one prior ITP therapy, E5501 (once-daily for 28 days) was well tolerated and, at higher dose, was effective at increasing platelet counts. Here, 53 of 57 subjects who completed 28 days of study treatment (placebo, 2.5, 5, 10 or 20 mg E5501) in 501-CL-003 were treated with E5501 in a 6-month extension study, 501-CL-004. Subjects classified as responders in 501-CL-003 (i.e. those whose platelet count had risen by a minimum of 20 ×109/L above baseline to ≥50 ×109/L at Day 28) continued to receive their original E5501 blinded dose when they entered 501-CL-004. Subjects who were nonresponders in 501-CL-003 initially received open-label E5501 10 mg once-daily. E5501 dose was titrated upwards in an open-label fashion in 10 mg increments every 14 days depending on subject response (to a maximum of 40 mg once-daily for nonresponders and blinded dose plus 20 mg once-daily for responders). Additionally, concomitant medications were reduced according to subject response. Effectiveness analyses included only the 53 subjects in 501-CL-004. Safety analyses were performed on combined data from 501-CL-003 and 501-CL-004 (n=64). Subjects were regarded as responders in 501-CL-004 if their platelet count was ≥50 ×109/L and had risen by a minimum of 20 ×109/L above baseline (from 501-CL-003). Subjects had an overall platelet response if, in the absence of rescue medication, they were responders for 75% of the time over the last 14 weeks of the 24 week study (‘durable platelet response’) or were responders on any 4 consecutive weeks (‘transient platelet response’). E5501 showed effectiveness as measured by durable and overall platelet response. The durable platelet response rate was 52.8% for all subjects, 72% for subjects who were responders in 501-CL-003, and 35.7% for subjects who had been nonresponders. The overall platelet response rate was 75.5% for all subjects, 88% for responders, and almost two thirds (64.3%) for nonresponders. Following treatment with E5501, median platelet counts were maintained for the duration of treatment (Figure 1). E5501 also showed effectiveness as measured by a reduction or withdrawal of concomitant steroid medications. Among subjects using steroids, 54.2% decreased their use by >50%, including 33.3% who discontinued their use permanently. Twenty of 25 (80%) responders from 501-CL-003 maintained a platelet response throughout 501-CL-004 without requiring an upward dose titration. Twenty-one of 28 nonresponders required, but only 10 subjects received, an upward dose titration; of these, 7 (70%) achieved an overall response. E5501 was well tolerated, with a favorable safety profile. All 64 subjects (100%) experienced one or more treatment-emergent adverse events (TEAEs); most were mild, transient, and resolved completely. The most common TEAEs were fatigue (37.5%), headache (32.8%) and epistaxis (25%). TEAEs leading to study discontinuation were reported in 10/64 (15.6%) subjects. Serious TEAEs were reported in 12/64 (18.8%) subjects (Table 1). Of these, only 4 (6.3%) were considered by the investigators to be treatment-related. Forty-three of 64 subjects (67.2%) reported a bleeding event; 3 had a clinically significant grade 3 bleed (epistaxis, hemorrhagic diathesis or intracranial bleed) and 1 had a grade 4 GI bleed related to hemorrhagic gastritis. None were considered to be related to study drug. All other bleeding events were grades 1 or 2. Nine subjects met the criteria for recurrence of thrombocytopenia, defined as a platelet count that decreased to <10 ×109/L upon discontinuation of E5501. Four of these were deemed serious; all 4 recovered. Thromboembolic events were reported in 4 of 64 subjects (6.3%). One had a grade 3 deep vein thrombosis, 1 had a grade 3 stroke, and 1 had TIA and MI (Day 20) and a grade 4 retinal artery occlusion (14 days posttreatment). All 3 of these subjects had multiple risk factors for thrombosis. The fourth subject had grade 1 superficial thrombophlebitis. In conclusion, results from this 6-month extension study are supportive of the long-term efficacy and safety of E5501 in adults with difficult-to-manage, relapsed or refractory ITP. Disclosures: Bussel: Amgen: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Research Funding; Cangene: Research Funding; GlaxoSmithKline: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Research Funding; Genzyme: Research Funding; Immunomedics: Research Funding; Ligand: Membership on an entity's Board of Directors or advisory committees, Research Funding; Eisai Inc: Membership on an entity's Board of Directors or advisory committees, Research Funding; Shionogi: Membership on an entity's Board of Directors or advisory committees, Research Funding; Sysmex: Membership on an entity's Board of Directors or advisory committees, Research Funding; Portola: Consultancy. Zhang:Eisai: Employment. Tang:Eisai: Employment. McIntosh:Eisai: Employment. Kuter:Amgen: Consultancy, Research Funding; GlaxoSmithKline: Consultancy, Research Funding; ONO: Consultancy; Shionogi: Consultancy, Research Funding; Pfizer: Consultancy; Protalix: Consultancy, Research Funding; Risk Managment Foundation: Consultancy.
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Obi, Arinze Stephen, Si-Heon Lee, Hyun-Sam Jung, and Jae-Jung Jung. "A Center-Tapped Transformer Based Multifunctional Single-Phase Converter with Wide DC-Bus Control." Sensors 23, no. 4 (February 16, 2023): 2227. http://dx.doi.org/10.3390/s23042227.
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Alongside the rapid increase in distributed power generation and load, the demand for highly efficient and reliable power converters is increasing. This has resulted in the rise of grid interfaced renewable energy sources (RES), rapid deployment of battery energy storage systems (BESS) coupled with energy managment systems (EMS), and DC based grid. This paper presents a center-tapped transformer-based single-stage single-phase full-bridge (FB) bidirectional AC-DC converter and its control strategy to improve controllability and reliability in applications such as DC distribution, PV/BESS grid interfacing, vehicle to grid (V2G), and so on. In contrast to conventional galvanically isolated topologies, a single-phase center-tapped transformer is introduced. It links and galvanically isolates the converters and the grid and provides its leakage inductance as the needed inductor required for current control (depending on the design). Furthermore, it reduces the number of conventionally required power conversion stages by employing a wide DC-bus voltage control strategy, resulting in a single converter that undergoes a single power conversion. Additionally, the voltage level can be increased to further enhance the output quality by cascading multiple converters (Multi-Level). The structure, operation, and basic control scheme are discussed in detail. Verification through a 220 Vrms, 1.8 kVA, and 45∼100 VDC simulation and small-scale experimental prototype (60∼100 VDC voltage) for practical validation of the topology is also presented.
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Bussel, James B., Jenny Zhang, Shande Tang, Joe McIntosh, and David J. Kuter. "A Randomized, Double-Blind, Placebo-Controlled Phase II Trial on the Efficacy, Safety and Tolerability of E5501 (AKR501) In Subjects with Chronic Immune Thrombocytopenia (ITP)." Blood 116, no. 21 (November 19, 2010): 71. http://dx.doi.org/10.1182/blood.v116.21.71.71.
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Abstract Abstract 71 Chronic immune thrombocytopenia (ITP) is a condition of low platelet counts due to increased autoimmune-mediated platelet destruction and suboptimal platelet production. Thrombopoietin (TPO) receptor agonists are a novel class of agents which increase platelet counts by mimicking the principal physiologic regulator of platelet production, TPO. TPO agonists have demonstrated efficacy in randomized controlled trials in patients with ITP who are refractory to 1st and 2nd line agents. E5501 (previously AKR501) is a novel, orally-active, once-a-day TPO agonist which increased platelet counts in healthy volunteers. Here, we report data from a Phase II, multicenter, randomized, double-blind, placebo-controlled, dose-ranging, parallel group 4-week study (501-CL-003) of E5501 in subjects with ITP whose disease was refractory to, or had relapsed after, at least one prior ITP therapy. Subjects were enrolled if they had a baseline platelet count of <30 x109/L, or if they had a baseline platelet count of <50 x109/L and were on stable corticosteroid therapy. Sixty-four subjects were randomized to E5501 (2.5, 5, 10 or 20 mg) or placebo in a 3:3:3:3:1 randomization ratio, respectively. E5501 or placebo was administered orally, once daily for 28 days. Response to E5501 was based on weekly platelet counts. The primary endpoint was responder rate at Day 28. Responders were defined as subjects whose platelet count was ≥50 x109/L and had risen by a minimum of 20 x109/L above baseline. Responder rate increased in subjects receiving E5501 in a dose-dependent manner (Table 1). At Day 28, the responder rate in the E5501 20 mg group was 80% (12 of 15 subjects) vs 0% in the placebo group (p=0.0036). The responder rate was also significantly higher with E5501 20 mg than with E5501 2.5 mg (80% vs 13.3%; p=0.0007). In non-splenectomized subjects, the responder rate at Day 28 was 51.2% in the combined E5501 group and 88.9% in the E5501 20 mg group, compared with 44.4% and 66.7% respectively in splenectomized subjects. Median platelet counts at Day 28, and change in platelet counts above baseline, increased in subjects receiving E5501 in a dose-dependent manner (Table 2). The majority (57.6%) of subjects responded to a dose of ≥5 mg E5501 by Day 7. Subjects treated with E5501 20 mg achieved a 93.3% response rate on Day 7. None of the 5 placebo-treated subjects responded at any time during the study. E5501 was well tolerated, with a similar proportion of subjects showing treatment-emergent adverse events (TEAEs) across all dose groups. Most TEAEs were mild, transient, and resolved completely. TEAEs occurring in ≥10% of E5501-treated subjects were fatigue (20.3%), headache (20.3%) and epistaxis (15.3%). There were no clinically relevant changes in vital signs or physical examination findings. Three subjects (2 in the 2.5 mg and 1 in the 10 mg E5501 group) reported serious TEAEs. Of the two subjects in the 2.5 mg E5501 group, one reported thrombocytopenia and one reported a GI bleed; both had platelet counts <10 x109/L. The one subject in the 10 mg E5501 group, a 72-year-old Hispanic male with a significant history of cardiovascular disease (including myocardial infarction [MI], coronary artery vein bypass graft, 3 prior transient ischemic attacks [TIAs], chronic obstructive pulmonary disease, hypertension, systolic ejection murmur, angioplasty, stent placement, hyperlipidemia, and small vessel disease), had TIA and MI on Day 20 and a retinal artery occlusion 14 days after E5501 was discontinued. At the time of the events his platelet counts were 40–47 x109/L. Three other E5501-treated subjects (6.8% in total) experienced TEAEs leading to study drug withdrawal: 1 receiving 5 mg E5501 had Grade 2 musculoskeletal chest pain; 2 receiving 20 mg E5501 had excessively increased platelet counts with no clinical sequellae. In conclusion, E5501 was effective in increasing platelet counts in subjects with ITP. At 20 mg E5501, 80% of patients had responded at Day 28, with a median platelet count of 95 x109/L, and >90% of patients had responded by Day 7. E5501 was generally well tolerated and had a favorable safety profile. These data support continued development of E5501 as a potentially effective treatment with an acceptable safety profile in non-splenectomized and splenectomized patients with ITP. Disclosures: Bussel: Amgen: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Research Funding; Cangene: Research Funding; GlaxoSmithKline: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Research Funding; Genzyme: Research Funding; Immunomedics: Research Funding; Ligand: Membership on an entity's Board of Directors or advisory committees, Research Funding; Eisai Inc: Membership on an entity's Board of Directors or advisory committees, Research Funding; Shionogi: Membership on an entity's Board of Directors or advisory committees, Research Funding; Sysmex: Membership on an entity's Board of Directors or advisory committees, Research Funding; Portola: Consultancy. Zhang:Eisai: Employment. Tang:Eisai: Employment. McIntosh:Eisai: Employment. Kuter:Amgen: Consultancy, Research Funding; GlaxoSmithKline: Consultancy, Research Funding; ONO: Consultancy; Shionogi: Consultancy, Research Funding; Pfizer: Consultancy; Protalix: Consultancy, Research Funding; Risk Managment Foundation: Consultancy.
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Guadagnolo, B., G. K. Zagars, A. K. Raymond, R. S. Benjamin, and E. M. Sturgis. "Osteosarcoma of the jaw/craniofacial bones: Outcomes following multimodality treatment." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 10511. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.10511.
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10511 Purpose: To evaluate outcomes for patients with osteosarcoma of the jaw/craniofacial bones treated with surgery or combined modality therapy (CMT) consisting of surgery and radiation therapy (RT). Methods: Retrospective analysis was performed on data for 119 patients with osteosarcoma of jaw/craniofacial bones who underwent definitive resection with or without RT between 1960 and 2007. Median age was 33 years (range, 7–77 years). Ninety-two (77%) underwent surgery alone while 27 (23%) were treated with CMT. Median RT dose was 60 Gy (range, 50–66 Gy). Kaplan-Meier method was used to calculate the actuarial curves for survival (OS), disease-specific survival (DSS), local recurrence (LR), distant metastatic relapse (DM), and complication rates; and the log-rank statistic was used to test for significance of differences between curves. Results: Median follow-up was 5.8 years (range, 0.25 to 44.5 years). The OS rates at 5 and 10 years were 63% and 55%, respectively. Corresponding DSS rates were 67% and 61% respectively. Surgical margin status (positive/uncertain vs. negative) was adversely prognostic for OS (p=0.0001) and DSS (0.0001). Stratified analysis by margin status showed that CMT compared to surgery alone improved OS (80% vs. 31%, p=0.02) and DSS (80% vs. 35%, p=0.02) for patients with positive/uncertain margins. Multivariate analysis showed that CMT for patients with positive/uncertain margins improved OS (p<0.0001). Forty-four patients (40%) experience LR and 25 (21%) developed DM. There was no difference in DSS if relapse was isolated LR vs. DM (26% vs. 29%, respectively at 5 years, p=0.48) Local control (LC) rates were 59% and 57% at 5 and 10 years, respectively. The use of CMT vs. surgery alone significantly improved LC for patients with positive/uncertain margins (75% vs. 24%, p=0.006). The rate of surgical complications was 28% at 5 years. Rates of RT-associated complications were 40% and 47% at 5 and 10 years, respectively. Conclusions: RT in addition to surgery improves OS, DSS, and LC for patients with osteosarcoma of the jaw/craniofacial bones who have positive/uncertain surgical margins. Complication rates from surgery and RT are high, but LR is lethal in this disease. Morbidity risks must be weighed against the need to eradicate disease with primary local managmement. No significant financial relationships to disclose.
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Antonio, Quarticelli. "Periculo Procuratio: Managment Risk." Journal of Advanced Health Care, August 23, 2019. http://dx.doi.org/10.36017/jahc1908-012.
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The Management Risk originated in the early 1980s in the United States with the aim of reducing the tendency to legal recourse by patients who had unforeseen clinical incidents that occurred during health treatments to which they were subjected. Also in Italy the Management Risk is born and develops to protect the employees of the National Health System and to protect the health of Patients / Users. The study will examine in a practical way the medical and legal responsibilities of a Medical Radiology Technician in the protection of the patient / client.
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"EXECUTIVE SUMMARY: SCENARIOS, REAL OPTIONS AND INTERGRATED RISK MANAGMENT." Long Range Planning 36, no. 1 (February 2003): 12. http://dx.doi.org/10.1016/s0024-6301(02)00206-6.
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Hsiao-Mei, Liang, Wang Chih-Hwa, Shann-Ren, Kang, Hsuuw Yan-Der, and Hung Kuo-Hsiang. "Employing Ultrahigh-Frequency RFID Technology on Deer Farm Managment." Indian Journal of Animal Research, OF (September 29, 2015). http://dx.doi.org/10.18805/ijar.5541.
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This project uses ultrahigh-frequency (UHF) ear tags and readers with a readable range of 3 to 5 m. Forty stags were tagged with radio-frequency identification (RFID) ear tags and allocated into 20 pens. When deer with RFID ear tags walked through the aisle, handheld RFID readers, used as personal digital assistants (PDAs), and stationary RFID readers in frequency range received signals from the tags, and individual deer tag data were transmitted immediately and completely through wireless PDAs to a computer. The inputted data were sent to the deer-farm management system to be collated and organized. Farmers obtained individual deer data without approaching the deer, which decreased the risk of the deer attacking. Employing UHF-RFID technology integrated with software contributes to enhancing the efficiency of deer identification and farm management.
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"Enhancing financial risk managment in corporation – a case of some vietnam listed banks." Journal of Contemporary Issues in Business and Government 27, no. 02 (March 2, 2021). http://dx.doi.org/10.47750/cibg.2021.27.02.115.
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Dewachter, Hans, Marco Lyrio, and Stan Maes. "A Multi-Factor Model for the Valuation and Risk Managment of Demand Deposits." SSRN Electronic Journal, 2006. http://dx.doi.org/10.2139/ssrn.1689550.
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Mikhaleva, Liudmila M., Olesya A. Vasyukova, Andrey E. Birukov, Mikhail Yu Guschin, Konstantin Yu Midiber, Emma P. Akopyan, and Tatyana N. Khovanskaya. "Gastric Neuroendocrine Neoplasias: Literature Review." Annals of the Russian academy of medical sciences, March 12, 2020. http://dx.doi.org/10.15690/vramn1258.
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A brief retrospective journey into the history of neouroendocrine neoplasias serves to remind the histology and distribution of neuroendocrine cells in the gastric mucosa, followed by chronological review of NEN discovery and theory development up to the present moment. The morphological classification of gastric NET consisting of 4 possible types is highlighted: the correct interpretation of the pathological findings, taking into account not only the histological features of the tumor itself, but also of the adjacent mucosa, allows to suggest the appropriate managment, which fundamentally affects patient survival.
The review provides other current classifications of the gastric neuroendocrine neoplasia depending on its location, embryogenesis, functional activity, histological grade (with a focus on the Ki-67 labeling index counting, and ways to improve the interobserver reliability in routine practice). Moreover, the differences in the gastric NET and NEC TNM classification are emphasized. The drawbacks of all classifications are discussed and the possibilities for their further development are considered. An important part of the review is the description of a possible immunohistochemical markers, since immunohistochemistry is widely used to confirm the diagnosis. In addition, INSM1 (insulinomaassociatedprotein 1), the new immunohistochemical and molecular marker for NEN is discussed: according to the literature, it contributes to more accurate assessment of the tumor malignant potential and the metastatic risk.
Furthermore, modern methods of endoscopic and PET/CT imaging (68-gallium DOTATATE PET/CT, molecular imaging using SSTR (somatostatin receptor) PET/CT or GLP-1R (Glucagon-like peptide-1 receptor) SPECT (single photon emission computed tomography)/CT), which allows the clinician to suspect a NEN even before morphological analysis of the resected specimen and adequately select the extent of surgical intervention are shown.
In conclusion, we would like to reiterate the importance of further research on the gastric NET subtype pathogenesis and their clinical behavior, also of the correlation of the endoscopic, morphological, and immunohistochemical picture with the patient prognosis to improve managment tactics.
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Webb, Alastair JS, Amy Lawson, Linxin Li, Sara Mazzucco, and Peter M. Rothwell. "Physiological determinants of residual cerebral arterial pulsatility on best medical treatment after TIA or minor stroke." Journal of Cerebral Blood Flow & Metabolism, November 5, 2020, 0271678X2096998. http://dx.doi.org/10.1177/0271678x20969984.
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Cerebral arterial pulsatility is strongly associated with cerebral small vessel disease and lacunar stroke yet its dependence on central versus local haemodynamic processes is unclear. In a population-based study of patients on best medical managment, 4–6 weeks after a TIA or non-disabling stroke, arterial stiffness and aortic systolic, diastolic and pulse pressures were measured (Sphygmocor). Middle cerebral artery peak and trough flow velocities and Gosling’s pulsatility index were measured by transcranial ultrasound. In 981 participants, aortic and cerebral pulsatility rose strongly with age in both sexes, but aortic diastolic pressure fell more with age in men whilst cerebral trough velocity fell more in women. There was no significant association between aortic systolic or diastolic blood pressure with cerebral peak or trough flow velocity but aortic pulse pressure explained 37% of the variance in cerebral arterial pulsatility, before adjustment, whilst 49% of the variance was explained by aortic pulse pressure, arterial stiffness, age, gender and cardiovascular risk factors. Furthermore, arterial stiffness partially mediated the relationship between aortic and cerebral pulsatility. Overall, absolute aortic pressures and cerebral blood flow velocity were poorly correlated but aortic and cerebral pulsatility were strongly related, suggesting a key role for transmission of aortic pulsatility to the brain.
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Pilecki, Michal. "Zarządzanie Ryzykiem W Tworzeniu Wartości Na Przykładzie Przedsiębiorstwa Z Branży Spożywczej (Risk Managment in Creating Value of Company in Example of Food Production Branch Companies)." SSRN Electronic Journal, 2013. http://dx.doi.org/10.2139/ssrn.2248153.
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Abdelaal, A. A., M. A. M. Hassan, M. A. M. Aboelnaga, and M. T. Rayan. "Comparison between Stenting and Stentless Technique in Biliary Anastomosis after Living Donor Liver Transplantation." QJM: An International Journal of Medicine 113, Supplement_1 (March 1, 2020). http://dx.doi.org/10.1093/qjmed/hcaa050.046.
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Abstract Background billiary complications is the most common complication after LDLT. Biliary complications include stricture, leakage, cholangitis, biliary stones, hemobilia and ductopenia. Risk factors of complications include advanced donor age multiple anastomoses, long cold and warm ischemia times, hepatic artery thrombosis and duct-to-duct reconstruction. Aim of the Work it is a combined retrospective and prospective analytical study to compare between using stent and stentless technique in biliary anastomosis in living donor liver transplantation. Patients and Methods in this observational study we did comparative study between stented and stentless technique. We compared the main complications; leakage, stricture and cholangitis. Diagnosis of each complications is built up by follow up serum liver profile, and Ultrasonography. We did MRCP to diagnose stricture and follow up drains or aspiration of any collection to confirm leakage. All cases of cholangitis was admitted to our hepatobiliary unit to control the condition and to exclude any concomitant stricture or leakage. Results there is a significant decrease in the previously mentioned postoperative biliary complication using stentless technique by decreasing biliary infection rate and, thus, decreasing stricture and leakage. Managment of complicated case was initially done by hospital admission. ERCP was done for all cases of sticture. Conclusion biliary complications after living donor liver transplant can significantly be reduced by using stentless techinque.
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Prudêncio, Diego Ailton, Nicola Maffulli, Filippo Migliorini, Thiago Teixeira Serafim, Luis Felipe Nunes, Luciana Sayuri Sanada, and Rodrigo Okubo. "Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis." BMC Sports Science, Medicine and Rehabilitation 15, no. 1 (January 26, 2023). http://dx.doi.org/10.1186/s13102-023-00618-2.
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AbstractAchilles tendinopathy (AT) is one of the most frequent overuse injuries in the ankle. The evidence base for its conservative management AT continues to evolve, but there is still a gap in the evidence for the efficacy of any modality of treatment in high-quality studies. This systematic review and meta-analysis investigated the efficacy of EE in improving pain and function in adult patients with mid-portion Achilles tendinopathy compared to other forms of exercise. A search was performed in PubMed, BIREME, SportDiscus, Cinahl, Web of Science and PEDro, in November 2022. The methodological quality was evaluated using the Risk of Bias 2 tool (RoB2) of the Cochrane collaboration, and the meta-analysis was performed using the Review Manager 5.1 program. 2024 articles were identified and eight fulfilled the inclusion criteria. RoB2 presented a final score with 62.5% of the studies presented “some concerns”, and 37.5% (five and three articles, respectively) presenting “high risk” of bias. EE was effective for the managment of AT. The only variable for which a meta-analysis was possible was pain (five articles), analysed with the visual analogue scale/numerical visual scale. The mean difference (MD) in treatment effect using EE was − 1.21 (− 2.72 to − 0.30) with a 95% of confidence interval (CI), thus identifying a significant positive effect for the improvement of pain in patients with AT in whom EE was used. EE is effective in the management of AT. The meta-analysis shows the need for appropriately powered randomized controlled trials with better design, the use of standard outcome measures and well-planned protocols for conservative management of AT.Level of evidence: Level 1.Registration: CRD42018118016.
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Mordasewicz, Magdalena. "Zarządzanie ryzykiem w tworzeniu wartości na przykładzie przedsiębiorstwa z branży handlu hurtowego (Risk and Value Managment in the Wholesale Enterprise with the Use of Scenario Simulations)." SSRN Electronic Journal, 2013. http://dx.doi.org/10.2139/ssrn.2248966.
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Duarte, Mariano, Javier Coyle, Analia Aquieri, Claudio Yaryour, and Eleonora Savio Galimberti. "Abstract P108: Standardised and Interdisciplinary Management of Hypertensive Urgency Improve Patients Medicalcare and Follow Up." Hypertension 70, suppl_1 (September 2017). http://dx.doi.org/10.1161/hyp.70.suppl_1.p108.
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Acute severe hypertension (ASH) includes low risk to life threatening events and is defined as sustained blood pressure (BP) > 180/100 mmHg. There are 2 types of ASH: hypertensive emergency (HE), and hypertensive urgency (HU). The difference is the presence (HE) or absence (HU) of acute target organ damage (TOD). Unassisted HU can evolve to HE. More than 80 % of ASH was HU with inadequate managment. The aim of the present study was to standardize the HU management based on interdisciplinary team work and to differenciate low from high risk HU. We studied 193 patients with ASH (64±12,6 years old, 117 women and 76 men). HU evaluation consisted of physical exam, ECG, chest X-Ray, full blood and urine work, retinal exam. Patient education and patient’s follow-up inmediately after acute presentation were also included. We identified 2 HU populations: High-risk HU (previous hypertensive patients or with chronic TOD), and low-risk HU (no TOD). The latter would rest for 1 h until BP <160/100 mmHg. High-risk HU typically present 4 th sound, ventricular hypertrophy, creatinine>1.5 mg/dL or “arterial-venous” crosses in retinal exam, and will receive pharmacological treatment (orally labetalol 200 mg). We monitored patients for 2 h after the drug was administered, and if BP <160/100, patients were sent home, to keep rest, follow a low-sodium diet and be reevaluated 24 h later. If BP >160/100 mmHg patients will receive a 2 nd dose of labetalol. The study revealed that 41 of 193 pacients (22%) were not diagnosed with high BP before, and chronic TOD was identified in 19 of them. From 152 hypertensive patients, only 31 (20%) were adequately managed and treated. The most frequent cause that triggered HU was the dietary transgression (excessive salt ingestion). In conclusion, standardized assessment and management of HU revealed that a high percentage of patients with high BP lack adequate diagnosis and/or management, and end up developing HU. Implementation of resting allowed us to achieve the goal of BP<160/100 in low-risk HU patients. High-risk HU patients were best and safe treated with orally labetalol. The new guideline also secured a medical follow-up of all HU patients, decreasing their fall-off of the medical system (<10%) and improving their long-term medical management.
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Tondelli, Manuela, Chiara Galli, Giulia Vinceti, Luigi Fiondella, Simone Salemme, Chiara Carbone, Maria Angela Molinari, Annalisa Chiari, and Giovanna Zamboni. "Anosognosia in Early- and Late-Onset Dementia and Its Association With Neuropsychiatric Symptoms." Frontiers in Psychiatry 12 (May 13, 2021). http://dx.doi.org/10.3389/fpsyt.2021.658934.
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Background: The symptom anosognosia or unawareness of disease in dementia has mainly been studied in patients with late-onset dementia (LOD, ≥65 years), whereas little is known on whether it is also present in patients with early-onset dementia (EOD, <65 years). We aimed at investigating differences in anosognosia between LOD and EOD, by also studying its association with different clinical variants of EOD and the presence of neuropsychiatric symptoms.Methods: A total of 148 patients, 91 EOD and 57 LOD, were recruited and underwent extended clinical assessment and caregiver interview that included questionnaires aimed at measuring anosognosia and neuropsychiatric symptoms. Differences in anosognosia between EOD and LOD and between subgroups with different clinical variants were investigated, as well as correlation between anosognosia and neuropsychiatric symptoms. A regression analysis was applied to explore the association between anosognosia and development of neuropsychiatric symptoms during disease progression.Results: Median levels of anosognosia were not significantly different between EOD and LOD. Anosognosia increased overtime with disease progression and was higher in frontotemporal dementia patients or, more precisely, in frontotemporal dementia and Alzheimer's disease variants associated with involvement of the frontal lobes. Higher levels of early anosognosia were associated with higher frequency and severity of subsequent neuropsychiatric symptoms, in particular apathy, later in the course of the disease.Conclusion: Anosognosia is a frequent symptom of EOD, occurring in 94.5% of all-cause EOD, and it is associated with higher risk of developing neuropsychiatric symptoms during disease progression. Recognising anosognosia may be helpful for clinicians and families to reduce diagnostic delay and improve disease managment.
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Tojal Sierra, L., R. Soria Navarro, I. Juanes Dominguez, E. Saez De Buruaga, E. Virosta Gil, Z. Fernandez Fernandez De Leceta, M. J. Apodaca Arrizabalaga, et al. "Covid-19 pandemic's impact on management of cardiovascular risk factors in a Phase IIIs period of a cardiac rehabilitation program, fact or fiction?" European Heart Journal 42, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.2680.
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Abstract Introduction The global pandemic due to Covid-19 has constituded a challenge in the follow up and monitoring of cardiac rehabilitation's programs. The State of alarm declared last year in Spain, led to strict home confinement that could have had an impact in the progress of patients Aim To analyze the effect of home confinement on the managment of cardiovascular risk factors (CVRF) in patients included in phase III of a cardiac rehabilitation program (CRP) and also to evaluate the self-care education received during CRP. Methods and materials Descriptive, comparative and retrospective analysis of patients in phase III of a CRP. The sample was divided into two groups: Post-Covid group (consecutive CRP patients with follow up one year after the cardiac event from 6/21/2020 [date of end of home confinement in Spain] to 12/31/2020) and Group Pre-Covid (consecutive CRP patients with follow up one year after the cardiac event from 6/21/2019 to 12/31/2019). Demographic and CVRF data from end of phase II consultation were compared with those from the phase III consultation (one year after the event) for both groups. The SPSS statistics v23 program was used for statistical analysis. Results 283 patients, 137 patients from the pre-Covid group and 146 patients from the post-Covid group. No statistically significant differences were found between the two populations (Table 1). No statistically significant differences were found in the achievement of the CVRF target values: systolic blood pressure <140mmHg (94 vs 107; p=0.216), diastolic blood pressure <90mmHg (121 vs 130, p=0.276), LDL-c <70 mg/dl (86 (71.7%) vs 89 (73.6%); p=0.743), LDL-c <55 mg/dl (41 (34.2%) Vs 47 (38.8%); p=0.451), HbA1c figure <7% (106 vs 111; p=0.478), baseline fasting blood glucose <110 mg/dl (103 vs 107; p=0.970). Regarding the variation of the CVRF figures between the final consultation of phase III and that of phase II, no statistically significant differences were found between the two groups: difference in LDL-c figure for phase III consultation with respect to phase II (−0.5±20.3 mg/dl in pre-Covid group vs −5.3±24.4 mg/dl in post-Covid group; p=0.102), difference in HDL-c (4.6±26.1 mg/dl pre-Covid group vs −0.6±24.9 mg/dl post-Covid group; p=0.113), difference in total cholesterol level (4.6±26.1 mg/dl vs −0.6±24.9 mg/dl; p=0.113), difference in HbA1c (0.1±0.3% in pre-Covid group vs 0.1±0.6% in group post-Covid), Table 2. Conclusions Home confinement has not contribute to a worsening in CVRF control in patients in a phase III of a CRP, in our study. The education given in a CRP concerning to the management of CVRF is the essential factor that grant an adequate patient control in extraordinary circumstances. Funding Acknowledgement Type of funding sources: None.
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Haigh, Richard, Daniel Murphy, and Jill Moran. "EP27 The Exeter Biologics Management Plan." Rheumatology 59, Supplement_2 (April 1, 2020). http://dx.doi.org/10.1093/rheumatology/keaa109.026.
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Abstract Background The introduction of biologic drugs has been life-changing for our patients, but these drugs are very expensive. Moreover, they are immunosuppressive and are associated with an increased infection risk. Conventional practice is to maintain the same dose long term. An internal audit identified significant drug wastage; £40,000 drug 'wasted' per year by repeat prescription requests, hoarding of supplies and missed doses. Dose reduction could result in cost savings and reduced complications, but this strategy also risks loss of disease control & requires enhanced monitoring. Methods We set up a new 'Biologics Managment Plan' Service (BMP) with the following aims: 1. Reduce costs from wastage, 2. Enable patients to confidently reduce dose by introducing a part time nurse and biologics administrator, 3. Assess efficacy, 4. Receive patient feedback. We formulated criteria to ensure eligibility for dose reduction and a dose reduction protocol for each biologic drug. We organised an intensification of follow up, monitoring and support. We maintained close liaison with pharmacy regarding prescription management and vial sharing on Day Case Unit. We fully counselled our BMP patients and subsequently obtained detailed patient feedback using a patient experience measure (PREM), plus free text comments. We examined clinical outcomes including disease activity assessments, occurrence of flares and, where possible, radiological outcomes, in patients with inflammatory arthritis undergoing biologic dose reduction. Results 82 patients entered our BMP, 48 with rheumatoid arthritis (RA). 70% were able to dose reduce successfully. Mean dose reduction was 43%. For the 48 patients with RA, disease duration, presence of erosive disease nor serological status determined dose reduction outcome. 13 patients lost control of disease with dose reduction, but regained control rapidly with intervention. 2 patients switched biologic drug after a period of poor disease control. There was no progression of erosive disease in 31 RA patients who had follow up X-rays, within 18/12 of dose reduction. Similar outcomes were seen in ankylosing spondylitis (15), psoriatic arthritis (19) and JIA (2) with ∼70% success rate. Our PREM revealed >95% felt involved, had sufficient information, & felt that drug reduction had not caused interference with daily life. All would recommend our project to others. We calculated this project was able to save £269,278.58 in the first 12 months. Conclusion It is possible to reduce the dose of biologic drugs in selected patients with inflammatory arthritis in remission. Patients were keen to reduce their drug doses and engaged enthusiastically in the process. Enhanced follow-up and support ensured that patients felt 'looked after' and rapid intervention can manage any loss of control of disease promptly. Significant cost savings can be made. We have begun to determine whether therapeutic drug monitoring can complement this process. Disclosures R. Haigh: Honoraria; speaker fees Pfizer. Grants/research support; conference attendance Pfizer, UCB. D. Murphy: None. J. Moran: None.
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ALSaadi, Nasser, and Norhayatizakuan Norhayatizakuan. "The Impact of Risk Management Practices on the Performance of Construction Projects." Studies of Applied Economics 39, no. 4 (May 4, 2021). http://dx.doi.org/10.25115/eea.v39i4.4164.
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Construction performance and risk management has been widely discussed in the literature from various perspectives. The main objective of performing risk management in construction industry is to ensure timely delivery of good construction within sepecific budget. However, the failure of many construction projects in meeting deadlines, cost and quality targets is continuously on the rise and there are signs of accentuating year after year suffering significant financial losses of construciton works in Oman. Therefore, there is a need for empirical evidences to explain the relationship between risk management and project performance. This study applied quantitative methods to examine this relationship. Construciton companies from grade excellent to grade second in Oman haven included in the survey. The result revealed that practicing risk managementimprove the performance of construciton project significantly. Based on this result it is essential to hire qualified project managers who has sufficient knowledge in risk managmeent and its main activities.
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Архипов, Олександр Євгенійович, Андрій Володимирович Скиба, and Олена Іванівна Хоріна. "THE EXTANDING OF ECONOMIC-COST MODEL OF INFORMATION SECURITY RISKS MANAGMENT BY THE USE OF SOCIAL-PSYCHOLOGICAL TYPES OF INTRUDERS." Ukrainian Information Security Research Journal 17, no. 1 (March 25, 2015). http://dx.doi.org/10.18372/2410-7840.17.8326.
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Dergach, Anna. "ORGANIZATIONAL SUPPORT OF STATE MANAGEMENT OF INVESTMENT PROJECTS." Bioeconomics and Agrarian Business 12, no. 2 (2022). http://dx.doi.org/10.31548/bioeconomy13(2).2022.17-27.
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Current trends in social and economic development in Ukraine, which are characterized by an increase in interest in boosting investment revenues, have made it necessary to search for new approaches to organizational support of state management of investment projects. This problem emerged due to the fact that the post-war restoration of territories requires a holistic theory of the formation, management and development of investment activities at various levels (state, regional), which is currently absent. The difficulty of solving this problem largely lies in the limited opportunities for domestic government savings, the inability of investors to compensate for the lack of investment in the real sector of the economy due to the low profitability of enterprises and a high degree of risks. Based on this, the purpose of the study is to develop organizational support of state management of investment projects. Scientific works of domestic and foreign authors, separate regulatory provisions and instructions served as the theoretical basis for this paper. The generalization of different scientific points of view regarding the organizational support of state management of investment projects allowed the author to come to the conclusion that there is no single point of view regarding the interpretation of this category, which is why the author's interpretation is proposed. The detailed concept expands the existing scientific basis taking into account current trends and allows accomodating the interests of all participants in the investment process. Based on the principles of monitoring, an architecture of organizational support of state managment of investment projects has been developed, which includes information, analytical and communication components, making it possible to form a comprehensive system for monitoring changes. The expediency of using the Microsoft Project investment project management applied software package, the advantage of which is its relative ease of use, availability, and ability to correct resource deviations, is substantiated. Theoretical research was practically tested in the framework of teaching the discipline "State mechanisms for managing investment programs and projects". The practical value of the results obtained lies in the fact that they are the basis for making managerial decisions in the development of national and regional projects and programs for investment and social and economic development of regions. The material can be useful for scientists, employees of government agencies, industry associations, university teachers, postgraduates and students