WorldWideScience

Sample records for assessment guidelines cancer

  1. Approach to fever assessment in ambulatory cancer patients receiving chemotherapy: a clinical practice guideline

    Science.gov (United States)

    Krzyzanowska, M.K.; Walker-Dilks, C.; Atzema, C.; Morris, A.; Gupta, R.; Halligan, R.; Kouroukis, T.; McCann, K.

    2016-01-01

    Background This guideline was prepared by the Fever Assessment Guideline Development Group, a group organized by the Program in Evidence-Based Care at the request of the Cancer Care Ontario Systemic Treatment Program. The mandate was to develop a standardized approach (in terms of definitions, information, and education) for the assessment of fever in cancer patients receiving chemotherapy. Methods The guideline development methods included a search for existing guidelines, literature searches in medline and embase for systematic reviews and primary studies, internal review by content and methodology experts, and external review by targeted experts and intended users. Results The search identified eight guidelines that had partial relevance to the topic of the present guideline and thirty-eight primary studies. The studies were mostly noncomparative prospective or retrospective studies. Few studies directly addressed the topic of fever except as one among many symptoms or adverse effects associated with chemotherapy. The recommendations concerning fever definition are supported mainly by other existing guidelines. No evidence was found that directly pertained to the assessment of fever before a diagnosis of febrile neutropenia was made. However, some studies evaluated approaches to symptom management that included fever among the symptoms. Few studies directly addressed information needs and resources for managing fever in cancer patients. Conclusions Fever in patients with cancer who are receiving systemic therapy is a common and potentially serious symptom that requires prompt assessment, but currently, evidence to inform best practices concerning when, where, and by whom that assessment is done is very limited.

  2. Assessment of Cancer-Related Fatigue: Role of the Oncology Nurse in Translating NCCN Assessment Guidelines into Practice

    OpenAIRE

    Piper, Barbara F.; Borneman, Tami; Sun, Virginia Chih-Yi; Koczywas, Marianna; Uman, Gwen; Ferrell, Betty; James, Raysenia L.

    2008-01-01

    Despite the availability of the National Comprehensive Cancer Network’s (NCCN) evidence-based practice guidelines for the assessment and management of Cancer-Related Fatigue (CRF), assessment of CRF still is not routinely performed at many institutions and oncology practice settings. Numerous patient-, provider-, and system-related barriers exist that hinder the translation of these guidelines into practice by oncology nurses and other health care providers. Oncology nurses can play vital rol...

  3. EPA`s program for risk assessment guidelines: Cancer classification issues

    Energy Technology Data Exchange (ETDEWEB)

    Wiltse, J. [Environmental Protection Agency, Washington, DC (United States)

    1990-12-31

    Issues presented are related to classification of weight of evidence in cancer risk assessments. The focus in this paper is on lines of evidence used in constructing a conclusion about potential human carcinogenicity. The paper also discusses issues that are mistakenly addressed as classification issues but are really part of the risk assessment process. 2 figs.

  4. Utility of routine data sources for feedback on the quality of cancer care: an assessment based on clinical practice guidelines

    Directory of Open Access Journals (Sweden)

    Baade Peter

    2009-05-01

    Full Text Available Abstract Background Not all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem. The purpose of this study was to assess the utility of various data sources in providing feedback on the quality of cancer care. Methods Published clinical practice guidelines were used to obtain a list of processes-of-care of interest to clinicians. These were assigned to one of four data categories according to their availability and the marginal cost of using them for feedback. Results Only 8 (3% of 243 processes-of-care could be measured using population-based registry or administrative inpatient data (lowest cost. A further 119 (49% could be measured using a core clinical registry, which contains information on important prognostic factors (e.g., clinical stage, physiological reserve, hormone-receptor status. Another 88 (36% required an expanded clinical registry or medical record review; mainly because they concerned long-term management of disease progression (recurrences and metastases and 28 (11.5% required patient interview or audio-taping of consultations because they involved information sharing between clinician and patient. Conclusion The advantages of population-based cancer registries and administrative inpatient data are wide coverage and low cost. The disadvantage is that they currently contain information on only a few processes-of-care. In most jurisdictions, clinical cancer registries, which can be used to report on many more processes-of-care, do not cover smaller hospitals. If we are to provide feedback about all patients, not just those in larger academic hospitals with the most developed data systems, then we need to develop sustainable population-based data systems that capture information on prognostic factors at the time of initial diagnosis and information on management of disease progression.

  5. Best Practice Guidelines in Assessment, Risk Reduction, Management, and Surveillance for Post-Breast Cancer Lymphedema

    OpenAIRE

    Jane M Armer; Jennifer M. Hulett; Bernas, Michael; Ostby, Pam; Stewart, Bob R.; Cormier, Janice N.

    2013-01-01

    Breast cancer-related lymphedema (LE) is a progressive, chronic disease that affects millions of cancer survivors and primarily results from surgical lymphatic vessel/node removal and radiation therapy. Patient education and support for importance of early detection is essential in helping health care providers detect lymphedema early, when there is the best chance to prevent progression. Improved imaging and surgical techniques have decreased the incidence of LE; however, effective risk-redu...

  6. Assessing racial/ethnic disparities in chemotherapy treatment among breast cancer patients in context of changing treatment guidelines

    OpenAIRE

    Silva, Abigail; Rauscher, Garth H.; Hoskins, Kent; Rao, Ruta; Ferrans, Carol Estwing

    2013-01-01

    Conflicting study results with regards to racial/ethnic disparities in chemotherapy use among breast cancer patients may be due to the different sample populations, treatment data sources, and treatment eligibility definitions used. This study examined chemotherapy disparity in the context of changing treatment guidelines and explored factors that may help explain treatment differences observed.

  7. Sexuality After Breast Cancer: Need for Guideline

    Directory of Open Access Journals (Sweden)

    Vaziri Sh

    2012-02-01

    Full Text Available Background: Clinical experiences have revealed that patients with breast cancer experience various sexual problems following their treatment. Breast cancer negatively impacts the sexual life of the afflicted couples, and as a traumatic event can influence women’s psychosexual functioning and intimate relationship. This review focuses on sexuality after breast cancer and on a growing need for bio-psycho-social guidelines for breast cancer treatment. Methods: This study aims to review the literature on management, psychological outcomes and sexual dysfunction in patients with breast cancer. Results: Although the benefits of the current treatment strategies are well established, many cancer survivors are at risk for developing psycho physiological symptoms including sexual dysfunction. Cancer and treatment-related factors can influence sexual functioning. We review current treatment -related side effects on sexual functioning such as desire, arousal and orgasm in breast cancer patients. Despite the impact of medical treatment on survival of patients with breast cancer, no satisfactory steps have been taken towards improving sexual functioning of these patients. Conclusion: Breast cancer affects many aspects of sexuality, including changes in physical functioning and in the perception of feminity. Sexual dysfunction following breast cancer should be diagnosed and managed as a systematic approach with multidisciplinary inputs. Healthcare professionals should assess the effects of medical and surgical treatment on the sexuality of breast cancer survivors.

  8. Small Wind Site Assessment Guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Olsen, Tim [Advanced Energy Systems LLC, Eugene, OR (United States); Preus, Robert [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-09-01

    Site assessment for small wind energy systems is one of the key factors in the successful installation, operation, and performance of a small wind turbine. A proper site assessment is a difficult process that includes wind resource assessment and the evaluation of site characteristics. These guidelines address many of the relevant parts of a site assessment with an emphasis on wind resource assessment, using methods other than on-site data collection and creating a small wind site assessment report.

  9. Development of a diet quality index assessing adherence to the Swedish nutrition recommendations and dietary guidelines in the Malmö Diet and Cancer cohort.

    OpenAIRE

    Drake, Isabel; Gullberg, Bo; Ericson, Ulrika; Sonestedt, Emily; Nilsson, Jan; Wallström, Peter; Hedblad, Bo; Wirfält, Elisabet

    2011-01-01

    OBJECTIVE: To develop a diet quality index (DQI) that assesses adherence to the Swedish nutrition recommendations (SNR) and the Swedish dietary guidelines (SDG). DESIGN: A cross-sectional study within the Malmö Diet and Cancer (MDC) cohort. A diet history method collected dietary data, a structured questionnaire lifestyle and socio-economic information, and anthropometric data were collected by direct measurements. The index (DQI-SNR) included six components: SFA, PUFA, fish and shellfish, di...

  10. [Verification of testicular cancer guidelines].

    Science.gov (United States)

    Nonomura, Norio; Azuma, Haruhito

    2012-12-01

    Testicular cancer is a rare disease that affects 1-2 in 100,000 people in Japan ; however, it is a very significant disease in that it has a high prevalence amongst young adults aged in their 20s and 30s and it brings about metastasis from a relatively early stage. The 2009 edition of the Testicular Cancer Clinical Practice Guidelines sets out a detailed summary of 32 clinical questions (CQ) considered necessary in routine clinical practice across the fields of epidemiology, diagnosis, treatment, etc, in the form of recommendations and commentary. These CQs are considered extremely important in understanding the foundation of future testicular cancer treatment guidelines. In this symposium, five doctors gave lectures consisting of the following contents in which they validated the guidelines and gave concrete clinical practice examples through cases they had experienced themselves with regards to the treatment strategies for (1) stage I patients, (2) patients with advanced cancer and (3) patients with extragonadal germ cell tumors. (1) Stage I patients : In seminoma cases, the doctors focused on the relapse prevention effect provided by single-agent carboplatin adjuvant chemotherapy. In non-seminoma cases, treatment options were considered according to risk based on the presence or absence of vascular invasion, a prognostic factor. (2) Patients with advanced cancer : 30% of testicular cancers are metastatic and progress to advanced cancer. In refractory cases resistant to bleomycin, etoposide and cisplatin therapy, etoposide ifosfamide, and cisplatin therapy and vinblastine, ifosfamide and cisplatin therapy have been used, but without satisfactory results and the development of new salvage chemotherapy is an important issue. The therapeutic strategies against advanced testicular cancer were narrowed down to (2) -1) therapeutic effects from ultra-high-dose chemotherapy, (2) -2) salvage chemotherapy in cases where residual tumors are observed in induction

  11. [Guideline for integrated geriatric assessment].

    Science.gov (United States)

    Reyes-Morales, Hortensia; Doubova, Svetlana Vladislavovna; García-González, José Juan; Espinosa-Aguilar, Amilcar; Jiménez-Uribe, Rodrigo; Peña-Valdovinos, Abel; Mendoza-Núñez, Víctor Manuel

    2009-01-01

    A clinical practice guideline was developed as a response to the increasing of elderly in Mexican population due to the epidemiological transition; this instrument allows the assessment of health conditions for people from 60 years of age and older, and it can be a tool for helping family physicians and nurses in providing care for the main health problems of this group of age. The guideline for gerontologic assessment includes six principal health priorities in older people (loss of vision, difficulty to hear, falls or problems walking, nutritional disorders, memory difficulties, and sleep disorders); additionally, another four components for assessment are revised (medication use, physical functionality, quality of life, and social support). Simple recommendations for detection, diagnosis and management of these problems in primary care settings are presented. PMID:20141660

  12. American Cancer Society Head and Neck Cancer Survivorship Care Guideline.

    Science.gov (United States)

    Cohen, Ezra E W; LaMonte, Samuel J; Erb, Nicole L; Beckman, Kerry L; Sadeghi, Nader; Hutcheson, Katherine A; Stubblefield, Michael D; Abbott, Dennis M; Fisher, Penelope S; Stein, Kevin D; Lyman, Gary H; Pratt-Chapman, Mandi L

    2016-05-01

    Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society. PMID:27002678

  13. 2011 Nutritional Assessment Guidelines : information

    Directory of Open Access Journals (Sweden)

    Lisa Freeman

    2011-05-01

    Full Text Available Careful assessment of nutritional needs of dogs and cats must be taken into consideration in order to maintain optimum health, be part of a treatment regimen for a diseased state, or to maximise the quality of life in all animals. Therefore, the goal of these WSAVA Guidelines is that a nutritional assessment and specific nutritional recommendation be made on every patient on every visit. This will become known as the 5th Vital Assessment (5VA, following the four vital assessments of temperature, pulse, respiration and pain that are already addressed on each patient interaction. Routinely doing a brief screening evaluation of the nutritional status during history taking and the physical examination can be seamlessly performed as part of every patient exam. Nutrition-related risk factors that can be easily identified from the history and physical examination include age (growing or old, suboptimal body condition score (overweight or thin, muscle loss, atypical or homemade diet, medical conditions, or changes in appetite. An extended evaluation would follow, if one or more risk factors is identified on screening. These guidelines provide criteria to evaluate the animal and the diet, as well as key feeding and environmental factors. In addition, recommendations for interpretation, analysis, and action are included so that a plan for optimising the animal's nutritional status can be instituted. Client compliance with nutritional recommendations requires input from the veterinarian, veterinary technicians/nurses, and the hospital staff. A team approach to continuous nutritional education, implementation of appropriate protocols, and focused client communication, utilising these WSAVA Nutritional Guidelines, are key components to reach this 5VA goal.

  14. Sexuality After Breast Cancer: Need for Guideline

    OpenAIRE

    Vaziri, Sh; Lotfi Kashani, F

    2012-01-01

    Background Clinical experiences have revealed that patients with breast cancer experience various sexual problems following their treatment. Breast cancer negatively impacts the sexual life of the afflicted couples, and as a traumatic event can influence women’s psychosexual functioning and intimate relationship. This review focuses on sexuality after breast cancer and on a growing need for bio-psycho-social guidelines for breast cancer treatment. Methods This study aims to review the literat...

  15. Penile Cancer: Clinical Practice Guidelines in Oncology

    OpenAIRE

    Clark, Peter E.; Philippe E. Spiess; Agarwal, Neeraj; Biagioli, Matthew C.; Eisenberger, Mario A.; Greenberg, Richard E.; Herr, Harry W.; Inman, Brant A.; Kuban, Deborah A.; Kuzel, Timothy M.; Lele, Subodh M.; Michalski, Jeff; Pagliaro, Lance; Pal, Sumanta K.; Patterson, Anthony

    2013-01-01

    Squamous cell carcinoma of the penis represents approximately 0.5% of all cancers among men in the United States and other developed countries. Although rare, it is associated with significant disfigurement, and only half of the patients survive beyond 5 years. Proper evaluation of both the primary lesion and lymph nodes is critical, because nodal involvement is the most important factor of survival. The NCCN Clinical Practice Guidelines in Oncology for Penile Cancer provide recommendations o...

  16. Cervical cancer in pregnant women: treat, wait or interrupt? Assessment of current clinical guidelines, innovations and controversies

    OpenAIRE

    Han, Sileny N; Mhallem Gziri, Mina; van Calsteren, Kristel; Amant, Frédéric

    2013-01-01

    Cervical cancer during pregnancy is relatively uncommon. However, the incidence is expected to increase as more women delay childbearing. When preservation of the pregnancy is desired, optimal treatment is a major challenge to all. Whereas delay of treatment is an option for pre-invasive disease, and also small invasive carcinomas without lymph node involvement, management of tumours >2 cm remains experimental. Type of treatment needs to be individualized and depends mainly on gestational age...

  17. Implementing the Exercise Guidelines for Cancer Survivors

    OpenAIRE

    WOLIN, KATHLEEN Y.; Schwartz, Anna L; Matthews, Charles E.; Courneya, Kerry S.; Schmitz, Kathryn H.

    2012-01-01

    In 2009, the American College of Sports Medicine convened an expert roundtable to issue guidelines on exercise for cancer survivors. This multidisciplinary group evaluated the strength of the evidence for the safety and benefits of exercise as a therapeutic intervention for survivors. The panel concluded that exercise is safe and offers myriad benefits for survivors including improvements in physical function, strength, fatigue, quality of life (QOL), and possibly recurrence and survival. Rec...

  18. Guidelines for Camouflage Assessment Using Observers

    NARCIS (Netherlands)

    Ronconi, P.; Jacobs, P.A.M.; Mauer, E.; Huebner, G.; Dotoli, P.; Peak, J.E.; Hepfinger, L.; Balma, R.; Christopher, G.; Fleuriet, J.; Honke, T.

    2007-01-01

    The objective of SCI-095 was to advance alternative techniques for determining the camouflage effectiveness of military systems reliably at reduced cost. SCI-095 produced “Guidelines for Camouflage Assessment Using Observers” which is a standardized methodology for observerbased tests and statistica

  19. Guidelines and Ethical Considerations for Assessment Center Operations: International Task Force on Assessment Center Guidelines.

    Science.gov (United States)

    Public Personnel Management, 2000

    2000-01-01

    This update of the International Personnel Management Association's guidelines for organizational psychologists, human resource management specialists, and others addresses elements of assessment centers, policy statements, assessor training, informed participation, and participants' rights. (SK)

  20. ESUR guidelines: ovarian cancer staging and follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Forstner, Rosemarie [Paracelsus Medical University, Department of Radiology, Landeskliniken Salzburg, Salzburg (Austria); Sala, Evis [University of Cambridge, Cambridge University Hospitals, NHS Foundation Trust, Cambridge (United Kingdom); Kinkel, Karen [Geneva University Hospital, Clinique des Grangettes, Geneva (Switzerland); Spencer, John A. [St James' s University Hospital, Leeds (United Kingdom)

    2010-12-15

    To design clear guidelines for the staging and follow-up of patients with ovarian cancer, and to provide the radiologist with a framework for use in multidisciplinary conferences. Guidelines for ovarian cancer staging and follow-up were defined by the female imaging subcommittee of the ESUR (European Society of Urogenital Radiology) based on the expert consensus of imaging protocols of 12 leading institutions and a critical review of the literature. Computed tomography (CT) with coverage of the base of the lungs to the inguinal region is regarded as the imaging technique of choice for preoperative staging. Critical diagnostic criteria are presented and the basis for a structured report for preoperative staging is outlined. Following primary treatment for ovarian cancer, clinical assessment and CA-125 are routinely used to monitor patients. For suspected recurrence, CT remains the imaging modality of choice, with positron emission tomography (PET)/CT emerging as the optimal imaging technique for suspected recurrence, particularly in patients with negative CT or magnetic resonance imaging (MRI). CT is the imaging modality of choice for preoperative staging and detection of recurrence in patients with ovarian cancer. (orig.)

  1. Guidelines for Camouflage Assessment Using Observers

    OpenAIRE

    Ronconi, P.; Jacobs, P.A.M.; Mauer, E.; Huebner, G.; Dotoli, P.; Peak, J.E.; Hepfinger, L.; Balma, R.; Christopher, G.; Fleuriet, J.; Honke, T.

    2007-01-01

    The objective of SCI-095 was to advance alternative techniques for determining the camouflage effectiveness of military systems reliably at reduced cost. SCI-095 produced “Guidelines for Camouflage Assessment Using Observers” which is a standardized methodology for observerbased tests and statistical analysis. A comparative trial concluded that following the recommended procedures as described in this standardized methodology and with careful attention to experimental setup, produces consiste...

  2. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

    Science.gov (United States)

    Runowicz, Carolyn D; Leach, Corinne R; Henry, N Lynn; Henry, Karen S; Mackey, Heather T; Cowens-Alvarado, Rebecca L; Cannady, Rachel S; Pratt-Chapman, Mandi L; Edge, Stephen B; Jacobs, Linda A; Hurria, Arti; Marks, Lawrence B; LaMonte, Samuel J; Warner, Ellen; Lyman, Gary H; Ganz, Patricia A

    2016-02-20

    The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for

  3. Korean Guidelines for Colorectal Cancer Screening and Polyp Detection

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Bo In [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of); Hong, Sung Pil [Yensei University College of Medicine, Seoul (Korea, Republic of); Kim, Seong Eun [Ewha Womans University School of Medicine, Seoul (Korea, Republic of)

    2012-04-15

    Colorectal cancer is currently the second most common cancer among Korean males and the fourth most common among females. Since the majority of colorectal cancer case present following the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are vital methods in its prevention. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish national guidelines for colorectal cancer screening and polyp detection. The proposed guidelines have been developed by the Korean Multi-Society Task Force using evidence-based methods. Systematic reviews and meta-analyses have been used to form the statements contained in the guidelines. This paper discusses the epidemiology of colorectal cancers and adenomas in Korea as well as optimal methods for screening of colorectal cancer and detection of adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.

  4. Korean Guidelines for Colorectal Cancer Screening and Polyp Detection

    International Nuclear Information System (INIS)

    Colorectal cancer is currently the second most common cancer among Korean males and the fourth most common among females. Since the majority of colorectal cancer case present following the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are vital methods in its prevention. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish national guidelines for colorectal cancer screening and polyp detection. The proposed guidelines have been developed by the Korean Multi-Society Task Force using evidence-based methods. Systematic reviews and meta-analyses have been used to form the statements contained in the guidelines. This paper discusses the epidemiology of colorectal cancers and adenomas in Korea as well as optimal methods for screening of colorectal cancer and detection of adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.

  5. Guidelines for lung cancer in 2015: Consensus and controversy

    OpenAIRE

    Lu, Shun; Yong-feng YU; Wen-xiang JI

    2016-01-01

    The standardization of diagnosis and treatment of lung cancer has important significance for improving the prognosis of patients with lung cancer. A thorough and accurate interpretation of the guidelines of lung cancer is conducive to enhance a deeper understanding of the standardized diagnosis and treatment of lung cancer. The authors of this article intend to give a brief summary and comment for the latest information about diagnosis and treatment of lung cancer at home and abroad, focusing...

  6. Clinical practice guidelines and consensus statements in oncology--an assessment of their methodological quality.

    Directory of Open Access Journals (Sweden)

    Carmel Jacobs

    Full Text Available BACKGROUND: Consensus statements and clinical practice guidelines are widely available for enhancing the care of cancer patients. Despite subtle differences in their definition and purpose, these terms are often used interchangeably. We systematically assessed the methodological quality of consensus statements and clinical practice guidelines published in three commonly read, geographically diverse, cancer-specific journals. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. METHODS: Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. FINDINGS: Thirty-four consensus statements and 67 clinical practice guidelines were evaluated. The rigour of development score for consensus statements over the three journals was 32% lower than that of clinical practice guidelines. The editorial independence score was 15% lower for consensus statements than clinical practice

  7. DEGRO practical guidelines: radiotherapy of breast cancer I

    OpenAIRE

    Sedlmayer, F.; Sautter-Bihl, M.-L.; Budach, W.; Dunst, J.; Fastner, G.; Feyer, P.; Fietkau, R; Haase, W.; Harms, W.; Souchon, R; Wenz, F.; Sauer, R.; ,

    2013-01-01

    Background and purpose The aim of the present paper is to update the practical guidelines for postoperative adjuvant radiotherapy of breast cancer published in 2007 by the breast cancer expert panel of the German Society for Radiooncology (Deutsche Gesellschaft für Radioonkologie, DEGRO). The present recommendations are based on a revision of the German interdisciplinary S-3 guidelines published in July 2012. Methods A comprehensive survey of the literature concerning radiotherapy following b...

  8. National Cancer Centre Singapore Consensus Guidelines for Hepatocellular Carcinoma.

    Science.gov (United States)

    Chow, Pierce K H; Choo, Su Pin; Ng, David C E; Lo, Richard H G; Wang, Michael L C; Toh, Han Chong; Tai, David W M; Goh, Brian K P; Wong, Jen San; Tay, Kiang Hiong; Goh, Anthony S W; Yan, Sean X; Loke, Kelvin S H; Thang, Sue Ping; Gogna, Apoorva; Too, Chow Wei; Irani, Farah Gillian; Leong, Sum; Lim, Kiat Hon; Thng, Choon Hua

    2016-04-01

    Hepatocellular carcinoma (HCC) is the 6th most common cancer in the world, but the second most common cause of cancer death. There is no universally accepted consensus practice guidelines for HCC owing to rapid developments in new treatment modalities, the heterogeneous epidemiology and clinical presentation of HCC worldwide. However, a number of regional and national guidelines currently exist which reflect practice relevant to the epidemiology and collective experience of the consensus group. In 2014, clinicians at the multidisciplinary Comprehensive Liver Cancer Clinic (CLCC) at the National Cancer Centre Singapore (NCCS) reviewed the latest published scientific data and existing international and regional practice guidelines, such as those of the National Comprehensive Cancer Network, American Association for the Study of Liver Diseases and the Asian Pacific Association for the Study of the Liver, and modified them to reflect local practice. These would serve as a template by which treatment outcomes can be collated and benchmarked against international data. The NCCS Consensus Guidelines for HCC have been successfully implemented in the CLCC since their publication online on 26(th) September 2014, and the guidelines allow outcomes of treatment to be compared to international data. These guidelines will be reviewed periodically to incorporate new data. PMID:27386428

  9. Clinical practice guidelines on cancer-associated thrombosis: a review on scope and methodology.

    Science.gov (United States)

    Lee, Agnes Y Y; Peterson, Erica A; Wu, Cynthia

    2016-04-01

    Cancer-associated thrombosis is a well-recognized complication in patients with cancer. It imposes significant patient morbidity and anxiety, increases personal and societal financial burden, and is the second-leading cause of death in this population. There have been increasing research efforts to reduce the incidence of venous thromboembolism (VTE) and optimize its treatment but the quality of evidence is diverse. To assist clinicians in providing care based on best-available evidence, many international and national organizations have issued clinical practice guidelines. Among these, the most highly cited resources include those developed by the American College of Chest Physicians, the American Society of Clinical Oncology and the European Society of Medical Oncology. Nationally-based guidelines have also been published by various groups, including the Italian Association of Medical Oncology, the National Comprehensive Cancer Network, the French National Federation of the League of Centers Against Cancer, and the British Committee for Standards in Haematology. This review will cover fundamental aspects of clinical practice guideline development and evaluation, summarize the scope and methodology of published guidelines on the management of cancer-associated thrombosis and assess the quality of selected, international guidelines using the validated Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Areas of consensus and uncertainties will be briefly highlighted. PMID:27067964

  10. Implementing Thrombosis Guidelines in Cancer Patients: A Review

    Directory of Open Access Journals (Sweden)

    Dominique Farge-Bancel

    2014-10-01

    Full Text Available Venous thromboembolism is a frequent and serious complication in patients with cancer. It is an independent prognostic factor of death in cancer patients and the second leading cause of death, but physicians often underestimate its importance, as well as the need for adequate prevention and treatment. Management of venous thromboembolism in patients with cancer requires the coordinated efforts of a wide range of clinicians, highlighting the importance of a multidisciplinary approach. However, a lack of consensus among various national and international clinical practice guidelines has contributed to knowledge and practice gaps among practitioners, and inconsistent approaches to venous thromboembolism. The 2013 international guidelines for thrombosis in cancer have sought to address these gaps by critically re-evaluating the evidence coming from clinical trials and synthesizing a number of guidelines documents. An individualized approach to prophylaxis is recommended for all patients.

  11. CTD² Publication Guidelines | Office of Cancer Genomics

    Science.gov (United States)

    The Cancer Target Discovery and Development (CTD2) Network is a “community resource project” supported by the National Cancer Institute’s Office of Cancer Genomics. Members of the Network release data to the broader research community by depositing data into NCI-supported or public databases. Data deposition is NOT equivalent to publishing in a peer-reviewed journal. Unless there is a manuscript associated with a dataset, the Network considers data to be formally unpublished.

  12. Guidelines for Assessment of and Intervention With Persons With Disabilities

    Science.gov (United States)

    American Psychologist, 2012

    2012-01-01

    The goal of these "Guidelines for Assessment of and Intervention With Persons With Disabilities" is to help psychologists conceptualize and implement more effective, fair, and ethical psychological assessments and interventions with persons with disabilities. The guidelines provide suggestions on ways psychologists can make their practices more…

  13. Cancer-related fatigue. Clinical practice guidelines in oncology.

    Science.gov (United States)

    2003-07-01

    These guidelines propose a treatment algorithm in which patients are evaluated regularly for fatigue using a brief screening instrument, and are treated as indicated by their fatigue level. The algorithm's goal is to identify and treat all patients with fatigue that causes distress or interferes with their daily activities or functioning. Management of fatigue begins with primary oncology team members who perform the initial screening and either provide basic education and counseling or expand the initial screening to a more focused evaluation for moderate or higher levels of fatigue. At this point the patient is assessed for current disease and treatment status, a review of body systems, and an in-depth fatigue evaluation. In addition, the patient is assessed for the presence of seven treatable factors known to contribute to fatigue: pain, emotional distress, sleep disturbance, anemia, alterations in nutrition, deconditioning, and comorbidities. If any of these conditions are present, they should be treated according to practice guidelines, with referral to other care professionals as appropriate, and the patient's fatigue should be reevaluated regularly. If none of the seven factors are present or the fatigue is unresolved, selection of appropriate fatigue management and treatment strategies is considered within the context of the patient's clinical status: receiving active cancer treatment, receiving disease-free long-term follow-up, or receiving care at the end of life. Management of fatigue is cause-specific when conditions known to cause fatigue can be identified and treated. When specific causes, such as infection, fluid and electrolyte imbalances, or cardiac dysfunction, cannot be identified and corrected, nonpharmacologic and pharmacologic treatment of the fatigue should be considered. Nonpharmacologic interventions may include a moderate exercise program to improve functional capacity and activity tolerance, psychosocial programs to manage stress and

  14. Guidelines for rating Global Assessment of Functioning (GAF

    Directory of Open Access Journals (Sweden)

    Aas IH Monrad

    2011-01-01

    Full Text Available Abstract Background Global Assessment of Functioning (GAF is a scoring system for the severity of illness in psychiatry. It is used clinically in many countries, as well as in research, but studies have shown several problems with GAF, for example concerning its validity and reliability. Guidelines for rating are important. The present study aimed to identify the current status of guidelines for rating GAF, and relevant factors and gaps in knowledge for the development of improved guidelines. Methods A thorough literature search was conducted. Results Few studies of existing guidelines have been conducted; existing guidelines are short; and rating has a subjective element. Seven main categories were identified as being important in relation to further development of guidelines: (1 general points about guidelines for rating GAF; (2 introduction to guidelines, with ground rules; (3 starting scoring at the top, middle or bottom level of the scale; (4 scoring for different time periods and of different values (highest, lowest or average; (5 the finer grading of the scale; (6 different guidelines for different conditions; and (7 different languages and cultures. Little information is available about how rules for rating are understood by different raters: the final score may be affected by whether the rater starts at the top, middle or bottom of the scale; there is little data on which value/combination of GAF values to record; guidelines for scoring within 10-point intervals are limited; there is little empirical information concerning the suitability of existing guidelines for different conditions and patient characteristics; and little is known about the effects of translation into different languages or of different cultural understanding. Conclusions Few studies have dealt specifically with guidelines for rating GAF. Current guidelines for rating GAF are not comprehensive, and relevant points for new guidelines are presented. Theoretical and

  15. Adherence to Diet and Physical Activity Cancer Prevention Guidelines and Cancer Outcomes: A Systematic Review.

    Science.gov (United States)

    Kohler, Lindsay N; Garcia, David O; Harris, Robin B; Oren, Eyal; Roe, Denise J; Jacobs, Elizabeth T

    2016-07-01

    Many studies have reported that adherence to health promotion guidelines for diet, physical activity, and maintenance of healthy body weight may decrease cancer incidence and mortality. A systematic review was performed to examine associations between adherence to established cancer prevention guidelines for diet and physical activity and overall cancer incidence and mortality. PubMed, Google Scholar, and Cochrane Reviews databases were searched following the current recommendations of Preferred Reporting Items for Systematic Reviews and Meta-analysis Approach (PRISMA). Twelve studies met inclusion criteria for this review. High versus low adherence to established nutrition and physical activity cancer prevention guidelines was consistently and significantly associated with decreases of 10% to 61% in overall cancer incidence and mortality. Consistent significant reductions were also shown for breast cancer incidence (19%-60%), endometrial cancer incidence (23%-60%), and colorectal cancer incidence in both men and women (27%-52%). Findings for lung cancer incidence were equivocal, and no significant relationships were found between adherence and ovarian or prostate cancers. Adhering to cancer prevention guidelines for diet and physical activity is consistently associated with lower risks of overall cancer incidence and mortality, including for some site-specific cancers. Cancer Epidemiol Biomarkers Prev; 25(7); 1018-28. ©2016 AACR. PMID:27340121

  16. [NCCN Asian consensus statement - can Asian patients with cancer accept treatment modalities from NCCN guidelines ?].

    Science.gov (United States)

    Ozono, Seiichiro; Hinotsu, Shiro; Namiki, Mikio; Akaza, Hideyuki

    2014-06-01

    To spread the National Comprehensive Cancer Network(NCCN)guidelines widely in Asia, committee members from Asian countries have been preparing an Asia Consensus Statement(ACS)along the NCCN guidelines. The ACS for Kidney Cancer guidelines and Prostate Cancer guidelines were issued in 2009 and in 2011, respectively. In addition, second versions of both these guidelines were issued in 2011 and 2013, respectively. In this review, the process and contents of NCCN ACS have been described. PMID:25129079

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

    Science.gov (United States)

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

    2016-07-01

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

  18. Guideline on aspects of cancer-related venous thrombosis.

    Science.gov (United States)

    Watson, Henry G; Keeling, David M; Laffan, Mike; Tait, Robert Campbell; Makris, Mike

    2015-09-01

    The guideline was drafted by a writing group identified by the Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology (BCSH). All the authors are consultants in haematology in the UK. A search was performed of PubMed and Embase using the term 'cancer' combined with 'thrombosis', 'treatment', 'prophylaxis' and 'clinical presentation'. The search covered articles published up until December 2014. Only human studies were included and articles not written in English were excluded. References in recent reviews were also examined. The writing group produced the draft guideline, which was subsequently revised by consensus by members of the Haemostasis and Thrombosis Task Force of the BCSH and the BCSH executive. The guideline was then reviewed by the sounding board of the British Society for Haematology (BSH). This comprises 50 or more members of the BSH who have reviewed the guidance and commented on the content and application to the UK setting. The 'GRADE' system was used to quote levels and grades of evidence, details of which can be found at: http://www.bcshguidelines.com/BCSH_PROCESS/EVIDENCE_LEVELS_AND_GRADES_OF_RECOMMENDATION/43_GRADE.html. The objective of this guideline is to provide healthcare professionals with clear guidance on the prevention and management of venous thromboembolism (VTE) in patients with cancer and to advise on an approach to screening for cancer in patients with unprovoked VTE in whom cancer was not initially suspected based on clinical grounds. PMID:26114207

  19. Life Cycle Assessment Guideline for Protection Relay : 615 series

    OpenAIRE

    Liimatainen, Viivi

    2012-01-01

    This thesis is made for ABB Oy, Medium Voltage Products in Vaasa. The main goal of the thesis is to make Life Cycle Assessment (LCA) guideline for protection and control relay product families because the earlier made LCA studies are not valid anymore and the guideline, LCA tool and database are not up-to-date. During the new LCA guideline process product family 615 series LCA study is carried out as an example. The LCA study is based on ISO 14040 standard series and the guideline so call...

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

    OpenAIRE

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

    2016-01-01

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

  1. TARGET Publication Guidelines | Office of Cancer Genomics

    Science.gov (United States)

    Like other NCI large-scale genomics initiatives, TARGET is a community resource project and data are made available rapidly after validation for use by other researchers. To act in accord with the Fort Lauderdale principles and support the continued prompt public release of large-scale genomic data prior to publication, researchers who plan to prepare manuscripts containing descriptions of TARGET pediatric cancer data that would be of comparable scope to an initial TARGET disease-specific comprehensive, global analysis publication, and journal editors who receive such manuscripts, are stron

  2. Expert Consensus Contouring Guidelines for Intensity Modulated Radiation Therapy in Esophageal and Gastroesophageal Junction Cancer

    International Nuclear Information System (INIS)

    Purpose/Objective(s): Current guidelines for esophageal cancer contouring are derived from traditional 2-dimensional fields based on bony landmarks, and they do not provide sufficient anatomic detail to ensure consistent contouring for more conformal radiation therapy techniques such as intensity modulated radiation therapy (IMRT). Therefore, we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume (CTV) in esophageal or gastroesophageal junction (GEJ) cancer. Methods and Materials: Eight expert academically based gastrointestinal radiation oncologists participated. Three sample cases were chosen: a GEJ cancer, a distal esophageal cancer, and a mid-upper esophageal cancer. Uniform computed tomographic (CT) simulation datasets and accompanying diagnostic positron emission tomographic/CT images were distributed to each expert, and the expert was instructed to generate gross tumor volume (GTV) and CTV contours for each case. All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and to generate draft consensus contours. The panel then refined these contours to generate the contouring atlas. Results: The κ statistics indicated substantial agreement between panelists for each of the 3 test cases. A consensus CTV atlas was generated for the 3 test cases, each representing common anatomic presentations of esophageal cancer. The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases. Conclusions: This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas. This atlas will serve as a reference for IMRT contours for clinical practice and prospective trial design. Subsequent patterns of failure analyses of clinical datasets using these guidelines may require modification in the future

  3. Expert Consensus Contouring Guidelines for Intensity Modulated Radiation Therapy in Esophageal and Gastroesophageal Junction Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Abraham J., E-mail: wua@mskcc.org [Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Bosch, Walter R. [Washington University, St. Louis, Missouri (United States); Chang, Daniel T. [Stanford Cancer Institute, Stanford, California (United States); Hong, Theodore S. [Massachusetts General Hospital, Boston, Massachusetts (United States); Jabbour, Salma K. [Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Kleinberg, Lawrence R. [Johns Hopkins Medical Center, Baltimore, Maryland (United States); Mamon, Harvey J. [Brigham and Women' s Hospital, Boston, Massachusetts (United States); Thomas, Charles R. [Knight Cancer Institute, Oregon Health & Sciences University, Portland, Oregon (United States); Goodman, Karyn A. [Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2015-07-15

    Purpose/Objective(s): Current guidelines for esophageal cancer contouring are derived from traditional 2-dimensional fields based on bony landmarks, and they do not provide sufficient anatomic detail to ensure consistent contouring for more conformal radiation therapy techniques such as intensity modulated radiation therapy (IMRT). Therefore, we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume (CTV) in esophageal or gastroesophageal junction (GEJ) cancer. Methods and Materials: Eight expert academically based gastrointestinal radiation oncologists participated. Three sample cases were chosen: a GEJ cancer, a distal esophageal cancer, and a mid-upper esophageal cancer. Uniform computed tomographic (CT) simulation datasets and accompanying diagnostic positron emission tomographic/CT images were distributed to each expert, and the expert was instructed to generate gross tumor volume (GTV) and CTV contours for each case. All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and to generate draft consensus contours. The panel then refined these contours to generate the contouring atlas. Results: The κ statistics indicated substantial agreement between panelists for each of the 3 test cases. A consensus CTV atlas was generated for the 3 test cases, each representing common anatomic presentations of esophageal cancer. The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases. Conclusions: This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas. This atlas will serve as a reference for IMRT contours for clinical practice and prospective trial design. Subsequent patterns of failure analyses of clinical datasets using these guidelines may require modification in the future.

  4. Lung cancer management in limited resource settings: Guidelines for appropriate good care

    International Nuclear Information System (INIS)

    Lung cancer is a major cause of cancer death worldwide and is becoming an increasing problem in developing countries. It is important that, in countries where health care resources are limited, these resources are used most effectively and cost-effectively. The authors, with the support of the International Atomic Energy Agency, drew on existing evidence-based clinical guidelines, published systematic reviews and meta-analyses, as well as recent research publications, to summarise the current evidence and to make broad recommendations on the non-surgical treatment of patients with lung cancer. Tables were constructed which summarise the different treatment options for specific groups of patients, the increase in resource use for and the likely additional clinical benefit from each option. These tables can be used to assess the cost-effectiveness and appropriateness of different interventions in a particular health care system and to develop local clinical guidelines

  5. Swiss clinical practice guidelines on field cancerization of the skin.

    Science.gov (United States)

    Hofbauer, Günther; Anliker, Mark; Boehncke, Wolf-Henning; Brand, Christoph; Braun, Ralph; Gaide, Olivier; Hafner, Jürg; Hunger, Robert; Itin, Peter; Kaeuper, Gina; Lautenschlager, Stephan; Mainetti, Carlo; Streit, Markus

    2014-01-01

    Actinic keratosis (AK) affects millions of people worldwide, and its prevalence continues to increase. AK lesions are caused by chronic ultraviolet radiation exposure, and the presence of two or more AK lesions along with photodamage should raise the consideration of a diagnosis of field cancerization. Effective treatment of individual lesions as well as field cancerization is essential for good long-term outcomes. The Swiss Registry of Actinic Keratosis Treatment (REAKT) Working Group has developed clinical practice guidelines for the treatment of field cancerization in patients who present with AK. These guidelines are intended to serve as a resource for physicians as to the most appropriate treatment and management of AK and field cancerization based on current evidence and the combined practical experience of the authors. Treatment of AK and field cancerization should be driven by consideration of relevant patient, disease, and treatment factors, and appropriate treatment decisions will differ from patient to patient. Prevention measures and screening recommendations are discussed, and special considerations related to management of immunocompromised patients are provided. PMID:25539459

  6. Peak load arrangements : Assessment of Nordel guidelines

    Energy Technology Data Exchange (ETDEWEB)

    2009-07-01

    Two Nordic countries, Sweden and Finland, have legislation that empowers the TSO to acquire designated peak load resources to mitigate the risk for shortage situations during the winter. In Denmark, the system operator procures resources to maintain a satisfactory level of security of supply. In Norway the TSO has set up a Regulation Power Option Market (RKOM) to secure a satisfactory level of operational reserves at all times, also in winter with high load demand. Only the arrangements in Finland and Sweden fall under the heading of Peak Load Arrangements defined in Nordel Guidelines. NordREG has been invited by the Electricity Market Group (EMG) to evaluate Nordel's proposal for 'Guidelines for transitional Peak Load Arrangements'. The EMG has also financed a study made by EC Group to support NordREG in the evaluation of the proposal. The study has been taken into account in NordREG's evaluation. In parallel to the EMG task, the Swedish regulator, the Energy Markets Inspectorate, has been given the task by the Swedish government to investigate a long term solution of the peak load issue. The Swedish and Finnish TSOs have together with Nord Pool Spot worked on finding a harmonized solution for activation of the peak load reserves in the market. An agreement accepted by the relevant authorities was reached in early January 2009, and the arrangement has been implemented since 19th January 2009. NordREG views that the proposed Nordel guidelines have served as a starting point for the presently agreed procedure. However, NordREG does not see any need to further develop the Nordel guidelines for peak load arrangements. NordREG agrees with Nordel that the market should be designed to solve peak load problems through proper incentives to market players. NordREG presumes that the relevant authorities in each country will take decisions on the need for any peak load arrangement to ensure security of supply. NordREG proposes that such decisions should be

  7. Personality Assessment with Adolescents: Challenges and Guidelines

    Science.gov (United States)

    Crespi, Tony D.; Politikos, Natalie N.

    2008-01-01

    Approximately 4.5 to 6.3 million youth experience serious emotional disturbances. Unfortunately, many of them have unmet mental health needs. Tools used in personality assessment can offer unparalleled assistance in diagnosis, and assist in designing appropriate interventions. Unfortunately, not all psychologists embrace personality assessment as…

  8. Evaluation process of global environmental impact: assessment guidelines

    International Nuclear Information System (INIS)

    In developed and developing countries, the EIA (Environmental Impact Assessment) is becoming mandatory for the approval of Industrial projects and projects of Environmental hazards. The approving authority of each country has its own guidelines to get projects approved and make project proponents responsible to submit Environmental Impact Statement for the its detailed assessment. In this paper authors have studied an existing EIA Global guidelines and its evaluation process of altogether 40 countries from four continents, Asia, Pacific/Middle East, Europe, Australia and America/Canada. This evaluation process is recorded in the tabulation form and it has been formulated stage wise in which stage one highlights the inception of EIA guidelines of each country and stage two and three gives implementation process. The inception stage of guidelines gives an idea that when EIA was started and an implementation stages provide all information that when EIA become a part of legislation that provide an opportunity to the reader to understand the decision making process for project approvals. The main objective of writing EIA guidelines is to monitor the sustain ability of various types of the projects under different sectoral guidelines, therefore Projects related with different Sectors have been chosen and a detailed record in tabulation form gives an idea to understand the interaction of these guidelines. To make this paper more comprehensive, authors have gone thorough the sectoral guidelines of altogether 64 countries and studied 21 sector oriented project fields. These are of Agriculture/Irrigation, Biodiversity, Coastal/Marine, Community Participation, Extractive industries, Fisheries, Forestry, Hazard Risk, Health, Human settlement, Industry, Multi sectorial, Ports and Harbors, Power, refugees/resettlement, Social, Strategies/Planning, Tourism/Recreational, transportation, Waste Pollution and Wetlands/Water resources. (author)

  9. Venous thromboembolism (VTE) risk assessment and prophylaxis in acute orthopaedic admissions: improving compliance with national guidelines

    OpenAIRE

    Watts, Laura; Grant, David

    2013-01-01

    “Each year over 25,000 people die from Venous Thromboembolism (VTE) contracted in hospital. This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents”. (1) Orthopaedic patients are at particular risk of VTE. In 2011, the project team carried out an audit into compliance with national VTE assessment guidelines on all acute trauma and orthopaedic admissions during a two week period at a District General Hospital. The study demonstrated that compliance was ini...

  10. Interpretation of NCCN Clinical Practice Guidelines in Oncology:Cancer-Related Fatigue

    Institute of Scientific and Technical Information of China (English)

    YE Zhen-hua; DU Fu-rong; WU Yin-ping; YANG Xue; YI Zi

    2016-01-01

    Cancer-related fatigue (CRF) is a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. It exerts deleterious effects on many aspects of the body, including physical, social, cognitive, and vocational functioning, and makes the patients or their relatives feel emotional and spiritual distress. Nevertheless, it is still under the way of diagnosis and treatment. Based on the National Comprehensive Cancer Network (NCCN) Clinical Guidelines in Oncology-CRF (version 1. 2016), standards of care for CRF assessment and management, standards for evaluation and treatment and interventions for patients on active treatment were critically interpreted in this article.

  11. Individual Breast Cancer risk assessment in Underserved Populations: Integrating empirical Bioethics and Health Disparities Research

    OpenAIRE

    Anderson, Emily E.; Hoskins, Kent

    2012-01-01

    Research suggests that individual breast cancer risk assessment may improve adherence to recommended screening and prevention guidelines, thereby decreasing morbidity and mortality. Further research on the use of risk assessment models in underserved minority populations is critical to informing national public health efforts to eliminate breast cancer disparities. However, implementing individual breast cancer risk assessment in underserved patient populations raises particular ethical issue...

  12. Guidelines for assessment of work disability: An international survey

    NARCIS (Netherlands)

    Boer, W.E.L. de; Rijkenberg, A.M.; Donceel, P.

    2011-01-01

    Background: Assessments of long-term work disability are carried out by social insurance physicians (SIPs) and are little supported with evidence or instruments. Guidelines are hardly ever used in social insurance medicine. Developments in social insurance medicine might be slow as insurance is diff

  13. Salt contamination assessment and remediation guidelines

    International Nuclear Information System (INIS)

    Environmental impacts associated with excess salt in oil and surface water or groundwater (a frequent occurrence in oil and gas production) may be manifested as degradation of soil chemical or physical properties, impaired vegetable growth and degraded surface or groundwater quality. Spill prevention is by far the most effective and most efficient way of avoiding these adverse effects and the attendant remediation costs. However, when spills do occur effective response, based on a comprehensive understanding of impacts, salt movements and remediation procedures can mitigate the adverse environmental effects. This guide is designed to assist those involved in the prevention, assessment, remediation and management of salt-contaminated sites. It summarizes the regulatory requirements in Alberta, including salt remediation objectives, and provides an overview of salt spill problems and effective site assessment and remediation procedures. Background information on the sources of salt, the movement of salt in soil and groundwater, and the adverse effects of salt on soil, vegetation and groundwater is provided in an appendix attached to the Guide. A selected bibliography and a glossary of terms are also included. 42 refs., tabs., figs

  14. AHNS Series: Do you know your guidelines?Principles of radiation therapy for head and neck cancer: A review of the National Comprehensive Cancer Network guidelines.

    Science.gov (United States)

    Gooi, Zhen; Fakhry, Carole; Goldenberg, David; Richmon, Jeremy; Kiess, Ana P

    2016-07-01

    This article is a continuation of the "Do You Know Your Guidelines" series, an initiative of the American Head and Neck Society's Education Committee to increase awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network guidelines for radiotherapy in the treatment for head and neck cancers are reviewed here in a systematic fashion according to site and stage. These guidelines outline indications for primary and adjuvant treatment, as well as general principles of radiotherapy. © 2016 Wiley Periodicals, Inc. Head Neck 38: 987-992, 2016. PMID:27015108

  15. Assessment of cumulative evidence on genetic associations: Interim guidelines

    OpenAIRE

    Ioannidis, John; Boffetta, Paolo; Little, Julian; O'Brien, Thomas; Uitterlinden, André; Vineis, Paolo; Balding, David; Chokkalingam, Anand; Dolan, Siobhan; Flanders, Dana; Higgins, Julian; McCarthy, Mark; McDermott, David; Page, Grier; Rebbeck, Timothy

    2008-01-01

    textabstractEstablished guidelines for causal inference in epidemiological studies may be inappropriate for genetic associations. A consensus process was used to develop guidance criteria for assessing cumulative epidemiologic evidence in genetic associations. A proposed semi-quantitative index assigns three levels for the amount of evidence, extent of replication, and protection from bias, and also generates a composite assessment of 'strong', 'moderate' or 'weak' epidemiological credibility...

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  17. Evaluation of the Definitions of “High-Risk” Cutaneous Squamous Cell Carcinoma Using the American Joint Committee on Cancer Staging Criteria and National Comprehensive Cancer Network Guidelines

    OpenAIRE

    Melinda B. Chu; Slutsky, Jordan B.; Dhandha, Maulik M.; Beal, Brandon T.; Armbrecht, Eric S.; Walker, Ronald J.; Varvares, Mark A.; Fosko, Scott W.

    2014-01-01

    Recent guidelines from the American Joint Committee on Cancer (AJCC) and National Comprehensive Cancer Network (NCCN) have been proposed for the assessment of “high-risk” cutaneous squamous cell carcinomas (cSCCs). Though different in perspective, both guidelines share the common goals of trying to identify “high-risk” cSCCs and improving patient outcomes. Thus, in theory, both definitions should identify a similar proportion of “high-risk” tumors. We sought to evaluate the AJCC and NCCN d...

  18. Colorectal Cancer Risk Assessment Tool

    Science.gov (United States)

    ... know before using this tool: The Colorectal Cancer Risk Assessment Tool was designed for use by doctors and other health providers with their patients. If you are not a health ... your personal risk of colorectal cancer. (Colorectal cancer is another way ...

  19. Cancer Risk Prediction and Assessment

    Science.gov (United States)

    Cancer prediction models provide an important approach to assessing risk and prognosis by identifying individuals at high risk, facilitating the design and planning of clinical cancer trials, fostering the development of benefit-risk indices, and enabling estimates of the population burden and cost of cancer.

  20. Intersecting Guidelines: Administering Erythropoiesis-Stimulating Agents to Chronic Kidney Disease Patients with Cancer

    Science.gov (United States)

    Bennett, Charles L.; Becker, Pamela S.; Kraut, Eric H.; Samaras, Athena T.; West, Dennis P.

    2009-01-01

    There has been a dramatic sea change in the use of erythropoiesis-stimulating agents (ESAs) for anemic persons with chronic kidney disease (CKD) or cancer patients undergoing chemotherapy. An important area that has not been addressed previously is a CKD patient who also has a malignancy. Clinical guidelines exist that outline recommended treatments for each disease, but the intersection of the two disease processes presents difficult decisions for patients and physicians. Herein, we review the background underlying recent revisions in clinical alerts and guidelines for ESAs, and provide guidance for treating anemia among CKD patients who are receiving no therapy, chemotherapy with curative intent, or chemotherapy with palliative intent. The guiding principle is that comprehensive assessment of risks and benefits in the relevant clinical setting is imperative. PMID:19175532

  1. American Cancer Society guideline for the early detection of prostate cancer: update 2010.

    Science.gov (United States)

    Wolf, Andrew M D; Wender, Richard C; Etzioni, Ruth B; Thompson, Ian M; D'Amico, Anthony V; Volk, Robert J; Brooks, Durado D; Dash, Chiranjeev; Guessous, Idris; Andrews, Kimberly; DeSantis, Carol; Smith, Robert A

    2010-01-01

    In 2009, the American Cancer Society (ACS) Prostate Cancer Advisory Committee began the process of a complete update of recommendations for early prostate cancer detection. A series of systematic evidence reviews was conducted focusing on evidence related to the early detection of prostate cancer, test performance, harms of therapy for localized prostate cancer, and shared and informed decision making in prostate cancer screening. The results of the systematic reviews were evaluated by the ACS Prostate Cancer Advisory Committee, and deliberations about the evidence occurred at committee meetings and during conference calls. On the basis of the evidence and a consensus process, the Prostate Cancer Advisory Committee developed the guideline, and a writing committee drafted a guideline document that was circulated to the entire committee for review and revision. The document was then circulated to peer reviewers for feedback, and finally to the ACS Mission Outcomes Committee and the ACS Board of Directors for approval. The ACS recommends that asymptomatic men who have at least a 10-year life expectancy have an opportunity to make an informed decision with their health care provider about screening for prostate cancer after they receive information about the uncertainties, risks, and potential benefits associated with prostate cancer screening. Prostate cancer screening should not occur without an informed decision-making process. Men at average risk should receive this information beginning at age 50 years. Men in higher risk groups should receive this information before age 50 years. Men should either receive this information directly from their health care providers or be referred to reliable and culturally appropriate sources. Patient decision aids are helpful in preparing men to make a decision whether to be tested. PMID:20200110

  2. EPA`s program for risk assessment guidelines: Quantification issues

    Energy Technology Data Exchange (ETDEWEB)

    Dourson, M.L. [Environmental Protection Agency, Washington, DC (United States)

    1990-12-31

    The quantitative procedures associated with noncancer risk assessment include reference dose (RfD), benchmark dose, and severity modeling. The RfD, which is part of the EPA risk assessment guidelines, is an estimation of a level that is likely to be without any health risk to sensitive individuals. The RfD requires two major judgments: the first is choice of a critical effect(s) and its No Observed Adverse Effect Level (NOAEL); the second judgment is choice of an uncertainty factor. This paper discusses major assumptions and limitations of the RfD model.

  3. Do African-American men need separate prostate cancer screening guidelines?

    OpenAIRE

    Shenoy, Divya; Packianathan, Satyaseelan; Chen, Allen M.; Vijayakumar, Srinivasan

    2016-01-01

    Background In 2012, the United States Preventative Services Task Force issued new guidelines recommending that male U.S. residents, irrespective of race, no longer be screened for prostate cancer. In African American men, the incidence of prostate cancer is almost 60 % higher and the mortality rate is two to three times greater than in Caucasians. The purpose of this study is to reduce African American men's prostate cancer burden by demonstrating they need separate screening guidelines. Meth...

  4. Adherence to Cancer Screening Guidelines and Predictors of Improvement Among Participants in the Kansas State Employee Wellness Program

    Directory of Open Access Journals (Sweden)

    Siu-kuen Azor Hui, PhD, MSPH

    2013-07-01

    Full Text Available Introduction Employee wellness programs (EWPs have been used to implement worksite-based cancer prevention and control interventions. However, little is known about whether these programs result in improved adherence to cancer screening guidelines or how participants’ characteristics affect subsequent screening. This study was conducted to describe cancer screening behaviors among participants in a state EWP and identify factors associated with screening adherence among those who were initially nonadherent. Methods We identified employees and their dependents who completed health risk assessments (HRAs as part of the Kansas state EWP in both 2008 and 2009. We examined baseline rates of adherence to cancer screening guidelines in 2008 and factors associated with adherence in 2009 among participants who were initially nonadherent. Results Of 53,095 eligible participants, 13,222 (25% participated in the EWP in 2008 and 6,205 (12% participated in both years. Among the multiyear participants, adherence was high at baseline to screening for breast (92.5%, cervical (91.8%, and colorectal cancer (72.7%. Of participants who were initially nonadherent in 2008, 52.4%, 41.3%, and 33.5%, respectively, became adherent in the following year to breast, cervical, and colorectal cancer screening. Suburban/urban residence and more frequent doctor visits predicted adherence to breast and colorectal cancer screening guidelines. Conclusion The effectiveness of EWPs for increasing cancer screening is limited by low HRA participation rates, high rates of adherence to screening at baseline, and failure of nonadherent participants to get screening. Improving overall adherence to cancer screening guidelines among employees will require efforts to increase HRA participation, stronger interventions for nonadherent participants, and better access to screening for rural employees.

  5. Pay attention to the rehabilitation of cancer patients--Excerpts of the 2013 NCCN Guidelines for Survivorship

    Institute of Scientific and Technical Information of China (English)

    Xiaoming Wu

    2014-01-01

    For some survivors, the consequences of cancer are minimal;these patients can return to a normal life after the completion of treatment. In fact, a majority of cancer survivors report being in good general health and experience good to excellent quality of life. A recent review suggests that at least 50%of survivors suf er from some late ef ects of cancer treat-ment. The most common problems in cancer survivors are depression, pain, and fatigue. The guidelines suggest the fol owing standards for survivorship care:(1) prevention of new and recurrent cancers and other late ef ects;(2) surveil ance for cancer spread, recurrence, or second cancers;(3) assessment of late psychosocial and medical ef ects;(4) intervention for conse-quences of cancer and treatment (eg, medical problems, symptoms, psychologic distress, financial and social concerns);and (5) coordination of care between primary care providers and specialists to ensure that al of the survivor’s health needs are met. The NCCN Survivorship Panel hopes that these guidelines can help both oncologic and primary health care profession-als lessen the burden left on survivors by their cancer experience so they can transition back to a rewarding life.

  6. Assessment of the cortisol awakening response: Expert consensus guidelines.

    Science.gov (United States)

    Stalder, Tobias; Kirschbaum, Clemens; Kudielka, Brigitte M; Adam, Emma K; Pruessner, Jens C; Wüst, Stefan; Dockray, Samantha; Smyth, Nina; Evans, Phil; Hellhammer, Dirk H; Miller, Robert; Wetherell, Mark A; Lupien, Sonia J; Clow, Angela

    2016-01-01

    The cortisol awakening response (CAR), the marked increase in cortisol secretion over the first 30-45 min after morning awakening, has been related to a wide range of psychosocial, physical and mental health parameters, making it a key variable for psychoneuroendocrinological research. The CAR is typically assessed from self-collection of saliva samples within the domestic setting. While this confers ecological validity, it lacks direct researcher oversight which can be problematic as the validity of CAR measurement critically relies on participants closely following a timed sampling schedule, beginning with the moment of awakening. Researchers assessing the CAR thus need to take important steps to maximize and monitor saliva sampling accuracy as well as consider a range of other relevant methodological factors. To promote best practice of future research in this field, the International Society of Psychoneuroendocrinology initiated an expert panel charged with (i) summarizing relevant evidence and collective experience on methodological factors affecting CAR assessment and (ii) formulating clear consensus guidelines for future research. The present report summarizes the results of this undertaking. Consensus guidelines are presented on central aspects of CAR assessment, including objective control of sampling accuracy/adherence, participant instructions, covariate accounting, sampling protocols, quantification strategies as well as reporting and interpreting of CAR data. Meeting these methodological standards in future research will create more powerful research designs, thus yielding more reliable and reproducible results and helping to further advance understanding in this evolving field of research. PMID:26563991

  7. Chemotherapy for bladder cancer: treatment guidelines for neoadjuvant chemotherapy, bladder preservation, adjuvant chemotherapy, and metastatic cancer

    DEFF Research Database (Denmark)

    Sternberg, Cora N; Donat, S Machele; Bellmunt, Joaquim;

    2007-01-01

    To determine the optimal use of chemotherapy in the neoadjuvant, adjuvant, and metastatic setting in patients with advanced urothelial cell carcinoma, a consensus conference was convened by the World Health Organization (WHO) and the Société Internationale d'Urologie (SIU) to critically review the...... published literature on chemotherapy for patients with locally advanced bladder cancer. This article reports the development of international guidelines for the treatment of patients with locally advanced bladder cancer with neoadjuvant and adjuvant chemotherapy. Bladder preservation is also discussed, as...

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

    International Nuclear Information System (INIS)

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

  9. 77 FR 45350 - Notice of Availability of Microbial Risk Assessment Guideline: Pathogenic Microorganisms With...

    Science.gov (United States)

    2012-07-31

    ... document for public comment in July, 2011(76 FR 44586). EPA received two public comments--one from a member... AGENCY Notice of Availability of Microbial Risk Assessment Guideline: Pathogenic Microorganisms With... Assessment Guideline: Pathogenic Microorganisms with Focus on Food and Water (MRA Guideline). The...

  10. Vessel based delineation guidelines for the elective lymph node regions in breast cancer radiation therapy – PROCAB guidelines

    International Nuclear Information System (INIS)

    Objective: A national project to improve the quality of breast radiation therapy was started, named PROCAB (PROject on CAncer of the Breast). One of the objectives was to reach a national consensus guideline for the delineation of the regional lymph node areas in breast radiation therapy. Methods: The realization of the new guidelines was a step by step process that started with multiple expert meetings where the existing guidelines were analyzed and the delineations of the lymph node regions were performed together with a surgeon, specialized in the anatomy of the drainage of the breast. Results: The delineation guidelines are vessel-based. Since the occurrence of pathological lymph nodes is typically around the veins, the cranial and caudal borders of all different nodal regions are based on a 5 mm margin around the veins, except for the parasternal lymph node area. Compared to the existing guidelines there are some major changes. Conclusion: With this project a national as well as a European (ESTRO) consensus guideline for the delineation of the regional lymph node areas in breast RT is reached. The new delineation atlas is vessel-based and no longer field-based

  11. Breast Cancer Guidelines in Canada: A Review of Development and Implementation

    OpenAIRE

    Folkes, Amy; Urquhart, Robin; Zitzelsberger, Louise; Grunfeld, Eva

    2008-01-01

    A series of specific clinical practice guidelines (CPGs) were published in Canada in 1998. A primary objective of these ‘Clinical Practice Guidelines for the Care and Treatment of Breast Cancer’ was to decrease the variation in breast cancer care across the country. Prior to this, researchers found moderate compliance with consensus recommendations for breast cancer therapies in several Canadian provinces. However, a recent study concluded that the publication of the Canadian CPGs did not red...

  12. Effectiveness of the World Health Organization Cancer Pain Relief Guidelines: an integrative review

    OpenAIRE

    Carlson CL

    2016-01-01

    Cathy L Carlson School of Nursing, Northern Illinois University, DeKalb, IL, USA Abstract: Inadequate cancer pain relief has been documented extensively across historical records. In response, in 1986, the World Health Organization (WHO) developed guidelines for cancer pain treatment. The purpose of this paper is to disseminate the results of a comprehensive, integrative review of studies that evaluate the effectiveness of the WHO guidelines. Studies were included if they: 1) identified pati...

  13. Clinical Practice Guidelines for Gastric Cancer in Korea: An Evidence-Based Approach

    OpenAIRE

    Lee, Jun Haeng; Kim, Jae G; Jung, Hye-Kyung; Kim, Jung Hoon; Jeong, Woo Kyoung; Jeon, Tae Joo; Kim, Joon Mee; Kim, Young Il; Ryu, Keun Won; Kong, Seong-Ho; Kim, Hyoung-Il; Jung, Hwoon-Yong; Kim, Yong Sik; Zang, Dae Young; Cho, Jae Yong

    2014-01-01

    Although gastric cancer is quite common in Korea, the treatment outcome is relatively favorable compared to those in western countries. However, there are currently no Korean multidisciplinary guidelines for gastric cancer. Experts from related societies developed guidelines de novo to meet Korean circumstances and requirements, including 23 recommendation statements for diagnosis (n=9) and treatment (n=14) based on relevant key questions. The quality of the evidence was rated according to th...

  14. Epigenetic processes and cancer risk assessment

    International Nuclear Information System (INIS)

    The U.S. Environmental Protection Agency's Guidelines for Carcinogen Risk Assessment encourages the use of mechanistic data in the assessment of human cancer risk at low (environmental) exposure levels. The key events that define a particular mode of action for tumor formation have been concentrated to date more on mutational responses that are broadly the result of induced DNA damage and enhanced cell proliferation. While it is clear that these processes are important in terms of tumor induction, other modes that fall under the umbrella of epigenetic responses are increasingly being considered to play an important role in susceptibility to tumor induction by environmental chemicals and as significant modifiers of tumor responses. Alterations in gene expression, DNA repair, cell cycle control, genome stability and genome reprogramming could be the result of modification of DNA methylation and chromatin remodeling patterns as a consequence of exposure to environmental chemicals. These concepts are described and discussed

  15. Lung cancer: assessing resectability

    OpenAIRE

    Quint, Leslie E

    2003-01-01

    Staging classification in patients with non-small cell lung cancer does not always correlate perfectly with surgical resectability. Therefore, it is important to evaluate individual features of a patient’s tumor in order to determine if surgical resection is the optimal method of treatment, regardless of tumor stage. Such features include characteristics of the primary tumor, regional lymph nodes and distant sites.

  16. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer.

    Science.gov (United States)

    Ono, Hiroyuki; Yao, Kenshi; Fujishiro, Mitsuhiro; Oda, Ichiro; Nimura, Satoshi; Yahagi, Naohisa; Iishi, Hiroyasu; Oka, Masashi; Ajioka, Yoichi; Ichinose, Masao; Matsui, Toshiyuki

    2016-01-01

    In response to the rapid and wide acceptance and use of endoscopic treatments for early gastric cancer, the Japan Gastroenterological Endoscopy Society (JGES), in collaboration with the Japanese Gastric Cancer Association (JGCA), has produced 'Guidelines for ESD and EMR for Early Gastric Cancer', as a set of basic guidelines in accordance with the principles of evidence-based medicine. These Guidelines cover the present state of knowledge and are divided into the following seven categories: Indications, Preoperative diagnosis, Techniques, Evaluation of curability, Complications, Long-term postoperative surveillance, and Histology. Twenty-three statements were finally accepted as guidelines, and the majority of these were obtained from descriptive studies with lower evidence levels. A number of statements had to be created by consensus (the lowest evidence level), as evidence levels remain low for many specific areas in this field. PMID:26234303

  17. Adoptability and limitation of cancer treatment guidelines: a Chinese oncologist's perspective

    Institute of Scientific and Technical Information of China (English)

    DU Chang-zheng; GU Jin

    2012-01-01

    In recent years,great progress has been made in the treatment of cancer;one of the significant reasons is the wide adaptation and implementation of standardized treatment based on high-level clinical evidence.Undoubtedly,the advent of guidelines that represent the achievement of the latest and highest quality clinical studies made a significant contribution to the improvement of cancer treatment and management.Aside from cancer patient care,guidelines have also been widely used as standards or primary references in the diagnosis and treatment of other diseases.Numerous guidelines are being enacted each year by a variety of guideline-makers, including national, regional and intemational academic organizations, medical associations,as well as research institutions and hospitals.

  18. Receipt of Guideline-Concordant Treatment in Elderly Prostate Cancer Patients

    International Nuclear Information System (INIS)

    Purpose: To examine the proportion of elderly prostate cancer patients receiving guideline-concordant treatment, using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Methods and Materials: A total of 29,001 men diagnosed in 2004-2007 with localized prostate cancer, aged 66 to 79 years, were included. We characterized the proportion of men who received treatment concordant with the National Comprehensive Cancer Network guidelines, stratified by risk group and age. Logistic regression was used to examine covariates associated with receipt of guideline-concordant management. Results: Guideline concordance was 79%-89% for patients with low- or intermediate-risk disease. Among high-risk patients, 66.6% of those aged 66-69 years received guideline-concordant management, compared with 51.9% of those aged 75-79 years. Discordance was mainly due to conservative management—no treatment or hormone therapy alone. Among the subgroup of patients aged ≤76 years with no measured comorbidity, findings were similar. On multivariable analysis, older age (75-79 vs 66-69 years, odds ratio 0.51, 95% confidence interval 0.50-0.57) was associated with a lower likelihood of guideline concordance for high-risk prostate cancer, but comorbidity was not. Conclusions: There is undertreatment of elderly but healthy patients with high-risk prostate cancer, the most aggressive form of this disease

  19. Expert validation of fit-for-purpose guidelines for designing programmes of assessment.

    NARCIS (Netherlands)

    Dijkstra, J.; Galbraith, R.; Hodges, B.D.; McAvoy, P.A.; McCrorie, P.; Southgate, L.J.; Vleuten, C.P.M. van der; Wass, V.; Schuwirth, L.W.

    2012-01-01

    ABSTRACT: BACKGROUND: An assessment programme, a purposeful mix of assessment activities, is necessary to achieve a complete picture of assessee competence. High quality assessment programmes exist, however, design requirements for such programmes are still unclear. We developed guidelines for desig

  20. DEGRO practical guidelines for radiotherapy of breast cancer VI: therapy of locoregional breast cancer recurrences

    International Nuclear Information System (INIS)

    To update the practical guidelines for radiotherapy of patients with locoregional breast cancer recurrences based on the current German interdisciplinary S3 guidelines 2012. A comprehensive survey of the literature using the search phrases ''locoregional breast cancer recurrence'', ''chest wall recurrence'', ''local recurrence'', ''regional recurrence'', and ''breast cancer'' was performed, using the limits ''clinical trials'', ''randomized trials'', ''meta-analysis'', ''systematic review'', and ''guidelines''. Patients with isolated in-breast or regional breast cancer recurrences should be treated with curative intent. Mastectomy is the standard of care for patients with ipsilateral breast tumor recurrence. In a subset of patients, a second breast conservation followed by partial breast irradiation (PBI) is an appropriate alternative to mastectomy. If a second breast conservation is performed, additional irradiation should be mandatory. The largest reirradiation experience base exists for multicatheter brachytherapy; however, prospective clinical trials are needed to clearly define selection criteria, long-term local control, and toxicity. Following primary mastectomy, patients with resectable locoregional breast cancer recurrences should receive multimodality therapy including systemic therapy, surgery, and radiation +/- hyperthermia. This approach results in high local control rates and long-term survival is achieved in a subset of patients. In radiation-naive patients with unresectable locoregional recurrences, radiation therapy is mandatory. In previously irradiated patients with a high risk of a second local recurrence after surgical resection or in patients with unresectable recurrences, reirradiation should be strongly considered. Indication and dose concepts

  1. Approaches to cancer assessment in EPA's Integrated Risk Information System

    International Nuclear Information System (INIS)

    The U.S. Environmental Protection Agency's (EPA) Integrated Risk Information System (IRIS) Program develops assessments of health effects that may result from chronic exposure to chemicals in the environment. The IRIS database contains more than 540 assessments. When supported by available data, IRIS assessments provide quantitative analyses of carcinogenic effects. Since publication of EPA's 2005 Guidelines for Carcinogen Risk Assessment, IRIS cancer assessments have implemented new approaches recommended in these guidelines and expanded the use of complex scientific methods to perform quantitative dose-response assessments. Two case studies of the application of the mode of action framework from the 2005 Cancer Guidelines are presented in this paper. The first is a case study of 1,2,3-trichloropropane, as an example of a chemical with a mutagenic mode of carcinogenic action thus warranting the application of age-dependent adjustment factors for early-life exposure; the second is a case study of ethylene glycol monobutyl ether, as an example of a chemical with a carcinogenic action consistent with a nonlinear extrapolation approach. The use of physiologically based pharmacokinetic (PBPK) modeling to quantify interindividual variability and account for human parameter uncertainty as part of a quantitative cancer assessment is illustrated using a case study involving probabilistic PBPK modeling for dichloromethane. We also discuss statistical issues in assessing trends and model fit for tumor dose-response data, analysis of the combined risk from multiple types of tumors, and application of life-table methods for using human data to derive cancer risk estimates. These issues reflect the complexity and challenges faced in assessing the carcinogenic risks from exposure to environmental chemicals, and provide a view of the current trends in IRIS carcinogenicity risk assessment.

  2. New Guidelines Issued for Cancer Patients' Post-Treatment Pain

    Science.gov (United States)

    ... advise doctors to consider the use of non-traditional treatments for pain. These include hypnosis, meditation and ... recommended precautions to minimize the risk of abuse, addiction or harmful side effects, the guidelines advise. "Of ...

  3. DEGRO practical guidelines for radiotherapy of breast cancer IV. Radiotherapy following mastectomy for invasive breast cancer

    International Nuclear Information System (INIS)

    Since the last recommendations from the Breast Cancer Expert Panel of the German Society for Radiation Oncology (DEGRO) in 2008, evidence for the effectiveness of postmastectomy radiotherapy (PMRT) has grown. This growth is based on updates of the national S3 and international guidelines, as well as on new data and meta-analyses. New aspects were considered when updating the DEGRO recommendations. The authors performed a comprehensive survey of the literature. Data from recently published (meta-)analyses, randomized clinical trials and international cancer societies' guidelines yielding new aspects compared to 2008 were reviewed and discussed. New aspects were included in the current guidelines. Specific issues relating to particular PMRT constellations, such as the presence of risk factors (lymphovascular invasion, blood vessel invasion, positive lymph node ratio > 20 %, resection margins 2 cm or a combination of ≥ 2 risk factors) and 1-3 positive lymph nodes are emphasized. The evidence for improved overall survival and local control following PMRT for T4 tumors, positive resection margins, > 3 positive lymph nodes and in T3 N0 patients with risk factors such as lymphovascular invasion, G3 grading, close margins, and young age has increased. Recently identified risk factors such as invasive lobular subtype and negative hormone receptor status were included. For patients with 1-3 positive lymph nodes, the recommendation for PMRT has reached the 1a level of evidence. PMRT is mandatory in patients with T4 tumors and/or positive lymph nodes and/or positive resection margins. PMRT should be strongly considered in patients with T3 N0 tumors and risk factors, particularly when two or more risk factors are present. (orig.)

  4. Cancer risk assessments and environmental regulation

    International Nuclear Information System (INIS)

    Governmental regulation of toxic substances, such as carcinogens and radiation, prompts both legal and scientific controversies. Industry, environmental activist groups, government regulators, and the general public are all concerned with the question of how environmental risk to public health is to be measured and what level of risk warrants government action under the environmental laws. Several recent events shed light on the fundamental scientific and legal problems inherent in such regulation, and these events may affect the direction of future developments. These events include implementation of generic Risk Assessment Guidelines by the US EPA, litigation challenging EPA's regulation of carcinogenic substances, new scientific understanding of the relative risks from human exposure to natural and man-made sources, and the continuing growth of toxic tort litigation in which victims of cancer seek large damages from industrial emitters of pollution

  5. Guidelines for the welfare and use of animals in cancer research

    OpenAIRE

    Workman, P; Aboagye, E O; Balkwill, F; Balmain, A; Bruder, G; Chaplin, D. J.; Double, J A; Everitt, J; Farningham, D A H; Glennie, M. J.; Kelland, L R; Robinson, V.; Stratford, I J; Tozer, G. M.; Watson, S.

    2010-01-01

    Animal experiments remain essential to understand the fundamental mechanisms underpinning malignancy and to discover improved methods to prevent, diagnose and treat cancer. Excellent standards of animal care are fully consistent with the conduct of high quality cancer research. Here we provide updated guidelines on the welfare and use of animals in cancer research. All experiments should incorporate the 3Rs: replacement, reduction and refinement. Focusing on animal welfare, we present recomme...

  6. Familial gastric cancer: guidelines for diagnosis, treatment and periodic surveillance

    OpenAIRE

    Kluijt, Irma; Sijmons, Rolf H; Hoogerbrugge, Nicoline; Plukker, John T.; de Jong, Daphne; van Krieken, J. Han; van Hillegersberg, Richard; Ligtenberg, Marjolijn; Bleiker, Eveline; Cats, Anemieke

    2012-01-01

    Hereditary diffuse gastric cancer (HDGC) is a relatively rare disorder, with a mutated CDH1 gene as the only known cause. Carriers of a germline mutation in CDH1 have a lifetime risk of > 80% of developing diffuse gastric cancer. As periodic gastric surveillance is of limited value in detecting early stages of HDGC, prophylactic gastrectomy is advised for this patient group. Little is known about other types of familial gastric cancer. The Dutch working group on hereditary gastric cancer has ...

  7. Establishing a family risk assessment clinic for breast cancer.

    LENUS (Irish Health Repository)

    Mulsow, Jurgen

    2012-02-01

    Breast cancer is the most common cancer affecting European women and the leading cause of cancer-related death. A total of 15-20% of women who develop breast cancer have a family history and 5-10% a true genetic predisposition. The identification and screening of women at increased risk may allow early detection of breast cancer and improve prognosis. We established a family risk assessment clinic in May 2005 to assess and counsel women with a family history of breast cancer, to initiate surveillance, and to offer risk-reducing strategies for selected high-risk patients. Patients at medium or high risk of developing breast cancer according to NICE guidelines were accepted. Family history was determined by structured questionnaire and interview. Lifetime risk of developing breast cancer was calculated using Claus and Tyrer-Cuzick scoring. Risk of carrying a breast cancer-related gene mutation was calculated using the Manchester system. One thousand two hundred and forty-three patients have been referred. Ninety-two percent were at medium or high risk of developing breast cancer. Formal assessment of risk has been performed in 368 patients, 73% have a high lifetime risk of developing breast cancer, and 72% a Manchester score >or=16. BRCA1\\/2 mutations have been identified in 14 patients and breast cancer diagnosed in two. Our initial experience of family risk assessment has shown there to be a significant demand for this service. Identification of patients at increased risk of developing breast cancer allows us to provide individuals with accurate risk profiles, and enables patients to make informed choices regarding their follow-up and management.

  8. Spatial differentiation in life cycle impact assessment - the EDIP-2003 methodology. Guidelines from the Danish EPA

    DEFF Research Database (Denmark)

    Hauschild, Michael Zwicky; Potting, José

    Guideline on the accordance between the environmental impact predicted in the life cycle assessment and the expected occurrence of actual impact.......Guideline on the accordance between the environmental impact predicted in the life cycle assessment and the expected occurrence of actual impact....

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

    Directory of Open Access Journals (Sweden)

    Ashraf Abusamra

    2016-01-01

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

  10. Noninvasive diagnosis of hepatocellular carcinoma: Elaboration on Korean liver cancer study group-National Cancer Center Korea Practice Guidelines compared with other guidelines and remaining issues

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Jeong Hee; Lee, Jeong Min [Dept. of Radiology, Seoul National University Hospital, Seoul (Korea, Republic of); Park, Joong Won [Center for Liver Cancer, National Cancer Center, Goyang (Korea, Republic of)

    2016-02-15

    Hepatocellular carcinoma (HCC) can be diagnosed based on characteristic findings of arterial-phase enhancement and portal/delayed 'washout' in cirrhotic patients. Several countries and major academic societies have proposed varying specific diagnostic criteria for HCC, largely reflecting the variable HCC prevalence in different regions and ethnic groups, as well as different practice patterns. In 2014, a new version of Korean practice guidelines for management of HCC was released by the Korean Liver Cancer Study Group (KLCSG) and the National Cancer Center (NCC). According to the KLCSG-NCC Korea practice guidelines, if the typical hallmark of HCC (i.e., hypervascularity in the arterial phase with washout in the portal or 3 min-delayed phases) is identified in a nodule ≥ 1 cm in diameter on either dynamic CT, dynamic MRI, or MRI using hepatocyte-specific contrast agent in high-risk groups, a diagnosis of HCC is established. In addition, the KLCSG-NCC Korea practice guidelines provide criteria to diagnose HCC for subcentimeter hepatic nodules according to imaging findings and tumor marker, which has not been addressed in other guidelines such as Association for the Study of Liver Diseases and European Association for the Study of the Liver. In this review, we briefly review the new HCC diagnostic criteria endorsed by the 2014 KLCSG-NCC Korea practice guidelines, in comparison with other recent guidelines; we furthermore address several remaining issues in noninvasive diagnosis of HCC, including prerequisite of sonographic demonstration of nodules, discrepancy between transitional phase and delayed phase, and implementation of ancillary features for HCC diagnosis.

  11. Current Guidelines for the Diagnosis and Treatment of Breast Cancer

    OpenAIRE

    Hayes, Teresa G.; Peterson, Leif E; Weinberg, Armin D.

    1998-01-01

    The management of breast cancer is a significant public health issue. Early detection of breast cancer through screening mammography, physician clinical examination and breast self-examination can reduce breast cancer mortality by approximately 30%. Most major health organisations agree that yearly mammographic screening should begin at the age of 40 years, although there is some controversy about the need for mammography between the ages of 40 and 49 years. The use of mammographic screening ...

  12. Implementing Thrombosis Guidelines in Cancer Patients: A Review

    OpenAIRE

    Dominique Farge-Bancel; Henri Bounameaux; Benjamin Brenner; Büller, Harry R.; Ajay Kakkar,; Ingrid Pabinger; Michael Streiff; Philippe Debourdeau

    2014-01-01

    Venous thromboembolism is a frequent and serious complication in patients with cancer. It is an independent prognostic factor of death in cancer patients and the second leading cause of death, but physicians often underestimate its importance, as well as the need for adequate prevention and treatment. Management of venous thromboembolism in patients with cancer requires the coordinated efforts of a wide range of clinicians, highlighting the importance of a multidisciplinary approach. However,...

  13. Guidelines for assessing the knowledge management maturity of organizations

    Directory of Open Access Journals (Sweden)

    C. J. Kruger

    2007-11-01

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

  14. Basal Cell Skin Cancer, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology.

    Science.gov (United States)

    Bichakjian, Christopher K; Olencki, Thomas; Aasi, Sumaira Z; Alam, Murad; Andersen, James S; Berg, Daniel; Bowen, Glen M; Cheney, Richard T; Daniels, Gregory A; Glass, L Frank; Grekin, Roy C; Grossman, Kenneth; Higgins, Susan A; Ho, Alan L; Lewis, Karl D; Lydiatt, Daniel D; Nehal, Kishwer S; Nghiem, Paul; Olsen, Elise A; Schmults, Chrysalyne D; Sekulic, Aleksandar; Shaha, Ashok R; Thorstad, Wade L; Tuli, Malika; Urist, Marshall M; Wang, Timothy S; Wong, Sandra L; Zic, John A; Hoffmann, Karin G; Engh, Anita

    2016-05-01

    Basal cell carcinoma (BCC) of the skin is the most common cancer, with a higher incidence than all other malignancies combined. Although it is rare to metastasize, patients with multiple or frequently recurring BCC can suffer substantial comorbidity and be difficult to manage. Assessment of risk is a key element of management needed to inform treatment selection. The overall management of BCC primarily consists of surgical approaches, with radiation therapy as an alternate or adjuvant option. Many superficial therapies for BCC have been explored and continue to be developed, including topicals, cryosurgery, and photodynamic therapy. Two hedgehog pathway inhibitors were recently approved by the FDA for systemic treatment of advanced and metastatic BCC, and others are in development. The NCCN Guidelines for Basal Cell Skin Cancer, published in full herein, include recommendations for selecting among the various surgical approaches based on patient-, lesion-, and disease-specific factors, as well as guidance on when to use radiation therapy, superficial therapies, and hedgehog pathway inhibitors. PMID:27160235

  15. Endorectal MRI assessment of local relapse after surgery for prostate cancer: A model to define treatment field guidelines for adjuvant radiotherapy in patients at high risk for local failure

    International Nuclear Information System (INIS)

    Purpose: To assess the role of endorectal magnetic resonance imaging (MRI) in defining local relapse after radical prostatectomy for prostate cancer to help to reassess the clinical target volume (CTV) for adjuvant postprostatectomy radiotherapy. Methods and Materials: Sixty patients undergoing an endorectal MRI before salvage radiotherapy were selected. Spatial coordinates of the relapses were assessed using two reference points: the inferior border of the pubic symphysis (point 1) and the urethro-vesical anastomosis (point 2). Every lesion on MRI was delineated on the planning computed tomography and center of mass coordinates were plotted in two separate diagrams (along the x, y, and z axes) with the urethro-vesical anastomosis as the coordinate origin. An 'ideal' CTV was constructed, centered at a point defined by the mathematical means of each of the three coordinates with dimensions defined as twice 2 standard deviations in each of the three axes. The dosimetric impact of the new CTV definition was evaluated in six adjuvantly treated patients. Results: The ideal CTV center of mass was located at coordinates 0 (x), -5 (y), and -3 (z) mm with SDs of 6 (x), 6 (y), and 9 (z) mm, respectively. The CTV size was 24 (x) x 24 (y) x 36 (z) mm. Significant rectal sparing was observed with the new CTV. Conclusions: A CTV with an approximately cylindrical shape (∼4 x 3 cm) centered 5 mm posterior and 3 mm inferior to the urethro-vesical anastomosis was defined. Such CTV may reduce the irradiation of normal nontarget tissue in the pelvis potentially improving treatment tolerance

  16. [3rd Hungarian Breast Cancer Consensus Conference - Surgery Guidelines].

    Science.gov (United States)

    Lázár, György; Bursics, Attila; Farsang, Zoltán; Harsányi, László; Kósa, Csaba; Maráz, Róbert; Mátrai, Zoltán; Paszt, Attila; Pavlovics, Gábor; Tamás, Róbert

    2016-09-01

    Therapy for breast cancer today is characterised by ever more precise diagnostic methods and ever more effective oncological treatments, a trend which will certainly continue in the future. Breast preservation and the application of oncoplastic principles are increasingly popular. A sentinel lymph node biopsy in the surgical treatment of the axilla is primary, with the indication for axillary block dissection (ABD) narrowing and radiation therapy becoming an alternative to ABD in certain cases. This publication summarises our recommendations on the surgical treatment of breast cancer based on the content of the 2nd Breast Cancer Consensus Conference and considering the latest international studies and professional recommendations. PMID:27579720

  17. Comparative assessment of bioanalytical method validation guidelines for pharmaceutical industry.

    Science.gov (United States)

    Kadian, Naveen; Raju, Kanumuri Siva Rama; Rashid, Mamunur; Malik, Mohd Yaseen; Taneja, Isha; Wahajuddin, Muhammad

    2016-07-15

    The concepts, importance, and application of bioanalytical method validation have been discussed for a long time and validation of bioanalytical methods is widely accepted as pivotal before they are taken into routine use. United States Food and Drug Administration (USFDA) guidelines issued in 2001 have been referred for every guideline released ever since; may it be European Medical Agency (EMA) Europe, National Health Surveillance Agency (ANVISA) Brazil, Ministry of Health and Labour Welfare (MHLW) Japan or any other guideline in reference to bioanalytical method validation. After 12 years, USFDA released its new draft guideline for comments in 2013, which covers the latest parameters or topics encountered in bioanalytical method validation and approached towards the harmonization of bioanalytical method validation across the globe. Even though the regulatory agencies have general agreement, significant variations exist in acceptance criteria and methodology. The present review highlights the variations, similarities and comparison between bioanalytical method validation guidelines issued by major regulatory authorities worldwide. Additionally, other evaluation parameters such as matrix effect, incurred sample reanalysis including other stability aspects have been discussed to provide an ease of access for designing a bioanalytical method and its validation complying with the majority of drug authority guidelines. PMID:27179186

  18. Health impact assessment: A comparison of 45 local, national, and international guidelines

    International Nuclear Information System (INIS)

    This article provides a comparison of health impact assessment (HIA) guidelines from around the world and for multiple geographic scales. We identify commonalities and differences within HIA guides to discuss the plausibility of consensus guidelines and to inform guideline development. The practice of HIA has grown over the last two decades with a concurrent growth of HIA guides. This study expands on earlier review work and includes guides published since 2007 (Mindell, Boltong and Forde, 2008). From April 2010 to October 2011, 45 HIA guides were identified through an internet search and review of previous research. Common characteristics, key features, and the HIA process were analyzed. The 45 documents recommended similar but not identical processes for conducting HIAs. These analyses suggest that guidelines for HIAs are similar in many areas of the world and that new HIA practitioners can use these findings to inform their approach. Further discussion is needed to determine if the approaches established in these guidelines are followed and if one set of common guidelines could be written for use in numerous countries and regions. - Highlights: ► We analyze 45 health impact assessment (HIA) guidelines worldwide. ► We examine similarities and unique attributes of each guideline. ► We discuss the advantages and disadvantages of developing consensus guidelines. ► Identifying additional guidelines aides in future HIA work and evaluation.

  19. Assessment and prevention of behavioural and social risk factors associated with oral cancer: protocol for a systematic review of clinical guidelines and systematic reviews to inform primary care dental professionals

    OpenAIRE

    Mathur, Sweta; Conway, David J.; Worlledge-Andrew, Heather; Macpherson, Lorna M. D.; Ross, Alastair J.

    2015-01-01

    Background Tobacco and alcohol are recognised as the major risk factors for both oral cavity (mouth) and oropharyngeal (throat) cancers, with increasing acceptance of the role of human papillomavirus (HPV) in the aetiology of oropharyngeal cancers. In addition, there is a significant increased risk for oral cancer among lower socioeconomic groups, males and older age groups. There is a growing evidence for the potential role of primary care professionals in smoking cessation and reducing alco...

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

    OpenAIRE

    Lalla, Rajesh V.; Bowen, Joanne; Barasch, Andrei; Elting, Linda; Epstein, Joel; Keefe, Dorothy M.; McGuire, Deborah B.; Migliorati, Cesar; Nicolatou‐Galitis, Ourania; Peterson, Douglas E.; Raber‐Durlacher, Judith E.; Sonis, Stephen T.; Elad, Sharon; ,

    2014-01-01

    BACKGROUND Mucositis is a highly significant, and sometimes dose‐limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for mucositis. METHODS A literature search was conducted to identify eligible published articles, based on predefined inclusion/exclusion criteria. Each article was independently reviewed by 2 reviewer...

  1. Sociodemographic disparities in advanced ovarian cancer survival and adherence to treatment guidelines

    OpenAIRE

    Bristow, RE; Chang, J.; Ziogas, A.; Campos, B.; Chavez, LR; Anton-Culver, H.

    2015-01-01

    © 2015 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. Objective: To estimate whether race or ethnic and socioeconomic strata are independently associated with advanced-stage ovarian cancer-specific survival after adjusting for adherence to National Comprehensive Cancer Network treatment guidelines. Methods: The design was a retrospective population-based cohort study of patients with stage IIIC-IV epithelial ovarian ca...

  2. 2014 Korean Liver Cancer Study Group-National Cancer Center Korea Practice Guideline for the Management of Hepatocellular Carcinoma

    OpenAIRE

    ,

    2015-01-01

    The guideline for the management of hepatocellular carcinoma (HCC) was first developed in 2003 and revised in 2009 by the Korean Liver Cancer Study Group and the National Cancer Center, Korea. Since then, many studies on HCC have been carried out in Korea and other countries. In particular, a substantial body of knowledge has been accumulated on diagnosis, staging, and treatment specific to Asian characteristics, especially Koreans, prompting the proposal of new strategies. Accordingly, the n...

  3. 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.

  4. Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up.

    Science.gov (United States)

    Glynne-Jones, R; Nilsson, P J; Aschele, C; Goh, V; Peiffert, D; Cervantes, A; Arnold, D

    2014-10-01

    Squamous cell carcinoma of the anus (SCCA) is a rare cancer but its incidence is increasing throughout the world, and is particularly high in the human immunodeficiency virus positive (HIV+) population. A multidisciplinary approach is mandatory (involving radiation therapists, medical oncologists, surgeons, radiologists and pathologists). SCCA usually spreads in a loco-regional manner within and outside the anal canal. Lymph node involvement at diagnosis is observed in 30%-40% of cases while systemic spread is uncommon with distant extrapelvic metastases recorded in 5%-8% at onset, and rates of metastatic progression after primary treatment between 10 and 20%. SCCA is strongly associated with human papilloma virus (HPV, types 16-18) infection. The primary aim of treatment is to achieve cure with loco-regional control and preservation of anal function, with the best possible quality of life. Treatment dramatically differs from adenocarcinomas of the lower rectum. Combinations of 5FU-based chemoradiation and other cytotoxic agents (mitomycin C) have been established as the standard of care, leading to complete tumour regression in 80%-90% of patients with locoregional failures in the region of 15%. There is an accepted role for surgical salvage. Assessment and treatment should be carried out in specialised centres treating a high number of patients as early as possible in the clinical diagnosis. To date, the limited evidence from only 6 randomised trials [1,2,3,4,5,6,7], the rarity of the cancer, and the different behaviour/natural history depending on the predominant site of origin, (the anal margin, anal canal or above the dentate line) provide scanty direction for any individual oncologist. Here we aim to provide guidelines which can assist medical, radiation and surgical oncologists in the practical management of this unusual cancer. PMID:25239441

  5. Anal cancer: ESMO–ESSO–ESTRO clinical practice guidelines for diagnosis, treatment and follow-up

    International Nuclear Information System (INIS)

    Squamous cell carcinoma of the anus (SCCA) is a rare cancer but its incidence is increasing throughout the world, and is particularly high in the human immunodeficiency virus positive (HIV+) population. A multidisciplinary approach is mandatory (involving radiation therapists, medical oncologists, surgeons, radiologists and pathologists). SCCA usually spreads in a loco-regional manner within and outside the anal canal. Lymph node involvement at diagnosis is observed in 30–40% of cases while systemic spread is uncommon with distant extrapelvic metastases recorded in 5–8% at onset, and rates of metastatic progression after primary treatment between 10% and 20%. SCCA is strongly associated with human papilloma virus (HPV, types 16–18) infection. The primary aim of treatment is to achieve cure with loco-regional control and preservation of anal function, with the best possible quality of life. Treatment dramatically differs from adenocarcinomas of the lower rectum. Combinations of 5FU-based chemoradiation and other cytotoxic agents (mitomycin C) have been established as the standard of care, leading to complete tumour regression in 80–90% of patients with locoregional failures in the region of 15%. There is an accepted role for surgical salvage. Assessment and treatment should be carried out in specialised centres treating a high number of patients as early as possible in the clinical diagnosis. To date, the limited evidence from only 6 randomised trials [1,2,3,4,5,6,7], the rarity of the cancer, and the different behaviour/natural history depending on the predominant site of origin, (the anal margin, anal canal or above the dentate line) provide scanty direction for any individual oncologist. Here we aim to provide guidelines which can assist medical, radiation and surgical oncologists in the practical management of this unusual cancer

  6. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer

    NARCIS (Netherlands)

    Offersen, B.V.; Boersma, L.J.; Kirkove, C.; Hol, S.; Aznar, M.C.; Sola, A. Biete; Kirova, Y.M.; Pignol, J.P.; Remouchamps, V.; Verhoeven, K.; Weltens, C.; Arenas, M.; Gabrys, D.; Kopek, N.; Krause, M.; Lundstedt, D.; Marinko, T.; Montero, A.; Yarnold, J.; Poortmans, P.M.P.

    2015-01-01

    BACKGROUND AND PURPOSE: Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. T

  7. Clinical use of cancer biomarkers in epithelial ovarian cancer: updated guidelines from the European Group on Tumor Markers

    NARCIS (Netherlands)

    Sölétormos, G.; Duffy, M.J.; Othman Abu Hassan, S.; Verheijen, RHM; Tholander, B.; Bast jr., R.C.; Gaarenstroom, K.N.; Sturgeon, C.M.; Bonfrer, J.M.G.; Petersen, P.H.; Troonen, H.; Carlo Torre, G.; Kanty Kulpa, J.; Tuxen, M.K.; Molina, R.

    2016-01-01

    OBJECTIVE: To present an update of the European Group on Tumor Markers guidelines for serum markers in epithelial ovarian cancer. METHODS: Systematic literature survey from 2008 to 2013. The articles were evaluated by level of evidence and strength of recommendation. RESULTS: Because of its low sens

  8. DEGRO practical guidelines for radiotherapy of breast cancer IV. Radiotherapy following mastectomy for invasive breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wenz, Frederik; Sperk, Elena [Universitaetsmedizin Mannheim, Klinik fuer Strahlentherapie und Radioonkologie, Mannheim (Germany); Budach, Wilfried [Heinrich-Heine-University, Duesseldorf (Germany); Dunst, Juergen [University Hospital Schleswig-Holstein, Luebeck (Germany); Feyer, Petra [Vivantes Hospital Neukoelln, Berlin (Germany); Fietkau, Rainer; Sauer, Rolf [University Hospital Erlangen, Erlangen (Germany); Haase, Wulf [Formerly St.-Vincentius-Hospital, Karlsruhe (Germany); Harms, Wolfgang [St. Clara Hospital, Basel (Switzerland); Piroth, Marc D. [Helios Hospital, Wuppertal (Germany); Sautter-Bihl, Marie-Luise [Municipal Hospital, Karlsruhe (Germany); Sedlmayer, Felix; Fussl, Christoph [Paracelsus Medical University Hospital, Salzburg (Germany); Souchon, Rainer; Collaboration: Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)

    2014-08-15

    Since the last recommendations from the Breast Cancer Expert Panel of the German Society for Radiation Oncology (DEGRO) in 2008, evidence for the effectiveness of postmastectomy radiotherapy (PMRT) has grown. This growth is based on updates of the national S3 and international guidelines, as well as on new data and meta-analyses. New aspects were considered when updating the DEGRO recommendations. The authors performed a comprehensive survey of the literature. Data from recently published (meta-)analyses, randomized clinical trials and international cancer societies' guidelines yielding new aspects compared to 2008 were reviewed and discussed. New aspects were included in the current guidelines. Specific issues relating to particular PMRT constellations, such as the presence of risk factors (lymphovascular invasion, blood vessel invasion, positive lymph node ratio > 20 %, resection margins < 3 mm, G3 grading, young age/premenopausal status, extracapsular invasion, negative hormone receptor status, invasive lobular cancer, size > 2 cm or a combination of ≥ 2 risk factors) and 1-3 positive lymph nodes are emphasized. The evidence for improved overall survival and local control following PMRT for T4 tumors, positive resection margins, > 3 positive lymph nodes and in T3 N0 patients with risk factors such as lymphovascular invasion, G3 grading, close margins, and young age has increased. Recently identified risk factors such as invasive lobular subtype and negative hormone receptor status were included. For patients with 1-3 positive lymph nodes, the recommendation for PMRT has reached the 1a level of evidence. PMRT is mandatory in patients with T4 tumors and/or positive lymph nodes and/or positive resection margins. PMRT should be strongly considered in patients with T3 N0 tumors and risk factors, particularly when two or more risk factors are present. (orig.) [German] Seit der letzten Aktualisierung der 2008 publizierten Leitlinie der &apos

  9. Opioid Prescribing Laws and Emergency Department Guidelines for Chronic Non-Cancer Pain in Washington State.

    Science.gov (United States)

    Skaer, Tracy L; Nwude, Azuka C

    2016-06-01

    Rising mortality rates, increased opioid prescription abuse, and a perceived need to provide practitioners with structured guidance in opioid prescribing have prompted the Washington State Legislature to establish new legal standards of practice regarding chronic non-cancer pain management. Clinicians are required to conduct a detailed physical examination and health history prior to treatment. Risk assessments for abuse and detailed periodic reviews of treatment are required at least every 6 months. Those considered "high risk" or who have significant psychiatric comorbidities will be required to sign and follow a written agreement or pain contract, obtain their pain prescriptions from a single provider, and submit to biological drug screening. Unless an exemption exists, patients prescribed > 120 mg of morphine-equivalents daily, considered severe pain nonresponders, necessitating dosage escalation, diagnosed with multifaceted mental health-related comorbidities, demonstrating diagnostic ambiguity, and/or requiring significant treatment individualization are referred to a pain specialist. Episodic care settings should refrain from supplying opioids to chronic pain patients whenever possible. The ER is for Emergencies coalition instituted the Seven Best Practices program throughout the state to reduce unnecessary visits, coordinate prescribing practice, reduce Medicaid expenditures, and improve overall patient care. The state reported approximately $33.65 million in savings in 2013 through the use of these practices and converting Medicaid participants from fee-for-service to managed care plans. Similar legislation to complement clinical practice guidelines is expected to be enacted in other states. It is vital that practitioners comprehend the new guidelines and make appropriate adjustments in their opioid prescribing habits. PMID:26369588

  10. Colon Cancer Risk Assessment - Gauss Program

    Science.gov (United States)

    An executable file (in GAUSS) that projects absolute colon cancer risk (with confidence intervals) according to NCI’s Colorectal Cancer Risk Assessment Tool (CCRAT) algorithm. GAUSS is not needed to run the program.

  11. Interpretation of NCCN Guidelines: General Therapies on Non-small Cell Lung Cancer (Version 6. 2015

    Directory of Open Access Journals (Sweden)

    Xin-en HUANG

    2015-06-01

    Full Text Available Lung cancer is one of the most common malignant tumors in China and ranks the first of cancer-related death. The major etiological agent of lung cancer is an industry-made and promoted addictive product, so lung cancer is considered to be a unique disease in all cancers. Effective policies for public health are required to prevent the smoking initiation so as to reduce the mortality of lung cancer, so Food and Drug Administration (FDA has introduced a series of measures to monitor the tobacco products. As to patients with strong suspicion of lung cancer in stage Ⅰ-Ⅱ, a preoperative biopsy is needed and intra-operative diagnosis is necessary before pneumonectomy, bilobectomy or lobectomy if the preoperative tissue diagnosis is not obtained. However, lung cancer still cannot be easily diagnosed and cured, so the annual improvement and update of new therapeutic protocols and the development of new agents is of great significance. Non-small cell lung cancer (NSCLC accounts for about 80% of all lung cancer, and above 75% NSCLC patients are in middle-advanced stage when diagnosed, so they have lost the optimal therapeutic opportunity and the 5-year survival rate is relatively low. Therefore, this study mainly interpreted the National Comprehensive Cancer Network (NCCN guidelines on the general therapies on NSCLC, hoping to provide references for the treatment of NSCLC patients and prolong their long-term survival.

  12. Playing Around: Benefits, Assessments, and Guidelines for Adolescents' Educational Games.

    Science.gov (United States)

    Clark, Linda Nielsen

    1978-01-01

    Underachieving high school students participated in an English program, in which they could select games or other activities as rewards for academic or social skills mastery specified in a weekly contract. Students' game preferences and teacher guidelines on game use were identified. (SJL)

  13. European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment

    DEFF Research Database (Denmark)

    Cath, Danielle C; Hedderly, Tammy; Ludolph, Andrea G;

    2011-01-01

    members. Detailed clinical assessment guidelines of tic disorders and their comorbidities in both children and adults are presented. Screening methods that might be helpful and necessary for specialists' differential diagnosis process are suggested in order to further analyse cognitive abilities...

  14. WHEN IS THERE ENOUGH EVIDENCE TO PERFORM A NONLINEAR CANCER ASSESSMENT?

    Science.gov (United States)

    Under U.S. EPA's Proposed Guidelines for Carcinogen Risk Assessment (FR 61:179670-18011, 199996), departure from the default linear cancer assessment may be made for carcinogens for which there is sufficient evidence of a nonlinear mechanism. DCP, and agricultural fumigant that ...

  15. Comprehensive geriatric assessment basics for the cancer professional.

    Science.gov (United States)

    Extermann, Martine

    2003-01-01

    A comprehensive geriatric assessment (CGA) has been a cornerstone of geriatric practice for many years. However, oncology practitioners are still unfamiliar with it. Yet, recent research has shown an important potential to improve the daily care of older cancer patients. The purpose of this article is to review the basic nature of a CGA, its effectiveness, its applicability to cancer patients, and its cost-effectiveness. Cancer is one of the major health problems in our society. Furthermore, the incidence of cancer increases with age. Nowadays, half of the cancers occur beyond the age of 70. Given the aging of the US population, this proportion is expected to increase in the next decades. A challenge for the oncologists is that older people can have a highly variable health status. Yet little is known yet about how to best assess and integrate into decision making the various health problems patients may have. Taking their clues from the experience of geriatricians, geriatric oncologists advocate the use of a comprehensive geriatric assessment (CGA) as one of the tools to deal with this problem. It is, for example, part of the National Comprehensive Cancer Network (NCCN) guidelines for the elderly'. This article offers a primer on CGA for the reader unfamiliar with the approach in an oncologic setting. PMID:12699111

  16. Fuzzy sets applications for cancer risk assessment.

    Science.gov (United States)

    Molchanov, P A; Dudatiev, A V; Podobna, Y Y; Molchanova, O P

    2002-09-01

    The method of cancer risk assessment on the basis of the Fuzzy Set Theory is presented. The method is based on a multifactor risk assessment of cancer diseases. The individual risk of cancer disease is evaluated as the probability of disease multiplied by the value of an individual dose. An acupuncture method of cancer risk assessments was developed. The method is based on the analysis of changes of an electromagnetic field (biofield) of a person. The method allows to determine both cancer probability and probable location of the process. PMID:12298344

  17. Sustainability Monitoring and Assessment Routine: Results from pilot applications of the FAO SAFA Guidelines

    OpenAIRE

    Jawtusch, Julia; Schader, Christian; Stolze, Matthias; Baumgart, Lukas; Niggli, Urs

    2013-01-01

    There is currently no common understanding of how to measure sustainability in the food sector. To close this gap, the FAO has developed Guidelines for Sustainability Assessments of Food and Agriculture Systems (SAFA), which were published as a test version in June 2012. The Guidelines describe about 60 sustainability objectives, which are classified into 20 themes and four dimensions: Good governance, Environmental integrity, Economic resilience, Social well-being, as well as assessment proc...

  18. ASCOT guidelines revised 1996 edition. Guidelines for organizational self-assessment of safety culture and for reviews by the assessment of safety culture in organizations team

    International Nuclear Information System (INIS)

    In order to properly assess safety culture, it is necessary to consider the contribution of all organizations which have an impact on it. Therefore, while assessing the safety culture in an operating organization it is necessary to address at least its interfaces with the local regulatory agency, utility corporate headquarters and supporting organizations. These guidelines are primarily intended for use by any organization wishing to conduct a self-assessment of safety culture. They should also serve as a basis for conducting an international peer review of the organization's self-assessment carried out by an ASCOT (Assessment of Safety Culture in Organizations Team) mission

  19. Assessing resectability of lung cancer

    International Nuclear Information System (INIS)

    In order to assess the value of computed tomography (CT) of the mediastinum, upper abdomen and head in the assessment of resectability of lung cancer, the CT findings of 262 patients, of whom 198 underwent thoracotomy, were anlyzed retrospectively and the stagings obtained at CT and thoracotomy were compared. Mediastinal CT reliably predicted resectability when there was no evidence of mediastinal involvement. However, it was often impossible to determine whether tumour with apparent mediastinal infiltration on CT was resectable or not. The sole finding of lymph node enlargement did not permit differentiation of benign from malignant lymphadenopathy when the lymph node diameter as < 25 mm and the lymphadenopathy was confined to one lymph node station. Upper abdominal metastases were found in 6.1% and brain metastases in 4.6% of patients and neither the histological type nor other features of the tumour were found to be useful predictors of their presence. The large number of non-specific findings decreased the utility of abdominal CT. The appropriate strategy for the pre-operative evaluation of patients with lung cancer is discussed. (author). 29 refs.; 1 fig.; 10 tabs

  20. DEGRO practical guidelines for radiotherapy of breast cancer VI: therapy of locoregional breast cancer recurrences

    Energy Technology Data Exchange (ETDEWEB)

    Harms, Wolfgang [St. Claraspital, Abteilung fuer Radioonkologie, Basel (Switzerland); Budach, W. [Heinrich-Heine-University, Duesseldorf (Germany); Dunst, J. [University Hospital Schleswig-Holstein, Kiel (Germany); Feyer, P. [Vivantes Hospital Neukoelln, Berlin (Germany); Fietkau, R.; Sauer, R. [University Hospital Erlangen, Erlangen (Germany); Krug, D. [University Hospital Heidelberg, Heidelberg (Germany); Piroth, M.D. [Witten/Herdecke University, HELIOS-Hospital Wuppertal, Wuppertal (Germany); Sautter-Bihl, M.L. [Municipal Hospital, Karlsruhe (Germany); Sedlmayer, F. [Paracelsus Medical University Hospital, Salzburg (Austria); Wenz, F. [University of Heidelberg, University Medical Center Mannheim, Medical Faculty Mannheim, Mannheim (Germany); Haase, W.; Souchon, R.; Collaboration: Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)

    2016-04-15

    To update the practical guidelines for radiotherapy of patients with locoregional breast cancer recurrences based on the current German interdisciplinary S3 guidelines 2012. A comprehensive survey of the literature using the search phrases ''locoregional breast cancer recurrence'', ''chest wall recurrence'', ''local recurrence'', ''regional recurrence'', and ''breast cancer'' was performed, using the limits ''clinical trials'', ''randomized trials'', ''meta-analysis'', ''systematic review'', and ''guidelines''. Patients with isolated in-breast or regional breast cancer recurrences should be treated with curative intent. Mastectomy is the standard of care for patients with ipsilateral breast tumor recurrence. In a subset of patients, a second breast conservation followed by partial breast irradiation (PBI) is an appropriate alternative to mastectomy. If a second breast conservation is performed, additional irradiation should be mandatory. The largest reirradiation experience base exists for multicatheter brachytherapy; however, prospective clinical trials are needed to clearly define selection criteria, long-term local control, and toxicity. Following primary mastectomy, patients with resectable locoregional breast cancer recurrences should receive multimodality therapy including systemic therapy, surgery, and radiation +/- hyperthermia. This approach results in high local control rates and long-term survival is achieved in a subset of patients. In radiation-naive patients with unresectable locoregional recurrences, radiation therapy is mandatory. In previously irradiated patients with a high risk of a second local recurrence after surgical resection or in patients with unresectable recurrences, reirradiation should be strongly considered. Indication and dose concepts

  1. Qualitative assessment of agritourism safety guidelines: a demonstration project.

    Science.gov (United States)

    Tutor-Marcom, Robin; Greer, Annette; Clay, Maria; Ellis, Tammy; Thompson, Tami; Adam-Samura, Esther Seisay

    2013-01-01

    In 2007, the National Children's Center for Rural and Agricultural Health and Safety (NCCRAHS) published Agritourism Health and Safety Guidelines for Children to provide helpful recommendations for protecting the health and safety of children visiting agritourism farms. Supplement A: Policies and Procedures Guide and Supplement B: Worksite Guide were subsequently published in 2009 and provided agritourism farms with checklists to use in reviewing, planning, and implementing their own health and safety practices. In order to better understand what would be required of a farm wishing to implement the guidelines using Supplements A and B, the North Carolina Agromedicine Institute conducted a single-family farm demonstration project with support from the NCCRAHS. The aims of the project were to (1) determine child health and safety risks associated with an existing agritourism farm; (2) determine the cost of making improvements necessary to reduce risks; and (3) use project findings to motivate other agritourism farms, Cooperative Extension agents, and agritourism insurers to adopt or recommend Agritourism Health and Safety Guidelines for Children for their own farms or farms with which they work. At the conclusion of the study, the target farm was in compliance with an average of 86.9% of items in Supplements A and B. Furthermore, 89% of individuals self-identifying as farmers or farm workers and 100% of Cooperative Extension agents and agritourism insurers attending an end-of-project workshop indicated their intent to adopt or recommend Agritourism Health and Safety Guidelines for Children for their own farms or farms with which they work. PMID:23540301

  2. Association between the Adherence to the International Guidelines for Cancer Prevention and Mammographic Density.

    Directory of Open Access Journals (Sweden)

    Adela Castelló

    Full Text Available Mammographic density (MD is considered a strong predictor of Breast Cancer (BC. The objective of the present study is to explore the association between MD and the compliance with the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR recommendations for cancer prevention.Data of 3584 women attending screening from a population-based multicenter cross-sectional study (DDM-Spain collected from October 7, 2007 through July 14, 2008, was used to calculate a score that measures the level of compliance with the WCRF/AICR recommendations: R1Maintain adequate body weight; R2Be physically active; 3RLimit the intake of high density foods; R4Eat mostly plant foods; R5Limit the intake of animal foods; R6Limit alcohol intake; R7Limit salt and salt preserved food intake; R8Meet nutritional needs through diet. The association between the score and MD (assessed by a single radiologist using a semi-quantitative scale was evaluated using ordinal logistic models with random center-specific intercepts adjusted for the main determinants of MD. Stratified analyses by menopausal status and smoking status were also carried out.A higher compliance with the WCRF/AICR recommendations was associated with lower MD (OR1-unit increase = 0.93 95%CI:0.86;0.99. The association was stronger in postmenopausal women (OR = 0.91 95%CI:0.84;0.99 and nonsmokers (OR = 0.87;95%CI:0.80;0.96 for nonsmokers, OR = 1.01 95%CI:0.91;1.12 for smokers, P-interaction = 0.042. Among nonsmokers, maintaining adequate body weight (OR = 0.81 95%CI:0.65;1.01, practicing physical activity (OR = 0.68 95%CI:0.48;0.96 and moderating the intake of high-density foods (OR = 0.58 95%CI:0.40;0.86 and alcoholic beverages (OR = 0.76 95%CI:0.55;1.05 were the recommendations showing the strongest associations with MD.postmenopausal women and non-smokers with greater compliance with the WCRF/AICR guidelines have lower MD. These results may provide guidance to design specific

  3. Investigation into the actual application of the diagnostic and therapeutic guidelines for colon cancer

    Directory of Open Access Journals (Sweden)

    Dario Antonelli

    2011-12-01

    Full Text Available

    Background: In colon cancer, the effectiveness of the cure is largely dependent on the early detection of the pathology. It is therefore useful to investigate the quality prevention programs. As a result, the Italian Healthcare System is increasingly adopting Quality Assurance by implementing diagnostic and therapeutic guidelines.
    In this study, a comparison was made between the current pathways undertaken by patients with colon cancer and the prescribed guidelines. The analysis investigates the diagnostic pathways that lead to the discovery of colon cancer, the service center where the pathway started and the therapy regimen administered to treat the cancer.

    Methods: The analysis covers all 205,000 patients who accessed one Italian Local Health Agency during the year 2007. In order to fund the costs of the services, the local regional council requested the collection of data from the Agency itself. Starting from this raw data, a data warehouse was built, the required data extracted and, eventually, the actual pathways were created.

    Results and conclusions: Only 11.2% of colon cancer patients underwent the sequence of exams recommended by the official guidelines. 54.4% of them only partly followed the sequence of recommended exams. The remaining patients underwent exams that did not comply at all with the guidelines. Furthermore, there is evidence of a lack of prevention for some patients, particularly for those that only discovered the pathology when they arrived at the Emergency Department.

  4. ASCOT guidelines. Guidelines for organizational self-assessment of safety culture and for reviews by the Assessment of Safety Culture in Organizations Team

    International Nuclear Information System (INIS)

    These guidelines describe an approach used in conducting an Assessment of Safety Culture in Organizations Team (ASCOT) review. They are intended to assist the team members in conducting their reviews and at the same time provide guidance to hosts preparing to receive an ASCOT review. They may also be used by any organization wishing to conduct their own self-assessment of safety culture, independent of an ASCOT review

  5. DEGRO practical guidelines for radiotherapy of breast cancer I. Breast-conserving therapy

    International Nuclear Information System (INIS)

    Background: The present paper is an update of the practical guidelines for radiotherapy of breast cancer published in 2006 by the breast cancer expert panel of the German Society of Radiation Oncology (DEGRO). These recommendations have been elaborated on the basis of the S3 guidelines of the German Cancer Society that were revised in March 2007 by an interdisciplinary panel. Methods: The DEGRO expert panel performed a comprehensive survey of the literature, comprising lately published meta-analyses, data from recent randomized trials and guidelines of international breast cancer societies, referring to the criteria of evidence-based medicine. In addition to the more general statements of the German Cancer Society, this paper emphasizes specific radiotherapeutic aspects. It is focused on radiotherapy after breast-conserving surgery. Technique, targeting, and dose are described in detail. Results: Postoperative radiotherapy significantly reduces rates of local recurrence. The more pronounced the achieved reduction is, the more substantially it translates into improved survival. Four prevented local recurrences result in one avoided breast cancer death. This effect is independent of age. An additional boost provides a further absolute risk reduction for local recurrence irrespective of age. Women > 50 years have a hazard ratio of 0.59 in favor of the boost. For DCIS, local recurrence was 2.4% per patient year even in a subgroup with favorable prognostic factors leading to premature closure of the respective study due to ethical reasons. For partial-breast irradiation as a sole method of radiotherapy, results are not yet mature enough to allow definite conclusions. Conclusion: After breast-conserving surgery, whole-breast irradiation remains the gold standard of treatment. The indication for boost irradiation should no longer be restricted to women ≤ 50 years. Partial-breast irradiation is still an experimental treatment and therefore discouraged outside controlled

  6. Preliminary Guideline for the High Temperature Structure Integrity Assessment Procedure Part II. High Temperature Structural Integrity Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Han; Kim, J. B.; Lee, H. Y.; Park, C. G.; Joo, Y. S.; Koo, G. H.; Kim, S. H

    2007-02-15

    A high temperature structural integrity assessment belongs to the Part II of a whole preliminary guideline for the high temperature structure. The main contents of this guideline are the evaluation procedures of the creep-fatigue crack initiation and growth in high temperature condition, the high temperature LBB evaluation procedure, and the inelastic evaluations of the welded joints in SFR structures. The methodologies for the proper inelastic analysis of an SFR structures in high temperatures are explained and the guidelines of inelastic analysis options using ANSYS and ABAQUS are suggested. In addition, user guidelines for the developed NONSTA code are included. This guidelines need to be continuously revised to improve the applicability to the design and analysis of the SFR structures.

  7. Personalized Medicine and Oncology Practice Guidelines: A Case Study of Contemporary Biomarkers in Colorectal Cancer

    OpenAIRE

    Kelley, Robin K; Van Bebber, Stephanie L; Phillips, Kathryn A; Venook, Alan P.

    2011-01-01

    Predictive and prognostic biomarkers offer a potential means to personalize cancer medicine, although many reach the marketplace before they have been validated, and their adoption is often hindered by variable clinical evidence. Because of this variability in supporting evidence, clinical practice guidelines formulated by panels of subspecialty experts may be particularly important in guiding stakeholders’ acceptance and use of new personalized medicine biomarker tests and other nascent tech...

  8. H2S release rate assessment guidelines and audit forms

    International Nuclear Information System (INIS)

    Development of a process to evaluate and calculate potential hydrogen sulfide release has been recommended by the Canadian Association of Petroleum Producers' Drilling and Completion Committee, and the Alberta Energy and Utilities Board. To facilitate the process, CAPP has released guidelines describing a methodology and standard for the industry to calculate the potential hydrogen sulfide release rates of a well, and a standardized format for the documentation and retention of data. The Guidelines describe a four-step process, with each step having an increasing degree of complexity. Step One describes the zone hydrogen sulfide exclusion area maps, defining when reporting is to be used (based on well location and distance from inhabited areas). Step Two provides details of the recommended method for determining hydrogen sulfide release through a data search process. Step Three consists of a series of instructions in the use of geologic analogs, data editing and wellbore design to further refine the cumulative hydrogen sulfide release rate. Step Four contains information designed to assist in detailed geological and reservoir modeling. It is not necessary to use all four steps in all cases. The user, however, is advised to use sound engineering judgement and due diligence in the calculation decisions. Sample calculations are provided for a variety of different situations. Measurement techniques are described in an appendix. A completed example of an audit form is attached. 10 + 6 refs., tabs

  9. EPRG Tier 2 guidelines for the assessment of defects in transmission pipeline girth welds

    Energy Technology Data Exchange (ETDEWEB)

    Andrews, Robert Bob [BMT Flett Technolohy, Loughborough, (United Kingdom); Denys, Rudi [Labo Soete, Universiteit Gent, Gent, (Belgium); Knauf, Gerhard [Salzgitter Mannesmann Forschung, Duisburg, (Germany); Zarea, Mures [GDF SUEZ, Saint-Denis la Plaine, (France)

    2010-07-01

    The guidelines governing the development of pipeline technology need to be updated with the increasing use of automated ultrasonic inspection and higher strength pipeline. This paper described proposed revisions to Tier 2 of the European Pipeline Research Group (EPRG) weld defect guidelines. Three particular aspects were studied: the extension of the guidelines to include grade L555 (X80) material, the assessment of surface-breaking defects with height up to 5 mm and the assessment of multiple co-planar defects. Experimental studies were carried out to define the required levels of weld metal yield strength for the safe application of the guidelines. The results of 560 curved wide plate tests showed that the Tier 2 limits prevent failure at remote strain below 0.5% and require higher weld quality. Following these results, the defect interaction criteria have been made less restrictive.

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

    Directory of Open Access Journals (Sweden)

    Sushma Bhatnagar

    2015-01-01

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

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

    Science.gov (United States)

    Bhatnagar, Sushma; Gupta, Maynak

    2015-01-01

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

  12. The development of assessment and remediation guidelines for contaminated soils, a review of the science

    International Nuclear Information System (INIS)

    Soil contamination is no longer restricted to isolated incidents and locations; it is a general and contentious problem. However, the problem is complex, starting with the very definition of what level and type of contamination is unacceptable. A myriad of regulatory and de facto guidelines have emerged, and they are extremely fragmented, inconsistent and incomplete. This review attempts to summarize the historical development of assessment and remediation guidelines, to highlight the unique difficulties of the problem, and then to discuss the scientific information that exists and that is needed to improve guidelines. This is an unlimited scope for research on this subject. (author)

  13. British Association for Sexual Health and HIV: framework for guideline development and assessment.

    Science.gov (United States)

    Kingston, Margaret; Radcliffe, Keith; Cousins, Darren; Fifer, Helen; FitzGerald, Mark; Grover, Deepa; Hardman, Sarah; Higgins, Stephen; Rayment, Michael; Sullivan, Ann

    2016-03-01

    SummaryThe Clinical Effectiveness Group of the British Association for Sexual Health has updated their methodology for the production of national guidelines for the management of sexually transmitted infections and related conditions. The main changes are the adoption of the GRADE system for assessing evidence and making recommendations and the introduction of a specific Conflict of Interests policy for Clinical Effectiveness Group members and guideline authors. This new methodology has been piloted during the production of the 2015 British Association for Sexual Health & HIV guideline on the management of syphilis. PMID:26464503

  14. Genetic cancer risk assessment in practice

    International Nuclear Information System (INIS)

    The advent of genetic testing has made a dramatic impact on the management of individuals with inherited susceptibility to cancer and their relatives. Genetic counsel ing, with or without testing, is warranted when clues to familial cancer are recognized. Today, genetic testing for classic cancer genetic syndromes is now the standard of care, and has been complemented by genetic testing for other situations commonly encountered in clinical practice. Genetic testing for colorectal cancer, breast cancer, kidney cancer, thyroid cancer, melanoma, and pancreatic cancer raise important issues about the parameters for testing. Genetic cancer risk assessment can lead to measurable reductions in morbidity and mortality through strategies that rely on surveillance, chemo prevention, and risk-reducing surgery

  15. Staging of uterine cervical cancer with MRI: guidelines of the European Society of Urogenital Radiology

    Energy Technology Data Exchange (ETDEWEB)

    Balleyguier, Corinne [Radiology Department, Institut Gustave Roussy, Villejuif (France); Sala, E. [Radiology Department, Addenbrooke' s Hospital, Cambridge (United Kingdom); Cunha, T. da [Radiology Department, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisbon (Portugal); Bergman, A. [Department of Radiology, Uppsala University Hospital (Sweden); Brkljacic, B. [Department of Diagnostic and Interventional Radiology, University Hospital ' ' Dubrava' ' , Zagreb (Croatia); Danza, F. [Dipartimento di Bioimmaginie Scienze Radiologiche, Universita Cattolica del S. Cuore, Rome (Italy); Forstner, R. [Zentralroentgeninstitut, Landeskliniken Salzburg, Salzburg (Austria); Hamm, B. [Department of Radiology, Charite Humboldt Universitaet, Berlin (Germany); Kubik-Huch, R. [Institut Radiologie, Kantonsspital Baden, Baden (Switzerland); Lopez, C.; Manfredi, R. [Department of Radiology, ' ' A. Gemelli' ' University Hospital, Rome (Italy); McHugo, J. [Department of Radiology, Birmingham Women' s Hospital, Birmingham (United Kingdom); Oleaga, L. [Radiology Department, Hospital Clinic, Barcelona (Spain); Togashi, K. [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Graduate School of Medicine, Kyoto (Japan); Kinkel, K. [Institut de Radiologie, Clinique des Grangettes, Geneva (Switzerland)

    2011-05-15

    To design clear guidelines for the staging and follow-up of patients with uterine cervical cancer, and to provide the radiologist with a framework for use in multidisciplinary conferences. Methods: Guidelines for uterine cervical cancer staging and follow-up were defined by the female imaging subcommittee of the ESUR (European Society of Urogenital Radiology) based on the expert consensus of imaging protocols of 11 leading institutions and a critical review of the literature. The results indicated that high field Magnetic Resonance Imaging (MRI) should include at least two T2-weighted sequences in sagittal, axial oblique or coronal oblique orientation (short and long axis of the uterine cervix) of the pelvic content. Axial T1-weighted sequence is useful to detect suspicious pelvic and abdominal lymph nodes, and images from symphysis to the left renal vein are required. The intravenous administration of Gadolinium-chelates is optional but is often required for small lesions (<2 cm) and for follow-up after treatment. Diffusion-weighted sequences are optional but are recommended to help evaluate lymph nodes and to detect a residual lesion after chemoradiotherapy. Expert consensus and literature review lead to an optimized MRI protocol to stage uterine cervical cancer. MRI is the imaging modality of choice for preoperative staging and follow-up in patients with uterine cervical cancer. (orig.)

  16. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer

    International Nuclear Information System (INIS)

    Background and purpose: Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists. Material and methods: During ESTRO teaching courses on breast cancer, teachers sought consensus on delineation of CTV through dialogue based on cases. One teacher delineated CTV on CT scans of 2 patients, followed by discussion and adaptation of the delineation. The consensus established between teachers was sent to other teams working in the same field, both locally and on a national level, for their input. This was followed by developing a broad consensus based on discussions. Results: Borders of the CTV encompassing a 5 mm margin around the large veins, running through the regional lymph node levels were agreed, and for the breast/thoracic wall other vessels were pointed out to guide delineation, with comments on margins for patients with advanced breast cancer. Conclusion: The ESTRO consensus on CTV for elective RT of breast cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency

  17. Quality Assessment of Clinical Practice Guidelines Developed by Professional Societies in Turkey

    Science.gov (United States)

    Yaşar, Ilknur; Kahveci, Rabia; Baydar Artantaş, Aylin; Ayhan Başer, Duygu; Gökşin Cihan, Fatma; Şencan, Irfan; Koç, Esra Meltem; Özkara, Adem

    2016-01-01

    Background Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. There is a limited number of studies on guidelines in Turkey. The quality of Ministry of Health guidelines have formerly been assessed whereas there is no information on the other guidelines developed in the country. Aim This study aims to assess the quality of CPGs that are developed by professional societies that work for the health sector in Turkey, and compare the findings with international guidelines. Methodology Professional societies that work for the health sector were determined by using the data obtained from the Ministry of Internal Affairs. Inclusion and exclusion criteria were defined for selecting the CPGs. Guidelines containing recommendations about disease management to the doctors, accessible online, developed within the past 5 years, citing references for recommendations, about the diseases over 1% prevalence according to the “Statistical Yearbook of Turkey 2012” were included in the study. The quality of CPGs were assessed with the AGREE II instrument, which is an internationally recognized tool for this purpose. Four independent reviewers, who did not participate in the development of the selected guidelines and were trained in CPG appraisal, used the AGREE instrument for assessment of the selected guidelines. Findings 47 professional societies were defined which provided access to CPGs in their websites; 3 of them were only open to members so these could not be reached. 8 CPGs from 7 societies were selected from a total of 401 CPGs from 44 societies. The mean scores of the domains of the guidelines which were assessed by the AGREE II tool were; Scope and purpose: 64%, stakeholder involvement: 37.9%, rigour of development: 35.3%, clarity and presentation: 77.9%, applicability: 49.0% and editorial independence: 46.0%. Conclusion This is the first

  18. Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3)

    International Nuclear Information System (INIS)

    The procedure guideline for radioiodine therapy (RIT) of differentiated thyroid cancer (version 3) is the counterpart to the procedure guideline for 131I whole-body scintigraphy (version 3) and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Recommendation for ablative 131I therapy is given for all differentiated thyroid carcinoma (DTC) >1 cm. Regarding DTC ≤1 cm 131I ablation may be helpful in an individual constellation. Preparation for 131I ablation requires low iodine diet for two weeks and TSH stimulation by withdrawal of thyroid hormone medication or by use of recombinant human TSH (rhTSH). The advantages of rhTSH (no symptoms of hypothyroidism, lowerblood activity) and the advantages of endogenous TSH stimulation (necessary for 131I-therapy in patients with metastases, higher sensitivity of 131I whole-body scan) are discussed. In most centers standard activities are used for 131I ablation. If pretherapeutic dosimetry is planned, the diagnostic administration of 131I should not exceed 1-10MBq, alternative tracers are 123I or 124I. The recommendations for contraception and family planning are harmonized with the recommendation of ATA and ETA. Regarding the best possible protection of salivary glands the evidence is insufficient to recommend a specific setting. To minimize the risk of dental caries due to xerostomia patients should use preventive strategies for dental hygiene. (orig.)

  19. The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer

    International Nuclear Information System (INIS)

    The accurate harvesting of a sentinel node in breast cancer includes a sequence of procedures with components from different medical specialities, including nuclear medicine, radiology, surgical oncology and pathology. The aim of this document is to provide general information about sentinel lymph node detection in breast cancer patients. The Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the European Association of Nuclear Medicine (EANM) have written and approved these guidelines to promote the use of nuclear medicine procedures with high quality. The final result has been discussed by distinguished experts from the EANM Oncology Committee, the SNMMI and the European Society of Surgical Oncology (ESSO). The present guidelines for nuclear medicine practitioners offer assistance in optimizing the diagnostic information from the SLN procedure. These guidelines describe protocols currently used routinely, but do not include all existing procedures. They should therefore not be taken as exclusive of other nuclear medicine modalities that can be used to obtain comparable results. It is important to remember that the resources and facilities available for patient care may vary. (orig.)

  20. Guidelines and procedures for the International Code Assessment and Applications Program

    International Nuclear Information System (INIS)

    This document presents the guidelines and procedures by which the International Code Assessment and Applications Program (ICAP) will be conducted. The document summarizes the management structure of the program and the relationships between and responsibilities of the United States Nuclear Regulatory Commission (USNRC) and the international participants. The procedures for code maintenance and necessary documentation are described. Guidelines for the performance and documentation of code assessment studies are presented. An overview of an effort to quantify code uncertainty, which the ICAP supports, is included

  1. Guidelines for a national epidemiological surveillance system of thyroid cancer in France

    International Nuclear Information System (INIS)

    At the request of the French Department of Health, a multidisciplinary Thyroid Cancer Committee, coordinated by the French Public Health Agency analysed the observed increase of thyroid cancer incidence in France and outlined the limits of the present case registration system. This Committee set up guidelines to improve the national surveillance system of thyroid cancer. The Committee analysed 4 models for the incidence survey, 3 of which have been excluded: a poor cost-benefit ratio precludes the constitution of a national registry dedicated to thyroid cancer; however, the Committee has recommended this model that still exists for thyroid cancer of the youth(under 19 years old), a national system base exclusively on pathological data would only be relevant after significant improvement of data collection, obligatory of all cases of thyroid cancer is inappropriate considering the fit prognosis of this cancer. A two level system is proposed with continuous registration of incident caes through the National Hospital Discharge survey, specific focused analysis of clinical and pathological data in case of a cluster alert in any given area. Whatever the system, it seems necessary to in general: propose a unique health registration number per patient, improve access to medical data, organize a national standardised collection of pathological findings, follow up the diagnosis practices related to thyroid cancer that have an impact on incidence rates. In conclusion, a reliable incidence survey and a follow up of diagnostic practices and of risk factors may provide a relevant model of epidemiological survey of thyroid cancers in France but such a system requires a long lasting strategic and financial involvement. (author)

  2. DEGRO practical guidelines. Radiotherapy of breast cancer I. Radiotherapy following breast conserving therapy for invasive breast cancer

    International Nuclear Information System (INIS)

    Background and purpose: The aim of the present paper is to update the practical guidelines for postoperative adjuvant radiotherapy of breast cancer published in 2007 by the breast cancer expert panel of the German Society for Radiooncology (Deutsche Gesellschaft fuer Radioonkologie, DEGRO). The present recommendations are based on a revision of the German interdisciplinary S-3 guidelines published in July 2012. Methods: A comprehensive survey of the literature concerning radiotherapy following breast conserving therapy (BCT) was performed using the search terms 'breast cancer', 'radiotherapy', and 'breast conserving therapy'. Data from lately published meta-analyses, recent randomized trials, and guidelines of international breast cancer societies, yielding new aspects compared to 2007, provided the basis for defining recommendations according to the criteria of evidence-based medicine. In addition to the more general statements of the DKG (Deutsche Krebsgesellschaft), this paper addresses indications, target definition, dosage, and technique of radiotherapy of the breast after conservative surgery for invasive breast cancer. Results: Among numerous reports on the effect of radiotherapy during BCT published since the last recommendations, the recent EBCTCG report builds the largest meta-analysis so far available. In a 15 year follow-up on 10,801 patients, whole breast irradiation (WBI) halves the average annual rate of disease recurrence (RR 0.52, 0.48-0.56) and reduces the annual breast cancer death rate by about one sixth (RR 0.82, 0.75-0.90), with a similar proportional, but different absolute benefit in prognostic subgroups (EBCTCG 2011). Furthermore, there is growing evidence that risk-adapted dose augmentation strategies to the tumor bed as well as the implementation of high precision RT techniques (e.g., intraoperative radiotherapy) contribute substantially to a further reduction of local relapse rates. A main focus of ongoing research lies in partial breast

  3. DEGRO practical guidelines. Radiotherapy of breast cancer I. Radiotherapy following breast conserving therapy for invasive breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sedlmayer, F. [Paracelsus Medical Univ. Hospital, Salzburg (Austria). Dept. of Radiotherapy and Radiation Oncology; Sautter-Bihl, M.L. [Staedtisches Klinium Karlsruhe (Germany). Klinik fuer Radioonkologie und Strahlentherapie; Budach, W. [University Hospital Duesseldorf (Germany)] [and others

    2013-10-15

    Background and purpose: The aim of the present paper is to update the practical guidelines for postoperative adjuvant radiotherapy of breast cancer published in 2007 by the breast cancer expert panel of the German Society for Radiooncology (Deutsche Gesellschaft fuer Radioonkologie, DEGRO). The present recommendations are based on a revision of the German interdisciplinary S-3 guidelines published in July 2012. Methods: A comprehensive survey of the literature concerning radiotherapy following breast conserving therapy (BCT) was performed using the search terms 'breast cancer', 'radiotherapy', and 'breast conserving therapy'. Data from lately published meta-analyses, recent randomized trials, and guidelines of international breast cancer societies, yielding new aspects compared to 2007, provided the basis for defining recommendations according to the criteria of evidence-based medicine. In addition to the more general statements of the DKG (Deutsche Krebsgesellschaft), this paper addresses indications, target definition, dosage, and technique of radiotherapy of the breast after conservative surgery for invasive breast cancer. Results: Among numerous reports on the effect of radiotherapy during BCT published since the last recommendations, the recent EBCTCG report builds the largest meta-analysis so far available. In a 15 year follow-up on 10,801 patients, whole breast irradiation (WBI) halves the average annual rate of disease recurrence (RR 0.52, 0.48-0.56) and reduces the annual breast cancer death rate by about one sixth (RR 0.82, 0.75-0.90), with a similar proportional, but different absolute benefit in prognostic subgroups (EBCTCG 2011). Furthermore, there is growing evidence that risk-adapted dose augmentation strategies to the tumor bed as well as the implementation of high precision RT techniques (e.g., intraoperative radiotherapy) contribute substantially to a further reduction of local relapse rates. A main focus of ongoing

  4. PROSPER guidelines: Guidelines for peer review and for plant self-assessment of operational experience feedback process

    International Nuclear Information System (INIS)

    Effective use of operational performance information is an important element in any plant operator's arrangements for enhancing the operational safety of a nuclear power plant (NPP). This has been recognized in the IAEA Safety Fundamental, The Safety of Nuclear Installations (Safety Series No. 110). Under the technical aspects of safety, one of the principles of operation and maintenance is that the operating organization and the regulatory body shall establish complementary programmes to analyse operating experience to ensure that lessons are learned and acted upon. Such experience shall be shared with relevant national and international bodies. The Convention on Nuclear Safety, which entered into force in July 1996, also recognized the importance of operational experience feedback as a tool of high importance for the safety of nuclear plant operation and its further enhancement. It follows that the arrangements and results achieved under the operation experience feedback process in Member States will be covered by the national report under the Convention and will be subject to periodical review. These principles are further expanded in the IAEA Safety Standards Safety of Nuclear Power Plants: Operation (Safety Standard Series No. NS-R-2, year 2000) under the Feedback of The IAEA-led Peer Review of the effectiveness of the Operational Safety Performance Experience Review process (PROSPER) and associated guidelines have been developed to provide advice and assistance to utilities or individual power plants to strengthen and enhance the effectiveness of operational experience programmes in achieving these fundamental objectives. The objectives of the former IAEA Assessment of Significant Safety Events Team (ASSET) service have been expanded to include an evaluation of the effective use of all operating performance information available to the plant (e.g. external operating experience, internal low-level and near miss event reports and other relevant operating

  5. EPa`s program for risk assessment guidelines: Exposure issues

    Energy Technology Data Exchange (ETDEWEB)

    Callahan, M.A. [Environmental Protection Agency, Washington, DC (United States)

    1990-12-31

    Three major issues to be dealt with over the next ten years in the exposure assessment field are: consistency in terminology, the impact of computer technology on the choice of data and modeling, and conceptual issues such as the use of time-weighted averages.

  6. ARN Training Course on Advance Methods for Internal Dose Assessment: Application of Ideas Guidelines

    International Nuclear Information System (INIS)

    Dose assessment in case of internal exposure involves the estimation of committed effective dose based on the interpretation of bioassay measurement, and the assumptions of hypotheses on the characteristics of the radioactive material and the time pattern and the pathway of intake. The IDEAS Guidelines provide a method to harmonize dose evaluations using criteria and flow chart procedures to be followed step by step. The EURADOS Working Group 7 'Internal Dosimetry', in collaboration with IAEA and Czech Technical University (CTU) in Prague, promoted the 'EURADOS/IAEA Regional Training Course on Advanced Methods for Internal Dose Assessment: Application of IDEAS Guidelines' to broaden and encourage the use of IDEAS Guidelines, which took place in Prague (Czech Republic) from 2-6 February 2009. The ARN identified the relevance of this training and asked for a place for participating on this activity. After that, the first training course in Argentina took place from 24-28 August for training local internal dosimetry experts. (authors)

  7. Baltic Climate Vulnerability Assessment Framework : Introduction and Guidelines

    OpenAIRE

    Hjerpe, Mattias; Wilk, Julie

    2010-01-01

    This Vulnerability Assessment Framework was put together within the project Baltic Challenges and Chances for local and regional development generated by Climate Change financed by the European Regional Development Fund and the Baltic Sea Region Programme 2007-2013. The purpose of the framework is to guide and assist the Target Areas (TA) within the project in mapping and analysing the challenges and chances created by climate change. The Vulnerability exercises have originally been developed...

  8. Portfolio Assessment in High School Chemsitry: One Teacher's Guidelines

    Science.gov (United States)

    Phelps, Amy J.; Laporte, Mark M.; Mahood, Aileen

    1997-05-01

    It is standard practice in many chemistry classes to accept a correct numerical calculation as evidence of understanding. This happens for a variety of reasons like efficiency of grading and the presumption that evaluation done in this way is truly objective. As teachers of chemistry become more concerned with helping students develop better conceptual understandings and process skills, in addition to the development of algorithmic skills, this type of one dimensional testing is becoming increasingly less appropriate as the sole form of assessment. This paper describes the implementation of portfolio assessment in high school chemistry classrooms by one teacher in an effort to hold students accountable for more than factual recall and to involve students with an opportunity to reflect on their work throughout the year and to tell the story of their experience in high school chemistry through presentation of their best work. The portfolio was not the only assessment used in the classroom, but was a culminating experience for the students and the teacher. Early in the year the teacher established three main categories which were sub-divided into nine distinct portfolio elements. Students had to include five of the nine elements in their final portfolio project. The nine elements by category were: Category I: solve a problem, design an experiment, analyze a result, group effort in problem solving; Category II: Identify a misconception, evolution of a concept, shows growth or improvement; and Category III: defend a position and critique a current event. The portfolio elements were due at specific times throughout the second semester and there was a review process established so the students could refine their assignments. Completing the portfolio allowed students to develop a better understanding of the topics involved in the five portfolio elements through the revision process and it provided the students with the opportunity to think about what they had learned in

  9. General guidelines for the assessment of internal dose from monitoring data: Progress of the IDEAS project

    International Nuclear Information System (INIS)

    In recent major international intercomparison exercises on intake and internal dose assessments from monitoring data, the results calculated by different participants varied significantly. Based on this experience the need for harmonisation of the procedures has been formulated within an EU 5. Framework Programme research project. The aim of the project, IDEAS, is to develop general guidelines for standardising assessments of intakes and internal doses. The IDEAS project started in October 2001 and ended in June 2005. The project is closely related to some goals of the work of Committee 2 of the ICRP and since 2003 there has been close cooperation between the two groups. To ensure that the guidelines are applicable to a wide range of practical situations, the first step was to compile a database of well-documented cases of internal contamination. In parallel, an improved version of an existing software package was developed and distributed to the partners for further use. A large number of cases from the database was evaluated independently by the partners and the results reviewed. Based on these evaluations, guidelines were drafted and discussed with dosimetry professionals from around the world by means of a virtual workshop on the Internet early in 2004. The guidelines have been revised and refined on the basis of the experiences and discussions in this virtual workshop. The general philosophy of the Guidelines is presented here, focusing on the principles of harmonisation, optimisation and proportionality. Finally, the proposed Levels of Task to structure the approach of internal dose evaluation are reported. (authors)

  10. 77 FR 45329 - Availability of Microbial Risk Assessment Guideline: Pathogenic Microorganisms With Focus on Food...

    Science.gov (United States)

    2012-07-31

    ... Listserv, a free electronic mail subscription service for industry, trade groups, consumer interest groups... Food Safety and Inspection Service Availability of Microbial Risk Assessment Guideline: Pathogenic Microorganisms With Focus on Food and in Water AGENCY: Food Safety and Inspection Service, USDA. ACTION:...

  11. Best Practices for Mental Health in Child Welfare: Screening, Assessment, and Treatment Guidelines

    Science.gov (United States)

    Romanelli, Lisa Hunter; Landsverk, John; Levitt, Jessica Mass; Leslie, Laurel K.; Hurley, Maia M.; Bellonci, Christopher; Gries, Leonard T.; Pecora, Peter J.; Jensen, Peter S.

    2009-01-01

    The Best Practices for Mental Health in Child Welfare Consensus Conference focused on developing guidelines in five key areas (screening and assessment, psychosocial interventions, psychopharmacologic treatment, parent engagement, and youth empowerment) related to children's mental health. This paper provides an overview of issues related to the…

  12. Guidelines for Assessing the Need for Adaptive Devices for Visually Impaired Pedestrians at Signalized Intersections.

    Science.gov (United States)

    Gallagher, Brian R.; de Oca, Patricia Montes

    1998-01-01

    Presents guidelines for orientation and mobility instructors and traffic engineers to assess the need for adaptive devices to make crosswalks at signalized intersections accessible to pedestrians with visual impairments. The discussions of audible and tactile pedestrian devices, along with case examples, distinguish when each device should be…

  13. 76 FR 67439 - External Peer Review Meeting for Draft Microbial Risk Assessment Guideline: Pathogenic...

    Science.gov (United States)

    2011-11-01

    ... AGENCY External Peer Review Meeting for Draft Microbial Risk Assessment Guideline: Pathogenic... guidance for a 60 day comment period (76 FR 44586-44587). The public comment period ended on September 26... attend this peer review meeting as observers. Time will be set aside at the meeting for observers to...

  14. Clinical assessment of chest pain and guidelines for imaging

    Energy Technology Data Exchange (ETDEWEB)

    Gruettner, J., E-mail: joachim.gruettner@umm.de [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Henzler, T. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Sueselbeck, T. [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Fink, C. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Borggrefe, M.; Walter, T. [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany)

    2012-12-15

    For many emergency facilities, risk assessment of patients with diffuse chest pain still poses a major challenge. In their currently valid recommendations, the international cardiological societies have defined a standardized assessment of the prognostically relevant cardiac risk criteria. Here the classic sequence of basic cardiac diagnostics including case history (cardiac risk factors), physical examination (haemodynamic and respiratory vital parameters), ECG (ST segment analysis) and laboratory risk markers (troponin levels) is paramount. The focus is, on the one hand, on timely indication for percutaneous catheterization, especially in patients at high cardiac risk with or without ST-segment elevation in the ECG, and, on the other hand, on the possibility of safely discharging patients with intermediate or low cardiac risk after non-invasive exclusion of a coronary syndrome. For patients in the intermediate or low risk group, physical or pharmacological stress testing in combination with scintigraphy, echocardiography or magnetic resonance imaging is recommended in addition to basic diagnostics. Moreover, the importance of non-invasive coronary imaging, primarily cardiac CT angiography (CCTA), is increasing. Current data show that in intermediate or low risk patients this method is suitable to reliably rule out coronary heart disease. In addition, attention is paid to the major differential diagnoses of acute coronary syndrome, particularly pulmonary embolism and aortic dissection. Here the diagnostic method of choice is thoracic CT, possibly also in combination with CCTA aiming at a triple rule-out.

  15. Clinical assessment of chest pain and guidelines for imaging

    International Nuclear Information System (INIS)

    For many emergency facilities, risk assessment of patients with diffuse chest pain still poses a major challenge. In their currently valid recommendations, the international cardiological societies have defined a standardized assessment of the prognostically relevant cardiac risk criteria. Here the classic sequence of basic cardiac diagnostics including case history (cardiac risk factors), physical examination (haemodynamic and respiratory vital parameters), ECG (ST segment analysis) and laboratory risk markers (troponin levels) is paramount. The focus is, on the one hand, on timely indication for percutaneous catheterization, especially in patients at high cardiac risk with or without ST-segment elevation in the ECG, and, on the other hand, on the possibility of safely discharging patients with intermediate or low cardiac risk after non-invasive exclusion of a coronary syndrome. For patients in the intermediate or low risk group, physical or pharmacological stress testing in combination with scintigraphy, echocardiography or magnetic resonance imaging is recommended in addition to basic diagnostics. Moreover, the importance of non-invasive coronary imaging, primarily cardiac CT angiography (CCTA), is increasing. Current data show that in intermediate or low risk patients this method is suitable to reliably rule out coronary heart disease. In addition, attention is paid to the major differential diagnoses of acute coronary syndrome, particularly pulmonary embolism and aortic dissection. Here the diagnostic method of choice is thoracic CT, possibly also in combination with CCTA aiming at a triple rule-out.

  16. Adherence to Cancer Screening Guidelines and Predictors of Improvement Among Participants in the Kansas State Employee Wellness Program

    OpenAIRE

    Siu-kuen Azor Hui, PhD, MSPH; Kimberly K. Engelman, PhD; Theresa I. Shireman, PhD, RPh; Edward F. Ellerbeck, MD, MPH

    2013-01-01

    Introduction Employee wellness programs (EWPs) have been used to implement worksite-based cancer prevention and control interventions. However, little is known about whether these programs result in improved adherence to cancer screening guidelines or how participants’ characteristics affect subsequent screening. This study was conducted to describe cancer screening behaviors among participants in a state EWP and identify factors associated with screening adherence among those who were initia...

  17. Portfolio assessment and evaluation: Implications and guidelines for clinical nursing education

    Directory of Open Access Journals (Sweden)

    M.M. Chabeli

    2002-09-01

    Full Text Available With the advent of Outcomes-Based Education in South Africa, the quality of nursing education is debatable, especially with regard to the assessment and evaluation of clinical nursing education, which is complex and renders the validity and reliability of the methods used questionable. This paper seeks to explore and describe the use of portfolio assessment and evaluation, its implications and guidelines for its effective use in nursing education. Firstly, the concepts of assessment, evaluation, portfolio and alternative methods of evaluation are defined. Secondly, a comparison of the characteristics of the old (traditional methods and the new alternative methods of evaluation is made. Thirdly, through deductive analysis, synthesis and inference, implications and guidelines for the effective use of portfolio assessment and evaluation are described.

  18. Optimal Pain Assessment in Pediatric Rehabilitation: Implementation of a Nursing Guideline.

    Science.gov (United States)

    Kingsnorth, Shauna; Joachimides, Nick; Krog, Kim; Davies, Barbara; Higuchi, Kathryn Smith

    2015-12-01

    In Ontario, Canada, the Registered Nurses' Association promotes a Best Practice Spotlight Organization initiative to enhance evidence-based practice. Qualifying organizations are required to implement strategies, evaluate outcomes, and sustain practices aligned with nursing clinical practice guidelines. This study reports on the development and evaluation of a multifaceted implementation strategy to support adoption of a nursing clinical practice guideline on the assessment and management of acute pain in a pediatric rehabilitation and complex continuing care hospital. Multiple approaches were employed to influence behavior, attitudes, and awareness around optimal pain practice (e.g., instructional resources, electronic reminders, audits, and feedback). Four measures were introduced to assess pain in communicating and noncommunicating children as part of a campaign to treat pain as the fifth vital sign. A prospective repeated measures design examined survey and audit data to assess practice aligned with the guideline. The Knowledge and Attitudes Survey (KNAS) was adapted to ensure relevance to the local practice setting and was assessed before and after nurses' participation in three education modules. Audit data included client demographics and pain scores assessed annually over a 3-year window. A final sample of 69 nurses (78% response rate) provided pre-/post-survey data. A total of 108 pediatric surgical clients (younger than 19 years) contributed audit data across the three collection cycles. Significant improvements in nurses' knowledge, attitudes, and behaviors related to optimal pain care for children with disabilities were noted following adoption of the pain clinical practice guideline. Targeted guideline implementation strategies are central to supporting optimal pain practice. PMID:26395294

  19. Toxicity guidelines for waste assessment of nuclear power scenarios

    International Nuclear Information System (INIS)

    Under the provisions of the 1991 French radioactive waste management law, various fuel cycle scenarios will be assessed and compared in terms of feasibility, flexibility, cost, and ultimate waste radio-toxic inventory. The latter criterion may be further broken down into 'potential radio-toxic inventory' (the radio-toxic inventory of all the radionuclides produced) and 'residual radio-toxic inventory' (the radionuclide fraction reaching the biosphere alter migration from the repository). The innovative scientific contribution of this study is to consider a third type of radio-toxic inventory: the potential radio-toxic inventory alter conditioning, i.e. taking into account the containment capacity of the radionuclide conditioning matrices. The matrix fraction subjected to alteration over time determines the potential for radionuclide release, hence the notion of the potential radio-toxic inventory alter conditioning. An initial comparison of possible scenarios is proposed by considering orders of magnitude for the radionuclide containment capacity of the disposal matrices and for their mobilization potential. All the scenarios investigated are normalized to the same annual electric power production so that a legitimate comparison can be established for the ultimate wasteform produced per year of operation. This approach reveals significant differences among the scenarios considered that do not appear when only the raw potential radio-toxic inventory is taken into account. The matrix containment performance has a decisive effect on the final impact of a given scenario or type of scenario. Pu recycling scenarios thus reduce the potential radio-toxicity by roughly a factor of 50 compared with an open cycle; the gain rises to a factor of about 300 for scenarios in which Pu and the minor actinides are recycled. Interestingly, the results obtained by the use of a dedicated containment matrix for the minor actinides in a scenario limited to Pu recycling were comparable to

  20. Bothrops lanceolatus bites: guidelines for severity assessment and emergent management.

    Science.gov (United States)

    Resiere, Dabor; Mégarbane, Bruno; Valentino, Ruddy; Mehdaoui, Hossein; Thomas, Laurent

    2010-01-01

    Approximately 20-30 declared snakebite cases occurin Martinique each year. Bothrops lanceolatus, a member of the Crotalidae family, is considered to be the only involved snake. B. lanceolatus, commonly named "Fer-de-Lance", is endemic and only found on this Caribbean island. Envenomation local features include the presence of fang marks, swelling, pain, bleeding from punctures, and ecchymosis. Severe envenomation is associated with multiple systemic thromboses appearing within 48 h of the bite and resulting in cerebral, myocardial or pulmonary infarctions. Diagnosis requires first of all identification of the snake. Coagulation tests are helpful to identify thrombocytopenia or disseminated intravascular coagulation. A clinical score based on 4 grades is helpful to assess envonimation severity. A specific monovalent equine anti-venom (Bothrofav(®), Sanofi-Pasteur, France) to neutralize B. lanceolatus venom is available. Its early administration within 6h from the biting in case of progressive local injures, general signs or coagulation disturbances is effective to prevent severe thrombosis and coagulopathy. Its tolerance is considered to be good. Despite an increasing incidence of bites, no deaths have been recently attributed to B. lanceolatus in Martinique, probably due to the currently recommended strategy of early antivenom administration when required. PMID:22069552

  1. Assessment of EPRI water chemistry guidelines for new nuclear power plants

    International Nuclear Information System (INIS)

    Water chemistry control technologies for nuclear power plants have been significantly enhanced over the past few decades to improve material and equipment reliability and fuel performance, and to minimize radionuclide production and transport. Chemistry Guidelines have been developed by the Electric Power Research Institute (EPRI) for current operating plants and have been intermittently revised over the past twenty-five years for the protection of systems and components and for radiation management. As new plants are being designed for improved safety and increased power production, it is important to ensure that the designs consider implementation of industry approved water chemistry controls. In parallel, the industry will need to consider and develop updated water chemistry guidelines as well as plant startup and operational strategies based on the advanced plant designs. In 2010, EPRI began to assess chemistry control strategies at advanced plants, based on the Design Control Documents (DCDs), Combined Construction and Operating License Applications (COLA), and operating experiences (where they exist) against current Water Chemistry Guidelines. Based on this assessment, differences between planned chemistry operations at new plants and the current Guidelines will be identified. This assessment will form the basis of future activities to address these differences. The project will also assess and provide, as feasible, water chemistry guidance for startup and hot functional testing of the new plants. EPRI will initially assess the GE-Hitachi/Toshiba ABWR and the Westinghouse AP1000 designs. EPRI subsequently plans to assess other plant designs such as the AREVA U.S. EPR, Mitsubishi Heavy Industries (MHI) U.S. APWR, and GE-Hitachi (GE-H) ESBWR. This paper discusses the 2010 assessments of the ABWR and AP1000. (author)

  2. Are we following the guidelines on non-muscle invasive bladder cancer?

    Science.gov (United States)

    Reis, Leonardo Oliveira; Moro, Juliano Cesar; Ribeiro, Luis Fernando Bastos; Voris, Brunno Raphael Iamashita; Sadi, Marcos Vinicius

    2016-01-01

    ABSTRACT Objectives To evaluate the clinical practice of non-muscle invasive bladder cancer (NMIBC) treatment in Brazil in relation to international guidelines: Sociedade Brasileira de Urologia (SBU), European Association of Urology (EAU) and American Urological Association (AUA). Materials and Methods Cross-sectional study using questionnaires about urological practice on treatment of NMIBC during the 32nd Brazilian Congress of Urology. A total of 650 question forms were answered. Results There were 73% of complete answers (total of 476 question forms). In total, 246 urologists (51.68%) lived in the southeast region and 310 (65.13%) treat 1 to 3 cases of NMIBC per month. Low risk cancer: Only 35 urologists (7.5%) apply the single intravesical dose of immediate chemotherapy with Mitomicin C recommended by the above guidelines. Adjuvant therapy with BCG 2 to 4 weeks after TUR is used by 167 participants (35.1%) and 271 urologists (56.9%) use only TUR. High risk tumors: 397 urologists (83.4%) use adjuvant therapy, 375 (78.8%) use BCG 2 to 4 weeks after TUR, of which 306 (64.3%) referred the use for at least one year. Intravesical chemotherapy with Mitomicin C (a controversial recommendation) was used by 22 urologists (4.6%). BCG dose raised a lot of discrepancies. Induction doses of 40, 80 and 120mg were referred by 105 (22%), 193 (40.4%) and 54 (11.3%) respectively. Maintenance doses of 40, 80 and 120mg were referred by 190 (48.7%), 144 (37.0%) and 32 (8.2%) urologists, respectively. Schemes of administration were also varied and the one cited by SWOG protocol was the most used: 142 (29.8%). Conclusion SBU, EAU and AUA guidelines are partially respected by Brazilian urologists, particularly in low risk tumors. In high risk tumors, concordance rates are comparable to international data. Further studies are necessary to fully understand the reasons of such disagreement. PMID:27136464

  3. Community cancer programs as strategic alliances: challenges and guidelines for action.

    OpenAIRE

    Kaluzny, A D

    1991-01-01

    This paper assesses the utility of strategic alliances as a way of expanding and improving the quality of cancer care provided in communities with limited access to major treatment centres. Alliances provide an organizational model for future community-based cancer programs by accommodating a growing need for interdependence among organizations and providers while permitting substantial independence and autonomy. Five managerial challenges to ensuring effective and efficient delivery of cance...

  4. Application of epidemiologic studies of radiation-induced breast cancer to mammographic screening guidelines

    International Nuclear Information System (INIS)

    The question of benefit/risk ratio for the mammographic screening of asymptomatic women has been under intense scrutiny for several years. The studies of radiogenic breast cancer show good agreement in the quantitative estimation of the magnitude of radiation risks, in spite of the variations among the several studies in radiation quality factors, exposure fractionation, and the background population rate of breast cancer. There is a report indicating no evidence for the synergism between radiation and benign breast disease, late menopause, or the family history of breast cancer. According to the report, the radiogenic breast cancer risk is 3-fold higher in nulliparous women as compared with parous women. The analyses of lifetime risks and benefits suggest that the choice of an additive vs. multiplicative risk model is not crucial. The benefit/risk ratio shows strong age dependence which agrees well with the current U.S. guidelines, namely that the routine mammographic screening of the general population of asymptomatic women is recommended only after age of 50. (Yamashita, S.)

  5. Guideline for assessing the performance of electric power systems in natural hazard and human threat events

    Science.gov (United States)

    Savage, W.U.; Nishenko, S.P.; Honegger, D.G.; Kempner, L., Jr.

    2006-01-01

    Electric power utilities are familiar with and skilled in preparing for and responding to almost-routine natural hazard events such as strong wind and ice storms and seasonal floods, as well as intentional human acts such as vandalism. Recent extreme weather (hurricanes Katrina and Rita), extremely destructive international earthquakes (in Sumatra and Pakistan), and nation-wide concerns regarding future terrorist attacks have increased the pressure on utilities to take appropriate steps to avoid being overwhelmed by such infrequent and exceedingly severe events. Determining what constitutes the appropriate steps to take requires various levels of understanding of the specific hazards and the risks faced by the utility. The American Lifelines Alliance (www. americanlifelinesalliance.org) has prepared a Guideline that provides clear, concise, and nationally-applicable guidance on determining the scope and level of effort necessary to assess power system performance in the wide range of natural hazard or human threat events. Included in this Guideline are specific procedures to follow and information to consider in performing standardized assessments. With the results of such assessments, utility owners can effectively establish and carry out risk management programs that will lead to achieving appropriate levels of performance in future events. The Guideline incorporates an inquiry-driven process with a two-phase performance assessment that can be applied to power systems of any size. The screening phase enables systems or components that are clearly not at risk to be screened out early. The subsequent analysis phase uses results from the screening phase to prioritize and allocate resources for more detailed assessments of hazard, vulnerability, and system performance. This process helps assure that the scope of the assessment meets the specific performance objectives of the inquiry. A case history is presented to illustrate the type of experience with an inquiry

  6. DEGRO practical guidelines: radiotherapy of breast cancer III - radiotherapy of the lymphatic pathways

    Energy Technology Data Exchange (ETDEWEB)

    Sautter-Bihl, M.L. [Staedtisches Klinikum Karlsruhe, Klinik fuer Radioonkologie und Strahlentherapie, Karlsruhe (Germany); Sedlmayer, F.; Fussl, C. [LKH Salzburg, Paracelsus Medical University Hospital, Department of Radiotherapy and Radiation Oncology, Salzburg (Austria); Budach, W. [University Hospital Duesseldorf, Duesseldorf (Germany); Dunst, J. [University Hospital Schleswig-Holstein, Luebeck (Germany); Feyer, P. [Klinikum Neukoelln, Berlin (Germany); Fietkau, R.; Sauer, R. [University Hospital Erlangen, Erlangen (Germany); Harms, W. [St. Clara Hospital, Basel, Basel (Switzerland); Piroth, M.D. [Helios-Klinikum Wuppertal, Klinik fuer Strahlentherapie und Radioonkologie, Wuppertal (Germany); Souchon, R. [University Hospital Tuebingen, Tuebingen (Germany); Wenz, F. [University Hospital Mannheim, Mannheim (Germany); Haase, W.

    2014-04-15

    The purpose of this work is to update the practical guidelines for adjuvant radiotherapy of the regional lymphatics of breast cancer published in 2008 by the breast cancer expert panel of the German Society of Radiation Oncology (DEGRO). A comprehensive survey of the literature concerning regional nodal irradiation (RNI) was performed using the following search terms: ''breast cancer'', ''radiotherapy'', ''regional node irradiation''. Recent randomized trials were analyzed for outcome as well as for differences in target definition. Field arrangements in the different studies were reproduced and superimposed on CT slices with individually contoured node areas. Moreover, data from recently published meta-analyses and guidelines of international breast cancer societies, yielding new aspects compared to 2008, provided the basis for defining recommendations according to the criteria of evidence-based medicine. In addition to the more general statements of the German interdisciplinary S3 guidelines updated in 2012, this paper addresses indications, targeting, and techniques of radiotherapy of the lymphatic pathways after surgery for breast cancer. International guidelines reveal substantial differences regarding indications for RNI. Patients with 1-3 positive nodes seem to profit from RNI compared to whole breast (WBI) or chest wall irradiation alone, both with regard to locoregional control and disease-free survival. Irradiation of the regional lymphatics including axillary, supraclavicular, and internal mammary nodes provided a small but significant survival benefit in recent randomized trials and one meta-analysis. Lymph node irradiation yields comparable tumor control in comparison to axillary lymph node dissection (ALND), while reducing the rate of lymph edema. Data concerning the impact of 1-2 macroscopically affected sentinel node (SN) or microscopic metastases on prognosis are conflicting. Recent data

  7. Assessment of external costs for transport project evaluation: Guidelines in some European countries

    Energy Technology Data Exchange (ETDEWEB)

    Petruccelli, Umberto, E-mail: umberto.petruccelli@unibas.it

    2015-09-15

    Many studies about the external costs generated by the transport system have been developed in the last twenty years. To standardize methodologies and assessment procedures to be used in the evaluation of the projects, some European countries recently have adopted specific guidelines that differ from each other in some aspects even sensibly. This paper presents a critical analysis of the British, Italian and German guidelines and is aimed at cataloguing the external cost types regarded and the assessment methods indicated as well as to highlight the differences of the results, in terms of applicability and reliability. The goal is to contribute to a European standardization process that would lead to the drafting of guidelines suited for all EU countries. - Highlights: • The analyzed guidelines agree on the methods to evaluate costs from air pollution, greenhouse gases and accidents. • They recommend respectively: dose-resp. approach; costs to reduce/permit emissions; whole direct, indirect and social costs. • For noise, DE guide indicates defensive expenditure or SP methods; IT guide, SP method; UK guide, the hedonic prices one. • For on territory impact, DE guide regards only the barrier effect; the IT one, also the soil consumption and system effects. • British guide proposes a qualitative methodology to estimate the impact on various landscapes and environments.

  8. Assessment of external costs for transport project evaluation: Guidelines in some European countries

    International Nuclear Information System (INIS)

    Many studies about the external costs generated by the transport system have been developed in the last twenty years. To standardize methodologies and assessment procedures to be used in the evaluation of the projects, some European countries recently have adopted specific guidelines that differ from each other in some aspects even sensibly. This paper presents a critical analysis of the British, Italian and German guidelines and is aimed at cataloguing the external cost types regarded and the assessment methods indicated as well as to highlight the differences of the results, in terms of applicability and reliability. The goal is to contribute to a European standardization process that would lead to the drafting of guidelines suited for all EU countries. - Highlights: • The analyzed guidelines agree on the methods to evaluate costs from air pollution, greenhouse gases and accidents. • They recommend respectively: dose-resp. approach; costs to reduce/permit emissions; whole direct, indirect and social costs. • For noise, DE guide indicates defensive expenditure or SP methods; IT guide, SP method; UK guide, the hedonic prices one. • For on territory impact, DE guide regards only the barrier effect; the IT one, also the soil consumption and system effects. • British guide proposes a qualitative methodology to estimate the impact on various landscapes and environments

  9. [Constipation in Patients with Incurable Cancer - Recommendations of the German S3 Guideline 'Palliative Medicine'].

    Science.gov (United States)

    Wirz, Stefan; Simon, Steffen; Frieling, Thomas; Bausewein, Claudia; Voltz, Raymond; Pralong, Anne; Mönig, Stefan; Follmann, Markus; Holtmann, Martin; Becker, Gerhild

    2016-08-01

    According to the German S3-guideline 'Palliative Medicine' which has been supported by the German Guideline Program in Oncology, constipation in palliative patients requires a consistent prophylaxis and therapy. Constipation is caused by immobilisation, poor health, exsiccosis, a low-fiber diet or a preexisting functional constipation. Further important causes are substances with constipating side effects, such as opioids or anticholinergic drugs. Pragmatically, constipation should be assessed by subjective parameters such as the feeling of incomplete evacuation, straining, or other complaints. Objective parameters are hard stool or reduced number of bowel movements. For the early detection of constipation the amount of the stool mass and the stool frequency are applicable. If constipation occurs, a standardized escalating protocol applying adequate fluid intake, a high fibre diet, and laxatives is recommended. New prokinetic agents, secretagogues, or opioid antagonists may be used as reserve drugs. PMID:27509350

  10. Cancer Risk Assessment for the Primary Care Physician

    OpenAIRE

    Korde, Larissa A; Gadalla, Shahinaz M.

    2009-01-01

    Cancer is the second leading cause of death in the United States. Cancer risk assessment can be divided into two major categories: assessment of familial or genetic risk and assessment of environmental factors that may be causally related to cancer. Identification of individuals with a suspected heritable cancer syndrome can lead to additional evaluation and to interventions that can substantially decrease cancer risk. Special attention should also be paid to potentially modifiable cancer ris...

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

    Directory of Open Access Journals (Sweden)

    Kadiyala Srikanth

    2009-10-01

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

  12. Guidelines for the Assessment of Dredge Material for Disposal in Irish Waters

    OpenAIRE

    Cronin, M.; McGovern, E.; McMahon, T.; Boelens, R

    2006-01-01

    Prior to the present guidelines the assessment, by the Marine Institute on behalf of the Department of Communication, Marine and Natural Resources, of the suitability of dredged materials for disposal at sea had employed provisional action levels as an aid to evaluation. These provisional action levels were based entirely on sediment chemistry. The responsible agencies have decided that these levels now need to be updated and formalised. The approach proposed in this document aims to provi...

  13. Adoption of practice guidelines and assessment tools in substance abuse treatment

    OpenAIRE

    McCarty Dennis; Saedi Goal; Fuller Bret E; Rieckmann Traci

    2010-01-01

    Abstract Background The gap between research and practice limits utilization of relevant, progressive and empirically validated strategies in substance abuse treatment. Methods Participants included substance abuse treatment programs from the Northeastern United States. Structural equation models were constructed with agency level data to explore two outcome variables: adoption of practice guidelines and assessment tools at two points in time; models also included organizational, staffing and...

  14. Procedure guideline for iodine-131 whole-body scintigraphy for differentiated thyroid cancer. Version 2

    International Nuclear Information System (INIS)

    The version 2 of the procedure guideline for iodine-131 whole-body scintigraphy for differentiated thyroid cancer is an update of the procedure guideline published in 1999. The following statements are added or modified: The two alternatives of an endogenous TSH-stimulation by the withdrawal of the thyroidal hormone medication and of an exogenous TSH-stimulation by the injection of the recombinant human TSH (rhTSH) have an equal sensitivity for the diagnostic use of radioiodine and for the measurement of thyroglobulin. Image acquisition under rhTSH is obtained approximately 48 h after the radioiodine administration, while an interval of about 72 h is preferred under endogenous TSH-stimulation. If iodine-negative metastases are expected, the feasibility of scintigraphy using 99mTc sestamibi or preferably positron emission tomography using 18F-fluorodeoxyglucose should be considered. The sensitivity of FDG-PET is increased by TSH-stimulation. Before planning the iodine-131 scintigraphy the patient has to avoid iodine-containing medication and the possibility of additives of iodine in vitamin- and electrolyte-supplementation has to be considered. (orig.)

  15. Operational safety review programmes for nuclear power plants. Guidelines for assessment

    International Nuclear Information System (INIS)

    The IAEA has been offering the Operational Safety Review Team (OSART) programme to provide advice and assistance to Member States in enhancing the operational safety of nuclear power plants (NPPs). Simultaneously, the IAEA has encouraged self-assessment and review by Member States of their own nuclear power plants to continuously improve nuclear safety. Currently, some utilities have been implementing safety review programmes to independently review their own plants. Corporate or national operational safety review programmes may be compliance or performance based. Successful utilities have found that both techniques are necessary to provide assurance that (i) as a minimum the NPP meets specific corporate and legal requirements and (ii) management at the NPP is encouraged to pursue continuous improvement principles. These programmes can bring nuclear safety benefits to the plants and utilities. The IAEA has conducted two pilot missions to assess the effectiveness of the operational review programme. Based on these missions and on the experience gained during OSART missions, this document has been developed to provide guidance on and broaden national/corporate safety review programmes in Member States, and to assist in maximizing their benefits. These guidelines are intended primarily for the IAEA team to conduct assessment of a national/corporate safety review programme. However, this report may also be used by a country or utility to establish its own national/corporate safety review programme. The guidelines may likewise be used for self-assessment or for establishing a baseline when benchmarking other safety review programmes. This report consists of four parts. Section 2 addresses the planning and preparation of an IAEA assessment mission and Sections 3 and 4 deal with specific guidelines for conducting the assessment mission itself

  16. General guidelines for the assessment of internal dose from monitoring data (project Ideas)

    International Nuclear Information System (INIS)

    In recent major international intercomparison exercises on intake and internal dose assessments from monitoring data, the results calculated by different participants varied significantly. This was mainly due to the broad variety of methods and assumptions applied in the assessment procedure. Based on these experiences the need for harmonization of the procedures has been formulated within an EC research project under the 5. Framework Programme. The aim of the project, IDEAS, is to develop general guidelines for standardizing assessments of intakes and internal doses. The IDEAS project started in October 2001 and will end in March 2005. Eight institutions from seven European countries are participating. Inputs from internal dosimetry professionals from across Europe are also being used to ensure a broad consensus in the outcome of the project. The IDEAS project is closely related to some goals of the work of committee 2 of the ICRP and since 2003 there has been close cooperation between the two groups. To ensure that the guidelines are applicable to a wide range of practical situations, the first step has been to compile a database of well-documented cases of internal contamination. In parallel, an improved version of an existing software package has been developed and distributed to the partners for further use. A large number of cases from the database have been evaluated independently by partners in the project using the same software and the results have been reviewed. Based on these evaluations, guidelines are being drafted and will be discussed with dosimetry professionals from around the world by means of a virtual workshop on the Internet early in 2004. The guidelines will be revised and refined on the basis of the experiences and discussions of this virtual workshop and the outcome of an intercomparison exercise organised as part of the project. This will be open to all internal dosimetry professionals. (author)

  17. Guideline for assessing risks arising from adoption of a cloud service

    OpenAIRE

    Tomčová, Zuzana

    2014-01-01

    This thesis focuses on assessment of IT risks related to company's adoption of a cloud ser-vice. The goal of the thesis is to identify generally applicable set of IT risks, which will serve as a basis for the proposed risk assessment guideline. The work is organized as follows: Introduction and literature review is presented in the first chapter. The author provides theoretical background supporting better understand-ing of the topic in the Chapter two, where concept of the cloud computing an...

  18. APPLICATION OF SEDIMENT QUALITY GUIDELINES IN THE ASSESSMENT OF MANGROVE SURFACE SEDIMENT IN MENGKABONG LAGOON, SABAH, MALAYSIA

    Directory of Open Access Journals (Sweden)

    S. M. Praveena, M. Radojevic, M. H. Abdullah, A. Z. Aris

    2008-01-01

    Full Text Available There have been numerous sediment quality guidelines developed to monitor the sediments. Sediment quality guidelines are very useful to screen sediment contamination by comparing sediment contaminant concentration with the corresponding quality guideline, provide useful tools for screening sediment chemical data to identify pollutants of concern and prioritise problem sites and relatively good predictors of contaminations. However, these guidelines are chemical specific and do not include biological parameters. Aquatic ecosystems, including sediments, must be assessed in multiple components (biological data, toxicity, physicochemistry by using intregrated approaches in order to establish a complete and comprehensive set of sediment quality guidelines. Numerous sediment quality guidelines Washington Department of Ecology Sediment Quality Guideline, Australian and New Zealand Environment and Conservation Council, Swedish Environmental Sediment Quality, Screening Quick Reference Table, Portuguese Legislation on the Classification of Dredged Materials in Coastal Zones and Interim Sediment Quality Guideline for Hong Kong have been applied to the Mengkabong lagoon mangrove sediment and discussed. The most appropriate guideline that meets the prioritization criteria consistent with international initiatives and regulations is interim sediment quality values for Hong Kong. The guideline verifies that all the metals are below the Interim Sediment Quality Value-low. However, site-specific, biological testing and ecological analysis of exisiting benthics community structure related to sediment contamination are needed for final decision making in the case of Mengkabong lagoon.

  19. Preliminary Guideline for the High Temperature Structure Integrity Assessment Procedure Part I. High Temperature Structure Design Guide

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Han; Kim, J. B.; Lee, H. Y.; Park, C. G.; Joo, Y. S.; Koo, G. H.; Kim, S. H

    2007-02-15

    A preliminary guideline for the design and evaluation of LMR high temperature structure is presented based upon ASME B and PV Code, Section III, Subsection NH. The main contents of this guideline are the materials, general design, vessel, piping, core support structure, pumps, valves, fabrication, examination, and testing for the class 1 components. The ratcheting evaluation, enhanced creep assessment, welds design and evaluation, inelastic analysis approach, piping design alternatives, and bellows design method are described in appendices. A user of this guideline should follow the essential procedures and may refer to other pertinent codes, standards, laws, regulations, or other pertinent documents when this guideline does not lead to proper design of the structure. While this guideline adopts major procedures of Subsection NH, it refers to the RCC-MR and/or DDS in some amount for the items where these codes have excellency to improve this guideline.

  20. 2013 European Thyroid Association Guidelines for Cervical Ultrasound Scan and Ultrasound-Guided Techniques in the Postoperative Management of Patients with Thyroid Cancer

    Science.gov (United States)

    Leenhardt, L.; Erdogan, M.F.; Hegedus, L.; Mandel, S.J.; Paschke, R.; Rago, T.; Russ, G.

    2013-01-01

    Cervical ultrasound scanning (US) is considered a key examination, by all major thyroid and endocrine specialist societies for the postoperative follow-up of thyroid cancer patients to assess the risk of recurrence. Neck US imaging is readily available, non-invasive, relatively easy to perform, cost-effective, and can guide diagnostic and therapeutic procedures with low complication rates. Its main shortcoming is its operator-dependency. Because of the pivotal role of US in the care of thyroid cancer patients, the European Thyroid Association convened a panel of international experts to review technical aspects, indications, results, and limitations of cervical US in the initial staging and follow-up of thyroid cancer patients. The main aim is to establish guidelines for both a cervical US scanning protocol and US-guided diagnostic and therapeutic procedures in patients with thyroid cancer. This report presents (1) standardization of the US scanning procedure, techniques of US-guided fine-needle aspiration, and reporting of findings; (2) definition of criteria for classification of malignancy risk based on cervical US imaging characteristics of neck masses and lymph nodes; (3) indications for US-guided fine-needle aspiration and for biological in situ assessments; (4) proposal of an algorithm for the follow-up of thyroid cancer patients based on risk stratification following histopathological and cervical US findings, and (5) discussion of the potential use of US-guided localization and ablation techniques for locoregional thyroid metastases. PMID:24847448

  1. ARN Training on Advance Methods for Internal Dose Assessment: Application of Ideas Guidelines

    International Nuclear Information System (INIS)

    Dose assessment in case of internal exposure involves the estimation of committed effective dose based on the interpretation of bioassay measurement, and the assumptions of hypotheses on the characteristics of the radioactive material and the time pattern and the pathway of intake. The IDEAS Guidelines provide a method to harmonize dose evaluations using criteria and flow chart procedures to be followed step by step. The EURADOS Working Group 7 'Internal Dosimetry', in collaboration with IAEA and Czech Technical University (CTU) in Prague, promoted the 'EURADOS/IAEA Regional Training Course on Advanced Methods for Internal Dose Assessment: Application of IDEAS Guidelines' to broaden and encourage the use of IDEAS Guidelines, which took place in Prague (Czech Republic) from 2-6 February 2009. The ARN identified the relevance of this training and asked for a place for participating on this activity. After that, the first training course in Argentina took place from 24-28 August for training local internal dosimetry experts. This paper resumes the main characteristics of this activity. (authors)

  2. High Temperature Structure Leak Before Break Assessment Guideline(V1.0)

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chang-Gyu; Kim, Jong-Bum; Lee, Hyeong-Yeon; Joo, Young-Sang; Lee, Jae-Han

    2007-03-15

    This study describes the Leak Before Break(LBB) procedure applicable to the reactor structure of Liquid Metal Reactor(LMR) which is operated at a high temperature. The purpose of LBB in LMR is to assure the defence in depth safety. The technically advanced countries of LMR development, such as Japan, UK and France, have their own LBB evaluation code. Their procedures are investigated thoroughly and the draft edition of LBB assessment guideline for the high temperature LMR structures is proposed. The key issues are the defect initiation, the defect propagation and the fast rupture of structures under the fatigue loading or the creep-fatigue loading condition. Additionlly, the detectable defect length and crack opening evaluation for the leakage detection method are analyzed and included in this guideline. Additionally, the detectable defect length and the creep-fatigue defect growth with a circumferential through wall defect for a KALIMER-600 IHTS hot leg piping based on this high temperature LBB assessment guideline were evaluated.

  3. Assessment of EPRI water chemistry guidelines for new nuclear power plants

    International Nuclear Information System (INIS)

    Water chemistry control technologies for nuclear power plants have been significantly enhanced over the past few decades to improve material and equipment reliability and fuel performance, and to minimize radionuclide production and transport. Chemistry Guidelines have been developed by the Electric Power Research Institute (EPRI) for currently operating plants and have been intermittently revised over the past twenty-five years for the protection of systems and components and for radiation management. As new plants are being designed for improved safety and increased power production, it is important to ensure that the designs consider implementation of state-of-the-art, industry developed water chemistry controls. In parallel, the industry will need to consider and update water chemistry guidelines as well as plant startup and operational strategies based on the advanced plant designs. EPRI has performed assessments of water chemistry control guidance or assumptions provided in design and licensing documents for several advanced plant designs. These designs include: Westinghouse AP1000 Pressurized Water Reactor AREVA US-EPR Pressurized Water Reactor Mitsubishi Nuclear Energy Systems/Mitsubishi Heavy Industries Advanced Pressurized Water Reactor Korea Hydro and Nuclear Power APR1400 Pressurized Water Reactor Toshiba Advanced Boiling Water Reactor (ABWR) General Electric-Hitachi Economic Simplified Boiling Water Reactor (ESBWR) The intent of these assessments was to identify key design differences in each of the new plant designs relative to the current operating fleet and to identify differences in water chemistry specifications or design assumptions provided in design and licensing documents for the plants in comparison to current EPRI Water Chemistry Guidelines. This paper provides a summary of the key results of these assessments. The fundamental design and operation of the advanced plants is similar to the currently operating fleet. As such, the new plants are

  4. Application of IDEAS guidelines: the IDEAS/IAEA intercomparison exercise on internal dose assessment

    International Nuclear Information System (INIS)

    As part of the EU Fifth Framework Programme IDEAS project 'General Guidelines for the Evaluation of Incorporation Monitoring Data', and in collaboration with the International Atomic Energy Agency, a new intercomparison exercise for the assessment of doses from intakes of radionuclides was organised. Several cases were selected, to cover a wide range of practices in the nuclear fuel cycle and medical applications. The cases were: (1) acute intake of HTO, (2) acute inhalation of the fission products 137Cs and 90Sr, (3) acute inhalation of 60Co, (4) repeated intakes of 131I, (5) intake of enriched uranium and (6) single intake of Pu isotopes and 241Am. This intercomparison exercise especially focused on the effect of the Guidelines proposed by the IDEAS project for harmonization of internal dosimetry. (authors)

  5. Trend of glycated hemoglobin testing in diabetic patients: to assess compliance with clinical practice guidelines

    International Nuclear Information System (INIS)

    Objective: To determine appropriate use of glycated hemoglobin (HbA1c) testing in accordance with current recommended guidelines. Study Design: Descriptive study. Place and Duration of Study: Chemical Pathology Department Shifa International Hospital, Islamabad from Oct 2011 to Oct 2012. Material and Methods: We randomly selected 170 known diabetic patients' data from our Laboratory Information System (LIS) who were retrospective analyzed for HbA1c to check for intervals and test frequency for each patient in one year. Patients with follow-up for at least one year at Shifa International Hospital, Islamabad and having their routine investigations in our chemical pathology laboratory were included. The concentrations of HbA1c for all the specimens were measured immunoturbidimetrically using a microparticle agglutination inhibition method. Four guidelines namely World Health Organization (WHO), American Diabetic Association (ADA), Canadian Diabetic Association (CDA) and National Institute for Health and Clinical Excellence (NICE) about HbA1c testing were utilized for data interpretation. All tests ordered within a 2 months period or more than 6 months following the previous order were labeled as inappropriate. Results: Only 35.8% of the patients were being properly monitored as per guidelines. Out of 64% patients who were inappropriately monitored, 12.9% had repeat orders within 2 months while 51.1% of patients were being monitored at longer interval against recommended guidelines. Conclusions: Glycated hemoglobin is a useful tool to objectively assess the prior glycemic control of patients with type 1 and type 2 diabetes. The study highlights that in large proportion of diabetic patients, HbA1c is not utilized properly as a tool to assess the risk of diabetic complications but in a small proportion is also tested unnecessarily which adds to avoidable health expenditure. (author)

  6. Staging of endometrial cancer with MRI: Guidelines of the European Society of Urogenital Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kinkel, K. [Geneva University Hospital and Institut de Radiologie, Clinique des Grangettes, Chene-Bougeries/Geneva (Switzerland); Clinique des Grangettes, Institut de radiologie, Chene-Bougerie/Geneva (Switzerland); Forstner, R. [LandesklinikenSalzburg, Zentralroentgeninstitut, Salzburg (Austria); Danza, F.M. [Universita Cattolica del S. Cuore, Dipartimento di Bioimmagini e scienze radiologiche, Rome (Italy); Oleaga, L. [Hospital Clinic, Radiology Department, Barcelona (Spain); Cunha, T.M. [Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Department of Radiology, Lisboa Codex (Portugal); Bergman, A. [Uppsala University Hospital, Department of Radiology, Uppsala (Sweden); Barentsz, J.O. [Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen (Netherlands); Balleyguier, C. [Institut de Cancerologie Gustave Roussy, Department of Radiology, Villejuif Cedex (France); Brkljacic, B. [University Hospital ' ' Dubrava' ' , Department of Diagnostic and Interventional Radiology, Zagreb (Croatia); University of Zagreb, Medical School, Zagreb (Croatia); Spencer, J.A. [St James' s Institute of Oncology, Department of Clinical Radiology, Leeds (United Kingdom)

    2009-07-15

    The purpose of this study was to define guidelines for endometrial cancer staging with MRI. The technique included critical review and expert consensus of MRI protocols by the female imaging subcommittee of the European Society of Urogenital Radiology, from ten European institutions, and published literature between 1999 and 2008. The results indicated that high field MRI should include at least two T2-weighted sequences in sagittal, axial oblique or coronal oblique orientation (short and long axis of the uterine body) of the pelvic content. High-resolution post-contrast images acquired at 2 min {+-} 30 s after intravenous contrast injection are suggested to be optimal for the diagnosis of myometrial invasion. If cervical invasion is suspected, additional slice orientation perpendicular to the axis of the endocervical channel is recommended. Due to the limited sensitivity of MRI to detect lymph node metastasis without lymph node-specific contrast agents, retroperitoneal lymph node screening with pre-contrast sequences up to the level of the kidneys is optional. The likelihood of lymph node invasion and the need for staging lymphadenectomy are also indicated by high-grade histology at endometrial tissue sampling and by deep myometrial or cervical invasion detected by MRI. In conclusion, expert consensus and literature review lead to an optimized MRI protocol to stage endometrial cancer. (orig.)

  7. Venous thromboembolism in cancer patients: risk assessment, prevention and management.

    Science.gov (United States)

    Tukaye, Deepali N; Brink, Heidi; Baliga, Ragavendra

    2016-03-01

    Thrombosis and thromboembolic events contribute to significant morbidity in cancer patients. Venous thrombosis embolism (which includes deep vein thrombosis and pulmonary embolism) accounts for a large percentage of thromboembolic events. Appropriate identification of cancer patients at high risk for venous thromboembolism and management of thromboembolic event is crucial in improving the quality of care for cancer patients. However, thromboembolism in cancer patients is a complex problem and the management has to be tailored to each individual. The focus of this review is to understand the complex pathology, physiology and risk factors that drive the process of venous thrombosis and embolism in cancer patients and the current guidelines in management. PMID:26919091

  8. A framework for evidence-adaptive quality assessment that unifies guideline-based and performance-indicator approaches.

    OpenAIRE

    Advani, Aneel; Goldstein, Mary; Musen, Mark A.

    2002-01-01

    Automated quality assessment of clinician actions and patient outcomes is a central problem in guideline- or standards-based medical care. In this paper we describe a unified model representation and algorithm for evidence-adaptive quality assessment scoring that can: (1) use both complex case-specific guidelines and single-step population-wide performance-indicators as quality measures; (2) score adherence consistently with quantitative population-based medical utilities of the quality measu...

  9. Clinical Practice Guideline for the prevention and early detection of breast and ovarian cancer in women from HBOC (hereditary breast and ovarian cancer) families.

    Science.gov (United States)

    Singer, C F; Tea, M K; Pristauz, G; Hubalek, M; Rappaport, C; Riedl, C C; Helbich, T H

    2015-12-01

    An estimated 10% of breast cancer cases exhibit a higher familial incidence, and functional mutations in BRCA (breast cancer-gene) 1 or 2 are responsible for the development of malignant tumors in approximately half of these cases. Women with a germline mutation in either of the two genes have a lifetime risk of up to 85% to develop breast cancer, and of up to 60% risk to develop ovarian cancer. This clinical practice guideline defines the individual and familial tumor constellations that represent an indication for BRCA germline testing. It also describes the therapeutic options (early detection programme vs prophylactic surgery) that arise from the result of a BRCA mutational analysis. This guideline further includes recommendations regarding the use of multigene panels and therapeutic aspects that arise from the selective use of poly ADP ribose polymerase (PARP) inhibitors in patients with known BRCA1 or 2 mutations. It replaces the previous version of the "Clinical Practice Guideline for the Prevention and Early Detection of Breast- and Ovarian Cancer in women from HBOC (hereditary breast and ovarian cancer) families" which was published in 2012. PMID:26525377

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

    Science.gov (United States)

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

    2016-03-01

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

  11. Reliability and accuracy assessment of radiation therapy oncology group-endorsed guidelines for brachial plexus contouring

    International Nuclear Information System (INIS)

    The goal of this work was to validate the Radiation Therapy Oncology Group (RTOG)-endorsed guidelines for brachial plexus (BP) contouring by determining the intra- and interobserver agreement. Accuracy of the delineation process was determined using anatomically validated imaging datasets as a gold standard. Five observers delineated the right BP on three cadaver computed tomography (CT) datasets. To assess intraobserver variation, every observer repeated each delineation three times with a time interval of 2 weeks. The BP contours were divided into four regions for detailed analysis. Inter- and intraobserver variation was verified using the Computerized Environment for Radiation Research (CERR) software. Accuracy was measured using anatomically validated fused CT-magnetic resonance imaging (MRI) datasets by measuring the BP inclusion of the delineations. The overall kappa (κ) values were rather low (mean interobserver overall κ: 0.29, mean intraobserver overall κ: 0.45), indicating poor inter- and intraobserver reliability. In general, the κ coefficient decreased gradually from the medial to lateral BP regions. The total agreement volume (TAV) was much smaller than the union volume (UV) for all delineations, resulting in a low Jaccard index (JI; interobserver agreement 0-0.124; intraobserver agreement 0.004-0.636). The overall accuracy was poor, with an average total BP inclusion of 38 %. Inclusions were insufficient for the most lateral regions (region 3: 21.5 %; region 4: 12.6 %). The inter- and intraobserver reliability of the RTOG-endorsed BP contouring guidelines was poor. BP inclusion worsened from the medial to lateral regions. Accuracy assessment of the contours showed an average BP inclusion of 38 %. For the first time, this was assessed using the original anatomically validated BP volume. The RTOG-endorsed BP guidelines have insufficient accuracy and reliability, especially for the lateral head-and-neck regions. (orig.)

  12. Adherence to guidelines of pain assessment and intervention in internal medicine wards.

    Science.gov (United States)

    Kerner, Yehudit; Plakht, Ygal; Shiyovich, Arthur; Schlaeffer, Pnina

    2013-12-01

    Proper management of pain reduces morbidity, assists in recovery, and increases patient satisfaction. The role of a nurse in an accurate pain evaluation is pivotal. It seems that pain evaluation guidelines are not fully adhered to by nurses. The aim of this study was to assess the performance of pain evaluation and management by nurses in patients admitted in internal medicine wards and to identify groups of patients in which pain evaluation was insufficient. In this cross-sectional study medical records of 59 randomly chosen patients were reviewed: age 64.5 ± 18.5 years, 55% women, and hopitalization length 3.9 ± 1.6 days. Data relating to pain evaluation and management were obtained for every patient-hospitalization day (total 213 patient-days) and compared with the guidelines. Pain was evaluated in 176 out of 213 encounters (66.2%): 84.3% upon admission and 72.7% daily routine evaluation in accordance with guidelines. In 23.7% of evaluations, pain level warranted alleviating treatment (visual analog scale ≥3). However, such treatment was administered in only 29.3% of these cases. Reevaluation after treatment and additional evaluations thereafter were performed in 33.3% and 22% of encounters, respectively. The independent factors associated with the reduced performance of pain evaluation were: widower (odds ratio [OR] 0.88, 95% confidence interval [CI] 0.78-0.98; p = .024), reduced level of consicousnness (OR 0.77, 95% CI 0.63-0.95; p = .013), mental disorders as a cause of hospitalization (OR 0.81, 95% CI 0.71-0.94; p = .004), and isolation (OR 0.87, 95% CI 0.76-0.99; p = .03). Pain assessment and management in internal medicine wards is insufficient, especially in the above subgroups. Specific education programs targeted to the latter subgroups and to the unique pain assessment tools are warranted. PMID:23178103

  13. 246 Assessment of the Quality of Methodological Rigour and Reporting of Clinical Practice Guidelines for the Management of Allergic Rhinitis—Qugar Study

    OpenAIRE

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

    2012-01-01

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

  14. European project for developing general guidelines for harmonising internal dose assessment procedures (IDEAS)

    International Nuclear Information System (INIS)

    Several international intercomparison exercises on intake and internal dose assessments from monitoring data led to the conclusion that the results calculated by different participants varied significantly mainly because of the wide variety of methods and assumptions applied in the assessment procedure. Based on these experiences the need for harmonisation of the procedures has been formulated as an EU research project under the 5th Framework Programme (2001-2005), with the aim of developing general guidelines for standardising assessments of intakes and internal doses. In the IDEAS project eight institutions from seven European countries are participating using inputs also from internal dosimetry professionals from across Europe to ensure broad consensus in the outcome of the project. The IDEAS project is explained

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

    International Nuclear Information System (INIS)

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

  16. Hereditary cancer risk assessment: essential tools for a better approach

    OpenAIRE

    Gomy, Israel; Estevez Diz, Maria Del Pilar

    2013-01-01

    Hereditary cancer risk assessment (HCRA) is a multidisciplinary process of estimating probabilities of germline mutations in cancer susceptibility genes and assessing empiric risks of cancer, based on personal and family history. It includes genetic counseling, testing and management of at-risk individuals so that they can make well-informed choices about cancer surveillance, surgical treatment and chemopreventive measures, including biomolecular cancer therapies. Providing patients and famil...

  17. Summary report on new regulatory codes and criteria and guidelines: IAEA guidelines for WWER reactor coolant system integrity assessment

    International Nuclear Information System (INIS)

    In the frame of the nuclear safety programme to assist the countries of Central and Eastern Europe, the IAEA identified and ranked in total 263 safety issues for WWER-440/230, WWER-440/213 and WWER-1000/320 nuclear power plants, related to both design and operation. In the area of reactor coolant system integrity, 24 safety issues were identified and 15 of them ranked as of high safety significance. These include: reactor pressure-vessel integrity and related aspects, primary and secondary high-energy piping integrity, steam generator integrity and reliability of the non-destructive testing for in-service inspection. In addition to obtaining international consensus on possible solutions to address the safety issues identified and to reviewing completeness of proposed safety improvements, the IAEA initiated development of guidelines to address the issues of highest safety concern. In the area of the reactor coolant system integrity, guidelines for the leak before break concept application, for the pressurized thermal shock analysis and for the in-service inspection systems qualification were developed. Further activities of the IAEA were focused on the implementation of guidelines developed in the Member States concerned. With this objective, a co-ordinated research programme 'round-robin exercise on WWER-440 reactor pressure vessel embrittlement, annealing and re-embrittlement', a 'WWER-440/213 pressurized thermal shock analysis benchmark exercise' and a pilot study to implement the qualification approach to a real power plant component have been initiated by the IAEA and are well under way at present. In this paper, an overview of these IAEA activities related to reactor coolant system integrity is provided and the main principles and elements of guidelines developed discussed. (orig.)

  18. The application of national and international guidelines in the assessment of the radiological quality of drinking water

    International Nuclear Information System (INIS)

    Full text: The World Health Organisation has developed international guidelines for drinking water quality which define acceptable levels of contaminants including radionuclides. These guidelines were the basis for the recent Australian water quality guidelines developed by the National Health and Medical Research Council in conjunction with the Agriculture and Resource Management Council of Australia and New Zealand. This paper highlights some of the practical problems in applying the guidelines in the assessment of groundwater supplies in Australia where the radium content of the water may be significant and the presence of other dissolved minerals can create difficulties in the analytical procedures. Generally, screening methods are based on the determination of gross alpha and beta radioactivity and the limitations of these techniques are discussed. The issue is also addressed as to the appropriate actions in the event of guideline values for specific radionuclides being exceeded

  19. Assessment of a cancer screening program.

    Science.gov (United States)

    Rabeneck, Linda; Lansdorp-Vogelaar, Iris

    2015-12-01

    Several Asian countries are implementing nationwide cancer screening programs. Assessment of the effectiveness of these programs is critical to their success as this is the only way to ensure that the benefits of screening outweigh the harms. In this paper we focus on colorectal cancer (CRC) screening to illustrate the principles of screening program assessment. The International Agency for Research on Cancer (IARC) has defined organized screening, distinguishing it from opportunistic screening. The key advantage of organized screening is that it provides greater protection against the possible harms of screening. Since screening is a process, not simply a test, the effectiveness of a program depends on the quality of each step in the cancer screening process. The evaluation of long-term screening program outcomes (CRC incidence and mortality) will not be observable for many years, given the time it takes to plan, pilot and implement a program. However, early performance indicators of the impact of screening should be monitored to give an early indication whether the program is on track. The European Union (EU) has recommended a minimum dataset to be collected and reported regularly by a screening program. Using information from these data tables, early performance indicators can be generated (e.g., participation rate, proportion of screen-detected cancers that are early-stage). Subsequently, modeling the natural history of the disease can be very helpful to estimate long-term outcomes, making use of these directly measured early performance indicators. Modeling can also be used to estimate the cost-effectiveness of a screening program and the potential impact of changes in policy, as illustrated by its recent use in the Netherlands to change the definition of a positive fecal immunochemical test (FIT) for the CRC screening program. Programs should consider modeling as an important component of screening program evaluation. PMID:26651258

  20. Advanced Imaging and Receipt of Guideline Concordant Care in Women with Early Stage Breast Cancer

    Science.gov (United States)

    Buist, Diana S. M.; Gold, Laura S.; Zeliadt, Steven; Hunter Merrill, Rachel; Etzioni, Ruth; Ramsey, Scott D.; Sullivan, Sean D.; Kessler, Larry

    2016-01-01

    Objective. It is unknown whether advanced imaging (AI) is associated with higher quality breast cancer (BC) care. Materials and Methods. Claims and Surveillance Epidemiology and End Results data were linked for women diagnosed with incident stage I-III BC between 2002 and 2008 in western Washington State. We examined receipt of preoperative breast magnetic resonance imaging (MRI) or AI (defined as computed tomography [CT]/positron emission tomography [PET]/PET/CT) versus mammogram and/or ultrasound (M-US) alone and receipt of guideline concordant care (GCC) using multivariable logistic regression. Results. Of 5247 women, 67% received M-US, 23% MRI, 8% CT, and 3% PET/PET-CT. In 2002, 5% received MRI and 5% AI compared to 45% and 12%, respectively, in 2008. 79% received GCC, but GCC declined over time and was associated with younger age, urban residence, less comorbidity, shorter time from diagnosis to surgery, and earlier year of diagnosis. Breast MRI was associated with GCC for lumpectomy plus radiation therapy (RT) (OR 1.55, 95% CI 1.08–2.26, and p = 0.02) and AI was associated with GCC for adjuvant chemotherapy for estrogen-receptor positive (ER+) BC (OR 1.74, 95% CI 1.17–2.59, and p = 0.01). Conclusion. GCC was associated with prior receipt of breast MRI and AI for lumpectomy plus RT and adjuvant chemotherapy for ER+ BC, respectively. PMID:27525122

  1. Compliance with clinical practice guidelines for breast cancer treatment: a population-based study of quality-of-care indicators in Italy

    Directory of Open Access Journals (Sweden)

    Sacerdote Carlotta

    2013-01-01

    Full Text Available Abstract Background It has been documented that variations exist in breast cancer treatment despite wide dissemination of clinical practice guidelines. The aim of this population-based study was to evaluate the impact of regional guidelines (Piedmont guidelines, PGL for breast cancer diagnosis and treatment on quality-of-care indicators in the Northwestern Italian region of Piedmont. Methods We included two samples of women aged 50–69 years with incident breast cancer treated in Piedmont before and after the introduction of PGL: 600 in 2002 (pre-PGL and 621 in 2004 (post-PGL. Patients were randomly selected among all incident breast cancer cases identified through the hospital discharge records database. We extracted clinical data on breast cancer cases from medical charts and ascertained vital status through linkage with town offices. We assessed compliance with 14 quality-of-care indicators from PGL recommendations, before and after their introduction in clinical practice. Results Among patients with invasive lesions, 77.1% (N = 368 and 77.5% (N = 383 in the pre-PGL and post-PGL groups, respectively, received breast conservative surgery (BCS as a first-line treatment. Following BCS, 87.7% received radiotherapy in 2002, compared to 87.9% in 2004. Of all patients at medium-to-high risk of distant metastasis, 65.5% (N = 268 and 63.6% (N = 252 received chemotherapy in 2002 and in 2004, respectively. Among the 117 patients with invasive lesions and negative estrogen receptor status in 2002, hormonal therapy was prescribed in 23 of them (19.6%. The incorrect prescription of hormonal therapy decreased to 10.8% (N = 10 among the 92 estrogen receptor-negative patients in 2004 (p Compliance with PGL recommendations was already high in the pre-PGL group, although some quality-of-care indicators did not reach the standard. In the pre/post analysis, 8 out of 14 quality-of-care indicators showed an improvement from 2002 to 2004, but only 4 out of 14

  2. Inhalation cancer risk assessment of cobalt metal.

    Science.gov (United States)

    Suh, Mina; Thompson, Chad M; Brorby, Gregory P; Mittal, Liz; Proctor, Deborah M

    2016-08-01

    Cobalt compounds (metal, salts, hard metals, oxides, and alloys) are used widely in various industrial, medical and military applications. Chronic inhalation exposure to cobalt metal and cobalt sulfate has caused lung cancer in rats and mice, as well as systemic tumors in rats. Cobalt compounds are listed as probable or possible human carcinogens by some agencies, and there is a need for quantitative cancer toxicity criteria. The U.S. Environmental Protection Agency has derived a provisional inhalation unit risk (IUR) of 0.009 per μg/m(3) based on a chronic inhalation study of soluble cobalt sulfate heptahydrate; however, a recent 2-year cancer bioassay affords the opportunity to derive IURs specifically for cobalt metal. The mechanistic data support that the carcinogenic mode of action (MOA) is likely to involve oxidative stress, and thus, non-linear/threshold mechanisms. However, the lack of a detailed MOA and use of high, toxic exposure concentrations in the bioassay (≥1.25 mg/m(3)) preclude derivation of a reference concentration (RfC) protective of cancer. Several analyses resulted in an IUR of 0.003 per μg/m(3) for cobalt metal, which is ∼3-fold less potent than the provisional IUR. Future research should focus on establishing the exposure-response for key precursor events to improve cobalt metal risk assessment. PMID:27177823

  3. Preoperative mediastinal lymph node staging for non-small cell lung cancer: 2014 update of the 2007 ESTS guidelines

    OpenAIRE

    De Leyn, Paul; Dooms, Christophe; Kuzdzal, Jaroslaw; Lardinois, Didier; Passlick, Bernward; Rami-Porta, Ramon; Turna, Akif; Van Schil, Paul; Venuta, Frederico; Waller, David; Weder, Walter; Zielinski, Marcin

    2014-01-01

    Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small cell lung cancer (NSCLC) is of paramount importance. In 2007, the European Society of Thoracic Surgeons (ESTS) published an algorithm on preoperative mediastinal staging integrating imaging, endoscopic and surgical techniques. Over the last years more evidence of the different mediastinal staging technique has become available. Therefore, a revision of the ESTS guidelines w...

  4. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making

    DEFF Research Database (Denmark)

    Schmoll, H J; Van Cutsem, E; Stein, A;

    2012-01-01

    Colorectal cancer (CRC) is the most common tumour type in both sexes combined in Western countries. Although screening programmes including the implementation of faecal occult blood test and colonoscopy might be able to reduce mortality by removing precursor lesions and by making diagnosis...... patients by a combination of chemotherapy and surgery. Treatment decisions must be based on the available evidence, which has been the basis for this consensus conference-based guideline delivering a clear proposal for diagnostic and treatment measures in each stage of rectal and colon cancer...

  5. Practice guideline on prophylactic cranial irradiation in small-cell lung cancer

    International Nuclear Information System (INIS)

    Purpose: To develop an evidence-based clinical practice guideline that would address the following questions: (a) What is the role of prophylactic cranial irradiation (PCI) in patients with limited or extensive stage small-cell lung cancer (SCLC) who have achieved complete remission in response to induction therapy (chemotherapy or chemoradiotherapy)? (b) What dose and fractionation schedules of PCI are optimal? (c) Does the use of PCI in patients with SCLC in complete remission affect quality of life? Survival, disease-free survival, quality of life, and adverse effects were the outcomes of interest. Methods and Materials: A systematic review of the published literature was undertaken to provide the data for an evidence-based practice guideline. Results: Six randomized controlled trials and one fully published individual patient data meta-analysis were included in the systematic review of the evidence. For patients who have achieved complete response after induction therapy, there is evidence of a disease-free survival benefit (4 of 6 trials) and an overall survival benefit (meta-analysis). There is insufficient evidence to make a definitive recommendation with respect to dose. There is some indication that 30-36 Gy in 2-3 Gy per fraction, or a biologically equivalent dose, may produce a better outcome than a lower dose or less aggressive fractionation regimen. The schedule commonly used in Canada is 25 Gy in 10 fractions over 2 weeks. Data from further research, including a trial currently ongoing that compares 25 Gy in 10 fractions with 36 Gy in 18 fractions, will be required to determine optimal dose of PCI. There is insufficient evidence to make recommendations concerning the optimal timing of PCI in relation to the administration of chemotherapy. Lung DSG members generally felt that it should be given as soon as possible after completion of chemotherapy. There is evidence from trials with data for up to 2 years of follow-up that prophylactic cranial

  6. Guidelines for timely initiation of chemotherapy: a proposed framework for access to medical oncology and haematology cancer clinics and chemotherapy services.

    Science.gov (United States)

    Alexander, M; Beattie-Manning, R; Blum, R; Byrne, J; Hornby, C; Kearny, C; Love, N; McGlashan, J; McKiernan, S; Milar, J L; Murray, D; Opat, S; Parente, P; Thomas, J; Tweddle, N; Underhill, C; Whitfield, K; Kirsa, S; Rischin, D

    2016-08-01

    These guidelines, informed by the best available evidence and consensus expert opinion, provide a framework to guide the timely initiation of chemotherapy for treating cancer. They sit at the intersection of patient experience, state-of-the-art disease management and rational efficient service provision for these patients at a system level. Internationally, cancer waiting times are routinely measured and publicly reported. In Australia, there are existing policies and guidelines relating to the timeliness of cancer care for surgery and radiation therapy; however, until now, equivalent guidance for chemotherapy was lacking. Timeliness of care should be informed, where available, by evidence for improved patient outcomes. Independent of this, it should be recognised that shorter waiting periods are likely to reduce patient anxiety. While these guidelines were developed as part of a proposed framework for consideration by the Victorian Department of Health, they are clinically relevant to national and international cancer services. They are intended to be used by clinical and administrative staff within cancer services. Adoption of these guidelines, which are for the timely triage, review and treatment of cancer patients receiving systemic chemotherapy, aims to ensure that patients receive care within a timeframe that will maximise health outcomes, and that access to care is consistent and equitable across cancer services. Local monitoring of performance against this guideline will enable cancer service providers to manage proactively future service demand. PMID:27553996

  7. Breast Cancer Risk Assessment SAS Macro (Gail Model)

    Science.gov (United States)

    A SAS macro (commonly referred to as the Gail Model) that projects absolute risk of invasive breast cancer according to NCI’s Breast Cancer Risk Assessment Tool (BCRAT) algorithm for specified race/ethnic groups and age intervals.

  8. Clinical practice recommendations for quality of life assessment in patients with gynecological cancer.

    Science.gov (United States)

    Leppert, Wojciech; Gottwald, Leszek; Forycka, Maria

    2015-12-01

    Quality of life (QoL) is a multidimensional concept regarding self-assessment of patients' situation. Quality of life has not been clearly defined up to date, although it is clear that it is a subjective self-assessment that to a significant extent is determined by individual needs, beliefs, values, attitudes, which are changing with time. Health-related QoL comprises basic dimensions such as patients' performance status, physical, emotional, and social functioning, symptoms of the disease and adverse effects of treatment, spiritual (God and existential) and other dimensions. In women, the ovary, cervical, corpus uterus, vagina and vulva cancers deteriorate QoL by disease progression and consequences of treatment, also in cancer survivors. Common symptoms include the genito-urinary system, the lower gastrointestinal tract and peripheral neuropathies induced by chemotherapy. In young women, QoL is impaired by infertility, sexual problems and menopause symptoms. An overview of QoL questionnaires used in oncology with special regard to patients with gynecological tumors was conducted. A screening tool for psychological state assessment of oncology patients (distress thermometer), the Edmonton Symptom Assessment System (ESAS) and modular approach of QoL assessment recommended by the EORTC (European Organization for the Research and Treatment of Cancer) were presented. Practical guidelines were proposed to assess appropriately QoL in patients with gynecological cancers who stay at in-patient gynecology units and those treated at home and in an ambulatory care setting. PMID:26848300

  9. Nutritional status assessment in colorectal cancer patients

    Directory of Open Access Journals (Sweden)

    Joana Pedro Lopes

    2013-04-01

    Full Text Available The present study intended to evaluate the nutritional status of Portuguese colorectal patients and associated it with surgery type as well as quality of life outcomes. Malnutrition can affect up to 85% of cancer patients and specifically 30-60% in colorectal cancer and can significantly influence health outcomes. A sample of 50 colorectal cancer patients was evaluated in what refers to several anthropometric measures, food intake, clinical history, complications rate before and after surgery procedure. The sample was divided between convention and fast-track procedures. Most of the individuals were overweight or obese but had lost weight on the past six months. Despite mild, there were signs of malnutrition in this sample with high losses of fat free mass, weight and also fat mass during the hospitalization period. These results reinforce the importance of malnutrition assessment in colorectal patients as well as consider weight loss on the past months and body composition in order to complement nutritional status evaluation.

  10. UPSAT guidelines. 1996 edition. Reference document for IAEA Uranium Productions Safety Assessment Teams (UPSATs)

    International Nuclear Information System (INIS)

    The IAEA Uranium Production Safety Assessment Team (UPSAT) programme provides advice and assistance to Member States to enhance the safety and environmental performance of uranium production facilities during construction, commissioning and operation. Sound design and construction are prerequisite for the safe and environmentally responsible operation of uranium mines and mills. However, the safety of the facility depends ultimately on sound policies, procedures and practices; on the capability and reliability of the construction, commissioning and operating personnel; on comprehensive instructions; and on adequate resources. A positive attitude and conscientiousness on the part of the management and staff in discharging their responsibilities is important to safety. The UPSAT guidelines have been developed in the following areas: (1) management, organization and administration; (2) training and qualification; (3) operation (4) maintenance; (5) safety, fire protection, emergency planning, and preparedness; (6) radiation protection; (7) environmental monitoring programme; (8) construction management; (9) commissioning and decommissioning

  11. DEGRO practical guidelines: radiotherapy of breast cancer II. Radiotherapy of non-invasive neoplasia of the breast

    International Nuclear Information System (INIS)

    To complement and update the 2007 practice guidelines of the breast cancer expert panel of the German Society of Radiation Oncology (DEGRO) for radiotherapy (RT) of breast cancer. Owing to its growing clinical relevance, in the current version, a separate paper is dedicated to non-invasive proliferating epithelial neoplasia of the breast. In addition to the more general statements of the German interdisciplinary S3 guidelines, this paper is especially focused on indication and technique of RT in addition to breast conserving surgery. The DEGRO expert panel performed a comprehensive survey of the literature comprising recently published data from clinical controlled trials, systematic reviews as well as meta-analyses, referring to the criteria of evidence-based medicine yielding new aspects compared to 2005 and 2007. The literature search encompassed the period 2008 to September 2012 using databases of PubMed and Guidelines International Network (G-I-N). Search terms were ''non invasive breast cancer'', ''ductal carcinoma in situ, ''dcis'', ''borderline breast lesions'', ''lobular neoplasia'', ''radiotherapy'' and ''radiation therapy''. In addition to the more general statements of the German interdisciplinary S3 guidelines, this paper is especially focused on indications of RT and decision making of non-invasive neoplasia of the breast after surgery, especially ductal carcinoma in situ. Among different non-invasive neoplasia of the breast only the subgroup of pure ductal carcinoma in situ (DCIS; synonym ductal intraepithelial neoplasia, DIN) is considered for further recurrence risk reduction treatment modalities after complete excision of DCIS, particularly RT following breast conserving surgery (BCS), in order to avoid a mastectomy. About half of recurrences are invasive cancers. Up to 50?% of all recurrences require salvage mastectomy. Randomized clinical trials and a huge number of mostly observational studies have unanimously demonstrated that RT significantly

  12. Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3); Verfahrensanweisung zur Radioiodtherapie (RIT) beim differenzierten Schilddruesenkarzinom (Version 3)

    Energy Technology Data Exchange (ETDEWEB)

    Dietlein, M.; Schicha, H. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Dressler, J. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Nuklearmedizinsiche Klinik der Henriettenstiftung, Hannover (Germany); Eschner, W. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Deutsche Gesellschaft fuer Medizinische Physik (DGMP) (Germany); Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Gruenwald, F. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Frankfurt Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Lassmann, M. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Deutsche Gesellschaft fuer Medizinische Physik (DGMP) (Germany); Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Leisner, B. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Allgemeines Krankenhaus St. Georg, Hamburg (Germany); Luster, M.; Reiners, C. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Moser, E. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Radiologische Universitaetsklinik Freiburg (Germany); Schober, O. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Muenster Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    2007-07-01

    The procedure guideline for radioiodine therapy (RIT) of differentiated thyroid cancer (version 3) is the counterpart to the procedure guideline for {sup 131}I whole-body scintigraphy (version 3) and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Recommendation for ablative {sup 131}I therapy is given for all differentiated thyroid carcinoma (DTC) >1 cm. Regarding DTC {<=}1 cm {sup 131}I ablation may be helpful in an individual constellation. Preparation for {sup 131}I ablation requires low iodine diet for two weeks and TSH stimulation by withdrawal of thyroid hormone medication or by use of recombinant human TSH (rhTSH). The advantages of rhTSH (no symptoms of hypothyroidism, lowerblood activity) and the advantages of endogenous TSH stimulation (necessary for {sup 131}I-therapy in patients with metastases, higher sensitivity of {sup 131}I whole-body scan) are discussed. In most centers standard activities are used for {sup 131}I ablation. If pretherapeutic dosimetry is planned, the diagnostic administration of {sup 131}I should not exceed 1-10MBq, alternative tracers are {sup 123}I or {sup 124}I. The recommendations for contraception and family planning are harmonized with the recommendation of ATA and ETA. Regarding the best possible protection of salivary glands the evidence is insufficient to recommend a specific setting. To minimize the risk of dental caries due to xerostomia patients should use preventive strategies for dental hygiene. (orig.)

  13. The guidelines project of the IOBC global WG and risk assessment of transgenic arthropods

    International Nuclear Information System (INIS)

    The guidelines project 'Development of International Scientific Biosafety Testing Guidelines for Transgenic Plants' is an international initiative of public sector scientists organized within a global Working Group on 'Transgenic Organisms in Integrated Pest Management and Biological Control' under the umbrella of the International Organization of Biological Control (IOBC). The project aims to: - develop comprehensive, transparent scientific guidelines for pre-release biosafety testing of transgenic plants, which could serve as an international standard; - extend the guidelines for possible use in post-release monitoring; - facilitate the development of the scientific capacity in developing and developed countries to implement the guidelines. - test the application the guidelines in real policy contexts to assist in the evaluation of particular transgenic crops. - publish the guidelines and periodically revise them in response to new developments thereby providing for their up-to-date, long-time use. (author)

  14. Summary guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Halsnaes, K.; Painuly, J.P.; Turkson, J.; Meyer, H.J.; Markandya, A.

    1999-09-01

    This document is a summary version of the methodological guidelines for climate change mitigation assessment developed as part of the Global Environment Facility (GEF) project Economics of Greenhouse Gas Limitations; Methodological Guidelines. The objectives of this project have been to develop a methodology, an implementing framework and a reporting system which countries can use in the construction of national climate change mitigation policies and in meeting their future reporting obligations under the FCCC. The methodological framework developed in the Methodological Guidelines covers key economic concepts, scenario building, modelling tools and common assumptions. It was used by several country studies included in the project. (au) 13 refs.

  15. Design and implementation of a decision support system for breast cancer treatment based on clinical practice guidelines

    International Nuclear Information System (INIS)

    Evidence based medicine is the clinical practice that uses medical data and proof in order to make efficient clinical decisions. Information technology (IT) can play a crucial role in exploiting the huge size of raw medical data involved. In an attempt to improve clinical efficacy, health care society nowadays also utilizes a new assistant, clinical guidelines. Our research concerns the medical domain of the breast cancer disease. Our research's focus is twofold; our primary goal is to ensure consistency in clinical practice by importing clinical guidelines in an IT driven decision support system (DSS). Furthermore, we seek to improve visualization of disease specific, clinical data, providing for it's faster and more efficient use. (orig.)

  16. Spinal opioids in adult patients with cancer pain: a systematic review: a European Palliative Care Research Collaborative (EPCRC) opioid guidelines project

    DEFF Research Database (Denmark)

    Kurita, Geana Paula; Kaasa, Stein; Sjøgren, Per

    2011-01-01

    A systematic review, undertaken according to an initiative to revise European Association for Palliative Care guidelines on the use of opioids for cancer pain, which aimed to analyse analgesic efficacy and side effects of spinal opioids in adult cancer patients previously treated with systemic...

  17. Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea

    Science.gov (United States)

    Memtsoudis, Stavros G.; Ramachandran, Satya Krishna; Nagappa, Mahesh; Opperer, Mathias; Cozowicz, Crispiana; Patrawala, Sara; Lam, David; Kumar, Anjana; Joshi, Girish P.; Fleetham, John; Ayas, Najib; Collop, Nancy; Doufas, Anthony G.; Eikermann, Matthias; Englesakis, Marina; Gali, Bhargavi; Gay, Peter; Hernandez, Adrian V.; Kaw, Roop; Kezirian, Eric J.; Malhotra, Atul; Mokhlesi, Babak; Parthasarathy, Sairam; Stierer, Tracey; Wappler, Frank; Hillman, David R.; Auckley, Dennis

    2016-01-01

    The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients’ conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence. PMID:27442772

  18. Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea.

    Science.gov (United States)

    Chung, Frances; Memtsoudis, Stavros G; Ramachandran, Satya Krishna; Nagappa, Mahesh; Opperer, Mathias; Cozowicz, Crispiana; Patrawala, Sara; Lam, David; Kumar, Anjana; Joshi, Girish P; Fleetham, John; Ayas, Najib; Collop, Nancy; Doufas, Anthony G; Eikermann, Matthias; Englesakis, Marina; Gali, Bhargavi; Gay, Peter; Hernandez, Adrian V; Kaw, Roop; Kezirian, Eric J; Malhotra, Atul; Mokhlesi, Babak; Parthasarathy, Sairam; Stierer, Tracey; Wappler, Frank; Hillman, David R; Auckley, Dennis

    2016-08-01

    The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients' conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence. PMID:27442772

  19. Guideline development and impact assessment for registration of medical, dental and veterinary x-ray apparatus

    International Nuclear Information System (INIS)

    Under the NSW Radiation Control Act 1990, radiation apparatus used for diagnostic medical, dental and veterinary purposes will be required to become registered. The inspection required prior to registration will be conducted by a Consulting Radiation Expert who has been accredited by the Environment Protection Authority (EPA) as being competent in the field of quality assurance assessment of radiation apparatus used for diagnostic medical, dental and veterinary purposes. When regulating any activity in NSW, there is a requirement to undertake a regulatory impact statement of the proposed regulation. In addition, the introduction of any accompanying guideline requires a cost-benefit analysis. Costs may include enforcement, administrative and compliance activities. The calculation of benefit relies heavily on the improvement in apparatus performance (and hence dose reduction) that can be obtained with the introduction of a mandatory practice such as apparatus registration. This paper discusses the development of the registration guideline for NSW, including a summary of the public comments received. It further discusses the methodology and data used for the accompanying cost-benefit analysis. Information in this paper is presented in three parts: EPA field survey, cost analysis, and benefit analysis. For NSW it was estimated that the introduction of registration of these apparatus, over a two year period, would result in early replacement and repair costs (present values) to the medical industry of between $5.7 and $11.0 million, with an additional $2.5 million in EPA enforcement costs. The introduction of the proposed system of registration is expected to result in an estimated savings in quantifiable health detriment costs to NSW of between $11.8 and $17.7 million, and reduce the risk of radiation induced mortality. (authors)

  20. Efficacy of a touchscreen computer based family cancer history questionnaire and subsequent cancer risk assessment

    OpenAIRE

    Westman, J; Hampel, H.; Bradley, T.

    2000-01-01

    OBJECTIVE—A computer based touchscreen family cancer history questionnaire was developed and implemented to facilitate the provision of cancer risk assessments for the ambulatory and outpatient populations of a free standing cancer hospital.
METHODS—A questionnaire consisting of a series of branched point decision making screens was developed which enables the participant to enter demographic data, personal cancer history, and cancer histories for first and second degree relatives. A freestan...

  1. The use of preoperative radiotherapy in the management of patients with clinically resectable rectal cancer: a practice guideline

    Directory of Open Access Journals (Sweden)

    Rumble R Bryan

    2003-11-01

    Full Text Available Abstract Background This systematic review with meta-analysis was designed to evaluate the literature and to develop recommendations regarding the use of preoperative radiotherapy in the management of patients with resectable rectal cancer. Methods The MEDLINE, CANCERLIT and Cochrane Library databases, and abstracts published in the annual proceedings of the American Society of Clinical Oncology and the American Society for Therapeutic Radiology and Oncology were systematically searched for evidence. Relevant reports were reviewed by four members of the Gastrointestinal Cancer Disease Site Group and the references from these reports were searched for additional trials. External review by Ontario practitioners was obtained through a mailed survey. Final approval of the practice guideline report was obtained from the Practice Guidelines Coordinating Committee. Results Two meta-analyses of preoperative radiotherapy versus surgery alone, nineteen trials that compared preoperative radiotherapy plus surgery to surgery alone, and five trials that compared preoperative radiotherapy to alternative treatments were obtained. Randomized trials demonstrate that preoperative radiotherapy followed by surgery is significantly more effective than surgery alone in preventing local recurrence in patients with resectable rectal cancer and it may also improve survival. A single trial, using surgery with total mesorectal excision, has shown similar benefits in local recurrence. Conclusion For adult patients with clinically resectable rectal cancer we conclude that: • Preoperative radiotherapy is an acceptable alternative to the previous practice of postoperative radiotherapy for patients with stage II and III resectable rectal cancer; • Both preoperative and postoperative radiotherapy decrease local recurrence but neither improves survival as much as postoperative radiotherapy combined with chemotherapy. Therefore, if preoperative radiotherapy is used

  2. Infant Mental Health Assessment and Intervention Guidance for Service Providers and Families of Young Children. Service Guideline 4.

    Science.gov (United States)

    Connecticut Birth to Three System, Hartford.

    This guide offers assessment and intervention guidelines for the Connecticut Birth to Three system concerning the emotional and psychological well-being of infants and toddlers in the system. Emphasis is on infants and toddlers who exhibit symptoms of traumatic stress disorder, depression or other affective disorders, regulatory disorders, sleep…

  3. Assessing non-resectability of lung cancer

    International Nuclear Information System (INIS)

    To investigate whether the assessment of resectability of lung cancer can be reliably made on the basis of computed tomography (CT), the thoracic CT scans of 96 lung cancer patients who were operated on, and in whom the tumour was classified to be of stage III at preoperative CT or at thoracotomy, were analysed. Of the patients, 58 underwent complete resection of the tumour, whereas thoracotomy resulted in non-complete resection or exploration only in 38 cases. Overlapping of the CT findings in the groups of complete and non-successful resection was observed. The majority of tumours with apparent growth to the carina, trachea, oesophagus or great vessels at CT were completely resected. Tumours that only bordered on the pleura could not be distinguished from those with pleural invasion. Mediastinal lymph node enlargement did not always mean metastatic spread. We conclude that there is no definite sign that identifies non-resectability of lung tumours, and a certain proportion of non-curative thoracotomies must be accepted. (orig.)

  4. Follow-up for cervical cancer: a Program in Evidence-Based Care systematic review and clinical practice guideline update

    Science.gov (United States)

    Elit, L.; Kennedy, E.B.; Fyles, A.; Metser, U.

    2016-01-01

    Background In 2009, the Program in Evidence-based Care (pebc) of Cancer Care Ontario published a guideline on the follow-up of cervical cancer. In 2014, the pebc undertook an update of the systematic review and clinical practice guideline for women in this target population. Methods The literature from 2007 to August 2014 was searched using medline and embase [extended to 2000 for studies of human papillomavirus (hpv) dna testing]. Outcomes of interest were measures of survival, diagnostic accuracy, and quality of life. A working group evaluated the need for changes to the earlier guidelines and incorporated comments and feedback from internal and external reviewers. Results One systematic review and six individual studies were included. The working group concluded that the new evidence did not warrant changes to the 2009 recommendations, although hpv dna testing was added as a potentially more sensitive method of detecting recurrence in patients treated with radiotherapy. Comments from internal and external reviewers were incorporated. Recommendations Summary Follow-up care after primary treatment should be conducted and coordinated by a physician experienced in the surveillance of cancer patients. A reasonable follow-up strategy involves visits every 3–4 months within the first 2 years, and every 6–12 months during years 3–5. Visits should include a patient history and complete physical examination, with elicitation of relevant symptoms. Vaginal vault cytology examination should not be performed more frequently than annually. Combined positron-emission tomography and computed tomography, other imaging, and biomarker evaluation are not advocated; hpv dna testing could be useful as a method of detection of recurrence after radiotherapy. General recommendations for follow-up after 5 years are also provided. PMID:27122975

  5. Optimal contouring of seminal vesicle for definitive radiotherapy of localized prostate cancer: comparison between EORTC prostate cancer radiotherapy guideline, RTOG0815 protocol and actual anatomy

    International Nuclear Information System (INIS)

    Intermediate- to-high-risk prostate cancer can locally invade seminal vesicle (SV). It is recommended that anatomic proximal 1-cm to 2-cm SV be included in the clinical target volume (CTV) for definitive radiotherapy based on pathology studies. However, it remains unclear whether the pathology indicated SV extent is included into the CTV defined by current guidelines. The purpose of this study is to compare the volume of proximal SV included in CTV defined by EORTC prostate cancer radiotherapy guideline and RTOG0815 protocol with the actual anatomic volume. Radiotherapy planning CT images from 114 patients with intermediate- (36.8%) or high-risk (63.2%) prostate cancer were reconstructed with 1-mm-thick sections. The starting and ending points of SV and the cross sections of SV at 1-cm and 2-cm from the starting point were determined using 3D-view. Maximum (D1H, D2H) and minimum (D1L, D2L) vertical distance from these cross sections to the starting point were measured. Then, CTV of proximal SV defined by actual anatomy, EORTC guideline and RTOG0815 protocol were contoured and compared (paired t test). Median length of D1H, D1L, D2H and D2L was 10.8 mm, 2.1 mm, 17.6 mm and 8.8 mm (95th percentile: 13.5mm, 5.0mm, 21.5mm and 13.5mm, respectively). For intermediate-risk patients, the proximal 1-cm SV CTV defined by EORTC guideline and RTOG0815 protocol inadequately included the anatomic proximal 1-cm SV in 62.3% (71/114) and 71.0% (81/114) cases, respectively. While for high-risk patients, the proximal 2-cm SV CTV defined by EORTC guideline inadequately included the anatomic proximal 2-cm SV in 17.5% (20/114) cases. SV involvement indicated by pathology studies was not completely included in the CTV defined by current guidelines. Delineation of proximal 1.4 cm and 2.2 cm SV in axial plane may be adequate to include the anatomic proximal 1-cm and 2-cm SV. However, part of SV may be over-contoured

  6. Spanish guideline for the definition and assessment of risk-informed inservice inspection programs for piping

    International Nuclear Information System (INIS)

    The recent emphasis on risk-informed in-service inspection has been taken on by the Spanish Utilities and the Spanish Regulatory Body in their proposal for a co-operation project for defining a Risk-Informed In-Service Inspection Guideline for Piping. This paper describes first the main features of this Spanish guideline and then the results of the pilot applications developed in order to check the consistency of the guideline. (authors)

  7. Reliability and accuracy assessment of radiation therapy oncology group-endorsed guidelines for brachial plexus contouring

    Energy Technology Data Exchange (ETDEWEB)

    Velde, Joris van de [Ghent University, Department of Anatomy, Ghent (Belgium); Ghent University, Department of Radiotherapy, Ghent (Belgium); Vercauteren, Tom; Gersem, Werner de; Vandecasteele, Katrien; Vuye, Philippe; Vanpachtenbeke, Frank; Neve, Wilfried de [Ghent University, Department of Radiotherapy, Ghent (Belgium); Wouters, Johan; Herde, Katharina d' ; Kerckaert, Ingrid; Hoof, Tom van [Ghent University, Department of Anatomy, Ghent (Belgium)

    2014-07-15

    The goal of this work was to validate the Radiation Therapy Oncology Group (RTOG)-endorsed guidelines for brachial plexus (BP) contouring by determining the intra- and interobserver agreement. Accuracy of the delineation process was determined using anatomically validated imaging datasets as a gold standard. Five observers delineated the right BP on three cadaver computed tomography (CT) datasets. To assess intraobserver variation, every observer repeated each delineation three times with a time interval of 2 weeks. The BP contours were divided into four regions for detailed analysis. Inter- and intraobserver variation was verified using the Computerized Environment for Radiation Research (CERR) software. Accuracy was measured using anatomically validated fused CT-magnetic resonance imaging (MRI) datasets by measuring the BP inclusion of the delineations. The overall kappa (κ) values were rather low (mean interobserver overall κ: 0.29, mean intraobserver overall κ: 0.45), indicating poor inter- and intraobserver reliability. In general, the κ coefficient decreased gradually from the medial to lateral BP regions. The total agreement volume (TAV) was much smaller than the union volume (UV) for all delineations, resulting in a low Jaccard index (JI; interobserver agreement 0-0.124; intraobserver agreement 0.004-0.636). The overall accuracy was poor, with an average total BP inclusion of 38 %. Inclusions were insufficient for the most lateral regions (region 3: 21.5 %; region 4: 12.6 %). The inter- and intraobserver reliability of the RTOG-endorsed BP contouring guidelines was poor. BP inclusion worsened from the medial to lateral regions. Accuracy assessment of the contours showed an average BP inclusion of 38 %. For the first time, this was assessed using the original anatomically validated BP volume. The RTOG-endorsed BP guidelines have insufficient accuracy and reliability, especially for the lateral head-and-neck regions. (orig.) [German] Ziel der Studie war

  8. Changes in acute response to radiation after implementation of new national guidelines for head and neck cancer

    DEFF Research Database (Denmark)

    Hansen, C. R.; Bertelsen, Anders; Zukauskaite, R.;

    2015-01-01

    Purpose/Objective: New national guidelines (GL) for radiotherapy (RT) of head and neck cancer (HNC) were implemented at the beginning of 2013. One purpose of the new GL was to nationally standardise the expansion from GTV to high risk CTV (CTV1). This standardisation has resulted in change...... of volume of CTV1 for most institutions which previously used different margins. Change in CTV1 volume definition could influence the risk and time evolution of adverse effects e.g. mucositis. This study investigates change in acute response during RT in a centre where GTV to CTV1 margin was increased from...

  9. Genetic testing for young-onset colorectal cancer: case report and evidence-based clinical guidelines

    OpenAIRE

    Zhou, Yaolin; Boardman, Lisa A; Miller, Robert C.

    2010-01-01

    Background Young-onset colorectal cancer is clinicopathologically different from older-onset colorectal cancer and tends to occur in patients with hereditary germline conditions such as Lynch syndrome and familial adenomatous polyposis. Case report. We describe the case of a 44-year-old man with a paternal history of colon polyps, a personal 2-year history of hematochezia, and a diagnosis of rectal cancer. Further clinical evaluation of the patient at our institution determined the cancer to ...

  10. Health literacy and meeting breast and cervical cancer screening guidelines among Asians and whites in California

    OpenAIRE

    Sentell, Tetine; Braun, Kathryn L; Davis, James; Davis, Terry

    2015-01-01

    Objectives Empirical evidence regarding cancer screening and health literacy is mixed. Cancer is the leading cause of death in Asian Americans, yet screening rates are notably low. Using a population-based sample, we determined if health literacy: (1) was associated with breast and cervical cancer screening, and (2) helped to explain Asian cancer screening disparities. Methods We analyzed the 2007 California Health Interview Survey for Asian (Japanese, Chinese, Filipino, Korean, Vietnamese, o...

  11. ICF linked Dutch physiotherapy guidelines concerning initial assessment, treatment and evaluation in hip and knee osteoarthritis.

    NARCIS (Netherlands)

    Peter, W.; Jansen, M.J.; Hurkmans, E.J.; Bloo, H.; Dekker-Bakker, L.M.M.C.J.; Dilling, R.G.; Hilberdink, W.K.H.A.; Kersten-Smit, C.; Rooij, M. de; Veenhof, C.; Vermeulen, E.M.; Vos, I. de; Schoones, J.W.; Vliet Vlieland, T.P.

    2011-01-01

    Purpose: In 2001 the Royal Dutch Society for Physical Therapy (KNGF) Guideline for hip and knee osteoarthritis (HKOA) was developed. Since then, many scientific papers on physical therapy interventions as well as national and international guidelines were published. Relevance: An update of the physi

  12. Application of OECD Guideline 423 in assessing the acute oral toxicity of moniliformin.

    Science.gov (United States)

    Jonsson, Martina; Jestoi, Marika; Nathanail, Alexis V; Kokkonen, Ulla-Maija; Anttila, Marjukka; Koivisto, Pertti; Karhunen, Pirkko; Peltonen, Kimmo

    2013-03-01

    Moniliformin is a Fusarium mycotoxin highly prevalent in grains and grain-based products worldwide. In this study, the acute oral toxicity of moniliformin was assessed in Sprague-Dawley male rats according to OECD Guideline 423 with a single-dose exposure. Clinical observations and histopathological changes were recorded together with the excretion of moniliformin via urine and feces, utilizing a novel liquid chromatography-mass spectrometry method. According to our study, moniliformin is acutely toxic to rats with a rather narrow range of toxicity. Moniliformin can be classified into category 2 (LD(50) cut-off value 25 mg/kg b.w.), according to the Globally Harmonized System for the classification of chemicals. The clinical observations included muscular weakness, respiratory distress and heart muscle damage. Pathological findings confirmed that heart is the main target tissue of acute moniliformin toxicity. A significant proportion (about 38%) of the administered moniliformin was rapidly excreted in urine in less than 6 h. However, the toxicokinetics of the majority of the administered dose still requires clarification, as the total excretion was only close to 42%. Considering the worldwide occurrence of moniliformin together with its high acute toxicity, research into the subchronic toxicity is of vital importance to identify the possible risk in human/animal health. PMID:23201451

  13. European guidelines for quality assurance in colorectal cancer screening and diagnosis

    DEFF Research Database (Denmark)

    von Karsa, L; Patnick, J; Segnan, N;

    2013-01-01

    -based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.  They include 10 chapters and over 250 recommendations, individually graded...... according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and...... appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open...

  14. Assessment of the psychological distress difficulties in patients with cancer using the national comprehensive cancer network rapid screening measure

    Institute of Scientific and Technical Information of China (English)

    Hamid Saeedi Saedi; Mona Koochak Pour; Emad Sabahi; Soodabeh Shahidsales

    2012-01-01

    Objective: Clinical guidelines like National Comprehensive Cancer Network Disease recommend routine psychological distress screening as a common problem among patients with cancer. The purpose of this study was to assess the prevalence of clinically significant emotional distress related to demographic and clinical association by standard distress thermometer (DT) within the patients lived in different regions of Gilan state, Iran. Methods: Participants (n = 256) completed the DT, rapid screening measure for distress and identified the presence or absence of 34 problems using the standardized checklist. Results: More than 59 percent of participants had more than 4 cut-off score for distress. The scores varied significantly in case of reported emotional source of distress, physical, physiological and total number of concerns (P < 0.001).DT scores more than four were more likely to report 22 of 32 problems on the problem list. In case of the practical and family problems, the main problems were related to child care and dealing with children, respectively. Moreover worrisome and nervousness were considered the prominent emotional problems in the list. Conclusion: Our result promise that distress thermometer measurement tool compare favorably with longer measures used to screening of distress in cancerous patients. Accompaniment of a psychologist expert in lethal or chronic disease consultation with the therapeutic team and training the rest of members of the team might be able to decrease the emotional distress problems of the cancerous patients.

  15. A treatment planning comparison of four target volume contouring guidelines for locally advanced pancreatic cancer radiotherapy

    International Nuclear Information System (INIS)

    Background and purpose: Contouring of target volumes varies significantly in radiotherapy of pancreatic ductal adenocarcinoma (PDAC). There is a lack of consensus as to whether elective lymph nodes (eLN’s) should be included or not in the planning target volume (PTV). In the present study we analyzed the dosimetric coverage of the eLN’s and organs at risk (OAR) by comparing four different contouring guidelines. Methods and materials: PTVs were delineated with (Oxford and RTOG guidelines) or without (Michigan and SCALOP guidelines) including the eLNs in eleven patients with PDAC. eLNs included the peripancreatic, paraaortic, paracaval, celiac trunk, superior mesenteric and portal vein clinical target volumes (CTVs). A 3D-CRT plan (50.40 Gy in 28 fractions) was performed to analyze and compare the dosimetric coverage of all eLNs and OAR between the 4 contouring guidelines. Results: The size of Oxford and RTOG PTVs was comparable and significantly larger than the SCALOP and Michigan PTVs. Interestingly the eLNs received a significant amount of incidental dose irradiation by PTV-based plans that only aimed to treat the tumor without the eLNs. The dosimetric coverage of eLN presented a large variability according to the respective contouring methods. The difference in the size of the 4 PTVs was reflected to the dose distribution at the OAR. Conclusions: Our study provides important information regarding the impact of different contouring guidelines on the dose distribution to the eLNs and the OAR in patients with locally advanced PDAC treated with radiotherapy

  16. SCART guidelines. Reference report for IAEA Safety Culture Assessment Review Team (SCART)

    International Nuclear Information System (INIS)

    The IAEA Director General stressed the role of safety culture in his concluding remarks at the Meeting of the Contracting Parties to the Convention on Nuclear Safety in 2002: 'As we have learned in other areas, it is not enough simply to have a structure; it is not enough to say that we have the necessary laws and the appropriate regulatory bodies. All these are important, but equally important is that we have in place a safety culture that gives effect to the structure that we have developed. To me, effectiveness and transparency are keys. So, it is an issue which I am pleased to see, you are giving the attention it deserves and we will continue to work with you in clarifying, developing and applying safety culture through our programmes and through our technical cooperation activities.' The concept of safety culture was initially developed by the International Nuclear Safety Advisory Group (INSAG) after the Chernobyl accident in 1986. Since then the IAEA's perspective of safety culture has expanded with time as its recognition of the complexities of the concept developed. Safety culture is considered to be specific organizational culture in all types of organizations with activities that give rise to radiation risks. The aim is to make safety culture strong and sustainable, so that safety becomes a primary focus for all activities in such organizations, even for those, which might not look safety-related at first. SCART (Safety Culture Assessment Review Team) is a safety review service, which reflects the expressed interest of Members States for methods and tools for safety culture assessment. It is a replacement for the earlier service ASCOT (Assessment of Safety Culture in Organizations Team). The IAEA Safety Fundamentals, Requirements and Guides (Safety Standards) are the basis for the SCART Safety Review Service. The reports of INSAG, identifying important current nuclear safety issues, serve also as references during a SCART mission. SCART missions are based

  17. GEOTHERMAL ENVIRONMENTAL IMPACT ASSESSMENT: GROUND WATER MONITORING GUIDELINES FOR GEOTHERMAL DEVELOPMENT

    Science.gov (United States)

    This report discusses potential ground water pollution from geothermal resource development, conversion, and waste disposal, and proposes guidelines for developing a ground water monitoring plan for any such development. Geothermal processes, borehole logging, and injection well ...

  18. Molecular and Serological Assessment of Chronic HBV Carriers and Additional Burden of Applying Updated Guidelines in Pakistan

    International Nuclear Information System (INIS)

    Objective: To assess the additional burden of the patients eligible for treatment, based on recommendations on viral load, in the light of 2009 version of AASLD guidelines, as compared to 2004 guidelines and to determine the frequency of HBeAg in chronic HBV carriers. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Virology Department, Armed Forces Institute of Pathology, Rawalpindi, from November 2010 to January 2012. Methodology: Persons with chronic HBV infection, reporting for HBV DNA PCR test, were included in the study and blood samples were collected. HBV DNA load was determined by Real Time PCR. HBsAg and HBeAg were tested by ELISA. Results: Out of the 801 subjects positive for HBsAg, 74 (9.24%) were positive for HBeAg. Out of them, 113 (14.1%) had HBV DNA load > 100,000 copies/ml and were eligible for treatment according to AASLD 2004 guidelines. Forty one (5.1%) had HBV load between 10,000 and 100,000 copies/ml, and were additionally eligible for treatment as per AASLD 2009 guidelines. The 5.1% of 4.5 million estimated HBV carries in Pakistan comes to 229500. Conclusion: There was a low HBeAg positivity and HBV DNA positivity in our chronic HBV infected persons. Moreover, there is an increase of 229500 potential candidates for HBV treatment in Pakistan based on viral load testing, according to the AASLD 2009 guidelines when compared with 2004 guidelines. The increase in the number of candidates for treatment may require an additional expenditure of tens of billions of rupees. (author)

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

    OpenAIRE

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

    2001-01-01

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

  20. Delineation of target volumes and organs at risk in adjuvant radiotherapy of early breast cancer: National guidelines and contouring atlas by the Danish Breast Cancer Cooperative Group

    International Nuclear Information System (INIS)

    During the past decade planning of adjuvant radiotherapy (RT) of early breast cancer has changed from two-dimensional (2D) to 3D conformal techniques. In the planning computerised tomography (CT) scan both the targets for RT and the organs at risk (OARs) are visualised, enabling an increased focus on target dose coverage and homogeneity with only minimal dose to the OARs. To ensure uniform RT in the national prospective trials of the Danish Breast Cancer Cooperative Group (DBCG), a national consensus for the delineation of clinical target volumes (CTVs) and OARs was required. Material and methods. A CT scan of a breast cancer patient after surgical breast conservation and axillary lymph node (LN) dissection was used for delineation. During multiple dummy-runs seven experienced radiation oncologists contoured all CTVs and OARs of interest in adjuvant breast RT. Two meetings were held in the DBCG Radiotherapy Committee to discuss the contouring and to approve a fi nal consensus. The Dice similarity coefficient (DSC) was used to evaluate the delineation agreement before and after the consensus. Results. The consensus delineations of CTVs and OARs are available online and a table is presented with a contouring description of the individual volumes. The consensus provides recommendations for target delineation in a standard patient both in case of breast conservation or mastectomy. Before the consensus, the average value of the DSC was modest for most volumes, but high for the breast CTV and the heart. After the consensus, the DSC increased for all volumes. Conclusion. The DBCG has provided the fi rst national guidelines and a contouring atlas of CTVs and OARs definition for RT of early breast cancer. The DSC is a useful tool in quantifying the effect of the introduction of guidelines indicating improved inter-delineator agreement. This consensus will be used by the DBCG in our prospective trials

  1. Caries risk assessment in young adults using Public Dental Service guidelines and the Cariogram-a comparative study

    DEFF Research Database (Denmark)

    Hänsel Petersson, Gunnel; Ericson, Ewa; Isberg, Per-Erik; Twetman, Svante

    2012-01-01

    Abstract Objectives. To investigate the caries risk profiles in young adults and to compare the risk classification using the Public Dental Service (PDS) guidelines with a risk assessment program, the Cariogram. Materials and methods. All 19-year-old patients registered at eight public dental...... to the PDS guidelines. A research team collected whole saliva samples and information from a questionnaire and a structured interview in order to calculate risk according to the Cariogram model. Results. The mean DFS value was 4.9 and 23% of the patients were registered as caries-free (DFS = 0). The...... PDS risk classification was predominantly based on past caries and/or present caries activity. The majority was classified as 'some risk', while 16.7% were assessed as being of 'high' or 'very high risk'. The corresponding value for the two highest risk groups in the Cariogram model was 17.4%. The...

  2. Nutritional status assessment in colorectal cancer patients

    OpenAIRE

    Joana Pedro Lopes; Paula Manuela de Castro Cardoso Pereira; Ana Filipa dos Reis Baltazar Vicente; Alexandra Bernardo; María Fernanda de Mesquita

    2013-01-01

    The present study intended to evaluate the nutritional status of Portuguese colorectal patients and associated it with surgery type as well as quality of life outcomes. Malnutrition can affect up to 85% of cancer patients and specifically 30-60% in colorectal cancer and can significantly influence health outcomes. A sample of 50 colorectal cancer patients was evaluated in what refers to several anthropometric measures, food intake, clinical history, complications rate before and after surgery...

  3. Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea.

    OpenAIRE

    Chung, F; Memtsoudis, SG; Ramachandran, SK; Nagappa, M; Opperer, M; Cozowicz, C; Patrawala, S; Lam, D.; Kumar, A; Joshi, GP; Fleetham, J; Ayas, N; Collop, N; Doufas, AG; Eikermann, M

    2016-01-01

    The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading...

  4. DEGRO practical guidelines for radiotherapy of breast cancer V. Therapy for locally advanced and inflammatory breast cancer, as well as local therapy in cases with synchronous distant metastases

    Energy Technology Data Exchange (ETDEWEB)

    Budach, Wilfried; Matuschek, Christiane; Boelke, Edwin [University Hospital, Heinrich-Heine-University Duesseldorf, Klinik fuer Strahlentherapie und Radioonkologie, Duesseldorf (Germany); Dunst, Juergen [University Hospital Schleswig-Holstein, Luebeck (Germany); Feyer, Petra [Vivantes Hospital Neukoelln, Berlin (Germany); Fietkau, Rainer; Sauer, Rolf [University Hospital Erlangen, Erlangen (Germany); Harms, Wolfgang [St. Clara Hospital, Basel (Switzerland); Piroth, Marc D. [Helios Hospital, Wuppertal (Germany); Sautter-Bihl, Marie-Luise [Municipal Hospital, Karlsruhe (Germany); Sedlmayer, Felix [Paracelsus Medical University Hospital, Salzburg (Austria); Wenz, Frederick [Universitaetsmedizin Mannheim, Mannheim (Germany); Haase, Wulf; Souchon, Rainer; Collaboration: Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)

    2015-08-15

    The purpose of this work is to give practical guidelines for radiotherapy of locally advanced, inflammatory and metastatic breast cancer at first presentation. A comprehensive survey of the literature using the search phrases ''locally advanced breast cancer'', ''inflammatory breast cancer'', ''breast cancer and synchronous metastases'', ''de novo stage IV and breast cancer'', and ''metastatic breast cancer'' and ''at first presentation'' restricted to ''clinical trials'', ''randomized trials'', ''meta-analysis'', ''systematic review'', and ''guideline'' was performed and supplemented by using references of the respective publications. Based on the German interdisciplinary S3 guidelines, updated in 2012, this publication addresses indications, sequence to other therapies, target volumes, dose, and fractionation of radiotherapy. International and national guidelines are in agreement that locally advanced, at least if regarded primarily unresectable and inflammatory breast cancer should receive neoadjuvant systemic therapy first, followed by surgery and radiotherapy. If surgery is not amenable after systemic therapy, radiotherapy is the treatment of choice followed by surgery, if possible. Surgery and radiotherapy should be administered independent of response to neoadjuvant systemic treatment. In patients with a de novo diagnosis of breast cancer with synchronous distant metastases, surgery and radiotherapy result in considerably better locoregional tumor control. An improvement in survival has not been consistently proven, but may exist in subgroups of patients. Radiotherapy is an important part in the treatment of locally advanced and inflammatory breast cancer that should be given to all patients regardless to the intensity and effect of

  5. Bone Health in Patients with Breast Cancer: Recommendations from an Evidence-Based Canadian Guideline

    Directory of Open Access Journals (Sweden)

    Alexander H. G. Paterson

    2013-12-01

    Full Text Available Bone loss is common in patients with breast cancer. Bone modifying agents (BMAs, such as bisphosphonates and denosumab, have been shown to reverse or stabilize bone loss and may be useful in the primary and metastatic settings. The purpose of this review is to provide clear evidence-based strategies for the management of bone loss and its symptoms in breast cancer. A systematic review of clinical trials and meta-analyses published between 1996 and 2012 was conducted of MEDLINE and EMBASE. Reference lists were hand-searched for additional publications. Recommendations were developed based on the best available evidence. Zoledronate, pamidronate, clodronate, and denosumab are recommended for metastatic breast cancer patients; however, no one agent can be recommended over another. Zoledronate or any oral bisphosphonate and denosumab should be considered in primary breast cancer patients who are postmenopausal on aromatase inhibitor therapy and have a high risk of fracture and/or a low bone mineral density and in premenopausal primary breast cancer patients who become amenorrheic after therapy. No one agent can be recommended over another. BMAs are not currently recommended as adjuvant therapy in primary breast cancer for the purpose of improving survival, although a major Early Breast Cancer Cooperative Trialists’ Group meta-analysis is underway which may impact future practice. Adverse events can be managed with appropriate supportive care.

  6. Preventive vaccination against cervical cancer: Korean Society of Gynecologic Oncology Guideline

    OpenAIRE

    Min, Kyung-Jin; Kwon, Sang-Hoon; Kim, Sunghoon; Kim, Hyun Jung; Seong, Seok Ju; Song, Yong Jung; Shin, Jin Woo; Lee, Keun Ho; Lim, Myong Cheol; Chung, Hyun Hoon; Ju, Woong; Hong, Jin Hwa; Lee, Jeong-Won; Kim, Jae-Weon; Bae, Duk-Soo

    2016-01-01

    After human papillomavirus (HPV) vaccine guidelines published by Korean Society of Gynecologic Oncology (KSGO) in 2011, new studies have been published, leading to additional data regarding efficacy, safety, number of vaccination rounds, and ideal age of vaccine administration. We searched and reviewed the literatures focused on the efficacy of 2-dose schedule vaccination, the efficacy of 3-dose schedule vaccination in middle-aged women, the ideal age of 3-dose schedule vaccination, the safet...

  7. ASCOT guidelines

    International Nuclear Information System (INIS)

    These guidelines describe an approach used in conducting an Assessment of Safety Culture in Organizations Team (ASCOT) review. They are intended to assist the team members in conducting their reviews and at the same time provide guidance to hosts preparing to receive an ASCOT review. They may also be used by any organization wishing to conduct their own self-assessment of safety culture, independent of an ASCOT review

  8. Prevailing Practice Versus Clinical Guideline: The In-Patient Assessment And Management Of Childhood Bronchopneumonia In A Malaysian District Hospital

    Directory of Open Access Journals (Sweden)

    Jacynta Jayaram

    2008-12-01

    Full Text Available Introduction: Pneumonia is the most commondiagnosis made in hospitalised children. The MalaysianClinical Practice Guidelines on pneumonia andrespiratory tract infections provides a comprehensiveguidance in the local context. We evaluated thedocumented assessment and management of childrendiagnosed with pneumonia admitted to the children’sward, Hospital Batu Pahat against this guideline.Methods: We performed a retrospective analysis ofhospital case notes for children admitted from Januaryto May 2004.Results: Ninety six case notes were analysed. Mostpatients (84% had at least four positive clinical featuresleading to the diagnosis of pneumonia. 92% met theguideline criteria for admission. Sp02 was performed for58% on admission, and 58% with reading below 95%received supplemental oxygen. Throughout hospitalstay, each patient had an average of four investigations(range: 1 – 12. Among 23 patients who hadfurther investigations, justifications were only recordedin seven patients (30.4%, and changes inmanagement resulted in 23%. The most commonantibiotic prescribed was intravenous Penicillin (97 %.In 17 patients who met the guideline classification forsevere pneumonia, none received the recommendedantibiotic combination. The median time to feverresolution was 22 hours (range 2 – 268, and medianhospital stay was 3 days (range 1 – 12.Conclusions: Although the quality of clinicalassessment and antibiotic choices were acceptable,there was a failure to critically evaluate patientsaccording to disease severity and initiate correspondinginvestigations and managements. Future efforts need tobe directed at promoting further guideline adherenceand the exercise of critical judgment in patientevaluation.

  9. Availability, content and quality of local guidelines for the assessment of suicide attempters in university and general hospitals in the Netherlands.

    NARCIS (Netherlands)

    Verwey, B.; Waarde, J.A. van; Rooij, I.A.L.M. van; Gerritsen, G.; Zitman, F.G.

    2006-01-01

    OBJECTIVE: This study was performed to investigate the availability, content and quality of local guidelines for the assessment of suicide attempters in the Netherlands. METHOD: All university and general hospitals in the Netherlands were asked to provide their local guidelines. Published national g

  10. Development of the Stroke-unit Discharge Guideline: choice of assessment instruments for prediction in the subacute phase post-stroke

    NARCIS (Netherlands)

    R. Meijer; J. van Limbeek; R. de Haan

    2006-01-01

    The purpose of this paper is to present the design of an evidence-based dataset of assessment instruments for the prognostic factors of the Stroke-unit Discharge Guideline (SDG), a consensus based guideline for the decision of the discharge destination from the hospital stroke unit. In our systemati

  11. Development of the Stroke-unit Discharge Guideline: choice of assessment instruments for prediction in the subacute phase post-stroke.

    NARCIS (Netherlands)

    Meijer, R.; Limbeek, J. van; Haan, R. de

    2006-01-01

    The purpose of this paper is to present the design of an evidence-based dataset of assessment instruments for the prognostic factors of the Stroke-unit Discharge Guideline (SDG), a consensus based guideline for the decision of the discharge destination from the hospital stroke unit. In our systemati

  12. Multidisciplinary team conferences promote treatment according to guidelines in rectal cancer

    DEFF Research Database (Denmark)

    Brännström, Fredrik; Kroll Bjerregaard, Jon; Winbladh, Anders;

    2015-01-01

    BACKGROUND: Multidisciplinary team (MDT) conferences have been introduced into standard cancer care, though evidence that it benefits the patient is weak. We used the national Swedish Rectal Cancer Register to evaluate predictors for case discussion at a MDT conference and its impact on treatment...... radiotherapy. These results indirectly support the introduction into clinical practice of discussing all rectal cancer patients at MDT conferences, not least those being treated at low-volume hospitals.......BACKGROUND: Multidisciplinary team (MDT) conferences have been introduced into standard cancer care, though evidence that it benefits the patient is weak. We used the national Swedish Rectal Cancer Register to evaluate predictors for case discussion at a MDT conference and its impact on treatment....... MATERIAL AND METHODS: Of the 6760 patients diagnosed with rectal cancer in Sweden between 2007 and 2010, 78% were evaluated at a MDT. Factors that influenced whether a patient was discussed at a preoperative MDT conference were evaluated in 4883 patients, and the impact of MDT evaluation on the...

  13. Guidelines for information about therapy experiments: a proposal on best practice for recording experimental data on cancer therapy

    Directory of Open Access Journals (Sweden)

    González-Beltrán Alejandra N

    2012-01-01

    Full Text Available Abstract Background Biology, biomedicine and healthcare have become data-driven enterprises, where scientists and clinicians need to generate, access, validate, interpret and integrate different kinds of experimental and patient-related data. Thus, recording and reporting of data in a systematic and unambiguous fashion is crucial to allow aggregation and re-use of data. This paper reviews the benefits of existing biomedical data standards and focuses on key elements to record experiments for therapy development. Specifically, we describe the experiments performed in molecular, cellular, animal and clinical models. We also provide an example set of elements for a therapy tested in a phase I clinical trial. Findings We introduce the Guidelines for Information About Therapy Experiments (GIATE, a minimum information checklist creating a consistent framework to transparently report the purpose, methods and results of the therapeutic experiments. A discussion on the scope, design and structure of the guidelines is presented, together with a description of the intended audience. We also present complementary resources such as a classification scheme, and two alternative ways of creating GIATE information: an electronic lab notebook and a simple spreadsheet-based format. Finally, we use GIATE to record the details of the phase I clinical trial of CHT-25 for patients with refractory lymphomas. The benefits of using GIATE for this experiment are discussed. Conclusions While data standards are being developed to facilitate data sharing and integration in various aspects of experimental medicine, such as genomics and clinical data, no previous work focused on therapy development. We propose a checklist for therapy experiments and demonstrate its use in the 131Iodine labeled CHT-25 chimeric antibody cancer therapy. As future work, we will expand the set of GIATE tools to continue to encourage its use by cancer researchers, and we will engineer an ontology to

  14. Assessment of radiological referral practice and effect of computer-based guidelines on radiological requests in two emergency departments

    International Nuclear Information System (INIS)

    AIM: To assess medical emergency radiology referral practice compared with a set of French guidelines and to measure the efficiency of computer-based guidelines on unnecessary medical imaging. MATERIALS AND METHODS: All radiological requests were computerized in the medical emergency departments of two French teaching hospitals. During control periods, radiological requests were recorded but no action was taken. During intervention periods, reminder displays on screen indicated the appropriate recommendations. Three control and three intervention periods of 1 month each were conducted. The percentage of requests that did not conform to the guidelines and variation related to periods of control and intervention were measured. RESULTS: The proportion of requests that did not conform to the guidelines was 33·2% when the guidelines were inactive and decreased to 26·9% when the recommendations were active (P < 0·0001). The three imaging examinations (chest radiographs, abdominal plain radiographs and CT of the brain) accounted for more than 80% of all requests; more than 50% of abdominal plain radiographs requests did not conform with recommendations while this percentage was respectively 24·9% and 15·8% for chest radiographs and computed tomography (CT) of the brain. Seven situations accounted for 70% of non-conforming radiological referrals; in these situations, junior practitioners' knowledge was inadequate. CONCLUSION: While the computer provided advice that was tailored to the needs of individual patients, concurrent with care, the effect of our intervention was weak. However, our study identified the few situations that were responsible for the majority of unnecessary radiological requests; we expect that this result could help clinicians and radiologists to develop more specific actions for these situations. Carton, M. et al. (2002). Clinical Radiology (2002)

  15. The revised Bethesda guidelines: extent of utilization in a university hospital medical center with a cancer genetics program

    Directory of Open Access Journals (Sweden)

    Mukherjee Aparna

    2010-11-01

    Full Text Available Abstract Background In 1996, the National Cancer Institute hosted an international workshop to develop criteria to identify patients with colorectal cancer who should be offered microsatellite instability (MSI testing due to an increased risk for Hereditary Nonpolyposis Colorectal Cancer (HNPCC. These criteria were further modified in 2004 and became known as the revised Bethesda Guidelines. Our study aimed to retrospectively evaluate the percentage of patients diagnosed with HNPCC tumors in 2004 who met revised Bethesda criteria for MSI testing, who were referred for genetic counseling within our institution. Methods All HNPCC tumors diagnosed in 2004 were identified by accessing CoPath, an internal database. Both the Tumor Registry and patients' electronic medical records were accessed to collect all relevant family history information. The list of patients who met at least one of the revised Bethesda criteria, who were candidates for MSI testing, was then cross-referenced with the database of patients referred for genetic counseling within our institution. Results A total of 380 HNPCC-associated tumors were diagnosed at our institution during 2004 of which 41 (10.7% met at least one of the revised Bethesda criteria. Eight (19.5% of these patients were referred for cancer genetic counseling of which 2 (25% were seen by a genetics professional. Ultimately, only 4.9% of patients eligible for MSI testing in 2004 were seen for genetic counseling. Conclusion This retrospective study identified a number of barriers, both internal and external, which hindered the identification of individuals with HNPCC, thus limiting the ability to appropriately manage these high risk families.

  16. Serum YKL-40 in risk assessment for colorectal cancer

    DEFF Research Database (Denmark)

    Johansen, Julia Sidenius; Christensen, Ib Jarle; Jørgensen, Lars Nannestad;

    2015-01-01

    to endoscopy due to symptoms or other risk factors for colorectal cancer. Blood samples were collected just before large bowel endoscopy. Serum YKL-40 was determined by ELISA. Serum YKL-40 was higher (P < 0.0001, unadjusted for confounding covariates) in subjects diagnosed with colon cancer (median......The aim of the present study was to test the hypothesis that high serum YKL-40 associates with colorectal cancer in subjects at risk of colorectal cancer. We measured serum YKL-40 in a prospective study of 4,496 Danish subjects [2,064 men, 2,432 women, median age 61 years (range, 18-97)] referred...... useful in combination with other biomarkers in risk assessment for colorectal cancer. Cancer Epidemiol Biomarkers Prev; 24(3); 621-6. ©2015 AACR....

  17. Best practice guidelines for the use of the assessment centre method in South Africa (5th edition

    Directory of Open Access Journals (Sweden)

    Deon Meiring

    2016-04-01

    Full Text Available Orientation: Assessment Centres (ACs have a long and successful track record in South Africa when used for selection and development purposes. The popularity of the approach is mainly attributable to the ACs’ numerous strengths, which include the perceived fairness, practical utility and strong associations with on-the-job performance. To maintain the integrity of the AC, it is important for practitioners and decision makers to apply the method in a consistent and standardised manner.Research purpose: The purpose of the report is to provide practitioners and decision makers with practical guidelines and concrete procedures when using ACs as part of the organisation’s human resource management strategy. Motivation for the study: The past decade has seen significant advances in the science and practice of ACs. Now in its fifth edition, the revised Guidelines seek to provide important information to practitioners and decision makers on a number of factors when used in conjunction with the AC method, namely, technology, validation, legislation, ethics and culture.Main findings: The Guidelines provide specific suggestions and recommendations for using technology as part of the manner of delivery. Issues of culture, diversity and representation are also discussed. New features of the Guidelines include more concrete guidance on how to conduct a validation study as well as unpacking several ethical dilemmas that practitioners may encounter. Of critical importance is a position statement on the use of ACs in relation to new legislation (Employment Equity Amendment Act, Section 8, clause d pertaining to psychometric testing.Practical/managerial implications: The Guidelines serve as a benchmark of best practice for practitioners and decision makers who intend on, or are currently, using ACs in their organisations.Contribution/value-add: In the absence of formal standards governing the use of ACs in South Africa, the Guidelines provide an important

  18. DEGRO practical guidelines: radiotherapy of breast cancer II. Radiotherapy of non-invasive neoplasia of the breast

    Energy Technology Data Exchange (ETDEWEB)

    Souchon, R. [University Hospital Tuebingen, Klinik fuer Radioonkologie, Tuebingen (Germany); Sautter-Bihl, M.L. [Municipal Hospital Karlsruhe, Karlsruhe (Germany); Sedlmayer, F. [LKH Salzburg, Paracelsus Medical University Hospital, Salzburg (Austria); Budach, W. [University Hospital Duesseldorf, Duesseldorf (Germany); Dunst, J. [University Hospital Schleswig-Holstein, Luebeck (Germany); Feyer, P. [Klinikum Neukoelln, Berlin (Germany); Fietkau, R.; Sauer, R. [University Hospital Erlangen, Erlangen (Germany); Harms, W. [St. Clara Hospital, Basel (Switzerland); Wenz, F. [University Hospital Mannheim, Mannheim (Germany); Haase, W.

    2014-01-15

    To complement and update the 2007 practice guidelines of the breast cancer expert panel of the German Society of Radiation Oncology (DEGRO) for radiotherapy (RT) of breast cancer. Owing to its growing clinical relevance, in the current version, a separate paper is dedicated to non-invasive proliferating epithelial neoplasia of the breast. In addition to the more general statements of the German interdisciplinary S3 guidelines, this paper is especially focused on indication and technique of RT in addition to breast conserving surgery. The DEGRO expert panel performed a comprehensive survey of the literature comprising recently published data from clinical controlled trials, systematic reviews as well as meta-analyses, referring to the criteria of evidence-based medicine yielding new aspects compared to 2005 and 2007. The literature search encompassed the period 2008 to September 2012 using databases of PubMed and Guidelines International Network (G-I-N). Search terms were ''non invasive breast cancer'', ''ductal carcinoma in situ, ''dcis'', ''borderline breast lesions'', ''lobular neoplasia'', ''radiotherapy'' and ''radiation therapy''. In addition to the more general statements of the German interdisciplinary S3 guidelines, this paper is especially focused on indications of RT and decision making of non-invasive neoplasia of the breast after surgery, especially ductal carcinoma in situ. Among different non-invasive neoplasia of the breast only the subgroup of pure ductal carcinoma in situ (DCIS; synonym ductal intraepithelial neoplasia, DIN) is considered for further recurrence risk reduction treatment modalities after complete excision of DCIS, particularly RT following breast conserving surgery (BCS), in order to avoid a mastectomy. About half of recurrences are invasive cancers. Up to 50?% of all recurrences require salvage mastectomy

  19. SEOM clinical guidelines for the treatment of antiemetic prophylaxis in cancer patients receiving chemotherapy.

    Science.gov (United States)

    García Gómez, Jesús; Pérez López, M Eva; García Mata, Jesús; Isla Casado, Dolores

    2010-11-01

    Chemotherapy-induced emesis is one of the most frequent side effects that affect the quality of life of cancer patients undergoing chemotherapy. In recent years, clinical research has allowed us to increase our therapeutic arsenal with new drugs that have increased efficiency in the control of nausea and vomiting associated with chemo. This guide provides and update of the earlier published by our society and represents the continued commitment of SEOM to move forward and improve in the supportive care of cancer patients. PMID:20974571

  20. Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused.

    Science.gov (United States)

    Adams, Joyce A; Kellogg, Nancy D; Farst, Karen J; Harper, Nancy S; Palusci, Vincent J; Frasier, Lori D; Levitt, Carolyn J; Shapiro, Robert A; Moles, Rebecca L; Starling, Suzanne P

    2016-04-01

    The medical evaluation is an important part of the clinical and legal process when child sexual abuse is suspected. Practitioners who examine children need to be up to date on current recommendations regarding when, how, and by whom these evaluations should be conducted, as well as how the medical findings should be interpreted. A previously published article on guidelines for medical care for sexually abused children has been widely used by physicians, nurses, and nurse practitioners to inform practice guidelines in this field. Since 2007, when the article was published, new research has suggested changes in some of the guidelines and in the table that lists medical and laboratory findings in children evaluated for suspected sexual abuse and suggests how these findings should be interpreted with respect to sexual abuse. A group of specialists in child abuse pediatrics met in person and via online communication from 2011 through 2014 to review published research as well as recommendations from the Centers for Disease Control and Prevention and the American Academy of Pediatrics and to reach consensus on if and how the guidelines and approach to interpretation table should be updated. The revisions are based, when possible, on data from well-designed, unbiased studies published in high-ranking, peer-reviewed, scientific journals that were reviewed and vetted by the authors. When such studies were not available, recommendations were based on expert consensus. PMID:26220352

  1. New guidelines for diagnosis of gestational diabetes: Pathology-based impact assessment

    Directory of Open Access Journals (Sweden)

    Ezekiel Uba Nwose

    2013-01-01

    Full Text Available Background: A recent study indicated an average of 19.5% abnormal oral glucose tolerance in antenatal clients per year. Aim: The purpose of this study was to determine the impact on gestational diabetes cases due to new guidelines for diagnosis and classification of hyperglycaemia in pregnancy. Materials and Methods: This study reviewed the archived clinical pathology data on oral glucose tolerance tests performed between January 1999 and December 2008 on antenatal clients ( N = 615. The cases were reviewed to determine changes if any in percentage of gestational diabetes due to new guidelines. Results: Over the 10 years period, a yearly average of additional 10.8% antenatal cases suggestive of gestational diabetes was observed due to the new recommended thresholds. Further, the average yearly incidence would have increased from 8.8 cases to 16.2 cases, which translates to almost 46% increase in the prospective numbers of gestational diabetes. Conclusions: This report presents the extent of how the new recommended guidelines for diagnosis and classification of hyperglycaemia in pregnancy could increase the prevalence of gestational diabetes. It also provides pathology-based evidence for the epidemiology of gestational diabetes mellitus and allows for planning the costs that would be attendant to the full implementation of the new guidelines.

  2. Hereditary diffuse gastric cancer: updated clinical guidelines with an emphasis on germline CDH1 mutation carriers

    NARCIS (Netherlands)

    Post, R.S. van der; Vogelaar, I.P.; Carneiro, F.; Guilford, P.; Huntsman, D.; Hoogerbrugge, N.; Caldas, C.; Schreiber, K.E.; Hardwick, R.H.; Ausems, M.G.; Bardram, L.; Benusiglio, P.R.; Bisseling, T.M.; Blair, V.; Bleiker, E.; Boussioutas, A.; Cats, A.; Coit, D.; DeGregorio, L.; Figueiredo, J.; Ford, J.M.; Heijkoop, E.; Hermens, R.; Humar, B.; Kaurah, P.; Keller, G.; Lai, J.; Ligtenberg, M.J.; O'Donovan, M.; Oliveira, C.; Pinheiro, H.; Ragunath, K.; Rasenberg, E.; Richardson, S.; Roviello, F.; Schackert, H.; Seruca, R.; Taylor, A.; Huurne, A. Ter; Tischkowitz, M.; Joe, S.T.; Dijck, B. van; Grieken, N.C. van; Hillegersberg, R. van; Sandick, J.W. van; Vehof, R.; Krieken, J.H.J.M. van; Fitzgerald, R.C.

    2015-01-01

    Germline CDH1 mutations confer a high lifetime risk of developing diffuse gastric (DGC) and lobular breast cancer (LBC). A multidisciplinary workshop was organised to discuss genetic testing, surgery, surveillance strategies, pathology reporting and the patient's perspective on multiple aspects, inc

  3. Hereditary diffuse gastric cancer : updated clinical guidelines with an emphasis on germline CDH1 mutation carriers

    NARCIS (Netherlands)

    van der Post, Rachel S.; Vogelaar, Ingrid P.; Carneiro, Fatima; Guilford, Parry; Huntsman, David; Hoogerbrugge, Nicoline; Caldas, Carlos; Schreiber, Karen E. Chelcun; Hardwick, Richard H.; Ausems, Margreet G. E. M.; Bardram, Linda; Benusiglio, Patrick R.; Bisseling, Tanya M.; Blair, Vanessa; Bleiker, Eveline; Boussioutas, Alex; Cats, Annemieke; Coit, Daniel; DeGregorio, Lynn; Figueiredo, Joana; Ford, James M.; Heijkoop, Esther; Hermens, Rosella; Humar, Bostjan; Kaurah, Pardeep; Keller, Gisella; Lai, Jennifer; Ligtenberg, Marjolijn J. L.; O'Donovan, Maria; Oliveira, Carla; Pinheiro, Hugo; Ragunath, Krish; Rasenberg, Esther; Richardson, Susan; Roviello, Franco; Schackert, Hans; Seruca, Raquel; Taylor, Amy; ter Huurne, Anouk; Tischkowitz, Marc; Joe, Sheena Tjon A.; van Dijck, Benjamin; van Grieken, Nicole C. T.; van Hillegersberg, Richard; van Sandick, Johanna W.; Vehof, Rianne; van Krieken, J. Han; Fitzgerald, Rebecca C.

    2015-01-01

    Germline CDH1 mutations confer a high lifetime risk of developing diffuse gastric (DGC) and lobular breast cancer (LBC). A multidisciplinary workshop was organised to discuss genetic testing, surgery, surveillance strategies, pathology reporting and the patient's perspective on multiple aspects, inc

  4. Rationale, design, and implementation protocol of the Dutch clinical practice guideline Pain in patients with cancer: a cluster randomised controlled trial with short message service (SMS) and interactive voice response (IVR)

    OpenAIRE

    te Boveldt Nienke; Engels Yvonne; Besse Kees; Vissers Kris; Vernooij-Dassen Myrra

    2011-01-01

    Abstract Background One-half of patients with cancer have pain. In nearly one out of two cancer patients with pain, this was undertreated. Inadequate pain control still remains an important problem in this group of patients. Therefore, in 2008 a national, evidence-based multidisciplinary clinical practice guideline 'pain in patients with cancer' has been developed. Yet, publishing a guideline is not enough. Implementation is needed to improve pain management. An innovative implementation stra...

  5. Review on adjuvant chemotherapy for rectal cancer - why do treatment guidelines differ so much?

    DEFF Research Database (Denmark)

    Poulsen, Laurids Ø; Qvortrup, Camilla; Pfeiffer, Per;

    2015-01-01

    ) radiotherapy, four randomized studies were found where use of adjuvant chemotherapy showed no benefit in survival. Three trials were found in which a subset of patients received preoperative (chemo) radiotherapy. Two of these trials showed a statistically significant benefit of adjuvant chemotherapy. Twenty......BACKGROUND: The use of postoperative adjuvant chemotherapy is controversial for rectal adenocarcinoma. Both international and national guidelines display a great span varying from recommending no adjuvant chemotherapy at all, over single drug 5-fluororuacil (5-FU), to combinations of 5-FU...... trials were identified in which the patients did not receive preoperative (chemo) radiotherapy, including five Asian studies in which a statistically significant benefit from adjuvant chemotherapy was reported. CONCLUSIONS: Most of the data found did not support the use of postoperative adjuvant...

  6. [Clinical practice guidelines for assessment and treatment of transsexualism. SEEN Identity and Sexual Differentiation Group (GIDSEEN)].

    Science.gov (United States)

    Moreno-Pérez, Oscar; Esteva De Antonio, Isabel

    2012-01-01

    Transsexual patients can only be diagnosed and treated at functional gender identity Units with provision of high quality care, development of clinical practice guidelines, and interdisciplinary working groups. The therapeutic process has three mainstays: initial psychological diagnostic evaluation and psychotherapy, endocrinological evaluation and hormone therapy, and sex reassignment surgery. Cross-sex hormone therapy is essential for the anatomical and psychological transition process in duly selected patients. Hormones help optimize real-life sex identity, improve quality of life, and limit psychiatric co-morbidities often associated to lack of treatment. Development of this clinical practice guideline addresses the need for implementing a coordinated action protocol for comprehensive health care for transgender people in the National Health System. PMID:22542505

  7. Analyzing the "CareGap": assessing gaps in adherence to clinical guidelines in adult soft tissue sarcoma.

    Science.gov (United States)

    Waks, Zeev; Goldbraich, Esther; Farkash, Ariel; Torresani, Michele; Bertulli, Rossella; Restifo, Nicola; Locatelli, Paolo; Casali, Paolo; Carmeli, Boaz

    2013-01-01

    Clinical decision support systems (CDSSs) are gaining popularity as tools that assist physicians in optimizing medical care. These systems typically comply with evidence-based medicine and are designed with input from domain experts. Nonetheless, deviations from CDSS recommendations are abundant across a broad spectrum of disorders, raising the question as to why this phenomenon exists. Here, we analyze this gap in adherence to a clinical guidelines-based CDSS by examining the physician treatment decisions for 1329 adult soft tissue sarcoma patients in northern Italy using patient-specific parameters. Dubbing this analysis "CareGap", we find that deviations correlate strongly with certain disease features such as local versus metastatic clinical presentation. We also notice that deviations from the guideline-based CDSS suggestions occur more frequently for patients with shorter survival time. Such observations can direct physicians' attention to distinct patient cohorts that are prone to higher deviation levels from clinical practice guidelines. This illustrates the value of CareGap analysis in assessing quality of care for subsets of patients within a larger pathology. PMID:23542965

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

    OpenAIRE

    E. Van Cutsem; Cervantes, A.; Adam, R.; Sobrero, A; van Krieken, J. H.; Aderka, D; Aranda Aguilar, E; Bardelli, A.; Benson, A; Bodoky, G; Ciardiello, F; D'Hoore, A; Diaz-Rubio, E; Douillard, J-Y; Ducreux, M.

    2016-01-01

    Colorectal cancer (CRC) is one of the most common malignancies in Western countries. Over the last 20 years, and the last decade in particular, the clinical outcome for patients with metastatic CRC (mCRC) has improved greatly due not only to an increase in the number of patients being referred for and undergoing surgical resection of their localised metastatic disease but also to a more strategic approach to the delivery of systemic therapy and an expansion in the use of ablative techniques. ...

  9. Assessing, Counseling, and Treating Patients at High Risk for Breast Cancer.

    Science.gov (United States)

    Clifford, Edward; Hughes, Kevin S; Roberts, Maegan; Pirzadeh-Miller, Sara; McLaughlin, Sarah A

    2016-10-01

    Identifying patients at high risk of carrying pathogenic variants in genes is a crucial part of providing both accurate counseling and evidence-based treatment recommendations. Current risk assessment models have strengths and weaknesses that may limit their applicability to specific clinical circumstances. Clinicians must have knowledge regarding variations in available models, how they should be used, and what data they can expect from specific models. In addition, indications for genetic testing are expanding, and the adoption of next-generation sequencing has allowed the creation of multigene testing panels. Complex consequences of panel testing have included an increase in the incidence of identifying variants of uncertain significance and the identification of pathogenic variants in genes for which treatment guidelines are not available. Women diagnosed with breast cancer who carry pathogenic variants in genes with proven associations with breast cancer (BRCA1/2) or highly likely associations (PTEN, PALB2) require additional risk assessment to facilitate treatment decisions that will limit in-breast tumor recurrence and contralateral breast cancer. PMID:27401444

  10. Validation of a guideline-based composite outcome assessment tool for asthma control

    Directory of Open Access Journals (Sweden)

    Bendall Kate L

    2007-03-01

    Full Text Available Abstract Background A global definition of asthma control does not currently exist. The purpose of this study was to validate two new guideline-based composite measures of asthma control, defined as totally controlled (TC asthma and well controlled (WC asthma. Methods We used data from 3416 patients randomised and treated in the multi-centre Gaining Optimal Asthma controL (GOAL study. The criteria comprising the asthma control measures were based on Global Initiative for Asthma/National Institutes of Health guidelines. This validation study examined the measurement properties of the asthma control measures using data from run-in, baseline, 12 and 52 weeks. Forced expiratory volume in 1 second (FEV1 and the Asthma Quality of Life Questionnaire (AQLQ were used as the reference criteria in the validation analysis. Results Both measures had good discriminative ability showing significant differences in FEV1 and AQLQ scores between control classification both cross-sectionally and longitudinally (p 1 after 52 weeks than the individual components of each asthma control measure. Both of the reference criteria were independently related to each asthma control measure (p 1 and AQLQ scores at 52 weeks by control classification at 12 weeks (p Conclusion The guideline-based composite asthma control measures of WC asthma and TC asthma have good psychometric properties and are both valid functional indices of disease control in asthma.

  11. Optimizing HER2 assessment in breast cancer

    DEFF Research Database (Denmark)

    Holten-Rossing, Henrik; Møller Talman, Maj-Lis; Kristensson, Martin;

    2015-01-01

    In breast cancer, analysis of HER2 expression is pivotal for treatment decision. This study aimed at comparing digital, automated image analysis with manual reading using the HER2-CONNECT algorithm (Visiopharm) in order to minimize the number of equivocal 2+ scores and the need for reflex...

  12. Assessing the diagnostic accuracy of the identification of hyperkinetic disorders following the introduction of government guidelines in England

    Directory of Open Access Journals (Sweden)

    Ford Tamsin

    2008-11-01

    Full Text Available Abstract Background Previous studies have suggested that both underdiagnosis and overdiagnosis routinely occur in ADHD and hyperkinesis (hyperkinetic disorders. England has introduced governmental guidelines for these disorders' detection and treatment, but there has been no study on clinical diagnostic accuracy under such a regime. Methods All open cases in three Child and Adolescent Mental Health Services (CAMHS in the South East of England were assessed for accuracy in the detection of hyperkinetic disorders, using a two-stage process employing the Strengths and Difficulties Questionnaire (SDQ for screening, with the cut-off between "unlikely" and "possible" as the threshold for identification, and the Development And Well-Being Assessment (DAWBA as a valid and reliable standard. Results 502 cases were collected. Their mean age 11 years (std dev 3 y; 59% were clinically diagnosed as having a hyperkinetic disorder including ADHD. Clinicians had missed two diagnoses of hyperkinesis and six of ADHD. The only 'false positive' case was one that had become asymptomatic on appropriate treatment. Conclusion The identification of children with hyperkinetic disorders by three ordinary English CAMHS teams appears now to be generally consistent with that of a validated, standardised assessment. It seems likely that this reflects the impact of Governmental guidelines, which could therefore be an appropriate tool to ensure consistent accurate diagnosis internationally.

  13. Developing Guidelines on the Assessment and Treatment of Delirium in Older Adults at the End of Life

    OpenAIRE

    Brajtman, Susan; Wright, David; Hogan, David B.; Allard, Pierre; Bruto, Venera; Burne, Deborah; Gage, Laura; Pierre R Gagnon; Sadowski, Cheryl A; Helsdingen, Sherri; Wilson, Kimberley

    2011-01-01

    Background and Purpose Delirium at the end of life is common and can have serious consequences on an older person’s quality of life and death. In spite of the importance of detecting, diagnosing, and managing delirium at the end of life, comprehensive clinical practice guidelines (CPG) are lacking. Our objective was to develop CPG for the assessment and treatment of delirium that would be applicable to seniors receiving end-of-life care in diverse settings. Methods Using as a starting point t...

  14. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis.

    Science.gov (United States)

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

    2014-02-01

    Atopic dermatitis (AD) is a chronic, pruritic, inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in the management and care of AD, providing updated and expanded recommendations based on the available evidence. In this first of 4 sections, methods for the diagnosis and monitoring of disease, outcomes measures for assessment, and common clinical associations that affect patients with AD are discussed. Known risk factors for the development of disease are also reviewed. PMID:24290431

  15. Assessing cognitive function and capacity in older adults with cancer.

    Science.gov (United States)

    McKoy, June M; Burhenn, Peggy S; Browner, Ilene S; Loeser, Kari L; Tulas, Katrina M; Oden, Megan R; Rupper, Randall W

    2014-01-01

    The number of older individuals with cancer is increasing exponentially, mandating that oncologists contemplate more comprehensive and multidisciplinary approaches to treatment of this cohort. Recruitment of assessment instruments validated in older patients can be invaluable for guiding treatment and decision-making by both patients and providers, and can arguably contribute to improving outcomes and health-related quality of life. The Comprehensive Geriatric Assessment is one such validated instrument that can be used by oncologists to assess patient readiness and appropriateness for prescribed cancer therapy. As a multidisciplinary diagnostic and treatment process, it comprises functional status, cognitive status, social support, and advance care preferences, and is an ideal instrument for evaluating complex older individuals. It is well established that many older individuals with cancer travel with multiple comorbid illnesses, including cognitive impairment, and when presented with a cancer diagnosis struggle to choose from multiple treatment options. In addition to the complete medical history, the ability of patients to decide on a course of therapy in concert with their oncologist is critically important. Alternatively, many oncologists are conflicted as to whether true informed consent for treatment can be obtained from many older patients. Having a roadmap to decision-making capacity is therefore an inescapable imperative in geriatric oncology, because careful attention must be directed at identifying older patients with cancer who might benefit from these assessments and the individualized treatment plans that emerge. PMID:24453297

  16. Thromboprophylaxis Guidelines in Cancer with a Primary Focus on Ambulatory Patients Receiving Chemotherapy: A Review from the Southern Network on Adverse Reactions (SONAR)

    Science.gov (United States)

    Maxwell, Whitney D.; Bennett, Charles L.

    2014-01-01

    Patients with cancer are at increased risk for venous thromboembolism (VTE). Factors related to cancer type, site, stage, duration, and extent of disease contribute to the oncology patient’s risk of VTE. Patient-specific factors such as history of prior VTE and comorbidity are also contributory. The role of treatment-related factors, including chemotherapy regimen, has been a focus of recent investigation because most cases of VTE in the oncology setting occur in ambulatory patients. Thus, an emerging area of clinical research is primary VTE prophylaxis in the ambulatory cancer setting. Clinical guidelines currently recommend primary thromboprophylaxis in cancer patients who are undergoing surgery, who are hospitalized, and who are in a specific subset of high-risk ambulatory cancer patients. Validated risk stratification tools are essential for identification of patients who are at high risk of thrombosis. Emerging data from recently published clinical trials, as well as ongoing studies, are likely to advance our understanding of the potential utility of antithrombotic agents for primary prophylaxis in ambulatory patients with cancer and may influence future clinical guideline recommendations. PMID:23111863

  17. Biliary tract obstruction secondary to cancer: management guidelines and selected literature review.

    Science.gov (United States)

    Lokich, J J; Kane, R A; Harrison, D A; McDermott, W V

    1987-06-01

    Malignant biliary tract obstruction (MBTO) due to either primary biliary tract cancer or metastasis to the porta hepatis is a common clinical problem. The most common metastatic tumors causing MBTO in order of frequency are gastric, colon, breast, and lung cancers. Radiographic diagnostic procedures should proceed in a cost-effective sequence from ultrasonography, computerized tomography (CT), percutaneous transhepatic cholangiography (PTHC), and endoscopic retrograde pancreatography with the goal of establishing the site of the biliary tract obstruction. The identification of the site of obstruction could be established by ultrasound 70% to 80%, CT scan 80% to 90%, PTHC 100%, and endoscopic retrograde cholangiography (ERCP) 85%. Therapeutic intervention by radiographic decompression (PTHC or endoscopic prosthesis), surgical bypass, or radiation therapy with or without chemotherapy may be selectively used based on (1) the site of obstruction; (2) the type of primary tumor; and (3) the presence of specific symptoms related to the obstruction. ("Prophylactic" biliary tract decompression to prevent ascending cholangitis is not supported by the literature in that the frequency of sepsis in the face of malignant obstruction is small (in contrast to sepsis associated with stone disease). Furthermore, PTHC with drainage as a long-term procedure is associated with a substantial frequency of sepsis and is unnecessary and possibly problematic as a preoperative procedure simply to reduce the bilirubin level. The use of radiation therapy in conjunction with chemotherapy for patients not deemed suitable for a surgical bypass because of the presence of proximal obstruction is an important alternative to PTHC. PMID:3295131

  18. Evaluation of Chemical Warfare Agent Percutaneous Vapor Toxicity: Derivation of Toxicity Guidelines for Assessing Chemical Protective Ensembles.

    Energy Technology Data Exchange (ETDEWEB)

    Watson, A.P.

    2003-07-24

    Percutaneous vapor toxicity guidelines are provided for assessment and selection of chemical protective ensembles (CPEs) to be used by civilian and military first responders operating in a chemical warfare agent vapor environment. The agents evaluated include the G-series and VX nerve agents, the vesicant sulfur mustard (agent HD) and, to a lesser extent, the vesicant Lewisite (agent L). The focus of this evaluation is percutaneous vapor permeation of CPEs and the resulting skin absorption, as inhalation and ocular exposures are assumed to be largely eliminated through use of SCBA and full-face protective masks. Selection of appropriately protective CPE designs and materials incorporates a variety of test parameters to ensure operability, practicality, and adequacy. One aspect of adequacy assessment should be based on systems tests, which focus on effective protection of the most vulnerable body regions (e.g., the groin area), as identified in this analysis. The toxicity range of agent-specific cumulative exposures (Cts) derived in this analysis can be used as decision guidelines for CPE acceptance, in conjunction with weighting consideration towards more susceptible body regions. This toxicity range is bounded by the percutaneous vapor estimated minimal effect (EME{sub pv}) Ct (as the lower end) and the 1% population threshold effect (ECt{sub 01}) estimate. Assumptions of exposure duration used in CPE certification should consider that each agent-specific percutaneous vapor cumulative exposure Ct for a given endpoint is a constant for exposure durations between 30 min and 2 hours.

  19. American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) Practice Guideline for the Transperineal Permanent Brachytherapy of Prostate Cancer

    International Nuclear Information System (INIS)

    Transperineal permanent prostate brachytherapy is a safe and efficacious treatment option for patients with organ-confined prostate cancer. Careful adherence to established brachytherapy standards has been shown to improve the likelihood of procedural success and reduce the incidence of treatment-related morbidity. A collaborative effort of the American College of Radiology (ACR) and American Society for Therapeutic Radiation Oncology (ASTRO) has produced a practice guideline for permanent prostate brachytherapy. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, physicist and dosimetrist. Factors with respect to patient selection and appropriate use of supplemental treatment modalities such as external beam radiation and androgen suppression therapy are discussed. Logistics with respect to the brachtherapy implant procedure, the importance of dosimetric parameters, and attention to radiation safety procedures and documentation are presented. Adherence to these practice guidelines can be part of ensuring quality and safety in a successful prostate brachytherapy program.

  20. General guidelines for safe and expeditious international transport of samples subjected to biological dosimetry assessment

    International Nuclear Information System (INIS)

    It has been observed that victims of accidental overexposures show better chance of survival if they receive medical treatment early. The increased risk of scenarios involving mass casualties has stimulated the scientific community to develop tools that would help the medical doctors to treat victims. The biological dosimetry has become a routine test to estimate the dose, supplementing physical and clinical dosimetry. In case of radiation emergencies, in order to provide timely and effectively biological dosimetry assistance it is essential to guarantee an adequate transport of blood samples in principal, for providing support to countries that do not have bio-dosimetry laboratories. The objective of the present paper is to provide general guidelines, summarised in 10 points, for timely and proper receiving and sending of blood samples under National and International regulations, for safe and expeditious international transport. These guidelines cover the classification, packaging, marking, labelling, refrigeration and documentation requirements for the international shipping of blood samples and pellets, to provide assistance missions with a tool that would contribute with the preparedness for an effective bio-dosimetric response in cases of radiological or nuclear emergencies. (authors)

  1. Guidelines for youth sports clubs to develop, implement, and assess health promotion within its activities.

    Science.gov (United States)

    Kokko, Sami

    2014-05-01

    The settings approach to health promotion is a world-known concept concerning settings like city, hospital, school, and workplace. The concept has also been used in some regionally specific settings, such as island, prison, or university. However, there are still many, often noninstitutional, settings that have a lot of potential but have not yet been recognized. One of the newcomers is the youth sports club, which has the potential to reach a lot of children and adolescents and is effective, via its casual educational nature based on voluntary participation. According to research, health is an important aim for most youth sports clubs, but it has not been converted into practical actions. Indeed, the clubs often recognize the importance of healthy lifestyles, but there is a lack of understanding of what to do to reinforce it within one's activities. That is why, on the basis of the results of the Health Promoting Sports Club survey in Finland, guidelines for clubs to enhance health promotion as a part of their activities were created. The aim of this article is to present the guidelines, theirs rationale, and practical examples. PMID:24357861

  2. Patient safety in external beam radiotherapy – Guidelines on risk assessment and analysis of adverse error-events and near misses: Introducing the ACCIRAD project

    International Nuclear Information System (INIS)

    In 2011 the European Commission launched a tender to develop guidelines for risk analysis of accidental and unintended exposures in external beam radiotherapy. This tender was awarded to a consortium of 6 institutions, including the ESTRO, in late 2011. The project, denominated “ACCIRAD”, recently finished the data collection phase. Data were collected by surveys administered in 38 European countries. Results indicate non-uniform implementation of event registration and classification, as well as incomplete or zero implementation of risk assessment and events analysis. Based on the survey results and analysis thereof, project leaders are currently drafting proposed guidelines entitled “Guidelines for patient safety in external beam radiotherapy – Guidelines on risk assessment and analysis of adverse-error events and near misses”. The present article describes the aims and current status of the project, including results of the surveys

  3. Methodological guidelines

    International Nuclear Information System (INIS)

    The guideline document establishes a general overview of the main components of climate change mitigation assessment. This includes an outline of key economic concepts, scenario structure, common assumptions, modelling tools and country study assumptions. The guidelines are supported by Handbook Reports that contain more detailed specifications of calculation standards, input assumptions and available tools. The major objectives of the project have been provided a methodology, an implementing framework and a reporting system which countries can follow in meeting their future reporting obligations under the FCCC and for GEF enabling activities. The project builds upon the methodology development and application in the UNEP National Abatement Coasting Studies (UNEP, 1994a). The various elements provide countries with a road map for conducting climate change mitigation studies and submitting national reports as required by the FCCC. (au) 121 refs

  4. Methodological guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Halsnaes, K.; Callaway, J.M.; Meyer, H.J.

    1999-04-01

    The guideline document establishes a general overview of the main components of climate change mitigation assessment. This includes an outline of key economic concepts, scenario structure, common assumptions, modelling tools and country study assumptions. The guidelines are supported by Handbook Reports that contain more detailed specifications of calculation standards, input assumptions and available tools. The major objectives of the project have been provided a methodology, an implementing framework and a reporting system which countries can follow in meeting their future reporting obligations under the FCCC and for GEF enabling activities. The project builds upon the methodology development and application in the UNEP National Abatement Coasting Studies (UNEP, 1994a). The various elements provide countries with a road map for conducting climate change mitigation studies and submitting national reports as required by the FCCC. (au) 121 refs.

  5. Assessment of Breast Cancer Risk and Belief in Breast Cancer Screening Among the Primary Healthcare Nurses.

    Science.gov (United States)

    İz, Fatma Başalan; Tümer, Adile

    2016-09-01

    Breast cancer is the most frequently diagnosed cancer in women. Early detection of breast cancer is known to increase survival rates significantly after diagnosis. This research was carried out to determine the level of breast cancer risk among primary healthcare nurses and their belief in breast cancer screening. In this descriptive research, the data were collected in face-to-face interviews with the participants. The researchers contacted all primary healthcare nurses currently working in the province. The data collection tools included a questionnaire form on sociodemographic characteristics, breast cancer risk assessment form, and Champion's Health Belief Model Scale (CHBMS) for breast cancer screening. In data analysis, descriptive statistics, t test, and analysis of variance (ANOVA) were used. The mean age of nurses was 35 ± 3.6. The mean score for the breast cancer risk assessment form was calculated as 82.9 ± 18.7. The subscale scores for the CHBMS for breast cancer screening were as follows: susceptibility 7.3 ± 1.8, seriousness 19.5 ± 4.1, benefits of breast self-exam 15.5 ± 2.6, barriers to breast self-exam 15.1 ± 2.8, self-efficacy 40.3 ± 7.0, and motivation 19.5 ± 4.1. The risk of breast cancer was found to be low in the study group. The analysis of the subscale scores for the CHBMS for breast cancer screening revealed that nurses had a below-average susceptibility perception, a somewhat lower perception of seriousness, an above-average mean score for perceived benefits, a moderate barrier perception, a relatively high perceived self-efficacy, and motivation above average. PMID:26758047

  6. Evaluation of the Families SHARE workbook: an educational tool outlining disease risk and healthy guidelines to reduce risk of heart disease, diabetes, breast cancer and colorectal cancer

    OpenAIRE

    Koehly, Laura M.; Morris, Bronwyn A.; Skapinsky, Kaley; Goergen, Andrea; Ludden, Amanda

    2015-01-01

    Background Common diseases such as heart disease, diabetes, and cancer are etiologically complex with multiple risk factors (e.g., environment, genetic, lifestyle). These risk factors tend to cluster in families, making families an important social context for intervention and lifestyle-focused disease prevention. The Families Sharing Health Assessment and Risk Evaluation (SHARE) workbook was designed as an educational tool outlining family health history based risk of heart disease, type 2 d...

  7. Radiation Therapy Oncology Group Consensus Panel Guidelines for the Delineation of the Clinical Target Volume in the Postoperative Treatment of Pancreatic Head Cancer

    International Nuclear Information System (INIS)

    Purpose: To develop contouring guidelines to be used in the Radiation Therapy Oncology Group protocol 0848, a Phase III randomized trial evaluating the benefit of adjuvant chemoradiation in patients with resected head of pancreas cancer. Methods and Materials: A consensus committee of six radiation oncologists with expertise in gastrointestinal radiotherapy developed stepwise contouring guidelines and an atlas for the delineation of the clinical target volume (CTV) in the postoperative treatment of pancreas cancer, based on identifiable regions of interest and margin expansions. Areas at risk for subclinical disease to be included in the CTV were defined, including nodal regions, anastomoses, and the preoperative primary tumor location. Regions of interest that could be reproducibly contoured on postoperative imaging after a pancreaticoduodenectomy were identified. Standardized expansion margins to encompass areas at risk were developed after multiple iterations to determine the optimal margin expansions. Results: New contouring recommendations based on CT anatomy were established. Written guidelines for the delineation of the postoperative CTV and normal tissues, as well as a Web-based atlas, were developed. Conclusions: The postoperative abdomen has been a difficult area for effective radiotherapy. These new guidelines will help physicians create fields that better encompass areas at risk and minimize dose to normal tissues.

  8. Guidelines and workbook for assessment of organization and administration of utilities seeking operating license for a nuclear power plant. Guidelines for utility organization and administration plan. Volume 1

    International Nuclear Information System (INIS)

    The Guidelines are intended to provide guidance to the user in preparing a written plan for a proposed nuclear organization and administration. The Guidelines allow for individual approaches to organizational structures to account for differences in plant size, number of operating units, number of plant sites, and the individual utility approach to providing technical support. These unique approaches, however, should meet the criteria of a reasoned, fully developed, and logically consistent focus on the user's organization in terms of organization of work, policies and procedures, staffing, and external relationships

  9. Genetic Assessment of Breast Cancer Risk in Primary Care Practice

    OpenAIRE

    Burke, Wylie; Culver, Julie; Pinsky, Linda; Hall, Sarah; Reynolds, Susan E; Yasui, Yutaka; Press, Nancy

    2009-01-01

    Family history is increasingly important in primary care as a means to detect candidates for genetic testing or tailored prevention programs. We evaluated primary care physicians’ skills in assessing family history for breast cancer risk, using unannounced standardized patient visits to 86 general internists and family medicine practitioners in King County, WA. Transcripts of clinical encounters were coded to determine ascertainment of family history, risk assessment, and clinical follow-up. ...

  10. Serological assessment of gastric mucosal atrophy in gastric cancer

    Directory of Open Access Journals (Sweden)

    Bornschein Jan

    2012-01-01

    Full Text Available Abstract Background Non-invasive tools for gastric cancer screening and diagnosis are lacking. Serological testing with the detection of pepsinogen 1 (PG1, pepsinogen 2 (PG2 and gastrin 17 (G17 offers the possibility to detect preneoplastic gastric mucosal conditions. Aim of this study was to assess the performance of these serological tests in the presence of gastric neoplasia. Methods Histological and serological samples of 118 patients with gastric cancer have been assessed for tumor specific characteristics (Laurén type, localisation, degree of mucosal abnormalities (intestinal metaplasia, atrophy and serological parameters (PG1, PG2, PG1/2-ratio, G17, H. pylori IgG, CagA status. Association of the general factors to the different serological values have been statistically analyzed. Results Patients with intestinal type gastric cancer had lower PG1 levels and a lower PG1/2-ratio compared to those with diffuse type cancer (p = 0.003. The serum levels of PG2 itself and G17 were not significantly altered. H. pylori infection in general had no influence on the levels of PG1, PG2 and G17 in the serum of gastric cancer patients. There was a trend towards lower PG1 levels in case of positive CagA-status (p = 0.058. The degree of both intestinal metaplasia and atrophy correlated inversely with serum levels for PG1 and the PG1/2-ratio (p Conclusions Glandular atrophy and a positive CagA status are determinant factors for decreased pepsinogen 1 levels in the serum of patients with gastric cancer. The serological assessment of gastric atrophy by analysis of serum pepsinogen is only adequate for patients with intestinal type cancer.

  11. A consensus-based guideline defining the clinical target volume for pelvic lymph nodes in external beam radiotherapy for uterine cervical cancer

    International Nuclear Information System (INIS)

    The objective of this study was to develop a consensus-based guideline as well as an atlas defining pelvic nodal clinical target volumes in external beam radiotherapy for uterine cervical cancer. A working subgroup to establish the consensus-based guideline on clinical target volumes for uterine cervical cancer was formulated by the Radiation Therapy Study Group of the Japan Clinical Oncology Group in July 2008. The working subgroup consisted of seven radiation oncologists. The process resulting in the consensus included a comparison of contouring on CT images among the members, reviewing of published textbooks and the relevant literature and a distribution analysis of metastatic nodes on computed tomography/magnetic resonance imaging of actual patients. The working subgroup defined the pelvic nodal clinical target volumes for cervical cancer and developed an associated atlas. As a basic criterion, the lymph node clinical target volume was defined as the area encompassed by a 7 mm margin around the applicable pelvic vessels. Modifications were made in each nodal area to cover adjacent adipose tissues at risk of microscopic nodal metastases. Although the bones and muscles were excluded, the bowel was not routinely excluded in the definition. Each of the following pelvic node regions was defined: common iliac, external iliac, internal iliac, obturator and presacral. Anatomical structures bordering each lymph node region were defined for six directions; anterior, posterior, lateral, medial, cranial and caudal. Drafts of the definition and the atlas were reviewed by members of the JCOG Gynecologic Cancer Study Group (GCSG). We developed a consensus-based guideline defining the pelvic node clinical target volumes that included an atlas. The guideline will be continuously updated to reflect the ongoing changes in the field. (author)

  12. Guiding the Grey: The Implementation and Evaluation of a Journal Club amongst a Librarian and Clinical Practice Guideline Developers – A Cancer Care Case Study

    OpenAIRE

    Vaska, Marcus; Kostaras, Xanthoula (Alberta Health Services, Canada); MacLeod, Emily (Alberta Health Services, Canada); Meek, Elysa (Alberta Health Services, Canada); Shea-Budgell, Melissa (Alberta Health Services, Canada); Watson, Laurissa (Alberta Health Services, Canada); GreyNet, Grey Literature Network Service

    2014-01-01

    Introduction/Goal: As a research-intensive facility located within a cancer care environment, library services provided at the Holy Cross Site closely adhere to an embedded librarian mandate, one where the librarian “actively engages in activities, possesses extensive knowledge of the researcher’s work, and offers assistance above and beyond common library service expectations” (Strain, 2011). The Guideline Utilization Resource Unit (GURU) is composed of knowledge management specialists...

  13. Predictors of adherence to screening guidelines for chronic diseases of lifestyle, cancers, and HIV in a health-insured population in South Africa

    Directory of Open Access Journals (Sweden)

    Leegale Adonis

    2014-03-01

    Full Text Available Background: Adherence to screening guidelines has been widely accepted to reduce morbidity, mortality, and cost outcomes. The aim of this study was to identify predictors of adherence to screening guidelines for chronic diseases of lifestyle (CDL, cancers, and HIV in a health-insured population in South Africa, some of whom voluntarily opt into a wellness program that incentivizes screening. Method: A cross-sectional study for the period 2007–2011 was conducted using a random sample of 170,471 health insurance members from a single insurer. Adherence to screening guidelines was calculated from medical claims data. Results: Adherence to screening guidelines ranged from 1.1% for colorectal cancer to 40.9% for cholesterol screening. Members of the wellness program were up to three times more likely to screen for diseases (odds ratio [OR]=3.2 for HIV screening, confidence interval [CI]=2.75–3.73. Plan type (full comprehensive plan was most strongly associated with cholesterol screening (OR=3.53, CI=3.27–3.80, and most negatively associated (hospital-only core plan with cervical cancer screening (OR= 0.44, CI=0.28–0.70. Gender was a negative predictor for glucose screening (OR=0.88, CI=0.82–0.96. Provincial residence was most strongly associated with cervical cancer screening (OR=1.89, CI=0.65–5.54. Conclusion: Adherence to screening recommendations was <50%. Plan type, gender, provincial residence, and belonging to an incentivized wellness program were associated with disproportionate utilization of screening services, even with equal payment access.

  14. Prevention and management guidelines to oral health care for patients with head and neck cancer: HCT20, Carisolv and Chlorhexidine varnish are suggested

    International Nuclear Information System (INIS)

    Orofacial complications are unfortunately common with all modalities used in the management of patients with head and neck cancer. It is well known that hypo salivation develops if radiation therapy involves the salivary glands. A significant decrease in salivary volume can adversely affect oral comfort, mucous health, dentition, deglutition and mastication. Xerostomia may lead to consumption of diet high in carbohydrates and make good oral hygiene difficult. The purpose of this study is to report a new prevention and management guidelines to oral and dental health care for patients with head and neck cancer who will treat with radiotherapy. New materials as HCT20, Carisolv and chlorhexidine varnish are suggested. (author)

  15. School-Based Mental Health Professionals' Bullying Assessment Practices: A Call for Evidence-Based Bullying Assessment Guidelines

    Science.gov (United States)

    Blake, Jamilia; Banks, Courtney S.; Patience, Brenda A.; Lund, Emily M.

    2014-01-01

    A sample of 483 school-based mental health professionals completed a survey about the training they have received related to conducting bullying assessments in schools, competence in conducting an assessment of bullying, and the bullying assessment methods they used. Results indicate that school counselors were usually informed about incidents of…

  16. Deliverable 4.3 Decision support guideline based on LCA and cost/efficiency assessment

    OpenAIRE

    Larsen, Henrik Fred; Hansen, Peter Augusto; Boyer-Souchet, Florence

    2010-01-01

    The environmental sustainability assessments described in this report is based on life cycle assessments (LCA) of selected waste water treatment technology (WWTT) cases included in NEPTUNE. The basic approach in these assessments (avoided against induced impacts) is described in Deliverable 4.1 (Larsen et al. 2007) and other methodological issues (e.g. normalization and weighting) in Deliverable 4.2 (Larsen et al. 2009). The basic approach is illustrated in a simplified way for the case ozona...

  17. Optical transillumination spectroscopy of breast tissue for cancer risk assessment

    Science.gov (United States)

    Lilge, Lothar; Blyschak, Kristina; Simick, Michelle; Jong, Roberta A.

    2003-10-01

    Breast cancer is the most commonly occurring cancer in women. The lifetime risk of being diagnosed with breast cancer is approximately 1 in 10 thereby the highest out of all cancers. Breast cancer screening programs have been shown to decrease the mortality rates of women between ages 50-69, since cancers are detected at an earlier, more favourable stage. It is apparent that the development of breast cancer is a slow process following initial transformation of the breast tissue. Hence, there has been a strong effort within the research community to understand risk factors for the disease. Risk factors are defined as those characteristics that are more common in people with the disease when compared to the normal population. Quantification of an individual's breast cancer rate may lead that individual to modify her lifestyle and/or diet. Lifestyle changes could lead to a reduction in the incidence of breast cancer. Anatomically, the presence of increased amounts of fibroglandular tissue raises the estimated risk by up to 6 fold (correct for age), hence representing one of the strongest known risk factors pertaining to the entire female population. In this study the relative area of mammographic densities within a mammogram will be used as a global risk assessment tool. It has been shown previously that quantification of water, lipids, haemoglobin and other tissue chromophores of the optically interrogated breast tissue, which also gives rise to the mammographic densities, is feasible through near-infrared spectroscopy. Thus, the hypothesis for this study is that optical transillumination spectroscopy provides consistent and/or complementary information to conventional mammography in quantifying breast tissue density.

  18. Contouring Guidelines for the Axillary Lymph Nodes for the Delivery of Radiation Therapy in Breast Cancer: Evaluation of the RTOG Breast Cancer Atlas

    Energy Technology Data Exchange (ETDEWEB)

    Gentile, Michelle S. [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois (United States); Usman, Asad A.; Neuschler, Erin I. [Department of Radiology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois (United States); Sathiaseelan, Vythialinga; Hayes, John P. [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois (United States); Small, William, E-mail: WMSMALL@lumc.edu [Department of Radiation Oncology, Loyola University, Chicago, Illinois (United States)

    2015-10-01

    Purpose: The purpose of this study was to identify the axillary lymph nodes on pretreatment diagnostic computed tomography (CT) of the chest to determine their position relative to the anatomic axillary borders as defined by the Radiation Therapy Oncology Group (RTOG) breast cancer atlas for radiation therapy planning. Methods and Materials: Pretreatment diagnostic CT chest scans available for 30 breast cancer patients with clinically involved lymph nodes were fused with simulation CT. Contouring of axillary levels I, II, and III according to the RTOG guidelines was performed. Measurements were made from the area of distal tumor to the anatomic borders in 6 dimensions for each level. Results: Of the 30 patients, 100%, 93%, and 37% had clinical involvement of levels I, II, and III, respectively. The mean number of lymph nodes dissected was 13.6. The mean size of the largest lymph node was 2.4 cm. Extracapsular extension was seen in 23% of patients. In 97% of patients, an aspect of the involved lymph node lay outside of the anatomic border of a level. In 80% and 83% of patients, tumor extension was seen outside the cranial (1.78 ± 1.0 cm; range, 0.28-3.58 cm) and anterior (1.27 ± 0.92 cm; range, 0.24-3.58 cm) borders of level I, respectively. In 80% of patients, tumor extension was seen outside the caudal border of level II (1.36 ± 1.0 cm, range, 0.27-3.86 cm), and 0% to 33% of patients had tumor extension outside the remaining borders of all levels. Conclusions: To cover 95% of lymph nodes at the cranial and anterior borders of level I, an additional clinical target volume margin of 3.78 cm and 3.11 cm, respectively, is necessary. The RTOG guidelines may be insufficient for coverage of axillary disease in patients with clinical nodal involvement who are undergoing neoadjuvant chemotherapy, incomplete axillary dissection, or treatment with intensity modulated radiation therapy. In patients with pretreatment diagnostic CT chest scans, fusion with

  19. Contouring Guidelines for the Axillary Lymph Nodes for the Delivery of Radiation Therapy in Breast Cancer: Evaluation of the RTOG Breast Cancer Atlas

    International Nuclear Information System (INIS)

    Purpose: The purpose of this study was to identify the axillary lymph nodes on pretreatment diagnostic computed tomography (CT) of the chest to determine their position relative to the anatomic axillary borders as defined by the Radiation Therapy Oncology Group (RTOG) breast cancer atlas for radiation therapy planning. Methods and Materials: Pretreatment diagnostic CT chest scans available for 30 breast cancer patients with clinically involved lymph nodes were fused with simulation CT. Contouring of axillary levels I, II, and III according to the RTOG guidelines was performed. Measurements were made from the area of distal tumor to the anatomic borders in 6 dimensions for each level. Results: Of the 30 patients, 100%, 93%, and 37% had clinical involvement of levels I, II, and III, respectively. The mean number of lymph nodes dissected was 13.6. The mean size of the largest lymph node was 2.4 cm. Extracapsular extension was seen in 23% of patients. In 97% of patients, an aspect of the involved lymph node lay outside of the anatomic border of a level. In 80% and 83% of patients, tumor extension was seen outside the cranial (1.78 ± 1.0 cm; range, 0.28-3.58 cm) and anterior (1.27 ± 0.92 cm; range, 0.24-3.58 cm) borders of level I, respectively. In 80% of patients, tumor extension was seen outside the caudal border of level II (1.36 ± 1.0 cm, range, 0.27-3.86 cm), and 0% to 33% of patients had tumor extension outside the remaining borders of all levels. Conclusions: To cover 95% of lymph nodes at the cranial and anterior borders of level I, an additional clinical target volume margin of 3.78 cm and 3.11 cm, respectively, is necessary. The RTOG guidelines may be insufficient for coverage of axillary disease in patients with clinical nodal involvement who are undergoing neoadjuvant chemotherapy, incomplete axillary dissection, or treatment with intensity modulated radiation therapy. In patients with pretreatment diagnostic CT chest scans, fusion with

  20. Esophageal Cancer: Role of Imaging in Primary Staging and Response Assessment Post Neoadjuvant Therapy.

    Science.gov (United States)

    Griffin, Yvette

    2016-08-01

    Advances in the early detection and treatment of esophageal cancer have meant improved survival rates for patients with esophageal cancer. Accurate pretreatment and post-neoadjuvant treatment staging of esophageal cancer is essential for assessing operability and determining the optimum treatment plan. This article reviews the multimodality imaging approach in the diagnosis, staging, and assessment of treatment response in esophageal cancer. PMID:27342898

  1. International guidelines for the in vivo assessment of skin properties in non-clinical settings

    DEFF Research Database (Denmark)

    du Plessis, Johan; Stefaniak, Aleksandr; Eloff, Fritz;

    2013-01-01

    There is an emerging perspective that it is not sufficient to just assess skin exposure to physical and chemical stressors in workplaces, but that it is also important to assess the condition, i.e. skin barrier function of the exposed skin at the time of exposure. The workplace environment, repre...

  2. The Clinician's Toolbox: Assessing the Sexual Impacts of Cancer on Adolescents and Young Adults with Cancer (AYAC

    Directory of Open Access Journals (Sweden)

    Sylvie Aubin, PhD

    2015-09-01

    Conclusion: Cancer can have a significant impact on numerous domains of AYAC sexuality. The assessment of and attention to the impact of sexuality on AYAC is crucial in order to provide effective and comprehensive quality patient cancer care. Aubin S and Perez S. The clinician's toolbox: assessing the sexual impacts of cancer on adolescents and young adults with cancer (AYAC. Sex Med 2015;3:198–212.

  3. Moving Forward in Human Cancer Risk Assessment

    OpenAIRE

    Paules, Richard S.; Aubrecht, Jiri; Corvi, Raffaella; Garthoff, Bernward; Kleinjans, Jos C.

    2010-01-01

    Background The current safety paradigm for assessing carcinogenic properties of drugs, cosmetics, industrial chemicals, and environmental exposures relies mainly on in vitro genotoxicity testing followed by 2-year rodent bioassays. This testing battery is extremely sensitive but has low specificity. Furthermore, rodent bioassays are associated with high costs, high animal burden, and limited predictive value for human risks. Objectives We provide a response to a growing appeal for a paradigm ...

  4. Effects of screening for psychological distress on patient outcomes in cancer : A systematic review

    NARCIS (Netherlands)

    Meijer, Anna; Roseman, Michelle; Delisle, Vanessa C.; Milette, Katherine; Levis, Brooke; Syamchandra, Achyuth; Stefanek, Michael E.; Stewart, Donna E.; de Jonge, Peter; Coyne, James C.; Thombs, Brett D.

    2013-01-01

    Objective: Several practice guidelines recommend routine screening for psychological distress in cancer care. The objective was to evaluate the effect of screening cancer patients for psychological distress by assessing the (1) effectiveness of interventions to reduce distress among patients identif

  5. Consensus clinical guidelines for the assessment of cognitive and behavioural problems in Tuberous Sclerosis.

    Science.gov (United States)

    de Vries, Petrus; Humphrey, Ayla; McCartney, Deborah; Prather, Penny; Bolton, Patrick; Hunt, Ann

    2005-07-01

    Tuberous Sclerosis (TSC) is a genetic disorder characterised by abnormal growths in a wide range of organs. In the brain, abnormalities of differentiation, proliferation and migration can produce a range of neuropsychiatric features such as mental retardation, autism and ADHD. Although these manifestations are not diagnostic of the disorder, cognitive and behavioural features are often of greatest concern to families yet limited clinical assessment and interventions are currently offered. A consensus panel at a TSC Brain/Behaviour workshop recommended that the cognitive and behavioural profiles of individuals with TSC should be assessed at regular intervals in a planned fashion in accordance with the difficulties associated with the disorder. Evaluations should include the use of standardised neuropsychological and behavioural tools as appropriate to the age and developmental level of the individual assessed. These cognitive and behavioural profiles should be incorporated in the overall formulation of the needs of the person with TSC to plan educational, social and clinical management strategies. Assessments should be documented so that individual longitudinal progress can be monitored. The paper outlines the problems associated with TSC, the purpose of recommended assessments, developmentally appropriate stages for assessment, and identifies specific areas that should be targeted for assessment. PMID:15981129

  6. Review of achievements of the OECD Working Party on Manufactured Nanomaterials' Testing and Assessment Programme. From exploratory testing to test guidelines.

    Science.gov (United States)

    Rasmussen, Kirsten; González, Mar; Kearns, Peter; Sintes, Juan Riego; Rossi, François; Sayre, Phil

    2016-02-01

    This paper charts the almost ten years of history of OECD's work on nanosafety, during which the programme of the OECD on the Testing and Assessment of Manufactured Nanomaterials covered the testing of eleven nanomaterials for about 59 end-points addressing physical-chemical properties, mammalian and environmental toxicity, environmental fate and material safety. An overview of the materials tested, the test methods applied and the discussions regarding the applicability of the OECD test guidelines, which are recognised methods for regulatory testing of chemicals, are given. The results indicate that many existing OECD test guidelines are suitable for nanomaterials and consequently, hazard data collected using such guidelines will fall under OECD's system of Mutual Acceptance of Data (MAD) which is a legally binding instrument to facilitate the international acceptance of information for the regulatory safety assessment of chemicals. At the same time, some OECD test guidelines and guidance documents need to be adapted to address nanomaterials while new test guidelines and guidance documents may be needed to address endpoints that are more relevant to nanomaterials. This paper presents examples of areas where test guidelines or guidance for nanomaterials are under development. PMID:26603783

  7. APPLICATION OF SEDIMENT QUALITY GUIDELINES IN THE ASSESSMENT OF MANGROVE SURFACE SEDIMENT IN MENGKABONG LAGOON, SABAH, MALAYSIA

    OpenAIRE

    S. M. Praveena, M. Radojevic, M. H. Abdullah, A. Z. Aris

    2008-01-01

    There have been numerous sediment quality guidelines developed to monitor the sediments. Sediment quality guidelines are very useful to screen sediment contamination by comparing sediment contaminant concentration with the corresponding quality guideline, provide useful tools for screening sediment chemical data to identify pollutants of concern and prioritise problem sites and relatively good predictors of contaminations. However, these guidelines are chemical specific and do not include bio...

  8. Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation.

    NARCIS (Netherlands)

    Peter, W.F.H.; Jansen, M.J.; Hurkmans, E.J.; Bloo, H.; Dekker-Bakker, L.M.M.C.J.; Dilling, R.G.; Hilberdink, W.K.H.A.; Kersten-Smit, C.; Rooij, M. de; Veenhof, C.; Vermeulen, H.M.; Vos, R.J. de; Schoones, J.W.; Vliet Vlieland, T.P.M.

    2011-01-01

    BACKGROUND: An update of a Dutch physiotherapy practice guideline in Hip and Knee Osteoarthritis (HKOA) was made, based on current evidence and best practice. METHODS: A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters: initial as

  9. Identification of the most influential factors in the Norwegian guidelines for risk assessment of dispersion of contaminants from sediments.

    Science.gov (United States)

    Saloranta, Tuomo M; Ruus, Anders; Borgå, Katrine

    2011-10-01

    The Norwegian guidelines for risk assessment of contaminated sediments are used to identify areas of concern where remediation may be needed to meet the governmental long-term goal of clean fjords and harbors along the Norwegian coastline. By a thorough sensitivity analysis, this study identifies the most influential factors and parameters for the Tier 2A model in this risk guideline, which are used to estimate fluxes of contaminants from sediments due to diffusion and bioturbation (F(diff)), resuspension caused by ship traffic (F(skipnorm)), and uptake and predation of benthic biota (F(org)). The sensitivity analysis is run for 36 different scenarios combining 3 different sizes of contaminated area, 3 harbor types, and 3 persistent organic pollutants, namely lindane (γ-hexachlorocyclohexane), benzo[a]pyrene, and 2,2',4,4',5,5'-hexachlorobiphenyl (PCB-153), as well as the metal mercury (Hg). The most influential parameters vary from scenario to scenario, but generally 5 parameters appear to be particularly influential for the fluxes and transport estimated by the Tier 2A model: flux of organic carbon to sediment (OC(sed)), factor for increased diffusion due to bioturbation (a), sediment-water partitioning coefficient (K(d)), benthic biota-water bioconcentration factor (BCF(fisk)), and mass of resuspended fine sediment during arrival or departure of a ship (m(sed)). We also quantify which of the 3 fluxes (F(diff), F(skipnorm), and F(org)) dominate in the different scenarios. Our sensitivity analysis results can be used by authorities, problem owners, consultants, and environmental managers involved in contaminated sediment management to gain insight on the key processes and parameters and to focus their site-specific or laboratory-based measurement efforts on the key parameters and thus increase efficiency and reliability in the contaminated sediment risk assessment. PMID:21384542

  10. Guidelines for the environmental impact assessment in procedure for mining projects

    Energy Technology Data Exchange (ETDEWEB)

    Salminen, R.; Heikkinen, P.; Nikkarinen, M.; Parkkinen, J.; Sipilae, P.; Suomela, P.; Wennerstroem, M.

    2000-01-01

    The procedure for environmental impact assessment (EIA) in connection with mining covers extraction, preparation and processing of metallic minerals or other extractable minerals when the total amount of ore to be extracted is at least 550 000 tonnes per year or when the surface area of the open-cast mine exceeds 25 hectares. In addition, the Ministry of the Environment can decide that the assessment procedure shall be applied to an individual project (The EIA Act paragraph 1, section 4.) The EIA procedure is two-stage. The first stage comprises drawing up of an assessment programme. The second stage includes collecting assessment reports on the basis of which an assessment of the environmental impact will be made. The authority concerned shall then disseminate information on the project and arrange hearing of the parties. Hearing is followed by submission of an executive summary of the assessment programme and the environmental impact assessment, which together with the environmental impact statement will be used by the licensing authority when taking decision on the matter. The environmental impact assessment procedure in connection with mining will coincide either with the application for mining concession or the submission of the environmental impact statement to the Safety Technology Authority together with a general plan. The aim of the environmental impact assessment is to study what indirect and direct, both positive and negative, effects the project will have on the surrounding nature, man, society and industry. A further aim is to present a proposal for actions in order to prevent and limit the detrimental effects of the project on the environment as well as to present a proposal for a follow-up programme. The dialogue between the operator and the contact authority is of great importance during the entire process of the environmental impact assessment. It is in the interest of all parties that the environmental impact assessment will be made with care. In

  11. Initial clinical validation of Health Heritage, a patient-facing tool for personal and family history collection and cancer risk assessment.

    Science.gov (United States)

    Baumgart, Leigh A; Postula, Kristen J Vogel; Knaus, William A

    2016-04-01

    Personal and family health histories remain important independent risk factors for cancer; however they are currently not being well collected or used effectively. Health Heritage was designed to address this need. The purpose of this study was to validate the ability of Health Heritage to identify patients appropriate for further genetic evaluation and to accurately stratify cancer risk. A retrospective chart review was conducted on 100 random patients seen at an adult genetics clinic presenting with concern for an inherited predisposition to cancer. Relevant personal and family history obtained from the patients' medical records was entered into Health Heritage. Recommendations by Health Heritage were compared to national guidelines of eligibility for genetic evaluation. Agreement between Health Heritage referral for genetic evaluation and guideline eligibility for genetic evaluation was 97 % (sensitivity 98 % and specificity 88 %). Risk stratification for cancer was also compared between Health Heritage and those documented by a geneticist. For patients at increased risk for breast, ovarian, or colorectal cancer as determined by the geneticist, risk stratification by Health Heritage agreed 90, 93, and 75 %, respectively. Discordances in risk stratification were attributed to both complex situations better handled by the geneticist and Health Heritage's adherence to incorporating all information into its algorithms. Health Heritage is a clinically valid tool to identify patients appropriate for further genetic evaluation and to encourage them to confirm the assessment and management recommendations with cancer genetic experts. Health Heritage also provides an estimate of cancer risk that is complementary to a genetics team. PMID:26711915

  12. Neuropathological assessment and validation of mouse models for Alzheimer's disease: applying NIA-AA guidelines

    Directory of Open Access Journals (Sweden)

    C. Dirk Keene

    2016-06-01

    Full Text Available Dozens of transgenic mouse models, generally based on mutations associated with familial Alzheimer's disease (AD, have been developed, in part, for preclinical testing of candidate AD therapies. However, none of these models has successfully predicted the clinical efficacy of drugs for treating AD patients. Therefore, development of more translationally relevant AD mouse models remains a critical unmet need in the field. A concept not previously implemented in AD preclinical drug testing is the use of mouse lines that have been validated for neuropathological features of human AD. Current thinking suggests that amyloid plaque and neurofibrillary tangle deposition is an essential component for accurate modeling of AD. Therefore, the AD translational paradigm would require pathologic Aβ and tau deposition, a disease-relevant distribution of plaques and tangles, and a pattern of disease progression of Aβ and tau isoforms similar to the neuropathological features found in the brains of AD patients. Additional parameters useful to evaluate parallels between AD and animal models would include 1 cerebrospinal fluid (CSF AD biomarker changes with reduced Aβ and increased phospho-tau/tau; 2 structural and functional neuroimaging patterns including MRI hippocampal atrophy, fluorodeoxyglucose (FDG, and amyloid/tau PET alterations in activity and/or patterns of pathologic peptide deposition and distribution; and 3 cognitive impairment with emphasis on spatial learning and memory to distinguish presymptomatic and symptomatic mice at specific ages. A validated AD mouse model for drug testing would likely show tau-related neurofibrillary degeneration following Aβ deposition and demonstrate changes in pathology, CSF analysis, and neuroimaging that mirror human AD. Development of the ideal model would revolutionize the ability to establish the translational value of AD mouse models and serve as a platform for discussions about national phenotyping guidelines

  13. Neuropathological assessment and validation of mouse models for Alzheimer's disease: applying NIA-AA guidelines.

    Science.gov (United States)

    Keene, C Dirk; Darvas, Martin; Kraemer, Brian; Liggitt, Denny; Sigurdson, Christina; Ladiges, Warren

    2016-01-01

    Dozens of transgenic mouse models, generally based on mutations associated with familial Alzheimer's disease (AD), have been developed, in part, for preclinical testing of candidate AD therapies. However, none of these models has successfully predicted the clinical efficacy of drugs for treating AD patients. Therefore, development of more translationally relevant AD mouse models remains a critical unmet need in the field. A concept not previously implemented in AD preclinical drug testing is the use of mouse lines that have been validated for neuropathological features of human AD. Current thinking suggests that amyloid plaque and neurofibrillary tangle deposition is an essential component for accurate modeling of AD. Therefore, the AD translational paradigm would require pathologic Aβ and tau deposition, a disease-relevant distribution of plaques and tangles, and a pattern of disease progression of Aβ and tau isoforms similar to the neuropathological features found in the brains of AD patients. Additional parameters useful to evaluate parallels between AD and animal models would include 1) cerebrospinal fluid (CSF) AD biomarker changes with reduced Aβ and increased phospho-tau/tau; 2) structural and functional neuroimaging patterns including MRI hippocampal atrophy, fluorodeoxyglucose (FDG), and amyloid/tau PET alterations in activity and/or patterns of pathologic peptide deposition and distribution; and 3) cognitive impairment with emphasis on spatial learning and memory to distinguish presymptomatic and symptomatic mice at specific ages. A validated AD mouse model for drug testing would likely show tau-related neurofibrillary degeneration following Aβ deposition and demonstrate changes in pathology, CSF analysis, and neuroimaging that mirror human AD. Development of the ideal model would revolutionize the ability to establish the translational value of AD mouse models and serve as a platform for discussions about national phenotyping guidelines and standards

  14. Self-assessment in cancer patients referred to palliative care

    DEFF Research Database (Denmark)

    Strömgren, Annette S; Goldschmidt, Dorthe; Groenvold, Mogens;

    2002-01-01

    -based study using the European Organization for Research and Treatment of Cancer quality-of-life instrument EORTC QLQ-C30, the Edmonton Symptom Assessment System (ESAS), and the Hospital Anxiety and Depression Scale (HADS) in cancer patients who were receiving palliative care. This report describes the......-based study of symptomatology in consecutive cancer patients in palliative care, achieving rather complete data from the participants. The symptomatology in these patients was very pronounced. The questionnaires were able to detect clinically important differences between places of service.......BACKGROUND: Research in palliative care is considered difficult due to the poor health of patients. However, patient-provided data are essential for a thorough description of patient symptomatology and for the evaluation of care. METHODS: The authors examined the feasibility of a questionnaire...

  15. Technical guidelines for head and neck cancer IMRT on behalf of the Italian association of radiation oncology - head and neck working group

    International Nuclear Information System (INIS)

    Performing intensity-modulated radiotherapy (IMRT) on head and neck cancer patients (HNCPs) requires robust training and experience. Thus, in 2011, the Head and Neck Cancer Working Group (HNCWG) of the Italian Association of Radiation Oncology (AIRO) organized a study group with the aim to run a literature review to outline clinical practice recommendations, to suggest technical solutions and to advise target volumes and doses selection for head and neck cancer IMRT. The main purpose was therefore to standardize the technical approach of radiation oncologists in this context. The following paper describes the results of this working group. Volumes, techniques/strategies and dosage were summarized for each head-and-neck site and subsite according to international guidelines or after reaching a consensus in case of weak literature evidence

  16. Factors Associated with Men's Assessment of Prostate Cancer Treatment Choice.

    Science.gov (United States)

    Ross, Louie E; Howard, Daniel L; Bowie, Janice V; Thorpe, Roland J; Kinlock, Ballington L; Burt, Carol; LaVeist, Thomas A

    2016-06-01

    The objective of this study is to examine factors among a group of African American and White men in North Carolina and their assessment of prostate cancer treatment choice or belief that treatment chosen was best. A sample of men (N = 877) with a history of prostate cancer diagnosis was recruited from the North Carolina Cancer Registry during 2007-2008 and asked to participate in a telephone interview covering several measures about their initial prostate cancer treatment. Logistic regression was used to assess demographic, psychosocial, and clinical factors on whether they felt that they had chosen the best treatment for the disease. Respondents were majority White (52.7 %), married (75.9 %), and had surgery (67.9 %) as their initial treatment. At the bivariate level, factors associated with the belief that the treatment chosen was best were as follows: White race/ethnicity, higher levels of education, a more recent treatment date, having health insurance coverage, type of treatment received, higher levels of bother from side effects, greater contentment with their quality of life, and doctor discussions of the various treatment options. Similarly, the multivariate analysis showed increased odds of belief that the treatment chosen was the best among demographic (i.e., race/ethnicity, level of education, and health insurance coverage) as well as psychosocial and clinical variables (i.e., greater bother from side effects, greater contentment with their quality of life, and initial treatment received). Results suggest that demographic, psychosocial, and clinical factors play an important role for men in assessing their treatment choices for prostate cancer. PMID:25893926

  17. Selective Nodal Irradiation for Head and Neck Cancer Using Intensity-Modulated Radiotherapy: Application of RTOG Consensus Guidelines in Routine Clinical Practice

    International Nuclear Information System (INIS)

    Purpose: We have been using intensity-modulated radiotherapy (IMRT) for selective neck irradiation. This article presents an analysis of patterns of failure and their dosimetric correlation. Methods and Materials: Between October 2003 and January 2008, 83 patients with head-and-neck cancer were treated with IMRT. Nodal levels were contoured as per the Radiation Therapy Oncology Group (RTOG) consensus guidelines. Results: There were 32 relapses with 23 local relapses (21 local relapses alone and 2 local and regional relapses, simultaneously), 9 regional relapses (including 2 simultaneous local and regional relapses), and 5 distant relapses, of which 2 patients had local relapses. At 2 and 3 years, the locoregional relapse-free survival rates were was 68.3% and 60.8%, respectively, while the overall survival rates were 84.1% and 81.7%, respectively. Subgroup analyses revealed significant differences in locoregional relapse-free survival rates for total treatment times of 53 days, a volume of CTV1PTV (i.e., the volume prescribed 70 Gy) 177 cc, a V100 for CTV1PTV of 91%, and a minimum dose to CTV1PTV of 54 Gy. There were no failures in the elective nodal volume, substantiating both the nodal selection criteria and the RTOG consensus guidelines for delineation of neck node levels. Conclusions: IMRT for head-neck cancer is feasible, using elective nodal selection criteria along with RTOG consensus guidelines for the radiological boundaries of levels of neck nodes.

  18. The Role of Measurement Quality on Practical Guidelines for Assessing Measurement and Structural Invariance

    Science.gov (United States)

    Kang, Yoonjeong; McNeish, Daniel M.; Hancock, Gregory R.

    2016-01-01

    Although differences in goodness-of-fit indices (?GOFs) have been advocated for assessing measurement invariance, studies that advanced recommended differential cutoffs for adjudicating invariance actually utilized a very limited range of values representing the quality of indicator variables (i.e., magnitude of loadings). Because quality of…

  19. Ultrasound Assessment of Endothelial Function: A Technical Guideline of the Flow-mediated Dilation Test.

    Science.gov (United States)

    Rodriguez-Miguelez, Paula; Seigler, Nichole; Harris, Ryan A

    2016-01-01

    Cardiovascular disease is the primary cause of mortality and a major cause of disability worldwide. The dysfunction of the vascular endothelium is a pathological condition characterized mainly by a disruption in the balance between vasodilator and vasoconstrictor substances and is proposed to play an important role in the development of atherosclerotic cardiovascular disease. Therefore, a precise evaluation of endothelial function in humans represents an important tool that could help better understand the etiology of multiple cardio-centric pathologies. Over the past twenty-five years, many methodological approaches have been developed to provide an assessment of endothelial function in humans. Introduced in 1989, the FMD test incorporates a forearm occlusion and subsequent reactive hyperemia that promotes nitric oxide production and vasodilation of the brachial artery. The FMD test is now the most widely utilized, non-invasive, ultrasonic assessment of endothelial function in humans and has been associated with future cardiovascular events. Although the FMD test could have clinical utility, it is a physiological assessment that has inherited several confounding factors that need to be considered. This article describes a standardized protocol for determining FMD including the recommended methodology to help minimize the physiological and technical issues and improve the precision and reproducibility of the assessment. PMID:27167596

  20. Guidelines for the design of digital closed questions for assessment and learning in higher education

    NARCIS (Netherlands)

    Draaijer, S.; Hartog, R.J.M.

    2007-01-01

    Systems for computer based assessment as well as learning management systems offer a number of innovative closed question types, which are used more and more in higher education. These closed questions are used in computer based summative exams, in diagnostic tests, and in computer based activating

  1. [Operative guidelines for the shoe industry: risk assessment and environmental hygiene].

    Science.gov (United States)

    Paraluppi, Paolo

    2012-01-01

    Considering the most relevant factors for occupational safety and health, the Safety Check application in the footwear industry makes little and medium size factories employers able to carry out risk assessment. However, in specific cases, it is necessary to achieve an in-depth evaluation. PMID:22697034

  2. ECCC-guidelines for generation and assessment of weld creep data

    International Nuclear Information System (INIS)

    In the framework of the European Projects ''Weld Creep'' and ''Advanced Creep'', working group WG1 of the European Collaborative Creep Committee'' elaborated recommendations for Data Generation and Data Evaluation of creep rupture data of welded joints and the application in design and analysis. The recommendations are based on extensive investigations and round robin assessments of the members of working group 1. In this paper an overview on these activities and recommendations and some more detailed descriptions of development and application is given. In the recommendations for Data Generation test specimen design, test procedures and documentation as well as specific hints on the preparation of microstructures by thermal simulation to characterize the properties of heat affected zones in ferritic materials are addressed. The recommendations for Data Assessment include Data Evaluation and extrapolation, derivation of creep rupture curves and weld reduction factors. In order to develop these recommendations creep rupture data assessments were performed and compared by members of the working group on a number of typical working datasets. The results are included in a new issue of the Weld Data Assessment Volume of the ECCC recommendations. Finally, recommendations and experience obtained will be evaluated with respect to their application on components. (orig.)

  3. ECCC-guidelines for generation and assessment of weld creep data

    Energy Technology Data Exchange (ETDEWEB)

    Holdsworth, S.R. [EMPA, Swiss Federal Labs. for Materials Testing and Research (Switzerland); Klenk, A. [MPA, Univ. Stuttgart (Germany)

    2007-07-01

    In the framework of the European Projects ''Weld Creep'' and ''Advanced Creep'', working group WG1 of the European Collaborative Creep Committee'' elaborated recommendations for Data Generation and Data Evaluation of creep rupture data of welded joints and the application in design and analysis. The recommendations are based on extensive investigations and round robin assessments of the members of working group 1. In this paper an overview on these activities and recommendations and some more detailed descriptions of development and application is given. In the recommendations for Data Generation test specimen design, test procedures and documentation as well as specific hints on the preparation of microstructures by thermal simulation to characterize the properties of heat affected zones in ferritic materials are addressed. The recommendations for Data Assessment include Data Evaluation and extrapolation, derivation of creep rupture curves and weld reduction factors. In order to develop these recommendations creep rupture data assessments were performed and compared by members of the working group on a number of typical working datasets. The results are included in a new issue of the Weld Data Assessment Volume of the ECCC recommendations. Finally, recommendations and experience obtained will be evaluated with respect to their application on components. (orig.)

  4. 76 FR 21256 - Proposed Assessment Rate Adjustment Guidelines for Large and Highly Complex Institutions

    Science.gov (United States)

    2011-04-15

    ... (76 FR 10672 (Feb. 25, 2011)), the FDIC Board amended its assessment regulations (the Amended... FR 10672 (February 25, 2011) (to be codified at 12 CFR 327.9). \\2\\ A large institution is defined as...' non-lending interest income, fiduciary revenues, and investment banking fees, combined, exceed...

  5. Guidelines for Exposure Assessment in Health Risk Studies Following a Nuclear Reactor Accident

    OpenAIRE

    Bouville, André; Linet, Martha S.; Hatch, Maureen; Mabuchi, Kiyohiko; Simon, Steven L.

    2013-01-01

    Background: Worldwide concerns regarding health effects after the Chernobyl and Fukushima nuclear power plant accidents indicate a clear need to identify short- and long-term health impacts that might result from accidents in the future. Fundamental to addressing this problem are reliable and accurate radiation dose estimates for the affected populations. The available guidance for activities following nuclear accidents is limited with regard to strategies for dose assessment in health risk s...

  6. Assessing Educational Needs in Medical Practice: Guidelines for the CME Planning Committee Member

    OpenAIRE

    Jennett, P. A.; Laxdal, O. E.

    1984-01-01

    The most relevant and effective continuing medical education activities are those which address carefully identified and prioritized learning needs. As a consequence, discussions and activities of CME planning committees frequently focus upon the identification and assessment of physicians' educational needs. The physicians who serve as representatives of learners on such committees are often new to the planning, educational terms, approaches, and techniques. The basic ideas, definitions and ...

  7. JPN Guidelines for the management of acute pancreatitis: severity assessment of acute pancreatitis

    OpenAIRE

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

    2006-01-01

    This article addresses the criteria for severity assessment and the severity scoring system of the Ministry of Health and Welfare of Japan; now the Japanese Ministry of Health, Labour, and Welfare (the JPN score). It also presents data comparing the JPN score with the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Ranson score, which are the major measuring scales used in the United States and Europe. The goal of investigating these scoring systems is the achievement...

  8. Ethically sound technology? Guidelines for interactive ethical assessment of personal health monitoring.

    Science.gov (United States)

    Palm, Elin; Nordgren, Anders; Verweij, Marcel; Collste, Göran

    2013-01-01

    Novel care-technologies possess a transformational potential. Future care and support may be provided via monitoring technologies such as smart devices, sensors, actors (robots) and Information and Communication Technologies. Such technologies enable care provision outside traditional care institutions, for instance in the homes of patients. Health monitoring may become "personalized" i.e. tailored to the needs of individual care recipients' but may also alter relations between care providers and care recipents, shape and form the care environment and influence values central to health-care. Starting out from a social constructivist theory of technology, an interactive ethical assessment-model is offered. The suggested model supplements a traditional analysis based on normative ethical theory (top-down approach) with interviews including relevant stakeholders (a bottom-up approach). This method has been piloted by small-scale interviews encircling stakeholder perspectives on three emerging technologies: (1) Careousel, a smart medicine-management device, (2) Robot Giraff, an interactive and mobile communication-device and (3) I-Care, a care-software that combines alarm and register system. By incorporating stakeholder perspectives into the analysis, the interactive ethical assessment model provides a richer understanding of the impact of PHM-technologies on ethical values than a traditional top-down model. If the assessment is conducted before the technology has reached the market - preferably in close interaction with developers and users - ethically sound technologies may be obtained. PMID:23920461

  9. Environmental carcinogenic agents and cancer prevention. Risk assessment and management

    International Nuclear Information System (INIS)

    Many agents in our environment have been established as being carcinogenic, and in most cases, the carcinogenic properties of these agents were identified because of high-dose occupational or accidental exposure. Risk characterization, taking into account the dose-response relationship, and exposure assessment are essential for risk assessment and subsequent cancer prevention. Based on scientific risk assessment, risk management should be conducted practically by considering the economic, social, political, and other technical issues and by balancing the risks and benefits. Asbestos and environmental tobacco smoke are typical examples of established carcinogenic agents in the general environment, contributing to low-dose exposure. Further epidemiological studies are required to investigate the carcinogenicity of low-dose exposure to known carcinogenic agents such as arsenic and cadmium through dietary intake, radiation via medical and natural exposure, and air pollution due to diesel exhaust. In contrast, occupational chemical exposure to 1,2-dichloropropane and/or dichloromethane, whose carcinogenicity had not been established, was suggested to cause cholangiocarcinoma among workers involved in offset color proof-printing only after a rare situation of high-dose exposure was unveiled. Continuous monitoring of unusual cancer occurrences in target populations such as workers in occupational and regional settings as well as exposure reduction to suspected carcinogenic agents to levels as low as reasonably achievable is essential for reducing the risk of cancer due to environmental carcinogens. (author)

  10. Review and analysis of external quality assessment of breast cancer services in Europe: Supporting information for the development of a European Quality Assurance scheme for Breast Cancer Services

    OpenAIRE

    DEANDREA SILVIA; LERDA Donata; LOPEZ ALCALDE JESUS; NEAMTIU LUCIANA; SAZ PARKINSON ZULEIKA ESTHER; ULUTURK ASLI

    2015-01-01

    The JRC, the European Commission’s in-house science service, was assigned in December 2012 with the tasks of (i) developing a new version of the European guidelines for breast cancer screening and diagnosis (in the following mentioned as 'the new European Guidelines') and of (ii) developing a voluntary European Quality Assurance scheme for breast cancer services based on the European legislative framework on accreditation (defined in Regulation (EC) No 765/2008) (in the following mentioned as...

  11. Toward Guidelines for Population-level Ecological Risk Assessment: Results of a U.S. EPA Risk Assessment Forum Workshop

    Science.gov (United States)

    The choice of levels of biological organization reflected in ecological risk assessment (ERA) is receiving increasing attention. Most ERAs conducted for chemicals by the U.S. EPA, and indeed by most organizations worldwide, focus on organism-level attributes (e.g., survival, gro...

  12. Post-mastectomy radiotherapy in Denmark: From 2D to 3D treatment planning guidelines of The Danish Breast Cancer Cooperative Group

    DEFF Research Database (Denmark)

    Thomsen, Mette Skovhus; Berg, Martin; Nielsen, Hanne M.;

    2008-01-01

    , it was investigated whether it was possible to find a treatment technique alternative to the one recommended by the Danish Breast Cancer Cooperative Group (DBCG). A dosimetric comparison of a combined photon/electron 3-field technique (3F) and a partial wide tangent technique (PWT) was carried out on individual......This paper describes the procedure of changing from 2D to 3D treatment planning guidelines for post-mastectomy radiotherapy in Denmark. The aim of introducing 3D planning for post-mastectomy radiotherapy was to optimize the target coverage and minimize the dose to the normal tissues. Initially...... to 3F. It was concluded that PWT was an appropriate choice of technique for future radiation treatment of post-mastectomy patients. A working group was formed and guidelines for 3D planning were developed during a series of workshops where radiation oncologists and physicists from all radiotherapy...

  13. Deliverable 4.3 Decision support guideline based on LCA and cost/efficiency assessment

    DEFF Research Database (Denmark)

    Larsen, Henrik Fred; Hansen, Peter Augusto; Boyer-Souchet, Florence

    2010-01-01

    four clusters related to the main purpose of the treatment, e.g. nutrient removal or micropollutant removal. All are assessed within the cluster by comparing with the reference or by looking at induced versus avoided environmental impacts potentials originated from the various emissions and flows...... inventory of cluster 1 on micropollutant removal, tracks 22 organic micropollutants (pharmaceuticals) that have been sampled in different WWTTs by NEPTUNE partners. The resulting inventory is then modelled according to the EDIP97 methodology on the GaBi LCA modelling software, i.e. GaBi 4 (PE 2008), with...

  14. Critical features of peer assessment of clinical performance to enhance adherence to a low back pain guideline for physical therapists: a mixed methods design

    NARCIS (Netherlands)

    Maas, M.J.M.; Dulmen, S.A. van; Sagasser, M.H.; Heerkens, Y.F.; Vleuten, C.P.M. van der; Nijhuis, M.W.; Wees, P.J. van der

    2015-01-01

    BACKGROUND: Clinical practice guidelines are intended to improve the process and outcomes of patient care. However, their implementation remains a challenge. We designed an implementation strategy, based on peer assessment (PA) focusing on barriers to change in physical therapy care. A previously pu

  15. Assessment of Adaptive Reuse of Heritage Shop Houses for Sleep Lodging in Malaysia: Fulfilment of Conservation Guidelines

    OpenAIRE

    Othuman Mydin M.A.; Keling N.A.; Sani N. Md.; Abas N.F.

    2014-01-01

    This study focuses on the compliance of adaptive reuse of historic shop houses for sleep lodging with reference to the Guidelines for Conservation Areas and Heritage Buildings by Majlis Perbandaran Pulau Pinang (MPPP). Through this research, awareness towards the compliance of building conservation guidelines for heritage shop houses will be clarified accordingly. The goal of this study is to determine and extract vital clauses and components of Guidelines for Conservation Areas and Heritage ...

  16. The Conversations About Cancer (CAC) project: assessing feasibility and audience impacts from viewing The Cancer Play.

    Science.gov (United States)

    Beach, Wayne A; Buller, Mary K; Dozier, David M; Buller, David B; Gutzmer, Kyle

    2014-01-01

    Basic communication research has identified a major social problem: communicating about cancer from diagnosis through death of a loved one. Over the past decade, an award-winning investigation into how family members talk through cancer on the telephone, based on a corpus of 61 phone calls over a period of 13 months, has been transformed into a theatrical production entitled The Cancer Play. All dialogue in the play is drawn from naturally occurring (transcribed) interactions between family members as they navigate their way through the trials, tribulations, hopes, and triumphs of a cancer journey. This dramatic performance explicitly acknowledges the power of the arts as an exceptional learning tool for extending empirical research, exploring ordinary family life, and exposing the often taken-for-granted conceptions of health and illness. In this study, a Phase I STTR project funded by the National Cancer Institute (NCI), we assess the feasibility of educating and impacting cancer patients, family members, and medical professionals who viewed the play as a live performance and through DVD screenings. Pre- and postperformance questionnaires were administered to solicit audience feedback. Pre-post change scores demonstrate overwhelming and positive impacts for changing opinions about the perceived importance, and attributed significance, of family communication in the midst of cancer. Paired-sample t-tests were conducted on five factor-analyzed indices/indicators-two indices of opinions about cancer and family communication, two indices measuring the importance of key communication activities, and the self-efficacy indicator-and all factors improved significantly (academic and health care professions are discussed. PMID:24098921

  17. General guidelines for the harmonisation of internal dose assessment: the Ideas Project

    International Nuclear Information System (INIS)

    The determination of internal doses is an essential component of individual monitoring programmes for workers. Assessment of internal doses can be divided into two phases: 1. determination of the amount of radioactive material in the human body by direct measurements and/or by indirect methods and 2. the interpretation of monitoring data in terms of intake and/or internal dose taking into account many influencing factors and assumptions, such as the physical and chemical characteristics of the radioactive substances, the mode of intake, the biokinetic and energy absorption processes, the individual parameters, etc. This second phase is particularly important because of the number of variables and uncertainties involved. Although the International Commission on Radiological Protection (ICRP) and International Atomic Energy Agency (IAEA) have published extensive tables of dose per unit intake (dose coefficients), these are default values based on assumptions about the intake parameters that may not be valid in specific situations

  18. Practice Guidelines for the Assessment of Clinically Significant Treatment Outcomes in the Children's Mental Health System.

    Science.gov (United States)

    Chomycz, Suzanne; Schmidt, Fred

    2016-01-01

    The use of program evaluation to monitor client change and improve intervention effectiveness is gaining increasing importance in the mental health field. However, there is a lack of literature available in community-based clinics for those who desire to evaluate the effectiveness of services. Through this article the authors review the literature on the best methods to assess clinically significant treatment outcomes in community-based children's mental health services. The strengths and weaknesses of commonly recommended methods of evaluating change are discussed (i.e., reliable change index, percentage of improvement, normative comparisons, and effect size) using a dataset from a community-based parenting program (N = 308). PMID:26086975

  19. Guidelines for Using Fallout Radionuclides to Assess Erosion and Effectiveness of Soil Conservation Strategies

    International Nuclear Information System (INIS)

    Soil degradation currently affects 1.9 billion hectares of agricultural land worldwide, and the area of degraded land is increasing rapidly at a rate of 5 to 7 million hectares each year. Most of this degradation is caused by inappropriate and poor land management practices in agriculture and livestock production. Among all degradation processes, including soil acidification, salinization and nutrient mining, soil erosion is by far the most common type of land degradation, accounting for 84% of affected areas, with more than three quarters of the affected surface land area located in developing countries. Current concerns about the impacts of soil erosion on crop productivity and the environment, as well as the deployment of effective soil conservation measures, have generated an urgent need to obtain reliable quantitative data on the extent and actual rates of soil erosion to underpin sustainable soil conservation strategies. The quest for new approaches for assessing soil erosion to complement conventional methods has led to the development of methodologies based on the use of fallout radionuclides (FRNs) as soil erosion tracers. With increasing attention being paid to land degradation worldwide, this publication explains and demonstrates FRN based methods to trace soil movement and to assess soil erosion at different spatial and temporal scales, and to evaluate the effectiveness of soil conservation strategies to ensure sustainable land management in agricultural systems. This publication summarizes the experiences and knowledge gained since the end of the 1990s in the use of FRNs by the IAEA and by scientists from both developed and developing countries involved in IAEA research networks. This publication provides guidance in the application of FRNs to stakeholders involved in sustainable agricultural development

  20. Validation of the MEDFICTS dietary questionnaire: A clinical tool to assess adherence to American Heart Association dietary fat intake guidelines

    Directory of Open Access Journals (Sweden)

    Bindeman Jody

    2003-06-01

    Full Text Available Abstract Background Dietary assessment tools are often too long, difficult to quantify, expensive to process, and largely used for research purposes. A rapid and accurate assessment of dietary fat intake is critically important in clinical decision-making regarding dietary advice for coronary risk reduction. We assessed the validity of the MEDFICTS (MF questionnaire, a brief instrument developed to assess fat intake according to the American Heart Association (AHA dietary "steps". Methods We surveyed 164 active-duty US Army personnel without known coronary artery disease at their intake interview for a primary prevention cardiac intervention trial using the Block food frequency (FFQ and MF questionnaires. Both surveys were completed on the same intake visit and independently scored. Correlations between each tools' assessment of fat intake, the agreement in AHA step categorization of dietary quality with each tool, and the test characteristics of the MF using the FFQ as the gold standard were assessed. Results Subjects consumed a mean of 36.0 ± 13.0% of their total calories as fat, which included saturated fat consumption of 13.0 ± 0.4%. The majority of subjects (125/164; 76.2% had a high fat (worse than AHA Step 1 diet. There were significant correlations between the MF and the FFQ for the intake of total fat (r = 0.52, P 70 [high fat diet] was negligible (kappa statistic = 0.036. The MF was accurate at the extremes of fat intake, but could not reliably identify the 3 AHA dietary classifications. Alternative MF cutpoints of 50 (high fat diet were highly sensitive (96%, but had low specificity (46% for a high fat diet. ROC curve analysis identified that a MF score cutoff of 38 provided optimal sensitivity 75% and specificity 72%, and had modest agreement (kappa = 0.39, P Conclusions The MEDFICTS questionnaire is most suitable as a tool to identify high fat diets, rather than discriminate AHA Step 1 and Step 2 diets. Currently recommended

  1. The nutritional assessment of head and neck cancer patients.

    Science.gov (United States)

    Magnano, Mauro; Mola, Patrizia; Machetta, Giacomo; Maffeis, Paola; Forestiero, Ilenia; Cavagna, Roberta; Artino, Elena; Boffano, Paolo

    2015-12-01

    Patients affected by head and neck cancer are particularly at risk for nutritional depletion. The aim of this study was to evaluate the nutritional status of patients affected by head and neck cancer at diagnosis. All adult patients with head and neck cancer between January 2009 and December 2013 were included. The following data were recorded: demographics, tobacco and/or alcohol consumption, weight, height, the reference weight 6 months before the diagnosis, tumor site, tumor stage, and laboratory data. Then, Body mass index (BMI), and Buzby nutrition risk index (NRI) were calculated. Statistical analysis was used to search for associations among multiple variables. 122 men and 22 women were enrolled. As for reference BMI, 77 patients were overweight, whereas just 7 subjects were underweight. At diagnosis, 72 subjects were overweight according to BMI, whereas 52 patients were underweight. Instead, according to NRI, 96 patients were severely malnourished, 42 patients were moderately malnourished, whereas just 6 patients had a normal value of NRI. The assessment of nutrition by BMI excluded from a thorough consideration all overweight and obese patients with head and neck cancer. Instead, NRI correctly identified both undernourished and overweight/obese patients as "malnourished" subjects. PMID:25534287

  2. A dataset to assess providers׳ knowledge and attitudes towards the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline.

    Science.gov (United States)

    Pokharel, Yashashwi; Steinberg, Lynne; Chan, Winston; Akeroyd, Julia M; Jones, Peter H; Nambi, Vijay; Nasir, Khurram; Petersen, Laura; Ballantyne, Christie M; Virani, Salim S

    2016-06-01

    We previously examined provider׳s understanding of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol management guideline (DOI: http://dx.doi.org/10.1016/j.jacl.2015.11.002)(Virani et al., 2013) [1], and also assessed whether a case-based educational intervention could improve providers׳ knowledge gaps and attitudes towards the guideline (DOI: 10.1016/j.atherosclerosis.2015.12.044) (Pokharel, et al., 2016) [2]. Here we describe the dataset that we used to examine our objectives. PMID:27054163

  3. Inconsistencies in clinical guidelines for obstetric anaesthesia for Caesarean section

    DEFF Research Database (Denmark)

    Winther, Lars; Mitchell, A U; Møller, Ann

    2013-01-01

    Anaesthetists need evidence-based clinical guidelines, also in obstetric anaesthesia. We compared the Danish, English, American, and German national guidelines for anaesthesia for Caesarean section. We focused on assessing the quality of guideline development and evaluation of the guidelines...

  4. A French guideline for defect assessment at elevated temperature and leak before break analysis

    Energy Technology Data Exchange (ETDEWEB)

    Drubay, B.; Chapuliot, St.; Lacire, M.H.; Marie, St. [CEA Saclay, Lab. d' Ingegrite des Structures et Normalisation, LISN, 91 - Gif sur Yvette (France); Deschanels, H. [FRAMATOME/Novatome, 69 - Lyon (France); Cambefort, P. [Electricite de France (EDF/SEPTEN), 69 - Lyon (France)

    2001-07-01

    A large program is performed in France in order to develop, for the design and operating FBR (fast breeder reactor) plants, defect assessment procedures and Leak-Before-Break methods (L.B.B.). The main objective of this A16 guide is to propose analytical solutions at elevated temperature coherent with those proposed at low temperature by the RSE-M. The main items developed in this A16 guide for laboratory specimen, plates, pipes and elbows are the following: evaluation of ductile crack initiation and crack propagation based on the J parameter and material characteristics as J{sub R}-{delta}a curve or J{sub i}/G{sub fr}. Algorithms to evaluate the maximum endurable load under increasing load for through wall cracks or surface cracks are also proposed; determination of fatigue or creep-fatigue crack initiation based on the {sigma} approach calculating stress and strain at a characteristic distance d from the crack tip; evaluation of fatigue crack growth based on da/dN-{delta}K{sub eff} relationship with a {delta}K{sub eff} derived from a simplified estimation of {delta}J for the cyclic load; evaluation of creep-fatigue crack growth adding the fatigue crack growth and the creep crack growth during the hold time derived from a simplified evaluation of C{sup *}; Leak-Before-Break procedure. The fracture mechanic parameters determined in the A16 guide (K{sub 1}, J, C{sup *}) are derived from handbooks and formula in accordance with those proposed in the RSE-M document for in service inspection. Those are: the K{sub I} handbook for a large panel of surface and through-wall defect in plates, pipes and elbows; elastic stress and reference stress formula; analytical Js and Cs{sup *} formulations for mechanical and through thickness thermal load. The main part of the formula and assessment methodologies proposed in the A16 guide are included in a software, called MJSAM, developed under the MS Windows environment in support of the document. This allows a simple application of

  5. A French guideline for defect assessment at elevated temperature and leak before break analysis

    International Nuclear Information System (INIS)

    A large program is performed in France in order to develop, for the design and operating FBR (fast breeder reactor) plants, defect assessment procedures and Leak-Before-Break methods (L.B.B.). The main objective of this A16 guide is to propose analytical solutions at elevated temperature coherent with those proposed at low temperature by the RSE-M. The main items developed in this A16 guide for laboratory specimen, plates, pipes and elbows are the following: evaluation of ductile crack initiation and crack propagation based on the J parameter and material characteristics as JR-Δa curve or Ji/Gfr. Algorithms to evaluate the maximum endurable load under increasing load for through wall cracks or surface cracks are also proposed; determination of fatigue or creep-fatigue crack initiation based on the σ approach calculating stress and strain at a characteristic distance d from the crack tip; evaluation of fatigue crack growth based on da/dN-ΔKeff relationship with a ΔKeff derived from a simplified estimation of ΔJ for the cyclic load; evaluation of creep-fatigue crack growth adding the fatigue crack growth and the creep crack growth during the hold time derived from a simplified evaluation of C*; Leak-Before-Break procedure. The fracture mechanic parameters determined in the A16 guide (K1, J, C*) are derived from handbooks and formula in accordance with those proposed in the RSE-M document for in service inspection. Those are: the KI handbook for a large panel of surface and through-wall defect in plates, pipes and elbows; elastic stress and reference stress formula; analytical Js and Cs* formulations for mechanical and through thickness thermal load. The main part of the formula and assessment methodologies proposed in the A16 guide are included in a software, called MJSAM, developed under the MS Windows environment in support of the document. This allows a simple application of the analysis proposed in the document. (authors)

  6. Quality Guidelines

    Science.gov (United States)

    ... www.nlm.nih.gov/medlineplus/criteria.html MedlinePlus Quality Guidelines To use the sharing features on this ... materials must also meet our existing quality guidelines. Quality, authority and accuracy of health content The organization's ...

  7. Wind generation systems for remote communities: market assessment and guidelines for wind turbines selection

    International Nuclear Information System (INIS)

    Wind technology and its market potential in remote communities of the Canadian North were discussed. These communities, unserviced by the main utility electricity grid, generate their own electricity using high quality, expensive diesel fuel to power diesel driven generators. The logistics of delivering fuel to these remote communities is an expensive operation. Wind resource in many of these communities is substantial and wind energy is seen as a prime candidate for supplying electricity to many potential sites in the Arctic and also areas in Quebec and Newfoundland. However, the severe service (i.e., cold climate, remote locations with limited facilities) requires special considerations to ensure that equipment installed performs reliably. This report described some demonstration projects in northern Canada over the last ten years, where an understanding of the special needs of wind turbines in remote areas has been developed. A guide which assessed the suitability of wind turbines for Arctic applications was included to assist organisations in preparing requirements to be used in acquiring wind turbines for use in cold regions. Refs., tabs., figs

  8. Quality-of-life assessment in advanced cancer.

    LENUS (Irish Health Repository)

    Donnelly, S

    2000-07-01

    In the past 5 years, quality-of-life (QOL) assessment measures such as the McGill, McMaster, Global Visual Analogue Scale, Assessment of QOL at the End of Life, Life Evaluation Questionnaire, and Hospice QOL Index have been devised specifically for patients with advanced cancer. The developers of these instruments have tried to respond to the changing needs of this specific population, taking into account characteristics including poor performance status, difficulty with longitudinal study, rapidly deteriorating physical condition, and change in relevant issues. Emphasis has been placed on patient report, ease and speed of completion, and the existential domain or meaning of life. Novel techniques in QOL measurement have also been adapted for palliative care, such as judgment analysis in the Schedule for the Evaluation of Individual Quality of Life. It is generally agreed that a single tool will not cover all QOL assessment needs.

  9. Reporting of prognostic studies of tumour markers: a review of published articles in relation to REMARK guidelines

    OpenAIRE

    Mallett, S.; Timmer, A.; Sauerbrei, W.; Altman, D. G.

    2009-01-01

    Background: Poor reporting compromises the reliability and clinical value of prognostic tumour marker studies. We review articles to assess the reporting of patients and events using REMARK guidelines, at the time of guideline publication. Methods: We sampled 50 prognostic tumour marker studies from higher impact cancer journals between 2006 and 2007. The inclusion criteria were cancer; focus on single biological tumour marker; survival analysis; multivariable analysis; and not gene array or ...

  10. Assessing risks for gastric cancer: New tools for pathologists

    Institute of Scientific and Technical Information of China (English)

    Robert M Genta; Massimo Rugge

    2006-01-01

    Although the Sydney Systems (original and updated) for the classification of gastritis have contributed substantially to the uniformity of the reporting of gastric conditions, they lack immediacy in conveying to the user information about gastric cancer risk. In this review, we summarize the current understanding of the gastric lesions associated with an increased risk for cancer, and present the rationale for a proposal for new ways of reporting gastritis. In addition to the traditional histopathological data gathered and evaluated according to the Sydney System rules, pathologists could add an assessment expressed as grading and staging of the gastric inflammatory and atrophic lesions and integrate these findings with pertinent laboratory information on pepsinogens and gastrin levels. Such an integrated report could facilitate clinicians' approach to the management of patients with gastric conditions.

  11. National Academy of Clinical Biochemistry laboratory medicine practice guidelines for use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers

    DEFF Research Database (Denmark)

    Sturgeon, Catharine M; Duffy, Michael J; Stenman, Ulf-Håkan;

    2008-01-01

    BACKGROUND: Updated National Academy of Clinical Biochemistry (NACB) Laboratory Medicine Practice Guidelines for the use of tumor markers in the clinic have been developed. METHODS: Published reports relevant to use of tumor markers for 5 cancer sites--testicular, prostate, colorectal, breast...... prostatic disease when total PSA is advanced disease. Fecal occult blood testing may be used for screening asymptomatic adults 50...... may be used for determining prognosis in lymph node-negative patients. CA15-3/BR27-29 or carcinoembryonic antigen may be used for therapy monitoring in advanced disease. CA125 is recommended (with transvaginal ultrasound) for early detection of ovarian cancer in women at high risk for this disease. CA...

  12. Multimedia Environmental Pollutant Assessment System (MEPAS) application guidance. Guidelines for evaluating MEPAS input parameters for Version 3.1

    International Nuclear Information System (INIS)

    The Multimedia Environmental Pollutant Assessment System (MEPAS) was developed by Pacific Northwest Laboratory (PNL) for the U.S. Department of Energy (DOE) Office of Environment, Safety and Health and Office of Environmental Management and Environmental Restoration. MEPAS is a set of computer codes developed to provide decision makers with risk information integrated for hazardous, radioactive, and mixed-waste sites based on their potential hazard to public health. It is applicable to a wide range of environmental management and regulatory conditions, including inactive sites covered under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) and active air and water releases covered under the Clean Air Act, the Clean Water Act, and the Resource Conservation and Recovery Act. MEPAS integrates contaminant release, transport, and exposure models into a single system. An interactive user interface assists the investigator in defining problems, assembling data and entering input, and developing reports. PNL has compiled two documents that explain the methodology behind the MEPAS model and instruct the user in how to input, retrieve, and evaluate data. This report contains detailed guidelines for defining the input data required to conduct an analysis with MEPAS. Entries for each variable have a short definition, units, and text explaining what a variable is and how it can be quantified. As appropriate, ranges and typical values are given. This report also contains listings of the input screens (worksheets) that are used in the MEPAS user interface for these variables

  13. Guidelines and workbook for assessment of organization and administration of utilities seeking operating license for a nuclear power plant. Guidelines for utility organization and administration plan. Volume 1, Revision 1

    International Nuclear Information System (INIS)

    Volumes 1 and 2 of this report are a partial response to the requirements of Item I.B.1.1 of the ''NRC Action Plan Developed as a Result of the TMI-2 Accident,'' NUREG-0660, and are designed to serve as a basis for replacing the earlier NUREG-0731, ''Guidelines for Utility Management Structure and Technical Resources.'' These Guidelines are intended to provide guidance to the user in preparing a written plan for a proposed nuclear organization and administration. The purpose of the Workbook (Vol. 2) is to guide the NRC reviewer through a systematic review and assessment of a proposed organization and administration. It is the NRC's intention to incorporate these Guidelines and Workbook into a future revision of the Standard Review Plan (SRP), NUREG-0800. However, at this time the report is being published so that the material may be used on a voluntary basis by industry to systematically prepare or evaluate their organization or administration plans. Use of the report by the NRC would not occur until after it has been incorpoarted in the SRP

  14. 基于最新癌痛治疗指南分析住院患者癌痛用药规范性%Analysis of Drug Use Normalization in Inpatients with Cancer Pain Based on the Latest Cancer Pain Treat-ment Guidelines

    Institute of Scientific and Technical Information of China (English)

    邵燕; 李欣荣

    2015-01-01

    selec-tion and the time of administration. In the guide group 1 the proportion of oxywdone controlled-release tablets was signiticantly higher than that in the guide group 2, the ratio of taking the medicine on time in the guide group 1 was also higher than that in the guide group 2. Both groups showed difference from the guidelines in the pain assessment and titration and specific analgesic drug use. Conclusion:The findings indicate the difference between the pain treatment and the guidelines in therapeutic medication of cancer pain, and the propaganda and education of relevant knowledge should be strengthened to promote the treatment standard.

  15. Cancer Risk Assessment: Should New Science be Applied? Workgroup summary

    Energy Technology Data Exchange (ETDEWEB)

    Richard J. Bull; Antone L. Brooks

    2002-12-15

    OAK-B135 A symposium discussing the implications of certain phenomena observed in radiation biology for cancer risk assessment in general. In July of 2002 a workshop was convened that explored some of the intercellular phenomena that appear to condition responses to carcinogen exposure. Effects that result from communication between cells that appear to either increase the sphere of damage or to modify the sensitivity of cells to further damage were of particular interest. Much of the discussion focused on the effects of ionizing radiation that were transmitted from cells directly hit to cells not receiving direct exposure to radiation (bystander cells). In cell culture, increased rates of mutation, chromosomal aberration, apoptosis, genomic instability, and decreased clonogenic survival have all been observed in cells that have experienced no direct radiation. In addition, there is evidence that low doses of radiation or certain chemicals give rise to adaptive responses in which the treated cells develop resistance to the effects of high doses given in subsequent exposures. Data were presented at the workshop indicating that low dose exposure of animals to radiation and some chemicals frequently reduces the spontaneous rate of mutation in vitro and tumor responses in vivo. Finally, it was concluded that considerable improvement in understanding of how genetic variation may modify the impact of these phenomena is necessary before the risk implications can be fully appreciated. The workshop participants discussed the substantive challenge that these data present with respect to simple linear methodologies that are currently used in cancer risk assessment and attempted to identify broad strategies by which these phenomena may start to be used to refine cancer risk assessment methods in the future.

  16. Radiation risk models for all solid cancers other than those types of cancer requiring individual assessments after a nuclear accident.

    Science.gov (United States)

    Walsh, Linda; Zhang, Wei

    2016-03-01

    In the assessment of health risks after nuclear accidents, some health consequences require special attention. For example, in their 2013 report on health risk assessment after the Fukushima nuclear accident, the World Health Organisation (WHO) panel of experts considered risks of breast cancer, thyroid cancer and leukaemia. For these specific cancer types, use was made of already published excess relative risk (ERR) and excess absolute risk (EAR) models for radiation-related cancer incidence fitted to the epidemiological data from the Japanese A-bomb Life Span Study (LSS). However, it was also considered important to assess all other types of solid cancer together and the WHO, in their above-mentioned report, stated "No model to calculate the risk for all other solid cancer excluding breast and thyroid cancer risks is available from the LSS data". Applying the LSS models for all solid cancers along with the models for the specific sites means that some cancers have an overlap in the risk evaluations. Thus, calculating the total solid cancer risk plus the breast cancer risk plus the thyroid cancer risk can overestimate the total risk by several per cent. Therefore, the purpose of this paper was to publish the required models for all other solid cancers, i.e. all solid cancers other than those types of cancer requiring special attention after a nuclear accident. The new models presented here have been fitted to the same LSS data set from which the risks provided by the WHO were derived. Although it is known already that the EAR and ERR effect modifications by sex are statistically significant for the outcome "all solid cancer", it is shown here that sex modification is not statistically significant for the outcome "all solid cancer other than thyroid and breast cancer". It is also shown here that the sex-averaged solid cancer risks with and without the sex modification are very similar once breast and thyroid cancers are factored out. Some other notable model

  17. Overview of resulting tools, guidelines, and instruments. IN-SAFETY Workpackage 3: New models, tools and guidelines for road safety assessment, Deliverable 3.4.

    OpenAIRE

    Dijkstra, A. Bald, S. Benz, T. & Gaitanidou, E. (eds.)

    2009-01-01

    Road safety will most probably be influenced by introducing Advanced Driver Assistance Systems (ADAS) or Intelligent Vehicle Safety Systems (IVSS). The effects of these systems on road safety can be assessed in different ways. This document gives a short overview of methodologies which allow for assessing road safety effects (Chapter 2), This Deliverable gives an overview of the outcome of work package 3 of IN-SAFETY. Two methodologies have basically been applied: • simulation model • risk an...

  18. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Chief Editor

    2016-06-01

    Full Text Available AUTHOR GUIDELINES Indian Journal of Community Health (IJCH accepts only online submission of manuscript(s by using Open Journal software (OJS at http://www.iapsmupuk.org/journal/index.php/IJCH/login Online SubmissionsAlready have a Username/Password for Indian Journal of Community Health (IJCH? GO TO LOGINNeed a Username/Password?GO TO REGISTRATIONNote: Registration and login are required to submit items online and to track the status of current submissions.Author GuidelinesIJCH strictly adheres on the recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals as per the standard universal guidelines given by International Committee of Medical Journal Editors (ICMJE - Recommendations for Uniform Requirements for Manuscripts. Authors are requested to visit http://www.icmje.org/index.html before making online submission of their manuscript(s. http://www.icmje.org/recommendations/browse/manuscript-preparation/preparing-for-submission.html Preparing for SubmissionGeneral PrinciplesReporting GuidelinesManuscript SectionsTitle PageAbstractIntroductionMethodsResultsDiscussionReferencesTablesIllustrations (FiguresUnits of MeasurementAbbreviations and Symbols 1. General PrinciplesThe text of articles reporting original research is usually divided into Introduction, Methods, Results, and Discussion sections. This so-called “IMRAD” structure is not an arbitrary publication format but a reflection of the process of scientific discovery. Articles often need subheadings within these sections to further organize their content. Other types of articles, such as meta-analyses, may require different formats, while case reports, narrative reviews, and editorials may have less structured or unstructured formats.Electronic formats have created opportunities for adding details or sections, layering information, cross-linking, or extracting portions of articles in electronic versions. Supplementary electronic

  19. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Chief Editor

    2015-12-01

    Full Text Available Author GuidelinesIJCH strictly adheres on the recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals as per the standard universal guidelines given by International Committee of Medical Journal Editors (ICMJE - Recommendations for Uniform Requirements for Manuscripts. Authors are requested to visit http://www.icmje.org/index.html before making online submission of their manuscript(s.  http://www.icmje.org/recommendations/browse/manuscript-preparation/preparing-for-submission.html Preparing for SubmissionPAGE CONTENTSGeneral PrinciplesReporting GuidelinesManuscript SectionsTitle PageAbstractIntroductionMethodsResultsDiscussionReferencesTablesIllustrations (FiguresUnits of MeasurementAbbreviations and Symbols1. General PrinciplesThe text of articles reporting original research is usually divided into Introduction, Methods, Results, and Discussion sections. This so-called “IMRAD” structure is not an arbitrary publication format but a reflection of the process of scientific discovery. Articles often need subheadings within these sections to further organize their content. Other types of articles, such as meta-analyses, may require different formats, while case reports, narrative reviews, and editorials may have less structured or unstructured formats.Electronic formats have created opportunities for adding details or sections, layering information, cross-linking, or extracting portions of articles in electronic versions. Supplementary electronic-only material should be submitted and sent for peer review simultaneously with the primary manuscript.2. Reporting GuidelinesReporting guidelines have been developed for different study designs; examples include CONSORT for randomized trials, STROBE for observational studies, PRISMA for systematic reviews and meta-analyses, and STARD for studies of diagnostic accuracy. Journals are encouraged to ask authors to follow these guidelines because

  20. Screening for colorectal cancer: possible improvements by risk assessment evaluation?

    Science.gov (United States)

    Nielsen, Hans J; Jakobsen, Karen V; Christensen, Ib J; Brünner, Nils

    2011-11-01

    Emerging results indicate that screening improves survival of patients with colorectal cancer. Therefore, screening programs are already implemented or are being considered for implementation in Asia, Europe and North America. At present, a great variety of screening methods are available including colono- and sigmoidoscopy, CT- and MR-colonography, capsule endoscopy, DNA and occult blood in feces, and so on. The pros and cons of the various tests, including economic issues, are debated. Although a plethora of evaluated and validated tests even with high specificities and reasonable sensitivities are available, an international consensus on screening procedures is still not established. The rather limited compliance in present screening procedures is a significant drawback. Furthermore, some of the procedures are costly and, therefore, selection methods for these procedures are needed. Current research into improvements of screening for colorectal cancer includes blood-based biological markers, such as proteins, DNA and RNA in combination with various demographically and clinically parameters into a "risk assessment evaluation" (RAE) test. It is assumed that such a test may lead to higher acceptance among the screening populations, and thereby improve the compliances. Furthermore, the involvement of the media, including social media, may add even more individuals to the screening programs. Implementation of validated RAE and progressively improved screening methods may reform the cost/benefit of screening procedures for colorectal cancer. Therefore, results of present research, validating RAE tests, are awaited with interest. PMID:21854094

  1. Current aspects of radiation-induced cancer risk assessment

    International Nuclear Information System (INIS)

    The agenda of the closed meeting of the commission shows the following main topics: 1) Recent dosimetry /Ro 87/ and new data on cancer mortality in the Atomic Bomb survivors of Hiroshima and Nagasaki as a function of age at the time of exposure /Pr 87; Si 87; IC 87.1/. 2) Models and assumptions given in the epidemiological tables of the U.S. National Institute of Health (NIH) /NIH 85/ for assessment of probability of cancer induction due to exposure to ionizing radiation (probability of causation), and possibilities of interpreting these data so as to match them with conditions in the F.R.G. 3) Results of epidemiological studies with occupationally exposed persons working in nuclear installations or medical establishments, and with population groups living in the environs of nuclear installations. 4) Recent knowledge about radon-induced lung cancer, and recommendations of and measures taken by other countries for reducing radon concentrations in buildings. The summarizing appraisals and recommendations agreed upon by the SSK members upon discussion of the items are given in this publication. (orig./MG) With 31 figs., 41 tabs

  2. Use of EORTC Target Definition Guidelines for Dose-Intensified Salvage Radiation Therapy for Recurrent Prostate Cancer: Results of the Quality Assurance Program of the Randomized Trial SAKK 09/10

    International Nuclear Information System (INIS)

    Purpose: Different international target volume delineation guidelines exist and different treatment techniques are available for salvage radiation therapy (RT) for recurrent prostate cancer, but less is known regarding their respective applicability in clinical practice. Methods and Materials: A randomized phase III trial testing 64 Gy vs 70 Gy salvage RT was accompanied by an intense quality assurance program including a site-specific and study-specific questionnaire and a dummy run (DR). Target volume delineation was performed according to the European Organisation for the Research and Treatment of Cancer guidelines, and a DR-based treatment plan was established for 70 Gy. Major and minor protocol deviations were noted, interobserver agreement of delineated target contours was assessed, and dose-volume histogram (DVH) parameters of different treatment techniques were compared. Results: Thirty European centers participated, 43% of which were using 3-dimensional conformal RT (3D-CRT), with the remaining centers using intensity modulated RT (IMRT) or volumetric modulated arc technique (VMAT). The first submitted version of the DR contained major deviations in 21 of 30 (70%) centers, mostly caused by inappropriately defined or lack of prostate bed (PB). All but 5 centers completed the DR successfully with their second submitted version. The interobserver agreement of the PB was moderate and was improved by the DR review, as indicated by an increased κ value (0.59 vs 0.55), mean sensitivity (0.64 vs 0.58), volume of total agreement (3.9 vs 3.3 cm3), and decrease in the union volume (79.3 vs 84.2 cm3). Rectal and bladder wall DVH parameters of IMRT and VMAT vs 3D-CRT plans were not significantly different. Conclusions: The interobserver agreement of PB delineation was moderate but was improved by the DR. Major deviations could be identified for the majority of centers. The DR has improved the acquaintance of the participating centers with the trial protocol

  3. Fracture risk assessment: improved evaluation of vertebral integrity among metastatic cancer patients to aid in surgical decision-making

    Science.gov (United States)

    Augustine, Kurt E.; Camp, Jon J.; Holmes, David R.; Huddleston, Paul M.; Lu, Lichun; Yaszemski, Michael J.; Robb, Richard A.

    2012-03-01

    Failure of the spine's structural integrity from metastatic disease can lead to both pain and neurologic deficit. Fractures that require treatment occur in over 30% of bony metastases. Our objective is to use computed tomography (CT) in conjunction with analytic techniques that have been previously developed to predict fracture risk in cancer patients with metastatic disease to the spine. Current clinical practice for cancer patients with spine metastasis often requires an empirical decision regarding spinal reconstructive surgery. Early image-based software systems used for CT analysis are time consuming and poorly suited for clinical application. The Biomedical Image Resource (BIR) at Mayo Clinic, Rochester has developed an image analysis computer program that calculates from CT scans, the residual load-bearing capacity in a vertebra with metastatic cancer. The Spine Cancer Assessment (SCA) program is built on a platform designed for clinical practice, with a workflow format that allows for rapid selection of patient CT exams, followed by guided image analysis tasks, resulting in a fracture risk report. The analysis features allow the surgeon to quickly isolate a single vertebra and obtain an immediate pre-surgical multiple parallel section composite beam fracture risk analysis based on algorithms developed at Mayo Clinic. The analysis software is undergoing clinical validation studies. We expect this approach will facilitate patient management and utilization of reliable guidelines for selecting among various treatment option based on fracture risk.

  4. The significance of nuclear ER in the assessment of ER status of breast cancer and ovarian cancer tissues

    International Nuclear Information System (INIS)

    The significance of estrogen receptor in cell nucleus in the assessment of the ER status of patients with breast cancer and ovarian cancer was assessed 151 breast cancer tissues and 124 ovarian cancer tissues were analyzed for their EcR and EnR using radioligand binding assay (RBA). In 36.42% of the breast cancer tissues, both EcR and EnR were positive. This rate was significantly lower than that of tissues with positive EcR alone (55.63%). In the ovarian cancer tissues, the rate of both EcR and EnR position (34.68%) was also significantly lower than that of EcR positive alone (51.61%). Only 65.48% of EcR-positive breast cancer tissues and 67.19% EcR-positive ovarian cancer tissues were accompanied by EnR positive. To assess the ER status of breast cancer or ovarian cancer, it is important to analyse not only EcR but also EnR

  5. Overview of resulting tools, guidelines, and instruments. IN-SAFETY Workpackage 3: New models, tools and guidelines for road safety assessment, Deliverable 3.4.

    NARCIS (Netherlands)

    Dijkstra, A. Bald, S. Benz, T. & Gaitanidou, E. (eds.)

    2009-01-01

    Road safety will most probably be influenced by introducing Advanced Driver Assistance Systems (ADAS) or Intelligent Vehicle Safety Systems (IVSS). The effects of these systems on road safety can be assessed in different ways. This document gives a short overview of methodologies which allow for ass

  6. Guidelines for a national epidemiological surveillance system of thyroid cancer in France; Recommandations pour la mise en place d'un dispositif de surveillance epidemiologique nationale des cancers thyroidiens

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2002-10-01

    At the request of the French Department of Health, a multidisciplinary Thyroid Cancer Committee, coordinated by the French Public Health Agency analysed the observed increase of thyroid cancer incidence in France and outlined the limits of the present case registration system. This Committee set up guidelines to improve the national surveillance system of thyroid cancer. The Committee analysed 4 models for the incidence survey, 3 of which have been excluded: a poor cost-benefit ratio precludes the constitution of a national registry dedicated to thyroid cancer; however, the Committee has recommended this model that still exists for thyroid cancer of the youth(under 19 years old), a national system base exclusively on pathological data would only be relevant after significant improvement of data collection, obligatory of all cases of thyroid cancer is inappropriate considering the fit prognosis of this cancer. A two level system is proposed with continuous registration of incident caes through the National Hospital Discharge survey, specific focused analysis of clinical and pathological data in case of a cluster alert in any given area. Whatever the system, it seems necessary to in general: propose a unique health registration number per patient, improve access to medical data, organize a national standardised collection of pathological findings, follow up the diagnosis practices related to thyroid cancer that have an impact on incidence rates. In conclusion, a reliable incidence survey and a follow up of diagnostic practices and of risk factors may provide a relevant model of epidemiological survey of thyroid cancers in France but such a system requires a long lasting strategic and financial involvement. (author)

  7. Announcing the CDC guideline for prescribing opioids for chronic pain.

    Science.gov (United States)

    Houry, Debra; Baldwin, Grant

    2016-06-01

    This guideline provides recommendations for primary care providers who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses: (a) when to initiate or continue opioids for chronic pain; (b) opioid selection, dosage, duration, follow-up, and discontinuation; and (c) assessing risk and addressing harms of opioid use. This guideline is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including abuse, dependence, overdose, and death (Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep 2016;65:1-49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1.). PMID:27178083

  8. ECONOMIC ANALYSIS OF ENVIRONMENTAL REGULATIONS: APPLICATION OF THE RANDOM UTILITY MODEL TO RECREATIONAL BENEFIT ASSESSMENT FOR THE MP&M EFFLUENT GUIDELINE

    OpenAIRE

    Tudor, Lynne G.; Besedin, Elena Y.; Fisher, Michael; Smith, Stuart

    1999-01-01

    The present study focuses on a state-wide case study to evaluate recreational benefits from forthcoming effluent limitation guidelines for the Metal Products and Machinery Industry. The study combines water quality modeling and a random utility model to assess how changes in water quality from the regulation will affect consumer valuation of water resources. Based on preliminary results, the MP&M regulation has the potential to generate substantial recreational benefits in Ohio.

  9. The fish sexual development test: an OECD test guideline proposal with possible relevance for environmental risk assessment. Results from the validation programme

    DEFF Research Database (Denmark)

    Holbech, Henrik; Brande-Lavridsen, Nanna; Kinnberg, Karin Lund;

    2010-01-01

    The Fish Sexual Development Test (FSDT) has gone through two validations as an OECD test guideline for the detection of endocrine active chemicals with different modes of action. The validation has been finalized on four species: Zebrafish (Danio rerio), Japanese medaka (Oryzias latipes), three s...... as a population relevant endpoint and the results of the two validation rounds will be discussed in relation to environmental risk assessment and species selection....

  10. Methods for assessing uncertainty in fundamental assumptions and associated models for cancer risk assessment.

    Science.gov (United States)

    Small, Mitchell J

    2008-10-01

    The distributional approach for uncertainty analysis in cancer risk assessment is reviewed and extended. The method considers a combination of bioassay study results, targeted experiments, and expert judgment regarding biological mechanisms to predict a probability distribution for uncertain cancer risks. Probabilities are assigned to alternative model components, including the determination of human carcinogenicity, mode of action, the dosimetry measure for exposure, the mathematical form of the dose-response relationship, the experimental data set(s) used to fit the relationship, and the formula used for interspecies extrapolation. Alternative software platforms for implementing the method are considered, including Bayesian belief networks (BBNs) that facilitate assignment of prior probabilities, specification of relationships among model components, and identification of all output nodes on the probability tree. The method is demonstrated using the application of Evans, Sielken, and co-workers for predicting cancer risk from formaldehyde inhalation exposure. Uncertainty distributions are derived for maximum likelihood estimate (MLE) and 95th percentile upper confidence limit (UCL) unit cancer risk estimates, and the effects of resolving selected model uncertainties on these distributions are demonstrated, considering both perfect and partial information for these model components. A method for synthesizing the results of multiple mechanistic studies is introduced, considering the assessed sensitivities and selectivities of the studies for their targeted effects. A highly simplified example is presented illustrating assessment of genotoxicity based on studies of DNA damage response caused by naphthalene and its metabolites. The approach can provide a formal mechanism for synthesizing multiple sources of information using a transparent and replicable weight-of-evidence procedure. PMID:18844862

  11. Developing a national food defense guideline based on a vulnerability assessment of intentional food contamination in Japanese food factories using the CARVER+Shock vulnerability assessment tool.

    Science.gov (United States)

    Kanagawa, Yoshiyuki; Akahane, Manabu; Hasegawa, Atsushi; Yamaguchi, Kentaro; Onitake, Kazuo; Takaya, Satoshi; Yamamoto, Shigeki; Imamura, Tomoaki

    2014-12-01

    The awareness of food terrorism has increased following the September 11, 2001 terrorist attacks in New York City, United States, and many measures and policies dealing with this issue have been established worldwide. Suspected deliberate food-poisoning crimes have occurred in Japan, although they are not regarded as acts of food terrorism. One area of concern is that the small- to medium-sized companies that dominate Japan's food industry are extremely vulnerable to deliberate food poisoning. We conducted a literature research on food defense measures undertaken by the World Health Organization and in the United States and Europe. Using the Carver+Shock vulnerability assessment tool, eight food factories and related facilities in Japan were evaluated and we found the level of awareness of food defense to be low and the measures inappropriate. On the basis of this evaluation, we developed a set of guidelines that Japanese food companies can use to help develop their food defense strategies and to serve as a reference in considering specific measures. PMID:25496071

  12. Guidelines on the scope, content, and use of comprehensive risk assessment in the management of high-level nuclear waste transportation

    International Nuclear Information System (INIS)

    This report discusses the scope of risk assessment strategies in the management of the transport of high-level radioactive wastes. In spite of the shortcomings of probabilistic risk assessment(PRA), the Transportation Needs Assessment recommended this as the preferred methodology to assess the risks of high level nuclear waste (HLNW) transportation. A PRA also will need to heed the lessons learned from the development and application of PRA elsewhere, such as in the nuclear power industry. A set of guidelines will aid this endeavor by outlining the appropriate scope, content, and use of a risk assessment which is more responsive to the uncertainties, human-technical interactions, social forces, and iterative relationship with risk management strategies, than traditional PRAS. This more expansive definition, which encompasses but is not totally reliant on rigorous data requirements and quantitative probability estimates, we term Comprehensive Risk Assessment (CRA) Guidelines will be developed in three areas: the limitations of existing methodologies and suggested modifications; CRA as part of a flexible, effective, adaptive risk management system for HLNW transportation; and, the use of CRA in risk communication

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

    Science.gov (United States)

    Troyer, Caitlin M; Gerber, Leah R

    2015-10-01

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

  14. Canine mammary tumors: a review and consensus of standard guidelines on epithelial and myoepithelial phenotype markers, HER2, and hormone receptor assessment using immunohistochemistry.

    Science.gov (United States)

    Peña, L; Gama, A; Goldschmidt, M H; Abadie, J; Benazzi, C; Castagnaro, M; Díez, L; Gärtner, F; Hellmén, E; Kiupel, M; Millán, Y; Miller, M A; Nguyen, F; Poli, A; Sarli, G; Zappulli, V; de las Mulas, J Martín

    2014-01-01

    Although there have been several studies on the use of immunohistochemical biomarkers of canine mammary tumors (CMTs), the results are difficult to compare. This article provides guidelines on the most useful immunohistochemical markers to standardize their use and understand how outcomes are measured, thus ensuring reproducibility of results. We have reviewed the biomarkers of canine mammary epithelial and myoepithelial cells and identified those biomarkers that are most useful and those biomarkers for invasion and lymph node micrometastatic disease. A 10% threshold for positive reaction for most of these markers is recommended. Guidelines on immunolabeling for HER2, estrogen receptors (ERs), and progesterone receptors (PRs) are provided along with the specific recommendations for interpretation of the results for each of these biomarkers in CMTs. Only 3+ HER2-positive tumors should be considered positive, as found in human breast cancer. The lack of any known response to adjuvant endocrine therapy of ER- and PR-positive CMTs prevents the use of the biological positive/negative threshold used in human breast cancer. Immunohistochemistry results of ER and PR in CMTs should be reported as the sum of the percentage of positive cells and the intensity of immunolabeling (Allred score). Incorporation of these recommendations in future studies, either prospective or retrospective, will provide a mechanism for the direct comparison of studies and will help to determine whether these biomarkers have prognostic significance. Finally, these biomarkers may ascertain the most appropriate treatment(s) for canine malignant mammary neoplasms. PMID:24227007

  15. Assessing breast cancer masking risk with automated texture analysis in full field digital mammography

    DEFF Research Database (Denmark)

    Kallenberg, Michiel Gijsbertus J; Lilholm, Martin; Diao, Pengfei;

    2015-01-01

    PURPOSE The goal of this work is to develop a method to assess the risk of breast cancer masking, based on image characteristics beyond breast density. METHOD AND MATERIALS From the Dutch breast cancer screening program we collected 285 screen detected cancers, and 109 cancers that were screen...... (Quartile 1/2) versus high (Quartile 3/4) texture risk score. We computed odds ratios (OR) for breast cancer masking risk (i.e. interval versus screen detected cancer) for each of the subgroups. The OR was 1.63 (1.04-2.53 95%CI) for the high dense group (as compared to the low dense group), whereas for the...... assessing the risk that a breast cancer is masked in regular mammography, independently of breast density. As such it offers opportunities to further enhance personalized breast cancer screening, beyond breast density....

  16. Assessment of breast cancer tumour size using six different methods

    Energy Technology Data Exchange (ETDEWEB)

    Meier-Meitinger, Martina; Uder, Michael; Schulz-Wendtland, Ruediger; Adamietz, Boris [Erlangen University Hospital, Institute of Diagnostic Radiology, Erlangen (Germany); Haeberle, Lothar; Fasching, Peter A.; Bani, Mayada R.; Heusinger, Katharina; Beckmann, Matthias W. [Erlangen University Hospital, University Breast Center, Department of Gynecology and Obstetrics, Erlangen (Germany); Wachter, David [Erlangen University Hospital, Institute of Pathology, Erlangen (Germany)

    2011-06-15

    Tumour size estimates using mammography (MG), conventional ultrasound (US), compound imaging (CI) and real-time elastography (RTE) were compared with histopathological specimen sizes. The largest diameters of 97 malignant breast lesions were measured. Two US and CI measurements were made: US1/CI1 (hypoechoic nucleus only) and US2/CI2 (hypoechoic nucleus plus hyperechoic halo). Measurements were compared with histopathological tumour sizes using linear regression and Bland-Altman plots. Size prediction was best with ultrasound (US/CI/RTE: R{sup 2} 0.31-0.36); mammography was poorer (R{sup 2} = 0.19). The most accurate method was US2, while US1 and CI1 were poorest. Bland-Altman plots showed better size estimation with US2, CI2 and RTE, with low variation, while mammography showed greatest variability. Smaller tumours were better assessed than larger ones. CI2 and US2 performed best for ductal tumours and RTE for lobular cancers. Tumour size prediction accuracy did not correlate significantly with breast density, but on MG tumours were more difficult to detect in high-density tissue. The size of ductal tumours is best predicted with US2 and CI2, while for lobular cancers RTE is best. Hyperechoic tumour surroundings should be included in US and CI measurements and RTE used as an additional technique in the clinical staging process. (orig.)

  17. Assessing Oral Cancer Awareness Among Rural Latino Migrant Workers.

    Science.gov (United States)

    Dodd, Virginia J; Schenck, David P; Chaney, Elizabeth H; Padhya, Tapan

    2016-06-01

    Latino migrant farm workers suffer significant health disparities, including poor oral health. The purpose of this research was to assess Latino migrant farm workers' OC awareness, including knowledge and care-seeking behaviors. A 42-item survey was developed. Trained, bilingual researchers verbally administered the survey to migrant farm workers in Hillsborough County, Florida. Frequencies and descriptive statistics were generated to report baseline data. The sample consisted of 53.7 % female respondents. The mean age for males and females respectively was 38.7 and 39.2. Most respondents had attended grade school; 6.7 % never attended school. Perceptions of cancer susceptibility were present; knowledge of OC risk factors, signs and symptoms was low. Participants were unlikely to seek preventive care. The results contribute to the limited studies regarding Latino migrant farm workers and oral cancer risk factor awareness and knowledge. Findings highlight factors influencing motivation and care-seeking behaviors, as well as provide guidance for development of educational materials. PMID:26018959

  18. Epigenetics and cancer: implications for drug discovery and safety assessment

    International Nuclear Information System (INIS)

    It is necessary to determine whether chemicals or drugs have the potential to pose a threat to human health. Research conducted over the last two decades has led to the paradigm that chemicals can cause cancer either by damaging DNA or by altering cellular growth, probably via receptor-mediated changes in gene expression. However, recent evidence suggests that gene expression can be altered markedly via several diverse epigenetic mechanisms that can lead to permanent or reversible changes in cellular behavior. Key molecular events underlying these mechanisms include the alteration of DNA methylation and chromatin, and changes in the function of cell surface molecules. Thus, for example, DNA methyltransferase enzymes together with chromatin-associated proteins such as histone modifying enzymes and remodelling factors can modify the genetic code and contribute to the establishment and maintenance of altered epigenetic states. This is relevant to many types of toxicity including but not limited to cancer. In this paper, we describe the potential for interplay between genetic alteration and epigenetic changes in cell growth regulation and discuss the implications for drug discovery and safety assessment

  19. Clinical guidelines.

    Science.gov (United States)

    Uppal, Elaine

    2016-01-01

    This article is part of the Advancing practice series which is aimed at exploring practice issues in more depth, considering topics that are frequently encountered and facilitating the development of new insights. Elaine Uppal focuses on the importance of all midwives developing guideline writing skills to ensure that local, national and international midwifery/maternity guidelines are up to date, relevant and reflect midwifery knowledge alongside 'gold' standard evidence. The article aims to consider the development, use and critical appraisal of clinical guidelines. It will define and explain guidelines; discuss their development and dissemination; and consider issues relating to their use in practice. Techniques to critique and develop guidelines using the AGREE tool will be outlined in the form of practice challenges to be undertaken by the individual or in a group. PMID:26975126

  20. ASSET guidelines

    International Nuclear Information System (INIS)

    The IAEA Assessment of Safety Significant Events Team (ASSET) Service provides advice and assistance to Member States to enhance the overall level of plant safety while dealing with the policy of prevention of incidents at nuclear power plants. The ASSET programme, initiated in 1986, is not restricted to any particular group of Member States, whether developing or industrialized, but is available to all countries with nuclear power plants in operation or approaching commercial operation. The IAEA Safety Series publications form common basis for the ASSET reviews, including the Nuclear Safety Standards (NUSS) and the Basic Safety Principles (Recommendations of Safety Series No. 75-INSAG-3). The ASSET Guidelines provide overall guidance for the experts to ensure the consistency and comprehensiveness of their review of incident investigations. Additional guidance and reference material is provided by the IAEA to complement the expertise of the ASSET members. ASSET reviews accept different approaches that contribute to ensuring an effective prevention of incidents at plants. Suggestions are offered to enhance plant safety performance. Commendable good practices are identified and generic lessons are communicated to other plants, where relevant, for long term improvement

  1. Adherence to Guidelines among Italian Urologists on Imaging Preoperative Staging of Low-Risk Prostate Cancer: Results from the MIRROR (Multicenter Italian Report on Radical Prostatectomy Outcomes and Research Study

    Directory of Open Access Journals (Sweden)

    Alchiede Simonato

    2012-01-01

    Full Text Available Objective. A number of evidence-based guidelines for diagnosis and management of prostate cancer have been published. The aim of this study is to evaluate the adherence of Italian urologists to the guidelines concerning the preoperative imaging staging of prostate cancer. Methods. In October 2007 a multicentric observational perspective study called Multicentric Italian Report on Radical prostatectomy Outcome and Research (MIRROR was started in 135 Italian urology centers. Recruitment was closed in December 2008 and 2,408 cases were collected. In this paper we have taken into consideration all examinations carried out for preoperative imaging staging, evaluating compliance with the recommendations in the American Urological Association (AUA and European Association of Urology (EAU guidelines. Results. Five hundred sixty-seven (53.34% patients were not managed according to the EAU guidelines concerning T-staging, 545 (51.27% concerning N-staging and 757 (71.21% concerning M-staging. According to AUA guidelines, we also analyzed patients with a Gleason grade of biopsy specimens of 7: 238 (57.35% of these patients had undergone testing for T staging, 244 (57.35% for N-staging and 322 (77.60% for M-staging. Conclusions. The compliance of Italian urologists with the guidelines is low, leading to an inappropriate increase in cost of care and unnecessary anxiety for the patients.

  2. Development and Validation of the Assessment of Health Literacy in Breast and Cervical Cancer Screening

    OpenAIRE

    Han, Hae-Ra; Huh, Boyun; Kim, Miyong T.; Kim, Jiyun; Nguyen, Tam

    2014-01-01

    For many people limited health literacy is a major barrier to effective preventive health behavior such as cancer screening, yet a comprehensive health literacy measure that is specific to breast and cervical cancer screening is not readily available. The purpose of this paper is to describe the development and testing of a new instrument to measure health literacy in the context of breast and cervical cancer screening, the Assessment of Health Literacy in Cancer Screening (AHL-C). The AHL-C ...

  3. Critical Appraisal of Translational Research Models for Suitability in Performance Assessment of Cancer Centers

    OpenAIRE

    Rajan, Abinaya; Sullivan, Richard; Bakker, Suzanne; van Harten, Wim H.

    2012-01-01

    This study aimed to critically appraise translational research models for suitability in performance assessment of cancer centers. Process models, such as the Process Marker Model and Lean and Six Sigma applications, seem to be suitable for performance assessment of cancer centers. However, they must be thoroughly tested in practice.

  4. Assessing metal toxicity in sediments using the equilibrium partitioning model and empirical sediment quality guidelines: A case study in the nearshore zone of the Bohai Sea, China

    International Nuclear Information System (INIS)

    Highlights: • Based on the EqP model, 35% samples had potential metal toxicity in sediments. • The empirical SQGs are not suitable for assessing sediment toxicity in Bohai Sea. • The EqP model is a much needed tool for metal toxicity assessment in coastal China. - Abstract: Surface sediments were collected from five nearshore (wastewater discharges, aquaculture facilities and a seaport) sites in Bohai Bay and Laizhou Bay, China. The equilibrium partitioning (EqP) model and empirical sediment quality guidelines (SQGs) were applied to assess the potential metal toxicity in the collected sediments. The results show that, based on the EqP model, 35% of stations exhibited potential metal toxicity. Several metals (Cu, Ni and Cr) exceeded the empirical SQGs (9–93% of the time), however these guidelines may not be suitable for use in the Bohai Sea owing to the background concentrations. The EqP model is a more useful method for assessing potential metal toxicity in Bohai Sea sediment than the empirical SQGs. Additionally, we have provided new understanding about methods for assessing sediment metal toxicity in the Bohai Sea that may be useful in other coastal areas in China

  5. Examining guidelines for the site selection for geological disposal. Research activities principle for future risk assessment and quality assurance

    International Nuclear Information System (INIS)

    A draft for the committee in charge of nuclear safety regulations regarding geological disposal of high-level radioactive wastes from nuclear facilities is presented. The report particularly concerns with a line of policy or principle at the stage of investigation activities for the site selection and site characterization. IAEA guidelines are consulted. (S. Ohno)

  6. Risk management guidelines

    International Nuclear Information System (INIS)

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

  7. American Society of Clinical Oncology Policy Statement: The Role of the Oncologist in Cancer Prevention and Risk Assessment

    OpenAIRE

    Zon, Robin T.; Goss, Elizabeth; Vogel, Victor G.; Chlebowski, Rowan T.; Jatoi, Ismail; Robson, Mark E.; Wollins, Dana S.; Garber, Judy E.; Brown, Powel; Kramer, Barnett S.

    2008-01-01

    Oncologists have a critical opportunity to utilize risk assessment and cancer prevention strategies to interrupt the initiation or progression of cancer in cancer survivors and individuals at high risk of developing cancer. Expanding knowledge about the natural history and prognosis of cancers positions oncologists to advise patients regarding the risk of second malignancies and treatment-related cancers. In addition, as recognized experts in the full spectrum of cancer care, oncologists are ...

  8. Metadata Guidelines

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This document provides guidelines on metadata and metadata requirements for ServCat documents. Information on metadata is followed by an instructional flowchart and...

  9. Cancer immunotherapy and immune-related response assessment: The role of radiologists in the new arena of cancer treatment

    Energy Technology Data Exchange (ETDEWEB)

    Nishino, Mizuki, E-mail: Mizuki_Nishino@DFCI.HARVARD.EDU [Department of Radiology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215 (United States); Tirumani, Sree H.; Ramaiya, Nikhil H. [Department of Radiology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215 (United States); Hodi, F. Stephen [Department of Medical Oncology and Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, 450 Brookline Ave., Boston, MA 02215 (United States)

    2015-07-15

    Highlights: • The successful clinical application of cancer immunotherapy has opened a new arena for the treatment of advanced cancers. • Cancer immunotherapy is associated with a variety of important radiographic features in the assessments of tumor response and immune-related adverse events. • The state-of-the art knowledge of immunotherapy and the related radiologic manifestations are essential for radiologists. - Abstract: The recent advances in the clinical application of anti-cancer immunotherapeutic agents have opened a new arena for the treatment of advanced cancers. Cancer immunotherapy is associated with a variety of important radiographic features in the assessments of tumor response and immune-related adverse events, which calls for radiologists’ awareness and in-depth knowledge on the topic. This article will provide the state-of-the art review and perspectives of cancer immunotherapy, including its molecular mechanisms, the strategies for immune-related response assessment on imaging and their pitfalls, and the emerging knowledge of radiologic manifestations of immune-related adverse events. The cutting edge clinical and radiologic investigations are presented to provide future directions.

  10. Cancer immunotherapy and immune-related response assessment: The role of radiologists in the new arena of cancer treatment

    International Nuclear Information System (INIS)

    Highlights: • The successful clinical application of cancer immunotherapy has opened a new arena for the treatment of advanced cancers. • Cancer immunotherapy is associated with a variety of important radiographic features in the assessments of tumor response and immune-related adverse events. • The state-of-the art knowledge of immunotherapy and the related radiologic manifestations are essential for radiologists. - Abstract: The recent advances in the clinical application of anti-cancer immunotherapeutic agents have opened a new arena for the treatment of advanced cancers. Cancer immunotherapy is associated with a variety of important radiographic features in the assessments of tumor response and immune-related adverse events, which calls for radiologists’ awareness and in-depth knowledge on the topic. This article will provide the state-of-the art review and perspectives of cancer immunotherapy, including its molecular mechanisms, the strategies for immune-related response assessment on imaging and their pitfalls, and the emerging knowledge of radiologic manifestations of immune-related adverse events. The cutting edge clinical and radiologic investigations are presented to provide future directions

  11. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS).

    Science.gov (United States)

    Vilmann, Peter; Clementsen, Paul Frost; Colella, Sara; Siemsen, Mette; De Leyn, Paul; Dumonceau, Jean-Marc; Herth, Felix J; Larghi, Alberto; Vazquez-Sequeiros, Enrique; Vasquez-Sequeiros, Enrique; Hassan, Cesare; Crombag, Laurence; Korevaar, Daniël A; Konge, Lars; Annema, Jouke T

    2015-06-01

    This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE), produced in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). It addresses the benefit and burden associated with combined endobronchial and esophageal mediastinal nodal staging of lung cancer. The Scottish Intercollegiate Guidelines Network (SIGN) approach was adopted to define the strength of recommendations and the quality of evidence.The article has been co-published with permission in the European Journal of Cardio-Thoracic Surgery and the European Respiratory Journal. Recommendations 1 For mediastinal nodal staging in patients with suspected or proven non-small-cell lung cancer (NSCLC) with abnormal mediastinal and/or hilar nodes at computed tomography (CT) and/or positron emission tomography (PET), endosonography is recommended over surgical staging as the initial procedure (Recommendation grade A). The combination of endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic (esophageal) ultrasound with fine needle aspiration, with use of a gastrointestinal (EUS-FNA) or EBUS (EUS-B-FNA) scope, is preferred over either test alone (Recommendation grade C). If the combination of EBUS and EUS-(B) is not available, we suggest that EBUS alone is acceptable (Recommendation grade C).Subsequent surgical staging is recommended, when endosonography does not show malignant nodal involvement (Recommendation grade B). 2 For mediastinal nodal staging in patients with suspected or proven non-small-cell peripheral lung cancer without mediastinal involvement at CT or CT-PET, we suggest that EBUS-TBNA and/or EUS-(B)-FNA should be performed before therapy, provided that one or more of the following conditions is present: (i) enlarged or fluorodeoxyglucose (FDG)-PET-avid ipsilateral hilar nodes; (ii) primary tumor without FDG uptake; (iii) tumor size ≥ 3 cm (Fig. 3a

  12. Oral cancer: molecular technologies for risk assessment and diagnosis

    Institute of Scientific and Technical Information of China (English)

    Wan Tao Chen

    2008-01-01

    @@ Purpose: The effective biomarkers related to diagnosis, metastasis, drug resistance and irradiation sensitivity of oral cancers will help the pathologist and oncologist to determine the molecular taxonomy diagnosis and design the individualization treatment for the patients with oral cancers.

  13. Author Guidelines

    OpenAIRE

    Chief Editor

    2015-01-01

    Author GuidelinesIJCH strictly adheres on the recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals as per the standard universal guidelines given by International Committee of Medical Journal Editors (ICMJE - Recommendations for Uniform Requirements for Manuscripts). Authors are requested to visit http://www.icmje.org/index.html before making online submission of their manuscript(s).SectionsEditorial:On issues of current public health needA...

  14. OSART guidelines

    International Nuclear Information System (INIS)

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

  15. The analysis to the latest changes in NCCN Guidelines of Central Nervous System Cancers about low-grade gliomas and glioblastoma

    Institute of Scientific and Technical Information of China (English)

    Tianyu Wang; Xiong Xiao; Nan Ji

    2016-01-01

    Gliomas are the most common primary tumors of the central nervous system,around 70 % of the malignant brain tumors are gliomas.In the NCCN Guideline Ver.1 2015,the assessment before systemic treatment,treatment principles and prognosis factors of gliomas has significantly changed based on the researches up to date,we try to analyze the reason and the effect of these changes.The most important change is the reintroduction of PCV chemotherapy in systemic treatment,which narrows the gap of prognosis between WHO Ⅱ and Ⅲ gliomas.Other changes including the assessment before systemic treatment,usage of RT and the promotion of evidence level about the Tumor Treating Fields.

  16. A brief assessment of physical functioning for prostate cancer patients

    Directory of Open Access Journals (Sweden)

    Jin-Shei Lai

    2010-06-01

    Full Text Available Jin-Shei Lai1, Rita Bode2, Hwee-Lin Wee3, David Eton4, David Cella11Department of Medical Social Sciences, 2Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, IL USA; 3Department of Pharmacy, National University of Singapore, Singapore; 4Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USAAbstract: We aimed to validate a more rapid, yet reliable means of assessing physical function (PF for patients with prostate cancer. The sample included 128 prostate cancer patients recruited from urology and general oncology clinics at two Chicago-area hospitals. The main outcome measures were: A 36-item PF item bank that included a 5-item short form (BriefPF and the 10-item PF subscale (PF-10 from the Medical Outcomes Study SF-36. Validity, information function, and relative precision (calculated using Rasch analysis and raw scores of the BriefPF were compared to the PF-10 and the full PF item bank. We found that the BriefPF and PF-10 were strongly correlated (r = 0.85 with the PF bank, and all three scales differentiated patients according to performance status (FPF bank(2,124 = 32.51 P < 0.001, FPF-10(2,121 = 27.35 P < 0.001, FBriefPF (2,123 = 38.40 P < 0.001. BriefPF has excellent precision relative to the PF-10 in measuring patients with different performance status levels. The Rasch-based information function indicated that the BriefPF was more informative than PF-10 in measuring moderate to higher functioning patients. Hence, the BriefPF offers a parsimonious and precise measure of PF for use among men with prostate cancer, and may aid in the timely inclusion of patient-reported outcomes in treatment decision-making.Keywords: quality-of-life, item bank, short-form, Medical Outcomes Study

  17. Cuidados paliativos oncológicos: elementos para o debate de diretrizes nesta área Palliative care in cancer: elements for debating the guidelines

    Directory of Open Access Journals (Sweden)

    Ronaldo Corrêa Ferreira da Silva

    2006-10-01

    Full Text Available Este artigo tem como objetivo apresentar elementos para o debate de diretrizes em programas de cuidados paliativos no Brasil. Foi construído por meio de levantamento bibliográfico em base de dados (MEDLINE, LILACS e Biblioteca Cochrane, em sítios na Internet de organizações e instituições interessadas em cuidados paliativos, em textos de autores fundamentais na área, em livros de referência, em obras citadas nas referências destes mesmos livros e no Banco de Teses da CAPES. Os dados foram agrupados em quatro categorias temáticas: controle de sintomas, organização de serviços, aspectos psicossociais e espirituais. Com isso, procedeu-se a discussão do câncer como um problema de saúde pública e seu impacto no indivíduo, o conceito de cuidados paliativos e seu contexto na atenção à saúde, os modelos de programas e suas diretrizes, a morte e o morrer e os cuidados e cuidadores. O artigo termina apontando os desafios do sistema de saúde brasileiro em estruturar programas de cuidados ao final da vida em conseqüência do envelhecimento da população e do aumento da incidência do câncer.The aim of this study was to present elements for debating guidelines on palliative care programs for cancer. A literature survey searched various databases (MEDLINE, LILACS, and Cochrane Library, homepages of palliative care organizations, publications by renowned authors in this area, reference textbooks on the subject, relevant articles cited by these books, and the thesis/dissertation database of CAPES (the Brazilian Coordinating Body for Training University Level Personnel. The data were grouped into four thematic categories: symptomatic palliation, organization of services, psychosocial characteristics, and spiritual characteristics. The article then proceeds to discuss cancer as a public health problem and its impact on individuals, the concept of palliative care and its context in health care, program models and their guidelines, death

  18. Hereditary cancer risk assessment: insights and perspectives for the Next-Generation Sequencing era

    Directory of Open Access Journals (Sweden)

    Israel Gomy

    2016-01-01

    Full Text Available Abstract Hereditary cancer risk assessment is a multidisciplinary and dynamic process, with the purpose of estimating probabilities of germline mutations in cancer susceptibility genes and assessing empiric risks of cancer based on personal and family histories, in order to offer clinical and molecular diagnoses and clinical management based on these risks. Genetic tests are available and most of them are reimbursed by insurance companies, although they are generally not covered by the public health systems of developing countries. More recently, molecular diagnosis of hereditary cancer is feasible through next-generation sequencing (NGS panels. Here we review the benefits and limitations of NGS technologies in the clinical practice.

  19. Hereditary cancer risk assessment: insights and perspectives for the Next-Generation Sequencing era.

    Science.gov (United States)

    Gomy, Israel; Diz, Maria Del Pilar Estevez

    2016-05-13

    Hereditary cancer risk assessment is a multidisciplinary and dynamic process, with the purpose of estimating probabilities of germline mutations in cancer susceptibility genes and assessing empiric risks of cancer based on personal and family histories, in order to offer clinical and molecular diagnoses and clinical management based on these risks. Genetic tests are available and most of them are reimbursed by insurance companies, although they are generally not covered by the public health systems of developing countries. More recently, molecular diagnosis of hereditary cancer is feasible through next-generation sequencing (NGS) panels. Here we review the benefits and limitations of NGS technologies in the clinical practice. PMID:27192130

  20. Hereditary cancer risk assessment: insights and perspectives for the Next-Generation Sequencing era

    Science.gov (United States)

    Gomy, Israel; Diz, Maria Del Pilar Estevez

    2016-01-01

    Abstract Hereditary cancer risk assessment is a multidisciplinary and dynamic process, with the purpose of estimating probabilities of germline mutations in cancer susceptibility genes and assessing empiric risks of cancer based on personal and family histories, in order to offer clinical and molecular diagnoses and clinical management based on these risks. Genetic tests are available and most of them are reimbursed by insurance companies, although they are generally not covered by the public health systems of developing countries. More recently, molecular diagnosis of hereditary cancer is feasible through next-generation sequencing (NGS) panels. Here we review the benefits and limitations of NGS technologies in the clinical practice. PMID:27192130

  1. Environmental risk assessment for new human pharmaceuticals in the European Union according to the draft guideline/discussion paper of January 2001.

    Science.gov (United States)

    Straub, Jürg Oliver

    2002-10-01

    Since 1993, an environmental risk assessment (ERA) for a new drug application has been stipulated by EU Directive 93/39/EEC amending Directive 65/65/EEC. In early 2001, after several unpublished draft versions for an ERA guideline, a draft guideline/discussion paper for an ERA for non-GMO-containing drugs was published by the European Medicines Evaluation Agency (EMEA). The draft guideline describes a step-wise, tiered procedure for the ERA. The first tier consists of deriving a crude predicted environmental concentration (PEC) in the aquatic compartment for the active pharmaceutical ingredient (API) or its major metabolites, based on predicted amounts used and specific removal rates in sewage treatment or surface waters. If this crude PEC is labelling (i.e. package leaflets for the patients regarding returning and proper disposal of unused medicines), restricted use through in-hospital or in-surgery administration under supervision only, or the recommendation of environmental analytical monitoring up to ecological field studies. PMID:12270681

  2. Population prevalence of hereditary breast cancer phenotypes and implementation of a genetic cancer risk assessment program in southern Brazil

    Directory of Open Access Journals (Sweden)

    Edenir I. Palmero

    2009-01-01

    Full Text Available In 2004, a population-based cohort (the Núcleo Mama Porto Alegre - NMPOA Cohort was started in Porto Alegre, southern Brazil and within that cohort, a hereditary breast cancer study was initiated, aiming to determine the prevalence of hereditary breast cancer phenotypes and evaluate acceptance of a genetic cancer risk assessment (GCRA program. Women from that cohort who reported a positive family history of cancer were referred to GCRA. Of the 9218 women enrolled, 1286 (13.9% reported a family history of cancer. Of the 902 women who attended GCRA, 55 (8% had an estimated lifetime risk of breast cancer ³ 20% and 214 (23.7% had pedigrees suggestive of a breast cancer predisposition syndrome; an unexpectedly high number of these fulfilled criteria for Li-Fraumeni-like syndrome (122 families, 66.7%. The overall prevalence of a hereditary breast cancer phenotype was 6.2% (95%CI: 5.67-6.65. These findings identified a problem of significant magnitude in the region and indicate that genetic cancer risk evaluation should be undertaken in a considerable proportion of the women from this community. The large proportion of women who attended GCRA (72.3% indicates that the program was well-accepted by the community, regardless of the potential cultural, economic and social barriers.

  3. The assessment of sediment screening risk in Venice Lagoon and other coastal areas using international sediment quality guidelines

    International Nuclear Information System (INIS)

    A number of studies carried out in recent years have shown the presence of a wide range of contaminants in the Venice Lagoon. It is important to have a good understanding of the ecological quality of Venice Lagoon sediments, in order to: i) define and locate areas where a threat to the environment is present and therefore an intervention is needed (i.e. in situ assessment and management); and ii) define sustainable and environmentally correct ways of managing sediments which are to be dredged for navigational purposes or in relation to other interventions (i.e., ex situ management). Materials and Methods: To examine how various regional and international SQGs 'classed' screening risk in Venice Lagoon sediments, data on median contaminant levels in surface sediments in Venice Lagoon resulting from a literature review were compared to a range of local and international sediment quality guidelines (SQGs). Then data on sediment contaminant levels in various areas and sub-basins of Venice Lagoon (main Lagoon, Porto Marghera and Venice City Canals) and in other regional and international transitional and coastal ecosystems with various levels of human impact (urbanization and industrialization) were evaluated based upon a selected consensus-based SQG. Finally, screening sediment quality for all of Venice Lagoon was mapped and contoured, relative to this consensus-based SQG and briefly compared with direct toxicity measurement through a battery of bioassays. Results: SQGs allow the sediment areas to be put in terms of potential, or screening, risk. Although there were some differences depending upon which specific SQGs were applied, the Venice SQGs and other international SQGs provided the same general picture of screening risk in Venice Lagoon despite geographic differences. Venice Lagoon South has the lowest screening risk levels, Venice Lagoon Central/North has the highest (and is nearest to the Porto Marghera and Venice City Canals sites). Discussion: The Venice

  4. Assessment of Adaptive Reuse of Heritage Shop Houses for Sleep Lodging in Malaysia: Fulfilment of Conservation Guidelines

    Directory of Open Access Journals (Sweden)

    Othuman Mydin M.A.

    2014-01-01

    Full Text Available This study focuses on the compliance of adaptive reuse of historic shop houses for sleep lodging with reference to the Guidelines for Conservation Areas and Heritage Buildings by Majlis Perbandaran Pulau Pinang (MPPP. Through this research, awareness towards the compliance of building conservation guidelines for heritage shop houses will be clarified accordingly. The goal of this study is to determine and extract vital clauses and components of Guidelines for Conservation Areas and Heritage Buildings (GCAHB towards adaptive reuse of heritage shop houses so that revitalization of these buildings can be ensured when changing the original function of the property. The aim is also to evaluate the compliance of the adaptive reuse of heritage shop houses with the GCAHB, and, lastly, to provide recommendations for adaptive reuse of heritage shop houses, also in compliance with the GCAHB. Additionally, heritage building owners can use this dissertation as a reference whenever they intend to adaptively reuse their buildings. Furthermore, recommendations in this research could be used for future reference.

  5. Disparities in Cancer Genetic Risk Assessment and Testing.

    Science.gov (United States)

    Underhill, Meghan L; Jones, Tarsha; Habin, Karleen

    2016-07-01

    Scientific and technologic advances in genomics have revolutionized genetic counseling and testing, targeted therapy, and cancer screening and prevention. Among younger women, African American and Hispanic women have a higher rate of cancers that are associated with hereditary cancer risk, such as triple-negative breast cancer, which is linked to poorer outcomes. Therefore, genetic testing is particularly important in diverse populations. Unfortunately, all races and ethnic groups are not well represented in current genetic testing practices, leading to disparities in cancer prevention and early detection. PMID:27314195

  6. Are Radiation Therapy Oncology Group Para-aortic Contouring Guidelines for Pancreatic Neoplasm Applicable to Other Malignancies—Assessment of Nodal Distribution in Gynecological Malignancies

    International Nuclear Information System (INIS)

    Purpose: Intensity modulated radiation therapy is used to reduce dose to adjacent critical structures while maintaining adequate target coverage, but it requires precise target localization. We report the 3-dimensional distribution of para-aortic (PA) lymph nodes (LN) in pelvic malignancies. We propose a guideline to accurately define the PA LN by anatomic landmarks and compare our data with published guidelines for pancreatic cancer. Methods and Materials: A retrospective analysis was performed on 46 patients with pelvic malignancies and positive PA LNs. Positive LNs were defined based on size and morphology or fluorodeoxyglucose avidity. All PA LNs were characterized into 3 groups based on location: left PA (between aorta and left psoas muscle), aortocaval (between aorta and inferior vena cava), and right paracaval (between inferior vena cava and right psoas muscle). Patients with retrocrural LNs were also analyzed. Results: One hundred thirty-three positive PA LNs were evaluated. The majority of the PA LNs were in the left PA (59%) and aortocaval (35) regions, and only 8% were in the right paracaval region. All patients with positive right paracaval LNs also had involved left PA LNs, with only 1 exception. The highest PA LN involvement was at the level of the renal vessels and was seen in 28% of patients. Of these patients with disease extending to renal vessels, 38% had retrocrural LN involvement. Conclusions: The nodal contouring for the PA region should not be defined by a fixed circumferential margin around the vessels. The left PA and aortocaval spaces should be covered adequately because these are common locations of PA LNs. For microscopic disease superiorly, contouring should extend up to renal vessels rather than a fixed bony landmark. For patients who have nodal involvement at renal vessels, one can consider including retrocrural LNs. Radiation Therapy Oncology Group Para-aortic Contouring Guidelines for Pancreatic Neoplasm are not applicable to

  7. Clinical Practice Guidelines for Subarachnoid Haemorrhage Treatment

    OpenAIRE

    José Ramón Tejera del Valle; Danny Barrueta Reyes; Joaquín Aguilar Trujillo; José Gómez Cruz; Líder Tejera Sánchez

    2009-01-01

    Clinical Practice Guidelines for Subarachnoid Haemorrhage Treatment. The concept, diagnosis, classification and treatment are reviewed in its different stages, including aspects of the neurosurgical treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  8. Clinical Practice Guidelines for Intracranial Tumours Treatment

    OpenAIRE

    Danny Barrueta Reyes; Juan Guillermo Trigo Naranjo

    2009-01-01

    Clinical Practice Guidelines for Intracranial Tumours Treatment. We review the physiopathology, diagnosis (stressing screening studies) and treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  9. Omission of bone scanning according to staging guidelines leads to futile therapy in non-small cell lung cancer

    International Nuclear Information System (INIS)

    The leading European and American professional societies recommend that bone scans (BS) should be performed in the staging of lung cancer only in those patients with bone pain. This prospective study investigated the sensitivity of conventional skeletal scintigraphy in detecting osseous metastases in patients with lung cancer and addressed the potential consequences of failure to use this method in the work-up of asymptomatic patients. Subsequent to initial diagnosis of non-small cell lung cancer, 100 patients were examined and questioned regarding skeletal complaints. Two specialists in internal medicine decided whether they would recommend a bone scan on the basis of the clinical evaluation. Skeletal scintigraphy was then performed blinded to the findings of history and physical examination. The combined results of magnetic resonance imaging (MRI) of the vertebral column, positron emission tomography (PET) of skeletal bone and the subsequent clinical course served as the gold standard for the identification of osseous metastases. Bone scintigraphy showed an 87% sensitivity in the detection of bone metastases. Failure to perform skeletal scintigraphy in asymptomatic patients reduced the sensitivity of the method, depending on the interpretation of the symptoms, to 19-39%. Without the findings of skeletal scintigraphy and the gold standard methods, 14-22% of patients would have undergone unnecessary surgery or neoadjuvant therapy. On this basis it is concluded that bone scans should not be omitted in asymptomatic patients. (orig.)

  10. Omission of bone scanning according to staging guidelines leads to futile therapy in non-small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Schirrmeister, Holger [Department of Nuclear Medicine, University of Kiel, Kiel (Germany); Arslandemir, Coskun; Hetzel, Martin [Department of Internal Medicine II, University of Ulm, Robert-Koch-Strasse 8, 89081, Ulm (Germany); Glatting, Gerhard; Buck, Andreas [Department of Nuclear Medicine, University of Ulm, Ulm (Germany); Mayer-Steinacker, Regine; Bommer, Martin [Department of Hematology and Oncology, University of Ulm, Ulm (Germany); Dreinhoefer, Karsten [Department of Orthopedics, University of Ulm, Ulm (Germany)

    2004-07-01

    The leading European and American professional societies recommend that bone scans (BS) should be performed in the staging of lung cancer only in those patients with bone pain. This prospective study investigated the sensitivity of conventional skeletal scintigraphy in detecting osseous metastases in patients with lung cancer and addressed the potential consequences of failure to use this method in the work-up of asymptomatic patients. Subsequent to initial diagnosis of non-small cell lung cancer, 100 patients were examined and questioned regarding skeletal complaints. Two specialists in internal medicine decided whether they would recommend a bone scan on the basis of the clinical evaluation. Skeletal scintigraphy was then performed blinded to the findings of history and physical examination. The combined results of magnetic resonance imaging (MRI) of the vertebral column, positron emission tomography (PET) of skeletal bone and the subsequent clinical course served as the gold standard for the identification of osseous metastases. Bone scintigraphy showed an 87% sensitivity in the detection of bone metastases. Failure to perform skeletal scintigraphy in asymptomatic patients reduced the sensitivity of the method, depending on the interpretation of the symptoms, to 19-39%. Without the findings of skeletal scintigraphy and the gold standard methods, 14-22% of patients would have undergone unnecessary surgery or neoadjuvant therapy. On this basis it is concluded that bone scans should not be omitted in asymptomatic patients. (orig.)

  11. Lung cancer trends: smoking, obesity, and sex assessed in the Staten Island University’s lung cancer patients

    OpenAIRE

    Gupta, Shilpi; Hassan, Samer; Bhatt, Vijaya R.; Abdul Sater, Houssein; Dilawari, Asma

    2014-01-01

    Introduction The incidence of lung cancer in the United States decreased by 1.8% from 1991 to 2005 while it increased by 0.5% in females. We assessed whether nonsmokers afflicted with lung cancer at Staten Island University Hospital are disproportionately female in comparison to national averages. We also evaluated different factors including race, histology, and body mass index (BMI) in correlation with smoking history. Methods A retrospective chart review was conducted from 2005 to 2011 on ...

  12. Breast Cancer Risk Assessment: Moving Beyond BRCA 1 and 2.

    Science.gov (United States)

    Scalia-Wilbur, Jennifer; Colins, Bradley L; Penson, Richard T; Dizon, Don S

    2016-01-01

    The National Cancer Institute estimates that 12.3% of all women (about 1 in 8) would be diagnosed with breast cancer throughout their lifetime. In 2015, a projected 231,840 new cases are expected in the United States, accompanied by 40,290 deaths. Presently, breast cancer is responsible for 6.8% of all cancer deaths, and roughly 30% of all cancers in women. Since the discovery of the BRCA gene in 1994, efforts have been made to develop effective screening methods for breast cancer detection. Although the BRCA gene certainly opened the door to breast cancer genetics, a wide variety of new genes have recently been linked to breast cancer risk, and the tools to screen for genes beyond just BRCA1 and BRCA2 are available. However, the indications for both screening and prevention of inherited predispositions beyond BRCA1 and BRCA2 are not entirely clear, and as a result, much of the ongoing work is aimed at determining the role of broader genetic screening in women deemed at sufficiently high risk for breast cancer based on family history. On this topic, we provide a brief overview of the genes associated with breast cancer risk as well as the technological platforms available to patients. We conclude by discussing recommendations of expert groups and what they practically mean for patients. PMID:26617204

  13. Delineation of target volumes and organs at risk in adjuvant radiotherapy of early breast cancer: national guidelines and contouring atlas by the Danish Breast Cancer Cooperative Group

    DEFF Research Database (Denmark)

    Nielsen, Mette H; Berg, Martin; Pedersen, Anders N;

    2013-01-01

    During the past decade planning of adjuvant radiotherapy (RT) of early breast cancer has changed from two-dimensional (2D) to 3D conformal techniques. In the planning computerised tomography (CT) scan both the targets for RT and the organs at risk (OARs) are visualised, enabling an increased focu...... on target dose coverage and homogeneity with only minimal dose to the OARs. To ensure uniform RT in the national prospective trials of the Danish Breast Cancer Cooperative Group (DBCG), a national consensus for the delineation of clinical target volumes (CTVs) and OARs was required....

  14. Combined perioperative plasma endoglin and VEGF-A assessment in colorectal cancer patients.

    OpenAIRE

    Bogusław Kedra; Adam Kukliński; Krystyna Pawlak; Piotr Myśliwiec

    2009-01-01

    Colorectal cancer growth and spread is absolutely dependent on angiogenesis with vascular endothelial growth factor (VEGF) being the most important cytokine involved in the process. Endoglin, a membrane co-receptor for TGF-beta, has recently emerged as a sensitive index of cancer stage. There is now sufficient evidence indicating that microvessel density assessed by endoglin-immunostaining correlates with stage of colorectal cancer and patient survival. An association of a soluble form of end...

  15. Combined perioperative plasma endoglin and VEGF--a assessment in colorectal cancer patients.

    OpenAIRE

    Krystyna Pawlak; Piotr Myśliwiec; Adam Kukliński; Bogusław Kedra

    2009-01-01

    Colorectal cancer growth and spread is absolutely dependent on angiogenesis with vascular endothelial growth factor (VEGF) being the most important cytokine involved in the process. Endoglin, a membrane co-receptor for TGF-beta, has recently emerged as a sensitive index of cancer stage. There is now sufficient evidence indicating that microvessel density assessed by endoglin-immunostaining can correlate with stage of colorectal cancer and patient survival. An association of a soluble form of ...

  16. Inflammatory Bowel Disease and Skin Cancer: An Assessment of Patient Risk Factors, Knowledge, and Skin Practices

    OpenAIRE

    Kimmel, Jessica N.; Taft, Tiffany H.; Laurie Keefer

    2016-01-01

    Objective. Patients with inflammatory bowel disease (IBD) are at increased risk from skin cancer. Aims include assessing IBD patients' risk factors and knowledge of skin cancer and current skin protection practices to identify gaps in patient education regarding skin cancer prevention in IBD. Methods. IBD patients ≥ 18 years were recruited to complete an online survey. Results. 164 patients (mean age 43.5 years, 63% female) with IBD (67% Crohn's disease, 31% ulcerative colitis, and 2% indeter...

  17. Antibody validation and scoring guidelines for ABCG2 immunohistochemical staining in formalin-fixed paraffin-embedded colon cancer tissue

    DEFF Research Database (Denmark)

    Cederbye, Camilla Natasha; Palshof, Jesper Andreas; Hansen, Tine Plato;

    2016-01-01

    cancer (CRC), probably because of the use of different antibodies and scoring approaches. In this study, we systematically studied six commercially available anti-ABCG2 antibodies, using cell lines with up-regulation of ABCG2, and selected one antibody for validation in CRC tissue. Furthermore, we...... cytoplasmic signal. Intra-tumor heterogeneity in ABCG2 immunoreactivity was observed; however, statistical analyses of tissue microarrays (TMAs) and the corresponding whole sections from primary tumors of 57 metastatic CRC patients revealed a strong positive correlation between maximum TMA scores and whole...

  18. Measuring somatic symptoms with the CES-D to assess depression in cancer patients after treatment: Comparison among patients with oral/oropharyngeal, gynecological, colorectal, and breast cancer

    OpenAIRE

    van Wilgen, C.P.; Dijkstra, P.U.; Stewart, R. E.; Ranchor, A.V.; Roodenburg, J.L.N.

    2006-01-01

    There is a high prevalence of depression after cancer treatment. In the literature, several authors have raised questions about assessing somatic symptoms to explore depression after cancer treatment. These somatic sequelae are a consequence of cancer treatment and should cause higher depression rates in cancer patients. In this study, the Somatic domain on a depression questionnaire, the Center for Epidemiologic Studies-Depression scale (CES-D) was analyzed in different cancer patients after...

  19. Guidelines for Follow-Up of Women at High Risk for Inherited Breast Cancer: Consensus Statement from the Biomed 2 Demonstration Programme on Inherited Breast Cancer

    Directory of Open Access Journals (Sweden)

    P. Møller

    1999-01-01

    Full Text Available Protocols for activity aiming at early diagnosis and treatment of inherited breast or breast-ovarian cancer have been reported. Available reports on outcome of such programmes are considered here. It is concluded that the ongoing activities should continue with minor modifications. Direct evidence of a survival benefit from breast and ovarian screening is not yet available. On the basis of expert opinion and preliminary results from intervention programmes indicating good detection rates for early breast cancers and 5-year survival concordant with early diagnosis, we propose that women at high risk for inherited breast cancer be offered genetic counselling, education in ‘breast awareness’ and annual mammography and clinical expert examination from around 30 years of age. Mammography every second year may be sufficient from 60 years on. BRCA1 mutation carriers may benefit from more frequent examinations and cancer risk may be reduced by oophorectomy before 40–50 years of age. We strongly advocate that all activities should be organized as multicentre studies subjected to continuous evaluation to measure the effects of the interventions on long-term mortality, to match management options more precisely to individual risks and to prepare the ground for studies on chemoprevention.

  20. DNA Reactivity as a Mode of Action and Its Relevance to Cancer Risk Assessment

    Science.gov (United States)

    The ability of a chemical to induce mutations has long been a driver in the cancer risk assessment process. The default strategy has been that mutagenic chemicals demonstrate linear cancer dose responses, especially at low exposure levels. In the absence of additional confounding...

  1. Research Priorities, Measures, and Recommendations for Assessment of Tobacco Use in Clinical Cancer Research.

    Science.gov (United States)

    Land, Stephanie R; Toll, Benjamin A; Moinpour, Carol M; Mitchell, Sandra A; Ostroff, Jamie S; Hatsukami, Dorothy K; Duffy, Sonia A; Gritz, Ellen R; Rigotti, Nancy A; Brandon, Thomas H; Prindiville, Sheila A; Sarna, Linda P; Schnoll, Robert A; Herbst, Roy S; Cinciripini, Paul M; Leischow, Scott J; Dresler, Carolyn M; Fiore, Michael C; Warren, Graham W

    2016-04-15

    There is strong evidence that cigarette smoking causes adverse outcomes in people with cancer. However, more research is needed regarding those effects and the effects of alternative tobacco products and of secondhand smoke, the effects of cessation (before diagnosis, during treatment, or during survivorship), the biologic mechanisms, and optimal strategies for tobacco dependence treatment in oncology. Fundamentally, tobacco is an important source of variation in clinical treatment trials. Nevertheless, tobacco use assessment has not been uniform in clinical trials. Progress has been impeded by a lack of consensus regarding tobacco use assessment suitable for cancer patients. The NCI-AACR Cancer Patient Tobacco Use Assessment Task Force identified priority research areas and developed recommendations for assessment items and timing of assessment in cancer research. A cognitive interview study was conducted with 30 cancer patients at the NIH Clinical Center to evaluate and improve the measurement items. The resulting Cancer Patient Tobacco Use Questionnaire (C-TUQ) includes "Core" items for minimal assessment of tobacco use at initial and follow-up time points, and an "Extension" set. Domains include the following: cigarette and other tobacco use status, intensity, and past use; use relative to cancer diagnosis and treatment; cessation approaches and history; and secondhand smoke exposure. The Task Force recommends that assessment occur at study entry and, at a minimum, at the end of protocol therapy in clinical trials. Broad adoption of the recommended measures and timing protocol, and pursuit of the recommended research priorities, will help us to achieve a clearer understanding of the significance of tobacco use and cessation for cancer patients.Clin Cancer Res; 22(8); 1907-13. ©2016 AACR. PMID:26888828

  2. Rectal cancer staging: Multidetector-row computed tomography diagnostic accuracy in assessment of mesorectal fascia invasion

    OpenAIRE

    Ippolito, Davide; Drago, Silvia Girolama; Franzesi, Cammillo Talei; Fior, Davide; Sironi, Sandro

    2016-01-01

    AIM: To assess the diagnostic accuracy of multidetector-row computed tomography (MDCT) as compared with conventional magnetic resonance imaging (MRI), in identifying mesorectal fascia (MRF) invasion in rectal cancer patients.

  3. Assessing uncertainty in published risk estimates using hexavalent chromium and lung cancer mortality as an example

    Science.gov (United States)

    Introduction: The National Research Council recommended quantitative evaluation of uncertainty in effect estimates for risk assessment. This analysis considers uncertainty across model forms and model parameterizations with hexavalent chromium [Cr(VI)] and lung cancer mortality a...

  4. Assessing model uncertainty using hexavalent chromium and lung cancer mortality as an example [Abstract 2015

    Science.gov (United States)

    Introduction: The National Research Council recommended quantitative evaluation of uncertainty in effect estimates for risk assessment. This analysis considers uncertainty across model forms and model parameterizations with hexavalent chromium [Cr(VI)] and lung cancer mortality a...

  5. PCBS: CANCER DOSE-RESPONSE ASSESSMENT AND APPLICATION TO ENVIRONMENTAL MIXTURES (1996)

    Science.gov (United States)

    This report updates the cancer dose-response assessment for polychlorinated biphenyls (PCBs) and shows how information on toxicity, disposition, and environmental processes can be considered together to evaluate health risks from PCB mixtures in the environment. Processes that ch...

  6. Baseline ecological risk assessment of the Calcasieu Estuary, Louisiana: 2. An evaluation of the predictive ability of effects-based sediment quality guidelines

    Science.gov (United States)

    MacDonald, Donald D.; Ingersoll, Christopher G.; Smorong, Dawn E.; Sinclair, Jesse A.; Lindskoog, Rebekka; Wang, Ning; Severn, Corrine; Gouguet, Ron; Meyer, John; Field, Jay

    2011-01-01

    Three sets of effects-based sediment-quality guidelines (SQGs) were evaluated to support the selection of sediment-quality benchmarks for assessing risks to benthic invertebrates in the Calcasieu Estuary, Louisiana. These SQGs included probable effect concentrations (PECs), effects range median values (ERMs), and logistic regression model (LRMs)-based T50 values. The results of this investigation indicate that all three sets of SQGs tend to underestimate sediment toxicity in the Calcasieu Estuary (i.e., relative to the national data sets), as evaluated using the results of 10-day toxicity tests with the amphipod, Hyalella azteca, or Ampelisca abdita, and 28-day whole-sediment toxicity tests with the H. azteca. These results emphasize the importance of deriving site-specific toxicity thresholds for assessing risks to benthic invertebrates.

  7. Cancer Risk Assessment by Rural and Appalachian Family Medicine Physicians

    Science.gov (United States)

    Kelly, Kimberly M.; Love, Margaret M.; Pearce, Kevin A.; Porter, Kyle; Barron, Mary A.; Andrykowski, Michael

    2009-01-01

    Context: Challenges to the identification of hereditary cancer in primary care may be more pronounced in rural Appalachia, a medically underserved region. Purpose: To examine primary care physicians' identification of hereditary cancers. Methods: A cross-sectional survey was mailed to family physicians in the midwestern and southeastern United…

  8. Screening for Prostate Cancer

    Science.gov (United States)

    ... of Internal Medicine Summaries for Patients Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee ... Physicians The full report is titled “Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee ...

  9. Accuracy of self-reported tobacco assessments in a head and neck cancer treatment population

    International Nuclear Information System (INIS)

    Prospective analysis was performed of self-reported and biochemically confirmed tobacco use in 50 head and neck cancer patients during treatment. With 93.5% compliance to complete weekly self-report and biochemical confirmatory tests, 29.4% of smokers required biochemical assessment for identification. Accuracy increased by 14.9% with weekly vs. baseline self-reported assessments. Data confirm that head and neck cancer patients misrepresent true tobacco use during treatment.

  10. Primary care physicians' use of family history for cancer risk assessment

    OpenAIRE

    Stockdale Alan; Ashikaga Takamaru; Wood Marie E; Flynn Brian S; Dana Greg S; Naud Shelly

    2010-01-01

    Abstract Background Family history (FH) assessment is useful in identifying and managing patients at increased risk for cancer. This study assessed reported FH quality and associations with physician perceptions. Methods Primary care physicians practicing in two northeastern U.S. states were surveyed (n = 880; 70% response rate). Outcome measures of FH quality were extent of FH taken and ascertaining age at cancer diagnosis for affected family members. Predictors of quality measured in this s...

  11. Reliability and Validity of the Korean Cancer Pain Assessment Tool (KCPAT)

    OpenAIRE

    Kim, Jeong A; Choi, Youn Seon; Lee, Juneyoung; Park, Jeanno; Lee, Myung Ah; Yeom, Chang Hwan; Jang, Se Kwon; Yoon, Duck Mi; Kim, Jun Suk

    2005-01-01

    The Korean Cancer Pain Assessment Tool (KCPAT), which was developed in 2003, consists of questions concerning the location of pain, the nature of pain, the present pain intensity, the symptoms associated with the pain, and psychosocial/spiritual pain assessments. This study was carried out to evaluate the reliability and validity of the KCPAT. A stratified, proportional-quota, clustered, systematic sampling procedure was used. The study population (903 cancer patients) was 1% of the target po...

  12. A practical approach for linearity assessment of calibration curves under the International Union of Pure and Applied Chemistry (IUPAC) guidelines for an in-house validation of method of analysis.

    Science.gov (United States)

    Sanagi, M Marsin; Nasir, Zalilah; Ling, Susie Lu; Hermawan, Dadan; Ibrahim, Wan Aini Wan; Naim, Ahmedy Abu

    2010-01-01

    Linearity assessment as required in method validation has always been subject to different interpretations and definitions by various guidelines and protocols. However, there are very limited applicable implementation procedures that can be followed by a laboratory chemist in assessing linearity. Thus, this work proposes a simple method for linearity assessment in method validation by a regression analysis that covers experimental design, estimation of the parameters, outlier treatment, and evaluation of the assumptions according to the International Union of Pure and Applied Chemistry guidelines. The suitability of this procedure was demonstrated by its application to an in-house validation for the determination of plasticizers in plastic food packaging by GC. PMID:20922968

  13. Risk assessment of gastric cancer associated with asbestosis: a case report

    OpenAIRE

    Park, Soo-Hong; Kang, Dong-Mug; Koo, Bon-Hak; Kim, Young-ki; Kim, Jong-Eun

    2015-01-01

    Background The International Agency for Research on Cancer classifies asbestos as belonging to Carcinogen Group 2A for gastric cancer. We herein report a case of gastric cancer associated with asbestosis and describe the work-related and risk assessments of asbestos exposure for gastric cancer. Case presentation The 66-year-old male patient in our case worked in asbestos spinning factories. His level of cumulated asbestos fiber exposure was estimated to be 38.0–71.0 f-yr/cc. Thus, the Excess ...

  14. Cancer treatment-related cardiac toxicity: prevention, assessment and management.

    Science.gov (United States)

    Fanous, Ibrahim; Dillon, Patrick

    2016-08-01

    Cancer therapies, especially anthracyclines and monoclonal antibodies, have been linked with increased rates of cardiotoxicity. The development of some cardiac side effects happens over several months, and changes in ejection fraction can be detected long before permanent damage or disability occurs. Advanced heart failure could be averted with better and earlier detection. Methodologies for early detection of cardiac changes include stress echocardiograms, cardiac velocity measurements, radionuclide imaging, cardiac MRI and several potential biomarkers. Many agents have been described for prophylaxis of cardiac events precipitated by cancer therapy. Prophylactic use of beta-blockers and ACE inhibitors may be considered for use with trastuzumab in breast cancer as tolerated. Recovery of cardiac function is possible early after the injury from a cancer therapy. Late complications for coronary artery disease, hypertension and arrhythmia are underappreciated. Treatments for severe cancer therapy-related cardiac complications follow the existing paradigms for congestive heart failure and coronary artery disease, although outcomes for cancer patients differ from outcomes for non-cancer patients. PMID:27372782

  15. Geriatric Assessment in Older Patients with Breast Cancer

    OpenAIRE

    Klepin, Heidi; Mohile, Supriya; Hurria, Arti

    2009-01-01

    Most cases of breast cancer are diagnosed in older adults. Compared with younger women, older women as a group are at increased risk for breast-cancer-specific mortality and at higher risk for treatment-associated morbidity as well. At the same time, older women are less likely to be offered preventive care or adjuvant therapy for this disease. There are major gaps in evidence regarding the optimal evaluation and treatment of older women with breast cancer due to significant under-representat...

  16. Spiritual Assessment in a Patient With Lung Cancer.

    Science.gov (United States)

    Borneman, Tami

    2014-01-01

    CASE STUDY  Mr. G., an 82-year-old retired European man, was diagnosed with stage 4 non-small cell lung cancer (NSCLC) and recently enrolled on a phase II clinical trial. He is married and has two adult children, who are very supportive. He and his wife described themselves as nonpracticing Catholics. He had never smoked, and there was no personal or family history of cancer. Fatigue was the main side effect from the clinical trial drugs, necessitating frequent periods of rest throughout the day and ultimately requiring dose reduction. His left leg was edematous and painful, and he was diagnosed with and treated for deep-vein thrombosis. Over time, these symptoms resolved, and Mr. G. enjoyed a fairly normal quality of life (QOL). He continued to do well for almost a year, but then his cancer progressed and his performance status began to decline. When offered treatment options, he elected to discontinue the clinical trial, take a break, and then initiate single-agent chemotherapy. Mr. G. was enrolled in a palliative care research study that provided patient-tailored education by an advanced practitioner (AP). The education addressed each QOL domain: physical, psychological, social, and spiritual. When the AP connected with Mr. G. during one of his clinic appointments, he appeared very concerned. He shared that he previously had lived in a communist country and now that he was in the United States, he was afraid of losing his insurance and having to stop treatment. The conversation was interrupted as he was called in for his appointment, yet he consented to talk about the matter further by telephone. The AP contacted Mr. G. the next day. He shared a glimpse of his childhood and experience in his homeland to try to explain his current fears. After reassuring him that his insurance would not be withdrawn, the AP asked whether he would be willing to talk about his life before coming to the United States more than 50 years ago. She wanted to assess where he was

  17. The role of skin conductivity in a low frequency exposure assessment for peripheral nerve tissue according to the ICNIRP 2010 guidelines

    Science.gov (United States)

    Schmid, Gernot; Cecil, Stefan; Überbacher, Richard

    2013-07-01

    Based on numerical computations using commercially available finite difference time domain code and a state-of-the art anatomical model of a 5-year old child, the influence of skin conductivity on the induced electric field strength inside the tissue for homogeneous front-to-back magnetic field exposure and homogeneous vertical electric field exposure was computed. Both ungrounded as well as grounded conditions of the body model were considered. For electric field strengths induced inside CNS tissue the impact of skin conductivity was found to be less than 15%. However, the results demonstrated that the use of skin conductivity values as obtainable from the most widely used data base of dielectric tissue properties and recommended by safety standards are not suitable for exposure assessment with respect to peripheral nerve tissue according to the ICNIRP 2010 guidelines in which the use of the induced electric field strengths inside the skin is suggested as a conservative surrogate for peripheral nerve exposure. This is due to the fact that the skin conductivity values derived from these data bases refer to the stratum corneum, the uppermost layer of the skin, which does not contain any nerve or receptor cells to be protected from stimulation effects. Using these skin conductivity values which are approximately a factor 250-500 lower than skin conductivity values used in studies on which the ICNIRP 2010 guidelines are based on, may lead to overestimations of the induced electric field strengths inside the skin by substantially more than a factor of 10. However, reliable conductivity data of deeper skin layers where nerve and preceptor cells are located is very limited. It is therefore recommended to include appropriate background information in the ICNIRP guidelines and the dielectric tissue property databases, and to put some emphasis on a detailed layer-specific characterization of skin conductivity in near future.

  18. The role of skin conductivity in a low frequency exposure assessment for peripheral nerve tissue according to the ICNIRP 2010 guidelines

    International Nuclear Information System (INIS)

    Based on numerical computations using commercially available finite difference time domain code and a state-of-the art anatomical model of a 5-year old child, the influence of skin conductivity on the induced electric field strength inside the tissue for homogeneous front-to-back magnetic field exposure and homogeneous vertical electric field exposure was computed. Both ungrounded as well as grounded conditions of the body model were considered. For electric field strengths induced inside CNS tissue the impact of skin conductivity was found to be less than 15%. However, the results demonstrated that the use of skin conductivity values as obtainable from the most widely used data base of dielectric tissue properties and recommended by safety standards are not suitable for exposure assessment with respect to peripheral nerve tissue according to the ICNIRP 2010 guidelines in which the use of the induced electric field strengths inside the skin is suggested as a conservative surrogate for peripheral nerve exposure. This is due to the fact that the skin conductivity values derived from these data bases refer to the stratum corneum, the uppermost layer of the skin, which does not contain any nerve or receptor cells to be protected from stimulation effects. Using these skin conductivity values which are approximately a factor 250–500 lower than skin conductivity values used in studies on which the ICNIRP 2010 guidelines are based on, may lead to overestimations of the induced electric field strengths inside the skin by substantially more than a factor of 10. However, reliable conductivity data of deeper skin layers where nerve and preceptor cells are located is very limited. It is therefore recommended to include appropriate background information in the ICNIRP guidelines and the dielectric tissue property databases, and to put some emphasis on a detailed layer-specific characterization of skin conductivity in near future. (paper)

  19. The European initiative for quality management in lung cancer care

    DEFF Research Database (Denmark)

    Blum, Torsten G; Rich, Anna; Baldwin, David;

    2014-01-01

    Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe....... The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a...... feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed...

  20. Assessment of cultural sensitivity of cancer information in ethnic print media.

    Science.gov (United States)

    Friedman, Daniela B; Hoffman-Goetz, Laurie

    2006-06-01

    Ethnic minority populations prefer cancer information that is respectful of their customs and beliefs about health and illness. Community newspapers are an important source of cancer information for ethnic groups. Our purpose is to evaluate the cultural sensitivity of cancer information in mass print media targeting ethnic minority readership. We assessed for cultural sensitivity 27 cancer articles published in English-language ethnic newspapers (Jewish, First Nations, Black/Caribbean, East Indian) in 2000 using the Cultural Sensitivity Assessment Tool (CSAT). We found that the overall average CSAT score of 27 cancer articles was 2.71. (Scorespapers. Cancer articles from East Indian newspapers had a mean CSAT score of 2.30 and were classified as culturally insensitive. Four articles were considered culturally sensitive but did not mention ethnic populations as intended readers or as high-risk groups for cancer. We found that, using the CSAT measure, overall, cancer articles in ethnic newspapers included in this study were culturally sensitive. Given limitations of this instrument, we recommend an additional checklist for evaluating the cultural sensitivity of printed cancer information. PMID:16720539

  1. Combined perioperative plasma endoglin and VEGF-A assessment in colorectal cancer patients.

    Directory of Open Access Journals (Sweden)

    Bogusław Kedra

    2009-01-01

    Full Text Available Colorectal cancer growth and spread is absolutely dependent on angiogenesis with vascular endothelial growth factor (VEGF being the most important cytokine involved in the process. Endoglin, a membrane co-receptor for TGF-beta, has recently emerged as a sensitive index of cancer stage. There is now sufficient evidence indicating that microvessel density assessed by endoglin-immunostaining correlates with stage of colorectal cancer and patient survival. An association of a soluble form of endoglin with lymph node and distant metastases has recently been reported in two studies. Both of them used local elaborated immunoassays for endoglin assessment. The aim of our study was to determine the efficacy of plasma endoglin, assessed using a commercial kit, as a marker of tumor spread and distant metastases in colorectal cancer patients. We studied 48 colorectal cancer patients, compared with 22 healthy subjects, using ELISA. We observed that colorectal cancer patients had increased plasma VEGF-A, but not endoglin levels. However, we found an association of plasma endoglin with the stage of malignancy. Endoglin levels were increased in metastasis-positive patients when compared to both metastasis-negative patients and healthy volunteers. Plasma endoglin correlated with VEGF-A, CEA and CA19.9. Endoglin assessment in plasma does not seem useful as a maker of colorectal cancer. Our observations indicate however that it might be helpful in selecting patients with metastatic disease.

  2. Combined perioperative plasma endoglin and VEGF--a assessment in colorectal cancer patients.

    Directory of Open Access Journals (Sweden)

    Krystyna Pawlak

    2009-12-01

    Full Text Available Colorectal cancer growth and spread is absolutely dependent on angiogenesis with vascular endothelial growth factor (VEGF being the most important cytokine involved in the process. Endoglin, a membrane co-receptor for TGF-beta, has recently emerged as a sensitive index of cancer stage. There is now sufficient evidence indicating that microvessel density assessed by endoglin-immunostaining can correlate with stage of colorectal cancer and patient survival. An association of a soluble form of endoglin with lymph node and distant metastases has recently been reported in two studies. Both of them used local elaborated immunoassays for endoglin assessment. The aim of our study was to determine the efficacy of plasma endoglin, assessed using a commercial kit, as a marker of tumor spread and distant metastases in colorectal cancer patients. We studied 48 colorectal cancer patients, compared with 22 healthy subjects, using ELISA. We observed that colorectal cancer patients had increased plasma VEGF-A, but not endoglin levels. However, we found an association of plasma endoglin with the stage of malignancy. Endoglin levels were increased in metastasis-positive patients when compared to both metastasis-negative patients and healthy volunteers. Plasma endoglin correlated with VEGF-A, CEA and CA19.9. Endoglin assessment in plasma does not seem useful as a maker of colorectal cancer. Our observations indicate however that it might be helpful in selecting patients with metastatic disease.

  3. Multitarget stool DNA for colorectal cancer screening: A review and commentary on the United States Preventive Services Draft Guidelines

    Science.gov (United States)

    Berger, Barry M; Levin, Bernard; Hilsden, Robert J

    2016-01-01

    Multitarget stool DNA (mt-sDNA) testing was approved for average risk colorectal cancer (CRC) screening by the United States Food and Drug Administration and thereafter reimbursed for use by the Medicare program (2014). The United States Preventive Services Task Force (USPSTF) October 2015 draft recommendation for CRC screening included mt-sDNA as an “alternative” screening test that “may be useful in select clinical circumstances”, despite its very high sensitivity for early stage CRC. The evidence supporting mt-sDNA for routine screening use is robust. The clinical efficacy of mt-sDNA as measured by sensitivity, specificity, life-years gained (LYG), and CRC deaths averted is similar to or exceeds that of the other more specifically recommended screening options included in the draft document, especially those requiring annual testing adherence. In a population with primarily irregular screening participation, tests with the highest point sensitivity and reasonable specificity are more likely to favorably impact CRC related morbidity and mortality than those depending on annual adherence. This paper reviews the evidence supporting mt-sDNA for routine screening and demonstrates, using USPSTF’s modeling data, that mt-sDNA at three-year intervals provides significant clinical net benefits and fewer complications per LYG than annual fecal immunochemical testing, high sensitivity guaiac based fecal occult blood testing and 10-year colonoscopy screening. PMID:27190584

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

    Directory of Open Access Journals (Sweden)

    Ngozi Kalu

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

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

    Science.gov (United States)

    Kalu, Ngozi; Lufesi, Norman; Havens, Deborah; Mortimer, Kevin

    2016-01-01

    The Cooking and Pneumonia Study (CAPS) is a pragmatic cluster-level randomized controlled trial of the effect of an advanced cookstove intervention on pneumonia in children under the age of 5 years (under 5s) in Malawi (www.capstudy.org). The primary outcome of the trial is the incidence of pneumonia during a two-year follow-up period, as diagnosed by healthcare providers who are using the World Health Organization (WHO) integrated management of childhood illnesses (IMCI) pneumonia assessment protocol and who are blinded to the trial arms. We evaluated the quality of pneumonia assessment in under 5s in this setting via a cross-sectional study of provider-patient encounters at nine outpatient clinics located within the catchment area of 150 village-level clusters enrolled in the trial across the two study locations of Chikhwawa and Karonga, Malawi, between May and June 2015 using the IMCI guidelines as a benchmark. Data were collected using a key equipment checklist, an IMCI pneumonia knowledge test, and a clinical evaluation checklist. The median number of key equipment items available was 6 (range 4 to 7) out of a possible 7. The median score on the IMCI pneumonia knowledge test among 23 clinicians was 75% (range 60% to 89%). Among a total of 176 consultations performed by 15 clinicians, a median of 9 (range 3 to 13) out of 13 clinical evaluation tasks were performed. Overall, the clinicians were adequately equipped for the assessment of sick children, had good knowledge of the IMCI guidelines, and conducted largely thorough clinical evaluations. We recommend the simple pragmatic approach to quality assurance described herein for similar studies conducted in challenging research settings. PMID:27187773

  6. Assessing Patient-Centered Communication in Cancer Care: Stakeholder Perspectives

    OpenAIRE

    Mazor, Kathleen M.; Gaglio, Bridget; Nekhlyudov, Larissa; Alexander, Gwen L.; Stark, Azadeh; Hornbrook, Mark C.; Walsh, Kathleen; Boggs, Jennifer; Lemay, Celeste A.; Firneno, Cassandra; Biggins, Colleen; Blosky, Mary Ann; Arora, Neeraj K.

    2013-01-01

    Patient reports of their communication experiences during cancer care could increase understanding of the communication process, stimulate improvements, inform interventions, and provide a basis for evaluating changes in communication practices.

  7. Mechanical Characterization of Breast Tissue Constituents for Cancer Assessment

    OpenAIRE

    Zaeimdar, Shima

    2014-01-01

    Breast elastography is a method of cancer detection that uses the response of soft tissue to deformations, leading to discovery of abnormalities. The methods of Clinical Breast Examination and Breast Self-Examination are based primarily on stiffness and, hence, on the mechanics of tissue constituents examined by palpation (Goodson, 1996). However, little is known about the mechanical characteristics of breast tissue under compression and the contribution of tissue mechanics to breast cancer d...

  8. Pairing smoking-cessation services with lung cancer screening: A clinical guideline from the Association for the Treatment of Tobacco Use and Dependence and the Society for Research on Nicotine and Tobacco.

    Science.gov (United States)

    Fucito, Lisa M; Czabafy, Sharon; Hendricks, Peter S; Kotsen, Chris; Richardson, Donna; Toll, Benjamin A

    2016-04-15

    Smoking cessation is crucial for reducing cancer risk and premature mortality. The US Preventive Services Task Force (USPSTF) has recommended annual lung cancer screening with low-dose computed tomography (LDCT), and the Center for Medicare and Medicaid Services recently approved lung screening as a benefit for patients ages 55 to 77 years who have a 30 pack-year history. The Society for Research on Nicotine and Tobacco (SRNT) and the Association for the Treatment of Tobacco Use and Dependence (ATTUD) developed the guideline described in this commentary based on an illustrative literature review to present the evidence for smoking-cessation health benefits in this high-risk group and to provide clinical recommendations for integrating evidence-based smoking-cessation treatment with lung cancer screening. Unfortunately, extant data on lung cancer screening participants were scarce at the time this guideline was written. However, in this review, the authors summarize the sufficient evidence on the benefits of smoking cessation and the efficacy of smoking-cessation interventions for smokers ages 55 to 77 years to provide smoking-cessation interventions for smokers who seek lung cancer screening. It is concluded that smokers who present for lung cancer screening should be encouraged to quit smoking at each visit. Access to evidence-based smoking-cessation interventions should be provided to all smokers regardless of scan results, and motivation to quit should not be a necessary precondition for treatment. Follow-up contacts to support smoking-cessation efforts should be arranged for smokers. Evidence-based behavioral strategies should be used at each visit to motivate smokers who are unwilling to try quitting/reducing smoking or to try evidence-based treatments that may lead to eventual cessation. Cancer 2016;122:1150-9. © 2016 American Cancer Society. PMID:26916412

  9. Dietary guidelines

    DEFF Research Database (Denmark)

    Jelsøe, Erling

    2015-01-01

    in a number of countries have addressed the issue of making dietary guidelines that integrate health and sustainability, but in all cases they have been met with different kinds of resistance. This article reviews the development towards an integrated understanding of health and sustainability in...... relation to food and eating and the emergence of proposals for integrated guidelines. It explores the conflicts and controversies that have arisen in the wake of the various proposals and identifies a number of different types of conflicts. These relate to conflicts of interests between the various actors...... involved and political resistance against initiatives that are perceived as being in conflict with the values of a market economy and free trade. Furthermore, there are controversies that can be broadly characterised as relating to the politics of knowledge and have to do with the differentiation of...

  10. Guidelines for the Review of Research Reactor Safety: Revised Edition. Reference Document for IAEA Integrated Safety Assessment of Research Reactors (INSARR)

    International Nuclear Information System (INIS)

    The Integrated Safety Assessment of Research Reactors (INSARR) is an IAEA safety review service available to Member States with the objective of supporting them in ensuring and enhancing the safety of their research reactors. This service consists of performing a comprehensive peer review and an assessment of the safety of the respective research reactor. The reviews are based on IAEA safety standards and on the provisions of the Code of Conduct on the Safety of Research Reactors. The INSARR can benefit both the operating organizations and the regulatory bodies of the requesting Member States, and can include new research reactors under design or operating research reactors, including those which are under a Project and Supply Agreement with the IAEA. The first IAEA safety evaluation of a research reactor operated by a Member State was completed in October 1959 and involved the Swiss 20 MW DIORIT research reactor. Since then, and in accordance with its programme on research reactor safety, the IAEA has conducted safety review missions in its Member States to enhance the safety of their research reactor facilities through the application of the Code of Conduct on the Safety of Research Reactors and the relevant IAEA safety standards. About 320 missions in 51 Member States were undertaken between 1972 and 2012. The INSARR missions and other limited scope safety review missions are conducted following the guidelines presented in this publication, which is a revision of Guidelines for the Review of Research Reactor Safety (IAEA Services Series No. 1), published in December 1997. This publication details those IAEA safety standards and guidance publications relevant to the safety of research reactors that have been revised or published since 1997. The purpose of this publication is to give guidance on the preparation, implementation, reporting and follow-up of safety review missions. It is also intended to be of assistance to operators and regulators in conducting

  11. Author guidelines

    OpenAIRE

    Chief Editor

    2014-01-01

    AUTHOR GUIDELINESIndian Journal of Community Health (IJCH) accepts only online submission of manuscript(s) by using Open Journal software (OJS) at http://www.iapsmupuk.org/journal/index.php/IJCH/loginOnline SubmissionsAlready have a Username/Password for Indian Journal of Community Health (IJCH)? GO TO LOGINNeed a Username/Password?GO TO REGISTRATIONNote: Registration and login are required to submit items online and to track the status of current submissions.Author GuidelinesIJCH strictly ad...

  12. Normal tissue complication probability model parameter estimation for xerostomia in head and neck cancer patients based on scintigraphy and quality of life assessments

    International Nuclear Information System (INIS)

    With advances in modern radiotherapy (RT), many patients with head and neck (HN) cancer can be effectively cured. However, xerostomia is a common complication in patients after RT for HN cancer. The purpose of this study was to use the Lyman–Kutcher–Burman (LKB) model to derive parameters for the normal tissue complication probability (NTCP) for xerostomia based on scintigraphy assessments and quality of life (QoL) questionnaires. We performed validation tests of the Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) guidelines against prospectively collected QoL and salivary scintigraphic data. Thirty-one patients with HN cancer were enrolled. Salivary excretion factors (SEFs) measured by scintigraphy and QoL data from self-reported questionnaires were used for NTCP modeling to describe the incidence of grade 3+ xerostomia. The NTCP parameters estimated from the QoL and SEF datasets were compared. Model performance was assessed using Pearson’s chi-squared test, Nagelkerke’s R2, the area under the receiver operating characteristic curve, and the Hosmer–Lemeshow test. The negative predictive value (NPV) was checked for the rate of correctly predicting the lack of incidence. Pearson’s chi-squared test was used to test the goodness of fit and association. Using the LKB NTCP model and assuming n=1, the dose for uniform irradiation of the whole or partial volume of the parotid gland that results in 50% probability of a complication (TD50) and the slope of the dose–response curve (m) were determined from the QoL and SEF datasets, respectively. The NTCP-fitted parameters for local disease were TD50=43.6 Gy and m=0.18 with the SEF data, and TD50=44.1 Gy and m=0.11 with the QoL data. The rate of grade 3+ xerostomia for treatment plans meeting the QUANTEC guidelines was specifically predicted, with a NPV of 100%, using either the QoL or SEF dataset. Our study shows the agreement between the NTCP parameter modeling based on SEF and QoL data

  13. Assessment of diagnosis of inflammatory breast cancer cases at two cancer centers in Egypt and Tunisia

    OpenAIRE

    Schairer, Catherine; Soliman, Amr S; Omar, Sherif; Khaled, Hussein; Eissa, Saad; Ayed, Farhat Ben; Khalafallah, Samir; Ayoub, Wided Ben; Kantor, Elizabeth D.; Merajver, Sofia; Swain, Sandra M; Gail, Mitchell; Brown, Linda Morris

    2013-01-01

    The diagnosis of inflammatory breast cancer (IBC) is largely clinical and therefore inherently somewhat subjective. The objective of this study was to evaluate the diagnosis of IBC at two centers in North Africa where a higher proportion of breast cancer is diagnosed as IBC than in the United States (U.S.). Physicians prospectively enrolled suspected IBC cases at the National Cancer Institute (NCI) – Cairo, Egypt, and the Institut Salah Azaiz (ISA), Tunisia, recorded extent and duration of si...

  14. ASSESSMENT OF DISEASE ORIENTED DEPRESSION IN BREAST CANCER PATIENT

    Directory of Open Access Journals (Sweden)

    Manoharan Preeth

    2011-02-01

    Full Text Available Depression is a common symptom in cancer patients, which is difficult to be detected and consequently to be treated. It deteriorates over the course of cancer treatment, persists long after the end of therapy and influences negatively the quality of life. The aim of this study was to examine the prevalence rate and level anxiety and depression in breast cancer patient using HAD scale.The study was conducted on 94 female patients suffering from various stages of breast cancer. Patients included who were in the age group between 18-65yrs, estimated survival time more than six months, ability to speak and patients were excluded if they were affected by known mental disorder and metastasis in brain. Demographic data was collected from each patient’s medical record e.g. cancer type, date of cancer diagnosis, extension of the diseases, sites of metastasis, estimated life time. Levels of anxiety and depression were self rated by HADS (hospital anxiety and depression scaleOut of 94 patients twenty patients (21% were reported as mild depression (mean score 8.93 and 23 (24% patients as mild anxiety (mean score 9.42 likewise five Patients were reported as (positive cases chronic depression (mean score is 12.23 and six patients as chronic anxiety.(mean score is 12.23 The results of this present study clearly demonstrated that prevalence of anxiety and depression rates depended on the patients’ educational level, age, occupation, menopause and diagnosis period. Our study found that the depression and anxiety were common in most of the patients affected with breast cancer is also there was no relation between the anxiety and depression and stages of diseases. We think that this study needs to be extended in the future to involve more patient is may be further be tested to evaluate the same sample again, after psychiatric intervention is carried out.

  15. Barriers and Facilitators for Utilization of Genetic Counseling and Risk Assessment Services in Young Female Breast Cancer Survivors

    OpenAIRE

    Beth Anderson; Jennifer McLosky; Elizabeth Wasilevich; Sarah Lyon-Callo; Debra Duquette; Glenn Copeland

    2012-01-01

    Introduction. Women diagnosed with breast cancer at a young age are more likely to carry a cancer predisposing genetic mutation. Per the current NCCN recommendations, women diagnosed under age 50 should be referred to cancer genetic counseling for further risk evaluation. This study seeks to assess patient-reported barriers and facilitators to receiving genetic counseling and risk assessment among a community-based population of young breast cancer survivors (YBCS). Methods. Through the Michi...

  16. Improving the application of a practice guideline for the assessment and treatment of suicidal behavior by training the full staff of psychiatric departments via an e-learning supported Train-the-Trainer program : study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    de Beurs, Derek P.; de Groot, Marieke H.; de Keijser, Jos; Verwey, Bastiaan; Mokkenstorm, Jan; Twisk, Jos W. R.; van Duijn, Erik; van Hemert, Albert M.; Verlinde, Lia; Spijker, Jan; van Luijn, Bert; Vink, Jan; Kerkhof, Ad J. F. M.

    2013-01-01

    Background: In 2012, in The Netherlands a multidisciplinary practice guideline for the assessment and treatment of suicidal behavior was issued. The release of guidelines often fails to change professional behavior due to multiple barriers. Structured implementation may improve adherence to guidelin

  17. Improving the application of a practice guideline for the assessment and treatment of suicidal behavior by training the full staff of psychiatric departments via an e-learning supported Train-the-Trainer program: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Beurs, D.P. de; Groot, M.H. de; Keijser, J. de; Verwey, B.; Mokkenstorm, J.; Twisk, J.W.R.; Duijn, E. van; Hemert, A.M. van; Verlinde, L.; Spijker, J.; Luijn, B. van; Vink, J.; Kerkhof, A.J.

    2013-01-01

    BACKGROUND: In 2012, in The Netherlands a multidisciplinary practice guideline for the assessment and treatment of suicidal behavior was issued. The release of guidelines often fails to change professional behavior due to multiple barriers. Structured implementation may improve adherence to guidelin

  18. Rationale, design, and implementation protocol of the Dutch clinical practice guideline Pain in patients with cancer: a cluster randomised controlled trial with short message service (SMS and interactive voice response (IVR

    Directory of Open Access Journals (Sweden)

    te Boveldt Nienke

    2011-12-01

    Full Text Available Abstract Background One-half of patients with cancer have pain. In nearly one out of two cancer patients with pain, this was undertreated. Inadequate pain control still remains an important problem in this group of patients. Therefore, in 2008 a national, evidence-based multidisciplinary clinical practice guideline 'pain in patients with cancer' has been developed. Yet, publishing a guideline is not enough. Implementation is needed to improve pain management. An innovative implementation strategy, Short Message Service with Interactive Voice Response (SVS-IVR, has been developed and pilot tested. This study aims to evaluate on effectiveness of this strategy to improve pain reporting, pain measurement and adequate pain therapy. In addition, whether the active role of the patient and involvement of caregivers in pain management may change. Methods/design A cluster randomised controlled trial with two arms will be performed in six oncology outpatient clinics of hospitals in the Southeastern region of the Netherlands, with three hospitals in the intervention and three in the control condition. Follow-up measurements will be conducted in all hospitals to study the long-term effect of the intervention. The intervention includes training of professionals (medical oncologists, nurses, and general practitioners and SMS-IVR to report pain in patients with cancer to improve pain reporting by patients, pain management by medical oncologists, nurses, and general practitioners, and decrease pain intensity. Discussion This innovative implementation strategy with technical tools and the involvement of patients, may enhance the use of the guideline 'pain in patients with cancer' for pain management. Short Message Service alerts may serve as a tool to support self-management of patients. Therefore, the SMS-IVR intervention may increase the feeling of having control over one's life. Trail registration Netherlands Trial Register (NTR: NTR2739

  19. Evidence-Based Assessment in Case Management to Improve Abnormal Cancer Screen Follow-Up

    Science.gov (United States)

    Vourlekis, Betsy; Ell, Kathleen; Padgett, Deborah

    2005-01-01

    The authors describe an evidence-based assessment protocol for intensive case management to improve screening diagnostic follow-up developed through a research project in breast and cervical cancer early detection funded by the Centers for Disease Control and Prevention. Three components of an evidence-based approach to assessment are presented…

  20. Cancer risk assessment of azo dyes and aromatic amines from garment and footwear

    NARCIS (Netherlands)

    Zeilmaker MJ; Kroese ED; Haperen P van; Veen MP van; Bremmer HJ; Kranen HJ van; Wouters MFA; Janus J; LBM

    1999-01-01

    A quantitative assessment was performed to estimate the cancer risk to individuals wearing garment and footwear coloured with azo dyes. Basically, the risk assessment consists of both a comparison of the (estimated) level of aromatic amines which, during the wearing of garment and footwear, enters

  1. CT for assessment of pancreatic and periampullary cancer

    International Nuclear Information System (INIS)

    Over a period of 2 years, 77 patients, strongly suspected of having pancreatic cancer, had abdominal CT as part of the diagnostic work-up. The CT images were reviewed by 2 radiologists who did not know the clinical course, the surgical procedure, or the final diagnosis. The positive predictive value of CT for the diagnosis of pancreatic cancer was 92% (82-97%) and the negative predictive value 69% (41-89%). The 95% confidence limits of the positive predictive value of CT in staging the extent of periampullary cancer in 52 patients varied between 21 to 79% and 59 to 100%, with the lowest values in diagnosis of liver metastases. The confidence limits for the negative predictive values in staging varied between 17 to 56% and 67 to 94%, with the highest values concerning liver metastases. We conclude that CT cannot be used as the only diagnostic procedure for confirming or excluding the diagnosis of pancreatic or periampullary cancer, and that the staging of periampullary cancer by CT alone is too inaccurate for the evaluation of resectability. (orig.)

  2. ESUR prostate MR guidelines 2012

    International Nuclear Information System (INIS)

    The aim was to develop clinical guidelines for multi-parametric MRI of the prostate by a group of prostate MRI experts from the European Society of Urogenital Radiology (ESUR), based on literature evidence and consensus expert opinion. True evidence-based guidelines could not be formulated, but a compromise, reflected by ''minimal'' and ''optimal'' requirements has been made. The scope of these ESUR guidelines is to promulgate high quality MRI in acquisition and evaluation with the correct indications for prostate cancer across the whole of Europe and eventually outside Europe. The guidelines for the optimal technique and three protocols for ''detection'', ''staging'' and ''node and bone'' are presented. The use of endorectal coil vs. pelvic phased array coil and 1.5 vs. 3 T is discussed. Clinical indications and a PI-RADS classification for structured reporting are presented. (orig.)

  3. Systemic Therapy in Men With Metastatic Castration-Resistant Prostate Cancer: American Society of Clinical Oncology and Cancer Care Ontario Clinical Practice Guideline

    Science.gov (United States)

    Basch, Ethan; Loblaw, D. Andrew; Oliver, Thomas K.; Carducci, Michael; Chen, Ronald C.; Frame, James N.; Garrels, Kristina; Hotte, Sebastien; Kattan, Michael W.; Raghavan, Derek; Saad, Fred; Taplin, Mary-Ellen; Walker-Dilks, Cindy; Williams, James; Winquist, Eric; Bennett, Charles L.; Wootton, Ted; Rumble, R. Bryan; Dusetzina, Stacie B.; Virgo, Katherine S.

    2014-01-01

    Purpose To provide treatment recommendations for men with metastatic castration-resistant prostate cancer (CRPC). Methods The American Society of Clinical Oncology and Cancer Care Ontario convened an expert panel to develop evidence-based recommendations informed by a systematic review of the literature. Results When added to androgen deprivation, therapies demonstrating improved survival, improved quality of life (QOL), and favorable benefit-harm balance include abiraterone acetate/prednisone, enzalutamide, and radium-223 (223Ra; for men with predominantly bone metastases). Improved survival and QOL with moderate toxicity risk are associated with docetaxel/prednisone. For asymptomatic/minimally symptomatic men, improved survival with unclear QOL impact and low toxicity are associated with sipuleucel-T. For men who previously received docetaxel, improved survival, unclear QOL impact, and moderate to high toxicity risk are associated with cabazitaxel/prednisone. Modest QOL benefit (without survival benefit) and high toxicity risk are associated with mitoxantrone/prednisone after docetaxel. No benefit and excess toxicity are observed with bevacizumab, estramustine, and sunitinib. Recommendations Continue androgen deprivation (pharmaceutical or surgical) indefinitely. Abiraterone acetate/prednisone, enzalutamide, or 223Ra should be offered; docetaxel/prednisone should also be offered, accompanied by discussion of toxicity risk. Sipuleucel-T may be offered to asymptomatic/minimally symptomatic men. For men who have experienced progression with docetaxel, cabazitaxel may be offered, accompanied by discussion of toxicity risk. Mitoxantrone may be offered, accompanied by discussion of limited clinical benefit and toxicity risk. Ketoconazole or antiandrogens (eg, bicalutamide, flutamide, nilutamide) may be offered, accompanied by discussion of limited known clinical benefit. Bevacizumab, estramustine, and sunitinib should not be offered. There is insufficient evidence to

  4. Risk assessment of the thyroid cancer after radioactive iodine exposure

    International Nuclear Information System (INIS)

    For more than twenty years, the thyroid cancers incidence is increasing for men and women. A linear trend, statistically significant in function of the diagnosis period is observed. The selected model includes sex, age, calendar period. The projection has been realised on twenty years from 1997 in function of sex, age and diagnosis period. The results of the projection show a multiplication of the spontaneous incidence rate of thyroid cancer by 2.5 for women and by two for men on the period. (N.C.)

  5. An Assessment to Inform Pediatric Cancer Provider Development and Delivery of Survivor Care Plans.

    Science.gov (United States)

    Warner, Echo L; Wu, Yelena P; Hacking, Claire C; Wright, Jennifer; Spraker-Perlman, Holly L; Gardner, Emmie; Kirchhoff, Anne C

    2015-12-01

    Current guidelines recommend all pediatric cancer survivors receive a survivor care plan (SCP) for optimal health management, yet clinical delivery of SCPs varies. We evaluated oncology providers' familiarity with and preferences for delivering SCPs to inform the implementation of a future SCP program at our institution. From November 2013 to April 2014, oncology providers from the Primary Children's Hospital in Salt Lake City, UT, completed a survey (n=41) and a 45-min focus group (n=18). Participants reported their familiarity with and training in SCP guidelines, opinions on SCPs, and barriers to delivering SCPs. As a secondary analysis, we examined differences in survey responses between physicians and nurses with Fisher's exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Participants reported high familiarity with late effects of cancer treatment (87.8%) and follow-up care that cancer survivors should receive (82.5%). Few providers had delivered an SCP (oncologists 35.3% and nurses 5.0%; p=0.03). Barriers to providing SCPs included lack of knowledge (66.7%), SCP delivery is not expected in their clinic (53.9%), and no champion (48.7%). In qualitative comments, providers expressed that patient age variation complicated SCP delivery. Participants supported testing an SCP intervention program (95.1%) and felt this should be a team-based approach. Strategies for optimal delivery of SCPs are needed. Participants supported testing an SCP program to improve the quality of patient care. Team-based approaches, including nurses and physicians, that incorporate provider training on and support for SCP delivery are needed to improve pediatric cancer care. PMID:25893925

  6. Sunscreen compliance with regional clinical practice guidelines and product labeling standards in New Zealand.

    Science.gov (United States)

    Sporer, Matthias E; Mathy, Joanna E; Kenealy, John; Mathy, Jon A

    2016-03-01

    INTRODUCTION For general practitioners, practice nurses and community pharmacists in New Zealand, a core duty is to educate patients about sun protection. We aimed to evaluate compliance of locally available sunscreens with regional clinical practice guidelines and sunscreen labelling standards, to assist clinicians in advising consumers on sunscreen selection. METHODS We audited all sunscreens available at two Auckland stores for three New Zealand sunscreen retailers. We then assessed compliance with accepted regional clinical practice guidelines for sun protection from the New Zealand Guidelines Group. We further assessed compliance with regional Australia/New Zealand consumer standards for sunscreen labelling. RESULTS All sunscreens satisfied clinical guidelines for broad-spectrum protection, and 99% of sunscreens met or exceeded clinical guidelines for minimal Sun Protection Factor. Compliance with regional standardized labelling guidelines is voluntary in New Zealand and 27% of audited sunscreens were not fully compliant with SPF labelling standards. DISCUSSION Sunscreens were generally compliant with clinical guidelines for minimal sun protection. However there was substantial noncompliance with regional recommendations for standardized sunscreen labelling. Primary health care clinicians should be aware that this labelling noncompliance may mislead patients into thinking some sunscreens offer more sun protection than they do. Mandatory compliance with the latest regional labelling standards would simplify sunscreen selection by New Zealand consumers. KEYWORDS Sunscreen; Sun Protection Factor; SPF; Skin Neoplasms; Melanoma; Skin Cancer Prevention. PMID:27477372

  7. Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Nutritional assessment

    Directory of Open Access Journals (Sweden)

    S. Ruiz-Santana

    2011-11-01

    Full Text Available Current parameters to assess nutritional status in critically-ill patients are useful to evaluate nutritional status prior to admission to the intensive care unit. However, these parameters are of little utility once the patient's nutritional status has been altered by the acute process and its treatment. Changes in water distribution affect anthropometric variables and biochemical biomarkers, which in turn are affected by synthesis and degradation processes. Increased plasma levels of prealbumin and retinol -proteins with a short half-life- can indicate adequate response to nutritional support, while reduced levels of these proteins indicate further metabolic stress. The parameters used in functional assessment, such as those employed to assess muscular or immune function, are often altered by drugs or the presence of infection or polyneuropathy. However, some parameters can be used to monitor metabolic response and refeeding or can aid prognostic evaluation.

  8. Systematic review on tuberculosis transmission on aircraft and update of the European Centre for Disease Prevention and Control risk assessment guidelines for tuberculosis transmitted on aircraft (RAGIDA-TB).

    Science.gov (United States)

    Kotila, Saara M; Payne Hallström, Lara; Jansen, Niesje; Helbling, Peter; Abubakar, Ibrahim

    2016-01-01

    As a setting for potential tuberculosis (TB) transmission and contact tracing, aircraft pose specific challenges. Evidence-based guidelines are needed to support the related-risk assessment and contact-tracing efforts. In this study evidence of TB transmission on aircraft was identified to update the Risk Assessment Guidelines for TB Transmitted on Aircraft (RAGIDA-TB) of the European Centre for Disease Prevention and Control (ECDC). Electronic searches were undertaken from Medline (Pubmed), Embase and Cochrane Library until 19 July 2013. Eligible records were identified by a two-stage screening process and data on flight and index case characteristics as well as contact tracing strategies extracted. The systematic literature review retrieved 21 records. Ten of these records were available only after the previous version of the RAGIDA guidelines (2009) and World Health Organization guidelines on TB and air travel (2008) were published. Seven of the 21 records presented some evidence of possible in-flight transmission, but only one record provided substantial evidence of TB transmission on an aircraft. The data indicate that overall risk of TB transmission on aircraft is very low. The updated ECDC guidelines for TB transmission on aircraft have global implications due to inevitable need for international collaboration in contract tracing and risk assessment. PMID:26848520

  9. Automated texture scoring for assessing breast cancer masking risk in full field digital mammography

    DEFF Research Database (Denmark)

    Kallenberg, Michiel Gijsbertus J; Petersen, Kersten; Lilholm, Martin;

    PURPOSE: The goal of this work is to develop a method to identify women at high risk for having breast cancer that is easily missed in regular mammography screening. Such a method will provide a rationale for selecting women for adjunctive screening. It goes beyond current risk assessment models...... five-fold cross validation. To assess the independency of the texture scores of breast density, density was determined for each image using Volpara. RESULTS: The odds ratios for interval cancer were 1.59 (95%CI: 0.76-3.32), 2.07 (1.02-4.20), and 3.14 (1.60-6.17) for quartile 2, 3 and 4 respectively...... with the risk of having a breast cancer that is missed in regular mammography screening. As such it offers opportunities to further enhance personalized breast cancer screening....

  10. Zebrafish as a model to assess cancer heterogeneity, progression and relapse

    Directory of Open Access Journals (Sweden)

    Jessica S. Blackburn

    2014-07-01

    Full Text Available Clonal evolution is the process by which genetic and epigenetic diversity is created within malignant tumor cells. This process culminates in a heterogeneous tumor, consisting of multiple subpopulations of cancer cells that often do not contain the same underlying mutations. Continuous selective pressure permits outgrowth of clones that harbor lesions that are capable of enhancing disease progression, including those that contribute to therapy resistance, metastasis and relapse. Clonal evolution and the resulting intratumoral heterogeneity pose a substantial challenge to biomarker identification, personalized cancer therapies and the discovery of underlying driver mutations in cancer. The purpose of this Review is to highlight the unique strengths of zebrafish cancer models in assessing the roles that intratumoral heterogeneity and clonal evolution play in cancer, including transgenesis, imaging technologies, high-throughput cell transplantation approaches and in vivo single-cell functional assays.

  11. Interview: European collaboration in relative effectiveness assessment: the use of patient registries and development of common guidelines.

    Science.gov (United States)

    Goettsch, Wim

    2013-07-01

    Wim Goettsch is currently the Project Leader of Work Package 5 of the European Network of Health Technology Assessment (EUnetHTA) Joint Action 2 (2012-2015). EUnetHTA is a network of the health technology assessment organizations in Europe responsible for advising or deciding on the national reimbursement of pharmaceuticals and other health technologies. In this work package, rapid joint assessments of the relative effectiveness of pharmaceuticals are piloted between more than 25 health technology assessment organizations around Europe. These pilots are based on the methodology that was developed in a similar work package in EUnetHTA JA1 (2010-2012), of which Dr Goettsch was also the Project Leader. Until the beginning of 2013, Dr Goettsch was the Deputy Secretary of the Medicinal Products Reimbursement Committee at Dutch Healthcare Insurance Board (CVZ). The Dutch Medicinal Products Reimbursement Committee advises the Dutch Minister of Health on whether new drugs need to be included in the basic insurance package. Before joining CVZ, he worked as a research manager for the PHARMO Institute (Utrecht, The Netherlands) and was responsible for the coordination of numerous pharmacoepidemiological and outcomes studies for international offices of pharmaceutical companies, such as AstraZeneca, Novartis, Pfizer and GlaxoSmithKline. Dr Goettsch has approximately 50 publications in peer-reviewed international journals. PMID:24236677

  12. Assessment of depression and anxiety in adult cancer outpatients: a cross-sectional study

    OpenAIRE

    Shahzad Mohammad A; Munir Waqar; Jadoon Nauman A; Choudhry Zeshan S

    2010-01-01

    Abstract Background The prevalence of anxiety and depressive disorders in cancer patients and its associated factors in Pakistan is not known. There is a need to develop an evidence base to help introduce interventions as untreated depression and anxiety can lead to significant morbidity. We assessed the prevalence of depression and anxiety among adult outpatients with and without cancer as well as the effect of various demographic, clinical and behavioral factors on levels of depression and ...

  13. Assessment of surgical risk in colo-rectal cancer patients: POSSUM or ACPGBI?

    OpenAIRE

    Goulart, A; Martins, S

    2013-01-01

    Introduction: Several models have been developed with the purpose of predicting surgical risk of patients submitted to colorectal cancer surgery. However, to date, there isn’t any model that fulfills this purpose in a satisfactory manner. Methods: We consulted the clinical processes of 345 patients, who were submitted to surgical colorectal cancer treatment at the General Surgery department in Hospital de Braga, and calculated surgical risk based on the following risk assessment scal...

  14. Towards understanding patients' and caregivers' assessments of symptoms and quality of life in lung cancer

    OpenAIRE

    Broberger, Eva

    2007-01-01

    Lung cancer is associated with a wide range of symptoms arising from both disease progression and treatment side effects. Nurses caring for patients with lung cancer are thus challenged to help patients cope with a variety of problems. Individual perspectives, influences and experiences are of great importance to consider when interpreting patients and caregivers assessments of symptoms and quality of life. The overall aim of this thesis is to gain better understanding of...

  15. Breast cancer risk and historical exposure to pesticides from wide-area applications assessed with GIS.

    OpenAIRE

    Brody, Julia Green; Aschengrau, Ann; McKelvey, Wendy; Rudel, Ruthann A.; Swartz, Christopher H.; Kennedy, Theresa

    2004-01-01

    Pesticides are of interest in etiologic studies of breast cancer because many mimic estrogen, a known breast cancer risk factor, or cause mammary tumors in animals, but most previous studies have been limited by using one-time tissue measurements of residues of only a few pesticides long banned in the United States. As an alternative method to assess historical exposures to banned and current-use pesticides, we used geographic information system (GIS) technology in a population-based case-con...

  16. Role of Scintimammography in Assessing the Response of Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer

    OpenAIRE

    Trehan, Romeeta; Seam, Rajeev K; Manoj K. Gupta; Sood, Ashwani; Dimri, Kislay; Mahajan, Rohit

    2014-01-01

    Locally advanced breast cancer (LABC) is a common cancer in the developing countries. Neoadjuvant chemotherapy (NACT) is a very important step in the treatment of such tumors and hence that the disease can be down staged and made amenable for surgery. All the tumors do not respond to the therapy equally. Hence, it becomes very important to predict the response of chemotherapy in such cases. This study evaluated the role of scintimammography in assessing the response to NACT in 23 patients wit...

  17. Breast cancer risk assessment using genetic variants and risk factors in a Singapore Chinese population

    OpenAIRE

    Lee, Charmaine Pei Ling; Irwanto, Astrid; Salim, Agus; Yuan, Jian-Min; Liu, Jianjun; Koh, Woon Puay; Hartman, Mikael

    2014-01-01

    Introduction Genetic variants for breast cancer risk identified in genome-wide association studies (GWAS) in Western populations require further testing in Asian populations. A risk assessment model incorporating both validated genetic variants and established risk factors may improve its performance in risk prediction of Asian women. Methods A nested case-control study of female breast cancer (411 cases and 1,212 controls) within the Singapore Chinese Health Study was conducted to investigat...

  18. Assessment of Breast Cancer Awareness among Female University Students in Ajman, United Arab Emirates

    OpenAIRE

    Shatha S. Al-Sharbatti; Shaikh, Rizwana B; Elsheba Mathew; Al-Biate, Mawahib A.

    2014-01-01

    Objectives: The aim of this study was to assess female university students’ knowledge of breast cancer and its preventative measures and to identify their main misconceptions regarding breast cancer. Methods: This cross-sectional study was conducted between April 2011 and June 2012 and included female students from three large universities in Ajman, United Arab Emirates (UAE). A stratified random sampling procedure was used. Data were collected through a validated, pilot-tested, self-administ...

  19. Evolution of cancer risk assessment and counseling related to psychological, financial and legal implications.

    Science.gov (United States)

    Snyder, Carrie

    2016-07-01

    Cancer risk assessment, genetic counseling and genetic testing have experienced advances and changes over the past two decades due to improved technology, legal movements to protect those at an increased risk for cancer due to genetics, as well as advances in detection, prevention and treatment. This brief article will provide a summary of these advances over three eras of cancer genetics: pre-discovery of the more common high impact genes, namely BRCA1/BRCA2 and the mismatch repair genes associated with Lynch syndrome; the time during which the genes were being discovered; and current day. PMID:26920353

  20. Assessing breast cancer masking risk in full field digital mammography with automated texture analysis

    DEFF Research Database (Denmark)

    Kallenberg, Michiel Gijsbertus J; Lilholm, Martin; Diao, Pengfei;

    2015-01-01

    Purpose: The goal of this work is to develop a method to assess the risk of breast cancer masking, based on image characteristics beyond breast density. Method: From the Dutch breast cancer screening program we collected 285 screen detected cancers, and 109 cancers that were screen negative and....../4) texture risk score. We computed odds ratios for breast cancer masking risk (i.e. interval versus screen detected cancer) for each of the subgroups. The odds ratio was 1.63 (1.04-2.53 95%CI) in the high dense group (as compared to the low dense group), whereas for the high texture score group (as compared...... determine cancer detection status in a five-fold cross validation. To assess the interaction of the texture scores with breast density, Volpara Density Grade was determined for each image. Results: We grouped women into low (VDG 1/2) versus high (VDG 3/4) dense, and low (Quartile 1/2) versus high (Q 3...

  1. ASSET guidelines. Revised 1991 Edition

    International Nuclear Information System (INIS)

    The present publication is an updated version of the IAEA Assessment of Safety Significant Events Team (ASSET) Guidelines, IAEA-TECDOC-573, published in 1990. Sections 5 and 6 include revised definitions and investigation guidelines for identification of both direct and root causes. These revisions were recommended by a Consultants Meeting held in Vienna on 3-7 December 1990. This guidance is not intended to infringe an expert's prerogative to investigate additional items. Its main purpose is to provide a basic structure and ensure consistency in the assessments. Use of the ASSET guidelines should also facilitate comparison between the observations made in different nuclear power plants and harmonize the reporting of generic ASSET results. The guidelines should always be used with a critical attitude and a view to possible improvements

  2. 'Act on oncology' as a new comprehensive approach to assess prostate cancer centres--method description and results of a pilot study.

    Directory of Open Access Journals (Sweden)

    Wieland Voigt

    Full Text Available Multidisciplinary care of prostate cancer is increasingly offered in specialised cancer centres. It requires the optimisation of medical and operational processes and the integration of the different medical and non-medical stakeholders.To develop a standardised operational process assessment tool basing on the capability maturity model integration (CMMI able to implement multidisciplinary care and improve process quality and efficiency.Information for model development was derived from medical experts, clinical guidelines, best practice elements of renowned cancer centres, and scientific literature. Data were organised in a hierarchically structured model, consisting of 5 categories, 30 key process areas, 172 requirements, and more than 1500 criteria. Compliance with requirements was assessed through structured on-site surveys covering all relevant clinical and management processes. Comparison with best practice standards allowed to recommend improvements. 'Act On Oncology'(AoO was applied in a pilot study on a prostate cancer unit in Europe.Several best practice elements such as multidisciplinary clinics or advanced organisational measures for patient scheduling were observed. Substantial opportunities were found in other areas such as centre management and infrastructure. As first improvements the evaluated centre administration described and formalised the organisation of the prostate cancer unit with defined personnel assignments and clinical activities and a formal agreement is being worked on to have structured access to First-Aid Posts.In the pilot study, the AoO approach was feasible to identify opportunities for process improvements. Measures were derived that might increase the operational process quality and efficiency.

  3. Urinary metalloproteinases: noninvasive biomarkers for breast cancer risk assessment

    DEFF Research Database (Denmark)

    Pories, Susan E; Zurakowski, David; Roy, Roopali;

    2008-01-01

    Matrix metalloproteinases (MMP) and a disintegrin and metalloprotease 12 (ADAM 12) can be detected in the urine of breast cancer patients and provide independent prediction of disease status. To evaluate the potential of urinary metalloproteinases as biomarkers to predict breast cancer risk status......, urine samples from women with known risk marker lesions, atypical hyperplasia and lobular carcinoma in situ (LCIS), were analyzed. Urine samples were obtained from 148 women: 44 women with atypical hyperplasia, 24 women with LCIS, and 80 healthy controls. MMP analysis was done using gelatin zymography...... and ADAM 12 analysis was done via immunoblotting with monospecific antibodies and subsequent densitometric measurement. Positive urinary MMP-9 levels indicated a 5-fold risk of atypical hyperplasia and >13-fold risk of LCIS compared with normal controls. Urinary ADAM 12 levels were significantly...

  4. DNA repair, human cancer and assessment of radiation hazards

    International Nuclear Information System (INIS)

    Cancers, like genetic defects, are thought to be caused primarily by changes in DNA. Part of the evidence in support of this hypothesis derives from the study of certain rare hereditary disorders in man associated with high risk of cancer. Cells derived from patients suffering from at least one of these disorders, ataxia telangiectasia, appear to be defective in their ability to repair the damage caused by radiation and/or certain other environmental agents. Studies of the consequences of DNA repair suggest that currently accepted estimates of the carcinogenic hazards of low level radiation are substantially correct. There would appear to be some margin of safety involved in these risk estimates for the majority of the population, but any major reduction in the currently accepted risk estimates appears inadvisable in view of the existence of potentially radiosensitive subgroups forming a minority in the general population. (author)

  5. Assessment of rehabilitation needs in colorectal cancer treatment

    DEFF Research Database (Denmark)

    Wiedenbein, Liza; Kristiansen, Maria; Adamsen, Lis;

    2016-01-01

    clinical practices related to identification and documentation of rehabilitation needs among patients with colorectal cancer at Danish hospitals. Material and methods A retrospective clinical audit was conducted utilizing data from patient files randomly selected at surgical and oncology hospital...... departments treating colorectal cancer patients. Forty patients were included, 10 from each department. Semi-structured interviews were carried out among clinical nurse specialists. Audit data was analyzed using descriptive statistics, qualitative data using thematic analysis. Results Documentation of...... physical, psychological and social rehabilitation needs initially and at end of treatment was evident in 10% (n = 2) of surgical patient trajectories and 35% (n = 7) of oncology trajectories. Physical rehabilitation needs were documented among 90% (n = 36) of all patients. Referral to municipal...

  6. Nuclear medicine in the assessment of differentiated thyroid cancer

    Energy Technology Data Exchange (ETDEWEB)

    Rutherford, G.-C. [Nuclear Medicine Department, Nottingham City Hospital, Nottingham (United Kingdom)], E-mail: gaylerutherford@doctors.org.uk; Franc, B. [Department of Radiology, Nuclear Medicine Section, University of California, San Francisco, CA (United States); O' Connor, A. [Nuclear Medicine Department, Nottingham City Hospital, Nottingham (United Kingdom)

    2008-04-15

    Despite modern multi-modality treatment, 10-30% of patients treated for differentiated thyroid cancer (DTC) ultimately develop local recurrence or metastatic disease. These malignancies are frequently slow-growing and secondary surgical resection is often undertaken along with radioactive iodine treatment. Correlation of radiological imaging with nuclear medicine studies is essential for individualized treatment planning, and to optimize this management. Radiologists should be familiar with the interpretation of various nuclear medicine studies used to image differentiated thyroid neoplasms.

  7. Nuclear medicine in the assessment of differentiated thyroid cancer

    International Nuclear Information System (INIS)

    Despite modern multi-modality treatment, 10-30% of patients treated for differentiated thyroid cancer (DTC) ultimately develop local recurrence or metastatic disease. These malignancies are frequently slow-growing and secondary surgical resection is often undertaken along with radioactive iodine treatment. Correlation of radiological imaging with nuclear medicine studies is essential for individualized treatment planning, and to optimize this management. Radiologists should be familiar with the interpretation of various nuclear medicine studies used to image differentiated thyroid neoplasms

  8. Breast Cancer Detection Using Interferometric MUSIC: Experimental and Numerical Assessment

    OpenAIRE

    Ruvio, Giuseppe; Solimene, Raffaele; Cuccaro, Antonio; Gaetano, Domenico; Browne, Jacinta; Ammann, Max

    2014-01-01

    Purpose: In microwave breast cancer detection, it is often beneficial to arrange sensors in close proximity to the breast. The resultant coupling generally changes the antenna response. As an a priori characterization of the radio frequency system becomes difficult, this can lead to severe degradation of the detection efficacy. The purpose of this paper is to demonstrate the advantages of adopting an interferometric multiple signal classification (I-MUSIC) approach due to its limited dependen...

  9. Assessment of the Evolution of Cancer Treatment Therapies

    OpenAIRE

    Mónica Valladares; Alejandro Tres; Julio Lambea; Berta Sáez-Gutierrez; Manuel Arruebo; Nuria Vilaboa; África González-Fernández

    2011-01-01

    Cancer therapy has been characterized throughout history by ups and downs, not only due to the ineffectiveness of treatments and side effects, but also by hope and the reality of complete remission and cure in many cases. Within the therapeutic arsenal, alongside surgery in the case of solid tumors, are the antitumor drugs and radiation that have been the treatment of choice in some instances. In recent years, immunotherapy has become an important therapeutic alternative, and is now the first...

  10. Epistemological problems in assessing cancer risks at low radiation doses

    International Nuclear Information System (INIS)

    Historically, biology has not been subjected to any epistemological analysis as has been the case with mathematics and physics. Our knowledge of the effects in biological systems of various stimuli proves to be dualistic in a complementary (although not mutually exclusive) way, which bears resemblance to the knowledge of phenomena in quantum physics. The dualistic limbs of biological knowledge are the action of stimuli and the response of the exposed, biological system. With regard to radiogenic cancer, this corresponds to the action of the ionizations and the response of the exposed mammal to that action, respectively. The following conclusions can be drawn from the present analysis: Predictions as to radiogenic cancer seem often if not always to have neglected the response variability (variations in radiosensitivity) in individuals or among individuals in populations, i.e. the predictions have been based exclusively on radiation doses and exposure conditions. The exposed individual or population, however, must be considered an open statistical system, i.e. a system in which predictions as to the effect of an agent are only conditionally possible. The knowledge is inverse to the size of the dose or concentration of the active agent. On epistemological grounds, we can not gain knowledge about the carcinogenic capacity of very low (non-dominant) radiation doses. Based on the same principle, we can not predict cancer risks at very low (non-dominant) radiation doses merely on the basis of models, or otherwise interpolated or extrapolated high-dose effects, observed under special exposure conditions

  11. Translating psychosocial research findings into practice guidelines.

    Science.gov (United States)

    Hinds, Pamela S; Gattuso, Jami S; Barnwell, Elizabeth; Cofer, Mary; Kellum, La-Kenya; Mattox, Sandy; Norman, Gina; Powell, Brent; Randall, Elizabeth; Sanders, Cathy

    2003-01-01

    Evidence-based practice guidelines are increasingly used by healthcare professionals to guide patient care and effect positive patient outcomes. These guidelines are usually based on laboratory-based parameters and lack the psychosocial dimensions of patient care. The authors describe the process used by a hospital-based interdisciplinary team to successfully develop evidence-based psychosocial guidelines designed to foster hopefulness in pediatric patients with cancer, their families, and their healthcare providers. From these guidelines, 4 clinical care projects were developed and are described in this article. PMID:12909791

  12. Buckling-driven delamination growth in composite laminates: Guidelines for assessing the threat posed by interlaminar matrix delamination

    DEFF Research Database (Denmark)

    Bhushan, Karihaloo; Stang, Henrik

    2008-01-01

    This paper is concerned with development of a simple procedure to assess the threat posed by interlaminar matrix delaminations to the integrity of composite laminates when they are situated in a compressive stress field. Depending upon the size of the delamination, its location below the surface...... and on the level of the applied stress, it may or may not buckle away from the rest of the laminate. If it buckles, the post-buckling response will depend upon the applied compressive stress level, the thickness of the delaminated ply and the interlaminar critical energy release rate of the composite...

  13. Reducing patients' suicide ideation through training mental health teams in the application of the Dutch multidisciplinary practice guideline on assessment and treatment of suicidal behavior : study protocol of a randomized controlled trial

    NARCIS (Netherlands)

    de Beurs, Derek P.; de Groot, Marieke H.; Bosmans, Judith E.; de Keijser, Jos; Mokkenstorm, Jan; Verwey, Bas; van Duijn, Erik; de Winter, Remco F. P.; Kerkhof, Ad J. F. M.

    2013-01-01

    Background: To strengthen suicide prevention skills in mental health care in The Netherlands, multidisciplinary teams throughout the country are trained in the application of the new Dutch guideline on the assessment and treatment of suicidal behavior. Previous studies have shown beneficial effects

  14. The first step in the development of text mining technology for cancer risk assessment: identifying and organizing scientific evidence in risk assessment literature

    Directory of Open Access Journals (Sweden)

    Sun Lin

    2009-09-01

    Full Text Available Abstract Background One of the most neglected areas of biomedical Text Mining (TM is the development of systems based on carefully assessed user needs. We have recently investigated the user needs of an important task yet to be tackled by TM -- Cancer Risk Assessment (CRA. Here we take the first step towards the development of TM technology for the task: identifying and organizing the scientific evidence required for CRA in a taxonomy which is capable of supporting extensive data gathering from biomedical literature. Results The taxonomy is based on expert annotation of 1297 abstracts downloaded from relevant PubMed journals. It classifies 1742 unique keywords found in the corpus to 48 classes which specify core evidence required for CRA. We report promising results with inter-annotator agreement tests and automatic classification of PubMed abstracts to taxonomy classes. A simple user test is also reported in a near real-world CRA scenario which demonstrates along with other evaluation that the resources we have built are well-defined, accurate, and applicable in practice. Conclusion We present our annotation guidelines and a tool which we have designed for expert annotation of PubMed abstracts. A corpus annotated for keywords and document relevance is also presented, along with the taxonomy which organizes the keywords into classes defining core evidence for CRA. As demonstrated by the evaluation, the materials we have constructed provide a good basis for classification of CRA literature along multiple dimensions. They can support current manual CRA as well as facilitate the development of an approach based on TM. We discuss extending the taxonomy further via manual and machine learning approaches and the subsequent steps required to develop TM technology for the needs of CRA.

  15. Assessment of depression and anxiety in adult cancer outpatients: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Shahzad Mohammad A

    2010-10-01

    Full Text Available Abstract Background The prevalence of anxiety and depressive disorders in cancer patients and its associated factors in Pakistan is not known. There is a need to develop an evidence base to help introduce interventions as untreated depression and anxiety can lead to significant morbidity. We assessed the prevalence of depression and anxiety among adult outpatients with and without cancer as well as the effect of various demographic, clinical and behavioral factors on levels of depression and anxiety in cancer patients. Methods This cross-sectional study was carried out in outpatient departments of Multan Institute of Nuclear Medicine and Radiotherapy and Nishtar Medical College Hospital, Multan. Aga Khan University Anxiety and Depression Scale (AKUADS was used to define the presence of depression and anxiety in study participants. The sample consisted of 150 diagnosed cancer patients and 268 participants without cancer (control group. Results The mean age of cancer patients was 40.85 years (SD = 16.46 and median illness duration was 5.5 months, while the mean age of the control group was 39.58 years (SD = 11.74. Overall, 66.0% of the cancer patients were found to have depression and anxiety using a cutoff score of 20 on AKUADS. Among the control group, 109 subjects (40.7% had depression and anxiety. Cancer patients were significantly more likely to suffer from distress compared to the control group (OR = 2.83, 95% CI = 1.89-4.25, P = 0.0001. Performing logistic regression analysis showed that age up to 40 years significantly influenced the prevalence of depression and anxiety in cancer patients. There was no statistically significant difference between gender, marital status, locality, education, income, occupation, physical activity, smoking, cancer site, illness duration and mode of treatment, surgery related to cancer and presence of depression and anxiety. Cancers highly associated with depression and anxiety were gastrointestinal

  16. Assessment of depression and anxiety in adult cancer outpatients: a cross-sectional study

    International Nuclear Information System (INIS)

    The prevalence of anxiety and depressive disorders in cancer patients and its associated factors in Pakistan is not known. There is a need to develop an evidence base to help introduce interventions as untreated depression and anxiety can lead to significant morbidity. We assessed the prevalence of depression and anxiety among adult outpatients with and without cancer as well as the effect of various demographic, clinical and behavioral factors on levels of depression and anxiety in cancer patients. This cross-sectional study was carried out in outpatient departments of Multan Institute of Nuclear Medicine and Radiotherapy and Nishtar Medical College Hospital, Multan. Aga Khan University Anxiety and Depression Scale (AKUADS) was used to define the presence of depression and anxiety in study participants. The sample consisted of 150 diagnosed cancer patients and 268 participants without cancer (control group). The mean age of cancer patients was 40.85 years (SD = 16.46) and median illness duration was 5.5 months, while the mean age of the control group was 39.58 years (SD = 11.74). Overall, 66.0% of the cancer patients were found to have depression and anxiety using a cutoff score of 20 on AKUADS. Among the control group, 109 subjects (40.7%) had depression and anxiety. Cancer patients were significantly more likely to suffer from distress compared to the control group (OR = 2.83, 95% CI = 1.89-4.25, P = 0.0001). Performing logistic regression analysis showed that age up to 40 years significantly influenced the prevalence of depression and anxiety in cancer patients. There was no statistically significant difference between gender, marital status, locality, education, income, occupation, physical activity, smoking, cancer site, illness duration and mode of treatment, surgery related to cancer and presence of depression and anxiety. Cancers highly associated with depression and anxiety were gastrointestinal malignancies, chest tumors and breast cancer. This study

  17. Guidelines for the review research reactor safety. Reference document for IAEA Integrated Safety Assessment of Research Reactors (INSARR)

    International Nuclear Information System (INIS)

    In 1992, the IAEA published new safety standards for research reactors as part of the set of publications considered by its Research Reactor Safety Programme (RRSP). This set also includes publications giving guidance for all safety aspects related to the lifetime of a research reactor. In addition, the IAEA has also revised the Safety Standards for radiation protection. Consequently, it was considered advisable to revise the Integrated Safety Assessment of Research Reactors (INSARR) procedures to incorporate the new requirements and guidance as well as to extend the scope of the safety reviews to currently operating research reactors. The present report is the result of this revision. The purpose of this report is to give guidance on the preparation, execution, reporting and follow-up of safety review mission to research reactors as conducted by the IAEA under its INSARR missions safety service. However, it will also be of assistance to operators and regulators in conducting: (a) ad hoc safety assessments of research reactors to address individual issues such as ageing or safety culture; and (b) other types of safety reviews such as internal and peer reviews and regulatory inspections

  18. The Yin-Yang of Guidelines and Disparity

    OpenAIRE

    Mok, Tony

    2014-01-01

    Understanding guideline compliance is important, but understanding the treatment outcomes associated with compliance is more important. In response to a study of guideline use in treating lung cancer patients in the People’s Republic of China, the author discusses the purpose of guidelines and approaches to compliance with them.

  19. Clinical Practice Guidelines for Critical Patients’ Nutrition.

    OpenAIRE

    Marta Patricia Casanova González; Roberto Travieso Peña; Félix Molina Díaz

    2009-01-01

    Clinical Practice Guidelines for Critical Patients’ Nutrition. This document includes a review and update of aspects related with nutritional assessment of patients in critical condition; indications, contraindications and procedures for enteral and parenteral nutrition and its follow up. It includes assessment guidelines focused on the most important aspects to be accomplished.

  20. Preclinical Assessment of Vernonia amygdalina Leaf Extracts as DNA Damaging Anti-cancer Agent in the Management of Breast Cancer

    Directory of Open Access Journals (Sweden)

    Ernest Izevbigie

    2008-12-01

    Full Text Available Breast cancer is the leading cause of death among women between 40 and 55 years of age and is the second overall cause of death among women. Fortunately, the mortality rate from breast cancer has decreased in recent years due to an increased emphasis on early detection and more effective treatments. Despite early detection, conventional and chemotherapeutic methods of treatment, about 7% of women still died every year. Hence, the aim of the present study was to assess the therapeutic efficacy of Vernonia amygdalina (VA leaf extracts as anti-cancer agent against human breast cancer in vitro using the MTT [3-(4, 5-dimethylthiazol-2-yl-2,5-diphenyltetrazolium bromide] and alkaline single cell gel electrophoresis (Comet assays, respectively. In this experiment, human breast adenocarcinoma (MCF-7 cells were treated with different doses of VA leaf extracts for 48 hours. Data obtained from the MTT assay showed that VA significantly ((P < 0.05 reduced the viability of MCF-7 cells in a dose-dependent manner upon 48 hours of exposure. Data generated from the comet assay also indicated a slight dose-dependent increase in DNA damage in MCF-7 cells associated with VA treatment. We observed a slight increase in comet tail-length, tail arm and tail moment, as well as in percentages of DNA cleavage at all doses tested, showing an evidence that VA-induced minimal genotoxic damage in MCF-7 cells. Taken together, our findings suggest that VA treatment moderately (P < 0.05 reduces cellular viability and induces minimal DNA damage in MCF-7 cells. These findings provide evidence that VA extracts represent a DNA-damaging anti-cancer agent against breast cancer and its mechanisms of action functions, at least in part, through minimal DNA damage and moderate toxicity in tumors cells.