A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care

Aquaculture Site-Selection and Marine Spatial Planning: The Roles of GIS-Based Tools and Models

Around the globe, increasing human activities in coastal and offshore waters have created complex conflicts between different sectors competing for space and between the use and conservation of ocean resources. Like other users, aquaculture proponents evaluate potential offshore sites based primarily on their biological suitability, technical feasibility, and cost considerations. Recently, Marine Spatial Planning (MSP) has been promoted as an approach for achieving more ecosystem-based marine management, with a focus on balancing multiple management objectives in a holistic way. Both industry-specific and multiple-use planners all rely heavily on spatially-referenced data, Geographic Information System (GIS)-based analytical tools, and Decision Support Systems (DSS) to explore a range of options and assess their costs and benefits. Although ecological factors can currently be assessed fairly comprehensively, better tools are needed to evaluate and incorporate the economic and social considerations that will also be critical to identifying potential sites and achieving successful marine plans. This section highlights the advances in GIS-based DSS in relation to their capability for aquaculture site selection and their integration into multiple-use MSP. A special case of multiple-use planning—the potential co-location of offshore wind energy and aquaculture—is also discussed, including an example in the German EEZ of the North Sea