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Sample records for aging management guideline

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.)

  9. 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.

  10. 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.

  11. Guidelines for Crisis Management.

    Science.gov (United States)

    Wimberley, Lloyd

    1985-01-01

    The article offers guidelines for crisis prediction, preplanning, support team development, and post-crisis management that can handle aggressive behavior and convey to the child the existence of a legitimate system for enhancing positive self control. (CL)

  12. 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.

  13. Managing electronic records: A guideline

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, J.G.

    1994-10-25

    A committee at Martin Marietta Energy Systems (MMES) has drafted a guideline to assist offices in the management of electronic records. This paper will address the activities surrounding its creating. The guideline is for use by creators, users, and custodians of any type of electronic information. The guideline supports and supplements requirements from DOE and the National Archives and Records Administration (NARA), other internal processes such as system reviews, and the comprehensive records management program. While an in-house publication, it could prove useful to other organizations implementing an electronic records management program.

  14. Managing electronic records: A guideline

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, J.

    1995-07-01

    A committee at Martin Marietta Energy Systems (MMES) has drafted a guideline to assist offices in the management of electronic records. This paper will address the activities surrounding its creating. The guideline is for use by creators, users, and custodians of any type of electronic information. The guideline supports and supplements requirements from DOE and the National Archives and Records Administration (NARA), other internal processes such as system reviews, and the comprehensive records management program. While an in-house publication, it could prove useful to other organizations implementing an electronic records management program.

  15. 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.

  16. Australian Infrastructure Financial Management Guidelines

    Directory of Open Access Journals (Sweden)

    Chris Champion

    2009-11-01

    Full Text Available The Institute of Public Works Engineering Australia (IPWEA has recently published the Australian Infrastructure Financial Management Guidelines. The Guidelines provide new assistance to link the technical (engineering and financial aspects of managing infrastructure and services, and to assist infrastructure owners such as local government to develop sustainable long-term asset and financial management plans. Financial management for long-life infrastructure assets (such as roads, water, sewerage, and stormwater networks, and community buildings is about ensuring sustainability in the provision of services required by the community. These new Guidelines offer advice for every organisation and individual with responsibility for the management of infrastructure assets. They assist in defining best practice approaches for: • Accounting for infrastructure • Depreciation, valuation, useful life, fair value • Managing financial sustainability • Integrating asset management planning and long term financial planning • Meeting requirements for financial reporting The project was a joint initiative of IPWEA and the National Local Government Financial Management Forum. A steering committee representing national and state governments, technical and financial professionals, local government associations and auditors oversaw it.

  17. Implications of the Eighth Joint National Committee Guidelines for the Management of High Blood Pressure for Aging Adults: Atherosclerosis Risk in Communities Study.

    Science.gov (United States)

    Miedema, Michael D; Lopez, Faye L; Blaha, Michael J; Virani, Salim S; Coresh, Josef; Ballantyne, Christie M; Folsom, Aaron R

    2015-09-01

    The recent 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the Eight Joint National Committee Panel may significantly affect the aging US population. We performed a cross-sectional analysis of black and white participants in Atherosclerosis Risk in Communities who participated in the fifth study visit (2011-2013). Sitting blood pressure was calculated from the average of 3 successive readings taken after a 5-minute rest. Currently, prescribed antihypertensive medications were recorded by reviewing medication containers brought to the visit. Blood pressure control was defined using both the Seventh and Eighth Joint National Committee thresholds. Of 6088 participants (mean age, 75.6 [range, 66-90] years, 58.4% women; 23.2% black), 54.9% had either diabetes mellitus or chronic kidney disease. The prevalence of hypertension according to Seventh Joint National Committee thresholds was 81.9%, and 62.8% of the entire sample were at blood pressure goal. Using the Eighth Joint National Committee thresholds, 79.4% were at blood pressure goal (16.6% were reclassified as at-goal). Reclassification was higher for individuals with diabetes mellitus or chronic kidney disease (20.6%) when compared with individuals without either condition (11.6%). The use of antihypertensive medications in our cohort was high, with 75.0% prescribed at least 1 antihypertensive medication and 46.7% on ≥2 antihypertensive agents. In conclusion, in a US cohort of aging white and black individuals, ≈1 in 6 individuals were reclassified as having blood pressure at goal by Eighth Joint National Committee guidelines. Despite these less aggressive goals, >20% remain uncontrolled by the new criteria.

  18. Guidelines for the management of neovascular age-related macular degeneration by the European Society of Retina Specialists (EURETINA)

    DEFF Research Database (Denmark)

    Schmidt-Erfurth, Ursula; Chong, Victor; Loewenstein, Anat

    2014-01-01

    to the exponential increase in life expectancy and environmental risks. Advances in medical research have identified vascular endothelial growth factor (VEGF) as an important pathophysiological player in neovascular AMD and intraocular inhibition of VEGF as one of the most efficient therapies in medicine. The wide......, unresolved medicolegal debates about the use of off-label substances and overwhelming problems in large population management. The burden of disease has turned into a burden of care with a dissociation of scientific advances and real-world clinical performance. Simultaneously, ground-breaking innovations...

  19. Guidelines for asthma management: a review and comparison of 5 current guidelines.

    Science.gov (United States)

    Myers, Timothy R

    2008-06-01

    The first clinical practice guidelines for the assessment and management of asthma were published over 20 years ago in New Zealand and Australia. During the same period, British and Scottish groups were collaborating on a United Kingdom version of asthma guidelines. Shortly after the introduction of the New Zealand and Canadian guidelines, the National Heart, Lung, and Blood Institute of the United States National Institutes of Health participated in 2 additional asthma guideline endeavors, which were published in the early 1990s. The National Heart, Lung, and Blood Institute formed the National Asthma Education and Prevention Program to develop asthma guidelines for the United States, and participated with an international task force to develop guidelines for the treatment of asthma in all countries, which resulted in the formation of the Global Initiative for Asthma in the mid-1990s. The asthma guidelines issued by professional societies and other groups prior to the late 1990s were primarily based on consensus or expert opinion in each guideline committee, though those opinions were based on the available studies. The early guidelines played a vital role in bridging the gap between various treatment options and recent discoveries in basic science, and served as the vehicle to implementation into daily clinical practice. Asthma guidelines have been published and revised in dozens of countries around the world and have become reputable directives or "road maps" in asthma diagnosis, treatment, and management for patients of all ages. The guidelines have similar formats. The dissemination and implementation of the early guidelines was inconsistent, and they were criticized for not being evidence-based. As the knowledge of asthma pathophysiology continues to expand, along with basic science research on asthma diagnosis, treatment, and management, as well as education of the asthma patient, it is essential that the asthma guidelines be frequently updated and based on

  20. 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...

  1. Clinical practice guidelines in patient management

    Directory of Open Access Journals (Sweden)

    Santosh Kumar

    2001-01-01

    Full Text Available Efforts have always been made to evolve certain prin-ciples to reduce the variability in the management of patients and make medical care more appropriate. These efforts have become almost a movement since 1980s as evidenced in the development of clinical practice guide-lines in all medical disciplines. This article describes the need for clinical practice guidelines and their de-velopment methods and qualities. Advantages and limi-tations of clinical practice guidelines are enumerated. The salient features of various available clinical prac-tice guidelines in urology are also described.

  2. [Guidelines for the management of human resources].

    Science.gov (United States)

    Charbonnier, E; Vaubourdolle, M; Pernet, P; Gerrier, F

    2013-06-01

    The management of human resources is a major issue for laboratory accreditation, since it allows to show the proofs of competency assessment, a basis to ensure the confidence. In this paper, the main processes involved are described: the general process for the management of human resources and the authorization for personnel process. Guidelines for document control are also proposed. At least, examples are given to facilitate the implementation of these guidelines in a medical laboratory.

  3. Workshop presentation: research guidelines for Construction Management

    Directory of Open Access Journals (Sweden)

    Marco Alvise Bragadin

    2013-10-01

    Full Text Available 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 procurement 5 construction management for major public works & complex projects

  4. Management of asthma: the current US and European guidelines.

    Science.gov (United States)

    Reddy, Ashwini P; Gupta, Meera R

    2014-01-01

    Asthma management guidelines aim to improve the implementation of current knowledge into daily clinical practice by establishing a consensus of scientific practices for the management of asthma. Initial guidelines were based on consensus of expert opinion in order to employ a severity-based classification system as a guide to treatment. However, advances in asthma research led to the development of evidence-based guidelines and a major paradigm shift to control-based asthma management. Control-based management is central to the published guidelines developed by The National Heart, Lung, and Blood Institute (NHLBI), The Global Initiative for Asthma (GINA), and The British Thoracic Society (BTS), each one using the same volume of evidence but emphasizing aspects particular to their specific patient populations and socioeconomic needs. This chapter summarizes the evolution of these guidelines and summarizes the key points and evidence used in the recommendations for the assessment, monitoring, and management of asthma in all ages, with particular emphasis on the NHLBI guidelines.

  5. 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...

  6. [Essential guidelines for Quality Management System].

    Science.gov (United States)

    Daunizeau, A

    2013-06-01

    The guidelines describe the essential parts of the quality management system to fulfil the requirements of the standard EN ISO 15 189. It includes mainly the organisation, the definition of responsibilities, training of personnel, the document control, the quality control, identification and control of nonconformities, corrective actions, preventive actions and evaluation, as audits and the management review.

  7. Clinical Practice Guidelines for Convulsive Condition Management

    Directory of Open Access Journals (Sweden)

    Victor Rene Navarro Machado

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Convulsive Condition Management. It has been redefined as the occurrence of two or more successive convulsions without conscience recuperation between them; or the occurrence of convulsive uninterrupted activity for more than 5 minutes, including focal crisis. This document includes a review and update of conceptual, etiological and classification aspects for diagnosis and treatment, stressing the various therapy trends. It includes assessment guidelines focused on the most important aspects to be accomplished.

  8. 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.

  9. [Guidelines for the management of dyslipidemia].

    Science.gov (United States)

    Díaz Rodríguez, Ángel

    2014-09-01

    The AHA/ACC 2013 guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease (ASCVD) in adults contains major differences with the previous ESC/EAS 2011 guidelines and the remaining international guidelines, which has generated major controversies. The AHA/ACC document has developed a new model for estimating cardiovascular risk for primary prevention which is not comparable with the SCORE recommended in the European guidelines. This guideline does not establish a fixed target for low-density lipoprotein cholesterol (LDLc). Instead, it identifies 4 major statin benefit groups at risk for the development ASCVD, who should receive low-, moderate-, and high-intensity statin therapy to reduce LCLc. In contrast, the European guidelines maintain LDLc as the main treatment target and non-high-density lipoprotein cholesterol as a secondary treatment target. The document recommends calculating cardiovascular risk for the overall treatment of patients with dyslipidemia according to 4 risk levels (low, moderate, high, and very high), establishes LDLc treatment targets, and recommends a statin-based therapeutic strategy and other, lipid-lowering strategies, aimed at achieving these targets. The American guidelines cannot be extrapolated to the European population. Target-based treatment, as recommended in the EAS/ESC guidelines, is the best strategy for Europe. In Spain, the Primary Care Guidelines of the Spanish Society of Family and Community Medicine (semFYC) and the Spanish Society of Primary Care Physicians (SEMERGEN) are based on the European recommendations. Finally, the Spanish Society of Arteriosclerosis (SEA), SEMERGEN, semFYC and the Spanish Society of General Medicine (SEMG) are reaching a consensus on the approach and management of patients with atherogenic dyslipidemia in primary care.

  10. ESHRE guideline: management of women with endometriosis

    NARCIS (Netherlands)

    Dunselman, G.A.; Vermeulen, N.; Becker, C.; Calhaz-Jorge, C.; D'Hooghe, T.; Bie, B. De; Heikinheimo, O.; Horne, A.W.; Kiesel, L.; Nap, A.; Prentice, A.; Saridogan, E.; Soriano, D.; Nelen, W.L.D.M.

    2014-01-01

    STUDY QUESTION: What is the optimal management of women with endometriosis based on the best available evidence in the literature? SUMMARY ANSWER: Using the structured methodology of the Manual for ESHRE Guideline Development, 83 recommendations were formulated that answered the 22 key questions on

  11. Clinical management guidelines of pediatric septic shock

    Directory of Open Access Journals (Sweden)

    Khilnani Praveen

    2005-01-01

    Full Text Available Septic shock in children is the prototype combination of hypovolemia,cardiogenic and distributive shock. Recently published American college of critical care medinie(ACCM recommendations for hemodynamic support of neonatal and pediatric patients with sepsis,Surviving sepsis campaign and its pediatric considerations and subsequent revision of definitions for pediatric sepsis has led to compilation of this review article. Practical application of this information in Indian set up in a child with septic shock will be discussed based on available evidence.Though guidelines mainly apply to pediatric age group,however a reference has been made to neonatal age group wherever applicable.

  12. 40 CFR 60.35e - Waste management guidelines.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 6 2010-07-01 2010-07-01 false Waste management guidelines. 60.35e... (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Emission Guidelines and Compliance Times for Hospital/Medical/Infectious Waste Incinerators § 60.35e Waste management guidelines. For approval, a...

  13. Guidelines for Middle Managers for Thriving amid Continuous Change

    OpenAIRE

    2016-01-01

    This thesis suggests the much needed guidelines for middle managers for thriving amid continuous change. Middle managers, being an integral part of their organizations, needed a set of consolidated guidelines for thriving in the times of continuous change. Thriving requires high engagement, learning and growth as a response in stressful situations. The proposed guidelines include elements from literature and recommendations of the middle managers which came from co-creation sessions with midd...

  14. 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.

  15. Canadian Thoracic Society 2012 Guideline Update: Diagnosis and Management of Asthma in Preschoolers, Children and Adults

    Directory of Open Access Journals (Sweden)

    M Diane Lougheed

    2012-01-01

    Full Text Available BACKGROUND: In 2010, the Canadian Thoracic Society (CTS published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and/or gaps in the previous guidelines.

  16. 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 develope...

  17. 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.

  18. 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)

  19. 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.

  20. 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

    2015-10-06

    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.

  1. 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...

  2. 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.

  3. 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.

  4. Management of Hypertension: Adapting New Guidelines for Active Patients.

    Science.gov (United States)

    Tanji, Jeffrey L.; Batt, Mark E.

    1995-01-01

    Discusses recent guidelines on hypertension from the National Heart, Lung, and Blood Institute and details the latest management protocols for patients with high blood pressure. The article helps physicians interpret the guidelines for treating active patients, highlighting diagnosis, step care revision, pharmacology, and sports participation…

  5. [Guidelines for quality management of dialysis solutions].

    Science.gov (United States)

    Pérez García, R; González Parra, E; Ceballos, F; Escallada Cotero, R; Gómez-Reino, Ma I; Martín-Rabadán, P; Pérez García, A; Ramírez Chamond, R; Sobrino, P E; Solozábal, C

    2004-01-01

    A Best Practice Guideline about Dialysis fluid purity has been developed under the leadership of the Spanish Society of Nephrology. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. The Guideline was based on the European pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis (Section IV), literature reviews, according to their level of evidence, and the opinion of the expert spanish group. Two levels of quality of water were defined: purified water and high purified water (Ultra pure) and for dialysate: standard dialysate and ultra pure dialysate. Regular use of ultra pure dialysate is necessary for hemofiltration and hemodiafiltration on-line and desirable for high-flux hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anemia and amyloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (1.1.2), microbial and endotoxins: [table: see text] Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (Anexos). For microbiological monitoring, TSA or R2A medium are recommended, incubated during 5 days at a temperature of 30-35 degrees C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to www.senefro.org

  6. Perils of the new labor management guidelines.

    Science.gov (United States)

    Cohen, Wayne R; Friedman, Emanuel A

    2015-04-01

    Recent guidelines issued jointly by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine for assessing labor progress differ substantially from those described initially by Friedman, which have guided clinical practice for decades. The guidelines are based on results obtained from new and untested methods of analyzing patterns of cervical dilatation and fetal descent. Before these new guidelines are adopted into clinical practice, the results obtained by these unconventional analytic approaches should be validated and shown to be superior, or at least equivalent, to currently accepted standards. The new guidelines indicate the patterns of labor originally described by Friedman are incorrect and, further, are inapplicable to modern obstetric practice. We contend that the original descriptions of normal and abnormal labor progress, which were based on direct clinical observations, accurately describe progress in dilatation and descent, and that the differences reported more recently are likely attributable to patient selection and the potential inaccuracy of very high-order polynomial curve-fitting methods. The clinical evaluation of labor is a process of serially estimating the likelihood of a safe vaginal delivery. Because many factors contribute to that likelihood, such as cranial molding, head position and attitude, and the bony architecture and capacity of the pelvis, graphic labor patterns should never be used in isolation. The new guidelines are based heavily on unvalidated notions of labor progress and ignore clinical parameters that should remain cornerstones of intrapartum decision-making.

  7. 2015 UK national guideline for the management of infection with Chlamydia trachomatis.

    Science.gov (United States)

    Nwokolo, Nneka C; Dragovic, Bojana; Patel, Sheel; Tong, C Y William; Barker, Gary; Radcliffe, Keith

    2016-03-01

    This guideline offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of Chlamydia trachomatis genital infection. It covers the management of the initial presentation, as well the prevention of transmission and future infection. The guideline is aimed at individuals aged 16 years and older presenting to healthcare professionals working in departments offering Level 3 care in sexually transmitted infections management within the UK. However, the principles of the recommendations should be adopted across all levels, using local care pathways where appropriate.

  8. 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.

  9. [Guidelines for management of epilepsy--commentary on Scottish ("SIGN") guidelines].

    Science.gov (United States)

    Planjar-Prvan, Miljenka; Granić, Davorka

    2005-01-01

    The choice of AED (antiepileptic drug), worldwide and in Croatia, is been still based on the physician's subjective decision, personal experience, knowledge and marketing pressure made by big pharmaceutical industries. Therefore, according to some opinions, there is a need of treatment guidelines for epilepsy that would provide relevant information based on scientific evidence on the efficacy, tolerability and safety of AEDs. The guidelines, published by a competent source, should be designed as to allow for easy access to the information on the best practice in specific cases. An extensive background literature review was made to identify such a type of guidelines for the management of epilepsy. The literature review revealed a number of references with the recommendations for treating epilepsy in different groups of patients and from various, specific aspects of epilepsy treatment. However, only one comprehensive set of guidelines for the diagnosis and treatment of epilepsy treatment was found, i.e. the evidence-based guidelines published by the Scottish Intercollegiate Guidelines Network (SIGN). The development of this set of guidelines is quite extensively described in order to illustrate how rigorous and long-lasting the process was, including a great number of health professionals at the national level. Such a type of well designed guidelines facilitates access to highest educational standards for all professionals involved in the primary and secondary care of people with epilepsy. However, it is clear that guidelines can fully replace the standards of clinical practice based on critical evaluation and integration of all clinical data of each individual patient. No guidelines can replace the physician's obligation to keep informed of the novel achievements in the epileptology either.

  10. 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.

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

    Directory of Open Access Journals (Sweden)

    Anna Brończyk-Puzoń

    2015-01-01

    Full Text Available 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.

  12. [Clinical practice guidelines and knowledge management in healthcare].

    Science.gov (United States)

    Ollenschläger, Günter

    2013-10-01

    Clinical practice guidelines are key tools for the translation of scientific evidence into everyday patient care. Therefore guidelines can act as cornerstones of evidence based knowledge management in healthcare, if they are trustworthy, and its recommendations are not biased by authors' conflict of interests. Good medical guidelines should be disseminated by means of virtual (digital/electronic) health libraries - together with implementation tools in context, such as guideline based algorithms, check lists, patient information, a.s.f. The article presents evidence based medical knowledge management using the German experiences as an example. It discusses future steps establishing evidence based health care by means of combining patient data, evidence from medical science and patient care routine, together with feedback systems for healthcare providers.

  13. Clinical guidelines in the management of prosthetic joint infection.

    Science.gov (United States)

    Minassian, Angela M; Osmon, Douglas R; Berendt, Anthony R

    2014-09-01

    Clinical practice guidelines for the diagnosis and management of prosthetic joint infection have been produced by a range of organizations. Guidelines stress the importance of multi-disciplinary working and of adopting a methodical approach. This includes careful assessment of the patient's surgical, medical and psychosocial problems, rational investigation, a decision-making framework for surgery and targeted, sometimes prolonged, use of intravenous or highly bioavailable oral antibiotics. Despite limited high-quality evidence, adoption of clinical guidelines can improve practice by reducing variation and by establishing conditions for the subsequent conduct of multicentre studies or systematic reviews.

  14. 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.

  15. Guidelines help managers deal with ethical issues.

    Science.gov (United States)

    Gould, G R; Younkins, E W

    1989-07-01

    While a great deal of effort has been devoted to improving financial management techniques in the healthcare industry, little attention has been paid to addressing the ethical issues facing financial managers. In the years ahead, the ability to evaluate the ethical aspects of alternative courses of action may be as important as technical and managerial skills.

  16. 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats.

    Science.gov (United States)

    Epstein, Mark; Rodan, Ilona; Griffenhagen, Gregg; Kadrlik, Jamie; Petty, Michael; Robertson, Sheilah; Simpson, Wendy

    2015-01-01

    The robust advances in pain management for companion animals underlie the decision of AAHA and AAFP to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines for Dogs and Cats . The 2015 guidelines summarize and offer a discriminating review of much of this new knowledge. Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian-client-patient relationship. The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual-patient basis. The guidelines include both pharmacologic and nonpharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention, and treatment of pain in animals. Postsurgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Degenerative joint disease is one of the most significant and under-diagnosed diseases of cats and dogs. Degenerative joint disease is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats. These guidelines support veterinarians in incorporating pain management into practice, improving patient care.

  17. 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.

  18. BSACI guideline for the management of chronic urticaria and angioedema.

    Science.gov (United States)

    Powell, R J; Leech, S C; Till, S; Huber, P A J; Nasser, S M; Clark, A T

    2015-03-01

    This guidance for the management of patients with chronic urticaria and angioedema has been prepared by the Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is aimed at both adult physicians and paediatricians practising in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a Web-based system. Their comments and suggestions were carefully considered by the Standards of Care Committee. Where evidence was lacking, a consensus was reached by the experts on the committee. Included in this management guideline are clinical classification, aetiology, diagnosis, investigations, treatment guidance with special sections on children with urticaria and the use of antihistamines in women who are pregnant or breastfeeding. Finally, we have made recommendations for potential areas of future research.

  19. Management guidelines and outcome measures in polymyalgia rheumatica (PMR).

    Science.gov (United States)

    Dasgupta, B; Matteson, E L; Maradit-Kremers, H

    2007-01-01

    Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease of the elderly that is subject to wide variations in clinical practice and is managed both in the primary and secondary care settings by general practitioners, rheumatologists and non-rheumatologists. Considerable uncertainty exists relating to diagnosis, management and outcome in patients with PMR. The guidelines presented here seek to improve outcomes for PMR patients by outlining a process to ensure more accurate diagnosis and timely specialist referral. The guidelines are directed to promote more conservative treatment and to ensure early bone protection in order to reduce the common morbidity of osteoporotic fractures. Furthermore, these guidelines specify the goals of treatment, including clinical and patient-based outcomes, and provide advice concerning monitoring for disease activity and complications.

  20. Business Principles and Management. Curriculum Guidelines.

    Science.gov (United States)

    Clemson Univ., SC. Vocational Education Media Center.

    This senior high school curriculum guide offers a general overview of the American business system and a study of various forms of business ownership, internal organization and management functions of business, and the financing of business. Ten areas are explored in the course: (1) capitalism; (2) money, credit, and banking; (3) government and…

  1. 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...

  2. Saudi Oncology Society clinical management guidelines for renal cell carcinoma

    Directory of Open Access Journals (Sweden)

    Shouki Bazarbashi

    2011-01-01

    Full Text Available In this report, guidelines for the evaluation, medical and surgical management of renal cell carcinoma is presented. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7th edition. The recommendations are presented with supporting evidence level.

  3. 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…

  4. Severe tooth wear: European consensus statement on management guidelines

    DEFF Research Database (Denmark)

    Loomans, Bas AC; Attin, Thomas; Opdam, Niek JM;

    2016-01-01

    This paper reports a European expert consensus statement on guidelines for the management of severe tooth wear. It focuses on the definition of physiological versus pathological tooth wear and recommends diagnosis, monitoring and counseling to define the activity of the wear. Restorative interven...

  5. Canadian Thoracic Society 2012 Guideline Update: Diagnosis and Management of Asthma in Preschoolers, Children and Adults: Executive Summary

    Directory of Open Access Journals (Sweden)

    M Diane Lougheed

    2012-01-01

    Full Text Available BACKGROUND: In 2010, the Canadian Thoracic Society (CTS published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and/or gaps in the previous guidelines.

  6. 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.

  7. KDOQI US commentary on the 2013 KDIGO Clinical Practice Guideline for Lipid Management in CKD.

    Science.gov (United States)

    Sarnak, Mark J; Bloom, Roy; Muntner, Paul; Rahman, Mahboob; Saland, Jeffrey M; Wilson, Peter W F; Fried, Linda

    2015-03-01

    The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guideline for management of dyslipidemia in chronic kidney disease (CKD) was published in 2003. Since then, considerable evidence, including randomized controlled trials of statin therapy in adults with CKD, has helped better define medical treatments for dyslipidemia. In light of the new evidence, KDIGO (Kidney Disease: Improving Global Outcomes) formed a work group for the management of dyslipidemia in patients with CKD. This work group developed a new guideline that contains substantial changes from the prior KDOQI guideline. KDIGO recommends treatment of dyslipidemia in patients with CKD primarily based on risk for coronary heart disease, which is driven in large part by age. The KDIGO guideline does not recommend using low-density lipoprotein cholesterol level as a guide for identifying individuals with CKD to be treated or as treatment targets. Initiation of statin treatment is no longer recommended in dialysis patients. To assist US practitioners in interpreting and applying the KDIGO guideline, NKF-KDOQI convened a work group to write a commentary on this guideline. For the most part, our work group agreed with the recommendations of the KDIGO guideline, although we describe several areas in which we believe the guideline statements are either too strong or need to be more nuanced, areas of uncertainty and inconsistency, as well as additional research recommendations. The target audience for the KDIGO guideline includes nephrologists, primary care practitioners, and non-nephrology specialists such as cardiologists and endocrinologists. As such, we also put the current recommendations into the context of other clinical practice recommendations for cholesterol treatment.

  8. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Kluk, A.F. [Dept. of Energy, Germantown, MD (United States); Neal, R.M. [Scientech, Inc., Germantown, MD (United States)

    1996-12-31

    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.

  10. Electronics waste management: Indian practices and guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Bandyopadhyay, Amitava [Department of Chemical Engineering. University of Calcutta, 92, A.P.C.Road. Kolkata 700 009 (India)

    2010-07-01

    Electronic waste or e-waste or waste electrical and electronic equipment (WEEE) is a popular, informal name for discarded electrical and electronic equipment (EEE) with all of their peripherals at their end-of-life. WEEE constitutes 8% of municipal waste and is one of the fastest growing waste streams. The fraction of precious and other metals in e-waste is over 60%, while pollutants comprise a meager 2.70%. Given the volume of WEEE generated containing toxic materials, it emerges as a risk to the society. Considering the high toxicity of these pollutants especially when burned or recycled in uncontrolled environments, the Basel Convention has identified e-waste as hazardous, and developed a framework for controls on transboundary movement of such waste. In contrast, WEEE can offer a tremendous business opportunity if it would treat in proper manner. The management of the WEEE has thus become a global challenge in today's world. Several nations across the globe have implemented or are about to implement WEEE regulations based on the principle of Extended Producer Responsibility (EPR). Both existing and proposed solutions are implemented with various degrees of centralization. Practical implementations however, can give rise to absurd organizational outcomes. In the light of these findings, the present paper deals with the Indian initiatives on the WEEE management keeping pace with the international scenario. Initially, this paper aims to draw an overview on the basics of WEEE. Next, the international legislative practices followed by Indian initiatives intended to help manage these growing quantities of this waste stream are discussed.

  11. Electronics waste management: Indian practices and guidelines

    Directory of Open Access Journals (Sweden)

    Amitava Bandyopadhyay

    2010-09-01

    Full Text Available Electronic waste or e-waste or waste electrical and electronic equipment (WEEE is a popular, informal name for discarded electrical and electronic equipment (EEE with all of their peripherals at their end-of-life. WEEE constitutes 8% of municipal waste and is one of the fastest growing waste streams. The fraction of precious and other metals in e-waste is over 60%, while pollutants comprise a meager 2.70%. Given the volume of WEEE generated containing toxic materials, it emerges as a risk to the society. Considering the high toxicity of these pollutants especially when burned or recycled in uncontrolled environments, the Basel Convention has identified e-waste as hazardous, and developed a framework for controls on transboundary movement of such waste. In contrast, WEEE can offer a tremendous business opportunity if it would treat in proper manner. The management of the WEEE has thus become a global challenge in today’s world. Several nations across the globe have implemented or are about to implement WEEE regulations based on the principle of Extended Producer Responsibility (EPR. Both existing and proposed solutions are implemented with various degrees of centralization. Practical implementations however, can give rise to absurd organizational outcomes. In the light of these findings, the present paper deals with the Indian initiatives on the WEEE management keeping pace with the international scenario. Initially, this paper aims to draw an overview on the basics of WEEE. Next, the international legislative practices followed by Indian initiatives intended to help manage these growing quantities of this waste stream are discussed.

  12. 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

  13. Head injury management guidelines for general practitioners.

    Science.gov (United States)

    Ganz, Jeremy C

    2011-07-01

    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.

  14. Second Korean guidelines for the management of Crohn's disease

    Science.gov (United States)

    Park, Jae Jun; Ye, Byong Duk; Kim, Jong Wook; Park, Dong Il; Yoon, Hyuk; Im, Jong Pil; Lee, Kang Moon; Yoon, Sang Nam; Lee, Heeyoung

    2017-01-01

    Crohn's disease (CD) is a chronic, progressive, and disabling inflammatory bowel disease (IBD) with an uncertain etiopathogenesis. CD can involve any site of the gastrointestinal tract from the mouth to the anus, and is associated with serious complications, such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower compared with those in Western countries, but they have been rapidly increasing during the recent decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies have been applied for the treatment of this disease. Concerning CD management, there have been substantial discrepancies among clinicians according to their personal experience and preference. To suggest recommendable approaches to the diverse problems of CD and to minimize the variations in treatment among physicians, guidelines for the management of CD were first published in 2012 by the IBD Study Group of the Korean Association for the Study of Intestinal Diseases. These are the revised guidelines based on updated evidence, accumulated since 2012. These guidelines were developed by using mainly adaptation methods, and encompass induction and maintenance treatment of CD, treatment based on disease location, treatment of CD complications, including stricture and fistula, surgical treatment, and prevention of postoperative recurrence. These are the second Korean guidelines for the management of CD and will be continuously revised as new evidence is collected. PMID:28239314

  15. Progression of Tokyo Guidelines and Japanese Guidelines for management of acute cholangitis and cholecystitis.

    Science.gov (United States)

    Mayumi, Toshihiko; Someya, Kazuki; Ootubo, Hiroki; Takama, Tatsuo; Kido, Takashi; Kamezaki, Fumihiko; Yoshida, Masahiro; Takada, Tadahiro

    2013-12-01

    The Japanese Guidelines for management of acute cholangitis and cholecystitis were published in 2005 as the first practical guidelines presenting diagnostic and severity assessment criteria for these diseases. After the Japanese version, the Tokyo Guidelines (TG07) were reported in 2007 as the first international practical guidelines. There were some differences between the two guidelines, and some weak points in TG07 were pointed out, such as low sensitivity for diagnosis and the presence of divergence between severity assessment and clinical judgment for acute cholangitis. Therefore, revisions were started to not only make them up to date but also concurrent with the same diagnostic and severity assessment criteria. The Revision Committee for the revision of TG07 (TGRC) performed validation studies of TG07 and new diagnostic and severity assessment criteria of acute cholangitis and cholecystitis. These were retrospective multi-institutional studies that collected cases of acute cholangitis, cholecystitis, and non-inflammatory biliary disease. TGRC held 35 meetings as well as international email exchanges with co-authors abroad and held three International Meetings. Through these efforts, TG13 improved the diagnostic sensitivity for acute cholangitis and cholecystitis, and presented criteria with extremely low false positive rates. Furthermore, severity assessment criteria adapted for clinical use, flowcharts, and many new diagnostic and therapeutic modalities were presented. The world's first management bundles of acute cholangitis and cholecystitis were also presented. The revised Japanese version was published with the same content as TG13. An electronic application of TG13 that can help to diagnose and assess the severity of these diseases using the criteria of TG13 was made for free download.

  16. 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.

  17. 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.

  18. [Guidelines for the management of diabetes mellitus type 2].

    Science.gov (United States)

    Mediavilla Bravo, José Javier

    2014-09-01

    In the last few years, the publication of new studies in diabetes, together with the development of new classes of blood glucose-lowering medications, have led to updates of the most prestigious clinical practice guidelines for the treatment of diabetes. Thus, a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes on the management of hyperglycemia in type 2 diabetes was published in April 2012. An update of one of the evidence-based guidelines issued by the Canadian Diabetes Association appeared in 2013 and this year, 2014, saw the publication of the consensus document of the redGDPS, whose guidelines are those most closely followed by primary care physicians in Spain. The three guidelines highlight the need for an individualized approach to type 2 diabetes mellitus, outlining both target glycemic goals and distinct treatment regimens based on patient characteristics, disease stage and the presence of comorbidities or complications. In the treatment of the disease, the three guidelines also stress the importance of considering patients' opinions and of recommending lifestyle modifications to achieve good disease control. Metformin is identified as the first-line drug, with the addition of other glucose-lowering agents if necessary.

  19. 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.

  20. 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.

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

    DEFF Research Database (Denmark)

    Vasen, H.F.; Moslein, G.; Alonso, A.

    2008-01-01

    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 collaborative studies. Thirty......-one experts from nine European countries participated in these workshops. Prior to the meeting, various participants examined the most important management issues according to the latest publications. A systematic literature search using Pubmed and reference lists of retrieved articles, and manual searches...... of relevant articles, was performed. During the workshop, all recommendations were discussed in detail. Because most of the studies that form the basis for the recommendations were descriptive and/or retrospective in nature, many of them were based on expert opinion. The guidelines described herein may...

  2. Assessing biocomputational modelling in transforming clinical guidelines for osteoporosis management.

    Science.gov (United States)

    Thiel, Rainer; Viceconti, Marco; Stroetmann, Karl

    2011-01-01

    Biocomputational modelling as developed by the European Virtual Physiological Human (VPH) Initiative is the area of ICT most likely to revolutionise in the longer term the practice of medicine. Using the example of osteoporosis management, a socio-economic assessment framework is presented that captures how the transformation of clinical guidelines through VPH models can be evaluated. Applied to the Osteoporotic Virtual Physiological Human Project, a consequent benefit-cost analysis delivers promising results, both methodologically and substantially.

  3. 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....

  4. 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.

  5. Habitat Management for Wintering American Woodcock on Southeastern Bottomland Refuges: Basic Management Guidelines and Strategies

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Basic guidelines for management of habitat in winter for woodcock on refuges in the SE is presented along with consideration for use of the desired forestry conditons.

  6. 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.

  7. [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...

  8. Case reports and clinical guidelines for managing radix entomolaris

    Science.gov (United States)

    Thomas, Bejoy J.; Nishad, A.; Paulaian, Benin; Sam, Jonathan Emil

    2016-01-01

    Knowledge about the external and internal anatomy of the tooth is essential for successful dental practice. Anomalies in the tooth are often encountered which poses difficulties in dental treatments. As like any other tooth, mandibular first molars are also prone for anatomic malformations. One such anatomic variation is the presence of extra root distolingually. This distolingual root is called radix entomolaris (RE). The presence of an additional root can lead to difficulties during endodontic therapy. This article is a report of two cases describing the management of the first mandibular molars with an RE and clinical guidelines for its management. PMID:27829770

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

    Science.gov (United States)

    Alfadhel, Majid; Mutairi, Fuad Al; Makhseed, Nawal; Jasmi, Fatma Al; Al-Thihli, Khalid; Al-Jishi, Emtithal; AlSayed, Moeenaldeen; Al-Hassnan, Zuhair N; Al-Murshedi, Fathiya; Häberle, Johannes; Ben-Omran, Tawfeg

    2016-01-01

    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 extremely obvious. Method We searched PubMed and Embase databases to include published materials from 2011 to 2014 that were not covered by the European guidelines, which was published in 2012. We followed the process of a Delphi conference and involved one preliminary meeting and two follow-up meetings with email exchanges between the Middle East Hyperammonemia and Urea Cycle Disorders Scientific Group regarding each draft of the manuscript. Results and discussion We have developed consensus guidelines based on the highest available level of evidence. The aim of these guidelines is to homogenize and harmonize the treatment protocols used for patients with acute hyperammonemia, and to provide a resource to not only metabolic physicians, but also physicians who may come in contact with individuals with acute hyperammonemia. Conclusion These suggested guidelines aim to ease the challenges faced by physicians dealing with acute hyperammonemia in the region. In addition, guidelines have demonstrated useful collaboration between experts in the region, and provides information that will hopefully improve the outcomes of patients with acute hyperammonemia. PMID:27099506

  10. Second Korean guidelines for the management of ulcerative colitis

    Science.gov (United States)

    Choi, Chang Hwan; Moon, Won; Kim, You Sun; Kim, Eun Soo; Lee, Bo-In; Jung, Yunho; Yoon, Yong Sik; Lee, Heeyoung; Park, Dong Il

    2017-01-01

    Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by a relapsing and remitting course. The direct and indirect costs of the treatment of UC are high, and the quality of life of patients is reduced, especially during exacerbation of the disease. The incidence and prevalence of UC in Korea are still lower than those of Western countries, but have been rapidly increasing during the past decades. Various medical and surgical therapies, including biologics, are currently used for the management of UC. However, many challenging issues exist, which sometimes lead to differences in practice between clinicians. Therefore, the IBD study group of the Korean Association for the Study of Intestinal Diseases established the first Korean guidelines for the management of UC in 2012. This is an update of the first guidelines. It was generally made by the adaptation of several foreign guidelines as was the first edition, and encompasses treatment of active colitis, maintenance of remission, and indication of surgery for UC. The specific recommendations are presented with the quality of evidence and classification of recommendations. PMID:28239313

  11. 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.

  12. Japanese pediatric guideline for the treatment and management of bronchial asthma 2012.

    Science.gov (United States)

    Hamasaki, Yuhei; Kohno, Yoichi; Ebisawa, Motohiro; Kondo, Naomi; Nishima, Sankei; Nishimuta, Toshiyuki; Morikawa, Akihiro; Aihara, Yukoh; Akasawa, Akira; Adachi, Yuichi; Arakawa, Hirokazu; Ikebe, Toshiichi; Ichikawa, Kunio; Inoue, Toshishige; Iwata, Tsutomu; Urisu, Atsuo; Ohya, Yukihiro; Okada, Kenji; Odajima, Hiroshi; Katsunuma, Toshio; Kameda, Makoto; Kurihara, Kazuyuki; Sakamoto, Tatsuo; Shimojo, Naoki; Suehiro, Yutaka; Tokuyama, Kenichi; Nambu, Mitsuhiko; Fujisawa, Takao; Matsui, Takehiko; Matsubara, Tomoyo; Mayumi, Mitsufumi; Mochizuki, Hiroyuki; Yamaguchi, Koichi; Yoshihara, Shigemi

    2014-08-01

    A new version of the Japanese pediatric guideline for the treatment and management of bronchial asthma was published in Japanese at the end of 2011. The guideline sets the pragmatic goal for clinicians treating childhood asthma as maintaining a "well-controlled level" for an extended period in which the child patient can lead a trouble-free daily life, not forgetting the ultimate goal of obtaining remission and/or cure. Important factors in the attainment of the pragmatic goal are: (i) appropriate use of anti-inflammatory drugs; (ii) elimination of environmental risk factors; and (iii) educational and enlightening activities for the patient and caregivers regarding adequate asthma management in daily life. The well-controlled level refers to a symptom-free state in which no transient coughs, wheezing, dyspnea or other symptoms associated with bronchial asthma are present, even for a short period of time. As was the case in the previous versions of the guideline, asthmatic children younger than 2 years of age are defined as infantile asthma patients. Special attention is paid to these patients in the new guideline: they often have rapid exacerbation and easily present chronic asthmatic conditions after the disease is established.

  13. 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.

  14. Clinical guidelines for the management of craniofacial fibrous dysplasia

    Directory of Open Access Journals (Sweden)

    Lee JS

    2012-05-01

    Full Text Available Abstract Fibrous dysplasia (FD is a non-malignant condition caused by post-zygotic, activating mutations of the GNAS gene that results in inhibition of the differentiation and proliferation of bone-forming stromal cells and leads to the replacement of normal bone and marrow by fibrous tissue and woven bone. The phenotype is variable and may be isolated to a single skeletal site or multiple sites and sometimes is associated with extraskeletal manifestations in the skin and/or endocrine organs (McCune-Albright syndrome. The clinical behavior and progression of FD may also vary, thereby making the management of this condition difficult with few established clinical guidelines. This paper provides a clinically-focused comprehensive description of craniofacial FD, its natural progression, the components of the diagnostic evaluation and the multi-disciplinary management, and considerations for future research.

  15. Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0-4 years).

    Science.gov (United States)

    Tremblay, Mark S; Leblanc, Allana G; Carson, Valerie; Choquette, Louise; Connor Gorber, Sarah; Dillman, Carrie; Duggan, Mary; Gordon, Mary Jane; Hicks, Audrey; Janssen, Ian; Kho, Michelle E; Latimer-Cheung, Amy E; Leblanc, Claire; Murumets, Kelly; Okely, Anthony D; Reilly, John J; Stearns, Jodie A; Timmons, Brian W; Spence, John C

    2012-04-01

    The Canadian Society for Exercise Physiology (CSEP), with assistance from multiple partners, stakeholders, and researchers, developed the first Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0-4 years). These national guidelines are in response to a call from health and health care professionals, child care providers, and fitness practitioners for guidance on sedentary behaviour in the early years. The guideline development process followed the Appraisal of Guidelines for Research Evaluation (AGREE) II framework. The recommendations are informed by evidence from a systematic review that examined the relationships between sedentary behaviour (predominantly screen time) and health indicators (healthy body weight, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and cardio-metabolic disease risk factors) for three age groups (infants aged Development and Evaluation (GRADE) system. The new guidelines include a preamble to provide context, followed by the specific recommendations. The final guidelines benefitted from extensive on-line consultations with input from >900 domestic and international stakeholders, end-users, and key informants. The final guidelines state: for healthy growth and development, caregivers should minimize the time infants (aged games) is not recommended. For children 2-4 years, screen time should be limited to under 1 h per day; less is better.

  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. [National disease management guidelines (NVL) for chronic CAD : What is new, what is particularly important?].

    Science.gov (United States)

    Werdan, K

    2016-09-01

    Coronary heart disease (CAD) is widespread and affects 1 in 10 of the population in the age group 40-79 years in Germany. The German national management guidelines on chronic CAD comprise evidence and expert-based recommendations for the diagnostics of chronic stable CAD as well as for interdisciplinary/multidisciplinary therapy and care of patients with stable CAD. The focus is on the diagnostics, prevention, medication therapy, revascularization, rehabilitation, general practitioner care and coordination of care. Recommendations for optimizing cooperation between all medical specialties involved as well as the definition of mandatory and appropriate measures are essential aims of the guidelines both to improve the quality of care and to strengthen the position of the patient.

  18. Management of hyperglycemia in geriatric patients with diabetes mellitus: South Asian consensus guidelines.

    Science.gov (United States)

    Baruah, Manash P; Kalra, Sanjay; Unnikrishnan, Ambika Gopalkrishnan; Raza, Syed Abbas; Somasundaram, Noel; John, Mathew; Katulanda, Prasad; Shrestha, Dina; Bantwal, Ganpathy; Sahay, Rakesh; Latt, Tint Swe; Pathan, Faruque

    2011-04-01

    Asia is home to four of the world's five largest diabetic populations, two of them being South Asian nations, namely, India and Pakistan. This problem is compounded by a substantial rise in the elderly population in Asian countries. On the other hand, the heterogeneous health condition and multiple co-morbidities make the care of chronic disease in the elderly a challenging task. The aim of the South Asian Consensus Guidelines is to provide evidence-based recommendations to assist healthcare providers in the rational management of type 2 diabetes mellitus in the elderly population. Current Guidelines used systematic reviews of available evidence to form its key recommendations. No evidence grading was done for the purpose of this manuscript. The clinical questions of the guidelines, the methodology of literature search, and medical writing strategy were finalized by consultations in person and through mail. The South Asian Consensus guideline emphasizes tailoring of glycemic goals for patients based on age, co-morbid conditions especially that of cardiovascular system, risk of hypoglycemia, and life expectancy. It also recommends cautious use of available pharmacotherapy in geriatric patients with diabetes. The primary principle of diabetes therapy should be to achieve euglycemia, without causing hypoglycemia. Appropriate use of modern insulins and oral drugs, including incretin mimetics will help physicians achieve this aim.

  19. Management of hyperglycemia in geriatric patients with diabetes mellitus: South Asian consensus guidelines

    Directory of Open Access Journals (Sweden)

    Manash P Baruah

    2011-01-01

    Full Text Available Asia is home to four of the world′s five largest diabetic populations, two of them being South Asian nations, namely, India and Pakistan. This problem is compounded by a substantial rise in the elderly population in Asian countries. On the other hand, the heterogeneous health condition and multiple co-morbidities make the care of chronic disease in the elderly a challenging task. The aim of the South Asian Consensus Guidelines is to provide evidence-based recommendations to assist healthcare providers in the rational management of type 2 diabetes mellitus in the elderly population. Current Guidelines used systematic reviews of available evidence to form its key recommendations. No evidence grading was done for the purpose of this manuscript. The clinical questions of the guidelines, the methodology of literature search, and medical writing strategy were finalized by consultations in person and through mail. The South Asian Consensus guideline emphasizes tailoring of glycemic goals for patients based on age, co-morbid conditions especially that of cardiovascular system, risk of hypoglycemia, and life expectancy. It also recommends cautious use of available pharmacotherapy in geriatric patients with diabetes. The primary principle of diabetes therapy should be to achieve euglycemia, without causing hypoglycemia. Appropriate use of modern insulins and oral drugs, including incretin mimetics will help physicians achieve this aim.

  20. Effective maintenance practices to manage system aging

    Science.gov (United States)

    Chockie, Alan; Bjorkelo, Kenneth

    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 of maintenance programs on addressing the system and component aging degradation issues. An effective maintenance program was found to be essential to the management of system and component aging. Four key elements of an effective maintenance program that are important to an aging management were identified: (1) the selection of critical systems and components; (2) the development of an understanding of aging through the collection and analysis of equipment performance information; (3) the development of appropriate preventive and predictive maintenance tasks to manage equipment and system aging degradation; and (4) 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.

  1. Guidelines for managing the orthodontic-restorative patient.

    Science.gov (United States)

    Kokich, V G; Spear, F M

    1997-03-01

    Occasionally, patients require restorative treatment during or after orthodontic therapy. Patients with worn or abraded teeth, peg-shaped lateral incisors, fractured teeth, multiple edentulous spaces, or other restorative needs may require tooth positioning that is slightly different from a nonrestored, nonabraded, completely dentulous adolescent. Generally, orthodontists are not accustomed to dealing with patients who require restorative intervention. Should the objectives of orthodontic treatment differ for the restorative patient compared with the nonrestorative patient? How should the teeth be positioned during orthodontic therapy to facilitate specific restorations? Should teeth be restored before, during, or perhaps after orthodontics? The answers to these and other important questions are vital to the successful treatment of some orthodontic patients. This article will provide a series of eight guidelines to help the interdisciplinary team manage treatment for the orthodontic-restorative patient.

  2. 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…

  3. Dutch guideline for the management of hypertensive crisis -- 2010 revision.

    Science.gov (United States)

    van den Born, B J H; Beutler, J J; Gaillard, C A J M; de Gooijer, A; van den Meiracker, A H; Kroon, A A

    2011-05-01

    Hypertensive crises are divided into hypertensive urgencies and emergencies. Together they form a heterogeneous group of acute hypertensive disorders depending on the presence or type of target organs involved. Despite better treatment options for hypertension, hypertensive crisis and its associated complications remain relatively common. In the Netherlands the number of patients starting renal replacement therapy because of 'malignant hypertension' has increased in the past two decades. In 2003, the first Dutch guideline on hypertensive crisis was released to allow a standardised evidence-based approach for patients presenting with a hypertensive crisis. In this paper we give an overview of the current management of hypertensive crisis and discuss several important changes incorporated in the 2010 revision. These changes include a modification in terminology replacing 'malignant hypertension' with 'hypertensive crisis with retinopathy and reclassification of hypertensive crisis with retinopathy under hypertensive emergencies instead of urgencies. With regard to the treatment of hypertensive emergencies, nicardipine instead of nitroprusside or labetalol is favoured for the management of perioperative hypertension, whereas labetalol has become the drug of choice for the treatment of hypertension associated with pre-eclampsia. For the treatment of hypertensive urgencies, oral administration of nifedipine retard instead of captopril is recommended as first-line therapy. In addition, a section on the management of hypertensive emergencies according to the type of target organ involved has been added. Efforts to increase the awareness and treatment of hypertension in the population at large may lower the incidence of hypertensive crisis and its complications.

  4. JPN Guidelines for the management of acute pancreatitis: cutting-edge information

    OpenAIRE

    Takada, Tadahiro; Kawarada, Yoshifumi; Hirata, Koichi; Mayumi, Toshihiko; Yoshida, Masahiro; Sekimoto, Miho; Hirota, Masahiko; Kimura, Yasutoshi; Takeda, Kazunori; Isaji, Shuji; Koizumi, Masaru; Otsuki, Makoto; Matsuno, Seiki

    2006-01-01

    The JPN Guidelines for the Management of Acute Pancreatitis are organized under the subject headings: epidemiology, diagnosis, management strategy, severity assessment and transfer criteria, management of gallstone pancreatitis, nonsurgical management, and surgical management. The Guidelines contain cutting-edge information on each of these subjects, as well as a section on the Japanese medical insurance system which provides information that should prove useful to physicians in other countri...

  5. Canadian Physical Activity Guidelines for the Early Years (aged 0-4 years).

    Science.gov (United States)

    Tremblay, Mark S; Leblanc, Allana G; Carson, Valerie; Choquette, Louise; Connor Gorber, Sarah; Dillman, Carrie; Duggan, Mary; Gordon, Mary Jane; Hicks, Audrey; Janssen, Ian; Kho, Michelle E; Latimer-Cheung, Amy E; Leblanc, Claire; Murumets, Kelly; Okely, Anthony D; Reilly, John J; Spence, John C; Stearns, Jodie A; Timmons, Brian W

    2012-04-01

    The Canadian Society for Exercise Physiology (CSEP), with assistance from multiple partners, stakeholders, and researchers, developed the first Canadian Physical Activity Guidelines for the Early Years (aged 0-4 years). These national guidelines were created in response to an urgent call from public health, health care, child care, and fitness practitioners for healthy active living guidance for the early years. The guideline development process was informed by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument and the evidence assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The recommendations are informed by evidence from a systematic review that examined the relationships between physical activity and health indicators (healthy body weight, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and cardio-metabolic disease risk factors) for three age groups (infants aged benefitted from an extensive on-line consultation process with input from over 900 domestic and international stakeholders, end-users, and key informants. The final guideline recommendations state that for healthy growth and development, infants (aged develop movement skills, and progression toward at least 60 min of energetic play by 5 years of age. More daily physical activity provides greater benefits.

  6. Management of acute diarrhoeal disease at Edendale Hospital: Are standard treatment guidelines followed?

    Directory of Open Access Journals (Sweden)

    Kershinee Reddy

    2016-12-01

    Full Text Available Background. Diarrhoeal disease (DD is a major cause of childhood mortality in developing countries. In South Africa (SA, it ranks as one of the top five causes of under-5 mortality. Local and global guidelines on the management of acute DD are readily available. The Standard Treatment Guidelines (STGs and Essential Drugs List for Hospital Level Paediatrics are a recognised standard of care for children in SA hospitals. However, children still die from this preventable disease. Objective. To determine whether doctors adhered to standard treatment guidelines when treating children under 5 years of age presenting to Edendale Hospital in Pietermaritzburg, KwaZulu-Natal Province, with acute DD. Methods. The study was a retrospective clinical audit of individual patient records. Results. One hundred and thirty-five patient records were reviewed. Forty-seven percent had a correct nutritional assessment, 41% were correctly assessed for shock and 27% for dehydration. Appropriate investigations were undertaken in 12%. Ninety-seven percent of patients had appropriate fluid plans prescribed. Zinc was prescribed in only 39% of patients, whereas 84% were appropriately not prescribed antibiotics and no patients received anti-diarrhoeal medication. In 90% of patients, the correct post-care patient referral was made, and 47% of caregivers were adequately advised about ongoing care of their children. Conclusion. This study identifies substantial non-adherence to the SA STGs for the management of young children with acute DD.

  7. Management of acute viral bronchiolitis in children: Evidence beyond guidelines.

    Science.gov (United States)

    Iqbal, Shaikh Mohammed

    2012-01-01

    Acute viral bronchiolitis is one of the leading causes of worldwide admission of children under 2 years of age during winter months. There is a lack of consensus regarding the clinical definition of acute viral bronchiolitis in children and hence the management varies across the globe. The purpose of this article is to review the epidemiology, etiology, risk factors, pathophysiology, clinical presentation, assessment and management of children with respiratory syncytial virus (RSV) bronchiolitis. The available evidence in the worldwide literature suggests that supportive and symptomatic management is still the mainstay of management in this condition. The key to reducing the morbidity and mortality in children with RSV bronchiolitis is through prevention of infection through immunoprophylaxis especially in high-risk children.

  8. Guideline concordant detection and management of depression among Alaska Native and American Indian people in primary care

    Directory of Open Access Journals (Sweden)

    Vanessa Y. Hiratsuka

    2015-10-01

    Full Text Available Background: A tribal health organization in Alaska implemented a primary care depression screening, detection and management initiative amongst 55,000 Alaska Native/American Indian people (AN/AIs. Objectives: (a To describe the proportion of AN/AIs screening positive for depression with depression noted or diagnosed and proportion with guideline concordant management and (b to assess whether management varied by patient and provider factors. Research design: Secondary analysis of electronic and paper medical record information of 400 AN/AIs. Measures: Provider variables, patient demographics and patient clinical factors were electronically queried. Manual chart audits assessed depression notation, diagnoses and management within 12 weeks of positive screening. Multilevel ordinal logistic modelling assessed management by patient and provider factors. Results: A depression diagnosis was present in 141 (35% charts and 151 (38% had depressive symptoms noted. Detection was higher among AN/AIs with moderate and severe depression (p<0.001. In total, 258 patients (66% received guideline concordant management, 32 (8% had some management, and 110 (28% received no management. Younger patient age and increased provider tenure increased odds of management. Conclusions: Most AN/AIs screening positive for depression received initial guideline concordant management. Additional outreach to older patients and additional support for providers newer to practices appears warranted.

  9. 36 CFR 292.42 - Management standards and guidelines.

    Science.gov (United States)

    2010-07-01

    ... guidelines. 292.42 Section 292.42 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF... standards and guidelines. (a) In addition to existing statutory and regulatory authority governing administration of National Forest System lands and resources, the standards and guidelines in §§ 292.43 to...

  10. Summary of the 2008 BTS/SIGN British Guideline on the management of asthma.

    Science.gov (United States)

    Levy, Mark L; Thomas, Mike; Small, Iain; Pearce, Linda; Pinnock, Hilary; Stephenson, Paul

    2009-01-01

    The 2008 BTS/SIGN British Guideline on the management of asthma provides comprehensive updated evidence-based guidance on asthma management for healthcare professionals. This primary care-focussed summary has been produced to aid dissemination and implementation of the key guideline messages into primary care. The section on diagnosis emphasises the new integrated symptom-based approach with clinicians using their deductive skills to determine the probability that the patient has asthma. The various tools used for monitoring asthma are discussed. There are sections on both non-pharmacological and pharmacological management of chronic asthma in adults and children. Treatment options for children are subdivided into the under-5s and children aged 5-12 years. Poor asthma control is manifested by exacerbations and acute asthma. Personalised asthma action plans for guided self management should be provided and used when levels of asthma control change. There are sections on difficult asthma and the treatment of exacerbations and acute severe asthma. Various outcome measures for auditing the quality of asthma care are discussed.

  11. JSNT-Guidelines for the Management of Severe Head Injury (Abridged edition).

    Science.gov (United States)

    Shima, Katsuji; Aruga, Tohru; Onuma, Takehide; Shigemori, Minoru

    2010-01-01

    The aim of this article is to introduce the principal part of the JSNT-guidelines for the management of severe head injury in adults. The JSNT-guidelines were developed in 2000 by the Guidelines Committee of the Japan Society of Neurotraumatology (JSNT) based on the results of literature review and the Committee consensus. The guidelines updated in 2006 consist of 7 topics pertaining not only to prehospital care, initial, ICU and surgical management, but also the management of pediatric and geriatric patients. The JSNT-guidelines are of practical nature accounting for the difference in the medical system and conditions in Japan, but in their essence they are similar to those of Western countries. Reports on the application of these guidelines indicate their positive affect on the results of management of severe head injury.

  12. 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.

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

    Science.gov (United States)

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

    2014-11-27

    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/m(2)) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m(2) and those with BMI > 35 kg/m(2) 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.

  14. Management of type 2 diabetes mellitus: is it in accordance with the guidelines?

    Science.gov (United States)

    Chan, G C; Ghazali, O; Khoo, E M

    2005-12-01

    A cross-sectional study was conducted among 517 patients with diabetes mellitus at all health centres in Melaka Tengah District to examine whether these patients and their associated cardiovascular risk factors were managed according to current guidelines. All patients had Type 2 diabetes mellitus with mean age of 57.9 +/- 10.5 years and the mean duration of diabetes was 7.2 +/- 6.0 years. The glycaemic control was poor with 53.6% of the patients having HbAlc above 8% (mean = 8.5%) and 24% of them had microalbuminuria. Among these patients with poor glycaemic control, about 47.6% of them were on monotherapy. Three hundred and fifty (67.7%) patients had hypertension but only 11 (3.1%) achieved target blood pressure of less than 130/80 mmHg. Only 18.3% of the diabetics with hypertension were prescribed angiotensin converting enzyme inhibitors and 0.3% with angiotensin receptor blockers. Nearly two-third of them had low-density lipoprotein cholesterol greater than 2.6 mmol/l (mean = 3.4 mmol/l) but only 6.8% were prescribed lipid-lowering agents. Aspirin was prescribed to 8.2% of diabetics aged above 40 years. Sixteen percent of the patients smoked, 53% did not do any exercise, and the mean BMI was 26.8 kg/mn. The management of diabetes mellitus and its associated cardiovascular risk factors was suboptimal on the basis of current clinical guidelines. A greater effort in educating doctors in the health centres about these management and adherence to the guidelines is important in reducing patients' risk of cardiovascular disease and its associated morbidity and mortality.

  15. Ageing male and testosterone: Current status and treatment guidelines

    Directory of Open Access Journals (Sweden)

    S S Vasan

    2006-01-01

    Full Text Available Because the decline in androgens is generally gradual and not a complete deficiency, clinical significance of this decline is still unclear, and there is controversy as to whether a specific syndrome of androgen deficiency or ′andropause′ exists. The term andropause or androgen deficiency in aging males (ADAM underwent revisions to, partial androgen deficiency in aging male (PADAM, late onset hypogonadism (LOH and now symptomatic late onset hypogonadism (SLOH, signifying, the evolving nature of this phenomenon. Since this happens at a time of life, when many men have associated comorbities, it′s difficult to assess the exact impact of androgen decline, due to which, the issues surrounding androgen replacement therapy in men with symptomatic late-onset hypogonadism have been marred in controversy. Although with age, a decline in testosterone levels will occur in virtually all men, there is no way of predicting, who, will experience andropausal symptoms of sufficient severity and also long-term safety data on testosterone administration in this setting, is lacking. This article will focus on the controversies and practices of androgen replacement.

  16. Management of hypertension in CKD: beyond the guidelines.

    Science.gov (United States)

    Judd, Eric; Calhoun, David A

    2015-03-01

    Hypertension (HTN) and CKD are closely associated with an intermingled cause and effect relationship. Blood pressure (BP) typically rises with declines in kidney function, and sustained elevations in BP hasten progression of kidney disease. This review addresses current management issues in HTN in patients with CKD including altered circadian rhythm of BP, timing of antihypertensive medication dosing, BP targets, diagnostic challenges in evaluating secondary forms of HTN, and the role of salt restriction in CKD. HTN in patients with CKD is often accompanied by a decrease in the kidney's ability to remove salt. Addressing this salt sensitivity is critical for the management of HTN in CKD. In addition to the well-established use of an ACEI or angiotensin receptor blocker, dietary salt restriction and appropriate diuretic therapy make up the mainstay of HTN treatment in patients with CKD. Bedtime dosing of antihypertensive medications can restore nocturnal dips in BP, and future clinical practice guidelines may recommend bedtime dosing of 1 or more antihypertensive medications in patients with CKD.

  17. 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...

  18. Environmental guidelines for development of Cultural Resource Management plans. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-08-01

    The purpose of this document is to provide guidelines to the DOE field managements with responsibility for the development of an individual Cultural Resource Management Plan for each DOE facility and program.

  19. 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

  20. National stroke association guidelines for the management of transient ischemic attacks

    NARCIS (Netherlands)

    Johnston, S. Claiborne; Nguyen-Huynh, Mai N.; Schwarz, Miriam E.; Fuller, Kate; Williams, Christina E.; Josephson, S. Andrew

    2006-01-01

    Objective: Transient ischemic attacks are common and important harbingers of subsequent stroke. Management varies widely, and most published guidelines have not been updated in several years. We sought to create comprehensive, unbiased, evidence-based guidelines for the management of patients with t

  1. Management of Thyroid Peroxidase Antibody Euthyroid Women in Pregnancy: Comparison of the American Thyroid Association and the Endocrine Society Guidelines

    Directory of Open Access Journals (Sweden)

    L. Mehran

    2013-01-01

    Full Text Available The presence of thyroid autoantibodies is relatively high in women of childbearing age. There is evidence that positive thyroperoxidase antibody even in euthyroid women may increase the risk of spontaneous and recurrent pregnancy loss and preterm delivery. However, the evidence is not enough to justify recommendation on the screening of pregnant women for thyroid autoantibodies or LT4 supplementation for reducing maternal or fetal complications. In this paper we reviewed the related evidence and compared the new guidelines of the American Thyroid Association and Endocrine Society with respect to the screening and management of positive thyroperoxidase antibody in euthyroid pregnant women. As there was no major contradiction or disagreement between the two guidelines, either one of two guidelines may be used by clinicians for the appropriate management of thyroid autoimmunity during pregnancy.

  2. Utility of the 2006 Sendai and 2012 Fukuoka guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas

    Science.gov (United States)

    Hsiao, Chih-Yang; Yang, Ching-Yao; Wu, Jin-Ming; Kuo, Ting-Chun; Tien, Yu-Wen

    2016-01-01

    Abstract This study aimed to evaluate the utility of the 2006 Sendai and 2012 Fukuoka guidelines for differentiating malignant intraductal papillary mucinous neoplasm (IPMN) of the pancreas from benign IPMN. Between January 2000 and March 2015, a total of 138 patients underwent surgery and had a pathologically confirmed pancreatic IPMN. Clinicopathological parameters were reviewed, and all patients were classified according to both the 2006 Sendai and 2012 Fukuoka guidelines. Univariate and multivariate analyses were used for identifying significant factors associated with malignancy in IPMN. There were 9 high-grade dysplasia (HGD) and 37 invasive cancers (ICs) in the 138 patients. The positive predictive value (PPV) and negative predictive value (NPV) of the Sendai and Fukuoka guidelines for HGD/IC was 35.1%, 43.3%, 100%, and 85.4%, respectively. Of the 36 patients with worrisome features using the Fukuoka guideline, 7 patients had HGD/IC in their IPMNs. According to the multivariate analysis, jaundice, tumors of ≥3 cm, presence of mural nodule on imaging, and aged IPMN. The Sendai guideline had a better NPV, but the Fukuoka guideline had a better PPV. We suggest that patients with worrisome features based on the Fukuoka guideline be aggressively managed. PMID:27661043

  3. Identifying an appropriate Content Management System to develop Clinical Practice Guidelines: A perspective.

    Science.gov (United States)

    Reddy, Sandeep; Herring, Sally; Gray, Allison

    2015-12-03

    Clinical Practice Guidelines are widely used to inform and improve the quality and consistency of clinical practice. Developing and publishing Clinical Practice Guidelines is a complex task involving multiple components. Electronic Content Management Systems are increasingly employed to make this task more manageable. The Content Management System market offers a variety of options for publishing content on the Internet. However, there are limited products that comprehensively address the requirements of publishing Clinical Practice Guidelines. The authors are involved in publishing guidelines for remote clinical practitioners in Australia and present their perspective about identifying an appropriate Content Management System. Several elements essential to addressing their unique editing needs are defined in this article. Unfortunately, customisation is very expensive and laborious: few Content Management System providers can comprehensively meet the needs of Clinical Practice Guidelines publishing. Being pragmatic about the level of functionality a product can offer to support publication is essential.

  4. The wound/burn guidelines - 5: Guidelines for the management of lower leg ulcers/varicose veins.

    Science.gov (United States)

    Ito, Takaaki; Kukino, Ryuichi; Takahara, Masakazu; Tanioka, Miki; Nakamura, Yasuhiro; Asano, Yoshihide; Abe, Masatoshi; Ishii, Takayuki; Isei, Taiki; Inoue, Yuji; Imafuku, Shinichi; Irisawa, Ryokichi; Ohtsuka, Masaki; Ohtsuka, Mikio; Ogawa, Fumihide; Kadono, Takafumi; Kawakami, Tamihiro; Kawaguchi, Masakazu; Kono, Takeshi; Kodera, Masanari; Sakai, Keisuke; Nakanishi, Takeshi; Hashimoto, Akira; Hasegawa, Minoru; Hayashi, Masahiro; Fujimoto, Manabu; Fujiwara, Hiroshi; Maekawa, Takeo; Matsuo, Koma; Madokoro, Naoki; Yamasaki, Osamu; Yoshino, Yuichiro; Le Pavoux, Andres; Tachibana, Takao; Ihn, Hironobu

    2016-08-01

    Varicose veins are treated at multiple clinical departments, but as patients often visit the dermatology clinic first due to leg ulcers, the present Guidelines for the Management of Lower Leg Ulcers/Varicose Veins were prepared in consideration of the importance of the dermatologist's role. Also, the disease concept of chronic venous insufficiency or chronic venous disorders and the CEAP classification of these disorders are presented. The objective of the present guidelines is to properly guide the diagnosis and treatment of lower leg ulcers/varicose veins by systematically presenting evidence-based recommendations that support clinical decisions.

  5. [Pediatric pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group].

    Science.gov (United States)

    Párniczky, Andrea; Czakó, László; Dubravcsik, Zsolt; Farkas, Gyula; Hegyi, Péter; Hritz, István; Kelemen, Dezső; Morvay, Zita; Oláh, Attila; Pap, Ákos; Sahin-Tóth, Miklós; Szabó, Flóra; Szentkereszti, Zsolt; Szmola, Richárd; Takács, Tamás; Tiszlavicz, László; Veres, Gábor; Szücs, Ákos; Lásztity, Natália

    2015-02-22

    Pediatric pancreatitis is a rare disease with variable etiology. In the past 10-15 years the incidence of pediatric pancreatitis has been increased. The management of pediatric pancreatitis requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. In 8 clinical topics (diagnosis; etiology; prognosis; imaging; therapy; biliary tract management; complications; chronic pancreatitis) 50 relevant questions were defined. Evidence was classified according to the UpToDate(®) grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinical statements were accepted with total (more than 95%) agreement. The present Hungarian Pancreatic Study Group guideline is the first evidence based pediatric pancreatitis guideline in Hungary. The present guideline is the first evidence-based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference for daily patient care in pediatric pancreatitis and guides financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary.

  6. Space age management for social problems

    Science.gov (United States)

    Levine, A. L.

    1973-01-01

    Attempts to apply space age management to social problems were plagued with difficulties. Recent experience in the State of Delaware and in New York City, however, indicate new possibilities. Project management as practiced in NASA was applied with promising results in programs dealing with housing and social services. Such applications are feasible, according to recent research, because project management utilizes social and behavioral approaches, as well as advanced management tools, such as PERT, to achieve results.

  7. 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.

  8. Regional Guidelines for management of patients absent Without Leave (AWOL)

    OpenAIRE

    Public Health Agency

    2015-01-01

    The overarching purpose of these guidelines is to promote the safety and protection of service users and others in the event of a service user going missing or Absent Without Leave (AWOL). The guidelines provide a framework for all staff when it is determined that a service user is absent without leave.

  9. [Dutch Preventive Youth Health Care Service guideline on children born too early and/or too small for gestational age].

    Science.gov (United States)

    van der Pal, Sylvia M; Heerdink, Nen; Kamphuis, Mascha; Pols, Margreet A

    2014-01-01

    In children who are born prematurely or whose birth weight is too low for gestational age (small for gestational age (SGA)) intensive care and follow up are desirable.However, obstacles include the shared care of children born very preterm (care service (and other professionals) and the identification of possible late onset health problems in children born late preterm (32-37 weeks of gestation). This guideline is multidisciplinary and evidence based and is relevant to all professionals involved in the care of this group of children. The main recommendations are: (a) timely and complete transfer of information after discharge from hospital; (b) structured exchange of information in aftercare; (c) assigning a case manager to each child; (d) monitoring growth and development by adjusting age for preterm birth, and (e) using special growth charts for children born preterm to evaluate growth and development.

  10. Suggested guidelines for the diagnosis and management of urea cycle disorders

    Directory of Open Access Journals (Sweden)

    Häberle Johannes

    2012-05-01

    Full Text Available Abstract Urea cycle disorders (UCDs are inborn errors of ammonia detoxification/arginine synthesis due to defects affecting the catalysts of the Krebs-Henseleit cycle (five core enzymes, one activating enzyme and one mitochondrial ornithine/citrulline antiporter with an estimated incidence of 1:8.000. Patients present with hyperammonemia either shortly after birth (~50% or, later at any age, leading to death or to severe neurological handicap in many survivors. Despite the existence of effective therapy with alternative pathway therapy and liver transplantation, outcomes remain poor. This may be related to underrecognition and delayed diagnosis due to the nonspecific clinical presentation and insufficient awareness of health care professionals because of disease rarity. These guidelines aim at providing a trans-European consensus to: guide practitioners, set standards of care and help awareness campaigns. To achieve these goals, the guidelines were developed using a Delphi methodology, by having professionals on UCDs across seven European countries to gather all the existing evidence, score it according to the SIGN evidence level system and draw a series of statements supported by an associated level of evidence. The guidelines were revised by external specialist consultants, unrelated authorities in the field of UCDs and practicing pediatricians in training. Although the evidence degree did hardly ever exceed level C (evidence from non-analytical studies like case reports and series, it was sufficient to guide practice on both acute and chronic presentations, address diagnosis, management, monitoring, outcomes, and psychosocial and ethical issues. Also, it identified knowledge voids that must be filled by future research. We believe these guidelines will help to: harmonise practice, set common standards and spread good practices with a positive impact on the outcomes of UCD patients.

  11. The management of hypogonadism in aging male patients.

    Science.gov (United States)

    Sharma, Vishwamitra; Perros, Petros

    2009-01-01

    This article focuses on the evaluation and management of hypogonadism in aging male patients in the light of recent guidelines. The benefits of treating severe hypogonadism resulting from identifiable pituitary or primary gonadal disease are well established. Milder forms of hypogonadism in the aging male, known as andropause, are common, and constitute an expanding area of clinical interest and research. Several studies indicate that testosterone replacement therapy may produce a wide range of benefits for men with hypogonadism, including improvement in libido, bone density, muscle mass, body composition, mood, and cognition. Currently available data are insufficient to permit a definitive verdict on the balance between risks and benefits of testosterone replacement therapy in aging males.

  12. ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes.

    Science.gov (United States)

    Syngal, Sapna; Brand, Randall E; Church, James M; Giardiello, Francis M; Hampel, Heather L; Burt, Randall W

    2015-02-01

    This guideline presents recommendations for the management of patients with hereditary gastrointestinal cancer syndromes. The initial assessment is the collection of a family history of cancers and premalignant gastrointestinal conditions and should provide enough information to develop a preliminary determination of the risk of a familial predisposition to cancer. Age at diagnosis and lineage (maternal and/or paternal) should be documented for all diagnoses, especially in first- and second-degree relatives. When indicated, genetic testing for a germline mutation should be done on the most informative candidate(s) identified through the family history evaluation and/or tumor analysis to confirm a diagnosis and allow for predictive testing of at-risk relatives. Genetic testing should be conducted in the context of pre- and post-test genetic counseling to ensure the patient's informed decision making. Patients who meet clinical criteria for a syndrome as well as those with identified pathogenic germline mutations should receive appropriate surveillance measures in order to minimize their overall risk of developing syndrome-specific cancers. This guideline specifically discusses genetic testing and management of Lynch syndrome, familial adenomatous polyposis (FAP), attenuated familial adenomatous polyposis (AFAP), MUTYH-associated polyposis (MAP), Peutz-Jeghers syndrome, juvenile polyposis syndrome, Cowden syndrome, serrated (hyperplastic) polyposis syndrome, hereditary pancreatic cancer, and hereditary gastric cancer.

  13. Current management of bipolar affective disorder: is it reflective of the BAP guidelines?

    Science.gov (United States)

    Farrelly, N; Dibben, C; Hunt, N

    2006-01-01

    In October 2003 the British Association of Psychopharmacology (BAP) published evidence-based guidelines on the management of bipolar disorder. The aim of this study was to assess whether the guidelines could provide the basis for examining clinical decisions and the extent to which practice accords with these guidelines. Case notes of out patients with bipolar disorder were reviewed. Demographic details, and treatment recommendations were determined. The management of affective episodes was evaluated and compared with BAP guidelines. In 84 subjects, 224 affective episodes were identified. Treatment was consistent with BAP guidelines in 72% of episodes. Mania was more likely to be managed in accordance with guidelines than depression or mixed episodes. The use of antidepressant medication was the most likely intervention to deviate from recommendations. Reasons for treatments at odds with the guidelines were identified. Our study demonstrates that clinical practice among a range of psychiatrists broadly reflects the guidelines that have been issued by the British Association of Psychopharmacology (BAP). The BAP guidelines offer a practical and auditable basis for the short- and long-term treatment of bipolar affective disorder.

  14. Bullous pemphigoid: associations and management guidelines: facts and controversies.

    Science.gov (United States)

    Ruocco, Eleonora; Wolf, Ronni; Caccavale, Stefano; Brancaccio, Gabriella; Ruocco, Vincenzo; Lo Schiavo, Ada

    2013-01-01

    Bullous pemphigoid (BP) is an organ-specific human autoimmune disease typical of the elderly, which may be associated with many different disorders (immune, neurologic, psychiatric, hematologic, pulmonary, and cardiovascular), as well as with different types of tumors. The crucial question is whether these associations are casual or causal. In particular, the relationship between BP and malignancy is still a matter of debate. Although this association often has been emphasized, it is not clear whether the coexistent malignancy and BP are pathogenically connected or if their association is merely linked to aging. In our survey, the BP/neoplasm association ratios have not increased with age. Instead, significantly higher ratios have been found in younger patients; therefore, a meticulous investigation for a malignant neoplasm should always be pursued in young or middle-aged patients with BP, in particular regarding the severe forms of the disorder or those refractory to conventional treatment. The management of BP strictly depends on the multifactorial pathogenesis of this disorder. In fact, inflammation in BP seems to be more crucial for blister formation than in other autoimmune bullous disorders, such as pemphigus. Even if first-line treatments are typically immunosuppressants, newer therapeutic agents targeting specific pathogenic steps that are linked with inflammation have been proposed. Treatments selectively suppressing autoantibody formation, inflammation cascade, or both are available. Grouping therapies according to their mechanism of action may be useful to test new drug associations or to evaluate efficacy and tolerability of drugs with the same target.

  15. Management of asthma and COPD patients: feasibility of the application of guidelines in general practice.

    NARCIS (Netherlands)

    Jans, M.P.; Schellevis, F.G.; Hensbergen, W. van; Dukkers van Emden, T.; Eijk, J.T.M. van

    1998-01-01

    Objective: To examine the feasibility of the application of guidelines to the management of asthma and chronic obstructive pulmonary disease (COPD) by assessing compliance with the guidelines and listing the barriers general practitioners (GPs) encountered during implementation. Insight into the fea

  16. Dental management of patients using antithrombotic drugs: critical appraisal of existing guidelines

    NARCIS (Netherlands)

    van Diermen, D.E.; Aartman, I.H.A.; Baart, J.A.; Hoogstraten, J.

    2009-01-01

    Objectives The aims were: 1) to identify the guidelines available for management of dental invasive procedures in patients on antithrombotic drugs; 2) to assess their quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument; and 3) to summarize their conclusions and re

  17. European guidelines on management of restless legs syndrome

    DEFF Research Database (Denmark)

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

    2012-01-01

    of routine neurological practice in Europe. New drugs have also become available, and further randomized controlled trials have been undertaken. These guidelines were undertaken by the EFNS in collaboration with the European Neurological Society and the European Sleep Research Society....

  18. Characterizing patient-oriented tools that could be packaged with guidelines to promote self-management and guideline adoption: A meta-review

    NARCIS (Netherlands)

    Vernooij, R.W.M.; Willson, M.; Gagliardi, A.R.; Armstrong, M.; Brouwers, M.; Bussières, A.; Fleuren, M.; Gali, K.; Huckson, S.; Jones, S.; Lewis, S.Z.; James, R.; Marshall, C.; Mazza, D.

    2016-01-01

    Background: Self-management is an important component of care for patients or consumers (henceforth termed patients) with chronic conditions. Research shows that patients view guidelines as potential sources of self-management support. However, few guidelines provide such support. The primary purpos

  19. 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.

  20. Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines.

    Science.gov (United States)

    Mitchell, A L; Gandhi, A; Scott-Coombes, D; Perros, P

    2016-05-01

    This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the management of thyroid cancer in adults and is based on the 2014 British Thyroid Association guidelines. Recommendations • Ultrasound scanning (USS) of the nodule or goitre is a crucial investigation in guiding the need for fine needle aspiration cytology (FNAC). (R) • FNAC should be considered for all nodules with suspicious ultrasound features (U3-U5). If a nodule is smaller than 10 mm in diameter, USS guided FNAC is not recommended unless clinically suspicious lymph nodes on USS are also present. (R) • Cytological analysis and categorisation should be reported according to the current British Thyroid Association Guidance. (R) • Ultrasound scanning assessment of cervical nodes should be done in FNAC-proven cancer. (R) • Magnetic resonance imaging (MRI) or computed tomography (CT) should be done in suspected cases of retrosternal extension, fixed tumours (local invasion with or without vocal cord paralysis) or when haemoptysis is reported. When CT with contrast is used pre-operatively, there should be a two-month delay between the use of iodinated contrast media and subsequent radioactive iodine (I131) therapy. (R) • Fluoro-deoxy-glucose positron emission tomography imaging is not recommended for routine evaluation. (G) • In patients with thyroid cancer, assessment of extrathyroidal extension and lymph node disease in the central and lateral neck compartments should be undertaken pre-operatively by USS and cross-sectional imaging (CT or MRI) if indicated. (R) • For patients with Thy 3f or Thy 4 FNAC a diagnostic hemithyroidectomy is recommended. (R) • Total thyroidectomy is recommended for patients with tumours greater than 4 cm in diameter or tumours of any size in association with any of the following characteristics: multifocal disease, bilateral disease, extrathyroidal

  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. 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

  3. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and other causes of Thyrotoxicosis

    DEFF Research Database (Denmark)

    Ross, Douglas S; Burch, Henry B; Cooper, David S;

    2016-01-01

    BACKGROUND: Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management...

  4. Guidelines for applying management treatments to benefit breeding waterfowl in the Dakotas and Montana

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This report, created by the Region 6, Habitat and Population Evaluation Team (HAPET), provides biological guidelines for applying management treatments designed to...

  5. [Autoimmune pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group].

    Science.gov (United States)

    Dubravcsik, Zsolt; Farkas, Gyula; Hegyi, Péter; Hritz, István; Kelemen, Dezső; Lásztity, Natália; Morvay, Zita; Oláh, Attila; Pap, Ákos; Párniczky, Andrea; Sahin-Tóth, Miklós; Szentkereszti, Zsolt; Szmola, Richárd; Takács, Tamás; Tiszlavicz, László; Szücs, Ákos; Czakó, László

    2015-02-22

    Autoimmune pancreatitis is a rare disease which can even mimic pancreatic tumor, however, unlike the latter, it requires not surgical but conservative management. Correct diagnosis and differential diagnosis of autoimmune pancreatitis and treatment of these patients requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 29 relevant clinical questions in 4 topics were defined (Basics; Diagnosis; Differential diagnostics; Therapy). Evidence was classified according to the UpToDate(®) grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinial questions were accepted with almost total (more than 95%) agreement. The present guideline is the first evidence based autoimmune pancreatitis guideline in Hungary. The guideline may provide very important and helpful data for tuition of autoimmune pancreatitis, for everyday practice and for establishing proper finance. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary.

  6. 7 CFR 1484.33 - Must Cooperators follow certain financial management guidelines?

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Must Cooperators follow certain financial management... follow certain financial management guidelines? (a) A Cooperator shall implement and maintain a financial management system that conforms to generally accepted accounting principles. (b) A Cooperator shall...

  7. 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.

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

    DEFF Research Database (Denmark)

    Vasen, Hans F A; Blanco, Ignacio; Aktan-Collan, Katja

    2013-01-01

    important clinical questions. Then a systematic literature search was performed using the Pubmed database and manual searches of relevant articles. During the workshops the outcome of the literature search was discussed in detail. The guidelines described in this paper may be helpful for the appropriate...

  10. Guidelines for the management of work-related asthma

    NARCIS (Netherlands)

    Baur, X.; Sigsgaard, T.; Aasen, T.B.; Burge, P.S.; Heederik, D.; Henneberger, P.; Maestrelli, P.; Rooyackers, J.M.; Schlünssen, V.; Vandenplas, O.; Wilken, D.

    2012-01-01

    Work-related asthma, which includes occupational asthma and work-aggravated asthma, has become one of the most prevalent occupational lung diseases. These guidelines aim to upgrade occupational health standards, contribute importantly to transnational legal harmonisation and reduce the high socio-ec

  11. Eyelid aging: pathophysiology and clinical management

    Directory of Open Access Journals (Sweden)

    Renato Wendell Damasceno

    2015-10-01

    Full Text Available ABSTRACTLife expectancy is increasing in most countries. With increasing age, many individuals may develop involutional ophthalmic diseases, such as eyelid aging. Dermatochalasis, ptosis, ectropion, and entropion are common disorders in middle-aged and older adults. This review outlines the pathophysiology and clinical management of these involutional eyelid disorders. Recently, a decrease in elastic fibers with ultrastructural abnormalities and an overexpression of elastin-degrading enzymes have been demonstrated in involutional ectropion and entropion. This may be the consequence of local ischemia, inflammation, and/or chronic mechanical stress. Eyelid aging with progressive loss of tone and laxity may affect the ocular surface and adnexal tissues, resulting in different clinical symptoms and signs. Surgical management depends on the appropriate correction of the underlying anatomical defect.

  12. The dissemination of the British Guideline on the Management of Asthma 2003.

    Science.gov (United States)

    Dennis, S M; Edwards, S; Partridge, M R; Pinnock, H J; Qureshi, S J

    2004-09-01

    The BTS/SIGN British Guideline on the Management of Asthma was published in February 2003 (4). If health outcomes are to be influenced successfully, dissemination of the guideline and implementation of recommendations is essential. We report the dissemination activities undertaken during the 18 weeks following the guideline launch. To facilitate implementation a range of educational materials were produced reflecting the key messages from the guideline. In addition to postal mailing of the guideline to appropriate healthcare professionals, both educational materials and the guidelines were made freely available from the BTS and SIGN websites. In total, 135,710 copies of the guideline and 90,198 copies of the Quick Reference Guide were downloaded in the first 18 weeks, representing a considerable increase over the number of copies of the 1997 guidelines disseminated by mailing alone. Large quantities of educational materials were downloaded with many used for teaching purposes. An on-line survey suggested that most respondents rated the materials as useful or very useful. Using websites to disseminate guidelines is a cost-effective method of informing health professionals of their content and is a more active process than the passive receipt of mailed copies. The availability of interactive educational materials for use in teaching appears to have been popular.

  13. Clinical practice guidelines for the medical management of nonhospitalized ulcerative colitis: The patient perspective.

    Science.gov (United States)

    Steinhart, A Hillary; Fernandes, Aida

    2015-01-01

    A series of clinical practice guidelines were recently developed by the Canadian Association of Gastroenterology (CAG) to provide clinicians with recommendations for the medical management of nonhospitalized ulcerative colitis (UC) patients. These guidelines were developed, reviewed and agreed on by expert clinicians and methodologists. Following the finalization of the guidelines, a group of patients with UC as well as several inflammatory bowel disease clinicians, were brought together for a half-day workshop to provide feedback from the patient perspective. At the workshop, the guideline development process was described and the guidelines were reviewed to ensure comprehension. Patients then had the opportunity to provide their insight to the relevance of the guideline development process and the content of the guidelines as it related to their personal experiences with UC. The patient group believed that, although the new guidelines will be a tremendous resource for the health care provider community, a more 'lay-friendly' version would better facilitate dialogue between patients and their health care practitioners. The importance of the patient/physician relationship is paramount when making decisions regarding treatment plans, in which patient preferences play a key role in determining the most appropriate therapy and dosing regimen, which, in turn, impact the likelihood of adherence to the treatment plan. It was also believed that quality of life issues were not fully addressed in the guidelines. Much could be learned from shared experiences and coping strategies that would empower patients to take charge of their health and become equal partners with their care providers.

  14. An international comparison of occupational health guidelines for the management of mental disorders and stress-related psychological symptoms

    NARCIS (Netherlands)

    Joosen, Margot C. W.; Brouwers, Evelien P. M.; van Beurden, Karlijn M.; Terluin, Berend; Ruotsalainen, Jani H.; Woo, Jong-Min; Choi, Kyeong-Sook; Eguchi, Hisashi; Moriguchi, Jiro; van der Klink, Jac J. L.; van Weeghel, Jaap

    2015-01-01

    Background We compared available guidelines on the management of mental disorders and stress-related psychological symptoms in an occupational healthcare setting and determined their development and reporting quality. Methods To identify eligible guidelines, we systematically searched National Guide

  15. Guideline of the European Thyroid Association: Management of Subclinical Hypothyroidism

    Directory of Open Access Journals (Sweden)

    V V Fadeyev

    2013-12-01

    Full Text Available Европейская Тиреоидная ассоциация (ETA, www.eurothyroid.com в последние годы стала активно заниматься созданием и публикацией клинических рекомендаций по диагностике и лечению заболеваний щитовидной железы (ЩЖ. К слову, раньше ЕТА, в отличие от ее американских сестер, выпускавших и обновлявших по 3-4 рекомендации в год, особого внимания этому не уделяла. Сейчас же только в разработке постоянно находятся 2-3 документа, которые вывешены на сайте ассоциации, и всем ее членам предлагается критиковать их предварительные версии. На сей раз перед нами рекомендации по диагностике и лечению субклинического гипотиреоза (СГ, которые бы хотелось представить и обсудить. Pearce, Brabant G, Duntas L, Monzani F, Peeters R, Razvi S, Wemeau J1L. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J 2013;2:2151-228.

  16. Age to age: insight into managing a multigenerational staff.

    Science.gov (United States)

    Stanley, Kay B

    2007-01-01

    Diversity in age and culture-medical practices and healthcare entities mirror the business world in the diversity of culture and age groups among their employees and patients. Differences create challenges, but with understanding and skillful communication, distinctions become opportunities for growth and excellence. The concept we are exploring is that as a generation we are who we are because of what was going on in our world during our formative years. We find that just naming ourselves aspart ofa group is a good starting point. The objective of this article is to identify characteristics of various age groups and to present ways to promote harmony and to maximize performance through practical management techniques. The goal is to better understand ourselves and each other so that our work is more productive and rewarding.

  17. 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 treatment...... the Danish guidelines regarding the diagnostic criteria for acute otitis media and surgical treatment of RAOM and COME. METHODS: The GRADE system (The Grading of Recommendations Assessment, Development and Evaluation) was used in order to comply with current standards of evidence assessment in formulation...... of recommendations. An extensive literature search was conducted between July and December 2014. The quality of the existing literature was assessed using AGREE II (Appraisal of Guidelines for Research & Evaluation), AMSTAR (assessing the Methodological Quality of Systematic Reviews), QUADAS-2 (Quality of Diagnostic...

  18. European guidelines on managing adverse effects of medication for ADHD

    OpenAIRE

    Graham, J.; Banaschewski, Tobias; Buitelaar, J; Coghill, D.; Danckaerts, M.; Dittmann, R. W.; Döpfner, M.; Hamilton, R; Hollis, C.; Holtmann, M.; Hulpke-Wette, M.; Lecendreux, M.; Rosenthal, E; Rothenberger, A; Santosh, P.

    2011-01-01

    Abstract The safety of ADHD medications is not fully known. Concerns have arisen about both a lack of contemporary-standard information about medications first licensed several decades ago, and signals of possible harm arising from more recently developed medications. These relate to both relatively minor adverse effects and extremely serious issues such as sudden cardiac death and suicidality. A guidelines group of the European Network for Hyperkinetic Disorders (EUNETHYDIS) has t...

  19. AREVA-Aging Management Concepts and Tools

    Energy Technology Data Exchange (ETDEWEB)

    Zander, A.; Nopper, H.

    2014-07-01

    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)

  20. Acute adult asthma--assessment of severity and management and comparison with British Thoracic Society Guidelines.

    Science.gov (United States)

    Hart, S R; Davidson, A C

    1999-01-01

    To investigate the accuracy of clinical severity assessment of asthmatics and to compare emergency and subsequent ward management with British Thoracic Society (BTS) Guidelines, the records of all patients admitted for severe asthma (46) over a 5-month period to a District General Hospital were inspected. Variations from recommended management were revealed. Appropriate oxygen administration was often not provided in casually and patients frequently left hospital before their discharge criteria were attained: recommended diurnal variations in peak flow were exceeded in 26%. Eleven per cent of discharges were against medical advice, making provision of adequate management logistically difficult. Adherence to BTS guidelines on the need for arterial blood gas (ABG) analysis would have led to a failure to detect significant hypoxaemia in 25% of cases. This study identified substantial variations from BTS management guidelines. It is suggested that oximetry is necessary on arrival to guide selection for arterial blood gas analysis.

  1. The British Thoracic Society guidelines on the investigation and management of pulmonary nodules.

    Science.gov (United States)

    Baldwin, David R; Callister, Matthew E J

    2015-08-01

    The British Thoracic Society guideline for the investigation and management of pulmonary nodules is published as a supplement to this edition of the journal. It provides recommendations for the management of an individual with single or multiple pulmonary nodules and is a comprehensive reference text.

  2. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

    DEFF Research Database (Denmark)

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

    2017-01-01

    Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal ...

  3. Radix entomolaris: 2 case reports and clinical guidelines for endodontic management.

    Science.gov (United States)

    Latha, S Jothi; Velmurugan, N; Kavitha, M; Kumar, A R Pradeep

    2014-01-01

    Variations in dental anatomy and root canal systems are often reported in the dental literature. Among them, Radix entomolaris (RE) is the presence of an additional lingual root in mandibular molars. Though RE appears relatively infrequently, knowledge of the condition will aid in its management. This article presents 2 case reports of RE and clinical guidelines for endodontic management.

  4. Evidence-based guidelines for the management of hypertension in children with chronic kidney disease.

    Science.gov (United States)

    Dionne, Janis M

    2015-11-01

    Hypertension is common in children with chronic kidney disease and early evidence suggests that it is a modifiable risk factor for renal and cardiovascular outcomes. Recommendations for blood pressure management in children with chronic kidney disease can be found in various clinical practice guidelines including the 4th Task Force Report, the European Society of Hypertension pediatric recommendations, and the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for the management of blood pressure in chronic kidney disease. Unfortunately, as pediatric trial evidence is limited, there are discrepancies in the recommendations that may lead to inconsistent clinical care and practice variation. This article reviews the strength of evidence behind each of the clinical practice guideline recommendations regarding blood pressure assessment, treatment targets, and first-line antihypertensive medications. The benefits and cautions of use of clinical practice guidelines are described with emphasis on the importance of reading beyond the summary statements.

  5. A New Guidelines For Using Erythromycin In Management Of Childhood Cyclic Vomiting Syndrome

    Directory of Open Access Journals (Sweden)

    Mahmood Haghighat

    2016-11-01

    Full Text Available Cyclic vomiting syndrome (CVS is a functional disorder without any determined cause, though some motility disorders are considered in stream of this syndrome. There is no clear treatment for CVS and all treatments are borrowed from treatment of other similar diseases such as migraine. Clinical practice guideline instructs the pediatricians and pediatric gastroenterologists for treatment of CVS in both inpatient and outpatient settings. Since there is no practical guideline for the empirical management of CVS, this guideline was prepared for framing the treatments in a scienti­c and simple way for this disorder.

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

    OpenAIRE

    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.

  7. Guidelines for the management of neuroendocrine tumours by the Brazilian gastrointestinal tumour group

    Science.gov (United States)

    Riechelmann, Rachel P; Weschenfelder, Rui F; Costa, Frederico P; Andrade, Aline Chaves; Osvaldt, Alessandro Bersch; Quidute, Ana Rosa P; dos Santos, Allan; Hoff, Ana Amélia O; Gumz, Brenda; Buchpiguel, Carlos; Vilhena Pereira, Bruno S; Lourenço Junior, Delmar Muniz; da Rocha Filho, Duilio Reis; Fonseca, Eduardo Antunes; Riello Mello, Eduardo Linhares; Makdissi, Fabio Ferrari; Waechter, Fabio Luiz; Carnevale, Francisco Cesar; Coura-Filho, George B; de Paulo, Gustavo Andrade; Girotto, Gustavo Colagiovanni; Neto, João Evangelista Bezerra; Glasberg, João; Casali-da-Rocha, Jose Claudio; Rego, Juliana Florinda M; de Meirelles, Luciana Rodrigues; Hajjar, Ludhmila; Menezes, Marcos; Bronstein, Marcello D; Sapienza, Marcelo Tatit; Fragoso, Maria Candida Barisson Villares; Pereira, Maria Adelaide Albergaria; Barros, Milton; Forones, Nora Manoukian; do Amaral, Paulo Cezar Galvão; de Medeiros, Raphael Salles Scortegagna; Araujo, Raphael L C; Bezerra, Regis Otaviano França; Peixoto, Renata D’Alpino; Aguiar, Samuel; Ribeiro, Ulysses; Pfiffer, Tulio; Hoff, Paulo M; Coutinho, Anelisa K

    2017-01-01

    Neuroendocrine tumours are a heterogeneous group of diseases with a significant variety of diagnostic tests and treatment modalities. Guidelines were developed by North American and European groups to recommend their best management. However, local particularities and relativisms found worldwide led us to create Brazilian guidelines. Our consensus considered the best feasible strategies in an environment involving more limited resources. We believe that our recommendations may be extended to other countries with similar economic standards. PMID:28194228

  8. 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.

  9. 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.

  10. Challenge Identification for the Objective Provision Tree Application to the Effectiveness Evaluation for the Accident Management Guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Huichang [TUEV Rheinland Korea Ltd., Seoul (Korea, Republic of); Kim, Hanchul; Lee, Sunghan [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

    2013-05-15

    As a part of the OPT application for the effectiveness evaluation of the accident management guidelines, challenges which could threaten the safety functions required to maintain the safety, were identified. The identification of detailed provisions in terms of the accident management guidelines is being performed and the visualizing the identified elements of OPT is also under performance. With this logical structure of OPT, the provision of useful tool to evaluate the effectiveness of accident management guideline framework, is expected. The OPT method is a highly logical and top-down approach to identify the vulnerable aspect of the framework which includes the accident management guidelines, such as Emergency Operating Procedures (EOPs), Severe Accident Management Guides (SAMGs) and even Extensive Damage Mitigating Guidelines and FLEX guides. In virtue of this logical tool, the evaluation for the framework of the accident management guidelines was tried in this study.

  11. JSA guideline for the management of malignant hyperthermia crisis 2016.

    Science.gov (United States)

    2017-02-28

    Malignant hyperthermia (MH) can be fatal if the crisis is not appropriately treated. It is an inherited disease usually triggered by the administration of volatile inhalational anesthetics and/or succinylcholine, a muscle relaxant. In a patient with suspected MH, the mechanism of calcium release from storage in the sarcoplasmic reticulum in the skeletal muscle is abnormally accelerated. Unexplained hypercarbia representing >55 mmHg of end-tidal carbon dioxide, tachycardia, and muscle rigidity (including masseter muscle rigidity) are early signs of the initiation of MH, because the metabolism is accelerated. The body temperature can rise by >0.5 °C/15 min and may reach ≥40 °C. Respiratory and metabolic acidosis, arrhythmia, cola-colored urine, increased levels of serum potassium, and tented T-waves on electrocardiogram are common and can lead to cardiac arrest. MH should be treated by discontinuation of the triggering agents, administration of intravenous dantrolene (initially 1 mg/kg), and reduction of the body temperature. Early diagnosis and sufficient dantrolene with body temperature reduction are essential to relieve the patient's MH crisis. This guideline in Japanese translation has been posted on the website: http://www.anesth.or.jp/guide/pdf/guideline_akuseikounetsu.pdf .

  12. Improving Adherence to Guidelines for the Diagnosis and Management of Pelvic Inflammatory Disease: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Bette Liu

    2012-01-01

    Full Text Available Background. Evidence suggests adherence to clinical guidelines for pelvic inflammatory disease (PID diagnosis and management is suboptimal. We systematically reviewed the literature for studies describing strategies to improve the adherence to PID clinical guidelines. Methods. The databases MEDLINE and EMBASE, and reference lists of review articles were searched from January 2000 to April 2012. Only studies with a control group were included. Results. An interrupted time-series study and two randomised controlled trials (RCTs were included. The interrupted time-series found that following a multifaceted patient and practitioner intervention (practice protocol, provision of antibiotics on-site, written instructions for patients, and active followup, more patients received the recommended antibiotics and attended for followup. One RCT found a patient video on PID self-care did not improve medication compliance and followup. Another RCT found an abbreviated PID treatment guideline for health-practitioners improved their management of PID in hypothetical case scenarios but not their diagnosis of PID. Conclusion. There is limited research on what strategies can improve practitioner and patient adherence to PID diagnosis and management guidelines. Interventions that make managing PID more convenient, such as summary guidelines and provision of treatment on-site, appear to lead to better adherence but further empirical evidence is necessary.

  13. Overview of guidelines for the management of dyslipidemia: EU perspectives

    Directory of Open Access Journals (Sweden)

    Giner-Galvañ V

    2016-09-01

    Full Text Available Vicente Giner-Galvañ,1 María José Esteban-Giner,1 Vicente Pallarés-Carratalá2,3 1Department of General Internal Medicine, Unit of Hypertension and Cardiometabolic Risk, Hospital Mare de Déu dels Lliris, Alcoy, Alicante, 2Department of Health Surveillance, Unión de Mutuas, Castellón de la Plana, 3Department of Medicine, Universitat Jaume I, Castellón, Spain Abstract: Modern medicine is characterized by a continuous genesis of evidence making it very difficult to translate the latest findings into a better clinical practice. Clinical practice guidelines (CPG emerge to provide clinicians evidence-based recommendations for their daily clinical practice. However, the high number of existing CPG as well as the usual differences in the given recommendations usually increases the clinician’s confusion and doubts. It has apparently been the case for the 2013 American College of Cardiology/American Heart Association (ACC/AHA Guideline on the Treatment of Blood Cholesterol. These CPG proposed new and controversial concepts that have usually been considered an antagonist shift respective to European CPG. The most controversial published proposals are: 1 to consider evidence just from randomized clinical trials, 2 creation of a new cardiovascular (CV risk calculator, 3 to consider reducing CV risk instead of reducing low-density lipoprotein cholesterol (LDLc as the target of the treatment, and 4 consideration of statins as the only drugs for treatment. A deep analysis of the 2013 American College of Cardiology/American Heart Association CPG and comparison with the European ones show that from a practical and clinical point of view, there are more similarities than differences. To further help clinicians in their daily work, in the present globalized world, it is time to discuss and adopt a mutually agreed upon document created by both sides of the Atlantic. Probably it is not a short-term solution. Meanwhile, taking advantage of the similarities

  14. A framework for crafting clinical practice guidelines that are relevant to the care and management of people with multimorbidity.

    Science.gov (United States)

    Uhlig, Katrin; Leff, Bruce; Kent, David; Dy, Sydney; Brunnhuber, Klara; Burgers, Jako S; Greenfield, Sheldon; Guyatt, Gordon; High, Kevin; Leipzig, Rosanne; Mulrow, Cynthia; Schmader, Kenneth; Schunemann, Holger; Walter, Louise C; Woodcock, James; Boyd, Cynthia M

    2014-04-01

    Many patients of all ages have multiple conditions, yet clinicians often lack explicit guidance on how to approach clinical decision-making for such people. Most recommendations from clinical practice guidelines (CPGs) focus on the management of single diseases, and may be harmful or impractical for patients with multimorbidity. A major barrier to the development of guidance for people with multimorbidity stems from the fact that the evidence underlying CPGs derives from studies predominantly focused on the management of a single disease. In this paper, the investigators from the Improving Guidelines for Multimorbid Patients Study Group present consensus-based recommendations for guideline developers to make guidelines more useful for the care of people with multimorbidity. In an iterative process informed by review of key literature and experience, we drafted a list of issues and possible approaches for addressing important coexisting conditions in each step of the guideline development process, with a focus on considering relevant interactions between the conditions, their treatments and their outcomes. The recommended approaches address consideration of coexisting conditions at all major steps in CPG development, from nominating and scoping the topic, commissioning the work group, refining key questions, ranking importance of outcomes, conducting systematic reviews, assessing quality of evidence and applicability, summarizing benefits and harms, to formulating recommendations and grading their strength. The list of issues and recommendations was reviewed and refined iteratively by stakeholders. This framework acknowledges the challenges faced by CPG developers who must make complex judgments in the absence of high-quality or direct evidence. These recommendations require validation through implementation, evaluation and refinement.

  15. 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

  16. Guidelines for the evaluation and management of status epilepticus.

    Science.gov (United States)

    Brophy, Gretchen M; Bell, Rodney; Claassen, Jan; Alldredge, Brian; Bleck, Thomas P; Glauser, Tracy; Laroche, Suzette M; Riviello, James J; Shutter, Lori; Sperling, Michael R; Treiman, David M; Vespa, Paul M

    2012-08-01

    Status epilepticus (SE) treatment strategies vary substantially from one institution to another due to the lack of data to support one treatment over another. To provide guidance for the acute treatment of SE in critically ill patients, the Neurocritical Care Society organized a writing committee to evaluate the literature and develop an evidence-based and expert consensus practice guideline. Literature searches were conducted using PubMed and studies meeting the criteria established by the writing committee were evaluated. Recommendations were developed based on the literature using standardized assessment methods from the American Heart Association and Grading of Recommendations Assessment, Development, and Evaluation systems, as well as expert opinion when sufficient data were lacking.

  17. 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

  18. Ethical management guidelines for the shanghai disease-based biobank network.

    Science.gov (United States)

    Zhu, Shu; Shen, Mingxian; Qiu, Xiangxing; Gan, Rongxing; Hu, Qingli

    2015-02-01

    The Ethical Management Guidelines for the Shanghai Disease-Based Biobank Network are intended to safeguard the interests of all the participants, to standardize the construction, management, and resource sharing of the Shanghai Disease-based Biobank Network, to promote the development of medical research, and to improve public health and well-being. The guidelines contain seven chapters: General Principles; Informed Consent; Use of Bio-samples from Persons without the Capacity to Consent; Privacy and Confidentiality; Applications of Use of Biological Samples and Data; Intellectual Property and Resource Sharing; and Conflict of Interest.

  19. 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...

  20. 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.

  1. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus.

    Science.gov (United States)

    Fitzgerald, Rebecca C; di Pietro, Massimiliano; Ragunath, Krish; Ang, Yeng; Kang, Jin-Yong; Watson, Peter; Trudgill, Nigel; Patel, Praful; Kaye, Philip V; Sanders, Scott; O'Donovan, Maria; Bird-Lieberman, Elizabeth; Bhandari, Pradeep; Jankowski, Janusz A; Attwood, Stephen; Parsons, Simon L; Loft, Duncan; Lagergren, Jesper; Moayyedi, Paul; Lyratzopoulos, Georgios; de Caestecker, John

    2014-01-01

    These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia.

  2. SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014.

    Science.gov (United States)

    Lowe, Sandra A; Bowyer, Lucy; Lust, Karin; McMahon, Lawrence P; Morton, Mark; North, Robyn A; Paech, Michael; Said, Joanne M

    2015-10-01

    This guideline is an evidence based, practical clinical approach to the management of Hypertensive Disorders of Pregnancy. Since the previous SOMANZ guideline published in 2008, there has been significant international progress towards harmonisation of definitions in relation to both the diagnosis and management of preeclampsia and gestational hypertension. This reflects increasing knowledge of the pathophysiology of these conditions, as well as their clinical manifestations. In addition, the guideline includes the management of chronic hypertension in pregnancy, an approach to screening, advice regarding prevention of hypertensive disorders of pregnancy, and discussion of recurrence risks and long term risk to maternal health. The literature reviewed included the previous SOMANZ Hypertensive Disorders of Pregnancy guideline from 2008 and its reference list, plus all other published National and International Guidelines on this subject. Medline, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Registry of Controlled Trials (CCRCT), National Institute for Health and Care Excellence (NICE) Evidence Search, and Database of Abstracts and Reviews of Effects (DARE) were searched for literature published between January 2007 and March, 2014.

  3. Communication Management Guidelines for Software Organizations in Pakistan with clients from Afghanistan

    Science.gov (United States)

    Arif Shah, Muhammad; Hashim, Rathiah; Shah, Adil Ali; Farooq Khattak, Umar

    2016-11-01

    Developing software through Global Software Development (GSD) became very common now days in the software industry. Pakistan is one of the countries where projects are taken and designed from different countries including Afghanistan. The purpose of this paper is to identify and provide an analysis on several communication barriers that can have a negative impact on the project and to provide management guidelines for medium size software organizations working in Pakistan with clients from Afghanistan and to overcome these communication barriers and challenges organizations face when coordinating with client. Initially we performed a literature review to identify different communication barriers and to check if there are any standardized communications management guidelines for medium size software houses provided in the past. The second stage of the research paper involves guidelines with vendor's perspective that include interviews and focus group discussions with different stakeholders and employees of software houses with clients from Afghanistan. Based on those interviews and discussions we established communication management guidelines in order to overcome the communication problems and barriers working with clients from Afghanistan. As a result of the literature review, we have identified that barriers such as cultural barriers and language barrier were one of the main reasons behind the project failure and suggested that software organizations working in Pakistan should follow certain defined communication guidelines in order to overcome communication barriers that affect the project directly.

  4. Genetic management guidelines for captive propagation of freshwater mussels (unionoidea)

    Science.gov (United States)

    Jones, J.W.; Hallerman, E.M.; Neves, R.J.

    2006-01-01

    Although the greatest global diversity of freshwater mussels (???300 species) resides in the United States, the superfamily Unionoidea is also the most imperiled taxon of animals in the nation. Thirty-five species are considered extinct, 70 species are listed as endangered or threatened, and approximately 100 more are species of conservation concern. To prevent additional species losses, biologists have developed methods for propagating juvenile mussels for release into the wild to restore or augment populations. Since 1997, mussel propagation facilities in the United States have released over 1 million juveniles of more than a dozen imperiled species, and survival of these juveniles in the wild has been documented. With the expectation of continued growth of these programs, agencies and facilities involved with mussel propagation must seriously consider the genetic implications of releasing captive-reared progeny. We propose 10 guidelines to help maintain the genetic resources of cultured and wild populations. Preservation of genetic diversity will require robust genetic analysis of source populations to define conservation units for valid species, subspecies, and unique populations. Hatchery protocols must be implemented that minimize risks of artificial selection and other genetic hazards affecting adaptive traits of progeny subsequently released to the wild. We advocate a pragmatic, adaptive approach to species recovery that incorporates the principles of conservation genetics into breeding programs, and prioritizes the immediate demographic needs of critically endangered mussel species.

  5. Guidelines for the management of traumatic dental injuries. III. Primary teeth.

    Science.gov (United States)

    Flores, Marie Therese; Malmgren, Barbro; Andersson, Lars; Andreasen, Jens Ove; Bakland, Leif K; Barnett, Frederick; Bourguignon, Cecilia; DiAngelis, Anthony; Hicks, Lamar; Sigurdsson, Asgeir; Trope, Martin; Tsukiboshi, Mitsuhiro; von Arx, Thomas

    2007-08-01

    Trauma to the primary dentition present special problems and the management is often different as compared with permanent teeth. An appropriate emergency treatment plan is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. 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 specialties were included in the group. In cases in which the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence based on literature research and professional opinion. In this third article out of three, the IADT Guidelines for the management of traumatic injuries in the primary dentition, are presented.

  6. 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.

  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

    a sub workflow can be described in a declarative workflow management system: the Resultmaker Online Consultant (ROC). The example demonstrates that declarative primitives allow to naturally extend the paper based flowchart to an executable model without introducing a complex cyclic control flow graph....

  8. 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…

  9. Dyslipidemia management in primary prevention of cardiovascular disease:Current guidelines and strategies

    Institute of Scientific and Technical Information of China (English)

    Aditya D Hendrani; Tolulope Adesiyun; Renato Quispe; Steven R Jones; Neil J Stone; Roger S Blumenthal; Seth S Martin

    2016-01-01

    Cardiovascular disease is the leading cause of death in the United States. In 2010, the Centers for Disease Control and Prevention estimated that $444 billion was spent on cardiovascular diseases alone, about $1 of every $6 spent on health care. As life expectancy continues to increase, this annual cost will also increase, making costeffective primary prevention of cardiovascular disease highly desirable. Because of its role in development of atherosclerosis and clinical events, dyslipidemia management is a high priority in cardiovascular prevention. Multiple major dyslipidemia guidelines have been published around the world recently, four of them by independent organizations in the United States alone. They share the goal of providing clinical guidance on optimal dyslipidemia management, but guidelines differ in their emphasis on pharmacotherapy, stratification of groups, emphasis on lifestyle modification, and use of a fixed target or percentage reduction in low density lipoprotein cholesterol. This review summarizes eight major guidelines for dyslipidemia management and considers the basis for their recommendations. Our primary aim is to enhance understanding of dyslipidemia management guidelines in patient care for primary prevention of future cardiovascular risk.

  10. Managing Asthma in Elementary and Middle Schools: Adherence to Federal Laws and National Guidelines

    Science.gov (United States)

    Schilling, Ethan J.; Neuharth-Pritchett, Stacey; Getch, Yvette Q.; Lease, A. Michele

    2017-01-01

    The current study examined teacher-reported asthma management practices in school and adherence to federal guidelines for students with asthma. 593 kindergarten-eighth grade teachers completed surveys regarding compliance with federal laws and policies, information-seeking behavior, asthma-related professional development, and asthma management…

  11. 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,…

  12. 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.

  13. European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants - 2013 Update

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  14. 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-to-da...

  15. Evaluation of syndromic management guidelines for treatment of sexually transmitted infections in South African women

    NARCIS (Netherlands)

    van der Eem, Lisette; Dubbink, Jan Henk; Struthers, Helen E; McIntyre, James A; Ouburg, Sander; Morre, Servaas A; Kock, Marleen M; Peters, Remco P H

    2016-01-01

    OBJECTIVE: To evaluate the performance of three different guidelines for the management of vaginal discharge syndrome (VDS) for women living in a rural setting in South Africa. METHODS: We conducted a secondary analysis of data from a cross-sectional study in Mopani District, South Africa. The 2015

  16. Dyslipidemia management in primary prevention of cardiovascular disease: Current guidelines and strategies.

    Science.gov (United States)

    Hendrani, Aditya D; Adesiyun, Tolulope; Quispe, Renato; Jones, Steven R; Stone, Neil J; Blumenthal, Roger S; Martin, Seth S

    2016-02-26

    Cardiovascular disease is the leading cause of death in the United States. In 2010, the Centers for Disease Control and Prevention estimated that $444 billion was spent on cardiovascular diseases alone, about $1 of every $6 spent on health care. As life expectancy continues to increase, this annual cost will also increase, making cost-effective primary prevention of cardiovascular disease highly desirable. Because of its role in development of atherosclerosis and clinical events, dyslipidemia management is a high priority in cardiovascular prevention. Multiple major dyslipidemia guidelines have been published around the world recently, four of them by independent organizations in the United States alone. They share the goal of providing clinical guidance on optimal dyslipidemia management, but guidelines differ in their emphasis on pharmacotherapy, stratification of groups, emphasis on lifestyle modification, and use of a fixed target or percentage reduction in low density lipoprotein cholesterol. This review summarizes eight major guidelines for dyslipidemia management and considers the basis for their recommendations. Our primary aim is to enhance understanding of dyslipidemia management guidelines in patient care for primary prevention of future cardiovascular risk.

  17. ESCMID and ECMM Joint Clinical Guidelines for the Diagnosis and Management of Mucormycosis 2013

    NARCIS (Netherlands)

    Cornely, O.A.; Arikan-Akdagli, S.; Dannaoui, E.; Groll, A.H.; Lagrou, K.; Chakrabarti, A.; Lanternier, F.; Pagano, L.; Skiada, A.; Akova, M.; Arendrup, M.C.; Boekhout, T.; Chowdhary, A.; Cuenca-Estrella, M.; Freiberger, T.; Guinea, J.; Guarro, J.; de Hoog, S.; Hope, W.; Johnson, E.; Kathuria, S.; Lackner, M.; Lass-Flörl, C.; Lortholary, O.; Meis, J.F.; Meletiadis, J.; Muñoz, P.; Richardson, M.; Roilides, E.; Tortorano, A.M.; Ullmann, A.J.; van Diepeningen, A.; Verweij, P.; Petrikkos, G.

    2014-01-01

    These European Society for Clinical Microbiology and Infectious Diseases and European Confederation of Medical Mycology Joint Clinical Guidelines focus on the diagnosis and management of mucormycosis. Only a few of the numerous recommendations can be summarized here. To diagnose mucormycosis, direct

  18. 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-to-date...

  19. 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.

  20. Bangladesh national guidelines on the management of tuberculosis and diabetes mellitus co-morbidity (summary

    Directory of Open Access Journals (Sweden)

    Mohammad Delwar Hossain

    2016-01-01

    Full Text Available Tuberculosis (TB and diabetes mellitus (DM have synergetic relationship. People with diabetes are 2–3 times at higher risk of getting active TB disease. On the other hand, TB or anti-TB treatment may cause glucose intolerance. The dual disease of DM and TB is more likely to be associated with atypical disease presentation, higher probability of treatment failure and complications. In most of the health-care delivery systems of the world, DM and TB are managed separately by two vertical health-care delivery programs in spite of clear interaction between the two diseases. Thus, there should be a uniform management service for TB-DM co-morbidity. Realizing this situation, Bangladesh Diabetic Samity (BADAS, a nonprofit, nongovernment organization for the management of diabetes in Bangladesh, with the patronization of TB CARE II Project funded by U.S. Agency for International Development (USAID, launched a project in 2013 titled BADAS-USAID TB Care II, Bangladesh with the goal of “Integrated approach to increase access to TB services for diabetic patients.” One of the project objective and activity was to develop a national guideline for the management of TB-DM comorbidity. Thus, under the guidance of National Tuberculosis Control Program, of the Directorate General of Health Services, Government of the People's Republic of Bangladesh and World Health Organization (WHO, this guideline was developed in 2014. It is based on the existing “National Guidelines and Operational Manual for TB Control” (5th edition and guidelines for management of DM as per WHO and International Diabetes Federations. Along with that, expert opinions from public health experts and clinicians and “Medline”-searched literature were used to develop the guidelines. These guidelines illustrate the atypical presentation of the TB-DM co-morbidity, recommendations for screening, treatment, and follow-up of these patients and also recommendations in case of management of

  1. MANAGEMENT OF INFORMATION SECURITY FROM DEVELOPMENT STAGE BY APPLYING COBIT GUIDELINES

    OpenAIRE

    Ashish Ukidve*, Ds S S Mantha, Milind Tadvalkar

    2016-01-01

    COBIT is a collection of good processes and practices for IT governance. It offers the effective measures, indicators and activities for enterprise. COBIT has also been applied to many other governance, e.g. security governance, software process IT services management. Since COBIT is general-purpose, it requires expert knowledge for the implementation of each application. Although the guideline of security management are also published, we examined the contents of COBIT and defined a framewor...

  2. Environmental guidelines for Development of Cultural Resource Management plans. Working draft for comment

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-01

    DOE has stewardship responsibilities for managing the cultural resources remaining on DOE-owned and other lands impacted by DOE programs. Goal of the DOE-wide Cultural Resource Management (CRM) program is to identify and consolidate compliance actions associated with statutory and regulatory requirements. This document is to provide guidelines to DOE field managers; its implementation is intended to assure that each DOE facility and program complies with executive orders, statutes, and regulations governing the management of cultural resources. It covers CRM goals, existing conditions, CRM methods, CRM procedures and administration, and plan attachments. Glossary, legislation, and documents are covered in appendices.

  3. [Guidelines for the diagnosis and management of bronchial asthma--a comparison of the Japanese guidelines for the adult asthma with GINA and ICR].

    Science.gov (United States)

    Kabe, J

    1996-11-01

    Although the concept of asthma management of the Japanese Guidelines is basically similar in the other guidelines including GINA, ICR, of British Thoracic Society, and of the other countries, assuming that asthma is a chronic inflammatory disorder of the airway, the program of stepwise pharmacologic therapy is not the same in various points. Therapy suggested in the Japanese Guidelines is different in 1) oral antiallergic drugs are widely used, 2) patients prefer oral bronchodilators to inhaled bronchodilators, 3) sustained released theophylline in the long term management and intravenous infusion of aminophylline for the treatment of acute exacerbation are accepted and frequently used by the physicians. Also the differences in the choice of medication between GINA, which is characterized by concept of cost, and other guidelines are discussed.

  4. 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.

  5. 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.

  6. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease.

    Science.gov (United States)

    Ricotta, John J; Aburahma, Ali; Ascher, Enrico; Eskandari, Mark; Faries, Peter; Lal, Brajesh K

    2011-09-01

    Management of carotid bifurcation stenosis is a cornerstone of stroke prevention and has been the subject of extensive clinical investigation, including multiple controlled randomized trials. The appropriate treatment of patients with carotid bifurcation disease is of major interest to the community of vascular surgeons. In 2008, the Society for Vascular Surgery published guidelines for treatment of carotid artery disease. At the time, only one randomized trial, comparing carotid endarterectomy (CEA) and carotid stenting (CAS), had been published. Since that publication, four major randomized trials comparing CEA and CAS have been published, and the role of medical management has been re-emphasized. The current publication updates and expands the 2008 guidelines with specific emphasis on six areas: imaging in identification and characterization of carotid stenosis, medical therapy (as stand-alone management and also in conjunction with intervention in patients with carotid bifurcation stenosis), risk stratification to select patients for appropriate interventional management (CEA or CAS), technical standards for performing CEA and CAS, the relative roles of CEA and CAS, and management of unusual conditions associated with extracranial carotid pathology. Recommendations are made using the GRADE (Grades of Recommendation Assessment, Development and Evaluation) system, as has been done with other Society for Vascular Surgery guideline documents.[corrected] The perioperative risk of stroke and death in asymptomatic patients must be management as the first-line therapy.

  7. Kidney Disease: Improving Global Outcomes guidelines on anaemia management in chronic kidney disease: a European Renal Best Practice position statement.

    Science.gov (United States)

    Locatelli, Francesco; Bárány, Peter; Covic, Adrian; De Francisco, Angel; Del Vecchio, Lucia; Goldsmith, David; Hörl, Walter; London, Gerard; Vanholder, Raymond; Van Biesen, Wim

    2013-06-01

    Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) group has produced comprehensive clinical practice guidelines for the management of anaemia in CKD patients. These guidelines addressed all of the important points related to anaemia management in CKD patients, including therapy with erythropoieis stimulating agents (ESA), iron therapy, ESA resistance and blood transfusion use. Because most guidelines were 'soft' rather than 'strong', and because global guidelines need to be adapted and implemented into the regional context where they are used, on behalf of the European Renal Best Practice Advisory Board some of its members, and other external experts in this field, who were not participants in the KDIGO guidelines group, were invited to participate in this anaemia working group to examine and comment on the KDIGO documents in this position paper. In this article, the group concentrated only on those guidelines which we considered worth amending or adapting. All guidelines not specifically mentioned are fully endorsed.

  8. Total quality in acute care hospitals: guidelines for hospital managers.

    Science.gov (United States)

    Holthof, B

    1991-08-01

    Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements.

  9. 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

  10. 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......The aim of this brief paper is to raise two inter-related points of discussion on ISO certification as a travelling concept. One concerns the focus on ISO 14000 global standards as a concept being appropriated to different contexts, translated and transformed to perform in a new context. The second...

  11. Management of female uro-genital fistulas: Framing certain guidelines

    Directory of Open Access Journals (Sweden)

    Singh R

    2010-01-01

    Full Text Available Background: The study was carried out to discuss the pathogenesis and management protocol of seven different varieties of female uro-genital fistulas (FUGFs. Patients and Methods: During 2000-2007, total of 15 FUGFs were operated, which belonged to seven different varieties requiring different routes and surgical procedures for their repair. Different fistulas with different pathophysiological factors required specific examinations and investigations preoperatively. Results: The results of the repaired FUGFs, following the general surgical principles, were acceptable with formation of only one residual fistula. Conclusions: Successful correction of FUGFs is a surgical challenge. Detailed history, through examination and planning, atraumatic tissue handling, routine use of the interposition or onlay reinforcement flaps and vigilant postoperative care were found the key factors in successful outcome of the repaired fistulas.

  12. Practical Guideline for Fatigue Management in Inflammatory Bowel Disease.

    Science.gov (United States)

    Kreijne, J E; Lie, M R K L; Vogelaar, L; van der Woude, C J

    2016-01-01

    During active inflammatory bowel disease (IBD) fatigue is a common symptom, which seems related to active gut inflammation. However, even in remission many patients suffer from fatigue that negatively affects quality of life and work productivity. Currently, robust knowledge on the pathogenesis and treatment of IBD-related fatigue is lacking. In order to alleviate the burden of IBD-related fatigue, a systematic approach is mandatory. We propose a fatigue attention cycle to enhance identification, evaluation and management of fatigued IBD patients. The benefits of the cycle are twofold. Firstly, it allows the systematic and uniform identification of patients with severe fatigue, in turn allowing tailored non-pharmacological and pharmacological interventions. Secondly, uniform identification of such patients creates a well-defined patient base to investigate the underlying pathogenesis of fatigue, resulting in a greater understanding of this debilitating phenomenon and possibly resulting in the discovery of predictive factors and new treatment interventions.

  13. Administration and School Management: Adequacy Guidelines of Contemporary Capitalism

    Directory of Open Access Journals (Sweden)

    Flávio Reis Santos

    Full Text Available The theme of this article despite the fact that the applicant in the context of research in the field of education, gain importance and relevance because of all the reflections set out in the framework of the debate about the conduct of public policies for education to the extent that we note that the old problems remain negatively affecting both educational and school management, as the quality of the training processes that happen inside it. The practical continuity in the formulation and implementation of such policies may reside in the constant adaptation of the education and public school to the heterogeneity of the capitalist market demands in proportion as the Brazilian government underwent orientation and World Bank interference in the administration of social issues.

  14. 2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.

    Science.gov (United States)

    Macle, Laurent; Cairns, John; Leblanc, Kori; Tsang, Teresa; Skanes, Allan; Cox, Jafna L; Healey, Jeff S; Bell, Alan; Pilote, Louise; Andrade, Jason G; Mitchell, L Brent; Atzema, Clare; Gladstone, David; Sharma, Mike; Verma, Subodh; Connolly, Stuart; Dorian, Paul; Parkash, Ratika; Talajic, Mario; Nattel, Stanley; Verma, Atul

    2016-10-01

    The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.

  15. Uptake of guidelines in the management of patients taking anticoagulants and antiplatelet agents presenting for elective surgery.

    Science.gov (United States)

    Cheung, K; Halliwell, R; Cope, L; Khong, D

    2012-11-01

    Management guidelines for patients on antithrombotic agents presenting for surgery have long been disseminated. Clinical practice, however, does not always follow published guidelines in a timely manner, despite their dissemination. This project is an audit of the management of patients on anticoagulants or antiplatelet agents presenting for elective surgery in a large metropolitan teaching hospital. An audit was conducted of the management of patients on anticoagulants or antiplatelet agents presenting for elective surgery at Westmead Hospital to determine the percentage of patients whose management complied with guidelines, and to identify the prevailing reasons for guideline deviation. This was an observational study with qualitative and quantitative aspects. Data was collected for the 102 patients who fulfilled the inclusion criteria: 55.4% of decisions by surgeons and 51.4% of decisions by anaesthetists made in this study matched guidelines; 31.4% of decisions made by anaesthetists were fully compliant with guidelines; 20% of anaesthetic decisions were unintentionally compliant and 48.6% of anaesthetic decisions were noncompliant. A variety of reasons were cited for decisions made without the use of guidelines such as other clinical imperatives, lack of guideline awareness and a belief that it is not the role of the anaesthetist to manage perioperative antithrombotic therapy, amongst others. It is evident from this audit that compliance with guidelines remains an area where there is an opportunity for further practice improvement.

  16. 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.

  17. 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

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

    Directory of Open Access Journals (Sweden)

    Angel Moya

    2010-01-01

    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 (

  19. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP.

    Science.gov (United States)

    Lingford-Hughes, A R; Welch, S; Peters, L; Nutt, D J

    2012-07-01

    The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.

  20. Diagnosis and management of hymenoptera venom allergy: British Society for Allergy and Clinical Immunology (BSACI) guidelines.

    Science.gov (United States)

    Krishna, M T; Ewan, P W; Diwakar, L; Durham, S R; Frew, A J; Leech, S C; Nasser, S M

    2011-09-01

    This guidance for the management of patients with hymenoptera venom allergy has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and pediatricians practising allergy. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are epidemiology, risk factors, clinical features, diagnostic tests, natural history of hymenoptera venom allergy and guidance on undertaking venom immunotherapy (VIT). There are also separate sections on children, elevated baseline tryptase and mastocytosis and mechanisms underlying VIT. Finally, we have made recommendations for potential areas of future research.

  1. 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.

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

    DEFF Research Database (Denmark)

    Tølle, Martin; Vesterager, Johan

    2002-01-01

    to the Virtual Enterprise concept of GLOBEMEN as well as introducing different types of partnership and information needs related to each of these. - Chapter 4 gives a description of a Vision and Business Environment for OKP This section starts with a description of the holistic vision of how an OKP enterprise......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...... (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-Project...

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

    DEFF Research Database (Denmark)

    Juul, N.; Sollid, S.; Sundstrom, T.

    2008-01-01

    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

    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.

  5. [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.

  6. Treating asthma by the guidelines: developing a medication management information system for use in primary care.

    Science.gov (United States)

    Twiggs, Joan E; Fifield, J; Jackson, E; Cushman, R; Apter, A

    2004-01-01

    The aim of this study was to develop, implement, and assess an automated asthma medication management information system (MMIS) that provides patient-specific evaluative guidance based on 1997 NAEPP clinical consensus guidelines. MMIS was developed and implemented in primary care settings within a pediatric asthma disease management program. MMIS infrastructure featured a centralized database with Internet access. MMIS collects detailed patient asthma medication data, evaluates pharmacotherapy relative to practitioner-reported disease severity, symptom control and model of guideline-recommended severity-appropriate medications and produces a patient-specific "curbside consult" feedback report. A system algorithm translates actual detailed medication data into actual severity-specific medication-class combinations. A table-driven computer program compares actual medication-class combinations to a guideline-based medication-class combinations model. Methodology determines whether the patient was prescribed a "severity-appropriate" amount or an amount "more" or "less" medication than indicated for patient's reported severity. Feedback messages comment on comparison. Missing data, unrecognized amounts of controller medication or unrecognized medication combinations create error cases. Post hoc review analyzed error cases to determine prevalence of non-guideline medicating practices among these practitioners. Proportion of valid and error cases across two clinical visits before and after post hoc clinical review were measured, as well as proportion of severity-appropriate, out-of-severity and non-guideline medications. MMIS produced a valid feedback report for 83% of patient visits. Missing data accounted for 60% of error cases. Practitioners used severity-appropriate medications for 60% of cases. When non-severity-appropriate medications were used they tended to be "too much" rather than "too little" (22%, 5%), suggesting appropriate use of guideline-recommended "step

  7. Evidence, Guidelines, and Gut Checks: Musings on Entering the Post-Statin Era of Lipid Management.

    Science.gov (United States)

    Mancini, G B John

    2016-03-01

    This viewpoint describes the results of a survey administered to 55 physicians who are key opinion leader experts in dyslipidemia management and thoroughly knowledgeable about current guidelines and emerging therapies. The purpose was to determine the level of low density lipoprotein-cholesterol (LDL-C) achieved with maximally tolerated statin monotherapy that would trigger a preference by most for use of the soon to be available proprotein convertase subtilisin/kexin type 9 inhibitor as the next add-on agent. Because current guidelines suggest a uniform LDL-C goal when treating patients meeting guideline indications for therapy, it was expected that the size of the gap between LDL-C goal and LDL-C attained with maximally tolerated statins would uniformly dictate when proprotein convertase subtilisin/kexin type 9 inhibitors would be desired. This expectation, however, was not met. In particular, the results suggest that primary prevention patients and patients with chronic kidney disease do not appear to represent high priority circumstances for achieving even the current LDL-C goal despite existing guidelines. Implications for future guidelines in the post-statin era are discussed.

  8. Integration of complementary and alternative medicine information and advice in chronic disease management guidelines.

    Science.gov (United States)

    Team, Victoria; Canaway, Rachel; Manderson, Lenore

    2011-01-01

    The growing evidence on the benefits and risks of complementary and alternative medicine (CAM) and its high rate of use (69% of Australians) - particularly for chronic or recurrent conditions - means increasing attention on CAM. However, few people disclose CAM use to their GP, and health professionals tend to inadequately discuss CAM-related issues with their patients, partly due to insufficient knowledge. As clinical and non-clinical chronic condition management guidelines are a means to educate primary health care practitioners, we undertook a content analysis of guidelines relevant to two common chronic conditions - cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) - to assess their provision of CAM-related information. Ten current Australian guidelines were reviewed, revealing scant CAM content. When available, the CAM-relevant information was brief, in some cases unclear, inconclusive and lacking in direction to the GP or health care provider. Although we focus on CVD and T2DM, we argue the value of all chronic condition management guidelines integrating relevant evidence-informed information and advice on CAM risks, benefits and referrals, to increase GP awareness and knowledge of appropriate CAM therapies, and potentially to facilitate doctor-client discussion about CAM.

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

    DEFF Research Database (Denmark)

    McAlindon, T E; Bannuru, R R; Sullivan, M C

    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, Belgium, Sweden, Denmark, Australia, Japan, and Canada) and a patient representative comprised the Osteoarthritis...

  10. Recommendations for the Clinical Management of Hepatitis C in Iran: A Consensus-Based National Guideline

    Science.gov (United States)

    Alavian, Seyed Moayed; Hajarizadeh, Behzad; Bagheri Lankarani, Kamran; Sharafi, Heidar; Ebrahimi Daryani, Nasser; Merat, Shahin; Mohraz, Minoo; Mardani, Masoud; Fattahi, Mohamad Reza; Poustchi, Hossein; Nikbin, Mehri; Nabavi, Mahmood; Adibi, Peyman; Ziaee, Masood; Behnava, Bita; Rezaee-Zavareh, Mohammad Saeid; Colombo, Massimo; Massoumi, Hatef; Bizri, Abdul Rahman; Eghtesad, Bijan; Amiri, Majid; Namvar, Ali; Hesamizadeh, Khashayar; Malekzadeh, Reza

    2016-01-01

    Context Hepatitis C virus (HCV) infection is a major public health issue worldwide, including Iran. The new direct-acting antiviral agents (DAAs) with high efficacy have changed the landscape of HCV treatment. This guideline provides updated recommendations for clinical management of HCV infection in Iran. Evidence Acquisition The recommendations of this guideline are based on international and national scientific evidences and consensus-based expert opinion. Scientific evidences were collected through a systematic review of studies that evaluated efficacy and safety of DAA regimens, using PubMed, Scopus and Web of Science. Expert opinion was based on the consensus of Iran Hepatitis Scientific Board (IHSB) in the 3rd national consensus on management of Hepatitis C in Iran, held on 22nd of July 2016. Results Pegylated Interferon alpha (PegIFN), Ribavirin (RBV), Sofosbuvir (SOF), Ledipasvir (LDV) and Daclatasvir (DCV) are currently available in Iran. Pre-treatment assessments include HCV RNA level, HCV genotype and resistance testing, assessment of liver fibrosis, and underlying diseases. In HCV genotype 1 and 4, DCV/SOF and LDV/SOF are recommended. In HCV genotype 2, SOF plus RBV and in HCV genotype 3, DCV/SOF is recommended. Additional care for underlying diseases should be considered. Conclusions Affordable new HCV treatment regimens are available in Iran, providing an opportunity for HCV elimination. Recommendations provided in this current national guideline can facilitate evidence-based management of HCV infection. PMID:27799966

  11. Recommendations for the Clinical Management of Hepatitis C in Iran: A Consensus-Based National Guideline

    Directory of Open Access Journals (Sweden)

    Alavian

    2016-08-01

    Full Text Available Context Hepatitis C virus (HCV infection is a major public health issue worldwide, including Iran. The new direct-acting antiviral agents (DAAs with high efficacy have changed the landscape of HCV treatment. This guideline provides updated recommendations for clinical management of HCV infection in Iran. Evidence Acquisition The recommendations of this guideline are based on international and national scientific evidences and consensus-based expert opinion. Scientific evidences were collected through a systematic review of studies that evaluated efficacy and safety of DAA regimens, using PubMed, Scopus and Web of Science. Expert opinion was based on the consensus of Iran Hepatitis Scientific Board (IHSB in the 3rd national consensus on management of Hepatitis C in Iran, held on 22nd of July 2016. Results Pegylated Interferon alpha (PegIFN, Ribavirin (RBV, Sofosbuvir (SOF, Ledipasvir (LDV and Daclatasvir (DCV are currently available in Iran. Pre-treatment assessments include HCV RNA level, HCV genotype and resistance testing, assessment of liver fibrosis, and underlying diseases. In HCV genotype 1 and 4, DCV/SOF and LDV/SOF are recommended. In HCV genotype 2, SOF plus RBV and in HCV genotype 3, DCV/SOF is recommended. Additional care for underlying diseases should be considered. Conclusions Affordable new HCV treatment regimens are available in Iran, providing an opportunity for HCV elimination. Recommendations provided in this current national guideline can facilitate evidence-based management of HCV infection.

  12. Development of the regulatory guide on the management of aging for the operating NPP

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Tae Myung; Lee, Jae Kyung; Byeon, Chang Soo; Kim, Hyo Soo [Chungju Univ., Cheongju (Korea, Republic of); Kim, Young Ryul; Eun, Hui Kwang [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

    2000-03-15

    this is the first final report, and it includes the analysis of PSR regulation status for the operating NPP of foreign countries and thus established scope and method of Korean PSR. The detailed requirements of aging management, as one of the most important factors, is planned to be dealt in the second final report, The result of study so far can be summarized as below, The necessity and feasibility of domestic PSR application is confirmed through the investigation, comparison and review of PSR implementation and regulation status in foreign countries, And, detailed analysis of vaseline guidelines of IAEA performed to establish a skeleton of desirable safety review guideline for Korean NPP. Our own objectives, scope and strategy of review for PWR are roughly set up form factor by factor analysis of PSR implementation experience in foreign countries and background of IAEA guidelines. The essential elements of review for each PSR safety factors are classified and proposed. For efficient review of proposed safety factors and elements, three different option of framework for PSR guidelines are proposed and compared. Through analysis of strength safety factors and elements, three different options of framework for PSR guidelines are proposed and compared. Through analysis of strength and weakness of the three optional frameworks proposed for Korean PSR guideline, the third one is recommended as the best for both owner and regulator. By maintaining the current framework of SAR at maximum and, at the same time, referring the basic concept of IAEA PSR guide, the detailed contents and its review elements are chosen. The standards on the aging was proposed preliminarily for the application of aging evaluation in PSR.

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

    DEFF Research Database (Denmark)

    Heskestad, Ben; Waterloo, Knut; Ingebrigtsen, Tor;

    2012-01-01

    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...

  14. Influences on Case-Managed Community Aged Care Practice.

    Science.gov (United States)

    You, Emily Chuanmei; Dunt, David; Doyle, Colleen

    2016-10-01

    Case management has been widely implemented in the community aged care setting. In this study, we aimed to explore influences on case-managed community aged care practice from the perspectives of community aged care case managers. We conducted 33 semistructured interviews with 47 participants. We drew these participants from a list of all case managers working in aged care organizations that provided publicly funded case management program(s)/packages in Victoria, Australia. We used a multilevel framework that included such broad categories of factors as structural, organizational, case manager, client, and practice factors to guide the data analysis. Through thematic analysis, we found that policy change, organizational culture and policies, case managers' professional backgrounds, clients with culturally and linguistically diverse backgrounds, and case management models stood out as key influences on case managers' practice. In the future, researchers can use the multilevel framework to undertake implementation research in similar health contexts.

  15. Incorporating patient preferences in the management of multiple long-term conditions: is this a role for clinical practice guidelines?

    Directory of Open Access Journals (Sweden)

    Charlotte E. Young

    2015-11-01

    Full Text Available Background: Clinical practice guidelines provide an evidence-based approach to managing single chronic conditions, but their applicability to multiple conditions has been actively debated. Incorporating patient-preference recommendations and involving consumers in guideline development may enhance their applicability, but further understanding is needed. Objectives: To assess guidelines that include recommendations for comorbid conditions to determine the extent to which they incorporate patient-preference recommendations; use consumer-engagement processes during development, and, if so, whether these processes produce more patient-preference recommendations; and meet standard quality criteria, particularly in relation to stakeholder involvement. Design: A review of Australian guidelines published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Document analysis of guidelines examined the presence of patient-preference recommendations and the consumer-engagement processes used. The Appraisal of Guidelines for Research and Evaluation instrument was used to assess guideline quality. Results: Thirteen guidelines were reviewed. Twelve included at least one core patient-preference recommendation. Ten used consumer-engagement processes, including participation in development groups (seven guidelines and reviewing drafts (ten guidelines. More extensive consumer engagement was generally linked to greater incorporation of patient-preference recommendations. Overall quality of guidelines was mixed, particularly in relation to stakeholder involvement. Conclusions: Guidelines do incorporate some patient-preference recommendations, but more explicit acknowledgement is required. Consumer-engagement processes used during guideline development have the potential to assist in identifying patient preferences, but further research is needed. Clarification of the consumer role and investment in consumer training

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

    Science.gov (United States)

    Gupta, Dheeraj; Agarwal, Ritesh; Aggarwal, Ashutosh Nath; Maturu, V N; Dhooria, Sahajal; Prasad, K T; Sehgal, Inderpaul S; Yenge, Lakshmikant B; Jindal, Aditya; Singh, Navneet; Ghoshal, A G; Khilnani, G C; Samaria, J K; Gaur, S N; Behera, D

    2013-07-01

    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. The Saudi clinical practice guideline for the management of overweight and obesity in adults

    Science.gov (United States)

    Alfadda, Assim A.; Al-Dhwayan, Madhawi M.; Alharbi, Abdulhameed A.; Khudhair, Basema K. Al; Nozha, Omar M. Al; Al-Qahtani, Nawal M.; Alzahrani, Saad H.; Bardisi, Wedad M.; Sallam, Reem M.; Riva, John J.; Brożek, Jan L.; Schünemann, Holger J.; Moore, Ainsley

    2016-01-01

    Objective: To assist healthcare providers in evidence-based clinical decision-making for the management of overweight and obese adults in Saudi Arabia. Methods: The Ministry of Health, Riyadh, Kingdom of Saudi Arabia assembled an expert Saudi panel to produce this clinical practice guideline in 2015. In collaboration with the methodological working group from McMaster University, Hamilton, Canada, using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, which describes both the strength of recommendation and the quality of evidence Results: After identifying 11 questions, corresponding recommendations were agreed upon as guidance for the management of overweight and obese adults. These included strong recommendations in support of lifestyle interventions rather than usual care alone, individualized counseling interventions rather than generic educational pamphlets, physical activity rather than no physical activity, and physical activity in addition to diet rather than diet alone. Metformin and orlistat were suggested as conditional recommendations for the management of overweight and obesity in adults. Bariatric surgery was recommended, conditionally, for the management of obese adults (body mass index of ≥40 or ≥35 kg/m2 with comorbidities). Conclusions: The current guideline includes recommendation for the non-pharmacological, pharmacological, and surgical management of overweight and obese adults. In addition, the panel recommends conducting research priorities regarding lifestyle interventions and economic analysis of drug therapy within the Saudi context, as well as long term benefits and harms of bariatric surgery. PMID:27652370

  18. 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.

  19. Do United States' teachers know and adhere to the national guidelines on asthma management in the classroom? A systematic review.

    Science.gov (United States)

    Jaramillo, Yudilyn; Reznik, Marina

    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 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.

  20. 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.

  1. International clinical guideline for the management of classical galactosemia: diagnosis, treatment, and follow-up.

    Science.gov (United States)

    Welling, Lindsey; Bernstein, Laurie E; Berry, Gerard T; Burlina, Alberto B; Eyskens, François; Gautschi, Matthias; Grünewald, Stephanie; Gubbels, Cynthia S; Knerr, Ina; Labrune, Philippe; van der Lee, Johanna H; MacDonald, Anita; Murphy, Elaine; Portnoi, Pat A; Õunap, Katrin; Potter, Nancy L; Rubio-Gozalbo, M Estela; Spencer, Jessica B; Timmers, Inge; Treacy, Eileen P; Van Calcar, Sandra C; Waisbren, Susan E; Bosch, Annet M

    2017-03-01

    Classical galactosemia (CG) is an inborn error of galactose metabolism. Evidence-based guidelines for the treatment and follow-up of CG are currently lacking, and treatment and follow-up have been demonstrated to vary worldwide. To provide patients around the world the same state-of-the-art in care, members of The Galactosemia Network (GalNet) developed an evidence-based and internationally applicable guideline for the diagnosis, treatment, and follow-up of CG. The guideline was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. A systematic review of the literature was performed, after key questions were formulated during an initial GalNet meeting. The first author and one of the working group experts conducted data-extraction. All experts were involved in data-extraction. Quality of the body of evidence was evaluated and recommendations were formulated. Whenever possible recommendations were evidence-based, if not they were based on expert opinion. Consensus was reached by multiple conference calls, consensus rounds via e-mail and a final consensus meeting. Recommendations addressing diagnosis, dietary treatment, biochemical monitoring, and follow-up of clinical complications were formulated. For all recommendations but one, full consensus was reached. A 93 % consensus was reached on the recommendation addressing age at start of bone density screening. During the development of this guideline, gaps of knowledge were identified in most fields of interest, foremost in the fields of treatment and follow-up.

  2. 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.

  3. 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.

  4. 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.

  5. Comprehensive management of hydrocarbon storage tanks ageing

    Energy Technology Data Exchange (ETDEWEB)

    Lesueur, V.; Riethmuller, M.; Chauveau, D. [IS Services, Villepinte (France)

    2006-07-01

    Corrosion generates considerable material losses in industry and can result in irreversible damages to the environment and some times in losses in human lives. Hydrocarbon storage tanks are subject to various corrosion types like generalised corrosion resulting in large areas thickness reduction, or potentially dangerous local damage (pitting, crevice or craters). To keep safe storage conditions and save service life, it is essential: - to identify the risks by taking into account the stored products, the storage type, the environmental factors, the type of coating and the storage history, - to select the most appropriate NDT technique (acoustic emission, thickness ultrasonic measurement, TOFD, ACFM, visual inspection, remote UT..) depending on the part to be inspected and on the expected type of damage, - to propose the best solution for storage tank restoration (repair, improved protection..) - to modify the operating conditions - to define the NDT periodicity and the appropriate technique to apply according to the type of risks, to the former inspection results and to the regulation context, - to determine the remaining life of storage tank. This approach is named Comprehensive Management of hydrocarbon storage tank ageing. IS Services has developed a software called ''AGIR'' aiming at providing guidance and support to apply this approach. (orig.)

  6. Management of radiation oncology patients with a pacemaker or ICD : A new comprehensive practical guideline in The Netherlands

    NARCIS (Netherlands)

    Hurkmans, Coen W.; Knegjens, Joost L.; Oei, Bing S.; Maas, Ad J. J.; Uiterwaal, G. J.; van der Borden, Arnoud J.; Ploegmakers, Marleen M. J.; van Erven, Lieselot

    2012-01-01

    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. Availab

  7. 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...

  8. 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

  9. X-linked adrenoleukodystrophy (X-ALD: clinical presentation and guidelines for diagnosis, follow-up and management

    Directory of Open Access Journals (Sweden)

    Engelen Marc

    2012-08-01

    Full Text Available Abstract X-linked adrenoleukodystrophy (X-ALD is the most common peroxisomal disorder. The disease is caused by mutations in the ABCD1 gene that encodes the peroxisomal membrane protein ALDP which is involved in the transmembrane transport of very long-chain fatty acids (VLCFA; ≥C22. A defect in ALDP results in elevated levels of VLCFA in plasma and tissues. The clinical spectrum in males with X-ALD ranges from isolated adrenocortical insufficiency and slowly progressive myelopathy to devastating cerebral demyelination. The majority of heterozygous females will develop symptoms by the age of 60 years. In individual patients the disease course remains unpredictable. This review focuses on the diagnosis and management of patients with X-ALD and provides a guideline for clinicians that encounter patients with this highly complex disorder.

  10. Impact of updated European Consensus Guidelines on the management of neonatal respiratory distress syndrome on clinical outcome of preterm infants.

    Science.gov (United States)

    Smolarova, S; Kocvarova, L; Matasova, K; Zibolen, M; Calkovska, A

    2015-01-01

    European Consensus Guidelines (ECG) on the management of respiratory distress syndrome (RDS) have been developed and updated twice since 2007 reflecting changes in practice as new evidence emerges. The aim of this study was to evaluate the progress in clinical outcome of babies after the implementation of the updated ECG in 2010. Forty-eight neonates born in 2002-2003 (Group 02/03; n = 15) and in 2012-2013 (Group 12/13; n = 33) at gestational age of 26.2 ± 1.7 weeks were included into this retrospective study. Resuscitation procedures, ventilation support, and postnatal administration of surfactant were assessed. In Group 12/13, compared with Group 02/03, there was a higher rate of maternal corticosteroid prophylactic treatment (33 % vs. 0 %, p newborns improved considerably over the decade resulting in a significant reduction of mortality and morbidity.

  11. Guidelines for the management of gastroenteropancreatic neuroendocrine tumours (including bronchopulmonary and thymic neoplasms). Part II-specific NE tumour types

    DEFF Research Database (Denmark)

    Oberg, Kjell; Astrup, Lone Bording; Eriksson, Barbro;

    2004-01-01

    Part II of the guidelines contains a description of epidemiology, histopathology, clinical presentation, diagnostic procedure, treatment, and survival for each type of neuroendocrine tumour. We are not only including gastroenteropancreatic tumours but also bronchopulmonary and thymic neuroendocrine...... tumours. These guidelines essentially cover basic knowledge in the diagnosis and management of the different forms of neuroendocrine tumour. We have, however, tried to give more updated information about the epidemiology and histopathology, which is essential for the clinical management of these tumours....

  12. [Management of aortic valvular heart disease according to the 2012 guidelines].

    Science.gov (United States)

    Dayal, N B; Müller, H

    2014-05-28

    In 2012, the European Society of Cardiology (ESC) published an updated version of its guidelines on the management of valvular heart disease. Novelties include the use of advanced techniques for risk stratification and prognostic evaluation, such as stress and 3D echocardiography as well as measurement of left ventricular strain by speckle tracking. Equally important is the inclusion of percutaneous valve replacement or repair procedures, reflecting their ever-increasing use in clinical practice. Finally, the importance of a multidisciplinary approach to valvular heart disease, with collaboration of multiple specialities in a heart team has been put forward. We discuss practical aspects of the diagnostic and therapeutic approach to aortic valvular disease, including an outline of the surgical indications according to the ESC guidelines.

  13. [Guidelines for the management of severe traumatic brain injury. Part 3. Surgical management of severe traumatic brain injury (Options)].

    Science.gov (United States)

    Potapov, A A; Krylov, V V; Gavrilov, A G; Kravchuk, A D; Likhterman, L B; Petrikov, S S; Talypov, A E; Zakharova, N E; Solodov, A A

    2016-01-01

    Traumatic brain injury (TBI) is one of the main causes of mortality and severe disability in young and middle age patients. Patients with severe TBI, who are in coma, are of particular concern. Adequate diagnosis of primary brain injuries and timely prevention and treatment of secondary injury mechanisms markedly affect the possibility of reducing mortality and severe disability. The present guidelines are based on the authors' experience in developing international and national recommendations for the diagnosis and treatment of mild TBI, penetrating gunshot wounds of the skull and brain, severe TBI, and severe consequences of brain injury, including a vegetative state. In addition, we used the materials of international and national guidelines for the diagnosis, intensive care, and surgical treatment of severe TBI, which were published in recent years. The proposed recommendations for surgical treatment of severe TBI in adults are addressed primarily to neurosurgeons, neurologists, neuroradiologists, anesthesiologists, and intensivists who are routinely involved in treating these patients.

  14. 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

  15. Management guidelines of premature infants%早产儿管理指南

    Institute of Scientific and Technical Information of China (English)

    中华医学会儿科学分会新生儿学组

    2005-01-01

    Prematurity is one of the leading causes of death and disability in neonates. To improve the management of premature infants, the Subspecialty Group of Neonatology, Pediatric Society, Chinese Medical Association established the guideline on the 7th National Neonatal Academic Conference in October 2004. The guideline makes references to management at birth, respiration management, prevention and treatment of cerebral injury of premature infants, prevention and treatment of infection, maintenance of stable blood glucose, nutritional management, management of feeding intolerance, fluid balance, management of patent ducts arteriosus (PDA), prevention and treatment of anemia, treatment of jaundice of prematurity, prevention and treatment of retinopathy of prematurity (ROP), hearing screening, nursing and follow-up following discharge.%早产是新生儿发病和围产儿死亡最常见的因素,为提高早产儿的管理水平,降低病死率和致残率,新生儿学组经过2年多的讨论,于2004年10月第七届全国新生儿学术会议(海口)通过本指南,供各单位参考.本指南就早产儿出生时处理,呼吸管理,脑损伤的防治,感染的防治,保持血糖稳定,营养支持,消化问题的处理,液体平衡,动脉导管开放,贫血的防治,黄疸的治疗,早产儿视网膜病的防治,听力筛查,护理,出院后的随访等15个问题制定了具体的管理方案.

  16. 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.

  17. 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.

  18. Management of allergic and non-allergic rhinitis: a primary care summary of the BSACI guideline.

    Science.gov (United States)

    Angier, Elizabeth; Willington, Jenny; Scadding, Glenis; Holmes, Steve; Walker, Samantha

    2010-09-01

    Rhinitis is a common problem in primary care which is often managed sub-optimally. It causes considerable morbidity and has been shown to have a detrimental impact on people's ability to concentrate at school and at work. Rhinitis and asthma often present together, and symptomatic rhinitis can be associated with poor asthma control and increased risk of exacerbations. There is therefore a clear need to recognise and treat rhinitis according to guideline recommendations. This article is a primary care summary of the British Society for Allergy & Clinical Immunology (BSACI) Standards of Care Committee guideline on the management of rhinitis, written by a multi-disciplinary group of clinicians. It takes into account the time restrictions on assessment and the tests and equipment available in primary care, as well as the need for practical, clear and intuitive strategies for investigation and management. It recommends a stepwise approach to treatment, and highlights the relevance of less frequently prescribed treatments, including nasal douching leukotriene receptor antagonists and anticholinergics. Red flag symptoms are identified, together with indicators for referral. As with many other long term conditions, good communication between primary and secondary care in terms of timely and appropriate referral is a key factor for success.

  19. 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

    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...... and 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...

  20. Dental management of early childhood caries in spastic quadriparesis: a case report and clinical guidelines.

    Science.gov (United States)

    Hotwani, Kavita; Sharma, Krishna

    2013-01-01

    Cerebral palsy (CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of CP are often accompanied by epilepsy, secondary musculoskeletal problems, and disturbances of sensation, perception, cognition, communication, and behavior. Spastic quadriparesis is the most severe form of spastic cerebral palsy. The present report describes the management of a 5-year-old patient with early childhood caries and spastic quadriparesis. The oral manifestations and clinical guidelines are discussed considering the special health care needs in these patients so as to provide comprehensive dental care.

  1. GUIDELINES FOR RATIONALIZATION OF MANAGEMENT OF PERFORMANCE OF LOGISTICS SYSTEM OF TRANSPORT MACHINE MANUFACTURING ENTERPRISES

    Directory of Open Access Journals (Sweden)

    Yulia A. Anankina

    2013-01-01

    Full Text Available The main problems that occurs in a process of movement of material flows in the enterprises of transport machine manufacturing enterprises are stated in the article. Particular attention is paid to the rational use of vehicles on the existing capacity of the material flow of the enterprise. Process of transport service of material flow is concerned step by step. The place of transport in the logistics enterprise system is determined by authors. We give guidelines for rationalization of management of performance of logistics system of transport machine manufacturing enterprises in the context of compliance capacity utilization with the current provision of transport.

  2. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease

    DEFF Research Database (Denmark)

    Ruemmele, F M; Veres, G; Kolho, K L

    2014-01-01

    Children and adolescents with Crohn's disease (CD) present often with a more complicated disease course compared to adult patients. In addition, the potential impact of CD on growth, pubertal and emotional development of patients underlines the need for a specific management strategy of pediatric......-onset CD. To develop the first evidenced based and consensus driven guidelines for pediatric-onset CD an expert panel of 33 IBD specialists was formed after an open call within the European Crohn's and Colitis Organisation and the European Society of Pediatric Gastroenterolog, Hepatology and Nutrition...

  3. 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.

  4. 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

    and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations......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...

  5. Management of Breast Cancer during Pregnancy: Are We Compliant with Current Guidelines?

    Science.gov (United States)

    Shlensky, Victoria; Hallmeyer, Sigrun; Juarez, Lourdes; Parilla, Barbara V.

    2017-01-01

    Introduction The purpose of this study was to evaluate the management of patients with breast cancer in pregnancy treated at the Advocate Health Care, to determine whether these patients were treated according to guidelines for pregnant patients, which aim to maximize both fetal and maternal outcomes. Methods A retrospective chart review was performed at the Advocate Lutheran General Hospital, Christ Medical Center, and Illinois Masonic Medical Center from 2002 to 2012 on patients diagnosed with breast cancer during pregnancy using ICD-9 (International Classification of Diseases - 9th version) codes. Results Eleven patients between 12 and 37 weeks' gestation matched the search criteria. One patient terminated the pregnancy. Patients in our study were treated appropriately according to guidelines with the following exceptions. Trastuzumab was used in one patient during pregnancy which likely caused the oligohydramnios resulting in an induction of labor at 33 weeks. Three patients were delivered preterm between 34 and 36 weeks without an obstetric indication. Two patients underwent sentinel node biopsy. Conclusion The diagnosis of breast cancer in pregnancy is an infrequent but devastating diagnosis that is likely to increase. Although sentinel lymph node biopsy is not generally recommended in pregnancy, this may be an outdated guideline as using a low-dose lymphoscintigraphic technique appears to be safe in pregnancy. PMID:28255521

  6. [Gaucher disease--guidelines for diagnosis and management of adult patients].

    Science.gov (United States)

    Merkler, Marijan; Simić, Iveta; Pećin, Ivan; Muacević-Katanec, Diana; Sucur, Nediljko; Reiner, Zeljko

    2014-01-01

    Gaucher disease is an autosomal recessive disorder, characterized by decreased levels of the lysosomal enzyme glucocerebrosidase. This deficiency results in a decreased breakdown of this glycosphingolipid glucocerebroside, which accumulates in the lysosomes of the monocyte-macrophage system. It is the most common form of sphingolipidosis. Clinically, the principle signs of Gaucher's disease are hepatosplenomegaly, bone involvement, hematological changes and CNS involvement. The diagnosis of Gaucher disease has to be confirmed by the measurement of the activity of the enzyme glucocerebrosidase in leukocytes or fibroblasts and genetic testing. An effective therapy for Gaucher disease has now been available for more than 10 years. It consists of life-long intravenous replacement of the deficient enzyme--glucocerebrosidase. If enzyme replacement therapy is started early enough, it leads to significant improvement in patient's general condition and quality of life. The aim of this document is to provide to the Croatian medical audience the guidelines for diagnosis and management of adult patients with Gaucher disease. These guidelines are produced by specialists who have long lasting experience with patients with rare metabolic diseases working in the Division of Metabolic Diseases, Department of Internal Medicine, University Hospital Center Zagreb which is the Referral Center for Rare and Metabolic diseases of the Ministry of Health, Republic of Croatia. They were endorsed by the Croatian Society for Rare Diseases, Croatian Medical Association. These are the first guidelines published in Croatia on diagnosis, treatment and follow-up of Gaucher disease.

  7. 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

  8. The Turkish Guideline for the Diagnosis and Management of Urticaria-2016

    Directory of Open Access Journals (Sweden)

    Emek Kocatürk Göncü

    2016-09-01

    guideline will have a leading role in the diagnosis and treatment of urticaria and help the physician to overcome the challenges in the management.

  9. Integrated Pesticide Management at the Deutsche Bahn in Germany - guidelines for the sustainable vegetation management for maintenance of constructions and areas

    Directory of Open Access Journals (Sweden)

    Below, Michael

    2016-02-01

    Full Text Available The Deutsche Bahn has compiled guidelines for a sustainable vegetation management which follows the Directive 2009/128/EC. This integrated management includes tools like preventive measures, ensuring of the necessary level and check of success of applied plant protection measure. In detail, practical guidance for all constructions and areas are given where different legal regulations and requirements have to be implemented. The specific guidelines are available for unpaved surfaces, hard surfaces and railway tracks.

  10. Review of the International Society for Heart and Lung Transplantation Practice guidelines for management of heart failure in children.

    Science.gov (United States)

    Colan, Steven D

    2015-08-01

    In 2004, practice guidelines for the management of heart failure in children by Rosenthal and colleagues were published in conjunction with the International Society for Heart and Lung Transplantation. These guidelines have not been updated or reviewed since that time. In general, there has been considerable controversy as to the utility and purpose of clinical practice guidelines, but there is general recognition that the relentless progress of medicine leads to the progressive irrelevance of clinical practice guidelines that do not undergo periodic review and updating. Paediatrics and paediatric cardiology, in particular, have had comparatively minimal participation in the clinical practice guidelines realm. As a result, most clinical practice guidelines either specifically exclude paediatrics from consideration, as has been the case for the guidelines related to cardiac failure in adults, or else involve clinical practice guidelines committees that include one or two paediatric cardiologists and produce guidelines that cannot reasonably be considered a consensus paediatric opinion. These circumstances raise a legitimate question as to whether the International Society for Heart and Lung Transplantation paediatric heart failure guidelines should be re-reviewed. The time, effort, and expense involved in producing clinical practice guidelines should be considered before recommending an update to the International Society for Heart and Lung Transplantation Paediatric Heart Failure guidelines. There are specific areas of rapid change in the evaluation and management of heart failure in children that are undoubtedly worthy of updating. These domains include areas such as use of serum and imaging biomarkers, wearable and implantable monitoring devices, and acute heart failure management and mechanical circulatory support. At the time the International Society for Heart and Lung Transplantation guidelines were published, echocardiographic tissue Doppler, 3 dimensional

  11. 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...

  12. 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.)

  13. Factors Associated with Use of Guideline in Home Management of Malaria among Children in Rural South West Nigeria

    Science.gov (United States)

    Akerele, Adekunle; Yusuf, Oyindamola B.; Falade, Catherine O.; Ajayi, Ikeoluwapo O.; Pagnoni, Franco

    2011-01-01

    The dosage regimen for artemether-lumefantrine which is the standard of care for malaria in most of Sub-Saharan countries requires use of treatment guidelines and instructions to enhance caregivers' performance in the treatment of malaria. As part of a larger study evaluating its effectiveness in a rural local government area in southwestern Nigeria, 552 caregivers whose children had fever two weeks preceeding the survey were recruited. Information was collected with interviewer administered questionnaire. A multilevel logistic regression model was fitted using the gllamm approach in Stata to determine the factors associated with use of guideline. Age and educational background of caregiver were significantly associated with guideline use. Caregivers aged 26–30 years were 4 times more likely to use guideline than those aged >40 years. Caregivers with primary education were 4 times more likely to use guideline compared with caregivers with no formal education. Between-village variance was 0.00092 ± 0.3084. Guideline use reduced with increasing age and lower education. PMID:22312572

  14. Factors Associated with Use of Guideline in Home Management of Malaria among Children in Rural South West Nigeria

    Directory of Open Access Journals (Sweden)

    Adekunle Akerele

    2011-01-01

    Full Text Available The dosage regimen for artemether-lumefantrine which is the standard of care for malaria in most of Sub-Saharan countries requires use of treatment guidelines and instructions to enhance caregivers' performance in the treatment of malaria. As part of a larger study evaluating its effectiveness in a rural local government area in southwestern Nigeria, 552 caregivers whose children had fever two weeks preceeding the survey were recruited. Information was collected with interviewer administered questionnaire. A multilevel logistic regression model was fitted using the gllamm approach in Stata to determine the factors associated with use of guideline. Age and educational background of caregiver were significantly associated with guideline use. Caregivers aged 26–30 years were 4 times more likely to use guideline than those aged >40 years. Caregivers with primary education were 4 times more likely to use guideline compared with caregivers with no formal education. Between-village variance was 0.00092 ± 0.3084. Guideline use reduced with increasing age and lower education.

  15. 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.

  16. 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

  17. Progress in the implementation of NCCN guidelines for distress management by member institutions.

    Science.gov (United States)

    Donovan, Kristine A; Jacobsen, Paul B

    2013-02-01

    A 2005 survey of NCCN Member Institutions was among the first studies to evaluate the extent to which key elements of the NCCN Clinical Practice Guidelines in Oncology for Distress Management were being implemented as part of routine clinical practice. This study seeks to characterize current implementation of the guidelines by NCCN Member Institutions 7 years after the original study. Institutional representatives appointed to the NCCN Distress Management Panel were asked to complete an online survey in June 2012. The survey was similar to the 2005 survey, except that it solicited additional details about screening procedures. The survey was completed by representatives from 20 of 22 NCCN Member Institutions (91%). (Note: In this calculation, 1 consortium cancer cancer was counted as 2 NCCN Member Institutions.) Responses indicate that routine screening for distress is being conducted at 70% of institutions, with 25% screening inpatients and 60% screening outpatients. Among institutions screening outpatients, 50% screen all outpatients and 50% screen only certain subgroups of outpatients. In terms of method, 85% of institutions conducting screening use a patient self-report measure either alone or in combination with an interview; the Distress Thermometer is used at 59% of institutions that use a self-report measure. Findings show modest progress since 2005 in implementing guideline recommendations regarding distress screening, with a 7% increase in institutions conducting any routine screening and a 10% increase in institutions screening all outpatients routinely. Greater progress is evident in the use of self-report measures as part of screening, with a 23% increase in their use alone or in combination with an interview.

  18. [Invasive candidiasis in non-neutropenic adults : Guideline-based management in the intensive care unit].

    Science.gov (United States)

    Glöckner, A; Cornely, O A

    2013-12-01

    Invasive Candida infections represent a diagnostic and therapeutic challenge for clinicians particularly in the intensive care unit (ICU). Despite substantial advances in antifungal agents and treatment strategies, invasive candidiasis remains associated with a high mortality. Recent guideline recommendations on the management of invasive candidiasis by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) from 2012, the German Speaking Mycological Society and the Paul Ehrlich Society for Chemotherapy (DMykG/PEG) from 2011 and the Infectious Diseases Society of America (IDSA) from 2009 provide valuable guidance for diagnostic procedures and treatment of these infections but need to be interpreted in the light of the individual situation of the patient and the local epidemiology of fungal pathogens. The following recommendations for management of candidemia are common to all three guidelines. Any positive blood culture for Candida indicates disseminated infection or deep organ infection and requires antifungal therapy. Treatment should be initiated as soon as possible. Removal or changing of central venous catheters or other foreign material in the bloodstream is recommended whenever possible. Ophthalmological examination for exclusion of endophthalmitis and follow-up blood cultures during therapy are also recommended. Duration of therapy should be 14 days after clearance of blood cultures and resolution of symptoms. Consideration of surgical options and a prolonged antifungal treatment (weeks to months) are required when there is organ involvement. During the last decade several new antifungal agents were introduced into clinical practice. These innovative drugs showed convincing efficacy and favorable safety in randomized clinical trials. Consequently, they were integrated in recent therapeutic guidelines, often replacing former standard drugs as first-line options. Echinocandins have emerged as the generally preferred primary treatment in

  19. 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.

  20. Guidelines for Diagnosis and Management of Pediatric Food Allergy in Japan

    Directory of Open Access Journals (Sweden)

    Tokuko Mukoyama

    2007-01-01

    Full Text Available In Japan, the prevalence of food allergy has been increasing and a variety of problems have emerged regarding what should be considered a food allergy. A treatment regimen consists of avoiding the offending food (elimination diet therapy and receiving nourishment from alternative foods (substitutional diet therapy. There is a growing concern that confusion has resulted from the lack of a consensus on the procedures for diagnosing and treating food allergies. The Food Allergy Committee of the Japanese Society of Pediatric Allergy and Clinical Immunology established the “Guidelines for Diagnosis and Management of Pediatric Food Allergy.” Definition, classification, pathophysiology, clinical disorders and management of food allergy are discussed and determined.

  1. Practical guidelines for managing adults with 22q11.2 deletion syndrome

    Science.gov (United States)

    Fung, Wai Lun Alan; Butcher, Nancy J.; Costain, Gregory; Andrade, Danielle M.; Boot, Erik; Chow, Eva W.C.; Chung, Brian; Cytrynbaum, Cheryl; Faghfoury, Hanna; Fishman, Leona; García-Miñaúr, Sixto; George, Susan; Lang, Anthony E.; Repetto, Gabriela; Shugar, Andrea; Silversides, Candice; Swillen, Ann; van Amelsvoort, Therese; McDonald-McGinn, Donna M.; Bassett, Anne S.

    2015-01-01

    22q11.2 Deletion syndrome (22q11.2DS) is the most common microdeletion syndrome in humans, estimated to affect up to 1 in 2,000 live births. Major features of this multisystem condition include congenital anomalies, developmental delay, and an array of early- and later-onset medical and psychiatric disorders. Advances in pediatric care ensure a growing population of adults with 22q11.2DS. Informed by an international panel of multidisciplinary experts and a comprehensive review of the existing literature concerning adults, we present the first set of guidelines focused on managing the neuropsychiatric, endocrine, cardiovascular, reproductive, psychosocial, genetic counseling, and other issues that are the focus of attention in adults with 22q11.2DS. We propose practical strategies for the recognition, evaluation, surveillance, and management of the associated morbidities. PMID:25569435

  2. BASHH UK guideline for the management of epididymo-orchitis, 2010.

    Science.gov (United States)

    Street, E; Joyce, A; Wilson, J

    2011-07-01

    The BASHH UK guideline for the management of epididymo-orchitis has been updated in 2010. Consideration should be made of the changing potential aetiologies of epididymo-orchitis - mumps in non-immune individuals and tuberculosis in the immunocompromised and men from countries of high prevalence. The treatment of sexually acquired epididymo-orchitis has changed given the high levels of quinolone-resistant gonorrhoea such that ceftriaxone and doxycycline are recommended in those at high risk of gonorrhoea and doxycycline or ofloxacin in those patients where gonorrhoea is considered unlikely (negative microscopy for Gram-negative intracellular diplococci and no risk factors for gonorrhoea identified). A clinical care pathway has also been produced to simplify the management of epididymo-orchitis.

  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.

  4. [Method report 2007 of the Programme for National Disease Management Guidelines--background and content].

    Science.gov (United States)

    Weinbrenner, Susanne; Lelgemann, Monika; Ollenschäger, Günter; Kleudgen, Susanne; Niederstadt, Christina; Thole, Henning; Sänger, Sylvia; Zorn, Ulrich; Selbmann, Hans-Konrad; Kopp, Ina

    2007-01-01

    The Programme for National Disease Management Guidelines (German DM-CPG Programme) was established in 2002 by the German Medical Association (umbrella organisation of the German Chambers of Physicians) and joined by the Association of the Scientific Medical Societies (AWMF)--umbrella organisation of more than 150 professional societies--and by the National Association of Statutory Health Insurance Physicians (NASHIP) in 2003. The programme provides a conceptual basis for disease management, focussing on high priority healthcare topics and aiming at the implementation of best practice recommendations for prevention, acute care, rehabilitation and chronic care. It is organised by the German Agency for Quality in Medicine, a founding member of the Guidelines International Network G-I-N. The main objective of the German DM-CPG Programme is to establish consensus among the medical professions on evidence-based key recommendations covering all sectors of healthcare provision and facilitating the coordination of care for the individual patient through time and across interfaces. Within the last year DM-CPGs have been published for asthma, COPD, type 2 diabetes and coronary heart disease. In addition, experts from national patient self-help groups have been developing patient guidance based upon the recommendations for healthcare providers. The article describes background, methods and tools of the DM-CPG programme using the DM-CPG Method Report 2007.

  5. British Society for Allergy and Clinical Immunology guidelines for the management of egg allergy.

    Science.gov (United States)

    Clark, A T; Skypala, I; Leech, S C; Ewan, P W; Dugué, P; Brathwaite, N; Huber, P A J; Nasser, S M

    2010-08-01

    This guideline advises on the management of patients with egg allergy. Most commonly, egg allergy presents in infancy, with a prevalence of approximately 2% in children and 0.1% in adults. A clear clinical history and the detection of egg white-specific IgE (by skin prick test or serum assay) will confirm the diagnosis in most cases. Egg avoidance advice is the cornerstone of management. Egg allergy often resolves and re-introduction can be achieved at home if reactions have been mild and there is no asthma. Patients with a history of severe reactions or asthma should have reintroduction guided by a specialist. All children with egg allergy should receive measles, mumps and rubella (MMR) vaccination. Influenza and yellow fever vaccines should only be considered in egg-allergic patients under the guidance of an allergy specialist. This guideline was prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) and is intended for allergists and others with a special interest in allergy. The recommendations are evidence-based but where evidence was lacking consensus was reached by the panel of specialists on the committee. The document encompasses epidemiology, risk factors, diagnosis, treatment, prognosis and co-morbid associations.

  6. [European guideline for the management of precancerous conditions in the stomach and it's application to Japan].

    Science.gov (United States)

    Haruma, Ken; Kamada, Tomoari; Murao, Takahisa; Yamanaka, Yoshiyuki; Ohsawa, Motoyasu; Shiotani, Akiko; Inoue, Kazuhiko

    2013-08-01

    Atrophic gastritis, intestinal metaplasia, and Helicobacter pylori (H. pylori) infection are commonly recognized as the risk factor of gastric cancer. In Japan mass screening by the X-ray examination or endoscopy has been performed for a long time in general population or in work place because of the high death rate and high incidence of gastric cancer. Periodic endoscopy has been recommended for the subjects with atrophic gastritis and/or intestinal metaplasia to detect gastric cancer in early stage. On the other hand, there was no guideline to manage premalignant conditions such as atrophic gastritis, intestinal metaplasia, and dysplasia in foreign countries. Recently the guideline for the management of precancerous conditions and lesions in the stomach (MAPS) has been published by the combined efforts of the European Society of Gastrointestinal Endoscopy, European Helicobacter Study Group, European Society of Pathology, and the Sociedade Portuguesa de Endoscopia Digestiva. In this article the main statements have been discussed on comparing the understandings as the premalignant conditions in Japan.

  7. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Patient Education Programmes in the Management of Osteoarthritis

    Science.gov (United States)

    Health Education Journal, 2011

    2011-01-01

    Objective: The purpose of this study was to develop guidelines and recommendations on patient education programmes of any type, targeted specially to individuals with OA and which were designed to improve the clinical effectiveness of managing OA. Methods: The Ottawa Methods Group contacted specialized organizations that focus on management for…

  8. Update: Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure - United States, 2016.

    Science.gov (United States)

    Oduyebo, Titilope; Petersen, Emily E; Rasmussen, Sonja A; Mead, Paul S; Meaney-Delman, Dana; Renquist, Christina M; Ellington, Sascha R; Fischer, Marc; Staples, J Erin; Powers, Ann M; Villanueva, Julie; Galang, Romeo R; Dieke, Ada; Muñoz, Jorge L; Honein, Margaret A; Jamieson, Denise J

    2016-02-12

    CDC has updated its interim guidelines for U.S. health care providers caring for pregnant women during a Zika virus outbreak (1). Updated guidelines include a new recommendation to offer serologic testing to asymptomatic pregnant women (women who do not report clinical illness consistent with Zika virus disease) who have traveled to areas with ongoing Zika virus transmission. Testing can be offered 2-12 weeks after pregnant women return from travel. This update also expands guidance to women who reside in areas with ongoing Zika virus transmission, and includes recommendations for screening, testing, and management of pregnant women and recommendations for counseling women of reproductive age (15-44 years). Pregnant women who reside in areas with ongoing Zika virus transmission have an ongoing risk for infection throughout their pregnancy. For pregnant women with clinical illness consistent with Zika virus disease,* testing is recommended during the first week of illness. For asymptomatic pregnant women residing in areas with ongoing Zika virus transmission, testing is recommended at the initiation of prenatal care with follow-up testing mid-second trimester. Local health officials should determine when to implement testing of asymptomatic pregnant women based on information about levels of Zika virus transmission and laboratory capacity. Health care providers should discuss reproductive life plans, including pregnancy intention and timing, with women of reproductive age in the context of the potential risks associated with Zika virus infection.

  9. The Digital Age: Challenges for Records Management.

    Science.gov (United States)

    Plocher, David

    1999-01-01

    Discusses advances in information technology that are being embraced by federal agencies and considers the implications for records management. Highlights include federal Web sites; the National Archives and Records Administration (NARA); and the impact of changing technology. (Author/LRW)

  10. Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia

    Science.gov (United States)

    Abdel-Wahab, Omar; Andritsos, Leslie A.; Banerji, Versha; Barrientos, Jacqueline; Blachly, James S.; Call, Timothy G.; Catovsky, Daniel; Dearden, Claire; Demeter, Judit; Else, Monica; Forconi, Francesco; Gozzetti, Alessandro; Ho, Anthony D.; Johnston, James B.; Jones, Jeffrey; Juliusson, Gunnar; Kraut, Eric; Kreitman, Robert J.; Larratt, Loree; Lauria, Francesco; Lozanski, Gerard; Montserrat, Emili; Parikh, Sameer A.; Park, Jae H.; Polliack, Aaron; Quest, Graeme R.; Rai, Kanti R.; Ravandi, Farhad; Robak, Tadeusz; Saven, Alan; Seymour, John F.; Tadmor, Tamar; Tallman, Martin S.; Tam, Constantine; Tiacci, Enrico; Troussard, Xavier; Zent, Clive S.; Zenz, Thorsten; Zinzani, Pier Luigi; Falini, Brunangelo

    2017-01-01

    Hairy cell leukemia is an uncommon hematologic malignancy characterized by pancytopenia and marked susceptibility to infection. Tremendous progress in the management of patients with this disease has resulted in high response rates and improved survival, yet relapse and an appropriate approach to re-treatment present continuing areas for research. The disease and its effective treatment are associated with immunosuppression. Because more patients are being treated with alternative programs, comparison of results will require general agreement on definitions of response, relapse, and methods of determining minimal residual disease. The development of internationally accepted, reproducible criteria is of paramount importance in evaluating and comparing clinical trials to provide optimal care. Despite the success achieved in managing these patients, continued participation in available clinical trials in the first-line and particularly in the relapse setting is highly recommended. The Hairy Cell Leukemia Foundation convened an international conference to provide common definitions and structure to guide current management. There is substantial opportunity for continued research in this disease. In addition to the importance of optimizing the prevention and management of the serious risk of infection, organized evaluations of minimal residual disease and treatment at relapse offer ample opportunities for clinical research. Finally, a scholarly evaluation of quality of life in the increasing number of survivors of this now manageable chronic illness merits further study. The development of consensus guidelines for this disease offers a framework for continued enhancement of the outcome for patients. PMID:27903528

  11. 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.

  12. 2013 ESH/ESC guidelines for the management of arterial hypertension: what has changed in daily clinical practice?

    Science.gov (United States)

    Liakos, Charalampos I; Grassos, Charalampos A; Babalis, Dimitrios K

    2015-03-01

    This is a review article aiming to make focus on the changes made in the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines for the management of arterial hypertension with some criticism for each element discussed in the text. Given that in the real world clinical practice physicians would hardly spend the time needed for studying the 77 pages manuscript of the recently released 2013 ESH/ESC hypertension guidelines, the present review summarizes all the significant updates (along with their clinical implications) compared to the 2007 ESH/ESC hypertension guidelines and the 2009 reappraisal document.

  13. Management of Hepatitis B: A Longitudinal National Survey – Impact of the Canadian Hepatitis B Consensus Guidelines

    Directory of Open Access Journals (Sweden)

    Paul Marotta

    2010-01-01

    Full Text Available BACKGROUND: The Canadian Association for the Study of the Liver, and The Association of Medical Microbiology and Infectious Diseases Canada, jointly developed the Canadian Chronic Hepatitis B (HBV Consensus Guidelines to assist practitioners involved in the management of this complex disease. These guidelines were published in The Canadian Journal of Gastroenterology in June 2007 and distributed to all Canadian gastroenterologists and hepatologists.

  14. Update on the 2012 guidelines for the management of pediatric traumatic brain injury – information for the anesthesiologist

    OpenAIRE

    Hardcastle, Nina; Benzon, Hubert A.; Vavilala, Monica S.

    2014-01-01

    Traumatic brain injury (TBI) is a significant contributor to death and disability in children. Considering the prevalence of pediatric TBI, it is important for the clinician to be aware of evidence-based recommendations for the care of these patients. The first edition of the Guidelines for the Acute Medical Management of Severe Traumatic Brain Injury in Infants, Children, and Adolescents was published in 2003. The Guidelines were updated in 2012, with significant changes in the recommendatio...

  15. Managing aging workers: a mixed methods study on bundles of HR practices for aging workers

    NARCIS (Netherlands)

    Kooij, D.T.A.M.; Jansen, P.G.W.; Dikkers, J.S.E.; Lange, A.H. de

    2014-01-01

    Since abilities and motives change with age and common human resource (HR) practices might be less suitable for aging employees, scholars and practitioners are currently challenged to find new ways of managing aging workers and motivating them to continue working. Therefore, this mixed methods study

  16. Richtlijn 'Astma bij kinderen (0-19 jaar' voor de jeugdgezondheidszorg [Guidelines for 'Asthma in children (ages 0-19)' for youth healthcare

    NARCIS (Netherlands)

    Breuning-Boers,J.M.; Heerdink, M.; Kamphuis,M.; Gameren-Oosterom, H. van; Lanting,C.

    2012-01-01

    The objective of the evidence-based guidelines 'Asthma in children (ages 0-19)' for youth healthcare (CHC) is the prevention and reduction of asthma symptoms. The guidelines contain a lot of recommendations that apply to all disciplines in healthcare that deal with children. Primary prevention (prev

  17. 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

  18. 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.

  19. 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.

    2015-01-01

    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

  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. German Guidelines.

    Science.gov (United States)

    Kruis, Wolfgang; Nguyen, Gia P; Leifeld, Ludger

    2016-10-01

    Because of its frequency, diverticular disease is a burden on health care systems. Only few formal guidelines covering all aspects of the disease exist. Here, some selected statements from the German guidelines are given. The guidelines include significant recommendations for the diagnosis and management of diverticular disease. Both diagnosis and management depend definitely on clear definitions of the situation of an individual patient. Therefore, a new classification is proposed that is based on earlier suggestions. An internationally established classification would not only enable better patient care but could also lead to studies with comparable results.

  2. Current European guidelines for management of arterial hypertension: Are they adequate for use in primary care? Modelling study based on the Norwegian HUNT 2 population

    Directory of Open Access Journals (Sweden)

    Hetlevik Irene

    2009-10-01

    Full Text Available Abstract Background Previous studies indicate that clinical guidelines using combined risk evaluation for cardiovascular diseases (CVD may overestimate risk. The aim of this study was to model and discuss implementation of the current (2007 hypertension guidelines in a general Norwegian population. Methods Implementation of the current European Guidelines for the Management of Arterial Hypertension was modelled on data from a cross-sectional, representative Norwegian population study (The Nord-Trøndelag Health Study 1995-97, comprising 65,028 adults, aged 20-89, of whom 51,066 (79% were eligible for modelling. Results Among individuals with blood pressure ≥120/80 mmHg, 93% (74% of the total, adult population would need regular clinical attention and/or drug treatment, based on their total CVD risk profile. This translates into 296,624 follow-up visits/100,000 adults/year. In the Norwegian healthcare environment, 99 general practitioner (GP positions would be required in the study region for this task alone. The number of GPs currently serving the adult population in the study area is 87 per 100,000 adults. Conclusion The potential workload associated with the European hypertension guidelines could destabilise the healthcare system in Norway, one of the world's most long- and healthy-living nations, by international comparison. Large-scale, preventive medical enterprises can hardly be regarded as scientifically sound and ethically justifiable, unless issues of practical feasibility, sustainability and social determinants of health are considered.

  3. The impact of supervision on stock management and adherence to treatment guidelines: a randomized controlled trial.

    Science.gov (United States)

    Trap, B; Todd, C H; Moore, H; Laing, R

    2001-09-01

    Ensuring the availability of essential drugs and using them appropriately are crucial if limited resources for health care are to be used optimally. While training of health workers throughout Zimbabwe in drug management (including stock management and rational drug use) resulted in significant improvements in a variety of drug use indicators, these achievements could not be sustained, and a new strategy was introduced based on the supervision of primary health care providers. This was launched in 1995 with a training course in supervisory skills for district pharmacy staff. In order to evaluate the impact of the supervision and the effectiveness of the training programme, adherence to standard treatment guidelines (STG) and stock management protocols was evaluated in a randomized controlled trial. The study compared three different groups of health facilities: those that received supervision for either use of STG (n = 23) or stock management (n = 21) - each facility acting as control for the other area of supervision - and a comparison group of facilities which received no supervision (n = 18). On-the-spot supervision by a specially trained pharmacy staff, based around identified deficiencies, took place at the start of the study and 3 months later. The evaluation compared performance on a variety of drug management indicators at baseline and 6-8 months after the second supervisory visit. The results of the study showed that, following supervision, overall stock management improved significantly when compared with the control and comparison groups. Similar improvements were demonstrated for adherence to STG, although the effect was confounded by other interventions. The study also showed that supervision has a positive effect on improving performance in areas other than those supervised, and demonstrated that pharmacy technicians with limited clinical skills can be trained to influence primary health care workers to positively improve prescribing practices

  4. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries

    Science.gov (United States)

    Matteelli, Alberto; Abubakar, Ibrahim; Aziz, Mohamed Abdel; Baddeley, Annabel; Barreira, Draurio; Den Boon, Saskia; Borroto Gutierrez, Susana Marta; Bruchfeld, Judith; Burhan, Erlina; Cavalcante, Solange; Cedillos, Rolando; Chaisson, Richard; Chee, Cynthia Bin-Eng; Chesire, Lucy; Corbett, Elizabeth; Dara, Masoud; Denholm, Justin; de Vries, Gerard; Falzon, Dennis; Ford, Nathan; Gale-Rowe, Margaret; Gilpin, Chris; Girardi, Enrico; Go, Un-Yeong; Govindasamy, Darshini; D. Grant, Alison; Grzemska, Malgorzata; Harris, Ross; Horsburgh Jr, C. Robert; Ismayilov, Asker; Jaramillo, Ernesto; Kik, Sandra; Kranzer, Katharina; Lienhardt, Christian; LoBue, Philip; Lönnroth, Knut; Marks, Guy; Menzies, Dick; Migliori, Giovanni Battista; Mosca, Davide; Mukadi, Ya Diul; Mwinga, Alwyn; Nelson, Lisa; Nishikiori, Nobuyuki; Oordt-Speets, Anouk; Rangaka, Molebogeng Xheedha; Reis, Andreas; Rotz, Lisa; Sandgren, Andreas; Sañé Schepisi, Monica; Schünemann, Holger J.; Sharma, Surender Kumar; Sotgiu, Giovanni; Stagg, Helen R.; Sterling, Timothy R.; Tayeb, Tamara; Uplekar, Mukund; van der Werf, Marieke J.; Vandevelde, Wim; van Kessel, Femke; van't Hoog, Anna; Varma, Jay K.; Vezhnina, Natalia; Voniatis, Constantia; Vonk Noordegraaf-Schouten, Marije; Weil, Diana; Weyer, Karin; Wilkinson, Robert John; Yoshiyama, Takashi; Zellweger, Jean Pierre; Raviglione, Mario

    2015-01-01

    Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100 000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon-gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3–4 month isoniazid plus rifampicin; or 3–4 month rifampicin alone. PMID:26405286

  5. Establishing a quality management system for unit-use testing based on NCCLS proposed guideline (EP18-P).

    Science.gov (United States)

    Whitley, R J; Santrach, P J; Phillips, D L

    2001-05-01

    Point of care tests often employ unit-use test devices. By their very nature (single use, disposable, self-contained) such devices present unique challenges for quality assurance (QA) and quality control (QC). The proposed NCCLS guideline (EP18-P) recommends a quality management system for unit-use testing. The document addresses regulatory considerations, proposes the development of a partnership between users and manufacturers, provides a source of error matrix, and suggests practical approaches to quality monitoring, identification and management of these potential problems. The key to the success of this guideline is cooperation and open exchange of information among manufacturers, users, regulators, and accrediting agencies.

  6. Assessing the IADC Space Debris Mitigation Guidelines: A Case for Ontology-based Data Management

    Science.gov (United States)

    Walls, R.; Gaylor, D.; Reddy, V.; Furfaro, R.; Jah, M.

    2016-09-01

    As the population of man-made debris orbiting the Earth increases, so does the risk of damaging collisions. The Inter-Agency Space Debris Coordination Committee (IADC) has issued space debris mitigation guidelines including a key recommendation that before mission's end, spacecraft should move far enough from GEO so as not to be an operational hazard to other objects in active missions. It can be extremely difficult to determine if a spacecraft or operator is in compliance with this guideline, as it requires prediction of future actions based upon many data types. Furthermore, there has been no comprehensive assessment of the adequacy or validity of the IADC recommendations. The EU strives for a Code of Conduct in space, the United Nations-Committee On Peaceful Uses of Outer Space (UN-COPUOS) strives for guidelines to ensure the Long Term Sustainability of Space Activities (LTSSA), the FAA is concerned with Space Traffic Management (STM), etc. If rules, policies, guidelines, and laws are put in place, how can any entity know who and what is adhering to them, when we don't even know how to quantify and assess behavior of space objects? The University of Arizona aims to address this salient issue. As part of its new Space Object Behavioral Sciences (SOBS) initiative, the University of Arizona is developing an ontology-based system to support integration, use, and sharing of space domain data. As a first use-case, we will test the system's ability to assess compliance with the IADC recommendation to move beyond GEO at the end of a mission as well as the adequacy and validity of recommendations. We describe the relevant data types gathered for this use-case, present a prototype ontology, and outline methods for combining semantic analysis with astrodynamics modeling. Without loss of generality, we present this method as an approach that will form the foundation of SOBS and be used to address pressing challenges in Space Situational Awareness (SSA), Orbital Safety

  7. 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

  8. 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

  9. [Neuroanesthetic management for surgical clipping of a ruptured cerebral aneurysm: clinical practice guidelines].

    Science.gov (United States)

    Ingelmo Ingelmo, I; Carmona Aurioles, J; Rama-Maceiras, P; Fàbregas Julià, N; Hernández-Palazón, J

    2010-12-01

    Subarachnoid hemorrhage due to spontaneous rupture of a cerebral aneurysm is associated with high rates of morbidity and mortality and requires multidisciplinary treatment. The debate on surgical vs endovascular treatment continues, although short-term clinical outcomes and survival rates are better after endovascular treatment. In Spain, a strong trend toward reduced use of clipping has been noted, and neuroanesthetists are less often called on to provide anesthesia in this setting. Our intervention, however, can be decisive. The neuroscience working group of the Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor has developed guidelines for managing anesthesia in these procedures. Based on a national survey and a systematic review of the literature, the recommendations emphasize the importance of ensuring appropriate intracranial conditions, treating complications, and taking steps to protect against cerebral hemorrhage.

  10. [Japanese guideline on thalidomide usage in the management of erythema nodosum leprosum].

    Science.gov (United States)

    Ishii, Norihisa; Ishida, Yutaka; Okano, Yoshiko; Ozaki, Motoaki; Gidoh, Masaich; Kumano, Kimiko; Goto, Masamichi; Nogami, Reiko; Hatano, Kentaro; Yamada, Akatsuki; Yotsu, Rie Roselyne

    2011-09-01

    Treatment of erythema nodosum leprosum (ENL, type 2 reaction) using thalidomide provides effective alternative choice to steroid therapy. Yet, the Japanese National Health Insurance approves thalidomide prescription only for the treatment of multiple myeloma under the Thalidomide Education and Risk Management System (TERMS). Benefit of thalidomide therapy for patients with ENL is already an established fact based on various reports from other countries, but limited experiences and standards in Japan have hindered application of the medication to our patients. This led us to compose a local guideline. Based on and following the TERMS, we suggest starting thalidomide from 50-100 mg/day and then onwards adjusting the dose according to the symptoms of each patient, not to exceed the maximum recommended dose of 300 mg/day, for the treatment of ENL.

  11. Clinical guidelines for the management of acute viral infections in patients with systemic lupus erythematosus.

    Science.gov (United States)

    Ramos-Casals, M; Cuadrado, M J; Alba, P; Sanna, G; Brito-Zerón, P; Bertolaccini, L; Babini, A; Moreno, A; D'Cruz, D; Khamashta, M A

    2009-12-01

    In recent decades, many research groups have focused on the role of viral infections in the etiopathogenesis of systemic lupus erythematosus (SLE), the so-called "viral hypothesis". The main candidates are herpes viruses such as Epstein-Barr virus (EBV) and cytomegalovirus (CMV), which have a high seroprevalence in the general population. However, a viral causal agent of SLE has not yet been discovered, although many interesting clinical findings on the complex interactions between viruses and SLE have been made. This review analyzes 88 cases of acute viral infections in adult patients with SLE and identifies situations in which viral infections influenced the diagnosis, prognosis or treatment of SLE. We also propose clinical guidelines for the management of these infections in patients with SLE.

  12. Management of acute fever in children: guideline for community healthcare providers and pharmacists.

    Science.gov (United States)

    Green, Robin; Jeena, Prakash; Kotze, Shane; Lewis, Humphrey; Webb, David; Wells, Mike

    2013-09-03

    Fever is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with a self-limiting viral infection in children, it may also be a presenting symptom of more serious conditions requiring urgent medical care. Therefore, it is essential to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who can be managed conservatively at home. This guideline aims to assist pharmacists, primary healthcare workers and general practitioners in risk-stratifying children who present with fever, deciding on when to refer, the appropriate use of antipyretic medication and how to advise parents and caregivers. 

  13. Are Guidelines Needed for the Diagnosis and Management of Incipient Alzheimer's Disease and Mild Cognitive Impairment?

    Directory of Open Access Journals (Sweden)

    Katie Palmer

    2010-01-01

    Full Text Available Current research is aiming to push the boundaries of the point at which a diagnosis of Alzheimer Disease (AD can be made. Clinical syndromes such as Mild Cognitive Impairment (MCI and various clinical and biological markers of AD may help to identify people in the early stage of AD, before a full dementia syndrome is present. In the first part of this paper, we discuss whether MCI represents incipient AD, and examine some of the methods currently used in research to identify AD patients in the preclinical phase. In the second part, we discuss whether specific guidelines are needed for the diagnosis and management of MCI and incipient AD, and consider the potential impact of this on clinical practice and public health from the perspective of patients, caregivers, and healthcare providers.

  14. 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

    on an individual's absolute risk of ischaemic heart disease and should be comprehensive in nature. Lifestyle interventions should focus on counselling to stop smoking, modify diet and take regular exercise. A healthy diet, exercise and maintaining normal body weight tend to reduce dyslipidaemia; if not effective......-infected persons should be screened at regular intervals for a history of metabolic disease, dyslipidaemia, diabetes mellitus, hypertension and alteration of body composition; cardiovascular risk and renal function should also be assessed. Efforts to prevent cardiovascular disease will vary in intensity depending....... Prevention and management of type 2 diabetes mellitus and hypertension follow guidelines used in the general population. When using medical interventions to prevent and/or treat metabolic disease(s), impairment of the efficacy of ART should be avoided by considering the possibility of pharmacokinetic...

  15. 2014 Korean Liver Cancer Study Group-National Cancer Center Korea practice guideline for the management of hepatocellular carcinoma.

    Science.gov (United States)

    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 new guideline presented herein was developed on the basis of recent evidence and expert opinions. The primary targets of this guideline are patients with suspicious or newly diagnosed HCC. This guideline provides recommendations for the initial treatment of patients with newly diagnosed HCC.

  16. 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.

  17. Updated scar management practical guidelines: non-invasive and invasive measures.

    Science.gov (United States)

    Monstrey, Stan; Middelkoop, Esther; Vranckx, Jan Jeroen; Bassetto, Franco; Ziegler, Ulrich E; Meaume, Sylvie; Téot, Luc

    2014-08-01

    Hypertrophic scars and keloids can be aesthetically displeasing and lead to severe psychosocial impairment. Many invasive and non-invasive options are available for the plastic (and any other) surgeon both to prevent and to treat abnormal scar formation. Recently, an updated set of practical evidence-based guidelines for the management of hypertrophic scars and keloids was developed by an international group of 24 experts from a wide range of specialities. An initial set of strategies to minimize the risk of scar formation is applicable to all types of scars and is indicated before, during and immediately after surgery. In addition to optimal surgical management, this includes measures to reduce skin tension, and to provide taping, hydration and ultraviolet (UV) protection of the early scar tissue. Silicone sheeting or gel is universally considered as the first-line prophylactic and treatment option for hypertrophic scars and keloids. The efficacy and safety of this gold-standard, non-invasive therapy has been demonstrated in many clinical studies. Other (more specialized) scar treatment options are available for high-risk patients and/or scars. Pressure garments may be indicated for more widespread scarring, especially after burns. At a later stage, more invasive or surgical procedures may be necessary for the correction of permanent unaesthetic scars and can be combined with adjuvant measures to achieve optimal outcomes. The choice of scar management measures for a particular patient should be based on the newly updated evidence-based recommendations taking individual patient and wound characteristics into consideration.

  18. 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.

  19. Models for estimating the metabolic syndrome biological age as the new index for evaluation and management of metabolic syndrome

    Science.gov (United States)

    Kang, Young Gon; Suh, Eunkyung; Chun, Hyejin; Kim, Sun-Hyun; Kim, Deog Ki; Bae, Chul-Young

    2017-01-01

    Purpose This study aims to propose a metabolic syndrome (MS) biological age model, through which overall evaluation and management of the health status and aging state in MS can be done easily. Through this model, we hope to provide a novel evaluation and management health index that can be utilized in various health care fields. Patient and methods MS parameters from American Heart Association/National Heart, Lung, and Blood Institute guidelines in 2005 were used as biomarkers for the estimation of MS biological age. MS biological age model development was done by analyzing data of 263,828 participants and clinical application of the developed MS biological age was assessed by analyzing the data of 188,886 subjects. Results The principal component accounted for 36.1% in male and 38.9% in female of the total variance in the battery of five variables. The correlation coefficient between corrected biological age and chronological age in males and females were 0.711 and 0.737, respectively. Significant difference for mean MS biological age and chronological age between the three groups, normal, at risk and MS, was seen (P<0.001). Conclusion For the comprehensive approach in MS management, MS biological age is expected to be additionally utilized as a novel evaluation and management index along with the traditional MS diagnosis. PMID:28203066

  20. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum

    DEFF Research Database (Denmark)

    Alexander, Erik K; Pearce, Elizabeth N; Brent, Gregory A

    2017-01-01

    autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy......BACKGROUND: Thyroid disease in pregnancy is a common clinical problem. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines...... is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception and the postpartum period. METHODS: The specific clinical questions addressed in these guidelines were based...

  1. Canadian Society of Nephrology Commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis: management of glomerulonephritis in adults.

    Science.gov (United States)

    Cybulsky, Andrey V; Walsh, Michael; Knoll, Greg; Hladunewich, Michelle; Bargman, Joanne; Reich, Heather; Humar, Atul; Samuel, Susan; Bitzan, Martin; Zappitelli, Michael; Dart, Allison; Mammen, Cherry; Pinsk, Maury; Muirhead, Norman

    2014-03-01

    The KDIGO (Kidney Disease: Improving Global Outcomes) clinical practice guideline for management of glomerulonephritis was recently released. The Canadian Society of Nephrology convened a working group to review the recommendations and comment on their relevancy and applicability to the Canadian context. A subgroup of adult nephrologists reviewed the guideline statements for management of glomerular disease in adults and agreed with most of the guideline statements developed by KDIGO. This commentary highlights areas for which there is lack of evidence and areas in need of translation of evidence into clinical practice. Areas of controversy or uncertainty, including the choice of second-line agents, are discussed in more detail. Existing practice variation also is addressed. The relevance of treatment recommendations to the Canadian practitioner is discussed.

  2. Canadian Society of Nephrology Commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis: management of nephrotic syndrome in children.

    Science.gov (United States)

    Samuel, Susan; Bitzan, Martin; Zappitelli, Michael; Dart, Allison; Mammen, Cherry; Pinsk, Maury; Cybulsky, Andrey V; Walsh, Michael; Knoll, Greg; Hladunewich, Michelle; Bargman, Joanne; Reich, Heather; Humar, Atul; Muirhead, Norman

    2014-03-01

    The KDIGO (Kidney Disease: Improving Global Outcomes) clinical practice guideline for management of glomerulonephritis was recently released. The Canadian Society of Nephrology convened a working group to review the recommendations and comment on their relevancy and applicability to the Canadian context. A subgroup of pediatric nephrologists reviewed the guideline statements for management of childhood nephrotic syndrome and agreed with most of the guideline statements developed by KDIGO. This commentary highlights areas in which there is lack of evidence and areas in need of translation of evidence into clinical practice. Areas of controversy or uncertainty, including the length of corticosteroid therapy for the initial presentation and relapses, definitions of steroid resistance, and choice of second-line agents, are discussed in more detail. Existing practice variation is also addressed.

  3. Guideline for the management of wounds in patients with lower-extremity neuropathic disease: an executive summary.

    Science.gov (United States)

    Crawford, Penny Ellen; Fields-Varnado, Myra

    2013-01-01

    This article summarizes the WOCN Evidence-Based Clinical Practice Guideline for Management of Wounds in Patients with Lower Extremity Neuropathic Disease. It is intended for use by physicians, nurses, therapists, and other health care professionals who work with adults who have or are at risk for, lower-extremity neuropathic disease (LEND), and includes updated scientific literature available from January 2003 through February 2012. The full guideline contains definitions of lower extremity neuropathic disorders and disease, prevalence of the problem, relevance and significance of the disorders, as well as comprehensive information about etiology, the nervous system, pathogenesis, and the overall management goals for patients at risk for developing neuropathic foot ulcers. A detailed assessment section describes how to conduct a full clinical history and physical examination. The guideline also provides two approaches to interventions. The first focuses on prevention strategies to reduce the risk of developing LEND wounds or recurrence, including life-long foot offloading, routine dermal temperature surveillance, use of adjunctive therapies, medication management, and implementing lower extremity amputation prevention measures and patient self-care education. The second approach summarized LEND wound management strategies including wound cleansing, debridement, infection management, maintenance of intact peri-wound skin, nutrition considerations, pain and paresthesia management, edema management, offloading and management of gait and foot deformity, medication management, surgical options, adjunctive therapies, patient education, and health care provider follow-up. A comprehensive reference list, glossary of terms, and several appendices regarding an algorithm to determine wound etiology, pharmacology, Lower Extremity Amputation (LEAP) Program, diabetes foot screening and other information is available at the end of the guideline.

  4. EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria

    DEFF Research Database (Denmark)

    Zuberbier, T; Asero, R; Bindslev-Jensen, C

    2009-01-01

    This guideline, together with its sister guideline on the classification of urticaria (Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, Church MK, Giménez-Arnau AM et al. EAACI/GA(2)LEN/EDF/WAO Guideline: definition, classification and diagnosis of urticaria. Allergy 2009;64: 1417-1426), is ...

  5. Key European guidelines for the diagnosis and management of patients with phenylketonuria

    DEFF Research Database (Denmark)

    van Spronsen, Francjan J; van Wegberg, Annemiek Mj; Ahring, Kirsten;

    2017-01-01

    We developed European guidelines to optimise phenylketonuria (PKU) care. To develop the guidelines, we did a literature search, critical appraisal, and evidence grading according to the Scottish Intercollegiate Guidelines Network method. We used the Delphi method when little or no evidence...

  6. Management of Food Allergy in Japan “Food Allergy Management Guideline 2008 (Revision from 2005” and “Guidelines for the Treatment of Allergic Diseases in Schools”

    Directory of Open Access Journals (Sweden)

    Motohiro Ebisawa

    2009-01-01

    Full Text Available In 2005, the “Food Allergy Management Guideline 2005” was published. In order to encompass food allergy from infancy to adulthood, the project committee included not only pediatricians, but also internists, dermatologists, and otolaryngologists. After the release of the guideline, oral food challenge tests were approved as a medical examination on hospital admission by the national health insurance system in 2006, and the tests at outpatient clinics were also approved in 2008. As clearly stated in the guideline, it is essential for general practitioners to refer food allergy patients to specialists to receive accurate diagnosis. A specialist is needed because the oral food challenge test, which is sometimes required for accurate diagnosis, carries the potential risk of developing an adverse reaction. In 2008, the “Food Allergy Management Guideline 2008” was revised to update recent advances, such as the appropriate conditions needed to perform oral food challenge tests and probability curves for hen's egg and cow's milk developed in Japan. In the same year, “The Guidelines for the Treatment of Allergic Diseases in Schools” was published by the Japanese Society of School Health. In addition to the guideline, “School Life Management Certificate (for Allergic Diseases” was developed in order to allow the verification of the diagnosis and encourage the discussion of countermeasures by parents/guardians and school teachers for students requiring special care. It is hoped that this review article will be useful for doctors treating food allergy and that the quality of life of food allergy patients and their parents will be improved.

  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.; 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

  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. 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

  10. ESCMID dagger and ECMM double dagger joint clinical guidelines for the diagnosis and management of mucormycosis 2013

    NARCIS (Netherlands)

    Cornely, O. A.; Arikan-Akdagli, S.; Dannaoui, E.; Groll, A. H.; Lagrou, K.; Chakrabarti, A.; Lanternier, F.; Pagano, L.; Skiada, A.; Akova, M.; Arendrup, M. C.; Boekhout, T.; Chowdhary, A.; Cuenca-Estrella, M.; Freiberger, T.; Guinea, J.; Guarro, J.; de Hoog, S.; Hope, W.; Johnson, E.; Kathuria, S.; Lackner, M.; Lass-Floerl, C.; Lortholary, O.; Meis, J. F.; Meletiadis, J.; Munoz, P.; Richardson, M.; Roilides, E.; Tortorano, A. M.; Ullmann, A. J.; van Diepeningen, A.; Verweij, P.; Petrikkos, G.

    2014-01-01

    These European Society for Clinical Microbiology and Infectious Diseases and European Confederation of Medical Mycology Joint Clinical Guidelines focus on the diagnosis and management of mucormycosis. Only a few of the numerous recommendations can be summarized here. To diagnose mucormycosis, direct

  11. [Clinical guideline for management of patients with low risk differentiated thyroid carcinoma].

    Science.gov (United States)

    Díez, Juan José; Oleaga, Amelia; Álvarez-Escolá, Cristina; Martín, Tomás; Galofré, Juan Carlos

    2015-01-01

    Incidence of thyroid cancer is increasing in Spain and worldwide. Overall thyroid cancer survival is very high, and stratification systems to reliably identify patients with worse prognosis have been developed. However, marked differences exist between the different specialists in clinical management of low-risk patients with thyroid carcinoma. Almost half of all papillary thyroid carcinomas are microcarcinomas, and 90% are tumors < 2 cm that have a particularly good prognosis. However, they are usually treated more aggressively than needed, despite the lack of adequate scientific support. Surgery remains the gold standard treatment for these tumors. However, lobectomy may be adequate in most patients, without the need for total thyroidectomy. Similarly, prophylactic lymph node dissection of the central compartment is not required in most cases. This more conservative approach prevents postoperative complications such as hypoparathyroidism or recurrent laryngeal nerve injury. Postoperative radioiodine remnant ablation and strict suppression of serum thyrotropin, although effective for the more aggressive forms of thyroid cancer, have not been shown to be beneficial for the treatment of low risk patients, and may impair their quality of life. This guideline provides recommendations from the task force on thyroid cancer of the Spanish Society of Endocrinology and Nutrition for adequate management of patients with low-risk thyroid cancer.

  12. New cholesterol guidelines for the management of atherosclerotic cardiovascular disease risk: a comparison of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines with the 2014 National Lipid Association recommendations for patient-centered management of dyslipidemia.

    Science.gov (United States)

    Adhyaru, Bhavin B; Jacobson, Terry A

    2015-05-01

    This review discusses the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults and compares it with the 2014 National Lipid Association (NLA) Recommendations for Patient-Centered Management of Dyslipidemia. The review discusses some of the distinctions between the guidelines, including how to determine a patient's atherosclerotic cardiovascular disease risk, the role of lipoprotein treatment targets, the importance of moderate- and high-intensity statin therapy, and the use of nonstatin therapy in light of the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) trial.

  13. [ESC guidelines on the management of valvular heart disease. What has changed and what is new?].

    Science.gov (United States)

    Mangner, N; Schuler, G

    2013-12-01

    In 2012 the new and collaborative "Guidelines on the management of valvular heart disease (version 2012)" were published by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). These guidelines emphasize that decision-making in patients with valvular heart disease should ideally be carried out by a"heart team" with particular expertise in valvular heart disease. In aortic regurgitation pathologies of the aortic root are frequent and in patients with Marfan syndrome, surgery is indicated when the maximal ascending aortic diameter is ≥50 mm, while the threshold for intervention should be lower in patients with risk factors for progression. Regarding aortic stenosis, transcatheter aortic valve implantation (TAVI) should be performed only in hospitals with on-site cardiac surgery and with a"heart team" available to assess patient risks. The TAVI procedure is indicated in patients with severe symptomatic aortic stenosis who are judged by the"heart team" to be unsuitable for surgery but have sufficient life expectancy. It should be considered for high-risk patients with severe symptomatic aortic stenosis based on the individual risk profile assessed by the"heart team". Furthermore, low flow - low gradient aortic stenosis with normal ejection fraction and the difficult topic of asymptomatic severe aortic stenosis and the indications for aortic valve replacement are discussed. With respect to mitral regurgitation, valve repair should be the preferred technique when it is expected to be durable. The topics of asymptomatic mitral regurgitation as well as percutaneous mitral valve repair using the edge to edge technique as an alternative for high risk patients are discussed. Tricuspid disease should not be forgotten and during left-sided valve surgery, tricuspid valve surgery should be considered in the presence of mild to moderate secondary regurgitation if there is significant annular dilatation. Last but not least

  14. A Computer-Interpretable Version of the AACE, AME, ETA Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules

    DEFF Research Database (Denmark)

    Peleg, Mor; Fox, John; Patkar, Vivek

    2014-01-01

    .S. and European users for the purpose of diagnosis and management of thyroid nodules that is based on the "AACE, AME, ETA Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules," a narrative, evidence-based CPG.Methods: We initially employed the guideline-modeling language...

  15. 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.

  16. Management status of type 2 diabetes mellitus in tertiary hospitals in Beijing: gap between guideline and reality

    Institute of Scientific and Technical Information of China (English)

    LI Ming-zi; JI Li-nong; MENG Zhao-lin; GUO Xiao-hui; YANG Jin-kui; LU Ju-ming; L(U) Xiao-feng; HONG Xu

    2012-01-01

    Background Diabetes has become one of the most common chronic diseases and the third leading cause of death in China.Many programs have been initiated at national and local levels to address the illness.However,the effect of these programs in daily outpatient clinics is still unclear.The objective of this study was to investigate the management status of type 2 diabetes mellitus (T2DM) and factors associated with it in diabetes clinics of tertiary hospitals in Beijing.Methods A cross-sectional survey was conducted in six tertiary hospitals in Beijing.Control criteria were defined based on 2007 China guideline for type 2 diabetes (CGT2D).Results A sample of 1151 patients,age (60.8±9.2) years,and with a median disease duration of 7.3 years was included.The hemoglobin A1c (HbA1c) mean level was (7.15±1.50)%,the percentage of patients achieving the targets for HbA1c was 37.8%,blood pressure 65.6%,triglyceride (TG) 48.8%,high-density lipoprotein (HDL) 59.2%,low-density lipoprotein (LDL) 34.0%,and total cholesterol (TC) 42.0% The factors independently associated with glycemic control were diabetes duration (odds ratio (OR) =0.95; 95% confidence interval (C/): 0.919-0.982,P <0.01),body mass index (BMI) (OR=0.914,95% CI: 0.854-0.979,P=0.01) and smoking (OR=0.391,95% CI: 0.197-0.778,P<0.01).The factors independently associated with blood pressure control were BMI (OR=0.915,95% CI: 0.872-0.960,P <0.01) and male gender (OR=0.624,95% CI: 0.457-0.852,P <0.01).The factor independently associated with LDL control was education level (OR=1.429,95% CI: 1.078-1.896,P=0.013).Conclusions The management status of T2DM patients in tertiary hospitals in Beijing has improved remarkably.However,there is still room for further improvement to reach the guideline target.Long diabetes duration,high BMI,smoking,male gender and low education level were independently associated with poor metabolic control.

  17. Management of fibromyalgia: practical guides from recent evidence-based guidelines.

    Science.gov (United States)

    Häuser, Winfried; Ablin, Jacob; Perrot, Serge; Fitzcharles, Mary-Ann

    2017-01-04

    Fibromyalgia (FM) is a prevalent and costly condition worldwide, affecting approximately 2% of the general population. Recent evidence- and consensus‑based guidelines from Canada, Germany, Israel, and the European League Against Rheumatism aim to support physicians in achieving a comprehensive diagnostic workup of patients with chronic widespread (generalized) pain (CWP) and to assist patients and physicians in shared decision making on treatment options. Every patient with CWP requires, at the first medical evaluation, a complete history, medical examination, and some laboratory tests (complete blood count, measurement of C‑reactive protein, serum calcium, creatine phosphokinase, thyroid‑stimulating hormone, and 25‑hydroxyvitamin D levels) to screen for metabolic or inflammatory causes of CWP. Any additional laboratory or radiographic testing should depend on red flags suggesting some other medical condition. The diagnosis is based on the history of a typical cluster of symptoms (CWP, nonrestorative sleep, physical and/or mental fatigue) that cannot be sufficiently explained by another medical condition. Optimal management should begin with education of patients regarding the current knowledge of FM (including written materials). Management should be a graduated approach with the aim of improving health‑related quality of life. The initial focus should ensure active participation of patients in applying healthy lifestyle practices. Aerobic and strengthening exercises should be the foundation of nonpharmacologic management. Cognitive behavioral therapies should be considered for those with mood disorder or inadequate coping strategies. Pharmacologic therapies may be considered for those with severe pain (duloxetine, pregabalin, tramadol) or sleep disturbance (amitriptyline, cyclobenzaprine, pregabalin). Multimodal programs should be considered for those with severe disability.

  18. 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.

  19. 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)

  20. Effects of Guideline-based Hypertension Management in Rural Areas of Guangdong Province

    Institute of Scientific and Technical Information of China (English)

    Guang Li; An-Ping Cai; Yu-Jin Mo; Ji-Yan Chen; Rui-Bing Wei; Yu-Qing Huang; Song-Tao Tang

    2015-01-01

    Background:Despite the improvement in the health care industry,the rates of undetected,untreated,and uncontrolled hypertension (HTN)are still very high,especially in rural areas of China.The aim of this study was to investigate the efficacy and efficiency of a guideline-based HTN management (novel therapy) in population of rural areas of Guangdong Province.Methods:Totally,3113 patients with essential HTN in a rural area of Guangdong Province were enrolled and assigned to two groups,named traditional (n =372) and novel therapeutic (n =2741) groups,respectively.Patients in the traditional group were treated routinely,and patients in the novel group were treated in a novel model characterized by regular educational programs for hypertensive populations,close monitoring of blood pressure in combination with finely tuned antihypertensive medications,strict implementation of lifestyle modification and improving medical knowledge and skill of local medical staff efficiently.After 2 years of follow-up,primary endpoints including magnitude of systolic and diastolic blood pressures (SBP and DBP) decrease,treated and controlled rates,as well as secondary endpoints,were evaluated in both groups.Results:Initially,the treated rate was significantly higher in traditional group than that of novel group (71.15% vs.64.99%,P < 0.05),while the controlled rates were comparable and insignificant difference between baseline BP in both groups (31.07% vs.26.88%,P > 0.05).Four variables were significantly different,namely smoking rate,daily vegetable consumption (VC),and serum levels of low-density lipoprotein-cholesterol and fasting blood glucose between these two groups.After 2 years of follow-up,decreases in SBP and DBP were more prominent in the novel group (P < 0.001).Treated and controlled rates in both groups were both increased.Nevertheless,in comparison to the traditional group,controlled rate increased more significantly in the novel group (64.31% vs.37.85%,P

  1. Photovoltaic system criteria documents. Volume 1: Guidelines for evaluating the management and operations planning of photovoltaic applications

    Science.gov (United States)

    Koenig, John C.; Billitti, Joseph W.; Tallon, John M.

    1979-01-01

    Guidelines are provided to the Field Centers for organization, scheduling, project and cost control, and performance in the areas of project management and operations planning for Photovoltaics Test and Applications. These guidelines may be used in organizing a T and A Project Team for system design/test, site construction and operation, and as the basis for evaluating T and A proposals. The attributes are described for project management and operations planning to be used by the Field Centers. Specifically, all project management and operational issues affecting costs, schedules and performance of photovoltaic systems are addressed. Photovoltaic tests and applications include residential, intermediate load center, central station, and stand-alone systems. The sub-categories of system maturity considered are: Initial System Evaluation Experiments (ISEE); System Readiness Experiments (SRE); and Commercial Readiness Demonstration Projects (CRDP).

  2. Teaching in a digital age guidelines for designing teaching and learning

    CERN Document Server

    Bates, Anthony William

    2015-01-01

    The book examines the underlying principles that guide effective teaching in an age when all of us, and in particular the students we are teaching, are using technology. A framework for making decisions about your teaching is provided, while understanding that every subject is different, and every instructor has something unique and special to bring to their teaching.The book enables teachers and instructors to help students develop the knowledge and skills they will need in a digital age: not so much the IT skills, but the thinking and attitudes to learning that will bring them success.

  3. Japanese Guideline for Childhood Asthma

    Directory of Open Access Journals (Sweden)

    Toshiyuki Nishimuta

    2011-01-01

    JAGL differs from the Global Initiative for Asthma Guideline (GINA in that the former emphasizes long-term management of childhood asthma based on asthma severity and early diagnosis and intervention at <2 years and 2–5 years of age. However, a management method, including step-up or step-down of long-term management agents based on the status of asthma symptoms, is easy to understand and thus JAGL is suitable for routine medical treatment. JAGL also introduced treatment and management using a control test for children, recommending treatment and management aimed at complete control through avoiding exacerbation factors and appropriate use of antiinflammatory agents.

  4. [Chronic pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group].

    Science.gov (United States)

    Takács, Tamás; Czakó, László; Dubravcsik, Zsolt; Farkas, Gyula; Hegyi, Péter; Hritz, István; Kelemen, Dezső; Lásztity, Natália; Morvay, Zita; Oláh, Attila; Pap, Ákos; Párniczky, Andrea; Patai, Árpád; Sahin-Tóth, Miklós; Szentkereszti, Zsolt; Szmola, Richárd; Tiszlavicz, László; Szücs, Ákos

    2015-02-15

    Chronic pancreatitis is an inflammatory disease associated with structural and functional damage of the pancreas. In most cases pain, maldigestion and weight loss are the leading symptoms, which significantly worsen the quality of life. Correct diagnosis and differential diagnosis of chronic pancreatitis and treatment of these patients requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 123 relevant clinical questions in 11 topics were defined. Evidence was classified according to the UpToDate® grading system. The draft of the guidelines were presented and discussed at the consensus meeting in September 12, 2014. All clinical questions were accepted with total or strong agreement. The present guideline is the first evidence based guideline for chronic pancreatitis in Hungary. This guideline provides very important and helpful data for tuition, everyday practice and proper financing of chronic pancreatitis. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary.

  5. A review of a new Dutch guideline for management of recurrent varicose veins.

    Science.gov (United States)

    Lawson, James A; Toonder, Irwin M

    2016-03-01

    In 2013, the new Dutch guideline for "Venous Pathology" was published. The guideline was a revision and update from the guideline "Diagnostics and Treatment of Varicose Veins" from 2009 and the guideline "Venous Ulcer" from 2005. A guideline for "Deep Venous Pathology" and one for "Compression Therapy" was added to the overall guideline "Venous Pathology." The chapter about treatment of recurrent varicose veins after initial intervention was recently updated in 2015 and is reviewed here. The Dutch term "recidief varices" or the French "récidive de varices" should be used analogous to the English term "recurrent varicose veins." The DCOP Guideline Development Group Neovarices concluded that "recidief" in Dutch actually suggests recurrence after apparent successful treatment and ignores the natural progression of venous disease in its own right. So the group opted to use the term "neovarices." In the Dutch guideline, neovarices is meant to be an all embracing term for recurrent varicose veins caused by technical or tactical failure, evolvement from residual refluxing veins or natural progression of varicose vein disease at different locations of the treated leg after intervention. This report reviews the most important issues in the treatment of varicose vein recurrence, and discusses conclusions and recommendations of the Dutch Neovarices Guideline Committee.

  6. 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.

  7. Standardized Clinical Assessment And Management Plans (SCAMPs) Provide A Better Alternative To Clinical Practice Guidelines

    Science.gov (United States)

    Farias, Michael; Jenkins, Kathy; Lock, James; Rathod, Rahul; Newburger, Jane; Bates, David W.; Safran, Dana G.; Friedman, Kevin; Greenberg, Josh

    2014-01-01

    Variability in medical practice in the United States leads to higher costs without achieving better patient outcomes. Clinical practice guidelines, which are intended to reduce variation and improve care, have several drawbacks that limit the extent of buy-in by clinicians. In contrast, standardized clinical assessment and management plans (SCAMPs) offer a clinician-designed approach to promoting care standardization that accommodates patients’ individual differences, respects providers’ clinical acumen, and keeps pace with the rapid growth of medical knowledge. Since early 2009 more than 12,000 patients have been enrolled in forty-nine SCAMPs in nine states and Washington, D.C. In one example, a SCAMP was credited with increasing clinicians’ rate of compliance with a recommended specialist referral for children from 19.6 percent to 75 percent. In another example, SCAMPs were associated with an 11–51 percent decrease in total medical expenses for six conditions when compared with a historical cohort. Innovative tools such as SCAMPs should be carefully examined by policy makers searching for methods to promote the delivery of high-quality, cost-effective care. PMID:23650325

  8. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries.

    Science.gov (United States)

    Getahun, Haileyesus; Matteelli, Alberto; Abubakar, Ibrahim; Aziz, Mohamed Abdel; Baddeley, Annabel; Barreira, Draurio; Den Boon, Saskia; Borroto Gutierrez, Susana Marta; Bruchfeld, Judith; Burhan, Erlina; Cavalcante, Solange; Cedillos, Rolando; Chaisson, Richard; Chee, Cynthia Bin-Eng; Chesire, Lucy; Corbett, Elizabeth; Dara, Masoud; Denholm, Justin; de Vries, Gerard; Falzon, Dennis; Ford, Nathan; Gale-Rowe, Margaret; Gilpin, Chris; Girardi, Enrico; Go, Un-Yeong; Govindasamy, Darshini; D Grant, Alison; Grzemska, Malgorzata; Harris, Ross; Horsburgh, C Robert; Ismayilov, Asker; Jaramillo, Ernesto; Kik, Sandra; Kranzer, Katharina; Lienhardt, Christian; LoBue, Philip; Lönnroth, Knut; Marks, Guy; Menzies, Dick; Migliori, Giovanni Battista; Mosca, Davide; Mukadi, Ya Diul; Mwinga, Alwyn; Nelson, Lisa; Nishikiori, Nobuyuki; Oordt-Speets, Anouk; Rangaka, Molebogeng Xheedha; Reis, Andreas; Rotz, Lisa; Sandgren, Andreas; Sañé Schepisi, Monica; Schünemann, Holger J; Sharma, Surender Kumar; Sotgiu, Giovanni; Stagg, Helen R; Sterling, Timothy R; Tayeb, Tamara; Uplekar, Mukund; van der Werf, Marieke J; Vandevelde, Wim; van Kessel, Femke; van't Hoog, Anna; Varma, Jay K; Vezhnina, Natalia; Voniatis, Constantia; Vonk Noordegraaf-Schouten, Marije; Weil, Diana; Weyer, Karin; Wilkinson, Robert John; Yoshiyama, Takashi; Zellweger, Jean Pierre; Raviglione, Mario

    2015-12-01

    Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon-gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3-4 month isoniazid plus rifampicin; or 3-4 month rifampicin alone.

  9. Psychological management for head and neck cancer patients: United Kingdom National Multidisciplinary Guidelines.

    Science.gov (United States)

    Humphris, G

    2016-05-01

    This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It provides recommendations on the assessment and interventions for the psychological management in this patient group. Recommendations • Audit of information supplied to patients and carers should be conducted on an annual basis to update and review content and media presentation. (G) • Patients and carers should be invited to discuss treatment options and relate possible outcomes to functional retention or loss to provide a patient-centred approach. (G) • Clinical staff should inspect their systems of assessment to make them sensitive enough to identify patients with psychological difficulties. (G) • Flexibility, rather than rigid formulation is required to assess patients frequently, and to allow for change in circumstances to be noted. (G) • Multidisciplinary teams should determine the supportive care services available and commission extra assistance to provide patients and carers with timely information, education or brief supportive advice. (G) • Multidisciplinary teams need to inspect specialist services for mental health interventions at structured and complex levels for the small proportion of patients with more serious, but rarer, psychological difficulties. (G) • Clinical staff at all levels should receive communication skills training to raise and maintain consultation expertise with difficult patient and/or carer interactions. (G).

  10. Guidelines for prevention and management of complications following kidney transplantation in rats.

    Science.gov (United States)

    Pahlavan, P S; Mehrabi, A; Kashfi, A; Soleimani, M; Fani-Yazdi, S H; Schemmer, P; Gutt, C N; Friess, H; Weitz, J; Kraus, Th W; Büchler, M W; Schmidt, J

    2005-06-01

    Kidney transplantation in rats is a useful model for microsurgery, transplantation, and immunology studies. Our aim was to analyze various techniques of kidney transplantation in rats with emphasis on guidelines for the prevention and management of complications. Complications were categorized into general, vascular, and urological types and respectively attributed to long transplantation time, core body temperature drop, nonreplaced intraoperative blood loss, anastomosis failure, and ureteral anastomoses with stents or cannulas, which increase the risk of calculus formation. In conclusion, to decrease the complication rates the animal should be placed on a heating pad. For hemodynamic stability NaCl should be administered subcutaneously. To reduce the risk of thrombosis, ice-cold saline containing heparin should be administered. Vascular complications, which mainly depend on the microsurgeon's expertise, can be prevented by meticulous surgical technique (preferably an end-in-end anastomosis). The main urinary complications can be minimized by avoiding stents and cannulas and focusing on using techniques like the bladder-patch technique.

  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. Guidelines for the diagnosis and management of neuropathic pain: consensus of a group of Latin American experts.

    Science.gov (United States)

    Acevedo, Juan Carlos; Amaya, Abraham; Casasola, Oscar de León; Chinchilla, Nelson; De Giorgis, Marcelo; Florez, Sandra; Genis, Miguel Angel; Gomez-Barrios, Juan Vicente; Hernández, John Jairo; Ibarra, Eduardo; Moreno, Carlos; Orrillo, Enrique; Pasternak, Danilo; Romero, Sabina; Vallejo, Mariana; Velasco, Maritza; Villalobos, Alberto

    2009-01-01

    These consensus guidelines have been developed by a group of Latin American experts in pain management, to point out patterns and make practical recommendations to guide the diagnosis, identify warning signs (yellow and red flags), and establish comprehensive medical management (pharmacologic and nonpharmacologic treatment) and monitoring plans for patients enduring neuropathic pain. From the viewpoint of pharmacologic management, drugs are classified into groups according to efficacy, availability/accessibility, and safety criteria. Drugs are recommended for use depending on the disease and particular circumstances of each patient, with an approach that favors multimodal treatment while taking into consideration the idiosyncrasies of medical practice in Latin America.

  13. 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 <20-30 km; and (6) use a portfolio of approaches, including but not limited to MPAs. Three case studies illustrating the application of these principles to coral reef management in the Bohol Sea (Philippines), the Great Barrier Reef (Australia) and Kimbe Bay (Papua New

  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. Pharmacotherapy guidelines for the aged by family doctors for the use of family doctors: part C--Special pharmacology.

    Science.gov (United States)

    Bergert, F W; Conrad, D; Ehrenthal, K; Fessler, J; Gross, J; Gundermann, K; Kluthe, B; Lang Heinrich, W; Liesenfeld, A; Loew, P G; Luther, E; Pchalek, R; Seffrin, J; Sterzing, A; Wolfring, H-J; Zimmermann, U

    2009-03-01

    The part "Special pharmacology of the aged" of this guideline contains recommendations for typical conditions in the family doctors practice: in the January issue 2009 dementia and Morbus Parkinson, in this issue osteoporosis and urinary incontinence and in the next issue rectal incontinence and obstipation. This issue of the IJCPT contains the third part of the Pharmacotherapy guidelines for the aged by family doctors for family doctors. Part 3: Osteoporosis and urinary incontinence. Osteoporosis is a systematic disease characterized by low bone mass and declining bone structure. Exercise, adequate diet, nicotine abstinence as well as reduction of alcohol consumption may counteract the progression of the disease. Osteoporosis manifests in bone fractures with minimal trauma. Attention must be given to the risk of falling, e.g., by avoiding drugs that increase the risk of falling: e.g., psychotropic agents, analgesic drugs and antiarrhythmic agents. Specific osteoporosis medication e.g. calcium, vitamin D, biphosphonates and SERM (selective estrogen receptor modulators) is evaluated by family doctors according to indication, dosage, contraindications, long-term therapy and nature of any fracture. Duration of therapy is at least 3 - max. 5 years followed by reassessment of indication. There are 3 types of urine incontinence (urge-, stress-, and overflow-incontinence). Another standardization of urinary incontinence follows dysfunctions of the pelvic floor: detrusor muscle-dependent, due to sphincter spasm, prostate gland dependent. Urge incontinence with a dysfunction of the detrusor muscle is the most common type. Mixed types are frequent. Non-drug measures (e.g. pelvic muscle training, bladder training, toilet training are first choice treatments. Drug therapy (estrogen, imipramine) are without proven effect.

  16. Compliance with AAPM Practice Guideline 1.a: CT Protocol Management and Review - from the perspective of a university hospital.

    Science.gov (United States)

    Szczykutowicz, Timothy P; Bour, Robert K; Pozniak, Myron; Ranallo, Frank N

    2015-03-08

    The purpose of this paper is to describe our experience with the AAPM Medical Physics Practice Guideline 1.a: "CT Protocol Management and Review Practice Guideline". Specifically, we will share how our institution's quality management system addresses the suggestions within the AAPM practice report. We feel this paper is needed as it was beyond the scope of the AAPM practice guideline to provide specific details on fulfilling individual guidelines. Our hope is that other institutions will be able to emulate some of our practices and that this article would encourage other types of centers (e.g., community hospitals) to share their methodology for approaching CT protocol optimization and quality control. Our institution had a functioning CT protocol optimization process, albeit informal, since we began using CT. Recently, we made our protocol development and validation process compliant with a number of the ISO 9001:2008 clauses and this required us to formalize the roles of the members of our CT protocol optimization team. We rely heavily on PACS-based IT solutions for acquiring radiologist feedback on the performance of our CT protocols and the performance of our CT scanners in terms of dose (scanner output) and the function of the automatic tube current modulation. Specific details on our quality management system covering both quality control and ongoing optimization have been provided. The roles of each CT protocol team member have been defined, and the critical role that IT solutions provides for the management of files and the monitoring of CT protocols has been reviewed. In addition, the invaluable role management provides by being a champion for the project has been explained; lack of a project champion will mitigate the efforts of a CT protocol optimization team. Meeting the guidelines set forth in the AAPM practice guideline was not inherently difficult, but did, in our case, require the cooperation of radiologists, technologists, physicists, IT

  17. 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.

  18. 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

    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 guidelines in order to define a complete solution for interoperability....

  19. NICE CG178 Psychosis and Schizophrenia in Adults: Treatment and Management - an evidence-based guideline?

    Science.gov (United States)

    Taylor, Mark; Perera, Udayanga

    2015-05-01

    National Institute for Health and Care Excellence (NICE) clinical guideline (CG)178 was published in 2014. NICE guidelines occupy an important international position. We argue that CG178 overemphasises the use of cognitive-behavioural therapy for schizophrenia and those 'at risk' of psychosis, with recommendations that do not always reflect the evidence base. The CG178 recommendations on medications are limited.

  20. Burden of diabetic foot disorders, guidelines for management and disparities in implementation in Europe: a systematic literature review.

    Science.gov (United States)

    van Acker, Kristien; Léger, Philippe; Hartemann, Agnes; Chawla, Abhineet; Siddiqui, Mohd Kashif

    2014-11-01

    The study aimed to assess the economic and quality of life burden of diabetic foot disorders and to identify disparities in the recommendations from guidelines and the current clinical practice across the EU5 (Spain, Italy, France, UK and Germany) countries. Literature search of electronic databases (MEDLINE®, Embase® and Cochrane Database of Systematic Reviews) was undertaken. English language studies investigating economic and resource burden, quality of life and management of diabetic foot disease in the EU5 countries were included. Additionally, websites were screened for guidelines and current management practices in diabetic foot complication in EU5. Diabetic foot complications accounted for a total annual cost of €509m in the UK and €430 per diabetic patient in Germany, during 2001. The cost of diabetic foot complications increased with disease severity, with hospitalizations (41%) and amputation (9%) incurring 50% of the cost. Medical devices (orthopaedic shoes, shoe lifts and walking aids) were the most frequently utilized resources. Patients with diabetic foot complications experienced worsened quality of life, especially in those undergoing amputations and with non-healed ulcers or recurrent ulcers. Although guidelines advocate the use of multidisciplinary foot care teams, the utilization of multidisciplinary foot care teams was suboptimal. We conclude that diabetic foot disorders demonstrated substantial economic burden and have detrimental effect on quality of life, with more impairment in physical domain. Implementation of the guidelines and set-up of multidisciplinary clinics for holistic management of the diabetic foot disorders varies across Europe and remains suboptimal. Hence, guidelines need to be reinforced to prevent diabetic foot complications and to achieve limb salvage if complications are unpreventable.

  1. 78 FR 70076 - Aging Management of Internal Surfaces, Fire Water Systems, Atmospheric Storage Tanks, and...

    Science.gov (United States)

    2013-11-22

    ... COMMISSION Aging Management of Internal Surfaces, Fire Water Systems, Atmospheric Storage Tanks, and... Guidance (LR-ISG), LR-ISG-2012-02, ``Aging Management of Internal Surfaces, Fire Water Systems, Atmospheric... aging management programs (AMPs), aging management review (AMR) items, and definitions in NUREG-...

  2. Adherence to asthma guidelines in general practices.

    Science.gov (United States)

    Roghmann, M C; Sexton, M

    1999-06-01

    Adherence to asthma practice guidelines is low. Improved compliance could potentially improve care of patients with asthma. The purpose of this study was to determine if patients managed in a general practice with an associated asthma clinic are more likely to use asthma medications according to clinical practice guidelines than patients managed in the general surgery of the practice. A cross-sectional study of adult asthmatics, aged 18-55 years, was conducted in six British general practices. Prescription data on all asthma medication was collected for a 6-month period. Information on asthma clinic attendance, age, sex, employment status, other medical illness, and how patients used their inhaled beta2-agonist was collected through questionnaire. The prescription data for asthma medication and patient use of inhaled beta2-agonist were compared to the British Thoracic Society's (BTS) Guidelines for Management of Asthma in Adults to determine if the patient's asthma medication regimen was appropriate. There was no significant association found between appropriate asthma medication and asthma clinic attendance or other patient characteristics. Adherence to the BTS guidelines was low. Fifty-eight percent of the asthma patients used asthma medication regimens that were not consistent with the BTS guidelines published 1 year earlier. Adherence to the BTS guidelines was low regardless of patient characteristics, including asthma clinic attendance, age, sex, employment status, other medical illness, or individual practice. These findings underscore the need to document the utility of clinical practice guidelines which may improve physician compliance.

  3. Do accident and emergency senior house officers know the British guidelines on the management of acute asthma?

    Science.gov (United States)

    Ulahannan, T; Hardern, R D; Hamer, D W

    1996-03-01

    Avoidable deaths from asthma continue, even in hospital. Since the management of acute severe asthma is often initiated in the Accident and Emergency department, it is crucial that staff there have adequate knowledge. An anonymous questionnaire, containing items based on chart 6 of the UK guidelines, was completed by 66 Accident and Emergency Senior House Officers from the Yorkshire region. The study aim was to establish these doctors' levels of knowledge about the recommended management of acute asthma in Accident and Emergency. The median score was 10 (out of a possible 24) and the interquartile range 8-13. Further efforts are required to implement these guidelines so that the best patient outcomes can be achieved.

  4. 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.

  5. [Consensus guidelines for the management of community acquired pneumonia in the elderly patient].

    Science.gov (United States)

    González Del Castillo, Juan; Martín-Sánchez, Francisco Javier; Llinares, Pedro; Menéndez, Rosario; Mujal, Abel; Navas, Enrique; Barberán, José

    2014-01-01

    The incidence of community-acquired pneumonia increases with age and is associated with an elevated morbidity and mortality due to the physiological changes associated with aging and a greater presence of chronic disease. Taking into account the importance of this disease from an epidemiological and prognostic point of view, and the enormous heterogeneity described in the clinical management of the elderly, we believe a specific consensus document regarding this patient profile is necessary. The purpose of the present work was to perform a review of the evidence related to the risk factors for the etiology, the clinical presentation, the management and the treatment of community-acquired pneumonia in elderly patients with the aim of producing a series of specific recommendations based on critical analysis of the literature. This document is the result of the collaboration of different specialists representing the Spanish Society of Emergency Medicine and Emergency Care (SEMES), the Spanish Society of Geriatrics and Gerontology (SEGG), the Spanish Society of Chemotherapy (SEQ), the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Respiratory Medicine and Thoracic Surgery (SEPAR), Spanish Society of Home Hospitalization (SEHAD) and the Spanish Society of Infectious Disease and Clinical Microbiology (SEIMC).

  6. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care--short version.

    OpenAIRE

    Kleinschmidt, Stefan; Koppert, Wolfgang; Kessler, Paul; Huth, Ralf; Hartl, Wolfgang; Haase, Ulrike; Garten, Lars; Engelmann, Lothar; Eichler, Ingolf; Eggers, Verena; Dictus, Christine; Dall, Peter; Bürkle, Hartmut; Biniek, Rolf; Bäsell, Katrin

    2010-01-01

    Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2nd Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to hav...

  7. 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.

  8. Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

    Directory of Open Access Journals (Sweden)

    Hurkmans Coen W

    2012-11-01

    Full Text Available Abstract 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.

  9. [Guidelines for diagnosis and management of cirrhotic ascites and its complications. The Israeli Association for the Study of the Liver].

    Science.gov (United States)

    Sikuler, Emanuel; Ackerman, Zvi; Braun, Marius; Baruch, Yaakov; Bruck, Refael; Safadi, Rifaat; Shlomai, Amir; Ben-Ari, Ziv

    2012-12-01

    Ascites is the most common manifestation of decompensated liver cirrhosis. The life expectancy of cirrhotic patients developing uncomplicated ascites is 50% for 3 years. Refractory ascites, electrolyte imbalance, hepato-renal syndrome and spontaneous bacterial peritonitis may develop. Successful treatment can improve symptoms and outcomes. This article summarizes the Israeli Association for the Study of the Liver guidelines for diagnosis and management of cirrhotic ascites and its complications.

  10. 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

  11. Practical examples of how knowledge management is addressed in Point Lepreau heat transport ageing management programs

    Energy Technology Data Exchange (ETDEWEB)

    Slade, J. [NB Power Nuclear, Lepreau, New Brunswick (Canada)], E-mail: JSlade@NBPower.com; Gendron, T. [Atomic Energy of Canada Limited, Chalk River, Ontario (Canada); Greenlaw, G. [NB Power Nuclear, Lepreau, New Brunswick (Canada)

    2009-07-01

    In the mid-1990s, New Brunswick Power Nuclear implemented a Management System Process Model at the Point Lepreau Generating Station that provides the basic elements of a knowledge management program. As noted by the IAEA, the challenge facing the nuclear industry now is to make improvements in knowledge management in areas that are more difficult to implement. Two of these areas are: increasing the value of existing knowledge, and converting tacit knowledge to explicit knowledge (knowledge acquisition). This paper describes some practical examples of knowledge management improvements in the Point Lepreau heat transport system ageing management program. (author)

  12. 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

  13. ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part II - Management of Various Cardiovascular Complications.

    Science.gov (United States)

    Wang, Angela Yee Moon; Brimble, K Scott; Brunier, Gillian; Holt, Stephen G; Jha, Vivekanand; Johnson, David W; Kang, Shin-Wook; Kooman, Jeroen P; Lambie, Mark; McIntyre, Chris; Mehrotra, Rajnish; Pecoits-Filho, Roberto

    2015-01-01

    Cardiovascular mortality has remained high in patients on peritoneal dialysis (PD) due to the high prevalence of various cardiovascular complications including coronary artery disease, left ventricular hypertrophy and dysfunction, heart failure, arrhythmia (especially atrial fibrillation), cerebrovascular disease, and peripheral arterial disease. In addition, nearly a quarter of PD patients develop sudden cardiac death as the terminal life event. Thus, it is essential to identify effective treatment that may lower cardiovascular mortality and improve survival of PD patients. The International Society for Peritoneal Dialysis (ISPD) commissioned a global workgroup in 2012 to formulate a series of recommendation statements regarding lifestyle modification, assessment and management of various cardiovascular risk factors, and management of the various cardiovascular complications to be published in 2 guideline documents. This publication forms the second part of the guideline documents and includes recommendation statements on the management of various cardiovascular complications in adult chronic PD patients. The documents are intended to serve as a global clinical practice guideline for clinicians who look after PD patients. We also define areas where evidence is clearly deficient and make suggestions for future research in each specific area.

  14. ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part I - Assessment and Management of Various Cardiovascular Risk Factors.

    Science.gov (United States)

    Wang, Angela Yee Moon; Brimble, K Scott; Brunier, Gillian; Holt, Stephen G; Jha, Vivekanand; Johnson, David W; Kang, Shin-Wook; Kooman, Jeroen P; Lambie, Mark; McIntyre, Chris; Mehrotra, Rajnish; Pecoits-Filho, Roberto

    2015-01-01

    Cardiovascular disease contributes significantly to the adverse clinical outcomes of peritoneal dialysis (PD) patients. Numerous cardiovascular risk factors play important roles in the development of various cardiovascular complications. Of these, loss of residual renal function is regarded as one of the key cardiovascular risk factors and is associated with an increased mortality and cardiovascular death. It is also recognized that PD solutions may incur significant adverse metabolic effects in PD patients. The International Society for Peritoneal Dialysis (ISPD) commissioned a global workgroup in 2012 to formulate a series of recommendations regarding lifestyle modification, assessment and management of various cardiovascular risk factors, as well as management of the various cardiovascular complications including coronary artery disease, heart failure, arrhythmia (specifically atrial fibrillation), cerebrovascular disease, peripheral arterial disease and sudden cardiac death, to be published in 2 guideline documents. This publication forms the first part of the guideline documents and includes recommendations on assessment and management of various cardiovascular risk factors. The documents are intended to serve as a global clinical practice guideline for clinicians who look after PD patients. The ISPD workgroup also identifies areas where evidence is lacking and further research is needed.

  15. Canadian Society of Nephrology commentary on the KDIGO clinical practice guideline for CKD evaluation and management.

    Science.gov (United States)

    Akbari, Ayub; Clase, Catherine M; Acott, Phil; Battistella, Marisa; Bello, Aminu; Feltmate, Patrick; Grill, Allan; Karsanji, Meena; Komenda, Paul; Madore, Francois; Manns, Braden J; Mahdavi, Sara; Mustafa, Reem A; Smyth, Andrew; Welcher, E Sohani

    2015-02-01

    We congratulate the KDIGO (Kidney Disease: Improving Global Outcomes) work group on their comprehensive work in a broad subject area and agreed with many of the recommendations in their clinical practice guideline on the evaluation and management of chronic kidney disease. We concur with the KDIGO definitions and classification of kidney disease and welcome the addition of albuminuria categories at all levels of glomerular filtration rate (GFR), the terminology of G categories rather than stages to describe level of GFR, the division of former stage 3 into new G categories 3a and 3b, and the addition of the underlying diagnosis. We agree with the use of the heat map to illustrate the relative contributions of low GFR and albuminuria to cardiovascular and renal risk, though we thought that the highest risk category was too broad, including as it does people at disparate levels of risk. We add an albuminuria category A4 for nephrotic-range proteinuria and D and T categories for patients on dialysis or with a functioning renal transplant. We recommend target blood pressure of 140/90mm Hg regardless of diabetes or proteinuria, and against the combination of angiotensin receptor blockers with angiotensin-converting enzyme inhibitors. We recommend against routine protein restriction. We concur on individualization of hemoglobin A1c targets. We do not agree with routine restriction of sodium intake to 3.3g/d). We suggest screening for anemia only when GFR is 60mg/mmol or proteinuria with protein excretion > 1g/d as the referral threshold for proteinuria.

  16. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013.

    Science.gov (United States)

    Cornely, O A; Arikan-Akdagli, S; Dannaoui, E; Groll, A H; Lagrou, K; Chakrabarti, A; Lanternier, F; Pagano, L; Skiada, A; Akova, M; Arendrup, M C; Boekhout, T; Chowdhary, A; Cuenca-Estrella, M; Freiberger, T; Guinea, J; Guarro, J; de Hoog, S; Hope, W; Johnson, E; Kathuria, S; Lackner, M; Lass-Flörl, C; Lortholary, O; Meis, J F; Meletiadis, J; Muñoz, P; Richardson, M; Roilides, E; Tortorano, A M; Ullmann, A J; van Diepeningen, A; Verweij, P; Petrikkos, G

    2014-04-01

    These European Society for Clinical Microbiology and Infectious Diseases and European Confederation of Medical Mycology Joint Clinical Guidelines focus on the diagnosis and management of mucormycosis. Only a few of the numerous recommendations can be summarized here. To diagnose mucormycosis, direct microscopy preferably using optical brighteners, histopathology and culture are strongly recommended. Pathogen identification to species level by molecular methods and susceptibility testing are strongly recommended to establish epidemiological knowledge. The recommendation for guiding treatment based on MICs is supported only marginally. Imaging is strongly recommended to determine the extent of disease. To differentiate mucormycosis from aspergillosis in haematological malignancy and stem cell transplantation recipients, identification of the reverse halo sign on computed tomography is advised with moderate strength. For adults and children we strongly recommend surgical debridement in addition to immediate first-line antifungal treatment with liposomal or lipid-complex amphotericin B with a minimum dose of 5 mg/kg/day. Amphotericin B deoxycholate is better avoided because of severe adverse effects. For salvage treatment we strongly recommend posaconazole 4×200 mg/day. Reversal of predisposing conditions is strongly recommended, i.e. using granulocyte colony-stimulating factor in haematological patients with ongoing neutropenia, controlling hyperglycaemia and ketoacidosis in diabetic patients, and limiting glucocorticosteroids to the minimum dose required. We recommend against using deferasirox in haematological patients outside clinical trials, and marginally support a recommendation for deferasirox in diabetic patients. Hyperbaric oxygen is supported with marginal strength only. Finally, we strongly recommend continuing treatment until complete response demonstrated on imaging and permanent reversal of predisposing factors.

  17. 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

  18. Ageing management of french NPP civil work structures

    Science.gov (United States)

    Gallitre, E.; Dauffer, D.

    2011-04-01

    This paper presents EDF practice about concrete structure ageing management, from the mechanisms analysis to the formal procedure which allows the French company to increase 900 MWe NPP lifetime until 40 years; it will also introduce its action plan for 60 years lifetime extension. This practice is based on a methodology which identifies every ageing mechanism; both plants feedback and state of the art are screened and conclusions are drawn up into an "ageing analysis data sheet". That leads at first to a collection of 57 data sheets which give the mechanism identification, the components that are concerned and an analysis grid which is designed to assess the safety risk. This analysis screens the reference documents describing the mechanism, the design lifetime hypotheses, the associated regulation or codification, the feedback experiences, the accessibility, the maintenance actions, the repair possibility and so one. This analysis has to lead to a conclusion about the risk taking into account monitoring and maintenance. If the data sheet conclusion is not clear enough, then a more detailed report is launched. The technical document which is needed, is a formal detailed report which summarizes every theoretical knowledge and monitoring data: its objective is to propose a solution for ageing management: this solution can include more inspections or specific research development, or additional maintenance. After a first stage on the 900 MWe units, only two generic ageing management detailed reports have been needed for the civil engineering part: one about reactor building containment, and one about other structures which focuses on concrete inflating reactions. The second stage consists on deriving this generic analysis (ageing mechanism and detailed reports) to every plant where a complete ageing report is required (one report for all equipments and structures of the plant, but specific for each reactor). This ageing management is a continuous process because the

  19. A comprehensive Aging Management Program of a German NPP

    Energy Technology Data Exchange (ETDEWEB)

    Wildner, U.

    2014-07-01

    The majority of System, Structure and Components (SSC) in a nuclear power plants are designed to experience a service life, which is far above the intended design life. In most cases, only a small percentage of SSCs are subject to significant aging effects, which may affect the integrity or the function of the component. The process of aging management (AM) has the objective to monitor and control degradation effects which may compromise safety functions of the plant. And furthermore, to ensure, that testing and maintenance programs sufficiently provide preventive measures to control degradation effects. (Author)

  20. What do the recent American Heart Association/American College of Cardiology Foundation Clinical Practice Guidelines tell us about the evolving management of coronary heart disease in older adults?

    Institute of Scientific and Technical Information of China (English)

    Daniel Forman; Nanette K Wenger

    2013-01-01

    Biological aging predisposes older adults to increased cardiovascular disease (CHD) and greater disease complexity. Given the high age-related prevalence of CHD and age-related compounding factors, the recently updated American Heart Association/American College of Cardiology Foundation CHD-related guidelines increased their focus on older patients. These guidelines are predominately evidence-based (using data from quality randomized clinical trials) and are organized to delineate medications and procedures that best treat particular cardiovascular diseases. While such rationale and thought work well in young and middle aged adults, they become problematic in patients who are very old. Data pertaining to adults aged ≥ 80 are virtually absent from most randomized clinical trials, and even in the instances when very old patients were included, eligibility criteria typically excluded candidates with co-morbidities and complexities of customary CHD patients. While medications and interventions yielding benefit in clinical trials should theoretically produce the greatest benefits for patients with high intrinsic risk, age-related cardiovascular complexities also increase iatrogenic risks. Navigating between the potential for high benefit and high risk in "evidence-based" cardiovascular management remains a key Geriatric Cardiology challenge. In this review we consider the expanded Geriatric Cardiology content of current guidelines, acknowledging both the progress that has been made, as well as the work that still needs to be accomplished to truly address the patient-centered priorities of older CHD patients.

  1. 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.

  2. Managing care pathways combining SNOMED CT, archetypes and an electronic guideline system.

    Science.gov (United States)

    Bernstein, Knut; Andersen, Ulrich

    2008-01-01

    Today electronic clinical guideline systems exist, but they are not well integrated with electronic health records. This paper thus proposes that the patient's "position" in the pathway during the patient journey should be made visible to all involved healthcare parties and the patient. This requires that the generic knowledge, which is represented in the guidelines, is combined with the patient specific information - and then made accessible for all relevant parties. In addition to the decision support provided by the guideline system documentation support can be provided by templates based on archetypes. This paper provides a proposal for how the guideline system and the EHR can be integrated by the use of archetypes and SNOMED CT. SNOMED CT provides the common reference terminology and the semantic links between the systems. The proposal also includes the use of a National Patient Index for storing data about the patient's position in the pathway and for sharing this information by all involved parties.

  3. Guidelines for Development of a Base Comprehensive Plan to Manage Military Construction.

    Science.gov (United States)

    1985-09-01

    Communications - Transportation * Facilities - Energy - Architectural Compatibility - Landscape Planning / Design - Facilities Development - Fire Protection 38...Guidelines - Base Landscape Development Plan: 1. Landscape Design 2. Landscape Planning 3. Landscape Development Phasing M. Long Range Facilities

  4. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery

    DEFF Research Database (Denmark)

    Alfieri, S; Amid, P K; Campanelli, G

    2011-01-01

    To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain....

  5. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents.

    Science.gov (United States)

    Menter, Alan; Korman, Neil J; Elmets, Craig A; Feldman, Steven R; Gelfand, Joel M; Gordon, Kenneth B; Gottlieb, Alice B; Koo, John Y M; Lebwohl, Mark; Lim, Henry W; Van Voorhees, Abby S; Beutner, Karl R; Bhushan, Reva

    2009-09-01

    Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this fourth of 6 sections of the guidelines of care for psoriasis, we discuss the use of traditional systemic medications for the treatment of patients with psoriasis. Treatment should be tailored to meet individual patients' needs. We will discuss in detail the efficacy and safety, and offer recommendations for the use of the 3 most commonly used, and approved, traditional systemic agents: methotrexate, cyclosporine, and acitretin. We will also briefly discuss the available data for the use of azathioprine, fumaric acid esters, hydroxyurea, leflunomide, mycophenolate mofetil, sulfasalazine, tacrolimus, and 6-thioguanine in psoriasis.

  6. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery

    DEFF Research Database (Denmark)

    Alfieri, S; Amid, P K; Campanelli, G

    2011-01-01

    To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain.......To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain....

  7. Asian consensus workshop report: expert consensus guideline for the management of intermediate and advanced hepatocellular carcinoma in Asia.

    Science.gov (United States)

    Han, Kwang-Hyub; Kudo, Masatochi; Ye, Sheng-Long; Choi, Jong Young; Poon, Roonni Tung-Ping; Seong, Jinsil; Park, Joong-Won; Ichida, Takafumi; Chung, Jin Wook; Chow, Pierce; Cheng, Ann-Lii

    2011-01-01

    Hepatocellular carcinoma (HCC) is a highly prevalent disease in many Asian countries, accounting for 80% of victims worldwide. Screening programs improve the detection of early HCC and have a positive impact on survival, but the majority of HCC patients in Asia still present with advanced stage disease. The treatment outcomes of HCC are affected by multiple variables, including liver function, performance status of the patient, and tumor stage. Therefore, it is not easy to apply a multidisciplinary therapeutic approach for optimal management. At present, limited numbers of HCC patients are eligible for curative therapies such as surgery or ablation in Asia. Therefore, most patients are eligible for only palliative treatments. For optimal management, the treatment choice is guided by staging systems and treatment guidelines. Numerous staging systems have been proposed and treatment guidelines vary by region. According to the Barcelona Clinic Liver Cancer (BCLC) guideline based on evidence from randomized clinical trials, only transarterial chemoembolization (TACE) is recommended for intermediate stage HCC and sorafenib for advanced stage HCC. However, treatment guidelines from Asian countries have adopted several other therapeutic modalities such as a surgical approach, hepatic arterial infusion chemotherapy, external radiation, and their combinations based on clinical experiences for intermediate and advanced stage HCC. Although TACE is the main therapeutic modality in the intermediate stage, overall therapeutic outcomes depend on the tumor size. In the advanced stage, the prognosis depends on the tumor status, e.g. major vessel invasion or extrahepatic spread. Thus, a new staging system representing prognoses suitable for Asian HCC patients and a corresponding optimal treatment algorithm should be further investigated using evidence-based data, which will finally bring about an Asian consensus for the management of intermediate and advanced stage HCC.

  8. 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.

  9. Even-Aged vs. Uneven-Aged Silviculture: Implications for Multifunctional Management of Southern Pine Ecosystems

    Directory of Open Access Journals (Sweden)

    Ajay Sharma

    2016-04-01

    Full Text Available We evaluated even- and uneven-aged silvicultural options for slash pine (Pinus elliottii Engelm. using empirical data and the Forest Vegetation Simulator (FVS model. Data were collected from a mature unthinned slash pine plantation in a flatwoods site in Florida, and used to simulate six scenarios of even- and uneven-aged silvicultural regimes applied to slash pine stands, including a no-action option. These alternative silvicultural regimes were evaluated for multiple benefits including timber production, carbon storage and stand structural diversity over a period of 100 years. None of the silvicultural regimes maximized all the benefits. While even-aged management options were more efficient in total merchantable timber production (9.78 to 11.02 m3·ha−1·year−1 and overall carbon stocks (3.05 to 3.47 metric tons·ha−1·year−1, uneven-aged management options created overall more complex stand structure (Stand Structural Diversity (computed from Shannon’s Indices values = 1.92 and maintained a steady flow of yields, particularly sawtimber (34.29 to 58.46 m3·ha−1 every 10 year and aboveground carbon stocks (56.9 to 77.2 metric tons·ha−1. Optimal achievement of multiple benefits across the landscape, therefore, may require maintaining an assortment of management strategies. Both even- and uneven-aged management options have the potential to improve production and carbon storage of pine forests and are a substantial improvement over no action.

  10. 77 FR 27815 - Aging Management of Stainless Steel Structures and Components in Treated Borated Water

    Science.gov (United States)

    2012-05-11

    ... COMMISSION Aging Management of Stainless Steel Structures and Components in Treated Borated Water AGENCY..., ``Aging Management of Stainless Steel Structures and Components in Treated Borated Water.'' This LR-ISG... Power Plants (SRP-LR) and Generic Aging Lessons Learned (GALL) Report for the aging management...

  11. 77 FR 16270 - Updated Aging Management Criteria for Reactor Vessel Internal Components of Pressurized Water...

    Science.gov (United States)

    2012-03-20

    ... COMMISSION Updated Aging Management Criteria for Reactor Vessel Internal Components of Pressurized Water... license renewal interim staff guidance (LR-ISG), LR-ISG-2011-04, ``Updated Aging Management Criteria for... Aging Lessons Learned (GALL) Report for the aging management of stainless steel structures...

  12. South-East Asia study alliance guidelines on the management of acne vulgaris in South-East Asian patients.

    Science.gov (United States)

    Goh, Chee Leok; Abad-Casintahan, Flordeliz; Aw, Derrick Chen Wee; Baba, Roshidah; Chan, Lee Chin; Hung, Nguyen Thanh; Kulthanan, Kanokvalai; Leong, Hoe Nam; Medina-Oblepias, Marie Socouer; Noppakun, Nopadon; Sitohang, Irma Bernadette; Sugito, Titi Lestari; Wong, Su-Ni

    2015-10-01

    The management of acne in South-East Asia is unique, as Asian skin and local variables require a clinical approach unlike that utilized in other parts of the world. There are different treatment guidelines per country in the region, and a group of leading dermatologists from these countries convened to review these guidelines, discuss current practices and recent advances, and formulate consensus guidelines to harmonize the management of acne vulgaris in the region. Emphasis has been placed on formulating recommendations to impede the development of antibiotic resistance in Propionibacterium acnes. The group adopted the Acne Consensus Conference system for grading acne severity. The group recommends that patients may be treated with topical medications including retinoids, benzoyl peroxide (BPO), salicylic acid, a combination of retinoid and BPO, or a combination of retinoids and BPO with or without antibiotics for mild acne; topical retinoid with topical BPO and a oral antibiotic for moderate acne; and oral isotretinoin if the patient fails first-line treatment (a 6- or 8-week trial of combined oral antibiotics and topical retinoids with BPO) for severe acne. Maintenance acne treatment using topical retinoids with or without BPO is recommended. To prevent the development of antibiotic resistance, topical antibiotics should not be used as monotherapy or used simultaneously with oral antibiotics. Skin care, comprised of cleansing, moisturizing and sun protection, is likewise recommended. Patient education and good communication is recommended to improve adherence, and advice should be given about the characteristics of the skin care products patients should use.

  13. 2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition).

    Science.gov (United States)

    Satoh, Tetsurou; Isozaki, Osamu; Suzuki, Atsushi; Wakino, Shu; Iburi, Tadao; Tsuboi, Kumiko; Kanamoto, Naotetsu; Otani, Hajime; Furukawa, Yasushi; Teramukai, Satoshi; Akamizu, Takashi

    2016-12-30

    Thyroid storm is an endocrine emergency which is characterized by multiple organ failure due to severe thyrotoxicosis, often associated with triggering illnesses. Early suspicion, prompt diagnosis and intensive treatment will improve survival in thyroid storm patients. Because of its rarity and high mortality, prospective intervention studies for the treatment of thyroid storm are difficult to carry out. We, the Japan Thyroid Association and Japan Endocrine Society taskforce committee, previously developed new diagnostic criteria and conducted nationwide surveys for thyroid storm in Japan. Detailed analyses of clinical data from 356 patients revealed that the mortality in Japan was still high (∼11%) and that multiple organ failure and acute heart failure were common causes of death. In addition, multimodal treatment with antithyroid drugs, inorganic iodide, corticosteroids and beta-adrenergic antagonists has been suggested to improve mortality of these patients. Based on the evidence obtained by nationwide surveys and additional literature searches, we herein established clinical guidelines for the management of thyroid storm. The present guideline includes 15 recommendations for the treatment of thyrotoxicosis and organ failure in the central nervous system, cardiovascular system, and hepato-gastrointestinal tract, admission criteria for the intensive care unit, and prognostic evaluation. We also proposed preventive approaches to thyroid storm, roles of definitive therapy, and future prospective trial plans for the treatment of thyroid storm. We hope that this guideline will be useful for many physicians all over the world as well as in Japan in the management of thyroid storm and the improvement of its outcome.

  14. Japanese Guideline for Childhood Asthma 2014

    Directory of Open Access Journals (Sweden)

    Yuhei Hamasaki

    2014-01-01

    Full Text Available The Japanese Guideline for the Diagnosis and Treatment of Allergic Diseases 2013 (JAGL 2013 describes childhood asthma after the Japanese Pediatric Guideline for the Treatment and Management of Asthma 2012 (JPGL 2012 by the Japanese Society of Pediatric Allergy and Clinical Immunology. JAGL 2013 provides information on diagnosis by age group from infancy to puberty (0–15 years of age, treatment for acute exacerbations, long-term management by anti-inflammatory drugs, daily life guidance, and patient education to allow non-specialist physicians to refer to this guideline for routine medical treatment. JAGL differs from the Global Initiative for Asthma Guideline (GINA in that JAGL emphasizes early diagnosis and intervention at <2 years and 2–5 years of age. A management method, including step-up or step-down of long-term management drugs based on the status of asthma control levels, as in JAGL, is easy to understand, and thus the Guideline is suitable as a frame of reference for routine medical treatment. JAGL has also introduced treatment and management using a control test on children, recommending that the physician aim at complete control by avoiding exacerbation factors and by appropriate use of anti-inflammatory drugs.

  15. 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.

  16. 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.

  17. 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.

    Science.gov (United States)

    Menter, Alan; Korman, Neil J; Elmets, Craig A; Feldman, Steven R; Gelfand, Joel M; Gordon, Kenneth B; Gottlieb, Alice; Koo, John Y M; Lebwohl, Mark; Lim, Henry W; Van Voorhees, Abby S; Beutner, Karl R; Bhushan, Reva

    2009-04-01

    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.

  18. BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment.

    Science.gov (United States)

    Cooper, Stephen J; Reynolds, Gavin P; Barnes, Tre; England, E; Haddad, P M; Heald, A; Holt, Rig; Lingford-Hughes, A; Osborn, D; McGowan, O; Patel, M X; Paton, C; Reid, P; Shiers, D; Smith, J

    2016-08-01

    Excess deaths from cardiovascular disease are a major contributor to the significant reduction in life expectancy experienced by people with schizophrenia. Important risk factors in this are smoking, alcohol misuse, excessive weight gain and diabetes. Weight gain also reinforces service users' negative views of themselves and is a factor in poor adherence with treatment. Monitoring of relevant physical health risk factors is frequently inadequate, as is provision of interventions to modify these. These guidelines review issues surrounding monitoring of physical health risk factors and make recommendations about an appropriate approach. Overweight and obesity, partly driven by antipsychotic drug treatment, are important factors contributing to the development of diabetes and cardiovascular disease in people with schizophrenia. There have been clinical trials of many interventions for people experiencing weight gain when taking antipsychotic medications but there is a lack of clear consensus regarding which may be appropriate in usual clinical practice. These guidelines review these trials and make recommendations regarding appropriate interventions. Interventions for smoking and alcohol misuse are reviewed, but more briefly as these are similar to those recommended for the general population. The management of impaired fasting glycaemia and impaired glucose tolerance ('pre-diabetes'), diabetes and other cardiovascular risks, such as dyslipidaemia, are also reviewed with respect to other currently available guidelines.These guidelines were compiled following a consensus meeting of experts involved in various aspects of these problems. They reviewed key areas of evidence and their clinical implications. Wider issues relating to primary care/secondary care interfaces are discussed but cannot be resolved within guidelines such as these.

  19. Why don't clinicians adhere more consistently to guidelines for the Integrated Management of Childhood Illness (IMCI)?

    Science.gov (United States)

    Lange, Siri; Mwisongo, Aziza; Mæstad, Ottar

    2014-03-01

    The Integrated Management of Childhood Illness (IMCI) has been introduced to reduce child morbidity and mortality in countries with a poor health infrastructure. Previous studies have documented a poor adherence to clinical guidelines, but little is known about the reasons for non-adherence. This mixed-method study measures adherence to IMCI case-assessment guidelines and identifies the reasons for weak adherence. In 2007, adherence was measured through direct observation of 933 outpatient consultations performed by 103 trained clinicians in 82 health facilities in nine districts in rural Tanzania, while clinicians' knowledge of the guidelines was assessed through clinical vignettes. Other potential reasons for a weak adherence were assessed through both a health worker- and health facility survey, as well as by a qualitative follow-up study in 2009 in which in-depth interviews were conducted with 40 clinicians in 30 health facilities located in two of the same districts. Clinicians performed 28.4% of the relevant IMCI assessment tasks. The level of knowledge was considerably higher than actual performance, suggesting that lack of knowledge is not the only constraint for improved performance. Other important reasons for weak performance seem to be 1) lack of motivation to adhere to IMCI guidelines, stemming partly from a weak belief in the importance of following the guidelines and partly from weak intrinsic motivation, and 2) a physical and/or cognitive "overload", resulting in lack of capacity to concentrate fully on each and every case and a resort to simpler rules of thumb. Poor remunerations contribute to several of these factors.

  20. Guidelines on genetic evaluation and management of Lynch syndrome: a consensus statement by the US Multi-Society Task Force on colorectal cancer.

    Science.gov (United States)

    Giardiello, Francis M; Allen, John I; Axilbund, Jennifer E; Boland, C Richard; Burke, Carol A; Burt, Randall W; Church, James M; Dominitz, Jason A; Johnson, David A; Kaltenbach, Tonya; Levin, Theodore R; Lieberman, David A; Robertson, Douglas J; Syngal, Sapna; Rex, Douglas K

    2014-08-01

    The Multi-Society Task Force, in collaboration with invited experts, developed guidelines to assist health care providers with the appropriate provision of genetic testing and management of patients at risk for and affected with Lynch syndrome as follows: Figure 1 provides a colorectal cancer risk assessment tool to screen individuals in the office or endoscopy setting; Figure 2 illustrates a strategy for universal screening for Lynch syndrome by tumor testing of patients diagnosed with colorectal cancer; Figures 3-6 provide algorithms for genetic evaluation of affected and at-risk family members of pedigrees with Lynch syndrome; Table 10 provides guidelines for screening at-risk and affected persons with Lynch syndrome; and Table 12 lists the guidelines for the management of patients with Lynch syndrome. A detailed explanation of Lynch syndrome and the methodology utilized to derive these guidelines, as well as an explanation of, and supporting literature for, these guidelines are provided.

  1. 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

  2. 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

    BACKGROUND AND AIM: The general practitioner (GP) is the first contact with the health care system for most patients with COPD in Denmark. We studied, if participating in an educational program could improve adherence to guidelines, not least for diagnosis, staging, and treatment of the disease....... DESIGN AND SETTING: Two cross-sectional surveys were performed precisely one year apart before and after an educational program for the participating GPs. A total of 124 GPs completed the study; 1716 and 1342 patients with GP-diagnosed COPD and no concomitant asthma, respectively, were included...... 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...

  3. Web 2.0 systems supporting childhood chronic disease management: design guidelines based on information behaviour and social learning theories.

    Science.gov (United States)

    Ekberg, Joakim; Ericson, Leni; Timpka, Toomas; Eriksson, Henrik; Nordfeldt, Sam; Hanberger, Lena; Ludvigsson, Johnny

    2010-04-01

    Self-directed learning denotes that the individual is in command of what should be learned and why it is important. In this study, guidelines for the design of Web 2.0 systems for supporting diabetic adolescents' every day learning needs are examined in light of theories about information behaviour and social learning. A Web 2.0 system was developed to support a community of practice and social learning structures were created to support building of relations between members on several levels in the community. The features of the system included access to participation in the culture of diabetes management practice, entry to information about the community and about what needs to be learned to be a full practitioner or respected member in the community, and free sharing of information, narratives and experience-based knowledge. After integration with the key elements derived from theories of information behaviour, a preliminary design guideline document was formulated.

  4. 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

    relevant clinical questions with respect to patient-important outcomes. Quality ratings of the included studies were performed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 and Centre of Evidence Based Medicine (CEBM)-2 tools. Based upon the results, GRADE recommendations, a guideline...... 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......, 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-hospital observation...

  5. Healthcare Professionals’ and Policy Makers’ Views on Implementing a Clinical Practice Guideline of Hypertension Management: A Qualitative Study

    Science.gov (United States)

    Lee, Ping Yein; Liew, Su May; Abdullah, Adina; Abdullah, Nurdiana; Ng, Chirk Jenn; Hanafi, Nik Sherina; Chia, Yook Chin; Lai, Pauline S. M.; Wong, Stalia S. L.; Khoo, Ee Ming

    2015-01-01

    Introduction 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. Methods 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. Results 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. Conclusions 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

  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. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

    Science.gov (United States)

    Gralnek, Ian M; Dumonceau, Jean-Marc; Kuipers, Ernst J; Lanas, Angel; Sanders, David S; Kurien, Matthew; Rotondano, Gianluca; Hucl, Tomas; Dinis-Ribeiro, Mario; Marmo, Riccardo; Racz, Istvan; Arezzo, Alberto; Hoffmann, Ralf-Thorsten; Lesur, Gilles; de Franchis, Roberto; Aabakken, Lars; Veitch, Andrew; Radaelli, Franco; Salgueiro, Paulo; Cardoso, Ricardo; Maia, Luís; Zullo, Angelo; Cipolletta, Livio; Hassan, Cesare

    2015-10-01

    This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). Main Recommendations MR1. ESGE recommends immediate assessment of hemodynamic status in patients who present with acute upper gastrointestinal hemorrhage (UGIH), with prompt intravascular volume replacement initially using crystalloid fluids if hemodynamic instability exists (strong recommendation, moderate quality evidence). MR2. ESGE recommends a restrictive red blood cell transfusion strategy that aims for a target hemoglobin between 7 g/dL and 9 g/dL. A higher target hemoglobin should be considered in patients with significant co-morbidity (e. g., ischemic cardiovascular disease) (strong recommendation, moderate quality evidence). MR3. ESGE recommends the use of the Glasgow-Blatchford Score (GBS) for pre-endoscopy risk stratification. Outpatients determined to be at very low risk, based upon a GBS score of 0 - 1, do not require early endoscopy nor hospital admission. Discharged patients should be informed of the risk of recurrent bleeding and be advised to maintain contact with the discharging hospital (strong recommendation, moderate quality evidence). MR4. ESGE recommends initiating high dose intravenous proton pump inhibitors (PPI), intravenous bolus followed by continuous infusion (80 mg then 8 mg/hour), in patients presenting with acute UGIH awaiting upper endoscopy. However, PPI infusion should not delay the performance of early endoscopy (strong recommendation, high quality evidence). MR5. ESGE does not recommend the routine use of nasogastric or orogastric aspiration/lavage in patients presenting with acute UGIH (strong recommendation, moderate quality evidence). MR6. ESGE recommends intravenous erythromycin (single dose, 250 mg given 30 - 120 minutes prior to upper gastrointestinal [GI] endoscopy) in patients with clinically severe

  8. 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.

  9. The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update: focus on rehabilitation and exercise and surgical coronary revascularization.

    Science.gov (United States)

    Moe, Gordon W; Ezekowitz, Justin A; O'Meara, Eileen; Howlett, Jonathan G; Fremes, Steve E; Al-Hesayen, Abdul; Heckman, George A; Ducharme, Anique; Estrella-Holder, Estrellita; Grzeslo, Adam; Harkness, Karen; Lepage, Serge; McDonald, Michael; McKelvie, Robert S; Nigam, Anil; Rajda, Miroslaw; Rao, Vivek; Swiggum, Elizabeth; Virani, Sean; Van Le, Vy; Zieroth, Shelley; Arnold, J Malcolm O; Ashton, Tom; D'Astous, Michel; Dorian, Paul; Giannetti, Nadia; Haddad, Haissam; Isaac, Debra L; Kouz, Simon; Leblanc, Marie-Hélène; Liu, Peter; Ross, Heather J; Sussex, Bruce; White, Michel

    2014-03-01

    The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update provides focused discussions on the management recommendations on 2 topics: (1) exercise and rehabilitation; and (2) surgical coronary revascularization in patients with heart failure. First, all patients with stable New York Heart Association class I-III symptoms should be considered for enrollment in a tailored exercise training program, to improve exercise tolerance and quality of life. Second, selected patients with suitable coronary anatomy should be considered for bypass graft surgery. As in previous updates, the topics were chosen in response to stakeholder feedback. The 2013 Update also includes recommendations, values and preferences, and practical tips to assist the clinicians and health care workers manage their patients with heart failure.

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

    NARCIS (Netherlands)

    Lalla, R.V.; Bowen, J.; Barasch, A.; Elting, L.; Epstein, J.; Keefe, D.M.; McGuire, D.B.; Migliorati, C.; Nicolatou-Galitis, O.; Peterson, D.E.; Raber-Durlacher, J.E.; Sonis, S.T.; Elad, S.

    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

  11. 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

    and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations...

  12. 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…

  13. 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 ...

  14. Physiotherapy management of low back pain: does practice match the Dutch guidelines?

    NARCIS (Netherlands)

    Swinkels, I.C.S.; Ende, C.H.M. van den; Bosch, W. van den; Dekker, J.; Wimmers, R.H.

    2005-01-01

    The purpose of this study is to explore adherence by Dutch physiotherapists to the physiotherapists’ guideline for non-specific low back pain. For this study data from the National Information Service for Allied Health Care were used. This is a registration network that continuously collects informa

  15. Physiotherapy management of low back pain: does practice match the Dutch guidelines?

    NARCIS (Netherlands)

    Swinkels, I.C.; Ende, C.H.M. van den; Bosch, W.J.H.M. van den; Dekker, J.; Wimmers, R.H.

    2005-01-01

    The purpose of this study is to explore adherence by Dutch physiotherapists to the physiotherapists' guideline for non-specific low back pain. For this study data from the National Information Service for Allied Health Care were used. This is a registration network that continuously collects informa

  16. Framatome ANP worldwide experience in ageing and plant life management

    Energy Technology Data Exchange (ETDEWEB)

    Daeuwel, W.; Kastner, B.; Nopper, H. [Framatome ANP (Germany)

    2004-07-01

    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.)

  17. 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

  18. 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...

  19. [Spanish interdisciplinary committee for cardiovascular disease prevention and the spanish society of cardiology position statement on dyslipidemia management. Differences between the European and american guidelines].

    Science.gov (United States)

    Lobos Bejarano, José María; Galve, Enrique; Royo-Bordonada, Miguel Ángel; Alegría Ezquerra, Eduardo; Armario, Pedro; Brotons Cuixart, Carlos; Camafort Babkowski, Miguel; Cordero Fort, Alberto; Maiques Galán, Antonio; Mantilla Morató, Teresa; Pérez Pérez, Antonio; Pedro-Botet, Juan; Villar Álvarez, Fernando; González-Juanatey, José Ramón

    2015-04-01

    The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention.

  20. Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology Position Statement on Dyslipidemia Management: differences between the European and American Guidelines.

    Science.gov (United States)

    Lobos Bejarano, José María; Galve, Enrique; Royo-Bordonada, Miguel Ángel; Alegría Ezquerra, Eduardo; Armario, Pedro; Brotons Cuixart, Carlos; Camafort Babkowski, Miguel; Cordero Fort, Alberto; Maiques Galán, Antonio; Mantilla Morató, Teresa; Pérez Pérez, Antonio; Pedro-Botet, Juan; Villar Álvarez, Fernando; González-Juanatey, José Ramón

    2015-01-01

    The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention.

  1. [Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology position statement on dyslipidemia management. Differences between the European and American guidelines].

    Science.gov (United States)

    Lobos Bejarano, José María; Galve, Enrique; Royo-Bordonada, Miguel Ángel; Alegría Ezquerra, Eduardo; Armario, Pedro; Brotons Cuixart, Carlos; Camafort Babkowski, Miguel; Cordero Fort, Alberto; Maiques Galán, Antonio; Mantilla Morató, Teresa; Pérez Pérez, Antonio; Pedro-Botet, Juan; Villar Álvarez, Fernando; González-Juanatey, José Ramón

    2015-01-01

    The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention. Full English text available from:www.revespcardiol.org/en.

  2. Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology position statement on dyslipidemia management. Differences between the European and American guidelines.

    Science.gov (United States)

    Lobos Bejarano, José María; Galve, Enrique; Royo-Bordonada, Miguel Ángel; Alegría Ezquerra, Eduardo; Armario, Pedro; Brotons Cuixart, Carlos; Camafort Babkowski, Miguel; Cordero Fort, Alberto; Maiques Galán, Antonio; Mantilla Morató, Teresa; Pérez Pérez, Antonio; Pedro-Botet, Juan; Villar Álvarez, Fernando; González-Juanatey, José Ramón

    2014-11-01

    The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention.

  3. Clinical management of cranio-vertebral instability after whiplash, when guidelines should be adapted: a case report.

    Science.gov (United States)

    Rebbeck, Trudy; Liebert, Ann

    2014-12-01

    Cranio-vertebral instability (CVI) due to loss of bony or ligamentous integrity is one of the sequelae that may result after a whiplash mechanism injury. Due to the lack of specificity of diagnostic tests, this condition is often missed and the default classification of whiplash associated disorder (WAD) is assigned. This case report describes a 14-year-old boy who was initially classified with WAD II after a rugby injury. He was initially advised to return to usual activity, a treatment recommended in clinical guidelines for WAD. Due to an adverse response to this course of action, his primary carer, a musculoskeletal physiotherapist, continued with facilitating secondary referrals that ultimately led to a specialist physiotherapist. The patient was subsequently found to have CVI arising from a loss of bony integrity due to spina bifida atlanto, a congenital defect in the atlas. Treatment thus was immobilization and stabilization, a treatment usually recommended against in WAD guidelines. The patient recovered and within 8 weeks had returned to school and non-contact sports. This case study, therefore, presents a scenario where current clinical guidelines for whiplash could not be followed, and where pursuing clinical reasoning led to accurate diagnosis as well as safe and tailored management. The case also highlights the integrated roles that primary and specialist health professionals should play in the clinical pathway of care after WAD. As a result, an expanded diagnostic algorithm and pathway of care for WAD are proposed.

  4. The Impact of a National Guideline on the Management of Cancer Pain on the Practice of Pain Assessment and Registration.

    Science.gov (United States)

    Besse, Kees; Vernooij-Dassen, Myrra; Vissers, Kris; Engels, Yvonne

    2016-02-01

    The Dutch clinical practice guideline on the diagnosis and management of pain in patients with cancer was published in 2008 and intensively promoted to healthcare professionals who see patients with cancer. One of the most important recommendations is the systematic registering of the pain and its intensity. To evaluate in which degree this part of the practice guideline is implemented, we analyzed the medical records of patients attending the outpatient oncological clinic in an academic hospital, a large teaching hospital, and 4 smaller peripheral hospitals. None of the participating hospitals assessed pain by a standardized scale. Reference to pain in the medical record happened more frequently in the academic hospital than in the other hospitals. The frequency of recording pain in the medical record in the academic hospital was much higher in this study than the one previously reported, whereas the findings in the other hospitals were comparable. There may be several reasons for the difference in reporting rate of pain in patients with cancer. Our findings indicate that the clinical practice guideline with regard to pain registration is poorly implemented in oncology outpatient clinics. More efforts should be made to generate the awareness for the need of pain registration.

  5. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

    NARCIS (Netherlands)

    S. Di Saverio (Salomone); F. Coccolini (Federico); M. Galati (Marica); N. Smerieri (Nazareno); W.L. Biffl (Walter); L. Ansaloni (Luca); G. Tugnoli (Gregorio); G.C. Velmahos (George ); M. Sartelli (Massimo); C. Bendinelli (Cino); G.P. Fraga (Gustavo); M.D. Kelly (Michael ); F.A. Moore (Frederick); V. Mandala; V. Mandalà (Vincenzo); M. Masetti (Michele); E. Jovine (Elio); A.D. Pinna (Antonio ); A.B. Peitzman (Andrew); A. Leppaniemi (Ari); P.H. Sugarbaker (Paul ); H. van Goor (Harry); E.E. Moore (Ernest); J. Jeekel (Hans); F. Catena (Fausto)

    2013-01-01

    textabstractBackground: In 2013 Guidelines on diagnosis and management of ASBO have been revised and updated by the WSES Working Group on ASBO to develop current evidence-based algorithms and focus indications and safety of conservative treatment, timing of surgery and indications for laparoscopy.Re

  6. 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...

  7. 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.

  8. Invasive candidiasis in non neutropenic critically ill - need for region-specific management guidelines.

    Science.gov (United States)

    Ahmed, Armin; Azim, Afzal; Baronia, A K; Marak, Rungmei S K; Gurjar, Mohan

    2015-06-01

    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.

  9. 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.

  10. The management of anemia in pediatric peritoneal dialysis patients. Guidelines by an ad hoc European committee.

    Science.gov (United States)

    Schröder, Cornelis H

    2003-08-01

    Anemia is common in chronic renal failure. Guidelines for the diagnosis and treatment of anemia in adult patients are available. With respect to the diagnosis and treatment in children on peritoneal dialysis, the European Pediatric Peritoneal Dialysis Working Group (EPPWG) has produced guidelines. After a thorough diagnostic work-up, treatment should aim for a target hemoglobin concentration of at least 11 g/l. This can be accomplished by the administration of erythropoietin and iron preparations. Although there is sufficient evidence to advocate the intraperitoneal administration of erythropoietin, most pediatric nephrologists still apply erythropoietin by the subcutaneous route. Iron should preferably be prescribed as an oral preparation. Sufficient attention has to be paid to the nutritional intake in these children. There is no place for carnitine supplementation in the treatment of anemia in pediatric peritoneal dialysis patients.

  11. Lung cancer management in limited resource settings: guidelines for appropriate good care.

    Science.gov (United States)

    Macbeth, Fergus R; Abratt, Raymond P; Cho, Kwan H; Stephens, Richard J; Jeremic, Branislav

    2007-02-01

    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.

  12. Issues in the management of acute agitation: how much current guidelines consider safety?

    Directory of Open Access Journals (Sweden)

    Bruno ePacciardi

    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. The management of hypertension in Canada: a review of current guidelines, their shortcomings and implications for the future

    OpenAIRE

    McAlister, Finlay A; Campbell, Norman R.C.; Zarnke, Kelly; Levine, Mitchell; Graham, Ian D

    2001-01-01

    CLINICIANS ARE EXPOSED to numerous hypertension guidelines. However, their enthusiasm for these guidelines, and the impact of the guidelines, appears modest at best. Barriers to the successful implementation of a guideline can be identified at the level of the clinician, the patient or the practice setting; however, the shortcomings of the guidelines themselves have received little attention. In this paper, we review the hypertension guidelines that are most commonly encountered by Canadian c...

  14. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

    OpenAIRE

    Katzman, Martin A.; Bleau, Pierre; Blier, Pierre; Chokka, Pratap; Kjernisted, Kevin; van Ameringen, Michael; ,

    2014-01-01

    Background Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated. Methods These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980–2012). Treat...

  15. Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group

    DEFF Research Database (Denmark)

    Glahn, K P E; Ellis, F.R.; Halsall, P.J.

    2010-01-01

    Survival from a malignant hyperthermia (MH) crisis is highly dependent on early recognition and prompt action. MH crises are very rare and an increasing use of total i.v. anaesthesia is likely to make it even rarer, leading to the potential risk of reduced awareness of MH. In addition, dantrolene....... The guidelines consist of two textboxes: Box 1 on recognizing MH and Box 2 on the treatment of an MH crisis...

  16. 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....

  17. 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...

  18. 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

    Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and follow up are important for improving a favorable outcome. Guidelines...... should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers...

  19. [New DVO guideline for osteoporosis management 2014 and its importance for trauma surgeons].

    Science.gov (United States)

    Neuerburg, C; Stumpf, U; Schmidmaier, R; Kammerlander, C; Pfeilschifter, J; Mutschler, W; Böcker, W

    2015-11-01

    Osteoporosis-associated fractures represent a growing challenge in the treatment of orthopedic patients. In November 2014 a new revision of the guidelines on osteoporosis by the German Osteology Society (Dachverband Osteologie DVO) was adopted, in which additional risk factors for fractures and further treatment options have been included. On the one hand the existing model used to diagnose osteoporosis and estimate a high fracture risk as a guidance for the use of specific anti-osteoporotic therapy in patients without a fragility fracture was maintained and further refined. On the other hand the guideline includes the option to initiate a specific osteoporosis therapy without a prior bone densitometry in patients with typical radiographs of a proximal femur fracture and higher grade vertebral fractures, suspicious for osteoporosis, depending on the overall clinical context. This may reduce the treatment gap of osteoporosis in Germany. In this paper the changes in the DVO guidelines 2014 on osteoporosis are summarized, focusing on the most important changes with practical relevance for orthopedic surgeons.

  20. Wastewater management through the ages: a history of mankind.

    Science.gov (United States)

    Lofrano, Giusy; Brown, Jeanette

    2010-10-15

    Although much has been written about the history of water supply systems, there is a lack of corresponding information on wastewater management. This is surprising since the lack of sanitation affects human development to the same or even greater extent as the lack of clean water. While there may be an added stigma to discussing waste treatment, sanitation is widely perceived as meriting a significant claim on financial and political resources as well on the evolution of mankind. A literature review is presented on the evolution of wastewater management through the ages and its concurrent impact on human health and environment. Hopefully this information will improve the awareness of the past with a view to impacting future policies and technical developments. The review highlights the connection of environmental contamination with the ability to measure it, as well as the ways pollution control has been changed by advances in scientific knowledge. Attention is also drawn to the effects of political and societal events on wastewater management. A sanitation timeline has been constructed pointing out significant developments in the treatment of wastewater and improvements in analytical environmental chemistry. This review has been written in the belief that historical research showing the collective experience and "philosophy of sanitation" can provide inspiration to face future challenges.

  1. Promotion of Standard Treatment Guidelines and Building Referral System for Management of Common Noncommunicable Diseases in India

    Directory of Open Access Journals (Sweden)

    S K Jindal

    2011-01-01

    Full Text Available Treatment services constitute one of the five priority actions to face the global crisis due to noncommunicable diseases (NCDs. It is important to formulate standard treatment guidelines (STGs for an effective management, particularly at the primary and secondary levels of health care. Dissemination and implementation of STGs for NCDs on a country-wide scale involves difficult and complex issues. The management of NCDs and the associated costs are highly variable and huge. Besides the educational strategies for promotion of STGs, the scientific and administrative sanctions and sanctity are important for purposes of reimbursements, insurance, availability of facilities, and legal protection. An effective and functional referral- system needs to be built to ensure availability of appropriate care at all levels of health- services. The patient-friendly "to and fro" referral system will help to distribute the burden, lower the costs, and maintain the sustainability of services.

  2. Primary care summary of the British Thoracic Society Guideline on the management of non-cystic fibrosis bronchiectasis.

    Science.gov (United States)

    Hill, Adam T; Pasteur, Mark; Cornford, Charles; Welham, Sally; Bilton, Diana

    2011-06-01

    The British Thoracic Society (BTS) has recently published a guideline for the management of non-cystic fibrosis (non-CF) bronchiectasis in children and adults. This paper summarises the key recommendations applicable to the primary care setting. The key points are: • Think of the diagnosis of bronchiectasis in adults and children who present with a chronic productive cough or unexplained haemoptysis, and in children with asthma which responds poorly to treatment; • High resolution computed tomography (HRCT) scanning is needed to confirm the diagnosis • Sputum culture should be obtained at the start of an exacerbation prior to initiating treatment with antibiotics; Treatment should be started whilst awaiting the sputum result and should be continued for 14 days; • Patients with bronchiectasis have significant morbidity. Management in primary care is aimed at improving morbidity, and includes; patient education, treatment and monitoring, as well as appropriate referral to secondary care including assessment for long term antibiotics.

  3. Management Guidelines for Patients Choosing the Renal Supportive Care (RSC) Pathway: Information and Web-based Treatment Protocols Available to All.

    Science.gov (United States)

    Crail, Susan M

    2013-04-16

    Available guidelines fall into 2 categories - medication guides and service provision guides Few guidelines exist for the management of patients choosing to not have dialysis apart from those covering end of life (EOL) management and general ones for the management of chronic kidney disease. Most guidelines are only based on low level evidence, relying on expert opinion or current practice. This limits their usage when advising on matters such as trials of dialysis and caution should be applied when discussing these matters. More data is needed before firmer recommendations can be made. Units in Australia and New Zealand should consider maintaining registers of 'at risk' patients to allow greater input into symptom management and end-of-life support.

  4. Guidelines for developing NASA (National Aeronautics and Space Administration) ADP security risk management plans

    Science.gov (United States)

    Tompkins, F. G.

    1983-01-01

    This report presents guidance to NASA Computer security officials for developing ADP security risk management plans. The six components of the risk management process are identified and discussed. Guidance is presented on how to manage security risks that have been identified during a risk analysis performed at a data processing facility or during the security evaluation of an application system.

  5. Are tuberculosis patients in a tertiary care hospital in Hyderabad, India being managed according to national guidelines?

    Directory of Open Access Journals (Sweden)

    Kiran Kumar Kondapaka

    Full Text Available SETTING: A tertiary health care facility (Government General and Chest hospital in Hyderabad, India. OBJECTIVES: To assess a the extent of compliance of specialists to standardized national (RNTCP tuberculosis management guidelines and b if patients on discharge from hospital were being appropriately linked up with peripheral health facilities for continuation of anti-Tuberculosis (TB treatment. METHODS: A descriptive study using routine programme data and involving all TB patients admitted to inpatient care from 1(st January to 30(th June, 2010. RESULTS AND CONCLUSIONS: There were a total of 3120 patients admitted of whom, 1218 (39% required anti-TB treatment. Of these 1104 (98% were treated with one of the RNTCP recommended regimens, while 28 (2% were treated with non-RNTCP regimens. The latter included individually tailored MDR-TB treatment regimens for 19 patients and adhoc regimens for nine patients. A total of 957 (86% patients were eventually discharged from the hospital of whom 921 (96% had a referral form filled for continuing treatment at a peripheral health facility. Formal feedback from peripheral health facilities on continuation of TB treatment was received for 682 (74% patients. In a tertiary health facility with specialists the great majority of TB patients are managed in line with national guidelines. However a number of short-comings were revealed and measures to rectify these are discussed.

  6. Nuclear cardiac imaging for the diagnosis and management of heart failure: what can be learned from recent guidelines?

    Science.gov (United States)

    Vervloet, Delphine M; DE Sutter, Johan

    2016-01-20

    The aim of this review is to provide the clinical cardiologist and nuclear medicine specialist a brief overview of the currently accepted clinical use of cardiac nuclear imaging for the diagnosis and management of patients with heart failure based on recent (2012-2015) European Society of Cardiology (ESC) guidelines. We used the most recent ESC guidelines on heart failure, management of stable coronary artery disease, cardiac pacing, myocardial revascularisation, non-cardiac surgery and ventricular arrhythmias and sudden death. Nowadays cardiac nuclear imaging is useful in almost every step in heart failure from diagnostics to treatment. In first diagnosis of heart failure radionuclide imaging can provide information on ventricular function and volumes and nuclear imaging techniques provide accurate and reproducible left ventricular function assessment. In work out of the aetiology of the heart failure CMR, SPECT and PET imaging can demonstrate presence of inducible ischemia and myocardial viability. For prognostic information MIBG might be promising in the future. In treatment planning cardiac nuclear imaging is important to evaluate new angina and to assess accurate left ventricular ejection fraction before cardiac resynchronization therapy. Imaging stress testing is useful in the preoperative evaluation for non-cardiac surgery of heart failure patients. There is until now no recommended place for cardiac nuclear imaging in the follow-up of heart failure patients or prior to the initiation of cardiac rehabilitation.

  7. Review of VA/DOD Clinical Practice Guideline on management of acute stress and interventions to prevent posttraumatic stress disorder

    Directory of Open Access Journals (Sweden)

    William P. Nash, MD

    2012-06-01

    Full Text Available This article summarizes the recommendations of the Department of Veterans Affairs (VA/Department of Defense (DOD VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress that pertain to acute stress and the prevention of posttraumatic stress disorder, including screening and early interventions for acute stress states in various settings. Recommended interventions during the first 4 days after a potentially traumatic event include attending to safety and basic needs and providing access to physical, emotional, and social resources. Psychological first aid is recommended for management of acute stress, while psychological debriefing is discouraged. Further medical and psychiatric assessment and provision of brief, trauma-focused cognitive-behavioral therapy are warranted if clinically significant distress or functional impairment persists or worsens after 2 days or if the criteria for a diagnosis of acute stress disorder are met. Follow-up monitoring and rescreening are endorsed for at least 6 months for everyone who experiences significant acute posttraumatic stress. Four interventions that illustrate early intervention principles contained in the VA/DOD Clinical Practice Guideline are described.

  8. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery.

    Science.gov (United States)

    Duceppe, Emmanuelle; Parlow, Joel; MacDonald, Paul; Lyons, Kristin; McMullen, Michael; Srinathan, Sadeesh; Graham, Michelle; Tandon, Vikas; Styles, Kim; Bessissow, Amal; Sessler, Daniel I; Bryson, Gregory; Devereaux, P J

    2017-01-01

    The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery.

  9. Criteria for Incorporating the Guidelines of the Integrated Coastal Zone Management (ICZM) in Territorial Land Use Planning: Study Case for the Colombian Pacific Coastal Area

    OpenAIRE

    Ángela López Rodrí­guez; Paula Cristina Sierra-Correa; Pilar Lozano-Rivera

    2013-01-01

    In Colombia, Integrated Coastal Zone Management (ICZM) has been implemented through the “National Environmental Policy of the Oceanic Spaces and Coastal and Insular Areas of Colombia-PNAOCI” (Acronyms in Spanish), whose guidelines have considered the need to include marine and coastal ecosystems in land use planning. ICZM, as a special planning approach, can contribute to territorial land use planning of the municipalities located in coastal areas, because it can provide guidelines for the co...

  10. 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, H; Papini, E; Paschke, R;

    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 medical...... decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes...

  11. Investigation of paramedics' compliance with clinical practice guidelines for the management of chest pain.

    LENUS (Irish Health Repository)

    Figgis, Ken

    2012-01-31

    BACKGROUND: Acute coronary syndromes remain a leading cause of preventable early deaths. However, previous studies have indicated that paramedics\\' compliance with chest pain protocols is suboptimal and that many patients do not receive the benefits of appropriate prehospital treatment. AIMS: To evaluate paramedics\\' level of compliance with national clinical practice guidelines and to investigate why, in certain circumstances, they may deviate from the clinical guidelines. SETTING: The Health Service Executive Mid-Western Regional Ambulance Service which serves a mixed urban and rural population across three counties in the west of Ireland. METHOD: A retrospective review of completed ambulance Patient Care Report Forms was conducted for all adult patients with non-traumatic chest pain treated between 1 December 2007 and 31 March 2008. During the same study period, paramedics were asked to complete a prospective questionnaire survey investigating the rationale behind their treatment decisions, their estimation of patient risk and their attitudes towards the clinical practice guidelines and training. RESULTS: 382 completed Patient Care Report Forms were identified for patients with chest pain, of whom 84.8% received ECG monitoring, 75.9% were given oxygen, 44.8% were treated with sublingual glyceryl trinitrate (GTN) and 50.8% were treated with aspirin. Only 20.4% of patients had a prehospital 12-lead ECG recorded. 58 completed questionnaires were returned (response rate 15%); 64% of respondents said they had received insufficient training to identify ECG abnormalities. CONCLUSIONS: Prehospital treatment with oxygen, aspirin, sublingual GTN and ECG monitoring remains underused by paramedics, even though only a small number of patients had documented contraindications to their use. The small number of patients who received a prehospital 12-lead ECG is a cause of particular concern and suggests that incomplete patient assessment may contribute to undertreatment

  12. Guidelines for Implementing Advanced Distribution Management Systems-Requirements for DMS Integration with DERMS and Microgrids

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Jianhui [Argonne National Lab. (ANL), Argonne, IL (United States); Chen, Chen [Argonne National Lab. (ANL), Argonne, IL (United States); Lu, Xiaonan [Argonne National Lab. (ANL), Argonne, IL (United States)

    2015-08-01

    This guideline focuses on the integration of DMS with DERMS and microgrids connected to the distribution grid by defining generic and fundamental design and implementation principles and strategies. It starts by addressing the current status, objectives, and core functionalities of each system, and then discusses the new challenges and the common principles of DMS design and implementation for integration with DERMS and microgrids to realize enhanced grid operation reliability and quality power delivery to consumers while also achieving the maximum energy economics from the DER and microgrid connections.

  13. Evidence-based guidelines for pressure ulcer management at the end of life.

    Science.gov (United States)

    Langemo, Diane; Haesler, Emily; Naylor, Wayne; Tippett, Aletha; Young, Trudie

    2015-05-01

    It is important to develop an individualised plan of care for people at the end of life to prevent pressure ulcers, and to treat them if they do occur. This article discusses patient and risk assessment, prevention and care for pressure ulcers for the palliative care patient and the recommendations given in the palliative care section of the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline (National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance, 2014).

  14. 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

    should assist dentists and patients in decision making and for providing the best care effectively and efficiently. 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 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...

  15. 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

    The present study investigated changes in suspension stability and ecotoxicity of engineered nanoparticles (ENPs) by addition of Suwannee River natural organic matter and aging of stock and test suspensions prior to testing. Acute toxicity tests of silver (Ag), zinc oxide (ZnO), and titanium...... 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...

  16. Surgical management of abnormal uterine bleeding in fertile age women.

    Science.gov (United States)

    Finco, Andrea; Centini, Gabriele; Lazzeri, Lucia; Zupi, Errico

    2015-07-01

    Abnormal uterine bleeding is a common gynecological disease and represents one of the most frequent reasons for hospital admission to a specialist unit, often requiring further surgical treatment. Following the so-called PALM-COEIN system we will attempt to further clarify the surgical treatments available today. The first group (PALM) is characterized by structural lesions, which may be more appropriately treated by means of surgical management. Although hysterectomy remains the definitive and decisive choice, there are many alternative techniques available. These minimally invasive procedures offer the opportunity for a more conservative approach. Precise and accurate counseling facilitates better patient selection, based on the patient's desires, age and disease type, allowing treatment to be individually tailored to each woman.

  17. National Priority Setting of Clinical Practice Guidelines Development for Chronic Disease Management.

    Science.gov (United States)

    Jo, Heui-Sug; Kim, Dong Ik; Oh, Moo-Kyung

    2015-12-01

    By November 2013, a total of 125 clinical practice guidelines (CPGs) have been developed in Korea. However, despite the high burden of diseases and the clinical importance of CPGs, most chronic diseases do not have available CPGs. Merely 83 CPGs are related to chronic diseases, and only 40 guidelines had been developed in the last 5 yr. Considering the rate of the production of new evidence in medicine and the worsening burden from chronic diseases, the need for developing CPGs for more chronic diseases is becoming increasingly pressing. Since 2011, the Korean Academy of Medical Sciences and the Korea Centers for Disease Control and Prevention have been jointly developing CPGs for chronic diseases. However, priorities have to be set and resources need to be allocated within the constraint of a limited funding. This study identifies the chronic diseases that should be prioritized for the development of CPGs in Korea. Through an objective assessment by using the analytic hierarchy process and a subjective assessment with a survey of expert opinion, high priorities were placed on ischemic heart disease, cerebrovascular diseases, Alzheimer's disease and other dementias, osteoarthritis, neck pain, chronic kidney disease, and cirrhosis of the liver.

  18. Insomnia management for ageing employees with job stress

    Directory of Open Access Journals (Sweden)

    Roja I.

    2014-01-01

    Full Text Available 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 years suffering from insomnia caused by job stress. For the patients representing Group “A” cognitive hypnotherapy, intervention for improving coping with job stress and usage of the melatonergic drug was prescribed, while Group “B” patients received six weeks only drug. The severity of depressive episodes in employees was measured by Montgomery- Åsberg Depression Rating Scale, the level of anxiety was assessed by use Rosenberg Self-Esteem Scale. The results of the research show that insomnia patterns disappeared for 75% of women and 80% of men employees in Group A, but in Group B individuals, – only for 20% of women employees. The results acquired let concluding that the six-week treatment – cognitive hypnotherapy combined with melatonergic drug – is an effective treatment for aging workers suffering from sleep disorders.

  19. Management of the aging risk factor for Parkinson's disease.

    Science.gov (United States)

    Phillipson, Oliver T

    2014-04-01

    The aging risk factor for Parkinson's disease is described in terms of specific disease markers including mitochondrial and gene dysfunctions relevant to energy metabolism. This review details evidence for the ability of nutritional agents to manage these aging risk factors. The combination of alpha lipoic acid, acetyl-l-carnitine, coenzyme Q10, and melatonin supports energy metabolism via carbohydrate and fatty acid utilization, assists electron transport and adenosine triphosphate synthesis, counters oxidative and nitrosative stress, and raises defenses against protein misfolding, inflammatory stimuli, iron, and other endogenous or xenobiotic toxins. These effects are supported by gene expression via the antioxidant response element (ARE; Keap/Nrf2 pathway), and by peroxisome proliferator-activated receptor gamma co-activator 1 alpha (PGC-1 alpha), a transcription coactivator, which regulates gene expression for energy metabolism and mitochondrial biogenesis, and maintains the structural integrity of mitochondria. The effectiveness and synergies of the combination against disease risks are discussed in relation to gene action, dopamine cell loss, and the accumulation and spread of pathology via misfolded alpha-synuclein. In addition there are potential synergies to support a neurorestorative role via glial derived neurotrophic factor expression.

  20. Managing Preventive Maintenance, In-Service Inspection, Ageing Management within a Production Environment

    Energy Technology Data Exchange (ETDEWEB)

    Tillwick, D.L.; Bruyn, J.F. du; D' Arcy, A.J., E-mail: koos.dubruyn@necsa.co.z [SAFARI-1 Research Reactor, Necsa, PO Box 582 Pretoria (South Africa)

    2011-07-01

    SAFARI-1, the Nuclear Research Reactor located at Pelindaba, South Africa, has to meet a multitude of requirements relating to corporate policies and strategies, preventative maintenance, in-service inspection, plant ageing management, quality management, conventional and radiological safety, regulatory compliance; and security, commercial and financial goals which need to be incorporated into an integrated management system. The control of these various requirements and activities within the nuclear research reactor organisation becomes quite complex if the processes and systems are to be integrated maintained and at the same time managed so as to achieve the objectives and targets within the resources available. Plant maintenance is one aspect which became a challenge over the last decade to implement and optimize. This has been evidenced by the shorter reactor shut downs which are carefully planned to maintain operational schedules required for production and other interested parties. Although SAFARI-1 maintains ISO 9001 and ISO 14001 certification, its present commercial and operational schedules need a very well coordinated management system to achieve all stakeholder requirements and still function within the design and safety requirements. In order for SAFARI-1 to maintain an exceptionally high operational level of more than 300 full power days per year, the planning, implementation and coordination of routine maintenance, in-service inspection, and projects related to upgrades and ageing management need to be well structured and controlled. The effective and efficient implementation of such a management system will ultimately ensure the success of the reactor in the competitive environment. This becomes particularly relevant where the development and the responsibility of implementation of systems and processes lie not only within the SAFARI-1 organization but also within various other departments in the parent South African Nuclear Energy Corporation

  1. Digital Natives Coming of Age: Challenges for Managers

    Directory of Open Access Journals (Sweden)

    Andreea MITAN

    2014-10-01

    Full Text Available Youth unemployment is currently a stringent problem in many European countries. Most of the time, both the public opinion and the national and European institutions blame the economic crisis, the social conditioning of these youngsters, and point to the failure of the educational systems to provide them with the necessary qualifications needed on the market. There are a few initiatives, such as the Youth Guarantee launched in 2013, led by European public authorities in order to reduce this phenomenon, but these initiatives address solely the professional proficiency of the youngsters. And most authorities perceive them as citizens who need to be trained to fit with the existing working environments. The situation is, in fact, more complex, as todays youngsters are different from the previous generations in terms of the values they share and the basic way they process information. When speaking of the youth, the high unemployment rate due to system imbalance between people training and work fields’ requirements are just one side of the coin. The other side speaks about the impact digital technology has upon young people, favouring the emergence of the so called digital natives, and about the fact that the working environment in itself has to incorporate changes in order to accommodate these youngsters and fully benefit from their capabilities.     As Romanian digital natives come of age, minimizing the mind gap between elder managers and younger employees and candidates becomes an important issue that companies increasingly have to deal with. This article explores the digital natives’ expectations from their managers and from the companies they aim to work for, based upon a survey conducted in four universities in Bucharest. We propose a series of recommendations for managers who work closely with digital natives, in order to improve the work environment and create the premises for better job performance in their teams, possibly reducing

  2. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

    Science.gov (United States)

    Balneaves, Lynda G.; Faulkner, Guy; Ortiz, Abigail; McIntosh, Diane; Morehouse, Rachel L.; Ravindran, Lakshmi; Yatham, Lakshmi N.; Kennedy, Sidney H.; Lam, Raymond W.; MacQueen, Glenda M.; Milev, Roumen V.; Parikh, Sagar V.

    2016-01-01

    Background: The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. Methods: Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. “Complementary and Alternative Medicine Treatments” is the fifth of six sections of the 2016 guidelines. Results: Evidence-informed responses were developed for 12 questions for 2 broad categories of complementary and alternative medicine (CAM) interventions: 1) physical and meditative treatments (light therapy, sleep deprivation, exercise, yoga, and acupuncture) and 2) natural health products (St. John’s wort, omega-3 fatty acids; S-adenosyl-L-methionine [SAM-e], dehydroepiandrosterone, folate, Crocus sativus, and others). Recommendations were based on available data on efficacy, tolerability, and safety. Conclusions: For MDD of mild to moderate severity, exercise, light therapy, St. John’s wort, omega-3 fatty acids, SAM-e, and yoga are recommended as first- or second-line treatments. Adjunctive exercise and adjunctive St. John’s wort are second-line recommendations for moderate to severe MDD. Other physical treatments and natural health products have less evidence but may be considered as third-line treatments. CAM treatments are generally well tolerated. Caveats include methodological limitations of studies and paucity of data on long-term outcomes and drug interactions. PMID:27486153

  3. Clinical Guidelines for Management of Bone Health in Rett Syndrome Based on Expert Consensus and Available Evidence.

    Directory of Open Access Journals (Sweden)

    Amanda Jefferson

    Full Text Available We developed clinical guidelines for the management of bone health in Rett syndrome through evidence review and the consensus of an expert panel of clinicians.An initial guidelines draft was created which included statements based upon literature review and 11 open-ended questions where literature was lacking. The international expert panel reviewed the draft online using a 2-stage Delphi process to reach consensus agreement. Items describe the clinical assessment of bone health, bone mineral density assessment and technique, and pharmacological and non-pharmacological interventions.Agreement was reached on 39 statements which were formulated from 41 statements and 11 questions. When assessing bone health in Rett syndrome a comprehensive assessment of fracture history, mutation type, prescribed medication, pubertal development, mobility level, dietary intake and biochemical bone markers is recommended. A baseline densitometry assessment should be performed with accommodations made for size, with the frequency of surveillance determined according to individual risk. Lateral spine x-rays are also suggested. Increasing physical activity and initiating calcium and vitamin D supplementation when low are the first approaches to optimizing bone health in Rett syndrome. If individuals with Rett syndrome meet the ISCD criterion for osteoporosis in children, the use of bisphosphonates is recommended.A clinically significant history of fracture in combination with low bone densitometry findings is necessary for a diagnosis of osteoporosis. These evidence and consensus-based guidelines have the potential to improve bone health in those with Rett syndrome, reduce the frequency of fractures, and stimulate further research that aims to ameliorate the impacts of this serious comorbidity.

  4. Management of sepsis in neutropenic patients: 2014 updated guidelines from the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO).

    Science.gov (United States)

    Penack, Olaf; Becker, Carolin; Buchheidt, Dieter; Christopeit, Maximilian; Kiehl, Michael; von Lilienfeld-Toal, Marie; Hentrich, Marcus; Reinwald, Marc; Salwender, Hans; Schalk, Enrico; Schmidt-Hieber, Martin; Weber, Thomas; Ostermann, Helmut

    2014-07-01

    Sepsis is a major cause of mortality during the neutropenic phase after intensive cytotoxic therapies for malignancies. Improved management of sepsis during neutropenia may reduce the mortality of cancer therapies. Clinical guidelines on sepsis treatment have been published by others. However, optimal management may differ between neutropenic and non-neutropenic patients. Our aim is to give evidence-based recommendations for haematologist, oncologists and intensive care physicians on how to manage adult patients with neutropenia and sepsis.

  5. Acute otitis media guidelines: review and update.

    Science.gov (United States)

    Lieberthal, Allan S

    2006-07-01

    In 2004, the Subcommittee on Management of Acute Otitis Media of the American Academy of Pediatrics and American Academy of Family Physicians published evidence-based clinical practice guidelines on the "Diagnosis and Management of Acute Otitis Media." The guidelines included a definition of acute otitis media (AOM) that included three components: 1) a history of acute onset of signs and symptoms; 2) the presence of middle-ear effusion; and 3) signs and symptoms of middle-ear inflammation. An option to observe selected children with AOM for 48 to 72 hours without initial antibiotic therapy was proposed. This option was based on age, severity of illness, and certainty of diagnosis. Despite the changing prevalence of bacterial pathogens and increasing resistance of Streptococcus pneumoniae, amoxicillin remains the first-line antibiotic for initial antibacterial treatment of AOM. The guideline also addresses the management of otalgia, choice of antibiotics after initial treatment failure, and methods for preventing AOM.

  6. Management of adult and paediatric acute lymphoblastic leukaemia in Asia: resource-stratified guidelines from the Asian Oncology Summit 2013.

    Science.gov (United States)

    Yeoh, Allen E J; Tan, Daryl; Li, Chi-Kong; Hori, Hiroki; Tse, Eric; Pui, Ching-Hon

    2013-11-01

    Survival for adults and children with acute lymphoblastic leukaemia has risen substantially in recent years because use of improved risk-directed treatments and supportive care has widened. In nearly all developed countries, multidisciplinary panels of leukaemia experts have formulated clinical practice guidelines in which standard treatment approaches are recommended on the basis of current evidence. However, those guidelines do not take into account resource limitations in low-income countries, including financial and technical challenges. In Asia, huge disparities in economy and infrastructure exist between countries, and even among different regions in some large countries. At a consensus session held as part of the 2013 Asian Oncology Summit in Bangkok, Thailand, a panel of experts summarised recommendations for management of adult and paediatric acute lymphoblastic leukaemia. Strategies were developed for Asian countries on the basis of available financial, skill, and logistical resources and were stratified in a four-tier system according to the resources available in a particular country or region (basic, limited, enhanced, and maximum).

  7. Management of adult and paediatric acute lymphoblastic leukaemia in Asia: resource-stratified guidelines from the Asian Oncology Summit 2013

    Science.gov (United States)

    Yeoh, Allen EJ; Tan, Daryl; Li, Chi-Kong; Hori, Hiroki; Tse, Eric; Pui, Ching-Hon

    2014-01-01

    The survival rates for both adult and children with acute lymphoblastic leukaemia have improved substantially in recent years with wider use of improved risk-directed therapy and supportive care. In nearly all developed countries, clinical practice guidelines have been formulated by multidisciplinary panels of leukaemia experts, with the goal of providing recommendations on standard treatment approaches based on current evidence. However, those guidelines do not take into account resource limitations in low-income countries, including financial and technical challenges. In Asia, there are huge disparities in economy and infrastructure among the countries, and even among different regions in some large countries. This review summarizes the recommendations developed for Asian countries by a panel of adult and paediatric leukaemia therapists, based on the availability of financial, skill and logistical resources, at a consensus session held as part of the 2013 Asian Oncology Summit in Bangkok, Thailand. The management strategies described here are stratified by a four-tier system (basic, limited, enhanced and maximum) based on the resources available to a particular country or region. PMID:24176570

  8. Canadian Guidelines for the Management of Acute Exacerbations of Chronic Bronchitis

    Directory of Open Access Journals (Sweden)

    Meyer S Balter

    2003-01-01

    Full Text Available Acute exacerbations of chronic bronchitis (AECB account for over 1.5 million physician visits annually in Canada and are a cause of significant morbidity and mortality. This document represents a joint effort between respirologists, microbiologists, infectious disease specialists and family physicians to update the Canadian AECB guidelines published in 1994. Treatment recommendations are graded on the strength of evidence in the published literature where possible. The role for oral corticosteroid therapy in preventing treatment failures, speeding up recovery and delaying the time to next exacerbation is discussed. Risk factors for treatment failure were used to stratify patients into risk groups to help guide antibiotic treatment recommendations. The importance of emerging antimicrobial resistance to current antibiotics is reviewed and strategies to prevent future AECB episodes are suggested.

  9. 76 FR 74831 - Aging Management of Stainless Steel Structures and Components in Treated Borated Water

    Science.gov (United States)

    2011-12-01

    ... COMMISSION Aging Management of Stainless Steel Structures and Components in Treated Borated Water AGENCY...- ISG-2011-01, ``Aging Management of Stainless Steel Structures and Components in Treated Borated Water... management of stainless steel structures and components exposed to treated borated water. In response to...

  10. 77 FR 23513 - Updated Aging Management Criteria for Reactor Vessel Internal Components of Pressurized Water...

    Science.gov (United States)

    2012-04-19

    ... COMMISSION Updated Aging Management Criteria for Reactor Vessel Internal Components of Pressurized Water... Management Criteria for PWR Reactor Vessel Internal Components.'' The original notice provided the ADAMS... published a notice requesting public comments on draft LR-ISG-2011-04, ``Updated Aging Management...

  11. Medication and finance management among HIV-infected adults: the impact of age and cognition.

    Science.gov (United States)

    Thames, April D; Kim, Michelle S; Becker, Brian W; Foley, Jessica M; Hines, Lindsay J; Singer, Elyse J; Heaton, Robert K; Castellon, Steven A; Hinkin, Charles H

    2011-02-01

    This study examined the effects of aging and cognitive impairment on medication and finance management in an HIV sample. We observed main effects of age (older finance management. The interaction of advancing age and cognitive impairment may confer significant functional limitations for HIV individuals that may be better detected by performance-based measures of functional abilities rather than patient self-report.

  12. Building America Top Innovations 2013 Profile – Quality Management System Guidelines

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2013-09-01

    This Top Innovation profile describes quality management system tools that were customized for residential construction by BSC, IBACOS, and PHI, for use by builders, trades, and designers to help eliminate mistakes that would require high-cost rework.

  13. Guidelines for the Diagnosis and Management of Food Allergy : What's in It for Patients?

    Science.gov (United States)

    ... Respond to Pre-Award Requests Manage Your Award Negotiation & Initial Award After Award ... New Trial Launched in West Africa to Evaluate Three Vaccination Strategies , April 6, 2017 Monoclonal Antibody Cures Marburg Infection ...

  14. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer

    DEFF Research Database (Denmark)

    Van Cutsem, E; Cervantes, A; Adam, R;

    2016-01-01

    for and undergoing surgical resection of their localised metastatic disease but also to a more strategic approach to the delivery of systemic therapy and an expansion in the use of ablative techniques. This reflects the increase in the number of patients that are being managed within a multidisciplinary team...... based on the current available evidence to provide a series of evidence-based recommendations to assist in the treatment and management of patients with mCRC in this rapidly evolving treatment setting....

  15. A guideline for optimizing outage management of Eskom's transmission network / Michelle de Haan

    OpenAIRE

    de Haan, Michelle

    2012-01-01

    A streamlined process is needed to optimize the outage management of the Eskom transmission power system, as well as a ranking system in order to determine the best window of opportunity for an outage to occur thus positively impacting on Eskom‘s asset management. The outage data captured between 2007 and 2011 was analysed for all cancelled, turned down and completed outages. This data indicated that there were 19 902 completed outages, 5 312 cancelled outages and 1 889 turned down outages...

  16. 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

    BACKGROUND AND AIM: The general practitioner (GP) is the first contact with the health care system for most patients with COPD in Denmark. We studied, if participating in an educational program could improve adherence to guidelines, not least for diagnosis, staging, and treatment of the disease....... DESIGN AND SETTING: Two cross-sectional surveys were performed precisely one year apart before and after an educational program for the participating GPs. A total of 124 GPs completed the study; 1716 and 1342 patients with GP-diagnosed COPD and no concomitant asthma, respectively, were included...... 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 management options, improvements were also observed with regard to antismoking counseling, inhalator technique, physical...

  17. Implementation of World Health Organization Integrated Management of Childhood Illnesses (IMCI Guidelines for the Assessment of Pneumonia in the Under 5s in Rural Malawi.

    Directory of Open Access Journals (Sweden)

    Ngozi Kalu

    Full Text Available The Cooking and Pneumonia Study (CAPS is a pragmatic cluster-level randomized controlled trial of the effect of an advanced cookstove intervention on pneumonia in children under the age of 5 years (under 5s in Malawi (www.capstudy.org. The primary outcome of the trial is the incidence of pneumonia during a two-year follow-up period, as diagnosed by healthcare providers who are using the World Health Organization (WHO integrated management of childhood illnesses (IMCI pneumonia assessment protocol and who are blinded to the trial arms. We evaluated the quality of pneumonia assessment in under 5s in this setting via a cross-sectional study of provider-patient encounters at nine outpatient clinics located within the catchment area of 150 village-level clusters enrolled in the trial across the two study locations of Chikhwawa and Karonga, Malawi, between May and June 2015 using the IMCI guidelines as a benchmark. Data were collected using a key equipment checklist, an IMCI pneumonia knowledge test, and a clinical evaluation checklist. The median number of key equipment items available was 6 (range 4 to 7 out of a possible 7. The median score on the IMCI pneumonia knowledge test among 23 clinicians was 75% (range 60% to 89%. Among a total of 176 consultations performed by 15 clinicians, a median of 9 (range 3 to 13 out of 13 clinical evaluation tasks were performed. Overall, the clinicians were adequately equipped for the assessment of sick children, had good knowledge of the IMCI guidelines, and conducted largely thorough clinical evaluations. We recommend the simple pragmatic approach to quality assurance described herein for similar studies conducted in challenging research settings.

  18. Implementation of pregnancy weight management and obesity guidelines: a meta-synthesis of healthcare professionals' barriers and facilitators using the Theoretical Domains Framework.

    Science.gov (United States)

    Heslehurst, N; Newham, J; Maniatopoulos, G; Fleetwood, C; Robalino, S; Rankin, J

    2014-06-01

    Obesity in pregnancy is rising and is associated with severe health consequences for both the mother and the child. There is an increasing international focus on guidelines to manage the clinical risks of maternal obesity, and for pregnancy weight management. However, passive dissemination of guidelines is not effective and more active strategies are required for effective guideline implementation into practice. Implementation of guidelines is a form of healthcare professional behaviour change, and therefore implementation strategies should be based on appropriate behaviour change theory. This systematic review aimed to identify the determinants of healthcare professionals' behaviours in relation to maternal obesity and weight management. Twenty-five studies were included. Data synthesis of the existing international qualitative and quantitative evidence base used the Theoretical Domains Framework to identify the barriers and facilitators to healthcare professionals' maternal obesity and weight management practice. The domains most frequently identified included 'knowledge', 'beliefs about consequences' and 'environmental context and resources'. Healthcare professionals' weight management practice had the most barriers compared with any other area of maternal obesity practice. The results of this review will be used to inform the development of an intervention to support healthcare professional behaviour change.

  19. Public informations guidelines

    Energy Technology Data Exchange (ETDEWEB)

    None

    1986-06-01

    The purpose of these Public Information Guidelines is to provide principles for the implementation of the NWPA mandate and the Mission Plan requirements for the provision of public information. These Guidelines set forth the public information policy to be followed by all Office of Civilian Radioactive Waste Management (OCRWM) performance components. The OCRWM offices should observe these Guidelines in shaping and conducting public information activities.

  20. Managing transition: guidelines for mental health administrators facing services retrenchment due to funding cuts.

    Science.gov (United States)

    Raymond, J S

    1983-01-01

    This piece of writing is one part of a four part series on managing transition in turbulent times. The series is written for mental health administrators and is a product of the author's direct experience as chief administrator of addiction treatment facilities and programs for The Salvation Army in Hawaii. Despite the loss of several hundred thousands of dollars, the agency was able to manage its own transition to emerge stronger and with two full years of accreditation as a psychiatric facility by the prestigious Joint Commission on the Accreditation of Hospitals.

  1. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology.

    Science.gov (United States)

    Ludvigsson, Jonas F; Bai, Julio C; Biagi, Federico; Card, Timothy R; Ciacci, Carolina; Ciclitira, Paul J; Green, Peter H R; Hadjivassiliou, Marios; Holdoway, Anne; van Heel, David A; Kaukinen, Katri; Leffler, Daniel A; Leonard, Jonathan N; Lundin, Knut E A; McGough, Norma; Davidson, Mike; Murray, Joseph A; Swift, Gillian L; Walker, Marjorie M; Zingone, Fabiana; Sanders, David S

    2014-08-01

    A multidisciplinary panel of 18 physicians and 3 non-physicians from eight countries (Sweden, UK, Argentina, Australia, Italy, Finland, Norway and the USA) reviewed the literature on diagnosis and management of adult coeliac disease (CD). This paper presents the recommendations of the British Society of Gastroenterology. Areas of controversies were explored through phone meetings and web surveys. Nine working groups examined the following areas of CD diagnosis and management: classification of CD; genetics and immunology; diagnostics; serology and endoscopy; follow-up; gluten-free diet; refractory CD and malignancies; quality of life; novel treatments; patient support; and screening for CD.

  2. Provider Adherence to National Guidelines for Managing Hypertension in African Americans

    Directory of Open Access Journals (Sweden)

    Jeanette Sessoms

    2015-01-01

    Full Text Available Purpose. To evaluate provider adherence to national guidelines for the treatment of hypertension in African Americans. Design. A descriptive, preexperimental, quantitative method. Methods. Electronic medical records were reviewed and data were obtained from 62 charts. Clinical data collected included blood pressure readings, medications prescribed, laboratory studies, lifestyle modification, referral to hypertension specialist, and follow-up care. Findings. Overall provider adherence was 75%. Weight loss, sodium restriction, and physical activity recommendations were documented on 82.3% of patients. DASH diet and alcohol consumption were documented in 6.5% of participants. Follow-up was documented in 96.6% of the patients with controlled blood pressure and 9.1% in patients with uncontrolled blood pressure. Adherence in prescribing ACEIs in patients with a comorbidity of DM was documented in 70% of participants. Microalbumin levels were ordered in 15.2% of participants. Laboratory adherence prior to prescribing medications was documented in 0% of the patients and biannual routine labs were documented in 65% of participants. Conclusion. Provider adherence overall was moderate. Despite moderate provider adherence, BP outcomes and provider adherence were not related. Contributing factors that may explain this lack of correlation include patient barriers such as nonadherence to medication and lifestyle modification recommendations and lack of adequate follow-up. Further research is warranted.

  3. [CROATIAN GUIDELINES FOR DIAGNOSIS AND MANAGEMENT OF BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)].

    Science.gov (United States)

    Maslovara, Sinisa; Butković-Soldo, Silva; Drvis, Petar; Roje-Bedeković, Marina; Trotić, Robert; Branica, Srećko; Habek, Mario; Cvjetko, Tereza; Vesligaj, Tihana; Adamec, Ivan; Gabelić, Tereza; Jurić, Stjepan; Vceva, Andrijana; Vranjes, Zeljko; Sarić, Ingrid; Cejić, Olivera; Zivić, Tihomir

    2015-01-01

    BPPV is generally the most common cause of vertigo, caused by a pinch-off of tiny calcium carbonate crystals (called the otoconia or the otoliths) from the macula utriculi, most frequently due to the degenerative processes or a trauma, whereby the crystals, under the action of gravity in certain head positions coinciding with its direction, arrive to some of the semicircular canals, usually the posterior one, due to the existent anatomical circumstances and relationships, thus creating an inadequate stimulus of the cupular senses while floating through the endolymph and provoking symptoms of a strong and short-term dizziness. Two main clinical forms can be distinguished: canalolythiasis, with an accommodation of otolithic debris in the semicircular canal, and cupulolythiasis, with their location immediately next to the cupular sense. The diagnosis is established by a positive positioning test, Dix-Hallpike for the posterior and the supine roll for the lateral canal. Although one can expect a spontaneous recovery subsequent to few weeks or months, various methods of otolith repositioning to a less sensitive place lead to a prompt improvement while reducing or withdrawing the symptoms completely. These guidelines are intended for all who treat the BPPV in their work, with an intention to assist in the diagnosis and application of an appropriate therapeutic method.

  4. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients.

    Science.gov (United States)

    Cornely, O A; Bassetti, M; Calandra, T; Garbino, J; Kullberg, B J; Lortholary, O; Meersseman, W; Akova, M; Arendrup, M C; Arikan-Akdagli, S; Bille, J; Castagnola, E; Cuenca-Estrella, M; Donnelly, J P; Groll, A H; Herbrecht, R; Hope, W W; Jensen, H E; Lass-Flörl, C; Petrikkos, G; Richardson, M D; Roilides, E; Verweij, P E; Viscoli, C; Ullmann, A J

    2012-12-01

    This part of the EFISG guidelines focuses on non-neutropenic adult patients. Only a few of the numerous recommendations can be summarized in the abstract. Prophylactic usage of fluconazole is supported in patients with recent abdominal surgery and recurrent gastrointestinal perforations or anastomotic leakages. Candida isolation from respiratory secretions alone should never prompt treatment. For the targeted initial treatment of candidaemia, echinocandins are strongly recommended while liposomal amphotericin B and voriconazole are supported with moderate, and fluconazole with marginal strength. Treatment duration for candidaemia should be a minimum of 14 days after the end of candidaemia, which can be determined by one blood culture per day until negativity. Switching to oral treatment after 10 days of intravenous therapy has been safe in stable patients with susceptible Candida species. In candidaemia, removal of indwelling catheters is strongly recommended. If catheters cannot be removed, lipid-based amphotericin B or echinocandins should be preferred over azoles. Transoesophageal echocardiography and fundoscopy should be performed to detect organ involvement. Native valve endocarditis requires surgery within a week, while in prosthetic valve endocarditis, earlier surgery may be beneficial. The antifungal regimen of choice is liposomal amphotericin B +/- flucytosine. In ocular candidiasis, liposomal amphotericin B +/- flucytosine is recommended when the susceptibility of the isolate is unknown, and in susceptible isolates, fluconazole and voriconazole are alternatives. Amphotericin B deoxycholate is not recommended for any indication due to severe side effects.

  5. Periodic Fever: A Review on Clinical, Management and Guideline for Iranian Patients - Part II.

    Science.gov (United States)

    Ahmadinejad, Zahra; Mansouri, Sedigeh; Ziaee, Vahid; Aghighi, Yahya; Moradinejad, Mohammad-Hassan; Fereshteh-Mehregan, Fatemeh

    2014-06-01

    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 review other autoinflammatory disorders including hyper IgD, tumor necrosis factor receptor-associated periodic syndrome (TRAPS), cryopyrin associated periodic syndromes, autoinflammatory bone disorders and some other rare autoinflammatory disorders such as Sweet's and Blau syndromes. In cryopyrin associated periodic syndromes group, we discussed chronic infantile neurologic cutaneous and articular (CINCA) syndrome, Muckle-Wells syndrome and familial cold autoinflammatory syndrome. Autoinflammatory bone disorders are categorized to monogenic disorders such as pyogenic arthritis, pyoderma ;gangraenosum and acne (PAPA) syndrome, the deficiency of interleukine-1 receptor antagonist (DIRA) and Majeed syndrome and polygenic background or sporadic group such as chronic recurrent multifocal osteomyelitis (CRMO) or synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome are classified in sporadic group. Other autoinflammatory syndromes are rare causes of periodic fever in Iranian system registry.

  6. Periodic Fever: A Review on Clinical, Management and Guideline for Iranian Patients - Part II

    Science.gov (United States)

    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 review other autoinflammatory disorders including hyper IgD, tumor necrosis factor receptor–associated periodic syndrome (TRAPS), cryopyrin associated periodic syndromes, autoinflammatory bone disorders and some other rare autoinflammatory disorders such as Sweet’s and Blau syndromes. In cryopyrin associated periodic syndromes group, we discussed chronic infantile neurologic cutaneous and articular (CINCA) syndrome, Muckle-Wells syndrome and familial cold autoinflammatory syndrome. Autoinflammatory bone disorders are categorized to monogenic disorders such as pyogenic arthritis, pyoderma ;gangraenosum and acne (PAPA) syndrome, the deficiency of interleukine-1 receptor antagonist (DIRA) and Majeed syndrome and polygenic background or sporadic group such as chronic recurrent multifocal osteomyelitis (CRMO) or synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome are classified in sporadic group. Other autoinflammatory syndromes are rare causes of periodic fever in Iranian system registry. PMID:25562014

  7. Management of OAB in those over age 65.

    Science.gov (United States)

    Natalin, Ricardo; Lorenzetti, Fabio; Dambros, Miriam

    2013-10-01

    The International Continence Society (ICS) defines overactive bladder (OAB) as an association of symptoms including "urgency, with or without urge incontinence, usually with increased frequency and nocturia". This conditon has been associated with a decrease in quality of life and a higher related risk of overall health condition decrease, and is rising since its prevalence increases with age and the forecast for the world population estimates an increase of those over 65 years old. Aging alone can be considered a major risk factor for developing OAB symptoms that are considered multifactorial and due to body tissue and anatomic changes, lifestyle-associated factors, comorbidities and personal characteristics. The high prevalence of this condition and multiple etiology factors makes of its treatment a challenge-especially in the older population. A major concern over OAB treatment of elderly patients is the risk of cognitive side effects due to the pharmacologic treatment with anticholinergic drugs. First-line treatment for OAB symptoms are the use of pharmacologic therapy with antimuscarinic drugs, which has been proved to be effective in controlling urgency, urge incontinence episodes, incontinence episodes, and nocturia. The impact caused by this condition is significant regarding the economic and human costs associated bringing into attention the need of studying and reviewing this specific population. Conservative Management and Lifestyle Modifications: Behavioral therapy's aims are to reduce urinary frequency and urgency to an accepted level and to increase bladder outlet volume. It consists of actions to teach patients to improve and learn bladder control. Lifestyle modifications are a conjunct of daily activities that can be managed to have the lowest interference on the functioning of the urinary tract. Pharmacologic Therapy: There are various medications with antimuscarinic properties available for the treatment of OAB symptoms. The most commonly used are

  8. Return of the pulmonary nodule: the radiologist's key role in implementing the 2015 BTS guidelines on the investigation and management of pulmonary nodules.

    Science.gov (United States)

    Graham, Richard N J; Baldwin, David R; Callister, Matthew E J; Gleeson, Fergus V

    2016-01-01

    The British Thoracic Society has published new comprehensive guidelines for the management of pulmonary nodules. These guidelines are significantly different from those previously published, as they use two malignancy prediction calculators to better characterize the risk of malignancy. There are recommendations for a higher nodule size threshold for follow-up (≥5 mm or ≥80 mm(3)) and a reduction of the follow-up period to 1 year for solid pulmonary nodules; both of these will reduce the number of follow-up CT scans. PET-CT plays a crucial role in characterization also, with an ordinal scale being recommended for reporting. Radiologists will be the key in implementing these guidelines, and routine use of volumetric image-analysis software will be required to manage patients with pulmonary nodules correctly.

  9. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease

    NARCIS (Netherlands)

    Ruemmele, F. M.; Veres, G.; Kolho, K. L.; Griffiths, A.; Levine, A.; Escher, J. C.; Dias, J. Amil; Barabino, A.; Braegger, C. P.; Bronsky, J.; Buderus, S.; Martin-de-Carpi, J.; De Ridder, L.; Fagerberg, U. L.; Hugot, J. P.; Kierkus, J.; Kolacek, S.; Koletzkou, S.; Lionetti, P.; Miele, E.; Navas Lopez, V. M.; Paerregaard, A.; Russell, R. K.; Serban, D. E.; Shaoul, R.; Van Rheenen, P.; Veereman, G.; Weiss, B.; Wilson, D.; Dignass, A.; Eliakim, A.; Winter, H.; Turner, D.

    2014-01-01

    Children and adolescents with Crohn's disease (CD) present often with a more complicated disease course compared to adult patients. In addition, the potential impact of CD on growth, pubertal and emotional development of patients underlines the need for a specific management strategy of pediatric-on

  10. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage

    DEFF Research Database (Denmark)

    Steiner, Thorsten; Al-Shahi Salman, Rustam; Beer, Ronnie

    2014-01-01

    BACKGROUND: Intracerebral hemorrhage (ICH) accounted for 9% to 27% of all strokes worldwide in the last decade, with high early case fatality and poor functional outcome. In view of recent randomized controlled trials (RCTs) of the management of ICH, the European Stroke Organisation (ESO) has upd...

  11. 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...

  12. Diagnostic Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension: A Clinical Practice Guideline

    Directory of Open Access Journals (Sweden)

    Sanjay Mehta

    2010-01-01

    Full Text Available BACKGROUND: Pulmonary embolism is a common condition. Some patients subsequently develop chronic thromboembolic pulmonary hypertension (CTEPH. Many care gaps exist in the diagnosis and management of CTEPH patients including lack of awareness, incomplete diagnostic assessment, and inconsistent use of surgical and medical therapies.

  13. Effectiveness of Space Debris Mitigation Guidelines: Economic Potential of LEO and Traffic Management Issues

    Science.gov (United States)

    Belviso, Luciano

    Space debris probably represent one of the major issues for the future development and exploitation of space by all spacefaring nations. Considering the large range of possible mitigation techniques, some general criteria to evaluate them shall be taken into account: cost, effectiveness, technical and legal applicability in order to assess their effectiveness. Even though the Inter Agency Space Debris Coordination Committee (IADC) guidelines are considered as the basis for a new regulatory regime of mitigation, the problem concerning the legal instrument by which the international community would accept these guidelines remains still unsolved. In this paper, we will focus on the following issues: Economic potential of orbital regions. Since the international community lacks consensus to conclude a legally binding instrument, a voluntary adherence regime seems a possible way to apply mitigation measures. However, with mitigation efforts having only small effects into the future, expenditures are not easy to be justified today even if they could reduce the economic consequences of debris in the long period[1]. Some orbital regions, such as the Geostationary Orbit, are already the subject of international agreements, however, the properties of other regions of near-earth space are also distinct as far as their potential economic value is concerned[2]. Therefore, the applicability of mitigation techniques on the basis of cost-benefit analysis will be considered in this paper. Applicability of satellites traffic control. For satellites in Low Earth Orbit, the main hazard is posed by other object located in narrow sets of altitudes and inclinations[4]. Satellites control systems usually allow only a limited number of operation mostly related to small trajectory corrections and they can result not sufficient to avoid collisions with debris. That is why a complementary approach is required although this could represent an additional cost. In this paper we will consider the

  14. Management of sepsis in neutropenic patients: guidelines from the infectious diseases working party of the German Society of Hematology and Oncology.

    Science.gov (United States)

    Penack, O; Buchheidt, D; Christopeit, M; von Lilienfeld-Toal, M; Massenkeil, G; Hentrich, M; Salwender, H; Wolf, H-H; Ostermann, H

    2011-05-01

    Sepsis is a leading cause of mortality in neutropenic cancer patients. Early initiation of effective causative therapy as well as intensive adjunctive therapy is mandatory to improve outcome. We give recommendations for the management of adults with neutropenia and sepsis. The guidelines are written for clinicians involved in care of cancer patients and focus on pathophysiology, diagnosis and treatment of sepsis during neutropenia.

  15. Wetlands and agriculture - Relevance of good agricultural practice and wetland management guidelines for harmonizing the wise use of wetlands and agriculture

    NARCIS (Netherlands)

    Bos, J.; Hengsdijk, H.; Zingstra, H.L.

    2009-01-01

    The Conference of Contracting Parties to the Ramsar Convention meeting in 2002 in Valencia adopted Resolution VIII calling for guidelines to enhance the interaction between agriculture, wetlands and water resources management. Resolution VIII.34 requests among others to establish a framework for ide

  16. Clinical guidelines for management of thyroid nodule and cancer during pregnancy.

    Science.gov (United States)

    Galofré, Juan Carlos; Riesco-Eizaguirre, Garcilaso; Alvarez-Escolá, Cristina

    2014-03-01

    Special considerations are warranted in management of thyroid nodule and thyroid cancer during pregnancy. The diagnostic and therapeutic approach of thyroid nodules follows the standard practice in non-pregnant women. On the other hand, differentiated thyroid cancer management during pregnancy poses a number of challenges for the mother and fetus. The available data show that pregnancy is not a risk factor for thyroid cancer development or recurrence, although flare-ups cannot be completely ruled out in women with active disease. If surgery is needed, it should be performed during the second term or, preferably, after delivery. A majority of pregnant patients with low-risk disease only need adjustment in levothyroxine therapy. However, women with increased serum thyroglobulin levels before pregnancy or structural disease require regular thyroglobulin measurements and neck ultrasound throughout pregnancy. Pregnancy is an absolute contraindication for radioactive iodine administration.

  17. Evidence-based clinical practice guidelines for managing depression in persons living with HIV.

    Science.gov (United States)

    Relf, Michael V; Eisbach, Shelly; Okine, Kayj Nash; Ward, Terry

    2013-01-01

    Depressive symptoms and depression are prevalent among persons living with HIV (PLWH). Depression among PLWH is associated with a lower quality of life, reduced adherence to antiretroviral treatment, poorer self-care, worsened treatment outcomes, greater impairment in social and vocational functioning, and increased social isolation. Assessment of depression in PLWH is critical to facilitate referral and management. Fortunately, two simple screening questions can be used to assess for depression, and evidence supports the effective management of depression for PLWH. First-line treatment regimens for depression include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), or a combination of SSRI and CBT. This paper examines the contemporary evidence related to depression in the context of HIV infection. A case study has been included to illustrate an application of evidence-based treatment interventions recommended for clinical practice.

  18. Evaluation of Lands for Recreational Snowmobile Use (Guidelines for Natural Resources Management and Land Use Compatibility).

    Science.gov (United States)

    1981-05-01

    Percy , E. C., "The Snowmobile: Friend or Foe?" Journal of Trauma, Vol 12, No. 5 (May 1972), pp 444-446. Price, V. J., "Snowmobiles, The Winter Revolution...Fort Dix, NJ Hasset, John J., Agronomy Department, University of Illinois, Champaign, IL Huber, Phil, Environmental Offices, Fort Benning, GA Jackson ...Outdoor Recreation Director, Fort McCoy, WI Houser, James, Forester, Fort McCoy, WI Hutchinson, Julian, Land Manager, Fort McCoy, WI Jackson , Gary

  19. Waste management plan for pipeline construction works: basic guideline for its preparation

    Energy Technology Data Exchange (ETDEWEB)

    Serricchio, Claudio; Caldas, Flaviana V. [Petroleo Brasileiro S.A. (PETROBRAS), Rio de Janeiro, RJ (Brazil); Souza, Izabel C.A. de; Araujo, Ronaldo G. de [TELSAN, Rio de Janeiro, RJ (Brazil); Souza, Tania Mara [IMC-SASTE, Sao Paulo,SP (Brazil); Veronez, Fernanda A. [Bourscheid, Porto Alegre, RS (Brazil)

    2009-07-01

    During the stage of implementation of the land pipes enterprise, one of the main environmental aspects to be considered was the creation of solid and liquid waste. To mitigate the possible impacts to the environment, the main adopted mitigate measure was the implementation of a Waste Management Plan - WMP. Thus, the management of waste from pipes construction has the challenge of a great variety of stages and phases for the implementation of pipes and the diversity of local situations related to the topographic and hydro-geologic conditions. Considering the peculiarity of the pipes activities, this article proposes the elaboration of a Basic Guide to be used as reference for the creation of WMP's for similar enterprises, using as foundation the data from the three Gas Pipelines: Cabiunas - Vitoria; Vitoria - Cacimbas and Cacimbas - Catu. After the analysis of the three mentioned enterprises, it was verified that the waste management generated on the building and assembling of the land pipes normally occurs in accord with previous planning, but there's no systematization for the waste to be better recycled and reutilized, thus mitigating their creation. (author)

  20. Malignant hair follicle tumors of the periorbital region: A review of literature and suggestion of a management guideline.

    Science.gov (United States)

    Sia, Paul Ikgan; Figueira, Edwin; Allende, Alexandra; Selva, Dinesh

    2016-06-01

    Malignant hair follicle tumors are rare skin adnexal malignancies that have a predilection for the head and neck region. They can be categorized into a number of different subtypes. Histologically, they are distinct from their benign counterpart. To the best of our knowledge, there is no extensive review of these malignancies, especially in the periorbital region. We aim to provide a literature review and a guideline for management of these malignant tumors in the periorbital region. Database from Medline, PubMed, Embase, and Google Scholar were consulted. A total of 16 cases from the literature on hair follicle malignancies in the periorbital region were included in this review. The clinical presentations, diagnostic patterns, investigations used, and best management approach of these tumors are discussed. The American Joint Committee on Cancer (AJCC) 7(th) edition carcinoma of the eyelid staging system was used to describe their behaviors. We recommend wide excision surgery and a close follow-up for these tumors. Tumors presenting with a late stage require work-up for distant metastasis and consideration for exenteration procedures. The role of radiotherapy and chemotherapy in this context is still uncertain.