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Sample records for aging management guideline

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

    International Nuclear Information System (INIS)

    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 - heat exchangers

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-06-01

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

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

    International Nuclear Information System (INIS)

    Booker, S.; Katz, D.; Daavettila, N.; Lehnert, D.

    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

  4. 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.

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

    International Nuclear Information System (INIS)

    Toman, G.; Gazdzinski, R.; Schuler, K.

    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 guidelines for commercial nuclear power plant equipment

    International Nuclear Information System (INIS)

    Nakos, J.T.; Gazdzinski, R.F.; Toman, G.J.

    1994-01-01

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

  7. Guideline for ageing management in nuclear power plants

    International Nuclear Information System (INIS)

    Herter, K.H.; Schuler, X.; Hienstorfer, W.; Pompe, W.

    2007-01-01

    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.)

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

    International Nuclear Information System (INIS)

    Greenlaw, G.; Gendron, T.; Slade, J.; Rankin, B.

    2008-01-01

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

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

    International Nuclear Information System (INIS)

    1999-01-01

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

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

    International Nuclear Information System (INIS)

    2002-01-01

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

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

    International Nuclear Information System (INIS)

    Toman, G.; Gazdzinski, R.

    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

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

    International Nuclear Information System (INIS)

    Berg, R.; Stroinski, M.; Giachetti, R.

    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

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

    International Nuclear Information System (INIS)

    Berg, R.; Shao, J.; Krencicki, G.; Giachetti, R.

    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

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

    International Nuclear Information System (INIS)

    Toman, G.; Gazdzinski, R.; O'Hearn, E.

    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

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

    International Nuclear Information System (INIS)

    2008-01-01

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

  16. Development of aging management standard guidelines for HVAC facilities of NPPs in Korea

    International Nuclear Information System (INIS)

    Won, Se Youl; Lee, Jae Gon; Oh, Seung Jin

    2014-01-01

    Inspection and maintenance activities for air conditioning facilities within the plant are managed mainly for active facilities, and as the years of operation pass, a method for detecting in advance aging-related integrity problems of passive facilities and taking necessary measures against them is required. Therefore, this paper establishes a standard aging management guideline for air conditioning facilities by selecting systems for which those facilities are to be managed, analyzing degradation mechanisms and reviewing the current status of aging degradation management. According to the review of additional equipment-specific aging degradation mechanisms and the current status of management to apply the aging degradation program to air conditioning facilities, it has been found that internal and external visual inspection procedures for fans, dampers, coils, filters and housings have to be added. It has been confirmed that among additional equipment s, fire dampers, fan bearings and belts and air cleaning/conditioning units with charcoal filters do not require additional inspection as they are periodically inspected. It has been found, however, that air cleaning/conditioning units without charcoal filters are to be inspected along with fans, ducts and coils

  17. 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.)

  18. 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.

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

    International Nuclear Information System (INIS)

    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

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

    International Nuclear Information System (INIS)

    Clauss, J.M.

    1998-01-01

    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

  1. Severe accident management guidelines

    International Nuclear Information System (INIS)

    Uhle, Jennifer

    2014-01-01

    The events at Fukushima Daiichi have highlighted the importance of Severe Accident Management Guidelines (SAMGs). As the world has learned from the catastrophe and countries are considering changes to their nuclear regulatory programs, the content of SAMGs and their regulatory control are being evaluated. This presentation highlights several factors that are being addressed in the United States as rulemaking is underway pertaining to SAMGs. The question of how to be prepared for the unexpected is discussed with specific insights gleaned from Fukushima. (author)

  2. Guidelines for the Management of Wet Age-Related Macular Degeneration: Recommendations from a Panel of Greek Experts.

    Science.gov (United States)

    Androudi, Sofia; Dastiridou, Anna; Pharmakakis, Nikolaos; Stefaniotou, Maria; Kalogeropoulos, Christos; Symeonidis, Chrysanthos; Charonis, Alexandros; Tsilimbaris, Miltiadis

    2016-05-01

    To propose guidelines for the management of patients with wet age-related macular degeneration (wAMD), taking into account the results of large multicenter studies and clinical experience of retina experts. A team of retina experts developed a consensus paper after three consecutive meetings. The group was focused on guidelines to help clinical decision-making around the definition of successful treatment and the definition of non-response to therapy. Parameters suggestive of a successful response to treatments included: any gain in best corrected visual acuity (BCVA) or vision loss that is less than 5-10 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, reduction of central retinal thickness, partial or complete absorption of subretinal fluid (SRF), reduction of intraretinal fluid, reduction of pigment epithelial detachment or restoration of the anatomy of outer retinal layers. Non-response to current treatment was considered in the case of loss of BCVA greater than 10 ETDRS letters, increased retinal edema or increase of SRF as evidenced by optical coherence tomography or new bleeding in biomicroscopy. The introduction of anti-VEGF agents revolutionized the treatment of wAMD. Given the complexity of the disease, the emerging new agents and the difference of cases recruited in clinical trials compared to those appearing in every-day practice, it is essential to individualize treatment options taking into account the results of clinical trials.

  3. Management of uncomplicated malaria in children under 13 years of age at a district hospital in senegal : from official guidelines to usual practices

    OpenAIRE

    Sarrassat, Sophie; Lalou, Richard; Cisse, M.; Le Hesran, Jean-Yves

    2011-01-01

    Abstract Background To be effective, national malaria guidelines must be properly followed. This study evaluated nurses' practices in the management of uncomplicated malaria cases at a District Hospital. Its objective was to identify the reasons for discrepancies between official guidelines and usual practices. Methods This study took place at Oussouye hospital, south-western Senegal. Blood smears were available for biological diagnosis in patients aged more than five years while the Integrat...

  4. Management of uncomplicated malaria in children under 13 years of age at a district hospital in Senegal: from official guidelines to usual practices.

    Science.gov (United States)

    Sarrassat, Sophie; Lalou, Richard; Cissé, Moustapha; Le Hesran, Jean-Yves

    2011-09-29

    To be effective, national malaria guidelines must be properly followed. This study evaluated nurses' practices in the management of uncomplicated malaria cases at a District Hospital. Its objective was to identify the reasons for discrepancies between official guidelines and usual practices. This study took place at Oussouye hospital, south-western Senegal. Blood smears were available for biological diagnosis in patients aged more than five years while the Integrated Management of Childhood Illness recommended treating fevers presumptively in children under five. First line anti-malarial was Amodiaquine plus sulphadoxine-pyrimethamine (AQ+SP) bi-therapy. Hospital records of children under 13 years of age seen between 2004 and 2005 were reviewed. Among children treated with anti-malarials, 74% (2, 063/2, 789) received AQ+SP. However, only 22% (406/1, 879) of febrile children and 19% (429/2, 198) of children diagnosed with malaria got a blood smear. Moreover, an anti-malarial was prescribed for 80% (377/474) of children with a negative blood smear. The transition from chloroquine to AQ+SP was well followed. Nonetheless, blood smear use was very low and many over-prescriptions were reported. Reasons for discrepancies between guidelines and practices can be classified in three main categories: ambiguous guidelines, health system's dysfunctions and nurses' own considerations. Aside from the strengthening of the public health system, in order to guarantee practices complying with guidelines, training content should be more adapted to nurses' own considerations.

  5. Journal of Wildlife Management guidelines

    Science.gov (United States)

    William M. Block; Frank R. Thompson; Dawn Hanseder; Allison Cox; Anna Knipps

    2011-01-01

    These Guidelines apply to all Journal of Wildlife Management (JWM, The Journal) submissions. Publishing a professional manuscript proceeds most smoothly if authors understand the policy, procedures, format, and style of the outlet to which they are submitting a manuscript. These instructions supersede all previous guidelines. Manuscripts that clearly deviate from this...

  6. Misguided guidelines for managing labor.

    Science.gov (United States)

    Cohen, Wayne R; Friedman, Emanuel A

    2015-06-01

    In a recent review we expressed concerns about new guidelines for the assessment and management of labor recommended jointly by the American Congress of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM). These guidelines are based heavily on a new concept of how cervical dilatation and fetal descent progress, derived from the work of Zhang et al. In their Viewpoint article they have addressed, but not allayed, the concerns we described in our review. We assert that the dilatation curve promulgated by Zhang et al cannot be reconciled with direct clinical observation. Even if they were correct, however, it still does not follow that the ACOG/SMFM guidelines should recommend replacing the coherent system of identifying and managing labor aberrations described by Friedman. That system is grounded in well-established clinical principles based on decades of use and the objectively documented association of some labor abnormalities with poor fetal and maternal outcomes. Recommendations for new clinical management protocols should require the demonstration of superior outcomes through extensive, preferably prospective, assessment. Using untested guidelines for the management of labor may adversely affect women and children. Even if those guidelines were to reduce the currently excessive cesarean delivery rate, the price of that benefit is likely to be a trade-off in harm to parturients and their offspring. The nature and degree of that harm needs to be documented before considering adoption of the guidelines. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. 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.

  8. Management of uncomplicated malaria in children under 13 years of age at a district hospital in senegal: from official guidelines to usual practices

    Directory of Open Access Journals (Sweden)

    Le Hesran Jean-Yves

    2011-09-01

    Full Text Available Abstract Background To be effective, national malaria guidelines must be properly followed. This study evaluated nurses' practices in the management of uncomplicated malaria cases at a District Hospital. Its objective was to identify the reasons for discrepancies between official guidelines and usual practices. Methods This study took place at Oussouye hospital, south-western Senegal. Blood smears were available for biological diagnosis in patients aged more than five years while the Integrated Management of Childhood Illness recommended treating fevers presumptively in children under five. First line anti-malarial was Amodiaquine plus sulphadoxine-pyrimethamine (AQ+SP bi-therapy. Hospital records of children under 13 years of age seen between 2004 and 2005 were reviewed. Results Among children treated with anti-malarials, 74% (2, 063/2, 789 received AQ+SP. However, only 22% (406/1, 879 of febrile children and 19% (429/2, 198 of children diagnosed with malaria got a blood smear. Moreover, an anti-malarial was prescribed for 80% (377/474 of children with a negative blood smear. Conclusions The transition from chloroquine to AQ+SP was well followed. Nonetheless, blood smear use was very low and many over-prescriptions were reported. Reasons for discrepancies between guidelines and practices can be classified in three main categories: ambiguous guidelines, health system's dysfunctions and nurses' own considerations. Aside from the strengthening of the public health system, in order to guarantee practices complying with guidelines, training content should be more adapted to nurses' own considerations.

  9. Lupus nephritis management guidelines compared.

    Science.gov (United States)

    Wilhelmus, Suzanne; Bajema, Ingeborg M; Bertsias, George K; Boumpas, Dimitrios T; Gordon, Caroline; Lightstone, Liz; Tesar, Vladimir; Jayne, David R

    2016-06-01

    In the past years, many (randomized) trials have been performed comparing the treatment strategies for lupus nephritis. In 2012, these data were incorporated in six different guidelines for treating lupus nephritis. These guidelines are European, American and internationally based, with one separate guideline for children. They offer information on different aspects of the management of lupus nephritis including induction and maintenance treatment of the different histological classes, adjunctive treatment, monitoring of the patient, definitions of response and relapse, indications for (repeat) renal biopsy, and additional challenges such as the presence of vascular complications, the pregnant SLE patient, treatment in children and adolescents and considerations about end-stage renal disease and transplantation. In this review, we summarize the guidelines, determine the common ground between them, highlight the differences and discuss recent literature. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

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

    Science.gov (United States)

    Schmidt-Erfurth, Ursula; Chong, Victor; Loewenstein, Anat; Larsen, Michael; Souied, Eric; Schlingemann, Reinier; Eldem, Bora; Monés, Jordi; Richard, Gisbert; Bandello, Francesco

    2014-09-01

    Age-related macular degeneration (AMD) is still referred to as the leading cause of severe and irreversible visual loss world-wide. The disease has a profound effect on quality of life of affected individuals and represents a major socioeconomic challenge for societies due 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 introduction of anti-VEGF therapy has led to an overwhelming improvement in the prognosis of patients affected by neovascular AMD, allowing recovery and maintenance of visual function in the vast majority of patients. However, the therapeutic benefit is accompanied by significant economic investments, 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 in diagnostic technologies, such as optical coherence tomography, allows unprecedented high-resolution visualisation of disease morphology and provides a promising horizon for early disease detection and efficient therapeutic follow-up. However, definite conclusions from morphologic parameters are still lacking, and valid biomarkers have yet to be identified to provide a practical base for disease management. The European Society of Retina Specialists offers expert guidance for diagnostic and therapeutic management of neovascular AMD supporting healthcare givers and doctors in providing the best state-of-the-art care to their patients. NCT01318941. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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

    Science.gov (United States)

    Schmidt-Erfurth, Ursula; Chong, Victor; Loewenstein, Anat; Larsen, Michael; Souied, Eric; Schlingemann, Reinier; Eldem, Bora; Monés, Jordi; Richard, Gisbert; Bandello, Francesco

    2014-01-01

    Age-related macular degeneration (AMD) is still referred to as the leading cause of severe and irreversible visual loss world-wide. The disease has a profound effect on quality of life of affected individuals and represents a major socioeconomic challenge for societies due 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 introduction of anti-VEGF therapy has led to an overwhelming improvement in the prognosis of patients affected by neovascular AMD, allowing recovery and maintenance of visual function in the vast majority of patients. However, the therapeutic benefit is accompanied by significant economic investments, 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 in diagnostic technologies, such as optical coherence tomography, allows unprecedented high-resolution visualisation of disease morphology and provides a promising horizon for early disease detection and efficient therapeutic follow-up. However, definite conclusions from morphologic parameters are still lacking, and valid biomarkers have yet to be identified to provide a practical base for disease management. The European Society of Retina Specialists offers expert guidance for diagnostic and therapeutic management of neovascular AMD supporting healthcare givers and doctors in providing the best state-of-the-art care to their patients. Trial registration number NCT01318941. PMID:25136079

  12. 77 FR 13585 - Electricity Subsector Cybersecurity Risk Management Process Guideline

    Science.gov (United States)

    2012-03-07

    ... DEPARTMENT OF ENERGY Electricity Subsector Cybersecurity Risk Management Process Guideline AGENCY... Electricity Subsector Cybersecurity Risk Management Process guideline. The guideline describes a risk... Cybersecurity Risk Management Process Guideline. The primary goal of this guideline is to describe a risk...

  13. Aging management

    International Nuclear Information System (INIS)

    Godin, R.

    1995-01-01

    As of December 1994, 34 PWR 900 MW units and 20 PWR 1300 MW units are in operation, giving a total of more than 57,000 MW installed. These units are standardized and provide 75 percent of the French electrical output. They were all brought into service within a 15 year period. Considering the situation of those units in the production capacity, it is hardly necessary to point out the importance of a correct assessment of their potential lifetime (plant life management). This plant life management includes: technical aspects, safety aspects, economic aspects, operational aspects, national and international environment

  14. Severe accident management guidelines tool

    International Nuclear Information System (INIS)

    Gutierrez Varela, Javier; Tanarro Onrubia, Augustin; Martinez Fanegas, Rafael

    2014-01-01

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

  15. 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. © 2015 American Heart Association, Inc.

  16. Implications of the Eighth Joint National Committee Guidelines for the Management of High Blood Pressure for Aging Adults: The ARIC 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.

    2015-01-01

    The recent 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the Eight Joint National Committee Panel may significantly impact the aging US population. We performed a cross-sectional analysis of black and white participants in ARIC who participated in the 5th 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 7th and 8th Joint National Committee thresholds. Of 6,088 participants (mean age 75.6 years [range 66–90], 58.4% female, 23.2% African American), 54.9% had either diabetes or chronic kidney disease. The prevalence of hypertension according to 7th Joint National Committee thresholds was 81.9%, and 62.8% of the entire sample were at blood pressure goal. Using the 8th 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 or chronic kidney disease (20.6%) compared to individuals without either condition (11.6%). Use of antihypertensive medications in our cohort was high, with 75.0% prescribed at least one antihypertensive medication and 46.7% on 2 or more antihypertensive agents. In conclusion, in a US cohort of aging white and black individuals, approximately 1 in 6 individuals were reclassified as having blood pressure at goal by 8th Joint National Committee guidelines. Despite these less aggressive goals, over 20% remain uncontrolled by the new criteria. PMID:26150438

  17. 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

    UNLABELLED: Age-related macular degeneration (AMD) is still referred to as the leading cause of severe and irreversible visual loss world-wide. The disease has a profound effect on quality of life of affected individuals and represents a major socioeconomic challenge for societies due...

  18. Systematic review of guidelines for the physical management of osteoarthritis.

    Science.gov (United States)

    Larmer, Peter J; Reay, Nicholas D; Aubert, Elizabeth R; Kersten, Paula

    2014-02-01

    To undertake a systematic critical appraisal of guidelines to provide a summary of recommendations for the physical management of osteoarthritis (OA). The Cochrane Library, MEDLINE, CINAHL, SPORTDiscus with Full Text, Scopus, ScienceDirect, PEDro, and Google Scholar databases were searched (2000-2013) to identify all guidelines, protocols, and recommendations for the management or treatment of OA. In addition, Internet searches of all relevant arthritis organizations were undertaken. All searches were performed between July 2012 and end of April 2013. Guidelines that included only pharmacological, injection therapy, or surgical interventions were excluded. Guidelines published only in English were retrieved. OA guidelines developed from evidence-based research, consensus, and/or expert opinion were retrieved. There were no restrictions on severity or site of OA, sex, or age. Nineteen guidelines were identified for evaluation. The quality of all guidelines was critically appraised using the Appraisal of Guidelines for REsearch and Evaluation II instrument. Each guideline was independently reviewed. All relevant recommendations for the physical management of OA were synthesized, graded, and ranked according to available evidence. Seventeen guidelines with recommendations on the physical management of OA met the inclusion criteria and underwent a full critical appraisal. There were variations in the interventions, levels of evidence, and strength of recommendations across the guidelines. Forty different interventions were identified. Recommendations were graded from "strongly recommended" to "unsupported." Exercise and education were found to be strongly recommended by most guidelines. Exercise and education were key recommendations supporting the importance of rehabilitation in the physical management of OA. This critical appraisal can assist health care providers who are involved in the management of people with OA. Copyright © 2014 American Congress of

  19. 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.

  20. 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

  1. Effectiveness of Traumatic Brain Injury Management Guideline Introduction in Hungary.

    Science.gov (United States)

    Sorinola, Abayomi; Buki, Andras; Sandor, Janos; Czeiter, Endre

    2018-01-01

    To describe the impact of the Traumatic Brain Injury management guideline introduction in Hungary. Hospital discharge records (HDR) including age, gender, codes of interventions applied, ICD codes of diagnosed disorders of patients admitted between 01/01/2004 and 31/12/2010 with the diagnosis of intracranial injury (S06 by ICD10) from every inpatient institution in Hungary were collected from the database of National Health Insurance Fund (NHIF). The Case Fatality Ratios (CFR) for one week, one month and six months were calculated for the periods before and after the guideline introduction. The change of CFRs was applied as indicators for change of clinical quality elicited by the guideline. The centers together at one week, one month and six months had pre-guideline introduction CFRs of 23.4%, 37.7% and 47.5% and post-guideline introduction CFRs of 22.1%, 39.1%, and 50.0% respectively. The secondary institutions together at one week, one month and six months had pre-guideline introduction CFRs of 21.5%, 34.8% and 46.3% and post-guideline introduction CFRs of 21.9%, 37.0%, and 48.9% respectively. None of the CFRs showed significant change. The effectiveness of TBI management guideline adaptation in Hungary is poor. Without supportive financing and external auditing system, guideline introduction alone cannot achieve standard clinical practice and a reduction in CFR.

  2. 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...

  3. Ageing Management of CARR

    Energy Technology Data Exchange (ETDEWEB)

    Xiao, H., E-mail: Carr200404@hotmail.com [China Institute of Atomic Energy (CIAE), Beijing (China)

    2014-08-15

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

  4. Guidelines for education in energy management

    Directory of Open Access Journals (Sweden)

    Morales, C. M.

    2014-01-01

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

  5. [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.

  6. Guidelines for the responsible management of plutonium

    International Nuclear Information System (INIS)

    Agrell, P.H.

    1997-01-01

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

  7. SAGES Guidelines: Prevention and management of gastro ...

    African Journals Online (AJOL)

    SAGES Guidelines: Prevention and management of gastro-oesophageal varices and variceal haemorrhage in cirrhosis. J F Botha. Abstract. No Abstract South African Gastroenterology Review Vol. 6 (1) 2008: pp. 23-25. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  8. Sandia software guidelines, Volume 4: Configuration management

    Energy Technology Data Exchange (ETDEWEB)

    1992-06-01

    This volume is one in a series of Sandia Software Guidelines for use in producing quality software within Sandia National Laboratories. This volume is based on the IEEE standard and guide for software configuration management. The basic concepts and detailed guidance on implementation of these concepts are discussed for several software project types. Example planning documents for both projects and organizations are included.

  9. Adherence to Healthcare Waste Management Guidelines among ...

    African Journals Online (AJOL)

    BACKGROUND: Despite the set guidelines on Healthcare Waste Management in Kenya, mixing of different categories of waste, crude dumping and poor incineration are still a common phenomenon in public health facilities in Thika Subcounty, Kenya. Thika Subcounty generates 560 Kilograms of healthcare waste daily, ...

  10. Physician-centered management guidelines.

    Science.gov (United States)

    Pulde, M F

    1999-01-01

    The "Fortune 500 Most Admired" companies fully understand the irreverent premise "the customer comes second" and that there is a direct correlation between a satisfied work force and productivity, service quality, and, ultimately, organizational success. If health care organizations hope to recruit and retain the quality workforce upon which their core competency depends, they must develop a vision strategic plan, organizational structure, and managerial style that acknowledges the vital and central role of physicians in the delivery of care. This article outlines a conceptual framework for effective physician management, a "critical pathway," that will enable health care organizations to add their name to the list of "most admired." The nine principles described in this article are based on a more respectful and solicitous treatment of physicians and their more central directing role in organizational change. They would permit the transformation of health care into a system that both preserves the virtues of the physician-patient relationship and meets the demand for quality and cost-effectiveness.

  11. NPP Krsko Aging Management Program

    International Nuclear Information System (INIS)

    Glaser, B.; Spiler, J.

    2002-01-01

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

  12. [The German National Disease Management Guideline "Chronic Heart Failure"].

    Science.gov (United States)

    Weinbrenner, S; Langer, T; Scherer, M; Störk, S; Ertl, G; Muth, Ch; Hoppe, U C; Kopp, I; Ollenschläger, G

    2012-02-01

    Chronic heart failure (CHF) is an illness mostly affecting elderly people. In Germany CHF is one of the most common causes of death and at the same time one of the most common diagnosis in inpatient care. Due to the expected increase in life expectancy in the next few years experts predict a further step-up of the incidence. Against this background development of a national guideline on chronic heart failure was prioritised and accordingly the National Disease Management Guideline (NDMG) Chronic Heart Failure was developed by a multi- and interdisciplinary group. The guideline group comprised experts from all relevant scientific medical societies as well as a patient expert. The National Disease Management Guideline (NDMG) on Chronic Heart Failure aims at supporting patients and health care providers with respect to decisions on a specific health care problem by giving recommendations for actions. Recommendations are informed by the best available scientific evidence on this topic.Patients with CHF often suffer from multiple conditions. Due to this fact and the old age patients do have very complex and demanding health care needs. Thus accounting for co-morbidities is paramount in planning and providing health care for theses patients and communication between doctor and patient but also between all health care providers is crucial.Basic treatment strategies in chronic heart failure comprise management of risk factors and prognostic factors as well as appropriate consideration of co-morbidities accompanied by measures empowering patients in establishing a healthy life style and a self-dependant management of their illness.Psycho-social aspects have a very strong influence on patients' acceptance of the disease and their self-management. In addition they have a strong influence on therapy management of the treating physician thus they have to be addressed adequately during the consultation.The National Disease Management Guideline (NDMG) Chronic Heart Failure (CHF

  13. ORGEST: Regional guidelines and silvicultural models for sustainable forest management

    Energy Technology Data Exchange (ETDEWEB)

    Piqué, Míriam; Vericat, Pau; Beltrán, Mario

    2017-11-01

    Aim of the study: To develop regional guidelines for sustainable forest management. Area of the study: Forests of Catalonia (NE Spain). Material and methods: The process of developing the forest management guidelines (FMG) started by establishing a thorough classification of forest types at stand level. This classification hinges on two attributes: tree species composition and site quality based on ecological variables, which together determine potential productivity. From there, the management guidelines establish certain objectives and silvicultural models for each forest type. The forest type classifications, like the silvicultural models, were produced using both existing and newly-built growth models based on data from the National Forest Inventory (NFI) and expert knowledge. The effort involved over 20 expert working groups in order to better integrate the expertise and vision of different sectorial agents. Main results: The FMG consist in quantitative silvicultural models that include typical silvicultural variables, technical descriptions of treatments and codes of good practice. Guidelines now cover almost all forest types in Catalonia (spanning up to 90% of the Catalan forest area). Different silvicultural models have been developed for pure and mixed stands, different site quality classes (2–3 classes per species), and even- and multi-aged stands. Research highlights: FMG: i) orient the management of private and public forests, (ii) provide a technical scaffold for efficient allocation/investment of public subsidies in forest management, and (iii) bridge forest planning instruments at regional (strategic-tactical) and stand (operational) level.

  14. ORGEST: Regional guidelines and silvicultural models for sustainable forest management

    International Nuclear Information System (INIS)

    Piqué, Míriam; Vericat, Pau; Beltrán, Mario

    2017-01-01

    Aim of the study: To develop regional guidelines for sustainable forest management. Area of the study: Forests of Catalonia (NE Spain). Material and methods: The process of developing the forest management guidelines (FMG) started by establishing a thorough classification of forest types at stand level. This classification hinges on two attributes: tree species composition and site quality based on ecological variables, which together determine potential productivity. From there, the management guidelines establish certain objectives and silvicultural models for each forest type. The forest type classifications, like the silvicultural models, were produced using both existing and newly-built growth models based on data from the National Forest Inventory (NFI) and expert knowledge. The effort involved over 20 expert working groups in order to better integrate the expertise and vision of different sectorial agents. Main results: The FMG consist in quantitative silvicultural models that include typical silvicultural variables, technical descriptions of treatments and codes of good practice. Guidelines now cover almost all forest types in Catalonia (spanning up to 90% of the Catalan forest area). Different silvicultural models have been developed for pure and mixed stands, different site quality classes (2–3 classes per species), and even- and multi-aged stands. Research highlights: FMG: i) orient the management of private and public forests, (ii) provide a technical scaffold for efficient allocation/investment of public subsidies in forest management, and (iii) bridge forest planning instruments at regional (strategic-tactical) and stand (operational) level.

  15. 76 FR 57723 - Electricity Sector Cybersecurity Risk Management Process Guideline

    Science.gov (United States)

    2011-09-16

    ... DEPARTMENT OF ENERGY Electricity Sector Cybersecurity Risk Management Process Guideline AGENCY... public comment on DOE's intent 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...

  16. Current guidelines for management of children with functional constipation

    Directory of Open Access Journals (Sweden)

    V. P. Bulatov

    2015-01-01

    Full Text Available Despite the fact that functional constipations are a common and hence relevant problem of pediatrics, there are difficulties in managing this category of patients. The paper presents the current guidelines for the diagnosis and treatment of functional constipation in children, which rely on the principles of evidence-based medicine. Particular attention is given to the age-related aspects of constipation in childhood.

  17. 2014 UK national guideline for the management of anogenital herpes.

    Science.gov (United States)

    Patel, Raj; Green, John; Clarke, Emily; Seneviratne, Kanchana; Abbt, Naomi; Evans, Ceri; Bickford, Jane; Nicholson, Marian; O'Farrell, Nigel; Barton, Simon; FitzGerald, Mark; Foley, Elizabeth

    2015-10-01

    These guidelines concern the management of anogenital herpes simplex virus infections in adults and give advice on diagnosis, management, and counselling of patients. This guideline replaces the 2007 BASHH herpes guidelines and includes new sections on herpes proctitis, key points to cover with patients regarding transmission and removal of advice on the management of HSV in pregnancy which now has a separate joint BASHH/RCOG guideline. © The Author(s) 2015.

  18. Adherence to ministry of health guidelines in management of severe ...

    African Journals Online (AJOL)

    Background: Guidelines have shown to impact positively on the management of medical conditions. The impact of these guidelines has not been evaluated for severe preeclampsia and eclampsia in Kenya. Objective: To evaluate the level of adherence to Kenya Ministry of Health (MOH) guidelines in the management of ...

  19. 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 State...

  20. NPP Krsko Severe Accident Management Guidelines Implementation

    International Nuclear Information System (INIS)

    Basic, I.; Krajnc, B.; Bilic-Zabric, T.; Spiler, J.

    2002-01-01

    Severe Accident Management is a framework to identify and implement the Emergency Response Capabilities that can be used to prevent or mitigate severe accidents and their consequences. The USA NRC has indicated that the development of a licensee plant specific accident management program will be required in order to close out the severe accident regulatory issue (Ref. SECY-88-147). Generic Letter 88-20 ties the Accident management Program to IPE for each plant. The SECY-89-012 defines those actions taken during the course of an accident by the plant operating and technical staff to: 1) prevent core damage, 2) terminate the progress of core damage if it begins and retain the core within the reactor vessel, 3) maintain containment integrity as long as possible, and 4) minimize offsite releases. The subject of this paper is to document the severe accident management activities, which resulted in a plant specific Severe Accident Management Guidelines implementation. They have been developed based on the Krsko IPE (Individual Plant Examination) insights, Generic WOG SAMGs (Westinghouse Owners Group Severe Accident Management Guidances) and plant specific documents developed within this effort. Among the required plant specific actions the following are the most important ones: Identification and documentation of those Krsko plant specific severe accident management features (which also resulted from the IPE investigations). The development of the Krsko plant specific background documents (Severe Accident Plant Specific Strategies and SAMG Setpoint Calculation). Also, paper discusses effort done in the areas of NPP Krsko SAMG review (internal and external ), validation on Krsko Full Scope Simulator (Severe Accident sequences are simulated by MAAP4 in real time) and world 1st IAEA Review of Accident Management Programmes (RAMP). (author)

  1. Ageing Management Program Database

    International Nuclear Information System (INIS)

    Basic, I.; Vrbanic, I.; Zabric, I.; Savli, S.

    2008-01-01

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

  2. Management of research reactor ageing

    International Nuclear Information System (INIS)

    1995-03-01

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

  3. Management of research reactor ageing

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-03-01

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

  4. Clinical practice guideline: management of acute pancreatitis

    Science.gov (United States)

    Greenberg, Joshua A.; Hsu, Jonathan; Bawazeer, Mohammad; Marshall, John; Friedrich, Jan O.; Nathens, Avery; Coburn, Natalie; May, Gary R.; Pearsall, Emily; McLeod, Robin S.

    2016-01-01

    There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the management of complications of acute pancreatitis and of gall stone–induced pancreatitis. Une hausse de l’incidence de pancréatite aiguë a été constatée à l’échelle mondiale. Malgré l’amélioration de l’accès aux soins et aux techniques d’imagerie et d’intervention, la pancréatite aiguë est toujours associée à une morbidité et une mortalité importantes. Bien qu’il existe des guides de pratique clinique pour la prise en charge de la pancréatite aiguë, des études récentes sur la vérification de la prise en charge clinique de cette affection révèlent des lacunes importantes dans la conformité aux recommandations fondées sur des données probantes. Ces résultats mettent en relief l’importance de formuler des recommandations compréhensibles et applicables pour le diagnostic et la prise en charge de la pancréatite aiguë. La présente ligne directrice vise à fournir des recommandations fondées sur des données probantes pour la prise en charge de la pancréatite aiguë, qu’elle soit bénigne ou grave, ainsi que de ses complications et de celles de la pancréatite causée par un calcul biliaire. PMID:27007094

  5. NPP Krsko Severe Accident Management Guidelines Upgrade

    International Nuclear Information System (INIS)

    Mihalina, Mario; Spalj, Srdjan; Glaser, Bruno; Jalovec, Robi; Jankovic, Gordan

    2014-01-01

    Nuclear Power Plant Krsko (NEK) has decided to take steps for upgrade of safety measures to prevent severe accidents, and to improve the means to successfully mitigate their consequences. The content of the program for the NEK Safety Upgrade is consistent with the nuclear industry response to Fukushima accident, which revealed many new insights into severe accidents. Therefore, new strategies and usage of new systems and components should be integrated into current NEK Severe Accident Management Guidelines (SAMG's). SAMG's are developed to arrest the progression of a core damage accident and to limit the extent of resulting releases of fission products. NEK new SAMG's revision major changes are made due to: replacement of Electrical Recombiners by Passive Autocatalytic Recombiners (PARs) and the installation of Passive Containment Filtered Vent System (PCFV); to handle a fuel damage situation in Spent Fuel Pool (SFP) and to assess risk of core damage situation during shutdown operation. (authors)

  6. Managing problematic severe asthma: beyond the guidelines.

    Science.gov (United States)

    Pike, Katharine C; Levy, Mark L; Moreiras, John; Fleming, Louise

    2018-04-01

    This review discusses issues related to managing problematic severe asthma in children and young people. A small minority of children have genuinely severe asthma symptoms which are difficult to control. Children with genuinely severe asthma need investigations and treatments beyond those described within conventional guidelines. However, the majority of children with poor symptom control despite high-intensity treatment achieve improvement in their asthma control once attention has been paid to the basics of asthma management. Basic asthma management requires optimisation of inhaler technique and treatment adherence, avoidance of environmental triggers and self-management education. It is also important that clinicians recognise risk factors that predispose patients to asthma exacerbations and potentially life-threatening attacks. These correctable issues need to be tackled in partnership with children and young people and their families. This requires a coordinated approach between professionals across healthcare settings. Establishing appropriate infrastructure for coordinated asthma care benefits not only those with problematic severe asthma, but also the wider asthma population as similar correctable issues exist for children with asthma of all severities. Investigation and management of genuine severe asthma requires specialist multidisciplinary expertise and a systematic approach to characterising patients' asthma phenotypes and delivering individualised care. While inhaled corticosteroids continue to play a leading role in asthma therapy, new treatments on the horizon might further support phenotype-specific therapy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Consensus on the guidelines for the dietary management of classical galactosemia.

    Science.gov (United States)

    Kerckhove, Kristel Vande; Diels, Marianne; Vanhaesebrouck, Sigrid; Luyten, Karin; Pyck, Nancy; De Meyer, An; Van Driessche, Marleen; Robert, Martine; Corthouts, Karen; Caris, Ariane; Duchateau, Emilie; Dassy, Martine; Bihet, Genevieve

    2015-02-01

    Worldwide there is scientific discussion about the dietary management of galactosemia. The dietary management is very different in several countries among Europe, the US and Canada. The main points of discussion are related to the fact that i) despite a strict diet some patients still have poor outcomes; ii) there is lack of scientific knowledge about the role of endogenous production of galactose on disease evolution, with or without diet. The aim of the current work was the creation of a Belgian consensus on dietary guidelines for the management of galactosemia. A step-wise approach was used to achieve a consensus, including: a workshop, a Delphi round, discussion groups and a round table of different Belgian experts. The consensus is an agreement between strict guidelines (strict limitation of fruits, vegetables and soybean products/French guidelines) and the more liberal guidelines (comparable with a diet free of lactose/guidelines of UK and the Netherlands). The consensus document consists of different modules, including the medical context, the theoretical background of dietary guidelines and the age-specific practical dietary guidelines. A Belgian consensus on the guidelines for the dietary management of classical galactosemia was developed despite the uncertainties of the efficacy and practical application of these guidelines. The final consensus is based on scientific knowledge and practical agreement among experts. In the future, regular revision of the guidelines is recommended and a uniform European guideline is desirable. Copyright © 2014 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

  8. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis

    NARCIS (Netherlands)

    Mayumi, Toshihiko; Okamoto, Kohji; Takada, Tadahiro; Strasberg, Steven M.; Solomkin, Joseph S.; Schlossberg, David; Pitt, Henry A.; Yoshida, Masahiro; Gomi, Harumi; Miura, Fumihiko; Garden, O. James; Kiriyama, Seiki; Yokoe, Masamichi; Endo, Itaru; Asbun, Horacio J.; Iwashita, Yukio; Hibi, Taizo; Umezawa, Akiko; Suzuki, Kenji; Itoi, Takao; Hata, Jiro; Han, Ho-Seong; Hwang, Tsann-Long; Dervenis, Christos; Asai, Koji; Mori, Yasuhisa; Huang, Wayne Shih-Wei; Belli, Giulio; Mukai, Shuntaro; Jagannath, Palepu; Cherqui, Daniel; Kozaka, Kazuto; Baron, Todd H.; de Santibañes, Eduardo; Higuchi, Ryota; Wada, Keita; Gouma, Dirk J.; Deziel, Daniel J.; Liau, Kui-Hin; Wakabayashi, Go; Padbury, Robert; Jonas, Eduard; Supe, Avinash Nivritti; Singh, Harjit; Gabata, Toshifumi; Chan, Angus C. W.; Lau, Wan Yee; Fan, Sheung Tat; Chen, Miin-Fu; Ker, Chen-Guo; Yoon, Yoo-Seok; Choi, In-Seok; Kim, Myung-Hwan; Yoon, Dong-Sup; Kitano, Seigo; Inomata, Masafumi; Hirata, Koichi; Inui, Kazuo; Sumiyama, Yoshinobu; Yamamoto, Masakazu

    2018-01-01

    Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 (TG13),

  9. Guideline for primary care management of headache in adults

    Science.gov (United States)

    Becker, Werner J.; Findlay, Ted; Moga, Carmen; Scott, N. Ann; Harstall, Christa; Taenzer, Paul

    2015-01-01

    Abstract Objective To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. Quality of evidence A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. Main message A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. Conclusion A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache. PMID:26273080

  10. 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.

  11. Cable aging management

    International Nuclear Information System (INIS)

    Anandkumaran, A.; Sedding, H.

    2012-01-01

    Worldwide, due to the age of the majority of nuclear generating stations significant attention is being paid to the condition of the major components, e.g., reactor, steam generator, turbine generator, transformer, etc., with respect to relicensing and life extension. However, there is recognition that cable systems are critical to the safe, reliable and economic operation of nuclear power plants. Consequently, there is great interest in ageing management of low and medium voltage cables in the nuclear environment. Successful implementation of such programs requires an understanding of how the materials associated with cables and their accessories behave under normal operating and accident conditions. However, there is also a great need to determine the actual condition of the materials and systems in order to make rational decisions on whether or not to replace cables to ensure long term assurance of reliable operation. This proposed contribution describes an approach to cable ageing management of low and medium voltage cables based on measurements of material and electrical properties obtained in the laboratory and in the field. The effectiveness of various chemical, mechanical and electrical test methods are discussed in the context of, • Cable configuration, i.e., low or medium voltage, shielded or unshielded • Material type, i.e., PVC, XLPE, EPR, etc., • Ageing stress, i.e., electrical, thermal, radiation, thermal plus radiation, etc. These factors are key to identifying the most appropriate test method (or methods) to enable understanding of the current condition of the cable. While electrical test methods, e.g., ac withstand testing, partial discharge and various dielectric loss measurement techniques have been found effective for medium voltage cables, they are of very limited use on low voltage cables that constitute the majority of cables in nuclear power plants. This limited effectiveness is due to the lack of a well defined ground plane that is a

  12. Guidelines for Lifelong Education Management to Mobilize Learning Community

    Science.gov (United States)

    Charungkaittikul, Suwithida

    2018-01-01

    This article is a study of the guidelines for lifelong education management to mobilize learning communities in the social-cultural context of Thailand is intended to 1) analyze and synthesize the management of lifelong learning to mobilize learning community in the social-cultural context of Thailand; and 2) propose guidelines for lifelong…

  13. Guidelines for managing cardiovascular risk: an evolving area

    DEFF Research Database (Denmark)

    Currier, Judith S; Lundgren, Jens

    2008-01-01

    PURPOSE OF REVIEW: To reflect on the need for guidelines to assist clinicians in the management of cardiovascular risk in HIV-infected patients. RECENT FINDINGS: Over the past eight years guidelines for the management of dyslipidemia and metabolic complications of HIV infection have been developed...

  14. Revised guidelines on management of antenatal hydronephrosis

    Science.gov (United States)

    Sinha, A.; Bagga, A.; Krishna, A; Bajpai, M.; Srinivas, M.; Uppal, R.; Agarwal, I.

    2013-01-01

    Widespread antenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. The present guidelines update the recommendations published in 2000. Antenatal hydronephrosis (ANH) is transient and resolves by the third trimester in almost one-half cases. The presence of oligohydramnios and additional renal or extrarenal anomalies suggests significant pathology. All patients with ANH should undergo postnatal ultrasonography; the intensity of subsequent evaluation depends on anteroposterior diameter (APD) of the renal pelvis and/or Society for Fetal Urology (SFU) grading. Patients with postnatal APD exceeding 10 mm and/or SFU grade 3-4 should be screened for upper or lower urinary tract obstruction and vesicoureteric reflux (VUR). Infants with VUR should receive antibiotic prophylaxis through the first year of life, and their parents counseled regarding the risk of urinary tract infections. The management of patients with pelviureteric junction or vesicoureteric junction obstruction depends on clinical features and results of sequential ultrasonography and radionuclide renography. Surgery is considered in patients with increasing renal pelvic APD and/or an obstructed renogram with differential renal function <35-40% or its subsequent decline. Further studies are necessary to clarify the role of prenatal intervention, frequency of follow-up investigations and indications for surgery in these patients. PMID:23716913

  15. Cancer related fatigue: implementing guidelines for optimal management.

    Science.gov (United States)

    Pearson, Elizabeth J M; Morris, Meg E; McKinstry, Carol E

    2017-07-18

    Cancer-related fatigue (CRF) is a key concern for people living with cancer and can impair physical functioning and activities of daily living. Evidence-based guidelines for CRF are available, yet inconsistently implemented globally. This study aimed to identify barriers and enablers to applying a cancer fatigue guideline and to derive implementation strategies. A mixed-method study explored the feasibility of implementing the CRF guideline developed by the Canadian Association for Psychosocial Oncology (CAPO). Health professionals, managers and consumers from different practice settings participated in a modified Delphi study with two survey rounds. A reference group informed the design of the study including the surveys. The first round focused on guideline characteristics, compatibility with current practice and experience, and behaviour change. The second survey built upon and triangulated the first round. Forty-five health practitioners and managers, and 68 cancer survivors completed the surveys. More than 75% of participants endorsed the CAPO cancer related fatigue guidelines. Some respondents perceived a lack of resources for accessible and expert fatigue management services. Further barriers to guideline implementation included complexity, limited practical details for some elements, and lack of clinical tools such as assessment tools or patient education materials. Recommendations to enhance guideline applicability centred around four main themes: (1) balancing the level of detail in the CAPO guideline with ease of use, (2) defining roles of different professional disciplines in CRF management, (3) how best to integrate CRF management into policy and practice, (4) how best to ensure a consumer-focused approach to CRF management. Translating current knowledge on optimal management of CRF into clinical practice can be enhanced by the adoption of valid guidelines. This study indicates that it is feasible to adopt the CAPO guidelines. Clinical application may

  16. Management of acute epididymitis: are European guidelines being followed?

    Science.gov (United States)

    Drury, Nigel E; Dyer, Jonathan P; Breitenfeldt, Nicole; Adamson, Andrew S; Harrison, G S M

    2004-10-01

    Acute epididymitis is increasing in men aged 35 years or under due to sexually-transmitted Chlamydia trachomatis. This study examines whether Urological surgeons are following European guidelines for the management of acute epididymitis in these patients. A postal questionnaire survey was conducted of specialists in Urology in two regions of the UK. Of 79 completed replies, 41 (52%) take a detailed sexual history but only 34 (43%) refer patients to a Genitourinary medicine clinic. Quinolones are the most commonly prescribed first-line antibiotic by 56 (71%) respondents, principally ciprofloxacin. The current management of acute epididymitis in young men must be improved. Ciprofloxacin is not the optimal antimicrobial for the treatment of urogenital chlamydial infection. We recommend that all such patients be referred to local Genitourinary medicine services for contact-tracing and treatment of their sexual partners.

  17. European Guidelines for Obesity Management in Adults

    Directory of Open Access Journals (Sweden)

    Volkan Yumuk

    2015-12-01

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

  18. European Guidelines for Obesity Management in Adults

    Science.gov (United States)

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

    2015-01-01

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

  19. European Guidelines for Obesity Management in Adults.

    Science.gov (United States)

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

    2015-01-01

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

  20. Managing challenging interactions with family caregivers in the cancer setting: Guidelines for clinicians (TRIO Guidelines-2).

    Science.gov (United States)

    Laidsaar-Powell, Rebekah; Butow, Phyllis; Boyle, Frances; Juraskova, Ilona

    2018-06-01

    Family caregivers can, at times, add complexity to clinical encounters. Difficult family caregivers and dynamics may: derail consultation communication, reduce patient autonomy, and compromise effective clinical care. A paucity of practical strategies guiding effective clinician-family communication exists. This study aimed to develop and evaluate the first comprehensive, evidence-based guidelines (the TRIO guidelines) for oncology physicians and nurses to better manage several complex/challenging situations involving family members. TRIO Guidelines were based on a comprehensive review of literature, relevant guidelines, and feedback from an expert advisory group (n = 10). Draft guidelines underwent two rounds of evaluation via an online Delphi consensus process involving international experts (n = 35). Guidelines incorporate topic areas, strategies, and sub-strategies on managing challenging family involvement (7 topics). Example wording, behaviours and level of evidence are provided. Challenging triadic interactions require skillful navigation, and the TRIO Guidelines provide clear, specific, and evidence-based strategies for clinicians to utilise in these potentially stressful encounters. Training based on these guidelines may improve both patient care and clinician confidence. Implementation of these guidelines into medical/nursing curricula and as a component of continuing professional development programs will likely be highly beneficial. Copyright © 2018 Elsevier B.V. All rights reserved.

  1. Integrated ageing management of Atucha NPP

    International Nuclear Information System (INIS)

    Ranalli, Juan M.; Marchena, Martin H.; Zorrilla, Jorge R.; Antonaccio, Elvio E.; Brenna, Pablo; Yllanez, Daniela; Cruz, Gerardo Vera de la; Luraschi, Carlos; Sabransky, Mario

    2013-01-01

    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)

  2. Integrated Ageing Management of Atucha NPP

    International Nuclear Information System (INIS)

    Ranalli, J.M.; Marchena, M.H.; Zorrilla, J.R.; Sabransky, M.

    2012-01-01

    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)

  3. 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)

  4. Risk management guidelines for petroleum storage tank sites

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-10-01

    These guidelines provide a site management process designed particularly for soil and groundwater pollution originating from existing or former petroleum storage tank (PST) facilities and provide uniform standards for the remediation of polluted PST sites in Alberta. The numerical criteria, risk management objectives and technical information described in this document were compiled from four documents including Remediation Guidelines for Petroleum Storage Tank Sites 1994, the Canada-Wide Standards for Petroleum Hydrocarbons in Soil, Alberta Soil and Water Quality Guidelines for Hydrocarbons at Upstream Oil and Gas Facilities, and Guidelines for Managing Risks at Contaminated Sites in Alberta. The changes in these updated guidelines reflect new remediation criteria and provide a process for determining alternate site-specific management objectives for more petroleum storage tank sites. The guidelines were developed using a risk-based approach that ensures the protection of human health, safety and the environment. The guidelines apply to aboveground and underground storage tank facilities that contain gasoline, diesel, heating oil, and aviation fuel. The guidelines specify requirements by Alberta Environment and the Alberta Fire Code. The chapter on risk management process included information on site investigation, determination of soil type, pollution source removal, land use assessment, selection of exposure pathways, depth of remediation, human inhalation and groundwater protection pathways, and verification of remediation. figs, 4 tabs., 2 appendices.

  5. [The German Program for Disease Management Guidelines: CHD Guideline 2006. Short review].

    Science.gov (United States)

    Ollenschläger, Günter; Lelgemann, Monika; Kopp, Ina

    2006-12-15

    In Germany, the first national consensus on evidence-based recommendations for disease management in patients with chronic coronary heart disease was reached in summer 2006. After a development period of 4 years, the National Disease Management Guideline Chronic Coronary Heart Disease was finalized by nominal group process under the authorship of the scientific associations for cardiac rehabilitation (DGPR), cardiac surgery (DGTHG), cardiology (DGK), general internal medicine (DGIM), family medicine (DEGAM), and the Drug Commission of the German Medical Association (AKDAE). The recommendations' main sources are the ACC/AHA guidelines 2002 updates as well as existing German guidelines and reviews of recent scientific evidence. The article gives an overview on authors, sources, and key recommendations of the German National Disease Management Guideline Chronic Coronary Heart Disease 2006 (www.khk.versorgungsleitlinie.de).

  6. [The German Program for Disease Management Guidelines: COPD Guideline 2006. Short review].

    Science.gov (United States)

    Ollenschläger, Günter; Kopp, Ina; Lelgemann, Monika

    2007-01-15

    In Germany, the first national consensus on evidence-based recommendations for COPD prevention and disease management was reached in spring 2006. After a development period of 9 months, the National Disease Management Guideline COPD was finalized by nominal group process under the authorship of the scientific societies for pneumology (DGP and Atemwegsliga), general internal medicine (DGIM), family medicine (DEGAM), and the Drug Commission of the German Medical Association (AKDAE). The recommendations' main sources are the NICE COPD Guideline 2004, the GOLD Recommendations as well as existing German guidelines and reviews of recent scientific evidence. The article gives an overview on authors, sources, and key recommendations of the German National Disease Management Guideline COPD 2006 (www.copd.versorgungsleitlinien.de).

  7. Technical approach to aging management

    International Nuclear Information System (INIS)

    Vora, J.P.; Johnson, A.B. Jr.; Allen, R.P.

    1992-10-01

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

  8. 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.

  9. 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.

  10. Forest residues management guidelines for the Pacific Northwest.

    Science.gov (United States)

    John M. Pierovich; Edward H. Clarke; Stewart G. Pickford; Franklin R. Ward

    1975-01-01

    Forest residues often require treatment to meet land management objectives. Guideline statements for managing forest residues are presented to provide direction for achieving these objectives. The latest research information and the best knowledge of experts in various land management disciplines were used to formulate these statements. A unique keying system is...

  11. Adherence to management guidelines for childhood asthma in Australia.

    Science.gov (United States)

    Bereznicki, Bonnie J; Beggs, Sean; Duff, Caitlin; Bereznicki, Luke

    2015-12-01

    Little is known about doctors' treatment preferences for childhood asthma. The aim of this study was to investigate adherence to management guidelines for childhood asthma. One thousand general practitioners (GPs) and paediatric specialists in Australia were invited to take part in a survey, which collected demographic details and explored their familiarity with and adherence to childhood asthma management guidelines. Two hundred doctors (20% response rate) responded and were eligible for inclusion in the survey. Approximately half (54.5%) of the respondents were very familiar with at least one of the childhood asthma management guidelines. The majority of respondents (86.8%) followed guideline recommendations when prescribing initial maintenance therapy for childhood asthma, while 89.2% and 68.0% followed guideline recommendations regarding step-up and step-down therapy respectively. Overall familiarity with childhood asthma management guidelines could be improved. There is scope for improvement in the adherence to these guidelines when prescribing medication in childhood asthma, particularly for step-down therapy.

  12. Preparing strategic information management plans for hospitals: a practical guideline SIM plans for hospitals: a guideline.

    Science.gov (United States)

    Brigl, B; Ammenwerth, E; Dujat, C; Gräber, S; Grosse, A; Häber, A; Jostes, C; Winter, A

    2005-01-01

    Systematic information management in hospitals demands for a strategic information management plan (SIM plan). As preparing a SIM plan is a considerable challenge we provide a practical guideline that is directly applicable when a SIM plan is going to be prepared. The guideline recommends a detailed structure of a SIM plan and gives advice about its content and the preparation process. It may be used as template, which can be adapted to the individual demands of any hospital. The guideline was used in several hospitals preparing a SIM plan. Experiences showed that the SIM plans could be prepared very efficiently and timely using the guideline, that the proposed SIM plan structure suited well, that the guideline offers enough flexibility to meet the requirements of the individual hospitals and that the specific recommendations of the guideline were very helpful. Nevertheless, we must strive for a more comprehensive theory of strategic information management planning which -- in the sense of enterprise architecture planning -- represents the intrinsic correlations of the different parts of a SIM plan to a greater extent.

  13. Aging management database

    International Nuclear Information System (INIS)

    Vidican, Dan

    2003-01-01

    As operation time is accumulated, the overall safety and performance of NPP tend to decrease. The reasons for potential non-availability of the structures, Systems and Components (SCC) in operation, are various but they represent in different mode the end result of the ageing phenomena. In order to understand the ageing phenomena and to be able to take adequate countermeasures, it is necessary to accumulate a big amount of information, from worldwide and also from the own plant. These Data have to be organized in a systematic form, easy to retrieval and use. General requirements and structure of an Ageing DataBase Activities related to ageing evaluation have to allow: - Identification and evaluation of degradation phenomena, potential malfunction and failure mode of the plant typical components; - Trend analyses (on selected critical components), prediction of the future performance and the remaining service life. To perform these activities, it is necessary to have information on similar components behavior in different NPP (in different environment and different operating conditions) and also the results from different pilot studies. The knowledge of worldwide experience is worthwhile. Also, it is necessary to know very well the operating and environmental conditions in own NPP and to analyze in detail the failure mode and root cause for the components removed from the plant due to extended degradation. Based on the above aspects, one presents a proposal for the structure of an Ageing DataBase. It has three main sections: - Section A: General knowledge about ageing phenomena. It contain all the information collected based on the worldwide experience. It could have, a general part with crude information and a synthetic one, structured on typical components (if possible on different manufacturers). The synthetic part, has to consider different ageing aspects and different monitoring and evaluation methods (e. g. component, function, environment condition, specific

  14. 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.

  15. Guidelines for Management Information Systems in Canadian Health Care Facilities

    Science.gov (United States)

    Thompson, Larry E.

    1987-01-01

    The MIS Guidelines are a comprehensive set of standards for health care facilities for the recording of staffing, financial, workload, patient care and other management information. The Guidelines enable health care facilities to develop management information systems which identify resources, costs and products to more effectively forecast and control costs and utilize resources to their maximum potential as well as provide improved comparability of operations. The MIS Guidelines were produced by the Management Information Systems (MIS) Project, a cooperative effort of the federal and provincial governments, provincial hospital/health associations, under the authority of the Canadian Federal/Provincial Advisory Committee on Institutional and Medical Services. The Guidelines are currently being implemented on a “test” basis in ten health care facilities across Canada and portions integrated in government reporting as finalized.

  16. Labour management guidelines for a Tanzanian referral hospital

    DEFF Research Database (Denmark)

    Maaløe, Nanna; Housseine, Natasha; van Roosmalen, Jos

    2017-01-01

    hospital, this paper describes the development process of locally achievable, partograph-associated, and peer-reviewed labour management guidelines, and it presents an assessment of professional birth attendants’ perceptions. Methods: Part 1: Modification of evidence-based international guidelines through...... by staff and two external peer-review cycles, there were no major concerns with the guidelines internally nor externally. Thereby, international recommendations were condensed to the eight-paged ‘PartoMa guidelines ©’. This pocket booklet includes routine assessments, supportive care, and management......, locally achievable, and acceptable support for intrapartum surveillance, triage, and management. This is a crucial example of adapting evidence-based international recommendations to local reality. Trial registration: This paper describes the intervention of the PartoMa trial, which is registered...

  17. NDMA guidelines on management of nuclear and radiological emergencies

    International Nuclear Information System (INIS)

    Abani, M.C.

    2011-01-01

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

  18. The NPP Isar comprehensive Aging Management Program

    International Nuclear Information System (INIS)

    Zander, Andre; Ertl, Stefan

    2012-01-01

    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. Safety-related aspects and the targeted high availability of the power plant as well as the requirements stipulated by German regulatory authorities prompted the operator of NPP ISAR to introduce an aging surveillance program. The NPP Isar as well as the German NPPs has to be following in the scope of aging management the KTA 1403 guideline. The NPP Isar surveillance program based on the KTA 1403 guideline covers the following aspects: - Scoping and screening of safety relevant Systems, Structures and Components (SSC); - Identification of possible degradation mechanisms for safety relevant SSC; - Ensure, that testing and maintenance programs sufficiently provide preventive measures to control degradation effects; - Transferability check of industry experience (internal and external events); - Annual preparation of an AM status report. (author)

  19. Aging management of Cirus

    International Nuclear Information System (INIS)

    Sharma, R.C.

    2000-01-01

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

  20. [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.

  1. 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. © The Author(s) 2016.

  2. 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.

  3. Unmet needs in obesity management: From guidelines to clinic.

    Science.gov (United States)

    Ritten, Angela; LaManna, Jacqueline

    2017-10-01

    Despite the rather slow acceptance of obesity as a disease state, several obesity staging systems and weight-management guidelines have been developed and are in use, along with an ever-growing number of treatment options. Many primary care clinicians, including nurse practitioners (NPs), are at the forefront of clinical efforts to assist individuals with obesity, but face challenges due to lack of alignment and consensus among the various staging systems and guidelines. This is further complicated by shortfalls in clinical training related to obesity management and increasing complexities in reimbursement for obesity-related services. Unmet needs in the management of obesity thus stretch from guidelines to clinic. This article examines the principal barriers to effective management of individuals with obesity and considers how concerns might be overcome, with particular emphasis on the role of the NP. ©2017 American Association of Nurse Practitioners.

  4. A Guideline for Marine Corps Financial Managers

    National Research Council Canada - National Science Library

    Wright, Anthone

    1998-01-01

    ...), and Marine Corps orders, publications and directives to determine those keys areas considered most essential to Marine Corps financial management specialists in the performance of their duties...

  5. European guidelines on management of restless legs syndrome

    DEFF Research Database (Denmark)

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

    2012-01-01

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

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

    International Nuclear Information System (INIS)

    Mayboroda, O.

    2001-01-01

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

  7. [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.

  8. German disease management guidelines: surgical therapies for chronic heart failure.

    Science.gov (United States)

    Sindermann, J R; Klotz, S; Rahbar, K; Hoffmeier, A; Drees, G

    2010-02-01

    The German Disease Management Guideline "Chronic Heart Failure" intends to guide physicians working in the field of diagnosis and treatment of heart failure. The guideline provides a tool on the background of evidence based medicine. The following short review wants to give insights into the role of some surgical treatment options to improve heart failure, such as revascularization, ventricular reconstruction and aneurysmectomy, mitral valve reconstruction, ventricular assist devices and heart transplantation. (c) Georg Thieme Verlag KG Stuttgart-New York.

  9. 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…

  10. Forest management guidelines for controlling wild grapevines

    Science.gov (United States)

    H. Clay Smith

    1984-01-01

    Grapevines (Vitis spp.) are becoming a major problem to forest managers in the Appalachians, especially when clearcutting is done on highly productive hardwood sites. Where present, grapevines can reduce tree quality and growth, and eventually kill the tree. Silvical characteristics of grapevines are discussed as background for grapevine control....

  11. Progress of steam generator ageing management of Chinese NPPs

    International Nuclear Information System (INIS)

    Hongyun, L.; Chun, G.; Jun, T.; Zhigang, W.

    2012-01-01

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

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

    Science.gov (United States)

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

    2016-05-01

    These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline. © The Author(s) 2016.

  13. 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.

  14. Solid low level waste management guidelines

    International Nuclear Information System (INIS)

    Saunders, P.

    1995-01-01

    In the 1980's the nuclear industry began focusing a great deal of attention on minimizing the volume of low level radioactive waste (LLW) that required disposal. This was driven by several factors including rising disposal costs, increased regulatory pressures, and increased pressure from other organizations such as INPO. In the 1990's most utilities are faced with intense competition in the electrical generation market. The survival of a utility is based on their ability to produce electricity by the most efficient and economical means available. Waste management related costs are a substantial portion of most utilities O ampersand M budgets. Disposal site access denial continues to be a major factor in waste management program decision, and the pressures to minimize waste volumes from outside organizations is greater than ever

  15. Ageing management technical information investigations

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-08-15

    In February 2013, there are 50 units of commercial nuclear power plants (NPPs) in Japan. We enter into a period that 20 units of them are operating for more than 30 years. Currently, regulation imposes utilities to conduct ageing technical evaluations of each unit before operation of 30 years from the commissioning, to develop the long term maintenance management policy for next 10 years and to submit to the regulatory authority the policy with the report on ageing management technical evaluation (AMTE) for each NPP. It is necessary for regulatory side to develop technical information bases incorporating latest technical knowledge as operating experiences in domestic and abroad on ageing of the plants necessary to conduct reviews of AMTE for each unit. Based on these standpoints, technical information bases investigations have been conducted from the viewpoints of material degradation of ageing NPPs. In order to develop scientific regulator judgment bases related to ageing management (AM) and long-term operation (LTO), investigations on latest information on ageing management in domestic and abroad are conducted and a set of documents including technical evaluation review manuals necessary to conduct AMTE are prepared. To utilize the results of the investigations for ageing technical evaluation, database including latest information related to AM and LTO are developed, ran and operated. In addition, investigations related to Fugen nuclear plant, under decommissioning plants, investigations on mechanism of stress corrosion cracking (SCC), thermal ageing and preventive technologies for SCC, detection and diagnosis technology for ageing degradation and condition monitoring technology are performed to validate and confirm effectiveness of the technologies. (author)

  16. A critical appraisal of guidelines for the management of knee osteoarthritis using Appraisal of Guidelines Research and Evaluation criteria

    Science.gov (United States)

    Poitras, Stéphane; Avouac, Jérôme; Rossignol, Michel; Avouac, Bernard; Cedraschi, Christine; Nordin, Margareta; Rousseaux, Chantal; Rozenberg, Sylvie; Savarieau, Bernard; Thoumie, Philippe; Valat, Jean-Pierre; Vignon, Éric; Hilliquin, Pascal

    2007-01-01

    Clinical practice guidelines have been elaborated to summarize evidence related to the management of knee osteoarthritis and to facilitate uptake of evidence-based knowledge by clinicians. The objectives of the present review were summarizing the recommendations of existing guidelines on knee osteoarthritis, and assessing the quality of the guidelines using a standardized and validated instrument – the Appraisal of Guidelines Research and Evaluation (AGREE) tool. Internet medical literature databases from 2001 to 2006 were searched for guidelines, with six guidelines being identified. Thirteen clinician researchers participated in the review. Each reviewer was trained in the AGREE instrument. The guidelines were distributed to four groups of three or four reviewers, each group reviewing one guideline with the exception of one group that reviewed two guidelines. One independent evaluator reviewed all guidelines. All guidelines effectively addressed only a minority of AGREE domains. Clarity/presentation was effectively addressed in three out of six guidelines, scope/purpose and rigour of development in two guidelines, editorial independence in one guideline, and stakeholder involvement and applicability in none. The clinical management recommendation tended to be similar among guidelines, although interventions addressed varied. Acetaminophen was recommended for initial pain treatment, combined with exercise and education. Nonsteroidal anti-inflammatory drugs were recommended if acetaminophen failed to control pain, but cautiously because of gastrointestinal risks. Surgery was recommended in the presence of persistent pain and disability. Education and activity management interventions were superficially addressed in most guidelines. Guideline creators should use the AGREE criteria when developing guidelines. Innovative and effective methods of knowledge translation to health professionals are needed. PMID:18062805

  17. Guidelines for international plutonium management: Overview and implications

    International Nuclear Information System (INIS)

    Bryson, M.C.; Fitzgerald, C.P.; Kincaid, C.

    1998-01-01

    In September, 1997, nine of the world's plutonium-using countries agreed to a set of guidelines for international plutonium management, with acceptances to be submitted to the International Atomic Energy Agency on December 1. Following three years of discussion, the guidelines provide a unified package of accepted rules for the storage, handling, and transportation of civil plutonium as well as military plutonium that has been declared as no longer required for defense purposes. New requirements include a formal declaration of national plutonium strategies, which will recognize the environmental, economic, and proliferation concerns and the consequent importance of balancing plutonium supply and demand. Nations will also make annual declaration of their non-military stockpiles of unirradiated plutonium, together with estimates of the plutonium content in spent reactor fuel. These guidelines represent the first formally accepted recognition of the need for plutonium management of this scope and could thus provide a partial basis for future monitoring and policy regimes

  18. Guidelines on nitrogen management in agricultural systems

    International Nuclear Information System (INIS)

    2008-01-01

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

  19. [Quality indicators for National Disease Management Guidelines using the example of the National Disease Management Guideline for "Chronic Heart Failure"].

    Science.gov (United States)

    Nothacker, Monika Judith; Langer, Thomas; Weinbrenner, Susanne

    2011-01-01

    Together with an expert committee a structured approach to determining quality indicators for National Disease Management Guidelines has been developed. The key steps of this approach include: introducing guideline authors to the methodology at an early stage of the process of guideline development, pre-selecting recommendations of the guideline which are potentially measurable by means of quality indicators, assessing the potentially measurable quality indicators in written form using five criteria (including their importance for the health care system and clarity of definitions) and approving them in a formal consensus process. For lack of a database these quality indicators must be regarded as preliminary. For the National Disease Management Guideline "Chronic Heart Failure" nine rate-based indicators have been chosen. The indicators correspond to important strong recommendations (grade of recommendation: A) from the fields of diagnosis (two), general therapeutic strategy (two), specific treatment (three), clinical monitoring (one) and co-ordination of care (one). In a second step, the quality indicators have to be validated within a pilot project. The determination and assessment of the potential quality indicators have revealed room for improvement of guideline development. In particular, there is a need for more health care data and for specification of recommendations.

  20. [Management of a breast cystic syndrome: Guidelines].

    Science.gov (United States)

    Uzan, C; Seror, J-Y; Seror, J

    2015-12-01

    Breast cysts are common, often discovered incidentally or subsequently to pain or palpable mass. The purpose of these recommendations is to describe the sonographic findings for classifying breast cystic lesions, to analyze the value and contribution of various imaging techniques and sampling and to provide a management strategy. Literature review conducted by a small group and then reviewed and validated by the group designated by the Collège national des gynécologues et obstétriciens français (CNGOF) to make recommendations for clinical practice for benign breast lesions. Breast cysts are classified in 3 categories: simple cysts, complicated cysts and complex cysts. For simple cysts, after ultrasound, no further imaging is necessary, cytology is to consider only as analgesic. For complicated cysts, a control at 4-6 months is recommended; the use of cytology depends on the context (familial risk, difficulty of follow-up). In case of complex cyst, sampling by cytology or biopsy is recommended. More assessments of other imaging tests are reported. The sonographic characterization is essential for management of breast cyst. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  1. Water management planning guideline for waterpower

    International Nuclear Information System (INIS)

    2002-05-01

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

  2. 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…

  3. 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.

  4. 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...

  5. Adherence to International Guidelines in the Management of ...

    African Journals Online (AJOL)

    Purpose: The role of physicians in the overall management of hypertension and their adherence to the JNC VII, WHO/ISH and ESH guidelines were examined in this study. Method: Case notes of hypertensive patients diagnosed between 1 January 2004 and 30 September 2005, in the Cardiology Clinic of University of ...

  6. Compliance with standard treatment guidelines in the management ...

    African Journals Online (AJOL)

    Introduction: Hypertension is a leading lifestyle disease and major cause of morbidity and mortality in South Africa, and globally. Standard Treatment Guidelines are issued in this country to assist healthcare workers in the diagnosis and management there of. Considering the debilitating effects caused by hypertension, the ...

  7. Severe accident management. Optimized guidelines and strategies

    International Nuclear Information System (INIS)

    Braun, Matthias; Löffler, Micha; Plank, Hermann; Asse, Dietmar; Dimmelmeier, Harald

    2014-01-01

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

  8. 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

  9. Do we need regional guidelines for breast cancer management in the MENA region? MENA Breast Cancer Guidelines project.

    Science.gov (United States)

    Fayed, Reham; Hamza, Dina; Abdallah, Heba; Kelany, Mohamed; Tahseen, Amira; Aref, Adel T

    2017-01-01

    Breast cancer is the most common cancer among females worldwide in general and in the Middle East and the North African region (MENA region) in particular. Management of breast cancer in the MENA region faces a lot of challenges, which include younger age at presentation, aggressive behaviour, lack of national breast screening programmes and lack of reliable data registries as well as socioeconomic factors. These factors make applying the international guidelines for breast cancer management very challenging. The aim of this project is to explore the need for a regional breast cancer guideline as well as to screen the clinical practice of breast cancer management in the MENA region. Three web-based designed surveys were sent to more than 600 oncologists in the MENA region from the period of August 2013 to October 2014. Full descriptive data and information regarding the application of international breast cancer guidelines were collected. The software was using the IP address to prevent duplication of collected data. Descriptive analysis and results were shown as numbers and percentages. During the period of the survey, 104 oncologists responded, representing around an 11% response rate. The majority of replies came from Egypt (59 responses (59%)), followed by Saudi Arabia (ten responses (9.6%)). Fifty-one per cent of responders had more than ten years of experience, and further 31.7% had 5-10 years of experience. Seventy-four per cent were working in governmental hospitals, which is our target sector. There was a major defect in having a genetic counsel unit (78.8% declared an absence of this service), presence of a national breast screening programme (55.8% declared an absence of this service), performing sentinel lymph node biopsy (43.3% declared an absence of this service). The need for regional guidelines for the management of breast cancer was agreed upon by 90.6% of responders. There is a clear need to improve the management of breast cancer in the MENA

  10. Guidelines for respiratory motion management in radiation therapy

    International Nuclear Information System (INIS)

    Matsuo, Yukinori; Onishi, Hiroshi; Nakagawa, Keiichi

    2013-01-01

    Respiratory motion management (RMM) systems in external and stereotactic radiotherapies have been developed in the past two decades. Japanese medical service fee regulations introduced reimbursement for RMM from April 2012. Based on thorough discussions among the four academic societies concerned, these Guidelines have been developed to enable staff (radiation oncologists, radiological technologists, medical physicists, radiotherapy quality managers, radiation oncology nurses, and others) to apply RMM to radiation therapy for tumors subject to respiratory motion, safely and appropriately. (author)

  11. Guidelines for Quality Management of Apallic Syndrome / Vegetative State.

    Science.gov (United States)

    von Wild, Klaus; Gerstenbrand, Franz; Dolce, Giuliano; Binder, Heinrich; Vos, Pieter E; Saltuari, Leopold; Alekseenko, Yuri; Formisano, Rita; Ritz, Annegret; Ortega-Suhrkamp, Erika; Jörg, Johannes R; Potapov, Alexander A; León-Carrión, José; Vilcinis, Rimantas; Zitnay, George A

    2007-06-01

    to guarantee humanistic active nursing if treatment fails. Outcome depends on the cause and duration of AS/VS as well as patient's age. There is no single AS/VS specific laboratory investigation, no specific regimen or stimulating intervention to be recommended for improving higher cerebral functioning. Quality management requires at least 3 years of advanced training and permanent education to gain approval of qualification for AS/VS treatment and expertise. Sine qua non areas covering AS/VS institutions for early and long-term rehabilitation are required on a population base (prevalence of 2/100.000/year) to quicken functional restoration and to prevent or treat complications. Caring homes are needed for respectful humane nursing including basal sensor-motor stimulating techniques. Passive euthanasia is considered an act of mercy by physicians in terms of withholding treatment; however, ethical and legal issues with regard to withdrawal of nutrition and hydration and end of life discussions raise deep concerns. The aim of the guideline is to provide management guidance (on the best medical evidence class II and III or task force expertise) for neurologists, neurosurgeons, other physicians working with AS/VS patients, neurorehabilitation personnel, patients, next-of-kin, and health authorities.

  12. 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.

  13. International guidelines for groin hernia management

    DEFF Research Database (Denmark)

    Jørgensen, Lars Nannestad; Bisgaard, Thue

    2018-01-01

    a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading......-risk environments is not recommended in open surgery. In laparo-endoscopic repair it is never recommended. Local anesthesia in open repair has many advantages, and its use is recommended provided the surgeon is experienced in this technique. General anesthesia is suggested over regional in patients aged 65...... of clinically significant chronic pain is in the 10-12% range, decreasing over time. Debilitating chronic pain affecting normal daily activities or work ranges from 0.5 to 6%. Chronic postoperative inguinal pain (CPIP) is defined as bothersome moderate pain impacting daily activities lasting at least 3 months...

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

    International Nuclear Information System (INIS)

    Kluk, A.F.; Neal, R.M.

    1996-01-01

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

  15. Ageing management requirements in Sweden

    International Nuclear Information System (INIS)

    Gott, K.

    2007-01-01

    Since the adoption of the 1997 act of parliament concerning the abolishment of nuclear power in Sweden plant lives are no longer limited until 2010 as they were following the referendum in 1980. The Swedish Nuclear Power Inspectorate (SKI) has therefore in its most recent general regulations from 2004 introduced requirements for plants to develop ageing management programmes which should have been in place by the end of 2005. An ageing management programme for a nuclear power plant can be viewed as a high level coordinated programme consisting of several other programmes including maintenance and inspection programmes, and as such it should be an integrated part of the quality assurance system of the plant. The goals of the programme are to ensure that there is long term management of ageing and avoidance of the unexpected. For the Swedish regulator the safety aspects and not the economic aspects of ageing management are of primary importance. But there are clear advantages to utilities if large surprises which result in unplanned outages can be avoided. (author)

  16. 2017 European guidelines for the management of genital herpes.

    Science.gov (United States)

    Patel, Rajul; Kennedy, Oliver J; Clarke, Emily; Geretti, Anna; Nilsen, Arvid; Lautenschlager, Stephan; Green, John; Donders, Gilbert; van der Meijden, Willem; Gomberg, Mikhail; Moi, Harald; Foley, Elizabeth

    2017-12-01

    Genital herpes is one of the commonest sexually transmitted infections worldwide. Using the best available evidence, this guideline recommends strategies for diagnosis, management, and follow-up of the condition as well as for minimising transmission. Early recognition and initiation of therapy is key and may reduce the duration of illness or avoid hospitalisation with complications, including urinary retention, meningism, or severe systemic illness. The guideline covers a range of common clinical scenarios, such as recurrent genital herpes, infection during pregnancy, and co-infection with human immunodeficiency virus.

  17. The Saudi Guidelines for the Diagnosis and Management of COPD

    Science.gov (United States)

    Khan, Javed H.; Lababidi, Hani M. S.; Al-Moamary, Mohamed S.; Zeitouni, Mohammed O.; AL-Jahdali, Hamdan H.; Al-Amoudi, Omar S.; Wali, Siraj O.; Idrees, Majdy M.; Al-Shimemri, Abdullah A.; Al Ghobain, Mohammed O.; Alorainy, Hassan S.; Al-Hajjaj, Mohamed S.

    2014-01-01

    The Saudi Thoracic Society (STS) launched the Saudi Initiative for Chronic Airway Diseases (SICAD) to develop a guideline for the diagnosis and management of chronic obstructive pulmonary disease (COPD). This guideline is primarily aimed for internists and general practitioners. Though there is scanty epidemiological data related to COPD, the SICAD panel believes that COPD prevalence is increasing in Saudi Arabia due to increasing prevalence of tobacco smoking among men and women. To overcome the issue of underutilization of spirometry for diagnosing COPD, handheld spirometry is recommended to screen individuals at risk for COPD. A unique feature about this guideline is the simplified practical approach to classify COPD into three classes based on the symptoms as per COPD Assessment Test (CAT) and the risk of exacerbations and hospitalization. Those patients with low risk of exacerbation (COPD patients, as manifested with ≥2 exacerbation or hospitalization in the past year irrespective of the baseline symptoms, are classified as Class III. Class I and II patients require bronchodilators for symptom relief, while Class III patients are recommended to use medications that reduce the risks of exacerbations. The guideline recommends screening for co-morbidities and suggests a comprehensive management approach including pulmonary rehabilitation for those with a CAT score ≥10. The article also discusses the diagnosis and management of acute exacerbations in COPD. PMID:24791168

  18. 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.

  19. Frequency of adoption of practice management guidelines at trauma centers

    Science.gov (United States)

    Sobrino, Justin; Barnes, Sunni A.; Dahr, Nadine; Kudyakov, Rustam; Berryman, Candice; Nathens, Avery B.; Hemmila, Mark R.; Neal, Melanie

    2013-01-01

    Evidence-based management guidelines have been shown to improve patient outcomes, yet their utilization by trauma centers remains unknown. This study measured adoption of practice management guidelines or protocols by trauma centers. A survey of 228 trauma centers was conducted over 1 year; 55 completed the survey. Centers were classified into three groups: noncompliant, partially compliant, and compliant with adoption of management protocols. Characteristics of compliant centers were compared with those of the other two groups. Most centers were Level I (58%) not-for-profit (67%) teaching hospitals (84%) with a surgical residency (74%). One-third of centers had an accredited fellowship in surgical critical care (37%). Only one center was compliant with all 32 management protocols. Half of the centers were compliant with 14 of 32 protocols studied (range, 4 to 32). Of the 21 trauma center characteristics studied, only two were independently associated with compliant centers: use of physician extenders and daily attending rounds (both P < .0001). Adoption of management guidelines by trauma centers is inconsistent, with wide variations in practices across centers. PMID:23814383

  20. Misleading guidelines for the diagnosis and management of hypertension

    Directory of Open Access Journals (Sweden)

    Flávio Danni Fuchs

    2014-10-01

    Full Text Available International guidelines for the diagnosis and management of hypertension were recently released [1,2]. A historical trend of lowering the blood pressure (BP thresholds to diagnose hypertension in high risk individuals was unexpectedly reversed. BP targets for the treatment were modified accordingly. Therefore some individuals who were hypertensive before are now normotensive. Other guidelines still recommend the previous diagnostic limits and goals of treatment [3-5], resulting that an individual may be hypertensive in some countries and normotensive in others. The guidelines are more homogeneous in the recommendations for treatment, particularly in regard to the liberal options of drugs to starting the treatment. Unfortunately, in my view, this liberal view includes drugs without unbiased evidences of effectiveness, such as Angiotensin Receptor Blockers (ARB. In this point of view, I discuss the reasons and misconceptions in the establishment of diagnostic thresholds and the shortcomings in the recommendations of antihypertensive drugs.

  1. 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.

  2. 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.

  3. [The German program for disease management guidelines--implementation with pathways and quality management].

    Science.gov (United States)

    Ollenschläger, Günter; Lelgemann, Monika; Kopp, Ina

    2007-07-15

    In Germany, physicians enrolled in disease management programs are legally obliged to follow evidence-based clinical practice guidelines. That is why a Program for National Disease Management Guidelines (German DM-CPG Program) was established in 2002 aiming at implementation of best-practice evidence-based recommendations for nationwide as well as regional disease management programs. Against this background the article reviews programs, methods and tools for implementing DM-CPGs via clinical pathways as well as regional guidelines for outpatient care. Special reference is given to the institutionalized program of adapting DM-CPGs for regional use by primary-care physicians in the State of Hesse.

  4. Postoperative Pain Management after Carpal Tunnel Syndrome Surgical Treatment: Comparing Practice with Guidelines.

    Science.gov (United States)

    Utrobičić, Ivan; Utrobičić, Frane; Prološčić, Ivona; Utrobičić, Toni; Jerić, Milka; Jeličić Kadić, Antonia; Puljak, Livia

    2017-09-01

    The management of postoperative pain after carpal tunnel syndrome surgical treatment at a tertiary hospital was analyzed and compared with the guidelines for perioperative pain management. This retrospective study included 579 patients operated on for carpal tunnel syndrome at the Split University Hospital Center in Split, Croatia. The following key data were collected from patient medical records: age, gender, type and dosage of premedication, type and dosage of anesthesia, type and dosage of postoperative analgesia per each postoperative day. The procedures related to perioperative pain were analyzed and compared with the current guidelines for perioperative acute pain management. Study results showed that 99.6% of patients with carpal tunnel syndrome were operated under local anesthesia, of which 2.9% also received sedation. Analgesics were prescribed to 45% of patients after surgery, and according to patient charts, 39% of patients actually received postoperative analgesic(s). Generally, postoperative pain was treated on the fi rst postoperative day, mostly with nonsteroidal anti-inflammatory drugs. Only two patients received weak opioids for postoperative pain. Many recommendations from the guidelines for perioperative acute pain management were not followed. In conclusion, the guidelines should be followed and appropriate interventions used to improve postoperative pain management.

  5. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy.

    Science.gov (United States)

    Muraro, A; Werfel, T; Hoffmann-Sommergruber, K; Roberts, G; Beyer, K; Bindslev-Jensen, C; Cardona, V; Dubois, A; duToit, G; Eigenmann, P; Fernandez Rivas, M; Halken, S; Hickstein, L; Høst, A; Knol, E; Lack, G; Marchisotto, M J; Niggemann, B; Nwaru, B I; Papadopoulos, N G; Poulsen, L K; Santos, A F; Skypala, I; Schoepfer, A; Van Ree, R; Venter, C; Worm, M; Vlieg-Boerstra, B; Panesar, S; de Silva, D; Soares-Weiser, K; Sheikh, A; Ballmer-Weber, B K; Nilsson, C; de Jong, N W; Akdis, C A

    2014-08-01

    Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management of patients of all ages with food allergy is presented. The acute management of non-life-threatening reactions is covered in these guidelines, but for guidance on the emergency management of anaphylaxis, readers are referred to the related EAACI Anaphylaxis Guidelines. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

    International Nuclear Information System (INIS)

    1993-03-01

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

  7. 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.

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

    Directory of Open Access Journals (Sweden)

    Bruno Crestani

    2014-06-01

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

  9. 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.

  10. 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. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  11. Case reports and clinical guidelines for managing radix entomolaris

    Directory of Open Access Journals (Sweden)

    Bejoy J Thomas

    2016-01-01

    Full Text Available 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.

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    . 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......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...

  13. Review and analysis of management guidelines of basal cell carcinoma

    International Nuclear Information System (INIS)

    Garcia Nunez, Hernan

    2013-01-01

    International guidelines for management of basal cell carcinoma are reviewed and analyzed for decision-making in the appropriate therapeutic behavior for patients. The different therapies for the treatment of basal cell carcinoma are described. Different therapies are evaluated according to the risk (low or high) of recurrence to determine the appropriate treatment. According to the evidence, low-risk tumors have responded to topical therapy, curettage and electrodesiccation, cryotherapy or simple resection, and high-risk tumors are managed with surgery, radiotherapy or Mohs' micrographic surgery [es

  14. Guidelines on the management of abnormal liver blood tests

    Science.gov (United States)

    Cramb, Rob; Davison, Suzanne M; Dillon, John F; Foulerton, Mark; Godfrey, Edmund M; Hall, Richard; Harrower, Ulrike; Hudson, Mark; Langford, Andrew; Mackie, Anne; Mitchell-Thain, Robert; Sennett, Karen; Sheron, Nicholas C; Verne, Julia; Walmsley, Martine; Yeoman, Andrew

    2018-01-01

    These updated guidelines on the management of abnormal liver blood tests have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines, which this document supersedes, were written in 2000 and have undergone extensive revision by members of the Guidelines Development Group (GDG). The GDG comprises representatives from patient/carer groups (British Liver Trust, Liver4life, PBC Foundation and PSC Support), elected members of the BSG liver section (including representatives from Scotland and Wales), British Association for the Study of the Liver (BASL), Specialist Advisory Committee in Clinical Biochemistry/Royal College of Pathology and Association for Clinical Biochemistry, British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN), Public Health England (implementation and screening), Royal College of General Practice, British Society of Gastrointestinal and Abdominal Radiologists (BSGAR) and Society of Acute Medicine. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. These guidelines deal specifically with the management of abnormal liver blood tests in children and adults in both primary and secondary care under the following subheadings: (1) What constitutes an abnormal liver blood test? (2) What constitutes a standard liver blood test panel? (3) When should liver blood tests be checked? (4) Does the extent and duration of abnormal liver blood tests determine subsequent investigation? (5) Response to abnormal liver blood tests. They are not designed to deal with the management of the underlying liver disease. PMID:29122851

  15. [The German program for disease management guidelines: type 2 diabetes--diabetic retinopathy/maculopathy guideline 2006. Short review].

    Science.gov (United States)

    Ollenschläger, Günter; Kopp, Ina; Thole, Henning; Lelgemann, Monika

    2007-02-15

    In Germany, the first national consensus between six medical scientific associations on evidence-based recommendations for prevention and therapy of retinopathy/maculopathy in type 2 diabetes was reached in fall 2006. The recommendations' main sources are the NICE Retinopathy Guideline 2002, and existing German guidelines and reviews of recent scientific evidence. The article gives an overview on authors, sources, and key recommendations of the German National Disease Management Guideline Type 2 Diabetes-Retinopathy/Maculopathy 2006 (www.diabetes.versorgungsleitlinien.de).

  16. Interoperability Guidelines for Lithuanian E-Learning Management Systems

    Directory of Open Access Journals (Sweden)

    Eugenijus Kurilovas

    2011-08-01

    Full Text Available Purpose – the paper aims to analyse e-learning content and repositories along with the problems of learning organisation interoperability. The main objective of the paper is to analyse scientific research results and the newest international experience in the area and to provide interoperability guidelines and recommendations for the implementation of appropriate Lithuanian state programmes. The learning content and repositories recommendations are designed for the implementation of the Lithuanian education portal project as well as Lithuanian Virtual University (LVU programme’s information services’ (LABT / eLABa and e-learning services’ (LieDM sub-programmes. The whole education institution recommendations are designed for the maintenance and development of LVU programme’s management services’ (LieMSIS system.Design/methodology/approach – methods used for the general analysis of proposed interoperability guidelines (reccomendations were bibliographic research and comparative analysis of Lithuanian and foreign scientific works published in periodicals and large-scale EU-funded interoperability projects deliverables. System analysis and comparative analysis methods were used in order to formulate and analyse systems’ interoperability guidelines and recommendations. The author employed the experimental research method while working in the appropriate EU-funded interoperability projects to form the guidelines (recommendations. In order to summarize the results, the evaluative research method was used..Findings – the international guidelines and recommendations presented in the paper could be suitable for implementation while developing Lithuanian state education information systems such as the Lithuanian education portal, the Lithuanian academic libraries’ (eLABa system, the Lithuanian distance learning system (LieDM, and the Lithuanian universities’ management system (LieMSIS.Research limitations/implications – the paper

  17. Interoperability Guidelines for Lithuanian E-Learning Management Systems

    Directory of Open Access Journals (Sweden)

    Eugenijus Kurilovas

    2013-08-01

    Full Text Available Purpose – the paper aims to analyse e-learning content and repositories along with the problems of learning organisation interoperability. The main objective of the paper is to analyse scientific research results and the newest international experience in the area and to provide interoperability guidelines and recommendations for the implementation of appropriate Lithuanian state programmes. The learning content and repositories recommendations are designed for the implementation of the Lithuanian education portal project as well as Lithuanian Virtual University (LVU programme’s information services’ (LABT / eLABa and e-learning services’ (LieDM sub-programmes. The whole education institution recommendations are designed for the maintenance and development of LVU programme’s management services’ (LieMSIS system.Design/methodology/approach – methods used for the general analysis of proposed interoperability guidelines (reccomendations were bibliographic research and comparative analysis of Lithuanian and foreign scientific works published in periodicals and large-scale EU-funded interoperability projects deliverables. System analysis and comparative analysis methods were used in order to formulate and analyse systems’ interoperability guidelines and recommendations. The author employed the experimental research method while working in the appropriate EU-funded interoperability projects to form the guidelines (recommendations. In order to summarize the results, the evaluative research method was used.Findings – the international guidelines and recommendations presented in the paper could be suitable for implementation while developing Lithuanian state education information systems such as the Lithuanian education portal, the Lithuanian academic libraries’ (eLABa system, the Lithuanian distance learning system (LieDM, and the Lithuanian universities’ management system (LieMSIS.Research limitations/implications – the paper

  18. Management of Implantable Cardioverter Defibrillator Recipients: Care Beyond Guidelines.

    Science.gov (United States)

    Philippon, François; Sterns, Laurence D; Nery, Pablo B; Parkash, Ratika; Birnie, David; Rinne, Claus; Mondesert, Blandine; Exner, Derek; Bennett, Matthew

    2017-08-01

    This companion article is intended to address common clinical scenarios in patients with implantable defibrillators that were not addressed in the 2016 Canadian Cardiovascular Society/Canadian Heart Rhythm Society implantable cardioverter defibrillator guidelines including recommendations for device programming to improve detection, to minimize shocks (appropriate and inappropriate), and to minimize ventricular pacing. Important issues at the time of replacement such as device prescription, technical aspects (vascular access, extraction), and management of components on advisories are also discussed. Finally, common clinical scenarios such as management of patients with terminal illnesses, recurrent ventricular tachycardia, electrical storms, catheter ablation for ventricular tachycardia, and system infection management are considered. The management of these patients requires a team approach and comprehensive knowledge surrounding these common clinical scenarios. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  19. 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.

  20. Aging management and life extension

    International Nuclear Information System (INIS)

    Carey, John; Deng, Daniel; Tai, Tom M.

    2004-01-01

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

  1. Assessing the readiness of a school system to adopt food allergy management guidelines.

    Science.gov (United States)

    Eldredge, Christina; Patterson, Leslie; White, Brenda; Schellhase, Kenneth

    2014-08-01

    The prevalence of potentially fatal food allergies in school-aged children is rising. It is important for schools to have a food allergy management policy and an emergency action plan for each affected student. To examine the current status of food allergy guideline and/or policy implementation and adoption in a large school system in southeastern Wisconsin. A 24-item anonymous electronic survey was developed and completed by school principals and administrators in the Archdiocese of Milwaukee School System (approximately 125 schools) in southeastern Wisconsin. One in 4 responding schools reported no guidelines or policy. Schools that reported having students with special needs due to food allergy were more likely to have a local food allergy policy compared to schools that did not report having students with food allergy special needs (OR 6.3, 1.5-26, P = 0.01). Schools with food allergy guidelines/policies were 3.5 times more likely to require student individual action plans than schools with no guidelines or policies (OR 3.5, 1.00-12.2, P = 0.05). Gaps in evidence-based food allergy policy implementation were found in this school system. Schools with food-allergic children with special needs were more likely to have guidelines/policy, however, they were not more likely to require emergency action plans. The majority of schools (66, 90%) reported interest in receiving further information or training on food allergy management.

  2. 2013 European guideline on the management of lymphogranuloma venereum.

    Science.gov (United States)

    de Vries, H J C; Zingoni, A; Kreuter, A; Moi, H; White, J A

    2015-01-01

    WHAT IS NEW IN THIS UPDATED GUIDELINE?: This is the update version of the 2010 European guideline on the management of lymphogranuloma venereum (LGV). New issues are: Based on clonal relatedness of prevalent LGV strains there is evidence that the LGV epidemic among men who have sex with men (MSM) in the Western world prevailed already in the United States in the 1980s and was introduced into Europe by the end of the last century. A new LGV variant causing severe proctitis was unveiled and designated L2c. The L2b LGV variant causing the vast majority of infections among MSM is now also found among a few heterosexual women. Apart from HIV and STI screening, Hepatitis C Virus (HCV) testing should be offered to all LGV patients. To exclude reinfections, STI screening during a follow-up visit 3 months after an LGV diagnosis should be offered. © 2014 European Academy of Dermatology and Venereology.

  3. 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.

  4. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline.

    Science.gov (United States)

    Stassen, Nicole A; Bhullar, Indermeet; Cheng, Julius D; Crandall, Marie; Friese, Randall; Guillamondegui, Oscar; Jawa, Randeep; Maung, Adrian; Rohs, Thomas J; Sangosanya, Ayodele; Schuster, Kevin; Seamon, Mark; Tchorz, Kathryn M; Zarzuar, Ben L; Kerwin, Andrew

    2012-11-01

    During the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma in the Practice Management Guidelines for Nonoperative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the previous Eastern Association for the Surgery of Trauma guideline. The National Library of Medicine and the National Institutes of Health MEDLINE database were searched using PubMed (http://www.pubmed.gov). The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords liver injury and blunt abdominal trauma. One hundred seventy-six articles were reviewed, of which 94 were used to create the current practice management guideline for the selective nonoperative management of blunt hepatic injury. Most original hepatic guidelines remained valid and were incorporated into the greatly expanded current guidelines as appropriate. Nonoperative management of blunt hepatic injuries currently is the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury or patient age. Nonoperative management of blunt hepatic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and an operating room available for urgent laparotomy. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention. Intravenous contrast enhanced computed tomographic scan is the diagnostic modality of choice for evaluating blunt hepatic injuries. Repeated imaging should be

  5. Consensus guidelines on management of childhood convulsive status epilepticus.

    Science.gov (United States)

    Mishra, Devendra; Sharma, Suvasini; Sankhyan, Naveen; Konanki, Ramesh; Kamate, Mahesh; Kanhere, Sujata; Aneja, Satinder

    2014-12-01

    Status epilepticus has a wide etiological spectrum, and significant morbidity and mortality. Management using a pre-determined uniform protocol leads to better outcomes. Multiple protocols for management of childhood status epilepticus are available, without much consensus. A 'Multi-disciplinary Consensus Development Workshop on Management of Status Epilepticus in Children in India' was organized. The invited experts included Pediatricians, Pediatric neurologists, Neurologists, Epileptologists, and Pediatric intensive care specialists from India, with experience in the relevant field. Experts had previously been divided into focus groups and had interacted on telephone and e-mail regarding their group recommendations, and developed consensus on the topic. During the meeting, each group presented their recommendations, which were deliberated upon by the house and a consensus was reached on various issues; the document was finalized after incorporating suggestions of experts on the draft document. To provide consensus guidelines on evaluation and management of convulsive status epilepticus in children in India (excluding neonatal and super-refractory status epilepticus). Each institution should use a pre-determined protocol for management of status epilepticus; pre-hospital management and early stabilization is the key to a satisfactory outcome of status epilepticus. Pharmacotherapy should not be delayed for any investigations; the initial management should consist of a parenteral benzodiazepine by any route feasible. Subsequent management has been detailed. The group also felt the need for more epidemiological research on status epilepticus from India, and identified certain research areas for the purpose.

  6. Current European guidelines for management of cardiovascular disease

    DEFF Research Database (Denmark)

    Vinther, Johan L; Jacobsen, Rikke K; Jørgensen, Torben

    2018-01-01

    Background Health checks of the general population are widely used to prevent cardiovascular diseases, but are the current clinical guidelines from the European Society of Cardiology (ESC) suitable for screening the general population? Design A cross-sectional, population-based study of 978 men...... and women aged 40-65 years examined in 2010-2011 was used to estimate the proportion of the general Danish population fulfilling the criteria from the clinical guidelines from the ESC on medical treatment and lifestyle intervention to prevent cardiovascular disease. Methods The ESC criteria for medical...... treatment and lifestyle intervention were applied to a general population using information on previous cardiovascular diseases, known diabetes, urinalbumin, smoking, total cholesterol, systolic and diabolic blood pressure, low-density lipoprotein cholesterol and a multifactor risk score (SCORE). Results...

  7. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline.

    Science.gov (United States)

    Stassen, Nicole A; Bhullar, Indermeet; Cheng, Julius D; Crandall, Marie L; Friese, Randall S; Guillamondegui, Oscar D; Jawa, Randeep S; Maung, Adrian A; Rohs, Thomas J; Sangosanya, Ayodele; Schuster, Kevin M; Seamon, Mark J; Tchorz, Kathryn M; Zarzuar, Ben L; Kerwin, Andrew J

    2012-11-01

    During the last century, the management of blunt force trauma to the spleen has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma (EAST) in the Practice Management Guidelines for Non-operative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the current EAST guideline. The National Library of Medicine and the National Institute of Health MEDLINE database was searched using Pub Med (www.pubmed.gov). The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords splenic injury and blunt abdominal trauma. One hundred seventy-six articles were reviewed, of which 125 were used to create the current practice management guideline for the selective nonoperative management of blunt splenic injury. There has been a plethora of literature regarding nonoperative management of blunt splenic injuries published since the original EAST practice management guideline was written. Nonoperative management of blunt splenic injuries is now the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury, patient age, or the presence of associated injuries. Its use is associated with a low overall morbidity and mortality when applied to an appropriate patient population. Nonoperative management of blunt splenic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and has an operating room available for urgent laparotomy. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention

  8. LSN MS guidelines for the management of multiple sclerosis.

    Science.gov (United States)

    Shatila, A R; Koussa, S; Jabbour, R; Mourad, A; Aouad, A; Sabbagh, G; Kallab, K; Hilal, R; Khalifeh, R; Gebeily, S; Tourbah, A

    2013-12-01

    The prevalence of multiple sclerosis (MS) in Lebanon is unknown, as there are no available or reliable epidemiological studies to date. The circumstances of Middle East countries are different from those of Europe and North America in terms of differential diagnoses and disease management. The aim of the conference is to establish guidelines for diagnosis, treatment, follow-up and management of patients with MS in Lebanon. Another objective is to discuss and participate in research projects based on epidemiology, clinical trials and more fundamental aspects of the disease in the future. Under the authority of the Lebanese Society of Neurology (LSN), a group of neurologists took the initiative to participate in this LSN MS committee with the purpose of establishing a consensus for the management of patients with MS, and under the supervision of a Coordinator (A.T.) designed by the LSN board. Diagnostic and therapeutic, follow-up and research recommendations were proposed with special emphasis on the specific needs and circumstances of Lebanon. The experts highlighted the importance of considering particular needs, the identification of patients at high risk of developing MS in order to maximize therapeutic opportunities, and cost-effective control of treatment efficacy, as well as global assessment of disability. The experts established guidelines concerning diagnosis, treatment, and follow-up of patients with MS in Lebanon. Furthermore, they recommended some clinical and fundamental research projects. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  9. [The German program for disease management guidelines. Results and perspectives].

    Science.gov (United States)

    Ollenschläger, Günter; Kopp, Ina

    2007-05-15

    The Program for National Disease Management Guidelines (German DM-CPG Program) is a joint initiative of the German Medical Association (umbrella organization of the German Chambers of Physicians), the Association of the Scientific Medical Societies (AWMF), and of the National Association of Statutory Health Insurance Physicians (NASHIP). The program aims at developing, implementing and continuously updating best-practice recommendations for countrywide and regional disease management programs in Germany. Since 2003 twelve national guidelines (topics: asthma, chronic obstructive pulmonary disease, HI (Chronic heart failure), CVD (Chronic coronary heart disease) back pain, depression, several aspects of diabetes) have been produced by use of a standardized procedure in accordance with internationally consented methodologies. For countrywide dissemination and implementation the program uses a wide range of specialist journals, continuous medical education and quality management programs. So far, 36 out of 150 national scientific medical associations, four allied health profession organizations, and twelve national consumer organizations have been participating in the DM-CPG Program. Studies to evaluate the program's effects on health-care providers' behavior and patients' outcomes are under way.

  10. New guidelines for managing cow's milk allergy in infants.

    Science.gov (United States)

    Meyer, Rosan

    2008-01-01

    The prevalence of allergic disease has increased markedly over the last 50 years. Food allergy usually manifests in early childhood as part of the so-called atopic march and most commonly includes one or more of the following foods: cow's milk, hen's egg, soy, peanuts and tree nuts, wheat, sesame seed, kiwi fruit and seafood. In the UK about 2% of infants develop cow's milk protein allergy (CMPA), but as many as 15% of infants present with symptoms suggestive of an adverse reaction to cow's milk protein. The diagnosis of CMPA is based on one or more of the following: a detailed clinical history, allergy test results (skin prick testing [SPT] and/or specific immunoglobulin E [IgE]) and, if required, supervised incremental milk challenges. The majority of UK primary care centres do not have access to these tests and may also be unfamiliar with the interpretation or results. In addition, they do not have the facilities for supervised food challenges. Empirical treatment is often required pending confirmation of allergy or referral to a specialist centre, but requires clear guidelines. No consensus guidelines currently exist for the diagnosis and management of CMPA in the UK. An international task force has recently published proposed guidelines for the management of CMPA. These provide separate algorithms covering the diagnosis and management of CMPA for both breast-fed and formula-fed infants and discuss the use of hypoallergenic formulae, elimination diets and diagnostic tests. Revisions and adaptations for the UK market are required and are discussed in this article.

  11. 2015 AAHA/AAFP pain management guidelines for dogs and cats.

    Science.gov (United States)

    Epstein, Mark E; Rodanm, Ilona; Griffenhagen, Gregg; Kadrlik, Jamie; Petty, Michael C; Robertson, Sheilah A; Simpson, Wendy

    2015-03-01

    The robust advances in pain management for companion animals underlie the decision of the American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines. 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. These Guidelines support veterinarians in incorporating pain management into practice, improving patient care. The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual patient basis. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention and treatment of pain in animals. The Guidelines include both pharmacologic and non-pharmacologic 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. Post-surgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Chronic pain is dominated by degenerative joint disease (DJD), which is one of the most significant and under-diagnosed diseases of cats and dogs. DJD 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. © ISFM and AAFP 2015.

  12. GUIDELINES OF CARE FOR THE MANAGEMENT OF ATOPIC DERMATITIS

    Science.gov (United States)

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

    2014-01-01

    Atopic dermatitis (AD) is a chronic, pruritic inflammatory dermatosis that affects up to 25% of children and 2–3% of adults. This guideline addresses important clinical questions that arise in AD management and care, providing updated and expanded recommendations based on the available evidence. In this first of four sections, methods for diagnosis and monitoring of disease, outcomes measures for assessment and common clinical associations that affect patients with AD are discussed. Known risk factors for the development of disease are also reviewed. PMID:24290431

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

    Science.gov (United States)

    Heidemann, C H; Lous, J; Berg, J; Christensen, J J; Håkonsen, S J; Jakobsen, M; Johansen, C J; Nielsen, L H; Hansen, M P; Poulsen, A; Schousboe, L P; Skrubbeltrang, C; Vind, A B; Homøe, P

    2016-08-01

    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 for recurrent AOM (RAOM) and chronic otitis media with effusion (COME) has become the most frequently performed surgical procedure in pre-school children. Therefore, the Danish Health and Medicines Authority and the Danish Society of Otorhinolaryngology, Head and Neck Surgery deemed it necessary to update the Danish guidelines regarding the diagnostic criteria for acute otitis media and surgical treatment of RAOM and COME. 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 Accuracy Studies), Cochrane Risk of Bias Tool for randomized trials and ACROBAT-NRSI (A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies). The working group consisted of otolaryngologists, general practitioners, pediatricians, microbiologists and epidemiologists. Recommendations for AOM diagnosis, surgical management for RAOM and COME, including the role of adenoidectomy and treatment of ventilating tube otorrhea, are proposed in the guideline. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. 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.

  15. Improving care of post-infarct patients: effects of disease management programmes and care according to international guidelines.

    Science.gov (United States)

    Stark, Renee; Kirchberger, Inge; Hunger, Matthias; Heier, Margit; Leidl, Reiner; von Scheidt, Wolfgang; Meisinger, Christa; Holle, Rolf

    2014-03-01

    Cardiac disease management programmes (CHD-DMPs) and secondary cardiovascular prevention guidelines aim to improve complex care of post-myocardial infarction (MI) patients. In Germany, CHD-DMPs, in addition to incorporating medical care according to guidelines (guideline-care), also ensure regular quarterly follow-up. Thus, our aim was to examine whether CHD-DMPs increase the frequency of guideline-care and whether CHD-DMPs and guideline-care improve survival over 4 years. The study included 975 post-MI patients, registered by the KORA-MI Registry (Augsburg, Germany), who completed a questionnaire in 2006. CHD-DMP enrolment was reported by physicians. Guideline-care was based on patient reports regarding medical advice (smoking, diet, or exercise) and prescribed medications (statins and platelet aggregation inhibitors plus beta-blockers or renin-angiotensin inhibitors). All-cause mortality until December 31, 2010 was based on municipal registration data. Cox regression analyses were adjusted for age, sex, education, years since last MI, and smoking and diabetes. Physicians reported that 495 patients were CHD-DMP participants. CHD-DMP participation increased the likelihood of receiving guideline-care (odds ratio 1.55, 95% CI 1.20; 2.02) but did not significantly improve survival (hazard rate 0.90, 95% CI 0.64-1.27). Guideline-care significantly improved survival (HR 0.41, 95% CI 0.28; 0.59). Individual guideline-care components, which significantly improved survival, were beta-blockers, statins and platelet aggregation inhibitors. However, these improved survival less than guideline-care. This study shows that CHD-DMPs increase the likelihood of guideline care and that guideline care is the important component of CHD-DMPs for increasing survival. A relatively high percentage of usual care patients receiving guideline-care indicate high quality of care of post-MI patients. Reasons for not implementing guideline-care should be investigated.

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

    International Nuclear Information System (INIS)

    Grandemange, J.M.

    2002-01-01

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

  17. Guidelines for the Management of a Pregnant Trauma Patient.

    Science.gov (United States)

    Jain, Venu; Chari, Radha; Maslovitz, Sharon; Farine, Dan; Bujold, Emmanuel; Gagnon, Robert; Basso, Melanie; Bos, Hayley; Brown, Richard; Cooper, Stephanie; Gouin, Katy; McLeod, N Lynne; Menticoglou, Savas; Mundle, William; Pylypjuk, Christy; Roggensack, Anne; Sanderson, Frank

    2015-06-01

    Physical trauma affects 1 in 12 pregnant women and has a major impact on maternal mortality and morbidity and on pregnancy outcome. A multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus. The aim of this document is to provide the obstetric care provider with an evidence-based systematic approach to the pregnant trauma patient. Significant health and economic outcomes considered in comparing alternative practices. Published literature was retrieved through searches of Medline, CINAHL, and The Cochrane Library from October 2007 to September 2013 using appropriate controlled vocabulary (e.g., pregnancy, Cesarean section, hypotension, domestic violence, shock) and key words (e.g., trauma, perimortem Cesarean, Kleihauer-Betke, supine hypotension, electrical shock). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English between January 1968 and September 2013. Searches were updated on a regular basis and incorporated in the guideline to February 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). This guideline is expected to facilitate optimal and uniform care for pregnancies complicated by trauma. Summary Statement Specific traumatic injuries At this time, there is insufficient evidence to support the practice of disabling air bags for pregnant women. (III) Recommendations Primary survey 1. Every female of reproductive age with significant injuries should be considered pregnant until proven otherwise by a definitive pregnancy test or ultrasound scan. (III

  18. Spectrum Management Guidelines for National and Service Test and Training Ranges

    Science.gov (United States)

    2017-07-12

    Frequency Management Group RCC 700-17 SPECTRUM MANAGEMENT GUIDELINES FOR NATIONAL AND SERVICE TEST AND TRAINING RANGES DISTRIBUTION...left blank. DOCUMENT 700-01 SPECTRUM MANAGEMENT GUIDELINES FOR NATIONAL AND SERVICE TEST AND TRAINING RANGES July 2017...Prepared by RANGE COMMANDERS COUNCIL FREQUENCY MANAGEMENT GROUP Published by Secretariat Range Commanders Council U.S. Army White

  19. [Interest of psychiatric guidelines in managing agitation in intensive care].

    Science.gov (United States)

    Lazignac, Coralie; Ricou, Bara; Dan, Liviu; Virgillito, Salvatore; Adam, Eric; Seyedi, Majid; Cicotti, Andrei; Azi, Amine; Damsa, Cristian

    2007-02-14

    This paper discusses the importance of psychiatric guidelines and the position of the psychiatrist in the management of agitation in the intensive care unit. The use of psychiatric validated scales to assess agitation seems to ameliorate the quality of care in psychiatry, but also in intensive care. Psychiatric experts' recommendations for managing agitation are given, which is useful to create an open discussion with the intensivists. The use of sedative medication to protect the patient, staff and to prevent an escalation of violence remains a personal choice for each practitioner, depending on individual patient needs and context. In the treatment of agitated patients, an equilibrium needs to be found between the subjective dimension and the available data from evidence based medicine.

  20. Noonan syndrome: clinical features, diagnosis, and management guidelines.

    Science.gov (United States)

    Romano, Alicia A; Allanson, Judith E; Dahlgren, Jovanna; Gelb, Bruce D; Hall, Bryan; Pierpont, Mary Ella; Roberts, Amy E; Robinson, Wanda; Takemoto, Clifford M; Noonan, Jacqueline A

    2010-10-01

    Noonan syndrome (NS) is a common, clinically and genetically heterogeneous condition characterized by distinctive facial features, short stature, chest deformity, congenital heart disease, and other comorbidities. Gene mutations identified in individuals with the NS phenotype are involved in the Ras/MAPK (mitogen-activated protein kinase) signal transduction pathway and currently explain ∼61% of NS cases. Thus, NS frequently remains a clinical diagnosis. Because of the variability in presentation and the need for multidisciplinary care, it is essential that the condition be identified and managed comprehensively. The Noonan Syndrome Support Group (NSSG) is a nonprofit organization committed to providing support, current information, and understanding to those affected by NS. The NSSG convened a conference of health care providers, all involved in various aspects of NS, to develop these guidelines for use by pediatricians in the diagnosis and management of individuals with NS and to provide updated genetic findings.

  1. BTS guideline for the investigation and management of malignant pleural mesothelioma.

    Science.gov (United States)

    Woolhouse, Ian; Bishop, Lesley; Darlison, Liz; de Fonseka, Duneesha; Edey, Anthony; Edwards, John; Faivre-Finn, Corinne; Fennell, Dean A; Holmes, Steve; Kerr, Keith M; Nakas, Apostolos; Peel, Tim; Rahman, Najib M; Slade, Mark; Steele, Jeremy; Tsim, Selina; Maskell, Nick A

    2018-01-01

    The full guideline for the investigation and management of malignant pleural mesothelioma is published in Thorax . The following is a summary of the recommendations and good practice points. The sections referred to in the summary refer to the full guideline.

  2. Diffusion of a Distress Management Guideline into practice.

    Science.gov (United States)

    Tavernier, Susan S; Beck, Susan L; Dudley, William N

    2013-10-01

    The purpose of this study was to explore system and clinician-related barriers, and predictors for the adoption of the National Comprehensive Cancer Network Distress Management Guideline (DMG) into oncology outpatient practice. This descriptive, correlational study surveyed a national sample of oncology nurses working in an outpatient setting who completed the survey electronically or by mail. Study respondents (n = 409) were predominantly certified nurses (84%) yet largely unfamiliar with the DMG; 17% of respondents were using the DMG. Time, staff uncertainties and ambiguous accountability were the largest barriers to not assessing distress. Compared with those not using any assessment tool, those using the DMG were more comfortable discussing distress, worked as an oncology nurse longer, scored colleagues higher on valuing distress screening and had more organizational processes in place to support evidence-based practices. Significant predictors of DMG use included higher familiarity with the DMG (OR 3.81, p DMG, which are amenable to interventions. DMG adoption may be augmented by interventions, which increase familiarity with the guideline. Additionally, adoption of the DMG may improve through explicit articulation of the responsibilities oncology team members have in cancer-related distress screening and management. Further studies are needed to evaluate the efficacy of such interventions and their impact on patient care outcomes. Copyright © 2013 John Wiley & Sons, Ltd.

  3. Solid low level waste management guidelines: Final report

    International Nuclear Information System (INIS)

    Castagnacci, A.; Dalton, D.; Genoa, P.

    1994-11-01

    Since 1989, the nuclear industry has been moving in the direction of greater minimization of low level radioactive waste (LLW). This has been driven in part by increasing regulatory attention, but it also is in response to the desire on the part of nuclear utilities to be more cost efficient and to be environmentally responsive. Over the past half-dozen years, LLW disposal costs have increased dramatically. In addition, improvements in LLW volume reduction technologies have substantially reduced the volume of LLW that is disposed. At the same time, utilities are implementing aggressive source reduction programs and programs to reuse materials so as to extend the useful life of many materials. Thus, there has been a dramatic change in LLW economics and LLW management practices in just the past few years. This report was developed by utility nuclear experts to provide guidance to all utilities on mechanisms for integrating the program economics, advanced volume reduction techniques, and approaches to source reduction. Thus, utilizes will be able to use this report as a guide to optimizing their LLW program economics and minimizing LLW disposal volumes to the smallest reasonable fraction. This report discusses the implementation of these guidelines, management support, waste materials and waste inventory, radioactive tool and equipment management, protective clothing management, processing and volume reduction, solid LLW tracking, outage LLW management, and interim storage of LLW

  4. Guidelines to implement the license renewal technical requirements of 10CFR54 for integrated plant assessments and time-limited aging analyses. Final report

    International Nuclear Information System (INIS)

    Lehnert, G.; Philpot, L.

    1995-11-01

    This report documents the initial results of the Nuclear Energy Institute License Renewal Implementation Guideline Task Force over the period August 1994 to July 1995 to develop guidance for complying with technical requirements of 10CFR54. The report also provided a starting point for the development of NEI 95-10, ''Industry Guideline for Implementing the Requirements of 10CCR54-The License Renewal Rule''. Information in this document can be used by utilities to prepare the technical material needed in an application for license renewal (LR) of a nuclear power unit. This guideline provides methods for identifying systems, structures, and components (SSCs) and their intended functions within the scope of license renewal. It identifies structures and components (SCs) requiring aging management review and methods for performing the aging management review. The guideline provides a process for identifying and evaluating time-limited aging analyses

  5. 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.

  6. [Management of valvular heart disease : ESC/EACTS guidelines 2017].

    Science.gov (United States)

    Haude, M

    2017-12-01

    After 5 years the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery have released an update on the guidelines for the management of valvular heart diseases. In recent years published results of randomized trials in patients with aortic valve stenosis have resulted in updated recommendations for catheter-based prosthesis implantation (TAVI), which is now extended to patients presenting without a low risk for conventional surgical valve replacement. In mitral or tricuspid valvular disease, the recommendations for catheter-based therapies are less strong because of a lack of supportive scientific data. A special focus of these updated guidelines is on concomitant antithrombotic therapy in valvular heart disease and in the context of a combination with coronary artery disease and/or accompanying arrhythmia. Special emphasis was again put on the multidisciplinary heart team for the diagnostics and treatment of patients with valvular heart disease. In order to support the quality of treatment for patients with valvular heart disease, it is suggested that heart valve centers of excellence should be established, which have to fulfil complex personnel, structural and technological prerequisites.

  7. Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer.

    Science.gov (United States)

    Francis, Gary L; Waguespack, Steven G; Bauer, Andrew J; Angelos, Peter; Benvenga, Salvatore; Cerutti, Janete M; Dinauer, Catherine A; Hamilton, Jill; Hay, Ian D; Luster, Markus; Parisi, Marguerite T; Rachmiel, Marianna; Thompson, Geoffrey B; Yamashita, Shunichi

    2015-07-01

    Previous guidelines for the management of thyroid nodules and cancers were geared toward adults. Compared with thyroid neoplasms in adults, however, those in the pediatric population exhibit differences in pathophysiology, clinical presentation, and long-term outcomes. Furthermore, therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from overly aggressive treatment. For these reasons, unique guidelines for children and adolescents with thyroid tumors are needed. A task force commissioned by the American Thyroid Association (ATA) developed a series of clinically relevant questions pertaining to the management of children with thyroid nodules and differentiated thyroid cancer (DTC). Using an extensive literature search, primarily focused on studies that included subjects ≤18 years of age, the task force identified and reviewed relevant articles through April 2014. Recommendations were made based upon scientific evidence and expert opinion and were graded using a modified schema from the United States Preventive Services Task Force. These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules. Recommendations for the evaluation, treatment, and follow-up of children and adolescents with DTC are outlined and include preoperative staging, surgical management, postoperative staging, the role of radioactive iodine therapy, and goals for thyrotropin suppression. Management algorithms are proposed and separate recommendations for papillary and follicular thyroid cancers are provided. In response to our charge as an independent task force appointed by the ATA, we developed recommendations based on scientific evidence and expert opinion for the management of thyroid nodules and DTC in

  8. Cost-effectiveness analysis of revised WHO guidelines for management of childhood pneumonia in 74 Countdown countries.

    Science.gov (United States)

    Zhang, Shanshan; Incardona, Beatrice; Qazi, Shamim A; Stenberg, Karin; Campbell, Harry; Nair, Harish

    2017-06-01

    Treatment of childhood pneumonia is a key priority in low-income countries, with substantial resource implications. WHO revised their guidelines for the management of childhood pneumonia in 2013. We estimated and compared the resource requirements, total direct medical cost and cost-effectiveness of childhood pneumonia management in 74 countries with high burden of child mortality (Countdown countries) using the 2005 and 2013 revised WHO guidelines. We constructed a cost model using a bottom up approach to estimate the cost of childhood pneumonia management using the 2005 and 2013 WHO guidelines from a public provider perspective in 74 Countdown countries. The cost of pneumonia treatment was estimated, by country, for year 2013, including costs of medicines and service delivery at three different management levels. We also assessed country-specific lives saved and disability adjusted life years (DALYs) averted due to pneumonia treated in children aged below five years. The cost-effectiveness of pneumonia treatment was estimated in terms of cost per DALY averted by fully implementing WHO treatment guidelines relative to no treatment intervention for pneumonia. Achieving full treatment coverage with the 2005 WHO guidelines was estimated to cost US$ 2.9 (1.9-4.2) billion compared to an estimated US$ 1.8 (0.8-3.0) billion for the revised 2013 WHO guidelines in these countries. Pneumonia management in young children following WHO treatment guidelines could save up to 39.8 million DALYs compared to a zero coverage scenario in the year 2013 in the 74 Countdown countries. The median cost-effectiveness ratio per DALY averted in 74 countries was substantially lower for the 2013 guidelines: US$ 26.6 (interquartile range IQR: 17.7-45.9) vs US$ 38.3 (IQR: US$ 26.2-86.9) per DALY averted for the 2005 guideline respectively. Child pneumonia management as detailed in standard WHO guidelines is a very cost-effective intervention. Implementation of the 2013 WHO guidelines is

  9. Non-severe pneumonia in childhood: guidelines for management in ...

    African Journals Online (AJOL)

    Ann Burgess

    Among the under 5-year-olds worldwide there are about 156,000,000 cases of pneumonia each year. This causes about 20% of all deaths in this age group. Effective implementation of the WHO. Integrated Management of Childhood Illness (IMCI) reduces this morbidity and mortality. The recommendations for treating ...

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    BACKGROUND: Familial adenomatous polyposis (FAP) is a well-described inherited syndrome, which is responsible for cancer (CRC) cases. The syndrome is characterised by the development of hundreds to thousands of adenomas in the colorectum. Almost all patients will develop CRC...... if they are not identified and treated at an early stage. The syndrome is inherited as an autosomal dominant trait and caused by mutations in the APC gene. Recently, a second gene has been identified that also gives rise to colonic adenomatous polyposis, although the phenotype is less severe than typical FAP. The gene...... is the MUTYH gene and the inheritance is autosomal recessive. In April 2006 and February 2007, a workshop was organised in Mallorca by European experts on hereditary gastrointestinal cancer aiming to establish guidelines for the clinical management of FAP and to initiate collaborative studies. Thirty...

  11. 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.

  12. 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.

  13. Guidelines for the Detection and Management of Lead Poisoning for Physicians and Health Care Providers.

    Science.gov (United States)

    Illinois State Dept. of Public Health, Springfield.

    These Illinois guidelines provide information on the medical management and treatment of children with lead poisoning, based on Federal guidelines (revised in 1991) for determining lead poisoning at lower levels. The guidelines outline the effects of lead poisoning, sources of lead, estimated incidence of lead poisoning in Illinois, screening…

  14. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.

    Science.gov (United States)

    Flynn, Joseph T; Kaelber, David C; Baker-Smith, Carissa M; Blowey, Douglas; Carroll, Aaron E; Daniels, Stephen R; de Ferranti, Sarah D; Dionne, Janis M; Falkner, Bonita; Flinn, Susan K; Gidding, Samuel S; Goodwin, Celeste; Leu, Michael G; Powers, Makia E; Rea, Corinna; Samuels, Joshua; Simasek, Madeline; Thaker, Vidhu V; Urbina, Elaine M

    2017-09-01

    These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research. Copyright © 2017 by the American Academy of Pediatrics.

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

    Science.gov (United States)

    Al-Moamary, Mohamed S.; Alhaider, Sami A.; Idrees, Majdy M.; Al Ghobain, Mohammed O.; Zeitouni, Mohammed O.; Al-Harbi, Adel S.; Yousef, Abdullah A.; Al-Matar, Hussain; Alorainy, Hassan S.; Al-Hajjaj, Mohamed S.

    2016-01-01

    This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan. PMID:26933455

  16. Components selection for ageing management

    International Nuclear Information System (INIS)

    Mingiuc, C.; Vidican, D.

    2002-01-01

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

  17. 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 292.48...

  18. 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

    2014-01-01

    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. PMID:25429323

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

    Science.gov (United States)

    Righi, Angela Weber; Saurin, Tarcisio Abreu

    2015-09-01

    Although ergonomics has paid increasing attention to the perspective of complexity, methods for its operationalization are scarce. This study introduces a framework for the operationalization of the "attribute view" of complexity, which involves: (i) the delimitation of the socio-technical system (STS); (ii) the description of four complexity attributes, namely a large number of elements in dynamic interactions, a wide diversity of elements, unexpected variability, and resilience; (iii) the assessment of six management guidelines, namely design slack, give visibility to processes and outcomes, anticipate and monitor the impacts of small changes, monitor the gap between prescription and practice, encourage diversity of perspectives when making decisions, and create an environment that supports resilience; and (iv) the identification of leverage points for improving the STS design, based on both the analysis of relationships among the attributes and their classification as irreducible/manageable complexity, and liability/asset. The use of the framework is illustrated by the study of an emergency department of a University hospital. Data collection involved analysis of documents, observations of work at the front-line, interviews with employees, and the application of questionnaires. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

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

    DEFF Research Database (Denmark)

    Rostgaard, Tine

    2015-01-01

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

  1. Current management of gender identity disorder in childhood and adolescence: guidelines, barriers and areas of controversy.

    Science.gov (United States)

    Shumer, Daniel E; Spack, Norman P

    2013-02-01

    The approach to gender identity disorder (GID) in childhood and adolescence has been rapidly evolving and is in a state of flux. In an effort to form management recommendations on the basis of the available literature, The Endocrine Society published clinical practice guidelines in 2009. The guidelines recommend against sex role change in prepubertal children, but they recommend the use of gonadotropin-releasing hormone (GnRH) agonists to suppress puberty in adolescence, and the use of cross-sex hormones starting around age 16 for eligible patients. In actual practice, the approach to GID is quite variable due to continued lack of consensus and specific barriers to treatment that are unique to GID. Recent literature has focused on the mental health approach to prepubertal children with GID and short-term outcomes using pubertal suppression and cross-sex steroids in adolescents with GID. This review will describe the literature published since the release of The Endocrine Society guidelines regarding the management of GID in both children and adolescents.

  2. 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.

  3. 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

  4. 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 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 spend being sedentary during waking hours. This includes prolonged sitting or being restrained (e.g., stroller, high chair) for more than 1 h at a time. For those under 2 years, screen time (e.g., TV, computer, electronic games) is not recommended. For children 2-4 years, screen time should be limited to under 1 h per day; less is better.

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

    Science.gov (United States)

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

    2003-01-01

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

  6. Guidelines on the management of atrial fibrillation in the emergency department: a critical appraisal.

    Science.gov (United States)

    Costantino, Giorgio; Podda, Gian Marco; Falsetti, Lorenzo; Iannone, Primiano; Lages, Ana; Marra, Alberto M; Masala, Maristella; Reiakvam, Olaug Marie; Savva, Florentia; Schovanek, Jan; van Bree, Sjoerd; da Silva Chora, Inês João; Privitera, Graziella; Ragozzino, Silvio; von Rotz, Matthias; Woittiez, Lycke; Davidson, Christopher; Montano, Nicola

    2017-08-01

    Several guidelines often exist on the same topic, sometimes offering divergent recommendations. For the clinician, it can be difficult to understand the reasons for this divergence and how to select the right recommendations. The aim of this study is to compare different guidelines on the management of atrial fibrillation (AF), and provide practical and affordable advice on its management in the acute setting. A PubMed search was performed in May 2014 to identify the three most recent and cited published guidelines on AF. During the 1-week school of the European School of Internal Medicine, the attending residents were divided in five working groups. The three selected guidelines were compared with five specific questions. The guidelines identified were: the European Society of Cardiology guidelines on AF, the Canadian guidelines on emergency department management of AF, and the American Heart Association guidelines on AF. Twenty-one relevant sub-questions were identified. For five of these, there was no agreement between guidelines; for three, there was partial agreement; for three data were not available (issue not covered by one of the guidelines), while for ten, there was complete agreement. Evidence on the management of AF in the acute setting is largely based on expert opinion rather than clinical trials. While there is broad agreement on the management of the haemodynamically unstable patient and the use of drugs for rate-control strategy, there is less agreement on drug therapy for rhythm control and no agreement on several other topics.

  7. 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.

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

    International Nuclear Information System (INIS)

    Spieth-Achtnich, Angelika; Schmidt, Gerhard

    2014-01-01

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

  9. The role of self-treatment guidelines in self-management education for adult asthmatics

    NARCIS (Netherlands)

    van der Palen, Jacobus Adrianus Maria; Klein, J.J.; Zielhuis, G.A.; van Herwaarden, C.L.A.

    1998-01-01

    Guidelines on asthma management have changed considerably in the last two decades. Patient education has gained in popularity and especially asthma self-management training is thought to be essential in the treatment of adult asthma. Since 1989 many researchers have added self-treatment guidelines

  10. [Graphic synopsis of implementation of German guideline clearing reports in national disease management guidelines].

    Science.gov (United States)

    Thole, Henning

    2011-01-01

    While methods for the production of guidelines (evidence analysis, assessment, adaptation) have been continually refined throughout the past years, there is a lack of instruments for the production of easily understandable synopses. Definition of a methodological approach to encompass synopses by Spidernet diagrams. Tables of synopses can be generated with distinct information to bring down the main results in one Spidernet diagram. This is possible for both the entire synopsis and parts of it. Guideline comparisons require detailed analyses on the one hand and easily understandable presentations of their results on the other. Guideline synopses can be substantially supported by graphic presentation of the results of synopsis. Graphic synopsis is also helpful in other cases; it may be used, for example, to summarise HTA reports, systematic reviews or guidelines. Copyright © 2011. Published by Elsevier GmbH.

  11. Effective maintenance practices to manage system aging

    International Nuclear Information System (INIS)

    Chockie, A.; Bjorkelo, K.

    1992-01-01

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

  12. New labor management guidelines and changes in cesarean delivery patterns.

    Science.gov (United States)

    Rosenbloom, Joshua I; Stout, Molly J; Tuuli, Methodius G; Woolfolk, Candice L; López, Julia D; Macones, George A; Cahill, Alison G

    2017-12-01

    In 2010 the Consortium on Safe Labor published labor curves. It was proposed that the rate of cesarean delivery could be lowered by avoiding the diagnosis of arrest of dilation before 6 cm. However, there is little information on the uptake of the guidelines and on changes in cesarean delivery rates that may have occurred. The objective of the study was to test the following hypotheses: (1) among patients laboring at term, rates of arrest of dilation disorders have decreased, leading to a decrease in the rate of cesarean delivery; (2) in the second stage, pushing duration prior to diagnosis of arrest of descent has increased, also leading to a reduction in the rate of cesarean delivery for this indication. As a secondary aim, we investigated changes in maternal and neonatal morbidity. This was a secondary analysis of a prospective cohort study of all patients presenting at ≥37 weeks' gestation from 2010 through 2014 with a nonanomalous vertex singleton and no prior history of cesarean delivery. Rates of cesarean delivery, arrest of dilation, and changes in rates of maternal and neonatal morbidity were calculated in crude and adjusted models. Cervical dilation at diagnosis of the arrest of dilation, time spent at the maximal dilation prior to diagnosis of arrest of dilation, and time in the second stage prior to the diagnosis of arrest of descent were compared over the study period. There were 7845 eligible patients. The cesarean delivery rate in 2010 was 15.8% and, in 2014, 17.7% (P trend = .51). In patients undergoing cesarean delivery for the arrest of dilation, the median cervical dilation at the time of cesarean delivery was at 5.5 cm in 2010 and 6.0 cm in 2014 (P trend = .94). In these patients, there was an increase in the time spent at last dilation: 3.8 hours in 2010 to 5.2 hours in 2014 (P trend = .02). There was no change in the frequency of patients diagnosed with the arrest of dilation at labor management that have occurred over the initial years

  13. Guidelines for the design and management of artificial raptor ...

    African Journals Online (AJOL)

    The aim of this paper is to provide timber growers with silvicultural guidelines for the establishment of raptor perches and nest stands on forestry estates. Rodents do extensive damage to young saplings and as an ecologically friendly alternative to rodenticides, we provide guidelines on perch height and densities that can ...

  14. Glycogen Storage Disease Type III diagnosis and management guidelines

    NARCIS (Netherlands)

    Kishnani, Priya S.; Austin, Stephanie L.; Arn, Pamela; Bali, Deeksha S.; Med, Anne Boney; Case, Laura E.; Chung, Wendy K.; Desai, Dev M.; El-Gharbawy, Areeg; Haller, Ronald; Smit, G. Peter A.; Smith, Alastair D.; Hobson-Webb, Lisa D.; Wechsler, Stephanie Burns; Weinstein, David A.; Watson, Michael S.

    Disclaimer: ACMG standards and guidelines are designed primarily as an educational resource for medical geneticists and other health care providers to help them provide quality medical genetic services. Adherence to these standards and guidelines does not necessarily ensure a successful medical

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-12-01

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

  16. 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.

  17. Age-specific antibiotic prescribing and adherence to guidelines in pediatric patients in primary care.

    NARCIS (Netherlands)

    Ivanovska, V.; Hek, K.; Mantel-Teeuwisse, A.K.; Leufkens, H.G.M.; Dijk, L. van

    2018-01-01

    Background: Most antibiotics in children are used to treat viral and self-limiting conditions. This study aims to compare physicians' adherence to guidelines on antibiotic prescribing in fever and in ear and respiratory infections to children in different age groups in the Netherlands. Methods: Data

  18. EDF ageing management program of nuclear components: a safety and economical issue

    International Nuclear Information System (INIS)

    Faidy, C.

    2005-01-01

    Ageing management of Nuclear Power Plants is an essential issue for utilities, in term of safety and availability and corresponding economical consequences. Practically all nuclear countries have developed a systematic program to deal with ageing of components on their plants. This paper presents the ageing management program developed by EDF and that are compared with different other approaches in other countries (IAEA guidelines and GALL report). The paper presents a general overview of the programs, the major results, recommendations and conclusions. (author)

  19. Scandinavian guidelines for initial management of minor and moderate head trauma in children

    DEFF Research Database (Denmark)

    Astrand, Ramona; Rosenlund, Christina; Undén, Johan

    2016-01-01

    . CONCLUSIONS: We present new evidence and consensus based Scandinavian Neurotrauma Committee guidelines for initial management of minor and moderate head trauma in children. These guidelines should be validated before extensive clinical use and updated within four years due to rapid development of new......BACKGROUND: The management of minor and moderate head trauma in children differs widely between countries. Presently, there are no existing guidelines for management of these children in Scandinavia. The purpose of this study was to produce new evidence-based guidelines for the initial management...... 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...

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

    Science.gov (United States)

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

    2016-05-01

    Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first-line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research. © 2016 Japan Gastroenterological Endoscopy Society.

  1. Personalised Care Plan Management Utilizing Guideline-Driven Clinical Decision Support Systems.

    Science.gov (United States)

    Laleci Erturkmen, Gokce Banu; Yuksel, Mustafa; Sarigul, Bunyamin; Lilja, Mikael; Chen, Rong; Arvanitis, Theodoros N

    2018-01-01

    Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans.

  2. Service guidelines based on Resource Utilization Groups Version III for Home Care provide decision-making support for case managers.

    Science.gov (United States)

    Collister, Barbara; Stein, Glenda; Katz, Deborah; DeBruyn, Joan; Andrusiw, Linda; Cloutier, Sheila

    2012-01-01

    Increasing costs and budget reductions combined with increasing demand from our growing, aging population support the need to ensure that the scarce resources allocated to home care clients match client needs. This article details how Integrated Home Care for the Calgary Zone of Alberta Health Services considered ethical and economic principles and used data from the Resident Assessment Instrument for Home Care (RAI-HC) and case mix indices from the Resource Utilization Groups Version III for Home Care (RUG-III/HC) to formulate service guidelines. These explicit service guidelines formalize and support individual resource allocation decisions made by case managers and provide a consistent and transparent method of allocating limited resources.

  3. Ageing management and equipment qualification

    International Nuclear Information System (INIS)

    Stahl, Gunnar

    2014-01-01

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

  4. Ageing management of Indian PHWRs - safety aspects

    International Nuclear Information System (INIS)

    Kapoor, R.K.; Sah, B.M.L.; Das, M.; Srinivasan, G.R.

    1994-01-01

    Ageing management has now become a vital area of concern. Ageing management includes determination of degradation factors, taking various steps to determine present conditions of systems, structures and components and taking mitigating steps. It also includes updating, modernization, refurbishment etc. It is important that ageing management starts right from the time of commissioning of the unit and is treated as a continuous process, and a parallel effort to the normal running of the plant. Thus elaborate research and development efforts are required to be instituted. Life extension could have a high benefit to cost ratio. Various steps to ensure safety in ageing management are listed. Selection of critical items, condition monitoring and life estimation of the same and a chronological check sheet from 0 to 60 years, for Indian PHWRs is explained. Areas where future research and development and other efforts need to be directed is listed. The paper concludes emphasizing the need for a systematized approach to ageing management. It recommends intensive research in certain listed areas and suggests standing committees in specialized areas to tap Indian experience in other industries and establishments. A safety guide is also required to be produced to cover all facets of ageing management. (author). 3 appendices

  5. Ageing management studies of RAPS-1

    International Nuclear Information System (INIS)

    Bohra, A.K.; Jain, L.K.; Joshi, K.M.

    2006-01-01

    Unit-l of Rajasthan Atomic Power Station (RAPS-1) is the first nuclear power plant of India with pressurized heavy water reactor. The construction of Unit-l of Rajasthan Atomic Power Station (RAPS-1) was started in the year 1966 in collaboration with Canada. The Unit-1 achieved first criticality on August 1972 and was first synchronized to Grid on November 1972. During initial operation of the Unit, several problems were faced in its various systems and these were addressed by incorporating various engineering changes and procedures. In this unit various major innovative repairs were done like end shield leak repair, OPRD leak repair. Considering the operation of various systems of Unit-1, since year 1971 it was imperative to study ageing degradation mechanisms and mitigating measures were to be taken. Although the ageing management is a continuous process the opportunity of Unit-1 shutdown for upgradations from 30-04-2002 to 08-02-2004 was utilized for inspection and assessment of health of various SSC, which otherwise could not have been done with unit in operational state. This paper contains the following in detail. (1) Ageing management programme, its objectives and scope (2) Methodology of ageing management studies - Replacement and upgradation -Additional inspection programme based on ageing management review - Statistical analysis of ageing degradation occurrence - Estimation of residual life span of cables and relays (3) Criteria for selection of components for ageing management programme (4) Findings of ageing management studies-case studies. The ageing study done for RAPS-1 indicated that appropriate ageing monitoring methods and procedures exist in the station for taking timely mitigating measures. The technological obsoleteness has been overcome by installing new components of latest technology. On overall assessment, the Unit-1 was considered fit for further service. (author)

  6. Ageing management of concrete structure

    International Nuclear Information System (INIS)

    Parthipan, P.; Ramaprasad, G.S.; Senthil, R.

    2006-01-01

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

  7. Safety Aspects of Ageing Management throughout the Full Life Cycle of NPPs

    International Nuclear Information System (INIS)

    Dou, Yikang

    2012-01-01

    Most component failures stem from effects of one or multiple ageing mechanism(s). Ageing management is one of the most robust measures to prevent failure and to maintain and increase safety of nuclear power plants. Based on Nuclear Safety Guideline on Ageing Management (NS-G-2.12) published by IAEA in 2009, the paper summarizes main ageing management activities required for all stages of life cycle of NPPs, including design, construction/manufacture, commissioning, operation, life extension for long-term operation and decommissioning. Interactive relations of ageing management in successive stages are analyzed. Implementation of the IAEA Guideline in comprehensive way will bring new challenges to design conception, modes of construction, manufacture, commissioning, equipment qualification, O and M, licensing, life extension and decommissioning for NPPs, however, it will be beneficial to enhance nuclear safety level, especially to promote development of nuclear power in China in a safe, reliable, profitable and sustainable way. (author)

  8. Compliance with standard treatment guidelines in the management ...

    African Journals Online (AJOL)

    Peter Rapula Siko

    Introduction: Hypertension is a leading lifestyle disease and major cause of morbidity ... Drug Policy (NDP) in 1996.3,4 This was intended to promote ... through the use of different guidelines for primary health care ..... Elderly Program (SHEP).

  9. Proposed guidelines for the management of nodding syndrome

    African Journals Online (AJOL)

    EB

    , Makerere ... and subsequently, physical and cognitive rehabilitation. ... guidelines were developed and provides an outline of the specific treatments currently ... physiotherapist and a speech and language therapist. .... poor adherence, etc.

  10. 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

    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 followup are important for improving a favorable outcome. Guidelines sh...... goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented....

  11. Asthma Management in Educational Settings: Implementing Guideline-Based Care in Washington State Schools.

    Science.gov (United States)

    Evans-Agnew, Robin A; Klein, Nicole; Lecce, Sally

    2015-11-01

    Managing asthma in the schools is complex and requires careful planning. This article highlights key steps in implementing guideline-based care for children with asthma in Washington State schools: assessing students, establishing acuity, communicating with parents, and training staff. Advance planning can improve outcomes for students, parents, and school staff in managing this complex and prevalent disease. NASN recently developed asthma management guidelines. Developing state-specific guidelines provides an opportunity to speak specifically to state laws and nurse practice acts while also reinforcing the importance of specialized practice to school nurses, school administrators and teachers, parents, and students. © 2015 The Author(s).

  12. Ageing management in German nuclear power plants

    International Nuclear Information System (INIS)

    Becker, D.E.; Reiner, M.

    1998-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Annie M. Wu

    2015-01-01

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

  14. Neurosurgeons' management of lumbosacral radicular syndrome evaluated against a clinical guideline

    NARCIS (Netherlands)

    P.A.J. Luijsterburg (Pim); A.P. Verhagen (Arianne); S. Braak (Sigrid); A. Oemraw (Anushka); C.J.J. Avezaat (Cees); B.W. Koes (Bart)

    2004-01-01

    textabstractTo establish to what extent neurosurgeons subscribe to the lumbosacral radicular syndrome (LRS) guideline, and to evaluate their current management of patients with LRS against the guideline. All active neurosurgeons in the Netherlands (n=92) were mailed a questionnaire about the

  15. 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

  16. Regional Standards for Rangeland Health and Guidelines for Livestock Grazing Management ... A Progress Report

    OpenAIRE

    1996-01-01

    In August 1995, new BLM regulations for rangeland administration went into effect. The new regulations require BLM to establish regional standards for rangeland health and guidelines for grazing management. This publication is a report on the alternatives being considered for the Montana/Dakotas Rangeland Health Standards and Guidelines process.

  17. ESH-ESC guidelines for the management of hypertension.

    Science.gov (United States)

    Erdine, Serap; Ari, Oben; Zanchetti, A; Cifkova, R; Fagard, R; Kjeldsen, S; Mancia, G; Poulter, N; Rahn, K H; Rodicio, J L; Ruilope, L M; Staessen, J; van Zwieten, P; Waeber, B; Williams, B

    2006-06-01

    The following is a brief statement of the 2003 European Society of Hypertension (ESH)-European Society of Cardiology (ESC) guidelines for the management of arterial hypertension. The continuous relationship between the level of blood pressure and cardiovascular risk makes the definition of hypertension arbitrary. Since risk factors cluster in hypertensive individuals, risk stratification should be made and decision about the management should not be based on blood pressure alone, but also according to the presence or absence of other risk factors, target organ damage, diabetes, and cardiovascular or renal damage, as well as on other aspects of the patient's personal, medical and social situation. Blood pressure values measured in the doctor's office or the clinic should commonly be used as reference. Ambulatory blood pressure monitoring may have clinical value, when considerable variability of office blood pressure is found over the same or different visits, high office blood pressure is measured in subjects otherwise at low global cardiovascular risk, there is marked discrepancy between blood pressure values measured in the office and at home, resistance to drug treatment is suspected, or research is involved. Secondary hypertension should always be investigated. The primary goal of treatment of patient with high blood pressure is to achieve the maximum reduction in long-term total risk of cardiovascular morbidity and mortality. This requires treatment of all the reversible factors identified, including smoking, dislipidemia, or diabetes, and the appropriate management of associated clinical conditions, as well as treatment of the raised blood pressure per se. On the basis of current evidence from trials, it can be recommended that blood pressure, both systolic and diastolic, be intensively lowered at least below 140/90 mmHg and to definitely lower values, if tolerated, in all hypertensive patients, and below 130/80 mmHg in diabetics. Lifestyle measures should be

  18. Guideline on management of the acute asthma attack in children by Italian Society of Pediatrics.

    Science.gov (United States)

    Indinnimeo, Luciana; Chiappini, Elena; Miraglia Del Giudice, Michele

    2018-04-06

    Acute asthma attack is a frequent condition in children. It is one of the most common reasons for emergency department (ED) visit and hospitalization. Appropriate care is fundamental, considering both the high prevalence of asthma in children, and its life-threatening risks. Italian Society of Pediatrics recently issued a guideline on the management of acute asthma attack in children over age 2, in ambulatory and emergency department settings. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was adopted. A literature search was performed using the Cochrane Library and Medline/PubMed databases, retrieving studies in English or Italian and including children over age 2 year. Inhaled ß 2 agonists are the first line drugs for acute asthma attack in children. Ipratropium bromide should be added in moderate/severe attacks. Early use of systemic steroids is associated with reduced risk of ED visits and hospitalization. High doses of inhaled steroids should not replace systemic steroids. Aminophylline use should be avoided in mild/moderate attacks. Weak evidence supports its use in life-threatening attacks. Epinephrine should not be used in the treatment of acute asthma for its lower cost / benefit ratio, compared to β 2 agonists. Intravenous magnesium solphate could be used in children with severe attacks and/or forced expiratory volume1 (FEV1) lower than 60% predicted, unresponsive to initial inhaled therapy. Heliox could be administered in life-threatening attacks. Leukotriene receptor antagonists are not recommended. This Guideline is expected to be a useful resource in managing acute asthma attacks in children over age 2.

  19. Guidelines for the Gamification of Self-Management of Chronic Illnesses: Multimethod Study.

    Science.gov (United States)

    AlMarshedi, Alaa; Wills, Gary; Ranchhod, Ashok

    2017-05-12

    Gamification is the use of game elements and techniques in nongaming contexts. The use of gamification in health care is receiving a great deal of attention in both academic research and the industry. However, it can be noticed that many gamification apps in health care do not follow any standardized guidelines. This research aims to (1) present a set of guidelines based on the validated framework the Wheel of Sukr and (2) assess the guidelines through expert interviews and focus group sessions with developers. Expert interviews (N=6) were conducted to assess the content of the guidelines and that they reflect the Wheel of Sukr. In addition, the guidelines were assessed by developers (N=15) in 5 focus group sessions, where each group had an average of 3 developers. The guidelines received support from the experts. By the end of the sixth interview, it was determined that a saturation point was reached. Experts agreed that the guidelines accurately reflect the framework the Wheel of Sukr and that developers can potentially use them to create gamified self-management apps for chronic illnesses. Moreover, the guidelines were welcomed by developers who participated in the focus group sessions. They found the guidelines to be clear, useful, and implementable. Also, they were able to suggest many ways of gamifying a nongamified self-management app when they were presented with one. The findings suggest that the guidelines introduced in this research are clear, useful, and ready to be implemented for the creation of self-management apps that use the notion of gamification as described in the Wheel of Sukr framework. The guidelines are now ready to be practically tested. Further practical studies of the effectiveness of each element in the guidelines are to be carried out. ©Alaa AlMarshedi, Gary Wills, Ashok Ranchhod. Originally published in JMIR Serious Games (http://games.jmir.org), 12.05.2017.

  20. ACG clinical guidelines: diagnosis and management of celiac disease.

    Science.gov (United States)

    Rubio-Tapia, Alberto; Hill, Ivor D; Kelly, Ciarán P; Calderwood, Audrey H; Murray, Joseph A

    2013-05-01

    This guideline presents recommendations for the diagnosis and management of patients with celiac disease. Celiac disease is an immune-based reaction to dietary gluten (storage protein for wheat, barley, and rye) that primarily affects the small intestine in those with a genetic predisposition and resolves with exclusion of gluten from the diet. There has been a substantial increase in the prevalence of celiac disease over the last 50 years and an increase in the rate of diagnosis in the last 10 years. Celiac disease can present with many symptoms, including typical gastrointestinal symptoms (e.g., diarrhea, steatorrhea, weight loss, bloating, flatulence, abdominal pain) and also non-gastrointestinal abnormalities (e.g., abnormal liver function tests, iron deficiency anemia, bone disease, skin disorders, and many other protean manifestations). Indeed, many individuals with celiac disease may have no symptoms at all. Celiac disease is usually detected by serologic testing of celiac-specific antibodies. The diagnosis is confirmed by duodenal mucosal biopsies. Both serology and biopsy should be performed on a gluten-containing diet. The treatment for celiac disease is primarily a gluten-free diet (GFD), which requires significant patient education, motivation, and follow-up. Non-responsive celiac disease occurs frequently, particularly in those diagnosed in adulthood. Persistent or recurring symptoms should lead to a review of the patient's original diagnosis to exclude alternative diagnoses, a review of the GFD to ensure there is no obvious gluten contamination, and serologic testing to confirm adherence with the GFD. In addition, evaluation for disorders associated with celiac disease that could cause persistent symptoms, such as microscopic colitis, pancreatic exocrine dysfunction, and complications of celiac disease, such as enteropathy-associated lymphoma or refractory celiac disease, should be entertained. Newer therapeutic modalities are being studied in

  1. An overview of clinical guidelines for the management of vertebral compression fracture: a systematic review.

    Science.gov (United States)

    Parreira, Patrícia C S; Maher, Chris G; Megale, Rodrigo Z; March, Lyn; Ferreira, Manuela L

    2017-12-01

    Vertebral compression fractures (VCFs) are the most common type of osteoporotic fracture comprising approximately 1.4 million cases worldwide. Clinical practice guidelines can be powerful tools for promoting evidence-based practice as they integrate research findings to support decision making. However, currently available clinical guidelines and recommendations, established by different medical societies, are sometimes contradictory. The aim of this study was to appraise the recommendations and the methodological quality of international clinical guidelines for the management of VCFs. This is a systematic review of clinical guidelines for the management of VCF. Guidelines were selected by searching MEDLINE and PubMed, PEDro, CINAHL, and EMBASE electronic databases between 2010 and 2016. We also searched clinical practice guideline databases, including the National Guideline Clearinghouse and the Canadian Medical Association InfoBase. The methodological quality of the guidelines was assessed by two authors independently using the Appraisal of Guidelines, Research and Evaluation (AGREE) II Instrument. We also classified the strength of each recommendation as either strong (ie, based on high-quality studies with consistent findings for recommending for or against the intervention), weak (ie, based on a lack of compelling evidence resulting in uncertainty for benefit or potential harm), or expert consensus (ie, based on expert opinion of the working group rather than on scientific evidence). Guideline recommendations were grouped into diagnostic, conservative care, interventional care, and osteoporosis treatment and prevention of future fractures. Our study was prospectively registered on PROSPERO. Four guidelines from three countries, published in the period 2010-2013, were included. In general, the quality was not satisfactory (50% or less of the maximum possible score). The domains scoring 50% or less of the maximum possible score were rigor of development, clarity

  2. Guidelines and algorithms for managing the difficult airway.

    Science.gov (United States)

    Gómez-Ríos, M A; Gaitini, L; Matter, I; Somri, M

    2018-01-01

    The difficult airway constitutes a continuous challenge for anesthesiologists. Guidelines and algorithms are key to preserving patient safety, by recommending specific plans and strategies that address predicted or unexpected difficult airway. However, there are currently no "gold standard" algorithms or universally accepted standards. The aim of this article is to present a synthesis of the recommendations of the main guidelines and difficult airway algorithms. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

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

    DEFF Research Database (Denmark)

    Tølle, Martin; Vesterager, Johan

    2002-01-01

    This document is a deliverable of Work package 2 of the IMS Globemen (GMN) project: D23 Guidelines for Inter-Enterprise Management (IEM). IMS Globemen is an inter-regional project aiming to develop methods, tools and architectures to support inter-enterprise operations in one-of-kind industries......-Project, the developed solution for Inter-Enterprise Management. The structure of the deliverable is as follows: - Chapter 1 introduces the guidelines and outlines the structure of the deliverable - Chapter 2 defines key terms along with a list of acronyms used in the deliverable - Chapter 3 gives a general introduction...... for inter-enterprise management (IEM). - Chapter 5 contains the actual Guidelines The chapter contains guidelines for how to prepare enterprise network in being able to set up and manage virtual enterprises. The section consists of a set of activities an enterprise should/could consider when preparing...

  4. Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)

    NARCIS (Netherlands)

    Mori, Yasuhisa; Itoi, Takao; Baron, Todd H.; Takada, Tadahiro; Strasberg, Steven M.; Pitt, Henry A.; Ukai, Tomohiko; Shikata, Satoru; Noguchi, Yoshinori; Teoh, Anthony Yuen Bun; Kim, Myung-Hwan; Asbun, Horacio J.; Endo, Itaru; Yokoe, Masamichi; Miura, Fumihiko; Okamoto, Kohji; Suzuki, Kenji; Umezawa, Akiko; Iwashita, Yukio; Hibi, Taizo; Wakabayashi, Go; Han, Ho-Seong; Yoon, Yoo-Seok; Choi, In-Seok; Hwang, Tsann-Long; Chen, Miin-Fu; Garden, O. James; Singh, Harjit; Liau, Kui-Hin; Huang, Wayne Shih-Wei; Gouma, Dirk J.; Belli, Giulio; Dervenis, Christos; de Santibañes, Eduardo; Giménez, Mariano Eduardo; Windsor, John A.; Lau, Wan Yee; Cherqui, Daniel; Jagannath, Palepu; Supe, Avinash Nivritti; Liu, Keng-Hao; Su, Cheng-Hsi; Deziel, Daniel J.; Chen, Xiao-Ping; Fan, Sheung Tat; Ker, Chen-Guo; Jonas, Eduard; Padbury, Robert; Mukai, Shuntaro; Honda, Goro; Sugioka, Atsushi; Asai, Koji; Higuchi, Ryota; Wada, Keita; Yoshida, Masahiro; Mayumi, Toshihiko; Hirata, Koichi; Sumiyama, Yoshinobu; Inui, Kazuo; Yamamoto, Masakazu

    2018-01-01

    Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore,

  5. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

    NARCIS (Netherlands)

    Rhodes, Andrew; Evans, Laura E.; Alhazzani, Waleed; Levy, Mitchell M.; Antonelli, Massimo; Ferrer, Ricard; Kumar, Anand; Sevransky, Jonathan E.; Sprung, Charles L.; Nunnally, Mark E.; Rochwerg, Bram; Rubenfeld, Gordon D.; Angus, Derek C.; Annane, Djillali; Beale, Richard J.; Bellinghan, Geoffrey J.; Bernard, Gordon R.; Chiche, Jean-Daniel; Coopersmith, Craig; de Backer, Daniel P.; French, Craig J.; Fujishima, Seitaro; Gerlach, Herwig; Hidalgo, Jorge Luis; Hollenberg, Steven M.; Jones, Alan E.; Karnad, Dilip R.; Kleinpell, Ruth M.; Koh, Younsuck; Lisboa, Thiago Costa; Machado, Flavia R.; Marini, John J.; Marshall, John C.; Mazuski, John E.; McIntyre, Lauralyn A.; McLean, Anthony S.; Mehta, Sangeeta; Moreno, Rui P.; Myburgh, John; Navalesi, Paolo; Nishida, Osamu; Osborn, Tiffany M.; Perner, Anders; Plunkett, Colleen M.; Ranieri, Marco; Schorr, Christa A.; Seckel, Maureen A.; Seymour, Christopher W.; Shieh, Lisa; Shukri, Khalid A.; Simpson, Steven Q.; Singer, Mervyn; Thompson, B. Taylor; Townsend, Sean R.; van der Poll, Thomas; Vincent, Jean-Louis; Wiersinga, W. Joost; Zimmerman, Janice L.; Dellinger, R. Phillip

    2017-01-01

    Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012!' Design: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings

  6. [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.

  7. 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

  8. [Guidelines for the diagnosis and management of thyroid disease and their utility].

    Science.gov (United States)

    Hashimoto, Koshi; Mori, Masatomo

    2012-11-01

    Thyroid dysfunction is a common disorder in daily clinical practice, however due to unspecific and diverse symptoms of the disease, it is sometimes hard to make a definite diagnosis. Japan thyroid association (JTA) published 'Guideline for the diagnosis of thyroid disease, 2010' and it is open to the public on the JTA website(http : //www.japanthyroid.jp/doctor/ guideline/japanese.html). English version of the guideline is also available. JTA also published 'Guideline for the management of subclinical hypothyroidism 2008' and 'Guideline for the diagnosis of thyroid storm, version 2'. The latter in English version has been published in Thyroid(http : //www.ncbi.nlm.nih.gov/pubmed/22494618). The utility of these guidelines is discussed.

  9. Introducing the new BTS Guideline: Management of non-tuberculous mycobacterial pulmonary disease (NTM-PD).

    Science.gov (United States)

    Haworth, Charles S; Floto, R Andres

    2017-11-01

    The new BTS Guidelines for the management of non-tuberculous mycobacterial pulmonary disease combine the best available evidence with expert consensus to generate a set of pragmatic Guidelines, published as a supplement to this issue of Thorax, to assist in the management of these challenging infections. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for prostate cancer 2017.

    Science.gov (United States)

    Aljubran, Ali; Abusamra, Ashraf; Alkhateeb, Sultan; Alotaibi, Mohammed; Rabah, Danny; Bazarbashi, Shouki; Alkushi, Hussain; Al-Mansour, Mubarak; Alharbi, Hulayel; Eltijani, Amin; Alghamdi, Abdullah; Alsharm, Abdullah; Ahmad, Imran; Murshid, Esam

    2018-01-01

    This is an update to the previously published Saudi guidelines for the evaluation and medical and surgical management of patients diagnosed with prostate cancer. Prostate cancer is categorized according to the stage of the disease using the tumor node metastasis staging system 7 th edition. The guidelines are presented with supporting evidence levels based on a 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. Local factors, such as availability, logistic feasibility, and familiarity of various treatment modalities, have been taken into consideration. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health-care policymakers in the management of patients diagnosed with adenocarcinoma of the prostate.

  11. 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

    Lynch syndrome (LS) is characterised by the development of colorectal cancer, endometrial cancer and various other cancers, and is caused by a mutation in one of the mismatch repair genes: MLH1, MSH2, MSH6 or PMS2. In 2007, a group of European experts (the Mallorca group) published guidelines...

  12. Efficacy versus effectiveness trials : informing guidelines for asthma management

    NARCIS (Netherlands)

    Price, David; Hillyer, Elizabeth V.; van der Molen, Thys

    Purpose of review Randomized controlled trials, known as efficacy trials and long considered the gold standard for evidence-based asthma guidelines, are designed to test whether interventions have a benefit for selective patient populations under ideal conditions. The goal of pragmatic trials and

  13. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

    NARCIS (Netherlands)

    Okamoto, Kohji; Suzuki, Kenji; Takada, Tadahiro; Strasberg, Steven M.; Asbun, Horacio J.; Endo, Itaru; Iwashita, Yukio; Hibi, Taizo; Pitt, Henry A.; Umezawa, Akiko; Asai, Koji; Han, Ho-Seong; Hwang, Tsann-Long; Mori, Yasuhisa; Yoon, Yoo-Seok; Huang, Wayne Shih-Wei; Belli, Giulio; Dervenis, Christos; Yokoe, Masamichi; Kiriyama, Seiki; Itoi, Takao; Jagannath, Palepu; Garden, O. James; Miura, Fumihiko; Nakamura, Masafumi; Horiguchi, Akihiko; Wakabayashi, Go; Cherqui, Daniel; de Santibañes, Eduardo; Shikata, Satoru; Noguchi, Yoshinori; Ukai, Tomohiko; Higuchi, Ryota; Wada, Keita; Honda, Goro; Supe, Avinash Nivritti; Yoshida, Masahiro; Mayumi, Toshihiko; Gouma, Dirk J.; Deziel, Daniel J.; Liau, Kui-Hin; Chen, Miin-Fu; Shibao, Kazunori; Liu, Keng-Hao; Su, Cheng-Hsi; Chan, Angus C. W.; Yoon, Dong-Sup; Choi, In-Seok; Jonas, Eduard; Chen, Xiao-Ping; Fan, Sheung Tat; Ker, Chen-Guo; Giménez, Mariano Eduardo; Kitano, Seigo; Inomata, Masafumi; Hirata, Koichi; Inui, Kazuo; Sumiyama, Yoshinobu; Yamamoto, Masakazu

    2018-01-01

    We propose a new flowchart for the treatment of acute cholecystitis (AC) in the Tokyo Guidelines 2018 (TG18). Grade III AC was not indicated for straightforward laparoscopic cholecystectomy (Lap-C). Following analysis of subsequent clinical investigations and drawing on Big Data in particular, TG18

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  15. 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.

  16. 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

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

    Science.gov (United States)

    Toye, Christine; Blackwell, Scott; Maher, Sean; Currow, David C; Holloway, Kristi; Tieman, Jennifer; Hegarty, Meg

    2012-01-01

    In 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 or residential placements and

  18. Impact of the new American and British guidelines on the management and treatment of dyslipidemia in a Spanish working population.

    Science.gov (United States)

    Brotons, Carlos; Calvo-Bonacho, Eva; Moral, Irene; García-Margallo, María Teresa; Cortés-Arcas, María Victoria; Puig, Mireia; Vázquez-Pirillo, Gastón; Ruilope, Luis Miguel

    2014-11-01

    The guidelines of the American College of Cardiology/American Heart Association and the British National Institute for Health and Clinical Excellence on the management and treatment of dyslipidemia recommend significant changes, such as the abolition of therapeutic targets and the use of new risk tables. This study aimed to evaluate the impact of the use of these new guidelines compared with the application of European guidelines. Observational study conducted among Spanish workers. We included all workers registered with the Sociedad de Prevención de Ibermutuamur in 2011 whose cardiovascular risk could be evaluated. Cardiovascular risk was calculated for each worker using the Systematic Coronary Risk Evaluation cardiovascular risk tables for low-risk countries, as well as the tables recommended by the American and British guidelines. A total of 258,676 workers were included (68.2% men; mean age, 39.3 years). High risk was found in 3.74% of the population according to the Systematic Coronary Risk Evaluation tables and in 6.85% and 20.83% according to the British and American tables, respectively. Treatment would be needed in 20 558 workers according to the American guidelines and in 13,222 according to the British guidelines, but in only 2612 according to the European guidelines. By following the American guidelines, the cost of statins would increase by a factor of 8. The new recommendations would result in identifying more high-risk patients and in treating a larger fraction of the population with lipid-lowering drugs than with the European recommendations, which would result in increased costs. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  19. Operational and materials aspects of aging management

    International Nuclear Information System (INIS)

    Muscara, J.; Vora, J.P.; Moyer, C.E.

    2005-01-01

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

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

    Science.gov (United States)

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

    2015-03-01

    To analyze characteristics of clinical practice guidelines (CPGs) for the management of rheumatoid arthritis (RA) developed in Latin American (LA) countries and to describe the knowledge, use, and barriers for their implementation perceived among LA rheumatologists, a comprehensive literature search including Medline, PubMed, Cochrane Library, LILACS and Scielo was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was applied for evaluation. A survey was sent to PANLAR members containing questions related to knowledge about guidelines, application of the recommendations, and difficulties in implementing CPGs. Eight guidelines were identified. Most guidelines were evidence based (62 %), but in only 37 % a systematic literature search was done. None of the guidelines included patients' views and preferences, and only few of them stated an updating procedure. Funding body independence and disclosure of conflicts of interest were rarely reported. The survey was answered by 214 rheumatologists from all Latin American countries. Most rheumatologist reported knowledge and use of clinical guidelines, mainly international ones. In general, rheumatologist felt that guidelines apply to only a minority of patients seen in daily clinical practice. Limited access expensive drugs, suggested by the guidelines, was the most frequent barrier to guidelines implementation that was reported. A good number of guidelines on the treatment of rheumatoid arthritis have been developed in Latin America. Most of them are lacking some of the components recognized for high-quality clinical guidelines development. In spite that most rheumatologist know and apply guidelines, access to drugs is still a very important barrier to their implementation in Latin America.

  1. Research projects on life management: materials ageing

    International Nuclear Information System (INIS)

    Gomez Briceno, D.

    1997-01-01

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

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

    Science.gov (United States)

    Yamamoto, Masafumi

    2011-07-01

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

  3. Human Engineering Guidelines for Management Information Systems. Change 1,

    Science.gov (United States)

    1983-06-09

    beginner . chapter offers guidelines concerning training. 0 A brief review available for the infrequent user. Major training factors * A program for a...the training include a program specifically designed L Li LL for the beginner or naive user? 8. Is there a brief review for the intermittent user? Ei Li...250 pages of text. Flowchart - A graphic representation, using standard symbols, which portrays logical data and process- ing requirements. Formatting

  4. BSACI guideline for the diagnosis and management of cow's milk allergy.

    Science.gov (United States)

    Luyt, D; Ball, H; Makwana, N; Green, M R; Bravin, K; Nasser, S M; Clark, A T

    2014-01-01

    This guideline advises on the management of patients with cow's milk allergy. Cow's milk allergy presents in the first year of life with estimated population prevalence between 2% and 3%. The clinical manifestations of cow's milk allergy are very variable in type and severity making it the most difficult food allergy to diagnose. A careful age- and disease-specific history with relevant allergy tests including detection of milk-specific IgE (by skin prick test or serum assay), diagnostic elimination diet, and oral challenge will aid in diagnosis in most cases. Treatment is advice on cow's milk avoidance and suitable substitute milks. Cow's milk allergy often resolves. Reintroduction can be achieved by the graded exposure, either at home or supervised in hospital depending on severity, using a milk ladder. Where cow's milk allergy persists, novel treatment options may include oral tolerance induction, although most authors do not currently recommend it for routine clinical practice. Cow's milk allergy must be distinguished from primary lactose intolerance. 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 clinicians in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking the panel of experts in the committee reached consensus. Grades of recommendation are shown throughout. The document encompasses epidemiology, natural history, clinical presentations, diagnosis, and treatment. © 2014 John Wiley & Sons Ltd.

  5. Comparison of Western and Asian Guidelines Concerning the Management of Colon Cancer.

    Science.gov (United States)

    Pellino, Gianluca; Warren, Oliver; Mills, Sarah; Rasheed, Shahnawaz; Tekkis, Paris P; Kontovounisios, Christos

    2018-02-01

    Guidelines are important to standardize treatments and optimize outcomes. Several societies have published authoritative guidelines for patients with colon cancer, and a certain degree of variation can be predicted. This study aims to compare Western and Asian guidelines for the management of colon cancer. A literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies published between 2010 and 2017 by the online resources from the official Web sites of the societies/panels. Sources included guidelines by European Society of Medical Oncology, the Japanese Society for Cancer of the Colon and Rectum, and the National Comprehensive Cancer Network. Only full-text studies and the latest guidelines dealing with colon cancer were included. Studies and guidelines were separately assessed by 2 authors, who independently identified discrepancies and areas for further research. These were discussed and agreed with by all the authors. The recommendations of the guidelines of each society were compared, seeking discrepancies and potential areas for improvement. Endoscopic techniques for the management of early colon cancer are discussed in detail in the Asian guidelines. Asian guidelines advocate extended (D3) lymphadenectomy on a routine basis in T3/T4 and in selected T2 patients, whereas such an approach is still under investigation in Western countries. Only US guidelines describe neoadjuvant chemotherapy and radiotherapy. All the guidelines recommend adjuvant treatment in selected stage II patients, but agreement exists that this is performed without solid evidence, because better outcomes are hypothesized based on studies including stage III or stage II/III patients. The role of cytoreductive surgery with intra-abdominal chemotherapy is dubious, and European guidelines only recommend it in the setting of trials. Asian guidelines endorse an aggressive surgical approach to peritoneal disease. Only US

  6. Management of I and C ageing

    International Nuclear Information System (INIS)

    Caron, D.

    2000-01-01

    This report presents a brief perspective on the management of Instrumentation and Control (I and C) ageing in UK NPPs. It does not address the issues of refurbishment strategies, the use of digital I and C or the technical details of advanced monitoring techniques. These items are discussed in other country reports and elsewhere in this TECDOC. (author)

  7. Play for All Guidelines: Planning, Design and Management of Outdoor Play Settings for All Children. Second Edition.

    Science.gov (United States)

    Moore, Robin C., Ed.; Goltsman, Susan M., Ed.; Iacofano, Daniel S., Ed.

    These guidelines assist professional designers, park and recreation managers, and community groups when making decisions about the planning, design, and ongoing management of children's public play environments. The guidelines are updated to meet or exceed the requirements of the Americans with Disabilities Act Guidelines (July 26, 1991) and the…

  8. Guidelines for developing transportation management plans in Virginia.

    Science.gov (United States)

    2005-01-01

    A transportation management plan (TMP) is a comprehensive program of traffic control, communication, operation, and demand management strategies designed to maintain acceptable levels of traffic flow in work zones. A systematic procedure and/or check...

  9. WOCN 2016 Guideline for Prevention and Management of Pressure Injuries (Ulcers): An Executive Summary.

    Science.gov (United States)

    This article provides an executive summary of recommendations from the 2016 Guideline for Prevention and Management of Pressure Ulcers (Injuries) published by the Wound, Ostomy and Continence Nurses Society (WOCN). It presents an overview of the process used to update and develop the guideline, and lists the specific recommendations from the guideline for assessment, prevention, and treatment of pressure injuries. The guideline is a resource for physicians, nurses, therapists, and other healthcare professionals who work with adults who have/or are at risk for pressure injuries. The full text of the published guideline, which includes the available evidence supporting the recommendations and a complete reference list, is available from the Wound, Ostomy and Continence Nurses Society, 1120 Rt 73, Ste 200, Mount Laurel, NJ 08054; Web site: www.wocn.org. Refer to the Supplemental Digital Content (http://links.lww.com/JWOCN/A38) associated with this article for a complete reference list for the guideline. The guideline has been accepted for inclusion in the National Guideline Clearinghouse (www.guideline.gov/).

  10. Guidelines for management of noxious weeds at Hanford

    International Nuclear Information System (INIS)

    Roos, R.C.; Malady, M.B.

    1995-01-01

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

  11. Aging management and life extension - Containment aging study

    International Nuclear Information System (INIS)

    Tai, Tom M.; Deng, Daniel

    2004-01-01

    Bechtel is currently completing an aging study on a concrete containment structure. The target plant is a two-unit PWR plant with a generating capacity of about 850 MWe from each unit. Both units are less than 20 years old. The total electrical energy output from this plant site accounts for more than 50% of the utility's baseload operation. Although no utility in the United States has made a decision to submit a license renewal application, some have begun to investigate the feasibility of developing an life cycle management (LCM) program for a strategy to operate their plants efficiently, to investigate the financial benefit and safety implications of license renewal to operate their nuclear power plants beyond their current licensed periods, and to prepare a program plan for plant decommissioning. The LCM program includes economic, environmental, regulatory and technical aspects of continuing plant operations beyond the current license period. The Electric Power Research Institute (EPRI) has been supportive to assist utilities and owners groups in their research and development efforts to develop the technical requirements and the issues associated with important to license renewal structures. The focus of this paper is on the technical issues related to the evaluation of the material condition of the containment structure with respect to aging and the effective management of that aging. (author)

  12. Factors affecting adherence to national malaria treatment guidelines in management of malaria among public healthcare workers in Kamuli District, Uganda.

    Science.gov (United States)

    Bawate, Charles; Callender-Carter, Sylvia T; Nsajju, Ben; Bwayo, Denis

    2016-02-24

    Malaria remains a major public health threat accounting for 30.4 % of disease morbidity in outpatient clinic visits across all age groups in Uganda. Consequently, malaria control remains a major public health priority in endemic countries such as Uganda. Experiences from other countries in Africa that revised their malaria case management suggest that health workers adherence may be problematic. A descriptive, cross-sectional design was used and collected information on health system, health workers and patients. Using log-binomial regression model, adjusted prevalence risk ratios (PRRs) and their associated 95 % confidence intervals were determined in line with adherence to new treatment guidelines of parasitological diagnosis and prompt treatment with artemisinin combination therapy (ACT). Nine health centres, 24 health workers and 240 patient consultations were evaluated. Overall adherence to national malaria treatment guidelines (NMTG) was 50.6 % (122/241). It was significantly high at HC III [115 (53 %)] than at HC IV (29 %) [PRR = 0.28 (95 % CI 0.148 0.52), p = 0.000]. Compared to the nursing aide, the adherence level was 1.57 times higher among enrolled nurses (p = 0.004) and 1.68 times higher among nursing officers, p = 0.238, with statistical significance among the former. No attendance of facility malaria-specific continuing medical education (CME) sessions [PRR = 1.9 (95 % CI 1.29 2.78), p = 0.001] and no display of malaria treatment job aides in consultation rooms [PRR = 0.64 (95 % CI 0.4 1.03), p = 0.07] was associated with increased adherence to guidelines with the former showing a statistical significance and the association of the latter borderline statistical significance. The adherence was higher when the laboratory was functional [PRR = 0.47 (95 % CI 0.35 0.63)] when the laboratory was functional in previous 6 months. Age of health worker, duration of employment, supervision, educational level, and age of patient were found not associated with

  13. Single Health System Adherence to 2012 Cervical Cancer Screening Guidelines at Extremes of Age and Posthysterectomy.

    Science.gov (United States)

    Teoh, Deanna; Isaksson Vogel, Rachel; Hultman, Gretchen; Monu, Minnu; Downs, Levi; Geller, Melissa A; Le, Chap; Melton-Meaux, Genevieve; Kulasingam, Shalini

    2017-03-01

    To estimate the proportion of guideline nonadherent Pap tests in women aged younger than 21 years and older than 65 years and posthysterectomy in a single large health system. Secondary objectives were to describe temporal trends and patient and health care provider characteristics associated with screening in these groups. A retrospective cross-sectional chart review was performed at Fairview Health Services and University of Minnesota Physicians. Reasons for testing and patient and health care provider information were collected. Tests were designated as indicated or nonindicated per the 2012 cervical cancer screening guidelines. Point estimates and descriptive statistics were calculated. Patient and health care provider characteristics were compared between indicated and nonindicated groups using χ and Wilcoxon rank-sum tests. A total of 3,920 Pap tests were performed between September 9, 2012, and August 31, 2014. A total of 257 (51%; 95% confidence interval [CI] 46.1-54.9%) of tests in the younger than 21 years group, 536 (40%; 95% CI 37.7-43.1%) in the older than 65 years group, and 605 (29%; 95% CI 27.1-31.0%) in the posthysterectomy group were not indicated. White race in the older than 65 years group was the only patient characteristic associated with receipt of a nonindicated Pap test (P=.007). Health care provider characteristics associated with nonindicated Pap tests varied by screening group. Temporal trends showed a decrease in the proportion of nonindicated tests in the younger than 21 years group but an increase in the posthysterectomy group. For women aged younger than 21 years and older than 65 years and posthysterectomy, 35% of Pap tests performed in our health system were not guideline-adherent. There were no patient or health care provider characteristics associated with guideline nonadherent screening across all groups.

  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

    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

  15. Safety implications of diesel generator aging management

    International Nuclear Information System (INIS)

    Hoopingarner, K.R.

    1989-01-01

    Significant safety improvements can be achieved in diesel-generator management related to aging, testing, and other important regulatory concerns. This paper reports on the progress of aging research related to nuclear service diesel generators, which developed data and information supporting the recommended safety improvements. The key to diesel-generator safety improvements is the development of a new balanced approach where testing, inspections, monitoring and trending, training, and maintenance all have appropriate importance. Safety improvement is projected in a management program that concurrently achieves three goals: first, the reduction of the fast-start stressor by regulatory and utility actions; second, the establishment of more appropriate testing and trending procedures; third, the adoption and use of reliability-centered maintenance activities. This paper describes the recommended safety improvements and the positive role of utility management in the process and outlines a new recommended regulatory approach. Diesel generator aging and wear is the subject of research sponsored by the Nuclear Plant Aging Research (NPAR) Program under the US Nuclear Regulatory Commission (NRC). Office of Nuclear Regulatory Research. The research was conducted by Pacific Northwest Laboratory (PNL), which is operated for the US Department of Energy by Battelle Memorial Institute. 4 refs., 1 fig., 1 tab

  16. Practice guidelines for the diagnosis and management of microcytic anemias due to genetic disorders of iron metabolism or heme synthesis.

    Science.gov (United States)

    Donker, Albertine E; Raymakers, Reinier A P; Vlasveld, L Thom; van Barneveld, Teus; Terink, Rieneke; Dors, Natasja; Brons, Paul P T; Knoers, Nine V A M; Swinkels, Dorine W

    2014-06-19

    During recent years, our understanding of the pathogenesis of inherited microcytic anemias has gained from the identification of several genes and proteins involved in systemic and cellular iron metabolism and heme syntheses. Numerous case reports illustrate that the implementation of these novel molecular discoveries in clinical practice has increased our understanding of the presentation, diagnosis, and management of these diseases. Integration of these insights into daily clinical practice will reduce delays in establishing a proper diagnosis, invasive and/or costly diagnostic tests, and unnecessary or even detrimental treatments. To assist the clinician, we developed evidence-based multidisciplinary guidelines on the management of rare microcytic anemias due to genetic disorders of iron metabolism and heme synthesis. These genetic disorders may present at all ages, and therefore these guidelines are relevant for pediatricians as well as clinicians who treat adults. This article summarizes these clinical practice guidelines and includes background on pathogenesis, conclusions, and recommendations and a diagnostic flowchart to facilitate using these guidelines in the clinical setting. © 2014 by The American Society of Hematology.

  17. 76 FR 74834 - Interim Staff Guidance on Aging Management Program for Steam Generators

    Science.gov (United States)

    2011-12-01

    ... for Steam Generators AGENCY: Nuclear Regulatory Commission. ACTION: Interim staff guidance; issuance... (LR-ISG), LR-ISG-2011-02, ``Aging Management Program for Steam Generators.'' This LR-ISG provides the...) document, NEI 97-06, ``Steam Generator Program Guidelines,'' (NRC's Agencywide Documents Access and...

  18. National clinical guidelines for management of the palatally ectopic maxillary canine.

    Science.gov (United States)

    Husain, J; Burden, D; McSherry, P; Morris, D; Allen, M

    2012-08-01

    This review summarises updated clinical guidelines produced by the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS). This guideline on the management of the palatally ectopic maxillary canine illustrates the information contained in the recently updated online version. The timely recognition of ectopic canines is important for the overall management of the dentition. This review illustrates five management strategies for ectopic permanent canines: interceptive treatment by extraction of the deciduous canine, surgical exposure and orthodontic alignment, surgical removal of the palatally ectopic permanent canine, auto-transplantation and no active treatment/leave and observe. The current available evidence for each of these management options has been evaluated and awarded a grade used by the Scottish Intercollegiate Guidelines Network.

  19. Guideline-oriented perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.

    Science.gov (United States)

    Yamakage, Michiaki; Iwasaki, Sohshi; Namiki, Akiyoshi

    2008-01-01

    Increased airway hyperresponsiveness is a major concern in the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease. Guidelines using evidence-based medicine are continually being updated and published regarding the diagnosis, treatment, and prevention of these respiratory disorders. Perioperative management in these patients involves: (1) adequate control of airway hyperresponsiveness, including detection of purulent sputum and infection before surgery; (2) evidence-based control of anesthesia; and (3) the aggressive use of beta-2 adrenergic stimulants and the systemic administration of steroids for the treatment of acute attacks. Good preoperative control, including the use of leukotriene antagonists, can reduce the incidence of life-threatening perioperative complications. Awareness of recent guidelines is thus important in the management of patients with airway hyperresponsiveness. This review covers the most recent guidelines for the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.

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

    Science.gov (United States)

    2017-04-01

    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 .

  1. Ageing management of CANDUtm concrete containment buildings

    International Nuclear Information System (INIS)

    Philipose, K.E.; Gregor, F.E.

    2009-01-01

    The containment system in a Nuclear Power Plant (NPP) provides the final physical barrier against release of radioactive materials to the external environment. Even though there are different physical configurations to meet this fundamental safety function in various reactor types, a common feature is the use of a thick-walled concrete structure as part of the containment system commonly referred to as 'Concrete Containment Building'. In order for the concrete containment buildings to continue to provide the required safety function, it has to maintain its structural integrity. As well, its leak rates under test pressures must be maintained below acceptable limits. As some of the containment buildings of the CANDU nuclear power plants are approaching their fourth decade of successful operation, questions regarding the impact of ageing on their ultimate useful service life emerge. Ageing Management has become the tool for addressing those questions. In this paper, the ageing and ageing management of the CANDU concrete containments are discussed, including the specific programs being implemented to monitor and trend the ageing conditions. Specifically, the usefulness of the embedded strain gauges as a tool for the assessment of the condition of the containment concrete structure is discussed. Some of the operational and test data accumulated over the last 30 years have been evaluated and trended to provide some results and conclusions regarding the satisfactory long-term behaviour of the concrete containment buildings. (authors)

  2. Comparing 3 guidelines on the management of surgically removed pancreatic cysts with regard to pathological outcome.

    Science.gov (United States)

    Lekkerkerker, Selma J; Besselink, Marc G; Busch, Olivier R; Verheij, Joanne; Engelbrecht, Marc R; Rauws, Erik A; Fockens, Paul; van Hooft, Jeanin E

    2017-05-01

    Currently, 3 guidelines are available for the management of pancreatic cysts. These guidelines vary in their indication for resection of high-risk cysts. We retrospectively compared the final pathologic outcome of surgically removed pancreatic cysts with the indications for resection according to 3 different guidelines. Patients who underwent pancreatic resection were extracted from our prospective pancreatic cyst database (2006-present). The final histopathologic diagnosis was compared with the initial indication for surgery stated by the guidelines of the International Association of Pancreatology (IAP), European Study Group on Cystic tumors of the Pancreas and American Gastroenterological Association (AGA). We considered surgery in retrospect justified for malignancy, high-grade dysplasia, solid pseudopapillary neoplasms, neuroendocrine tumors or symptom improvement. Furthermore, we evaluated the patients with suspected intraductal papillary mucinous neoplasm (IPMN) separately. Overall, 115 patients underwent pancreatic resection. The preoperative diagnosis was correct in 83 of 115 patients (72%) and differentiation between benign and premalignant in 99 of 115 patients (86%). In retrospect, surgery was justified according to the aforementioned criteria in 52 of 115 patients (45%). For patients with suspected IPMN (n = 75) resection was justified in 36 of 67 (54%), 36 of 68 (53%), and 32 of 54 (59%) of patients who would have had surgery based on the IAP, European, or AGA guidelines, respectively. The AGA guideline would have avoided resection in 21 of 75 (28%) patients, versus 8 of 75 (11%) and 7 of 75 (9%) when the IAP or European guideline would have been applied strictly. Nevertheless, 4 of 33 patients (12%) with high-grade dysplasia or malignancy would have been missed with the AGA guidelines, compared with none with the IAP or European guidelines. Although fewer patients undergo unnecessary surgery based on the AGA guidelines, the risk of missing

  3. Reduce--recycle--reuse: guidelines for promoting perioperative waste management.

    Science.gov (United States)

    Laustsen, Gary

    2007-04-01

    The perioperative environment generates large amounts of waste, which negatively affects local and global ecosystems. To manage this waste health care facility leaders must focus on identifying correctable issues, work with relevant stakeholders to promote solutions, and adopt systematic procedural changes. Nurses and managers can moderate negative environmental effects by promoting reduction, recycling, and reuse of materials in the perioperative setting.

  4. Proposed guidelines for the management of nodding syndrome

    African Journals Online (AJOL)

    EB

    As part of the Ugandan Ministry of Health clinical management response, a multidisciplinary team developed a manual to guide the training of health workers with knowledge and skills to manage the patients. In the absence of a known cause, it was decided to offer symptomatic care. The objective is to relieve symptoms ...

  5. 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

    have, in the past, been most evident in the developed world, their prevalence in the developing world has been gradually increasing in recent decades. This poses unique issues in diagnosis and management which have been scarcely addressed in the literature or in extant guidelines. Depending...... 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....

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

    Energy Technology Data Exchange (ETDEWEB)

    Moser, R

    2005-06-15

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

  7. 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.

  8. Occupational therapy and physiotherapy for the patient with burns: principles and management guidelines.

    Science.gov (United States)

    Simons, M; King, S; Edgar, D

    2003-01-01

    Clinical practice guidelines are a tool to assist with clinical decision making. They provide information about the care for a condition and make recommendations based on research evidence, which can be adapted locally. A focus group within the Allied Health Interest Group of the Australian and New Zealand Burn Association has compiled the "Occupational Therapy and Physiotherapy for the Patient with Burns--Principles and Management Guidelines." These guidelines are designed as a practical guide to the relevant clinical knowledge and therapy intervention techniques required for effective patient management. Content areas include respiratory management, edema management, splinting and positioning, physical function (mobility, function, exercise), scar management, and psychosocial and mutual elements. The document has undergone extensive review by members of the Australian and New Zealand Burn Association to ensure clarity, internal consistency, and acceptability. The guidelines have been endorsed by the Australian and New Zealand Burn Association. An abridged version of the guidelines is included in this article, with the full document available from www.anzba.org.au.

  9. Management of Human Immunodeficiency Virus Infection in Advanced Age

    Science.gov (United States)

    Greene, Meredith; Justice, Amy C.; Lampiris, Harry W.; Valcour, Victor

    2013-01-01

    Importance Human immunodeficiency virus (HIV)-positive patients treated with antiretroviral therapy now have increased life expectancy and develop chronic illnesses that are often seen in older HIV-negative patients. Objective To address emerging issues related to aging with HIV. Screening older adults for HIV, diagnosis of concomitant diseases, management of multiple comorbid medical illnesses, social isolation, polypharmacy, and factors associated with end-of-life care are reviewed. Evidence Acquisition Published guidelines and consensus statements were reviewed. PubMed and PsycINFO were searched between January 2000 and February 2013. Articles not appearing in the search that were referenced by reviewed articles were also evaluated. Findings The population of older HIV-positive patients is rapidly expanding. It is estimated that by 2015 one-half of the individuals in the United States with HIV will be older than age 50. Older HIV-infected patients are prone to having similar chronic diseases as their HIV-negative counterparts, as well as illnesses associated with co-infections. Medical treatments associated with these conditions, when added to an antiretroviral regimen, increase risk for polypharmacy. Care of aging HIV-infected patients involves a need to balance a number of concurrent comorbid medical conditions. Conclusions and Relevance HIV is no longer a fatal disease. Management of multiple comorbid diseases is a common feature associated with longer life expectancy in HIV-positive patients. There is a need to better understand how to optimize the care of these patients. PMID:23549585

  10. Status of ageing management program for HANARO

    International Nuclear Information System (INIS)

    Kim, Sang-Jin; Shin, Jin-Won; Kim, Hyung-Kyoo; Jung, Hoan-Sung

    2012-01-01

    HANARO is a 30 MW open pool type research reactor which has been operated for 16 years since its initial criticality in February 1995. It has been used for nuclear material testing, radioisotope production, neutron transmutation doping, nuclear activation analysis, and neutron scattering experiments. Recently, new facilities such as FTL (Fuel Transfer Loop) and CNS (Cold Neutron Source) were installed in the reactor. HANARO was originally designed to operate for at least 20 years under full power operating condition, but the actual life time is expected to be much more than the design lifetime by supporting with a safety reassessment based on realistic data and maintenance activities for an ageing management. The conducted inspections, maintenance activities, and the future plan of the ageing management for HANARO are presented in this paper. (author)

  11. Managing ageing workforces: Empirical evidence from Germany

    OpenAIRE

    Drew, H.

    2013-01-01

    Demographic change (ageing populations and falling birth rates) affects all industrialised nations, including Germany. Traditionally, the problems associated with managing numbers of older workers were mitigated by the Altersteilzeitgesetz in Germany. Under this law, firms were offered financial support by the government to offer early retirement (Müller-Camen et al. 2009). As these provisions came to an end in 2010, the need to find alternative solutions to displacing older workers, as well ...

  12. 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.

  13. 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...... for recurrent AOM (RAOM) and chronic otitis media with effusion (COME) has become the most frequently performed surgical procedure in pre-school children. Therefore, the Danish Health and Medicines Authority and the Danish Society of Otorhinolaryngology, Head and Neck Surgery deemed it necessary to update...... 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...

  14. Clinical Practice Guidelines for the Management of Atopic Dermatitis 2016.

    Science.gov (United States)

    Saeki, Hidehisa; Nakahara, Takeshi; Tanaka, Akio; Kabashima, Kenji; Sugaya, Makoto; Murota, Hiroyuki; Ebihara, Tamotsu; Kataoka, Yoko; Aihara, Michiko; Etoh, Takafumi; Katoh, Norito

    2016-10-01

    Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. Most patients have an atopic predisposition. The definitive diagnosis of AD requires the presence of all three features: (i) pruritus; (ii) typical morphology and distribution of the eczema; and (iii) chronic and chronically relapsing course. The current strategies to treat AD in Japan from the perspective of evidence-based medicine consist of three primary measures: (i) the use of topical corticosteroids and tacrolimus ointment as the main treatment for the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice. © 2016 Japanese Dermatological Association.

  15. Regulatory Aspect of an Ageing Management Program

    International Nuclear Information System (INIS)

    Basic, I.; Zabric, I.; Savli, S.

    2006-01-01

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

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

    Centers for Disease Control (CDC) Podcasts

    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.

  17. Clean Air Act Guidelines and Standards for Waste Management

    Science.gov (United States)

    This page contains the stationary sources of air pollution for the waste management industries, and their corresponding air pollution regulations. To learn more about the regulations for each industry, just click on the links below.

  18. Proposed guidelines for the management of nodding syndrome

    African Journals Online (AJOL)

    EB

    Department of Psychiatry, Mulago hospital/Makerere University College of Health Sciences, Kampala, Uganda. 6. World Health ... As part of the Ugandan Ministry of Health clinical management ... Clustering in space or time with similar cases.

  19. Proposed guidelines for the management of nodding syndrome ...

    African Journals Online (AJOL)

    ... a poorly understood neurologic disorder of unknown aetiology that affects children and adolescents in Africa. ... needs were considered as seizure control, management of behavioural and psychiatric difficulties, nursing care, nutritional and ...

  20. 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...... maintenance of normal body temperature, proper fluid management, good nutritional support, appropriate management of the ductus arteriosus and support of the circulation to maintain adequate tissue perfusion....

  1. Epidemiological review of scorpion stings in Qatar. The need for regional management guidelines in emergency departments.

    Science.gov (United States)

    Alkahlout, Baha H; Abid, Muhammad M; Kasim, Mohammad M; Haneef, Shumaila M

    2015-07-01

    To review the epidemiology of scorpion sting in Qatar, to explore both the clinical significance, and the role of the emergency department (ED) in the management of such cases. In this retrospective study, we reviewed the records of all scorpion sting cases presented to the ED of Hamad General Hospital, Doha, Qatar between October 2010 and May 2013. A total of 111 cases of scorpion stings were reviewed, 81 (72.9%) were males and 30 (27.1%) were females, with a mean age of 38 years. Localized pain was the most frequent presenting complaint (89 [80.2%]), whereas localized redness (44 [39.6%]) and swelling (38 [34.2%]) were the most common clinical signs. Abroug's classification was used, and all cases  were found to be class I. All patients received symptomatic treatment and were sent home. Scorpion sting problem in Qatar has a low clinical significance. Data from such studies should be utilized to create more specific (local) management guidelines, which should be more efficient with more rational utilization of ED resources.

  2. Guidelines for the Diagnosis and Management of Food Allergy in the United States

    Science.gov (United States)

    Boyce, Joshua A.; Assa'ad, Amal; Burks, A. Wesley; Jones, Stacie M.; Sampson, Hugh A.; Wood, Robert A.; Plaut, Marshall; Cooper, Susan F.; Fenton, Matthew J.; Arshad, S. Hasan; Bahna, Sami L.; Beck, Lisa A.; Byrd-Bredbenner, Carol; Camargo, Carlos A.; Eichenfield, Lawrence; Furuta, Glenn T.; Hanifin, Jon M.; Jones, Carol; Kraft, Monica; Levy, Bruce D.; Lieberman, Phil; Luccioli, Stefano; McCall, Kathleen M.; Schneider, Lynda C.; Simon, Ronald A.; Simons, F. Estelle R.; Teach, Stephen J.; Yawn, Barbara P.; Schwaninger, Julie M.

    2014-01-01

    Food allergy is an important public health problem that affects children and adults and may be increasing in prevalence. Despite the risk of severe allergic reactions and even death, there is no current treatment for food allergy: the disease can only be managed by allergen avoidance or treatment of symptoms. The diagnosis and management of food allergy also may vary from one clinical practice setting to another. Finally, because patients frequently confuse nonallergic food reactions, such as food intolerance, with food allergies, there is an unfounded belief among the public that food allergy prevalence is higher than it truly is. In response to these concerns, the National Institute of Allergy and Infectious Diseases, working with 34 professional organizations, federal agencies, and patient advocacy groups, led the development of clinical guidelines for the diagnosis and management of food allergy. These Guidelines are intended for use by a wide variety of health care professionals, including family practice physicians, clinical specialists, and nurse practitioners. The Guidelines include a consensus definition for food allergy, discuss comorbid conditions often associated with food allergy, and focus on both IgE-mediated and non-IgE-mediated reactions to food. Topics addressed include the epidemiology, natural history, diagnosis, and management of food allergy, as well as the management of severe symptoms and anaphylaxis. These Guidelines provide 43 concise clinical recommendations and additional guidance on points of current controversy in patient management. They also identify gaps in the current scientific knowledge to be addressed through future research. PMID:21134576

  3. Ship nuclear power device of cable aging management

    International Nuclear Information System (INIS)

    Wei Hua; Chen Miao; Chen Tao

    2012-01-01

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

  4. Management of gastric cancer in Asia: resource-stratified guidelines.

    Science.gov (United States)

    Shen, Lin; Shan, Yan-Shen; Hu, Huang-Ming; Price, Timothy J; Sirohi, Bhawna; Yeh, Kun-Huei; Yang, Yi-Hsin; Sano, Takeshi; Yang, Han-Kwang; Zhang, Xiaotian; Park, Sook Ryun; Fujii, Masashi; Kang, Yoon-Koo; Chen, Li-Tzong

    2013-11-01

    Gastric cancer is the fourth most common cancer globally, and is the second most common cause of death from cancer worldwide. About three-quarters of newly diagnosed cases in 2008 were from Asian countries. With a high mortality-to-incidence ratio, management of gastric cancer is challenging. We discuss evidence for optimum management of gastric cancer in aspects of screening and early detection, diagnosis, and staging; endoscopic and surgical intervention; and the concepts of perioperative, postoperative, and palliative chemotherapy and use of molecularly targeted therapy. Recommendations are formulated on the basis of the framework provided by the Breast Health Global Initiative, using the categories of basic, limited, enhanced, and maximum level. We aim to provide a stepwise strategy for management of gastric cancer applicable to different levels of health-care resources in Asian countries. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. Analysis of the 2015 American and European guidelines for the management of infective endocarditis.

    Science.gov (United States)

    Tattevin, P; Mainardi, J-L

    2016-12-01

    The optimal management of infective endocarditis requires a broad range of expertise (infectious disease specialists, cardiologists, microbiologists, cardiac surgeons, and intensivists). Given the low level of evidence currently available to support the management of infective endocarditis, international guidelines have always been particularly awaited and rather well implemented. Their cautious analysis of the medical literature and the range of expertise combined within the groups in charge of these guidelines are usually broadly acknowledged and respected. The publications, a few weeks apart, of the 2015 updates of the American and European guidelines, was quite disturbing. Indeed, several discrepancies on major therapeutic propositions were observed, including empirical treatment (penicillin M+penicillin A+gentamicin for Europeans in acutely ill patients; penicillin A+beta-lactamase inhibitor+gentamicin for Americans), or first-line treatment for the most common pathogen responsible for endocarditis in 2016, Staphylococcus aureus (trimethoprim-sulfamethoxazole+clindamycin as an alternative in the European guidelines, while this regimen is not even mentioned in the American guidelines). Other discrepancies were observed, although less significant: the role of positron emission tomography labelled with 18 F-fluorodeoxyglucose and administration modalities for aminoglycosides. We aimed to detail the main changes brought upon by these guidelines, their discrepancies, and the 'pros' and 'cons' that may help you select the best treatment regimen for your patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  6. School Crisis Management Manual: Guidelines for Administrators. Second Edition.

    Science.gov (United States)

    Smith, Judie

    This three-part manual is intended for principals and other administrators responsible for developing and managing school crisis plans. Part 1, preparation for a school crisis, includes sections on the selection and training of members of the school crisis team, steps in developing a school crisis plan, and four crisis scenarios to train team…

  7. 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…

  8. 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....

  9. Interventions for Age-Related Macular Degeneration: Are Practice Guidelines Based on Systematic Reviews?

    Science.gov (United States)

    Lindsley, Kristina; Li, Tianjing; Ssemanda, Elizabeth; Virgili, Gianni; Dickersin, Kay

    2016-04-01

    Are existing systematic reviews of interventions for age-related macular degeneration incorporated into clinical practice guidelines? High-quality systematic reviews should be used to underpin evidence-based clinical practice guidelines and clinical care. We examined the reliability of systematic reviews of interventions for age-related macular degeneration (AMD) and described the main findings of reliable reviews in relation to clinical practice guidelines. Eligible publications were systematic reviews of the effectiveness of treatment interventions for AMD. We searched a database of systematic reviews in eyes and vision without language or date restrictions; the database was up to date as of May 6, 2014. Two authors independently screened records for eligibility and abstracted and assessed the characteristics and methods of each review. We classified reviews as reliable when they reported eligibility criteria, comprehensive searches, methodologic quality of included studies, appropriate statistical methods for meta-analysis, and conclusions based on results. We mapped treatment recommendations from the American Academy of Ophthalmology (AAO) Preferred Practice Patterns (PPPs) for AMD to systematic reviews and citations of reliable systematic reviews to support each treatment recommendation. Of 1570 systematic reviews in our database, 47 met inclusion criteria; most targeted neovascular AMD and investigated anti-vascular endothelial growth factor (VEGF) interventions, dietary supplements, or photodynamic therapy. We classified 33 (70%) reviews as reliable. The quality of reporting varied, with criteria for reliable reporting met more often by Cochrane reviews and reviews whose authors disclosed conflicts of interest. Anti-VEGF agents and photodynamic therapy were the only interventions identified as effective by reliable reviews. Of 35 treatment recommendations extracted from the PPPs, 15 could have been supported with reliable systematic reviews; however, only 1

  10. Ageing and plant life management software Comsy

    Energy Technology Data Exchange (ETDEWEB)

    Nopper, H.; Daeuwel, W.; Kastner, W. [Siemens Nuclear Power GmbH (SNP), Erlangen (Germany)

    2001-07-01

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

  11. Ageing and plant life management software Comsy

    International Nuclear Information System (INIS)

    Nopper, H.; Daeuwel, W.; Kastner, W.

    2001-01-01

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

  12. 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

  13. 2014 KLCSG-NCC 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. PMID:25918260

  14. 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

    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......INTRODUCTION: Despite the availability of evidence-based guidelines for the management of low back pain that contain consistent messages, large evidence-practice gaps in primary care remain. OBJECTIVES: To perform a systematic review and meta-synthesis of qualitative studies that have explored...... primary care clinicians' perceptions and beliefs about guidelines for low back pain, including perceived enablers and barriers to guideline adherence. METHODS: Studies investigatingperceptions and beliefs about low back pain guidelines were included if participants were primary care clinicians...

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

    International Nuclear Information System (INIS)

    Krajnc, B.; Basic, I.; Spiler, J.

    2001-01-01

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

  16. 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.

  17. 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.

  18. Clinical Practice Guidelines for the Medical Management of Nonhospitalized Ulcerative Colitis: The Patient Perspective

    Directory of Open Access Journals (Sweden)

    A Hillary Steinhart

    2015-01-01

    Full Text Available 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.

  19. Pilot study comparing sepsis management with and without electronic clinical practice guidelines in an academic emergency department.

    Science.gov (United States)

    Bond, Christopher M; Djogovic, Dennis; Villa-Roel, Cristina; Bullard, Michael J; Meurer, David P; Rowe, Brian H

    2013-03-01

    Sepsis is a potentially life-threatening condition that requires urgent management in an Emergency Department (ED). Evidence-based guidelines for managing sepsis have been developed; however, their integration into routine practice is often incomplete. Care maps may help clinicians meet guideline targets more often. To determine if electronic clinical practice guidelines (eCPGs) improve management of patients with severe sepsis and septic shock (SS/SS). The impact of an eCPG on the management of patients presenting with SS/SS over a 3-year period at a tertiary care ED was evaluated using retrospective case-control design and chart review methods. Cases and controls, matched by age and sex, were chosen from an electronic database using physician sepsis diagnoses. Data were compared using McNemar tests or paired t-tests, as appropriate. Overall, 51 cases and controls were evaluated; the average age was 62 years, and 60% were male. eCPG patients were more likely to have a central venous pressure and central venous oxygen saturation measured; however, lactate measurement, blood cultures, and other investigations were similarly ordered (all p > 0.05). The administration of antibiotics within 3 h (63% vs. 41%; p = 0.03) and vasopressors (45% vs. 20%; p = 0.02) was more common in the eCPG group; however, use of corticosteroids and other interventions did not differ between the groups. Overall, survival was high and similar between groups. A sepsis eCPG experienced variable use; however, physicians using the eCPG achieved more quality-of-care targets for SS/SS. Strategies to increase the utilization of eCPGs in Emergency Medicine seem warranted. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Chronic hepatitis B management based on standard guidelines in community primary care and specialty clinics.

    Science.gov (United States)

    Ku, Kevin C; Li, Jiayi; Ha, Nghi B; Martin, Marina; Nguyen, Vincent G; Nguyen, Mindie H

    2013-12-01

    Prior studies have underlined the need for increased screening and awareness of chronic hepatitis B (CHB), especially in certain high-risk populations. However, few studies have examined the patterns of evaluation and management of CHB between primary care physicians (PCP) and specialists according to commonly-used professional guidelines. Our goal was to examine whether necessary laboratory parameters used to determine disease status and eligibility for antiviral therapy were performed by PCPs and specialists. We conducted a retrospective study of 253 treatment-naïve CHB patients who were evaluated by PCP only (n=63) or by specialists (n=190) for CHB at a community multispecialty medical center between March 2007 and June 2009. Criteria for CHB management and treatment eligibility were based on the American Association for the Study of Liver Diseases 2007 guideline and the US Panel 2006 algorithm. Required parameters for optimal evaluation for CHB included hepatitis B e antigen (HBeAg), HBV DNA, and alanine aminotransferase (ALT). Preferred antiviral agents for CHB included pegylated interferon, adefovir, and entecavir. The majority of patients were Asians (90%) and (54%) with a mean age of 43±11.6 years. Compared to PCPs, specialists were more likely to order laboratory testing for ALT (94 vs. 86%, P=0.05), HBeAg (67 vs. 41%, P<0.0001) and HBV DNA (83 vs. 52%, P<0.0001). The proportion of patients having all three laboratory parameters was significantly higher among those evaluated by specialists compared to PCP (62 vs. 33%, P<0.0001). A total of 55 patients were initiated on antiviral treatment (n=47 by specialists and n=6 by PCPs). Lamivudine was prescribed more often by PCPs than specialists (33 vs. 2%, P=0.05). Preferred agents were used 96% of the time by specialists compared to 67% of those treated by PCPs (P=0.05). Patients evaluated by specialists for CHB are more likely to undergo more complete laboratory evaluation and, if eligible, are also more

  1. Evaluation of validity of Integrated Management of Childhood Illness guidelines in identifying edema of nutritional causes among Egyptian children.

    Science.gov (United States)

    El Habashy, Safinaz A; Mohamed, Maha H; Amin, Dina A; Marzouk, Diaa; Farid, Mohammed N

    2015-12-01

    The aim of this study was to assess the validity of the Integrated Management of Childhood Illness (IMCI) algorithm to detect edematous type of malnutrition in Egyptian infants and children ranging in age from 2 months to 5 years. This study was carried out by surveying 23 082 children aged between 2 months and 5 years visiting the pediatric outpatient clinic, Ain Shams University Hospital, over a period of 6 months. Thirty-eight patients with edema of both feet on their primary visit were enrolled in the study. Every child was assessed using the IMCI algorithm 'assess and classify' by the same physician, together with a systematic clinical evaluation with all relevant investigations. Twenty-two patients (57.9%) were proven to have nutritional etiology. 'Weight for age' sign had a sensitivity of 95.5%, a specificity of 56%, and a diagnostic accuracy of 78.95% in the identification of nutritional edema among all cases of bipedal edema. Combinations of IMCI symptoms 'pallor, visible severe wasting, fever, diarrhea', and 'weight for age' increased the sensitivity to 100%, but with a low specificity of 38% and a diagnostic accuracy of 73.68%. Bipedal edema and low weight for age as part of the IMCI algorithm can identify edema because of nutritional etiology with 100% sensitivity, but with 37% specificity. Revisions need to be made to the IMCI guidelines published in 2010 by the Egyptian Ministry of Health in the light of the new WHO guidelines of 2014.

  2. Effective recordkeeping technologies to manage aging

    International Nuclear Information System (INIS)

    Dukelow, J.S.; Johnson, A.B. Jr.; Vora, J.P.

    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

  3. 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.

  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. Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy.

    Science.gov (United States)

    McCowan, Lesley M; Figueras, Francesc; Anderson, Ngaire H

    2018-02-01

    Small for gestational age is usually defined as an infant with a birthweight restriction refers to a fetus that has failed to reach its biological growth potential because of placental dysfunction. Small-for-gestational-age babies make up 28-45% of nonanomalous stillbirths, and have a higher chance of neurodevelopmental delay, childhood and adult obesity, and metabolic disease. The majority of small-for-gestational-age babies are not recognized before birth. Improved identification, accompanied by surveillance and timely delivery, is associated with reduction in small-for-gestational-age stillbirths. Internationally and regionally, detection of small for gestational age and management of fetal growth problems vary considerably. The aim of this review is to: summarize areas of consensus and controversy between recently published national guidelines on small for gestational age or fetal growth restriction; highlight any recent evidence that should be incorporated into existing guidelines; and identify future research priorities in this field. A search of MEDLINE, Google, and the International Guideline Library identified 6 national guidelines on management of pregnancies complicated by fetal growth restriction/small for gestational age published from 2010 onwards. There is general consensus between guidelines (at least 4 of 6 guidelines in agreement) in early pregnancy risk selection, and use of low-dose aspirin for women with major risk factors for placental insufficiency. All highlight the importance of smoking cessation to prevent small for gestational age. While there is consensus in recommending fundal height measurement in the third trimester, 3 specify the use of a customized growth chart, while 2 recommend McDonald rule. Routine third-trimester scanning is not recommended for small-for-gestational-age screening, while women with major risk factors should have serial scanning in the third trimester. Umbilical artery Doppler studies in suspected small-for-gestational-age

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

    International Nuclear Information System (INIS)

    1998-08-01

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

  7. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding.

    Science.gov (United States)

    Gerson, Lauren B; Fidler, Jeff L; Cave, David R; Leighton, Jonathan A

    2015-09-01

    Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended

  8. Guidelines on the medical management of tritiated water overexposures

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-09-01

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

  9. Guidelines on the medical management of tritiated water overexposures

    International Nuclear Information System (INIS)

    1995-09-01

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

  10. Guidelines for Implementing Revenue Management in the Restaurant Industry

    OpenAIRE

    Ammunet, Mika

    2016-01-01

    The aim of this thesis is to draw an outline of how to implement revenue management in the restaurant industry. The practice well-known in the hotel and airline industry is proven to be suitable for the food and beverage businesses. First of all, the key strategic levers, price and duration, are presented and defined. Based on the basic principle that the demand for a product varies according to its price, the application of modern pricing and dynamic pricing is introduced in this thesis....

  11. Guidelines on the medical management of tritiated water overexposures

    International Nuclear Information System (INIS)

    1996-04-01

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

  12. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma.

    Science.gov (United States)

    Wall, Christopher J; Lynch, Joan; Harris, Ian A; Richardson, Martin D; Brand, Caroline; Lowe, Adrian J; Sugrue, Michael

    2010-03-01

    Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency, and is associated with significant morbidity if not managed appropriately. There is variation in management of acute limb compartment syndrome in Australia. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma were developed in accordance with Australian National Health and Medical Research Council recommendations. The guidelines were based on critically appraised literature evidence and the consensus opinion of a multidisciplinary team involved in trauma management who met in a nominal panel process. Recommendations were developed for key decision nodes in the patient care pathway, including methods of diagnosis in alert and unconscious patients, appropriate assessment of compartment pressure, timing and technique of fasciotomy, fasciotomy wound management, and prevention of compartment syndrome in patients with limb injuries. The recommendations were largely consensus based in the absence of well-designed clinical trial evidence. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma have been developed that will support consistency in management and optimize patient health outcomes.

  13. Recent Status RSG-GAS Ageing Management

    Energy Technology Data Exchange (ETDEWEB)

    Sunaryo, Geni Rina; Setianto; Tarigan, Alim [Puspiptek Area, Serpong (Indonesia); Wisnubroto, D. S. [Mampang Prapatan, Jakarta (Indonesia)

    2013-07-01

    RSG GAS Research Reactor.30 MW, which is the biggest scientific investment made by the Indonesian Government, is operating safely for about 27 years. This research reactor has been built and developed since year 1983. Critical attainment reached first on July 1987 and ceremonial opened by president of RI on August 20{sup th} 1987. Operated with full energy of 30 MW reached first time on March 1992. It started becoming commercially operated since 1995. RSG-GAS has a maximum thermal energy of 30 MW and has neutron flux of averaged 10{sup 14} n/cm{sup 2}.sec coming from fissile reaction. RSG-GAS is a reactor with pool type with fuel of 19.75% enriched U{sub 3}O{sub 8}Al/U{sub 3}Si{sub 2}Al and burned up ratio up to 56%. RSG GAS has been built for scientific purpose by utilizing neutron beam instruments and isotope productions. Facilities allowing Neutron Activation Analysis for research and industry are both on-line. For affording the utilization or the reactor operation approaching the designed life, the progressive ageing management is being applied. This paper will address the ageing management based on the importance to safety and SSC replacement ease consideration, which is implemented on RSG GAS. It consist of minimization of expected ageing prevention which is divided into prevention actions and followed by periodic review of this effectiveness, detection, monitoring and trending of ageing degradation through periodically inspections, and testing. Some activities such as NDT-ultrasonic to mitigating the ageing degradation of secondary water pipe lines, underwater camera for tank liners, infrared thermograph for understanding the cable insulation age, Eddy Current for inspecting the Heat Exchangers, surveillance corrosion for understanding the corrosion mechanism and structure material lifetime by immersing cupons into primary, secondary and raw water basin for many years and some ended by refurbishment-for secondary pump, are being applied. Based on the results

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

    International Nuclear Information System (INIS)

    Rinckel, M.A.; Young, G.G.

    2002-01-01

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

  15. Defence in Depth and Ageing Management

    Energy Technology Data Exchange (ETDEWEB)

    Fabbri, S.; Vega, G.; Diluch, A.; Versaci, R., E-mail: versaci@cnea.gov.ar [Comisión Nacional de Energía Atómica, Buenos Aires (Argentina)

    2014-10-15

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

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

    Directory of Open Access Journals (Sweden)

    Anand Shridharani

    2016-01-01

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

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

    Science.gov (United States)

    Shridharani, Anand; Owen, Ryan C; Elkelany, Osama O; Kim, Edward D

    2016-01-01

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

  18. Saudi Oncology Society clinical management guidelines for testicular germ cell tumors

    Directory of Open Access Journals (Sweden)

    Mohammed Al Otaibi

    2011-01-01

    Full Text Available In this report, guidelines for the evaluation, medical and surgical management of transitional cell carcinoma of testicular germ cell tumors 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 level of evidence.

  19. Management of achalasia in the UK, do we need new guidelines?

    Directory of Open Access Journals (Sweden)

    Jihene El Kafsi

    2016-12-01

    Conclusion: Diagnosis and management of achalasia within the UK is relatively standardised, although there remains limited access to HRM. Discussion at benign MDTs however is poor and follow-up differs widely. UK guidelines may help to make these more uniform.

  20. Compliance with national guidelines for the management of drug-drug interactions in Dutch community pharmacies.

    NARCIS (Netherlands)

    Buurma, H.; Schalekamp, T.; Egberts, A.C.G.; Smet, P.A.G.M. de

    2007-01-01

    BACKGROUND: Pharmacists contribute to the detection and prevention of drug therapy-related problems, including drug-drug interactions. Little is known about compliance with pharmacy practice guidelines for the management of drug-drug interaction alerts. OBJECTIVE: To measure the compliance of

  1. IAP/APA evidence-based guidelines for the management of acute pancreatitis

    NARCIS (Netherlands)

    Goor, H. van; et al.,

    2013-01-01

    BACKGROUND: There have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise

  2. IAP/APA evidence-based guidelines for the management of acute pancreatitis

    NARCIS (Netherlands)

    Besselink, Marc; van Santvoort, Hjalmar; Freeman, Martin; Gardner, Timothy; Mayerle, Julia; Vege, Santhi Swaroop; Werner, Jens; Banks, Peter; McKay, Colin; Fernandez-del Castillo, Carlos; French, Jeremy; Gooszen, Hein; Johnson, Colin; Sarr, Mike; Takada, Tadahiro; Windsor, John; Saluja, Ashok; Liddle, Rodger; Papachristou, Georgios; Singh, Vijay; Rünzi, Michael; Wu, Bechien; Singh, Vikesh; Bollen, Thomas; Morgan, Desiree; Mortele, Koenraad; Mittal, Anubhav; En-qiang, Mao; de Waele, Jan; Petrov, Maxim; Dellinger, Patchen; Lerch, Markus M.; Anderson, Roland; McClave, Stephen; Hartwig, Werner; Bruno, Marco; Oria, Alejandro; Baron, Todd; Castillo, Carlos Fernandez-Del; Fagenholz, Peter; Horvath, Karen; van Baal, Mark; Nealon, William; Andren-Sandberg, Ake; Bakker, Olaf; Bassi, Claudio; Buchler, Markus; Boermeester, Marja; Bradley, Ed; Fockens, Paul

    2013-01-01

    There have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise these

  3. EAACI Food Allergy and Anaphylaxis Guidelines: managing patients with food allergy in the community

    NARCIS (Netherlands)

    Muraro, A.; Agache, I.; Clark, A.; Sheikh, A.; Roberts, G.; Akdis, C. A.; Borrego, L. M.; Higgs, J.; Hourihane, J. O.'B.; Jorgensen, P.; Mazon, A.; Parmigiani, D.; Said, M.; Schnadt, S.; van Os-Medendorp, H.; Vlieg-Boerstra, B. J.; Wickman, M.

    2014-01-01

    The European Academy of Allergy and Clinical Immunology (EAACI) Food Allergy and Anaphylaxis Guidelines, managing patients with food allergy (FA) in the community, intend to provide guidance to reduce the risk of accidental allergic reactions to foods in the community. This document is intended to

  4. EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis.

    Science.gov (United States)

    Párniczky, Andrea; Abu-El-Haija, Maisam; Husain, Sohail; Lowe, Mark; Oracz, Grzegorz; Sahin-Tóth, Miklós; Szabó, Flóra K; Uc, Aliye; Wilschanski, Michael; Witt, Heiko; Czakó, László; Grammatikopoulos, Tassos; Rasmussen, Ib Christian; Sutton, Robert; Hegyi, Péter

    2018-03-01

    Pediatric pancreatitis is an underdiagnosed disease with variable etiology. In the past 10-15 years the incidence of pediatric pancreatitis has increased, it is now 3.6-13.3 cases per 100,000 children. Up-to-date evidence based management guidelines are lacking for the pediatric pancreatitis. The European Pancreatic Club, in collaboration with the Hungarian Pancreatic Study Group organized a consensus guideline meeting on the diagnosis and management of pancreatitis in the pediatric population. Pediatric Pancreatitis was divided into three main clinical categories: acute pancreatitis, acute recurrent pancreatitis and chronic pancreatitis. Fifteen relevant topics (acute pancreatitis: diagnosis; etiology; prognosis; imaging; complications; therapy; biliary tract management; acute recurrent pancreatitis: diagnosis; chronic pancreatitis: diagnosis, etiology, treatment, imaging, intervention, pain, complications; enzyme replacement) were defined. Ten experts from the USA and Europe reviewed and summarized the available literature. Evidence was classified according to the GRADE classification system. Within fifteen topics, forty-seven relevant clinical questions were defined. The draft of the updated guideline was presented and discussed at the consensus meeting held during the 49th Meeting of European Pancreatic Club, in Budapest, on July 1, 2017. These evidence-based guidelines provides the current state of the art of the diagnosis and management of pediatric pancreatitis. Copyright © 2018 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  5. The management of work-related asthma guidelines: a broader perspective

    NARCIS (Netherlands)

    Baur, X.; Aasen, T.B.; Burge, P.S.; Heederik, D.

    2012-01-01

    The aim of the European Respiratory Society work-related asthma guidelines is to present the management and prevention options of work-related asthma and their effectiveness. Work-related asthma accounts for 5-25% of all adult asthma cases and is responsible for a significant socioeconomic burden.

  6. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

    NARCIS (Netherlands)

    Rhodes, Andrew; Evans, Laura E.; Alhazzani, Waleed; Levy, Mitchell M.; Antonelli, Massimo; Ferrer, Ricard; Kumar, Anand; Sevransky, Jonathan E.; Sprung, Charles L.; Nunnally, Mark E.; Rochwerg, Bram; Rubenfeld, Gordon D.; Angus, Derek C.; Annane, Djillali; Beale, Richard J.; Bellinghan, Geoffrey J.; Bernard, Gordon R.; Chiche, Jean-Daniel; Coopersmith, Craig; de Backer, Daniel P.; French, Craig J.; Fujishima, Seitaro; Gerlach, Herwig; Hidalgo, Jorge Luis; Hollenberg, Steven M.; Jones, Alan E.; Karnad, Dilip R.; Kleinpell, Ruth M.; Koh, Younsuk; Lisboa, Thiago Costa; Machado, Flavia R.; Marini, John J.; Marshall, John C.; Mazuski, John E.; McIntyre, Lauralyn A.; McLean, Anthony S.; Mehta, Sangeeta; Moreno, Rui P.; Myburgh, John; Navalesi, Paolo; Nishida, Osamu; Osborn, Tiffany M.; Perner, Anders; Plunkett, Colleen M.; Ranieri, Marco; Schorr, Christa A.; Seckel, Maureen A.; Seymour, Christopher W.; Shieh, Lisa; Shukri, Khalid A.; Simpson, Steven Q.; Singer, Mervyn; Thompson, B. Taylor; Townsend, Sean R.; van der Poll, Thomas; Vincent, Jean-Louis; Wiersinga, W. Joost; Zimmerman, Janice L.; Dellinger, R. Phillip

    2017-01-01

    To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee

  7. Evaluation of a Pain Management Education Program and Operational Guideline on Nursing Practice, Attitudes, and Pain Management.

    Science.gov (United States)

    Bonkowski, Sara L; De Gagne, Jennie C; Cade, Makia B; Bulla, Sally A

    2018-04-01

    Nurses lack adequate pain management knowledge, which can result in poorly managed postsurgical pain. This study aimed to develop, implement, and evaluate pain management education and operational guidelines to improve nursing knowledge and pain management. This quality improvement project employed convenience samples of surgical oncology nurses and postoperative patients. The intervention involved an online module, live education, and operational guideline for pain management. Nurses completed pre- and postintervention practice and attitudes surveys. Random chart reviews of intravenous narcotic administrations the day before discharge were completed to evaluate whether narcotic administration changed after intervention. Readmissions and Hospital Consumer Assessment of Healthcare Providers and Systems data were collected to determine whether the intervention influenced patient satisfaction. A statistically significant improvement in nursing practice and intravenous narcotic administrations demonstrated changes to pain management practices employed by the nursing staff. Although not statistically significant, fewer pain-related readmissions occurred postintervention. Findings demonstrate that targeted pain management continuing education, paired with operational guidelines, improves nursing practice and decreases intravenous narcotic administrations prior to discharge. J Contin Educ Nurs. 2018;49(4):178-185. Copyright 2018, SLACK Incorporated.

  8. 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.

  9. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis.

    Science.gov (United States)

    Ross, Douglas S; Burch, Henry B; Cooper, David S; Greenlee, M Carol; Laurberg, Peter; Maia, Ana Luiza; Rivkees, Scott A; Samuels, Mary; Sosa, Julie Ann; Stan, Marius N; Walter, Martin A

    2016-10-01

    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 document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves' hyperthyroidism with antithyroid drugs, the management of pregnant hyperthyroid patients, and the

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

    International Nuclear Information System (INIS)

    Jonsson, Josefin Paeivioe; Andersson, Kjell; Bolado, Ricardo; Drottz Sjoeberg, Britt-Marie; Elam, Mark; Sundqvist, Goeran; Kojo, Matti; Meskens, Gaston; Pritrsky, Jozef; Richardson, Phil; Soneryd, Linda; Steinerova, Lucie; Szerszynski, Bronislaw; Wene, Clas-Otto; Vojtechova, Hana

    2010-02-01

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

  11. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada

    Science.gov (United States)

    Brown, Jacques P.; Josse, Robert G.

    2002-01-01

    Objective To revise and expand the 1996 Osteoporosis Society of Canada clinical practice guidelines for the management of osteoporosis, incorporating recent advances in diagnosis, prevention and management of osteoporosis, and to identify and assess the evidence supporting the recommendations. Options All aspects of osteoporosis care and its fracture complications — including classification, diagnosis, management and methods for screening, as well as prevention and reducing fracture risk — were reviewed, revised as required and expressed as a set of recommendations. Outcomes Strategies for identifying and evaluating those at high risk; the use of bone mineral density and biochemical markers in diagnosis and assessing response to management; recommendations regarding nutrition and physical activity; and the selection of pharmacologic therapy for the prevention and management of osteoporosis in men and women and for osteoporosis resulting from glucocorticoid treatment. Evidence All recommendations were developed using a justifiable and reproducible process involving an explicit method for the evaluation and citation of supporting evidence. Values All recommendations were reviewed by members of the Scientific Advisory Council of the Osteoporosis Society of Canada, an expert steering committee and others, including family physicians, dietitians, therapists and representatives of various medical specialties involved in osteoporosis care (geriatric medicine, rheumatology, endocrinology, obstetrics and gynecology, nephrology, radiology) as well as methodologists from across Canada. Benefits, harm and costs Earlier diagnosis and prevention of fractures should decrease the medical, social and economic burdens of this disease. Recommendations This document outlines detailed recommendations pertaining to all aspects of osteoporosis. Strategies for identifying those at increased risk (i.e., those with at least one major or 2 minor risk factors) and screening with central

  12. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty.

    Science.gov (United States)

    Dent, Elsa; Lien, Christopher; Lim, Wee Shiong; Wong, Wei Chin; Wong, Chek Hooi; Ng, Tze Pin; Woo, Jean; Dong, Birong; de la Vega, Shelley; Hua Poi, Philip Jun; Kamaruzzaman, Shahrul Bahyah Binti; Won, Chang; Chen, Liang-Kung; Rockwood, Kenneth; Arai, Hidenori; Rodriguez-Mañas, Leocadio; Cao, Li; Cesari, Matteo; Chan, Piu; Leung, Edward; Landi, Francesco; Fried, Linda P; Morley, John E; Vellas, Bruno; Flicker, Leon

    2017-07-01

    To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty. An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation. Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan. The recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  13. Nutrition management guideline for maple syrup urine disease: an evidence- and consensus-based approach.

    Science.gov (United States)

    Frazier, Dianne M; Allgeier, Courtney; Homer, Caroline; Marriage, Barbara J; Ogata, Beth; Rohr, Frances; Splett, Patricia L; Stembridge, Adrya; Singh, Rani H

    2014-07-01

    In an effort to increase harmonization of care and enable outcome studies, the Genetic Metabolic Dietitians International (GMDI) and the Southeast Regional Newborn Screening and Genetics Collaborative (SERC) are partnering to develop nutrition management guidelines for inherited metabolic disorders (IMD) using a model combining both evidence- and consensus-based methodology. The first guideline to be completed is for maple syrup urine disease (MSUD). This report describes the methodology used in its development: formulation of five research questions; review, critical appraisal and abstraction of peer-reviewed studies and unpublished practice literature; and expert input through Delphi surveys and a nominal group process. This report includes the summary statements for each research question and the nutrition management recommendations they generated. Each recommendation is followed by a standardized rating based on the strength of the evidence and consensus used. The application of technology to build the infrastructure for this project allowed transparency during development of this guideline and will be a foundation for future guidelines. Online open access of the full, published guideline allows utilization by health care providers, researchers, and collaborators who advise, advocate and care for individuals with MSUD and their families. There will be future updates as warranted by developments in research and clinical practice. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Comparing guidelines for adjuvant endocrine therapy in postmenopausal women with breast cancer: a coming of age.

    Science.gov (United States)

    Verma, Sunil; Jackisch, Christian

    2011-02-01

    Following surgery for early breast cancer, the standard of care for postmenopausal women is adjuvant therapy with any combination of radiation therapy, endocrine therapy, chemotherapy and/or targeted therapy. Clinicians rely on many tools, including guidelines, to make these treatment decisions. Such guidelines include the St Gallen consensus statement, the American Society of Clinical Oncology guidelines and the National Comprehensive Cancer Network guidelines, as well as various regional and national guidelines. Recommendations may vary, because different methods and criteria were used to assess the strength of supporting data. This article provides an overview of global guidelines for the adjuvant treatment of breast cancer and points out the major differences. Ongoing changes are highlighted, particularly those regarding the adjuvant endocrine treatment of postmenopausal women with breast cancer. While previous guidelines recommended tamoxifen alone, all major guidelines now recommend using third-generation aromatase inhibitors either in sequence with tamoxifen or as upfront treatment.

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

    NARCIS (Netherlands)

    Lundgren, J. D.; Battegay, M.; Behrens, G.; de Wit, S.; Guaraldi, G.; Katlama, C.; Martinez, E.; Nair, D.; Powderly, W. G.; Reiss, P.; Sutinen, J.; Vigano, A.

    2008-01-01

    BACKGROUND: Metabolic diseases are frequently observed in HIV-infected persons and, as the risk of contracting these diseases is age-related, their prevalence will increase in the future as a consequence of the benefits of antiretroviral therapy (ART). SUMMARY OF GUIDELINES: All HIV-infected persons

  16. Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines.

    Science.gov (United States)

    Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A; Parkinson, Martin; Dickson, Jon M

    2015-01-01

    Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  17. Early geriatric consultation increases adherence to TQIP Geriatric Trauma Management Guidelines.

    Science.gov (United States)

    Southerland, Lauren T; Gure, Tanya R; Ruter, Daniel I; Li, Michael M; Evans, David C

    2017-08-01

    The American College of Surgeons' Trauma Quality Improvement Program (TQIP) Geriatric Trauma Management Guidelines recommend geriatric consultation for injured older adults. However it is not known how or whether geriatric consultation improves compliance to these quality measures. This study is a retrospective chart review of our institutional trauma databank. Adherence to quality measures was compared before and after implementation of specific triggers for geriatric consultation. Secondary analyses evaluated adherence by service: trauma service (Trauma) or a trauma service with early geriatric consultation (GeriTrauma). The average age of the 245 patients was 76.7 years, 47% were women, and mean Injury Severity Score was 9.5 (SD ±8.1). Implementation of the GeriTrauma collaborative increased geriatric consultation rates from 2% to 48% but had minimal effect on overall adherence to TQIP quality measures. A secondary analysis comparing those in the post implementation group who received geriatric consultation (n = 94) to those who did not (n = 103) demonstrated higher rates of delirium diagnosis (36.2% vs 14.6%, P quality indicators is needed. Copyright © 2017 Elsevier Inc. All rights reserved.

  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. Guidelines on the irritable bowel syndrome: mechanisms and practical management

    Science.gov (United States)

    Spiller, R; Aziz, Q; Creed, F; Emmanuel, A; Houghton, L; Hungin, P; Jones, R; Kumar, D; Rubin, G; Trudgill, N; Whorwell, P

    2007-01-01

    Background IBS affects 5–11% of the population of most countries. Prevalence peaks in the third and fourth decades, with a female predominance. Aim To provide a guide for the assessment and management of adult patients with irritable bowel syndrome. Methods Members of the Clinical Services Committee of The British Society of Gastroenterology were allocated particular areas to produce review documents. Literature searching included systematic searches using electronic databases such as Pubmed, EMBASE, MEDLINE, Web of Science, and Cochrane databases and extensive personal reference databases. Results Patients can usefully be classified by predominant bowel habit. Few investigations are needed except when diarrhoea is a prominent feature. Alarm features may warrant further investigation. Adverse psychological features and somatisation are often present. Ascertaining the patients' concerns and explaining symptoms in simple terms improves outcome. IBS is a heterogeneous condition with a range of treatments, each of which benefits a small proportion of patients. Treatment of associated anxiety and depression often improves bowel and other symptoms. Randomised placebo controlled trials show benefit as follows: cognitive behavioural therapy and psychodynamic interpersonal therapy improve coping; hypnotherapy benefits global symptoms in otherwise refractory patients; antispasmodics and tricyclic antidepressants improve pain; ispaghula improves pain and bowel habit; 5‐HT3 antagonists improve global symptoms, diarrhoea, and pain but may rarely cause unexplained colitis; 5‐HT4 agonists improve global symptoms, constipation, and bloating; selective serotonin reuptake inhibitors improve global symptoms. Conclusions Better ways of identifying which patients will respond to specific treatments are urgently needed. PMID:17488783

  20. Vitiligo: concise evidence based guidelines on diagnosis and management.

    Science.gov (United States)

    Gawkrodger, David J; Ormerod, Anthony D; Shaw, Lindsay; Mauri-Sole, Inma; Whitton, Maxine E; Watts, M Jane; Anstey, Alex V; Ingham, Jane; Young, Katharine

    2010-08-01

    Vitiligo is a common disease that causes a great degree of psychological distress. In its classical forms it is easily recognised and diagnosed. This review provides an evidence based outline of the management of vitiligo, particularly with the non-specialist in mind. Treatments for vitiligo are generally unsatisfactory. The initial approach to a patient who is thought to have vitiligo is to make a definite diagnosis, offer psychological support, and suggest supportive treatments such as the use of camouflage cosmetics and sunscreens, or in some cases after discussion the option of no treatment. Active therapies open to the non-specialist, after an explanation of potential side effects, include the topical use of potent or highly potent steroids or calcineurin inhibitors for a defined period of time (usually 2 months), following which an assessment is made to establish whether or not there has been a response. Patients whose condition is difficult to diagnose, unresponsive to straightforward treatments, or is causing psychological distress, are usually referred to a dermatologist. Specialist dermatology units have at their disposal phototherapy, either narrow band ultraviolet B or in some cases photochemotherapy, which is the most effective treatment presently available and can be considered for symmetrical types of vitiligo. Depigmenting treatments and possibly surgical approaches may be appropriate for vitiligo in selected cases. There is no evidence that presently available systemic treatments are helpful and safe in vitiligo. There is a need for further research into the causes of vitiligo, and into discovering better treatments.

  1. Management of patients with sore throats in relation to guidelines: an interview study in Sweden.

    Science.gov (United States)

    Hedin, Katarina; Strandberg, Eva Lena; Gröndal, Hedvig; Brorsson, Annika; Thulesius, Hans; André, Malin

    2014-12-01

    To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews. Qualitative content analysis was used to analyse semi-structured interviews. Swedish primary care. A strategic sample of 25 GPs. Perceived management of sore throat patients. It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identified and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs. This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed significant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.

  2. 2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension

    Directory of Open Access Journals (Sweden)

    Chern-En Chiang

    2015-01-01

    The TSOC/THS hypertension guidelines provide the most updated information available in the management of hypertension. The guidelines are not mandatory, and members of the task force fully realize that treatment of hypertension should be individualized to address each patient's circumstances. Ultimately, the decision of the physician decision remains of the utmost importance in hypertension management.

  3. Feline immunodeficiency. ABCD guidelines on prevention and management.

    Science.gov (United States)

    Hosie, Margaret J; Addie, Diane; Belák, Sándor; Boucraut-Baralon, Corine; Egberink, Herman; Frymus, Tadeusz; Gruffydd-Jones, Tim; Hartmann, Katrin; Lloret, Albert; Lutz, Hans; Marsilio, Fulvio; Pennisi, Maria Grazia; Radford, Alan D; Thiry, Etienne; Truyen, Uwe; Horzinek, Marian C

    2009-07-01

    Feline immunodeficiency virus (FIV) is a retrovirus closely related to human immunodeficiency virus. Most felids are susceptible to FIV, but humans are not. Feline immunodeficiency virus is endemic in domestic cat populations worldwide. The virus loses infectivity quickly outside the host and is susceptible to all disinfectants. Feline immunodeficiency virus is transmitted via bites. The risk of transmission is low in households with socially well-adapted cats. Transmission from mother to kittens may occur, especially if the queen is undergoing an acute infection. Cats with FIV are persistently infected in spite of their ability to mount antibody and cell-mediated immune responses. Infected cats generally remain free of clinical signs for several years, and some cats never develop disease, depending on the infecting isolate. Most clinical signs are the consequence of immunodeficiency and secondary infection. Typical manifestations are chronic gingivostomatitis, chronic rhinitis, lymphadenopathy, weight loss and immune-mediated glomerulonephritis. Positive in-practice ELISA results obtained in a low-prevalence or low-risk population should always be confirmed by a laboratory. Western blot is the 'gold standard' laboratory test for FIV serology. PCR-based assays vary in performance. Cats should never be euthanased solely on the basis of an FIV-positive test result. Cats infected with FIV may live as long as uninfected cats, with appropriate management. Asymptomatic FIV-infected cats should be neutered to avoid fighting and virus transmission. Infected cats should receive regular veterinary health checks. They can be housed in the same ward as other patients, but should be kept in individual cages. At present, there is no FIV vaccine commercially available in Europe. Potential benefits and risks of vaccinating FIV-infected cats should be assessed on an individual cat basis. Needles and surgical instruments used on FIV-positive cats may transmit the virus to other cats

  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

    and Asthma European Network (GA(2)LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO). As members of the panel, the authors had prepared their suggestions regarding management of urticaria before the meeting. The draft of the guideline took into account all available evidence....... In the choice of second-line treatment, both their costs and risk/benefit profiles are most important to consider. Corticosteroids are not recommended for long-term treatment due to their unavoidable severe adverse effects. This guideline was acknowledged and accepted by the European Union of Medical...

  5. Wiki-Based Clinical Practice Guidelines for the Management of Adult Onset Sarcoma: A New Paradigm in Sarcoma Evidence

    Science.gov (United States)

    Neuhaus, S. J.; Thomas, D.; Desai, J.; Vuletich, C.; von Dincklage, J.; Olver, I.

    2015-01-01

    In 2013 Australia introduced Wiki-based Clinical Practice Guidelines for the Management of Adult Onset Sarcoma. These guidelines utilized a customized MediaWiki software application for guideline development and are the first evidence-based guidelines for clinical management of sarcoma. This paper presents our experience with developing and implementing web-based interactive guidelines and reviews some of the challenges and lessons from adopting an evidence-based (rather than consensus-based) approach to clinical sarcoma guidelines. Digital guidelines can be easily updated with new evidence, continuously reviewed and widely disseminated. They provide an accessible method of enabling clinicians and consumers to access evidence-based clinical practice recommendations and, as evidenced by over 2000 views in the first four months after release, with 49% of those visits being from countries outside of Australia. The lessons learned have relevance to other rare cancers in addition to the international sarcoma community. PMID:25784832

  6. Guideline-based management of non-muscle invasive bladder cancer

    Directory of Open Access Journals (Sweden)

    Justin R Gregg

    2015-01-01

    Full Text Available Introduction: Non-muscle invasive bladder cancer (NMIBC represents a broad spectrum of disease, the hallmarks of which include disease recurrence and progression. Clinicians have a number of surgical and therapeutic options at their disposal when treating this disease, and the underlying evidence continues to evolve. A number of professional organizations have invested in the development of clinical practice guidelines to guide patient management. Materials and Methods: We review and summarize four major guidelines, the American Urological Association, the European Association of Urology, the International Consultation on Urological Disease and the National Comprehensive Cancer Network. Results: Guideline panels differed in their composition, methodological approach and structure of recommendations. Despite this, many recommendations were similar between various panels, although differences are present in panel recommendations related to initial diagnosis and treatment, adjuvant therapy and disease surveillance. Conclusions: Guideline recommendations are similar at many decision points that clinicians face when managing NMIBC, although they are far from uniform. While future prospective, well-designed studies will hopefully clarify NMIBC management, urologists ultimately must rely on a combination of evidence-based recommendations, which they should seek to integrate with patients' values and preferences and the individual circumstances to provide the best possible patient care.

  7. 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.

  8. Evidence based guidelines and current practice for physiotherapy management of knee osteoarthritis.

    Science.gov (United States)

    Walsh, Nicola E; Hurley, Michael V

    2009-03-01

    To document physiotherapy provision for patients with knee osteoarthritis (OA) in relation to the United Kingdom (UK) recently published National Institute of health and Clinical Excellence (NICE) guidelines for osteoarthritis. Questionnaire survey of chartered physiotherapists. 300 postal questionnaires were distributed to Physiotherapy Departments requesting information regarding source of referrals, treatment aims, preferred methods of treatment and service delivery. Responses were received from 83 physiotherapists (28 %), predominantly working in the UK National Health Service. Approximately equal numbers of referrals came from primary and secondary care. Aims of physiotherapy management were to; encourage self-management; increase strength and range of movement; reduce pain; and improve function. To achieve these, exercise was utilised by 100% of practitioners, often supplemented with electrotherapeutic modalities (66%), manual therapy (64%) and acupuncture (60%). The majority of patients received individual treatment for a total contact time of 1-2 hours, whilst most group interventions lasted 5-6 hours. Approximately half (54%) of respondents reported using outcome measures to determine treatment efficacy. Although knee OA is usually managed in primary care, the similar number of referrals from primary and secondary care may suggest a deviation from evidence-based management guidelines. The guidelines' recommendations of exercise, patient education and self-management are observed by physiotherapists, but other modalities are often used despite poor or no research evidence supporting their efficacy. Whether any of these interventions are clinically beneficial is speculative as treatment outcomes were frequently under-evaluated.

  9. Summary of evidence-based guideline update: Evaluation and management of concussion in sports

    Science.gov (United States)

    Giza, Christopher C.; Kutcher, Jeffrey S.; Ashwal, Stephen; Barth, Jeffrey; Getchius, Thomas S.D.; Gioia, Gerard A.; Gronseth, Gary S.; Guskiewicz, Kevin; Mandel, Steven; Manley, Geoffrey; McKeag, Douglas B.; Thurman, David J.; Zafonte, Ross

    2013-01-01

    Objective: To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: We systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations. Results: Specific risk factors can increase or decrease concussion risk. Diagnostic tools to help identify individuals with concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, concussion history, and younger age identify those at risk for postconcussion impairments. Risk factors for recurrent concussion include history of multiple concussions, particularly within 10 days after initial concussion. Risk factors for chronic neurobehavioral impairment include concussion exposure and APOE ε4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion. Practice recommendations are presented for preparticipation counseling, management of suspected concussion, and management of

  10. 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

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

    Science.gov (United States)

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

    2008-01-01

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

  12. 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.

  13. Management of penetrating extraperitoneal rectal injuries: An Eastern Association for the Surgery of Trauma practice management guideline.

    Science.gov (United States)

    Bosarge, Patrick L; Como, John J; Fox, Nicole; Falck-Ytter, Yngve; Haut, Elliott R; Dorion, Heath A; Patel, Nimitt J; Rushing, Amy; Raff, Lauren A; McDonald, Amy A; Robinson, Bryce R H; McGwin, Gerald; Gonzalez, Richard P

    2016-03-01

    The management of penetrating rectal trauma invokes a complex decision tree that advocates the principles of proximal diversion (diversion) of the fecal stream, irrigation of stool from the distal rectum, and presacral drainage based on data from World War II and the Vietnam War. This guideline seeks to define the initial operative management principles for nondestructive extraperitoneal rectal injuries. A systematic review of the MEDLINE database using PubMed was performed. The search retrieved English language articles regarding penetrating rectal trauma from January 1900 to July 2014. Letters to the editor, case reports, book chapters, and review articles were excluded. Topics of investigation included the management principles of diversion, irrigation of stool from the distal rectum, and presacral drainage using the GRADE methodology. A total of 306 articles were screened leading to a full-text review of 56 articles. Eighteen articles were used to formulate the recommendations of this guideline. This guideline consists of three conditional evidence-based recommendations. First, we conditionally recommend proximal diversion for management of these injuries. Second, we conditionally recommend the avoidance of routine presacral drains and distal rectal washout in the management of these injuries.

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

    Directory of Open Access Journals (Sweden)

    Buhl R

    2012-02-01

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report the updated recommendations of a European panel of expert neonatologists who had developed consensus guidelines after critical examination of the most up-to-date....... For babies with RDS to have best outcomes, it is essential that they have optimal supportive care, including maintenance of a normal body temperature, proper fluid management, good nutritional support, management of the ductus arteriosus and support of the circulation to maintain adequate tissue perfusion....

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    . 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......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...

  17. Validation of a clinical leadership qualities framework for managers in aged care: a Delphi study.

    Science.gov (United States)

    Jeon, Yun-Hee; Conway, Jane; Chenoweth, Lynn; Weise, Janelle; Thomas, Tamsin Ht; Williams, Anna

    2015-04-01

    To establish validity of a clinical leadership framework for aged care middle managers (The Aged care Clinical Leadership Qualities Framework). Middle managers in aged care have responsibility not only for organisational governance also and operational management but also quality service delivery. There is a need to better define clinical leadership abilities in aged care middle managers, in order to optimise their positional authority to lead others to achieve quality outcomes. A Delphi method. Sixty-nine experts in aged care were recruited, representing rural, remote and metropolitan community and residential aged care settings. Panellists were asked to rate the proposed framework in terms of the relevance and importance of each leadership quality using four-point Likert scales, and to provide comments. Three rounds of consultation were conducted. The number and corresponding percentage of the relevance and importance rating for each quality was calculated for each consultation round, as well as mean scores. Consensus was determined to be reached when a percentage score reached 70% or greater. Twenty-three panellists completed all three rounds of consultation. Following the three rounds of consultation, the acceptability and face validity of the framework was confirmed. The study confirmed the framework as useful in identifying leadership requirements for middle managers in Australian aged care settings. The framework is the first validated framework of clinical leadership attributes for middle managers in aged care and offers an initial step forward in clarifying the aged care middle manager role. The framework provides clarity in the breadth of role expectations for the middle managers and can be used to inform an aged care specific leadership program development, individuals' and organisations' performance and development processes; and policy and guidelines about the types of activities required of middle managers in aged care. © 2014 John Wiley & Sons Ltd.

  18. [Knowledge and implementation of the S3 guideline on delirium management in Germany].

    Science.gov (United States)

    Saller, T; V Dossow, V; Hofmann-Kiefer, K

    2016-10-01

    Delirium is a common complication in critical care. The syndrome is often underestimated due to its potentially no less dangerous course as a hypoactive delirium. Therefore, current guidelines ask for a structured, regular and routine screening in all intensive care units. If delirium is diagnosed, symptomatic therapy should be initiated promptly. The aim of the current study was to evaluate recent German anesthetists' strategies regarding delirium care compared to the German guidelines for sedation and delirium in intensive care. In an online survey German hospitals' senior anesthetists (n = 922) were interviewed anonymously between May and June 2015 regarding guideline use in delirium management in German intensive care units. In 33 direct questions the anesthetists were invited to answer items regarding the structure of their hospitals, intensive care and delirium therapy in order to review their knowledge of the German delirium guidelines that expired in 2014. The 249 senior anesthetists who responded to the survey, can be associated with (or represent) a quarter of German intensive care beds and cases, respectively. In every tenth clinic that runs an intensive care unit the guideline was unknown. In three of four intensive care units physicians specified a preferred delirium score, the CAM-ICU (49.4 %) is used most frequently. With knowledge of the guidelines more often a recommended delirium score is used (p = 0.017). However, only 53.6 % of the respondents ascertain a score every eight hours and 36 % have no facility for standardized documentation in the records. At intensive care rounds, a possible diagnosis of delirium is an inherent part in only 34.9 % of the responders even with guideline knowledge. The particular gold standard for the therapy of delirium (alphaagonists for vegetative symptoms; 89.6 %, benzodiazepines for anxiety, 77.5 %; antipsychotics in 86.7 % for psychotic symptoms) is implemented more often with growing knowledge of

  19. Initial evaluation and referral guidelines for management of pelvic/ovarian masses.

    Science.gov (United States)

    Le, Tien; Giede, Christopher; Salem, Shia; Lefebvre, Guylaine; Rosen, Barry; Bentley, James; Kupets, Rachel; Power, Patti; Renaud, Marie-Claude; Bryson, Peter; Davis, Donald B; Lau, Susie; Lotocki, Robert; Senikas, Vyta; Morin, Lucie; Bly, Stephen; Butt, Kimberly; Cargill, Yvonne M; Denis, Nanette; Gagnon, Robert; Hietala-Coyle, Marja Anne; Lim, Kenneth Ian; Ouellet, Annie; Raciot, Maria-Hélène

    2009-07-01

    To optimize the management of adnexal masses and to assist primary care physicians and gynaecologists determine which patients presenting with an ovarian mass with a significant risk of malignancy should be considered for gynaecologic oncology referral and management. Laparoscopic evaluation, comprehensive surgical staging for early ovarian cancer, or tumour debulking for advanced stage ovarian cancer. To optimize conservative versus operative management of women with possible ovarian malignancy and to optimize the involvement of gynaecologic oncologists in planning and delivery of treatment. Published literature was retrieved through searches of PubMed or MEDLINE, CINAHL, and the Cochrane Library, using appropriate controlled vocabulary and key words. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Grey (unpublished) literature was identified by searching the web sites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. 1. Primary care physicians and gynaecologists should always consider the possibility of an underlying ovarian cancer in patients in any age group who present with an adnexal or ovarian mass. (II-2B) 2. Appropriate workup of a perimenopausal or postmenopausal woman presenting with an adnexal mass should include evaluation of symptoms and signs suggestive of malignancy, such as persistent pelvic/abdominal pain, urinary urgency/frequency, increased abdominal size/bloating, and difficulty eating. In addition, CA125 measurement should be considered. (II-2B) 3. Transvaginal or transabdominal ultrasound examination is recommended as part of the initial workup of a complex adnexal/ovarian mass. (II-2B) 4. Ultrasound reports should be standardized to include size and unilateral/bilateral location of the adnexal mass and

  20. BIM Guidelines Inform Facilities Management Databases: A Case Study over Time

    Directory of Open Access Journals (Sweden)

    Karen Kensek

    2015-08-01

    Full Text Available A building information model (BIM contains data that can be accessed and exported for other uses during the lifetime of the building especially for facilities management (FM and operations. Working under the guidance of well-designed BIM guidelines to insure completeness and compatibility with FM software, architects and contractors can deliver an information rich data model that is valuable to the client. Large owners such as universities often provide these detailed guidelines and deliverable requirements to their building teams. Investigation of the University of Southern California (USC Facilities Management Service’s (FMS website showed a detailed plan including standards, file names, parameter lists, and other requirements of BIM data, which were specifically designated for facilities management use, as deliverables on new construction projects. Three critical details were also unearthed in the reading of these documents: Revit was the default BIM software; COBie was adapted to help meet facilities management goals; and EcoDomus provided a display of the collected data viewed through Navisworks. Published accounts about the Cinema Arts Complex developed with and under these guidelines reported positive results. Further examination with new projects underway reveal the rapidly changing relational database landscape evident in the new USC “Project Record Revit Requirement Execution Plan (PRxP”.

  1. Management of peripheral arterial disease patients: comparing the ACC/AHA and TASC-II guidelines.

    Science.gov (United States)

    Mohler, Emile; Giri, Jay

    2008-09-01

    Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis associated with a high risk of morbidity and mortality from cardiovascular events. Despite this, PAD is often undiagnosed and, therefore, undertreated. The purpose of this review is to highlight and provide clinical insight into the similarities and differences between the available PAD treatment guidelines developed by the American College of Cardiology/American Heart Association (ACC/AHA) and the Trans-Atlantic Inter-Society Consensus II (TASC II) working group. Recommendations from the ACC/AHA 2005 Practice Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) and TASC II Inter-Society Consensus for the Management of Peripheral Arterial users for personal Disease, initiated in 2004 and published in 2007, were compared. Supplemental information was obtained by searching the PubMed and MEDLINE databases using relevant terms. Unintentional bias may have been introduced into the manuscript by not performing a systematic review of the literature with pre-defined search terms. While some variation exists in the content of the recommendations, both documents agree on the need for aggressive management of patients with PAD. In spite of these recommendations, there is a general lack of adherence to the current guidelines-a critical concern considering the high morbidity and mortality associated with the disease. However, the results of ongoing clinical trials may serve to increase awareness of the importance of aggressive management of PAD.

  2. Management of bleeding and coagulopathy following major trauma: an updated European guideline

    Science.gov (United States)

    2013-01-01

    Introduction Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient. When these recommendations are implemented patient outcomes may be improved. Methods The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature. Results Key changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants. The current guideline also includes recommendations and a discussion of thromboprophylactic strategies for all patients following traumatic injury. The most significant addition is a new section that discusses the need for every institution to develop, implement and adhere to an evidence-based clinical protocol to manage traumatically injured patients. The remaining recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies. Conclusions A comprehensive, multidisciplinary approach to trauma care and mechanisms with which to ensure that established protocols are consistently implemented will ensure a uniform and high standard of care across Europe and beyond. Please see related letter by Morel

  3. An observational analysis of provider adherence to AUA guidelines on the management of benign prostatic hyperplasia.

    Science.gov (United States)

    Auffenberg, Gregory B; Gonzalez, Chris M; Wolf, J Stuart; Clemens, J Quentin; Meeks, William; McVary, Kevin T

    2014-11-01

    We retrospectively evaluated urologist adherence to the AUA guidelines on the management of new patients with benign prostatic hyperplasia related lower urinary tract symptoms in a large university urology group. All first time benign prostatic hyperplasia/lower urinary tract symptom visits to the urology clinic at the Northwestern Medical Faculty Foundation between January 1, 2008 and December 31, 2012 were evaluated using an institutionally managed electronic medical record data repository. Clinical documentation and orders from each encounter were assessed to determine the rate of performance of guideline measures. Approximately 1% of all results were manually reviewed in a validation process designed to determine the reliability of the electronic medical record based system. A total of 3,494 eligible encounters were evaluated in the final analysis. Provider adherence rates with the 9 measures recommended in the guidelines varied by measure from 53.0% to 92.8%. The rate of performance of 5 not routinely recommended measures was 10.2% or less. Post-void residual and urinary flow measurement were optional measures, and were performed on 68.1% and 4.6% of new encounters respectively. Manual validation revealed the electronic medical record data extraction was concordant with manual review in 96.7% of cases (95% CI 94.8-98.5). Using electronic medical record based data extraction techniques, we reliably document a baseline adherence rate with AUA guidelines on the management of benign prostatic hyperplasia. Establishing this benchmark will be important for future investigation into patient outcomes related to guideline adherence and into methods for improving provider adherence. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  4. Venous thromboembolism management in Northeast Melbourne: how does it compare to international guidelines and data?

    Science.gov (United States)

    Lim, Hui Y; Chua, Chong C; Tacey, Mark; Sleeman, Matthew; Donnan, Geoffrey; Nandurkar, Harshal; Ho, Prahlad

    2017-09-01

    Venous thromboembolism (VTE) is a major cause of morbidity and mortality with significant heterogeneity in its management, both within our local practice and in international guidelines. To provide a holistic evaluation of 'real-world' Australian experience in the warfarin era, including how we compare to international guidelines. Retrospective evaluation of VTE from July 2011 to December 2012 at two major hospitals in Melbourne, Australia. These results were compared to recommendations in the international guidelines. A total of 752 episodes involving 742 patients was identified. Contrary to international guidelines, an unwarranted heritable thrombophilia screen was performed in 22.0% of patients, amounting to a cost of AU$29 000. The duration of anticoagulation was longer compared to international recommendations, although the overall recurrence (3.2/100 person-years) and clinically significant bleeding rates (2.4/100 person-years) were comparable to 'real-world' data. Unprovoked VTE (hazard ratio 2.06; P = 0.01) was a risk factor for recurrence, and there was no difference in recurrence between major VTE (proximal deep vein thrombosis (DVT) and/or pulmonary embolism) and isolated distal DVT (3.02 vs 3.94/100 person-years; P = 0.25). Fourteen patients were subsequently diagnosed with malignancy, and patients with recurrent VTE had increased risk of prospective cancer diagnosis (relative risk 6.68; P management strategies, including excessive thrombophilia screening and longer duration of anticoagulation. This audit highlights the need for national VTE guidelines, as well as prospective auditing of VTE management, in the direct oral anticoagulant era for future comparison. © 2017 Royal Australasian College of Physicians.

  5. Clinical practice guidelines for the diagnosis and management of melanoma: melanomas that lack classical clinical features.

    Science.gov (United States)

    Mar, Victoria J; Chamberlain, Alex J; Kelly, John W; Murray, William K; Thompson, John F

    2017-10-16

    A Cancer Council Australia multidisciplinary working group is currently revising and updating the 2008 evidence-based clinical practice guidelines for the management of cutaneous melanoma. While there have been many recent improvements in treatment options for metastatic melanoma, early diagnosis remains critical to reducing mortality from the disease. Improved awareness of the atypical presentations of this common malignancy is required to achieve this. A chapter of the new guidelines was therefore developed to aid recognition of atypical melanomas. Main recommendations: Because thick, life-threatening melanomas may lack the more classical ABCD (asymmetry, border irregularity, colour variegation, diameter > 6 mm) features of melanoma, a thorough history of the lesion with regard to change in morphology and growth over time is essential. Any lesion that is changing in morphology or growing over a period of more than one month should be excised or referred for prompt expert opinion. Changes in management as a result of the guidelines: These guidelines provide greater emphasis on improved recognition of the atypical presentations of melanoma, in particular nodular, desmoplastic and acral lentiginous subtypes, with particular awareness of hypomelanotic and amelanotic lesions.

  6. 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.

  7. [Management of chronic heart failure - a systematic review of guidelines in the context of the DMP revision].

    Science.gov (United States)

    Kötter, Thomas; Bartel, Carmen; Schramm, Susanne; Lange, Petra; Höfer, Eva; Hänsel, Michaela; Waffenschmidt, Siw; Waldt, Susanne Ein; Hoffmann-Eßer, Wiebke; Rüther, Alric; Lühmann, Dagmar; Scherer, Martin

    2013-01-01

    Disease Management Programmes (DMPs) are structured treatment programmes for chronic diseases. The DMP requirements are primarily derived from evidence-based guidelines. DMPs are regularly revised to ensure that they reflect current best practice and medical knowledge. The aim of this study was to assess the need for updating the German DMP module on heart failure by comparing it to relevant guidelines and identifying recommendations that should be revised. We systematically searched for clinical guidelines on heart failure published in German, English or French, and extracted relevant guideline recommendations. All included guidelines were assessed for methodological quality. To identify revision needs in the DMP, we performed a synoptic analysis of the extracted guideline recommendations and DMP requirements. 27 guidelines were included. The extracted recommendations covered all aspects of the management of heart failure. The comparison of guideline recommendations with DMP requirements showed that, overall, guideline recommendations were more detailed than DMP requirements, and that the guidelines covered topics not included in the DMP module. The DMP module is largely consistent with current guidelines on heart failure. We did not identify any need for significant revision of the DMP requirements. However, some specific recommendations of the DMP module could benefit from revision. Copyright © 2013. Published by Elsevier GmbH.

  8. Belgium: National approach to ageing management

    International Nuclear Information System (INIS)

    2014-01-01

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

  9. Guidelines for evaluating software configuration management plans for digital instrumentation and control systems

    International Nuclear Information System (INIS)

    Cheon, Se Woo; Park, Jong Kyun; Lee, Ki Young; Lee, Jang Soo; Kim, Jang Yeon

    2001-08-01

    Software configuration management (SCM) is the process for identifying software configuration items (CIs), controlling the implementation and changes to software, recording and reporting the status of changes, and verifying the completeness and correctness of the released software. SCM consists of two major aspects: planning and implementation. Effective SCM involves planning for how activities are to be performed, and performing these activities in accordance with the Plan. This report first reviews the background of SCM that include key standards, SCM disciplines, SCM basic functions, baselines, software entity, SCM process, the implementation of SCM, and the tools of SCM. In turn, the report provides the guidelines for evaluating the SCM Plan for digital I and C systems of nuclear power plants. Most of the guidelines in the report are based on IEEE Std 828 and ANSI/IEEE Std 1042. According to BTP-14, NUREG-0800, the evaluation topics on the SCM Plan is classified into three categories: management, implementation, and resource characteristics

  10. Colorectal neuroendocrine neoplasms - management guidelines (recommended by the Polish Network of Neuroendocrine Tumours).

    Science.gov (United States)

    Starzyńska, Teresa; Londzin-Olesik, Magdalena; Bałdys-Waligórska, Agata; Bednarczuk, Tomasz; Blicharz-Dorniak, Jolanta; Bolanowski, Marek; Boratyn-Nowicka, Agnieszka; Borowska, Małgorzata; Cichocki, Andrzej; Ćwikła, Jarosław B; Deptała, Andrzej; Falconi, Massimo; Foltyn, Wanda; Handkiewicz-Junak, Daria; Hubalewska-Dydejczyk, Alicja; Jarząb, Barbara; Junik, Roman; Kajdaniuk, Dariusz; Kamiński, Grzegorz; Kolasińska-Ćwikła, Agnieszka; Kowalska, Aldona; Król, Robert; Królicki, Leszek; Kunikowska, Jolanta; Kuśnierz, Katarzyna; Lampe, Paweł; Lange, Dariusz; Lewczuk-Myślicka, Anna; Lewiński, Andrzej; Lipiński, Michał; Marek, Bogdan; Nasierowska-Guttmejer, Anna; Nowakowska-Duława, Ewa; Pilch-Kowalczyk, Joanna; Remiszewski, Piotr; Rosiek, Violetta; Ruchała, Marek; Siemińska, Lucyna; Sowa-Staszczak, Anna; Steinhof-Radwańska, Katarzyna; Strzelczyk, Janusz; Sworczak, Krzysztof; Syrenicz, Anhelli; Szawłowski, Andrzej; Szczepkowski, Marek; Wachuła, Ewa; Zajęcki, Wojciech; Zemczak, Anna; Zgliczyński, Wojciech; Kos-Kudła, Beata

    2017-01-01

    Neuroendocrine neoplasms/tumours (NENs/NETs) of the large intestine are detected increasingly often, especially rectal tumours, which is probably associated with the widespread use of screening colonoscopy. There is a growing body of evidence supporting the thesis that the NENs of the rectum and the NENs of the colon are two different diseases. Rectal NENs are usually small lesions, of low to moderate histological malignancy, associated with good prognosis, and most may be treated endoscopically. NENs of the colon, however, are often aggressive, poorly differentiated, associated with a poor or uncer-tain prognosis, and require surgical treatment. The management guidelines regarding these groups of patients are constantly changing. On the basis of the recent literature data and conclusions reached by the working meeting of the Polish Network of Neuroendocrine Tumours (December 2016), this study completes and updates the data and management guidelines regarding colorectal NENs published in Endokrynologia Polska 2013; 64: 358-368.

  11. [The German program for disease management guidelines: evaluation by use of quality indicators].

    Science.gov (United States)

    Kopp, Ina B; Geraedts, Max; Jäckel, Wilfried H; Altenhofen, Lutz; Thomeczek, Christian; Ollenschläger, Günter

    2007-08-15

    The Program for National Disease Management Guidelines (German DM-CPG Program) in Germany aims at the implementation of best-practice recommendations for prevention, acute care, rehabilitation and chronic care in the setting of disease management programs and integrated health-care systems. Like other guidelines, DM-CPG need to be assessed regarding their influence on structures, processes and outcomes of care. However, quality assessment in integrated health-care systems is challenging. On the one hand, a multitude of potential domains for measurement, actors and perspectives need to be considered. On the other hand, measures need to be identified that assess the function of the diagnostic and therapeutic chain in terms of cooperation and coordination of care. The article reviews methods and use of quality indicators in the context of the German DM-CPG Program.

  12. Special issue on ageing management and long term operation of light water reactors

    International Nuclear Information System (INIS)

    Kashima, Koichi; Kanno, Masanori; Kimura, Itsurou

    2008-01-01

    Ageing management and long term operation of light water reactors became important in Japan and relevant research on physical and materials ageing has been carried out among organizations of government, academia and industry and establishment of technical standards and guideline based on the results is under way. The Japan Energy Policy Institute (JEPI) issued a special number discussing this theme, which consisted of ten reports of experts describing these activities. Main topics were ageing evaluation of reactor components due to neutron irradiation embrittlement and stress corrosion cracking, regulatory evaluation of deteriorations due to ageing with technical information basis, technology development in the area of inspection/monitoring, ageing evaluation and preventive maintenance/repairs, nuclear power plant life management of electric utilities, and advancement of reactor maintenance and inspection. (T. Tanaka)

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

    Science.gov (United States)

    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

    2015-05-01

    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. To identify eligible guidelines, we systematically searched National Guideline Clearinghouse, Guidelines International Network Library and PubMed. Members of the International Commission on Occupational Health (ICOH), were also consulted. Guidelines recommendations were compared and reporting quality was assessed using the AGREE II instrument. Of 2126 titles retrieved, 14 guidelines were included: 1 Japanese, 2 Finnish, 2 Korean, 2 British and 7 Dutch. Four guidelines were of high-reporting quality. Best described was the Scope and Purpose, and the poorest described were competing interests (Editorial independence) and barriers and facilitators for implementation (Applicability). Key recommendations were often difficult to identify. Most guidelines recommend employing an inventory of symptoms, diagnostic classification, performance problems and workplace factors. All guidelines recommend specific return-to-work interventions, and most agreed on psychological treatment and communication between involved stakeholders. Practice guidelines to address work disability due to mental disorders and stress-related symptoms are available in various countries around the world, however, these guidelines are difficult to find. To promote sharing, national guidelines should be accessible via established international databases. The quality of the guideline's developmental process varied considerably. To increase quality and applicability, guideline developers should adopt a common structure for the development and reporting of their guidelines, for example Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. Owing to differences in social systems, developers can learn from each other through reviews of this kind. Published by the BMJ Publishing Group Limited

  14. Singapore Cancer Network (SCAN) Guidelines for the Initial Evaluation, Diagnosis, and Management of Extremity Soft Tissue Sarcoma and Osteosarcoma.

    Science.gov (United States)

    2015-10-01

    The SCAN sarcoma workgroup aimed to develop Singapore Cancer Network (SCAN) clinical practice guidelines for the initial evaluation, diagnosis, and management of extremity soft tissue sarcoma and osteosarcoma. The workgroup utilised a consensus approach to create high quality evidence-based clinical practice guidelines suited for our local setting. Various international guidelines from the fields of radiology, pathology, orthopaedic surgery, medical, radiation and paediatric oncology were reviewed, including those developed by von Mehren Metal (J Natl Compr Canc Netw 2014), the National Collaborating Centre for Cancer (2006), the European Sarcoma Network Working Group (2012) and Grimer RJ et al (Sarcoma 2008). Our clinical practice guidelines contextualised to the local patient will streamline care and improve clinical outcomes for patients with extremity soft tissue and osteosarcoma. These guidelines form the SCAN Guidelines 2015 for the initial evaluation, diagnosis, and management of extremity soft tissue sarcoma and osteosarcoma.

  15. A guideline for future preservation, management & interpretation of Brownsville Plantation circa 1652 Northampton County, Virginia

    OpenAIRE

    Kagawa, Ron M.

    1996-01-01

    This thesis establishes a guideline for the future preservation, management and interpretation of Brownsville Plantation. Brownsville Plantation is located in Northampton County on Virginia's lower Eastern Shore. Brownsville's original 1262 acre parcel of land was first patented in 1652 by English Quakers, John and Ursula Browne. At the time of this research (July, 1995 to March, 1996) the property was held in ownership by The Nature Conservancy's Virginia Coast Reserve. Th...

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

    OpenAIRE

    Yulia A. Anankina

    2013-01-01

    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 manage...

  17. Food management for the aging population.

    Science.gov (United States)

    Militello, J; Coleman, L J; Haran, E

    1996-01-01

    The older population is becoming more important to our society everyday. These individuals are being studied for their past, present, and potential impact on markets and marketing. Evaluated as a user of products or services in the marketplace or an employee or volunteer within the marketing system, this segment is gaining a visibility and importance. An interview was conducted with five Nutrition Project Directors to obtain an overview of Federally Funded Nutrition Programs for the Elderly. The areas which were highlighted were service delivery, site activities, management styles, barriers to service, clientele composition, food planning and preparation, staffing, USDA funding, coordination, marketing, transportation, and volunteerism. The Second Quarter Service Provider Output Reports for 1991, which are compiled by the Nutrition Projects and submitted to the Area Agency on Aging, were utilized to obtain client profile information (Reports, 1991). The analysis sought to compare the programs offered in the five counties on a number of factors which could be quantified. It was hoped that by looking at the numerical ratios, and depicting them graphically, any trends or unique characteristics of the programs could be identified. In that the percentage of Florida's present elder population (17%) far exceeds the national average (12%) these findings could be utilized by nutrition programs outside of Florida to plan for future funds. Analysis of quantitative information on the five programs yielded information on cost comparisons and on services.

  18. Ageing management experience at NUR Reactor

    Energy Technology Data Exchange (ETDEWEB)

    Melllal, Sabrina; Rezig, Mohamed; Zamoun, Rachid; Ameur, Azeddin [Nuclear Research Center of Draria, Algiers (Algeria)

    2013-07-01

    NUR is a 1 MW, open pool reactor moderated and cooled by light water. It was commissioned in 1989. NUR is used for education and training in Nuclear Engineering and related topics for COMENA and National Scientific Community. It is also used to perform R and D works and services at national and regional levels. In this presentation, we describe the methodology and the main development activities related to the ageing management at NUR reactor. These activities include inspection actions and development actions to introduce modifications, to solve obsolescence issues in view to implement the required preventive and curative maintenance programs and to improve the performances of the installation. These actions involved mainly the Operation Assistance System of the Reactor (OAS), the secondary cooling loop, the cooling tower. A new OAS using a new technology and having more possibilities than the older one was introduced in the control system of the reactor. The OAS hardware structure, software structure and the main functions performed are presented. The second loop is entirely refurbished. Two new cooling towers are installed and connected to the main heat exchanger with new piping and valves. The architecture of this new installation is described and the performance assessed. Other actions which involve auxiliary systems like emergency electrical system, air pneumatic system and automatic fire extinguishing are presented.

  19. Aging management assessment of type B transportation packages

    International Nuclear Information System (INIS)

    Sullivan, G.J.; Stahmer, U.; Freeman, E.L.

    2004-01-01

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

  20. Integrated Financial Management Information Systems: Guidelines for effective implementation by the public sector of South Africa

    Directory of Open Access Journals (Sweden)

    Christoffel J. Hendriks

    2012-12-01

    Full Text Available Background: Integrated Financial Management Information Systems (IFMIS can improve public sector management by providing real-time financial information to managers in order to enhance their decision-making capabilities. The South African Public Service is currently busy with the implementation of an IFMIS. However, the implementation of such a project has proved to be a very demanding undertaking and has not been met with resounding success.Objectives: The research was conducted in order to identify the challenges and risks that are involved in the implementation of the IFMIS in South Africa. After identification of the challenges and risks, solutions or guidelines were developed that may make the implementation more successful.Method: The methodology that was used is that of a literature study where theories were explored and used to solve a research problem. Based on the theoretical research, solutions and guidelines were developed to solve challenges and risks experienced.Results: The results indicated that there are a number of challenges involved with the implementation of an IFMIS. A set of best practice guidelines was developed that may make the implementation more successful.Conclusion: The sheer size and complexity of an IFMIS poses significant challenges and a number of risks to the implementation process. There are, however, critical success factors or best practices that can be used for the project to succeed. It is recommended that these best practices be used by the South African Public Service.

  1. Development of a soil conservation standard and guidelines for OHV recreation management in California

    Science.gov (United States)

    Bedrossian, T.L.; Reynolds, S.D.

    2007-01-01

    In 2004, the California State Parks (CSP) agency contracted with the California Geological Survey (CGS) to update the 1991 Soil Conservation Guide-lines/Standards for Off-Highway Vehicle (OHV) Recreation Management. Per state legislation, the 1991 standards were updated to establish a generic and measurable standard at least sufficient to allow restoration of OHV areas and trails. Given the rapid increase in OHV use in California, the updated Soil Conservation Standard and Guidelines for OHV Recreation Management also allowed for sustainability of trail systems and recreation opportunities. A key part of the update was interaction with stakeholders, agencies, and other interest groups through public workshops and a Consulting Agency Review Committee composed of representatives from the U.S. Natural Resources Conservation Service, U.S. Forest Service, U.S. Bureau of Land Management, U.S. Geological Survey, California Department of Conservation, and CSP. CGS also assessed proposed revisions in three representative OHV areas to ensure that the updated Standard and Guidelines provided sufficient flexibility to allow their application to all sites state-wide, ecosystems with multiple geology and soils types, and a variety of vehicle uses. While geology was not the only basis for the guideline revisions, it was a major factor. CGS staff also had the breadth of knowledge and experience in engineering geology, hydrogeology, road and trail construction, erosion control, and OHV riding necessary to coordinate and develop the multidisciplinary and multi-stakeholder effort.

  2. A guideline for interpersonal capabilities enhancement to support sustainable facility management practice

    Science.gov (United States)

    Sarpin, Norliana; Kasim, Narimah; Zainal, Rozlin; Noh, Hamidun Mohd

    2018-04-01

    Facility management is the key phase in the development cycle of an assets and spans over a considerable length of time. Therefore, facility managers are in a commanding position to maximise the potential of sustainability through the development phases from construction, operation, maintenance and upgrade leading to decommission and deconstruction. Sustainability endeavours in facility management practices will contribute to reducing energy consumption, waste and running costs. Furthermore, it can also help in improving organisational productivity, financial return and community standing of the organisation. Facility manager should be empowered with the necessary knowledge and capabilities at the forefront facing sustainability challenge. However, literature studies show a gap between the level of awareness, specific knowledge and the necessary skills required to pursue sustainability in the facility management professional. People capability is considered as the key enabler in managing the sustainability agenda as well as being central to the improvement of competency and innovation in an organisation. This paper aims to develop a guidelines for interpersonal capabilities to support sustainability in facility management practice. Starting with a total of 7 critical interpersonal capabilities factors identified from previous questionnaire survey, the authors conducted an interview with 3 experts in facility management to assess the perceived importance of these factors. The findings reveal a set of guidelines for the enhancement of interpersonal capabilities among facility managers by providing what can be done to acquire these factors and how it can support the application of sustainability in their practice. The findings of this paper are expected to form the basis of a mechanism framework developed to equip facility managers with the right knowledge, to continue education and training and to develop new mind-sets to enhance the implementation of sustainability

  3. Guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis: An Indian perspective.

    Science.gov (United States)

    Gupta, Lalit Kumar; Martin, Abhay Mani; Agarwal, Nidheesh; D'Souza, Paschal; Das, Sudip; Kumar, Rajesh; Pande, Sushil; Das, Nilay Kanti; Kumaresan, Muthuvel; Kumar, Piyush; Garg, Anubhav; Singh, Saurabh

    2016-01-01

    Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening mucocutaneous adverse drug reactions with a high morbidity and mortality that require immediate medical care. The various immunomodulatory treatments include systemic corticosteroids, cyclosporine, intravenous immunoglobulin, cyclophosphamide, plasmapheresis and tumor necrosis factor-α inhibitors. The ideal therapy of Stevens-Johnson syndrome/toxic epidermal necrolysis still remains a matter of debate as there are only a limited number of studies of good quality comparing the usefulness of different specific treatments. The aim of this article is to comprehensively review the published medical literature and frame management guidelines suitable in the Indian perspective. The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these guidelines to its special interest group on cutaneous adverse drug reactions. The group performed a comprehensive English language literature search for management options in Stevens-Johnson syndrome/toxic epidermal necrolysis across multiple databases (PubMed, EMBASE, MEDLINE and Cochrane) for keywords (alone and in combination) and MeSH items such as "guidelines," "Stevens-Johnson syndrome," "toxic epidermal necrolysis," "corticosteroids," "intravenous immunoglobulin," "cyclosporine" and "management." The available evidence was evaluated using the strength of recommendation taxonomy and graded using a three-point scale. A draft of clinical recommendations was developed on the best available evidence which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, this final consensus statement was prepared. A total of 104 articles (meta-analyses, prospective and retrospective studies, reviews [including chapters in books], previous guidelines [including Indian guidelines of 2006] and case series) were critically evaluated and the evidence

  4. 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...... compliance, involving over-triage with computed tomography (CT) and hospital admissions. The aim of the present study was to investigate guideline compliance after an educational intervention....

  5. Guidelines for the symptomatic management of fever in children: systematic review of the literature and quality appraisal with AGREE II.

    Science.gov (United States)

    Chiappini, Elena; Bortone, Barbara; Galli, Luisa; de Martino, Maurizio

    2017-07-31

    Several societies have produced and disseminated clinical practice guidelines (CPGs) for the symptomatic management of fever in children. However, to date, the quality of such guidelines has not been appraised. To identify and evaluate guidelines for the symptomatic management of fever in children. The research was conducted using PubMed, guideline websites, and Google (January 2010 to July 2016). The quality of the CPGs was independently assessed by two assessors using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument, and specific recommendations in guidelines were summarised and evaluated. Domain scores were considered of sufficient quality when >60% and of good quality when >80%. Seven guidelines were retrieved. The median score for the scope and purpose domain was 85.3% (range 66.6-100%). The median score for the stakeholder involvement domain was 57.5% (range 33.3-83.3%) and four guidelines scored >60%. The median score for the rigour of development domain was 52.0% (range 14.6-98.9%), and only three guidelines scored >60%. The median score for the clarity of presentation domain was 80.9% (range 50.0-94.4%). The median score for the applicability domain was 39.3% (8.3-100%). Only one guideline scored >60%. The median score for the editorial independence domain was 48.84% (0-91.6%); only three guidelines scored >60%. Most guidelines were recommended for use even if with modification, especially in the methodology, the applicability and the editorial independence domains. Our results could help improve reporting of future guidelines, and affect the selection and use of guidelines in clinical practice. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. NICE guidelines for imaging studies in children with UTI adequate only in boys under the age of 6 months.

    Science.gov (United States)

    Ristola, Marko Tapani; Hurme, Timo

    2013-03-01

    The purpose of this study was to evaluate the applicability of the National Institute for Health and Clinical Excellence (NICE) guidelines for imaging studies in children under the age of three with first urinary tract infection (UTI). In our cohort of 112 patients, we gathered data regarding the occurrence of indications for ultrasonography (US) and voiding cystourethrography (VCUG) according to the NICE guidelines, dimercaptosuccinic acid (DMSA) scintigraphy examinations, UTI recurrence, antimicrobial prophylaxis (AMP), anti-reflux procedures, and other urological procedures. If the NICE guidelines had been applied, 13 of the 25 patients (52 %) with vesicoureteral reflux (VUR), including 6 of the 12 patients (50 %) with dilating VUR and 3 of the 4 patients who underwent endoscopic anti-reflux treatment, would have been missed, and a negative VCUG would have been avoided in 25 of the 42 patients (60 %) with no VUR. None of the missed diagnoses occurred in the younger boys' group. Based on these preliminary analyses, we feel that the NICE guidelines for imaging studies in children under 3 years old with UTI may be applicable to clinical use only in boys under 6 months of age. For other patients the guidelines were unsuccessful.

  7. IAP/APA evidence-based guidelines for the management of acute pancreatitis.

    Science.gov (United States)

    2013-01-01

    There have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise these guidelines using an evidence-based approach. Twelve multidisciplinary review groups performed systematic literature reviews to answer 38 predefined clinical questions. Recommendations were graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The review groups presented their recommendations during the 2012 joint IAP/APA meeting. At this one-day, interactive conference, relevant remarks were voiced and overall agreement on each recommendation was quantified using plenary voting. The 38 recommendations covered 12 topics related to the clinical management of acute pancreatitis: A) diagnosis of acute pancreatitis and etiology, B) prognostication/predicting severity, C) imaging, D) fluid therapy, E) intensive care management, F) preventing infectious complications, G) nutritional support, H) biliary tract management, I) indications for intervention in necrotizing pancreatitis, J) timing of intervention in necrotizing pancreatitis, K) intervention strategies in necrotizing pancreatitis, and L) timing of cholecystectomy. Using the GRADE system, 21 of the 38 (55%) recommendations, were rated as 'strong' and plenary voting revealed 'strong agreement' for 34 (89%) recommendations. The 2012 IAP/APA guidelines provide recommendations concerning key aspects of medical and surgical management of acute pancreatitis based on the currently available evidence. These recommendations should serve as a reference standard for current management and guide future clinical research on acute pancreatitis. Copyright © 2013 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  8. Ageing management of nuclear power plants

    International Nuclear Information System (INIS)

    Cepcek, Stefan; Uhrik, Peter; Ziakova, Marta

    2002-01-01

    In 1995 the Nuclear Regulatory Authority of the Slovak Republic (UJD) began to issue its own non-periodic publications, as an edition on Safety of Nuclear Installations with the aim to publish generally binding legal regulations, safety requirements, recommendations and guidelines related to UJD task. In the framework of the edition on Safety of Nuclear Installations the UJD issues three groups of publications: The first group of publications deals with generally binding legal regulations and international treaties or conventions related to peaceful use of nuclear energy. Publications are marked by a red stripe. The second group represents guidelines, which should clarify and supplement the requirements of generally binding legal regulations. Recommendations given by these documents are not generally binding, nevertheless following of these recommendations helps licensees to demonstrate fulfilment of generally binding requirements. The third group of publications represents documents, which have only informative character

  9. Feasibility and impact of a computer-guided consultation on guideline-based management of COPD in general practice.

    Science.gov (United States)

    Angus, Robert M; Thompson, Elizabeth B; Davies, Lisa; Trusdale, Ann; Hodgson, Chris; McKnight, Eddie; Davies, Andrew; Pearson, Mike G

    2012-12-01

    Applying guidelines is a universal challenge that is often not met. Intelligent software systems that facilitate real-time management during a clinical interaction may offer a solution. To determine if the use of a computer-guided consultation that facilitates the National Institute for Health and Clinical Excellence-based chronic obstructive pulmonary disease (COPD) guidance and prompts clinical decision-making is feasible in primary care and to assess its impact on diagnosis and management in reviews of COPD patients. Practice nurses, one-third of whom had no specific respiratory training, undertook a computer-guided review in the usual consulting room setting using a laptop computer with the screen visible to them and to the patient. A total of 293 patients (mean (SD) age 69.7 (10.1) years, 163 (55.6%) male) with a diagnosis of COPD were randomly selected from GP databases in 16 practices and assessed. Of 236 patients who had spirometry, 45 (19%) did not have airflow obstruction and the guided clinical history changed the primary diagnosis from COPD in a further 24 patients. In the 191 patients with confirmed COPD, the consultations prompted management changes including 169 recommendations for altered prescribing of inhalers (addition or discontinuation, inhaler dose or device). In addition, 47% of the 55 current smokers were referred for smoking cessation support, 12 (6%) for oxygen assessment, and 47 (24%) for pulmonary rehabilitation. Computer-guided consultations are practicable in general practice. Primary care COPD databases were confirmed to contain a significant proportion of incorrectly assigned patients. They resulted in interventions and the rationalisation of prescribing in line with recommendations. Only in 22 (12%) of those fully assessed was no management change suggested. The introduction of a computer-guided consultation offers the prospect of comprehensive guideline quality management.

  10. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Jauch, Edward C; Saver, Jeffrey L; Adams, Harold P; Bruno, Askiel; Connors, J J Buddy; Demaerschalk, Bart M; Khatri, Pooja; McMullan, Paul W; Qureshi, Adnan I; Rosenfield, Kenneth; Scott, Phillip A; Summers, Debbie R; Wang, David Z; Wintermark, Max; Yonas, Howard

    2013-03-01

    The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.

  11. Prospective Observational Evaluation of Sedation and Pain Management Guideline Adherence Across New Jersey Intensive Care Units.

    Science.gov (United States)

    Brophy, Alison; Cardinale, Maria; Andrews, Liza B; Kaplan, Justin B; Adams, Christopher; Opsha, Yekaterina; Brandt, Kimberly A; Dixit, Deepali; Nerenberg, Steven F; Saleh, Julie A

    2018-01-01

    The practice guidelines for the management of pain, agitation, and delirium (PAD) from the Society of Critical Care Medicine shifted from primarily focusing on the treatment of anxiety in 2002 to the treatment of pain in 2013. This prospective, observational, multicenter study aimed to assess the degree of practice adherence to the PAD guidelines for ventilated patients in New Jersey intensive care units (ICUs). Pharmacist investigators at 8 centers designated 4 days at least 10 days apart to evaluate all patients on mechanical ventilation. The primary outcomes included adherence to 4 guideline recommendations: treatment of pain before sedation, use of nonnarcotic analgesic medications, use of nonbenzodiazepine sedative medications, and use of goal-directed sedation. Of 138 patients evaluated, 50% had a primary medical diagnosis (as opposed to surgical, cardiac, or neurological diagnosis), and the median Sequential Organ Failure Assessment (SOFA) score was 7. Pain was treated prior to administration of sedatives in 55.4% of subjects, with fentanyl being the primary analgesic used. In addition, 19% received no analgesia, and 11.5% received nonopioid analgesia. Sedative agents were administered to 87 subjects (48 nonbenzodiazepine and 39 benzodiazepine). Of those receiving benzodiazepines, 22 received intermittent bolus regimens and 16 received continuous infusions, of which 5 were for another indication besides sedation. Validated scales measuring the degree of sedation were completed at least once in 56 (81.6%) patients receiving sedatives. Current sedation practices suggest that integration of evidence-based PAD guidelines across New Jersey adult ICUs is inconsistent despite pharmacist involvement.

  12. A quality project to improve compliance with AAP guidelines for inpatient management of neonatal hyperbilirubinemia.

    Science.gov (United States)

    Tartaglia, Kimberly M; Campbell, Jessica; Shaniuk, Paul; McClead, Richard E

    2013-07-01

    The goal of this study was to improve compliance with published guidelines regarding management of neonatal hyperbilirubinemia in infants admitted to a general pediatric hospital ward and to improve support for their breastfeeding mothers. This quality improvement project was conducted by using Plan-Do-Study-Act cycles and statistical process control methods. Study subjects were infants > 35 weeks' gestation admitted for hyperbilirubinemia to the general inpatient ward of a large, freestanding pediatric hospital. We developed and implemented a guideline for the inpatient management of jaundiced neonates, with ongoing feedback given to the faculty on group performance. Outcome measures included monthly compliance scores based on American Academy of Pediatrics (AAP) guidelines for management of neonates > 35 weeks' gestation and the percentage of admitted jaundiced, breastfeeding infants whose mothers received lactation consultation during hospitalization. To determine the AAP compliance score, we reviewed and assigned points to each patient admission for completion of a standard evaluation, avoidance of unnecessary intravenous (IV) fluids and peripheral IV line placement, avoidance of rebound bilirubin checks while in the hospital, and the bilirubin level at discharge. Mean monthly AAP compliance scores increased from 60.5% of total possible points during the baseline period (January 2010-December 2010) to 90.4% during the intervention period (January 2011-December 2011). Lactation consultations increased from 48% during our baseline period to 63% during our early intervention period and to 90% during the last 5 months of our intervention. Length of stay was unchanged during the baseline and intervention periods. Interprofessional collaboration between nurses and physicians combined with a thoughtful campaign to increase awareness of published guidelines were successful in improving the care of infants admitted with unconjugated hyperbilirubinemia.

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

    International Nuclear Information System (INIS)

    Jung, Jin Wook; Han, Eun Ok

    2011-01-01

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

  14. 2014 Guidelines of Taiwan Society of Cardiology (TSOC) for the Management of Pulmonary Arterial Hypertension

    Science.gov (United States)

    Hsu, Chih-Hsin; Ho, Wan-Jing; Huang, Wei-Chun; Chiu, Yu-Wei; Hsu, Tsu-Shiu; Kuo, Ping-Hung; Hsu, Hsao-Hsun; Chang, Jia-Kan; Cheng, Chin-Chang; Lai, Chao-Lun; Liang, Kae-Woei; Lin, Shoa-Lin; Sung, Hsao-Hsun; Tsai, Wei-Chuan; Weng, Ken-Pen; Hsieh, Kai-Sheng; Yin, Wei-Hsian; Lin, Shing-Jong; Wang, Kuo-Yang

    2014-01-01

    Pulmonary hypertension (PH) is a hemodynamic and pathophysiologic condition, defined as a mean pulmonary arterial pressure exceeding 25 mmHg at rest. According to the recent classifications, it is grouped into pulmonary arterial hypertension (PAH), heart-related, lung-related, thromboembolic, and miscellaneous PH. In the past two decades, tremendous advances have occurred in the field of PH. These include (1) development of clinical diagnostic algorithm and a monitoring strategy dedicated to PAH, (2) defining strong rationales for screening at-risk populations, (3) advent of pulmonary specific drugs which makes PAH manageable, (4) recognition of needs of having proper strategy of combining existing pulmonary specific drugs, and/or potential novel drugs, (5) pursuit of clinical trials with optimal surrogate endpoints and study durations, (6) recognition of critical roles of PH/right ventricular function, as well as interdependence of ventricles in different conditions, especially those with various phenotypes of heart failure, and (7) for rare diseases, putting equal importance on carefully designed observation studies, various registries, etc., besides double blind randomized studies. In addition, ongoing basic and clinical research has led to further understanding of relevant physiology, pathophysiology, epidemiology and genetics of PH/PAH. This guidelines from the working group of Pulmonary Hypertension of the Taiwan Society of Cardiology is to provide updated guidelines based on the most recent international guidelines as well as Taiwan’s domestic research on PH. The guidelines are mainly for the management of PAH (Group 1) ; however the majority of content can be helpful for managing other types of PH. PMID:27122817

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

    DEFF Research Database (Denmark)

    Jefferson, Amanda; Leonard, Helen; Siafarikas, Aris

    2016-01-01

    OBJECTIVES: 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. METHODS: An initial guidelines draft was created which included statements based upon literature review and 11 open-ended que...

  16. [What's new in the 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis].

    Science.gov (United States)

    Guan, H X

    2017-10-01

    The 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis has been officially published in October of 2016, five years after the publication of the previous version. Revised contents in the new guideline are summarized in this review.

  17. 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.

  18. Comparing American Gastroenterological Association Pancreatic Cyst Management Guidelines with Fukuoka Consensus Guidelines as Predictors of Advanced Neoplasia in Patients with Suspected Pancreatic Cystic Neoplasms.

    Science.gov (United States)

    Ma, Gene K; Goldberg, David S; Thiruvengadam, Nikhil; Chandrasekhara, Vinay; Kochman, Michael L; Ginsberg, Gregory G; Vollmer, Charles M; Ahmad, Nuzhat A

    2016-11-01

    In 2015, the American Gastroenterological Association (AGA) published guidelines to provide recommendations for management of suspected pancreatic cystic neoplasms (PCNs). The aim of this study was to compare efficacy of these with the Fukuoka consensus guidelines in predicting advanced neoplasia (AN) in patients with suspected PCNs. We performed a retrospective study of 239 patients who underwent surgical resection for suspected mucinous PCN at a tertiary care center from 2000 to 2014. Surgical pathology was the gold standard. The AGA and Fukuoka criteria were applied, and their performance in predicting AN, defined as invasive cancer or high-grade dysplasia (HGD), was assessed. Advanced neoplasia was found in 71 of 239 (29.7%) patients (28 invasive cancer, 43 HGD). The Fukuoka "high-risk" (FG-HR) and AGA "high-risk" (AGA-HR) criteria identified patients with AN with sensitivities of 28.2% and 35.2%, specificities of 95.8% and 94.0%, positive predictive values of 74.1% and 71.4%, and negative predictive values of 75.9% and 77.5%, respectively. Overall, there was no significant difference between the guidelines for prediction of AN. There were 7 and 6 cases with invasive cancer, and 23 and 24 cases with HGD missed by the FG-HR and AGA-HR guidelines, respectively. In a retrospective analysis, the AGA guidelines are not superior to the Fukuoka guidelines in identifying AN in suspected PCNs. Both sets of guidelines have fair PPV for detection of AN, which would lead to avoidable resections in patients without AN. Additionally, the high-risk features of both guidelines do not accurately identify all patients with AN. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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

    International Nuclear Information System (INIS)

    Shin, Tae Myung; Lee, Jae Kyung; Byeon, Chang Soo; Kim, Hyo Soo; Kim, Young Ryul; Eun, Hui Kwang

    2000-03-01

    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

  20. 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.

  1. Management of ageing in nuclear power plants

    International Nuclear Information System (INIS)

    Bora, J.S.; Ramteke, P.K.; Babar, A.K.; Kushwaha, H.S.; Venkat Raj, V.

    2001-01-01

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

  2. 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.

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

    International Nuclear Information System (INIS)

    Lindsay, D.C.

    1995-01-01

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

  4. Multicenter Cohort Study Comparing U.S. Management of Inpatient Pediatric Immune Thrombocytopenia to Current Treatment Guidelines.

    Science.gov (United States)

    Witmer, Char M; Lambert, Michele P; O'Brien, Sarah H; Neunert, Cindy

    2016-07-01

    Recent pediatric immune thrombocytopenia (ITP) guidelines have significantly altered and are encouraging an observational approach for patients without significant bleeding regardless of their platelet count. This retrospective multicenter cohort study utilized the Pediatric Health Information Systems (PHIS) administrative database. Subjects were 6 months to 18 years of age, admitted to a PHIS hospital between January 1, 2008 and September 30, 2014, with a primary diagnosis code for ITP. International Classification of Disease, Ninth Revision, Clinical Modification Code (ICD-9-CM) discharge codes identified significant bleeding. Pharmaceutical billing codes identified the use of pharmacologic therapy for ITP. Clinical management during preguideline admissions (January 1, 2008 to August 31, 2011) was compared to postguideline admissions (September 1, 2011 to September 30, 2014). A total of 4,937 subjects met inclusion criteria with a mean age of 6.2 (SD 5) years; 93.4% (4,613/4,937) received pharmacologic treatment for ITP but only 14.2% (699/4,937) had ICD-9-CM codes for significant bleeding; 11.5% (570/4,937) of subjects were readmitted. In comparing pre- versus postguideline time periods, the proportion of subjects receiving ITP pharmacologic treatment did not change (92.9% vs. 94.1%; P = 0.26). A decrease was found in the proportion of bone marrows performed (9.7% vs. 6.4%; P compared to 2008-2010 (12.9 vs. 14.5/10,000 PHIS admissions, P guidelines and evidence that supports a watchful waiting approach for pediatric patients with ITP, a large proportion of inpatients without significant bleeding are still receiving pharmacologic therapy. Continued efforts are needed to address why inpatient U.S. practice patterns are so discrepant from current treatment guidelines. © 2016 Wiley Periodicals, Inc.

  5. 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.

  6. Management of high blood pressure in children: similarities and differences between US and European guidelines.

    Science.gov (United States)

    Brady, Tammy M; Stefani-Glücksberg, Amalia; Simonetti, Giacomo D

    2018-03-28

    Over the last several decades, many seminal longitudinal cohort studies have clearly shown that the antecedents to adult disease have their origins in childhood. Hypertension (HTN), which has become increasingly prevalent in childhood, represents one of the most important risk factors for cardiovascular diseases (CVD) such as heart disease and stroke. With the risk of adult HTN much greater when HTN is manifest in childhood, the future burden of CVD worldwide is therefore concerning. In an effort to slow the current trajectory, professional societies have called for more rigorous, evidence-based guideline development to aid primary care providers and subspecialists in improving recognition, diagnosis, evaluation, and treatment of pediatric HTN. In 2016 the European Society of Hypertension and in 2017 the American Academy of Pediatrics published updated guidelines for prevention and management of high blood pressure (BP) in children. While there are many similarities between the two guidelines, important differences exist. These differences, along with the identified knowledge gaps in each, will hopefully spur clinical researchers to action. This review highlights some of these similarities and differences, focusing on several of the more important facets regarding prevalence, prevention, diagnosis, management, and treatment of childhood HTN.

  7. Update on recent guidelines for the management of urinary tract infections in children: the shifting paradigm

    Science.gov (United States)

    Paintsil, Elijah

    2016-01-01

    Purpose of review Recent guidelines on the management of urinary tract infections (UTIs) in children have seen a shift from aggressive imaging studies and the use of prophylactic antibiotics to a more restrictive and targeted approach. This review focuses on new additions to the literature on management of UTI from January 2011 to September 2012. Recent findings The causal relationship between UTI–vesicoureteral reflux (VUR) and renal scarring has been challenged by several studies. Concerns about unnecessary exposure to ionizing radiation, invasiveness of some of the procedures, and risk of infection have also been raised. With improved prenatal ultrasound, a ‘top-down’ approach to investigating febrile UTI in children using renal bladder ultrasound alone as an initial study has become popular. Several studies have reported that prophylactic antibiotics and imaging studies after first UTI can be reduced substantially without affecting the risk of recurrent UTI or renal scarring. Summary The use of targeted imaging approach in evaluating febrile UTI in children may lead to improved resource use and reduction of potential harmful procedures and interventions, without affecting outcomes of UTI in children. Providers using current guidelines should endeavor to collect practice-based evidence to validate and inform future guidelines. PMID:23241875

  8. Review of clinical practice guidelines for the management of LDL-related risk.

    Science.gov (United States)

    Morris, Pamela B; Ballantyne, Christie M; Birtcher, Kim K; Dunn, Steven P; Urbina, Elaine M

    2014-07-15

    Managing risk related to low-density lipoprotein (LDL) is vital in therapy for patients at risk for atherosclerotic cardiovascular disease (ASCVD) events given its important etiologic role in atherogenesis. Despite decades of research showing reduction of ASCVD risk with multiple approaches to lowering of LDL cholesterol, there continue to be significant gaps in care with inadequate numbers of patients receiving standard of care lipid-lowering therapy. Confusion regarding implementation of the multiple published clinical practice guidelines has been identified as one contributor to suboptimal management of LDL-related risk. This review summarizes the current guidelines for reduction of LDL-related cardiovascular risk provided by a number of major professional societies, which have broad applicability to diverse populations worldwide. Statements have varied in the process and methodology of development of recommendations, the grading system for level and strength of evidence, the inclusion or exclusion of expert opinion, the suggested ASCVD risk assessment tool, the lipoproteins recommended for risk assessment, and the lipoprotein targets of therapy. The similarities and differences among important guidelines in the United States and internationally are discussed, with recommendations for future strategies to improve consistency in approaches to LDL-related ASCVD risk and to reduce gaps in implementation of evidence-based therapies. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    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). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines. Results These guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions. Conclusions Anxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments. PMID:25081580

  10. 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.

  11. A look at statin cost-effectiveness in view of the 2013 ACC/AHA cholesterol management guidelines.

    Science.gov (United States)

    Deaño, Roderick C; Pandya, Ankur; Jones, Erica C; Borden, William B

    2014-09-01

    The 2013 cholesterol management guidelines presented a major shift in recommendations on which patients at risk of cardiovascular disease should be treated and how to treat them. Implementation of the guidelines is estimated to increase substantially the number of people who would be eligible for statin therapy. As the medical community considers the broad population impact of the new cholesterol guidelines, the issue of cost-effectiveness plays a role. This review covers the basic fundamentals of cost-effectiveness analysis and summarizes the key cost-effectiveness studies that relate to the new cholesterol guidelines.

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

    International Nuclear Information System (INIS)

    Lofaro, R.J.

    1995-01-01

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

  13. Aging management: Control of the knowledge data base

    Energy Technology Data Exchange (ETDEWEB)

    Schoeckle, F., E-mail: fs@amtec.de [Amtec Services, Hoher Steg 13, 74348 Laufen (Germany); Rothenhoefer, H. [Amtec Services, Hoher Steg 13, 74348 Laufen (Germany); Koenig, G. [EnBW Kernkraft, Kernkraftwerk Neckarwestheim, 74380 Neckarwestheim (Germany)

    2014-04-01

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

  14. Indian Society of Neuro-Oncology consensus guidelines for the contemporary management of medulloblastoma.

    Science.gov (United States)

    Gupta, Tejpal; Sarkar, Chitra; Rajshekhar, Vedantam; Chatterjee, Sandip; Shirsat, Neelam; Muzumdar, Dattatreya; Pungavkar, Sona; Chinnaswamy, Girish; Jalali, Rakesh

    2017-01-01

    The high success rate in the management medulloblastoma achieved in the western world is not exactly mirrored in developing countries including India. Socio-demographic differences, health-care disparity, and lack in uniformity of care with resultant widespread variations in the clinical practice are some of the reasons that may partly explain this difference in outcomes. Patients with medulloblastoma require a multi-disciplinary team approach involving but not limited to neuro-radiology, neurosurgery; neuropathology, molecular biology, radiation oncology, pediatric medical oncology and rehabilitative services for optimizing outcomes. The Indian Society of Neuro-Oncology (ISNO) constituted an expert multi-disciplinary panel with adequate representation from all stakeholders to prepare national consensus guidelines for the contemporary management of medulloblastoma. Minimum desirable, as well as preferable though optional recommendations (as appropriate), were developed and adopted for the pre-surgical work-up including neuroimaging; neurosurgical management including surgical principles, techniques, and complications; neuropathology reporting and molecular testing; contemporary risk-stratification in the molecular era; appropriate adjuvant therapy (radiotherapy and chemotherapy); and follow-up schedule in medulloblastoma. The current document represents a broad consensus reached amongst various stakeholders within the neuro-oncology community involved in the contemporary curative-intent management of children with medulloblastoma. It provides both general as well as specific guidelines and recommendations to be adopted by physicians and health care providers across India to achieve uniformity of care, improve disease-related outcomes, and compare results between institutions within the country.

  15. Evaluation of diabetes care management in primary clinics based on the guidelines of American Diabetes Association.

    Science.gov (United States)

    Albarrak, Ahmed Ismail; Mohammed, Rafiuddin; Assery, Bushra; Allam, Dalya; Morit, Sarah Al; Saleh, Reem Al; Zare'a, Reem

    2018-01-01

    There is a rapid increase in the incidence of diabetes mellitus in Saudi Arabia. Diabetes management is an essential constituent to prevent prognosis of diabetes complications. The main objective of this study was to assess diabetes care in primary clinics based on the guidelines of American Diabetes Association (ADA). A retrospective study at King Khaled University Hospitals, Riyadh, Saudi Arabia. A total of 200 patients were randomly selected from the databases of primary care clinics. An evaluation checklist was created based on the ADA treatment guidelines such as medical history, physical examination, laboratory evaluation, and referrals. The result showed that elements achieving the ADA targets for overall care were medical history (44.9%), physical examination (59.6%), laboratory evaluation (36.3%), and referrals (19.3%). The other subelement indicators such as referral to diabetes self-management education clinics (10%), dental examination (2%), HbA1c regular monitoring (33.5%), and blood pressure determination (100%) were documented with adherence to ADA standards. Diabetes management standards are an essential element in the success of the management plan. Most of the elements examined are not in full compliance with the ADA standard. Continues monitoring and self-review are recommended.

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

    Science.gov (United States)

    Bernstein, Charles N; Fried, Michael; Krabshuis, J H; Cohen, Henry; Eliakim, R; Fedail, Suleiman; Gearry, Richard; Goh, K L; Hamid, Saheed; Khan, Aamir Ghafor; LeMair, A W; Malfertheiner; Ouyang, Qin; Rey, J F; Sood, Ajit; Steinwurz, Flavio; Thomsen, Ole O; Thomson, Alan; Watermeyer, Gillian

    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 diseases have, in the past, been most evident in the developed world, their prevalence in the developing world has been gradually increasing in recent decades. This poses unique issues in diagnosis and management which have been scarcely addressed in the literature or in extant guidelines. Depending on the nature of the complaints, investigations to diagnose either form of IBD or to assess disease activity will vary and will also be influenced by geographic variations in other conditions that might mimic IBD. Similarly, therapy varies depending on the phenotype of the disease being treated and available 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. 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

    have, in the past, been most evident in the developed world, their prevalence in the developing world has been gradually increasing in recent decades. This poses unique issues in diagnosis and management which have been scarcely addressed in the literature or in extant guidelines. Depending...... on the nature of the complaints, investigations to diagnose either form of IBD or to assess disease activity will vary and will also be influenced by geographic variations in other conditions that might mimic IBD. Similarly, therapy varies depending on the phenotype of the disease being treated and available...... 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....

  18. NEPO cable system aging management programs

    International Nuclear Information System (INIS)

    Toman, G.

    2002-01-01

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

  19. Age Management in Danish Companies: What, How, and How Much?

    Directory of Open Access Journals (Sweden)

    Per H. Jensen

    2012-08-01

    Full Text Available This article investigates Danish employers’ behavior in the area of active aging, which is made topical by demographic aging. It describes age management practices and explains why some companies are more prone to employ age management than others. The study is based on a survey conducted among a representative sample of Danish employers, and 609 interviews in total have been carried out. Data have been scrutinized using frequency analysis for descriptive purposes as well as binary logistic regression analysis for explanatory purposes. Findings indicate that structural, cognitive, and action-oriented variables have significance for whether companies develop and employ active age management policies.

  20. Ageing Management for Research Reactors. Specific Safety Guide

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-10-15

    This Safety Guide was developed under the IAEA programme for safety standards for research reactors, which covers all the important areas of research reactor safety. It supplements and elaborates upon the safety requirements for ageing management of research reactors that are established in paras 6.68-6.70 and 7.109 of the IAEA Safety Requirements publication, Safety of Research Reactors. The safety of a research reactor requires that provisions be made in its design to facilitate ageing management. Throughout the lifetime of a research reactor, including its decommissioning, ageing management of its structures, systems and components (SSCs) important to safety is required, to ensure continued adequacy of the safety level, reliable operation of the reactor, and compliance with the operational limits and conditions. Managing the safety aspects of research reactor ageing requires implementation of an effective programme for the monitoring, prediction, and timely detection and mitigation of degradation of SSCs important to safety, and for maintaining their integrity and functional capability throughout their service lives. Ageing management is defined as engineering, operation, and maintenance strategy and actions to control within acceptable limits the ageing degradation of SSCs. Ageing management includes activities such as repair, refurbishment and replacement of SSCs, which are similar to other activities carried out at a research reactor in maintenance and testing or when a modification project takes place. However, it is important to recognize that effective management of ageing requires the use of a methodology that will detect and evaluate ageing degradation as a consequence of the service conditions, and involves the application of countermeasures for prevention and mitigation of ageing degradation. The objective of this Safety Guide is to provide recommendations on managing ageing of SSCs important to safety at research reactors on the basis of international

  1. Ageing Management for Research Reactors. Specific Safety Guide

    International Nuclear Information System (INIS)

    2010-01-01

    This Safety Guide was developed under the IAEA programme for safety standards for research reactors, which covers all the important areas of research reactor safety. It supplements and elaborates upon the safety requirements for ageing management of research reactors that are established in paras 6.68-6.70 and 7.109 of the IAEA Safety Requirements publication, Safety of Research Reactors. The safety of a research reactor requires that provisions be made in its design to facilitate ageing management. Throughout the lifetime of a research reactor, including its decommissioning, ageing management of its structures, systems and components (SSCs) important to safety is required, to ensure continued adequacy of the safety level, reliable operation of the reactor, and compliance with the operational limits and conditions. Managing the safety aspects of research reactor ageing requires implementation of an effective programme for the monitoring, prediction, and timely detection and mitigation of degradation of SSCs important to safety, and for maintaining their integrity and functional capability throughout their service lives. Ageing management is defined as engineering, operation, and maintenance strategy and actions to control within acceptable limits the ageing degradation of SSCs. Ageing management includes activities such as repair, refurbishment and replacement of SSCs, which are similar to other activities carried out at a research reactor in maintenance and testing or when a modification project takes place. However, it is important to recognize that effective management of ageing requires the use of a methodology that will detect and evaluate ageing degradation as a consequence of the service conditions, and involves the application of countermeasures for prevention and mitigation of ageing degradation. The objective of this Safety Guide is to provide recommendations on managing ageing of SSCs important to safety at research reactors on the basis of international

  2. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Giza, Christopher C; Kutcher, Jeffrey S; Ashwal, Stephen; Barth, Jeffrey; Getchius, Thomas S D; Gioia, Gerard A; Gronseth, Gary S; Guskiewicz, Kevin; Mandel, Steven; Manley, Geoffrey; McKeag, Douglas B; Thurman, David J; Zafonte, Ross

    2013-06-11

    To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article. We systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations. Specific risk factors can increase or decrease concussion risk. Diagnostic tools to help identify individuals with concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, concussion history, and younger age identify those at risk for postconcussion impairments. Risk factors for recurrent concussion include history of multiple concussions, particularly within 10 days after initial concussion. Risk factors for chronic neurobehavioral impairment include concussion exposure and APOE ε4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion. Practice recommendations are presented for preparticipation counseling, management of suspected concussion, and management of diagnosed concussion.

  3. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for urothelial cell carcinoma of the urinary bladder 2017

    Directory of Open Access Journals (Sweden)

    Hulayel Alharbi

    2018-01-01

    Full Text Available This is an update to the previously published Saudi guidelines for the evaluation and medical/surgical management of patients diagnosed with urothelial cell carcinoma of the urinary bladder. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7th edition. The guidelines are presented with their accompanying supporting evidence level, which is 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 policymakers in the management of patients diagnosed with urothelial cell carcinoma of the urinary bladder.

  4. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for urothelial cell carcinoma of the urinary bladder 2017.

    Science.gov (United States)

    Alharbi, Hulayel; Alkhateeb, Sultan; Murshid, Esam; Alotaibi, Mohammed; Abusamra, Ashraf; Rabah, Danny; Almansour, Mubarak; Alghamdi, Abdullah; Aljubran, Ali; Eltigani, Amin; Alkushi, Hussein; Ahmed, Imran; Alsharm, Abdullah; Bazarbashi, Shouki

    2018-01-01

    This is an update to the previously published Saudi guidelines for the evaluation and medical/surgical management of patients diagnosed with urothelial cell carcinoma of the urinary bladder. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7 th edition. The guidelines are presented with their accompanying supporting evidence level, which is 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 policymakers in the management of patients diagnosed with urothelial cell carcinoma of the urinary bladder.

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

    International Nuclear Information System (INIS)

    2004-01-01

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

  6. Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma.

    Science.gov (United States)

    Ho, Vanessa Phillis; Patel, Nimitt J; Bokhari, Faran; Madbak, Firas G; Hambley, Jana E; Yon, James R; Robinson, Bryce R H; Nagy, Kimberly; Armen, Scott B; Kingsley, Samuel; Gupta, Sameer; Starr, Frederic L; Moore, Henry R; Oliphant, Uretz J; Haut, Elliott R; Como, John J

    2017-01-01

    Traumatic injury to the pancreas is rare but is associated with significant morbidity and mortality, including fistula, sepsis, and death. There are currently no practice management guidelines for the medical and surgical management of traumatic pancreatic injuries. The overall objective of this article is to provide evidence-based recommendations for the physician who is presented with traumatic injury to the pancreas. The MEDLINE database using PubMed was searched to identify English language articles published from January 1965 to December 2014 regarding adult patients with pancreatic injuries. A systematic review of the literature was performed, and the Grading of Recommendations Assessment, Development and Evaluation framework was used to formulate evidence-based recommendations. Three hundred nineteen articles were identified. Of these, 52 articles underwent full text review, and 37 were selected for guideline construction. Patients with grade I/II injuries tend to have fewer complications; for these, we conditionally recommend nonoperative or nonresectional management. For grade III/IV injuries identified on computed tomography or at operation, we conditionally recommend pancreatic resection. We conditionally recommend against the routine use of octreotide for postoperative pancreatic fistula prophylaxis. No recommendations could be made regarding the following two topics: optimal surgical management of grade V injuries, and the need for routine splenectomy with distal pancreatectomy. Systematic review, level III.

  7. 2015 UK National Guideline on the management of non-gonococcal urethritis.

    Science.gov (United States)

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

    2016-02-01

    We present the updated British Association for Sexual Health and HIV guideline for the management of non-gonococcal urethritis in men. This document includes a review of the current literature on its aetiology, diagnosis and management. In particular it highlights the emerging evidence that azithromycin 1 g may result in the development of antimicrobial resistance in Mycoplasma genitalium and that neither azithromycin 1 g nor doxycycline 100 mg twice daily for seven days achieves a cure rate of >90% for this micro-organism. Evidence-based diagnostic and management strategies for men presenting with symptoms suggestive of urethritis, those confirmed to have non-gonococcal urethritis and those with persistent symptoms following first-line treatment are detailed. © The Author(s) 2015.

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

    Energy Technology Data Exchange (ETDEWEB)

    Tang, H. T. [Electric Power Research Institute, EPRI, 3420 Hillview Avenue, Palo Alto, California 94304 (United States)

    2006-09-15

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

  9. Opinions of Forest Managers, Loggers, and Forest Landowners in North Carolina regarding Biomass Harvesting Guidelines

    Directory of Open Access Journals (Sweden)

    Diane Fielding

    2012-01-01

    Full Text Available Woody biomass has been identified as an important renewable energy source capable of offsetting fossil fuel use. The potential environmental impacts associated with using woody biomass for energy have spurred development of biomass harvesting guidelines (BHGs in some states and proposals for BHGs in others. We examined stakeholder opinions about BHGs through 60 semistructured interviews with key participants in the North Carolina, USA, forest business sector—forest managers, loggers, and forest landowners. Respondents generally opposed requirements for new BHGs because guidelines added to best management practices (BMPs. Most respondents believed North Carolina’s current BMPs have been successful and sufficient in protecting forest health; biomass harvesting is only an additional component to harvesting with little or no modification to conventional harvesting operations; and scientific research does not support claims that biomass harvesting negatively impacts soil, water quality, timber productivity, or wildlife habitat. Some respondents recognized possible benefits from the implementation of BHGs, which included reduced site preparation costs and increases in proactive forest management, soil quality, and wildlife habitat. Some scientific literature suggests that biomass harvests may have adverse site impacts that require amelioration. The results suggest BHGs will need to be better justified for practitioners based on the scientific literature or linked to demand from new profitable uses or subsidies to offset stakeholder perceptions that they create unnecessary costs.

  10. Evidence based guidelines for the prevention, identification, and management of occupational asthma.

    Science.gov (United States)

    Nicholson, P J; Cullinan, P; Taylor, A J Newman; Burge, P S; Boyle, C

    2005-05-01

    Occupational asthma is the most frequently reported work related respiratory disease in many countries. This work was commissioned by the British Occupational Health Research Foundation to assist the Health and Safety Executive in achieving its target of reducing the incidence of occupational asthma in Great Britain by 30% by 2010. The guidelines aim to improve the prevention, identification, and management of occupational asthma by providing evidence based recommendations on which future practice can be based. The literature was searched systematically using Medline and Embase for articles published in all languages up to the end of June 2004. Evidence based statements and recommendations were graded according to the Royal College of General Practitioner's star system and the revised Scottish Intercollegiate Guidelines Network grading system. A total of 474 original studies were selected for appraisal from over 2500 abstracts. The systematic review produced 52 graded evidence statements and 22 recommendations based on 223 studies. Evidence based guidelines have become benchmarks for practice in healthcare and the process used to prepare them is well established. This evidence review and its recommendations focus on interventions and outcomes to provide a robust approach to the prevention, identification, and management of occupational asthma, based on and using the best available medical evidence. The most important action to prevent cases of occupational asthma is to reduce exposure at source. Thereafter surveillance should be performed for the early identification of symptoms, including occupational rhinitis, with additional functional and immunological tests where appropriate. Effective management of workers suspected to have occupational asthma involves the identification and investigation of symptoms suggestive of asthma immediately they occur. Those workers who are confirmed to have occupational asthma should be advised to avoid further exposure completely

  11. Review: Management of adnexal masses: An age-guided approach ...

    African Journals Online (AJOL)

    Adnexal masses in different age groups may need different management approaches. By elimination of the type of mass that is less likely in a specific age group one can identify the most prevalent group which can guide management. Most important of all, the probability of malignancy must either be identified or ruled out.

  12. The South African Society of Psychiatrists/Psychiatry Management Group management guidelines for adult attention-deficit/hyperactivity disorder

    Directory of Open Access Journals (Sweden)

    Renata Schoeman

    2017-04-01

    of Stellenbosch Business School with a thesis entitled ‘A funding model proposal for private health insurance for adult attention-deficit/hyperactivity disorder in the South African context’. This is first South African study exploring the situation with regard to the prevalence and treatment of adult ADHD. Dr Schoeman was tasked by the SIG with the drafting of guidelines. Dr Liebenberg provided valuable input. The guidelines were then circulated to the SIG members, as well as the Chair of the Public Sector SIG, for written feedback and evidence- based suggestions which were then incorporated into the guidelines. The final guidelines were circulated for written approval by the SIG members, followed by formal approval at a SIG meeting held on 14 August 2016, after which it was submitted to the South African Society of Psychiatrists (SASOP and Psychiatry Management Group (PsychMG boards for recommendation and ratification.

  13. Evaluating the level of adherence to Ministry of Health guidelines in the management of Severe Acute Malnutrition at Garissa Provincial General hospital, Garissa, Kenya

    Science.gov (United States)

    Warfa, Osman; Njai, Daniel; Ahmed, Laving; Admani, Bashir; Were, Fred; Wamalwa, Dalton; Osano, Boniface; Mburugu, Patrick; Mohamed, Musa

    2014-01-01

    Introduction Half of Kenya's high infant and under five mortality rates is due to malnutrition. Proper implementation of World Health Organization's (WHO) Evidence Based Guidelines (EBG) in management of severe acute malnutrition can reduce mortality rates to less than 5%. The objectives were to establish the level of adherence to WHO guideline and the proportion of children appropriately managed for severe acute malnutrition (steps 1-8) as per the WHO protocol in the management of severe acute malnutrition. This was a short longitudinal study of 96 children, aged 6-59 months admitted to the pediatric ward with diagnosis of severe acute malnutrition. Methods Data was extracted from patients’ medical files and recorded into an audit tool to compare care provided in this hospital with WHO guidelines. Results Non-edematous malnutrition was the commonest presentation (93.8%). A higher proportion (63.5%) of patients was male. Most (85.4%) of patients were younger than 2 years. Patients with non-edematous malnutrition were younger (mean age for non-edematous malnutrition was 16 (± 10.6) months versus 25 (± 13.7) months in edematous malnutrition). The commonest co- morbid condition was diarrhea (52.1%). Overall, 13 children died giving an inpatient case fatality rate of 13.5%. Appropriate management was documented in only 14.6% for hypoglycemia (step1), 5.2% for hypothermia (step 2) and 31.3% for dehydration (step 3). Conclusion The level of adherence to MOH guidelines was documented in 5 out of the 8 steps. Appropriate management of children with severe acute malnutrition was inadequate at Garissa hospital. PMID:25237411

  14. 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.

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    to the rare and unforeseeable nature of anaphylaxis, mainly includes case series and expert opinion (grade of evidence IV and V). These guidelines include an overview of the epidemiology of anaphylactic reactions during anaesthesia. A treatment algorithm is suggested, with emphasis on the incremental...... advice concerning follow-up procedures is provided. In addition, an algorithm is included with advice on how to manage patients with previous suspected anaphylaxis during anaesthesia. Lastly, Appendix 2 provides an overview of the incidence, mechanisms and possibilities for follow-up for some common drug...

  16. European Society of Gynaecological Oncology Guidelines for the Management of Patients With Vulvar Cancer

    DEFF Research Database (Denmark)

    Oonk, Maaike H M; Planchamp, François; Baldwin, Peter

    2017-01-01

    OBJECTIVE: The aim of this study was to develop clinically relevant and evidence-based guidelines as part of European Society of Gynaecological Oncology's mission to improve the quality of care for women with gynecologic cancers across Europe. METHODS: The European Society of Gynaecological...... Oncology Council nominated an international development group made of practicing clinicians who provide care to patients with vulvar cancer and have demonstrated leadership and interest in the management of patients with vulvar cancer (18 experts across Europe). To ensure that the statements are evidence...

  17. Management of atrial fibrillation around the world: a comparison of current ACCF/AHA/HRS, CCS, and ESC guidelines.

    Science.gov (United States)

    Wasmer, Kristina; Eckardt, Lars

    2011-10-01

    New guidelines for the management of atrial fibrillation (AF) have recently been published by the American College of Cardiology Foundation/American Heart Association, and Heart Rhythm Society (ACCF/AHA/HRS) task force on practice guidelines, the Canadian Cardiovascular Society (CCS), and the European Society of Cardiology (ESC). Although they all refer to the same scientific data and agree in the majority of AF management, interpretation, and weighing of study results are quite different in some aspects. While recommendations for stroke risk assessment and prophylaxis are rather conservative in the ESC guidelines, the CCS guideline recommendations are more conservative with regard to lenient rate control and the ACCF/AHA/HRS recommendations are rather strict with regard to rhythm management.

  18. Financial incentives and physician commitment to guideline-recommended hypertension management.

    Science.gov (United States)

    Hysong, Sylvia J; Simpson, Kate; Pietz, Kenneth; SoRelle, Richard; Broussard Smitham, Kristen; Petersen, Laura A

    2012-10-01

    To examine the impact of financial incentives on physician goal commitment to guideline-recommended hypertension care. Clinic-level cluster-randomized trial with 4 arms: individual, group, or combined incentives, and control. A total of 83 full-time primary care physicians at 12 Veterans Affairs medical centers completed web-based surveys measuring their goal commitment to guideline-recommended hypertension care every 4 months and telephone interviews at months 8 and 16. Intervention arm participants received performance-based incentives every 4 months for 5 periods. All participants received guideline education at baseline and audit and feedback every 4 months. Physician goal commitment did not vary over time or across arms. Participants reported patient nonadherence was a perceived barrier and consistent follow-up was a perceived facilitator to successful hypertension care, suggesting that providers may perceive hypertension management as more of a patient responsibility (external locus of control). Financial incentives may constitute an insufficiently strong intervention to influence goal commitment when providers attribute performance to external forces beyond their control.

  19. Comparison of two editions of Tokyo guidelines for the management of acute cholangitis.

    Science.gov (United States)

    Sun, Gang; Han, Lu; Yang, Yunsheng; Linghu, Enqiang; Li, Wen; Cai, Fengchun; Kong, Jinyan; Wang, Xiangdong; Meng, Jiangyun; Du, Hong; Wang, Hongbin; Huang, Qiyang; Hyder, Quratulain; Zhang, Xiuli

    2014-02-01

    The Tokyo guidelines from 2007 (TG07) and 2013 (TG13) were compared for the management of acute cholangitis (AC). We reviewed patients with clinically-proven AC by detecting purulent biles during biliary drainage. TG07 and TG13 were compared regarding diagnosis, severity grading and prognostic values. New risk factors for 30-day mortality were investigated. Definite diagnosis for 120 eligible patients was made in 104 (86.7%) and 101 (84.2%) cases by TG07 and TG13, respectively (P = 0.36), higher than 61 (50.8%) by Charcot's triad (P < 0.001). Diagnostic overlap and concordance (κ) are 90.8% (109/120) and 0.63 (P < 0.0001). Patients classified into mild and moderate grades by TG07 and TG13 differed significantly (P = 0.043). Both guidelines could not predict clinical outcomes except the needs for multi ERCP session by TG13. Intrahepatic obstruction (OR = 11.2, 95% CI: 1.55-226.9) and hypoalbuminemia (≤ 25.0 g/l; OR = 17.3, 95% CI: 3.5-313.6) were independent risk factors for 30-day mortality in multivariate model. Two guidelines are reproducible and reliable in AC diagnosis but different in severity grading. TG13 are more practical for immediate severity grading, enabling planning treatment upon admission. Intrahepatic obstruction is a new candidate predictor of 30-day mortality for further assessment. © 2013 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

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

    Energy Technology Data Exchange (ETDEWEB)

    El Younoussi, C.; Nacir, B.; El Bakkari, B.; Boulaich, Y. [Centre for Nuclear Studies of Maâmora (CENM), National Centre of Energy Sciences and Nuclear Techniques (CNESTEN), Rabat (Morocco)

    2014-08-15

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

  1. Guidelines for the management and treatment of periodic fever syndromes: Cryopyrin-associated periodic syndromes (cryopyrinopathies - CAPS).

    Science.gov (United States)

    Terreri, Maria Teresa R A; Bernardo, Wanderley Marques; Len, Claudio Arnaldo; da Silva, Clovis Artur Almeida; de Magalhães, Cristina Medeiros Ribeiro; Sacchetti, Silvana B; Ferriani, Virgínia Paes Leme; Piotto, Daniela Gerent Petry; Cavalcanti, André de Souza; de Moraes, Ana Júlia Pantoja; Sztajnbok, Flavio Roberto; de Oliveira, Sheila Knupp Feitosa; Campos, Lucia Maria Arruda; Bandeira, Marcia; Santos, Flávia Patricia Sena Teixeira; Magalhães, Claudia Saad

    2016-01-01

    To establish guidelines based on cientific evidences for the management of cryopyrin associated periodic syndromes. The Guideline was prepared from 4 clinical questions that were structured through PICO (Patient, Intervention or indicator, Comparison and Outcome), to search in key primary scientific information databases. After defining the potential studies to support the recommendations, these were graduated considering their strength of evidence and grade of recommendation. 1215 articles were retrieved and evaluated by title and abstract; from these, 42 articles were selected to support the recommendations. 1. The diagnosis of CAPS is based on clinical history and clinical manifestations, and later confirmed by genetic study. CAPS may manifest itself in three phenotypes: FCAS (mild form), MWS (intermediate form) and CINCA (severe form). Neurological, ophthalmic, otorhinolaryngological and radiological assessments may be highly valuable in distinguishing between syndromes; 2. The genetic diagnosis with NLRP3 gene analysis must be conducted in suspected cases of CAPS, i.e., individuals presenting before 20 years of age, recurrent episodes of inflammation expressed by a mild fever and urticaria; 3. Laboratory abnormalities include leukocytosis and elevated serum levels of inflammatory proteins; and 4. Targeted therapies directed against interleukin-1 lead to rapid remission of symptoms in most patients. However, there are important limitations on the long-term safety. None of the three anti-IL-1β inhibitors prevents progression of bone lesions. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

  2. Evaluation and Management of Traumatic Diaphragmatic Injuries: A Practice Management Guideline from the Eastern Association for the Surgery of Trauma.

    Science.gov (United States)

    McDonald, Amy A; Robinson, Bryce R H; Alarcon, Louis; Bosarge, Patrick L; Dorion, Heath; Haut, Elliott R; Juern, Jeremy; Madbak, Firas; Reddy, Srinivas; Weiss, Patricia; Como, John J

    2018-04-02

    Traumatic diaphragm injuries (TDI) pose both diagnostic and therapeutic challenges in both the acute and chronic phases. There are no published practice management guidelines to date for TDI. We aim to formulate a practice management guideline for TDI using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The working group formulated five Patient, Intervention, Comparator, Outcome (PICO) questions regarding the following topics: 1) diagnostic approach (laparoscopy vs. computed tomography); 2) non-operative management of penetrating right-sided injuries; 3) surgical approach (abdominal or thoracic) for acute TDI, including 4) the use of laparoscopy; and 5) surgical approach (abdominal or thoracic) for delayed TDI. A systematic review was undertaken and last updated December 2016. RevMan 5 (Cochran Collaboration) and GRADEpro (Grade Working Group) software were utilized. Recommendations were voted on by working group members. Consensus was obtained for each recommendation. A total of 56 articles were utilized to formulate the recommendations. Most studies were retrospective case series with variable reporting of outcomes measures and outcomes frequently not stratified to intervention or comparator. The overall quality of the evidence was very low for all PICOs. Therefore, only conditional recommendations could be made. Recommendations were made in favor of laparoscopy over CT for diagnosis, non-operative vs. operative approach for right-sided penetrating injuries, abdominal vs. thoracic approach for acute TDI, and laparoscopy (with the appropriate skill set and resources) vs. open approach for isolated TDI. No recommendation could be made for the preferred operative approach for delayed TDI. Very low-quality evidence precluded any strong recommendations. Further study of the diagnostic and therapeutic approaches to TDI is warranted. Guideline LEVEL OF EVIDENCE: 4.

  3. Managing conflicts of interest in the UK National Institute for Health and Care Excellence (NICE) clinical guidelines programme: qualitative study.

    Science.gov (United States)

    Graham, Tanya; Alderson, Phil; Stokes, Tim

    2015-01-01

    There is international concern that conflicts of interest (COI) may bias clinical guideline development and render it untrustworthy. Guideline COI policies exist with the aim of reducing this bias but it is not known how such policies are interpreted and used by guideline producing organisations. This study sought to determine how conflicts of interest (COIs) are disclosed and managed by a national clinical guideline developer (NICE: the UK National Institute for Health and Care Excellence). Qualitative study using semi-structured telephone interviews with 14 key informants: 8 senior staff of NICE's guideline development centres and 6 chairs of guideline development groups (GDGs). We conducted a thematic analysis. Participants regard the NICE COI policy as comprehensive leading to transparent and independent guidance. The application of the NICE COI policy is, however, not straightforward and clarity could be improved. Disclosure of COI relies on self reporting and guideline developers have to take "on trust" the information they receive, certain types of COI (non-financial) are difficult to categorise and manage and disclosed COI can impact on the ability to recruit clinical experts to GDGs. Participants considered it both disruptive and stressful to exclude members from GDG meetings when required by the COI policy. Nonetheless the impact of this disruption can be minimised with good group chairing skills. We consider that the successful implementation of a COI policy in clinical guideline development requires clear policies and procedures, appropriate training of GDG chairs and an evaluation of how the policy is used in practice.

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

    Science.gov (United States)

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

    2008-01-01

    In the modern day environment, workers' compensation costs continue to be a challenge, with a need to balance costs, benefits, and quality of medical care. The cost of workers' compensation care affects all stakeholders including workers, employers, providers, regulators, legislators, and insurers. Consequently, a continued commitment to quality, accessibility to care, and cost containment will help ensure that workers are afforded accessible, high quality, and cost-effective care. In 2004, workers' compensation programs in all 50 states, the District of Columbia, and federal programs in the United States combined received an income of $87.4 billion while paying out only $56 billion in medical and cash benefits with $31.4 billion or 37% in administrative expenses and profit. Occupational diseases represented only 8% of the workers' compensation claims and 29% of the cost. The American College of Occupational and Environmental Medicine (ACOEM) has published several guidelines; though widely adopted by WCPs, these guidelines evaluate the practice of medicine of multiple specialties without adequate expertise and expert input from the concerned specialties, including interventional pain management. An assessment of the ACOEM guidelines utilizing Appraisal of Guidelines for Research and Evaluation (AGREE) criteria, the criteria developed by the American Medical Association (AMA), the Institute of Medicine (IOM), and other significantly accepted criteria, consistently showed very low scores (evidence, standard of care, or expert consensus. Based on the evaluation utilizing appropriate and current evidence-based medicine (EBM) principles, the evidence ratings for diagnostic techniques of lumbar discography; cervical, thoracic, and lumbar facet joint nerve blocks and sacroiliac joint nerve blocks; therapeutic cervical and lumbar medial branch blocks and radiofrequency neurolysis; cervical interlaminar epidural steroid injections, caudal epidural steroid injections, and

  5. 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.

  6. Diagnostic evaluation and management of chronic thromboembolic pulmonary hypertension: A clinical practice guideline

    Science.gov (United States)

    Mehta, Sanjay; Helmersen, Doug; Provencher, Steeve; Hirani, Naushad; Rubens, Fraser D; De Perrot, Marc; Blostein, Mark; Boutet, Kim; Chandy, George; Dennie, Carole; Granton, John; Hernandez, Paul; Hirsch, Andrew M; Laframboise, Karen; Levy, Robert D; Lien, Dale; Martel, Simon; Shoemaker, Gerard; Swiston, John; Weinkauf, Justin

    2010-01-01

    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. METHODS A representative interdisciplinary panel of medical experts undertook a formal clinical practice guideline development process. A total of 20 key clinical issues were defined according to the patient population, intervention, comparator, outcome (PICO) approach. The panel performed an evidence-based, systematic, literature review, assessed and graded the relevant evidence, and made 26 recommendations. RESULTS Asymptomatic patients postpulmonary embolism should not be screened for CTEPH. In patients with pulmonary hypertension, the possibility of CTEPH should be routinely evaluated with initial ventilation/ perfusion lung scanning, not computed tomography angiography. Pulmonary endarterectomy surgery is the treatment of choice in patients with surgically accessible CTEPH, and may also be effective in CTEPH patients with disease in more ‘distal’ pulmonary arteries. The anatomical extent of CTEPH for surgical pulmonary endarterectomy is best assessed by contrast pulmonary angiography, although positive computed tomography angiography may be acceptable. Novel medications indicated for the treatment of pulmonary hypertension may be effective for selected CTEPH patients. CONCLUSIONS The present guideline requires formal dissemination to relevant target user groups, the development of tools for implementation into routine clinical practice and formal evaluation of the impact of the guideline on the quality of care of CTEPH patients. Moreover, the guideline will be updated periodically to reflect new evidence or clinical approaches. PMID:21165353

  7. Aging management of PWR reactor internals in U.S. plants

    International Nuclear Information System (INIS)

    Amberge, K.J.; Demma, A.

    2015-01-01

    This paper describes the development, aging management strategies and inspection results of the Pressurized Water Reactor (PWR) vessel internals inspection and evaluation guidelines. The goal of these guidelines is to provide PWR owners with robust aging management strategies to monitor degradation of internals components to support life extension as well as the current period of operation and power up-rate activities. The implementation of these guidelines began in 2010 within the U.S. PWR fleet and several examinations have been performed since. Examples of inspection results are presented for selected vessel internals components and are compared with simulation results. In summary, to date there have been no observations of austenitic stainless steel stress corrosion cracking (SCC), which is consistent with expectations based on the current understanding of the mechanism. Observations of irradiation assisted stress corrosion cracking (IASCC) have been limited and only found in baffle former bolting. Additionally, no macroscopic effects or global observations of void swelling impacts on general conditions of reactor internal hardware have been observed. (authors)

  8. The 2017 ESC/EACTS guidelines on the management of valvular heart disease : What is new and what has changed compared to the 2012 guidelines?

    Science.gov (United States)

    Baumgartner, Helmut

    2018-03-01

    Numerous new data on the diagnosis and management of valvular heart disease published since 2012 made an update of the practice guidelines of the European Society of Cardiology and European Association of Cardiothoracic Surgery necessary. This was particularly the case for the use of catheter interventional treatment, indications for intervention in asymptomatic patients, medical treatment and organization of care. This review summarizes the most important changes in the recommendations.

  9. Ageing management database development for PWR NPP steam generator

    International Nuclear Information System (INIS)

    Liu Hongyun; Xu Liangjun; Xiong Changhuai; Wang Xianyuan

    2005-01-01

    Steam generator (SG) is one of the key safe important equipment of NPP, which is covered by NPP aging management program. Steam Generator Aging Management Dabatase (SGAMDB) is developed to provide necessary information for SG aging management. RINPO is developing SGAMDB for domestic NPP. This system contains information and data about SG design, manufacture, operation and maintenance. The information include NPP fundamental data, SG design data, SG aging mechanism, SG operation data, SG ISI data, SG maintenance data and SG evaluation interface. The system runs at the intranet of Qinshan-1 NPP with B/S mode. It can provide information inquire and fundamental analysis for NPP SG aging team and SG aging researcher's. In addition, it provides necessary information and data for SG aging analysis and evaluation, such as all pressure test process and flaws of tubes, and collects the analysis results. (authors)

  10. Reliability methods in nuclear power plant ageing management

    International Nuclear Information System (INIS)

    Simola, K.

    1999-01-01

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

  11. Reliability methods in nuclear power plant ageing management

    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.)

  12. Anorexia of Aging: Assessment and Management.

    Science.gov (United States)

    Landi, Francesco; Picca, Anna; Calvani, Riccardo; Marzetti, Emanuele

    2017-08-01

    Older people often experience loss of appetite and/or decreased food intake that, unavoidably, impact energy metabolism and overall health status. The association of age-related nutritional deficits with several adverse outcomes has led to the recognition of a geriatric condition referred to as "anorexia of aging." Anorexia is an independent predictor of morbidity and mortality both in the community and across clinical settings. Multidimensional interventions within personalized care plans currently represent the most effective option to ensure the provision of adequate amounts of food, limit weight loss, and prevent adverse health outcomes in older adults. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    McAlindon, T E; Bannuru, R R; Sullivan, M C; Arden, N K; Berenbaum, F; Bierma-Zeinstra, S M; Hawker, G A; Henrotin, Y; Hunter, D J; Kawaguchi, H; Kwoh, K; Lohmander, S; Rannou, F; Roos, E M; Underwood, M

    2014-03-01

    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. 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 Guidelines Development Group (OAGDG). Based on previous OA guidelines and a systematic review of the OA literature, 29 treatment modalities were considered for recommendation. Evidence published subsequent to the 2010 OARSI guidelines was based on a systematic review conducted by the OA Research Society International (OARSI) evidence team at Tufts Medical Center, Boston, USA. Medline, EMBASE, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials were initially searched in first quarter 2012 and last searched in March 2013. Included evidence was assessed for quality using Assessment of Multiple Systematic Reviews (AMSTAR) criteria, and published criticism of included evidence was also considered. To provide recommendations for individuals with a range of health profiles and OA burden, treatment recommendations were stratified into four clinical sub-phenotypes. Consensus recommendations were produced using the RAND/UCLA Appropriateness Method and Delphi voting process. Treatments were recommended as Appropriate, Uncertain, or Not Appropriate, for each of four clinical sub-phenotypes and accompanied by 1-10 risk and benefit scores. Appropriate treatment modalities for all individuals with knee OA included biomechanical interventions, intra-articular corticosteroids, exercise (land-based and water-based), self-management and education, strength training, and

  14. 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.

  15. 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

  16. Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society

    Directory of Open Access Journals (Sweden)

    DE Moulin

    2007-01-01

    Full Text Available Neuropathic pain (NeP, generated by disorders of the peripheral and central nervous system, can be particularly severe and disabling. Prevalence estimates indicate that 2% to 3% of the population in the developed world suffer from NeP, which suggests that up to one million Canadians have this disabling condition. Evidence-based guidelines for the pharmacological management of NeP are therefore urgently needed. Randomized, controlled trials, systematic reviews and existing guidelines focusing on the pharmacological management of NeP were evaluated at a consensus meeting. Medications are recommended in the guidelines if their analgesic efficacy was supported by at least one methodologically sound, randomized, controlled trial showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment are based on degree of evidence of analgesic efficacy, safety, ease of use and cost-effectiveness. Analgesic agents recommended for first-line treatments are certain antidepressants (tricyclics and anticonvulsants (gabapentin and pregabalin. Second-line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine. Tramadol and controlled-release opioid analgesics are recommended as third-line treatments for moderate to severe pain. Recommended fourth-line treatments include cannabinoids, methadone and anticonvulsants with lesser evidence of efficacy, such as lamotrigine, topiramate and valproic acid. Treatment must be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Further studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes, and treatment of pediatric and central NeP.

  17. [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

  18. Clinical practice guidelines (CPGs) reduce costs in the management of isolated splenic injuries at pediatric trauma centers.

    Science.gov (United States)

    Gutierrez, Ivan M; Zurakowski, David; Chen, Qiaoli; Mooney, David P

    2013-02-01

    The American Pediatric Surgical Association Trauma Committee proposed the use of a clinical practice guideline (CPG) for the non-operative management of isolated splenic injuries in 1998. An analysis was conducted to determine the financial impact of CPGs on the management of these injuries. The Pediatric Health Information System database, which contains data from 44 children's hospitals, was used to identify children who sustained a graded isolated splenic injury between June 2005 and June 2010. Demographics, length of stay (LOS), readmission rates, and laboratory, imaging, procedural, and total cost data were determined for all hospitals verified as a pediatric trauma center by the American College of Surgeons and/or designated by their local authority. Comparisons were made between facilities self-identifying as having a splenic injury management CPG and those without a CPG. Children (1,154) with isolated splenic injuries (grades 1-4) were cared for in 26 pediatric trauma centers: 20 with a CPG and 6 without (non-CPG). Median costs were significantly lower at CPG than non-CPG centers for imaging (US $163 vs. US $641, P splenic injuries at a pediatric trauma center results in significantly reduced imaging, laboratory, and total hospital costs independent of patient age, gender, grade, and LOS.

  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. 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.

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

    Science.gov (United States)

    Mariaselvam, Suresh; Gopichandran, Vijayaprasad

    2016-01-01

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

  2. Guidelines for the management of common hazardous wastes in developing countries

    International Nuclear Information System (INIS)

    Smith, J.E. Jr; Helmick, J.; Ozolins, G.

    1991-01-01

    Several United Nations organizations, including the World Health Organization (WHO), World Bank (WB), and United Nations Environment Programme (UNEP), are cooperating in the development and implementation of a technology transfer and training program for management of hazardous wastes. A number of other organizations, including the International Solid Waste and Public Cleansing Association (ISWA) and the U.S. Environmental Protection Agency (EPA), are assisting in this effort. Waste-specific guidelines are being written for administrators and technical staff in developing countries who are responsible for waste management and for public health and environmental protection in general. Guidance documents are being developed for wastes based on requests from personnel in developing countries, including: metal finishing (e.g., electroplating) wastes, pesticides, chlorinated solvents (including PCBs), petrochemicals, waste oils, tannery/fellmongering/slaughterhouse wastes, clinical wastes, lead acid batteries, asbestos, and textile industry wastes. (au)

  3. WSES consensus conference: Guidelines for first-line management of intra-abdominal infections

    Directory of Open Access Journals (Sweden)

    Leppaniemi Ari

    2011-01-01

    Full Text Available Abstract Intra-abdominal infections are still associated with high rate of morbidity and mortality. A multidisciplinary approach to the management of patients with intra-abdominal infections may be an important factor in the quality of care. The presence of a team of health professionals from various disciplines, working in concert, may improve efficiency, outcome, and the cost of care. A World Society of Emergency Surgery (WSES Consensus Conference was held in Bologna on July 2010, during the 1st congress of the WSES, involving surgeons, infectious disease specialists, pharmacologists, radiologists and intensivists with the goal of defining recommendations for the early management of intra-abdominal infections. This document represents the executive summary of the final guidelines approved by the consensus conference.

  4. [The German program for disease management guidelines. Background, methods, and development process].

    Science.gov (United States)

    Ollenschläger, Günter; Kopp, Ina; Lelgemann, Monika; Sänger, Sylvia; Heymans, Lothar; Thole, Henning; Trapp, Henrike; Lorenz, Wilfried; Selbmann, Hans-Konrad; Encke, Albrecht

    2006-10-15

    The Program for National Disease Management Guidelines (German DM-CPG Program) was established in 2002 by the German Medical Association (umbrella organization of the German Chambers of Physicians) and joined by the Association of the Scientific Medical Societies (AWMF; umbrella organization of more than 150 professional societies) and by the National Association of Statutory Health Insurance Physicians (NASHIP) in 2003. The program provides a conceptual basis for disease management, focusing on high-priority health-care topics and aiming at the implementation of best practice recommendations for prevention, acute care, rehabilitation and chronic care. It is organized 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 Program is to establish consensus of the medical professions on evidence-based key recommendations covering all sectors of health-care 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, chronic obstructive pulmonary disease, 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 health-care providers. The article describes background, methods, and tools of the DM-CPG Program, and is the first of a publication series dealing with innovative recommendations and aspects of the program.

  5. Management of patients with refractory angina: Canadian Cardiovascular Society/Canadian Pain Society joint guidelines.

    Science.gov (United States)

    McGillion, Michael;