Experience In Management Of Cases Research Articles

Family members of older persons with multi-morbidity and their experiences of case managers in Sweden: an interpretive phenomenological approach.

Family members of older persons (75+) with multi-morbidity are likely to benefit from utilising case management services performed by case managers. However, research has not yet explored their experiences of case managers. The aim of the study was to deepen the understanding of the importance of case managers to family members of older persons (75+) with multi-morbidity. The study design was based on an interpretive phenomenological approach. Data were collected through individual interviews with 16 family members in Sweden. The interviews were analysed by means of an interpretive phenomenological approach. The findings revealed one overarching theme: "Helps to fulfil my unmet needs", based on three sub-themes: (1) "Helps me feel secure - Experiencing a trusting relationship", (2) "Confirms and strengthens me - Challenging my sense of being alone" and (3) "Being my personal guide - Increasing my competence". The findings indicate that case managers were able to fulfil unmet needs of family members. The latter recognised the importance of case managers providing them with professional services tailored to their individual needs. The findings can contribute to the improvement of case management models not only for older persons but also for their family members.

Delivering team training to medical home staff to impact perceptions of collaboration.

The purpose of this study was to explore whether an evidence-based educational and experiential intervention to develop team skills in medical homes would positively affect team members' perceptions of interprofessional collaboration. The study population consisted of primary care medical home practices associated with the health plan sponsor of this research. All practices were located within the greater Houston region of Texas and had more than 500 patients. A cluster design experimental study was conducted between August 2013 and June 2014. Fifty medical home practices, 25 intervention and 25 attention control, were recruited as study sites. Results indicate that individual team members in the medical homes receiving the intervention were significantly more likely than the individual team members in the attention control groups to report higher levels of positive perception of team collaboration after the 12-week intervention. This research indicates that educating teams about interprofessional collaboration tools and supporting technique use may be an effective strategy to assist medical homes in developing collaborative environments. Case management experience in collaboration supports the role facilitating team training. Transforming culture from hierarchical to team-based care supports the case management approach of collaborative practice. In addition, role satisfaction attained through the respect and communication of team-based care delivery may influence retention within the case management profession. As case managers in primary care settings assume roles of embedded care coordinators, program leaders, and transition facilitators, an understanding of collaboration techniques is needed to support the entire care team to achieve desired outcomes.

From Silos to Synergy: Results of the Interdisciplinary Curriculum in Oncology Palliative Education (iCOPE) on Student Learning Outcomes (FR457-A)

•Understand the rationale and design of a research study to test an innovative interdisciplinary palliative care curriculum, with applicability to attendees’ own institutions.•Name components of a plan to evaluate the outcomes of the innovative interdisciplinary palliative care curriculum.•Summarize the impact of iCOPE on learner outcomes. Interprofessional education (IPE) is essential to prepare a practice-ready workforce equipped to provide team-based, holistic patient and family centered palliative care. This abstract describes an interdisciplinary model for a mandatory, centrally driven, and sustainable curriculum in palliative care and presents results from a study including students of social work, medicine, nursing, and chaplaincy. In 2010 the University of Louisville received funding from the NCI (NIH-1-R25-CA-148005) to develop and test the impact of an interdisciplinary palliative oncology curriculum on learners. A pre/post mixed-methods research design was used to evaluate the impact of the curriculum on 391 students from chaplaincy, nursing, medicine, and social work over five semesters beginning in fall 2012. Participants completed four online case-based learning modules, a clinical rotation, a critical reflection assignment, and an interdisciplinary case management experience. Pre/post measures included the End-of-Life Professional Caregiver Survey (EPCS), evaluating palliative care–specific educational needs related to all eight domains of the consensus guidelines; and the Self-Efficacy for Interprofessional Experiential Learning Scale (SEIEL), measuring student self-efficacy perceptions related to learning collaboratively in interprofessional teams. Pre/post interdisciplinary palliative care knowledge questions were developed and administered. Students completed postcurriculum evaluation of the learning modalities and participated in focus groups to provide feedback on overall content, process, outcomes, and logistical considerations. Increases occurred in attitude and skill (EPCS, t(390)=-16.0, p<.001; d=0.81; SEIEL, t(385)=-30.6,p<.001; d=1.55); and a summation of correct knowledge-based questions (t(218)=13.3, p<.001; d=.89). Student ratings of high effectiveness and quality ranged from 89%-91%. Qualitative feedback revealed the following themes: high satisfaction with case-based interdisciplinary learning, clinical experiences; interdisciplinary team learning was new for most students. The iCOPE curriculum significantly improves interdisciplinary palliative care practice, knowledge, and skills, and is a highly valued experience for learners.

Understanding the challenges to implementing case management for people with dementia in primary care in England: a qualitative study using Normalization Process Theory.

BackgroundCase management has been suggested as a way of improving the quality and cost-effectiveness of support for people with dementia. In this study we adapted and implemented a successful United States’ model of case management in primary care in England. The results are reported elsewhere, but a key finding was that little case management took place. This paper reports the findings of the process evaluation which used Normalization Process Theory to understand the barriers to implementation.MethodsEthnographic methods were used to explore the views and experiences of case management. Interviews with 49 stakeholders (patients, carers, case managers, health and social care professionals) were supplemented with observation of case managers during meetings and initial assessments with patients. Transcripts and field notes were analysed initially using the constant comparative approach and emerging themes were then mapped onto the framework of Normalization Process Theory.ResultsThe primary focus during implementation was on the case managers as isolated individuals, with little attention being paid to the social or organizational context within which they worked. Barriers relating to each of the four main constructs of Normalization Process Theory were identified, with a lack of clarity over the scope and boundaries of the intervention (coherence); variable investment in the intervention (cognitive participation); a lack of resources, skills and training to deliver case management (collective action); and limited reflection and feedback on the case manager role (reflexive monitoring).ConclusionsDespite the intuitive appeal of case management to all stakeholders, there were multiple barriers to implementation in primary care in England including: difficulties in embedding case managers within existing well-established community networks; the challenges of protecting time for case management; and case managers’ inability to identify, and act on, emerging patient and carer needs (an essential, but previously unrecognised, training need). In the light of these barriers it is unclear whether primary care is the most appropriate setting for case management in England. The process evaluation highlights key aspects of implementation and training to be addressed in future studies of case management for dementia.

Vaccinations: eliminating preventable illness.

Jayne Skehan, RN, BSN, MSN, is Director of Pediatric Cardiology at Morgan Stanley Children's Hospital at New York Presbyterian Hospital in New York City. In addition to this role, she is a per diem Administrator at Mount Sinai Medical Center in Harlem. Ms. Skehan received her Bachelor of Science in Nursing Degree from the College of New Rochelle, New York, and her Master of Science in Nursing degree from Mercy College, Dobbs Ferry, New York. Jayme has experience in emergency cardiology and operating room management. She is currently a DNP doctoral candidate at Saint Peter's University in Englewood Cliffs, New Jersey. When Jayme is not doing school work, she is a community advocate, donating her time to youth programs, and is Vice President of Daytop Village Alumni Program. Her goal is to teach nursing upon completion of her doctoral degree. Jayme can be contacted at: [email protected]. Lynn S. Muller, RN, BA-HCM, CCM, JD, is a nurse attorney and managing partner of Muller & Muller. She is a CCM with extensive nursing and case management experience. Her practice includes family law, wills, trusts and estates, defense of health care professionals before the state licensing boards, as well as transactional and consulting work for practitioners and health care companies on such issues as regulatory investigation and compliance. Lynn is an adjunct professor in the Doctor of Nursing Program at Saint Peters University, where she teaches Legal and Ethical Parameters of Advance Practice Nursing and Health Policy and Politics. She is the author of numerous articles in professional journals and is the author of the legal chapters of the 3rd edition of Case Management: A Practical Guide for Education and Practice and the 2nd edition of the CMSA Core Curriculum for Case Management. She is a former Commissioner of CCMC, past president of the NJ Chapter of CMSA, and a former public defender, judge, and councilwoman. Address correspondence to Lynn S. Muller, RN, BA-HCM, CCM, JD, Muller & Muller, 15 West Main Street, Suite C, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can be given only by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like answered here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics they would like to see addressed in this department. Questions and other inquiries are accepted by e-mail at: [email protected].

Generalists or Specialists? Judge Experience and Productivity

I examine the role of judge experience on the duration of dispute resolution. By doing so, I distinguish between a general case management experience component and a subject specific experience component. I use a hand-collected data set on patent litigation cases and find that general case management is an important factor for court speed whereas I find no patent specific experience effect. This result strengthens the argument of the proponents of the generalist judge and creates doubts whether specialized (patent) courts help to increase the efficiency of the legal procedure.

A case management briefing on domestic violence.

Lynn S. Muller, RN, BA-HCM, CCM, JD, is a nurse attorney and managing partner of Muller & Muller. She is a CCM with extensive nursing and case management experience. Her practice includes family law, wills, trusts and estates, defense of health care professionals before the state licensing boards, as well as transactional and consulting work for practitioners and health care companies on such issues as regulatory investigation and compliance. Lynn is an adjunct professor in the Doctor of Nursing Program at Saint Peters University, where she teaches Legal and Ethical Parameters of Advance Practice Nursing and Health Policy and Politics. She is the author of numerous articles in professional journals and is the author of the legal chapters of the third edition of Case Management: A Practical Guide for Education and Practice and the second edition of CMSA Core Curriculum for Case Management. She is a former commissioner of CCMC, past president of the NJ Chapter of CMSA, and a former public defender, judge, and councilwoman. Address correspondence to Lynn S. Muller, RN, BA-HCM, CCM, JD, Esq., Muller & Muller, 15 West Main Street, Suite C, PO Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can only be given by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like answered here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics they would like to see addressed in this department. Questions and other inquiries are accepted by e-mail at:[email protected].

Case managers’ experiences of their everyday practice

Introduction.– Today, there is an interest in how Case Management (CM) should be designed to best suit the complex needs of the older people with multi-morbidity. Current research on CM has mainly focused on health care costs and consumption, but the results have been inconsistent and ranging from positive outcomes to no effect. To improve CM, there is need to investigate what mechanisms are important for a successful intervention. To advance this knowledge, there is a necessity for studies investigating the experiences of those practicing CM i.e. Case Managers. There might be unknown factors or interpersonal factors that can contribute to a CM intervention's success or failure. Therefore, the aim of this study was to explore the Case Managers’ experiences of their everyday practice. Methods.– The study design was qualitative and descriptive utilizing an ethnographic approach, consisting of participant observations, a focus group interview and individual interviews with nine Case Managers conducted during 2012/2013. The interviews were recorded and transcribed verbatim and then subjected to content analysis. Results.– Three main themes described Case Managers’ experience of their everyday practice: navigating the older person, working to improve the health care system and being the older persons advocate. Conclusions.– Findings from this study sheds light on the complexity of CM for older people with multi-morbidity, from the experiences of Case Managers. These findings could help in the development of CM models designed for older people with complex health needs.

Integrity and Accountability The Omnibus Final Rule

Lynn S. Muller, RN, BA-HCM, CCM, JD, is a Nurse Attorney and managing partner of Muller & Muller. She is an Adjunct Professor in the Doctor of Nursing Practice (DNP) program at Saint Peter's University of New Jersey. Lynn is a Certified Case Manager with extensive nursing and case management experience. Her practice includes defense of health care professionals before the state licensing boards, consultant on such issues as regulatory compliance and accreditation, civil litigation, Wills, Trusts, and Estates and Family law. Lynn is the author of numerous articles and the legal chapters of the 3rd edition of Case Management: A Practical Guide for Education and Practice and the 2nd edition of the CMSA Core Curriculum for Case Management. She is as a former Commissioner for CCMC and a past president of the NJ Chapter of CMSA. Address correspondence to Lynn S. Muller, RN, BA-HCM, CCM, JD, Esq., Muller & Muller, 15 West Main Street, Suite C, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can only be given by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like addressed here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics they would like to see addressed in this department. Questions and other inquiries are accepted by e-mail at: [email protected]. The author reports no conflicts of interest.

Advocacy and Organ and Tissue Donation

Lynn S. Muller, RN, BA-HCM, CCM, JD, is a Nurse Attorney and managing partner of Muller & Muller. She is an Adjunct Professor in the Doctor of Nursing Practice program at Saint Peter's College of New Jersey. Lynn is a Certified Case Manager with extensive nursing and case management experience. Her practice includes defense of health care professionals before the state licensing boards, consultant on such issues as regulatory compliance and accreditation, wills, trusts, and estates and family law. Lynn is the author of numerous articles and the legal chapters of the 3rd edition of Case Management: A Practical Guide for Education and Practice and the 2nd edition of the CMSA Core Curriculum for Case Management. She is a former Commissioner for CCMC and a past president of the NJ Chapter of CMSA. Address correspondence to Lynn S. Muller, RN, BA-HCM, CCM, JD, Esg., Muller & Muller, 15 West Main Street, Suite C, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can only be given by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like addressed here? We encourage readers to submit questions and/or manuscripts and practice concerns, as well as topics they would like to see addressed in this department. Questions and manuscript inquiries are accepted by e-mail at [email protected]. The author reports no conflicts of interest.

Working Smarter, Not Harder: How Excellent Judges Manage Cases

In 2012, the American College of Trial Lawyers (“ACTL”) Task Force on Discovery and Civil Justice, the ACTL Judiciary Committee, ACTL Jury Committee, ACTL Special Problems in the Administration of Justice Committee, and IAALS, the Institute for the Advancement of the American Legal System at the University of Denver, undertook a study on practices and methods for pretrial management of civil cases that might reduce cost and delays for litigants while saving judicial time and resources. This report is based on personal interviews with approximately 30 state and federal trial court judges, from diverse jurisdictions across the country, who were identified as being outstanding case managers and whose civil case management experience can serve as a model for others. Five general themes emerged from the interviews, with numerous specific practices and techniques discussed further in the report. Assess a case and its challenges at the outset. Use active and continuing judicial involvement when warranted to keep the parties and the case on track. There was strong consensus among the judges interviewed that becoming involved at the earliest stage of a case is critical. Some judges review cases as soon as they are assigned. Others hold off until the time of the initial case management or Rule 16 conference. Virtually all interviewed judges, however, agreed that a small expenditure of time at the very beginning of a case saves significantly more time as the case progresses. Convene an initial case management conference early in the life of the case. Discuss with the parties anticipated problems and issues, as well as deadlines for major case events. Initial conferences provide a valuable opportunity for judges to get a feel for the relative complexity of the case and the relationships among the parties and their counsel. By spending time in advance familiarizing themselves with the pleadings, judges can establish priorities for discovery. By obtaining input from counsel about the realistic timing for trial and for various pretrial events — such as amendment of pleadings, joinder of additional parties, discovery cutoffs, and expert disclosures — judges can establish a firm trial date and work backwards to set necessary pretrial deadlines that will assist in moving the case forward expeditiously. By limiting continuances to serious and unanticipated circumstances, judges can work toward meaningful and timely resolution in processing the case. Reduce and streamline motions practice to the extent appropriate and possible. Rule quickly on motions. The judges emphasized that motions practice drives cost and delay in the civil pretrial process. Many judges aim to resolve motions, especially discovery disputes, informally. This obviates the need for written submissions and focuses on oral presentations. The judges interviewed also overwhelmingly believe that prompt rulings on motions, including those announced from the bench, can dramatically expedite progress in cases, reduce litigants’ expenses, save judicial time and resources, and enhance ultimate resolution. Create a culture of collegiality and professionalism by being explicit and up front with lawyers about the court’s expectations, and then holding the participants to them. Interviewed judges universally recognized the importance of collegiality and professionalism among counsel. Most judges interviewed make their expectations of civility explicit during the initial discussions with counsel in the pretrial process. Explore settlement with the parties at an early stage and periodically throughout the pretrial process, where such conversations might benefit the parties and move the case toward resolution. Keeping the subject of settlement on the table expedites resolution, and periodically opening the topic for discussion may give lawyers the cover needed, with clients and opposing counsel, to avoid the appearance of negotiating from a position of weakness. The collective experience of these judges suggests several techniques that — used individually or together — can expedite resolution of cases with lower cost to litigants and courts. The ACTL and IAALS offer this report to share successful practices, and hope the report will spark further use of these and other practices to better serve litigants, lawyers, and the court. This report is primarily designed to provide civil trial court judges with proven techniques used by outstanding judges for more efficient pretrial case management. Nonetheless, trial lawyers may also choose to encourage adoption of these recommendations for use in cases they are handling, in order to decrease the delays and costs of today’s litigation.

Legal &amp; Regulatory Issues

Lynn S. Muller is a Nurse Attorney and managing partner of Muller & Muller. She is an Adjunct Professor in the Doctor of Nursing Practice (DNP) program at Saint Peter's University of New Jersey. Lynn is a certified case manager with extensive nursing and case management experience. Her practice includes defense of health care professionals before the state licensing boards, consultant on such issues as regulatory compliance and accreditation, wills, trusts and estates, and family law. Lynn is the author of numerous articles and the legal chapters of the third edition of Case Management: A Practical Guide for Education and Practice and the second edition of the CMSA Core Curriculum for Case Management. She is a former Commissioner for CCMC, a past president of the NJ Chapter of CMSA, and a former public defender, municipal court judge, and councilwoman. Joanne Reich, RN, MA, NE-A,BC, is Vice President and Chief Nursing Officer at Chilton Hospital located in Pompton Plains, NJ. Her practice has been primarily in maternal child health with administrative responsibility for behavioral health and chemical dependency services, spanning more than 32 years of professional nursing. Joanne has extensive nursing administration experience at community hospitals and medical centers. She holds national certification from the American Nurses Credentialing Center in nursing administration, advanced. For the past 5 years, Joanne serves as a board member for the nonprofit organization, Partnership for Maternal Child Health of Northern New Jersey, formerly known as The Northern New Jersey Maternal Child Health Consortium. Joanne received her bachelor's degree in the science of nursing from Seton Hall University and her master's degree in nursing education from New York University. Joanne is currently a doctoral candidate in the Doctor of Nursing Practice program at Saint Peter's College located in Jersey City, NJ. Address correspondence to Lynn S. Muller, RN, BA-HCM, CCM, JD, Esg., Muller & Muller, 15 West Main Street, Suite C, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can be given only by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Attention readers: Do you have a question or issue you would like addressed here? We encourage readers to submit questions and/or manuscripts and practice concerns, as well as topics they would like to see addressed in this department. Questions and manuscript inquiries are accepted by e-mail at [email protected]. The author reports no conflicts of interest.

Case Managers' perceptions on Strength Case Management experiences for poor families with the infants and early children

Case Managers' perceptions on Strength Case Management experiences for poor families with the infants and early children

A Case Management Experience: Implementing Best Practice Guidelines in the Community

This article discusses the implementation of a best practice guideline (BPG) in a community setting using a case management model The role of the case manager is presented as well as the process of evaluation. Challenges to implementing a BPG in a community setting are also addressed.

The Case Manager as Expert Witness

Lynn S. Muller, RN, BA-HCM, CCM, JD, is a Nurse Attorney and managing partner of Muller & Muller. She is a CCM with extensive nursing and case management experience. Her practice includes defense of health care professionals before the state licensing boards, as well as a consultant on such issues as regulatory compliance. Lynn is the author of numerous articles and the legal chapters of the 3rd edition of Case Management: A Practical Guide for Education and Practice and the 2nd edition of the CMSA Core Curriculum for Case Management. She is a former Commissioner of CCMC, past president of the NJ Chapter of CMSA and a former public defender, judge, and councilwoman. She was an Adjunct Professor for the Doctor of Nursing Practice Program at St. Peter's College. Address correspondence to Lynn S. Muller, RN, BA-HCM, CCM, JD, Muller & Muller, 15 West Main Street, PO Box 164, Bergenfield, NJ 07621 ([email protected]). This article first appeared in Jan/Feb 2007, Vol. 12 (1) of Professional Case Management and has been updated for this issue. Disclaimer: The content published is not meant to be construed as legal advice. The content is not legal advice. Readers must seek appropriate legal counsel either privately or within their agencies and organizations, and not use the educational information provided here as a means to legal advice. The author reports no conflicts of interest.

2011 Presidential Initiative

Carol K. Smith, RN-BC, MSN, has 15 years case management experience in a variety of settings. She is a Director on the CMSA National Board and serves on the National Public Policy Committee (PPC) and co-chairs the CMSA PPC Multi-State Licensure Task Force. Address correspondence to Carol K. Smith, RN-BC, MSN ([email protected]).

Participation in Child Welfare Services Through Information and Communication Technologies

Case management systems were designed to open the way for increased participation of young people and their families in child welfare interventions, and, their standardised format provides a valuable opportunity to use ICT in social work practice. Existing research is unclear about how effectively case management affects participation, nor, the impact of ICT on social work interventions. This paper describes the findings of qualitative research with service users about their experiences of case management and how ICT could further their involvement in critical decisions for families. Service users are keen to use ICT and this could help overcome the limitations of paper-based case management systems and exploit the communication potential of the internet and mobile phones. However, before ICT could be used, the complex ‘digital divide’ affecting disadvantaged families would need to be addressed and social workers’ understanding and current use of ICT would need to be explored.

To Chat or Not to Chat? That is the Question

Lynn S. Muller, RN, BA-HCM, CCM, JD, is a Nurse Attorney and managing partner of Muller & Muller. She is a CCM with extensive nursing and case management experience. Her practice includes defense of health care professionals before the state licensing boards, as well as consulting and transactional work for providers and other health professionals on such issues as regulatory compliance. Lynn is the author of numerous articles and the legal chapters of the 3rd edition of Case Management: A Practical Guide for Education and Practice and the 2nd edition of the CMSA Core Curriculum for Case Management. She is a frequent and popular speaker at regional and national conferences. Lynn is a past president of the NJ Chapter of CMSA and a former public defender, judge, and councilwoman. Address correspondence to Lynn S. Muller, RN, BA-HCM, CCM, JD, Muller & Muller, 15 West Main Street, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). The information contained in this department is for educational purposes only. It is not legal advice, which can only be given by an attorney admitted to practice in the jurisdiction/state(s) in which you practice.

An Epidemiologic Perspective on a Case Management Program

to improve a case management (CM) program using the principles and tools of epidemiology. Specifically, to use epidemiology to describe the population being managed, to analyze factors influencing outcomes, to assess the degree to which the CM process (or intervention) is related to those outcomes, to utilize the findings in order to make recommendations (to take action) for both better evaluation and improved and more efficient CM process, to provide an estimate of the impact of the CM program based on the comparison of pre-CM and post-CM interventions, and finally to discuss the caveat that pre-CM period probably does not provide a prediction of patterns to be expected in the post-CM period had CM not been present (an ideal, but difficult-to-find referent population for this kind of effectiveness analysis). a Medicare Advantage health plan. there were a total of 12,185 individuals who met the continuous enrollment requirement of 6 months (28 days) prior to initial contact with the CM department and 6 months after the contact date: 53% were female; the average age was 73.9 (standard deviation = ± 9.5). There was a linear relationship between the average "dose" of CM-as measured by the number of times a case manager had contact with a case-and the risk profile of the case-as measured by a standard risk assessment tool provided by the Centers for Medicare & Medicaid Services. The month-to-month costs for the study population prior to CM showed a sharp rise in the month prior to the initial contact with CM and a sharp decline beginning before the contact. This pattern was consistent across different risk profiles and our operational definition of CM "dose."The average costs 6 months prior to CM were higher than the average costs 6 months after the CM. The difference in cost varied by "dose" category. When coupled with the number of cases per dosage category, the greatest value for the CM program was in the management of moderate risk cases called two to four times.However, some of the overall decline that begins prior to the initial CM contact is likely attributed to "regression to the mean" (i.e., costs may have shown a decline in spite of CM) but not all. Subsequent studies will be designed to assess the degree to which this is the case by including an equivalent referent; ideally, one that has not experienced CM or, in the absence of that, one that experienced a different kind of CM so that a valid "comparative effectiveness" study can be conducted. the "dose" of CM to its cases was in synch with an independent assessment of risk of the cases. This implies that case managers were directing their resources to those in need. However, case managers and CM processes are a limited resource and it is of interest for management to allocate those CM resources in the most efficient way possible. Methods of assessment based on individual experiences of case managers can be improved with structured, population-based assessment. These population-based tools, according to the principles of epidemiology, will be used to better allocate CM resources for optimized impact on patient populations in the future.

Emerging Infections: A Tribute to the One Medicine, One Health Concept

Events in the last decade have taught us that we are now, more than ever, vulnerable to fatal zoonotic diseases such as those caused by haemorrhagic fever viruses, influenza, rabies and BSE/vCJD. Future research activities should focus on solutions to these problems arising at the interface between animals and humans. A 4-fold classification of emerging zoonoses was proposed: Type 1: from wild animals to humans (Hanta); Type 1 plus: from wild animals to humans with further human-to-human transmission (AIDS); Type 2: from wild animals to domestic animals to humans (Avian flu) and Type 2 plus: from wild animals to domestic animals to humans, with further human-to-human transmission (Severe Acute Respiratory Syndrome, SARS). The resulting holistic approach to emerging infections links microbiology, veterinary medicine, human medicine, ecology, public health and epidemiology. As emerging 'new' respiratory viruses are identified in many wild and domestic animals, issues of interspecies transmission have become of increasing concern. The development of safe and effective human and veterinary vaccines is a priority. For example, the spread of different influenza viruses has stimulated influenza vaccine development, just as the spread of Ebola and Marburg viruses has led to new approaches to filovirus vaccines. Interdisciplinary collaboration has become essential because of the convergence of human disease, animal disease and a common approach to biosecurity. High containment pathogens pose a significant threat to public health systems, as well as a major research challenge, because of limited experience in case management, lack of appropriate resources in affected areas and a limited number of animal research facilities in developed countries. Animal models that mimic certain diseases are key elements for understanding the underlying mechanisms of disease pathogenesis, as well as for the development and efficacy testing of therapeutics and vaccines. An updated veterinary curriculum is essential to empower future graduates to work in an international environment, applying international standards for disease surveillance, veterinary public health, food safety and animal welfare.