Common Management Issues Research Articles

Examining international practices in the management of pregnant women with von Willebrand disease

BackgroundThe management of pregnant women with von Willebrand disease (VWD) is complex as physiological pregnancy‐induced increases in plasma von Willebrand factor (VWF) may be blunted or absent. Women with VWD experience a heightened risk of postpartum hemorrhage (PPH) and special consideration must be given regarding neuraxial anesthesia (NA) and the need for prophylaxis at time of delivery. These challenges are compounded by a lack of robust evidence to guide clinical decision‐making. Objectives and MethodsTo determine the current international clinical practices in the management of pregnancy for women with VWD, the International Society on Thrombosis and Haemostasis (ISTH) conducted an international survey of health‐care providers (HCP). ResultsOne hundred thirty‐two respondents from 39 countries were included in the final analysis. Variations in clinical practice were identified in antenatal (monitoring of plasma VWF and ferritin levels), peripartum (optimal plasma VWF target at delivery) and postpartum management (definitions used for PPH and postpartum monitoring). A key area of divergence was suitability for NA for women with type 2 and type 3 VWD, with many respondents advising against the use of NA even with VWF supplementation (29% type 2 VWD, 37% type 3 VWD) but others advising use once plasma VWF activity was >50 IU/dL (57% type 2 VWD; 50% type 3 VWD). ConclusionsThis survey highlighted areas of uncertainty surrounding common management issues for pregnant women with VWD. These data underscore the need for international collaborative research efforts focused on peripartum management to improve care for pregnant women with VWD.

Management Issues and Controversies in Low-Risk Patients with Essential Thrombocythemia and Polycythemia Vera.

Essential thrombocythemia (ET) and polycythemia vera (PV) are the most common myeloproliferative neoplasms (MPNs). Treatment of ET and PV is based on the risk for subsequent thrombosis. High-risk patients, defined as older than 60, JAK2 V617F-positive patients, or patients with a history of prior thrombosis, merit cytoreduction to control blood counts, whereas a watchful waiting paradigm is utilized in low-risk patients. However, low-risk patients have a host of other specific management issues that arise during their disease course. This review will discuss the most common management issues specific to the care of low-risk patients, including anti-platelet therapy dosing, pregnancy, and indications for early cytoreduction. Although low-dose aspirin is well established in PV, its indications and dosing regimens are less clear in ET. Recent evidence has supported twice daily low-dose aspirin in ET and observation alone in very low-risk ET patients. Pregnancy is not contraindicated in MPNs, and we recommend aspirin throughout pregnancy with consideration for prophylactic postpartum anticoagulation. High phlebotomy needs, symptom burden, and extreme thrombocytosis are common reasons for initiation of cytoreduction in low-risk patients, although we typically do not start cytoreduction for an isolated high platelet count alone. Recent data has also demonstrated a potential disease-modifying effect of interferons in MPNs, with some experts now advocating the early use of interferon in low-risk patients, although more mature data is needed before practice guidelines change. We evaluate the literature to inform clinical decision-making regarding these controversies, including most recent data that has challenged the "watchful waiting" paradigm. Our discussion provides guidance on common clinical scenarios seen in low-risk ET and PV patients, who face a myriad of complex management decisions in their care.

Study on quality and safety management standard of lifesaving access to emergency care

A review of management problems found in lifesaving access to emergency care in healthcare organizations at all levels in China, and a reference international critical and emergency care systems and their quality and safety management standards were made by the authors. Based on such and special needs of such access, the paper studied the domestic lifesaving access to emergency care service workflow, and abstracted common management issues on the lifesaving access to emergency care. The study identified key elements of lifesaving access to emergency care management through case analysis, and formulated standard terms for such key elements. Hence a set of standards is developed for quality management fitting healthcare organizations at all levels in China′s lifesaving access to emergency care, serving as the guidance for their standardized management and evaluation. Key words: Emergency medical services; Lifesaving access to emergency care; Patient safety; Management standard

Radiologic Percutaneous Gastrostomy and Other Enteral Feeding Tubes: A Practical Review

AbstractGastrostomy tubes and other iterations of direct enteral feeding, such as gastrojejunostomy and jejunostomy tubes, offer a safe and effective means for continued nutrition for patients who cannot meet their minimum caloric requirement through oral intake alone. There are numerous methods for placement as well as options for types of tubes to be used. This review will briefly discuss the various options of tubes and techniques, as well as practical information regarding placement and common management issues.

Effective supervision of inland capture fisheries of Bangladesh and its hurdles in managing the resources

Community-based approaches have gained significant attention in inland open water fisheries management in Bangladesh. This article focuses on the challenges and opportunities of the inland open water fishery resources under community-based management approaches. The present study employed management information of waterbodies between 1991 and 2014 across a range of geographical locations and habitats. The study reveals that coordinated management of water bodies is essential given common management issues of waterbodies. Present study also reveals that complexity of different property rights and the diversity of users within individual clusters have had cumulatively adverse effects on fisheries. The study shows that different fisheries management policies promoted by the government of Bangladesh over time to have varied in strength and appropriateness. This study concludes that open water fisheries management through fishers’ community involvement is promising approach in Bangladesh but a variety of socio-economic factors that affect the governance in its implementation.

Variety, Novelty, and Perceptions of Scholarship in Research on Management and Organizations: An Appeal for Ambidextrous Scholarship

It is an exciting time to be a scholar studying management and organizations. Not only is the world of organizations becoming a richer place in terms of forms of organizational activities, it is also becoming richer in terms of the diversity of locales in which these varied forms of organizations are situated. The scholarly base, likewise, is increasing in absolute numbers, but also in the diversity of backgrounds of the scholars. Any demographic dimension by which the scholarly base can be measured is moving to a lower concentration and more variety. An important component to this shift is the wider variety of places from which scholars are emerging. Even at the start of the 1990s, the perceived international academic world was essentially a bipolar one, with one pole (the United States) larger in many respects than the other pole (Europe, but with a concentration in the United Kingdom). Pockets of management scholars in France, German, Japan, and Italy, among other places, were engaged in management research, but to a large extent were operating as isolated communities of scholars. Since the 1990s, however, we have seen an increasing number of previously highly localized scholarly communities join and contribute regularly to international conversations. Management scholar communities in any number of countries across the world are now more tightly connected with international academic debate on common management issues. By 2013, we could no longer consider the international academic community to be concentrated at the two poles. The international academic world had become easily tripolar and with a clear trajectory towards moving to a world without poles. Academics

The use of iPocket coach in business education

Purpose – The purpose of this paper is to present a review of an iPad application called iPocket Coach that can be used with a mobile device in business education. Design/methodology/approach – This paper discusses the educational benefits of this application for classroom use and develops a pedagogical exercise by which students can build interpersonal skills. Findings – The iPocket Coach can not only be used to develop skills but learn about common management issues involving conflict resolutions, personal development, providing constructive feedback, interviewing, performance evaluations, promotions, rewards, and terminations. Originality/value – The exercise developed can be used in a consumer behavior or sales management course that teaches students how to handle difficult customers.

Common Management Issues in Pediatric Patients with Mild Bleeding Disorders

Type 1 von Willebrand disease and mild platelet function defects are among the most common disorders seen by pediatric hematologists. The management and prevention of bleeding in these patients can be challenging, as there are limited published data to guide clinical practice, and a complete lack of randomized clinical trials. Desmopressin (DDAVP) and antifibrinolytics are the mainstays of treatment in these patients, yet the optimal dosing and timing of these agents to prevent or resolve bleeding, while minimizing adverse side effects, is sometimes unclear. DDAVP-induced hyponatremia is a particularly under-recognized complication in children with bleeding disorders who undergo surgery. Clinicians need to be aware of local measures that are equally important in treating problems such as epistaxis and surgical bleeding. This review will discuss the published literature and provide practical suggestions regarding four common management issues in the care of children and adolescents with mild bleeding disorders: epistaxis, heavy menstrual bleeding, dental extractions, and tonsillectomy.

International Practice Survey on the Management of Brain Metastases: Third International Consensus Workshop on Palliative Radiotherapy and Symptom Control

AimTo evaluate international patterns of practice for the management of metastatic disease to the brain. Materials and methodsAn online international practice survey was conducted from April to June 2010. Most of the survey questions were based on common management issues for which optimal management using level 1 evidence was lacking. The survey consisted of three sections: respondent demographics, 13 general questions regarding surgery, whole brain radiotherapy (WBRT) and radiosurgery and 13 questions related to specific scenarios. ResultsIn total, 445 individuals responded to the survey over a 3 month period. Ninety per cent of respondents worked in a hospital-based setting. Ninety-three per cent of respondents were radiation oncologists. Thirty-seven per cent worked in an academic setting. Only three of 26 survey questions generated at least 70% agreement for a favoured response. Eighty-eight per cent of respondents chose comfort measures only for patients with multiple brain metastases who have been previously treated with WBRT and who now present 6 months later with two to four brain metastases (all less than 4 cm in size) with uncontrolled extracranial disease and bedridden state. Seventy-eight per cent of respondents would use WBRT alone for initial treatment in patients with two to four brain metastases (all less than 4 cm in size), with active, uncontrolled extracranial disease and a Karnofsky performance status of 70. Seventy-eight per cent of respondents chose surgical resection for an enlarging single brain metastasis that has been previously treated with radiosurgery. The enlarging single brain metastasis is in a surgically accessible site and is now symptomatic. The patient has controlled extracranial disease, good performance status and magnetic resonance spectroscopy was not diagnostic. ConclusionsThere is a lack of uniform agreement for many common management issues (not well answered by level 1 evidence) in patients with metastatic disease to the brain.

An Australian study of midwives’ breast-feeding knowledge

Objective: to investigate midwives’ breast-feeding knowledge, assess associations between knowledge and role, and report on the validity and reliability of the Breast-feeding Knowledge Questionnaire for the Australian context. Design: postal questionnaire. Setting: national Australia. Participants: midwives ( n=3500) who are members of the Australian College of Midwives Inc (ACMI). Findings: a response rate of 31% ( n=1105) was obtained. Respondents were knowledgeable of the benefits of breast feeding and common management issues. Key areas requiring attention included management of low milk supply, immunological value of human milk, and management of a breast abscess during breast feeding. Participants over the age of 30, possessing IBCLC qualifications; having personal breast-feeding experience of more than three months; and more clinical experience achieved higher knowledge scores. Role perceptions were positive with 90% of midwives reporting being confident and effective in meeting the needs of breast-feeding women in the early postnatal period. Midwives’ role perception contributed 39% of the variance in general breast-feeding knowledge scores and was a significant predictor of participants’ breast-feeding knowledge. Key conclusions and implications for practice: the level of basic breast-feeding knowledge of Australian midwives was adequate but there are deficits in key areas. Knowledge variations by midwives may contribute to conflicting advice experienced by breast-feeding women. Further research is needed to investigate in-depth breast-feeding knowledge, breast-feeding promotion practices, and associations between knowledge and practice.

Thrombophilia: What's a Practitioner to Do?

Abstract Management of thrombophilia is an ever-changing field as new disorders are described and additional clinical experience accrues. This paper addresses three common management issues in the care of patients with thrombophilia. The first two topics are updates for common but perplexing hypercoagulable states and the last topic introduces a new option for optimal management of oral anticoagulant therapy. Dr. Jacob Rand updates and organizes the approach to patients with antiphospholipid syndrome. This syndrome is a common acquired thrombophilic state, but the diagnosis and treatment of patients remains a challenge. Dr. Rand outlines his diagnostic and treatment strategies based on the current understanding of this complicated syndrome. Dr. Barbara Konkle addresses the special concerns of managing women with thrombophilia. Hematologists are often asked to advise on the risks of hormonal therapy or pregnancy in a woman with a personal or family history of thrombosis or with an abnormal laboratory finding. Dr. Konkle reviews the available data on the risks of hormonal therapy and pregnancy in women with and without known underlying thrombophilic risk factors. In Section III, Dr. Gail Macik will discuss a new approach to warfarin management. Several instruments are now available for home prothrombin time (PT) monitoring. Self-testing and self management of warfarin are slowly emerging as reliable alternatives to traditional provider-based care and Dr. Macik reviews the instruments available and the results of studies that support this new management option.

Thrombophilia: what's a practitioner to do?

Management of thrombophilia is an ever-changing field as new disorders are described and additional clinical experience accrues. This paper addresses three common management issues in the care of patients with thrombophilia. The first two topics are updates for common but perplexing hypercoagulable states and the last topic introduces a new option for optimal management of oral anticoagulant therapy. Dr. Jacob Rand updates and organizes the approach to patients with antiphospholipid syndrome. This syndrome is a common acquired thrombophilic state, but the diagnosis and treatment of patients remains a challenge. Dr. Rand outlines his diagnostic and treatment strategies based on the current understanding of this complicated syndrome. Dr. Barbara Konkle addresses the special concerns of managing women with thrombophilia. Hematologists are often asked to advise on the risks of hormonal therapy or pregnancy in a woman with a personal or family history of thrombosis or with an abnormal laboratory finding. Dr. Konkle reviews the available data on the risks of hormonal therapy and pregnancy in women with and without known underlying thrombophilic risk factors. In Section III, Dr. Gail Macik will discuss a new approach to warfarin management. Several instruments are now available for home prothrombin time (PT) monitoring. Self-testing and self management of warfarin are slowly emerging as reliable alternatives to traditional provider-based care and Dr. Macik reviews the instruments available and the results of studies that support this new management option.

Anecdotal notes. Effective clinical evaluation and record keeping.

Faculty use numerous techniques to evaluate student nurses' clinical performance. The development of keen observational skills is crucial to evaluating students' performance, but this is only the first step. Fair student evaluations require the faculty member to recall incidents and draw sound conclusions about clinical performance events. There are various tools to assist the nurse educator in evaluating students' clinical performance. The authors describe one such tool, the anecdotal record, used by nursing faculty for clinical record keeping and evaluation. Guidelines for anecdotal record keeping and solutions to common management issues related to anecdotal record keeping are provided.