Efficient management of health centres human resources in Zambia

This study uses Data Envelopment Analysis (DEA) to estimate the degree of technical, allocative and cost efficiency in individual public and private health centres in Zambia; and to identify the relative inefficiencies in the use of various inputs among individual health centers. About 83% of the 40 health centres were technically inefficient; and 88% of them were both allocatively and cost inefficient. The privately owned health centers were found to be more efficient than public facilities. © 2006 Springer Science+Business Media, Inc.

An examination of the management of Russian civil society

This thesis begins by examining the concepts of civil society and social capital. Specifically, it outlines the role of health and education third sector organisations (TSOs) in building civil society and generating social capital which is conducive to democratisation. Following this, the thesis presents literature on civil society development in the context of the Russian Federation, highlighting a void in our understanding of health and education TSOs in this context. The literature review examines cultural-historic antecedents and their impact on civil society development. These antecedents result in three constraints which limit TSOs ability to establish civil society as an autonomous space. In light of these constraints, the thesis explores the present day realities faced by Russian TSOs and proposes that the all-dominant nature of the Russian state leads to managed civil society arrangements. Consequently the thesis addresses the question of how a managed civil society manifests itself in the context of the Russian Federation. Using a qualitative research design, the thesis investigates the control mechanisms created by legislative framework, the ability of third sector organisations to substitute for the state, and the organisational characteristics of TSOs within a managed civil society space. Based on interview data from 82 TSOs across three geographical regions, the empirical chapters explore these three aspects in-depth. Firstly, the thesis demonstrates how a specific legislative framework is used as a legally mandated method to manage civil society. Secondly, the thesis explores more subtle attempts by the state to manage civil society. And thirdly, the thesis highlights ways in which the state controls TSOs and coerces them to mimic marionette organisations. Overall, the evidence presented throughout the thesis highlights the idiosyncratic nature of managed civil society arrangements in Russia in which the state is able to control and direct civil society

Management of allergic conjunctivitis and dry eye

Ocular allergy is a common eye condition encountered in clinical practice. However, little is known how seasonal allergic conjunctivitis (SAC), the most common subtype, is managed in clinical practice. Further, dry eye, another common eye condition, may be misdiagnosed as SAC and vice-versa as they share similar signs and symptoms. In addition, despite the frequent recommendation of non-pharmacological treatments for SAC, evidenceto support their use has not been identified in the scientific literature. The aim of this thesis was therefore to determine the actual diagnosis and management of SAC and dry eye in clinical practice and investigate the efficacy of non-pharmacological treatments for these conditions. The diagnostic and management strategies for SAC and dry eye employed by pharmacy staff are found to be inconsistent with current guidelines and scientific evidence based upon a mystery shopper design. Cluster analysis of tear film metrics in normal and dry eye patients identified several clinically relevant groups of patients that may allow for targeted treatment recommendations. Using a novel environmental chamber model of SAC, the use of artificial tears and cold compresses, either alone or combined is an effective treatment modality for acute and symptomatic SAC, on a par with topical anti-allergic medication, and has been demonstrated for the first time. In addition, eyelid warming therapy with a simple, readily available, seed filled device is an effective method of treating meibomian gland dysfunction (MGD) related evaporative dry eye, perhaps the most common dry eye subtype. A greater focus on ophthalmology must be implemented as part of the formal education and training of pharmacy staff, while greater professional communication between community pharmacists, optometrists and the population they serve is required. Artificial tears and cold compresses may be considered as front line agents for acute SAC by pharmacy staff and optometrists, to whom pharmacological treatment options are limited.

The management of systemic hypertension in optometric practice

Aim: Systemic hypertension is a silent killer that may have very few warning signs. This study examines detection and management of patients with cardiovascular disease (CVD) by optometrists in the UK. Method: A survey was sent out to 1402 optometrists who practice in the UK to investigate the nature and knowledge of detection of systemic hypertension. Results: The survey response rate was 37%. Optometrists were neutral to slightly positive towards the use of blood pressure (BP) monitors, but not on a routine basis. The most frequently asked question during history and symptoms concerned the patient's prescribed medication for systemic hypertension, and the least was that of specifying the last BP measurement. The additional test most widely used in the examination of the systemic hypertensive patient was direct ophthalmoscopy with red-free filter. Over one-tenth of optometric practices had a BP monitor, with automated devices being the most popular. Patients most likely to have their BP measured were suspect systemic hypertensives. Retinal haemorrhages are the most important finding in influencing an optometrist's referral criteria for suspected systemic hypertension. Conclusion: Although optometrists monitor the retina for signs of damage from systemic hypertension, further education in this important condition is warranted. © 2005 The College of Optometrists.