Effects of an integrated medicines management program on medication appropriateness in hospitalized patients

Purpose. The effects of an integrated medicines management (IMM) program on medication appropriateness are discussed.

A qualitative study of the relationship between clinician attributes, organization, and patient characteristics on implementation of a disease management program

The purpose of this study was to examine the challenges of integrating an asthma disease management (DM) program into a primary care setting from the perspective of primary care practitioners. A second goal was to examine whether barriers differed between urban-based and nonurban-based practices. Using a qualitative design, data were gathered using focus groups in primary care pediatric practices. A purposeful sample included an equal number of urban and nonurban practices. Participants represented all levels in the practice setting. Important themes that emerged from the data were coded and categorized. A total of 151 individuals, including physicians, advanced practice clinicians, registered nurses, other medical staff, and nonmedical staff participated in 16 focus groups that included 8 urban and 8 nonurban practices. Content analyses identified 4 primary factors influencing the implementation of a DM program in a primary care setting. They were related to providers, the organization, patients, and characteristics of the DM program. This study illustrates the complexity of the primary care environment and the challenge of changing practice in these settings. The results of this study identified areas in a primary care setting that influence the adoption of a DM program. These findings can assist in identifying effective strategies to change clinical behavior in primary care practices. © 2008 Mary Ann Liebert, Inc.

Organizational Attributes of Practices Successful at a Disease Management Program

Objective: To assess the contribution of organizational factors to implementation of 3 asthma quality measures: enrollment in a disease management program, development of a written treatment plan, and prescription of severity-appropriate anti-inflammatory therapy. Study design: A total of 138 pediatric clinicians and 247 office staff in 13 urban clinics and 23 nonurban private practices completed questionnaires about their practice's organizational characteristics (eg, leadership, communication, perceived effectiveness, job satisfaction). Results: 94% of the clinicians and 92% of the office staff completed questionnaires. When adjusted for confounders, greater practice activity and perceived effectiveness in meeting family needs were associated with higher rates of enrollment in the Easy Breathing program, whereas higher scores for 3 organizational characteristics-communication timeliness, decision authority, and job satisfaction-were associated with both higher enrollment and a greater number of written treatment plans. None of the organizational characteristics was associated with greater use of anti-inflammatory therapy. Conclusions: Three organizational characteristics predicted 2 quality asthma measures: use of a disease management program and creation of a written asthma treatment plan. If these organizational characteristics were amenable to change, then our findings could help focus interventions in areas of effective and acceptable organizational change. © 2009 Mosby, Inc. All rights reserved.

Land Ocean Interactions in the Coastal Zone, LOICZ: lessons from Banda Aceh, Atlantis, and Canute

This special issue of Estuarine, Coastal and Shelf Science synthesizes and updates the developments in science related to Land Ocean Interactions in the Coastal Zone (LOICZ). Frequent updates about the dynamic coastal zone are useful and necessary as global change accelerates. There is an urgent need to improve the knowledge and understanding of the vulnerability of society and ecosystems to global change hazards in the coastal zone (Vermaat et al., 2005). The collection of papers in this special issue places new developments, findings, techniques and insights within the context of LOICZ science. For the convenience of the reader, the references to papers included in this special issue are printed in italic, whereas other references to LOICZ science are in normal print.

Mise en place d'un programme de prévention et de prise en charge du diabète en Suisse: le point de vue des patients et des professionnels de la santé [Implementation of a diabetes disease management program in Switzerland: patients' and healthcare professionals' point of view].

BACKGROUND: A reorganization of healthcare systems is required to meet the challenge of the increasing prevalence of chronic diseases, e.g. diabetes. In North-America and Europe, several countries have thus developed national or regional chronic disease management programs. In Switzerland, such initiatives have only emerged recently. In 2010, the canton of Vaud set up the "Diabetes Cantonal Program", within the framework of which we conducted a study designed to ascertain the opinions of both diabetic patients and healthcare professionals on the elements that could be integrated into this program, the barriers and facilitators to its development, and the incentives that could motivate these actors to participate. METHODS: We organized eight focus-groups: one with diabetic patients and one with healthcare professionals in the four sanitary areas of the canton of Vaud. The discussions were recorded, transcribed and submitted to a thematic content analysis. RESULTS: Patients and healthcare professionals were rather in favour of the implementation of a cantonal program, although patients were more cautious concerning its necessity. All participants envisioned a set of elements that could be integrated to this program. They also considered that the program could be developed more easily if it were adapted to patients' and professionals' needs and if it used existing structures and professionals. The difficulty to motivate both patients and professionals to participate was mentioned as a barrier to the development of this program however. Quality or financial incentives could therefore be created to overcome this potential problem. CONCLUSION: The identification of the elements to consider, barriers, facilitators and incentives to participate to a chronic disease management program, obtained by exploring the opinions of patients and healthcare professionals, should favour its further development and implementation.

Studies On Chitinoclastic Bacteria In Coastal Zone

The thesis is proposed to study the occurrence and distribution of chitinoclasts in water, sediment and fauna as related to site characteristics such as temperature, salinity, depth of water, pH, etc. Since no information is available on the chitinolytic properties of coastal strains, it is also proposed to study the chitinolytic activity of the bacterial isolates in relation to various environmental conditions. It is also planned to work out the taxonomy of some of the representative isolates and certain kinetic properties of their chitinases. It is expected that the results of the study would yield a comprehensive information-on the chitinoclastic bacteria in the southern coastal zone of west coast of India.

Ecosystem health of Montevideo coastal zone: A multi approach using some different benthic indicators to improve a ten-year-ago assessment

A study on the benthic ecosystem health was performed to assess the environmental quality of Montevideo coastal zone, in view of the construction of a new sanitation system. Data were compared to previous research undertaken 10 years ago, and biochemical composition of organic matter, heavy metals, organic matter, phytopigments, benthic diatoms, macrofauna community structure and a biotic index (AMBI) were used as proxies. Results indicate an environmental quality-gradient, with the worst conditions within the inner stations of Montevideo Bay and an improvement towards the adjacent coastal zone. Higher levels of chromium, lead, phaeopigments, organic biopolymers and poor benthic macrofauna and diatom communities, characterised the hypertrophic innermost portion of Montevideo Bay. Data indicated a clear deterioration of the adjacent coastal zone comparatively to that observed 10 years ago. The complementary use of approaches not applied before (benthic diatoms and organic biopolymers) with those formerly applied improve our assessment of the trophic status and the environmental health of the area. (C) 2010 Elsevier B.V. All rights reserved.

Nesting architecture and population structure of the fungus-growing ant Cyphomyrmex transversus (Formicidae: Myrmicinae: Attini) in the Brazilian coastal zone of Ilheus, Bahia

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Development of environmental and natural vulnerability maps for Brazilian coastal at Sao Sebastiao in São Paulo State

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Integrated biomarker responses as environmental status descriptors of a coastal zone (São Paulo, Brazil)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Amphibia, Anura, coastal zone, State of Piaui, northeastern Brazil.

Amphibians are an important component of terrestrial and aquatic freshwater communities worldwide. Especially to the Northern coastal zone of Brazil, the knowledge about amphibian communities is very scarce. We have studied amphibian assemblages along the coastal strip zone of the state of Piaui for two years, covering a distance of ca. 70 km. It was possible to prepare a list of 21 anurans from 6 families (Microhylidae, Hylidae, Leptodactylidae, Cycloramphidae, Leiuperidae, and Bufonidae). All species are common and widely distributed in Brazilian territory, mainly on the Caatinga biome. The results are important to amplify the knowledge on the biodiversity found at the coastal zone of the state of Piaui.

Informe de la Reunión del Grupo de Expertos en Planificación de los Usos del Mar y Administración de las Zonas Costeras en América Latina y el Caribe = Report of the Expert Group Meeting on Sea Use Planning and Coastal Area Management in Latin America and the Caribbean

Contiene la asistencia, organización de los trabajos y resumen de los debates de la reunión que tuvo por objetivo examinar las experiencias nacionales en la planificación y administración de las zonas costeras y oceánicas, la cooperación entre los países de la región, el papel de las Naciones Unidas y de las organizaciones regionales, y la identificación de las principales necesidades de los Estados de la región.

Ecomorphological patterns of the fishes inhabiting the tide pools of the Amazonian Coastal Zone, Brazil

Identificamos padrões ecomorfológicos que refletem a ecologia de espécies encontradas em poças de maré na Zona Costeira Amazônica (ZCA). Indivíduos de 19 espécies foram coletados no estado do Pará durante duas expedições em 2011. Foram estabelecidas dominância, grau de residência, guildas tróficas e tomadas medidas morfométricas de até 10 indivíduos de cada espécie. Calculou-se 23 atributos ecomorfológicos relacionados à locomoção, posição e forrageio, utilizados para o cálculo da distância ecomorfológica. Foram utilizadas Análises de Componentes Principais (PCA) para avaliar que atributos ecomorfológicos explicaram a variação entre as espécies. O teste de Mantel foi utilizado para testar a correlação da distância taxonômica com a morfologia das espécies e um teste de Mantel parcial para avaliar a correlação das guildas tróficas com os padrões ecomorfológicos, controlando-se o efeito da distância taxonômica entre as espécies. Nas análises formaram-se dois eixos principais para variação em relação aos padrões de locomoção, correlacionados à largura do pedúnculo caudal e formato da nadadeira anal, ocorrendo influência da distância taxonômica entre as espécies nos padrões ecomorfológicos. Espécies dominantes e residentes apresentaram menor capacidade de natação contínua. Quanto à posição na coluna d'água, formaram-se dois eixos principais da variação, correlacionados à posição do olho, área da nadadeira pélvica e formato do corpo, ocorrendo influência da distância taxônomica entre as espécies nas dissimilaridades morfológicas. A PCA agrupou espécies de hábito pelágico com espécies de hábito bentônico. Em relação ao forrageio, formaram-se dois eixos principais da variação, correlacionados ao tamanho da boca, tamanho do olho e comprimento do trato digestório. Espécies de diferentes guildas permaneceram agrupadas, sugerindo fraca relação da morfologia com o forrageio e não houve influência da distância taxonômica nas dissimilaridades nas guildas tróficas. Espécies residentes e dominantes em poças de maré na ZCA apresentam hábito sedentário, ocorrendo pouca influência da distância taxonômica nos padrões ecomorfológicos que se referem à posição na coluna d'água e locomoção, demonstrando que espécies distantes filogeneticamente podem apresentar padrões ecomorfológicos similares, e a morfologia demonstrou-se como fraca preditora das táticas de forrageio.

Environmental sensitivity index (ESI) mapping of oil spill in the amazon coastal zone: the PIATAM Mar project

A importância do monitoramento ambiental é medida pelos vários casos de derramamentos de óleo ocorridos no mundo durante as últimas três décadas. Isto tem incentivado as empresas e órgãos do governo envolvidos na prevenção e combate a estes acidentes a aperfeiçoarem cada vez mais os métodos, tanto preventivos como corretivos, para a minimização dos danos gerados por acidentes com derramamento de óleo. Este trabalho objetiva contextualizar de forma histórica como os acidentes com derramamento de óleo propiciaram o desenvolvimento de pesquisa tecnológica a partir de parcerias entre empresas de petróleo, agências de governo, universidades e institutos de pesquisa no Brasil, em especial na zona costeira Amazônica. Como resultado, índices de sensibilidade ambiental ao derramamento de óleo (ISA) foram definidos especialmente para a Amazônia costeira, onde processos fluviais e marinhos se encontram na foz do maior rio do mundo, o rio Amazonas. Perspectivas de pesquisa e respostas de emergência a acidentes são apresentadas, a fim de se conservar a diversidade socioambiental da mais importante região tropical do planeta.