WorldWideScience

Sample records for aging management guideline

  1. Aging management guideline for commercial nuclear power plants - heat exchangers

    International Nuclear Information System (INIS)

    This Aging Management Guideline (AMG) describes recommended methods for effective detection and mitigation of age-related degradation mechanisms in commercial nuclear power plant heat exchangers important to license renewal. The intent of this AMG is to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR 54. This AMG is presented in a manner that allows personnel responsible for performance analysis and maintenance to compare their plant-specific aging mechanisms (expected or already experienced) and aging management program activities to the more generic results and recommendations presented herein

  2. Aging management guideline for commercial nuclear power plants - heat exchangers

    Energy Technology Data Exchange (ETDEWEB)

    Booker, S.; Lehnert, D.; Daavettila, N.; Palop, E.

    1994-06-01

    This Aging Management Guideline (AMG) describes recommended methods for effective detection and mitigation of age-related degradation mechanisms in commercial nuclear power plant heat exchangers important to license renewal. The intent of this AMG is to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR 54. This AMG is presented in a manner that allows personnel responsible for performance analysis and maintenance to compare their plant-specific aging mechanisms (expected or already experienced) and aging management program activities to the more generic results and recommendations presented herein.

  3. Aging management guideline for commercial nuclear power plants-pumps

    International Nuclear Information System (INIS)

    This Aging Management Guideline (AMG) describes recommended methods for effective detection and mitigation of age-related degradation mechanisms in BWR and PWR commercial nuclear power plant pumps important to license renewal. The intent of this AMG is to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR Part 54. This AMG is presented in a manner that allows personnel responsible for performance analysis and maintenance to compare their plant-specific aging mechanisms (expected or already experienced) and aging management program activities to the more generic results and recommendations presented herein

  4. Aging Management Guideline for commercial nuclear power plants: Electrical switchgear

    International Nuclear Information System (INIS)

    This Aging Management Guideline (AMG) provides recommended methods for effective detection and mitigation of age-related degradation mechanisms in BWR and PWR commercial nuclear power plant electrical switchgear important to license renewal. The latent of this AMG to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR Part 54. This AMG is presented in a manner which allows personnel responsible for performance analysis and maintenance, to compare their plant-specific aging mechanisms (expected or already experienced) and aging management program activities to the more generic results and recommendations presented herein

  5. Aging management guideline for commercial nuclear power plants-pumps

    Energy Technology Data Exchange (ETDEWEB)

    Booker, S.; Katz, D.; Daavettila, N.; Lehnert, D. [MDC-Ogden Environmental and Energy Services, Southfield, MI (United States)

    1994-03-01

    This Aging Management Guideline (AMG) describes recommended methods for effective detection and mitigation of age-related degradation mechanisms in BWR and PWR commercial nuclear power plant pumps important to license renewal. The intent of this AMG is to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR Part 54. This AMG is presented in a manner that allows personnel responsible for performance analysis and maintenance to compare their plant-specific aging mechanisms (expected or already experienced) and aging management program activities to the more generic results and recommendations presented herein.

  6. Aging management guidelines for commercial nuclear power plant equipment

    International Nuclear Information System (INIS)

    The US Department of Energy, in cooperation with the Electric Power Research Institute and nuclear power plant utilities, has prepared ''Aging Management Guidelines'' (AMGs) for commodity types of equipment (e.g., pumps, electrical switchgear) important to license renewal. For the most part, this is also consistent with the Maintenance Rule, 10 CFR 50.65 (1991). AMGs concentrate on technical, (not licensing) issues and are directed toward systems engineers and plant maintenance staff. AMGs include a detailed summary of operating history, stressors, aging mechanisms, and various types of maintenance practices that can be combined to create effective programs that manage aging. All aging mechanisms were addressed; no attempt was made to limit the evaluation to aging mechanisms ''unique to license renewal,'' as defined in the License Renewal Rule, 10 CFR 54 (1991). The first AMG on Electrical Switchgear was published in July 1993. Six (6) additional AMGs will be published by the first quarter of calendar year 1994. It is anticipated that two more AMGs will be started in 1994. The seven ongoing AMG topics are as follows: (1) battery chargers, inverters and uninterruptible power supplies; (2) batteries, stationary; (3) heat exchangers; (4) motor control centers; (5) pumps; (6) switchgear, electric; (7) transformers, power and distribution. In Section 7, industry feedback regarding AMGs is discussed. Overall, the response has been very positive

  7. Plans to adapt Point Lepreau ageing management to new industry guidelines

    International Nuclear Information System (INIS)

    In preparation for PLGS life extension, NBPN spent considerable effort to evaluate the impact of ageing and to develop ageing management processes to maintain the required safety functions for extended operation. These were based on INPO AP-913. Recently, the CNSC has been developing Canadian ageing management guidelines in line with the IAEA approach. In response, NBPN plans to document how current PLGS processes meet the new CNSC guidelines and to identify any areas for improvement. Best practices from utilities that have retrofitted IAEA guidelines and PLGS experience in applying risk-based methods for ageing management will be used to implement improvements. (author)

  8. AMAT guidelines. Reference document for the IAEA Ageing Management Assessment Teams (AMATs)

    International Nuclear Information System (INIS)

    Effective ageing management is an important element for ensuring the safety of nuclear power plant. The IAEA Ageing Management Assessment Team (AMAT) programme provides advice and assistance to utilities or individual NPPs to strengthen and enhance the effectiveness of ageing management programs (AMPs). Such AMPs are required by an increasing number of safety utilities and implemented by an increasing number of utilities, often as a part of NPP life or life cycle management programs that involve the integration of ageing management and economic planning. The guidelines in this report are primarily intended for IAEA-led AMAT team members as a basic structure and common reference for peer reviews of AMPs

  9. IAEA guidance on ageing management for nuclear power plants. Guidance on effective management of the physical ageing of systems, structures and components important to safety for nuclear power plants. Overview. Programmatic guidelines. Component specific guidelines. Review guidelines. Version 1, 2002

    International Nuclear Information System (INIS)

    Operational experience shows that excellent plant safety and excellent performance go hand in hand, and that they are achieved by effective leadership and management that includes a unified approach to safety and production. This is also applicable to ageing management. Effective ageing management leads to both enhanced plant safety and enhanced performance and is a prerequisite for long service life. The IAEA project on Safety Aspects of NPP Ageing has produced since 1990 a comprehensive set of programmatic and component specific guidelines on managing ageing, while providing an interactive environment for information exchange and co-operation among practitioners, and has assisted Member States in the application of the guidelines through the provision of training and advice. The objective of the CD-ROM is to preserve the IAEA's guidance on ageing management and to facilitate its retrieval, updating, extension and dissemination in order to help increase the effectiveness of ageing management at nuclear power plants

  10. Aging management guideline for commercial nuclear power plants-stationary batteries. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Berg, R.; Shao, J.; Krencicki, G.; Giachetti, R. [Multiple Dynamics Corp., Southfield, MI (United States)

    1994-03-01

    The Aging Management Guideline (AMG) describes recommended methods for effective detection and mitigation of age-related degradation mechanisms in BWR and PWR commercial nuclear power plant stationary batteries important to license renewal. The intent of this AMG is to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR Part 54. This AMG is presented in a manner that allows personnel responsible for performance analysis and maintenance to compare their plant-specific aging mechanisms (expected or already experienced) and aging management program activities to the more generic results and recommendations presented herein.

  11. Aging Management Guideline for commercial nuclear power plants: Motor control centers; Final report

    Energy Technology Data Exchange (ETDEWEB)

    Toman, G.; Gazdzinski, R.; O`Hearn, E. [Ogden Environmental and Energy Services Co., Inc., Blue Bell, PA (United States)

    1994-02-01

    This Aging Management Guideline (AMG) provides recommended methods for effective detection and mitigation of age-related degradation mechanisms in Boiling Water Reactor (BWR) and Pressurized Water Reactor (PWR) commercial nuclear power plant motor control centers important to license renewal. The intent of this AMG is to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR Part 54. This AMG is presented in a manner that allows personnel responsible for performance analysis and maintenance to compare their plant-specific aging mechanisms (expected or already experienced) and aging management program activities to the more generic results and recommendations presented herein.

  12. Aging Management Guideline for commercial nuclear power plants: Electrical switchgear. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Toman, G.; Gazdzinski, R.; Schuler, K. [Ogden Environmental and Energy Services Co., Inc., Blue Bell, PA (United States)

    1993-07-01

    This Aging Management Guideline (AMG) provides recommended methods for effective detection and mitigation of age-related degradation mechanisms in BWR and PWR commercial nuclear power plant electrical switchgear important to license renewal. The latent of this AMG to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR Part 54. This AMG is presented in a manner which allows personnel responsible for performance analysis and maintenance, to compare their plant-specific aging mechanisms (expected or already experienced) and aging management program activities to the more generic results and recommendations presented herein.

  13. Aging Management Guideline for commercial nuclear power plants: Power and distribution transformers

    Energy Technology Data Exchange (ETDEWEB)

    Toman, G.; Gazdzinski, R. [Sandia National Labs., Albuquerque, NM (United States)

    1994-05-01

    This Aging Management Guideline (AMG) provides recommended methods for effective detection and mitigation of age-related degradation mechanisms in power and distribution transformers important to license renewal in commercial nuclear power plants. The intent of this AMG to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR Part 54. This AMG is presented in a manner which allows personnel responsible for performance analysis and maintenance to compare their plant-specific aging mechanisms (expected or already experienced) and aging management program activities to the more generic results and recommendations presented herein.

  14. Aging Management Guideline for commercial nuclear power plants: Power and distribution transformers

    International Nuclear Information System (INIS)

    This Aging Management Guideline (AMG) provides recommended methods for effective detection and mitigation of age-related degradation mechanisms in power and distribution transformers important to license renewal in commercial nuclear power plants. The intent of this AMG to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR Part 54. This AMG is presented in a manner which allows personnel responsible for performance analysis and maintenance to compare their plant-specific aging mechanisms (expected or already experienced) and aging management program activities to the more generic results and recommendations presented herein

  15. Aging Management Guideline for commercial nuclear power plants: Battery chargers, inverters and uninterruptible power supplies

    International Nuclear Information System (INIS)

    This Aging Management Guideline (AMG) describes recommended methods for effective detection and mitigation of age-related degradation mechanisms in BWR and PWR commercial nuclear power plant battery chargers, inverters and uninterruptible power supplies important to license renewal. The intent of this AMG is to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR Part 54. This AMG is presented in a manner that allows personnel responsible for performance analysis and maintenance to compare their plant-specific aging mechanisms (expected or already, experienced) and aging management program activities to the more generic results and recommendations presented herein

  16. Aging management guideline for commercial nuclear power plants-stationary batteries

    International Nuclear Information System (INIS)

    The Aging Management Guideline (AMG) describes recommended methods for effective detection and mitigation of age-related degradation mechanisms in BWR and PWR commercial nuclear power plant stationary batteries important to license renewal. The intent of this AMG is to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR Part 54. This AMG is presented in a manner that allows personnel responsible for performance analysis and maintenance to compare their plant-specific aging mechanisms (expected or already experienced) and aging management program activities to the more generic results and recommendations presented herein

  17. Aging Management Guideline for commercial nuclear power plants: Motor control centers

    International Nuclear Information System (INIS)

    This Aging Management Guideline (AMG) provides recommended methods for effective detection and mitigation of age-related degradation mechanisms in Boiling Water Reactor (BWR) and Pressurized Water Reactor (PWR) commercial nuclear power plant motor control centers important to license renewal. The intent of this AMG is to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR Part 54. This AMG is presented in a manner that allows personnel responsible for performance analysis and maintenance to compare their plant-specific aging mechanisms (expected or already experienced) and aging management program activities to the more generic results and recommendations presented herein

  18. SALTO guidelines. Guidelines for peer review of long term operation and ageing management of nuclear power plants

    International Nuclear Information System (INIS)

    other and apply good practices in dealing with LTO of NPPs. The peer review service is also an important mechanism through which the IAEA supports Member States in enhancing the safety of NPPs. The IAEA has conducted various types of safety review services that indirectly address some aspects of LTO, including safety review services for design, engineering, operation and external hazards. OSART (Operational Safety Review Team) services include some review of ageing management programmes. In addition, several Member States have requested AMAT (Ageing Management Assessment Team) missions. Through these activities and considering the increasing average age of NPPs connected to the grid worldwide, it was recognized that a comprehensive engineering safety review service on LTO would be very useful to Member States. The Safe Long Term Operation (SALTO) peer review is a new comprehensive engineering safety review service directly addressing strategy and the key elements for safe LTO of NPPs, which includes AMAT objectives and complements OSART reviews. The SALTO peer review service is designed to assist NPP operators in adopting a proper approach to long term operation of their plants and in implementing complete and appropriate activities to ensure that plant safety will be maintained during the LTO period. The SALTO peer review service can be tailored to focus on AMPs and/or on other programmes related to LTO to support the Member State in enhancing the safety of its NPPs. The SALTO peer review service can also support regulators in establishing or improving regulatory and licensing strategies for LTO of NPPs. These guidelines are primarily intended for members of the SALTO review team and they provide a basic structure and common reference for peer reviews of LTO. However, the guidelines could provide useful information to operating organizations of NPPs (or technical support organizations) for carrying out their own self-assessments or comprehensive programme reviews. The

  19. DOE-sponsored aging management guideline for electrical cable and terminators

    Energy Technology Data Exchange (ETDEWEB)

    Gazdzinski, R.F. [Ogden Enviromental and Energy Services, Inc., Blue Bell, PA (United States)

    1996-03-01

    The DOE-sponsored Aging Management Guideline (AMG) for Electrical Cable and Terminations provides an analysis of the potential age-related degradation mechanisms and effects for low-voltage and medium-voltage extruded cables and associated terminations used in commercial nuclear power plants. The AMG examined historical industry failure data and correlated this with postulated aging mechanisms and effects. Existing and developmental testing and condition monitoring techniques were evaluated, as well as current industry practices, in order to assess whether all significant aging mechanisms/effects are being effectively managed. Results of the study indicate that some aging mechanisms and effects are not directly addressed by current industry maintenance and surveillance practices; however, empirical evidence indicates that low- and medium-voltage cable and terminations are in general very reliable. A limited number of nondestructive (or essentially nondestructive) techniques currently available are potentially useful for evaluating low-voltage cable condition; however, such techniques do not currently exist for monitoring medium-voltage cable. Troubleshooting or diagnostic techniques are available to identify certain types of degradation.

  20. Guideline for ageing management in nuclear power plants; Leitlinie zum Alterungsmanagement in Kernkraftwerken

    Energy Technology Data Exchange (ETDEWEB)

    Herter, K.H.; Schuler, X. [Materialpruefungsanstalt (MPA), Univ. Stuttgart, Stuttgart (Germany); Hienstorfer, W.; Pompe, W. [TUeV SUeD Energietechnik GmbH, Filderstadt (Germany)

    2007-07-01

    During operation of nuclear power plants, the quality of systems, structures and components may change as a result of ageing (conceptional ageing, technological ageing or physical ageing), which will affect the system quality. Ageing management is necessary to ensure safety and availability throughout the life of the systems. This necessitates a systematic, integrative and knowledge-based approach. Systems, structures and components are grouped according to their relevance for meeting the set goals. Ageing mangement should be process-oriented and should be integrated in the organisational procedure in cooperation with the safety manager. The procedure should follow the PDCA principle (plan - do - check - act). The data, documents, knowledge and evaluations required for ageing management are part of the knowledge base of the nuclear power station and are updated regularly. The efficiency of ageing management must be reassessed at regular intervals. (orig.)

  1. Aging Management Guideline for commercial nuclear power plants: Battery chargers, inverters and uninterruptible power supplies. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Berg, R.; Stroinski, M.; Giachetti, R. [Multiple Dynamics Corp., Southfield, MI (United States)

    1994-02-01

    This Aging Management Guideline (AMG) describes recommended methods for effective detection and mitigation of age-related degradation mechanisms in BWR and PWR commercial nuclear power plant battery chargers, inverters and uninterruptible power supplies important to license renewal. The intent of this AMG is to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR Part 54. This AMG is presented in a manner that allows personnel responsible for performance analysis and maintenance to compare their plant-specific aging mechanisms (expected or already, experienced) and aging management program activities to the more generic results and recommendations presented herein.

  2. Aging management guideline for commercial nuclear power plants - tanks and pools

    Energy Technology Data Exchange (ETDEWEB)

    Blocker, E.; Smith, S.; Philpot, L.; Conley, J.

    1996-02-01

    Continued operation of nuclear power plants for periods that extend beyond their original 40-year license period is a desirable option for many U.S. utilities. U.S. Nuclear Regulatory Commission (NRC) approval of operating license renewals is necessary before continued operation becomes a reality. Effective aging management for plant components is important to reliability and safety, regardless of current plant age or extended life expectations. However, the NRC requires that aging evaluations be performed and the effectiveness of aging management programs be demonstrated for components considered within the scope of license renewal before granting approval for operation beyond 40 years. Both the NRC and the utility want assurance that plant components will be highly reliable during both the current license term and throughout the extended operating period. In addition, effective aging management must be demonstrated to support Maintenance Rule (10 CFR 50.65) activities.

  3. Aging management guideline for commercial nuclear power plants - tanks and pools

    International Nuclear Information System (INIS)

    Continued operation of nuclear power plants for periods that extend beyond their original 40-year license period is a desirable option for many U.S. utilities. U.S. Nuclear Regulatory Commission (NRC) approval of operating license renewals is necessary before continued operation becomes a reality. Effective aging management for plant components is important to reliability and safety, regardless of current plant age or extended life expectations. However, the NRC requires that aging evaluations be performed and the effectiveness of aging management programs be demonstrated for components considered within the scope of license renewal before granting approval for operation beyond 40 years. Both the NRC and the utility want assurance that plant components will be highly reliable during both the current license term and throughout the extended operating period. In addition, effective aging management must be demonstrated to support Maintenance Rule (10 CFR 50.65) activities

  4. The (safety-related) heat exchangers aging management guideline for commercial nuclear power plants, and developments since 1994

    Energy Technology Data Exchange (ETDEWEB)

    Clauss, J.M.

    1998-08-01

    The US Department of Energy (DOE), in cooperation with the Electric Power Research Institute (EPRI) and US nuclear power plant utilities, is preparing a series of aging management guidelines (AMGs) for commodity types of components (e.g., heat exchangers, electrical cable and terminations, pumps). Commodities are included in this series based on their importance to continued nuclear plant operation and license renewal. The AMGs contain a detailed summary of operating history, stressors, aging mechanisms, and various types of maintenance and surveillance practices that can be combined to create an effective aging management program. Each AMG is intended for use by the systems engineers and plant maintenance staff (i.e., an AMG is intended to be a hands-on technical document rather than a licensing document). The heat exchangers AMG, published in June 1994, includes the following information of interest to nondestructive examination (NDE) personnel: aging mechanisms determined to be non-significant for all applications; aging mechanisms determined to be significant for some applications; effective conventional programs for managing aging; and effective unconventional programs for managing aging. Since the AMG on heat exchangers was published four years ago, a brief review has been conducted to identify emerging regulatory issues, if any. The results of this review and lessons learned from the collective set of AMGs are presented.

  5. Risk management guidelines

    International Nuclear Information System (INIS)

    Northeast Utilities (NU) has developed and implemented a comprehensive probabilistic safety assessment (PSA) program in support of nuclear power plant engineering and operations. Included in this program is a formal policy statement on nuclear safety goals; formalized procedures for review of all plant design changes; a formal procedure for prioritizing new projects; and at least level 1 probabilistic safety studies on all four NU-operated nuclear units. A procedure on risk communication to senior management has also been implemented. This procedure was recently amended to provide quantitative guidelines for determining the acceptability of issues affecting risk. The guidelines described are believed to be unique to the utility industry. The guidelines provide consistency and delineation of authority in making risk management decisions. They are also intended to complement, rather than substitute for, other means of determining the acceptability of plant changes and conditions. Implementation of these guidelines illustrates the strong support that NU senior management has for PRA methods

  6. Ageing management

    International Nuclear Information System (INIS)

    Ageing management is generally defined in a broad sense covering not only ageing management of hardware (structures, systems and components), but also management issues such as keeping up with developments in state-of-the-art technology and the latest management practices. The importance assigned to traditional ageing management, in terms of issues related to hardware degradation problems, is clearly very high. The other aspects, for example developments in engineering or management, are considered important as well, but are less emphasized. Plant ageing management is composed of the following necessary elements, which are all linked together: understanding and knowledge of ageing-related damage mechanisms, including benchmarking of the consequences of damage mechanisms into macroscopic behaviour of materials and structures under applicable conditions; predictive models to extrapolate behaviour of systems, structures or components up to a defined time; qualified methods for detection and surveillance of ageing degradation; qualified mitigation, repair and replacements measures; reliable plant documentation, including optimisation of the ageing management programme based on current understanding and knowledge and periodic self-assessment; availability of a technical service and knowledge base. The subject of plant ageing management has gained increasing attention over the past years, notably as more nuclear power plants across the world are being considered for lifetime extension. In this context, the NEA has conducted numerous technical studies to assess the impact of ageing mechanisms on safe and reliable plant operation. International research activities have also been initiated or are under way to provide the technical basis for decision making. This article provides an overview of some of the activities and accomplishments of the NEA Committee on the Safety of Nuclear Installations (CSNI) Working Group on the Integrity and Ageing of Components and Structures

  7. Tropical fevers: Management guidelines

    Directory of Open Access Journals (Sweden)

    Sunit Singhi

    2014-01-01

    Full Text Available Tropical fevers were defined as infections that are prevalent in, or are unique to tropical and subtropical regions. Some of these occur throughout the year and some especially in rainy and post-rainy season. Concerned about high prevalence and morbidity and mortality caused by these infections, and overlapping clinical presentations, difficulties in arriving at specific diagnoses and need for early empiric treatment, Indian Society of Critical Care Medicine (ISCCM constituted an expert committee to develop a consensus statement and guidelines for management of these diseases in the emergency and critical care. The committee decided to focus on most common infections on the basis of available epidemiologic data from India and overall experience of the group. These included dengue hemorrhagic fever, rickettsial infections/scrub typhus, malaria (usually falciparum, typhoid, and leptospira bacterial sepsis and common viral infections like influenza. The committee recommends a ′syndromic approach′ to diagnosis and treatment of critical tropical infections and has identified five major clinical syndromes: undifferentiated fever, fever with rash / thrombocytopenia, fever with acute respiratory distress syndrome (ARDS, fever with encephalopathy and fever with multi organ dysfunction syndrome. Evidence based algorithms are presented to guide critical care specialists to choose reliable rapid diagnostic modalities and early empiric therapy based on clinical syndromes.

  8. Age management

    OpenAIRE

    Kratochvilová, Markéta

    2014-01-01

    The Bachelor‘s thesis focuses on Age Management and its areas of influence. This term is most often discussed in connection with a problem which is currently common for all European Union countries – the ageing of society. In the near future, the structure of society is very likely to be altered drastically as a consequence of this phenomenon and due to the severity of the effects, it is necessary to begin addressing this problem. The first part of the thesis concerns itself with processing d...

  9. Total quality management implementation guidelines

    Energy Technology Data Exchange (ETDEWEB)

    1993-12-01

    These Guidelines were designed by the Energy Quality Council to help managers and supervisors in the Department of Energy Complex bring Total Quality Management to their organizations. Because the Department is composed of a rich mixture of diverse organizations, each with its own distinctive culture and quality history, these Guidelines are intended to be adapted by users to meet the particular needs of their organizations. For example, for organizations that are well along on their quality journeys and may already have achieved quality results, these Guidelines will provide a consistent methodology and terminology reference to foster their alignment with the overall Energy quality initiative. For organizations that are just beginning their quality journeys, these Guidelines will serve as a startup manual on quality principles applied in the Energy context.

  10. Severe accident management guidelines tool

    International Nuclear Information System (INIS)

    Severe Accident is addressed by means of a great number of documents such as guidelines, calculation aids and diagnostic trees. The response methodology often requires the use of several documents at the same time while Technical Support Centre members need to assess the appropriate set of equipment within the adequate mitigation strategies. In order to facilitate the response, TECNATOM has developed SAMG TOOL, initially named GGAS TOOL, which is an easy to use computer program that clearly improves and accelerates the severe accident management. The software is designed with powerful features that allow the users to focus on the decision-making process. Consequently, SAMG TOOL significantly improves the severe accident training, ensuring a better response under a real situation. The software is already installed in several Spanish Nuclear Power Plants and trainees claim that the methodology can be followed easier with it, especially because guidelines, calculation aids, equipment information and strategies availability can be accessed immediately (authors)

  11. Bald eagle management guidelines, Oregon-Washington

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This report covers bald eagle management guidelines in Oregon and Washington. The purpose of these guidelines is to maintain the environmental conditions that are...

  12. Guidelines for Human-Leopard Conflict Management

    OpenAIRE

    Ministry of Environment and Forests GOI

    2011-01-01

    After careful consideration of the inputs received from a variety of stakeholders, the following framework guidelines are suggested for managing the humanleopard conflict situations in areas where leopards coexist among high densities of humans. URL:[http://moef.nic.in/downloads/public-information/guidelines-human-leopard-conflict-management.pdf].

  13. 76 FR 57723 - Electricity Sector Cybersecurity Risk Management Process Guideline

    Science.gov (United States)

    2011-09-16

    ... Electricity Sector Cybersecurity Risk Management Process Guideline AGENCY: Department of Energy. ACTION... to publish the Electricity Sector Cybersecurity Risk Management Process Guideline. The guideline describes a risk management process that is targeted to the specific needs of electricity...

  14. Ageing Management of CARR

    International Nuclear Information System (INIS)

    The paper introduced the ageing management of CARR, including the ageing management system, instances of ageing components, difficulties we met and follow up plan, and put forward some suggestions on strengthening and promoting ageing management. We hope to enhance international exchange and collaboration. It is a great challenge to do research on how to manage ageing effectively in the beginning of life, but it will enhance the safety of reactor operation, extend the life of the reactor and improve the quality of operation, making this work very meaningful

  15. Guidelines in human resources management

    OpenAIRE

    Neves, Carmo; Galvão, Ana Maria; Pereira, Fernando

    2012-01-01

    The purpose of this communication is to address the management of human resources in the organizations. The aim is to discuss a range of issues that are likely to be applied in the management of human resources, such as management skills, organizational development, and administrational management (also known as payroll issues). Reference is also made to some support tools for decision making as well as the coaching process in the management of human resources. The methodology ...

  16. Workshop presentation: research guidelines for Construction Management

    OpenAIRE

    Marco Alvise Bragadin

    2013-01-01

    Nowadays the European economic system challenges the construction sector to take part to industrial recovery of western countries. In co-operation with the Construction Production research group of the Tampere University of of research about construction management tools and methods were detected. Research guidelines: 1) Construction management: tools and methods to manage construction projects 2) environmental impact of construction projects 3) construction management and safety 4) project p...

  17. Guidelines for education in energy management

    Directory of Open Access Journals (Sweden)

    Morales, C. M.

    2014-01-01

    Full Text Available Although educating for energy management is nowadays recognized as an important topic, the process of training is far from the ideal. One of the main shortcomings identified in the research is related to procedures selection, aside from the consensus of academic authorities of its inter-disciplinary character. This article aims to highlight the guidelines for education in energy management, as well as to advance the workshops for its implementation. The results of the research are only a part of a Ph D studied completed by the writer. The effectiveness of the proposal was appraised experimentally and subjected to specialists’ valuation. Key words: education in energy management, guidelines, environmental education.

  18. Clinical Practice Guidelines for Coma Management

    OpenAIRE

    Julio Alonso Cortizo Hernández; Maribel Misas Menéndez; Zenia Lisset Hernández Millán; Diosdania Alfonso Falcón; Tania Pérez Ramos

    2009-01-01

    Clinical Practice Guidelines for Coma Management. It has been defined as acute alteration of wakefulness state, in which patients have a primitive response (or no response at all) to nociceptive stimulus without waking up and could reach the total absence of all reflex. This document includes a review and update of the main clinical aspects, concepts, aetiology and therapy for this condition. It includes assessment guidelines focused on the most important aspects to be accomplished.

  19. Clinical Practice Guidelines for Potential Donors Management

    Directory of Open Access Journals (Sweden)

    José Roque Nodal Arruebarrena

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Potential Donors Management. It has been defined as the patient in Glasgow coma with scale higher or equal to 8 who doesn´t present contradictions for transplant (possible donor and who has been diagnosed of encephalic death. This document reviews and updates concepts, lists indications and contraindications for different organs donation, clinical assessment of the donor and its treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  20. Clinical Practice Guidelines for Potential Donors Management

    OpenAIRE

    José Roque Nodal Arruebarrena; José Noel Marrero Rodríguez; Yenisey Quintero Menéndez; Aida M. Reyes Pérez; Julio Jova Dueñas

    2009-01-01

    Clinical Practice Guidelines for Potential Donors Management. It has been defined as the patient in Glasgow coma with scale higher or equal to 8 who doesn´t present contradictions for transplant (possible donor) and who has been diagnosed of encephalic death. This document reviews and updates concepts, lists indications and contraindications for different organs donation, clinical assessment of the donor and its treatment. It includes assessment guidelines focused on the most important aspect...

  1. Guidelines for the responsible management of plutonium

    International Nuclear Information System (INIS)

    Since 1994 an informal group of representatives of States party to the NPT has been trying to develop agreed international guidelines for the responsible management of non-military plutonium. This paper gives a brief description of the outcome. Since the results are still subject to decision by Governments, the description must be in general terms only. The paper describes the background to, and genesis of, the discussions and the general approach taken, which was based on commitment to the NPT, national responsibility for the management of nuclear materials and the fuel cycle, upholding of the IAEA's safeguards system, and a focus on civil material. An indication is given of the development of the Group's thinking, especially the decisions that any guidelines must be capable of accommodating surplus military plutonium, as well as civil, and that the main focus should be on measures to increase transparency. The resulting guidelines are described. Their main features are a re-statement of commitments and standards for the management of non-military plutonium with regard to non-proliferation, safety, and other fields, a commitment to the management of such plutonium according to a consistent national strategy, and a commitment to the publication of information on that strategy, and of annual statistics for holdings of plutonium in a consistent format. Other aspects of the guidelines are also explained. Finally, an attempt is made to assess the possible practical effects of the guidelines if adopted by governments. (author)

  2. NPP Krsko Aging Management Program

    International Nuclear Information System (INIS)

    As a part of Periodic Safety Review Program (PSR) NEK will review and perform some activities related to Equipment Qualification (EQ) and Aging Management Program (AMP). (EQ) and AMP are safety factors, which need to be assessed during PSR. The goal of PSR and AMP is to determine aging effects and give the conclusion whether the plant has been managed to control aging related degradations and that safety margins are maintained. The parallel goal is also to establish AMP for future plant operation and provide basis for possible Life Extension Program. NEK will develop NEK Aging and Life Cycle Management Program, similar by format and content to one determined by License Renewal program. The bases are in 10CFR54, and NEI 95-10 Industry Guidelines for 10 CFR 54 implementation. The process of establishment the AMP is to be done in two steps. The first step is dealing with SSC's (Systems Structures and Components) scoping and screening and identification of TLAA's (Time Limited Aging Analyses). That means, that a database of all SSC's and TLAA's will be created and then evaluated within AMP program. Based on the scope in first phase an evaluation will be performed in step two. NEK will maintain AMP program as a living program that may be also used for Life Extension and Life Cycle Management. This paper will present and describe AMP, scoping and screening process and the results achieved through the first phase of the project.(author)

  3. Review manual for aging management technical evaluation

    International Nuclear Information System (INIS)

    'Review Manual for Aging Management Technical Evaluation' defines the procedure for the Japan Nuclear Energy Safety Organization (JNES) to review technical adequacy of applicant's aging management technical evaluation report on aging degradation of nuclear power generation equipment which describes technical bases of long-term maintenance programs in applicant's operational safety program. JNES has prepared review manuals for aging management technical evaluation consisted of review manuals for six major degradation mechanisms (low-cycle fatigue, neutron irradiation embrittlement, irradiation assisted stress corrosion cracking, thermal aging embrittlement of cast austenitic stainless steel, insulation degradation of electric and instrumentation equipment, reduced strength and shielding performance of concrete), review manual for seismic safety and general review manual which correlates these manuals and conducted reviews for aging management technical evaluation. However, due to the enforcement of revised Act on the Regulation of Nuclear Source Material, Nuclear Fuel Material and Reactors on July 8, 2013 and the revision of safety standards related to aging management technical evaluation, the Nuclear Regulation Authority (NRA) revised aging management implementation guideline for nuclear power generation equipment and the secretariat of NRA revised the review guideline for aging management technical evaluation. As a result of these revisions, JNES revised review manuals for aging management technical evaluation and integrated them in this review manual. (author)

  4. Examination of Federal Data Management Plan Guidelines

    Directory of Open Access Journals (Sweden)

    Jennifer L. Thoegersen

    2015-06-01

    Full Text Available Data management plans as expectations of the grant proposal process are still fairly novel, and the expected format and content of these plans is still evolving. The objective of this research is to gain a greater understanding of the expected content for data management plans submitted as part of grant proposals to federal funding agencies. This paper examines federal funding agencies’ data management plan guidelines in relation to the broad elements of data management identified by the Interagency Working Group on Digital Data: Description, Impact, Content & Format, Protection, Preservation, Access, and Transfer of Responsibility. Specifically, statements in agencies’ guidelines were categorized into the most applicable category (or categories. The representation of each category within each agency’s guidelines was addressed, and the statements falling in each category were analyzed. Some categories, including Access and Preservation, were represented in all or nearly all of the guidelines examined. Other categories—Impact and Transfer of Responsibility—were rarely addressed. The expectations for data management plans are evolving and will likely continue to evolve as more agencies require them.

  5. [Cryptorchidism: guidelines for surgical management].

    Science.gov (United States)

    Sapin, E

    2014-01-01

    Cryptorchidism is one of the commonest congenital anomalies in the male genitalia, affecting 3 to 5% of male full-term neonates. It is a known cause of infertility associated with a greater risk of development of germ cell tumor. The benefits of early orchidopexy include psychological affects, prevention of testicular degeneration and decrease in the risk of testicular cancer. Laparoscopy is the best way to diagnose and manage intra-abdominal testes. PMID:24139390

  6. Managing Virtual Teams : Guidelines to Effective Leadership

    OpenAIRE

    Dragusha, Cajup

    2012-01-01

    As companies are operating more and more globally, the need for virtual teams is growing rapidly. The aim of this study was to provide some essential informa-tion and guidelines for any organisation that is planning to establish a virtual team as well as any individual who is planning to join a virtual team. Information and guidelines provided by this study would be a great asset to organisations, managers, team members etc. to gain a better knowledge and confidence at the commencement stages...

  7. EAU guidelines on pain management.

    Science.gov (United States)

    Francesca, Francesco; Bader, Pia; Echtle, Dieter; Giunta, Francesco; Williams, John

    2003-10-01

    Pain is the most common symptom of any illness; the physician's therapeutic task is twofold: to discover and treat the cause of pain and the pain itself, whether or not the underlying cause is treatable, to provide relief and reduce the suffering caused by pain. Although we use the term of pain to define all sensations that hurt or are unpleasant, actually two quite different kinds of pain exist. The first (nociceptive) is associated with tissue damage or inflammation, the second (neuropathic) results from a lesion to the peripheral or central nervous systems. Pain can also be divided in acute and chronic. Caregivers are to face pain in two main settings: after surgery and in cancer patients. These tasks require a multidisciplinary team, able to properly assess and treat pain. Postoperative pain is to be treated early and aggressively. Several drug options are available, to be tailored on the surgical procedure and the patient. Pain in cancer patients consists of different aspects: it can be caused by the cancer itself or may be secondary to muscular spasm or cancer treatments. The management involves mainly pharmacotherapy, but also primary treatments as surgery, radiochemotherapy or even antibiotics can provide an adequate relief. Analgesics are to be employed according to an ascending scale, but other options can be combined to improve the outcome when a satisfactory balance between relief and side effects is not achieved; they include invasive techniques, physical and psychological therapy. The mainstay of pain management entails a interdisciplinary cooperation; it requires a full knowledge of the methods of evaluation and treatment of this condition. PMID:14499670

  8. Ageing management in Sweden

    International Nuclear Information System (INIS)

    Since the adoption of the 1997 act of parliament concerning the abolishment of nuclear power in Sweden plant lives are no longer limited until 2010 as they were following the referendum in 1980. The Swedish Nuclear Power Inspectorate (SKI) has therefore in its most recent general regulations from 2004 introduced requirements for nuclear power plants to develop ageing management programmes which should have been in place by the end of 2005. Since SKI:s role is not to provide detailed regulations but to ensure that the licensees take the full responsibility for the safety of their plants the detailed contents of the programmes have not been stipulated by SKI. An ageing management programme should coordinate the plant efforts in other programmes such as maintenance, monitoring, inspection, environmental qualification, chemistry, periodic testing and surveillance programmes that should already exist. In this way an integrated and long term approach to these issues can be ensured and become a natural part in the overall management of the plant. To this end it is important that the ageing management programme, as all other central programmes and processes, is documented in the quality assurance system, overall management system and is included in the underlying safety analysis report of the plant. Once the ageing management programmes have been established SKI is planning to assess them specifically through a combination of inspection and document reviews during 2008 and 2009. Thereafter it is anticipated that the major regulatory effort will be concentrated to the assessment of the periodic safety reviews to determine the effectiveness of the programmes and whether further specific regulatory action is required. SKI will also continue its active involvement in national and international research efforts to improve the understanding of ageing and degradation mechanisms. (author)

  9. Hungary: National approach to ageing management

    International Nuclear Information System (INIS)

    Activities related to AM are determined by the NSR and the accompanying regulatory guidelines. These requirements are in line with the international practice and guidelines (e.g. NUREG 1801). Regulatory Guidelines related to AM in general are: − 1.26. Regulatory supervision of ageing management; − 3.13. Ageing management issues in the design phase of a NPP; − 4.12. Ageing management during the operation of a NPP. The licensee has to ensure the required condition of the plant and the intended safety functions via plant programmes, i.e., maintenance, AMPs, programmes maintaining the qualified status of equipment, scheduled replacements and reconstructions. The licensee has certain freedom and flexibility in application of these programmes. The licensee should continuously demonstrate the ability of SSCs to fulfil required safety functions is maintained. The demonstration of fulfilment of safety functions may be through safety analysis (e.g. TLAA), environmental qualification (EQ), AM or MEM, or by a combination of them. The basic objective of AM is to maintain the safety of the passive SSCs with safety function by managing ageing phenomena. For SSCs subject to ageing effects, this is realized by identification of degradation mechanisms, detection of ageing effects, evaluation and trend analysis, and introduction of preventive measures or retarding actions. When developing an AMP, IAEA NS-G-2.12 was taken into account, as well as US GALL Report, with ten generic attributes for AMP review

  10. Management of research reactor ageing

    International Nuclear Information System (INIS)

    As of December 1993, about one quarter of the operating research reactors were over 30 years old. The long life of research reactors has raised some concern amongst research reactor operators, regulators and, to some extent, the general public. The International Atomic Energy Agency commenced activities on the topic of research reactor ageing by appointing an internal working group in 1988 and convening a Consultants Meeting in 1989. The subject was also discussed at an international symposium and a regional seminar held in 1989 and 1992 respectively. A draft document incorporating information and experience exchanged at the above meetings was reviewed by a Technical Committee Meeting held in Vienna in 1992. The present TECDOC is the outcome of this meeting and contains recommendations, guidelines and information on the management of research reactor ageing, which should be used in conjunction with related publications of the IAEA Research Reactor Safety Programme, which are referenced throughout the text. This TECDOC will be of interest to operators and regulators involved with the safe operation of any type of research reactor to (a) understand the behaviour and influence of ageing mechanisms on the reactor structures, systems and components; (b) detect and assess the effect of ageing; (c) establish preventive and corrective measures to mitigate these effects; and (d) make decisions aimed at the safe and continued operation of a research reactor. 32 refs, tabs

  11. Clinical practice guideline: tonsillitis II. Surgical management.

    Science.gov (United States)

    Windfuhr, Jochen P; Toepfner, Nicole; Steffen, Gregor; Waldfahrer, Frank; Berner, Reinhard

    2016-04-01

    In 2013, a total of 84,332 patients had undergone extracapsular tonsillectomies (TE) and 11,493 a tonsillotomy (TT) procedure in Germany. While the latter is increasingly performed, the number of the former is continually decreasing. However, a constant number of approximately 12,000 surgical procedures in terms of abscess-tonsillectomies or incision and drainage are annually performed in Germany to treat patients with a peritonsillar abscess. The purpose of this part of the clinical guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through the surgical treatment options to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical treatment options encompass intracapsular as well as extracapsular tonsil surgery and are related to three distinct entities: recurrent episodes of (1) acute tonsillitis, (2) peritonsillar abscess and (3) infectious mononucleosis. Conservative management of these entities is subject of part I of this guideline. (1) The quality of evidence for TE to resolve recurrent episodes of tonsillitis is moderate for children and low for adults. Conclusions concerning the efficacy of TE on the number of sore throat episodes per year are limited to 12 postoperative months in children and 5-6 months in adults. The impact of TE on the number of sore throat episodes per year in children is modest. Due to the heterogeneity of data, no firm conclusions on the effectiveness of TE in adults can be drawn. There is still an urgent need for further research to reliably estimate the value of TE compared to non-surgical therapy of tonsillitis/tonsillo-pharyngitis. The impact of TE on quality of life is considered as being positive, but further research is mandatory to establish appropriate inventories and standardized evaluation procedures, especially in children. In contrast to TE, TT or comparable procedures are characterized by a substantially lower postoperative

  12. Ageing Management Program Database

    International Nuclear Information System (INIS)

    The aspects of plant ageing management (AM) gained increasing attention over the last ten years. Numerous technical studies have been performed to study the impact of ageing mechanisms on the safe and reliable operation of nuclear power plants. National research activities have been initiated or are in progress to provide the technical basis for decision making processes. The long-term operation of nuclear power plants is influenced by economic considerations, the socio-economic environment including public acceptance, developments in research and the regulatory framework, the availability of technical infrastructure to maintain and service the systems, structures and components as well as qualified personnel. Besides national activities there are a number of international activities in particular under the umbrella of the IAEA, the OECD and the EU. The paper discusses the process, procedure and database developed for Slovenian Nuclear Safety Administration (SNSA) surveillance of ageing process of Nuclear power Plant Krsko.(author)

  13. Waste management guidelines for remote (Arctic) regions

    Energy Technology Data Exchange (ETDEWEB)

    Owens, E.H.; Taylor, E. [Polaris Applied Sciences Inc., Bainbridge Island, WA (United States); O' Connell, K.; Smith, C. [Oil Spill Training Co., Inverness, Scotland (United Kingdom)

    2009-07-01

    Oil spill response operations in Arctic regions involve well planned logistics support due to the remoteness and lack of infrastructure in most locations. The waste material generated by oil spill response field activities must be managed, recycled or disposed. In remote areas, in-situ shoreline treatment options are preferred since they require minimal manpower and generate very little waste. The Emergency Prevention, Preparation and Response Working Group of the Arctic Council has developed guidelines and strategies for oil spill waste management in Arctic regions. In addition, a waste management calculator software program was developed to provide a planning framework to illustrate the potential consequences of different options for different shore types and oil types. Potential shoreline treatment waste generation volumes and waste types can then be identified. The planning tool identifies the preferred shoreline treatment options, estimates the amount of waste that would be generated and identifies the amount and per cent of the types of waste that are associated with each treatment option. A review of 11 case studies has shown that there is no correlation between the volumes of waste generated by shoreline treatment response activities and the original volume of spilled oil. Rather, the volume of waste generated during a response operation is a function of the nature of the spill, location, and length of oiled shoreline, combined with decisions made by the spill management team and the selected treatment methods. 10 refs., 4 tabs., 4 figs.

  14. Guidelines for managing cardiovascular risk: an evolving area

    DEFF Research Database (Denmark)

    Currier, Judith S; Lundgren, Jens

    2008-01-01

    PURPOSE OF REVIEW: To reflect on the need for guidelines to assist clinicians in the management of cardiovascular risk in HIV-infected patients. RECENT FINDINGS: Over the past eight years guidelines for the management of dyslipidemia and metabolic complications of HIV infection have been developed...... and revised as new information becomes available. SUMMARY: Current guidelines for managing cardiovascular risk in HIV patients are limited by the currently available data, but nonetheless provide a useful approach to assist clinicians....

  15. Managing Ulcerative Colitis – The Guidelines and Beyond

    Directory of Open Access Journals (Sweden)

    Mitchell RKL Lie

    2013-11-01

    Full Text Available Management guidelines offer clinicians clear, evidence-based and often succinct treatment advice. For ulcerative colitis these guidelines describe the use of 5-ASA, corticosteroids, thiopurines, cyclosporine, and anti-TNFα therapies. However, guidelines do have some drawbacks, mainly a lack of concrete advice concerning patients resistant to these aforementioned therapies. This review gives a short overview of current guidelines and addresses treatment alternatives for conventional therapies.

  16. Integrated ageing management of Atucha NPP

    Energy Technology Data Exchange (ETDEWEB)

    Ranalli, Juan M.; Marchena, Martin H.; Zorrilla, Jorge R.; Antonaccio, Elvio E.; Brenna, Pablo; Yllanez, Daniela; Cruz, Gerardo Vera de la; Luraschi, Carlos, E-mail: ranalli@cnea.gov.ar [Gerencia Coordinacion Proyectos CNEA-NASA, Comision Nacional de Energia Atomica, Buenos Aires (Argentina); Sabransky, Mario, E-mail: msabransky@na-sa.com.ar [Departamento Gestion de Envejecimiento, Central Nuclear Atucha I-II Nucleoelectrica Argentina S.A., Provincia de Buenos Aires (Argentina)

    2013-07-01

    Atucha NPP is a two PHWR unit site located in Lima, Province of Buenos Aires, 120 km north of Buenos Aires, Argentina. Until recent, the site was split in Atucha I NPP, a 350 MW pressure vessel heavy water reactor in operation since 1974; and Atucha II, a similar design reactor, twice as big as Atucha I finishing a delayed construction. With the start-up of Atucha II and aiming to integrate the management of the plants, the Utility (Nucleolectrica Argentina Sociedad Anonima - NASA) has reorganized its operation units. Within this reorganization, an Ageing Management Department has been created to cope with all ageing issues of both Atucha I and II units. The Atomic Energy Commission of Argentina (Comision Nacional de Energia Atomica - CNEA) is a state-owned R and D organization that; among other functions such as designing and building research reactors, developing uranium mining and supplying radioisotopes to the medical market; is in charge of providing support and technological update to all Argentinean NPPs. The Ageing Management Department of Atucha NPP and the Ageing Management Division of CNEA has formed a joint working group in order to set up an Integrated Ageing Management Program for Atucha NPP following IAEA guidelines. In the present work a summary of the activities, documental structure and first outputs of the Integrated Ageing Management Program of Atucha NPP is presented. (author)

  17. Integrated ageing management of Atucha NPP

    International Nuclear Information System (INIS)

    Atucha NPP is a two PHWR unit site located in Lima, Province of Buenos Aires, 120 km north of Buenos Aires, Argentina. Until recent, the site was split in Atucha I NPP, a 350 MW pressure vessel heavy water reactor in operation since 1974; and Atucha II, a similar design reactor, twice as big as Atucha I finishing a delayed construction. With the start-up of Atucha II and aiming to integrate the management of the plants, the Utility (Nucleolectrica Argentina Sociedad Anonima - NASA) has reorganized its operation units. Within this reorganization, an Ageing Management Department has been created to cope with all ageing issues of both Atucha I and II units. The Atomic Energy Commission of Argentina (Comision Nacional de Energia Atomica - CNEA) is a state-owned R and D organization that; among other functions such as designing and building research reactors, developing uranium mining and supplying radioisotopes to the medical market; is in charge of providing support and technological update to all Argentinean NPPs. The Ageing Management Department of Atucha NPP and the Ageing Management Division of CNEA has formed a joint working group in order to set up an Integrated Ageing Management Program for Atucha NPP following IAEA guidelines. In the present work a summary of the activities, documental structure and first outputs of the Integrated Ageing Management Program of Atucha NPP is presented. (author)

  18. Nutritional management of newborn infants: Practical guidelines

    Institute of Scientific and Technical Information of China (English)

    Xiao-Ming Ben

    2008-01-01

    The requirements of growth and organ development create a challenge in nutritional management of newborn infants, especially premature newborn and intestinal-failure infants. Since their feeding may increase the risk of necrotizing enterocolitis, some high-risk infants receive a small volume of feeding or parenteral nutrition (PN) without enteral feeding. This review summarizes the current research progress in the nutritional management of newborn infants. Searches of MEDLINE (1998-2007), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2007), abstracts and conference proceedings, references from relevant publications in the English language were performed, showing that breast milk is the preferred source of nutrients for enteral feeding of newborn infants. The number of nutrients found in human milk was recommended as a guideline in establishing the minimum and maximum levels in infant formulas. The fear of necrotizing enterocolitis and feeding intolerance are the major factors limiting the use of the enteral route as the primary means of nourishing premature infants. PN may help to meet many of the nutritional needs of these infants, but has significant detrimental side effects. Trophic feedings (small volume of feeding given at the same rate for at least 5 d) during PN are a strategy to enhance the feeding tolerance and decrease the side effects of PN and the time to achieve full feeding. Human milk is aey component of any strategy for enteral nutrition of all infants. However, the amounts of calcium, phosphorus, zinc and other nutrients are inadequate to meet the needs of the very low birth weight (VLBW) infants during growth. Therefore, safe and effective means to fortify human milk are essential to the care of VLBW infants.

  19. Ageing management for research reactors

    International Nuclear Information System (INIS)

    During the past several years, ageing of research reactor facilities continues to be an important safety issue. Despite the efforts exerted by operating organizations and regulatory authorities worldwide to address this issue, the need for an improved strategy as well as the need for establishing and implementing a systematic approach to ageing management at research reactors was identified. This paper discusses, on the basis of the IAEA Safety Standards, the effect of ageing on the safety of research reactors and presents a proactive strategy for ageing management. A systematic approach for ageing management is developed and presented together with its key elements, along with practical examples for their application. (author)

  20. Technical approach to aging management

    International Nuclear Information System (INIS)

    Systematic and effective control of age-related degradation of safety-related components, systems, and structures in nuclear power plants (NPPs) is an important challenge to plant operators. Several data bases, available to provide guidance on aging management, are summarized. However, the ultimate consideration is: How effectively is aging management being implemented at individual plants? Illustrated here is a specific strategy that served to develop the technical data base for the Nuclear Plant Aging Research Program. The strategy is comprehensive, systematic, and adaptable. Effective aging management at NPPs could be facilitated by a parallel strategy. The elements of a strategy are suggested

  1. European Guidelines for Obesity Management in Adults.

    Science.gov (United States)

    Yumuk, Volkan; Tsigos, Constantine; Fried, Martin; Schindler, Karin; Busetto, Luca; Micic, Dragan; Toplak, Hermann

    2015-01-01

    Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient's obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of life of obese patients are also included in treatment aims. Balanced hypocaloric diets result in clinically meaningful weight loss regardless of which macronutrients they emphasise. Aerobic training is the optimal mode of exercise for reducing fat mass while a programme including resistance training is needed for increasing lean mass in middle-aged and overweight/obese individuals. Cognitive behavioural therapy directly addresses behaviours that require change for successful weight loss and weight loss maintenance. Pharmacotherapy can help patients to maintain compliance and ameliorate obesity-related health risks. Surgery is the most effective treatment for morbid obesity in terms of long-term weight loss. A comprehensive obesity management can only be accomplished by a multidisciplinary obesity management team. We conclude that physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment. Treatment should be based on

  2. Antimicrobial management of intra-abdominal infections:Literature's guidelines

    Institute of Scientific and Technical Information of China (English)

    Massimo Sartelli; Fausto Catena; Federico Coccolini; Antonio Daniele Pinna

    2012-01-01

    Antimicrobial management of severe intra-abdominal infections (IAIs) involves a delicate balance of optimizing empirical therapy,which has been shown to improve clinical outcomes,while simultaneously reducing unnecessary antimicrobial use.Two sets of guidelines for the management of intra-abdominal infections were recently published.In 2010,the Surgical Infection Society and the Infectious Diseases Society of America (SIS-IDSA)created guidelines for the diagnosis and management of complicated IAIs.The new SIS-IDSA guidelines replace those previously published in 2002 and 2003.The World Society of Emergency Surgery (WSES) guidelines represent additional contributions,made by specialists worldwide,to the debate regarding proper antimicrobial drug methodology.These guidelines represent the conclusions of the consensus conference held in Bologna,Italy,in July 2010 during the first congress of the WSES.

  3. Guidelines International Network: Principles for Disclosure of Interests and Management of Conflicts in Guidelines.

    Science.gov (United States)

    Schünemann, Holger J; Al-Ansary, Lubna A; Forland, Frode; Kersten, Sonja; Komulainen, Jorma; Kopp, Ina B; Macbeth, Fergus; Phillips, Susan M; Robbins, Craig; van der Wees, Philip; Qaseem, Amir

    2015-10-01

    Conflicts of interest (COIs) have been defined by the American Thoracic Society as "a divergence between an individual's private interests and his or her professional obligations such that an independent observer might reasonably question whether the individual's professional actions or decisions are motivated by personal gain, such as direct financial, academic advancement, clinical revenue streams, or community standing." In the context of guideline development, the concerns are not simply about identifying and disclosing direct financial or indirect COIs. Despite this recognition, the management of COIs in guidelines is often unsatisfactory. In response to requests from its international membership and informed by existing syntheses of the evidence and policies of international organizations, the Guidelines International Network Board of Trustees developed guidance on the disclosure of interests and management of COIs. Current approaches are relatively similar throughout the guideline development community, with an increasing recognition of the importance of disclosing and managing indirect COIs. Although there are differences in detail among the approaches, the similarities allow for the formulation of 9 core principles for managing COIs. In formulating these principles, the Guidelines International Network Board of Trustees recognizes that COIs cannot be totally avoided when panel members are being chosen for certain guidelines or in certain settings; thus, the important issue is the management of COIs in a fair, judicious, transparent manner. PMID:26436619

  4. 77 FR 13585 - Electricity Subsector Cybersecurity Risk Management Process Guideline

    Science.gov (United States)

    2012-03-07

    ... Electricity Subsector Cybersecurity Risk Management Process Guideline AGENCY: Office of Electricity Delivery... Department of Energy (DOE) invites public comment on DOE's intent to publish the Electricity Subsector... targeted to the specific needs of electricity sector organizations. The objective of the guideline is...

  5. Guidelines for the management of contact dermatitis: an update.

    LENUS (Irish Health Repository)

    Bourke, J

    2012-02-01

    These guidelines for management of contact dermatitis have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for investigation and treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, including details of relevant epidemiological aspects, diagnosis and investigation.

  6. Guidelines for the management of contact dermatitis: an update.

    LENUS (Irish Health Repository)

    Bourke, J

    2009-05-01

    These guidelines for management of contact dermatitis have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for investigation and treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, including details of relevant epidemiological aspects, diagnosis and investigation.

  7. Equipment and building structures ageing management for WWER type NPPs

    International Nuclear Information System (INIS)

    This report presents the working group 'Equipment and building structures ageing management for WWER type NPPs' activities. The analysis of experience in ageing management, recommendations for regulatory guidelines on ageing management, investigation of case studies, definition suitable communication channels among regulators for ageing related data are given. Analyses of water chemistry, inspection data (safety margins criteria), plugging criteria, volume and time of ECT implementation in all WWER countries are presented. The results of Working group activity show that it is advisable to concentrate efforts on: set up the permanent communication channel among regulators, collection of regulatory criteria for WWER type NPP key components based on understanding of ageing mechanisms and data collection

  8. Guidelines (1988) for training in clinical laboratory management

    OpenAIRE

    Cediel, N.; Fraser, C G; Deom, A.; Josefsson, L.; Worth, H. G. J.; Zinder, O.

    1989-01-01

    Trainees in laboratory medicine must develop skills in laboratory management. Guidelines are detailed for laboratory staff in training, directors responsible for staff development and professional bodies wishing to generate material appropriate to their needs. The syllabus delineates the knowledge base required and includes laboratory planning and organization, control of operations, methodology and instrumentation, data management and statistics, financial management, clinical use of tests, ...

  9. Progress of steam generator ageing management of Chinese NPPs

    International Nuclear Information System (INIS)

    equipments, is included in the initial equipment list for ageing management. During the past five years, there have been some progress in this area in China. Based on IAEA plant ageing and life management guidelines, the SG ageing management systems of Chinese NPPs are established with SG ageing mechanism analysis, SG ageing management programme development and SG ageing management database development. The SG ageing assessment and remained life evaluation is under consideration. It is expected that these efforts would serve as the basement of further and extended SG ageing and life management in the future. (author)

  10. Integrated Guidelines for Management of Alloy 600 Locations

    Energy Technology Data Exchange (ETDEWEB)

    Na, Kyung-Hwan; Chung, Hansub; Yang, Jun-Seog; Lee, Kyoung-Soo [KHNP-Central Research Institute, Daejeon (Korea, Republic of)

    2015-05-15

    The locations experiencing PWSCC include steam generator tubes, pressurizer instrumental nozzles, control rod driving mechanism(CRDM) penetration nozzles, reactor outlet nozzles, and bottom mounted instrumental(BMI) nozzles. Korea Hydro and Nuclear Power Co.(KHNP) has developed integrated guidelines for management of alloy 600 locations and the guidelines are under review by the regulator. The guidelines consist of alloy 600 location database, inspection program, maintenance/preventive maintenance method, and finally water chemistry management for PWSCC mitigation. In this paper, the detailed contents are presented. The integrated guidelines collected all relevant information on the management of alloy 600 locations. This information may be useful for establishing the most effective preventive maintenance strategies by prioritization in addition to maintenance strategies. Table II summarize maintenance strategies for alloy 600 locations.

  11. Integrated Guidelines for Management of Alloy 600 Locations

    International Nuclear Information System (INIS)

    The locations experiencing PWSCC include steam generator tubes, pressurizer instrumental nozzles, control rod driving mechanism(CRDM) penetration nozzles, reactor outlet nozzles, and bottom mounted instrumental(BMI) nozzles. Korea Hydro and Nuclear Power Co.(KHNP) has developed integrated guidelines for management of alloy 600 locations and the guidelines are under review by the regulator. The guidelines consist of alloy 600 location database, inspection program, maintenance/preventive maintenance method, and finally water chemistry management for PWSCC mitigation. In this paper, the detailed contents are presented. The integrated guidelines collected all relevant information on the management of alloy 600 locations. This information may be useful for establishing the most effective preventive maintenance strategies by prioritization in addition to maintenance strategies. Table II summarize maintenance strategies for alloy 600 locations

  12. Aging management of Cirus

    International Nuclear Information System (INIS)

    Cirus, a 40 MWt tank type research reactor located at the Bhabha Atomic Research Centre, is in operation since 1960. In Cirus, heavy water is used as moderator, demineralized light water as primary coolant and natural uranium metal as fuel. The average availability factor had been about 70% till the year 1990 where after it started decreasing due to frequent problems with equipment and components. Systematic aging studies were therefore undertaken to assess the condition of structures, systems and components. Based on these studies, refurbishing requirements were identified and a detailed plan was drawn up for refurbishing. The reactor was shut down in October 1997 for execution of refurbishing jobs. A summary is presented of the results of aging studies and the refurbishing plans. Details of core unloading to facilitate refurbishing and some of the important jobs in the primary coolant system relating to pressure testing of primary coolant pipelines and repairs to identified leaky sections are discussed. (author)

  13. NDMA guidelines on management of nuclear and radiological emergencies

    International Nuclear Information System (INIS)

    The National Disaster Management Authority (NDMA), ever since it's formation as an apex policy making body for the country in the field of disaster management, has formulated a set of guidelines to assist the various ministries, states and stakeholders in preparing their plans to handle different types of disasters. The guidelines on management of nuclear and radiological emergencies assume great importance in the present context, as our country has very ambitious programme to exploit nuclear energy for peaceful uses. Though, we have an enviable and impeccable record of safety and virtually fail-safe operations in all our nuclear establishments, the possibility, however, remote it may be, of human error, systems failure, sabotage, earthquake, floods, terrorist attacks etc leading to the release of radioactive material in the public domain, cannot be entirely ruled out. With this view, it was decided to prepare the national guidelines by NDMA to manage any nuclear/radiological emergency in public domain. Through these guidelines, we aim to further strengthen our existing nuclear/radiological emergency management framework and generate public awareness, which will go a long way in allaying misapprehensions, if any, amongst the public about the country's nuclear programme. Like in all our guidelines for handling of different types of the disasters, in these Guidelines also, maximum emphasis has been laid on the prevention of nuclear and radiological emergencies, along with a detailed consideration of all other elements of the disaster management continuum. The national guidelines have been prepared and a consensus was arrived on various issues, after widespread consultations and elaborates discussions amongst experts as well as stakeholders. It is assumed that once these guidelines are implemented by the stakeholders and converted into action plans followed by SOPs that will further reduce the chances of accidents in the nuclear arena. (author)

  14. Guidelines for dietary management of menopausal women with simple obesity.

    Science.gov (United States)

    Brończyk-Puzoń, Anna; Piecha, Dariusz; Nowak, Justyna; Koszowska, Aneta; Kulik-Kupka, Karolina; Dittfeld, Anna; Zubelewicz-Szkodzińska, Barbara

    2015-03-01

    The problem of obesity affects all age groups. It is also observed among menopausal women. Menopause is the time in a woman's life when, as a consequence of hormonal changes occurring in the body, the risk of overweight and obesity increases significantly and, therefore, so does the risk of metabolic and cardiovascular diseases. Excess body weight in menopausal women may also be of social and psychological importance since the occurring symptoms may considerably decrease quality of life and sexual activity of these women. Reduction of body weight in obese menopausal women should play a vital role in treatment of this group of patients. Therefore, adequate management seems to be essential, and it should involve dietary, pharmacological and/or surgical treatment, depending on the patient's needs. Following a rational weight loss plan provided by a dietician under medical supervision may contribute to improvement of the health condition and quality of life. It is recommended to observe the guidelines on dietary management described in this article by adjusting a diet plan individually. The following work constitutes a review of articles from 2004-2014 which are available in the PubMed medical knowledge base and the Polish Medical Bibliography (Polska Bibliografia Lekarska). For this purpose, the following controlled vocabulary has been used: menopausal woman, menopausal diet, menopausal weight gain, menopausal weight loss, dietary management in menopause. PMID:26327888

  15. 2013 WSES guidelines for management of intra-abdominal infections

    Directory of Open Access Journals (Sweden)

    Sartelli Massimo

    2013-01-01

    Full Text Available Abstract Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The 2013 update of the World Society of Emergency Surgery (WSES guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections.

  16. European guidelines on management of restless legs syndrome

    DEFF Research Database (Denmark)

    Garcia-Borreguero, Diego; Ferini-Strambi, Luigi; Kohnen, Ralf;

    2012-01-01

    Since the publication of the first European Federation of Neurological Societies (EFNS) guidelines in 2005 on the management of restless legs syndrome (RLS; also known as Willis-Ekbom disease), there have been major therapeutic advances in the field. Furthermore, the management of RLS is now a part...

  17. Reliability methods and ageing management

    International Nuclear Information System (INIS)

    The aim of nuclear power plant ageing management is to maintain an adequate safety level through the planned and possibly extended lifetime of a plant. The technical definition of ageing is the following : ageing is the continuous time-dependent degradation of materials due to normal service conditions, which include normal operation and transient conditions (IAEA 1990). A logical concern for extending the life of nuclear power plants is whether plants age in such a way as to be significantly less safe as they get older. Generally, the overall reactor plant performance is used as a way of measuring the effect of plant aging. The performance indicators are : - number of scrams while critical; - number of selected safety system actuations; - number of significant operating events; - number of safety system failures; - forced outage rates; - number of equipment-forced outages; - collective radiation exposure per plant. Reliability methods are essential in the integration of component-specific ageing and degradation studies with the plant or system level analyses. Reliability based approaches together with the use of plant operating experience have an important role in all stages of ageing analyses. The phases of ageing analyses are (generally speaking): the identification of critical components, identification and evaluation of ageing effects and development of mitigation methods. The probabilistic safety analysis, PSA, is an efficient system analysis method, which is used to assess risk of operation of nuclear power plants. This paper promotes the use of reliability methods and a system analysis approach in nuclear power plant ageing management. (authors)

  18. An evidence and consensus based guideline for acute diarrhoea management

    OpenAIRE

    Armon, K; Stephenson, T; MacFaul, R; Eccleston, P; Werneke, U; Baumer, H

    2001-01-01

    OBJECTIVE—To develop an evidence and consensus based guideline for the management of the child who presents to hospital with diarrhoea (with or without vomiting), a common problem representing 16% of all paediatric medical attenders at an accident and emergency department. Clinical assessment, investigations (biochemistry and stool culture in particular), admission, and treatment are addressed. The guideline aims to aid junior doctors in recognising children who need admi...

  19. Landfill gas management facilities design guidelines

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-03-15

    In British Columbia, municipal solid waste landfills generate over 1000 tonnes of methane per year; landfill gas management facilities are required to improve the environmental performance of solid waste landfills. The aim of this document, developed by the British Columbia Ministry of the Environment, is to provide guidance for the design, installation, and operation of landfill gas management facilities to address odor and pollutant emissions issues and also address health and safety issues. A review of technical experience and best practices in landfill gas management facilities was carried out, as was as a review of existing regulations related to landfill gas management all over the world. This paper provides useful information to landfill owners, operators, and other professionals for the design of landfill gas management facilities which meet the requirements of landfill gas management regulations.

  20. UK national guidelines on the management of syphilis 2015.

    Science.gov (United States)

    Kingston, M; French, P; Higgins, S; McQuillan, O; Sukthankar, A; Stott, C; McBrien, B; Tipple, C; Turner, A; Sullivan, A K; Radcliffe, Keith; Cousins, Darren; FitzGerald, Mark; Fisher, Martin; Grover, Deepa; Higgins, Stephen; Kingston, Margaret; Rayment, Michael; Sullivan, Ann

    2016-05-01

    These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline. PMID:26721608

  1. Management Guidelines for Database Developers' Teams in Software Development Projects

    Science.gov (United States)

    Rusu, Lazar; Lin, Yifeng; Hodosi, Georg

    Worldwide job market for database developers (DBDs) is continually increasing in last several years. In some companies, DBDs are organized as a special team (DBDs team) to support other projects and roles. As a new role, the DBDs team is facing a major problem that there are not any management guidelines for them. The team manager does not know which kinds of tasks should be assigned to this team and what practices should be used during DBDs work. Therefore in this paper we have developed a set of management guidelines, which includes 8 fundamental tasks and 17 practices from software development process, by using two methodologies Capability Maturity Model (CMM) and agile software development in particular Scrum in order to improve the DBDs team work. Moreover the management guidelines developed here has been complemented with practices from authors' experience in this area and has been evaluated in the case of a software company. The management guidelines for DBD teams presented in this paper could be very usefully for other companies too that are using a DBDs team and could contribute towards an increase of the efficiency of these teams in their work on software development projects.

  2. Guidelines for Computer-Managed Testing.

    Science.gov (United States)

    Mizokawa, Donald T.; Hamlin, Michael D.

    1984-01-01

    Suggestions for software design in computer managed testing (CMT) cover instructions to testees, their physical format, provision of practice items, and time limit information; test item presentation, physical format, discussion of task demands, review capabilities, and rate of presentation; pedagogically helpful utilities; typefonts; vocabulary;…

  3. Guidelines for an EU waste management policy

    International Nuclear Information System (INIS)

    The Commission believes that a legally binding Community instrument is the only option, which will give sufficient assurances to European citizens on a high level of nuclear safety. The first objective of the legislative proposals is, therefore, to guarantee a high level of nuclear safety. The proposals will also enable the European nuclear industry to evolve within a stable legal framework. In addition, in a ruling on 10 December 2002, the Court of Justice of the EU stated that there were clear Community competencies for a) the establishment of a legislative and regulatory framework to govern the safety of nuclear installations, b) the implementation of measures relating to the assessment and verification of safety, c) the emergency preparedness and d) the siting of a nuclear installation and the design, construction and operation of nuclear installations. The European Commission, like the NEA and the IAEA, considers that nuclear safety should be looked at as a whole. All the civil nuclear facilities should be addressed, from their design to their end of lifetime, including the radioactive waste. Three fundamental topics for nuclear safety are consequently part of our proposals: the safety of nuclear facilities, the decommissioning of them at the end of their lifetime and the safe management of spent fuel and of radioactive waste. The proposed Waste Directive encourages progress on the safe management of all forms of radioactive waste, but clearly puts the emphasis on the need for greater progress on the safe long-term management of high-level waste and spent fuel. In particular, it urges Member States to develop repositories, in deep geological structures. Programmes will require the selection of at least one site, the launching of the licensing procedure, the building of the repository and its entry into operation. Member States will have to report on this programme at regular intervals. The reports will be subject to peer reviews by national experts. The

  4. Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers

    Science.gov (United States)

    Roberts, James R.; McCurdy, Leyla Erk

    2005-01-01

    These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health care providers, and outlines the environmental interventions…

  5. A Guideline for the Management of Renal Stones in Astronauts

    Science.gov (United States)

    Reyes, David; Locke, James; Johnston, Smith

    2014-01-01

    There are no specific guidelines for the management of renal stones in astronauts. Given the increased risk for bone loss, hypercalcuria, and stone formation due to microgravity, a clinical practice guideline is needed. Methods An extensive review of the literature and current aeromedical standards for the management of renal stones was done. The NASA Flight Medicine Clinic's electronic medical record and Longitudinal Survey of Astronaut Health were also reviewed. This information was used to create an algorithm for the management of renal stones in astronauts. Results Guidelines are proposed based on accepted standards of care, with consideration to the environment of spaceflight. In a usual medical setting, asymptomatic, small stones less than 7 mm are often observed over time. Given the constraints of schedule, and the risks to crew health and mission, this approach is too liberal. An upper limit of 3 mm stone diameter was adopted before requiring intervention, because this is the largest size that has a significant chance of spontaneous passage on its own. Other specific guidelines were also created. Discussion The spaceflight environment requires more aggressive treatment than would otherwise be found with the usual practice of medicine. A small stone can become a major problem because it may ultimately require medical evacuation from orbit. Thus renal stones are a significant mission threat and should be managed in a systematic way to mitigate risks to crew health and mission success.

  6. Strategy and Management Guideline on Preventive School Maintenance in Eritrea

    DEFF Research Database (Denmark)

    Vagnby, Bo Hellisen

    An action-oriented and practical guideline for the planning, organisation and management of preventive school maintenance in Eritrea. The manual is the result of a participatory planning process which has involved actors at the school and community level, district levels and the national policy...

  7. Project Management in Nuclear Power Plant Construction: Guidelines and Experience

    International Nuclear Information System (INIS)

    Project management is a leadership function primarily concerned with the organization, coordination and control of large undertakings, with the aim of achieving technical excellence, by working to quality standards, by optimizing the schedule, the supply chain and by minimizing costs. Competent project management can reduce costs through more efficient work sequences, higher productivity, shorter activity durations and the parallel reduction of accumulated interest during construction of nuclear power plants. Based on past proven practices in Member States, this publication provides advice and guidelines to project management from the preparatory phase to plant turnover to commissioning of nuclear power plants. The guidelines and experiences will enable project managers to obtain better performance in nuclear power plant construction. (author)

  8. Management of diabetes during Ramadan: practical guidelines.

    Science.gov (United States)

    Sunni, Muna; Brunzell, Carol; Nathan, Brandon; Moran, Antoinette

    2014-06-01

    Ramadan is a month-long period of heightened self-reflection about one's religion and one's relationships with others. During Ramadan, fasting during daylight hours is required. The fast is typically followed by a feast after dark. Although Muslims with certain medical conditions are allowed by Islamic law to abstain from fasting, many choose to fast during Ramadan for personal reasons. Diabetes is one of the most challenging conditions to manage during this time, and physicians and clinics with Muslim patients who have diabetes will need to be prepared if they are to support their patients who desire to fast. This article provides a general overview of Ramadan and offers practical guidance for managing adults and children with diabetes who are fasting during this important time in the Muslim calendar. PMID:25029798

  9. Guidelines of care for the management of acne vulgaris.

    Science.gov (United States)

    Zaenglein, Andrea L; Pathy, Arun L; Schlosser, Bethanee J; Alikhan, Ali; Baldwin, Hilary E; Berson, Diane S; Bowe, Whitney P; Graber, Emmy M; Harper, Julie C; Kang, Sewon; Keri, Jonette E; Leyden, James J; Reynolds, Rachel V; Silverberg, Nanette B; Stein Gold, Linda F; Tollefson, Megha M; Weiss, Jonathan S; Dolan, Nancy C; Sagan, Andrew A; Stern, Mackenzie; Boyer, Kevin M; Bhushan, Reva

    2016-05-01

    Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence. PMID:26897386

  10. Expectant Management of Miscarriage in View of NICE Guideline 154

    OpenAIRE

    Junaid Rafi; Haroona Khalil

    2014-01-01

    Objective. To find out the success rate of conservative management of complete two weeks for miscarriage in view of NICE Guideline 154. Design. Prospective observational study. Setting. Early pregnancy assessment units of District General Hospital in the United Kingdom. Participants. Women of less than 14 weeks’ gestation, with a diagnosis of miscarriage (missed miscarriage/anembryonic or incomplete miscarriage). Interventions. Expectant management for two weeks. Main Outcome Measure. (1) Eff...

  11. Revised guidelines for the clinical management of Lynch syndrome (HNPCC)

    DEFF Research Database (Denmark)

    Vasen, Hans F A; Blanco, Ignacio; Aktan-Collan, Katja; Gopie, Jessica P; Alonso, Angel; Aretz, Stefan; Bernstein, Inge; Bertario, Lucio; Burn, John; Capella, Gabriel; Colas, Chrystelle; Engel, Christoph; Frayling, Ian M; Genuardi, Maurizio; Heinimann, Karl; Hes, Frederik J; Hodgson, Shirley V; Karagiannis, John A; Lalloo, Fiona; Lindblom, Annika; Mecklin, Jukka-Pekka; Møller, Pal; Myrhoj, Torben; Nagengast, Fokko M; Parc, Yann; Ponz de Leon, Maurizio; Renkonen-Sinisalo, Laura; Sampson, Julian R; Stormorken, Astrid; Sijmons, Rolf H; Tejpar, Sabine; Thomas, Huw J W; Rahner, Nils; Wijnen, Juul T; Järvinen, Heikki Juhani; Möslein, Gabriela

    2013-01-01

    the clinical management of LS. Since then substantial new information has become available necessitating an update of the guidelines. In 2011 and 2012 workshops were organised in Palma de Mallorca. A total of 35 specialists from 13 countries participated in the meetings. The first step was to...... appropriate management of families with LS. Prospective controlled studies should be undertaken to improve further the care of these families....

  12. Phenylalanine hydroxylase deficiency: diagnosis and management guideline.

    Science.gov (United States)

    Vockley, Jerry; Andersson, Hans C; Antshel, Kevin M; Braverman, Nancy E; Burton, Barbara K; Frazier, Dianne M; Mitchell, John; Smith, Wendy E; Thompson, Barry H; Berry, Susan A

    2014-02-01

    Phenylalanine hydroxylase deficiency, traditionally known as phenylketonuria, results in the accumulation of phenylalanine in the blood of affected individuals and was the first inborn error of metabolism to be identified through population screening. Early identification and treatment prevent the most dramatic clinical sequelae of the disorder, but new neurodevelopmental and psychological problems have emerged in individuals treated from birth. The additional unanticipated recognition of a toxic effect of elevated maternal phenylalanine on fetal development has added to a general call in the field for treatment for life. Two major conferences sponsored by the National Institutes of Health held >10 years apart reviewed the state of knowledge in the field of phenylalanine hydroxylase deficiency, but there are no generally accepted recommendations for therapy. The purpose of this guideline is to review the strength of the medical literature relative to the treatment of phenylalanine hydroxylase deficiency and to develop recommendations for diagnosis and therapy of this disorder. Evidence review from the original National Institutes of Health consensus conference and a recent update by the Agency for Healthcare Research and Quality was used to address key questions in the diagnosis and treatment of phenylalanine hydroxylase deficiency by a working group established by the American College of Medical Genetics and Genomics. The group met by phone and in person over the course of a year to review these reports, develop recommendations, and identify key gaps in our knowledge of this disorder. Above all, treatment of phenylalanine hydroxylase deficiency must be life long, with a goal of maintaining blood phenylalanine in the range of 120-360 µmol/l. Treatment has predominantly been dietary manipulation, and use of low protein and phenylalanine medical foods is likely to remain a major component of therapy for the immediate future. Pharmacotherapy for phenylalanine

  13. Guidelines on nitrogen management in agricultural systems

    International Nuclear Information System (INIS)

    This publication deals with the topic of nitrogen management in agro-ecosystems. Nitrogen (N) is an essential plant nutrient, and N deficiency severely restricts crop yields in most cultivated soils. Therefore, substantial N inputs are required for optimum plant growth and adequate food, feed and fibre production. Developing countries use more than 55 million metric tons (t) of N fertilizers at an estimated value of US $16 billion annually, of which approximately 2 million t are used in Africa, 5 in Latin America and 50 in Asia. It is estimated that adequate production of food (in particular cereals) for present and future populations will not be achieved without external inputs of fertilizer N. However, management practices involving fertilizer N should be efficient in order to optimize crop production while minimizing adverse effects on the environment. Moreover, the use of alternative N sources such as organic residues and biological nitrogen fixation should be increased within the context of integrated soil fertility management to ensure food security in areas of the world where fertilizer N is too expensive or simply not available. At present, legumes such as soybean, common bean, groundnuts, chickpeas, cowpeas, etc., are fixing approximately 11 million t of N in developing countries. This publication covers, concisely and comprehensively, key topics dealing with the utilization of all sources of N in farming systems, in particular to demonstrate to scientists in developing countries how isotopic tracer technologies can be used in research to improve overall N use efficiency in agricultural systems while increasing crop yields in a sustainable manner, i.e. conserving the natural resource base and protecting the environment. It is a timely publication; increasing attention is being paid to N management in food production, energy consumption and environmental protection. The subject matter is covered in four chapters, starting with an introduction to N

  14. DOE guidelines for management of radioactive waste - historical perspectives

    International Nuclear Information System (INIS)

    From the beginning of the Manhattan Project in 1942 through the signing of the Atomic Energy Act (AEA) in 1946 and its reenactment in 1954, new policies and techniques began to evolve for managing waste produced in the manufacture of nuclear weapons. Even in the early days of war-time urgency, public health and safety were the major considerations in managing waste from this new technology. The Atomic Energy Commission (AEC), which took over from the Manhattan Engineer District (MED) in 1947, established initial waste category management guidelines (high level waste stored in tanks, solid low level waste disposed of primarily in trenches, and liquid waste released to ponds, cribs, and pits) based on the management concepts developed by the MED. The AEC and its successor agencies managed radioactive waste in a manner consistent with existing industrial health and safety requirements of that era. With the formation of the Department of Energy (DOE) in September 1977, techniques and internal requirements were already in place or being established that, in some cases, were more protective of human health and the environment than existing legislation and environmental standards. With the transition to environmental cleanup of former DOE weapons production facilities, new and revised guidelines were created to address hazardous and radioactive mixed waste, waste minimization, and recycling. This paper reviews the waste management guidelines as they have evolved from the MED through the resent time

  15. Water management planning guideline for waterpower

    International Nuclear Information System (INIS)

    Hydroelectric power has been used in Ontario for over 150 years, providing the impetus to economic development in the province. Currently, 83 hydroelectric utilities own the more than 200 hydro power facilities in Ontario, accounting for approximately 26 per cent of the total electrical generating capacity in the province. Flood control and the creation of recreational opportunities were added benefits derived from the construction of hydroelectric dams. The three ways of operating hydroelectric facilities are: run-of-the-river which involves minimal forebay storage, peaking which involves the operation of the dam for specific periods of high energy demand, and intermediate. The Ontario government plans to open the electricity market to competition, guided by four principles: (1) protecting consumers and offering more choice, (2) ensuring a strong business climate with a reliable supply of electricity, (3) protecting the environment, and (4) encouraging new ways of doing business and new sources of power. To address issues that arise from the operation of hydroelectric facilities, dam owners and hydroelectric facilities operators are required to develop Water Management Plans, outlining how the facility will be operated to balance environmental, social and economic objectives. The present document was developed to define goals and principles concerning planning, the scope of Water Management Plans, the criteria and the general planning process to be adopted for the preparation of the Plans. 1 tab., 4 figs

  16. European guidelines for the management of malignant pleural mesothelioma

    Directory of Open Access Journals (Sweden)

    Eric van Thiel

    2011-10-01

    Full Text Available Malignant Pleural Mesothelioma (MPM is nearly invariably lethal tumor of the pleura. Significant therapeutic nihilism exists among health professionals. Recent progress has reshaped the clinical landscape in the treatment of MPM. Two European guidelines have been published, one from the Task force of the European Respiratory Society (ERS and the European Society of Thoracic Surgery (ESTS and the other from the European Society of Medical Oncology (ESMO. With these guidelines and recommendations as a guidepost, this review discusses the major changes and their impact on the management of MPM.

  17. [National French guidelines for management of infants with cystic fibrosis].

    Science.gov (United States)

    Sermet-Gaudelus, I; Couderc, L; Vrielynck, S; Brouard, J; Weiss, L; Wizla, N; Llerena, C; Lebourgeois, M; Bailly, C; Dirou, A; Renouil, M; Dalphin, M-L; Rault, G; Munck, A; Roussey, M

    2014-06-01

    These guidelines aim to standardize the care of infants diagnosed with a typical form of cystic fibrosis (CF) at neonatal screening. They have been implemented by the National Working Group for Neonatal Screening of the French Federation for CF and have been validated using the Delphi methodology by a large group of clinicians involved in the care of CF infants. These guidelines encompass management and organization of care at diagnosis and describe nutritional, digestive, and respiratory monitoring and treatment during the first 2 years of life. PMID:24815598

  18. Severe accident management. Optimized guidelines and strategies

    International Nuclear Information System (INIS)

    The highest priority for mitigating the consequences of a severe accident with core melt lies in securing containment integrity, as this represents the last barrier against fission product release to the environment. Containment integrity is endangered by several physical phenomena, especially highly transient phenomena following high-pressure reactor pressure vessel failure (like direct containment heating or steam explosions which can lead to early containment failure), hydrogen combustion, quasi-static over-pressure, temperature failure of penetrations, and basemat penetration by core melt. Each of these challenges can be counteracted by dedicated severe accident mitigation hardware, like dedicated primary circuit depressurization valves, hydrogen recombiners or igniters, filtered containment venting, containment cooling systems, and core melt stabilization systems (if available). However, besides their main safety function these systems often have also secondary effects that need to be considered. Filtered containment venting causes (though limited) fission product release into the environment, primary circuit depressurization leads to loss of coolant, and an ex-vessel core melt stabilization system as well as hydrogen igniters can generate high pressure and temperature loads on the containment. To ensure that during a severe accident any available systems are used to their full beneficial extent while minimizing their potential negative impact, AREVA has implemented a severe accident management for German nuclear power plants. This concept makes use of extensive numerical simulations of the entire plant, quantifying the impact of system activations (operational systems, safety systems, as well as dedicated severe accident systems) on the accident progression for various scenarios. Based on the knowledge gained, a handbook has been developed, allowing the plant operators to understand the current state of the plant (supported by computational aids), to predict

  19. Head injury management guidelines for general practitioners

    Directory of Open Access Journals (Sweden)

    Jeremy C Ganz

    2011-01-01

    Full Text Available A complete examination of a head injured patient in the hospital requires a number of instruments. These include a stethoscope, sphygmomanometer, ophthalmoscope, otoscope, cotton wool, safety pin, tuning fork, reflex hammer and a small key to test the plantar response. Few of these are required at the accident scene. This is because, in the hospital, the aim is optimal definitive treatment. At the accident scene, the aim is prevention of secondary injury, rapid recording of the most important findings and safe efficient transport to the hospital. This short paper reviews how the local doctor should undertake a neurosurgical assessment of traumatic brain injury patients. Moreover, the primary management at accident scenes is described and the rationale behind the approach is outlined

  20. Guidelines for screening, diagnosis and management of hemoglobinopathies

    Directory of Open Access Journals (Sweden)

    Kanjaksha Ghosh

    2014-01-01

    Full Text Available The β-thalassemias and sickle cell disorders are a major health burden in India. Diagnosis and management of these disorders both in adults and in newborns using appropriate approaches and uniform technology are important in different regions of a vast and diverse country as India. In view of a National Thalassemia Control Program to be launched soon, a need was felt for guidelines on whom to screen, cost-effective technologies that are to be used as well as for establishing prenatal diagnosis programs in regional centers. Newborn screening for sickle cell disorders is in its infancy in India and uniform approaches need to be followed. Also, included are guidelines for monitoring and managing patients who are now growing older and need comprehensive care as well as management of complications of the disease.

  1. Strategy Guideline: Quality Management in Existing Homes; Cantilever Floor Example

    Energy Technology Data Exchange (ETDEWEB)

    Taggart, J.; Sikora, J.; Wiehagen, J.; Wood, A.

    2011-12-01

    This guideline is designed to highlight the QA process that can be applied to any residential building retrofit activity. The cantilevered floor retrofit detailed in this guideline is included only to provide an actual retrofit example to better illustrate the QA activities being presented. The goal of existing home high performing remodeling quality management systems (HPR-QMS) is to establish practices and processes that can be used throughout any remodeling project. The research presented in this document provides a comparison of a selected retrofit activity as typically done versus that same retrofit activity approached from an integrated high performance remodeling and quality management perspective. It highlights some key quality management tools and approaches that can be adopted incrementally by a high performance remodeler for this or any high performance retrofit. This example is intended as a template and establishes a methodology that can be used to develop a portfolio of high performance remodeling strategies.

  2. Information Management Software: Guidelines for Decision-Making and Information Management Software--A Selected Bibliography.

    Science.gov (United States)

    Kazlauskas, Edward John; Ingebretsen, Dorothy L.

    1987-01-01

    Describes the categories of available information management software, and provides guidelines for needs assessment, software selection, testing, and evaluation. The annotated bibliography cites general discussions and program reviews for the following types of software: file management, general database management, bibliographic management,…

  3. Management of Transient Loss of Consciousness: National Institute for Health and Clinical Excellence Guideline

    Science.gov (United States)

    ... Summaries for Patients Management of Transient Loss of Consciousness: National Institute for Health and Clinical Excellence Guideline ... Excellence Guideline for Management of Transient Loss of Consciousness.” It is in the 18 October 2011 issue ...

  4. Implementation of anaphylaxis management guidelines: a register-based study.

    Directory of Open Access Journals (Sweden)

    Linus Grabenhenrich

    Full Text Available BACKGROUND: Anaphylaxis management guidelines recommend the use of intramuscular adrenaline in severe reactions, complemented by antihistamines and corticoids; secondary prevention includes allergen avoidance and provision of self-applicable first aid drugs. Gaps between recommendations and their implementation have been reported, but only in confined settings. Hence, we analysed nation-wide data on the management of anaphylaxis, evaluating the implementation of guidelines. METHODS: Within the anaphylaxis registry, allergy referral centres across Germany, Austria and Switzerland provided data on severe anaphylaxis cases. Based on patient records, details on reaction circumstances, diagnostic workup and treatment were collected via online questionnaire. Report of anaphylaxis through emergency physicians allowed for validation of registry data. RESULTS: 2114 severe anaphylaxis patients from 58 centres were included. 8% received adrenaline intravenously, 4% intramuscularly; 50% antihistamines, and 51% corticoids. Validation data indicated moderate underreporting of first aid drugs in the Registry. 20% received specific instructions at the time of the reaction; 81% were provided with prophylactic first aid drugs at any time. CONCLUSION: There is a distinct discrepancy between current anaphylaxis management guidelines and their implementation. To improve patient care, a revised approach for medical education and training on the management of severe anaphylaxis is warranted.

  5. Calcium spray dryer waste management: Design guidelines: Final report

    Energy Technology Data Exchange (ETDEWEB)

    1987-09-01

    Calcium spray drying is a commercially available and applied technology used to control SO/sub 2/ emissions. This process is rapidly gaining utility acceptance. Because physical and chemical properties of wastes generated by calcium spray drying differ from those of conventional coal combustion by-products (fly ash and scrubber sludge) typical waste management practices may need to be altered. This report presents technical guidelines for designing and operating a calcium spray drying waste management system. Waste transfer, storage, pretreatment/conditioning, transport and disposal are addressed. The report briefly describes eighteen existing or planned calcium spray drying waste management systems. Results of waste property tests conducted as part of this study, and test data from other studies are reported and compared. Conceptual designs of both new and retrofit calcium spray drying waste management systems also are presented to demonstrate the economic impact of spray drying on waste management. Parametric cost sensitivity analyses illustrate the impact of significant design parameters on waste management costs. Existing calcium spray drying waste management experiences, as well as spray drying waste property data provided the basis for guideline development. Because existing calcium spray drying facilities burn low sulfur coal, this report is considered applicable only to calcium spray drying wastes produced from low sulfur coal. At this time, calcium spray drying is not expected to be feasible for high sulfur coal applications.

  6. Comparative effectiveness of guidelines for the management of hyperlipidemia and hypertension for type 2 diabetes patients.

    Directory of Open Access Journals (Sweden)

    Nilay D Shah

    Full Text Available BACKGROUND: Several guidelines to reduce cardiovascular risk in diabetes patients exist in North America, Europe, and Australia. Their ability to achieve this goal efficiently is unclear. METHODS AND FINDINGS: Decision analysis was used to compare the efficiency and effectiveness of international contemporary guidelines for the management of hypertension and hyperlipidemia for patients aged 40-80 with type 2 diabetes. Measures of comparative effectiveness included the expected probability of a coronary or stroke event, incremental medication costs per event, and number-needed-to-treat (NNT to prevent an event. All guidelines are equally effective, but they differ significantly in their medication costs. The range of NNT to prevent an event was small across guidelines (6.5-7.6 for males and 6.5-7.5 for females; a larger range of differences were observed for expected cost per event avoided (ranges, $117,269-$157,186 for males and $115,999-$163,775 for females. Australian and U.S. guidelines result in the highest and lowest expected costs, respectively. CONCLUSIONS: International guidelines based on the same evidence and seeking the same goal are similar in their effectiveness; however, there are large differences in expected medication costs.

  7. Development of nursing management competencies: guidelines for continuous education services

    Directory of Open Access Journals (Sweden)

    Priscila Meyenberg Cunha Sade

    2015-12-01

    Full Text Available Abstract OBJECTIVE Developing continuing education guidelines for the development of nursing management competencies along with the members of the Center of Nursing Continuing Education of Parana. METHOD A qualitative research outlined by the action research method, with a sample consisting of 16 nurses. Data collection was carried out in three stages and data were analyzed according to the thematic analysis technique. RESULTS It was possible to discuss the demands and difficulties in developing nursing management competencies in hospital organizations and to collectively design a guideline. CONCLUSION The action research contributed to the production of knowledge, confirming the need and the importance of changing the educational processes and evaluations, based on methodologies and instruments for professional development in accordance with human resource policies and contemporary organizational policies.

  8. Guidelines on the management of patients treated with iodine-131

    International Nuclear Information System (INIS)

    The purpose of these guidelines is to assist health care institutions establish protocols for the management of patients treated with iodine-131. These guidelines are written primarily for the use of Na131I in the treatment of benign and malignant thyroid disease. The principles have some application for the use of complex 131I-labelled radiopharmaceuticals in that the treated patient will become a temporary radiation source and since contamination with body fluids of treated patients must be guarded against. The document outlines radiation protection and logistical concerns associated with the management of 131I patients before, during and after therapy. These concerns include the safety of health care personnel, visitors, and any other persons who are at risk; and protection of the environment. (L.L.) 23 refs., 2 tabs

  9. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies.

    Science.gov (United States)

    Eichenfield, Lawrence F; Tom, Wynnis L; Berger, Timothy G; Krol, Alfons; Paller, Amy S; Schwarzenberger, Kathryn; Bergman, James N; Chamlin, Sarah L; Cohen, David E; Cooper, Kevin D; Cordoro, Kelly M; Davis, Dawn M; Feldman, Steven R; Hanifin, Jon M; Margolis, David J; Silverman, Robert A; Simpson, Eric L; Williams, Hywel C; Elmets, Craig A; Block, Julie; Harrod, Christopher G; Smith Begolka, Wendy; Sidbury, Robert

    2014-07-01

    Atopic dermatitis is a common and chronic, pruritic inflammatory skin condition that can affect all age groups. This evidence-based guideline addresses important clinical questions that arise in its management. In this second of 4 sections, treatment of atopic dermatitis with nonpharmacologic interventions and pharmacologic topical therapies are reviewed. Where possible, suggestions on dosing and monitoring are given based on available evidence. PMID:24813302

  10. Development of nursing management competencies: guidelines for continuous education services

    OpenAIRE

    Priscila Meyenberg Cunha Sade; Aida Maris Peres

    2015-01-01

    Abstract OBJECTIVE Developing continuing education guidelines for the development of nursing management competencies along with the members of the Center of Nursing Continuing Education of Parana. METHOD A qualitative research outlined by the action research method, with a sample consisting of 16 nurses. Data collection was carried out in three stages and data were analyzed according to the thematic analysis technique. RESULTS It was possible to discuss the demands and difficulties in deve...

  11. European guideline for the management of pelvic inflammatory disease

    DEFF Research Database (Denmark)

    Ross, J; Judlin, P; Nilas, Lisbeth

    2007-01-01

    Pelvic inflammatory disease (PID) remains one of the most important consequences of sexually transmitted infections (STIs) resulting in severe morbidity and acting as the economic justification for STI screening programmes. Early and appropriate therapy has the potential to significantly reduce the...... long-term complications of PID, and these evidence-based guidelines provide advice on the management of pelvic infection including the use of appropriate antimicrobial regimens....

  12. Clinical Practice Guideline for the Management of Intracranial Aneurysms

    OpenAIRE

    Jeong, Hae Woong; Seo, Jung Hwa; Kim, Sung Tae; Jung, Cheol Kyu; Suh, Sang-il

    2014-01-01

    Purpose An intracranial aneurysm, with or without subarachnoid hemorrhage (SAH), is a relevant health problem. The rupture of an intracranial aneurysm is a critical concern for individual health; even an unruptured intracranial aneurysm is an anxious condition for the individual. The aim of this guideline is to present current and comprehensive recommendations for the management of intracranial aneurysms, with or without rupture. Materials and Methods We performed an extensive literature sear...

  13. European guideline for the management of pelvic inflammatory disease

    DEFF Research Database (Denmark)

    Ross, J; Judlin, P; Nilas, Lisbeth

    2007-01-01

    Pelvic inflammatory disease (PID) remains one of the most important consequences of sexually transmitted infections (STIs) resulting in severe morbidity and acting as the economic justification for STI screening programmes. Early and appropriate therapy has the potential to significantly reduce t...... long-term complications of PID, and these evidence-based guidelines provide advice on the management of pelvic infection including the use of appropriate antimicrobial regimens....

  14. Danish guidelines on management of otitis media in preschool children

    DEFF Research Database (Denmark)

    Heidemann, C. H.; Lous, J.; Berg, J.;

    2016-01-01

    Introduction: Otitis media is one of the most common diseases in small children. This underlines the importance of optimizing diagnostics and treatment of the condition. Recent literature points toward a stricter approach to diagnosing acute otitis media (AOM). Moreover, ventilating tube treatmen....... Conclusion: Recommendations for AOM diagnosis, surgical management for RAOM and COME, including the role of adenoidectomy and treatment of ventilating tube otorrhea, are proposed in the guideline....

  15. Safe ageing management of nuclear power plants: An European synthesis

    International Nuclear Information System (INIS)

    for the most important (nonreplaceable) components; generic evaluations of specific important issues on the main ageing phenomena. Comparisons of ageing management approaches cover the following aspects, according to IAEA AMAT guidelines: strategy, utility organisation, activities including methodologies, procedures, and surveillance programs, and monitoring and assessment. The various ageing phenomena have been identified, with possible evaluation and mitigation methods. Management strategies include: identification and prioritisation of components of importance to safety and plant life; selection and identification of significant ageing mechanisms; ageing prediction criteria; surveillance and periodic testing methods; mitigation of ageing effects; maintenance programs and updating of operating parameters. Other aspects including industrial obsolescence and human, organisation and knowledge ageing are also identified and recommendations expressed. Material ageing management programs are given to illustrate the above strategies. Taking into account the physical understanding of these phenomena, zones of components concerned and potential effects are identified, prediction laws established, surveillance programs prepared, criteria applied and mitigation methods proposed

  16. Diagnosis and management of idiopathic pulmonary fibrosis: French practical guidelines

    Directory of Open Access Journals (Sweden)

    Bruno Crestani

    2014-06-01

    Full Text Available Idiopathic pulmonary fibrosis (IPF is the most frequent chronic idiopathic interstitial pneumonia in adults. The management of rare diseases in France has been organised by a national plan for rare diseases, which endorsed a network of expert centres for rare diseases throughout France. This article is an overview of the executive summary of the French guidelines for the management of IPF, an initiative that emanated from the French National Reference Centre and the Network of Regional Competence Centres for Rare Lung Diseases. This review aims at providing pulmonologists with a document that: 1 combines the current available evidence; 2 reviews practical modalities of diagnosis and management of IPF; and 3 is adapted to everyday medical practice. The French practical guidelines result from the combined efforts of a coordination committee, a writing committee and a multidisciplinary review panel, following recommendations from the Haute Autorité de Santé. All recommendations included in this article received at least 90% agreement by the reviewing panel. Herein, we summarise the main conclusions and practical recommendations of the French guidelines.

  17. Aging management for CCW Hx

    International Nuclear Information System (INIS)

    In Kori 3.4 Unit, there are four Component Cooling Water Heat exchanger(CCW Hx) which has been operating since commercial operation('85). Utility have tried to maintain its original condition or performance through maintenance activities and monitoring activities such as eddy current test of heater tubes, tube sleeving and tube plugging during the refueling provided time of plant. But we can not maintain this equipment performance for plant life time(40 years) due to degradation of tubes wall thickness which is used a CuNi based material. Therefore we now have plan to retrofit this heater timely and to extend heater life times which is incorporated the sea water temperature increase, the corrosion resister tube material and the plant power uprating(thermal duty increase) in future. In here, we express our experience that how this heater was managed and what activities were taken with aging management as of today

  18. Aging management and life extension

    International Nuclear Information System (INIS)

    Approximately 20% of the present electric generating capacity in the United States is supplied by nuclear power plants and may be retired due to initial license expiration between the years 2002 and 2030. One of the recommended actions for implementing the National Energy Strategy (Bill H.R. 776) is license renewal of currently operating nuclear power plants which DOE has estimated would save between $800 million and $1 billion in avoided new construction costs - and represent a nationwide benefit of as much as $350 billion - assuming the licenses are renewed for 20 years. The U.S. Atomic Energy Act of 1954 limits the duration of operating licenses of nuclear power plants to a maximum of 40 years but permits their renewal. And, although Title 10, Part 50.51 of Code of Federal Regulations (10CFR50.51) permitted license renewal, it provided no standards or procedures for renewal applications. License renewal requirements were established on January 13, 1992 when NRC's Final Rule (10 CFR Part 54) went into effect. The Final rule established the requirements that an applicant for license renewal must meet, the information that must be submitted to the NRC for review. This involves the performance of an Integrated Plant Assessment (IPA) which is designed to ensure that the effects of aging on important equipment will be adequately managed during the renewal term. The issuance of 10 CFR Part 54 established the regulatory and legal requirements for license renewal. The technical basis for, or viability of, license renewal has been explored by the Electric Power Research Institute (EPRI) since the late 1970s/early 1980s. The NRC as well as industry organizations such as EPRI have studied aging effects for close to two decades. The NRC's research program on plant aging degradation, which began formally in the early 1980s, is a comprehensive effort for the understanding and management of age-related degradation in safety-related systems, structures, and components (SSCs) and

  19. Influence of Planetary Protection Guidelines on Waste Management Operations

    Science.gov (United States)

    Hogan, John A.; Fisher, John W.; Levri, Julie A.; Wignarajah, Kanapathipi; Race, Margaret S.; Stabekis, Perry D.; Rummel, John D.

    2005-01-01

    Newly outlined missions in the Space Exploration Initiative include extended human habitation on Mars. During these missions, large amounts of waste materials will be generated in solid, liquid and gaseous form. Returning these wastes to Earth will be extremely costly, and will therefore likely remain on Mars. Untreated, these wastes are a reservoir of live/dead organisms and molecules considered to be "biomarkers" i.e., indicators of life). If released to the planetary surface, these materials can potentially confound exobiology experiments and disrupt Martian ecology indefinitely (if existent). Waste management systems must therefore be specifically designed to control release of problematic materials both during the active phase of the mission, and for any specified post-mission duration. To effectively develop waste management requirements for Mars missions, planetary protection guidelines must first be established. While previous policies for Apollo lunar missions exist, it is anticipated that the increased probability of finding evidence of life on Mars, as well as the lengthy mission durations will initially lead to more conservative planetary protection measures. To facilitate the development of overall requirements for both waste management and planetary protection for future missions, a workshop was conducted to identify how these two areas interface, and to establish a preliminary set of planetary protection guidelines that address waste management operations. This paper provides background regarding past and current planetary protection and waste management issues, and their interactions. A summary of the recommended planetary protection guidelines, anticipated ramifications and research needs for waste management system design for both forward (Mars) and backward (Earth) contamination is also provided.

  20. [Scandinavian guidelines for prehospital management of severe traumatic brain injury

    DEFF Research Database (Denmark)

    Sollid, S.; Sundstrom, T.; Kock-Jensen, C.;

    2008-01-01

    Head trauma is the cause the death for many young persons. The number of fatalities can be reduced through systematic management. Prevention of secondary brain injury combined with the fastest possible transport to a neurosurgical unit, have been shown to effectively reduce mortality and morbidity....... Evidence-based guidelines already exist that focus on all steps in the process. In the present article members of the Scandinavian Neurotrauma Committee present recommendations on prehospital management of traumatic brain injury adapted to the infrastructure of the Nordic region Udgivelsesdato: 2008/6/26...

  1. The Saudi guidelines for the diagnosis and management of COPD

    Directory of Open Access Journals (Sweden)

    Javed H Khan

    2014-01-01

    Full Text Available The Saudi Thoracic Society (STS launched the Saudi Initiative for Chronic Airway Diseases (SICAD to develop a guideline for the diagnosis and management of chronic obstructive pulmonary disease (COPD. This guideline is primarily aimed for internists and general practitioners. Though there is scanty epidemiological data related to COPD, the SICAD panel believes that COPD prevalence is increasing in Saudi Arabia due to increasing prevalence of tobacco smoking among men and women. To overcome the issue of underutilization of spirometry for diagnosing COPD, handheld spirometry is recommended to screen individuals at risk for COPD. A unique feature about this guideline is the simplified practical approach to classify COPD into three classes based on the symptoms as per COPD Assessment Test (CAT and the risk of exacerbations and hospitalization. Those patients with low risk of exacerbation (<2 in the past year can be classified as either Class I when they have less symptoms (CAT < 10 or Class II when they have more symptoms (CAT ≥ 10. High-risk COPD patients, as manifested with ≥2 exacerbation or hospitalization in the past year irrespective of the baseline symptoms, are classified as Class III. Class I and II patients require bronchodilators for symptom relief, while Class III patients are recommended to use medications that reduce the risks of exacerbations. The guideline recommends screening for co-morbidities and suggests a comprehensive management approach including pulmonary rehabilitation for those with a CAT score ≥10. The article also discusses the diagnosis and management of acute exacerbations in COPD.

  2. Pain management in pediatric age group

    Directory of Open Access Journals (Sweden)

    R Namrata

    2009-01-01

    Full Text Available The management of pain in palliative care of children is somewhat different from that in adults.The use of opioids in pediatric palliative care presents some unique challenges. Confident and rational use of opioids, illustrated by WHO Guidelines is essential for adequate management of pain in children with life limiting conditions.

  3. Guidelines for the diagnosis, prevention and management of osteoporosis.

    Science.gov (United States)

    Rossini, M; Adami, S; Bertoldo, F; Diacinti, D; Gatti, D; Giannini, S; Giusti, A; Malavolta, N; Minisola, S; Osella, G; Pedrazzoni, M; Sinigaglia, L; Viapiana, O; Isaia, G C

    2016-01-01

    Osteoporosis poses a significant public health issue. National Societies have developed Guidelines for the diagnosis and treatment of this disorder with an effort of adapting specific tools for risk assessment on the peculiar characteristics of a given population. The Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS) has recently revised the previously published Guidelines on the diagnosis, riskassessment, prevention and management of primary and secondary osteoporosis. The guidelines were first drafted by a working group and then approved by the board of SIOMMMS. Subsequently they received also the endorsement of other major Scientific Societies that deal with bone metabolic disease. These recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on leading experts' experience and opinion, and on good clinical practice. The osteoporosis prevention should be based on the elimination of specific risk factors. The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk, and this is the case only when the risk of fracture is rather high as measured with variables susceptible to pharmacological effect. DeFRA (FRAX® derived fracture risk assessment) is recognized as a useful tool for easily estimate the long-term fracture risk. Several secondary forms of osteoporosis require a specific diagnostic and therapeutic management. PMID:27339372

  4. An observational study of compliance with the Scandinavian guidelines for management of minimal, mild and moderate head injury

    Directory of Open Access Journals (Sweden)

    Heskestad Ben

    2012-04-01

    Full Text Available Abstract Background The Scandinavian guidelines for management of minimal, mild and moderate head injuries were developed to provide safe and cost effective assessment of head injured patients. In a previous study conducted one year after publication and implementation of the guidelines (2003, we showed low compliance, involving over-triage with computed tomography (CT and hospital admissions. The aim of the present study was to investigate guideline compliance after an educational intervention. Methods We evaluated guideline compliance in the management of head injured patients referred to the University Hospital of Stavanger, Norway. The findings from the previous study in 2003 were communicated to the hospitals physicians, and a feed-back loop training program for guideline implementation was conducted. All patients managed during the months January through June in the years 2005, 2007 and 2009 were then identified with an electronic search in the hospitals patient administrative database, and the patient files were reviewed. Patients were classified according to the Head Injury Severity Scale, and the management was classified as compliant or not with the guideline. Results The 1 180 patients were 759 (64% males and 421 (36% females with a mean age of 31.5 (range 0-97 years. Over all, 738 (63% patients were managed in accordance with the guidelines and 442 (37% were not. Compliance was not significantly different between minimal (56% and mild (59% injuries, while most moderate (93% injuries were managed in accordance with the guidelines (p Conclusions This study shows higher guideline compliance after an educational intervention involving feed-back on performance. A substantial number of patients are exposed to over-triage, involving unnecessary radiation from CT examinations, and unnecessary costs from hospital admissions.

  5. Ageing management issues for HIFAR

    International Nuclear Information System (INIS)

    The management of ageing in HIFAR, a 35 year old tank-type heavy-water moderated reactor, requires, as in other aged reactors, attention to a diverse range of issues. In addition to the physical condition of the plant and its ability to function safely, these include satisfying changing regulartory requirements, updating safety and administrative documentation, maintaining essential staff skills, satisfying user requirements in the face of technical obsolescence of facilities and ensuring cost effective availability. The last two issues pose particular difficulties until a choice is made and time tables set to either sustain existing facilities or replace them with a new reactor or other technology. Investments in HIFAR over the past 20 years have focussed on incremental upgrades of safety related features. There has only been limited upgrading of production and experimental facilities. A choice must be made between refurbishing the reactor for operation to 2025 or its replacement in about 2003 with a new reactor or other technology. Assessments of key components - the reactor aluminium tank, graphite reflector and reactor steel tank - have indicated that there are no foreseeable life limiting problems for continued operation to 2025 in full compliance with safety requirements. Any unforseen situation in which either of the tanks could not continue in use would, however, place at risk the very large investments for refurbishment of the rest of the plant required to enable operation to 2025. This refurbishment also would not provide any significant upgrading of experimental facilities. The ongoing management of HIFAR requires timely decisions between the scenarios of early closure and refurbishment. Extension of operations to 2025 would involve major expenditures in the period to 2002 which would not be incurrent with respect to HIFAR operations if the reactor was to be closed at about that time. (orig.)

  6. Ageing management for systems, structures and components

    International Nuclear Information System (INIS)

    During operation, ageing will influence the quality of systems, structures and components (SSC). Experts make a distinction between the phenomena of conceptional ageing, technological ageing and physical ageing. The quality of SSC may be influenced by conceptional ageing, quality, technological or physical ageing. The contribution outlines the preconditions for a comprehensive, standardized ageing management of nuclear power stations in the Federal Republic of Germany. (orig.)

  7. Contrast medium extravasation injury: guidelines for prevention and management

    International Nuclear Information System (INIS)

    Extravasation of contrast material is a well-recognized complication of contrast-enhanced imaging studies. The management of this complication is contentious; therefore, the Contrast Media Safety Committee of The European Society of Urogenital Radiology decided to review the literature and issue guidelines. A comprehensive literature search was carried out. The resulting report was discussed at the 8th European Symposium on Urogenital Radiology in Genoa, Italy. Automated power injection may result in extravasation of large volumes and may or can lead to severe tissue damage. Infants, young children and unconscious and debilitated patients are particularly at risk of extravasation during contrast media injection. Fortunately, most extravasations result in minimal swelling or erythema, with no long-term sequelae; however, severe skin necrosis and ulceration may occur. Large volumes of high osmolar contrast media are known to induce significant tissue damage. Compartment syndrome may be seen associated with extravasation of large volumes. Conservative management is often adequate, but in serious cases the advice of a plastic surgeon is recommended. Based on the review simple guidelines for prophylaxis and management of contrast medium extravasation injuries are proposed. (orig.)

  8. Contrast medium extravasation injury: guidelines for prevention and management

    Energy Technology Data Exchange (ETDEWEB)

    Bellin, Marie-France; Tomassin, Isabelle [Department of Radiology, University Hospital P. Brousse, AP-HP, University of Paris 11, 14 Avenue Paul Vaillant-Couturier, 94804 Villejuif Cedex (France); Jakobsen, Jarl Aa. [Department of Radiology, Rikshospitalet, 0017 Oslo (Norway); Thomsen, Henrik S. [Department of Diagnostic Radiology 54E2, Copenhagen University Hospital at Herlev, Herlev Ringvej 75, 2730 Herlev (Denmark); Morcos, Sameh K. [Department of Diagnostic Imaging, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S5 7AU (United Kingdom)

    2002-11-01

    Extravasation of contrast material is a well-recognized complication of contrast-enhanced imaging studies. The management of this complication is contentious; therefore, the Contrast Media Safety Committee of The European Society of Urogenital Radiology decided to review the literature and issue guidelines. A comprehensive literature search was carried out. The resulting report was discussed at the 8th European Symposium on Urogenital Radiology in Genoa, Italy. Automated power injection may result in extravasation of large volumes and may or can lead to severe tissue damage. Infants, young children and unconscious and debilitated patients are particularly at risk of extravasation during contrast media injection. Fortunately, most extravasations result in minimal swelling or erythema, with no long-term sequelae; however, severe skin necrosis and ulceration may occur. Large volumes of high osmolar contrast media are known to induce significant tissue damage. Compartment syndrome may be seen associated with extravasation of large volumes. Conservative management is often adequate, but in serious cases the advice of a plastic surgeon is recommended. Based on the review simple guidelines for prophylaxis and management of contrast medium extravasation injuries are proposed. (orig.)

  9. Guidelines for the clinical management of familial adenomatous polyposis (FAP)

    DEFF Research Database (Denmark)

    Vasen, H.F.; Moslein, G.; Alonso, A.; Aretz, S.; Bernstein, I.; Bertario, L.; Blanco, I.; Bulow, S.; Burn, J.; Capella, G.; Colas, C.; Engel, C.; Frayling, I.; Friedl, W.; Hes, F.J.; Hodgson, S.; Jarvinen, H.; Mecklin, J.P.; Moller, P.; Myrhoi, T.; Nagengast, F.M.; Parc, Y.; Phillips, R.; Clark, S.K.; Leon, M.P. de; Renkonen-Sinisalo, L.; Sampson, J.R.; Stormorken, A.; Tejpar, S.; Thomas, H.J.; Wijnen, J.; Vasen, H F A; Möslein, G; Alonso, A; Aretz, S; Bernstein, Inge Thomsen; Bertario, L; Blanco, I; Bülow, Steffen; Burn, J; Capella, G; Colas, C; Engel, C; Frayling, I; Friedl, W; Hes, F J; Hodgson, S; Järvinen, H; Mecklin, J-P; Møller, P; Myrhøi, T; Nagensgast, F M; Parc, Y; Phillips, R; Clark, S K; Ponz de Leon, M; Renkonen-Sinisalo, L; Sampson, J R; Stormorken, A; Tejpar, S; Thomas, H J W; Wijnen, J

    2008-01-01

    BACKGROUND: Familial adenomatous polyposis (FAP) is a well-described inherited syndrome, which is responsible for <1% of all colorectal cancer (CRC) cases. The syndrome is characterised by the development of hundreds to thousands of adenomas in the colorectum. Almost all patients will develop CRC...... typical FAP. The gene is the MUTYH gene and the inheritance is autosomal recessive. In April 2006 and February 2007, a workshop was organised in Mallorca by European experts on hereditary gastrointestinal cancer aiming to establish guidelines for the clinical management of FAP and to initiate...

  10. Guidelines for assessing the knowledge management maturity of organizations

    Directory of Open Access Journals (Sweden)

    C. J. Kruger

    2007-11-01

    Full Text Available In a recent article Kruger and Snyman hypothesized that progressions in knowledge management maturity (from a strategic perspective are directly related to an increased ability to speed up the strategic cycle of imitation, consolidation and innovation. The arguments proposed, however, neglected to supply the reader with a practical toolkit or even a roadmap (a time-related matrix, or questionnaire to successfully measure succession in knowledge management maturity. This article builds on the previous one and proposes a questionnaire consisting of six sections, containing 101 descriptive questions, to enable organizations to test and assess their knowledge management maturity empirically. The development of an instrument to measure knowledge management maturity required adhering to a research design that combined theoretical propositions with practical experimentation. As a point of departure, a knowledge management maturity matrix consisting of seven maturity levels was formulated. All questions contained within the matrix were benchmarked against a survey questionnaire developed by the public management service of the OECD (PUMA and were also pre-tested and validated. This process of refinement led to the formulation of the Knowledge Management Maturity Questionnaire. To avoid any taint of this research being based only on theoretical propositions, the questionnaire was tested by 178 master students of the University of Pretoria, South Africa, in nine different industries. The proposed questionnaire provides a bridge between theoretical propositions and practical usability, not only enabling knowledge management practitioners to assess the level of knowledge management maturity reached successfully but, more importantly, also serving as a guideline to institutionalize further and future knowledge management endeavours.

  11. Do clinical guidelines improve general practice management and referral of infertile couples?

    OpenAIRE

    Emslie, C.; Grimshaw, J; Templeton, A.

    1993-01-01

    OBJECTIVE--To evaluate guidelines for general practice management and referral of infertile couples. Guidelines were implemented with a disease specific reminder at the time of consultation (the guidelines were embedded within a structured infertility management sheet for each couple). DESIGN--Pragmatic randomised controlled trial. Participating practices were randomised to a group that received the guidelines and a control group. SETTING--82 general practices in Grampian region. SUBJECTS--10...

  12. Implementing WHO Feeding Guidelines for Inpatient Management of Malnourished Children

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy of adopting WHO feeding guidelines on weight gain and case fatality rate in malnourished children. Study Design: Cross-sectional, observational study. Place and Duration of Study: Department of Pediatrics, Dow University of Health Sciences, Karachi, from 2009 to 2010. Methodology: Patients above 6 months and less than 5 years of age with severe malnutrition were included during the study period, acute complications were treated and nutritional rehabilitation by WHO feeding formulae was done. Demographic details, clinical features, reasons for weight gain and risk factors of mortality were analyzed. Results: A total of 131 children were included. Mean age of children was 22 +- 18 months. There were 78% marasmic, 4% kwashiorkor and marasmic kwashiorkor 18% children. Resolution of edema took 8 +- 4 days, dermatosis cleared in 11 +- 3 days. Mean hospital stay was 10 +- 8 days. Case fatality rate was 13%. Mean weight gain was 5.25 +- 4.57 g/kg/day. Weight gain of > 5 gm/kg/day was associated with hospital stay of more than 7 days, acceptability and palatability of feed by the children and mothers and early clearance of infections. Conclusion: Implementation of WHO feeding guidelines resulted in adequate weight gain of inpatient malnourished children, however, adequate healthcare services are available at the therapeutic feeding centers. (author)

  13. Guidelines for the Evaluation of Dementia and Age-Related Cognitive Change

    Science.gov (United States)

    American Psychologist, 2012

    2012-01-01

    Dementia in its many forms is a leading cause of functional limitation among older adults worldwide and will continue to ascend in global health importance as populations continue to age and effective cures remain elusive. The following guidelines were developed for psychologists who perform evaluations of dementia and age-related cognitive…

  14. An Ageing Management Programme for the SAFARI-1 Research Reactor

    International Nuclear Information System (INIS)

    The SAFARI-1 Research Reactor is a 20 MW high flux material test reactor and has been continuously operational for nearly 47 years. In this period, ageing of the facility has been addressed by means of various, mainly reactive, maintenance and upgrade initiatives to replace components that have become unmaintainable for various reasons such as wear, corrosion and obsolescence. With the facility now approaching 50 years of continuous operation, a programme has been implemented to assess, address and implement ageing management in a more formal and proactive manner. The programme conforms to the recently published IAEA Safety Guide SSG-10 Ageing Management for Research Reactors and makes extensive use of the guidelines set therein as well as other tools and methods developed in various international meetings and workshops at the IAEA for identifying ageing issues at the facility. The paper presents an outline of the methodology for implementing the ageing management programme at the SAFARI-1 research reactor. Identification of SSCs important to the safety and sustainability of the facility that are susceptible to ageing, the ageing mechanisms affecting them and the remedial actions identified to mitigate or remove the effects of ageing are discussed. A methodology for determining priorities is also elaborated. Remedial actions are divided into four groups: safety critical, mission critical, lifetime extension and organizational, and an implementation strategy is described. (author)

  15. The Saudi Initiative for Asthma - 2016 update: Guidelines for the diagnosis and management of asthma in adults and children

    Directory of Open Access Journals (Sweden)

    Mohamed S Al-Moamary

    2016-01-01

    Full Text Available This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan.

  16. Network Security: Policies and Guidelines for Effective Network Management

    Directory of Open Access Journals (Sweden)

    Jonathan Gana KOLO

    2008-12-01

    Full Text Available Network security and management in Information and Communication Technology (ICT is the ability to maintain the integrity of a system or network, its data and its immediate environment. The various innovations and uses to which networks are being put are growing by the day and hence are becoming complex and invariably more difficult to manage by the day. Computers are found in every business such as banking, insurance, hospital, education, manufacturing, etc. The widespread use of these systems implies crime and insecurity on a global scale. In addition, the tremendous benefits brought about by Internet have also widened the scope of crime and insecurity at an alarming rate. Also, ICT has fast become a primary differentiator for institution/organization leaders as it offers effective and convenient means of interaction with each other across the globe. This upsurge in the population of organizations depending on ICT for business transaction has brought with it a growing number of security threats and attacks on poorly managed and secured networks primarily to steal personal data, particularly financial information and password.This paper therefore proposes some policies and guidelines that should be followed by network administrators in organizations to help them ensure effective network management and security of ICT facilities and data.

  17. Clinical practice guidelines for the management of hypothyroidism

    Directory of Open Access Journals (Sweden)

    Gabriela Brenta

    2013-06-01

    Full Text Available INTRODUCTION: Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. OBJECTIVES: In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. MATERIALS AND METHODS: The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy. RESULTS: Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D. CONCLUSIONS: These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given.

  18. Introducing Systematic Aging Management for Interim Storage Facilities in Germany

    International Nuclear Information System (INIS)

    In Germany twelve at-reactor and three central (away from reactor) dry storage facilities are in operation, where the fuel is stored in combined transport-and-storage casks. The safety of the storage casks and facilities has been approved and is licensed for up to 40 years operating time. If the availability of a final disposal facility for the stored wastes (spent fuel and high-level wastes from reprocessing) will be further delayed the renewal of the licenses can become necessary in future. Since 2001 Germany had a regulatory guideline for at-reactor dry interim storage of spent fuel. In this guideline some elements of ageing were implemented, but no systematic approach was made for a state-of-the-art ageing management. Currently the guideline is updated to include all kind of storage facilities (central storages as well) and all kinds of high level waste (also waste from reprocessing). Draft versions of the update are under discussion. In these drafts a systematic ageing management is seen as an instrument to upgrade the available technical knowledge base for possible later regulatory decisions, should it be necessary to prolong storage periods to beyond the currently approved limits. It is further recognized as an instrument to prevent from possible and currently unrecognized ageing mechanisms. The generation of information on ageing can be an important basis for the necessary safety-relevant verifications for long term storage. For the first time, the demands for a systematic monitoring of ageing processes for all safety-related components of the storage system are described. In addition, for inaccessible container components such as the seal system, the neutron shielding, the baskets and the waste inventory, the development of a monitoring program is recommended. The working draft to the revised guideline also contains recommendations on non-technical ageing issues such as the long-term preservation of knowledge, long term personnel planning and long term

  19. Components selection for ageing management

    International Nuclear Information System (INIS)

    questionnaire for the systems to emphasize interfaces separation and repair possibilities during plant operation; Components screening, was realized evaluating at every system the effect of its component failure (local, at the system level, at the plant level). 3. Critical representative components As result of the screening resulted a lot of components to be monitored from ageing point of view. But some are redundant components or are similar and work in the same conditions. For this reason where chosen critical representative components. The conclusions on these representative components shall be applied also to the rest of the critical components. 4. Correlation with maintenance categories. As result of the components screening results: Critical components (from the safety and reliability point of view); for these components shall be applied Condition Oriented Preventive Maintenance; Non critical components; for these components shall be applied Corrective Maintenance (they are Run to Failure Components); If during plant operation result that for some critical components it is enough to realize maintenance based on the manufacturer instruction, shall be applied for them Time Oriented Preventive Maintenance (instead of Condition Oriented Preventive Maintenance). Of course this is the first selection. After some times of application at Cernavoda NPP of an ageing Management Program it shall be revised according to the results in operation. (author)

  20. Towards more Manageable Coastal Building; Initial Coastal Building Construction Guidelines

    Directory of Open Access Journals (Sweden)

    Roslan Talib

    2011-01-01

    Full Text Available Problem statement: As we may not be aware that the coastal construction is different from inland construction. Building in a coastal environment is different from building in an inland area. In general, buildings in coastal areas must be designed and built to withstand higher loads due to its more extreme conditions. Nowadays, the issue of global warming, uncertainty of global weather and the climate change effect indirectly creating the coastal area with much more expose to extreme condition. Formulate initial guidelines with certain degree of details how coastal construction requirements are different from those for inland construction. Approach: Due to the exposure to higher loads and extreme conditions, these structures in coastal areas will cost more to design, construct, maintain, repair and insure. Proper and right usage of building materials including electrical and mechanical equipments, are crucial in order to minimize damage. Nowadays, the issue of global warming, uncertainty of global weather and the climate change effect indirectly creating the coastal area with much more expose to extreme condition. Feedback has been gathered from the government local engineers who are doing the management of the Government’s local buildings located along the coastal area of Peninsular Malaysia. Data findings through research method, discussion with the suppliers and discussion with coastal buildings maintenance crews also has been done. Results: The research finding discus the specific characteristics that makes for successful coastal buildings focusing in tropical region. Conclusion: We must accept on the idea of building in coastal areas will require more maintenance and upkeep. By having proper coastal building guideline may create more positive awareness in constructing better management coastal buildings and can save time and money to maintain the said structures.

  1. Guidelines for the Management of Depression During Pregnancy

    OpenAIRE

    Kim, Deborah R; O’Reardon, John P.; Epperson, C. Neill

    2010-01-01

    Guidelines regarding the treatment of depression during pregnancy were recently published by the American Psychiatric Association and the American College of Obstetricians and Gynecologists. We provide a commentary on these guidelines.

  2. Effective maintenance practices to manage system aging

    International Nuclear Information System (INIS)

    For a variety of economic and technical reasons, there has been a growing concern with the aging of complex systems and components and the role that maintenance can play in reducing this degradation. A study for the Nuclear Regulatory Commission was recently undertaken to identify effective maintenance practices that could be adapted by the nuclear industry in the United States to assist in managing the aging degradation of plant systems and components. Four organizations were examined to assess the influence that their maintenance programs have on their ability to address the systems and component aging degradation issues. An effective maintenance program was found to be essential to the management of system and component aging. The four key elements of an effective maintenance program that are important to an aging management program were identified. These are: the selection of critical systems and components; the development of an understanding of aging through the collection and analysis of equipment performance information; the development of appropriate preventive and predictive maintenance tasks to manage equipment and system aging degradation; the use of feedback mechanisms to continuously improve the management of aging systems and components. These elements were found to be common to all four organizations. In examining how the four organizations have structured their maintenance programs to include these key elements provides valuable lessons not only for the nuclear power industry, but also for any industrial organization that is concerned with the management of system and component aging degradation. This document provides detail, of these studies

  3. Medical management of patients after bariatric surgery: Principles and guidelines

    Institute of Scientific and Technical Information of China (English)

    Abd; Elrazek; Mohammad; Ali; Abd; Elrazek; Abduh; Elsayed; Mohamed; Elbanna; Shymaa; E; Bilasy

    2014-01-01

    Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index(BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients(BMI ≥ 30 kg/m2) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m2 and those with BMI > 35 kg/m2 with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

  4. Are diabetes management guidelines applicable in ‘real life’?

    Directory of Open Access Journals (Sweden)

    Viana Luciana V

    2012-11-01

    Full Text Available Abstract Background The American Diabetes Association (ADA has published several diabetes treatment algorithms, but none have been tested in real-life settings. The aim of this study is to analyze the feasibility of achieving and/or maintaining HbA1c levels Methods A one-year, single-arm interventional study was conducted with type 2 diabetes patients in a primary care unit. Intervention consisted of intensification of lifestyle changes and sequential prescription of drugs based on ADA guidelines using the medications available through the publicly funded Unified Health System (Sistema Único de Saúde, SUS. Results Ninety patients (age: 62.7±10.4 years; diabetes duration: 8.2±9.1 years completed the trial. During the intervention period, increases were observed in number of oral antidiabetic agent (OAD classes per patient (1.50±0.74 vs. 1.67±0.7; p=0.015, OAD pills per patient (2.64±1.89 vs. 3.33±2.23 pills/patient; p 1c (7.2±1.6% vs. 7.3±1.5%; p=0.453 or frequency of patients on target, defined as HbA1c 1c 1c during the trial (6.3±0.4 vs. 6.7±0.9%; p=0.002. No such change was observed in those with baseline HbA1c ≥7%. Conclusions In this group of patients with a mean baseline HbA1c of 7.2%, implementation of 2006/2009 ADA/EASD guidelines led to achievement of the therapeutic goal of HbA1c

  5. Quality of guidelines on the management of diabetes in pregnancy: a systematic review

    OpenAIRE

    Greuter Marjolein JE; van Emmerik Nathalie MA; Wouters Maurice GAJ; van Tulder Maurits W

    2012-01-01

    Abstract Background Diabetes during pregnancy can lead to severe risks for both mother and fetus when it is not managed properly. The use of rigorously developed guidelines with a robust implementation process can have a positive influence on the management of diabetes during pregnancy. This study aims to compare recommendations and assess the quality of clinical guidelines on gestational diabetes mellitus (GDM) and pre-existing diabetes mellitus during pregnancy. Methods Guidelines were sele...

  6. Management of fibromyalgia syndrome – an interdisciplinary evidence-based guideline

    OpenAIRE

    Sommer, Claudia; Schiltenwolf, Marcus; Offenbächer, Martin; Nutzinger, Detlev; Kühn, Edeltraud; Köllner, Volker; Herrmann, Markus; Henningsen, Peter; Felde, Eva; Flügge, Christl; Eich, Wolfgang; Arnold, Bernhard; Häuser, Winfried; Thieme, Kati; Kopp, Ina

    2008-01-01

    The prevalence of fibromyalgia syndrome (FMS) of 1–2% in the general population associated with high disease-related costs and the conflicting data on treatment effectiveness had led to the development of evidence-based guidelines designed to provide patients and physicians guidance in selecting among the alternatives. Until now no evidence-based interdisciplinary (including patients) guideline for the management of FMS was available in Europe. Therefore a guideline for the management of fibr...

  7. Complex socio-technical systems: Characterization and management guidelines.

    Science.gov (United States)

    Righi, Angela Weber; Saurin, Tarcisio Abreu

    2015-09-01

    Although ergonomics has paid increasing attention to the perspective of complexity, methods for its operationalization are scarce. This study introduces a framework for the operationalization of the "attribute view" of complexity, which involves: (i) the delimitation of the socio-technical system (STS); (ii) the description of four complexity attributes, namely a large number of elements in dynamic interactions, a wide diversity of elements, unexpected variability, and resilience; (iii) the assessment of six management guidelines, namely design slack, give visibility to processes and outcomes, anticipate and monitor the impacts of small changes, monitor the gap between prescription and practice, encourage diversity of perspectives when making decisions, and create an environment that supports resilience; and (iv) the identification of leverage points for improving the STS design, based on both the analysis of relationships among the attributes and their classification as irreducible/manageable complexity, and liability/asset. The use of the framework is illustrated by the study of an emergency department of a University hospital. Data collection involved analysis of documents, observations of work at the front-line, interviews with employees, and the application of questionnaires. PMID:25959314

  8. Acceptance and perceived barriers of implementing a guideline for managing low back in general practice

    Directory of Open Access Journals (Sweden)

    Pfingsten Michael

    2008-02-01

    Full Text Available Abstract Background Implementation of guidelines in clinical practice is difficult. In 2003, the German College of General Practitioners and Family Physicians (DEGAM released an evidence-based guideline for the management of low back pain (LBP in primary care. The objective of this study is to explore the acceptance of guideline content and perceived barriers to implementation. Methods Seventy-two general practitioners (GPs participating in quality circles within the framework of an educational intervention study for guideline implementation evaluated the LBP-guideline and its practicability with a standardised questionnaire. In addition, statements of group discussions were recorded using the metaplan technique and were incorporated in the discussion. Results Most GPs agree with the guideline content but believe that guideline stipulations are not congruent with patient wishes. Non-adherence to the guideline and contradictory information for patients by other professionals (e.g., GPs, orthopaedic surgeons, physiotherapists are important barriers to guideline adherence. Almost half of the GPs have no access to recommended multimodal pain programs for patients with chronic LBP. Conclusion Promoting adherence to the LBP guideline requires more than enhancing knowledge about evidence-based management of LBP. Public education and an interdisciplinary consensus are important requirements for successful guideline implementation into daily practice. Guideline recommendations need to be adapted to the infrastructure of the health care system. Trial registration BMBF Grant Nr. 01EM0113. FORIS (database for research projects in social science Reg #: 20040116 25.

  9. Autonomous Aircraft Operations using RTCA Guidelines for Airborne Conflict Management

    Science.gov (United States)

    Krishnamurthy, Karthik; Wing, David J.; Barmore, Bryan E.; Barhydt, Richard; Palmer, Michael T.; Johnson, Edward J.; Ballin, Mark G.; Eischeid, Todd M.

    2003-01-01

    A human-in-the-loop experiment was performed at the NASA Langley Research Center to study the feasibility of DAG-TM autonomous aircraft operations in highly constrained airspace. The airspace was constrained by a pair of special-use airspace (SUA) regions on either side of the pilot's planned route. Traffic flow management (TFM) constraints were imposed as a required time of arrival and crossing altitude at an en route fix. Key guidelines from the RTCA Airborne Conflict Management (ACM) concept were applied to autonomous aircraft operations for this experiment. These concepts included the RTCA ACM definitions of distinct conflict detection and collision avoidance zones, and the use of a graded system of conflict alerts for the flight crew. Three studies were conducted in the course of the experiment. The first study investigated the effect of hazard proximity upon pilot ability to meet constraints and solve conflict situations. The second study investigated pilot use of the airborne tools when faced with an unexpected loss of separation (LOS). The third study explored pilot interactions in an over-constrained conflict situation, with and without priority rules dictating who should move first. Detailed results from these studies were presented at the 5th USA/Europe Air Traffic Management R&D Seminar (ATM2003). This overview paper focuses on the integration of the RTCA ACM concept into autonomous aircraft operations in highly constrained situations, and provides an overview of the results presented at the ATM2003 seminar. These results, together with previously reported studies, continue to support the feasibility of autonomous aircraft operations.

  10. Works on ageing management for Cernavoda NPP

    International Nuclear Information System (INIS)

    The document presents a general overview of the activities realized by CITON in the area of ageing management for Cernavoda NPP components. There are considered especially safety related components. The initial activity in this field started with general analyses of ageing phenomena implication on NPP safety and establishment of a general program for ageing management. During 1994-2000 period a series of research and development works included in 'Nuclear Safety Research and Development Program' financed by Ministry of Industry and Resources allowed the completion of important steps in ageing management: condition indicators definition, selection of systems and components necessary of ageing monitoring and evaluation, establishment of initial reference values for selected components monitoring, etc. Starting with 2001 year the ageing program includes evaluation of the service life for main of components (one system after the other approach), evaluation of present surveillance and data collection and proposal for improvement by computerized data acquisition and processing, extension of system, ageing evaluation for the whole plant critical components, both from safety and availability point of view. This program, with proper support and cooperation from the NPP owner, will allow first evaluation of the whole Cernavoda NPP - Unit 1 ageing, safety and availability implications and presentation of recommendations for operating conditions and maintenance optimization. The document emphasizes also the status of Cernavoda units, from ageing management point of view and the necessary actions to be adopted (in CITON opinion). (authors)

  11. Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Fujishiro, Mitsuhiro; Iguchi, Mikitaka; Kakushima, Naomi; Kato, Motohiko; Sakata, Yasuhisa; Hoteya, Shu; Kataoka, Mikinori; Shimaoka, Shunji; Yahagi, Naohisa; Fujimoto, Kazuma

    2016-05-01

    Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first-line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research. PMID:26900095

  12. Development and validation of Maanshan severe accident management guidelines

    International Nuclear Information System (INIS)

    Maanshan is a Westinghouse pressurized water reactor Nuclear Power Plant (NPP) located in south Taiwan. The Severe Accident Management Guideline (SAMG) of Maanshan NPP is developed based on the Westinghouse Owners Group (WOG) SAMG. The Maanshan SAMG is developed at the end of 2002. MAAP4 code is used as tool to validate the SAMG strategies. The development process and characteristics of Maanshan SAMG is described. A Station BlackOut (SBO) accident for Maanshan NPP which occurred in March 2001 is cited as a reference case for SAMG validation. A SBO accident is simulated first. The severe accident progression is simulated and the entry condition of SAMG is described. Mitigation actions are then applied to demonstrate the effect of SAMG. A RCS depressurization, RCS injection, and containment hydrogen reduction strategies are used to restore the system to a stable condition as power is recovered. Hot leg creep rupture is occurs during the mitigation action that is not considered in WOG SAMG. The effect of the RCS depressurization, RCS injection, and containment hydrogen reduction strategies are analyzed with MAAP4 code

  13. Czech Republic: National approach to ageing management

    International Nuclear Information System (INIS)

    The physical ageing of all structures and components is managed and the graduated approach is used for this purpose at Czech NPPs. This is assured by plant life management programme (PLIM). According to PLIM programme the power plant structures and components (SCs) are divided into three categories according to: − Safety importance; − Technological and economic importance; − Strategic importance for further operation

  14. Failing ageing? Risk management in the active ageing society

    DEFF Research Database (Denmark)

    Rostgaard, Tine

    2015-01-01

    According to the European Commission's recent policy initiative on social investment, Danish Long term care offers new and innovative perspectives in ageing and the management of the risks associated thereof with the introduction of reablement (rehabilitering). From the perspective of governmenta...

  15. Strategy Guideline: Quality Management in Existing Homes - Cantilever Floor Example

    Energy Technology Data Exchange (ETDEWEB)

    Taggart, J. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States); Sikora, J. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States); Wiehagen, J. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States); Wood, A. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States)

    2011-12-01

    This guideline is designed to highlight the QA process that can be applied to any residential building retrofit activity. The cantilevered floor retrofit detailed in this guideline is included only to provide an actual retrofit example to better illustrate the QA activities being presented.

  16. Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management.

    Science.gov (United States)

    Windfuhr, Jochen P; Toepfner, Nicole; Steffen, Gregor; Waldfahrer, Frank; Berner, Reinhard

    2016-04-01

    More than 120,000 patients are treated annually in Germany to resolve repeated episodes of acute tonsillitis. Therapy is aiming at symptom regression, avoidance of complications, reduction in the number of disease-related absences in school or at work, increased cost-effectiveness and improved quality of life. The purpose of this part of the guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through different conservative treatment options in order to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical management in terms of intracapsular as well as extracapsular tonsillectomy (i.e. tonsillotomy) is the subject of part II of this guideline. To estimate the probability of tonsillitis caused by β-hemolytic streptococci, a diagnostic scoring system according to Centor or McIsaac is suggested. If therapy is considered, a positive score of ≥3 should lead to pharyngeal swab or rapid test or culture in order to identify β-hemolytic streptococci. Routinely performed blood tests for acute tonsillitis are not indicated. After acute streptococcal tonsillitis, there is no need to repeat a pharyngeal swab or any other routine blood tests, urine examinations or cardiological diagnostics such as ECG. The determination of the antistreptolysin O-titer (ASLO titer) and other antistreptococcal antibody titers do not have any value in relation to acute tonsillitis with or without pharyngitis and should not be performed. First-line therapy of β-hemolytic streptococci consists of oral penicillin. Instead of phenoxymethylpenicillin-potassium (penicillin V potassium), also phenoxymethlpenicillin-benzathine with a clearly longer half-life can be used. Oral intake for 7 days of one of both the drugs is recommended. Alternative treatment with oral cephalosporins (e.g. cefadroxil, cefalexin) is indicated only in cases of penicillin failure, frequent recurrences, and whenever a more

  17. Critical Appraisal of Clinical Practice Guidelines for Age-Related Macular Degeneration

    Directory of Open Access Journals (Sweden)

    Annie M. Wu

    2015-01-01

    Full Text Available Purpose. To evaluate the methodological quality of age-related macular degeneration (AMD clinical practice guidelines (CPGs. Methods. AMD CPGs published by the American Academy of Ophthalmology (AAO and Royal College of Ophthalmologists (RCO were appraised by independent reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE II instrument, which comprises six domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, and Editorial Independence, and an Overall Assessment score summarizing methodological quality across all domains. Results. Average domain scores ranged from 35% to 83% for the AAO CPG and from 17% to 83% for the RCO CPG. Intraclass correlation coefficients for the reliability of mean scores for the AAO and RCO CPGs were 0.74 and 0.88, respectively. The strongest domains were Scope and Purpose and Clarity of Presentation. The weakest were Stakeholder Involvement (AAO and Editorial Independence (RCO. Conclusions. Future AMD CPGs can be improved by involving all relevant stakeholders in guideline development, ensuring transparency of guideline development and review methodology, improving guideline applicability with respect to economic considerations, and addressing potential conflict of interests within the development group.

  18. Ageing management in German nuclear power plants

    International Nuclear Information System (INIS)

    In Germany the term ageing management comprises several aspects. A demand for a special 'ageing monitoring' programme is not explicitly contained in the regulations. However, from the Atomic Energy Act and its regulations results the operator's obligation to perform extensive measures to maintain the quality of the plant and the operating personnel working in the plant. From this point of view, comprehensive ageing management in German nuclear power plants has taken place right from the start under the generic term of quality assurance. (orig.)

  19. Ageing management in German nuclear power plants

    International Nuclear Information System (INIS)

    In Germany, the term 'ageing management' comprises several aspects. A demand for a special ageing monitoring programme is not explicitly contained in the regulations. However, from the Atomic Energy Act and its regulations results the operator's obligation to perform extensive measures to maintain the quality of the plant and the operating personnel working in the plant. From this point of view, comprehensive ageing management in German nuclear power plants has taken place right from the start under the generic term of quality assurance. (author)

  20. Diabetes management in Australian rural aged care facilities: A cross-sectional audit

    Directory of Open Access Journals (Sweden)

    Hanan Khalil

    2012-11-01

    Full Text Available AbstractBackground There is gap in the literature regarding the current practice of diabetes management of the elderly in Australia and its compliance with available Australian diabetes practice guidelines. Aims The aims of this study were to describe the pharmacological management of elderly residents with diabetes living in aged care facilities and to identify areas for improvement in the current management as recommended by the current diabetes management guidelines in Australia. Method Residents with diabetes from three rural aged care facilities were identified by nursing staff. A cross-sectional medical record audit was carried out to obtain data of residents diagnosed with diabetes. Thirty-four medical records were audited from three aged care facilities. Data including demographics, medical histories and medications were collected and analysed Results This study had two key findings; Firstly, it showed that about a third of residents with type 2 diabetes are managed with diet only. Secondly, of the residents who are managed with medications, less than half of those audited (41% were managed according to the current diabetes guidelines in terms of pharmacological treatment which included anti- hypertensive, lipid lowering and anti- platelet therapies. Of those patients with a history of CVD, all were receiving an antihypertensive medication, 71% were not managed for their lipids and 20% were not on any prophylactic anti-platelet therapy. Conclusion Management of patients with diabetes living in rural aged care facilities is inconsistent with the current management guidelines. Educational interventions targeting health professionals and patients might be beneficial to increase compliance with the current diabetes guidelines.

  1. Age Management Principles in Czech Agrarian Sector

    Directory of Open Access Journals (Sweden)

    H. Urbancová

    2014-09-01

    Full Text Available Within the frame of the entire economy, the modern conception of Age Management enables each and every employee to use their full potential without being put at a disadvantage for age reasons. Despite the fact that this area is important in terms of current demographic development, there are organisations that do not implement its measures. The article therefore concentrates on the identification and evaluation of Age Management application by Czech agricultural businesses. The data analysed was obtained based on a quantitative survey in which data was collected by means of a questionnaire survey (total companies: n=315, agricultural businesses: na=60. The outcomes show that Czech agricultural businesses are not quite familiar with the application of Age Management measures. One of the conclusions of the article is that from the social point of view Age Management measures may help improve the situation on the labour market, labour productivity, encourage young people to work in the agricultural sector and, last but not least, build, on the organisational level, an employer’s brand. Application of Age Management causes on the employees performance but also on the costs reduce and profit increase. This contribution is a follow-up to the project of University – wide internal grant agency (CIGA, number 20141002 - Human resource branding using of the new strategic trends in organisations in the Czech Republic.

  2. The nuclear power plant aging management process

    International Nuclear Information System (INIS)

    Aging management is not an end product rather it is a process that can be used by utilities to collect pertinent data; to assess the life of systems, structures, and components; to develop and assess alternative aging management strategies; and to implement strategies that provide the maximum economic and safety benefits at the least cost. Aging management is a process for: determining current component condition through data collection techniques such as D and M, inservice inspection, trending, and materials research; evaluating data obtained using various life assessment methods; calculating the end of functional life from estimates of functional degradation over time; identifying and implementing actions to maintain or improve plant safety and economics. The time-dependent rate of change in the condition of equipment is the governing parameter in the life assessment process; it has to be determined by aging management techniques as a part of the integrated aging management process. The aging management process provides benefits to a utility and its customers by maintaining or improving plant performance and safety. A systematic and well-planned program is required to: determine critical systems, structures, and components and their priority ranking; predict end of functional life for critical components; determine adequacy of operating and maintenance procedures and practices; recommend necessary improvements and implement them during scheduled refueling outages; provide documented justification for optimal set of performance improvement activities A number of tools and techniques that add value in the aging management process have been or are being developed. These tools offer economic and safety benefits to plant owners

  3. Development of regulatory guide for review of aging management of the operating NPP

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Tae Myung; Lee, Jae Kyung [Cheongju Univ., Cheongju (Korea, Republic of); Kim, Young Ryul [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

    2001-03-15

    This is the final report of the second year study. Based on the first year study, proposal of revised guidelines, analysis of revised or newly issued IAEA safety guides and reference guidelines of developed countries, and proposal of detailed guidelines of aging management in PSR have been performed in the second year study. The summary of results in the study so far can be summarized as below, overall view on PSR and idea of effective domestic application were leaded through additional investigation and comparison of legal basis, experiences and current status of PSR implementation among the countries having operating NPPs including Korea. Strategies of adequate application of PSR are roughly reevaluated and totally reestablished in summary from the analysis in factor by factor basis of PSR implementation experience in foreign countries and background of IAEA guidelines. Models and draft framework of PSR report in the first year study were summarized and reevaluated, and structure and outline options of PSR guidelines for judging the PSR report are newly proposed with comparison of their strengths and weaknesses based on the first year study. Among the opt ions, guidelines framework equivalent to the PSR report was picked up as the best. For the judgement of aging management, the most appropriate one was chosen for the detailed judgement of aging management review in our PSR being based on the Standard Review Plan for License Renewal (SRP-LR) in United States considering potential future usage in the judgement for continued operation of old NPP at the time of expiration of its design life. A draft PSR guidelines is prepared and attached by revision of basic guidelines issued in 2000, considering the issues discussed for the draft revision of IAEA PSR guide, the draft IAEA document about 'experience of PSR implementation of member states', and the characteristics of Hungarian PSR Guidelines.

  4. Ageing management of concrete structure

    International Nuclear Information System (INIS)

    It is a generally accepted fact that while designing a concrete structure the durability parameters of construction materials should be evaluated as carefully as possible like other properties such as mechanical, physical and chemical properties. No material is inherently durable as result of environmental interaction with microstructure and consequently, the properties of the materials change with time due to weathering action, chemical attack, abrasion or any mode of degradation. The main cause of ageing on structure, water, which is primary for both creation and destruction on many natural materials. In porous materials, water creates different types of physical and chemical process of degradation. The water movement through porous materials are controlled by the permeability of the respective materials. The rate of deterioration is affected by type of concentration of ions present in the water and chemical deposition of materials. Controlling weathering action, chemical attack, abrasion and selecting good quality construction material and methods of construction can increase the service life of the structure. (author)

  5. An audit of distribution and use of guidelines for management of head injury.

    OpenAIRE

    Madhok, R; Thomson, R G; Mordue, A.; Mendelow, A D; Barker, J

    1993-01-01

    Ensuring effective distribution of guidelines is an important step towards their implementation. To examine the effectiveness of dissemination of a guidelines card on management of head injury and determine its usefulness to senior house officers (SHOs), a questionnaire survey was performed in May 1990, after distribution of the cards in induction packs for new doctors and at postgraduate lectures and displaying the guidelines in accident and emergency departments and wards. A further survey,...

  6. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries

    DEFF Research Database (Denmark)

    Diangelis, Anthony J; Andreasen, Jens O; Ebeleseder, Kurt A;

    2012-01-01

    clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary...... goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented....

  7. Ageing management and equipment qualification

    International Nuclear Information System (INIS)

    The knowledge of how the environment and load of organic material in general and especially polymers and lubricants, is affecting the degradation of important properties, have increased during the last decade. However the restrictions using established additives like some color pigments due to their poisonousness e.g. pigments based at cadmium, lead, mercury etc. have caused problems when replacing additives to polymers. The replacement additives have often been used in new design without going through the required material qualification procedure. There have also been observed that some non-qualified and non-approved materials have been installed in some power plants due to false documentation. There are also a lot of new manufacturers, of materials similar to the previously qualified materials, active at the market. This increases the difficulty to ensure that the required material quality is used. New materials, new additives and new manufacturers makes if more and more difficult to assure that the expected material is present. This causes more strict demands of how the new materials often used in equipment at type-testing and in replacement materials are analyzed and documented. By implementing new steps for chemical, mechanical and electrical analysis and increase the general quality assurance content this issue can be managed. (authors)

  8. Guidelines for a palliative approach for aged care in the community setting: a suite of resources

    Directory of Open Access Journals (Sweden)

    David C. Currow

    2012-11-01

    Full Text Available AbstractIn Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary. The Guidelines for a Palliative Approach for Aged Care in the Community Setting were published by the Australian Government Department of Health and Ageing to inform practice in this area. There are three resource documents. The main document provides practical evidence based guidelines, good practice points, tools, and links to resources. This document is written for general practitioners, nurses, social workers, therapists, pastoral care workers, and other health professionals and responded to needs identified during national consultation. Evidence based guidelines were underpinned by systematic reviews of the research literature. Good practice points were developed from literature reviews and expert opinion. Two ‘plain English’ booklets were developed in a process involving consumer consultation; one is for older people and their families, the other for care workers. The resources are intended to facilitate home care that acknowledges and plans for the client’s deteriorating functional trajectory and inevitable death. At a time when hospitals and residential aged care facilities are under enormous pressure as the population ages, such a planned approach makes sense for the health system as a whole. The approach also makes sense for older people who wish to die in their own homes. Family needs are recognised and addressed. Unnecessary hospitalisations

  9. Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement

    OpenAIRE

    Chen, RC; Rumble, RB; Loblaw, DA; Finelli, A.; Ehdaie, B; Cooperberg, MR; Morgan, SC; Tyldesley, S; Haluschak, JJ; Tan, W.; Justman, S; Jain, S

    2016-01-01

    To endorse Cancer Care Ontario's guideline on Active Surveillance for the Management of Localized Prostate Cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations.The Active Surveillance for the Management of Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and the recommenda...

  10. Antibiotic Stewardship: Reassessment of Guidelines for Management of Neonatal Sepsis

    Science.gov (United States)

    Cotten, C. Michael

    2016-01-01

    Since publication of the first Guidelines to Prevent Perinatal Group B Strep (GBS) disease in 1996, the incidence and mortality from early onset sepsis (EOS), and particularly GBS, the leading cause of EOS, has drastically decreased. In 2010, the Centers for Disease Control (CDC) provided updated Guidelines for the prevention of perinatal Group B streptococcal disease. In 2012, the AAP Committee on Fetus and Newborn (COFN) provided a Clinical Report that provided a thorough review of EOS and voiced overall support of the 2010 CDC Guidelines. In addition, the COFN authors suggested an approach different from the 2010 CDC Guidelines for at-risk asymptomatic infants. The COFN also ventured into the uncertain territory of recommending longer duration of empirical antibiotic treatment for asymptomatic infants with negative cultures, but abnormal CBC and/or CRP values. With the current focus on antibiotic stewardship, the 2012 COFN Clinical Report algorithms evoked questions from the Neonatology community. The COFN has recently responded with modified recommendations for empirical antibiotic duration and explanations for the recommendations for use of antibiotics in subgroups of infants for whom the CDC did not recommend starting antibiotics. Our goal in this article is to review the 2010 CDC and 2012 COFN guidelines and COFN's recently published guideline modifications and discuss mechanisms that may reduce the number of term and near term infants to be started on antibiotics. PMID:25678005

  11. Guidelines for acute management of hyperammonemia in the Middle East region

    Directory of Open Access Journals (Sweden)

    Alfadhel M

    2016-03-01

    Full Text Available Majid Alfadhel,1,2 Fuad Al Mutairi,1,2 Nawal Makhseed,3 Fatma Al Jasmi,4 Khalid Al-Thihli,5 Emtithal Al-Jishi,6 Moeenaldeen AlSayed,7 Zuhair N Al-Hassnan,7,8 Fathiya Al-Murshedi,5 Johannes Häberle,9 Tawfeg Ben-Omran10 Middle East Hyperammonemia and Urea Cycle Disorders Scientific Group (MHUSG 1Department of Pediatrics, Division of Genetics, 2King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 3Department of Pediatrics, Jahra Hospital, Ministry of Health, Jahra City, Kuwait; 4Department of Pediatric, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates; 5Genetic and Developmental Medicine Clinic, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman; 6Salmaniya Medical Complex, Arabian Gulf University, Manama, Bahrain; 7Department of Medical Genetics, King Faisal Specialist Hospital & Research Center, 8The National Newborn Screening Program, Ministry of Health, Riyadh, Saudi Arabia; 9Department of Pediatrics, Division of Metabolism and Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland; 10Division of Clinical and Metabolic Genetics, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar Background: Hyperammonemia is a life-threatening event that can occur at any age. If treated, the early symptoms in all age groups could be reversible. If untreated, hyperammonemia could be toxic and cause irreversible brain damage to the developing brain.Objective: There are major challenges that worsen the outcome of hyperammonemic individuals in the Middle East. These include: lack of awareness among emergency department physicians about proper management of hyperammonemia, strained communication between physicians at primary, secondary, and tertiary hospitals, and shortage of the medications used in the acute management of hyperammonemia. Therefore, the urge to develop regional guidelines is

  12. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy

    DEFF Research Database (Denmark)

    Lalla, Rajesh V; Bowen, Joanne; Barasch, Andrei;

    2014-01-01

    BACKGROUND: Mucositis is a highly significant, and sometimes dose-limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines...... clinicians provide evidence-based management of mucositis secondary to cancer therapy....... criteria. The body of evidence for each intervention, in each treatment setting, was assigned a level of evidence, based on previously published criteria. Guidelines were developed based on the level of evidence, with 3 possible guideline determinations: recommendation, suggestion, or no guideline possible...

  13. Operational and materials aspects of aging management

    International Nuclear Information System (INIS)

    Understanding degradation phenomena and managing the detrimental effects of aging are important aspects of commercial nuclear power plant operations. Potential for materials degradation should be considered early in the design and development stages; during manufacturing, construction, and installation; and during all aspects of plant operation and maintenance. This would lead to increased reliability during plant operations, and would reduce the need for mitigating actions and unplanned maintenance. Thus, it is necessary to instill a culture at the technical, administrative, and management levels that continually asks, 'What happens with time?' The answer to this question is central to the continuous safe and economical operation of nuclear power plants. Based on the past 25 years of aging-related research at the U.S. Nuclear Regulatory Commission (NRC), the authors present an overview of the key elements of understanding and managing aging, and how they should be integrated for safe and economical power plant operation. The focus of this paper is hardware-oriented engineering and aging of materials. The paper discusses previous and ongoing NRC research studies on non-destructive examination and materials degradation that can be applied for proactive management of materials degradation and aging during plant operations. (author)

  14. Ageing management for reactor TRIGA PUSPATI

    International Nuclear Information System (INIS)

    The probability of a component, system or structure failure resulting from ageing degradation normally increases with the time of exposure to service condition unless countermeasures are taken. The objective of the management of ageing is to determine and apply these countermeasures. The Reactor TRIGA PUSPATI ageing management includes activities such as protection, repair, refurbishment or replacement, which are similar to other activities carried out at a reactor facility during routine maintenance or when a modification project takes place. However, it is important to distinguish between these different activities, because the management of ageing requires the use of methodology which will detect and evaluate deficiencies produced by the service conditions and will lead to the application of countermeasures for prevention and mitigation of the deficiencies. One approach to this methodology is a determination that the reactor systems and components can perform their safety functions during their service life and under the service conditions. This can be achieved through appropriately selecting systems and components which should be included in long term surveillance program, through data collection and through evaluation of the potential ageing effects. The above activities will be followed by countermeasures for prevention and mitigation of the ageing effects to ensure an adequate level of safety for the reactor facility. (author)

  15. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants - 2010 update

    DEFF Research Database (Denmark)

    Sweet, David G; Carnielli, Virgilio; Greisen, Gorm;

    2010-01-01

    Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report the updated recommendations of a European panel of expert neonatologists who had developed consensus guidelines after critical examination of the most up...

  16. Consensus guidelines for the management of hepatitis C infection.

    Science.gov (United States)

    2003-07-01

    At prevalence of 2.7% in the early 1990's, it is estimated that approximately 500,000 people in Saudi Arabia have been exposed to the hepatitis C virus (HCV). Over 80% of such individuals remain infected and most of them progress to chronic hepatitis C (CHC), cirrhosis, and/or hepatocellular carcinoma (HCC). The incidence of newly acquired hepatitis C infection in Saudi Arabia has declined with the recent reported prevalence of approximately 1%. This decline is largely due to the early implementation of testing of blood donors for HCV. However, it is pertinent that measures are taken to identify patients already infected and offer treatment to those with good prognostic factors. Hepatitis C genotype 4, the most predominant genotype in Saudi Arabia (62%) has been resistant to conventional interferon (IFN) therapy and sustained response rate to combination therapy with IFN plus ribavirin (RBV) has been poor. The recently completed Ministry of Health (MOH) clinical trial reports improved sustained virological response (SVR) rate of 65.2% among week 12 early responders of HCV genotype 4 chronic hepatitis patients using pegylated (PEG)-IFN alfa-2a (40 KD) plus RBV. This encouraging process calls for a change in patient management towards a more community-based approach. With the aim of assessing these changes and defining a management strategy for HCV infected patients in Saudi Arabia, a consensus conference was held and consensus guidelines issued. The final recommendation will be made available to all MOH, tertiary and non-government hospitals in the Kingdom to provide uniform care to all CHC patients. Based on the SVR of the above mentioned clinical trial, the committee recommends treatment for patients with histologically proven CHC, with elevated serum alanine aminotransferase (ALT) and positive HCV ribonucleic acid (RNA). Patients with normal serum ALT may not be treated if liver histology is normal or reveals only minimal changes. Patients with decompensated

  17. Research projects on life management: materials ageing

    International Nuclear Information System (INIS)

    Materials ageing is a time-dependent process, that involves the loss of availability of nuclear plants. Radiation embrittlement, stress corrosion cracking, irradiation assisted stress corrosion cracking, and thermal ageing are the most relevant time-dependent material degradation mechanisms that can be identified in the materials ageing process. The Materials Programme of Nuclear Energy Institute at CIEMAT carries out research projects and metallurgical examinations of failed components to gain some insight into the mechanisms of materials degradation with a direct impact on the life management of nuclear plants. (Author)

  18. Development of a Smartphone Application for Clinical-Guideline-Based Obesity Management

    OpenAIRE

    Jeon, Eunjoo; Park, Hyeoun-Ae

    2015-01-01

    Objectives The purpose of the study was to develop and evaluate a clinical-guideline-based smartphone application ('app') for obesity management. Methods Obesity-related knowledge and functional requirements were extracted from clinical practice guidelines, a literature review, and consultations with experts. The extracted knowledge was used to design obesity-management algorithms, and the functions of the developed app are presented through a use case diagram and activity diagrams. The datab...

  19. Implementing NCEP guidelines in a Web-based disease-management system.

    OpenAIRE

    Tsui, F. C.; Wagner, M.; Thompson, M. E.

    1997-01-01

    DMS is a Web-based disease-management system, which facilitates easy access for users and close connection to hospital information systems, based on clinical practice guidelines. Currently we are prototyping DMS in the area of hyperlipidemia management. However our approach is general. For each office visit, DMS generates an encounter form with recommendations based on the National Cholesterol Education Program (NCEP) guidelines. In between visits, DMS provides email notifications to clinicia...

  20. An assessment of clinical guidelines for the management of acute pancreatitis.

    OpenAIRE

    S. A. Norton; Cheruvu, C. V.; Collins, J.; Dix, F. P.; Eyre-Brook, I. A.

    2001-01-01

    BACKGROUND: Recent guidelines have been issued for the management of acute pancreatitis. The aim of this study was to audit the management of acute pancreatitis in one district general hospital, to determine the problems and benefits associated with the implementation of such guidelines. METHODS: Data were collected over the period 1991-1995 for all patients diagnosed as having acute pancreatitis who were admitted to one district general hospital. Data regarding severity grading, determinatio...

  1. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for testicular germ cell tumors

    Directory of Open Access Journals (Sweden)

    Mohammed Alotaibi

    2016-01-01

    Full Text Available This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with testicular germ cell tumors. It is categorized according to the stage of the disease using the tumor-node-metastasis staging system 7th edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with testicular germ cell tumors.

  2. Saudi oncology society and Saudi urology association combined clinical management guidelines for prostate cancer

    Directory of Open Access Journals (Sweden)

    Ashraf Abusamra

    2016-01-01

    Full Text Available This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with prostate cancer. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors who were selected by the Saudi oncology society and Saudi urological association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with adenocarcinoma of the prostate to.

  3. General practitioners' management of acute back pain: a survey of reported practice compared with clinical guidelines.

    OpenAIRE

    Little, P; Smith, L; Cantrell, T.; Chapman, J.; Langridge, J; R. Pickering

    1996-01-01

    OBJECTIVE: To compare general practitioners' reported management of acute back pain with 'evidence based' guidelines for its management. DESIGN: Confidential postal questionnaire. SETTING: One health district in the South and West region. SUBJECTS: 236 general practitioners; 166 (70%) responded. OUTCOME MEASURES: Examination routinely performed, 'danger' symptoms and signs warranting urgent referral, advice given, and satisfaction with management. RESULTS: A minority of general practitioners ...

  4. Aging management of nuclear fuel pool structures

    International Nuclear Information System (INIS)

    The long-term operations of a nuclear power plant (NPP) are currently impacted by the utility's capabilities with respect to spent fuel storage. Available options for the safe, long-term storage of spent fuel are quite limited; as such, maximized usage of existing on-site storage capacity (NPP) is quite important. The service life of existing fuel pool structures may be determined by a number of operations or age-related events. Management of these events is often critical to the structure's integrity and durability. From an operations vantage point, aging management relates to such characteristics as storage capacity, performance of pool water treatment systems, and physical liner damage. Primary issues related to structural integrity include materials degradation and environmental enclosure factors. The development of an effective aging management program should address both operational and structural issues. The goal of this paper is to provide recommendations for pool structure aging management, with benefits to both short and long-term, or extended life, operations. Because of their critical nature, the report will focus on spent fuel pools. Many of the concepts generated in this report may also be applied to other NPP pool structures (i.e., new fuel pools, reactor internals pits and transfer canals) because of similar physical/environmental effects

  5. AREVA-Aging Management Concepts and Tools

    International Nuclear Information System (INIS)

    n case of long term operation (LTO) it is necessary to ensure that safety and safety relevant systems, structures and components continue to perform their intended functions during long term operation. In order to fulfill these requirements a plant-wide and systematic Aging and Plant Life Management is essential. (Author)

  6. Adherence to evidence-based guidelines among diabetes self-management apps

    OpenAIRE

    Jessica Y. Breland; Yeh, Vivian M.; Yu, Jessica

    2013-01-01

    Smartphone apps can provide real-time, interactive self-management aid to individuals with diabetes. It is currently unclear whether existing diabetes self-management apps follow evidence-based guidelines. The purpose of this study was to evaluate the extent to which existing diabetes self-management apps address the seven self-management behaviors recommended by the American Association of Diabetes Educators (the AADE7™). The term “diabetes” identified relevant self-management apps via the A...

  7. From Paper Based Clinical Practice Guidelines to Declarative Workflow Management

    DEFF Research Database (Denmark)

    Lyng, Karen Marie; Hildebrandt, Thomas; Mukkamala, Raghava Rao

    2009-01-01

    We present a field study of oncology workflow, involving doctors, nurses and pharmacists at Danish hospitals and discuss the obstacles, enablers and challenges for the use of computer based clinical practice guidelines. Related to the CIGDec approach of Pesic and van der Aalst we then describe how...

  8. Essence of the revised guideline for the management of hyperuricemia and gout.

    Science.gov (United States)

    Yamanaka, Hisashi; Metabolism, The Guideline Revising Committee Of Japanese Society Of Gout And Nucleic Acid

    2012-07-01

    Hyperuricemia and gout are common diseases that can be treated by general and family physicians, but with the wide range of diagnosis and treatment departments that treat them, these are diseases for which guidelines are demonstrably useful. Published in 2002 by the Japanese Society of Gout and Nucleic Acid Metabolism in 2002, the Guideline for the Management of Hyperuricemia and Gout was subsequently revised, and in January 2010 the Revised Guideline for the Management of Hyperuricemia and Gout was published. While maintaining the spirit of the original guideline, the revised guideline not only fulfills the prerequisites required for formulating the current guideline but also incorporates new approaches such as the quantification of consensus levels. In addition to emphasizing that hyperuricemia has the duel aspects of being a urate deposition disease and a disease associated with lifestyle diseases, as well as the fact that all hyperuricemia patients require correction of lifestyle habits related to obesity, hypertension, and metabolic syndrome, the revised guideline covers the current evidence in detail. It is the author's sincere hope that this guideline will be utilized effectively in daily medical practice in this field. PMID:25237241

  9. India: National approach to ageing management

    International Nuclear Information System (INIS)

    AM deals with the identification of age related degradation and corrective measures to ensure safety. Considerations for AM of NPPs starts right from siting and continue through the stages of design, construction and commissioning. Implementation of AMP enables acceptable safety performance during operating phase and extended phase of operation. Special attention is required during the extended phase of operation such as time limited ageing assessment and corrective actions. Existing programmes relating to various activities and management of NPP (operation, maintenance, in-service inspection, surveillance and radiological protection) for safe operation are detailed in safety guides. AM addresses issues like understanding, predicting and detecting effects of ageing and corrective/mitigatory actions for age related degradations. It provides feed back to the designers, manufacturers, and operating organization regarding the need for effective AM of SSCs and related improvements at different stages of NPP life cycle

  10. Library management for the digital age a new paradigm

    CERN Document Server

    Todaro, Julie

    2014-01-01

    This revolutionary introduction to library management is the first conceived in and written for a digital age. Library Management for the Digital Age covers hierarchies, policies, communication, working relationships, facilities, human resources, settings, customer services, budgeting, and emergency management.

  11. Discussions about safety criteria and guidelines for radioactive waste management

    International Nuclear Information System (INIS)

    In Japan, the clearance levels for uranium-bearing waste have been established by the Nuclear Safety Commission (NSC). The criteria for uranium-bearing waste disposal are also necessary; however, the NSC has not concluded the discussion on this subject. Meanwhile, the General Administrative Group of the Radiation Council has concluded the revision of its former recommendation 'Regulatory exemption dose for radioactive solid waste disposal', the dose criteria after the institutional control period for a repository. The Standardization Committee on Radiation Protection in the Japan Health Physics Society (The Committee) also has developed the relevant safety criteria and guidelines for existing exposure situations, which are potentially applicable to uranium-bearing waste disposal. A new working group established by The Committee was initially aimed at developing criteria and guidelines specifically for uranium-bearing waste disposal; however, the aim has been shifted to broader criteria applicable to any radioactive wastes. (authors)

  12. Discussions about safety criteria and guidelines for radioactive waste management.

    Science.gov (United States)

    Yamamoto, Masafumi

    2011-07-01

    In Japan, the clearance levels for uranium-bearing waste have been established by the Nuclear Safety Commission (NSC). The criteria for uranium-bearing waste disposal are also necessary; however, the NSC has not concluded the discussion on this subject. Meanwhile, the General Administrative Group of the Radiation Council has concluded the revision of its former recommendation 'Regulatory exemption dose for radioactive solid waste disposal', the dose criteria after the institutional control period for a repository. The Standardization Committee on Radiation Protection in the Japan Health Physics Society (The Committee) also has developed the relevant safety criteria and guidelines for existing exposure situations, which are potentially applicable to uranium-bearing waste disposal. A new working group established by The Committee was initially aimed at developing criteria and guidelines specifically for uranium-bearing waste disposal; however, the aim has been shifted to broader criteria applicable to any radioactive wastes. PMID:21531746

  13. UK guidelines for the management of bone sarcomas

    OpenAIRE

    Gerrand, Craig; Athanasou, Nick; Brennan, Bernadette; Grimer, Robert; Judson, Ian; Morland, Bruce; Peake, David; Seddon, Beatrice; Whelan, Jeremy; ,

    2016-01-01

    This document is an update of the British Sarcoma Group guidelines published in 2010. The aim is to provide a reference standard for the clinical care of patients in the UK with bone sarcomas. Recent recommendations by the European Society of Medical Oncology, The National Comprehensive Cancer Network and The National Institute for Health and Care Excellence have been incorporated, and the literature since 2010 reviewed. The standards represent a consensus amongst British Sarcoma Group member...

  14. Are U.S. cancer screening test patterns consistent with guideline recommendations with respect to the age of screening initiation?

    Directory of Open Access Journals (Sweden)

    Kadiyala Srikanth

    2009-10-01

    Full Text Available Abstract Background U.S. cancer screening guidelines communicate important information regarding the ages for which screening tests are appropriate. Little attention has been given to whether breast, colorectal and prostate cancer screening test use is responsive to guideline age information regarding the age of screening initiation. Methods The 2006 Behavioral Risk Factor Social Survey and the 2003 National Health Interview Surveys were used to compute breast, colorectal and prostate cancer screening test rates by single year of age. Graphical and logistic regression analyses were used to compare screening rates for individuals close to and on either side of the guideline recommended screening initiation ages. Results We identified large discrete shifts in the use of screening tests precisely at the ages where guidelines recommend that screening begin. Mammography screening in the last year increased from 22% [95% CI = 20, 25] at age 39 to 36% [95% CI = 33, 39] at age 40 and 47% [95% CI = 44, 51] at age 41. Adherence to the colorectal cancer screening guidelines within the last year increased from 18% [95% CI = 15, 22] at age 49 to 19% [95% CI = 15, 23] at age 50 and 34% [95% CI = 28, 39] at age 51. Prostate specific antigen screening in the last year increased from 28% [95% CI = 25, 31] at age 49 to 33% [95% CI = 29, 36] and 42% [95% CI = 38, 46] at ages 50 and 51. These results are robust to multivariate analyses that adjust for age, sex, income, education, marital status and health insurance status. Conclusion The results from this study suggest that cancer screening test utilization is consistent with guideline age information regarding the age of screening initiation. Screening test and adherence rates increased by approximately 100% at the breast and colorectal cancer guideline recommended ages compared to only a 50% increase in the screening test rate for prostate cancer screening. Since information regarding the age of cancer screening

  15. Assessment and management of ageing of major nuclear power plant components important to safety: CANDU pressure tubes

    International Nuclear Information System (INIS)

    The report documents the current practices for assessment and management of the ageing of the pressure tubes in CANDU reactors and Indian PHWTRs. Chapter headings are: fuel channel and pressure tube description, design basis for the fuel channel and pressure tube, degradation mechanisms and ageing concerns for pressure tubes, inspection and monitoring methods for pressure tubes,assessment methods and fitness-for-service guidelines for pressure tubes, mitigation methods for pressure tubes, and pressure tube ageing management programme

  16. Ship nuclear power device of cable aging management

    International Nuclear Information System (INIS)

    Cable for marine nuclear power plant continuous delivery of electrical energy. Cable is mostly in the high temperature and strong radiation and harsh working environment, and can not be replaced in the lifetime This should be the cable aging management methods through research, maintenance and repair program to provide a scientific basis. Cable aging management approach for a number of different levels of cable management at different levels, relying on computers and other modern tools, the use of information management database software maintenance of the cable through the science of aging control. Cable Aging Management including the scope of cable aging management, classification management basis and used for different levels of management supervision and implementation of means testing approach. Application of the ship that has the operational management science, both planned maintenance to improve the science, but also improves the efficiency of aging management. This management method can be extended to nuclear power plants of cable aging management. (authors)

  17. Guidelines for management of noxious weeds at Hanford

    International Nuclear Information System (INIS)

    Integrated Pest Management Services is responsible for management and control of noxious weeds on the Hanford Site. Weed species and populations are prioritized and objective defined, according to potential site and regional impact. Population controls are implemented according to priority. An integrated approach is planned for noxious weed control in which several management options are considered and implemented separately or in coordination to best meet management objectives. Noxious weeds are inventories and monitored to provide information for planning and program review

  18. Regulatory Aspect of an Ageing Management Program

    International Nuclear Information System (INIS)

    The aspects of plant ageing management (AM) gained increasing attention over the last ten years. Numerous technical studies have been performed to study the impact of ageing mechanisms on the safe and reliable operation of nuclear power plants. National research activities have been initiated or are in progress to provide the technical basis for decision making processes. The long-term operation of nuclear power plants is influenced by economic considerations, the socio-economic environment including public acceptance, developments in research and the regulatory framework, the availability of technical infrastructure to maintain and service the systems, structures and components as well as qualified personnel. Besides national activities there are a number of international activities in particular under the umbrella of the IAEA, the OECD and the EU. The paper will provide the summary on Nuclear Plant Life Management (PLIM) (or Ageing Management Program (AMP)) and Plant Life Extension (PLEX) development in USA and European countries. Also, insights from such effort currently performing in Slovenia will be discussed.(author)

  19. Management of stable angina: A commentary on the European Society of Cardiology guidelines.

    Science.gov (United States)

    Ambrosio, Giuseppe; Komajda, Michel; Mugelli, Alessandro; Lopez-Sendón, José; Tamargo, Juan; Camm, John

    2016-09-01

    In 2013 the European Society of Cardiology (ESC) released new guidelines on the management of stable coronary artery disease. These guidelines update and replace the previous ESC guidelines on the management of stable angina pectoris, issued in 2006. There are several new aspects in the 2013 ESC guidelines compared with the 2006 version. This opinion paper provides an in-depth interpretation of the ESC guidelines with regard to these issues, to help physicians in making evidence-based therapeutic choices in their routine clinical practice. The first new element is the definition of stable coronary artery disease itself, which has now broadened from a 'simple' symptom, angina pectoris, to a more complex disease that can even be asymptomatic. In the first-line setting, the major changes in the new guidelines are the upgrading of calcium channel blockers, the distinction between dihydropyridines and non-dihydropyridine calcium channel blockers, and the presence of important statements regarding the combination of calcium channel blockers with beta-blockers. In the second-line setting, the 2013 ESC guidelines recommend the addition of long-acting nitrates, ivabradine, nicorandil or ranolazine to first-line agents. Trimetazidine may also be considered. However, no clear distinction is made among different second-line drugs, despite different quality of evidence in favour of these agents. For example, the use of ranolazine is supported by strong and recent evidence, while data supporting the use of the traditional agents appear relatively scanty. PMID:27222385

  20. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries. 1

    DEFF Research Database (Denmark)

    Diangelis, A J; Andreasen, J O; Ebeleseder, K A;

    2014-01-01

    clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary...... goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented. The Hebrew Edition is part of the IADT global effort to provide accessibility to...

  1. Effect of educational program and interview on adoption of guidelines for the management of neonatal hyperbilirubinemia.

    OpenAIRE

    McMILLAN, D.D.; Lockyer, J. M.; Magnan, L; Akierman, A; Parboosingh, J T

    1991-01-01

    OBJECTIVES: To determine (a) whether physicians are adhering to the guidelines for the management of neonatal hyperbilirubinemia, (b) what influences their decisions to investigate and treat the condition and (c) the effect of an educational program and clinical recall interview on compliance with the guidelines. DESIGN: Retrospective chart audit. SETTING: Urban tertiary care hospital. PARTICIPANTS: All term neonates who received phototherapy but were not admitted to the neonatal intensive ca...

  2. Proper management of rheumatoid arthritis in Latin America. What the guidelines say?

    OpenAIRE

    Brenol, Claiton V.; Nava, Jorge Ivan Gamez; Soriano, Enrique R

    2015-01-01

    To analyze characteristics of clinical practice guidelines (CPGs) for the management of rheumatoid arthritis (RA) developed in Latin American (LA) countries and to describe the knowledge, use, and barriers for their implementation perceived among LA rheumatologists, a comprehensive literature search including Medline, PubMed, Cochrane Library, LILACS and Scielo was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was applied for evaluation. A survey was se...

  3. Formalized 2003 European Guidelines on Cardiovascular Disease Prevention and for Management of Hypertension

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Anger, Z.; Buchtela, David; Tomečková, Marie; Veselý, Arnošt; Zvárová, Jana

    Manchester : European Society of Hypertension, 2005. s. 46. [Central-European Meeting on Hypertension /3./. 13.10.2005-16.10.2005, Sopron] R&D Projects: GA AV ČR(CZ) 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : formalized medical guidelines * guidelines on cardiovascular disease prevention and for management of hypertension Subject RIV: FA - Cardiovascular Disease s incl. Cardiotharic Surgery

  4. Evolution of Asthma Concept and Effect of Current Asthma Management Guidelines

    OpenAIRE

    Makino, Sohei; Sagara, Hironori

    2010-01-01

    Concept of asthma has changed from symptom-complex or airway hypersensitivity to airway inflammation and airway remodeling. Based on this concept asthma management guidelines (JGL) has been developed in Japan. Death from asthma has decreased drastically since the publication of the guidelines, although it is still high in elderly population. Further works are expected for "zero-death" from asthma and for tighter control of airway inflammation and resultant airway remodeling.

  5. A Comparison of Inpatient Glucose Management Guidelines: Implications for Patient Safety and Quality

    OpenAIRE

    Mathioudakis, Nestoras; Golden, Sherita Hill

    2015-01-01

    Inpatient glucose management guidelines and consensus statements play an important role in helping to keep hospitalized patients with diabetes and hyperglycemia safe and in optimizing the quality of their glycemic control. In this review article, we compare and contrast seven prominent US guidelines on recommended glycemic outcome measures and processes of care, with the goal of highlighting how variation among them might influence patient safety and quality. The outcome measures of interest ...

  6. Guidelines for operator competence - Optimising facility management processes; Leitfaden Betreiberkompetenz. Schritt fuer Schritt Facility Management Prozesse optimieren

    Energy Technology Data Exchange (ETDEWEB)

    Moser, R.

    2005-06-15

    This brochure issued by IFMA (International Facility Management Association) Switzerland and the Swiss Federal Office of Energy (SFOE) presents interactive guidelines for energy management in the area of facility management. These guidelines are based on the results of a project carried out by the International Energy Agency's Annex 40 'Operator competence'. The guidelines provide a step-by-step guide from initial analysis through to successful project completion and answer many questions that may crop up during the process. The focus is placed on energy aspects. Tools and 14 sample process descriptions are provided along with practical examples. Theoretical aspects are also presented and discussed, including models for operator roles and the processes involved. Also, change, risk and knowledge management are examined. Notes and information on possibilities for further education are presented.

  7. WWER pressure vessel life and ageing management for NPP long term operation in Russia

    International Nuclear Information System (INIS)

    To manage for WWER pressure vessel long term operation (LTO) in Russia Concern Rosenergoatom (Russian Utility) has organized complex measures for first generation WWER-440 power plant lifetime extension (PLEX) including reactor pressure vessel (RPV) items. Guidelines, methodological and technological procedures supporting RPV life and ageing management for LTO (45 years) has been developed. The next works with participation of 'Kurchatov Institute', 'Prometey Institute', OKB 'Gidropress', WWER NPPs has been fulfilled: new normative base; neutron flux reducing; cutting and tests of templets; supporting ageing managements programs for long term operation; RPV integrity assessment e.c. New radiation embrittlement model will be developed. New approaches has been developed to improve: surveillance programs; RPV integrity assessment guidelines; ISI system e.c. for LTO (60 years) of WWER-1000 RPV and WWER-440 RPV of second generation NPPs. (author)

  8. Management of hepatitis B: our practice and how it relates to the guidelines.

    Science.gov (United States)

    Yapali, Suna; Talaat, Nizar; Lok, Anna S

    2014-01-01

    Seven drugs have been approved for the treatment of chronic hepatitis B. Antiviral treatment has been shown to be effective in suppressing hepatitis B virus replication, decreasing inflammation and fibrosis in the liver, and preventing progression of liver disease. However, current medications do not eradicate hepatitis B virus; therefore, a key question is which patients need to start treatment and which patients can be monitored. Professional societies have developed guidelines to assist physicians in recognition, diagnosis, and optimal management of patients with chronic hepatitis B. These guidelines suggest preferred approaches, and physicians are expected to exercise clinical judgment to determine the most appropriate management based on the circumstances of the individual patient. This article reviews recommendations in hepatitis B guidelines and the basis for those recommendations, and we discuss what we do in our practice to illustrate factors that may influence decisions regarding hepatitis B management. PMID:23660419

  9. Objective provision tree application to the effectiveness evaluation of accident management guidelines

    International Nuclear Information System (INIS)

    After the Fukushima accident in 2011, various lessons and safety enhancement action items were announced by national regulatory bodies. Among those items, the enforcement of procedural efficiency verification for accidents management guidelines including emergency operating procedures (EOPs), severe accident management guides (SAMGs) and extensive damage mitigating guidelines (EDMG) if applicable, was raised. The Objective Provision Tree (OPT) method is a top down approach which starts from the level of Defense in Depth (DiD), objectives and barriers, safety functions, challenges, mechanisms and finally ends with provisions. The benefit of OPT application to safety concerns includes that the OPT enables the comprehensive review for the verification of consistency and integrity of safety requirements for a specific safety issue. In this study, the preliminary framework for the application of OPT to the effectiveness evaluation of accident management guideline was introduced

  10. Ageing and plant life management software Comsy

    International Nuclear Information System (INIS)

    Cost-effective power generation is becoming more important as the prices charged by power producers in the energy market continue to fall. To ease the cost situation there is a growing demand for innovative maintenance management methods which allow power plants to be economically operated over their entire lifetime. The purpose of a systematic ageing and plant life management program is to allow the lifetime of plant components to be planned, and to indicate when a component has reached the end of its effective lifetime before it fails. Another important function of such programs is to increase the availability of power plants as they age, and to enable implementation of a targeted maintenance strategy in terms of its economic and technical effect. Implementation of such programs requires the existence of detailed information concerning the status of the components as well as their operating conditions. Based on this information, an understanding of how the relevant ageing and degradation mechanisms work enables a prediction to be made concerning component lifetime. Advanced software programs provide such predictions at reasonable cost across all systems. (author)

  11. A comparison of inpatient glucose management guidelines: implications for patient safety and quality.

    Science.gov (United States)

    Mathioudakis, Nestoras; Golden, Sherita Hill

    2015-03-01

    Inpatient glucose management guidelines and consensus statements play an important role in helping to keep hospitalized patients with diabetes and hyperglycemia safe and in optimizing the quality of their glycemic control. In this review article, we compare and contrast seven prominent US guidelines on recommended glycemic outcome measures and processes of care, with the goal of highlighting how variation among them might influence patient safety and quality. The outcome measures of interest include definitions of glucose abnormalities and glycemic targets. The relevant process measures include detection and documentation of diabetes/hyperglycemia, methods of and indications for insulin therapy, management of non-insulin agents, blood glucose monitoring, management of special situations (e.g., parenteral/enteral nutrition, glucocorticoids, surgery, insulin pumps), and appropriate transitions of care. In addition, we address elements of quality improvement, such as glycemic control program infrastructure, glucometrics, insulin safety, and professional education. While most of these guidelines align with respect to outcome measures such as glycemic targets, there is significant heterogeneity among process measures, which we propose might introduce variation or even confusion in clinical practice and possibly affect quality of care. Guideline-related factors, such as rigor of development, clarity, and presentation, may also affect provider trust in and adherence to guidelines. There is a need for high-quality research to address knowledge gaps in optimal glucose management practice approaches in the hospital setting. PMID:25690724

  12. UK guidelines on the management of variceal haemorrhage in cirrhotic patients

    Science.gov (United States)

    Tripathi, Dhiraj; Stanley, Adrian J; Hayes, Peter C; Patch, David; Millson, Charles; Mehrzad, Homoyon; Austin, Andrew; Ferguson, James W; Olliff, Simon P; Hudson, Mark; Christie, John M

    2015-01-01

    These updated guidelines on the management of variceal haemorrhage have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines which this document supersedes were written in 2000 and have undergone extensive revision by 13 members of the Guidelines Development Group (GDG). The GDG comprises elected members of the BSG liver section, representation from British Association for the Study of the Liver (BASL) and Liver QuEST, a nursing representative and a patient representative. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. The nature of variceal haemorrhage in cirrhotic patients with its complex range of complications makes rigid guidelines inappropriate. These guidelines deal specifically with the management of varices in patients with cirrhosis under the following subheadings: (1) primary prophylaxis; (2) acute variceal haemorrhage; (3) secondary prophylaxis of variceal haemorrhage; and (4) gastric varices. They are not designed to deal with (1) the management of the underlying liver disease; (2) the management of variceal haemorrhage in children; or (3) variceal haemorrhage from other aetiological conditions. PMID:25887380

  13. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America.

    NARCIS (Netherlands)

    Pappas, P.G.; Kauffman, C.A.; Andes, D.; Benjamin Jr., D.K.; Calandra, T.; Edwards, J.E.; Filler, S.G.; Fisher, J.F.; Kullberg, B.J.; Ostrosky-Zeichner, L.; Reboli, A.C.; Rex, J.H.; Walsh, T.J.; Sobel, J.D.

    2009-01-01

    Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases

  14. Effective recordkeeping technologies to manage aging

    International Nuclear Information System (INIS)

    Pacific Northwest Laboratory has investigated the capability of current recordkeeping technology to support aging management. This paper discusses technical issues associated with potential enhancements of nuclear plant records systems--from the perspective of the lessons learned about equipment aging degradation mechanisms and associated surveillance and monitoring techniques during the U. S. Nuclear Regulatory Commission's Nuclear Plant Aging Research Program. The paper considers both the specific types of technical data needed to ensure continued safe operation and the use of new technology to upgrade record systems. Specific topics discussed include: equipment reliability data needed to support the assessment of the impact of aging on the continued operation of the plant; operational history data to support the assessment of residual life of mechanical and structural components and piping; tools for the analysis and trending of equipment reliability data and operational history data; design and implementation of plant record systems that will provide a comprehensive and usable engineering design basis for the plant; proposed improvements in the data input process for the plant records system; computerization of plant records systems, including conversion of existing records into machine-readable forms

  15. Effective recordkeeping technologies to manage aging

    Energy Technology Data Exchange (ETDEWEB)

    Dukelow, J.S.; Johnson, A.B. Jr. [Pacific Northwest Lab., Richland, WA (United States); Vora, J.P. [Nuclear Regulatory Commission, Washington, DC (United States)

    1992-10-01

    Pacific Northwest Laboratory has investigated the capability of current recordkeeping technology to support aging management. This paper discusses technical issues associated with potential enhancements of nuclear plant records systems--from the perspective of the lessons learned about equipment aging degradation mechanisms and associated surveillance and monitoring techniques during the U. S. Nuclear Regulatory Commission`s Nuclear Plant Aging Research Program. The paper considers both the specific types of technical data needed to ensure continued safe operation and the use of new technology to upgrade record systems. Specific topics discussed include: equipment reliability data needed to support the assessment of the impact of aging on the continued operation of the plant; operational history data to support the assessment of residual life of mechanical and structural components and piping; tools for the analysis and trending of equipment reliability data and operational history data; design and implementation of plant record systems that will provide a comprehensive and usable engineering design basis for the plant; proposed improvements in the data input process for the plant records system; computerization of plant records systems, including conversion of existing records into machine-readable forms.

  16. Effective recordkeeping technologies to manage aging

    Energy Technology Data Exchange (ETDEWEB)

    Dukelow, J.S.; Johnson, A.B. Jr. (Pacific Northwest Lab., Richland, WA (United States)); Vora, J.P. (Nuclear Regulatory Commission, Washington, DC (United States))

    1992-10-01

    Pacific Northwest Laboratory has investigated the capability of current recordkeeping technology to support aging management. This paper discusses technical issues associated with potential enhancements of nuclear plant records systems--from the perspective of the lessons learned about equipment aging degradation mechanisms and associated surveillance and monitoring techniques during the U. S. Nuclear Regulatory Commission's Nuclear Plant Aging Research Program. The paper considers both the specific types of technical data needed to ensure continued safe operation and the use of new technology to upgrade record systems. Specific topics discussed include: equipment reliability data needed to support the assessment of the impact of aging on the continued operation of the plant; operational history data to support the assessment of residual life of mechanical and structural components and piping; tools for the analysis and trending of equipment reliability data and operational history data; design and implementation of plant record systems that will provide a comprehensive and usable engineering design basis for the plant; proposed improvements in the data input process for the plant records system; computerization of plant records systems, including conversion of existing records into machine-readable forms.

  17. Canada: National approach to ageing management

    International Nuclear Information System (INIS)

    The Canadian regulatory approach to ensuring the implementation of effective AMPs for nuclear power plants is summarized as follows. Canada currently has 22 CANDU nuclear power reactors under operating licenses issued by the Canadian Nuclear Safety Commission (CNSC). The reactors began operation between 1971 and 1993. Through operating licenses, the CNSC requires licensees to comply with a number of in-service inspection standards and regulatory documents under CNSC Safety and Control Area ‘Fitness for Service’ of SSCs. These provide extensive requirements related to understanding, controlling and managing ageing

  18. Proposed guidelines for the management of nodding syndrome

    OpenAIRE

    Idro, R.; Musubire, K A; Byamah Mutamba, B; Namusoke, H; Muron, J; Abbo, C; Oriyabuzu, R; Ssekyewa, J; Okot, C; Mwaka, D; Ssebadduka, P; I. Makumbi; Opar, B; Aceng, JR; Mbonye, AK

    2013-01-01

    Nodding Syndrome is a poorly understood neurologic disorder of unknown aetiology that affects children and adolescents in Africa. Recent studies have suggested that the head nods are due to atonic seizures and Nodding Syndrome may be classified as probably symptomatic generalised epilepsy. As part of the Ugandan Ministry of Health clinical management response, a multidisciplinary team developed a manual to guide the training of health workers with knowledge and skills to manage the patients. ...

  19. Disability standards and guidelines for learning management systems: Evaluating accessibility

    OpenAIRE

    Moreno, Lourdes; Iglesias, Ana; Calvo, Rocío; Delgado, Sandra; Zaragoza, Luis

    2012-01-01

    Currently, the great majority of institutions of higher education use Learning Content Management Systems (LCMSs) and Learning Management Systems (LMS) as pedagogical tools. In order to make these systems accessible to all students, it is important to take into account not only educational standards, but also standards of accessibility. It is essential to have with procedures and well-established method for evaluating these tools, so in this paper we propose a method for evaluatin...

  20. Guidelines for ITIL Implementation : A Framework for IT Service Management

    OpenAIRE

    Assad, Muhammad Imran; Ahmad, Mian Abbas

    2015-01-01

    Information Technology Infrastructure Library (ITIL) is the most popular andthe influential framework for IT Service Management (ITSM). It is used for ITgovernance, management and control of IT services. It comprises of definedand best practices, developed in 1980’s by British Government Central ComputerTelecommunication Agency. The purpose of this thesis is to present theguidelines to implement ITIL. Available literature on ITIL discusses the importanceof ITIL, its benefits, facilitating and...

  1. GUIDELINES TO ORIENT ENVIRONMENTAL MANAGEMENT TOWARDS CORPORATE VALUE CREATION

    OpenAIRE

    Piñeiro Chousa, Juan; Romero Castro, Noelia

    2011-01-01

    Although the interrelations between Economy, firms and the environment are more and more obvious and verifiable on policy and management decision-making at all levels, corporate managers still find difficult to simultaneously achieve the classic financial objective of shareholder value creation and the improvement of the environmental performance of their organizations. In order to do this a conceptual framework is needed to make explicit the links between these two concepts. Basing on this c...

  2. Network Security: Policies and Guidelines for Effective Network Management

    OpenAIRE

    Jonathan Gana KOLO; Umar Suleiman DAUDA

    2008-01-01

    Network security and management in Information and Communication Technology (ICT) is the ability to maintain the integrity of a system or network, its data and its immediate environment. The various innovations and uses to which networks are being put are growing by the day and hence are becoming complex and invariably more difficult to manage by the day. Computers are found in every business such as banking, insurance, hospital, education, manufacturing, etc. The widespread use of these syst...

  3. Guidelines for assessing the knowledge management maturity of organizations

    OpenAIRE

    C.J. Kruger; M.M.M. Snyman

    2007-01-01

    In a recent article Kruger and Snyman hypothesized that progressions in knowledge management maturity (from a strategic perspective) are directly related to an increased ability to speed up the strategic cycle of imitation, consolidation and innovation. The arguments proposed, however, neglected to supply the reader with a practical toolkit or even a roadmap (a time-related matrix, or questionnaire) to successfully measure succession in knowledge management maturity. This article builds on th...

  4. Eighth joint national committee (JNC-8 guidelines and the outpatient management of hypertension in the African-American population

    Directory of Open Access Journals (Sweden)

    Nicole Abel

    2015-01-01

    Full Text Available Background: Hypertension is a common medical disease, occurring in about one third of young adults and almost two thirds of individuals over the age of 60. With the release of the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment (JNC-8 guidelines, there have been major changes in blood pressure management in the various subgroups. Aim: Optimal blood pressure management and markers of end-organ damage in African-American adult patients were compared between patients who were managed according to the JNC-8 hypertension management guidelines and those who were treated with other regimens. Materials and Methods: African-American patients aged 18 years or older with an established diagnosis of hypertension were included in the study who were followed up in our internal medicine clinic between January 1, 2013 and December 31, 2103; the data on their systolic and diastolic blood pressure readings, heart rate, body mass index (BMI, age, gender, comorbidities, and medications were recorded. Patients were divided into four groups based on the antihypertensive therapy as follows - Group 1: Diuretic only; Group 2: Calcium channel blocker (CCB only; Group 3: Diuretic and CCB; Group 4: Other antihypertensive agent. Their blood pressure control, comorbidities, and associated target organ damage were analyzed. Results: In all 323 patients, blood pressures were optimally controlled. The majority of the patients (79.6% were treated with either a diuretic, a CCB, or both. Intergroup comparison analysis showed no statistically significant difference in the mean systolic blood pressure, mean diastolic blood pressure, associated comorbidities, or frequency of target organ damage. Conclusion: Although diuretics or CCBs are recommended as first-line agents in African-American patients, we found no significant difference in the optimal control of blood pressure and frequency of end-organ damage compared to management with other agents.

  5. Barriers to Primary Care Clinician Adherence to Clinical Guidelines for the Management of Low Back Pain

    DEFF Research Database (Denmark)

    Slade, Susan C; Kent, Peter; Patel, Shilpa;

    2016-01-01

    qualitative methods had been used for both data collection and analysis. We searched major databases up to July 2014. Pairs of reviewers independently screened titles and abstracts, extracted data, appraised method quality using the CASP checklist, conducted thematic analysis and synthesized the results in......INTRODUCTION: Despite the availability of evidence-based guidelines for the management of low back pain that contain consistent messages, large evidence-practice gaps in primary care remain. OBJECTIVES: To perform a systematic review and meta-synthesis of qualitative studies that have explored...... primary care clinicians' perceptions and beliefs about guidelines for low back pain, including perceived enablers and barriers to guideline adherence. METHODS: Studies investigatingperceptions and beliefs about low back pain guidelines were included if participants were primary care clinicians and...

  6. Example of severe accident management guidelines validation and verification using full scope simulator

    International Nuclear Information System (INIS)

    The purpose of Severe Accident Management Guidelines (SAMG) is to provide guidelines to mitigate and control beyond design bases accidents. These guidelines are to be used by the technical support center that is established at the plant within one hour after the beginning of the accident as a technical support for the main control room operators. Since some of the accidents can progress very fast there are also two guidelines provided for the main control room operators. The first one is to be used if the core damage occurs and the TSC is not established yet and the second one after technical support center become operational. After SG replacement and power uprate in year 2000, NPP Krsko developed Rev.1 of these procedures, which have been validated and verified during one-week effort. Plant specific simulator capable of simulating severe accidents was extensively used.(author)

  7. Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain

    DEFF Research Database (Denmark)

    Slade, Susan C; Kent, Peter; Bucknall, Tracey;

    2015-01-01

    INTRODUCTION: Low back pain is the highest ranked condition contributing to years lived with disability, and is a significant economic and societal burden. Evidence-based clinical practice guidelines are designed to improve quality of care and reduce practice variation by providing graded...... recommendations based on the best available evidence. Studies of low back pain guideline implementation have shown no or modest effects at changing clinical practice. OBJECTIVES: To identify enablers and barriers to adherence to clinical practice guidelines for the management of low back pain. METHODS AND...... ANALYSIS: A systematic review and meta-synthesis of qualitative studies that will be conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines. Eight databases will be searched using a priori inclusion/exclusion criteria. Two...

  8. Defence in Depth and Ageing Management

    International Nuclear Information System (INIS)

    Accident prevention is the first safety priority of both designers and operators. It is achieved through the use of reliable structures, components, systems and procedures in a plant operated by personnel who are committed to a strong safety culture. For future nuclear power plants, consideration of multiple failures and severe accidents will be achieved in a more systematic and complete way from the design stage. Defence in depth (DID) consists of a hierarchical deployment of different levels of equipment and procedures in order to maintain the effectiveness of physical barriers placed between radioactive materials and workers, the public or the environment, in normal operation, anticipated operational occurrences and, for some barriers, in accidents at the plant. The primary way of preventing accidents is to achieve a high quality in design, construction and operation of the plant, and thereby to ensure that deviations from normal operation are infrequent. The best way to meet these premises of effectiveness of the barriers and the Systems, Structures and Components (SSCs) is to develop an ageing management programme to prevent potential failures and accidents. In this work we will refer to the ageing management programme for Atucha I and Atucha II power plants and to the Atucha I spent fuel storage. (author)

  9. Aging management review for license renewal and plant life management

    International Nuclear Information System (INIS)

    Full text: United States nuclear power plants are initially licensed for a period of 40-years. The 40-year term, which was established by the Atomic Energy Commission in the 1950s, is believed to be based on engineering judgement and is consistent with the typical amortization schedule for purchasing fossil power plants. Under 10 CFR Part 54, the license renewal rule, additional terms of 20-years may be obtained through the preparation of a license renewal application that must be reviewed and approved by the Nuclear Regulatory Commission (NRC). The license renewal rule requires that applicants perform ageing management reviews on passive long-lived structures and components to demonstrate that ageing will be managed during the period of extended operation (i.e., additional 20 years of operation). ageing of active components, which are excluded from 10 CFR Part 54, is accomplished through the Maintenance Rule, 10 CFR Part 65, using performance-based monitoring. The license renewal rule, 10 CFR Part 54, was initially published in 1991. After significant interaction with the nuclear industry from 1991 through 1994, the NRC revised the rule in 1995 to focus on passive long-lived structures and components. In 1998, the first two applications for license renewal were submitted to the NRC by Baltimore Gas and Electric for the two-unit Calvert Cliffs nuclear power plant and by Duke Energy for the three-unit Oconee nuclear power plant. In March 2000, the NRC approved the application for the two-unit Calvert Cliffs nuclear power plant for an additional 20 years. Two months later, the NRC approved the renewal of the operating licenses for the three-unit Oconee nuclear station. The NRC completed these reviews in a timely, predictable, and stable manner. As of February 2002, the NRC has approved renewal of operating licenses for eight nuclear units and has applications under review for 15 more units. Twelve additional companies have notified the NRC of their intention to seek

  10. Guidelines for Inter-Enterprise Management (IEM), GLOBEMEN Deliverable D23

    DEFF Research Database (Denmark)

    Tølle, Martin; Vesterager, Johan

    2002-01-01

    This document is a deliverable of Work package 2 of the IMS Globemen (GMN) project: D23 Guidelines for Inter-Enterprise Management (IEM). IMS Globemen is an inter-regional project aiming to develop methods, tools and architectures to support inter-enterprise operations in one-of-kind industries, in...... different lifecycle phases. This report focuses on management of the inter-enterprise delivery process. It is based on the identification of industrial requirements and the specification of the tools in GMN industrial case in EU. These have been reported in earlier deliverables D21 (Requirements) and D22...... (Specification). Correspondingly, this report operates as input for further generalisation over the lifecycle in D43: Guidelines for Virtual Manufacturing Enterprise. The main objective of the deliverable is to describe guidelines how companies may operate in an inter-enterprise environment supported by C...

  11. Guidelines for Local Governments on Solid Waste Management.

    Science.gov (United States)

    National Association of Counties, Washington, DC. Research Foundation.

    This document consists of ten guides on Solid Waste Management to assist local elected and appointed policy-making officials. They are entitled: Areawide Approaches; Legal Authority, Planning, Organization Design and Operation, Financing, Technical and Financial Assistance, Citizen Support, Personnel, and Action Plan and Bibliography. The guides…

  12. Measure Guideline. Water Management at Tub and Shower Assemblies

    Energy Technology Data Exchange (ETDEWEB)

    Dickson, Bruce [IBACOS, Inc., Pittsburgh, PA (United States)

    2011-12-01

    Due to the high concentrations of water and the consequential risk of water damage to the home’s structure a comprehensive water management system is imperative to protect the building assemblies underlying the finish surround of tub and shower areas. This guide shows how to install fundamental waterproofing strategies to prevent water related issues at shower and tub areas.

  13. 2003 CDC guidelines offer more choices for managing operatory surfaces.

    Science.gov (United States)

    2004-11-01

    The objective of this article to help dental professionals understand the changes in surface asepsis recommendations, to be able to classify environmental surfaces in the practice setting and successfully prevent or manage their contamination, as well as become familiar with the terminology used in discussing environmental surfaces and related infection control efforts. PMID:15651468

  14. Transnational Environmental Management between Corporate Guidelines and Local Practices

    DEFF Research Database (Denmark)

    Wangel, Arne

    2004-01-01

    is inspired by current research on the case of Carlsberg Breweries, which relates to one of the three main settings (Georg & Jørgensen 2003, 4) for the study of the implementation of environmental management initiatives, i.e. as part of the internal control strategies of multinational companies...

  15. Guidelines for Supermarket Management Programs in the Community College.

    Science.gov (United States)

    Haynes, William O.

    Unprecedented growth and technological advances in the food industry have created a need for well-trained supermarket management personnel. The community college is able to fill this need by offering sound 1- and 2-year career-oriented programs in this rapidly expanding area. This document contains suggestions for developing these programs,…

  16. A review of current guidelines for the management of Helicobacter pylori infection in children and adolescents

    OpenAIRE

    Jones, Nicola L

    2004-01-01

    Helicobacter pylori infection is acquired in childhood and plays a causative role in chronic gastritis, peptic ulcer disease and the development of gastric cancer. The present review focuses on recent advances in the management of H pylori infection in children and provides an update of current Canadian guidelines regarding clinical sequelae, diagnosis and treatment.

  17. The significance of clinical practice guidelines on adult varicocele detection and management

    Directory of Open Access Journals (Sweden)

    Anand Shridharani

    2016-01-01

    Full Text Available Varicoceles are the most common correctable etiology of male factor infertility. However, the detection and management of varicoceles have not been standardized. This has led to decades of debate regarding the effect of varicocele on male infertility and subsequently whether repair leads to an improved fertility status. The current body of evidence investigating the role of varicocele and varicocelectomy is weak and conflicting. The stance taken by the AUA and ASRM suggests that there is insufficient outcomes data to support evidenced-based guidelines, citing evidence used to provide current recommendations are generally of a low quality level. On the other hand, the EAU Guidelines give a level 1a of evidence for management of varicoceles that are clinically palpable, associated with subnormal semen analyses and having otherwise unexplained fertility. Besides aiding with clinical varicocele detection and management, clinical practice opinion statements and guidelines aim to direct and strengthen the infrastructure of future studies. We review the current status of opinion statements and guidelines in varicocele and management detection with focus on their application in practice.

  18. Institutional and Program Level Guidelines for Conflict Management in Higher Education

    Science.gov (United States)

    Warters, Bill; Wendy, Smith J.

    2003-01-01

    These guidelines were developed by a national working group seminar hosted by the FIPSE-funded Conflict Management in Higher Education Resource Center. They provide a set of best-practices related to the establishment of conflict-handling services for colleges and universities. Seminar participants were carefully chose to represent faculty,…

  19. Guidelines for Automatic Data Processing Physical Security and Risk Management. Federal Information Processing Standards Publication 31.

    Science.gov (United States)

    National Bureau of Standards (DOC), Washington, DC.

    These guidelines provide a handbook for use by federal organizations in structuring physical security and risk management programs for their automatic data processing facilities. This publication discusses security analysis, natural disasters, supporting utilities, system reliability, procedural measures and controls, off-site facilities,…

  20. Management of cutaneous squamous cell carcinoma in patients with epidermolysis bullosa: best clinical practice guidelines.

    Science.gov (United States)

    Mellerio, J E; Robertson, S J; Bernardis, C; Diem, A; Fine, J D; George, R; Goldberg, D; Halmos, G B; Harries, M; Jonkman, M F; Lucky, A; Martinez, A E; Maubec, E; Morris, S; Murrell, D F; Palisson, F; Pillay, E I; Robson, A; Salas-Alanis, J C; McGrath, J A

    2016-01-01

    This article summarizes recommendations reached following a systematic literature review and expert consensus on the diagnosis and management of cutaneous squamous cell carcinomas in people with epidermolysis bullosa. The guidelines are intended to help inform decision making by clinicians dealing with this complex complication of a devastating disease. PMID:26302137

  1. Towards Guidelines for Development and Management of Transnational Information Systems

    OpenAIRE

    Angele Cavaye; Paul Mantelaers; Wander van de Berg; Arre Zuurmond

    1998-01-01

    This paper focuses on transnational information systems (TIS) that cross organisational as well as international boundaries. Such systems are being built and used in increasing numbers, but very little attention has been paid to US in the literature. This paper describes an empirical study which gathered case study data from four TIS projects. The data were used to describe problems encountered during TIS development and management and to discuss solutions found for those problems. An interes...

  2. ACOG Recommendations and Guidelines for Cervical Cancer Screening and Management

    Centers for Disease Control (CDC) Podcasts

    2009-10-15

    Dr. Alan Waxman, a professor of obstetrics and gynecology at the University of New Mexico and chair of the American College of Obstetricians and Gynecologists (ACOG) committee for the underserved, talks about ACOG's recommendations for cervical cancer screening and management.  Created: 10/15/2009 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Cancer Prevention and Control (DCPC).   Date Released: 6/9/2010.

  3. Equipment ageing management at the Mochovce nuclear power plants

    International Nuclear Information System (INIS)

    The NPP's first document dealing with ageing management procedures and responsibilities was issued in 1996, hence, before any of the units was operable. The concept described in the document is highlighted in the article. The description encompasses the responsibility system, procedures to set up ageing management programmes for the various equipment items, and co-operation among the various departments in implementing the ageing management programmes. The Ageing Diagnosis and Management department has available both hardware and software to fulfil the ageing management programmes. (author)

  4. Suggested Guidelines for Transparency and Participation in Nuclear Waste Management Programmes. Deliverable 22

    International Nuclear Information System (INIS)

    The ARGONA project intended to demonstrate how participation and transparency link to the political and legal systems and how new approaches can be implemented in nuclear waste management programmes. Thereby, studies have been done of the institutional and cultural context within which processes of participation and transparency take place in order to understand how the processes can be applied. The project also included studies of theory in order to build participation and transparency on a firm ground, a number of case studies in Czech Republic, Finland, Sweden and UK, as well as implementation in Czech Republic to make a difference, learn and demonstrate. These proposed guidelines are thus the result of observations and conclusions made in these efforts, and should not be regarded as an attempt to give a comprehensive set of guidelines for nuclear waste management or even for the implementation of transparency and participation therein. However, it is the hope among the ARGONA participants that they can give relevant thoughts and stimulation to those involved in the nuclear waste management area, especially organizations that have, or may become, responsible for the implementation of processes of transparency and participation, such as implementing organizations, government agencies, regulators as well as regional and local communities. It should be recognized that some of the proposed guidelines may be more relevant for a certain type of bodies (such as an implementer) than for another type (such as local community) and vice versa. Some of the proposed guidelines are also relevant at broader societal level and for the European Union bodies. It will be up to the respective reader to judge the relevance for her or his organization. The suggested guidelines are followed by more detailed recommendations on how to combine the two basic forms of mediation that have been identified in ARGONA, namely mediation by demonstration and mediation by dialogue in Annex 1

  5. Guidelines and Care Management Issues for People with Alzheimer's Disease and Other Dementias

    OpenAIRE

    Katie Maslow; John Selstad; Susan J. Denman

    2002-01-01

    Most people with Alzheimer's disease and other dementias do not receive ongoing, intentional medical management for these conditions, and effective coordination of medical and non-medical care is rare. Many published guidelines and consensus statements provide recommendations for identification, diagnosis and ongoing management of key issues, including cognitive decline, behavioral and psychiatric symptoms, depression, safety, family caregiver support and use of community services. These reco...

  6. Guidelines for a european union waste management policy

    International Nuclear Information System (INIS)

    Nuclear power currently represents almost one third of the electricity produced and consumed in the European Union. It offers strengths in terms of energy dependence and climate protection. The nuclear option should remain open for the future to those Member States who would like it, but provided nuclear safety is guaranteed. In the public debate following the publication, in 2000,4 of the European Commission', Green Paper on security of energy supply, it became very clear that nuclear safety in an enlarged Europe remained a major concern. The future of the nuclear industry in Europe, therefore, depends on finding and communicating clear answers to safety concerns. In 2007, half a billion consumers will be able to choose their electricity supplier freely in Europe. Public opinion confidence is essential for the security and diversification of electricity supply consumers need. The acceptance of the nuclear option is conditioned by the public' perception of the safety when producing nuclear power and, in particular, in relation to the waste management issue. Recent European public opinion surveys have shown that the public is very concerned about radioactive waste management and also feel poorly informed about it. Th The Commission, therefore, believes that a legally binding Community instrument is the only option, which will give sufficient assurances to European citizens on a high level of nuclear safety. This is the justification of our legislative proposals in the areas of nuclear safety and waste or spent fuel management. The first objective of the proposals is, therefore, to guarantee a high level of nuclear safety. The proposals will also enable the European nuclear industry to evolve within a stable legal framework. But also a similar framework for all power plant operators securing fair competition in a changing electricity market. Our proposals confirm, the prime responsibilities on nuclear safety of operators under the jurisdiction of their national

  7. Guidelines on the medical management of tritiated water overexposures

    International Nuclear Information System (INIS)

    The Medical Advisers to the Atomic Energy Control Board provide advice to occupational and family physicians treating overexposed workers. GMA-7 provides information and guidance to medical practitioners on the medical management of individuals who have been overexposed to tritiated water. Various treatment principles are presented with special emphasis on techniques for facilitating removal of tritiated water from the body so as to reduce the total radiation dose. Risks and biological effects from exposures to tritiated water and various radiation protection precautions are also discussed. 32 refs., 1 tab

  8. Measure Guideline: Water Management at Tub and Shower Assemblies

    Energy Technology Data Exchange (ETDEWEB)

    Dickson, B.

    2011-12-01

    Due to the high concentrations of water and the consequential risk of water damage to the home's structure a comprehensive water management system is imperative to protect the building assemblies underlying the finish surround of tub and shower areas. This guide shows how to install fundamental waterproofing strategies to prevent water related issues at shower and tub areas. When conducting a total gut rehab of a structure or constructing a new home, best practice installation and detailing for effective waterproofing are critically important at bathtub and shower assemblies. Water management issues in a structure may go unrecognized for long periods, so that when they are finally observed, the damage from long-term water exposure is extensive. A gut rehab is often undertaken when a home has experienced a natural disaster or when the homeowners are interested in converting an old, high-energy-use building into a high-quality, efficient structure that meets or exceeds one of the national energy standards, such as ENERGY STAR or LEED for homes. During a gut rehab, bath areas need to be replaced with diligent attention to detail. Employing effective water management practices in the installation and detailing of tub and shower assemblies will minimize or eliminate water issues within the building cavities and on the finished surfaces. A residential tub-and-shower surround or shower-stall assembly is designed to handle a high volume of water - 2.5 gallons per minute, with multiple baths occurring during a typical day. Transitions between dissimilar materials and connections between multiple planes must be installed with care to avoid creating a pathway for water to enter the building assemblies. Due to the high volume of water and the consequential risk of water damage to the home's structure, a comprehensive water management system is imperative to protect the building assemblies underlying the finish surround of tub and shower areas. At each stage of

  9. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007.

    Science.gov (United States)

    2007-11-01

    Highlights of the National Asthma Education and Prevention Program's Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Full Report 2007 are presented in this EPR-3 summary report. The updated guidelines emphasize the importance of asthma control. Asthma control is the degree to which the manifestations of asthma are minimized by therapeutic intervention and the goals of therapy are met. Because asthma is highly variable, the level of control must be monitored on a periodic basis to determine whether therapy should be maintained or adjusted (stepped up if necessary, stepped down if possible). On the other hand, asthma severity is the intrinsic intensity of the disease process, most easily and directly measured in a patient not receiving long-term control therapy. For managing asthma, the recommendation is to assess severity to initiate therapy and assess control to adjust therapy. Recommendations for managing asthma include an expanded section on childhood asthma with addition of an age group 5 to 11 years old (earlier guidelines combined this group with adults). The guidelines provide new recommendations on patient education in settings beyond the physician's office, and new advice for controlling environmental factors that can cause asthma symptoms. The concepts of current impairment (frequency and intensity of symptoms, low lung function, and limitations of daily activities) and future risk (likelihood of exacerbations, progressive loss of lung function, or adverse side effects from medications) support a new approach to assessing and monitoring the patient's level of asthma control through use of multiple measures. The guidelines stress that some patients can still be at high risk for frequent exacerbations even if they have few day-to-day effects of asthma.Moreover, EPR-3 confirms the importance of teaching patients skills to self-monitor and manage asthma and to use a written asthma action plan, which should include

  10. Reducing energy costs in multifamily housing: guidelines for using energy-management companies

    Energy Technology Data Exchange (ETDEWEB)

    Shafer, P.

    1986-03-01

    This publication is designed to provide guidelines to help sponsors of multi-family projects assisted or insured by the U.S. Department of Housing and Urban Development (HUD), as well as other building owners, utilize performance agreements as a way to make energy-efficiency improvements. These guidelines are based on experience gained in a demonstration project initiated by HUD to test the feasibility of using Energy Management Companies (EMCs) to make energy improvements in assisted housing for the elderly or handicapped.

  11. Spain: National approach to ageing management

    International Nuclear Information System (INIS)

    The plant lifetime or AMR programmes in Spain started in the mid 1980´s with a joint programme shared by all Spanish utilities through their common organization UNESA, developing a methodology to be applied to two plants (an old BWR, Sta. M. de Garoña, and a modern PWR, Vandellós 2) which acted as pilot projects. The development of the methodology was based mainly in the existing technical documents from IAEA, as TECDOCs 338, 540, 547 and 670 and in some instances from EPRI documents (i.e. Monticello NPP and Surry NPP), as well as in the international experience available. The application of this UNESA methodology included: (a) scoping and screening of systems, structures and components (SSC) taking into account safety, availability, replacement and/or cost criteria; (b) study of potential degradation mechanisms affecting these SSC, that were previously grouped in different categories due to their singular components (i.e. vessel, steam generators, turbine-generator set, containment, etc.), or depending on their typology (families or commodities); (c) evaluation of the existing plant maintenance practices versus ageing mechanisms, classifying the SSC as high, medium or low in terms of risk of degradation: and (d) the establishment of improvements in maintenance practices (in broad sense: predictive, preventive and corrective maintenance histories, in-service inspection and erosion-corrosion programmes, in-service testing, environmental and seismic qualification programmes, TS surveillance tests, etc.). The main objectives of the UNESA methodology were: − The plant, as a set of SSC, can reach his design lifetime (40 years) in good safety and availability conditions; − The choice for extending the Operation License and the extension of the initial design lifetime beyond the 40 years, that is LTO, is preserved. The aforementioned general methodology defined by UNESA has been followed by all the Spanish plants since 1987 up to mid-1990´s. At that time, Spanish

  12. Development of Quality Management Systems for Clinical Practice Guidelines in Korea.

    Science.gov (United States)

    Jo, Heui-Sug; Kim, Dong Ik; Chang, Sung-Goo; Shin, Ein-Soon; Oh, Moo-Kyung

    2015-11-01

    This study introduces the Clinical practice guidelines (CPGs) appraisal system by the Korean Academy of Medical Sciences (KAMS). Quality management policies for CPGs vary among different countries, which have their own cultures and health care systems. However, supporting developers in guideline development and appraisals using standardized tools are common practices. KAMS, an organization representing the various medical societies of Korea, has been striving to establish a quality management system for CPGs, and has established a CPGs quality management system that reflects the characteristics of the Korean healthcare environment and the needs of its users. KAMS created a foundation for the development of CPGs, set up an independent appraisal organization, enacted regulations related to the appraisals, and trained appraisers. These efforts could enhance the ability of each individual medical society to develop CPGs, to increase the quality of the CPGs, and to ultimately improve the quality of the information available to decision-makers. PMID:26538997

  13. Development of Hypertension Management Mobile Application based on Clinical Practice Guidelines.

    Science.gov (United States)

    Kang, H; Park, H A

    2015-01-01

    This study aims to develop and evaluate a mobile application for hypertension management based on Clinical Practice Guidelines. The application was developed according to Web-Roadmap methodology. In planning phase, we defined the tasks and product of each phase, selected clinical practice guidelines and extracted intervention items for hypertension management. In analysis phase, we analysed intervention items and made data dictionary, rules, use-case diagram, hypertension management ontology and tailored recommendations for the application. In design phase, we developed an entity-relations diagram, algorithm, and user interface and coded them in the implementation phase. In evaluation phase, first, the knowledge-base was evaluated for its accuracy by experts and they proposed three more detailed recommendations, which were added to the application. Second, mobile heuristics were evaluated. The evaluators pointed out 33 usability-related problems on mobile heuristics items. Out of these, three problems were solved by reflecting evaluators' comments. PMID:25991219

  14. GUIDELINES FOR THE DIAGNOSIS AND MANAGEMENT OF SYNCOPE (2009

    Directory of Open Access Journals (Sweden)

    Angel Moya

    2016-01-01

    Full Text Available Внешние эксперты: Haruhiko Abe (Япония, David G. Benditt (США, Wyatt W. Decker (США, Blair P. Grubb (США, Horacio Kaufmann9 (США, Carlos Morillo (Канада, Brian Olshansky (США, Steve W. Parry (Великобритания, Robert Sheldon (Канада, Win K. Shen (СШАЧлены Комитета Европейского общества кардиологов по практическим рекомендациям (ESC Committee for Practice Guidelines: CPG: Alec Vahanian (Председатель (Франция, Angelo Auricchio (Швейцария,Jeroen Bax (Нидерланды, Claudio Ceconi (Италия, Veronica Dean (Франция, Gerasimos Filippatos (Греция, Christian Funck-Brentano (Франция, Richard Hobbs (Великобритания, Peter Kearney (Ирландия, Theresa McDonagh (Великобритания, Keith McGregor (Франция, Bogdan A. Popescu (Румыния, Zeljko Reiner (Хорватия, Udo Sechtem (Германия, Per Anton Sirnes (Норвегия, Michal Tendera (Польша, Panos Vardas (Греция, Petr Widimsky (ЧехияРецензенты: Angelo Auricchio (Координатор от CPG (Швейцария, Esmeray Acarturk (Турция, Felicita Andreotti (Италия, Riccardo Asteggiano (Италия, Urs Bauersfeld (Швейцария, Abdelouahab Bellou4 (Франция, Athanase Benetos6 (Франция, Johan Brandt (Швеция, Mina K. Chung3 (США, Pietro Cortelli 8 (Италия, Antoine Da Costa (Франция, Fabrice Extramiana (Франция, Jose´ Ferro7 (Португалия, Bulent Gorenek (Турция, Antti Hedman (Финляндия, Rafael Hirsch (Израиль, Gabriela Kaliska (Словакия, Rose Anne Kenny6 (Ирландия, Keld Per Kjeldsen (Дания, Rachel Lampert 3 (USA, Henning Mølgard (Denmark, Rain Paju (Эстония, Aras Puodziukynas (Литва, Antonio Raviele (

  15. Management of fibromyalgia syndrome – an interdisciplinary evidence-based guideline

    Directory of Open Access Journals (Sweden)

    Sommer, Claudia

    2008-12-01

    Full Text Available The prevalence of fibromyalgia syndrome (FMS of 1–2% in the general population associated with high disease-related costs and the conflicting data on treatment effectiveness had led to the development of evidence-based guidelines designed to provide patients and physicians guidance in selecting among the alternatives. Until now no evidence-based interdisciplinary (including patients guideline for the management of FMS was available in Europe. Therefore a guideline for the management of fibromyalgia syndrome (FMS was developed by 13 German medical and psychological associations and two patient self-help organisations. The task was coordinated by two German scientific umbrella organisations, the Association of the Scientific Medical Societies in Germany AWMF and the German Interdisciplinary Association of Pain Therapy DIVS. A systematic search of the literature including all controlled studies, systematic reviews and meta-analyses of pharmacological and non-pharmacological treatments of FMS was performed in the Cochrane Library (1993–12/2006, Medline (1980–12/2006, PsychInfo (1966–12/2006 and Scopus (1980–12/ 2006. Levels of evidence were assigned according to the classification system of the Oxford-Centre for Evidence Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures were used to reach a consensus on recommendations. The guideline was reviewed and finally approved by the boards of the societies involved and published online by the AWMF on april 25, 2008: http://www.uni-duesseldorf.de/AWMF/ll/041-004.htm. A short version of the guideline for patients is available as well: http://www.uni-duesseldorf.de/AWMF/ll/041-004p.htm. The following procedures in the management of FMS were strongly recommended: information on diagnosis and therapeutic options and patient-centered communication, aerobic exercise, cognitive and operant

  16. Management of fibromyalgia syndrome – an interdisciplinary evidence-based guideline

    Science.gov (United States)

    Häuser, Winfried; Arnold, Bernhard; Eich, Wolfgang; Felde, Eva; Flügge, Christl; Henningsen, Peter; Herrmann, Markus; Köllner, Volker; Kühn, Edeltraud; Nutzinger, Detlev; Offenbächer, Martin; Schiltenwolf, Marcus; Sommer, Claudia; Thieme, Kati; Kopp, Ina

    2008-01-01

    The prevalence of fibromyalgia syndrome (FMS) of 1–2% in the general population associated with high disease-related costs and the conflicting data on treatment effectiveness had led to the development of evidence-based guidelines designed to provide patients and physicians guidance in selecting among the alternatives. Until now no evidence-based interdisciplinary (including patients) guideline for the management of FMS was available in Europe. Therefore a guideline for the management of fibromyalgia syndrome (FMS) was developed by 13 German medical and psychological associations and two patient self-help organisations. The task was coordinated by two German scientific umbrella organisations, the Association of the Scientific Medical Societies in Germany AWMF and the German Interdisciplinary Association of Pain Therapy DIVS. A systematic search of the literature including all controlled studies, systematic reviews and meta-analyses of pharmacological and non-pharmacological treatments of FMS was performed in the Cochrane Library (1993–12/2006), Medline (1980–12/2006), PsychInfo (1966–12/2006) and Scopus (1980–12/ 2006). Levels of evidence were assigned according to the classification system of the Oxford-Centre for Evidence Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures were used to reach a consensus on recommendations. The guideline was reviewed and finally approved by the boards of the societies involved and published online by the AWMF on april 25, 2008: http://www.uni-duesseldorf.de/AWMF/ll/041-004.htm. A short version of the guideline for patients is available as well: http://www.uni-duesseldorf.de/AWMF/ll/041-004p.htm. The following procedures in the management of FMS were strongly recommended: information on diagnosis and therapeutic options and patient-centered communication, aerobic exercise, cognitive and operant behavioural therapy

  17. Aging management assessment of type B transportation packages

    International Nuclear Information System (INIS)

    The condition of a physical system such as a radioactive materials transportation package can change as it ages. The degree to which aging effects are identified, prevented or mitigated will depend on the types of inspections and maintenance performed on the critical components of the system. Routine inspections and maintenance may not address degradation mechanisms that are difficult to observe and can act over long periods of time. Aging management is a systematic effort to ensure that the system performs as designed over its entire service life and that degradation mechanisms do not prematurely end the service life. The Nuclear Waste Management Division (NWMD) of Ontario Power Generation (OPG) has developed an Aging Management Procedure and began performing aging management assessments on its Type B(U) packages. This paper discusses the Procedure and briefly describes the aging management assessment performed on the Roadrunner Transportation Package to demonstrate a practical application of the aging management process

  18. Development of Manitoba Hydro's public water safety around dams management guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Bonin, Dave; McPhail, Gord; Murphy, Shayla; Schellenberg, Gord [KGS Acres, Winnipeg, (Canada); Read, Nick [Manitoba Hydro, Winnipeg, (Canada)

    2010-07-01

    Several drowning fatalities and safety incidents have occurred around dams in Ontario, Manitoba and other jurisdictions in Canada. Following these incidents, Manitoba Hydro implemented several measures to improve public safety around its dams with the development of a warning signs manual. Manitoba Hydro found that a standard centralized approach to the process of improving public safety is better for ensuring compliance and consistency, even though they have safety measures in place. This paper described the process that Manitoba Hydro has followed in developing a formal set of public water safety around dams (PWSD) guidelines and a program for implementing these guidelines. This program was developed with the intent of providing a high standard of public protection and continuous improvement and monitoring on par with the effect spent on similar dam safety type programs. This paper focused on the development of the pilot PWSD management plan for Pine Falls generating station in order to test the effectiveness and usability of the guidelines.

  19. Ageing Management for Nuclear Power Plants. Safety Guide (Russian Edition)

    International Nuclear Information System (INIS)

    The median age of nuclear power plants connected to the grid worldwide is increasing. Ageing management has become an important issue in ensuring the availability of required safety functions throughout the service life of a plant. This Safety Guide provides recommendations on meeting the requirements for safe long term operation and identifies key elements of effective ageing management for nuclear power plants

  20. Guideline-based survey of outpatient COPD management by pulmonary specialists in Germany

    Directory of Open Access Journals (Sweden)

    Buhl R

    2012-02-01

    Full Text Available Thomas Glaab1,2, Claus Vogelmeier3, Andreas Hellmann4, Roland Buhl11Department of Respiratory Diseases III, Medical Center of the Johannes Gutenberg-University, Mainz, 2Medical Affairs Germany, Respiratory Medicine, Boehringer Ingelheim Pharma GmbH and Co, KG, Ingelheim, 3Department of Respiratory Diseases, University Hospitals of Giessen and Marburg, Marburg, 4Federal Association of Pneumologists, Augsburg, GermanyBackground: Little is known about the role of guidelines for the practical management of chronic obstructive pulmonary disease (COPD by office-based pulmonary specialists. The aim of this study was to assess their outpatient management in relation to current guideline recommendations for COPD.Methods: A nationwide prospective cross-sectional COPD questionnaire survey in the form of a multiple-choice questionnaire was sent to 1000 office-based respiratory specialists in Germany. The product-neutral questions focused on routine COPD management and were based on current national and international COPD guideline recommendations being consistent in severity classification and treatment recommendations.Results: A total of 590 pulmonary specialists (59% participated in the survey. Body plethysmography was considered the standard for diagnosis (65.9%, followed by spirometry (32%. Most respondents were able to cite the correct spirometric criteria for classifying moderate (87% to very severe COPD (77%. A quarter of the respondents equated the World Health Organization (WHO definition of chronic bronchitis with COPD. Notably, most participants preferred the updated national COPD guidelines (51.4% to the Global Initiative for Chronic Obstructive Lung Disease (GOLD guidelines (40.2%. Improvement of functional exercise capacity and quality of life were considered the two most relevant treatment goals; whereas impact on mortality was secondary. Treatment of COPD largely complied with the guidelines. However, a significant percentage of the

  1. [International clinical practice guidelines and management of rheumatology in Madagascar].

    Science.gov (United States)

    Ralandison, S; Rafalimanana, E; Rakotonirainy, H; Rabenja, R

    2012-02-01

    Developed countries issue recommendations regarding healthcare that aren't constantly appropriate for emergent countries. We suggest some remarks concerning rheumatology in Madagascar, taking account of scientific data, medical ethics, equality and equity. We have studied the minimal cost of care of medical conditions found in our hospital department if we were to follow international recommendations for their management. Then, we have estimated treatment expenses as a percentage of the SMIC (Malagasy minimum monthly salary). Out of 517 patients examined yearly, we have found 62.8% osteoarthritis cases, 6.3% rheumatoid arthritis (RA), and 4,2% septic arthritis. Therefore, the first month of treatment for an arthritis of the knee would absorb 147.3% of the SMIC; diagnosis and treatment of a case of septic arthritis would take up 1762.8% of the minimum wage, and a case of RA without biotherapy would require 175%. According to the American College of Rheumatology criteria which are used as a reference, the treatment of an arthritis of the knee would take only 23% of the SMIC. Caring for septic arthritis would demand 57.5% of the SMIC and while it would yield more arguments for diagnosis such as clinical examination, CRP, and Gram coloration on joint liquid aspiration. We can proceed to RA diagnosis with an acceptable security through precise clinical examination, blood cell count, ESR, CRP, rheumatoid factor and radiography. This means 56% of the SMIC. From this 517 patients, our suggestions would reduce the expense by 35,850% of the SMIC per year. The allocation of such funds onto the treatment of complicated forms of rheumatism would be fair. By refining and evaluating these suggestions, we would come up with appropriate recommendations for emergent countries. PMID:22223222

  2. Guidelines regarding management of adrenal insufficiency in the Holy month of Ramadan

    Directory of Open Access Journals (Sweden)

    Sheelu S Siddiqi

    2012-01-01

    Full Text Available Adrenal insufficiency is a life-threatening event, so it is recommended for patients with known adrenal insufficiency to be properly educated regarding sick-day management. In the month of Ramadan, people refrain from eating and drinking during daylight hours. It is very important for patients with adrenal insufficiency, who wish to keep a fast, to be well aware of the disease, the suitable drug to be used for that particular period, warning signs, sick-day management, physical activity, and dietary limits. This article describes guidelines for the sick-day management of patients with adrenal insufficiency, in the month of Ramadan.

  3. [Scandinavian guidelines on the pre-hospital management of traumatic brain injury

    DEFF Research Database (Denmark)

    Juul, N.; Sollid, S.; Sundstrom, T.; Kock-Jensen, C.; Eskesen, V.; Bellander, B.M.; Wester, K.; Romner, B.

    Head trauma causes the death of many young persons. The number of fatalities can be reduced through systematic management. Preventing secondary brain injury together with the fastest possible transport to a neurosurgical unit has been shown to be effective in reducing mortality and morbidity....... Evidence-based guidelines already exist that focus on all steps in the management. This article, which was written by members of the Scandinavian Neurotrauma Committee, presents recommendations on the pre-hospital management of traumatic brain injury adapted to the infrastructure of Scandinavia...

  4. Guidelines regarding management of adrenal insufficiency in the Holy month of Ramadan

    Science.gov (United States)

    Siddiqi, Sheelu S.; Singh, S. K.; Khan, Shakeel Ahamad; Ishtiaq, Osama; Pathan, Md. Faruque; Raza, Syed Abbas; Khan, A. K. Azad; Zargar, Abdul Hamid; Bantwal, Ganapathy

    2012-01-01

    Adrenal insufficiency is a life-threatening event, so it is recommended for patients with known adrenal insufficiency to be properly educated regarding sick-day management. In the month of Ramadan, people refrain from eating and drinking during daylight hours. It is very important for patients with adrenal insufficiency, who wish to keep a fast, to be well aware of the disease, the suitable drug to be used for that particular period, warning signs, sick-day management, physical activity, and dietary limits. This article describes guidelines for the sick-day management of patients with adrenal insufficiency, in the month of Ramadan. PMID:22837908

  5. Overview of the Environmental and Water Resources Institute's "Guidelines For Integrated Water Resources Management" Project

    Energy Technology Data Exchange (ETDEWEB)

    Gerald Sehlke

    2005-03-01

    Integrated Water Resources Management is a systematic approach to optimizing our understanding, control and management of water resources within a basin to meet multiple objectives. Recognition of the need for integrating water resources within basins is not unique to the Environmental and Water Resources Institute’s Integrated Water Resources Management Task Committee. Many individuals, governments and other organizations have attempted to develop holistic water resources management programs. In some cases, the results have been very effective and in other cases, valiant attempts have fallen far short of their initial goals. The intent of this Task Committee is to provide a set of guidelines that discusses the concepts, methods and tools necessary for integrating and optimizing the management of the physical resources and to optimize and integrate programs, organizations, infrastructure, and socioeconomic institutions into comprehensive water resources management programs.

  6. Ageing Management for Nuclear Power Plants: International Generic Ageing Lessons Learned (IGALL)

    International Nuclear Information System (INIS)

    This publication provides a common internationally agreed basis on what constitutes an acceptable ageing management programme, as well as a knowledge base on ageing management for the design of new plants, design and safety reviews, and aims to serve as a roadmap to available information on ageing management. It addresses ageing management of passive and active structures and components for water moderated reactors that can have an impact, directly or indirectly, on the safe operation of the plant and that are susceptible to ageing degradation. The information provided is relevant for plants under normal operation, for plants considering long term operation, as well as for new plants including new designs. It underlines that ageing management should be implemented from the start of operation of nuclear power plants and that adequate provisions to facilitate effective ageing management should be made during the plant design, construction commissioning, operation, and decommissioning

  7. Belgium: National approach to ageing management

    International Nuclear Information System (INIS)

    In Belgium, the licenses for operation of the nuclear power plants granted by Royal Decree do not specify a fixed lifetime. The oldest plants, Doel 1&2 and Tihange 1, have been operational since 1975. The 2003 law regarding the exit from nuclear power limits the operation of nuclear power plants to 40 years. However, in October 2009, the Belgian government declared that they intended to make it legally possible for Doel 1&2 and Tihange 1 to operate until 2025, which would mean a total lifetime of 50 years (this statement was confirmed by the Belgian government in June 2012, only for the Tihange 1 plant). The Belgian Federal Agency for Nuclear Control (FANC) published in 2009 a strategic note regarding the requirements of long-term operation for Doel 1&2 and Tihange 1. Electrabel GDF SUEZ started its LTO programme in order to respond to these requirements. The LTO programme consisted of the following areas of concern, identified in the FANC strategic note: − Preconditions for long-term operation considering the IAEA expectations; − Ageing management; − Design re-evaluation; − Knowledge, competence and behaviour management. The note also stated that the long-term operation of the plants should be evaluated within the framework of the fourth ten-yearly PSR, based upon IAEA NS-G-2.10. As such a license renewal was not required for LTO and the LTO approval will be integrated in the approval process of the 4th PSR. In its strategic note, the Belgian Federal Agency for Nuclear Control explicitly states that the AMP has to be in conformity with the USNRC 10CFR54 and IAEA SRS 57

  8. Evidence-based review of diabetic macular edema management: Consensus statement on Indian treatment guidelines

    Science.gov (United States)

    Das, Taraprasad; Aurora, Ajay; Chhablani, Jay; Giridhar, Anantharaman; Kumar, Atul; Raman, Rajiv; Nagpal, Manish; Narayanan, Raja; Natarajan, Sundaram; Ramasamay, Kim; Tyagi, Mudit; Verma, Lalit

    2016-01-01

    The purpose of the study was to review the current evidence and design a diabetic macular edema (DME) management guideline specific for India. The published DME guidelines from different organizations and publications were weighed against the practice trends in India. This included the recently approved drugs. DME management consisted of control of diabetes and other associated systemic conditions, such as hypertension and hyperlipidemia, and specific therapy to reduce macular edema. Quantification of macular edema is precisely made with the optical coherence tomography and treatment options include retinal laser, intravitreal anti-vascular endothelial growth factors (VEGF), and implantable dexamethasone. Specific use of these modalities depends on the presenting vision and extent of macular involvement. Invariable eyes with center-involving macular edema benefit from intravitreal anti-VEGF or dexamethasone implant therapy, and eyes with macular edema not involving the macula center benefit from retinal laser. The results are illustrated with adequate case studies and frequently asked questions. This guideline prepared on the current published evidence is meant as a guideline for the treating physicians. PMID:26953019

  9. Development of the ageing management database of PUSPATI TRIGA reactor

    Energy Technology Data Exchange (ETDEWEB)

    Ramli, Nurhayati, E-mail: nurhayati@nm.gov.my; Tom, Phongsakorn Prak; Husain, Nurfazila; Farid, Mohd Fairus Abd; Ramli, Shaharum [Reactor Technology Centre, Malaysian Nuclear Agency, MOSTI, Bangi, 43000 Kajang, Selangor (Malaysia); Maskin, Mazleha [Science Program, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Selangor (Malaysia); Adnan, Amirul Syazwan; Abidin, Nurul Husna Zainal [Faculty of Petroleum and Renewable Energy Engineering, Universiti Teknologi Malaysia (Malaysia)

    2016-01-22

    Since its first criticality in 1982, PUSPATI TRIGA Reactor (RTP) has been operated for more than 30 years. As RTP become older, ageing problems have been seen to be the prominent issues. In addressing the ageing issues, an Ageing Management (AgeM) database for managing related ageing matters was systematically developed. This paper presents the development of AgeM database taking into account all RTP major Systems, Structures and Components (SSCs) and ageing mechanism of these SSCs through the system surveillance program.

  10. Development of the ageing management database of PUSPATI TRIGA reactor

    International Nuclear Information System (INIS)

    Since its first criticality in 1982, PUSPATI TRIGA Reactor (RTP) has been operated for more than 30 years. As RTP become older, ageing problems have been seen to be the prominent issues. In addressing the ageing issues, an Ageing Management (AgeM) database for managing related ageing matters was systematically developed. This paper presents the development of AgeM database taking into account all RTP major Systems, Structures and Components (SSCs) and ageing mechanism of these SSCs through the system surveillance program

  11. Development of the ageing management database of PUSPATI TRIGA reactor

    Science.gov (United States)

    Ramli, Nurhayati; Maskin, Mazleha; Tom, Phongsakorn Prak; Husain, Nurfazila; Farid, Mohd Fairus Abd; Ramli, Shaharum; Adnan, Amirul Syazwan; Abidin, Nurul Husna Zainal

    2016-01-01

    Since its first criticality in 1982, PUSPATI TRIGA Reactor (RTP) has been operated for more than 30 years. As RTP become older, ageing problems have been seen to be the prominent issues. In addressing the ageing issues, an Ageing Management (AgeM) database for managing related ageing matters was systematically developed. This paper presents the development of AgeM database taking into account all RTP major Systems, Structures and Components (SSCs) and ageing mechanism of these SSCs through the system surveillance program.

  12. Plant maintenance and aging management: Are they the same?

    International Nuclear Information System (INIS)

    As part of the NRC's Nuclear Plant Aging Research Program, a number of aging studies were performed on safety-related systems and components which found that, even with current maintenance and monitoring practices in place, a large number of the reported failures are related to aging. This suggests that current practices are not sufficient to completely manage aging degradation, and other factors need to be considered. This paper examines the aging management process and the degree to which maintenance plays a part in it. Component failures and degradation mechanisms identified in aging studies of several different safety systems are summarized and evaluated, then con-elated with the components most frequently failed. This information, along with an analysis of failure causes, is then used to determine the extent to which aging is managed by current maintenance practices. Conclusions and recommendations for proper aging management arc also presented

  13. Aging management of reactor internals and license renewal of US PWR plants

    International Nuclear Information System (INIS)

    Age-related degradation mechanisms of key components are subject to aging management review by utilities considering plant license renewal. The management of aging effects in PWR internals must be demonstrated as specified in the US NRC Standard Review. The US NRC staff has also issued a Generic Aging Lessons Learned (GALL) report that documents the staff's basis for determining when existing generic programs are adequate to manage aging without change and when existing generic programs should be augmented for license renewal. The EPRI Materials Reliability Program (MRP) has been conducting studies to develop technical bases and guidelines to support aging management of PWR internals, with a particular attention to utility License Renewal commitments. The strategic approach taken by the MRP includes: developing an overall aging management framework, defining degradation mechanism screening values, categorizing and ranking internals components based on screening, performing functionality analyses and safety evaluation, and developing inspection and evaluation guidelines associated with each category of components. Screening criteria are developed for the following potential internals degradation mechanisms: - Stress Corrosion Cracking [Excluding Irradiation Effects]; - Irradiation-Assisted Stress Corrosion Cracking; - Thermal Aging Embrittlement; - Irradiation Embrittlement; - Void Swelling; - Stress Relaxation and Creep [Irradiation-enhanced]; - Wear; - Fatigue. The ranking and categorization calls to bin internals components into four categories: - Category A: component items for which aging degradation significance is minimal and aging effects are below the screening criteria; - Category C: 'lead' component items for which aging degradation significance is high or moderate and aging effects are above screening levels; - Category B: component items above screening levels but are not 'lead' component items and aging degradation significance is moderate; - Category

  14. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries. 3

    DEFF Research Database (Denmark)

    Diangelis, A J; Andreasen, J O; Ebeleseder, K A;

    2014-01-01

    Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group...... discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their...... opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can...

  15. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries

    DEFF Research Database (Denmark)

    Malmgren, Barbro; Andreasen, Jens O; Flores, Marie Therese;

    2012-01-01

    Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group...... discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their...... opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can...

  16. Management of Patients Aged ≥85 Years With ST-Elevation Myocardial Infarction.

    Science.gov (United States)

    Yudi, Matias B; Jones, Nicholas; Fernando, Dharsh; Clark, David J; Ramchand, Jay; Jones, Elizabeth; Dakis, Robynne; Johnson, Douglas; Chan, Robert; Islam, Amirul; Farouque, Omar; Horrigan, Mark

    2016-07-01

    Guidelines mandate urgent revascularization in patients presenting with ST-elevation myocardial infarction (STEMI) irrespective of age. Whether this strategy is optimal in patients aged ≥85 years remains uncertain. We aimed to assess the clinical characteristics and outcomes of patients aged ≥85 years with STEMI stratified by their management strategy. We analyzed baseline clinical characteristics of 101 consecutive patients aged ≥85 years who presented with STEMI to a tertiary Australian hospital. Patients were stratified based on whether they underwent invasive management with urgent coronary angiography ± percutaneous coronary intervention or conservative management. Our primary outcome was long-term mortality. Independent predictors of conservative management and long-term mortality were assessed by multivariate logistic regression and Cox proportional hazard modeling respectively. Of the 101 patients included, 45 underwent invasive management. Independent predictors of having conservative management were older age, anterior STEMI, and cognitive impairment (all p <0.01). Patients managed invasively had lower in-hospital (13.3% vs 32.1%, p = 0.03), 30-day (13.3% vs 37.5%, p <0.01), 12-month (22.2% vs 57.1%, p <0.01), and long-term (40.0% vs 75.0%, p <0.01) mortality. Invasive management was an independent predictor of lower long-term mortality (hazard ratio 0.29, 95% CI 0.11 to 0.76, p <0.01). In conclusion, patients aged ≥85 years with STEMI who were older, had cognitive impairment or presented with anterior ST-elevation were more likely to be managed conservatively. Those who underwent invasive management had reasonable short- and long-term outcomes. PMID:27217208

  17. Life management/aging 1995 annual report. Revision 1

    International Nuclear Information System (INIS)

    This report provides the 1995 status of the Life Management/Aging Management Program and the activities over the current fiscal year. It relates to the Tank Waste Remediation System and to the double shell tanks

  18. Aging management: Control of the knowledge data base

    International Nuclear Information System (INIS)

    Aging management is part of the safety management system in NPP Neckarwestheim, Germany. The central goal of aging management is to increase knowledge about aging mechanisms acting on systems, structures and components (SSC), steadily. Comprehensive knowledge is a pre-requisite to guard against aging related systematic failures. To increase knowledge it is necessary to gather and evaluate data of different departments, systematically. While a nuclear power plant is in service numerous events may occur which are related to aging and may have an influence on the quality of SSC. Relevant events may be malfunction, maintenance results, operational experience, results of surveillance or events in other utilities. It is important to evaluate these events concerning the aspect of aging, regularly, and to decide which measures are required to prevent similar unexpected events in the future. In some cases the new experience has to be assigned to comparable SSC. These evaluations and the necessary measures as well as the tracking of their effectiveness are performed by an aging management team that meets every 3 months. The resulting knowledge data base (aging management data base) supports the application of the PDCA cycle and provides an overview and fast access to all quality documents related to each SSC including surveillance measures and results. It simplifies the generation of annual status reports which demonstrate the efficiency of aging management. Finally, the procedure can be extended to SSC which are important for the availability of the plant and thus take a step forward from aging management to plant life management

  19. Management and Communication of the Companies' Knowledge; Guidelines for Intellectual Capital Statement

    OpenAIRE

    Justyna Fijalkowska

    2008-01-01

    This paper aims at analyzing the development of guidelines on Intellectual Capital Statement, providing a comparison of them and presenting their importance within the knowledge management process of the today's companies. We entered the Knowledge Era in which the basic economic resources are no longer financial capital, physical resources, or labor, but knowledge, called also intellectual capital (IC). Many analysts and investors demand for more information and they highlight the gap that ex...

  20. Characteristics of Trailer Thermal Environment during Commercial Swine Transport Managed under U.S. Industry Guidelines

    OpenAIRE

    Yijie Xiong; Angela Green; Richard S. Gates

    2015-01-01

    Simple Summary Temperature and thermal conditions of the interior of a swine trailer during transport were monitored over a broad range of outdoor conditions (34 trips total) managed according to industry best practice (Transport Quality Assurance (TQA) guidelines (NPB, 2008)). For the outdoor temperature range of 5 °C (40 °F) to 27 °C (80 °F), generally acceptable trailer thermal conditions were observed according to the TQA. Beyond this outdoor temperature range, undesirable conditions with...

  1. An Evaluation of Web-Based Clinical Practice Guidelines for Managing Problems Associated with Cannabis Use

    OpenAIRE

    Norberg, Melissa M; Turner, Michael W; Rooke, Sally E; Langton, Julia M; Gates, Peter J

    2012-01-01

    Background Cannabis is the most widely used illicit substance, and multiple treatment options and avenues exist for managing its use. There has been an increase in the development of clinical practice guidelines (CPGs) to improve standards of care in this area, many of which are disseminated online. However, little is known about the quality and accessibility of these online CPGs. Objective The purpose of study 1 was to determine the extent to which cannabis-related CPGs disseminated online a...

  2. Quality Control Guidelines for Managing Young Employees in Tourism : Case: S2S Travel Network

    OpenAIRE

    Krekilä, Sonja

    2013-01-01

    In the evermore competitive and globalized service market quality has proven to be the factor, which can provide the company with a significant competitive advantage. Therefore, excelling in quality management can be the key to success for the company. The objective of this thesis was to create quality control guidelines for the organization idea and the travel packages offered by it, which were developed in Tourism Product Development course in Kajaani University of Applied Sciences in 2...

  3. Guidelines for the diagnosis and management of cow's milk protein allergy in infants

    OpenAIRE

    Vandenplas, Yvan; Brueton, Martin; Dupont, Christophe; Hill, David; Isolauri, Erika; Koletzko, Sibylle; Oranje, Arnold P; Staiano, Annamaria

    2007-01-01

    Our aim was to develop guidance for general paediatricians and primary care physicians in diagnosing and managing cow’s milk protein allergy in infants. The guidelines were developed by discussion based on existing national recommendations and standards, clinical experience and, whenever possible, evidence from the literature. Separate algorithms cover breast-fed and formula-fed infants. The recommendations emphasise the importance of comprehensive history taking and c...

  4. Spanish guidelines for the management of autosomal dominant polycystic kidney disease

    OpenAIRE

    E. Ars; Bernis, C.; Fraga, G.; Martínez, V.; Martins Muñoz, Judith Fátima; Ortiz, A.; Torra, R; Pérez, M. V.; Antón Pérez, G.; Furlano, M.; Ayasreh, N.

    2014-01-01

    Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent cause of genetic renal disease and accounts for 6-10% of patients on renal replacement therapy (RRT). Very few prospective, randomized trials or clinical studies address the diagnosis and management of this relatively frequent disorder. No clinical guidelines are available to date. This is a consensus statement presenting the recommendations of the Spanish Working Group on Inherited Kidney Diseases, which were agreed to...

  5. OARSI guidelines for the non-surgical management of knee osteoarthritis.

    OpenAIRE

    McAlindon, TE; Bannuru, RR; Sullivan, MC; Arden, NK.; Berenbaum, F; Bierma-Zeinstra, SM; Hawker, GA; Henrotin, Y; Hunter, DJ; Kawaguchi, H; Kwoh, K; Lohmander, S; Rannou, F.; Roos, EM; Underwood, M.

    2014-01-01

    OBJECTIVE: To develop concise, up-to-date, patient-focused, evidence-based, expert consensus guidelines for the management of knee osteoarthritis (OA), intended to inform patients, physicians, and allied healthcare professionals worldwide. METHOD: Thirteen experts from relevant medical disciplines (primary care, rheumatology, orthopedics, physical therapy, physical medicine and rehabilitation, and evidence-based medicine), three continents and ten countries (USA, UK, France, Netherlands, Belg...

  6. 246 Assessment of the Quality of Methodological Rigour and Reporting of Clinical Practice Guidelines for the Management of Allergic Rhinitis—Qugar Study

    OpenAIRE

    Padjas, Agnieszka; Schünemann, Holger,; Bousquet, Jean; Brozek, Jan

    2012-01-01

    Background To assess the methodological rigour and transparency of reporting in clinical practice guidelines for the management of allergic rhinitis (AR). Methods We systematically searched MEDLINE, TRIP database (including the National Guidelines Clearinghouse) and professional society websites for guidelines about the management of AR published after the year 2000. We assumed that older guidelines would no longer influence current clinical practice. If the guideline was updated after 2000 w...

  7. Regulations and proactive management of ageing steam generators in Canada

    International Nuclear Information System (INIS)

    Effective ageing management programs of key safety-related structures, systems, and components (SSCs) are an efficient means for ensuring the long-term safe and reliable operation of nuclear power plants. In the early days of design of nuclear power plants, it was assumed that the operational life cycle of steam generators would be the same or similar to that of other key components in the reactor primary heat transport system. However, widespread degradation of the steam generator tubing that has occurred at a number of plants has shown that this original assumption was incorrect or at least too optimistic. Observed degradations can be attributed to a number of factors ranging from shortcomings in the design codes manufacturing processes, or water chemistry, and unanticipated mechanisms of material and component degradation resulting from high temperature, high fluid flow, cycling loads and presence of corrosive species. The licensees have responded to this challenge with extensive inspection and maintenance programs, supported by research and development in the areas of corrosion and mechanical degradation of tubes and internals, chemistry, thermal hydraulics, fouling, inspection and cleaning, and specialized inspection tools. This paper discusses the Canadian Nuclear Safety Commission approach towards ensuring that licensees operate and maintain their plants in a safe operational condition. It briefly describes elements of the CNSC requirements and the overall regulatory oversight process to achieve these goals. The paper also discusses the known degradation mechanisms in Canadian steam generators and describes the requirements in place to ensure licensees sufficiently monitor the condition of their SSCs and appropriately disposition the results of inspections. Particularly, the tube degradation is a major driving force for development of CANDU specific fitness-for-service guidelines, and for specialized inspection and monitoring technology to control steam

  8. Management of ageing in nuclear power plants

    International Nuclear Information System (INIS)

    Ageing is time dependent degradation of hardware and measured by percentage deviation of performance parameters with reference to their respective reference values. Ageing is influenced by environmental and operating stresses; lower the magnitude of stresses, lower the rate of degradation and vice versa. This paper describes test results of thermal ageing, radiation ageing and performance during loss of coolant accident (LOCA) environment (steam bound condition at 120 degC) on various types of electrical cables, elastomers and electronic process instruments. (author)

  9. Aging aircraft wiring: a proactive management methodology

    OpenAIRE

    Tambouratzis, Vasileios.

    2001-01-01

    During the last years, military budgets have been dramatically reduced and the services have been unable to acquire sufficient new systems. Military aviation is one of the areas that have been severely impacted. The result is that the current fleet faces significant aging aircraft problems. Aircraft wiring is one of the areas that have severely affected by the aging process. Recent accidents involving aging wiring problems and reduced operational readiness due to aging wiring have made clear ...

  10. Long-Term Ageing Management Strategies for Nuclear Power Plants

    International Nuclear Information System (INIS)

    All nuclear power plants have implemented some form of long-term ageing management at their facility. However, methodologies have been developed recently that can provide enhancements to the existing ageing management plans. Comprehensive long-term ageing management strategies consider the role of every system, structure, and component (SSC) in the nuclear power plant and assesses how ageing can prevent those SSCs from performing those roles. While the ultimate goal of the different methodologies is the same (that is, managing the ageing of plant SSCs to assure safety and cost efficiency) their focus and stakeholders are different, and therefore, there are differences in the specific methodologies. These categories of methodologies can be defined as experience-based, regulatory-based, and economic-based methodologies. This paper will provide an overview of the three different categories of ageing management methodologies. (author)

  11. Long-term aging management strategies for nuclear power plants

    International Nuclear Information System (INIS)

    All nuclear power plants have implemented some form of long-term aging management at their facility. However, methodologies have been developed recently that can provide enhancements to the existing aging management plans. This paper presents these comprehensive aging management strategies. Comprehensive long-term aging management strategies consider the role of every system, structure, and component (SSC) in the nuclear power plant and assesses how aging can prevent those SSCs from performing those roles. Nuclear power plants that have not implemented comprehensive long-term aging management strategies/programs utilize existing maintenance and inspection programs to manage plant aging. While maintenance and inspection have not been traditionally called aging management programs, they perform activities that are credited with managing aging. These activities have been performed for many years, and many of these programs exist as a result of commitments to specific regulations (e.g. In-Service Inspection). Other programs exist because they have been identified by standards or industry best practices. Operating experience provides feedback when failures occur so that enhancements to programs can be developed through the corrective actions process. While the above process has served the industry well and will continue, many gaps have been identified in the processes of plants that have implemented long-term aging management strategies. These gaps include, for example, missing programs, key components that are experiencing aging but aren't covered by any program, deficient or out-dated techniques being used in existing programs, and enhancements in the acceptance criteria for the program. Several methodologies have been developed to identify gaps in aging management and/or to confirm that the existing aging management is sufficient. These methodologies combine to provide a comprehensive long-term aging management strategy. While the ultimate goal of these methodologies

  12. Clinical Guidelines and Management of Ankyloglossia with 1-Year Followup: Report of 3 Cases

    Directory of Open Access Journals (Sweden)

    Mayur S. Bhattad

    2013-01-01

    Full Text Available The tongue is an important oral structure that affects speech, position of teeth, periodontal tissue, nutrition, swallowing, nursing, and certain social activities. Ankyloglossia (tongue tie is a congenital anomaly characterized by an abnormally short, thick lingual frenulum which affects movement of tongue. Though the effect of ankyloglossia in general appears to be a minor condition, but a major difference exists concerning the guidelines for tongue-tie division. There are no accepted practical criteria for the management of such condition, and hence this paper aims at bringing all the compilation in examination, diagnosis, treatment, and management of tongue tie together for better clinical approach.

  13. Clinical guidelines and management of ankyloglossia with 1-year followup: report of 3 cases.

    Science.gov (United States)

    Bhattad, Mayur S; Baliga, M S; Kriplani, Ritika

    2013-01-01

    The tongue is an important oral structure that affects speech, position of teeth, periodontal tissue, nutrition, swallowing, nursing, and certain social activities. Ankyloglossia (tongue tie) is a congenital anomaly characterized by an abnormally short, thick lingual frenulum which affects movement of tongue. Though the effect of ankyloglossia in general appears to be a minor condition, but a major difference exists concerning the guidelines for tongue-tie division. There are no accepted practical criteria for the management of such condition, and hence this paper aims at bringing all the compilation in examination, diagnosis, treatment, and management of tongue tie together for better clinical approach. PMID:23424685

  14. Radiation Safety Management Guidelines for PET-CT: Focus on Behavior and Environment

    International Nuclear Information System (INIS)

    Our purpose is to specify behavior and environmental factors aimed at reducing the exposed dosage caused by PET-CT and to develop radiation safety management guidelines adequate for domestic circumstances. We have used a multistep-multimethod as the methodological approach to design and to carry out the research both in quality and quantity, including an analysis on previous studies, professional consultations and a survey. The survey includes responses from 139 practitioners in charged of 109 PET-CTs installed throughout Korea(reported by the Korean Society of Nuclear Medicine, 2010). The research use 156 questions using Cronbach's α (alpha) coefficients which were: 0.818 for 'the necessity of setting and installing the radiation protective environment'; 0.916 for 'the necessity of radiation protection', 'setting and installing the radiation protective environment'; and 0.885 for 'radiation protection'. The check list, derived from the radiation safety management guidelines focused on behavior and environment, was composed of 20 items for the radiation protective environment: including 5 items for the patient; 4 items for the guardian; 3 items for the radiologist; and 8 items applied to everyone involved; for a total of 26 items for the radiation protective behavior including: 12 items for the patient; 1 item for the guardian, 7 items for the radiologist; and 6 items applied to everyone involved. The specific check list is shown in (Table 5-6). Since our country has no safety management guidelines of its own to reduce the exposed dosage caused by PET-CTs, we believe the guidelines developed through this study means great deal to the field as it is not only appropriate for domestic circumstances, but also contains specific check lists for each target who may be exposed to radiation in regards to behavior and environment.

  15. Radiation Safety Management Guidelines for PET-CT: Focus on Behavior and Environment

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jin Wook [Cancer Imaging Center, National University Cancer Hospital, Seoul (Korea, Republic of); Han, Eun Ok [Dept. of Radiological Technology, Daegu Health College, Seoul (Korea, Republic of)

    2011-09-15

    Our purpose is to specify behavior and environmental factors aimed at reducing the exposed dosage caused by PET-CT and to develop radiation safety management guidelines adequate for domestic circumstances. We have used a multistep-multimethod as the methodological approach to design and to carry out the research both in quality and quantity, including an analysis on previous studies, professional consultations and a survey. The survey includes responses from 139 practitioners in charged of 109 PET-CTs installed throughout Korea(reported by the Korean Society of Nuclear Medicine, 2010). The research use 156 questions using Cronbach's {alpha} (alpha) coefficients which were: 0.818 for 'the necessity of setting and installing the radiation protective environment'; 0.916 for 'the necessity of radiation protection', 'setting and installing the radiation protective environment'; and 0.885 for 'radiation protection'. The check list, derived from the radiation safety management guidelines focused on behavior and environment, was composed of 20 items for the radiation protective environment: including 5 items for the patient; 4 items for the guardian; 3 items for the radiologist; and 8 items applied to everyone involved; for a total of 26 items for the radiation protective behavior including: 12 items for the patient; 1 item for the guardian, 7 items for the radiologist; and 6 items applied to everyone involved. The specific check list is shown in (Table 5-6). Since our country has no safety management guidelines of its own to reduce the exposed dosage caused by PET-CTs, we believe the guidelines developed through this study means great deal to the field as it is not only appropriate for domestic circumstances, but also contains specific check lists for each target who may be exposed to radiation in regards to behavior and environment.

  16. Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I recommendations

    Directory of Open Access Journals (Sweden)

    Dheeraj Gupta

    2013-01-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the country. The Indian Chest Society (ICS and the National College of Chest Physicians (NCCP of India have joined hands to come out with these evidence-based guidelines to help the physicians at all levels of healthcare to diagnose and manage COPD in a scientific manner. Besides the International literature, the Indian studies were specifically analyzed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (a definitions, epidemiology, and disease burden; (b disease assessment and diagnosis; (c pharmacologic management of stable COPD; (d management of acute exacerbations; and (e nonpharmacologic and preventive measures. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP. The strength of recommendation was graded as A or B depending upon the level of evidence.

  17. Do United States’ Teachers Know and Adhere to the National Guidelines on Asthma Management in the Classroom? A Systematic Review

    Directory of Open Access Journals (Sweden)

    Yudilyn Jaramillo

    2015-01-01

    Full Text Available Proper asthma management in schools is important in achieving optimum asthma control in children with asthma. The National Heart, Lung, and Blood Institute (NHLBI has developed guidelines on classroom asthma management. We conducted a systematic review to examine teacher knowledge of the NHLBI guidelines on asthma management in the classroom. We searched PubMed and EMBASE using search terms “asthma management,” “teacher(s,” “school teacher,” and “public school.” The inclusion criteria were articles published in English from 1994 to May 2014 that focus on schools in the United States (US. From 535 titles and abstracts, 9 studies met inclusion criteria. All studies reported that school teachers did not know the policies and procedures of asthma management. Teachers relied on school nurses to handle medical emergencies. Some studies identified that lack of full-time school nurses was a barrier to asthma management. Only one study showed directly that classroom teachers were not following the NHLBI guidelines on asthma management. Our literature review revealed that US teachers do not know the NHLBI guidelines on asthma management in the classroom. Future research should focus on interventions targeted toward training classroom teachers on asthma management as per NHLBI guidelines to ultimately improve asthma management in schools.

  18. NEPO cable system aging management programs

    International Nuclear Information System (INIS)

    Full text: Cable polymer aging and condition monitoring is being studied in detail under the Nuclear Energy Plant Optimization Program (NEPO) that is co-sponsored by the U.S. Department of Energy and EPRI. Significant advances in modeling of polymer aging and condition monitoring have occurred and continue to be developed. The activities include: Analysis of the linearity of the Arrhenius model to room temperature; Development of a wear-out technique for determining remaining life of cable polymers; Determination of the aging fragility point for composite EPR/CSPE insulation with respect to LOCA function; Development of visual/tactile training aids for cable assessment; Development of a totally new nuclear magnetic resonance condition monitoring technique; Assessment of existing techniques with regard to repeatability, accuracy and ease of use. Through use of highly precise oxygen consumption experiments, the linearity of the Arrhenius model is being evaluated. In these experiments, polymer is placed in vials with a known amount of oxygen and aged at much lower temperatures than is possible with standard accelerated aging techniques. aging results are possible at room temperature. The technique is being applied to commonly used insulation and jacket polymers. The wear-out technique allows highly non-linear aging behavior to be made linear. The wearout point of a polymer is determined through high-rate aging and use of a condition monitoring technique to establish the end point. Then, micro-samples of cable that have been naturally aged are subjected to high rate aging to the same end point. The ratio of the remaining high rate aging period to the total high rate aging time provides a linear indication of the remaining service time. Initial screening of nuclear plant cable systems can use visual/tactile techniques to identify cable that has aged significantly. Training aids have been developed by developing sets of specimens with accelerated aging ranging from none

  19. Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO: 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery

    Directory of Open Access Journals (Sweden)

    Lupo Massimo

    2011-01-01

    Full Text Available Abstract Background There is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial. Open surgery or laparoscopy are used without standardized indications. Methods A panel of 13 international experts with interest and background in ASBO and peritoneal diseases, participated in a consensus conference during the 1st International Congress of the World Society of Emergency Surgery and 9th Peritoneum and Surgery Society meeting, in Bologna, July 1-3, 2010, for developing evidence-based recommendations for diagnosis and management of ASBO. Whenever was a lack of high-level evidence, the working group formulated guidelines by obtaining consensus. Recommendations In absence of signs of strangulation and history of persistent vomiting or combined CT scan signs (free fluid, mesenteric oedema, small bowel faeces sign, devascularized bowel patients with partial ASBO can be managed safely with NOM and tube decompression (either with long or NG should be attempted. These patients are good candidates for Water Soluble Contrast Medium (WSCM with both diagnostic and therapeutic purposes. The appearance of water-soluble contrast in the colon on X-ray within 24 hours from administration predicts resolution. WSCM may be administered either orally or via NGT (50-150 ml both immediately at admission or after an initial attempt of conservative treatment of 48 hours. The use of WSCM for ASBO is safe and reduces need for surgery, time to resolution and hospital stay. NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution surgery is recommended. Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for

  20. Guideline for the prevention, diagnosis and management of cryptococcal meningitis among HIV-infected persons: 2013 update

    Directory of Open Access Journals (Sweden)

    The Southern African HIV Clinicians Society

    2013-06-01

    Full Text Available Six years after the first Society guidelines were published, cryptococcal meningitis (CM remains an important cause of morbidity and mortality among HIV-infected adults in South Africa. Several important developments have spurred the  publication of updated guidelines to manage this common fungal opportunistic infection. Recommendations described here include: (1 screening and pre-emptive treatment; (2 laboratory diagnosis and monitoring; (3 management of a first episode of CM; (4 amphotericin B deoxycholate toxicity prevention, monitoring and management; (5 timing of antiretroviral therapy among patients with CM; (6 management of raised intracranial pressure; (7 management of relapse episodes of CM.

  1. Management guidelines of the Central, Mississippi, and Pacific Flyways for the Mid-continent Population of sandhill cranes

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This plan sets forth guidelines for the cooperative management of the Mid-continent Population of sandhill cranes (hereafter MCP). The range of the MCP is extensive...

  2. Comparação entre o tratamento farmacológico aplicado em crianças de zero a cinco anos atendidas em uma unidade de emergência e as diretrizes do III Consenso Brasileiro no Manejo da Asma Comparison between the drug treatment used in children up to five years of age treated in an emergency room and the guidelines established in the III Brazilian Consensus on Asthma Management

    Directory of Open Access Journals (Sweden)

    Ana Paula Ochoa Santos

    2007-02-01

    Full Text Available OBJETIVO: Avaliar o manejo da crise asmática em crianças de zero a cinco anos atendidas em uma unidade de emergência pediátrica da região metropolitana do Recife (PE e verificar se a condução da crise asmática pode interferir no tempo de permanência da criança no serviço de emergência. MÉTODOS: Estudo de natureza descritiva exploratória, abordagem quantitativa e corte transversal. Envolveu 246 crianças em crise asmática de uma unidade de emergência, tendo sido avaliada a conduta utilizada, a conduta preconizada pelo III Consenso Brasileiro no Manejo da Asma e o tempo de permanência da criança na emergência. RESULTADOS: Os fármacos foram utilizados de acordo com o preconizado em 69 atendimentos (28,1%. As doses dos fármacos foram concordantes com as preconizadas em 34 atendimentos (13,8% e os procedimentos de nebulização em 33 (13,4%. Não houve associação entre as condutas utilizadas e o tempo de permanência no serviço. Após aplicação do modelo de regressão, observou-se que crianças com asma de classificação persistente leve e intermitente tiveram um risco ajustado, respectivamente, de quatro e quinze vezes maior de permanecerem no serviço de emergência por tempo insuficiente para avaliação da resposta ao tratamento da crise, conforme o preconizado pelo consenso. CONCLUSÃO: Apesar de o manejo preconizado pelo consenso encontrar barreiras de aplicação como pouca familiaridade da equipe multidisciplinar com as diretrizes e ausência de recursos materiais e terapêuticos preconizados, a repercussão no tempo de permanência esteve relacionada a fatores classificatórios da doença.OBJECTIVE: To evaluate the management of asthma attacks in children up to five years of age treated in the pediatric emergency room of a hospital in the metropolitan area of the city of Recife, Brazil, as well as to determine whether the way in which asthma attacks are managed can influence the duration of emergency room visits

  3. Development of plant walkdown guidelines for risk management in nuclear power plant

    International Nuclear Information System (INIS)

    It is proposed that nuclear power plants use walkdowns to ensure that the PSA (probabilistic safety assessment) is reliable relative to the current plant operating conditions. Although such a proposal is provided in various PSA guidelines, such as NUREG/CR-2300, no formal procedures are available for conducting walkdown. It should be noted that PSA model plant conditions, even if assumed on the basis of careful investigation of their validity, sometimes fail in representing the current operating conditions of the plant. Their questionable validity is mainly attributable to alterations subsequent to test and maintenance activities, equipment modifications and changes in management procedure, in which are all implemented after the start of operation. Therefore, the assumptions have to be validated whenever an alterations implemented. Periodic inspections are advisable even when no changes are made. Plant walkdowns are the most effective method for validating the assumed conditions, provided that the walkdown is conducted according to well-prepared guidelines. The walkdown contributes effectively to risk management by detecting any variations due to alterations. In the present study, newly developed guidelines for plant walkdowns are discussed, which include the new concept of an 'offsite walkdown'. In the offsite walkdown, plant information is acquired by means of video and audio equipment and transferred to the offsite analysis team, and analyses can be performed at a remote location. (author)

  4. Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations : A Process Evaluation of Feasibility and Usefulness

    OpenAIRE

    Tistad, Malin; Palmcrantz, Susanne; Wallin, Lars; Ehrenberg, Anna; Olsson, Christina B.; Tomson, Göran; Lotta, Widén Holmqvist; Gifford, Wendy; Eldh, Ann Catrine

    2016-01-01

    Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations...

  5. Ageing Management in the CENM Triga Mark II Research Reactor

    International Nuclear Information System (INIS)

    Physical ageing is one of the most important factors that may reduce the safety margins calculated in the design of safety system components of a research reactor. In this context, special efforts are necessary for ensuring the safety of research reactors through appropriate ageing management actions. The paper deals with the overall aspects of the ageing management system of the Moroccan TRIGA Mark II research reactor. The management system covers among others, management of structures, critical components inspections, the control command system and nuclear instrumentation verification. The paper presents also how maintenance and periodic testing are organized and managed in the reactor module. Practical examples of ageing management actions of some systems and components during recent years are presented. (author)

  6. IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT: Cluster randomised controlled trial study protocol

    Directory of Open Access Journals (Sweden)

    Francis Jill

    2008-02-01

    Full Text Available Abstract Background Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidence-based clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters, which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the

  7. [Management of acute pain therapy: guidelines, recommendations and current practice in german hospitals].

    Science.gov (United States)

    Erlenwein, Joachim

    2016-01-01

    Organisational requirements and the education and training of stuff provide the basis for an adequate supply of quality in acute pain and should be the focus of efforts. Although organizational recommendations of the German guideline on "treatment of acute perioperative and post-traumatic pain" have been increasingly established in practice within the last few years, in many German hospitals there is still lagging far behind in the implementation of general supply conditions, such as regular pain measurement or the introduction of appropriate standardized treatment protocols for all areas of the hospital.As specialized care structures acute pain services have been implemented in 80% of the German hospitals, but only 45% of them meet quality criteria. Due to the heterogeneous realization of acute pain management in different hospitals, it comes apparent, that general guideline recommendations and binding definitions are required to achieve adequate supply conditions. PMID:26863643

  8. Development Process of Plant-specific Severe Accident Management Guidelines for Wolsong Nuclear Power Plants

    International Nuclear Information System (INIS)

    A severe accident, which occurred at the TMI in 1979 and Chernobyl in 1986, is an accident that exceeds design basis accidents and leads to significant core damage. The severe accident is the low possibility of occurrence but the high severity. To mitigate the consequences of the severe accidents, Korean Nuclear Safety Committee declared the Severe Accident Policy in 2001, which requested the development of Severe Accident Management Guidelines (SAMGs) for operating plants. SAMG is a symptom-based guidance that takes a set of actions to alleviate the outcomes of severe accidents and to get into the safe stable plant condition. The purpose of this paper is to presents the strategic development process of the PHWR SAMG. The guidelines consist of 5 categories: an emergency guide for the main control room (MCR) operators, a strategy implementing guide for the technical support center (TSC), six mitigation guides, a monitoring guide, and a termination guide

  9. World Gastroenterology Organization Practice Guidelines for the diagnosis and management of IBD in 2010

    DEFF Research Database (Denmark)

    Bernstein, Charles N; Fried, Michael; Krabshuis, J H;

    2010-01-01

    Inflammatory bowel disease (IBD) represents a group of idiopathic, chronic, inflammatory intestinal conditions. Its two main disease categories are: Crohn's disease (CD) and ulcerative colitis (UC), which feature both overlapping and distinct clinical and pathological features. While these diseas...... resources. The World Gastroenterology Organization has, accordingly, developed guidelines for diagnosing and treating IBD using a cascade approach to account for variability in resources in countries around the world....... have, in the past, been most evident in the developed world, their prevalence in the developing world has been gradually increasing in recent decades. This poses unique issues in diagnosis and management which have been scarcely addressed in the literature or in extant guidelines. Depending on the...... nature of the complaints, investigations to diagnose either form of IBD or to assess disease activity will vary and will also be influenced by geographic variations in other conditions that might mimic IBD. Similarly, therapy varies depending on the phenotype of the disease being treated and available...

  10. Reliability methods in nuclear power plant ageing management

    Energy Technology Data Exchange (ETDEWEB)

    Simola, K. [VTT Automation, Espoo (Finland). Industrial Automation

    1999-07-01

    The aim of nuclear power plant ageing management is to maintain an adequate safety level throughout the lifetime of the plant. In ageing studies, the reliability of components, systems and structures is evaluated taking into account the possible time-dependent degradation. The phases of ageing analyses are generally the identification of critical components, identification and evaluation of ageing effects, and development of mitigation methods. This thesis focuses on the use of reliability methods and analyses of plant- specific operating experience in nuclear power plant ageing studies. The presented applications and method development have been related to nuclear power plants, but many of the approaches can also be applied outside the nuclear industry. The thesis consists of a summary and seven publications. The summary provides an overview of ageing management and discusses the role of reliability methods in ageing analyses. In the publications, practical applications and method development are described in more detail. The application areas at component and system level are motor-operated valves and protection automation systems, for which experience-based ageing analyses have been demonstrated. Furthermore, Bayesian ageing models for repairable components have been developed, and the management of ageing by improving maintenance practices is discussed. Recommendations for improvement of plant information management in order to facilitate ageing analyses are also given. The evaluation and mitigation of ageing effects on structural components is addressed by promoting the use of probabilistic modelling of crack growth, and developing models for evaluation of the reliability of inspection results. (orig.)

  11. Reliability methods in nuclear power plant ageing management

    International Nuclear Information System (INIS)

    The aim of nuclear power plant ageing management is to maintain an adequate safety level throughout the lifetime of the plant. In ageing studies, the reliability of components, systems and structures is evaluated taking into account the possible time-dependent degradation. The phases of ageing analyses are generally the identification of critical components, identification and evaluation of ageing effects, and development of mitigation methods. This thesis focuses on the use of reliability methods and analyses of plant- specific operating experience in nuclear power plant ageing studies. The presented applications and method development have been related to nuclear power plants, but many of the approaches can also be applied outside the nuclear industry. The thesis consists of a summary and seven publications. The summary provides an overview of ageing management and discusses the role of reliability methods in ageing analyses. In the publications, practical applications and method development are described in more detail. The application areas at component and system level are motor-operated valves and protection automation systems, for which experience-based ageing analyses have been demonstrated. Furthermore, Bayesian ageing models for repairable components have been developed, and the management of ageing by improving maintenance practices is discussed. Recommendations for improvement of plant information management in order to facilitate ageing analyses are also given. The evaluation and mitigation of ageing effects on structural components is addressed by promoting the use of probabilistic modelling of crack growth, and developing models for evaluation of the reliability of inspection results. (orig.)

  12. Canadian Cardiovascular Society Guidelines for Evaluation and Management of Cardiovascular Complications of Cancer Therapy.

    Science.gov (United States)

    Virani, Sean A; Dent, Susan; Brezden-Masley, Christine; Clarke, Brian; Davis, Margot K; Jassal, Davinder S; Johnson, Christopher; Lemieux, Julie; Paterson, Ian; Sebag, Igal A; Simmons, Christine; Sulpher, Jeffrey; Thain, Kishore; Thavendiranathan, Paaldinesh; Wentzell, Jason R; Wurtele, Nola; Côté, Marc André; Fine, Nowell M; Haddad, Haissam; Hayley, Bradley D; Hopkins, Sean; Joy, Anil A; Rayson, Daniel; Stadnick, Ellamae; Straatman, Lynn

    2016-07-01

    Modern treatment strategies have led to improvements in cancer survival, however, these gains might be offset by the potential negative effect of cancer therapy on cardiovascular health. Cardiotoxicity is now recognized as a leading cause of long-term morbidity and mortality among cancer survivors. This guideline, authored by a pan-Canadian expert group of health care providers and commissioned by the Canadian Cardiovascular Society, is intended to guide the care of cancer patients with established cardiovascular disease or those at risk of experiencing toxicities related to cancer treatment. It includes recommendations and important management considerations with a focus on 4 main areas: identification of the high-risk population for cardiotoxicity, detection and prevention of cardiotoxicity, treatment of cardiotoxicity, and a multidisciplinary approach to cardio-oncology. All recommendations align with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Key recommendations for which the panel provides a strong level of evidence include: (1) that routine evaluation of traditional cardiovascular risk factors and optimal treatment of preexisting cardiovascular disease be performed in all patients before, during, and after receiving cancer therapy; (2) that initiation, maintenance, and/or augmentation of antihypertensive therapy be instituted per the Canadian Hypertension Educational Program guidelines for patients with preexisting hypertension or for those who experience hypertension related to cancer therapy; and (3) that investigation and management follow current Canadian Cardiovascular Society heart failure guidelines for cancer patients who develop clinical heart failure or an asymptomatic decline in left ventricular ejection fraction during or after cancer treatment. This guideline provides guidance to clinicians on contemporary best practices for the cardiovascular care of cancer patients. PMID:27343741

  13. Adherence to Canadian physical activity and sedentary behaviour guidelines among children 2 to 13 years of age.

    Science.gov (United States)

    Pujadas Botey, Anna; Bayrampour, Hamideh; Carson, Valerie; Vinturache, Angela; Tough, Suzanne

    2016-06-01

    Active living is relevant for healthy child development and disease prevention. In 2011-2012 new Canadian Physical Activity and Sedentary Behaviour Guidelines were developed for children under four and 5-17 years of age. This cross-sectional study assessed children's adherence to the national guidelines, using a large sample of Alberta children ages 2-4 and 5-13 years in 2013. The proportions of children achieving the average daily duration of physical activity and screen time recommended were determined, and child and parental predictors of non-achievement were identified. Participants were 631 parent and child dyads. Data were collected by parental reports of physical activity and screen time during weekdays, and analysed using univariate and multivariate techniques (p children's non-achievement of physical activity and screen time recommendations while adjusting for covariates. Sixty-two percent of children aged 2-4 and 26% of children aged 5-13 did not meet physical activity time recommendations, and 64% of children aged 2-4 and 23% of children aged 5-13 exceeded the maximum screen time recommendation. Several associations between parental age and education with non-achievement were observed but associations were not consistent across age groups or behaviours. Among preschoolers, those with middle-age parents were more likely to not achieve physical activity recommendations. Evidence of high non-achievement of the recommendations among children 2-4 years highlights the need for increased programming targeting preschool children. Further research is required to identify modifiable risk factors that may inform future health promotion efforts. PMID:26844180

  14. Preliminary guidelines for electricity distributor conservation and demand management activities : a guide for conservation and demand management investment

    International Nuclear Information System (INIS)

    In May 2004, electricity distributors in Ontario were asked to submit deferral accounts to the Ontario Energy Board to track expenditures on conservation and demand management initiatives. The deferral accounts must be established before the distributor could recover the costs through the next installment of the allowable return on equity in March 2004. The Board will determine the appropriateness of the actual expenditures. These guidelines offer short-term assistance to distributors in establishing conservation and demand management plans and initiatives. The following specific measures may be supported by the Board: energy efficiency; operational changes to smart control systems; load management measures which facilitate interruptible and dispatchable loads, dual fuel applications, thermal storage and demand response; fuel switching measures; programs targeted to low income and hard to reach consumers; and, distributed energy options such as tri-generation, cogeneration, ground source heat pumps, wind and biomass systems. These guidelines described the regulatory treatment of conservation and demand management investments along with cost effectiveness, allocation of costs, monitoring, evaluation, and implementation. 1 appendix

  15. Germany: National approach to ageing management

    International Nuclear Information System (INIS)

    The Fukushima Accidents have led to fundamental changes in the usage of nuclear power in Germany. On August 1, 2011, an amendment of the German Atomic Energy Act came into force. It consists basically of an accelerated step-by-step phase-out until 2022. Eight older NPPs were shut down immediately. The remaining NPP will be stepwise shut down so that the last one will stop commercial operation at the end of 2022. Against this background, long-term operation is not an issue anymore in Germany. However, for the NPPs in operation it is necessary to ensure the required quality of safety-related SSCs by an AM process, though the specified operational lifetime is not enlarged. The new nuclear safety standard KTA 1403 was established and issued in December 2010 specifies the German Reactor Safety Commission’s recommendation on AM of 2004 and is also considered to fulfil the related IAEA guidelines and WENRA safety levels

  16. Ageing management program of HANARO for continuous operation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyungkyoo [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2013-07-01

    Ageing means time-dependent changes of the quality and ageing may occur during the operating time of a facility and it is categorized into two basic types: physical ageing and non-physical ageing. The ageing management of equipment begins at the same time of installation. HANARO, the open-tank-in-pool type research reactor with 30MW thermal power, achieved its first criticality in 1995. It has been utilized for neutron science, material and fuel irradiation tests, radioisotope production, neutron transmutation doping (NTD), neutron activation analysis, and neutron radiography. Since ageing may affect the overall safety of a reactor facility, it is needed to detect and evaluate the effects on aged components and systems. After its initial criticality, various activities were conducted for the ageing management and the improvement of HANARO system, such as in-service inspection for the reactor structure and the safety related piping, preventive maintenance and the upgrade of the instrumentation and control system.

  17. Ageing management program of HANARO for continuous operation

    International Nuclear Information System (INIS)

    Ageing means time-dependent changes of the quality and ageing may occur during the operating time of a facility and it is categorized into two basic types: physical ageing and non-physical ageing. The ageing management of equipment begins at the same time of installation. HANARO, the open-tank-in-pool type research reactor with 30MW thermal power, achieved its first criticality in 1995. It has been utilized for neutron science, material and fuel irradiation tests, radioisotope production, neutron transmutation doping (NTD), neutron activation analysis, and neutron radiography. Since ageing may affect the overall safety of a reactor facility, it is needed to detect and evaluate the effects on aged components and systems. After its initial criticality, various activities were conducted for the ageing management and the improvement of HANARO system, such as in-service inspection for the reactor structure and the safety related piping, preventive maintenance and the upgrade of the instrumentation and control system

  18. Development of Integrated Regulatory Aging Management System related to Reactor Vessel Internals

    International Nuclear Information System (INIS)

    The primary function of the reactor vessel internals (RVIs) is to support the core, the control rod assemblies, the core support structure and the reactor pressure vessel (RPV) surveillance capsules. The RVIs have the additional function to direct the flow of the reactor coolant and provide shielding for the RPV. Ageing mechanisms are specific processes that gradually change characteristics of a component with time and use. According to the Generic Aging Lessons Learned (GALL) report, aging mechanisms, such as fatigue, embrittlement, corrosion, wear, radiation induced creep, relaxation and swelling, is related to RVIs. Establishing that effects of aging degradation in RVIs are adequately managed is vital for assuring continued functionality of RVIs. To achieve this goal, it is necessary to develop the regulatory standard as well as generic inspection and evaluation guideline for RVIs. In this paper, the Integrated Regulatory Aging Management System (IR-Aging), which efficiently manages key data necessary to the development of regulatory standards and assists effective evaluation of RVIs, is proposed. By using the proposed system, experts in different fields can co-operate to resolve safety issues and all users can share information and create valuable knowledge-base. In this paper, the Integrated Regulatory Aging Management System (IR-Aging) is proposed in order to manage data necessary to the development of regulatory standards and assists effective evaluation of RVIs. The proposed system provides various documents, such as US NRC and domestic regulatory documents, licensee's documents submitted to a regulatory body, and research documents. By using the proposed system, experts in different fields can co-operate to resolve safety issues and all users can share information and create valuable knowledge-base

  19. Do United States’ Teachers Know and Adhere to the National Guidelines on Asthma Management in the Classroom? A Systematic Review

    OpenAIRE

    Yudilyn Jaramillo; Marina Reznik

    2015-01-01

    Proper asthma management in schools is important in achieving optimum asthma control in children with asthma. The National Heart, Lung, and Blood Institute (NHLBI) has developed guidelines on classroom asthma management. We conducted a systematic review to examine teacher knowledge of the NHLBI guidelines on asthma management in the classroom. We searched PubMed and EMBASE using search terms “asthma management,” “teacher(s),” “school teacher,” and “public school.” The inclusion criteria were ...

  20. Scandinavian SSAI clinical practice guideline on pre-hospital airway management

    DEFF Research Database (Denmark)

    Rehn, M; Hyldmo, P K; Magnusson, V; Kurola, J; Kongstad, P; Rognås, L; Juvet, L K; Sandberg, M

    2016-01-01

    BACKGROUND: The Scandinavian society of anaesthesiology and intensive care medicine task force on pre-hospital airway management was asked to formulate recommendations following standards for trustworthy clinical practice guidelines. METHODS: The literature was systematically reviewed and the......); turn unconscious non-trauma patients into the recovery position when advanced airway management is unavailable (good practice recommendation); turn unconscious trauma patients to the lateral trauma position while maintaining spinal alignment when advanced airway management is unavailable [strong...... recommendation, low quality of evidence (QoE)]. We suggest that intermediately trained providers use a supraglottic airway device (SAD) or basic airway manoeuvres on patients in cardiac arrest (weak recommendation, low QoE). We recommend that advanced trained providers consider using an SAD in selected...

  1. Hypertension management guidelines update and research on the importance of blood pressure control.

    Science.gov (United States)

    Sealy, LaToya; Oliva, Arthur

    2014-01-01

    According to the Centers for Disease Control and Prevention (CDC), more than 65 million adults in America have hypertension (HTN) and fewer than half of those 65 million people have their blood pressure (BP) under control. More than 1,000 deaths occur each day related to HTN and Americans are at an increased risk of complications related to uncontrolled BP such as heart failure, stroke, myocardial infarction, and kidney disease (). Data from the National Home and Hospice Survey, which is conducted by the CDC, indicate that 41% of home care patients have HTN (). This research brief column profiles four recently published articles on HTN. The first discusses the most recent guidelines for managing HTN, which were released in early 2014. The second article describes the success of an intensive structured HTN medication management and management protocol. The third and fourth briefs describe studies investigating the ongoing risk of HTN poststroke. PMID:25370977

  2. 2015 UK National Guideline on the management of non-gonococcal urethritis.

    Science.gov (United States)

    Horner, P; Blee, K; O'Mahony, C; Muir, P; Evans, C; Radcliffe, K

    2016-02-01

    We present the updated British Association for Sexual Health and HIV guideline for the management of non-gonococcal urethritis in men. This document includes a review of the current literature on its aetiology, diagnosis and management. In particular it highlights the emerging evidence that azithromycin 1 g may result in the development of antimicrobial resistance in Mycoplasma genitalium and that neither azithromycin 1 g nor doxycycline 100 mg twice daily for seven days achieves a cure rate of >90% for this micro-organism. Evidence-based diagnostic and management strategies for men presenting with symptoms suggestive of urethritis, those confirmed to have non-gonococcal urethritis and those with persistent symptoms following first-line treatment are detailed. PMID:26002319

  3. European AIDS Clinical Society (EACS) guidelines on the prevention and management of metabolic diseases in HIV

    DEFF Research Database (Denmark)

    Lundgren, J D; Battegay, M; Behrens, G;

    2008-01-01

    BACKGROUND: Metabolic diseases are frequently observed in HIV-infected persons and, as the risk of contracting these diseases is age-related, their prevalence will increase in the future as a consequence of the benefits of antiretroviral therapy (ART). SUMMARY OF GUIDELINES: All HIV...... pharmacokinetic interactions and compromised adherence. Specialists in HIV and specialists in metabolic diseases should consult each other, in particular in difficult-to-treat cases. CONCLUSION: Multiple and relatively simple approaches exist to prevent metabolic diseases in HIV-infected persons; priority should...

  4. Integrated management for aging of Atucha Nuclear Power Plant

    International Nuclear Information System (INIS)

    Atucha NPP is a two PHWR unit site located in Lima, Province of Buenos Aires, 120 km north of Buenos Aires, Argentina.. With the start-up of Atucha II and aiming to integrate the Ageing Management of the plants, the Utility (Nucleolectrica Argentina Sociedad Anonima - NASA) created an Ageing Management Department to cope with all ageing issues of both Atucha I and II. In this project both organization has formed a joint working group. The role of CNEA is providing technical support to the plant in the development of procedures a methodological framework for the Ageing Management Program of Atucha NPP. The main documents that have being issued so far are: . An Ageing Management Manual, including standard definition of Materials, Ageing Related Degradation Mechanisms, Operation Environments customized for Atucha NPP. . Walk down procedures and checklists aimed to systematize data collection during outages. . Procedures for performing Ageing Management Reviews and Maintenance Reviews for passive and active components. . Condition Assessments of several safety related systems. . Condition assessment of electrical components. In the present work a summary of the activities, documental structure and first outputs of the Integrated Ageing Management Program of Atucha NPP is presented (author)

  5. The Management of Acute Upper Gastrointestinal Bleeding: A Comparison of Current Clinical Guidelines and Best Practice

    Directory of Open Access Journals (Sweden)

    Alison A. Taylor

    2014-12-01

    Full Text Available Acute upper gastrointestinal bleeding (AUGIB is the most common GI emergency, responsible for up to 70,000 hospital admissions in the UK and around 4,000 deaths. The latest UK national audit highlighted inconsistencies in both the management and service provision. Several national and international professional bodies have produced evidence-based recommendations on the management of AUGIB. We carried out a review of the guidance documentation published by four expert bodies including the National Institute of Clinical Excellence, the Scottish Intercollegiate Guidelines Network, the American College of Gastroenterology, and those published in the Annals of Internal Medicine. Consensus is still yet to be reached for initiating blood products in the emergency situation, with some evidence suggesting that liberal transfusion could exacerbate bleeding severity, although there is a lack of large randomised trials. It is widely agreed that prompt endoscopy within 24 hours improves outcomes, but evidence suggests that lowering this threshold confers no additional benefit. Use of proton pump inhibitors both pre and post-endoscopy for non-variceal bleeds is also advocated by professional bodies, with substantial evidence that it reduces the risk of re-bleeding. For patients with suspected oesophageal or gastric variceal bleeding, prophylactic antibiotics and vasopressin analogues are recommended, although guidelines vary on specific regimens. Recent UK and international guidelines provide a useful framework to guide management of patients who present to the emergency department with suspected AUGIB; however, their advice varies in some key areas due to a lack of large randomised trials as supporting evidence.

  6. Evidence-based clinical practice guidelines for interventional pain management in cancer pain

    Directory of Open Access Journals (Sweden)

    Sushma Bhatnagar

    2015-01-01

    Full Text Available Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10-15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician′s armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL of the suffering patients.

  7. Evidence-based Clinical Practice Guidelines for Interventional Pain Management in Cancer Pain.

    Science.gov (United States)

    Bhatnagar, Sushma; Gupta, Maynak

    2015-01-01

    Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10-15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician's armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical) can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs) evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL) of the suffering patients. PMID:26009665

  8. Electrical failure during cardiopulmonary bypass: an evaluation of incidence, causes, management and guidelines for preventative measures.

    LENUS (Irish Health Repository)

    Hargrove, M

    2012-02-03

    The incidence of electrical failure during cardiopulmonary bypass (CPB) has been reported to occur in approximately 1 per 1000 cases. While the resultant morbidity and mortality is low, electrical failure is a life-threatening scenario. We report three major electrical failures during CPB in a patient population of 3500 over a 15-year period. These cases involved mains failure and generator shut down, mains failure and generator power surge, and failure of the uninterruptable power supply (UPS), which caused protected sockets to shut down. Protocols for preventative maintenance, necessary equipment, battery backup and guidelines for the successful management of such accidents during CPB are discussed.

  9. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries

    DEFF Research Database (Denmark)

    Andersson, Lars; Andreasen, Jens O; Day, Peter;

    2012-01-01

    Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and...... were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth....

  10. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries. 2

    DEFF Research Database (Denmark)

    Diangelis, A J; Andreasen, J O; Ebeleseder, K A;

    2014-01-01

    Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and...... were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth. The Hebrew Edition is part of...

  11. Requirement analysis of computerized procedures of AP1000 severe accident management guidelines

    International Nuclear Information System (INIS)

    Computerized procedures are drawing increased interest for application in nuclear power plants to enhance operator performance, especially in the accident conditions. AP1000 Severe Accident Management Guidelines (SAMG) are established to protect the containment fission product boundaries and to mitigate the accident consequences. This paper introduces the AP1000 SAMG, and according to the functional requirements of the Computerized Procedure System (CPS), some requirements are analyzed. These requirements are special to the Computerized AP1000 SAMG, which need to be especially noticed in the design process. (author)

  12. Advances in the management of multiple sclerosis spasticity: multiple sclerosis spasticity guidelines.

    Science.gov (United States)

    Gold, Ralf; Oreja-Guevara, Celia

    2013-12-01

    Symptomatic therapy of multiple sclerosis (MS) is an important part of a comprehensive treatment plan that aims to improve patients' quality of life. In the current era of medical progress, several factors have led to the development of guidelines for MS management. There is continued need for an evidence-based approach supported by high-quality data from controlled clinical trials. Most healthcare systems require this approach and include it in the reimbursement process. Guidelines are usually committed by national or continental neurological societies. The Spanish Society of Neurology demyelinating diseases working group has developed a consensus document on spasticity in patients with MS. MS experts from the group used the metaplan method to sum up the most important recommendations about spasticity for inclusion in the guidance. Recommendations were classified according to the Scottish Intercollegiate Guidelines Network system and approved by all members of the group. In Germany, the guideline panel of the German Neurological Society endorsed the national competence network for multiple sclerosis (Krankheitsbezogenes Kompetenznetz Multiple Sklerose) to update the existing recommendations. The most recent fifth edition of the guidelines (dated April 2012) now also includes recommendations for treatment of key symptoms such as spasticity. More than 30 MS neurologists contributed to the new edition reflecting the need for broad expertise. After a first round in which key topics were defined, a web-based decision process was undertaken to further develop individual topics such as symptomatic therapy. The draft manuscript was reviewed once again by the group prior to submission to the official review process. The aims of spasticity treatment are to improve mobility and dexterity, achieve physiological movement patterns, reduce pain, facilitate nursing measures and avoid complications such as contractures. Representative antispasticity medications include baclofen

  13. Ageing management in heavy water plants

    International Nuclear Information System (INIS)

    With proper design and construction ageing can be minimized. It is important to understand the mechanics of ageing specific to service, develop baseline data and monitor to ensure that there are no premature failures especially where the service conditions are extreme and media used is highly corrosive and hazardous such as in heavy water plants. The key lies in an effective in-service inspection and determination of residual life for decision making vis-a-vis upgrading and ensuring safety. While quite a bit of work in this direction has been done in the Heavy Water Board, a lot more ground needs to be covered. (author)

  14. Clinical practice guideline on the optimal radiotherapeutic management of brain metastases

    Directory of Open Access Journals (Sweden)

    Wong Rebecca KS

    2005-04-01

    Full Text Available Abstract Background An evidence-based clinical practice guideline on the optimal radiotherapeutic management of single and multiple brain metastases was developed. Methods A systematic review and meta-analysis was performed. The Supportive Care Guidelines Group formulated clinical recommendations based on their interpretation of the evidence. External review of the report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from Cancer Care Ontario's Practice Guidelines Coordinating Committee (PGCC. Results One hundred and nine Ontario practitioners responded to the survey (return rate 44%. Ninety-six percent of respondents agreed with the interpretation of the evidence, and 92% agreed that the report should be approved. Minor revisions were made based on feedback from external reviewers and the PGCC. The PGCC approved the final practice guideline report. Conclusions For adult patients with a clinical and radiographic diagnosis of brain metastases (single or multiple we conclude that, • Surgical excision should be considered for patients with good performance status, minimal or no evidence of extracranial disease, and a surgically accessible single brain metastasis. • Postoperative whole brain radiotherapy (WBRT should be considered to reduce the risk of tumour recurrence for patients who have undergone resection of a single brain metastasis. • Radiosurgery boost with WBRT may improve survival in select patients with unresectable single brain metastases. • The whole brain should be irradiated for multiple brain metastases. Standard dose-fractionation schedules are 3000 cGy in 10 fractions or 2000 cGy in 5 fractions. • Radiosensitizers are not recommended outside research studies. • In select patients, radiosurgery may be considered as boost therapy with WBRT to improve local tumour control. Radiosurgery boost may improve survival in select patients. • Chemotherapy as primary therapy or

  15. Clinical practice guideline on the optimal radiotherapeutic management of brain metastases

    International Nuclear Information System (INIS)

    An evidence-based clinical practice guideline on the optimal radiotherapeutic management of single and multiple brain metastases was developed. A systematic review and meta-analysis was performed. The Supportive Care Guidelines Group formulated clinical recommendations based on their interpretation of the evidence. External review of the report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from Cancer Care Ontario's Practice Guidelines Coordinating Committee (PGCC). One hundred and nine Ontario practitioners responded to the survey (return rate 44%). Ninety-six percent of respondents agreed with the interpretation of the evidence, and 92% agreed that the report should be approved. Minor revisions were made based on feedback from external reviewers and the PGCC. The PGCC approved the final practice guideline report. For adult patients with a clinical and radiographic diagnosis of brain metastases (single or multiple) we conclude that, • Surgical excision should be considered for patients with good performance status, minimal or no evidence of extracranial disease, and a surgically accessible single brain metastasis. • Postoperative whole brain radiotherapy (WBRT) should be considered to reduce the risk of tumour recurrence for patients who have undergone resection of a single brain metastasis. • Radiosurgery boost with WBRT may improve survival in select patients with unresectable single brain metastases. • The whole brain should be irradiated for multiple brain metastases. Standard dose-fractionation schedules are 3000 cGy in 10 fractions or 2000 cGy in 5 fractions. • Radiosensitizers are not recommended outside research studies. • In select patients, radiosurgery may be considered as boost therapy with WBRT to improve local tumour control. Radiosurgery boost may improve survival in select patients. • Chemotherapy as primary therapy or chemotherapy with WBRT remains experimental. • Supportive

  16. Approaches to Ageing Management for Nuclear Power Plants. International Generic Ageing Lessons Learned (IGALL) Final Report

    International Nuclear Information System (INIS)

    The main deliverable of the International Generic Ageing Lessons Learned for Nuclear Power Plants (IGALL) Extrabudgetary Programme (EBP), the IGALL Safety Report, provides an internationally recognized basis for an acceptable ageing management programme, as well as a knowledge base on ageing management to aid in the design of new power plants, design reviews, modifications and upgrades, and to serve as a source of information on ageing management. This publication is a summary of the national approaches taken by Member States participating in the IGALL programme. This information was collected during the first phase of the IGALL programme between 2010 and 2013, and explains different national practices in the area of ageing management and the preparation for long term operation

  17. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version

    OpenAIRE

    DAS-Taskforce 2015; Baron, Ralf; Binder, Andreas; Biniek, Rolf; Braune, Stephan; Buerkle, Hartmut; Dall, Peter; Demirakca, Sueha; Eckardt, Rahel; Eggers, Verena; Eichler, Ingolf; Fietze, Ingo; Freys, Stephan; Fründ, Andreas; Garten, Lars

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from th...

  18. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version

    OpenAIRE

    Baron, R.; Binder, A.; Biniek, R; Braune, S; Buerkle, H; Dall, P.; Demirakca, S; Eckardt, R; Eggers, V; Eichler, I; Fietze, I.; Freys, S; Fründ, A; Garten, L; Gohrbandt, B

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the "Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care". Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from th...

  19. Improving pneumonia case-management in Benin: a randomized trial of a multi-faceted intervention to support health worker adherence to Integrated Management of Childhood Illness guidelines

    Directory of Open Access Journals (Sweden)

    Lama Marcel

    2009-08-01

    Full Text Available Abstract Background Pneumonia is a leading cause of death among children under five years of age. The Integrated Management of Childhood Illness strategy can improve the quality of care for pneumonia and other common illnesses in developing countries, but adherence to these guidelines could be improved. We evaluated an intervention in Benin to support health worker adherence to the guidelines after training, focusing on pneumonia case management. Methods We conducted a randomized trial. After a health facility survey in 1999 to assess health care quality before Integrated Management of Childhood Illness training, health workers received training plus either study supports (job aids, non-financial incentives and supervision of workers and supervisors or "usual" supports. Follow-up surveys were conducted in 2001, 2002 and 2004. Outcomes were indicators of health care quality for Integrated Management-defined pneumonia. Further analyses included a graphical pathway analysis and multivariable logistic regression modelling to identify factors influencing case-management quality. Results We observed 301 consultations of children with non-severe pneumonia that were performed by 128 health workers in 88 public and private health facilities. Although outcomes improved in both intervention and control groups, we found no statistically significant difference between groups. However, training proceeded slowly, and low-quality care from untrained health workers diluted intervention effects. Per-protocol analyses suggested that health workers with training plus study supports performed better than those with training plus usual supports (20.4 and 19.2 percentage-point improvements for recommended treatment [p = 0.08] and "recommended or adequate" treatment [p = 0.01], respectively. Both groups tended to perform better than untrained health workers. Analyses of treatment errors revealed that incomplete assessment and difficulties processing clinical findings

  20. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015 – short version

    Directory of Open Access Journals (Sweden)

    DAS-Taskforce 2015

    2015-11-01

    Full Text Available In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine, twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM in conjunction with Society of Critical Care Medicine (SCCM and American Society of Health-System Pharmacists (ASHP from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation, Grade “B” (recommendation and Grade “0” (open recommendation. The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.

  1. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version

    Science.gov (United States)

    Baron, Ralf; Binder, Andreas; Biniek, Rolf; Braune, Stephan; Buerkle, Hartmut; Dall, Peter; Demirakca, Sueha; Eckardt, Rahel; Eggers, Verena; Eichler, Ingolf; Fietze, Ingo; Freys, Stephan; Fründ, Andreas; Garten, Lars; Gohrbandt, Bernhard; Harth, Irene; Hartl, Wolfgang; Heppner, Hans-Jürgen; Horter, Johannes; Huth, Ralf; Janssens, Uwe; Jungk, Christine; Kaeuper, Kristin Maria; Kessler, Paul; Kleinschmidt, Stefan; Kochanek, Matthias; Kumpf, Matthias; Meiser, Andreas; Mueller, Anika; Orth, Maritta; Putensen, Christian; Roth, Bernd; Schaefer, Michael; Schaefers, Rainhild; Schellongowski, Peter; Schindler, Monika; Schmitt, Reinhard; Scholz, Jens; Schroeder, Stefan; Schwarzmann, Gerhard; Spies, Claudia; Stingele, Robert; Tonner, Peter; Trieschmann, Uwe; Tryba, Michael; Wappler, Frank; Waydhas, Christian; Weiss, Bjoern; Weisshaar, Guido

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation), Grade “B” (recommendation) and Grade “0” (open recommendation). The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine. PMID:26609286

  2. Surveillance program and aging management at ETRR-II

    International Nuclear Information System (INIS)

    Surveillance program, periodic testing, and in-service inspection are tools to manage the aging of the research reactors and keep the operation of the research reactors within its design, safety analysis, and operational limits and conditions (OLC's) for the lifetime of the research reactor. This paper describes the surveillance program and aging management of the most important systems, structures, and components (SSC's) of the second research reactor of Egypt (ETRR-II). We believe that the exchange of information and discussion between the members states, about this topic, can lead to the best practice for the research reactor surveillance and aging management. It is important for the members states to try to find benchmarking measures for this topic to make the aging management and surveillance program measurable and achievable. (author)

  3. Continuity of operations planning in college athletic programs: The case for incorporating Federal Emergency Management Guidelines.

    Science.gov (United States)

    Hall, Stacey A; Allen, Brandon L; Phillips, Dennis

    2016-01-01

    College athletic departments have a responsibility to provide a safe environment for student-athletes; however, most colleges do not have a crisis management plan that includes procedures for displaced student-athletes or alternate facilities to perform athletic events. Continuity of operations planning ensures athletic programs are equipped to maintain essential functions during, or shortly after, a disruption of operations due to possible hazards. Previous studies have identified a lack of emergency preparedness and continuity planning in college athletic departments. The purpose of this article is to illustrate in detail one approach to disaster planning for college athletic departments, namely the Federal Emergency Management Agency (FEMA) continuity of operations framework. By adhering to FEMA guidelines and promoting a best practices model, athletic programs can effectively plan to address potential hazards, as well as protect the organization's brand, image, and financial sustainability after a crisis event. PMID:26963231

  4. Developing and validating severe accident management guidelines using SAMPSON-RELAP/SCDAPSIM.MOD3.4

    International Nuclear Information System (INIS)

    The development and validation of Severe Accident Management Guidelines (SAMGs) must consider complex thermal-hydraulic and severe accident phenomena. Yet, many of the simplified integral Severe Accident codes, that have been used widely to develop SAMGs in Europe, Asia, and the United States, cannot accurately predict many of these complex interactions. By contrast, detailed codes such as SAMPSON-RELAP/SCDAPSIM have shown, through comparison with the TMI-2 accident and experiments, that they can predict such complex behavior. This paper describes the merger of SAMPSON with RELAP/SCDAPSIM/MOD3.4, reviews the severe accident phenomena important for Severe Accident Management, and then describes the potential impact of using SAMPSON-RELAP/SCDAPSIM on the development and validation of SAMGs. A companion paper, being presented at this conference provides an example of the application of SAMPSON-RELAP/SCDAPSIM for the development and validation of a SAMG for a Nuclear Power Plant. (authors)

  5. Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia

    DEFF Research Database (Denmark)

    Kroigaard, M; Garvey, L H; Gillberg, L;

    2007-01-01

    The present approach to the diagnosis, management and follow-up of anaphylaxis during anaesthesia varies in the Scandinavian countries. The main purpose of these Scandinavian Clinical Practice Guidelines is to increase the awareness about anaphylaxis during anaesthesia amongst anaesthesiologists....... It is hoped that increased focus on the subject will lead to prompt diagnosis, rapid and correct treatment, and standardised management of patients with anaphylactic reactions during anaesthesia across Scandinavia. The recommendations are based on the best available evidence in the literature, which...... incremental titration of adrenaline (epinephrine) and fluid therapy as first-line treatment. Recommendations for primary and secondary follow-up are given, bearing in mind that there are variations in geography and resources in the different countries. A list of National Centres from which anaesthesiologists...

  6. Relationship between energy systems and landscapes. Guidelines and tools for design and management

    Directory of Open Access Journals (Sweden)

    Elisabetta Ginelli

    2014-10-01

    Full Text Available Landscapes undergoing conservation, valorisation, management and reconstruction policies, become a fundamental factor for the local/global development of natural, cultural, human and social potentials of territories. With the contribution of technological design culture, the research, having a strong multidisciplinary character, focuses on managing the relationship between energy systems and landscapes with the general aim of subverting and transforming apparent conflicts in synergies, in order to overcome a sectorial and segmented approach barely based on energy performances. Through the introduction of a complex multidimensional methodology of analysis and evaluation the goal of this work, is to develop standards of acceptability, meta-design criteria and guidelines for design, intro- ducing a methodology for multidimen- sional complex analysis and evaluation, to support Public Authorities.

  7. [Japanese Guidelines for the Management of Stroke 2015: overview of the chapter on Subarachnoid Hemorrhage].

    Science.gov (United States)

    Ishihara, Hideyuki; Suzuki, Michiyasu

    2016-04-01

    After an interval of 6 years, the Japanese Guidelines for the Management of Stroke were revised in 2015 in accordance with recent advances in clinical knowledge. The chapter on subarachnoid hemorrhage includes new and revised recommendations for diagnosis, treatment selection, and management of vasospasm. The chapter on diagnosis recommends re-examination of vascular images at regular intervals in cases in which cerebral aneurysm was not detected on the first examination. The section dealing with treatment selection for cerebral aneurysmal emphasizes that the method for aneurysm obliteration should be selected based on consultation with both surgical and endovascular specialists. The role of triple-H therapy(i.e., induced hypertension, hypervolemia, and hemodilution) has changed from a preventive measure to a treatment option for symptomatic cerebral vasospasm. PMID:27333759

  8. The Chennai floods of 2015: urgent need for ethical disaster management guidelines.

    Science.gov (United States)

    Mariaselvam, Suresh; Gopichandran, Vijayaprasad

    2016-01-01

    India has suffered several natural disasters in recent years. The super cyclone of Orissa in 1999 and the tsunami on the southeastern coast in 2004, both led to major developments in disaster management abilities in the country. Almost a decade after the last major disaster that hit south India, the recent floods in Chennai in 2015 brought to the fore a whole set of ethical considerations. There were issues of inequity in the relief and response activities, conflicts and lack of coordination between the government and non-government relief and response, more emphasis on short-term relief activities rather than rehabilitation and reconstruction, and lack of crisis standards of care in medical services. This paper highlights these ethical issues and the need for ethical guidelines and an ethical oversight mechanism for disaster management and response. PMID:27260819

  9. NPP EQUIPMENT LIFETIME MANAGEMENT UNDER AGEING

    Directory of Open Access Journals (Sweden)

    Olga M. Gulina

    2012-01-01

    Full Text Available This paper deals with the problem of nuclear power plant (NPP equipment lifetimeprediction with the use of information about damage processes, operation conditions andpreventive actions. The developed model is based on Kalman linear stochastic filter. For steamgenerator heat-exchanged tubes we use the martingale theory for predicting the number ofsuppressed heat-exchanged tubes to the next control. Finally, we formulate the principle of SGlifetime optimal management.

  10. Developing a context appropriate clinical guideline for post-operative pain management in Ghana: A participatory approach

    Directory of Open Access Journals (Sweden)

    Lydia Aziato

    2015-01-01

    Full Text Available Clinical guidelines involve statements that guide clinicians to provide effective care to patients. However, there are no context appropriate clinical guidelines for post-operative pain (POP management in Ghana. This study sought to develop such a clinical guideline. The study adopted a participatory approach drawing from the existing literature to develop the guideline with the involvement of 27 experts and stakeholders including nurses, doctors, anaesthetists, pharmacists, patients, and patients’ relatives. Also, the guideline statements were discussed and finalised at a multidisciplinary consensus forum made up of 29 members. Consensus was achieved by employing procedures similar to a modified nominal group technique. Purposive sampling was employed. The guideline was made up of four dimensions described in a conceptual Radial Venn which emphasised inter-relationships among patient and family education, team work, monitoring and input by hospital leadership, and application of appropriate scientific recommendations for POP management. The effective collaboration with stakeholders resulted in the adoption of the clinical guideline by the Ghana Health Service for use within the Ghanaian health system.

  11. Adherence to evidence-based guidelines among diabetes self-management apps.

    Science.gov (United States)

    Breland, Jessica Y; Yeh, Vivian M; Yu, Jessica

    2013-09-01

    Smartphone apps can provide real-time, interactive self-management aid to individuals with diabetes. It is currently unclear whether existing diabetes self-management apps follow evidence-based guidelines. The purpose of this study was to evaluate the extent to which existing diabetes self-management apps address the seven self-management behaviors recommended by the American Association of Diabetes Educators (the AADE7™). The term "diabetes" identified relevant self-management apps via the Apple App Store search engine in March 2012. Ratings were based on app descriptions and downloads. Chi-square analyses assessed differences in apps based on developer type. Apps promoted a median of two AADE7™ skills. Overall reliability between description and download ratings was good (kappa = .66). Reliability of individual skills was variable (kappa = .25 to .91). Most diabetes apps do not conform to evidence-based recommendations, and future app reviews would benefit from testing app performance. Future apps may also benefit from theory-based designs. PMID:24073179

  12. Management of I and C ageing

    International Nuclear Information System (INIS)

    This country report is based on data collected within working committees of VGB Technical Association of Large Power Plant Operators, Essen, Germany, namely the report 'Ageing Diagnosis, Prediction and Substitute Strategies for I and C' by R. Heinbuch, J. Irlbeck (Bayernwerk Kernenergie AG Muenchen) and W. Bastl (Institut fuer Sicherheitstechnologie GmbH Garching). It was compiled in its current form by L. Mohrbach, VGB Headquarters, in his capacity as member of the IAEA Advisory Group on Nuclear Power Plant I and C Equipment: Periodical Testing, Evaluation and Maintenance Strategy. (author)

  13. 2010 Chinese guidelines for the management of hypertension%中国高血压防治指南2010

    Institute of Scientific and Technical Information of China (English)

    中国高血压防治指南修订委员会

    2011-01-01

    The 2010 Chinese guidelines for the management of hypertension is an update of the previous versions in 2005 and 1999. A guideline committee of nearly 100 members appointed by the Chinese Hypertension League (CHL) and the National Centre for Cardiovascular Disease (NCCD), in collaboration with the Chinese societies of cardiology, nephrology, neurology, gynecology and endocrinology, convened on several occasions and discussed the guidelines, drafted by a core writing group. The prevalence of hypertension has been increasing in China for decades, and reached 18.8% in the year 2002. The rates of awareness, treatment and control for hypertension patients remain low compared to high income countries, in spite of substantial improvements since 1991. In some communities, the control rate of hypertension increased up to 60%. The mortality rate of stroke, which is the major complication of hypertension in the Chinese population, gradually decreased during the period, more so in urban areas than in rural areas for the middle-aged and elderly populations; in the younger age groups, however, it increased. As hypertension is a "cardiovascular syndrome", the management strategy should be based on the overall risk of cardiovascular disease estimated with all related risk factors, target organ damage and co-morbidity of patients. The target blood pressure is set at SBP/DBP <140/90 mm Hg(1 mm Hg=0.133 kPa) in uncomplicated hypertension; <150/90 mm Hg for the elderly (≥65 years) or, if tolerable, <140/90 mm Hg; and <130/80 mm Hg for those with diabetes, coronary heart disease or renal disease. For these high risk patients, the management should be individualised. In general, lifestyle modification, such as sodium restriction, smoking cessation, moderation of body weight and alcohol consumption, and increasing dietary potassium intake and physical activity, should be implemented for prevention and control of hypertension. Five classes of antihypertensive drugs, including calcium

  14. Maintenance optimization through risk based ageing management program

    International Nuclear Information System (INIS)

    With increasing demand for energy and the need to control energy costs, many nuclear energy producers choose to extend the lifespan of their existing infrastructures while ensuring operation safety. The success of this decision requires a high level of expertise and know-how in managing the infrastructure life cycle. Oxand has developed and implemented dedicated integrated solutions to assist in managing the ageing of infrastructure over its life-cycle: operation, license renewal application and extended lifespan. These solutions enable to anticipate and optimize the maintenance of the infrastructures thanks to relevant Ageing Management Programs integrating owners' issues such as safety and availability. (author)

  15. Managing Commercial Tree Species for Timber Production and Carbon Sequestration: Management Guidelines and Financial Returns

    Energy Technology Data Exchange (ETDEWEB)

    Gary D. Kronrad

    2006-09-19

    A carbon credit market is developing in the United States. Information is needed by buyers and sellers of carbon credits so that the market functions equitably and efficiently. Analyses have been conducted to determine the optimal forest management regime to employ for each of the major commercial tree species so that profitability of timber production only or the combination of timber production and carbon sequestration is maximized. Because the potential of a forest ecosystem to sequester carbon depends on the tree species, site quality and management regimes utilized, analyses have determined how to optimize carbon sequestration by determining how to optimally manage each species, given a range of site qualities, discount rates, prices of carbon credits and other economic variables. The effects of a carbon credit market on the method and profitability of forest management, the cost of sequestering carbon, the amount of carbon that can be sequestered, and the amount of timber products produced has been determined.

  16. Safe management of NPP ageing in European union

    International Nuclear Information System (INIS)

    The paper presents the results of a study conducted by Framatome, EDF, Belgatom, Unesa and IPSN, with the support of the European Commission in order to evaluate the practices and provide recommendations for the development of a methodology to monitor, control and anticipate the ageing of Nuclear Islands, in order to maintain their level of safety during the whole NPP life cycle. The study includes a synthesis of available European and International reports, the identification of potential ageing mechanisms, their effects and the available identification and mitigation methods, and an evaluation of the existing ageing management practices in Belgium, France and Spain, using international recommendations as guidance documents. Recommendations are proposed on regulatory aspects, management, prediction, detection, follow, mitigation of physical ageing, human management and adaptation of safety culture and procedures. (author)

  17. Review of occupational medicine practice guidelines for interventional pain management and potential implications.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Singh, Vijay; Derby, Richard; Helm, Standiford; Trescot, Andrea M; Staats, Peter S; Prager, Joshua P; Hirsch, Joshua A

    2008-01-01

    In the modern day environment, workers' compensation costs continue to be a challenge, with a need to balance costs, benefits, and quality of medical care. The cost of workers' compensation care affects all stakeholders including workers, employers, providers, regulators, legislators, and insurers. Consequently, a continued commitment to quality, accessibility to care, and cost containment will help ensure that workers are afforded accessible, high quality, and cost-effective care. In 2004, workers' compensation programs in all 50 states, the District of Columbia, and federal programs in the United States combined received an income of $87.4 billion while paying out only $56 billion in medical and cash benefits with $31.4 billion or 37% in administrative expenses and profit. Occupational diseases represented only 8% of the workers' compensation claims and 29% of the cost. The American College of Occupational and Environmental Medicine (ACOEM) has published several guidelines; though widely adopted by WCPs, these guidelines evaluate the practice of medicine of multiple specialties without adequate expertise and expert input from the concerned specialties, including interventional pain management. An assessment of the ACOEM guidelines utilizing Appraisal of Guidelines for Research and Evaluation (AGREE) criteria, the criteria developed by the American Medical Association (AMA), the Institute of Medicine (IOM), and other significantly accepted criteria, consistently showed very low scores (< 30%) in most aspects of the these guidelines. The ACOEM recommendations do not appear to have been based on a careful review of the literature, overall quality of evidence, standard of care, or expert consensus. Based on the evaluation utilizing appropriate and current evidence-based medicine (EBM) principles, the evidence ratings for diagnostic techniques of lumbar discography; cervical, thoracic, and lumbar facet joint nerve blocks and sacroiliac joint nerve blocks; therapeutic

  18. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults.

    Science.gov (United States)

    Frerk, C; Mitchell, V S; McNarry, A F; Mendonca, C; Bhagrath, R; Patel, A; O'Sullivan, E P; Woodall, N M; Ahmad, I

    2015-12-01

    These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team. PMID:26556848

  19. Review and development of aging management programs of the main components at Paks NPP

    International Nuclear Information System (INIS)

    According to the License Renewal related Hungarian Atomic Energy Authority's Nuclear Safety Regulations and Guidelines a systematic review and development of the aging management programs of all the safety related equipment has been performed for Paks NPP. The AMP Review methodology is based on US NRC 10 attributes (Scope, Preventive actions, Parameters monitored or inspected, Detection of aging effects, Monitoring and trending, Acceptance criteria, Corrective actions, Confirmation processes, Administrative controls, Operating experience) taking into account the typical VVER-440 constructional, operational, QA and other administrative control features. This paper deals with the AMP review of the main components: RPV, RPV Internals, Steam Generators, Pressurisers, MCPs, Main Gate Valves and the Primary piping. All known and potential degradation mechanism was taken into consideration. All the aging management related programs and activities (ISI, Maintenance, Chemical control, Technical Condition Monitoring, Operational data monitoring, Operational experience monitoring, QA e.g.) together with the related NPP's internal procedures have been identified for the review. The results of the review ascertain the strengths and weaknesses of the previous programs and activities as related to the need to understand and manage the effects of aging of the main components. The methodology and the main results of the review as well as examples of typical recommendations for development of the current programs are reported in the paper. (author)

  20. Management and Communication of the Companies' Knowledge; Guidelines for Intellectual Capital Statement

    Directory of Open Access Journals (Sweden)

    Justyna Fijalkowska

    2008-04-01

    Full Text Available This paper aims at analyzing the development of guidelines on Intellectual Capital Statement, providing a comparison of them and presenting their importance within the knowledge management process of the today's companies. We entered the Knowledge Era in which the basic economic resources are no longer financial capital, physical resources, or labor, but knowledge, called also intellectual capital (IC. Many analysts and investors demand for more information and they highlight the gap that exists between the information found in companies' annual reports and the financial information regarding intangible part of the company requested by the market. Knowledge of the company should be measured and the effects should be communicated, as measurement without any further action has no sense. Intellectual capital statement seems an appropriate tool for that and becomes an integral part of the knowledge management of the modern enterprise. This kind of statement emphasizes the role of IC in relation to the value creation and communicates how knowledge resources are managed in the firms within a strategic objectives. This paper compares different approaches to IC statement preparation: underlines similarities and differences concerning the scope, methodology and terminology used and ensuing consequences. It raises significant implications for managers of the companies, researches and policy makers.

  1. Characteristics of Trailer Thermal Environment during Commercial Swine Transport Managed under U.S. Industry Guidelines

    Science.gov (United States)

    Xiong, Yijie; Green, Angela; Gates, Richard S.

    2015-01-01

    Simple Summary Temperature and thermal conditions of the interior of a swine trailer during transport were monitored over a broad range of outdoor conditions (34 trips total) managed according to industry best practice (Transport Quality Assurance (TQA) guidelines (NPB, 2008)). For the outdoor temperature range of 5 °C (40 °F) to 27 °C (80 °F), generally acceptable trailer thermal conditions were observed according to the TQA. Beyond this outdoor temperature range, undesirable conditions within the trailer were prevalent. Areas for potential improvement in transport management were identified. Stops resulted in rapid increases in temperature, which could be beneficial during cooler outdoor temperatures, but detrimental for warmer outdoor temperatures. Abstract Transport is a critical factor in modern pork production and can seriously affect swine welfare. While previous research has explored thermal conditions during transport, the impact of extreme weather conditions on the trailer thermal environment under industry practices has not been well documented; and the critical factors impacting microclimate are not well understood. To assess the trailer microclimate during transport events, an instrumentation system was designed and installed at the central ceiling level, pig level and floor-level in each of six zones inside a commercial swine trailer. Transport environmental data from 34 monitoring trips (approximately 1–4 h in duration each) were collected from May, 2012, to February, 2013, with trailer management corresponding to the National Pork Board Transport Quality Assurance (TQA) guidelines in 31 of these trips. According to the TQA guidelines, for outdoor temperature ranging from 5 °C (40 °F) to 27 °C (80 °F), acceptable thermal conditions were observed based on the criteria that no more than 10% of the trip duration was above 35 °C (95 °F) or below 0 °C (32 °F). Recommended bedding, boarding and water application were sufficient in this range

  2. Guidelines for improving the implementation of quality management systems to provide quality service delivery in education / Nompumelelo Yvonne Mbatha

    OpenAIRE

    Mbatha, Nompumelelo Yvonne

    2012-01-01

    The aim of this research was to develop guidelines for improving the implementation of Quality Management Systems to provide quality service delivery in education. The research was done by means of both a literature review and an empirical research. The focus of the literature review was to determine the nature and purpose of existing Quality Management Systems (QMS) in education; and the role of District Officials and Schools Management Teams (SMTs) in the implementation of QMS to provide qu...

  3. Variability in Postarrest Targeted Temperature Management Practice: Implications of the 2015 Guidelines.

    Science.gov (United States)

    Leary, Marion; Blewer, Audrey L; Delfin, Gail; Abella, Benjamin S

    2015-12-01

    In 2002 postarrest care was significantly altered when multiple randomized controlled trials found that therapeutic hypothermia at a goal temperature of 32-34°C significantly improved survival and neurologic outcomes. In 2013, targeted temperature management (TTM) was reexamined via a randomized controlled trial between 33°C and 36°C in post-cardiac arrest patients and found similar outcomes in both cohorts. Before the release of the 2015 American Heart Association (AHA) Guidelines, our group found that across hospitals in the United States, and even within the same institution, TTM protocol variability existed. After the 2013 TTM trial, it was anticipated that the 2015 Guidelines would clarify which target temperature should be used during postarrest care. The AHA released their updates for post-cardiac arrest TTM recently and, based on the literature available, have recommended the use of TTM at a goal temperature between 32°C and 36°C. Whether this variability has an effect on TTM implementation or patient outcomes is unknown. PMID:26642933

  4. DHR-ICMR Guidelines for diagnosis & management of Rickettsial diseases in India

    Directory of Open Access Journals (Sweden)

    Manuj Rahi

    2015-01-01

    Full Text Available Rickettsial diseases, caused by a variety of obligate intracellular, g0 ram-negative bacteria from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma, belonging to the Alphaproteobacteria, are considered some of the most covert emerging and re-emerging diseases and are being increasingly recognized. Among the major groups of rickettsioses, commonly reported diseases in India are scrub typhus, murine flea-borne typhus, Indian tick typhus and Q fever. Rickettsial infections are generally incapacitating and difficult to diagnose; untreated cases have case fatality rates as high as 30-45 per cent with multiple organ dysfunction, if not promptly diagnosed and appropriately treated. The vast variability and non-specific presentation of this infection have often made it difficult to diagnose clinically. Prompt antibiotic therapy shortens the course of the disease, lowers the risk of complications and in turn reduces morbidity and mortality due to rickettsial diseases. There is a distinct need for physicians and health care workers at all levels of care in India to be aware of the clinical features, available diagnostic tests and their interpretation, and the therapy of these infections. Therefore, a Task Force was constituted by the Indian Council of Medical Research (ICMR to formulate guidelines for diagnosis and management of rickettsial diseases. These guidelines include presenting manifestations, case definition, laboratory criteria (specific and supportive investigations and treatment.

  5. Surgical treatment of lung cancer. On the clinical guideline for the management of lung cancer

    International Nuclear Information System (INIS)

    Surgical treatments of lung cancer are discussed mainly on the evidence-based medicine (EBM)-based Clinical Guideline for the Management of Lung Cancer (revised 2005). Described items are application of surgical treatment, techniques, evidence bases for certain techniques, lymph node excision, video-assisted thoracoscopic surgery (VATS), postoperative therapy of non-small cell lung cancer (NSCC), preoperative adjuvant therapy of NSCC, and present state and future of surgical treatment. Comments are mentioned in this order as follows. The operation can be only applicable on physiological and oncological (clinical stage) considerations. For respectable cancer, lobectomy is essentially recommendable. Recommended techniques like bronchoplasty are orderly described with their evidence. Evidence is said to be insufficient to excise lymph nodes and to perform VATS. Postoperative radiotherapy (RT) of early stage NSCC is not a standard, but chemotherapy (CMT) is recommended because evidences have been accumulated until the revision of the guideline. Evidence is said not yet enough to recommend preoperative RT, CMT or RT+CMT as a standard. Studies of diagnosis and treatment of lung cancer are now under remarkable progress as exemplified by 3D therapeutic plan by CT-simulation, heavy ion therapy, stereotactic RT and intra-cavitary RT, and surgery will be still one of multiple modalities. (R.T.)

  6. CGCG clinical practice guidelines for the management of adult diffuse gliomas.

    Science.gov (United States)

    Jiang, Tao; Mao, Ying; Ma, Wenbin; Mao, Qing; You, Yongping; Yang, Xuejun; Jiang, Chuanlu; Kang, Chunsheng; Li, Xuejun; Chen, Ling; Qiu, Xiaoguang; Wang, Weimin; Li, Wenbin; Yao, Yu; Li, Shaowu; Li, Shouwei; Wu, Anhua; Sai, Ke; Bai, Hongmin; Li, Guilin; Chen, Baoshi; Yao, Kun; Wei, Xinting; Liu, Xianzhi; Zhang, Zhiwen; Dai, Yiwu; Lv, Shengqing; Wang, Liang; Lin, Zhixiong; Dong, Jun; Xu, Guozheng; Ma, Xiaodong; Cai, Jinquan; Zhang, Wei; Wang, Hongjun; Chen, Lingchao; Zhang, Chuanbao; Yang, Pei; Yan, Wei; Liu, Zhixiong; Hu, Huimin; Chen, Jing; Liu, Yuqing; Yang, Yuan; Wang, Zheng; Wang, Zhiliang; Wang, Yongzhi; You, Gan; Han, Lei; Bao, Zhaoshi; Liu, Yanwei; Wang, Yinyan; Fan, Xing; Liu, Shuai; Liu, Xing; Wang, Yu; Wang, Qixue

    2016-06-01

    The Chinese Glioma Cooperative Group (CGCG) Guideline Panel for adult diffuse gliomas provided recommendations for diagnostic and therapeutic procedures. The Panel covered all fields of expertise in neuro-oncology, i.e. neurosurgeons, neurologists, neuropathologists, neuroradiologists, radiation and medical oncologists and clinical trial experts. The task made clearer and more transparent choices about outcomes considered most relevant through searching the references considered most relevant and evaluating their value. The scientific evidence of papers collected from the literature was evaluated and graded based on the Oxford Centre for Evidence-based Medicine Levels of Evidence and recommendations were given accordingly. The recommendations will provide a framework and assurance for the strategy of diagnostic and therapeutic measures to reduce complications from unnecessary treatment and cost. The guideline should serve as an application for all professionals involved in the management of patients with adult diffuse glioma and also as a source of knowledge for insurance companies and other institutions involved in the cost regulation of cancer care in China. PMID:26966000

  7. The 2014 guidelines for the management of osteoarthritis: Place of hyaluronic acid preparations

    Directory of Open Access Journals (Sweden)

    N. V. Chichasova

    2015-01-01

    Full Text Available The paper gives data on the prevalence of osteoarthritis (OA and the rate of comorbidities in this disease. It discusses problems of adequate and safe therapy in these patients. The basic provisions of the 2015 clinical guidelines for the rational use of nonsteroidal antiinflammatory drugs (NSAIDs, as well as assessment of risk factors for NSAID-related complications are presented. The place of symptomatic slow-acting drugs for OA (SYSАDOA and a clash of opinions as to their efficacy among different national or international communities of specialists are discussed. The 2014 ESCEO International Committee guidelines for the management of OA patients, which confirm the necessity of prescribing SYSDOA as initial treatment, are presented. The properties and function of synovial fluid in health and OA are depicted. Clinical and experimental findings have shown that, by improving the lubricating properties of synovial fluid, exogenous hyaluronon has many anticatabolic and anabolic effects and affects pathogenetically significant factors in OA. The results of randomized clinical trials (RCTs comparing hyaluronans of different molecular weight are given. There are data of RCTs on the clinical efficacy and structuremodifying activity of hylan G-F 20 and on its significant pain relief in OA patients. The paper demonstrates benefits in surviving the analgesic effect of hylan G-F 20 versus intraarticular administration of glucocorticoids.

  8. Brazil: National approach to ageing management

    International Nuclear Information System (INIS)

    Eletrobras Eletronuclear, the Brazilian company responsible for the construction and operation of nuclear power plants, operates two PWR units at Central Nuclear Almirante Álvaro Alberto – CNAAA, situated in Angra dos Reis city. Angra 1 is a 640 MWe Westinghouse plant, operating since 1985, and Angra 2 is a 1350 MWe plant, designed by Areva-Siemens-KWU which started operation in 2001. A third unit, similar to Angra 2, is being constructed at the same site and is due to commence operation in 2016. Angra 1 and 2 nuclear steam supply systems have been designed to ASME and KTA codes, respectively. Brazilian nuclear power plants are licensed for a period of 40 years in accordance with the rule CNEN NE-1.04, ‘Licensing of Nuclear Installations’, issued by, the Brazilian regulatory board: Comissão Nacional de Energia Nuclear (CNEN). PSRs are conducted in accordance with CNEN NE-1.26, ‘Safety in Operating Nuclear Power Plants’, consistent with IAEA Safety Guide No. NS-G-2.10, ‘Periodic Safety Review of Nuclear Power Plants’. A comprehensive AMP at Angra NPP is being developed with the objective of coordinating operations, maintenance and engineering actions to control under acceptable limits the effects of ageing to maintain integrity and functional capability of SSCs important to safety the way that the licensing basis of the plants are maintained during the period of the current operating license and during the period of LTO, as defined in IAEA Safety Reports Series No.57, ‘Safe Long Term Operation of Nuclear Power Plants’. The AMP implementation project at Angra counts on the technical support of the designers of both plants. During the initial phase, technical visits of Westinghouse and Areva and the development of a pilot project for a mechanical system (by Westinghouse) contributed to the first assessments of the available documental infrastructure and of the proposed methodology for the development of AMP processes

  9. Characteristics of Trailer Thermal Environment during Commercial Swine Transport Managed under U.S. Industry Guidelines

    Directory of Open Access Journals (Sweden)

    Yijie Xiong

    2015-04-01

    Full Text Available Transport is a critical factor in modern pork production and can seriously affect swine welfare. While previous research has explored thermal conditions during transport, the impact of extreme weather conditions on the trailer thermal environment under industry practices has not been well documented; and the critical factors impacting microclimate are not well understood. To assess the trailer microclimate during transport events, an instrumentation system was designed and installed at the central ceiling level, pig level and floor-level in each of six zones inside a commercial swine trailer. Transport environmental data from 34 monitoring trips (approximately 1–4 h in duration each were collected from May, 2012, to February, 2013, with trailer management corresponding to the National Pork Board Transport Quality Assurance (TQA guidelines in 31 of these trips. According to the TQA guidelines, for outdoor temperature ranging from 5 °C (40 °F to 27 °C (80 °F, acceptable thermal conditions were observed based on the criteria that no more than 10% of the trip duration was above 35 °C (95 °F or below 0 °C (32 °F. Recommended bedding, boarding and water application were sufficient in this range. Measurements support relaxing boarding guidelines for moderate outdoor conditions, as this did not result in less desirable conditions. Pigs experienced extended undesirable thermal conditions for outdoor temperatures above 27 °C (80 °F or below 5 °C (40 °F, meriting a recommendation for further assessment of bedding, boarding and water application guidelines for extreme outdoor temperatures. An Emergency Livestock Weather Safety Index (LWSI condition was observed inside the trailer when outdoor temperature exceeded 10 °C (50 °F; although the validity of LWSI to indicate heat stress for pigs during transport is not well established. Extreme pig surface temperatures in the rear and middle zones of the trailer were more frequently experienced

  10. Characteristics of Trailer Thermal Environment during Commercial Swine Transport Managed under U.S. Industry Guidelines.

    Science.gov (United States)

    Xiong, Yijie; Green, Angela; Gates, Richard S

    2015-01-01

    Transport is a critical factor in modern pork production and can seriously affect swine welfare. While previous research has explored thermal conditions during transport, the impact of extreme weather conditions on the trailer thermal environment under industry practices has not been well documented; and the critical factors impacting microclimate are not well understood. To assess the trailer microclimate during transport events, an instrumentation system was designed and installed at the central ceiling level, pig level and floor-level in each of six zones inside a commercial swine trailer. Transport environmental data from 34 monitoring trips (approximately 1-4 h in duration each) were collected from May, 2012, to February, 2013, with trailer management corresponding to the National Pork Board Transport Quality Assurance (TQA) guidelines in 31 of these trips. According to the TQA guidelines, for outdoor temperature ranging from 5 °C (40 °F) to 27 °C (80 °F), acceptable thermal conditions were observed based on the criteria that no more than 10% of the trip duration was above 35 °C (95 °F) or below 0 °C (32 °F). Recommended bedding, boarding and water application were sufficient in this range. Measurements support relaxing boarding guidelines for moderate outdoor conditions, as this did not result in less desirable conditions. Pigs experienced extended undesirable thermal conditions for outdoor temperatures above 27 °C (80 °F) or below 5 °C (40 °F), meriting a recommendation for further assessment of bedding, boarding and water application guidelines for extreme outdoor temperatures. An Emergency Livestock Weather Safety Index (LWSI) condition was observed inside the trailer when outdoor temperature exceeded 10 °C (50 °F); although the validity of LWSI to indicate heat stress for pigs during transport is not well established. Extreme pig surface temperatures in the rear and middle zones of the trailer were more frequently experienced than in the

  11. Generic aging management programs for license renewal of BWR reactor coolant systems components

    International Nuclear Information System (INIS)

    The paper reviews the existing generic aging management programs (AMPs) for the reactor coolant system (RCS) components in boiling water reactors (BWRs), including the reactor pressure vessel and internals, the reactor recirculation system, and the connected piping. These programs have been evaluated in the U.S. Nuclear Regulatory Commission (NRC) report, Generic Aging Lessons Learned (GALL), NUREG-1801, for their use in the license renewal process to manage several aging effects, including loss of material, crack initiation and growth, loss of fracture toughness, loss of preload, wall thinning, and cumulative fatigue damage. The program evaluation includes a review of ten attributes (scope of program, preventive actions, parameters monitored/inspected, detection of aging effects, monitoring and trending, acceptance criteria, corrective actions, confirmative process, administrative control, and operating experience) for their effectiveness in managing a specific aging effect in a given component(s). The generic programs are based on the ASME Section XI inservice inspection requirements; industry guidelines for inspection and evaluation of aging effects in BWR reactor vessel, internals, and recirculation piping; monitoring and control of BWR water chemistry; and operating experience as reported in the USNRC generic communications and industry reports. The review concludes that all generic AMPs are acceptable for managing aging effects in BWR RCS components during an extended period of operation and do not need further evaluation. However, the plant-specific programs for managing aging in certain RCS components during an extended period of operation do require further evaluation. For some plant-specific AMPs, the GALL report recommends an aging management activity to verify their effectiveness. An example of such an activity is a one-time inspection of Class 1 small-bore piping to ensure that service-induced weld cracking is not occurring in the piping. Several of

  12. Generic Aging Management Programs for License Renewal of BWR Reactor Coolant System Components

    International Nuclear Information System (INIS)

    The paper reviews the existing generic aging management programs (AMPs) for the reactor coolant system (RCS) components in boiling water reactors (BWRs), including the reactor pressure vessel and internals, the reactor recirculation system, and the connected piping. These programs have been evaluated in the U.S. Nuclear Regulatory Commission (NRC) report, Generic Aging Lessons Learned (GALL), NUREG-1801, for their use in the license renewal process to manage several aging effects, including loss of material, crack initiation and growth, loss of fracture toughness, loss of preload, wall thinning, and cumulative fatigue damage. The program evaluation includes a review of ten attributes (scope of program, preventive actions, parameters monitored/inspected, detection of aging effects, monitoring and trending, acceptance criteria, corrective actions, confirmative process, administrative control, and operating experience) for their effectiveness in managing a specific aging effect in a given component(s). The generic programs are based on the ASME Section XI inservice inspection requirements; industry guidelines for inspection and evaluation of aging effects in BWR reactor vessel, internals, and recirculation piping; monitoring and control of BWR water chemistry; and operating experience as reported in the USNRC generic communications and industry reports. The review concludes that all generic AMPs are acceptable for managing aging effects in BWR RCS components during an extended period of operation and do not need further evaluation. However, the plant-specific programs for managing aging in certain RCS components during an extended period of operation do require further evaluation. For some plant-specific AMPs, the GALL report recommends an aging management activity to verify their effectiveness. An example of such an activity is a one-time inspection of Class 1 small-bore piping to ensure that service-induced weld cracking is not occurring in the piping. Several of

  13. Management of Differentiated Thyroid Cancer in Children: Focus on the American Thyroid Association Pediatric Guidelines.

    Science.gov (United States)

    Parisi, Marguerite T; Eslamy, Hedieh; Mankoff, David

    2016-03-01

    First introduced in 1946, radioactive iodine (I-131) produces short-range beta radiation with a half-life of 8 days. The physical properties of I-131 combined with the high degree of uptake in the differentiated thyroid cancers (DTCs) led to the use of I-131 as a therapeutic agent for DTC in adults. There are two indications for the potential use of I-131 therapy in pediatric thyroid disorders: nonsurgical treatment of hyperthyroidism owing to Graves' disease and the treatment of children with intermediate- and high-risk DTC. However, children are not just miniature adults. Not only are children and the pediatric thyroid gland more sensitive to radiation than adults but also the biologic behavior of DTC differs between children and adults as well. As opposed to adults, children with DTC typically present with advanced disease at diagnosis; yet, they respond rapidly to therapy and have an excellent prognosis that is significantly better than that in adult counterparts with advanced disease. Unfortunately, there are also higher rates of local and distant disease recurrence in children with DTC compared with adults, mandating lifelong surveillance. Further, children have a longer life expectancy during which the adverse effects of I-131 therapy may become manifest. Recognizing the differences between adults and children with DTC, the American Thyroid Association commissioned a task force of experts who developed and recently published a guideline to address the unique issues related to the management of thyroid nodules and DTC in children. This article reviews the epidemiology, diagnosis, staging, treatment, therapy-related effects, and suggestions for surveillance in children with DTC, focusing not only on the differences between adults and children with this disease but also on the latest recommendations from the inaugural pediatric management guidelines of the American Thyroid Association. PMID:26897719

  14. Guideline for the diagnosis and management of hypertension in adults - 2016.

    Science.gov (United States)

    Gabb, Genevieve M; Mangoni, Arduino A; Anderson, Craig S; Cowley, Diane; Dowden, John S; Golledge, Jonathan; Hankey, Graeme J; Howes, Faline S; Leckie, Les; Perkovic, Vlado; Schlaich, Markus; Zwar, Nicholas A; Medley, Tanya L; Arnolda, Leonard

    2016-07-18

    The National Heart Foundation of Australia has updated the Guide to management of hypertension 2008: assessing and managing raised blood pressure in adults (updated December 2010). Main recommendations For patients at low absolute cardiovascular disease risk with persistent blood pressure (BP) ≥ 160/100 mmHg, start antihypertensive therapy. The decision to treat at lower BP levels should consider absolute cardiovascular disease risk and/or evidence of end-organ damage, together with accurate BP assessment. For patients at moderate absolute cardiovascular disease risk with persistent systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, start antihypertensive therapy. Treat patients with uncomplicated hypertension to a target BP of management as a result of the guideline Ambulatory and/or home BP monitoring should be offered if clinic BP is ≥ 140/90 mmHg, as out-of-clinic BP is a stronger predictor of outcome. In selected high cardiovascular risk populations, aiming for a target of risk populations found improved cardiovascular outcomes and reduced mortality, with an increase in some treatment-related adverse events. PMID:27456450

  15. Risk-adapted management of acute pulmonary embolism: recent evidence, new guidelines.

    Science.gov (United States)

    Käberich, Anja; Wärntges, Simone; Konstantinides, Stavros

    2014-10-01

    Venous thromboembolism (VTE), the third most frequent acute cardiovascular syndrome, may cause life-threatening complications and imposes a substantial socio-economic burden. During the past years, several landmark trials paved the way towards novel strategies in acute and long-term management of patients with acute pulmonary embolism (PE). Risk stratification is increasingly recognized as a cornerstone for an adequate diagnostic and therapeutic management of the highly heterogeneous population of patients with acute PE. Recently published European Guidelines emphasize the importance of clinical prediction rules in combination with imaging procedures (assessment of right ventricular function) and laboratory biomarkers (indicative of myocardial stress or injury) for identification of normotensive PE patients at intermediate risk for an adverse short-term outcome. In this patient group, systemic full-dose thrombolysis was associated with a significantly increased risk of intracranial bleeding, a complication which discourages its clinical application unless hemodynamic decompensation occurs. A large-scale clinical trial program evaluating new oral anticoagulants in the initial and long-term treatment of venous thromboembolism showed at least comparable efficacy and presumably increased safety of these drugs compared to the current standard treatment. Research is continuing on catheter-directed, ultrasound-assisted, local, low-dose thrombolysis in the management of intermediate-risk PE. PMID:25386356

  16. Risk-Adapted Management of Acute Pulmonary Embolism: Recent Evidence, New Guidelines

    Directory of Open Access Journals (Sweden)

    Anja Käberich

    2014-10-01

    Full Text Available Venous thromboembolism (VTE, the third most frequent acute cardiovascular syndrome, may cause life-threatening complications and imposes a substantial socio-economic burden. During the past years, several landmark trials paved the way towards novel strategies in acute and long-term management of patients with acute pulmonary embolism (PE. Risk stratification is increasingly recognized as a cornerstone for an adequate diagnostic and therapeutic management of the highly heterogeneous population of patients with acute PE. Recently published European Guidelines emphasize the importance of clinical prediction rules in combination with imaging procedures (assessment of right ventricular function and laboratory biomarkers (indicative of myocardial stress or injury for identification of normotensive PE patients at intermediate risk for an adverse short-term outcome. In this patient group, systemic full-dose thrombolysis was associated with a significantly increased risk of intracranial bleeding, a complication which discourages its clinical application unless hemodynamic decompensation occurs. A large-scale clinical trial program evaluating new oral anticoagulants in the initial and long-term treatment of venous thromboembolism showed at least comparable efficacy and presumably increased safety of these drugs compared to the current standard treatment. Research is continuing on catheter-directed, ultrasound-assisted, local, low-dose thrombolysis in the management of intermediate-risk PE.

  17. Theories and Management of Aging: Modern and Ayurveda Perspectives

    Directory of Open Access Journals (Sweden)

    Hema Sharma Datta

    2011-01-01

    Full Text Available Aging is a complex phenomenon, a sum total of changes that occur in a living organism with the passage of time and lead to decreasing ability to survive stress, increasing functional impairment and growing probability of death. There are many theories of aging and skin remains the largest organ of the study. Skin aging is described as a consequence of intrinsic and extrinsic factors. The most common amongst visible signs of skin aging are wrinkles and there are various therapies including antiaging cosmeceuticals, sunscreens, chemical peeling, injectable agents, such as botox, fibrel, autologous fat grafting as also few surgical procedures have been used. Ayurveda, the Indian traditional medicine, describes aging with great details. This review provides modern and Ayurvedic perspectives on theories and management of aging.

  18. Plant life management for long term operation of light water reactors. Principles and guidelines

    International Nuclear Information System (INIS)

    The subject of this report was originally suggested by the IAEA Technical Working Group on Life Management of Nuclear Power Plants. It was then approved by the IAEA for work to begin in 2004. The participants in the group felt that it was time to address plant life management and ageing issues from the point of view of long term operation and licence renewal. It is believed that the nuclear power industry will only be able to survive if plant economics are favourable and safety is maintained. Therefore, the issue of ageing and obsolescence has to be addressed from an operational and safety standpoint, but also in the context of plant economics in terms of the cost of electricity production, including initial and recurring capital costs. Use of new technologies, such as advanced in-service inspection and condition based maintenance, should be considered, not only to predict the consequences of ageing and guard against them, but also to monitor equipment performance throughout the lifetime of the plant and to help establish replacement schedules for critical systems, structures and components, and to better estimate the optimum end of the operating licence, which means the end of the nuclear power plant's lifetime. The importance of nuclear power plant life management in facilitating the technical and economic goals of long term operation is presented in this report in terms of the requirement to ensure safe long term supplies of electricity in the most economically competitive way. Safe and reliable operation is discussed in terms of the overall economic benefits when plant life management is implemented. Preconditions for plant life management for long term operation are identified and approaches are reviewed. Plant life management should not be associated only with the extension of the operational lifetime of the nuclear power plant, but with an owner's attitude and a rational approach of the operating company towards running the business economically and safely

  19. Evaluation of NRC maintenance team inspection reports for managing aging

    International Nuclear Information System (INIS)

    A nuclear power plant's maintenance program is the principal vehicle through which age-related degradation is managed. Over the past two years, the NRC [Nuclear Regulatory Commission] has evaluated the maintenance program of every nuclear power plant in the U.S. The reports issued on these in-depth team inspections have been reviewed to ascertain the strengths and weaknesses of the programs as related to the need to understand and manage the effects of aging on nuclear power plant systems, structures, and components. Selected results of this review are presented in this paper, including examples of inspection and monitoring techniques successfully used by utilities to detect degradation due to aging. Attributes of plant maintenance programs where the NRC inspectors felt that improvement was needed to properly address the aging issue are also discussed. 6 refs., 1 tab

  20. Aging management at G.A. Siwabessy Multipurpose Reactor

    Energy Technology Data Exchange (ETDEWEB)

    Jupiter Sitorus Pane; Taswanda Taryo; Alim Tarigan; Alfahari Mardi; Koes Indra

    1998-10-01

    Aging phenomena was raised as an important issue at GAS-MPR after having some component degradation reported within its ten years operational record. This phenomena was anticipated by developing a program of aging management, where its purpose is to prevent an enlargement of degradation of the systems and components and failure. The aging managements include identification of system and component which have aging process enlargement and impact to the reactor operational safety, developing operational operation and maintenance practices, developing operational and maintenance data base, developing predictive maintenance program, and identifying and studying method and technology for inspection, testing, and surveillance. The result of studying on method and technology of testing, surveillance, and diagnostic conclude that FFT based noise spectrum analysis can be used to detect an anomaly of system and component performance. This analysis will be developed in the future using Auto Regressive Method, Kalman Filter, and Neural Network. (author)

  1. COMSY - A Software Tool for Aging and Plant Life Management

    International Nuclear Information System (INIS)

    A Plant-wide and systematic Aging and Plant Life Management is essential for the safe operation and/or availability of nuclear power plants. The Aging Management (AM) has the objective to monitor and control degradation effects for safety relevant Systems, Structures and Components (SSCs) which may compromise safety functions of the plant. The Plant Life Management (PLM) methodology also includes aging surveillance for availability relevant SSCs. AM and PLM cover mechanical components, electrical and I and C systems and civil structures All Aging and Plant Life Management rules call for a comprehensive approach, requiring the systematic collection of various aging and safety relevant data on a plant-wide basis. This data needs to be serviced and periodically evaluated. Due to the complexity of the process, this activity needs to be supported by a qualified software tool for the management of aging relevant data and associated documents (approx. 30 000 SSCs). In order to support the power plant operators AREVA NP has developed the software tool COMSY. The COMSY software with its integrated AM modules enables the design and setup of a knowledge-based power plant model compatible to the requirements of international and national rules (e.g. IAEA Safety Guide NS-G-2.12, KTA 1403). In this process, a key task is to identify and monitor degradation mechanisms. For this purpose the COMSY tool provides prognosis and trending functions, which are based on more than 30 years of experience in the evaluation of degradation effects and numerous experimental studies. Since 1998 COMSY has been applied successfully in more than fifty reactor units in this field. The current version 3.0 was revised completely and offers additional AM functions. All aging-relevant component data are compiled and allocated via an integrated power plant model. Owing to existing interfaces to other software solutions and flexible import functions, COMSY is highly compatible with already existing data

  2. 1993 guidelines for the management of mild hypertension: memorandum from a WHO/ISH meeting.

    OpenAIRE

    1993-01-01

    The present guidelines were prepared by the Guidelines Sub-Committee of the WHO/ISH (International Society of Hypertension) Mild Hypertension Liaison Committee. They represent the third revision of the WHO/ISH guidelines and were finalized after discussions at the Sixth WHO/ISH Meeting on Mild Hypertension in Chantilly, France, on 28-31 March 1993. The new guidelines discuss the cardiovascular risk in patients with hypertension, the definition and classification of mild hypertension, drug tre...

  3. Identifying and Ranking Guidelines for the Successful Deployment of Knowledge Management Models Using APQC

    OpenAIRE

    Saeedeh Mohammadraei Naeini; Mehdi Shami Zanjani; Mohammad Mousakhani

    2014-01-01

    In this research, three stage strategy (qualitativequantitative- quantitative) is applied. In the first stage, by studying and reviewing the relative works, especially the APQC model, the proposed guidelines are extracted and prepared. In the second stage, the validation of these guidelines is evaluated by experts in this field. The experts accepted 42 guidelines and ranked them. Three most important guidelines are: “Don’t make mistake! Knowledge is not only produced in R...

  4. Research of components aging and plant lifetime management in NPPs

    International Nuclear Information System (INIS)

    Components, systems and structures in NPPs gradually aging with time or use, are introduced when their characteristics and performance are not enough for the requirement of safety and economics, it will lead to lifetime end of the plant. It should develop plan to implement aging management in NPPs earlier in China in order to assure the safety and economics and prolong the lifetime of the nuclear power plants as so as possible

  5. Speech and Language Guidelines for Children Adopted from Abroad at Older Ages

    Science.gov (United States)

    Glennen, Sharon

    2009-01-01

    Children adopted from abroad at older ages have unique speech and language-learning issues. At adoption, the impact of longer stays in orphanages with their associated lack of enrichment, nutrition, and healthcare is more pronounced. After adoption, the children begin school in a new language soon after arriving home. These children quickly lose…

  6. Ageing Management of Concrete Structures in Nuclear Power Plants

    International Nuclear Information System (INIS)

    This publication is one in a series of reports on the assessment and management of ageing of major nuclear power plant components. Current practices for assessment of safety margins (fitness for service) and inspection, monitoring and mitigation of ageing related degradation of selected concrete structures related to NPPs are documented. Implications for and differences in new reactor designs are discussed. This information is intended to help all involved directly and indirectly in ensuring the safe operation of NPPs, and also to provide a common technical basis for dialogue between plant operators and regulators when dealing with age related licensing issues

  7. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Patient Education in the Management of Rheumatoid Arthritis (RA)

    Science.gov (United States)

    Brosseau, Lucie; Wells, George A.; Tugwell, Peter; Egan, Mary; Dubouloz, Claire-Jehanne; Welch, Vivian A.; Trafford, Laura; Sredic, Danjiel; Pohran, Kathryn; Smoljanic, Jovana; Vukosavljevic, Ivan; De Angelis, Gino; Loew, Laurianne; McEwan, Jessica; Bell, Mary; Finestone, Hillel M.; Lineker, Sydney; King, Judy; Jelly, Wilma; Casimiro, Lynn; Haines-Wangda, Angela; Russell-Doreleyers, Marion; Laferriere, Lucie; Lambert, Kim

    2012-01-01

    Background and purpose: The objective of this article is to create guidelines for education interventions in the management of patients ([greater than] 18 years old) with rheumatoid arthritis (RA). Methods: The Ottawa Methods Group identified and synthesized evidence from comparative controlled trials using Cochrane Collaboration methods. The…

  8. Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline

    NARCIS (Netherlands)

    Scholten, A.C.; Berben, S.A.A.; Westmaas, A.H.; Grunsven, P.M. van; Vaal, E.T. de; Hoogerwerf, N.; Doggen, C.J.; Schoonhoven, L.

    2015-01-01

    INTRODUCTION: Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was deve

  9. Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline

    NARCIS (Netherlands)

    Scholten, A.C.; Berben, S.A.A.; Westmaas, A.H.; Grunsven, P.M.; Vaal, de E.T.; Rood, Pleunie P.M.; Hoogerwerf, N.; Doggen, C.J.M.; Schoonhoven, L.

    2015-01-01

    Introduction Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was devel

  10. Reading and analysis on management guidelines for hyperthyroidism published in 2011 by American Thyroid Association and American Association of Clinical Endocrinologists

    International Nuclear Information System (INIS)

    Recently, the American Thyroid Association and American Association of Clinical Endocrinologists published 'Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists', and created 100 evidence-based recommendations. The guideline systematically introduced the diagnoses and therapies of hyperthyroidism, emphasizing the indications, contraindications, preparations, methodologies and follow-up strategies. The guideline also provided detailed management principles for hyperthyroidism in children and pregnancy, Graves' ophthalmopathy and some unusual causes of hyperthyroidism. (authors)

  11. Managing the effects of aging and reliability improvement

    International Nuclear Information System (INIS)

    Over recent years the electric power generating community has acknowledged the importance of the aging process on plant safety and availability. To cope with time-dependent degradation phenomenon that can affect active as well as passive components and lead to unacceptable, unanticipated failures requires research into the mechanisms of the aging process, advances in productive methods for assessing the aging impact on risk and availability, and a better understanding of power plant operations so that strategies for defending against this pervasive stress can be developed. This paper discusses current research advances and presents a framework to aid in the systematic integration of these three needs. As such it is anchored to research being conducted at Brookhaven National Laboratory in the areas of plant aging, life extension, reliability, performance indication, and risk assessment. The current question facing the industry can be simply stated. ''How can an acceptable level of safety and availability be maintained throughout the operational life of a nuclear power plant?'' The complexity of this question indicates that managing aging effects must be a continuous, coordinated process integrated with day-to-day tactical plant operation decisions. This implies that aging and reliability programs must be systemic properties of an organization's management, and that research into aging technology must be closely linked

  12. OSART guidelines

    International Nuclear Information System (INIS)

    The IAEA Operational Safety Review Team (OSART) programme provides advice and assistance to Member States to enhance the operational safety of nuclear power plants. These OSART Guidelines provide overall guidance for the experts to ensure the consistency and comprehensiveness of the operational safety review. Specific guidelines are provided as guide for the systematic review in the following areas important to operational safety: management, organization and administration, training and qualification, operations, maintenance, technical support, radiation protection, chemistry, emergency planning and preparedness

  13. A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world: 2010-2016.

    Science.gov (United States)

    Yu, Su Jong

    2016-03-01

    Many guidelines for hepatocellular carcinoma (HCC) have been published and updated globally. In contrast to other cancers, there is a range of treatment options for HCC involving several multidisciplinary care of the patient. Consequently, enormous heterogeneity in management trends has been observed. To support standard care for HCC, we systematically appraised 8 current guidelines for HCC around the world, including 3 guidelines from Asia, 2 from Europe, and 3 from the United States according to the selection criteria of credibility influence and multi-faceted. After a systematic appraisal, we found that these guidelines have both similarities and dissimilarities in terms of surveillance and treatment allocation recommendations due to regional differences in disease and other variables (diagnosis, staging systems) secondary to the lack of a solid, high level of evidence. In contrast to other tumors, the geographic differences in tumor biology (i.e., areas of increased hepatitis B prevalence) and available resources (organ availability for transplantation, medical technology, accessibility to treatment, health systems, and health resources) make it impractical to have an internationally universal guideline for all patients with HCC. Although Barcelona-Clinic Liver Cancer (BCLC) has long been dominant system for treatment-guiding staging of HCC, many Asia-pacific experts do not fully agree with its principle. The concepts of BCLC, for surgical resection or other locoregional therapy, are considered too conservative. Asian guidelines represent consensus about surgical resection and TACE indication for more advanced tumor. PMID:27044761

  14. [Clinical practice guidelines for systemic lupus erythematosus: Recommendations for general clinical management].

    Science.gov (United States)

    Trujillo-Martín, María M; Rúa-Figueroa Fernández de Larrinoa, Iñigo; Ruíz-Irastorza, Guillermo; Pego-Reigosa, José María; Sabio Sánchez, José Mario; Serrano-Aguilar, Pedro

    2016-05-01

    Systemic lupus erythematosus (SLE) is a complex rheumatic multisystemic disease of autoimmune origin with significant potential morbidity and mortality. It is one of the most common autoimmune diseases with an estimated prevalence of 20-150 cases per 100,000 inhabitants. The clinical spectrum of SLE is wide and variable both in clinical manifestations and severity. This prompted the Spanish Ministry of Health, Social Services and Equality to promote and fund the development of a clinical practice guideline (CPG) for the clinical care of SLE patients within the Programme of CPG in the National Health System which coordinates GuiaSalud. This CPG is is intended as the reference tool in the Spanish National Health System in order to support the comprehensive clinical management of people with SLE by all health professionals involved, regardless of specialty and level of care, helping to standardize and improve the quality of clinical decisions in our context in order to improve the health outcomes of the people affected. The purpose of this document is to present and discuss the rationale of the recommendations on the general management of SLE, specifically, clinical follow-up, general therapeutic approach, healthy lifestyles, photoprotection, and training programmes for patients. These recommendationsare based on the best available scientific evidence, on discussion and the consensus of expert groups. PMID:26975887

  15. PSYCHOLOGICAL PROBLEMS OF THE AGED AND ITS MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Sahoo Srinibash

    2013-10-01

    Full Text Available Aging is an inevitable biological phenomenon resulting from intrinsic and extrinsic damage to the various organs and systems. One does not know when old age begins. The “biological age” of a person is not identical to the “chronological age”. Victor Hugo once said 40 is the old age of youth where as 50 is the youth of old age. So in countries like India we are considering the age of 60 as the start of old age. The decline in cognitive functions is very common consequence of aging. It is significantly associated with poor self-perception, depression, fear, worry, anxiety, decreased memory, angry etc., which are sometimes life-threatening conditions. In Astanga Ayurveda, Jara Chikitsa exists as a separate branch but detailed descriptions are not available. We got the scattered references regarding prevention of Jara and management of old age problems. Mainly Rasayanas of different types are mentioned for prevention as well as promotion of health in old age. The Rasayana drugs and Panchakarma. Therapies not only promote the physical health but beneficial effects also seen on brain and its functional areas. Different Rasayanas and Panchakarma therapies with their effects will be detailed described in full paper.

  16. Assessing the impact of the U.S. Endangered Species Act recovery planning guidelines on managing threats for listed species.

    Science.gov (United States)

    Troyer, Caitlin M; Gerber, Leah R

    2015-10-01

    The Endangered Species Act (ESA) of the United States was enacted in 1973 to prevent the extinction of species. Recovery plans, required by 1988 amendments to the ESA, play an important role in organizing these efforts to protect and recover species. To improve the use of science in the recovery planning process, the Society for Conservation Biology (SCB) commissioned an independent review of endangered species recovery planning in 1999. From these findings, the SCB made key recommendations for how management agencies could improve the recovery planning process, after which the U.S. Fish and Wildlife Service and the National Marine Fisheries Service redrafted their recovery planning guidelines. One important recommendation called for recovery plans to make threats a primary focus, including organizing and prioritizing recovery tasks for threat abatement. We sought to determine the extent to which results from the SCB study were incorporated into these new guidelines and whether the SCB recommendations regarding threats manifested in recovery plans written under the new guidelines. Recovery planning guidelines generally incorporated the SCB recommendations, including those for managing threats. However, although recent recovery plans have improved in their treatment of threats, many fail to adequately incorporate threat monitoring. This failure suggests that developing clear guidelines for monitoring should be an important priority in improving ESA recovery planning. PMID:26108948

  17. Impact of Long-Term Endurance Training vs. Guideline-Based Physical Activity on Brain Structure in Healthy Aging.

    Science.gov (United States)

    Wood, Katelyn N; Nikolov, Robert; Shoemaker, J Kevin

    2016-01-01

    Brain structure is a fundamental determinant of brain function, both of which decline with age in the adult. Whereas short-term exercise improves brain size in older adults, the impact of endurance training on brain structure when initiated early and sustained throughout life, remains unknown. We tested the hypothesis that long-term competitive aerobic training enhances cortical and subcortical mass compared to middle to older-aged healthy adults who adhere to the minimum physical activity guidelines. Observations were made in 16 masters athletes (MA; 53 ± 6 years, VO2max = 55 ± 10 ml/kg/min, training > 15 years), and 16 active, healthy, and cognitively intact subjects (HA; 58 ± 9 years, VO2max = 38 ± 7 ml/kg/min). T1-weighted structural acquisition at 3T enabled quantification of cortical thickness and subcortical gray and white matter volumes. Cardiorespiratory fitness correlated strongly with whole-brain cortical thickness. Subcortical volumetric mass at the lateral ventricles, R hippocampus, R amygdala, and anterior cingulate cortex, correlated with age but not fitness. In a region-of-interest (ROI) group-based analysis, MA expressed greater cortical thickness in the medial prefrontal cortex, pre and postcentral gyri, and insula. There was no effect of group on the rate of age-related cortical or subcortical decline. The current data suggest that lifelong endurance training that produces high levels of cardiorespiratory fitness, builds cortical reserve early in life, and sustains this benefit over the 40-70 year age span. This reserve likely has important implications for neurological health later in life. PMID:27445798

  18. Empirical guidelines for forest management decision support systems based on the past experiences of the expert's community

    Directory of Open Access Journals (Sweden)

    A.F. Marques

    2013-07-01

    Full Text Available Aim of the study: Decision support systems for forest management (FMDSS have been developed world wide to account for a broad range of forest ecosystems, management goals and organizational frameworks (e.g. the wiki page of the FORSYS project reports 62 existing FMDSSs from 23 countries. The need to enhance the collaboration among this diverse community of developers and users fostered the rise of new group communication processes that could capture useful knowledge from past experiences in order to efficiently provide it to new FMDSS development efforts.Material and methods: This paper presents and tests an exploratory process aiming to identify the empirical guidelines assisting developers and users of FMDSS. This process encompasses aDelphi survey built upon the consolidation of the lessons-learned statements that summarize the past experiences of the experts involved in the FORSYS project. The experts come from 34 countries and have diverse interests, ranging from forest planners, IT developers, social scientists studying participatory planning, and researchers with interests in knowledge management and in quantitative models for forest planning.Main results: The proposed 37 empirical guidelines that group 102 lessons-learned cover a broad range of issues including the DSS development cycle, involvement of the stakeholders, methods, models and knowledge-based techniques in use.Research highlights: These results may be used for improving new FMDSS development processes, teaching and training and further suggest new features of FMDSS and future research topics. Furthermore, the guidelines may constitute a knowledge repository that may be continuously improved by a community of practice.Keywords: Forest management; guidelines; guidelines definition process; lessons learned; decision support systems; system architecture; knowledge management; participatory planning; Delphi.

  19. Experiences in ageing management of electrical system of research reactor Cirus

    International Nuclear Information System (INIS)

    CIRUS is 40 MV (thermal) research reactor which was commissioned in 1960. After three decades of operation, detailed ageing assessment of structures, systems and equipments of CIRUS was carried out with the objective of finalizing the plan to refurbish the reactor. As per the plan, extensive refurbishing was carried out between 1997 and 2002 and the reactor became operational on October 30, 2002. Ageing assessment and refurbishing works were carried out on electrical systems of CIRUS during above mentioned period. The electrical system comprises of different sub-systems namely Class-I system and reactor protection system, Class-II system, Class-III systems and Class-IV systems. This paper describes the method followed for ageing assessment of electrical systems of CIRUS as per international guidelines. Details of ageing assessment of each component of the sub-system and the results of the assessment are also given in the paper. Further, the paper describes the various refurbishing works carried out on the electrical systems, particularly on class-IE components towards ageing managements as well as safety upgradations. (author)

  20. Aging management of containment structures in nuclear power plants

    International Nuclear Information System (INIS)

    Research is being conducted by ORNL under US Nuclear Regulatory Commission (USNRC) sponsorship to address aging management of nuclear power plant containment and other safety-related structures. Documentation is being prepared to provide the USNRC with potential structural safety issues and acceptance criteria for use in continued service evaluations of nuclear power plants. Accomplishments include development of a Structural Materials Information Center containing data and information on the time variation of 144 material properties under the influence of pertinent environmental stressors or aging factors, evaluation of models for potential concrete containment degradation factors, development of a procedure to identify critical structures and degradation factors important to aging management, evaluations of nondestructive evaluation techniques. assessments of European and North American repair practices for concrete, review of parameters affecting corrosion of metals embedded in concrete, and development of methodologies for making current condition assessments and service life predictions of new or existing reinforced concrete structures in nuclear power plants

  1. Technical strategy map to employing nuclear power plant aging management

    International Nuclear Information System (INIS)

    Stated in this report are back ground of technical strategy map for nuclear power plant aging management, result of the first road map, significance of technical strategy map, introduction scenario, technology map, road map, upgrade in every year, three groups of academia, industry and government, plan of technical strategy map, upgrade system, comprehensive introduction scenario, measures of nuclear power plant aging management in Japan and the world, new inspection system, outline of 'technical strategy map 2008', preparation of technical information bases in industry, academia and government, collaboration of them, safety researches of neutron radiation damage, stress corrosion crack, fatigue, piping thinning, insulation degradation, concrete degradation, thermal aging, evaluation technologies of earthquake resistance, preparation of rules and standards, ideal maintenance, and training talent. (S.Y.)

  2. Instrumentation and control aging management: A focus on electronic parts and boards

    International Nuclear Information System (INIS)

    Full text: The nuclear power industry is currently facing increasing aging and obsolescence issues with original equipment installed for instrumentation, control, and safety system applications. One area that needs attention is the aging of electronic boards and components used in instrumentation and control (I and C) systems in nuclear power plants (NPPs). In this context, EPRI has launched a project dedicated to NPP electronic component and board aging management. The goals of this project are: 1) to better understand the degradation mechanisms of I and C electronic systems; 2) to develop new methods to monitor prevalent mechanisms and forecast generic aging cases; and 3) to give guidelines for the aging management of I and C electronic systems. The ultimate objectives are: 1) to reduce the likelihood of losing plant availability due to a board or component failure; and 2) to reduce the global cost of maintenance by optimizing preventive maintenance tasks and the schedule for refurbishment or renewal. Degradation mechanisms of electronic boards in NPP - Aging mechanisms of electronic parts depend on technologies, manufacturing quality, and conditions of environment and operation. Aging of electronic parts is well documented in harsh environments (e.g., aerospace, military, or automotive industries data). However, only a small amount of data on electronic part failures in NPPs is available because the conditions are benign and the failure rates are supposed to be low. It is thus difficult to identify what will predominantly cause the aging of electronic systems after 20 or 30 years of operation. Usual causes are temperature, corrosion, temperature cycles, or extrinsic aggressions (Electrical Over Stress (EOS), Electro Static Discharges (ESD)). From field data and bibliographic analyses, we found that electrolytic capacitors, relays, potentiometers, power devices (thyristors, power transistors, etc.), optocouplers, on-board connectors, printed boards, integrated

  3. The management of infant developmental needs by community nurses - Part 2: The development of guidelines for the support of community nurses in the management of infant developmental needs

    Directory of Open Access Journals (Sweden)

    R. Leech

    2007-09-01

    Full Text Available In the previous article, the author described, according to the scope of practice of registered nurses, the responsibilities oi community nurses with regard to the management of infant developmental needs in primary health care clinics in South Africa. In this article, the focus is on the development of guidelines for the support of community nurses in fulfilling these responsibilities. Before the development of the guidelines is addressed, a brief overview of the background of the study, assumptions of the researcher and the methodology of the study is given. The development of the set of guidelines (DEFINE HOPE is set against the background of the drive to improve the quality of developmental care for infants and their families. As guidelines help to translate scientific information into statements, it could be valuable to community nurses to improve their delivery of developmental care. To gather evidence for the formulation of the guidelines, the researcher utilised the themes identified during the analysis process in phase one of the research; investigated research articles; and compared findings and recommendations of the articles with the research findings obtained in phase one. In addition to the research findings and literature review, a focus group (health care professionals represented in the case study, was utilised to assist with the final development and validation of the guidelines. The researcher adapted a number of desirable attributes for guidelines, which are indicated in the literature, to compile the criteria for validation of the guidelines. In conclusion, guidelines are necessary to support community nurses in finding “best practice” within their scope of practice to ensure higher quality of developmental care to families with infants 0-2 years.

  4. Recommendations for managing cutaneous disorders associated with advancing age.

    Science.gov (United States)

    Humbert, Philippe; Dréno, Brigitte; Krutmann, Jean; Luger, Thomas Anton; Triller, Raoul; Meaume, Sylvie; Seité, Sophie

    2016-01-01

    The increasingly aged population worldwide means more people are living with chronic diseases, reduced autonomy, and taking various medications. Health professionals should take these into consideration when managing dermatological problems in elderly patients. Accordingly, current research is investigating the dermatological problems associated with the loss of cutaneous function with age. As cell renewal slows, the physical and chemical barrier function declines, cutaneous permeability increases, and the skin becomes increasingly vulnerable to external factors. In geriatric dermatology, the consequences of cutaneous aging lead to xerosis, skin folding, moisture-associated skin damage, and impaired wound healing. These problems pose significant challenges for both the elderly and their carers. Most often, nurses manage skin care in the elderly. However, until recently, little attention has been paid to developing appropriate, evidence-based, skincare protocols. The objective of this paper is to highlight common clinical problems with aging skin and provide some appropriate advice on cosmetic protocols for managing them. A review of the literature from 2004 to 2014 using PubMed was performed by a working group of six European dermatologists with clinical and research experience in dermatology. Basic topical therapy can restore and protect skin barrier function, which relieves problems associated with xerosis, prevents aggravating moisture-associated skin damage, and enhances quality of life. In conclusion, the authors provide physicians with practical recommendations to assist them in implementing basic skin care for the elderly in an integrated care approach. PMID:26929610

  5. Management of age-related degradation for nuclear power plants

    International Nuclear Information System (INIS)

    Life extension for nuclear power plants has been studied in the USA for the last six years, largely supported by EPRI, DOE and the USNRC. Though there are diverse opinions for the strategies and priorities of life extension and aging management, one common conclusion has been formulated regarding the need of current maintenance programs having to focus on aging and degradation management. Such program, called 'Maintenance Effectiveness Evaluation and Enhancement' or M3E for short, has been developed to assist plant operators to upgrade and enhance existing programs by integrating aging/degradation management activities for important or critical equipment and components. The key elements of the M3E program consist of the definition and selection of the critical components or commodities to be included in the scope, the survey/inventory of the current programs and their respective action steps, frequencies, corrective measures and extent of coverage, the component/commodity degradation mechanism, sites and severity, safety functions and service environments and lastly, the correlation of degradation/aging with the individual maintenance activities. The degree of correlation provides a measure of effectiveness and the opportunity to identify/specify needed enhancements, abandonment or generation of new maintenance activities. Implementation of the activities can then be prioritized at the option of the plant staff. (author)

  6. European AIDS Clinical Society (EACS) guidelines for the clinical management and treatment of HIV-infected adults

    DEFF Research Database (Denmark)

    Clumeck, N; Pozniak, A; Raffi, F;

    2008-01-01

    A working group of the European AIDS Clinical Society (EACS) have developed these guidelines for European clinicians to help them in the treatment of adults with HIV infection. This third version of the guidelines includes, as new topics, the assessment of patients at initial and subsequent clinic...... visits as well as post-exposure prophylaxis. A revision of the 2005 guidelines based on current data includes changes in the sections on primary HIV infection, when to initiate therapy, which drug combinations are preferred as initial combination regimens for antiretroviral-naïve patients, how to manage...... virological failure and the treatment of HIV during pregnancy. In Europe, there is a wide range of clinical practices in antiretroviral therapy depending on various factors such as drug registration, national policies, local availability, reimbursement and access to treatment. These can vary greatly from one...

  7. Policy options to improve leadership of middle managers in the Australian residential aged care setting: a narrative synthesis

    Directory of Open Access Journals (Sweden)

    Merlyn Teri

    2010-07-01

    Full Text Available Abstract Background The prevalence of both chronic diseases and multi-morbidity increases with longer life spans. As Australia's population ages, the aged care sector is under increasing pressure to ensure that quality aged care is available. Key to responding to this pressure is leadership and management capability within the aged care workforce. A systematic literature review was conducted to inform the policy development necessary for the enhancement of clinical and managerial leadership skills of middle managers within residential aged care. Methods Using scientific journal databases, hand searching of specialist journals, Google, snowballing and suggestions from experts, 4,484 papers were found. After a seven-tiered culling process, we conducted a detailed review (narrative synthesis of 153 papers relevant to leadership and management development in aged care, incorporating expert and key stakeholder consultations. Results • Positive staff experiences of a manager's leadership are critical to ensure job satisfaction and workforce retention, the provision of quality care and the well-being of care recipients, and potentially a reduction of associated costs. • The essential attributes of good leadership for aged care middle management are a hands-on accessibility and professional expertise in nurturing respect, recognition and team building, along with effective communication and flexibility. However, successful leadership and management outcomes depend on coherent and good organisational leadership (structural and psychological empowerment. • There is inadequate preparation for middle management leadership roles in the aged care sector and a lack of clear guidelines and key performance indicators to assess leadership and management skills. • Theory development in aged care leadership and management research is limited. A few effective generic clinical leadership programs targeting both clinical and managerial leaders exist. However

  8. Design of a management information system for the Shielding Experimental Reactor ageing management

    International Nuclear Information System (INIS)

    The problem of nuclear reactor ageing is a topic of increasing importance in nuclear safety recent years. Ageing management is usually implemented for reactors maintenance. In the practice, a large number of data and records need to be processed. However, there are few professional software applications that aid reactor ageing management, especially for research reactors. This paper introduces the design of a new web-based management information system (MIS), named the Shielding Experimental Reactor Ageing Management Information System (SERAMIS). It is an auxiliary means that helps to collect data, keep records, and retrieve information for a research reactor ageing management. The Java2 Enterprise Edition (J2EE) and network database techniques, such as three-tiered model, Model-View-Controller architecture, transaction-oriented operations, and JavaScript techniques, are used in the development of this system. The functionalities of the application cover periodic safety review (PSR), regulatory references, data inspection, and SSCs classification according to ageing management methodology. Data and examples are presented to demonstrate the functionalities. For future work, techniques of data mining will be employed to support decision-making.

  9. Design of a management information system for the Shielding Experimental Reactor ageing management

    Energy Technology Data Exchange (ETDEWEB)

    He Jie, E-mail: hejiejoe@163.co [Institute of Nuclear and New Energy Technology, Tsinghua University, Beijing 100084 (China); Xu Xianhong [Institute of Nuclear and New Energy Technology, Tsinghua University, Beijing 100084 (China)

    2010-01-15

    The problem of nuclear reactor ageing is a topic of increasing importance in nuclear safety recent years. Ageing management is usually implemented for reactors maintenance. In the practice, a large number of data and records need to be processed. However, there are few professional software applications that aid reactor ageing management, especially for research reactors. This paper introduces the design of a new web-based management information system (MIS), named the Shielding Experimental Reactor Ageing Management Information System (SERAMIS). It is an auxiliary means that helps to collect data, keep records, and retrieve information for a research reactor ageing management. The Java2 Enterprise Edition (J2EE) and network database techniques, such as three-tiered model, Model-View-Controller architecture, transaction-oriented operations, and JavaScript techniques, are used in the development of this system. The functionalities of the application cover periodic safety review (PSR), regulatory references, data inspection, and SSCs classification according to ageing management methodology. Data and examples are presented to demonstrate the functionalities. For future work, techniques of data mining will be employed to support decision-making.

  10. Changes in the management of acute ischemic stroke after publication of Japanese Guidelines for the Management of Stroke (2004). A multicenter cooperative study in Toyama prefecture

    International Nuclear Information System (INIS)

    It is unclear whether the management of stroke has been improved since the Japanese Guidelines for the Management of Stroke (2004) was published. The aim of the present study was to clarify changes in the management for acute ischemic stroke after publication of the Japanese Guidelines. We investigated the management of patients with acute ischemic stroke in nine hospitals belonging to the committee of Toyama Acute Ischemic Stroke Study, before and after publication of the Japanese Guidelines for the Management of Stroke (2004). Two-hundred and ninety-three acute ischemic stroke patients were registered in 2003 and 237 in 2006, respectively. The percentage of lacunar stroke was 39%, 37%, atherothrombotic infarction; 28%, 30%, cardioembolic stroke (CE); 21%, 22%, and others; 12%, 11%, respectively. The ratio of CE patients who were admitted within 3 hours of onset was significantly increased from 34% in 2003 to 57% in 2006. Although 74 patients (31%) with any clinical type were admitted within 3 hours of onset, thrombolytic therapy with tissue plasminogen activator (rt-PA) was administered to only 5 patients (2.1%) in 2006. Diffusion weighted images became available in all hospitals, and were more frequently used for diagnosis of acute ischemic stroke in 92% of patients in 2006 as compared to 59% in 2003. Ischemic lesions were more frequently detected before the start of treatment in 52% of patients in 2006 as compared to 43% in 2003. After the Japanese Guidelines for the Management of Stroke (2004) was published, the treatment of acute ischemic stroke patients appeared to follow this guideline in many patients. Thrombolytic therapy with rt-PA, however, was performed in very few patients. (author)

  11. Adherence to treatment guidelines in the pharmacological management of chronic heart failure in an Australian population

    Institute of Scientific and Technical Information of China (English)

    Dao-Kuo Yao; Le-Xin Wang; Shane Curran; Patrick Ball

    2011-01-01

    Background To document the pharmacotherapy of chronic heart failure (CHF) and to evaluate the adherence to treatment guidelines in Australian population.Methods The pharmacological management of 677 patients (female 46.7%,75.5±11.6 years) with CHF was retrospectively analyzed.Results The use of angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) and fl-blockers were 58.2%and 34.7%,respectively.Major reasons for non-use of ACE inhibitors/ARBs were hyperkalemia and elevated serum creatimne level.For patients who did not receive β-blockers,asthma and chronic obstructive pulmonary disease were the main contraindications.Treatment at or above target dosages for ACE inhibitors/ARBs and β-blockers was low for each medication (40.3% and 28.9%,respectively).Conclusions Evidenced-based medical therapies for heart failure were under used in a rural patient population.Further studies are required to develop processes to improve the optimal use of heart failure medications.

  12. Canadian Stroke Best Practice Recommendations: Managing transitions of care following Stroke, Guidelines Update 2016.

    Science.gov (United States)

    Cameron, Jill I; O'Connell, Colleen; Foley, Norine; Salter, Katherine; Booth, Rhonda; Boyle, Rosemary; Cheung, Donna; Cooper, Nancy; Corriveau, Helene; Dowlatshahi, Dar; Dulude, Annie; Flaherty, Patti; Glasser, Ev; Gubitz, Gord; Hebert, Debbie; Holzmann, Jacquie; Hurteau, Patrick; Lamy, Elise; LeClaire, Suzanne; McMillan, Taylor; Murray, Judy; Scarfone, David; Smith, Eric E; Shum, Vivian; Taylor, Kim; Taylor, Trudy; Yanchula, Catherine; Teasell, Robert; Lindsay, Patrice

    2016-10-01

    Every year, approximately 62,000 people with stroke and transient ischemic attack are treated in Canadian hospitals. For patients, families and caregivers, this can be a difficult time of adjustment. The 2016 update of the Canadian Managing Transitions of Care following Stroke guideline is a comprehensive summary of current evidence-based and consensus-based recommendations appropriate for use by clinicians who provide care to patients following stroke across a broad range of settings. The focus of these recommendations is on support, education and skills training for patients, families and caregivers; effective discharge planning; interprofessional communication; adaptation in resuming activities of daily living; and transition to long-term care for patients who are unable to return to or remain at home. Unlike other modules contained in the Canadian Stroke Best Practice Recommendations (such as acute inpatient care), many of these recommendations are based on consensus opinion, or evidence level C, highlighting the absence of conventional evidence (i.e. randomized controlled trials) in this area of stroke care. The quality of care transitions between stages and settings may have a direct impact on patient and family outcomes such as coping, readmissions and functional recovery. While many qualitative and non-controlled studies were reviewed, this gap in evidence combined with the fact that mortality from stoke is decreasing and more people are living with the effects of stroke, underscores the need to channel a portion of available research funds to recovery and adaptation following the acute phase of stroke. PMID:27443991

  13. Lessons learned from the CEOG generic accident management guidelines confirmation (validation) exercise

    International Nuclear Information System (INIS)

    In July 1995, the CE Owner's Group completed and issued Revision 0 of the Generic Accident Management Guidelines (AMG's) to the owners group task participants. This guidance provides a structured mechanism for the plant staff at CE utilities to respond to accidents that beyond the plant design basis and, possibly, the Emergency Operating Procedures. Prior to final issue of the generic AMGs, the CEOG conducted an AMG Confirmation Exercise to establish the ability of the AMGs to fulfill this important role. The specific objectives of the AMG Confirmation Exercise were to (1) clarify the interactions and transitions between the AMG/Technical Support Center (TSC) and the EOPS/Operations Personnel (2) validate the adequacy of the AMG data collection and plant condition diagnostic evaluation process and (3) assess the feasibility of the mechanical material and recommendations contained in the AMG's. The purpose of paper is to provide a detailed description of the AMG Confirmation Exercise as well as important lessons learned during the planning and implementation of the exercise. In addition, a discussion will be presented pertaining to the relationship between the AMG's (incumbent to the Technical Support Center) and the plants Emergency Operating Procedures (incumbent to the Control Room Operations Staff)

  14. Gastroesophageal reflux disease management according to contemporary international guidelines: A translational study

    Institute of Scientific and Technical Information of China (English)

    Fabio Pace; Gabriele Riegler; Annalisa de Leone; Patrizia Dominici; Enzo Grossi; the EMERGE Study Group

    2011-01-01

    AIM: To test the Genval recommendations and the usefulness of a short trial of proton pump inhibitor (PPI) in the initial management and maintenance treatment of gastroesophageal reflux disease (GERD) patients.METHODS: Five hundred and seventy seven patients with heartburn were recruited. After completing a psychometric tool to assess quality of life (PGWBI) and a previously validated GERD symptom questionnaire (QUID), patients were grouped into those with esophagitis (EE, n = 306) or without mucosal damage (NERD, n = 271) according to endoscopy results. The study started with a 2-wk period of high dose omeprazole (omeprazole test); patients responding to this PPI test entered an acute phase (3 mo) of treatment with any PPI at the standard dose. Finally, those patients with a favorable response to the standard PPI dose were maintained on a half PPI dose for a further 3-mo period.RESULTS: The test was positive in 519 (89.9%) patients, with a greater response in EE patients (96.4%) compared with NERD patients (82.6%) (P = 0.011). Both the percentage of completely asymptomatic patients, at 3 and 6 mo, and the reduction in heartburn intensity were significantly higher in the EE compared with NERD patients (P < 0.01). Finally, the mean PGWBI score was significantly decreased before and increased after therapy in both subgroups when compared with the mean value in a reference Italian population.CONCLUSION: Our study confirms the validity of the Genval guidelines in the management of GERD patients. In addition, we observed that the overall response to PPI therapy is lower in NERD compared to EE patients.

  15. Management under uncertainty: guide-lines for incorporating connectivity into the protection of coral reefs

    Science.gov (United States)

    McCook, L. J.; Almany, G. R.; Berumen, M. L.; Day, J. C.; Green, A. L.; Jones, G. P.; Leis, J. M.; Planes, S.; Russ, G. R.; Sale, P. F.; Thorrold, S. R.

    2009-06-01

    The global decline in coral reefs demands urgent management strategies to protect resilience. Protecting ecological connectivity, within and among reefs, and between reefs and other ecosystems is critical to resilience. However, connectivity science is not yet able to clearly identify the specific measures for effective protection of connectivity. This article aims to provide a set of principles or practical guidelines that can be applied currently to protect connectivity. These ‘rules of thumb’ are based on current knowledge and expert opinion, and on the philosophy that, given the urgency, it is better to act with incomplete knowledge than to wait for detailed understanding that may come too late. The principles, many of which are not unique to connectivity, include: (1) allow margins of error in extent and nature of protection, as insurance against unforeseen or incompletely understood threats or critical processes; (2) spread risks among areas; (3) aim for networks of protected areas which are: (a) comprehensive and spread—protect all biotypes, habitats and processes, etc., to capture as many possible connections, known and unknown; (b) adequate—maximise extent of protection for each habitat type, and for the entire region; (c) representative—maximise likelihood of protecting the full range of processes and spatial requirements; (d) replicated—multiple examples of biotypes or processes enhances risk spreading; (4) protect entire biological units where possible (e.g. whole reefs), including buffers around core areas. Otherwise, choose bigger rather than smaller areas; (5) provide for connectivity at a wide range of dispersal distances (within and between patches), emphasising distances principles to coral reef management in the Bohol Sea (Philippines), the Great Barrier Reef (Australia) and Kimbe Bay (Papua New Guinea) are described.

  16. Aging and Life Management System of Reactor Pressure Vessel

    OpenAIRE

    Ya-jin Liu; Jiang Guo; Kai-kai Gu

    2011-01-01

    Reactor pressure vessel (RPV), the only key component that can not be replaced in nuclear power plants (NPPs), is the main barrier against the radioactive leakage. The lifetime of NPPs is dependent heavily on the life of RPV, and thus, the aging and life research on a RPV is a key factor in determining the life extension of NPPs. The purpose of this paper is to introduce an aging and life management system for an operating RPV which can be used as a reference of the lifetime extension. In ord...

  17. Gender and age differences in conflict management within small businessess

    Directory of Open Access Journals (Sweden)

    Werner Havenga

    2008-11-01

    Full Text Available The objective of this exploratory study was to establish, through the application of the Rahim Organisational Inventory (ROC II instrument, how the gender and age status of owners/managers of small businesses relate to the application of different conflict-handling styles. The sample of 68 participants was taken using a convenience sampling technique to ensure representation from the strata of the 102 small businesses. Analysis of variances was used to determine if differences exist in conflict-handling styles within the gender and age status groups. The results of the statistical analysis done revealed that slight to significant variances were found, which are discussed accordingly.

  18. Guidelines for the Diagnosis and Management of Food Allergy in the United States

    Science.gov (United States)

    ... the disorder and, in turn, experience a better quality of life. Why You Need To Know About the Food Allergy Guidelines Approximately 1 in ... of the panel members. Make sure your doctor knows that the guidelines are ... that can help your doctor determine whether you have food allergy and if you ...

  19. Age Management and Sustainable Careers for the Improvement of the Quality of Ageing at Work.

    Science.gov (United States)

    Marcaletti, Francesco

    2014-01-01

    Prolonging working careers by increasing the statutory age for retirement has become compulsory in most Western societies in order to tackle the shrinking of the labour force, preserve economic productivity, foster knowledge transfer and reduce the risks of financial imbalances in social security systems. This imperative currently results in working careers that already exceed 40 years and come to an end after the age of 65 (e.g. in Italy). Over the next few decades, both career length and retirement age are expected to rise. Thus, creating more inclusive workplaces by increasing their quality is the precondition of a win-win situation for both employers and employees, regardless of age. A request for support in the development of sustainable careers from both private and public labour organisations has led to innovating the mainstream methodologies and research tools in the field of age management. Based on the key elements of the mainstream "work ability concept" - i.e. health, competencies, motivation and work organisation - the Quality of Ageing at Work questionnaire (QAW-q), developed by a team from the WWELL Research Centre, broadens its perspective by surveying elements bridging intra-organisational dimensions and which affect employees' conditions and external socio-institutional constraints: i.e. work-life balance, economic stability, professional identity and relationships in the workplace. The QAW-q is designed to analyse the influence of the different meanings of age (chronological age, seniority within the company and in the labour market) and correlate them with the different dimensions at individual and organisational levels; all these dimensions are weighted by the effect exerted by the passage of time. The results of the QAW-q survey, taken by employees of both private and public companies, serve as a basis for the implementation of measures addressing all the relevant dimensions of the human resource management cycle. PMID:26630520

  20. Management of pulmonary nodules according to the 2015 British Thoracic Society guidelines. Key messages for clinical practice.

    Science.gov (United States)

    Baldwin, David R

    2016-04-26

    The British Thoracic Society guideline on the investigation and management of pulmonary nodules is based on a comprehensive and systematic review of the literature on pulmonary nodules. Recent evidence has suggested that significant changes to existing guidelines are necessary. The use of 2 malignancy prediction calculators to better characterize the risk of malignancy was firmly supported by evidence, as were the recommendations for a higher nodule size threshold for follow‑up (≥5 mm or ≥80 mm3) and a reduction of the follow‑up period to 1 year for solid pulmonary nodules. Although caution is required where there is a history of cancer, both of these recommendations will reduce the number of follow‑up computed tomographies, thereby improving cost‑effectiveness and pressure on imaging services. Recent evidence has also confirmed the superiority of volumetry as the preferred measurement method and clarified the management of nodules with extended volume‑doubling times. Acknowledging the good prognosis of subsolid nodules, there are recommendations for less aggressive options in their management. The guidelines recommend ordinal scale reporting for positron emission tomography-computed tomography to facilitate incorporation into risk models. There are recommendations on when biopsy is most helpful, the threshold for treatment without histological confirmation, and surgical and nonsurgical treatment. The guideline also provides evidence‑based recommendations about the information that people need and that should be provided for them. The complexity of managing pulmonary nodules is made more accessible by 4 management algorithms. In the real world, it is surprising how easy these are to follow and how they seem to follow an intuitive approach. PMID:27121867

  1. Prevailing Practice Versus Clinical Guideline: The In-Patient Assessment And Management Of Childhood Bronchopneumonia In A Malaysian District Hospital

    Directory of Open Access Journals (Sweden)

    Jacynta Jayaram

    2008-12-01

    Full Text Available Introduction: Pneumonia is the most commondiagnosis made in hospitalised children. The MalaysianClinical Practice Guidelines on pneumonia andrespiratory tract infections provides a comprehensiveguidance in the local context. We evaluated thedocumented assessment and management of childrendiagnosed with pneumonia admitted to the children’sward, Hospital Batu Pahat against this guideline.Methods: We performed a retrospective analysis ofhospital case notes for children admitted from Januaryto May 2004.Results: Ninety six case notes were analysed. Mostpatients (84% had at least four positive clinical featuresleading to the diagnosis of pneumonia. 92% met theguideline criteria for admission. Sp02 was performed for58% on admission, and 58% with reading below 95%received supplemental oxygen. Throughout hospitalstay, each patient had an average of four investigations(range: 1 – 12. Among 23 patients who hadfurther investigations, justifications were only recordedin seven patients (30.4%, and changes inmanagement resulted in 23%. The most commonantibiotic prescribed was intravenous Penicillin (97 %.In 17 patients who met the guideline classification forsevere pneumonia, none received the recommendedantibiotic combination. The median time to feverresolution was 22 hours (range 2 – 268, and medianhospital stay was 3 days (range 1 – 12.Conclusions: Although the quality of clinicalassessment and antibiotic choices were acceptable,there was a failure to critically evaluate patientsaccording to disease severity and initiate correspondinginvestigations and managements. Future efforts need tobe directed at promoting further guideline adherenceand the exercise of critical judgment in patientevaluation.

  2. Maintenance related to life management: Survey and control of equipment ageing

    International Nuclear Information System (INIS)

    The aim of this paper is to review relevant objectives and aspects of the Maintenance Evaluation and Improvement Programmes for Nuclear Power Plant Life Management. Recent experience shows that current maintenance practice often fails to directly address long-term degradation that affects singular plant components and equipment populations. Instead, delayed attention to the consequences makes good Life Management unfeasible. This has brought about the need for specific Maintenance Evaluation and Improvement Programmes to adjust to the basic objective of Life Management which is to protect against, mitigate and/or monitor ageing that affects the safe, profitable life of the facility. The paper analyses the methodologies used, incidents during their application and the main conclusions reached from the implementation of these programmes in Spanish nuclear power plants. Special attention is paid to recommended solutions for improving the efficiency of the utility's contributions, its leadership in task development and integration, and its interfaces with organisations specialised in providing services that support Life Management Programmes. The coexistence of these and other similar maintenance programmes make it necessary to integrate tasks to optimise effort and tools. The paper analyses the guidelines to be considered when integrating these Programmes with other maintenance optimisation programmes (economy and feasibility, RCM) and with tasks derived from the application of Maintenance Rule regulatory requirements. Lastly, the paper reports on the state of these Maintenance Evaluation and Improvement Programmes, their development, what prospects they have, and the Industry's initiative and actions concerning the matter. (author)

  3. Behavior Management for School Aged Children with ADHD

    OpenAIRE

    Pfiffner, Linda J.; Haack, Lauren M.

    2014-01-01

    Behavior management treatments are the most commonly used nonpharmacological approaches for treating ADHD and associated impairments. This review focuses on behavioral parent training interventions for school age children in the home setting and adjunctive treatments developed to extend effects across settings. The underlying theoretical basis and content of these interventions are described. Empirical support includes numerous randomized clinical trials, systematic reviews, and meta-analyses...

  4. Gender and age differences in conflict management within small businessess

    OpenAIRE

    Werner Havenga

    2008-01-01

    The objective of this exploratory study was to establish, through the application of the Rahim Organisational Inventory (ROC II) instrument, how the gender and age status of owners/managers of small businesses relate to the application of different conflict-handling styles. The sample of 68 participants was taken using a convenience sampling technique to ensure representation from the strata of the 102 small businesses. Analysis of variances was used to determine if differences exist in confl...

  5. Insomnia management for ageing employees with job stress

    OpenAIRE

    Roja I.; Roja Z.; Kalkis H.

    2014-01-01

    In Latvia, the number of aging employees suffering from sleep disorders caused by job stress and poor sleep hygiene is increasing. The non-pharmacologic and pharmacologic treatment is prescribed for these employees in the sleep management. The aim of this research is to clarify the efficiency of using psychotherapy with learning and observing sleep hygiene, combined with the melatonergic drug during a six-week treatment course applied to 25 both male and female intellectual workers over 65 ye...

  6. Management of human immunodeficiency virus infection in advanced age

    OpenAIRE

    Greene, M; Justice, AC; Lampiris, HW; Valcour, V

    2013-01-01

    Importance: Human immunodeficiency virus (HIV) - positive patients treated with antiretroviral therapy now have increased life expectancy and develop chronic illnesses that are often seen in older HIV-negative patients. Objective: To address emerging issues related to aging with HIV. Screening older adults for HIV, diagnosis of concomitant diseases, management of multiple comorbid medical illnesses, social isolation, polypharmacy, and factors associated with end-of-life care are reviewed. Evi...

  7. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease: is universal screening appropriate?

    Science.gov (United States)

    Byrne, Christopher D; Targher, Giovanni

    2016-06-01

    Non-alcoholic fatty liver disease (NAFLD) is very common in people with type 2 diabetes and although estimates for the prevalence NAFLD vary according to age, obesity and ethnicity, some studies have indicated that up to 75% of patients with type 2 diabetes may be affected. During the last 15 years there has been a vast amount of research into understanding the natural history, aetiology and pathogenesis of NAFLD; and now there is a better understanding of the strengths and limitations of diagnostic tests for NAFLD, the influence of lifestyle changes and the effects of potential treatments. With this advance in knowledge, it is apposite that a number of organisations have started to develop guidelines for the diagnosis and management of NAFLD. Given the high proportion of patients with type 2 diabetes who are affected by this liver condition, it is now important to consider how any guideline will affect the care, diagnosis and treatment of patients with type 2 diabetes. It is to the credit of the European Association for the Study of the Liver (EASL), the European Association for the Study of Diabetes (EASD) and the European Association for the Study of Obesity (EASO) that guidelines for NAFLD have been produced (Diabetologia DOI: 10.1007/s00125-016-3902-y ) and a consensus achieved between these three organisations. The purpose of this commentary is to discuss briefly the EASL-EASD-EASO clinical practice guidelines with a focus on their relevance for clinicians caring for patients with type 2 diabetes. PMID:27053232

  8. The influence of natural organic matter and aging on suspension stability in guideline toxicity testing of silver, zinc oxide, and titanium dioxide nanoparticles with Daphnia magna

    DEFF Research Database (Denmark)

    Cupi, Denisa; Hartmann, Nanna Isabella Bloch; Baun, Anders

    2015-01-01

    dioxide (TiO2) ENPs with Daphnia magna were carried out following Organisation for Economic Co-operation and Development test guidelines. Daphnia magna was found to be very sensitive to Ag ENPs (48-h 50% effective concentration 33μgL-1), and aging of the test suspensions in M7 medium (up to 48h) did not...

  9. Aging management of nuclear power plants in Japan

    International Nuclear Information System (INIS)

    The Resource and Energy Agency of the Ministry of Trade and Industry (at present, the Nuclear and Industrial Safety Agency of the Ministry of Economy and Industry) carried out technical and present state conservation evaluations on soundness on a case of supposing operation of main apparatuses important for safety for sixty years, on three nuclear power plants constructed at initial period, on April, 1996, to open her basic concept on their aging management. The electricity companies also carried out their technical evaluation to investigate aging management measures for apparatuses important for safety and succession of operation, to summarize some essential measures for its long-term conservation plan. And, long-term and steady efforts such as technical development, preparation on national technical codes and private standards, data accumulation on materials and apparatuses are also required, to successively act them under adequate role-sharing and cooperation among government, universities and industries. Here were described periodical safety review, containing aging management technical evaluation, preparations of standards on apparatus maintenance standard, and so on, promotion of technical development, and Nuclear Power Plant Life Engineering Center (PLEC). (G.K.)

  10. Record of system upgrade and ageing management of HANARO

    International Nuclear Information System (INIS)

    HANARO is a powerful neutron source providing important nation-wide benefits, including neutron beam research, radioisotope (RI) supply, and medical and industrial applications. Its operation started in 1995 and its operation-day reached 2000 days in the April of 2008. During these 13 years, various activities were conducted for the improvement of system upgrade and the ageing management. The system upgrade activities include the improvements of reactor systems to resolve the issues found during the power operation and those to integrate the new experimental facilities such as a fuel test loop and the irradiation facilities. HANARO is a relative young facility but it is not in the exception in view of ageing management. The integrity of the structure components including the reactor vessel was examined bases on the ISI plan. The major equipments of the primary cooling system were over-hauled. The safety of the reactor building was examined and some repair was conducted. This presentation provides the summary of these activities and the further ageing management plan for the coming 10 years. (author)

  11. Safe management of NPP ageing in the European Union

    International Nuclear Information System (INIS)

    The objectives of the study covered by this report consist of providing recommendations for the development of a methodology to monitor, control and anticipate the ageing of Nuclear Islands, in order to maintain their level of safety during the whole NPP life cycle. This is obtained through a synthesis of the potential ageing mechanisms, their potential effects and the available identification and mitigation methods, and an evaluation of the existing ageing management practices in Belgium, France and Spain, using international recommendations as guidance documents. The aspects covered include, in particular, classification of component priorities, identification of degradation phenomena, surveillance methods and preventive maintenance and repair / replacement programs. This synthesis comparison work is the basis for the recommendations issued at the end of the study. (author)

  12. Ageing Management Based Maintenance at ETRR-II

    International Nuclear Information System (INIS)

    The second research reactor of Egypt, ETRR-II, is an open pool type multi-purpose reactor of 22 MW that has been in operation since 1998. The main purposes of ETRR-II are the production of radioisotopes, personnel training, research and development. Ageing management of ETRR-II is based on the maintenance programme. This programme was planned to have a proactive maintenance strategy that mainly depends on adequate preventive and predictive maintenance. Screening of SSCs is based on safety classes, needs and quality levels. The operation condition and maintenance history are the basis to assess the level of degradation. The ultimate aim of the maintenance team is to perform adequate maintenance work only when it is really necessary. The objectives of the ageing management based maintenance are to maintain and improve equipment availability, confirm compliance with operational limits and conditions, and detect and correct any abnormal condition that might affect reactor safety. The programme also helps to detect trends in ageing so that a plan for mitigating ageing effects can be prepared and implemented. Reactor service conditions are monitored through many parameters and conditions such as conductivity and pH of coolant water, water radiochemical analysis, thermal and hydraulic parameters, a leak detection system, corrosion rate of piping, vibration level of rotating equipment and control rod drop time

  13. A survey of the management of urinary tract infection in children in primary care and comparison with the NICE guidelines.

    LENUS (Irish Health Repository)

    Kennedy, Kieran M

    2010-01-01

    BACKGROUND: The aim of this study was to establish current practices amongst general practitioners in the West of Ireland with regard to the investigation, diagnosis and management of urinary tract infection (UTI) in children and to evaluate these practices against recently published guidelines from the National Institute for Health and Clinical Excellence (NICE). METHODS: A postal survey was performed using a questionnaire that included short clinical scenarios. All general practices in a single health region were sent a questionnaire, cover letter and SAE. Systematic postal and telephone contact was made with non-responders. The data was analysed using SPSS version 15. RESULTS: Sixty-nine general practitioners were included in the study and 50 (72%) responded to the questionnaire. All respondents agreed that it is important to consider diagnosis of UTI in all children with unexplained fever. Doctors accurately identified relevant risk factors for UTI in the majority (87%) of cases. In collecting urine samples from a one year old child, 80% of respondents recommended the use of a urine collection bag and the remaining 20% recommended collection of a clean catch sample. Respondents differed greatly in their practice with regard to detailed investigation and specialist referral after a first episode of UTI. Co-amoxiclav was the most frequently used antibiotic for the treatment of cystitis, with most doctors prescribing a five day course. CONCLUSIONS: In general, this study reveals a high level of clinical knowledge amongst doctors treating children with UTI in primary care in the catchment area of County Mayo. However, it also demonstrates wide variation in practice with regard to detailed investigation and specialist referral. The common practice of prescribing long courses of antibiotics when treating lower urinary tract infection is at variance with NICE\\'s recommendation of a three day course of antibiotics for cystitis in children over three months of age when

  14. Management guidelines for the implementation of m-learning in an open distance learning model / Johan Redelinghuys.

    OpenAIRE

    Redelinghuys, Johan

    2012-01-01

    Various modern communication technologies are available to higher education institutions involved in distance education to explore and implement for the effective provision of distance education programmes. The purpose of this study was to investigate the role of m- learning as part of distance education and to develop guidelines for the management of m- learning in an open distance learning model. The aims of this study are thus to determine the role of m-learning in open distance education,...

  15. Effect of guidelines on management of head injury on record keeping and decision making in accident and emergency departments.

    OpenAIRE

    Thomson, R.; Gray, J; Madhok, R; Mordue, A.; Mendelow, A D

    1994-01-01

    OBJECTIVE--To compare record keeping and decision making in accident and emergency departments before and after distribution of guidelines on head injury management as indices of implementation. DESIGN--Before (1987) and after (1990) study of accident and emergency medical records. SETTING--Two accident and emergency departments in England. PATIENTS--1144 adult patients with head injury in department 1 (533 in 1987, 613 in 1990) and 734 in department 2 (370, 364 respectively). MAIN MEASURES--...

  16. 2014 Korean Liver Cancer Study Group-National Cancer Center Korea Practice Guideline for the Management of Hepatocellular Carcinoma

    OpenAIRE

    ,

    2015-01-01

    The guideline for the management of hepatocellular carcinoma (HCC) was first developed in 2003 and revised in 2009 by the Korean Liver Cancer Study Group and the National Cancer Center, Korea. Since then, many studies on HCC have been carried out in Korea and other countries. In particular, a substantial body of knowledge has been accumulated on diagnosis, staging, and treatment specific to Asian characteristics, especially Koreans, prompting the proposal of new strategies. Accordingly, the n...

  17. Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

    International Nuclear Information System (INIS)

    Current clinical guidelines for the management of radiotherapy patients having either a pacemaker or implantable cardioverter defibrillator (both CIEDs: Cardiac Implantable Electronic Devices) do not cover modern radiotherapy techniques and do not take the patient’s perspective into account. Available data on the frequency and cause of CIED failure during radiation therapy are limited and do not converge. The Dutch Society of Radiotherapy and Oncology (NVRO) initiated a multidisciplinary task group consisting of clinical physicists, cardiologists, radiation oncologists, pacemaker and ICD technologists to develop evidence based consensus guidelines for the management of CIED patients. CIED patients receiving radiotherapy should be categorised based on the chance of device failure and the clinical consequences in case of failure. Although there is no clear cut-off point nor a clear linear relationship, in general, chances of device failure increase with increasing doses. Clinical consequences of device failures like loss of pacing, carry the most risks in pacing dependent patients. Cumulative dose and pacing dependency have been combined to categorise patients into low, medium and high risk groups. Patients receiving a dose of less than 2 Gy to their CIED are categorised as low risk, unless pacing dependent since then they are medium risk. Between 2 and 10 Gy, all patients are categorised as medium risk, while above 10 Gy every patient is categorised as high risk. Measures to secure patient safety are described for each category. This guideline for the management of CIED patients receiving radiotherapy takes into account modern radiotherapy techniques, CIED technology, the patients’ perspective and the practical aspects necessary for the safe management of these patients. The guideline is implemented in The Netherlands in 2012 and is expected to find clinical acceptance outside The Netherlands as well

  18. Scandinavian guidelines for initial management of minor and moderate head trauma in children

    DEFF Research Database (Denmark)

    Astrand, Ramona; Rosenlund, Christina; Undén, Johan

    2015-01-01

    of head trauma in the paediatric population in Scandinavia. The primary aim was to detect all children in need of neurosurgical intervention. Detection of any traumatic intracranial injury on CT scan was an important secondary aim. METHODS: General methodology according to the Appraisal of Guidelines...... guideline, discharge instructions and in-hospital observation instructions were drafted. For elements with low evidence, a modified Delphi process was used for consensus, which included relevant clinical stakeholders. RESULTS: The guidelines include criteria for selecting children for CT scans, in...

  19. Clinical practice guidelines for dementia in Australia.

    Science.gov (United States)

    Laver, Kate; Cumming, Robert G; Dyer, Suzanne M; Agar, Meera R; Anstey, Kaarin J; Beattie, Elizabeth; Brodaty, Henry; Broe, Tony; Clemson, Lindy; Crotty, Maria; Dietz, Margaret; Draper, Brian M; Flicker, Leon; Friel, Margeret; Heuzenroeder, Louise Mary; Koch, Susan; Kurrle, Susan; Nay, Rhonda; Pond, C Dimity; Thompson, Jane; Santalucia, Yvonne; Whitehead, Craig; Yates, Mark W

    2016-03-21

    About 9% of Australians aged 65 years and over have a diagnosis of dementia. Clinical practice guidelines aim to enhance research translation by synthesising recent evidence for health and aged care professionals. New clinical practice guidelines and principles of care for people with dementia detail the optimal diagnosis and management in community, residential and hospital settings. The guidelines have been approved by the National Health and Medical Research Council. The guidelines emphasise timely diagnosis; living well with dementia and delaying functional decline; managing symptoms through training staff in how to provide person-centred care and using non-pharmacological approaches in the first instance; and training and supporting families and carers to provide care. PMID:26985848

  20. Development process of aging management programs for major SSCs of a PWR plant

    International Nuclear Information System (INIS)

    A feasibility study for the continued operation of Kori Unit 1, PLiM Phase I, showed more adequacy of continued operation beyond the design life. Recently, a Phase II study was initiated to provide several technical licensing documents by performing additional systematic evaluations on a wider range of components. The objective of this paper is to present the methodology and draft results from life assessment and aging management processes for the Korean PLiM study. In order to explain the program, the following three major topics are summarized for 3 components and 7 commodity groups; 1) technical guidelines to provide evaluation methodology and procedure, 2) key findings in the aging management process of the lead plant and, 3) lessons learned and the works to do. From a technical point of view, the preliminary results give the possibility as a prototypal application. However, at present, further efforts including additional analyses in relation to periodic safety review are being made to assure the safety and reliability of the lead plant beyond the design life

  1. Semi-Annual Report on Work Supporting the International Forum for Reactor Aging Management (IFRAM)

    International Nuclear Information System (INIS)

    During the first six months of this project, Pacific Northwest National Laboratory has provided planning and leadership support for the establishment of the International Forum for Reactor Aging Management (IFRAM). This entailed facilitating the efforts of the Global Steering Committee to prepare the charter, operating guidelines, and other documents for IFRAM. It also included making plans for the Inaugural meeting and facilitating its success. This meeting was held on August 4 5, 2011, in Colorado Springs, Colorado. Representatives from Asia, Europe, and the United States met to share information on reactor aging management and to make plans for the future. Professor Tetsuo Shoji was elected chairperson of the Leadership Council. This kick-off event transformed the dream of an international forum into a reality. On August 4-5, 2011, IFRAM began to achieve its mission. The work completed successfully during this period was built upon important previous efforts. This included the development of a proposal for establishing IFRAM and engaging experts in Asia and Europe. The proposal was presented at Engagement workshops in Seoul, Korea (October 2009) and Petten, The Netherlands (May 2010). Participants in both groups demonstrated strong interest in the establishment of IFRAM. Therefore, the Global Steering Committee was formed to plan and carry out the start-up of IFRAM in 2011. This report builds on the initial activities and documents the results of activities over the last six months.

  2. Semi-Annual Report on Work Supporting the International Forum for Reactor Aging Management (IFRAM)

    Energy Technology Data Exchange (ETDEWEB)

    Bond, Leonard J.; Brenchley, David L.

    2011-11-30

    During the first six months of this project, Pacific Northwest National Laboratory has provided planning and leadership support for the establishment of the International Forum for Reactor Aging Management (IFRAM). This entailed facilitating the efforts of the Global Steering Committee to prepare the charter, operating guidelines, and other documents for IFRAM. It also included making plans for the Inaugural meeting and facilitating its success. This meeting was held on August 4 5, 2011, in Colorado Springs, Colorado. Representatives from Asia, Europe, and the United States met to share information on reactor aging management and to make plans for the future. Professor Tetsuo Shoji was elected chairperson of the Leadership Council. This kick-off event transformed the dream of an international forum into a reality. On August 4-5, 2011, IFRAM began to achieve its mission. The work completed successfully during this period was built upon important previous efforts. This included the development of a proposal for establishing IFRAM and engaging experts in Asia and Europe. The proposal was presented at Engagement workshops in Seoul, Korea (October 2009) and Petten, The Netherlands (May 2010). Participants in both groups demonstrated strong interest in the establishment of IFRAM. Therefore, the Global Steering Committee was formed to plan and carry out the start-up of IFRAM in 2011. This report builds on the initial activities and documents the results of activities over the last six months.

  3. Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness

    Science.gov (United States)

    Tistad, Malin; Palmcrantz, Susanne; Wallin, Lars; Ehrenberg, Anna; Olsson, Christina B.; Tomson, Göran; Holmqvist, Lotta Widén; Gifford, Wendy; Eldh, Ann Catrine

    2016-01-01

    Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future

  4. Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness

    Directory of Open Access Journals (Sweden)

    Malin Tistad

    2016-08-01

    Full Text Available Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs, yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a fourmonth leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the

  5. British Society of Gastroenterology/Association of Coloproctologists of Great Britain and Ireland guidelines for the management of large non-pedunculated colorectal polyps.

    Science.gov (United States)

    Rutter, Matthew D; Chattree, Amit; Barbour, Jamie A; Thomas-Gibson, Siwan; Bhandari, Pradeep; Saunders, Brian P; Veitch, Andrew M; Anderson, John; Rembacken, Bjorn J; Loughrey, Maurice B; Pullan, Rupert; Garrett, William V; Lewis, Gethin; Dolwani, Sunil

    2015-12-01

    These guidelines provide an evidence-based framework for the management of patients with large non-pedunculated colorectal polyps (LNPCPs), in addition to identifying key performance indicators (KPIs) that permit the audit of quality outcomes. These are areas not previously covered by British Society of Gastroenterology (BSG) Guidelines.A National Institute of Health and Care Excellence (NICE) compliant BSG guideline development process was used throughout and the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to structure the guideline development process. A systematic review of literature was conducted for English language articles up to May 2014 concerning the assessment and management of LNPCPs. Quality of evaluated studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) Methodology Checklist System. Proposed recommendation statements were evaluated by each member of the Guideline Development Group (GDG) on a scale from 1 (strongly agree) to 5 (strongly disagree) with >80% agreement required for consensus to be reached. Where consensus was not reached a modified Delphi process was used to re-evaluate and modify proposed statements until consensus was reached or the statement discarded. A round table meeting was subsequently held to finalise recommendations and to evaluate the strength of evidence discussed. The GRADE tool was used to assess the strength of evidence and strength of recommendation for finalised statements.KPIs, a training framework and potential research questions for the management of LNPCPs were also developed. It is hoped that these guidelines will improve the assessment and management of LNPCPs. PMID:26104751

  6. Guidelines for the early management of patients with myocardial infarction. British Heart Foundation Working Group.

    OpenAIRE

    Weston, C. F.; Penny, W J; Julian, D.G.

    1994-01-01

    In light of recent publications relating to resuscitation and pre-hospital treatment of patients suffering acute myocardial infarction of British Heart Foundation convened a working group to prepare guidelines outlining the responsibilities of general practitioners, ambulance services, and admitting hospitals. The guidelines emphasise the importance of the rapid provision of basic and advanced life support; adequate analgesia; accurate diagnosis; and, when indicted, thrombolytic treatment. Th...

  7. HYPERTENSIVE DIABETIC PATIENTS IN MELAKA WERE NOT MANAGED ACCORDING TO GUIDELINES

    OpenAIRE

    Chan GC

    2007-01-01

    Hypertension is an extremely common co-morbid condition in diabetes, affecting about 20-60% of patients with diabetes. Control of hypertension is dramatically effective in reducing cardiovascular events and mortality. The availability of clinical practice guidelines (CPG) raises an important question: are these guidelines being followed by the primary care doctors? This is a matter of great interest and importance and addressed in this cross sectional study involving 517 type 2 diabetes at pr...

  8. Management of COPD in general practice in Denmark--participating in an educational program substantially improves adherence to guidelines

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Hansen, Ejvind Frausing; Jensen, Michael Skov;

    2010-01-01

    for registration of smoking status (69% to 85%), BMI (8% to 40%), severity of dyspnea (Medical Research Council) (7% to 38%), and FEV(1)/FVC ratio (28% to 58%) (P < 0.001). Concerning the management options, improvements were also observed with regard to antismoking counseling, inhalator technique......, physical activity, and referral for rehabilitation; use of inhaled corticosteroids in patients with mild COPD (FEV(1) > 80%pred) declined from 76% to 45%. CONCLUSION: Diagnosis and management of COPD in general practice in Denmark is not according to guidelines, but substantial improvements can be achieved...

  9. Aging management of containment structures in nuclear power plants

    International Nuclear Information System (INIS)

    Research is being conducted by Oak Ridge National Laboratory under U.S. Nuclear Regulatory Commission sponsorship to address aging management of nuclear power plant containment and other safety-related structures. Documentation is being prepared to provide the US-NRC with potential structural safety issues and acceptance criteria for use in continued service evaluations of nuclear power plants. Accomplishments include development of a Structural Materials Information Center containing data and information on the time variation of 144 material properties under the influence of pertinent environmental stressors or aging factors, evaluation of models for potential concrete containment degradation factors, development of a procedure to identify critical structures and degradation factors important to aging management, evaluations of nondestructive evaluation techniques, assessments of European and North American repair practices for concrete, review of parameters affecting corrosion of metals embedded in concrete, and development of methodologies for making current condition assessments and service life predictions of new or existing reinforced concrete structures in nuclear power plants. (author). 29 refs., 2 figs

  10. Research on technological assessment for ageing management of reprocessing plant

    International Nuclear Information System (INIS)

    The purpose of the research program is to provide review manuals and technical database for Ageing Management Technical Evaluation Reports performed by licensees of spent fuel reprocessing plants in accordance with ordinance on Periodic Safety Review. A research programs have been conducted based on a contract with well-equipped organization since F.Y.2006. Four experimental subjects on ageing phenomena listed bellow in this program for the technological assessment of TOKAI plant, which have experienced many corrosion problems. TOKAI plant is the pilot plant for reprocessing service commissioned in Dec. 1980 and shifted to R and D in Apr. 2006. Corrosion of stainless steel made components in boiling nitric acid solutions at heating portions. Corrosion of titanium alloy made components in nitric acid condensates at condensate portions. Hydrogen degradation of titanium alloy made components in highly radioactive nitric acid solutions. Creep and fatigue of nickel-base alloy made furnaces which is operated in the conditions of daily cyclic heating. (author)

  11. The research project on technical information basis for aging management in Fukui and Kinki area. Final report

    International Nuclear Information System (INIS)

    The Research Project on Technical Information Basis for Aging Management was initiated in FY2006 by the Nuclear and Industrial Safety Agency (NISA) of the Ministry of Economy, Trade and Industry (METI) as a five-year program effectively, to promote aging management of domestic nuclear power plants. Its main objective was to improve the technical basis on which aging nuclear power plants are regulated. Upon taking part in the technical strategy map for Aging Management and Safe Long Term Operation, the experiences and achievements of the participating organizations were taken into account and the following four topics were chosen. The regional characteristics of the Fukui and Kinki area where 15 nuclear power plants, mainly PWRs, and many nuclear related research institutes and universities are located, were also considered. 1) The improvement of pipe thinning management in nuclear power plants, 2) The development of inspection techniques to monitor the initiation and propagation of defects, 3) The development of a guideline for evaluating weld repair methods, 4) The development of a guideline for evaluating the degradation of main structures. To promote this research project, INSS has established a regional consortium (called the 'Fukui Regional Cluster' in coordination with universities, research institutes, electric utilities and venders in the Fukui and Kinki area. INSS is acting as a coordinator to make contracts, facilitate execution, and compile annual reports. In FY2010, 11 continuing research subjects were proposed for this project and all were accepted. Of these, 5 subjects were related to the first topic (pipe thinning), 4 subjects to the second topic (inspection technique) and 1 subject to each of the other two topics (weld repair and main structures). All the subjects have been completed, fulfilling the requirements and expectations. (author)

  12. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of thyroid Nodules

    DEFF Research Database (Denmark)

    Gharib, Hossein; Papini, Enrico; Paschke, Ralf;

    2010-01-01

    American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules are systematically developed statements to assist health care professionals in medica...

  13. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules

    DEFF Research Database (Denmark)

    Gharib, Hossein; Papini, Enrico; Paschke, Ralf;

    2010-01-01

    American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules are systematically developed statements to assist health care professionals in medica...

  14. Framatome ANP worldwide experience in ageing and plant life management

    International Nuclear Information System (INIS)

    The deregulation of the power generation industry has resulted in increased competitive pressure and is forcing operators to improve plant operating economy while maintaining high levels of plant safety. A key factor to meet this challenge is to apply a comprehensive plant life management (PLIM) approach which addresses all relevant ageing and degradation mechanisms regarding the safety concept, plant components and documentation, plant personnel, consumables, operations management system and administrative controls. For this reason, Framatome ANP has developed an integrated PLIM concept focussing on the safety concept, plant components and documentation. Representative examples for plant wide analyses are described in the following. The results of the analyses support the plant owner for taking the strategic decisions, involved in plant life extension (PLEX). (orig.)

  15. Recommendations for managing cutaneous disorders associated with advancing age

    Directory of Open Access Journals (Sweden)

    Humbert P

    2016-02-01

    Full Text Available Philippe Humbert,1 Brigitte Dréno,2 Jean Krutmann,3 Thomas Anton Luger,4 Raoul Triller,5 Sylvie Meaume,6 Sophie Seité71Research and Studies Centre on the Integument (CERT, Clinical Investigation Centre (CIC BT506, Department of Dermatology, Besançon University Hospital, University of Franche-Comté, Besançon, France; 2Department of Dermato-Cancerology, Nantes University Hospital, Nantes, France; 3IUF-Leibniz Research Institute for Environmental Medicine, Heinrich-Heine-University, Düsseldorf, Germany; 4Department of Dermatology, University of Münster, Münster, Germany; 5International Centre of Dermatology, Hertford British Hospital, Levallois, France; 6Geriatric Service, Wounds and Healing, Rothschild Hôspital, Paris, France; 7La Roche-Posay Dermatological Laboratories, Asnières, FranceAbstract: The increasingly aged population worldwide means more people are living with chronic diseases, reduced autonomy, and taking various medications. Health professionals should take these into consideration when managing dermatological problems in elderly patients. Accordingly, current research is investigating the dermatological problems associated with the loss of cutaneous function with age. As cell renewal slows, the physical and chemical barrier function declines, cutaneous permeability increases, and the skin becomes increasingly vulnerable to external factors. In geriatric dermatology, the consequences of cutaneous aging lead to xerosis, skin folding, moisture-associated skin damage, and impaired wound healing. These problems pose significant challenges for both the elderly and their carers. Most often, nurses manage skin care in the elderly. However, until recently, little attention has been paid to developing appropriate, evidence-based, skincare protocols. The objective of this paper is to highlight common clinical problems with aging skin and provide some appropriate advice on cosmetic protocols for managing them. A review of the

  16. The Management of Visibilities in the Digital Age

    DEFF Research Database (Denmark)

    Flyverbom, Mikkel; Leonardi, Paul; Stohl, Cynthia;

    2016-01-01

    What we see, what we show and how we look are fundamental organizational concerns made ever more salient by the affordances, dynamics, and discourses of the digital age. Contemporary organizing practices are awash with material, mediated and managed visibilities: companies erect glass buildings...... with open and networked office spaces to efficiently share information, respond to stakeholder demands by crafting extensive transparency policies, and orchestrate the massive distribution of information online in the name of accountability. At the same time, states and corporations aggregate digital traces...

  17. Ageing management program for reactor components in HANARO

    International Nuclear Information System (INIS)

    The HANARO, an open-tank-in-pool type research reactor of 30MWth power in Korea, has operated for 8 years since its initial criticality in February of 1995. The reactor power has been gradually increased to 24 MWth through the service period. Therefore the reactor age is very young from the viewpoint of the ageing effect on the reactor structure and components by neutron irradiation considering the expected reactor lifetime. But, we have a few programs to manage the ageing from the aspect of design lifetime of reactor components. This paper summarizes the overall progress and plan for the ageing management for the reactor components including lifetime extension and design improvement, remote measurements and in-service inspections. The shutoff units and control absorber units have aged more rapidly than other structures or components because the number of rod drop cycles was higher than expected at the design stage. The system commissioning tests, periodic performance tests, and weekly operation for the stable supply of medical radioisotopes overriding the normal cycle operation have contributed to the high frequency of rod drop. Therefore, we have instituted a program to extend the lifetime of the shutoff units and the control absorber units. This program includes an endurance test to verify the performance for the extended number of drops and the management of shutdown methods to minimize the drop cycles for both the shutoff units and the control absorber units. The program also includes the design improvement of the damper mechanism of the control absorber units to reduce the impact force caused by rod drop. The inner shell of the reflector vessel surrounding the core is the most critical part from the viewpoint of neutron irradiation. The periodic measurement of the dimensional change in the vertical straightness of the inner shell is considered as one of the in-service inspections. We developed a few tools and verified the performance to measure the

  18. A Sporadic Small Jejunal GIST Presenting with Acute Lower Gastrointestinal Hemorrhage: A Review of the Literature and Management Guidelines.

    Science.gov (United States)

    Govindaraj, Sridar; Dias, Brendan Hermenigildo; Gautham, S L

    2015-04-01

    Gastrointestinal stromal tumors (GISTs) represent the majority of primary nonepithelial neoplasms of the digestive tract, most frequently expressing the KIT protein detected by immunohistochemical staining for the CD117 antigen. Jejunal GISTs account for approximately 10 % of GISTs. Patients usually present with abdominal discomfort. Jejunal GISTs may cause symptoms secondary to obstruction or hemorrhage. Pressure necrosis and ulceration of the overlying mucosa may cause gastrointestinal bleeding, and patients who experience significant blood loss may suffer from malaise and fatigue. Literature has classified small-bowel GISTs on the basis of size, and various established guidelines have advised conservative management of small jejunal GISTs (lower gastrointestinal hemorrhage in a 50-year-old postmenopausal woman necessitating an emergency laparotomy to control the bleed. The management of very small (<2 cm) small-bowel GISTs is controversial. While guidelines are primarily based on the risk of malignancy in GISTs, no guideline predicting the risk of complications in small-bowel GISTs exists. Hence, these tumors should be removed even if incidentally detected. PMID:25972676

  19. Materials ageing degradation programme in japan and proactive ageing management in NPP

    International Nuclear Information System (INIS)

    Predictive and preventive maintenance technologies are increasingly of importance for the long term operation (LTO) of Light Water Reactor (LWR) plants. In order for the realization LTO to be successful, it is essential that aging degradation phenomena should be properly managed by using adequate maintenance programs based on foreseeing the aging phenomena and evaluating their rates of development, where Nuclear Power Plants can be continued to operate beyond the original design life depending upon the regulatory authority rules. In combination with Periodic Safety Review (PSR) and adequate maintenance program, a plant life can be extended to 60 years or more. Plant Life Management (PLiM) is based upon various maintenance program as well as systematic safety review updated based upon the state of the art of science and technology. One of the potential life time limiting issue would be materials ageing degradation and therefore an extensive efforts have been paid world-widely. In 2007, NISA launched a national program on Enhanced Ageing Management Program and 4 nationwide clusters were formed to carry out the national program where materials ageing degradation was one of the major topics. In addition to these degradation modes, one important activities in this program is proactive materials degradation management directed by the author which is a kind of the extension program of NRC PMDA program based upon more fundamental approach by a systematic elicitation by the experts nominated from all over the world. NISA program can be divided into two phases, one is from fiscal years (FY) 2006 - 2010 and the other FY 2011. Later phase is focusing more on System Safety due to Fukushima NPP accident. The main objectives of the Phase I is to evaluate potential and complex degradation phenomena and their mechanisms in order to identify future risks of component aging in nuclear power plants. The following items are of particular concern in this phase: (a) investigation of

  20. Aging management of major light water reactor components

    International Nuclear Information System (INIS)

    Review of technical literature and field experience has identified stress corrosion cracking as one of the major degradation mechanisms for the major light water reactor components. Three of the stress corrosion cracking mechanisms of current concern are (a) primary water stress corrosion cracking (PWSCC) in pressurized water reactors, and (b) intergranular stress corrosion cracking (IGSCC) and (c) irradiation-assisted stress corrosion cracking (IASCC) in boiling water reactors. Effective aging management of stress corrosion cracking mechanisms includes evaluation of interactions between design, materials, stressors, and environment; identification and ranking of susceptible sites; reliable inspection of any damage; assessment of damage rate; mitigation of damage; and repair and replacement using corrosion-resistant materials. Management of PWSCC includes use of lower operating temperatures, reduction in residual tensile stresses, development of reliable inspection techniques, and use of Alloy 690 as replacement material. Management of IGSCC of nozzle and attachment welds includes use of Alloy 82 as weld material, and potential use of hydrogen water chemistry. Management of IASCC also includes potential use of hydrogen water chemistry

  1. Guidelines of care for the management of psoriasis and psoriatic arthritis Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies

    Energy Technology Data Exchange (ETDEWEB)

    Menter, A.; Korman, N.J.; Elmets, C.A.; Feldman, S.R.; Gelfand, J.M.; Gordon, K.B.; Gottlieb, A.; Koo, J.Y.M.; Lebwohl, M.; Lim, H.W.; Van Voorhees, A.S.; Beutner, K.R.; Bhushan, R. [University of Texas South West Medical Center Dallas, Dallas, TX (United States)

    2009-04-15

    Psoriasis is a common, chronic, inflammatory, multi-system disease with predominantly skin and joint manifestations affecting approximately 2% of the Population. In this third of 6 sections of the guidelines of care for psoriasis, we discuss the use of topical medications for the treatment of psoriasis. The majority of patients with psoriasis have limited disease (<5% body surface area involvement) and can be treated with topical agents, which generally provide a high efficacy-to-safety ratio. Topical agents may also be used adjunctively for patients with more extensive psoriasis undergoing therapy with either ultraviolet light, systemic or biologic medications. However, the use of topical agents as monotherapy in the setting of extensive disease or in the setting of limited, but recalcitrant, disease is not routinely recommended. Treatment should be tailored to meet individual patients' needs. We will discuss the efficacy and safety of as well as offer recommendations for the use of topical corticosteroids, vitamin D analogues, tazarotene, tacrolimus, pimecrolimus, emollients, salicylic acid, anthralin, coal tar, as well as combination therapy.

  2. The impact of nationally distributed guidelines on the management of paracetamol poisoning in accident and emergency departments. National Poison Information Service.

    OpenAIRE

    Bialas, M. C.; Evans, R J; Hutchings, A D; Alldridge, G; Routledge, P. A.

    1998-01-01

    OBJECTIVE: To assess the impact of the treatment guidelines on the management of paracetamol self poisoning in accident and emergency (A&E) departments. METHODS: 24 A&E departments in Wales and England provided details of their management of paracetamol poisoning before and after the distribution of national treatment guidelines to all A&E departments in the United Kingdom. RESULTS: Significant increases were seen in the availability of formal written policies, the display of treatment nomogr...

  3. Summary of 1993 World Health Organisation-International Society of Hypertension guidelines for the management of mild hypertension. Subcommittee of WHO/ISH Mild Hypertension Liaison committee.

    OpenAIRE

    1993-01-01

    As part of the ongoing process of issuing guidelines for managing hypertension the World Health Organisation and International Society of Hypertension present a summary of the latest guidelines for the management of mild hypertension. In both young and elderly people this condition is a risk factor for cardiovascular disease and should be treated. Information is presented on methods of diagnostic evaluation and assessment of risk. Methods of treatment, including changes in lifestyle, are cove...

  4. 中国高血压防治指南2010%2010 Chinese guidelines for the management of hypertension Writing group of 2010 Chinese guidelines for the management of hypertension

    Institute of Scientific and Technical Information of China (English)

    委员会

    2011-01-01

    Chinese Hypertension League (CHL) and the National Centre for Cardiovascular Disease (NCCD), in collaboration with the Chinese societies of cardiology, nephrology, neurology, gynecology and endocrinology, convened on several occasions and discussed the guidelines, drafted by a core writing group. The prevalence of hypertension has been increasing in China for decades, and reached 18. 8% in the year 2002. The rates of awareness, treatment and control for hypertension patients remain low compared to high income countries, in spite of substantial improvements since 1991. In some communities, the control rate of hypertension increased up to 60%. The mortality rate of stroke, which is the major complication of hypertension in the Chinese population, gradually decreased during the period, more so in urban areas than in rural areas for the middle-aged and elderly populations; in the younger age groups, however, it increased. As hypertension is a "cardiovascular syndrome", the management strategy should be based on the overall risk of cardiovascular disease estimated with all related risk factors, target organ damage and comorbidity of patients. The target blood pressure is set at SBP/DBP <140/90 mm Hg(l mm Hg=0. 133 kPa) in uncomplicated hypertension; <150/ 90 mm Hg for the elderly (≥65 years) or, if tolerable, <140/90 mm Hg; and <130/80 mm Hg for those with diabetes , coronary heart disease or renal disease. For these high risk patients, the management should be individualised. In general, lifestyle modification, such as sodium restriction, smoking cessation, moderation of body weight and alcohol consumption, and increasing dietary potassium intake and physical activity, should be implemented for prevention and control of hypertension. Five classes of antihypertensive drugs, including calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, diuretics and |3 receptor blockers, as well as single pill combinations of these agents, can be

  5. Are children with tuberculosis in Pakistan managed according to National programme policy guidelines? A study from 3 districts in Punjab

    Directory of Open Access Journals (Sweden)

    Baloch Noor

    2010-11-01

    Full Text Available Abstract Background The adherence to policies of National TB Control Programme (NTP to manage a case of tuberculosis (TB is a fundamental step to have a successful programme in any country. Childhood TB services faces an unmet challenge of case management due to difficulty with diagnosis and relatively new policies. For control of childhood TB in Pakistan, NTP developed and piloted its guidelines in 2006-2007. The objective of this study was to compare the documented case management practices of pediatricians and its impact on the outcome before and after introducing NTP policy guidelines. Findings An audit of case management practices of a historical cohort study was done in children below 15 years who were put on anti-tuberculosis treatment at all nine public hospitals in three districts in province of Punjab. The study period was two years pre-intervention (2004-05 and two years post-intervention (2006-07 after implementation of new NTP policy guidelines for childhood TB. There were 920 childhood TB cases registered during four years, 189 in pre-intervention period and 731 in post-intervention period. The practices changed significantly in post-intervention period for use of tuberculin skin test (63% of pulmonary cases, 19% of extrapulmonary cases and 67% for site unknown, and for the use of chest x-ray (69% of pulmonary cases, 16% of extrapulmonary cases and 74% for site unknown. Diagnostic scores were recorded for only a minority of cases (18%. The proportion of correct drugs pre- and post-intervention remained same. There were unknown treatment outcomes in 38 out of 141 cases (27% in pre-intervention and in 483 out of 551 cases (87% post-intervention, all among the 692 cases without documented treatment supporter. Conclusions The study has shown that pediatricians have started following parts of the national policy guidelines for management of childhood TB. The documented use of diagnostic tools is increased but record keeping of case

  6. Healthcare professionals' and policy makers' views on implementing a clinical practice guideline of hypertension management: a qualitative study.

    Directory of Open Access Journals (Sweden)

    Ping Yein Lee

    Full Text Available Most studies have reported barriers to guideline usage mainly from doctors' perspective; few have reported the perspective of other stakeholders. This study aimed to determine the views and barriers to adherence of a national clinical practice guideline (CPG on management of hypertension from the perspectives of policymakers, doctors and allied healthcare professionals.This study used a qualitative approach with purposive sampling. Seven in depth interviews and six focus group discussions were conducted with 35 healthcare professionals (policy makers, doctors, pharmacists and nurses at a teaching hospital in Kuala Lumpur, Malaysia, between February and June 2013. All interviews were audio-recorded, transcribed verbatim and checked. Thematic approach was used to analyse the data.Two main themes and three sub-themes emerged from this study. The main themes were (1 variation in the use of CPG and (2 barriers to adherence to CPG. The three sub-themes for barriers were issues inherent to the CPG, systems and policy that is not supportive of CPG use, and attitudes and behaviour of stakeholders. The main users of the CPG were the primary care doctors. Pharmacists only partially use the guidelines, while nurses and policy makers were not using the CPG at all. Participants had suggested few strategies to improve usage and adherence to CPG. First, update the CPG regularly and keep its content simple with specific sections for allied health workers. Second, use technology to facilitate CPG accessibility and provide protected time for implementation of CPG recommendations. Third, incorporate local CPG in professional training, link CPG adherence to key performance indicators and provide incentives for its use.Barriers to the use of CPG hypertension management span across all stakeholders. The development and implementation of CPG focused mainly on doctors with lack of involvement of other healthcare stakeholders. Guidelines should be made simple, current

  7. The role of guidelines and the patient's life-style in GPs' management of hypercholesterolaemia

    Directory of Open Access Journals (Sweden)

    Bring Johan

    2004-03-01

    Full Text Available Abstract Background Recent Swedish and joint European guidelines on hyperlipidaemia stress the high coronary risk for patients with already established arterio-sclerotic disease (secondary prevention or diabetes. For the remaining group, calculation of the ten-year risk for coronary events using the Framingham equation is suggested. There is evidence that use of and adherence to guidelines is incomplete and that tools for risk estimations are seldom used. Intuitive risk estimates are difficult and systematically biased. The purpose of the study was to examine how GPs use knowledge of guidelines in their decisions to recommend or not recommend a cholesterol-lowering drug and the reasons for their decisions. Methods Twenty GPs were exposed to six case vignettes presented on a computer. In the course of six screens, successively more information was added to the case. The doctors were instructed to think aloud while processing the cases (Think-Aloud Protocols and finally to decide for or against drug treatment. After the six cases they were asked to describe how they usually reason when they meet patients with high cholesterol values (Free-Report Protocols. The two sets of protocols were coded for cause-effect relations that were supposed to reflect the doctors' knowledge of guidelines. The Think-Aloud Protocols were also searched for reasons for the decisions to prescribe or not to prescribe. Results According to the protocols, the GPs were well aware of the importance of previous coronary heart disease and diabetes in their decisions. On the other hand, only a few doctors mentioned other arterio-sclerotic diseases like stroke and peripheral artery disease as variables affecting their decisions. There were several instances when the doctors' decisions apparently deviated from their knowledge of the guidelines. The arguments for the decisions in these cases often concerned aspects of the patient's life-style like smoking or overweight- either as

  8. OpenAIRE Guidelines for CRIS Managers: Supporting Interoperability of Open Research Information through Established Standards

    DEFF Research Database (Denmark)

    Houssos, Nikos; Jörg, Brigitte; Dvořák, Jan;

    2014-01-01

    OpenAIRE is the European infrastructure enabling researchers to comply with the European Union requirements for Open Access to research results. OpenAIRE collects metadata from data sources across Europe and beyond and defines interoperability guidelines to assist providers in exposing their...... information in a way that is compatible with OpenAIRE. This contribution focuses on a specific type of data source, CRIS systems, and the respective OpenAIRE guidelines, based on CERIF XML. A range of issues, spanning different aspects of information representation and exchange, needed to be addressed by the...

  9. Age management in Slovenian enterprises: the viewpoint of older employees

    Directory of Open Access Journals (Sweden)

    Jana Žnidaršič

    2010-12-01

    Full Text Available The main aim of this research is to highlight age management within Slovenian enterprises from the viewpoint of older employees by finding out what influences older employees to decide “should I stay or should I go”. The empirical research methodology is based on mixed strategy of approaching organizations (employees, which means that the quantitative (factor analysis, cluster analysis, correlation, regression, descriptive statistics and frequency distributions and qualitative parts (in-depth interviews analysis of research were conducted simultaneously. The results of the research indicate that there are in fact two groups of older employees, which can be referred to as “susceptible” and “insusceptible” in terms of how the employer can affect their decisions. “The unsusceptible” have already decided to retire as soon as possible and they cannot be influenced by any employer measure. On the other hand, “the susceptible” employees are sensitive to employers’ measures aimed at prolonging their working lives. Besides, a regression analysis confirmed a statistically significant correlation between the inclination towards extending one’s employment period and the susceptibility to the employer measures. It can thus be concluded that, through age management measures, an employer has an impact on an extended employment period of older employees. However, employers should be interested primarily in those employees who are inclined towards extending their working lives.

  10. Management of ageing research reactors in the Vinca Institute

    International Nuclear Information System (INIS)

    Nuclear research reactors in the Institute of nuclear sciences Vinca (former 'Boris Kidric'), built in late fifties, were among the first ones in the Southeast Europe. The RB reactor is constructed by Yugoslav scientists and put in operation at the end of April 1958 as a bare critical natural U-heavy water system. The RA reactor a 6.5 MW heavy water reactor, designed in ex-USSR, began operation in 1959 as one of research reactors with better characteristics in the world. Both reactors were built according to the national plan of development of nuclear energy in the country. Decision about future of the RA reactor in the Vinca Institute is not brought yet. Main improvements in operation and safety, and ageing management of the Vinca reactors in the past years are given in this paper. They are results of long experience acquired in management of the reactors operation, maintenance, testing, ageing of equipment and systems and development and application of new contemporary safety criteria

  11. Post design evaluation (ageing mechanisms, effects, management, monitoring, PSR, ISI)

    International Nuclear Information System (INIS)

    Although the nuclear plant was designed for the purpose of the 30-year life the early stages of construction, it also already has the plant abolished by passing in 30 years. There is a plant under operation and a plant that is employed variously, extends the original life and continues operation now, and the plant that is going to be abolished politically is before a life. By using a nuclear plant for a long period of time, damage. by the influence of irradiation, wear of slipping, corrosion, etc. appears. When this degradation is left, the serious accident is caused. In this lecture, refer to Assessment and management of ageing of major nuclear power plant components important to safety, Oct. 1999 of IAEA. A point of view from guide is introduced about management of the mechanism in the secular degradation mode expected by operating for a long period of time, the influence of secular degradation, and influence, monitoring technology, periodical safe evaluation, and a periodic inspection. And raises and explains the correspondence situation of secular degradation, and the example of evaluation of PSR and ISI equipment. The aging mechanism for reactor vessel internal components considered are related to embrittlement, fatigue, corrosion, radiation induced creep, relaxation and swelling, and mechanical wear. This lecture includes; monitoring methods, a description of periodic safety reviews and a sample of seismic design periodic safety report for the reactor internals

  12. Scope and selection of structures subject to aging management review

    International Nuclear Information System (INIS)

    The purpose of this work is to determine the structures included within the scope of license renewal based on the performance of the functions and select those intended for aging management review; one purpose is to show the methodology used to establish the structure and structural components that are subject to a review of aging management, within the framework of license renewal rule. This is through the application of different types of structures and structural components related and unrelated to safety located in the rooms of the reactor building where there are components of the reactor core isolation cooling system (Rcic), these structures are poured concrete, concrete block, structural steel, shielding walls, attached metal, pile foundations, etc.; other non- security related , such as: 1) inherent characteristics not related to security that protect the equipment related to the safety of the missiles, that is, walls, low walls, dikes, doors, etc., which also provide flood barriers to structures, systems and components related to safety, 2 ) whipping restrictions on non- security, shields mitigation jet, vent panels , etc. that are designed and installed to protect equipment related with the safety of the effects of a broken line of high energy. Only rooms where there are components of the Rcic 68 structures within the scope were identified. (Author)

  13. Hyaluronic acid gel fillers in the management of facial aging

    Directory of Open Access Journals (Sweden)

    Fredric S Brandt

    2008-03-01

    Full Text Available Fredric S Brandt1, Alex Cazzaniga21Private Practice in Coral Gables, Florida, USA and Manhattan, NY, USA, and Dermatology Research Institute, Coral Gables, FL, USA; 2Dermatology Research Institute, Coral Gables, Florida, USAAbstract: Time affects facial aging by producing cellular and anatomical changes resulting in the consequential loss of soft tissue volume. With the advent of new technologies, the physician has the opportunity of addressing these changes with the utilization of dermal fillers. Hyaluronic acid (HA dermal fillers are the most popular, non-permanent injectable materials available to physicians today for the correction of soft tissue defects of the face. This material provides an effective, non invasive, non surgical alternative for correction of the contour defects of the face due to its enormous ability to bind water and easiness of implantation. HA dermal fillers are safe and effective. The baby-boomer generation, and their desire of turning back the clock while enjoying an active lifestyle, has expanded the popularity of these fillers. In the US, there are currently eight HA dermal fillers approved for commercialization by the Food and Drug Administration (FDA. This article reviews the innate properties of FDA-approved HA fillers and provides an insight on future HA products and their utilization for the management of the aging face.Keywords: hyaluronic acid, aging face, dermal filler, wrinkles, Restylane, Perlane, Juvéderm

  14. Guidelines for Managing Life-Threatening Food Allergies in Massachusetts Schools

    Science.gov (United States)

    Sheetz, Anne H.; Goldman, Patricia G.; Millett, Kathleen; Franks, Jane C.; McIntyre, C. Lynne; Carroll, Constance R.; Gorak, Diane; Harrison, Christanne Smith; Carrick, Michele Abu

    2004-01-01

    During the past decade, prevalence of food allergies among children increased. Caring for children with life-threatening food allergies has become a major challenge for school personnel Prior to 2002, Massachusetts did not provide clear guidelines to assist schools in providing a safe environment for these children and preparing for an emergency…

  15. Formalized Interconnected Guidelines on Cardiovascular Disease Prevention and Those for Management of Diabetes, Dyslipidemia and Hypertension

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Anger, Z.; Buchtela, David; Tomečková, Marie; Veselý, Arnošt; Zvárová, Jana

    24 Suppl. 4, - (2006), s. 172-172. ISSN 0263-6352. [European Meeting on Hypertension /16./. 12.06.2006-15.06.2006, Madrid] R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : computer presentation * interconnected medical guidelines * cardiovascular prevention Subject RIV: FA - Cardiovascular Disease s incl. Cardiotharic Surgery

  16. Energy management systems in the practice. ISO 50001. A guideline for companies and institutions; Energiemanagementsysteme in der Praxis. ISO 50001. Leitfaden fuer Unternehmen und Organisationen

    Energy Technology Data Exchange (ETDEWEB)

    Kohlenborn, Walter; Kabisch, Sibylle; Klein, Johanna; Richter, Ina; Schuermann, Silas

    2012-06-15

    The guideline under consideration is an updated version of the guideline to the regulation EN 16001 and amended to ISO 50001. This contribution supports institutes in the implementation of an energy management system according to ISO 50001. The differences and commonalities to the European environment management system EMAS as well as to the regulation ISO 14001 are described. EMAS certified companies fulfil regularly all conditions of an energy management system. A practised energy management system is an excellent platform for the implementation of EMAS.

  17. “First, do no harm”: legal guidelines for health programmes affecting adolescents aged 10–17 who sell sex or inject drugs

    OpenAIRE

    Brendan Conner

    2015-01-01

    Introduction: There is a strong evidence base that the stigma, discrimination and criminalization affecting adolescent key populations (KPs) aged 10–17 is intensified due to domestic and international legal constructs that rely on law-enforcement-based interventions dependent upon arrest, pre-trial detention, incarceration and compulsory “rehabilitation” in institutional placement. While there exists evidence and rights-based technical guidelines for interventions among older cohorts, these g...

  18. Guidelines for the creation and management of geographic data bases within a GIS environment, version 1.0

    Energy Technology Data Exchange (ETDEWEB)

    Durfee, R.C.; Land, M.L.; McCord, R.A.; Olson, R.J.; Thomas, J.K.; Tinnel, E.P.; Voorhees, L.D.

    1994-07-01

    A Geographic Information System (GIS) provides the ability to manage and analyze all types of geographic and environmental information. It performs these functions by providing the tools necessary to capture, access, analyze, and display spatially referenced information in graphic and tabular form. Typical data elements that can be visualized in a map might include roads, buildings, topography, streams, waste areas, monitoring wells, groundwater measurements, soil sample results, landcover, and demography. The intent of this document is to provide data management and quality assurance (QA) guidelines that will aid implementors and users of GIS technology and data bases. These guidelines should be useful in all, phases of GIS activities, including the following: (1) project planning, (2) data collection and generation, (3) data maintenance and management, (4) QA and standards, (5) project implementation, (6) spatial analysis and data interpretation, (7) data transformation and exchange, and (8) output and reporting. The daily use of desktop GIS technologies within Martin Marietta Energy Systems, Inc. (Energy Systems), is a relatively new phenomenon, but usage is increasing rapidly. Large volumes of GIS-related data are now being collected and analyzed for the U.S. Department of Energy (DOE) Oak Ridge Reservation (ORR) and its facilities. It is very important to establish and follow good data management practices for GIS. In the absence of such practices, data-related problems will overwhelm users for many years. In comparison with traditional data processing and software life-cycle management, there is limited information on GIS QA techniques, data standards and structures, configuration control, and documentation practices. This lack of information partially results from the newness of the technology and the complexity of spatial information and geographic analysis techniques as compared to typical tabular data management.

  19. Guidelines for the creation and management of geographic data bases within a GIS environment, version 1.0

    International Nuclear Information System (INIS)

    A Geographic Information System (GIS) provides the ability to manage and analyze all types of geographic and environmental information. It performs these functions by providing the tools necessary to capture, access, analyze, and display spatially referenced information in graphic and tabular form. Typical data elements that can be visualized in a map might include roads, buildings, topography, streams, waste areas, monitoring wells, groundwater measurements, soil sample results, landcover, and demography. The intent of this document is to provide data management and quality assurance (QA) guidelines that will aid implementors and users of GIS technology and data bases. These guidelines should be useful in all, phases of GIS activities, including the following: (1) project planning, (2) data collection and generation, (3) data maintenance and management, (4) QA and standards, (5) project implementation, (6) spatial analysis and data interpretation, (7) data transformation and exchange, and (8) output and reporting. The daily use of desktop GIS technologies within Martin Marietta Energy Systems, Inc. (Energy Systems), is a relatively new phenomenon, but usage is increasing rapidly. Large volumes of GIS-related data are now being collected and analyzed for the U.S. Department of Energy (DOE) Oak Ridge Reservation (ORR) and its facilities. It is very important to establish and follow good data management practices for GIS. In the absence of such practices, data-related problems will overwhelm users for many years. In comparison with traditional data processing and software life-cycle management, there is limited information on GIS QA techniques, data standards and structures, configuration control, and documentation practices. This lack of information partially results from the newness of the technology and the complexity of spatial information and geographic analysis techniques as compared to typical tabular data management

  20. Assessment and management of ageing of electrical instrumentation and control cables

    International Nuclear Information System (INIS)

    This paper presents a summary of the results of an IAEA Co-ordinated Research Project (CRP) on Management of Ageing of In-containment Instrumentation and Control (I and C) Cables addressing current practices and techniques for assessing and managing ageing degradation of cables in real nuclear power plant (NPP) environments. These practices and techniques include environmental qualification, identification of cables of concern, condition monitoring, and predictive modelling. The paper shows how they should be integrated within a plant-specific ageing management programme utilising a systematic ageing management process, which is an adaptation of Deming Plan-Do-Check-Act cycle to ageing management. (author)

  1. Empirical guidelines for forest management decision support systems based on the past experiences of the expert's community

    Energy Technology Data Exchange (ETDEWEB)

    Marques, A. F.; Ficko, A.; Kangas, A.; Rosset, C.; Ferreti, F.; Rasinmaki, J.; Packalen, T.; Gordom, S.

    2013-09-01

    Aim of the study: Decision support systems for forest management (FMDSS) have been developed world wide to account for a broad range of forest ecosystems, management goals and organizational frameworks (e.g. the wiki page of the FORSYS project reports 62 existing FMDSSs from 23 countries). The need to enhance the collaboration among this diverse community of developers and users fostered the rise of new group communication processes that could capture useful knowledge from past experiences in order to efficiently provide it to new FMDSS development efforts. Material and methods: This paper presents and tests an exploratory process aiming to identify the empirical guidelines assisting developers and users of FMDSS. This process encompasses a Delphi survey built upon the consolidation of the lessons-learned statements that summarize the past experiences of the experts involved in the FORSYS project. The experts come from 34 countries and have diverse interests, ranging from forest planners, IT developers, social scientists studying participatory planning, and researchers with interests in knowledge management and in quantitative models for forest planning. Main results: The proposed 37 empirical guidelines that group 102 lessons-learned cover a broad range of issues including the DSS development cycle, involvement of the stakeholders, methods, models and knowledge based techniques in use. Research highlights: These results may be used for improving new FMDSS development processes, teaching and training and further suggest new features of FMDSS and future research topics. Furthermore, the guidelines may constitute a knowledge repository that may be continuously improved by a community of practice. (Author)

  2. Practical Management of HIV-Associated Anemia in Resource-Limited Settings: Prospective Observational Evaluation of a New Mozambican Guideline.

    Science.gov (United States)

    Brentlinger, Paula E; Silva, Wilson P; Vermund, Sten H; Valverde, Emilio; Buene, Manuel; Moon, Troy D

    2016-01-01

    Mozambique's updated guideline for management of HIV-associated anemia prompts clinicians to consider opportunistic conditions, adverse drug reactions, and untreated immunosuppression in addition to iron deficiency, intestinal helminthes, and malaria. We prospectively evaluated this guideline in rural Zambézia Province. Likely cause(s) of anemia were determined through prespecified history, physical examination, and laboratory testing. Diagnoses were "etiologic" if laboratory confirmed (sputum microscopy, blood culture, Plasmodium falciparum malaria rapid test) or "syndromic" if not. To assess hemoglobin response, we used serial point-of-care measurements. We studied 324 ambulatory, anemic (hemoglobin diagnosis was achieved in 79 (24.4%). Of 169 (52.2%) subjects who improved (hemoglobin increase of ≥1 g/dl without indications for hospitalization), only 65 (38.5%) received conventional management (iron supplementation, deworming, and/or antimalarials) alone. Thirty (9.3%) died and/or were hospitalized, and 125 (38.6%) were lost to follow-up. Multivariable linear and logistic regression models described better hemoglobin responses and/or outcomes in subjects with higher CD4(+) T-lymphocyte counts, pre-enrollment antiretroviral therapy and/or co-trimoxazole prophylaxis, discontinuation of zidovudine for suspected adverse reaction, and smear-positive tuberculosis. Adverse outcomes were associated with fever, low body mass index, bacteremia, esophageal candidiasis, and low or missing CD4(+) T cell counts. In this severely resource-limited setting, successful anemia management often required interventions other than conventional presumptive treatment, thus supporting Mozambique's guideline revision. PMID:26178574

  3. The clinical management of abdominal ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: a review of current guidelines and recommendations.

    Science.gov (United States)

    Pericleous, Marinos; Sarnowski, Alexander; Moore, Alice; Fijten, Rik; Zaman, Murtaza

    2016-03-01

    Several pathogenic processes have been implicated in the development of abdominal ascites. Portal hypertension, most usually in the context of liver cirrhosis, can explain about 75% of the cases, whereas infective, inflammatory and infiltrative aetiologies can account for the rest. In this article, we discuss the consensus best practice as published by three professional bodies for the management of ascites, spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). The aim of this study was to compare available clinical guidelines and identify areas of agreement and conflict. We carried out a review of the guidance documentation published by three expert bodies including the British Society of Gastroenterology, the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD), as well as a wider literature search for ascites, SBP and HRS. Abdominal ultrasonography, diagnostic paracentesis and ascitic fluid cultures are recommended by all three guidelines, especially when there is strong clinical suspicion for infection. EASL and AASLD advocate the use of ascitic amylase and mycobacterial cultures/PCR when there is strong suspicion for tuberculosis and pancreatitis, respectively. Ascitic cytology can be useful when cancer is suspected and has a good diagnostic yield if performed correctly. EASL supports the use of urinary electrolytes for all patients; however, the British Society of Gastroenterology and AASLD only recommend their use for therapy monitoring. All three societies recommend cefotaxime as the antibiotic of choice for SBP and large-volume paracentesis for the management of ascites greater than 5 l in volume. For HRS, cautious diuresis, volume expansion with albumin and the use of vasoactive drugs are recommended. There appears to be good concordance between recommendations by the European, American and British guidelines for the management of ascites and the possible

  4. CROATIAN UROLOGISTS' CLINICAL PRACTICE AND COMPLIANCE WITH GUIDELINES IN THE MANAGEMENT OF NON-NEUROGENIC MALE LOWER URINARY TRACT SYMPTOMS.

    Science.gov (United States)

    Tomasković, Igor; Tomić, Miroslav; Nikles, Sven; Neretljak, Ivan; Milicić, Valerija

    2015-12-01

    The aim of this study was to assess the Croatian urologists' management of non-neurogenic male lower urinary tract symptoms (LUTS) and their compliance with the European Association of Urology (EAU) guidelines. A cross-sectional survey included 51/179 Croatian urologists. We developed a questionnaire with questions addressing compliance with EAU guidelines. The rate of performing recommended evaluations on the initial assessment of patients with benign prostate hyperplasia (BPH)/LUTS varied from 8.0% (serum creatinine and voiding diary) to 100.0% (physical examination, prostate specific antigen and ultrasound). The international prostate symptom score was performed by 31%, analysis of urine sediment by 83%, urine culture by 53%, and serum creatinine by 8% of surveyed urologists. Only 8% of urologists regularly used bladder diary in patients with symptoms of nocturia. Our results indicated that 97% of urologists preferred alpha blockers as the first choice of treatment; 5-alpha reductase inhibitors (5ARI) were mostly prescribed (84%) in combination with an alpha-blocker, preferably as a continuous treatment, whilst 29% of urologists used to discontinue 5ARI after 1-2 years. Half of the Croatian urologists used antimuscarinics in the treatment of BPH/LUTS and recommended phytotherapeutic drugs in their practice. In conclusion, Croatian urologists do not completely comply with the guidelines available. PMID:27017719

  5. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis.

    Science.gov (United States)

    Eichenfield, Lawrence F; Tom, Wynnis L; Chamlin, Sarah L; Feldman, Steven R; Hanifin, Jon M; Simpson, Eric L; Berger, Timothy G; Bergman, James N; Cohen, David E; Cooper, Kevin D; Cordoro, Kelly M; Davis, Dawn M; Krol, Alfons; Margolis, David J; Paller, Amy S; Schwarzenberger, Kathryn; Silverman, Robert A; Williams, Hywel C; Elmets, Craig A; Block, Julie; Harrod, Christopher G; Smith Begolka, Wendy; Sidbury, Robert

    2014-02-01

    Atopic dermatitis (AD) is a chronic, pruritic, inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in the management and care of AD, providing updated and expanded recommendations based on the available evidence. In this first of 4 sections, methods for the diagnosis and monitoring of disease, outcomes measures for assessment, and common clinical associations that affect patients with AD are discussed. Known risk factors for the development of disease are also reviewed. PMID:24290431

  6. Which Clinical Guidelines Should Be Implemented for Management of Osteopenia in Primary Care? A Clin-IQ

    Directory of Open Access Journals (Sweden)

    Turia Hollingsworth

    2014-11-01

    Full Text Available Literature review was conducted to determine clinical guidelines for osteopenia management of immunocompetent patients in the primary care setting. It was concluded that pharmacological treatment should be offered to patients with osteopenia if they are considered high risk, which can be determined by utilizing the World Health Organization Fracture Risk Assessment Tool (FRAX® to evaluate 10-year risk. Patients with a calculated hip fracture probability of at least 3% or those with probability of 20% or more for all osteoporotic fractures may be offered bisphosphonate therapy.

  7. Canadian approach on regulatory issues regarding ageing management, long term operation and plant life management

    International Nuclear Information System (INIS)

    Full text: This paper discusses the Canadian Nuclear Safety Commission (CNSC) approach towards ensuring that licensees operate and maintain their plants in a safe operational condition. It briefly describes elements of the CNSC requirements and the overall regulatory process to achieve these goals. To strengthen the role of proactive ageing management at the Canadian nuclear power plants, the CNSC is developing its regulatory document framework and regulatory oversight activities, as well as promoting further research on ageing degradation mechanisms important to safety. The CNSC recognizes the importance of information exchange and cooperation, and is actively involved in a number of ageing management and structural integrity initiatives with industry and other regulatory agencies both within Canada and the international level. This paper describes the current and planned initiatives to improve the Canadian regulatory requirements for ageing management programs, long-term operation, as well as the oversight for the surveillance of critical SSCs, including the use of probabilistic methods for condition monitoring and operational assessment, and risk informed in-service inspections. (author)

  8. Canadian approach on regulatory issues regarding ageing management, long term operation and plant life management

    International Nuclear Information System (INIS)

    This paper discusses the Canadian Nuclear Safety Commission approach towards ensuring that licensees operate and maintain their plants in a safe operational condition. It briefly describes elements of the CNSC requirements and the overall regulatory oversight process to achieve these goals. CNSC staff recognizes the importance of cooperation and information exchange and is actively involved with a number of ageing management and structural integrity initiatives with industry and other national regulatory agencies both, within Canada and at international level. To strengthen the role of proactive ageing management at Canadian nuclear power plants, CNSC is continuously maintaining and improving as well as developing new regulatory documents, standards and compliance program activities, and encourage further research on ageing degradation of SSCs important to safety. The paper describes the current and planned initiatives to improve the Canadian regulatory requirements for ageing management programs, long term operation, as well as the oversight for the surveillance of critical SSCs, including the use of probabilistic methods for condition monitoring and operational assessment and risk informed in-service inspections. (author)

  9. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association task force on practice guidelines

    Science.gov (United States)

    The goals of the American College of Cardiology (ACC) and the American Heart Association (AHA) are to prevent cardiovascular (CV) diseases, improve the management of people who have these diseases through professional education and research, and develop guidelines, standards and policies that promot...

  10. Approach of British Nuclear Fuels to managing ageing

    International Nuclear Information System (INIS)

    The approach taken by BNFL to managing ageing is developed at the design stage and builds upon experience gained through designing, building, operating and decommissioning nuclear facilities since 1947. Much of the current philosophy was developed during the design and construction of the Thermal Oxide Reprocessing Plant (THORP). The process of managing ageing encompasses all the phases of the facility's life; that is, design, operation and decommissioning. Underlying all these phases is the input from the results of research and development and plant inspection activities. Plant ageing is managed by a policy of understanding the degradation mechanisms as far as possible and, from that knowledge, targeting for particular attention plants considered as vulnerable or for which we are uncertain of our understanding of the degradation processes; for example, THORP receipt and storage LWR storage racks have been fabricated from 304L stainless steel. In their storage environment, deionized water, the worst case measured corrosion rate for such steels is 0.03 mm/a. Given that the minimum material thickness used is 20 mm, corrosion over the design life is negligible and therefore there are no prescribed monitoring or maintenance requirements. Plant inspection policy was first developed for THORP, where targeted programmes of inspection are established. Inspection may be limited to visual inspection or may involve quantitative non-destructive testing such as ultrasonics, and in certain areas, such as dissolvers, on-line thickness monitors have been installed to facilitate the process. The programmes are updated as the actual plant operating conditions are better known and understood; therefore, for example, an SSC found to be operating at higher temperatures than originally planned or carrying a higher burden of corrodents may become targeted for inspection, whereas SSCs perceived to be benign may have inspection frequencies reduced. Similar policies are being developed for

  11. Managing Ageing in Spent Nuclear Fuel Storage Facilities

    International Nuclear Information System (INIS)

    Spent fuel pools (SFP) that are outside containment system without redundancy whose failure could release radioactive material that exceed allowable limit. If SFP have to continue to operate for long term after power plant shutdown it is essential to develop an ageing management program within the general life management program of the nuclear power plant. This work refers to the Atucha I nuclear power plant (NPP) SFPs. The fuel assembly (FA) of Atucha NPPs is 6 meter long and encompasses 36 Zircaloy-4 cladded fuel rods. For these spent fuel assemblies (SFA) there are two storage buildings located adjacent to the reactor building. One of the alternatives considered at the end of Atucha I operation is to transfer all SFAs to dry storage, another one is to continue the operation of the SFPs and to transfer to dry storage just a selected amount of SFAs. For the selection of the dry technology it should be kept in mind the characteristics of the Aturcha SFA, in particular, its length and burnup which differs according to the discharge date because of the use of natural uranium (NU) or slightly enriched uranium (SEU). Therefore, the fundamental point here is to keep in mind that it is the effect of ageing due to time and use that cause net changes in the characteristics of a System, Structure and Component (SSC). We employ formal processes to systematically identify and evaluate the Critical Systems, Structures and Components (CSSCs) in the facilities. A Technology Watch Programme is being established to ensure that degradation mechanisms, which could impact on facilities life, are promptly investigated so that mitigating programmes can be designed. With this methodology we analyse the following components of the pools, concrete wall stability, integrity of concrete structure, pool lining, and integrity of metal structure, pipe failures, degradation in storage racks and SFA degradation. (author)

  12. Issues in the management of acute agitation: how much current guidelines consider safety?

    Directory of Open Access Journals (Sweden)

    LucaDi Paolo

    2013-05-01

    Full Text Available Agitated behavior constitutes up to 10% of emergency psychiatric interventions. Pharmacological tranquilization is often used as a valid treatment for agitation but a strong evidence base does not underpin it. Available literature shows different recommendations, supported by research data, theoretical considerations or clinical experience. Rapid tranquilization is mainly based on parenteral drug treatment and the few existing guidelines on this topic, when suggesting the use of first generation antipsychotics and benzodiazepines, include drugs with questionable tolerability profile such as chlorpromazine, haloperidol, midazolam and lorazepam. In order to systematically evaluate safety concerns related to the adoption of such guidelines, we reviewed them independently from principal diagnosis while examining tolerability data for suggested treatments. There is a growing evidence about safety profile of second generation antipsychotics for rapid tranquilization but further controlled studies providing definitive data in this area are urgently needed.

  13. Lung cancer management in limited resource settings: Guidelines for appropriate good care

    International Nuclear Information System (INIS)

    Lung cancer is a major cause of cancer death worldwide and is becoming an increasing problem in developing countries. It is important that, in countries where health care resources are limited, these resources are used most effectively and cost-effectively. The authors, with the support of the International Atomic Energy Agency, drew on existing evidence-based clinical guidelines, published systematic reviews and meta-analyses, as well as recent research publications, to summarise the current evidence and to make broad recommendations on the non-surgical treatment of patients with lung cancer. Tables were constructed which summarise the different treatment options for specific groups of patients, the increase in resource use for and the likely additional clinical benefit from each option. These tables can be used to assess the cost-effectiveness and appropriateness of different interventions in a particular health care system and to develop local clinical guidelines

  14. Invasive candidiasis in non neutropenic critically ill - need for region-specific management guidelines

    Directory of Open Access Journals (Sweden)

    Armin Ahmed

    2015-01-01

    Full Text Available Use of antifungal agents has increased over past few decades. A number of risk factors such as immunosuppression, broad spectrum antibiotics, dialysis, pancreatitis, surgery, etc., have been linked with the increased risk of invasive candidiasis. Though there are various guidelines available for the use of antifungal therapy, local/regional epidemiology plays an important role in determining the appropriate choice of agent in situations where the offending organism is not known (i.e. empirical, prophylactic or preemptive therapy. Developing countries like India need to generate their own epidemiological data to facilitate appropriate use of antifungal therapy. In this article, the authors have highlighted the need for region-specific policies/guidelines for treatment of invasive candidiasis. Currently available Indian literature on candidemia epidemiology has also been summarized here.

  15. World Gastroenterology Organization Practice Guidelines for the diagnosis and management of IBD in 2010

    DEFF Research Database (Denmark)

    Bernstein, Charles N; Fried, Michael; Krabshuis, J H;

    2010-01-01

    Inflammatory bowel disease (IBD) represents a group of idiopathic, chronic, inflammatory intestinal conditions. Its two main disease categories are: Crohn's disease (CD) and ulcerative colitis (UC), which feature both overlapping and distinct clinical and pathological features. While these diseas...... resources. The World Gastroenterology Organization has, accordingly, developed guidelines for diagnosing and treating IBD using a cascade approach to account for variability in resources in countries around the world....

  16. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy

    OpenAIRE

    Lalla, Rajesh V.; Bowen, Joanne; Barasch, Andrei; Elting, Linda; Epstein, Joel; Keefe, Dorothy M.; McGuire, Deborah B.; Migliorati, Cesar; Nicolatou‐Galitis, Ourania; Peterson, Douglas E.; Raber‐Durlacher, Judith E.; Sonis, Stephen T.; Elad, Sharon; ,

    2014-01-01

    BACKGROUND Mucositis is a highly significant, and sometimes dose‐limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for mucositis. METHODS A literature search was conducted to identify eligible published articles, based on predefined inclusion/exclusion criteria. Each article was independently reviewed by 2 reviewer...

  17. Gender Instruments, Laws, Policies and Guidelines: A Tool for Human Resource Managers in Kenya

    OpenAIRE

    Catherine Kathure Kaimenyi; Anne Ngeretha

    2014-01-01

    The need for effective workplace policies and procedures has never been more important in today’s changing workplace. This is driven by changes to legislation, regulation and codes. Organizations policies must be in line with the national laws, procedures and policies, and since nations subscribe to various international laws and guidelines, these should accordingly be integrated in organization policies. Through a review of existing literature, this study examines important legislations that...

  18. Clinical Guidelines and Management of Ankyloglossia with 1-Year Followup: Report of 3 Cases

    OpenAIRE

    Bhattad, Mayur S.; Baliga, M. S.; Ritika Kriplani

    2013-01-01

    The tongue is an important oral structure that affects speech, position of teeth, periodontal tissue, nutrition, swallowing, nursing, and certain social activities. Ankyloglossia (tongue tie) is a congenital anomaly characterized by an abnormally short, thick lingual frenulum which affects movement of tongue. Though the effect of ankyloglossia in general appears to be a minor condition, but a major difference exists concerning the guidelines for tongue-tie division. There are no accepted prac...

  19. Periodic Fever: A Review on Clinical, Management and Guideline for Iranian Patients - Part II

    OpenAIRE

    Ahmadinejad, Zahra; Mansouri, Sedigeh; Ziaee, Vahid; Aghighi, Yahya; Moradinejad, Mohammad-Hassan; Fereshteh-Mehregan, Fatemeh

    2014-01-01

    Periodic fever syndromes are a group of diseases characterized by episodes of fever with healthy intervals between febrile episodes. In the first part of this paper, we presented a guideline for approaching patients with periodic fever and reviewed two common disorders with periodic fever in Iranian patients including familial Mediterranean fever (FMF) and periodic fever syndromes except for periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA). In this part, we revi...

  20. MANAGING DRUG USE IN THE ELDERLY. General practitioners’ adherence to guidelines and patients’ conceptions of medication

    OpenAIRE

    Modig, Sara

    2012-01-01

    Introduction: Older patients’ knowledge about their medicines is generally poor. Patients are entitled to be informed on an individual and adequate level. Evidence-based guidelines should, in most cases, be followed also in the treatment of elderly to avoid suboptimal treatment, for example for cardiovascular conditions, or risky prescriptions in the case of renal impairment. Objectives: 1. To describe frail elderly patients’ knowledge about and attitudes towards their medicines and to...