Compliance measurement-guided medication management programs in hypertension : a systematic review

Objectif principal: Il n’est pas démontré que les interventions visant à maîtriser voire modérer la médicamentation de patients atteints d’hypertension peuvent améliorer leur gestion de la maladie. Cette revue systématique propose d’évaluer les programmes de gestion contrôlée de la médicamentation pour l’hypertension, en s’appuyant sur la mesure de l’observance des traitements par les patients (CMGM). Design: Revue systématique. Sources de données: MEDLINE, EMBASE, CENTRAL, résumés de conférences internationales sur l’hypertension et bibliographies des articles pertinents. Méthodes: Des essais contrôlés randomisés (ECR) et des études observationnelles (EO) ont été évalués par 2 réviseurs indépendants. L’évaluation de la qualité (de ce matériel) a été réalisée avec l’aide de l’outil de Cochrane de mesure du risque de biais, et a été estimée selon une échelle à quatre niveaux de qualité Une synthèse narrative des données a été effectuée en raison de l'hétérogénéité importante des études. Résultats: 13 études (8 ECR, 5 EO) de 2150 patients hypertendus ont été prises en compte. Parmi elles, 5 études de CMGM avec l’utilisation de dispositifs électroniques comme seule intervention ont relevé une diminution de la tension artérielle (TA), qui pourrait cependant être expliquée par les biais de mesure. L’amélioration à court terme de la TA sous CMGM dans les interventions complexes a été révélée dans 4 études à qualité faible ou modérée. Dans 4 autres études sur les soins intégrés de qualité supérieure, il n'a pas été possible de distinguer l'impact de la composante CMGM, celle-ci pouvant être compromise par des traitements médicamenteux. L’ensemble des études semble par ailleurs montrer qu’un feed-back régulier au médecin traitant peut être un élément essentiel d’efficacité des traitements CMGM, et peut être facilement assuré par une infirmière ou un pharmacien, grâce à des outils de communication appropriés. Conclusions: Aucune preuve convaincante de l'efficacité des traitements CMGM comme technologie de la santé n’a été établie en raison de designs non-optimaux des études identifiées et des ualités méthodologiques insatisfaisantes de celles-ci. Les recherches futures devraient : suivre les normes de qualité approuvées et les recommandations cliniques actuelles pour le traitement de l'hypertension, inclure des groupes spécifiques de patients avec des problèmes d’attachement aux traitements, et considérer les résultats cliniques et économiques de l'organisation de soins ainsi que les observations rapportées par les patients.

Advances in therapeutic risk management through signal detection and risk minimisation tool analyses

Les quatre principales activités de la gestion de risque thérapeutique comportent l’identification, l’évaluation, la minimisation, et la communication du risque. Ce mémoire aborde les problématiques liées à l’identification et à la minimisation du risque par la réalisation de deux études dont les objectifs sont de: 1) Développer et valider un outil de « data mining » pour la détection des signaux à partir des banques de données de soins de santé du Québec; 2) Effectuer une revue systématique afin de caractériser les interventions de minimisation de risque (IMR) ayant été implantées. L’outil de détection de signaux repose sur la méthode analytique du quotient séquentiel de probabilité (MaxSPRT) en utilisant des données de médicaments délivrés et de soins médicaux recueillis dans une cohorte rétrospective de 87 389 personnes âgées vivant à domicile et membres du régime d’assurance maladie du Québec entre les années 2000 et 2009. Quatre associations « médicament-événement indésirable (EI) » connues et deux contrôles « négatifs » ont été utilisés. La revue systématique a été faite à partir d’une revue de la littérature ainsi que des sites web de six principales agences réglementaires. La nature des RMIs ont été décrites et des lacunes de leur implémentation ont été soulevées. La méthode analytique a mené à la détection de signaux dans l'une des quatre combinaisons médicament-EI. Les principales contributions sont: a) Le premier outil de détection de signaux à partir des banques de données administratives canadiennes; b) Contributions méthodologiques par la prise en compte de l'effet de déplétion des sujets à risque et le contrôle pour l'état de santé du patient. La revue a identifié 119 IMRs dans la littérature et 1,112 IMRs dans les sites web des agences réglementaires. La revue a démontré qu’il existe une augmentation des IMRs depuis l’introduction des guides réglementaires en 2005 mais leur efficacité demeure peu démontrée.

Bridging Knowledge Gaps in the Management of Acute Coronary Syndromes

Contexte L’occlusion d’une artère du cœur cause un syndrome coronarien aigu (SCA) soit avec une élévation du segment ST (IAMEST) ou sans élévation du segment ST (1). Le traitement des patients avec un IAMEST requiert soit une intervention coronarienne d’urgence (ICP primaire) ou une thérapie fibrinolytique (FL). La thérapie FL peut être administrée soit dans un contexte pré-hospitalier (PHL) ou à l’hôpital. Une prise en charge précoce des patients avec SCA peut être améliorée par un simple indice de risque. Objectifs Les objectifs de cette thèse étaient de : 1) comparer l’ICP primaire et la thérapie FL (2); décrire plusieurs systèmes internationaux de PHL; (3) développer et valider un indice de risque simplifié pour une stratification précoce des patients avec SCA. Méthodes Nous complétons des méta-analyses, de type hiérarchique Bayésiennes portant sur l’effet de la randomisation, d’études randomisées et observationnelles; complétons également un sondage sur des systèmes internationaux de PHL; développons et validons un nouvel indice de risque pour ACS (le C-ACS). Résultats Dans les études observationnelles, l’ICP primaire, comparée à la thérapie FL, est associée à une plus grande réduction de la mortalité à court-terme; mais ce sans bénéfices concluants à long terme. La FL pré-hospitalière peut être administrée par des professionnels de la santé possédant diverses expertises. Le C-ACS a des bonnes propriétés discriminatoires et pourrait être utilisé dans la stratification des patients avec SCA. Conclusion Nous avons comblé plusieurs lacunes importantes au niveau de la connaissance actuelle. Cette thèse de doctorat contribuera à améliorer l’accès à des soins de qualité élevée pour les patients ayant un SCA.

Cost-effectiveness of Transcatheter Mitral Valve Leaflet Repair for the Treatment of Mitral Regurgitation in Heart Failure

Contexte: La régurgitation mitrale (RM) est une maladie valvulaire nécessitant une intervention dans les cas les plus grave. Une réparation percutanée de la valve mitrale avec le dispositif MitraClip est un traitement sécuritaire et efficace pour les patients à haut risque chirurgical. Nous voulons évaluer les résultats cliniques et l'impact économique de cette thérapie par rapport à la gestion médicale des patients en insuffisance cardiaque avec insuffisance mitrale symptomatique. Méthodes: L'étude a été composée de deux phases; une étude d'observation de patients souffrant d'insuffisance cardiaque et de régurgitation mitrale traitée avec une thérapie médicale ou le MitraClip, et un modèle économique. Les résultats de l'étude observationnelle ont été utilisés pour estimer les paramètres du modèle de décision, qui a estimé les coûts et les avantages d'une cohorte hypothétique de patients atteints d'insuffisance cardiaque et insuffisance mitrale sévère traitée avec soit un traitement médical standard ou MitraClip. Résultats: La cohorte de patients traités avec le système MitraClip était appariée par score de propension à une population de patients atteints d'insuffisance cardiaque, et leurs résultats ont été comparés. Avec un suivi moyen de 22 mois, la mortalité était de 21% dans la cohorte MitraClip et de 42% dans la cohorte de gestion médicale (p = 0,007). Le modèle de décision a démontré que MitraClip augmente l'espérance de vie de 1,87 à 3,60 années et des années de vie pondérées par la qualité (QALY) de 1,13 à 2,76 ans. Le coût marginal était 52.500 $ dollars canadiens, correspondant à un rapport coût-efficacité différentiel (RCED) de 32,300.00 $ par QALY gagné. Les résultats étaient sensibles à l'avantage de survie. Conclusion: Dans cette cohorte de patients atteints d'insuffisance cardiaque symptomatique et d insuffisance mitrale significative, la thérapie avec le MitraClip est associée à une survie supérieure et est rentable par rapport au traitement médical.

Personnel management practices in the co-operative sector in Kerala

A study on the personnel management practices in the co+operative sector in the Kerala State is carried out during the years 1989-91, with the overall objective of assessing the extent of application of modern personnel management concepts in the cooperative organizations in the Kerala State. The specific objectives of the study are to assess the effectiveness of the various personnel management practices followed in the cooperative sector, to analyse the nature and extent of compensating the employees in co—operatives, to measure the level of job satisfaction derived by the employees, to evaluate the industrial relations existing in the co-operative organizations and to suggest, if found necessary, ways and means of toning up the personnel management practices followed in the co-operative sector in Kerala

Personnel Management Practices in the Kerala based Scheduled commercial Banks

The thesis entitled Personnel Management Practices in the Kerala-Based Scheduled Commercial Banks. Personnel management function is of cardinal importance, requiring a sophisticated and scientific approach. In a labour-intensive, service industry like banking. Productivity and ultimate profitability of the entire organization depend considerably on the effectiveness with which personnel management function is executed; and the prudence with which personnel problems are handle. The main objectives of the study are to understand the current status of personnel management functions in the banks and to evaluate the practices in the light of the principles and theories of personnel management so as to identify the strengths and weaknesses. The universe of this study is the eight Scheduled Commercial Banks based in Kerala. The major limitation of the study is that as State Bank of Travancore, the lone public sector bank based in Kerala did not grant permission for collection of data, this study had to be confined to private sector banks only. Almost the entire data used for this study are primary and were collected from the files and other records or the concerned banks. This report has chapters dealing with the functional areas of personnel management such as determination of human resource requirements, recruitment and selection, training and development, performance appraisal, promotions and compensation. Findings reveal that the practice of personnel management in the Kerala-based private sector scheduled commercial banks has not gained a degree of sophistication compatible with its role in modern business management.

A critical study of major construction projects in kerala vis-a-vis effectiveness in project implementation

Chapter 1 presents a brief note on the state at which the construction industry stands at present, bringing into focus the significance of the critical study. Relevance of the study, area of investigation and objectives of the study are outlined in this chapter. The 2nd chapter presents a review of the literature on the relevant areas. In the third chapter an analysis on time and cost overrun in construction highlighting the major factors responsible for it has been done. A couple of case studies to estimate loss to the nation on account of delay in construction have been presented in the chapter. The need for an appropriate estimate and a competent contractor has been emphasised for improving effectiveness in the project implementation. Certain useful equations and thoughts have been formulated on this area in this chapter that can be followed in State PWD and other Govt. organisations. Case studies on project implementation of major projects undertaken by Government sponsored/supported organizations in Kerala have been dealt with in Chapter 4. A detailed description of the project of Kerala Legislature Complex with a critical analysis has been given in this chapter. A detailed account of the investigations carried out on the construction of International Stadium, a sports project of Greater Cochin Development Authority is included here. The project details of Cochin International Airport at Nedumbassery, its promoters and contractors are also discussed in Chapter 4. Various aspects of implementation which led the above projects successful have been discussed in chapter 5. The data collected were analysed through discussion and perceptions to arrive at certain conclusions. The emergence of front-loaded contract and its impact on economics of the project execution are dealt with in this chapter. Analysis of delays in respect of the various project narrated in chapter 3 has been done here. The root causes of the project time and overrun and its remedial measures are also enlisted in this chapter. Study of cost and time overrun of any construction project IS a part of construction management. Under the present environment of heavy investment on construction activities in India, the consequences of mismanagement many a time lead to excessive expenditure which are not be avoidable. Cost consciousness, therefore has to be keener than ever before. Optimization in investment can be achieved by improved dynamism in construction management. The successful completion of coristruction projects within the specified programme, optimizing three major attributes of the process - quality, schedule and costs - has become the most valuable and challenging task for the engineer - managers to perform. So, the various aspects of construction management such as cost control, schedule control, quality assurance, management techniques etc. have also been discussed in this fifth chapter. Chapter 6 summarises the conclusions drawn from the above criticalr1 of rhajor construction projects in Kerala.

Performance Effectiveness Of Bank Managers: A Study Of Psycho-Social Correlates

The present study by the researcher focuses attention on the problem of performance effectiveness among managers operating in one of the critical and socially important sectors of our economy namely commercial banking. The banking sector is selected for the study due to two reasons. Firstly, commercial banking plays an important role in the country's development. Secondly, for improving the efficiency of the banking system, we need to know more about the performance dynamics of the executives in our banking organizations

"Delayering in FACT - Impact on Managerial Motivation and Team Effectiveness

The main objective of the Research was to study the Delayering scheme implemented in FACT in all its aspects and to examine wlietlier implementation of delayering has contributed to improvement in organizational performance by improving managerial motivation and team effectiveness. To enable this, a post-delayering impact assessment was done by eliciting views and analyzing the perception of managers affected by the change programme. Organisation-wide Surveys were carried out as part of data collection - prior to, during and after implementation. The methodology adopted was the Case Study approach, which involved a longitudinal study of the Implementation process using tools such- as Observation, Opinion surveys and Interviews and relating the research findings with the theories/ studies on the subject for generalization and for drawing conclusions

Experimental study using coir geotextiles in watershed management

This paper presents the results of a field experiment conducted in Kerala, South India, to test the effectiveness of coir geotextiles for embankment protection. In the context of sustainable watershed management, coir is a cheap and locally available material 5 that can be used to strengthen traditional earthen bunds or protect the banks of village ponds from erosion. Particularly in developing countries, where coir is abundantly available and textiles can be produced by small-scale industry, this is an attractive alternative for conventional methods

Interactive comment on “Experimental study using coir geotextiles in watershed management

This paper presents the results of a field experiment conducted in Kerala, South India, to test the effectiveness of coir geotextiles for embankment protection. The results reveal that treatment with geotextile in combination with grass is an effective eco-hydrological measure to protect steep slopes from erosion. In the context of sustainable watershed management, coir is a cheap and locally available material that can be used to strengthen traditional earthen bunds or protect the banks of village ponds from erosion. Particularly in developing countries, where coir is abundantly available and textiles can be produced by small-scale industry, this is an attractive alternative for conventional methods. The paper analyses the performance of different treatments with regard to soil moisture content, protection against erosion and biomass production

Studies on fish waste management practices in Aroor Seafood Industrial Belt, Kerala and conversion of seafood waste into a liquid plant growth supplement

This study was materialized to analyze the management issues regarding the seafood processing waste generated including its impact on the coastal community in one of the important seafood hubs of India Aroor Seafood Industrial Belt Alappuzha District Kerala The area has witnessed serious pollution issues related to seafood waste and seldom has any action been implemented by either the polluters or the preventers Further this study is also intended to suggest a low cost eco friendly method for utilizing the bulk quantity of seafood solid waste generated in the area for the promotion of organic farming The high nutritional value of seafood enables the subsequent offal to be considered as an excellent source for plant nutrition The liquid silage accepted worldwide as the cheapest and practical solution for rendering fish waste in bulk for production of livestock feed is adopted in this study to develop foliar fertilizer formulations from various seafood waste The effect of seafood foliar sprays is demonstrated by field studies on two plant varieties such as Okra and Amaranthus

Operational Flexibility: A Model for Effective Project Management

The aim of this study is to investigate the role of operational flexibility for effective project management in the construction industry. The specific objectives are to: a) Identify the determinants of operational flexibility potential in construction project management b) Investigate the contribution of each of the determinants to operational flexibility potential in the construction industry c) Investigate on the moderating factors of operational flexibility potential in a construction project environment d) Investigate whether moderated operational flexibility potential mediates the path between predictors and effective construction project management e) Develop and test a conceptual model of achieving operational flexibility for effective project management The purpose of this study is to findout ways to utilize flexibility inorder to manage uncertain project environment and ultimately achieve effective project management. In what configuration these operational flexibility determinants are demanded by construction project environment in order to achieve project success. This research was conducted in three phases, namely: (i) exploratory phase (ii) questionnaire development phase; and (iii) data collection and analysis phase. The study needs firm level analysis and therefore real estate developers who are members of CREDAI, Kerala Chapter were considered. This study provides a framework on the functioning of operational flexibility, offering guidance to researchers and practitioners for discovering means to gain operational flexibility in construction firms. The findings provide an empirical understanding on kinds of resources and capabilities a construction firm must accumulate to respond flexibly to the changing project environment offering practitioners insights into practices that build firms operational flexibility potential. Firms are dealing with complex, continuous changing and uncertain environments due trends of globalization, technical changes and innovations and changes in the customers’ needs and expectations. To cope with the increasingly uncertain and quickly changing environment firms strive for flexibility. To achieve the level of flexibility that adds value to the customers, firms should look to flexibility from a day to day operational perspective. Each dimension of operational flexibility is derived from competences and capabilities. In this thesis only the influence on customer satisfaction and learning exploitation of flexibility dimensions which directly add value in the customers eyes are studied to answer the followingresearch questions: “What is the impact of operational flexibility on customer satisfaction?.” What are the predictors of operational flexibility in construction industry? .These questions can only be answered after answering the questions like “Why do firms need operational flexibility?” and “how can firms achieve operational flexibility?” in the context of the construction industry. The need for construction firms to be flexible, via the effective utilization of organizational resources and capabilities for improved responsiveness, is important because of the increasing rate of changes in the business environment within which they operate. Achieving operational flexibility is also important because it has a significant correlation with a project effectiveness and hence a firm’s turnover. It is essential for academics and practitioners to recognize that the attainment of operational flexibility involves different types namely: (i) Modification (ii) new product development and (iii) demand management requires different configurations of predictors (i.e., resources, capabilities and strategies). Construction firms should consider these relationships and implement appropriate management practices for developing and configuring the right kind of resources, capabilities and strategies towards achieving different operational flexibility types.

Soil organic carbon management for sustainable land use in Sudano-Sahelian West Africa

Judged by their negative nutrient balances, low soil cover and low productivity, the predominant agro-pastoral farming systems in the Sudano-Sahelian zone of West Africa are highly unsustainable for crop production intensification. With kaolinite as the main clay type, the cation exchange capacity of the soils in this region, often less than 1 cmol_c kg^-1 soil, depends heavily on the organic carbon (Corg) content. However, due to low carbon sequestration and to the microbe, termite and temperature-induced rapid turnover rates of organic material in the present land-use systems, Corg contents of the topsoil are very low, ranging between 1 and 8 g kg^-1 in most soils. For sustainable food production, the availability of phosphorus (P) and nitrogen (N) has to be increased considerably in combination with an improvement in soil physical properties. Therefore, the adoption of innovative management options that help to stop or even reverse the decline in Corg typically observed after cultivating bush or rangeland is of utmost importance. To maintain food production for a rapidly growing population, targeted applications of mineral fertilisers and the effective recycling of organic amendments as crop residues and manure are essential. Any increase in soil cover has large effects in reducing topsoil erosion by wind and water and favours the accumulation of wind-blown dust high in bases which in turn improves P availability. In the future decision support systems, based on GIS, modelling and simulation should be used to combine (i) available fertiliser response data from on-station and on-farm research, (ii) results on soil productivity restoration with the application of mineral and organic amendments and (iii) our present understanding of the cause-effect relationships governing the prevailing soil degradation processes. This will help to predict the effectiveness of regionally differentiated soil fertility management approaches to maintain or even increase soil Corg levels.